Editorial: Vertebral Subluxation Complex and Functional Spinal Lesions; Differentiation and the Search for Mechanisms of Action Chiropractic has been entrenched in philosophy and theory to explain its role in health care. The philosophy has managed to provide a promissory note by perpetuating the belief that manipulative intervention plays some role in general health care. On the other hand, the theory of the subluxation complex has managed to focus on a single level lesion as the explanation to the effects of chiropractic intervention (1). The philosophy has not been able to contribute to the knowledge base for scientific inquiry. Its role in explaining chiropractic is relegated to that of philosophy and, as such, asserts a very weak argument in support of the chiropractic profession as a science discipline (2). Its role in chiropractic, however, cannot be dismissed; for, after all is said and done, the philosophy has maintained the principle idea of an innate function that has sustained the profession in its struggle to assert its role as a health care discipline. The question whether both the philosophy and the theory has placed the emphasis in the wrong areas for inquiry will be left for others to evaluate. The question for chiropractic is whether the emphasis on inquiry ought to be placed on a single level subluxation complex or whether a more global view is needed in the inquiry process. The reductionist theory for scientific inquiry has forced the chiropractic profession into a very narrow window for inquiry. The mechano-engineering, structural lesion concept (subluxation) has forced the profession to maintain its focus on the single level lesion (subluxation complex) as contributing to neurophysiologic changes within a wiring system schema. The possibility that a more global approach is needed can only be suggested by viewing not only technique development (3) within the chiropractic profession but the idea contained within Triano's "functional spinal lesion (FSL) (4)." This term expresses "a spine related disorder that involves function" as a dynamic model for inquiry as opposed to the static model of subluxation as structure.

Content Editorial........ Jan 1999 Virgil Seutter The problem in research References

The global approach to inquiry involves functional changes in the body as representative of more intrinsic function. While much of this is speculative, a candidate proposal would view a computational model as more realistic in evaluating the FSL in comparison to a restricted focus on the subluxation complex of a wiring system schema. The computational model involves analysis of data as part of an information system in which predetermined parameters constitute the basis for data extraction and analysis. How this is done is yet to be determined. It is, however, within a speculative mode that we might examine the computational model as a possibility.

The mechanistic, engineering principles for inquiry deals with the "real," or tangible phenomenon of observable events. In this process, a cause/effect relationship is established by association of the observable event or phenomenon. To the linear mind, it is real to the extent that a direct relationship is immediately apparent. What one sees (or feels), is what one describes as an objective observation. If, as an example, one looks at the "world is flat" view of things, one can take a palpatory walk along the spine and readily see (and feel) an asymmetry of relationships to muscle tonicity that suggests a subluxation, or "bone-out-of-place." In one sense, the notion of a bone out of place would certainly suggest that it could be pressing on the muscle in such a way as to "give the appearance" of a bone out of place (or an anatomical displacement of structure). A more sophisticated view, however (one punctuated by scholarly credentials), would assume that most certainly the process involves more detail of explanation. That's the scientific method. And it explains things. Or does it? If the arguments for either position are so secure in their emphasis on the argument, why can replicability not be produced in the manipulative protocol? Is the linear inquiry a reality? Or is it an illusion to our senses ... and a delusion to our logical (linear) thinking?

If, however, one looks at the "world is round" view of things, one is able to remove oneself from the immediate focal area and perceive a more global view of things. In this sense, the computational model for inquiry takes a perspective slightly removed from the immediate palpatory response that satisfies our senses ... as well as our logical association of events. It "zooms out" a little to take an overall perspective of the response. It removes itself from the immediate sensory/logical pursuit of explanation and inquires into nonlinear relationships ... that would not ordinarily be perceived by the senses.

Rather, in a context more suitable to the concept of functional changes, the "world is round" view perceives the FSL as a reciprocal response to adaptative postural mechanisms (in an aberrant behavioral context). It detects more than one subluxation because it appears to identify the reciprocal groupings of muscle that are constantly adapting to dynamics of postural change. If change cannot occur, the FSL becomes recognizable as an aberrant behavior. It does not permit the complex adaptive system to compromise its integrity in control. In a sense, it appears to "splint" the area most vulnerable to an "out of synch" global response. It would appear as a focal point by palpatory definition and observation. In a broader sense, that local area merely represents only one area of disturbed synchronization in the neurological control mechanism.

In other words, the computational model for inquiry suggests that the "world is round" view of things may, indeed, be viewed from a perspective slightly removed from immediate palpatory confinements. The computational model perceives the FSL as a representation of aberrant dynamics, but only as a small part of a chain of events that can only be viewed in an "out of context" relationship. It cannot be viewed in its entirety without some tool for analysis of correlated function. The recognition of spatial pattern changes in reflex activity (as in applied kinesiology, sacro occipital technic, activator, etc.) as somehow similar to mathematical searches for topographical spatial patterns can only be suggestive, at this point, that further inquiry into chiropractic methodology may be part of a computational problem of nonlinear dynamics rather than a strictly static, linear relationship within reductionist perimeters.

The problem in research

A dimensional perspective change (5) must introduce a method (computation model) whereby data may be extracted. That physiological response has not been a predictable event from procedural intervention can be conceded, but reflects another critical problem in the inquiry phase for epistemologic genesis. This involves the research/treatment phase in procedural application (intentionality) and recognizes the inability to format a correct application for the appropriate response. Quite simply, the research agenda cannot formulate the questions necessary to stage the experiment to the problem and expect to provide a satisfactory result.

The problem of staging the correct experiment stems from an inability to understand the exact nature of a manipulative intervention at the various spinal levels. Intervention at a single level follows neurological reflex arc concepts that comply with reductionist perimeters of segmental pathways. That multiple levels could be involved follow some of the concepts in recognition of primary and secondary lesions as a possibility and may follow propriospinal pathways. This perspective continues to follow reductionist, anatomical, static reference points.

Part of the inability to produce a consistent result from experimentation is the nature of the static reference point and where reductionist method no longer applies at the staging level. It is at this point where information strategy (the computational model) must apply its potential as a viable alternative inquiry in theoretical formatting of experimental design; for it is here where the attempt to differentiate spinal stresses in a dynamic mode of evaluation occurs rather than the static mode that is usually represented by radiographic examination or palpation.

The dynamic mode of evaluation is a pivotal departure from a static mode of evaluation. It represents the possible ability (through computational simulation) to differentiate immediate changes from a manipulative procedure --- as well as contact reflex intervention via the peripheral nervous system. That it is based upon changes in reflex activity is also a departure from reductionist strategy and ventures into an abstract, problematic inquiry that becomes an algorithmic extrapolation of an unknown factor. Whether computer assisted correlation of reflex pattern changes could provide an ability to trace sequences of change that might ultimately manifest as a reductionist phenomenon, the physiological response, has yet to be determined.

The inability to trace pattern changes that result from manipulation as a neurological perturbational response has prohibited an accurate staging in experimental design by not being able to see (in a visual sense) the interrelated effects of a multi level profile to the subluxation complex. It has focused on the reductionist paradigm of single level lesions and somato visceral response without understanding that a multi - dimensional organismic response occurs that transcends the reductionist ability to trace overlapping perturbational responses. It becomes that elusive, intangible epiphenomenal variable that randomly produces an effect that is placebo simply because it cannot be traced as an ordered event or a reproducible phenomenon.

The implication for staging research inquiry is that, in order to produce a measurable effect from manipulative procedure, multiple levels of reflex pathways must be recognized as an integral part of the subluxation complex and that a sequential decompression pattern could be possible as a prerequisite for manipulative procedure to manifest an intrinsic effect. This implicates a sensory dominant response by way of reflex activity and suggests a prominent consideration in evaluating the subluxation complex.

References

1. Proposed Mechanisms of Actions for Chiropractic Adjustments (These images and mechanisms are property (©) of Dr. Andrew S. Bonci and are reproduced on the linked site with permission)
2. Keating JC. A survey of philosophical barriers to research in chiropractic. J Calif Chiro Assn. 1989;33:4:184-186.
3. Bergmann TF. "Editorial: various forms of chiropractic technique." Chiro Technique. 1993;5:53-55.
4. Triano JJ. The subluxation complex: outcome measure of chiropractic diagnosis and treatment. Chiro Technique. 1990;114-120.
5. Keating JC. Philosophical barriers to technique research in chiropractic. Chiro Technique. 1989;23-29.