This section is compiled by Frank M. Painter, D.C. Send all comments or additions to:
Frankp@chiro.org
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Editorial Commentary:
The Vertebral Subluxation...it's the core concept of Chiropractic. From the historical standpoint, it is how Chiropractic differs from Osteopathy, Physical Therapy, and other derivative forms of “Manual Medicine”. It's the term we use to describe the dis-ease/lesion/disorder/loss of function and malposition that the chiropractic adjustment is reputed to correct.
Personally, I love the term. There are nay-sayers who maintain that the continued use of this “outdated term” is the reason why we are alienated from conventional medicine. I say hogwash! History (and Court testimony) clearly demonstrates that organized medicine perpetrated their illegal conspiracy to destroy the chiropractic profession for strictly financial reasons. [ 1 ]
Organized medicine has scoffed at chiropractic's subluxation hypothesis, because we didn't have the basic-science research necessary to demonstrate:
a relationship between joint fixation and degenerative changes
how joint fixation causes nerve interferance
how that nerve interferance leads to visceral, or “pseudo-visceral” disorders
the relationship between subluxation correction and improvement(s) in health
That should come as no big surprise, considering the many obstacles erected by organized medicine. Those included:
medical doctors who conducted research with chiropractors would lose their hospital priviledges
chiropractors were denied access to medical laboratories of all types
chiropractors were denied access to any form of Federal monies to conduct research
Our profession did not receive any Federal money for research, through the National Institute of Health, until around 1997. For that reason, we are the only profession that has paid for (most of) our own research. Everyone else (medicine) got a free ride. [ 2 ]
This is why we are still doing basic science research, with a very limited budget. Today, when the NIH budget for research is an astounding figure, their total contribution towards ALL the forms of alternative medicine research is miniscule This quote is most illuminating:
“Even more remarkable is the efficiency of chiropractic research. When compared to the NIH budget of nearly $20 billion, the $10 million investment in federal funds is substantially less than a tenth of 1 percent, which makes it less than a rounding error. Put another way, as a couple of wags have offered in the past, the federal government must believe in alternative medicine, because it has given chiropractic researchers homeopathic doses of money with which to work.”
[ 3 ]
Much of our literature support is still limited to Case Studies. All those do is to relate events, in serial order... Joe the Patient had otitis media, I adjusted him, and his ear infection went away. Interesting, but it's not "proof". To date there is a minimum of scientific evidence demonstrating a relationship between subluxation (as a cause) and the development of a physical complaint (visceral disease or pain syndromes). This page is devoted to discussing the available research that ties the chiropractic theories together.
The Vertebral Subluxation Complex
The original concept of the subluxation was that of a slightly misaligned vertebra, not sufficient to be qualified as a true luxation or dislocation, but substantial enough to impinge on the segmental nerves associated with it. This early concept stressed bony pressure on the nerve. Let's refer to this first definition as “bone-out-of-place” or BOOP.
It is widely accepted today that a subluxation is not merely a bone out of place; the general consensus being that there must, of necessity, be some sort of neurological involvement. But it would be short-sighted to neglect the contribution of associated muscles, which effect movement; ligaments, which not only hold the bones together, but place certain constraints on their movement; or vascular compromise which can be a major or contributing factor in the pathology and degeneration of spinal articulations. [ 2, 5 ]
A subluxation starts with a loss of function at the facet joints, or what we refer to as “fixation” of the joint. When a joint is fixated, receptors in the joint capsule send aberant signals back to the brain. The brain sends signals back to the muscles which move that joint, bringing them into contraction, in an attempt to release the fixation. The longer the joint remains fixated, the more the muscles will increase their tone, and they may become sore. This is the beginning of the cascade of events that is described as the subluxation complex.
Various Models of the Vertebral Subluxation Complex
We also have compelling research to demonstrate that fixation/subluxation of vertebral segments leads to rapid degeneration of
Fig 4. A and B, Z joint osteophyte formation on external surfaces of 2 L5 cephalad articular processes for the degeneration severity parameter. A is from a control animal (Cnull, 8-week), and B is from an 8-week fixation animal. Large white arrows (A) show smooth cephalad edge of articular process with no signs of osteophyte formation; Arrowheads (B) outline a +3 osteophyte. C and D, Internal surfaces of 2 L5 cephalad articular processes demonstrating Z joint articular cartilage degeneration for the degeneration severity parameter. C is from a control animal (Csau, 1-week), and D is from a 4-week fixation animal. Notice that hyaline articular cartilage of the control animal (C) is quite smooth, while that of the 4-week fixation animal (D) has marked roughening, pitting, and remodeling. The remodeling is so marked in D that the ventral portion of the articular process (bottom) is out of the plane of maximum focus. In addition, subchondral bone is exposed on dorsal portion of the articular process (hyaline articular cartilage has eroded). Arrows show deep pits within Z joint articular cartilage and subchondral bone. H, Hyaline cartilage on Z joint facet of cephalad articular process; S, subchondral bone.
(FROM: J Manipulative Physiol Ther 2004 (Mar); 27 (3): 141–154)
Is There a Need for an Animal Model for Spinal Manipulation Research?
Claire Johnson, MSEd, DC (Editor)
Ultimately, we face the questions that patients, students, other health care providers, or other researchers will ask us regarding spinal manipulation: “How does it work?” “What impact does spinal manipulation have?” “What style or technique works best?” “How can we make manipulation techniques more effective?” If we knew the answers to these questions, in the amount of detail that they deserve to be answered, then perhaps we would be more effective with educating our patients, selecting which patient would receive what technique, and how to continue to improve the care we provide. We would be better able to understand the mechanisms of manipulative therapy, which would then result in better research and better patient care. Animal model research might be able to bring us closer to answering such questions.
Publication of animal model research in the Journal of Manipulative and Physiological Therapeutics is not new. For example, nearly 20 years ago, De Boer and McKnight published a study proposing a surgical method in rabbits to mimic the conditions of chiropractic subluxation or spinal fixation that would help us better understand this phenomenon in the spine. [ 1 ] In 2001, Pickar and Wheeler demonstrated the physiological effects of manipulation and preload on the spine using an animal model. [ 2 ] And in 2004, Kawchuk et al demonstrated an animal model that could investigate a complication that would normally not be able to be evaluated in humans in a prospective manner. [ 3 ] Publication of animal models of spinal fixation has been reported in other journals as well. [ 4, 5, 6 ]
In this issue of the Journal of Manipulative and Physiological Therapeutics, Henderson et al present a new animal model for consideration. Although the use of animal models in research is not new, investigating a new technique is essential for the growth of this type of basic science research. Providing a model for reversible spinal fixations can help us to explore a whole new set of questions that up until this point have not yet been answered.
CONCLUSIONS: When inflammation was induced in a facet joint, inflammatory reactions spread to nerve roots, and leg symptoms were induced by chemical factors. These results support the possibility that facet joint inflammation induces radiculopathy.
CONCLUSIONS: By creating static and dynamic posterior instability of the cervical spine, this novel model of cervical spondylosis results in rapid intervertebral disc degeneration characterized by increased apoptosis and local inflammation, such as that seen clinically.
