theories of subluxation: an introduction toward the development of an operational understanding of...

Theories of Subluxation: Theories of Subluxation: An IntroductionAn Introduction

Toward the development of an Toward the development of an operational understanding operational understanding

of subluxationof subluxation

References:References:

Gatterman, Foundations of Chiropractic; Gatterman, Foundations of Chiropractic; Subluxation, 1995, Chapter 10 (R. Mootz, Subluxation, 1995, Chapter 10 (R. Mootz, D.C.)D.C.)

Korr, I.M., Neurobiologic Mechanisms of Korr, I.M., Neurobiologic Mechanisms of Manipulative Therapy, 1978Manipulative Therapy, 1978

Updated references:Updated references:

Chapters 4-9, Chapters 4-9, Fundamentals Fundamentals of Chiropractic, of Chiropractic, 2003, 2003, Redwood & ClevelandRedwood & Cleveland

(*8, “(*8, “Neurobiologic Relations Neurobiologic Relations and Chiropractic Applicationsand Chiropractic Applications”)”)

Also Recommended:Also Recommended:

Chiropractic Secrets, Chiropractic Secrets, 2000 2000

Gardner and MosbyGardner and Mosby

(Chapters by several PCC faculty)(Chapters by several PCC faculty)

(Good National Board Review)(Good National Board Review)

It’s out of print, but copies still are It’s out of print, but copies still are aroundaround

““Theoreticians of spinal manipulation, Theoreticians of spinal manipulation, at one time or another, have at one time or another, have implicated virtually every anatomical implicated virtually every anatomical component of the vertebral motor unit component of the vertebral motor unit in their attempts to explain the mode in their attempts to explain the mode of action of their therapy.”of action of their therapy.”

Drum, 1975Drum, 1975

Some proposed mechanisms:Some proposed mechanisms:theorytheory authorauthor

1. Restore vertebrae to 1. Restore vertebrae to Galen (1958)Galen (1958)

normal positionnormal position

2. Straighten the spine2. Straighten the spine Pare (1958)Pare (1958)

3. Restore blood flow3. Restore blood flow Still (1899)Still (1899)

4. Relieve nerve 4. Relieve nerve Palmer (1910)Palmer (1910) compressioncompression

Some proposed mechanisms:Some proposed mechanisms:

theorytheory authorauthor5. Relieve irritation of 5. Relieve irritation of Kunert (1965)Kunert (1965) sympathetic chainsympathetic chain

6. Mobilize fixated 6. Mobilize fixated Gillet (1968)Gillet (1968) vertebral segmentsvertebral segments

7. Shift fragment of 7. Shift fragment of Cyriax (1975)Cyriax (1975) IVDIVD

Some proposed mechanisms:Some proposed mechanisms:

theorytheory authorauthor8. Mobilize posterior 8. Mobilize posterior Mennell (1960)Mennell (1960) joints (z-joints)joints (z-joints)

9. Remove interference 9. Remove interference DeJarnette (1967)DeJarnette (1967) with CSF circulationwith CSF circulation

10. Stretch contracted 10. Stretch contracted Perl (1975)Perl (1975) musclesmuscles

Some proposed mechanisms:Some proposed mechanisms:

theorytheory authorauthor11. Correct abnormal 11. Correct abnormal Homewood (1963)Homewood (1963) somatovisceral reflexessomatovisceral reflexes

12. Remove “irritable”12. Remove “irritable” Korr (1976)Korr (1976) spinal lesionsspinal lesions

13. stretch/tear adhesions 13. stretch/tear adhesions Chrisman (1964)Chrisman (1964) around nerve rootsaround nerve roots

Some proposed mechanisms:Some proposed mechanisms:

theorytheory authorauthor

14. Reduce distortions 14. Reduce distortions Farfan (1973)Farfan (1973)

of the annulae (annulusof the annulae (annulus

fibrosusfibrosus

Neurobiologic Mechanisms of Manipulative Neurobiologic Mechanisms of Manipulative TherapyTherapy, 1978, 1978

How do we develop an How do we develop an operational understanding of operational understanding of subluxation? (i.e.: What subluxation? (i.e.: What research needs to be done to fill research needs to be done to fill in the pieces of the puzzle?)in the pieces of the puzzle?)

Adjustment/Corrective procedure

Change in the musculoskeletal system

Change in the nervous system

Change in organ dysfunction or tissue pathology or symptom complex

Areas of Research Involved in Mechanism of Action of Adjustments/Chiropractic Corrective Procedures

1 3

2

4

““Little scientific information is Little scientific information is currently available to resolve the currently available to resolve the questions of impact on human health questions of impact on human health that the FSL (functional spinal lesion) that the FSL (functional spinal lesion) may have.”may have.”

Triano, 1992Triano, 1992

Major Subluxation Theories Major Subluxation Theories (Dr. Charles Henderson, PCC Researcher)(Dr. Charles Henderson, PCC Researcher)

IVF EncroachmentIVF Encroachment

Altered Sensory Input (dysafferentation)Altered Sensory Input (dysafferentation)

Spinal Cord distortionSpinal Cord distortion

How do chiropractors evaluate How do chiropractors evaluate individuals clinically to determine the individuals clinically to determine the appropriateness of chiropractic care?appropriateness of chiropractic care?

Biomechanical evaluationBiomechanical evaluation Neurologic evaluationNeurologic evaluation Trophic assessmentTrophic assessment Psychosocial assessmentPsychosocial assessment

From Mootz, Chapter 10, Gatterman’s 1995 text;From Mootz, Chapter 10, Gatterman’s 1995 text; Foundations of Chiropractic: SubluxationFoundations of Chiropractic: Subluxation

Biomechanical EvaluationBiomechanical Evaluation

Contributing mechanical etiologies: (trauma, Contributing mechanical etiologies: (trauma, repetitive postural activities, etc..)repetitive postural activities, etc..)

Static asymmetries: (high shoulder, altered Static asymmetries: (high shoulder, altered curves, rotated foot, etc…)curves, rotated foot, etc…)

Dynamic asymmetries: (gait, other movements)Dynamic asymmetries: (gait, other movements) Passive and active individual joint ranges of Passive and active individual joint ranges of

motion: (static and motion palpation)motion: (static and motion palpation) Imaging procedures used to evaluate the above Imaging procedures used to evaluate the above

(x-ray, static and stress views, (x-ray, static and stress views, videoflouroscopy)videoflouroscopy)

Neurologic EvaluationNeurologic Evaluation

Symptoms (pain and its location and Symptoms (pain and its location and distribution- from patient history)distribution- from patient history)

Palpatory tendernessPalpatory tenderness Altered muscle tone (palpation, EMG)Altered muscle tone (palpation, EMG) Vasomotor findings (thermography)Vasomotor findings (thermography) Sudomotor findings (palpation and Sudomotor findings (palpation and

galvanic skin response testing)galvanic skin response testing)

Trophic AssessmentTrophic Assessment

Altered tissue textureAltered tissue texture Edema (signs of inflammation)Edema (signs of inflammation) Metabolic disturbancesMetabolic disturbances Nutritional imbalancesNutritional imbalances These may be signs of aberrant local tissue These may be signs of aberrant local tissue

metabolism or vascularity; metabolic metabolism or vascularity; metabolic disturbances and nutritional factors may disturbances and nutritional factors may be causative or complicating factors in be causative or complicating factors in somatic disturbances, e.g… “pro-somatic disturbances, e.g… “pro-inflammatory state”inflammatory state”

Psychosocial AssessmentPsychosocial Assessment

Mental attitude/outlookMental attitude/outlook Social interactionsSocial interactions Lifestyle habitsLifestyle habits StressStress

Theories/Models of SubluxationTheories/Models of Subluxation

BiomechanicalBiomechanicalNeurologicNeurologicTrophicTrophicPsychosocialPsychosocial

Biomechanical Models of Biomechanical Models of SubluxationSubluxation

Vertebral/spinal misalignmentVertebral/spinal misalignment Abnormal motion; fixation, Abnormal motion; fixation,

hypermobility, compensation reactionhypermobility, compensation reaction Joint dysfunction progressing to Joint dysfunction progressing to

spinal degenerationspinal degeneration

Neurological ModelsNeurological Models

Neurologic compression/traction/torsion; Neurologic compression/traction/torsion; affecting nerves, roots, cordaffecting nerves, roots, cord

Neurologic irritationNeurologic irritation Aberrant reflexesAberrant reflexes Deafferentation/dysafferentationDeafferentation/dysafferentation Neurodystrophic/neuroimmune effectsNeurodystrophic/neuroimmune effects

Trophic ModelsTrophic Models

Axoplasmic flow mechanismsAxoplasmic flow mechanisms Vertebrobasilar arterial insufficiencyVertebrobasilar arterial insufficiency Neurologic ischemia, macro and Neurologic ischemia, macro and

micromicro Lymphatic/venous stasisLymphatic/venous stasis CSF flow dynamicsCSF flow dynamics

Psychosocial ModelsPsychosocial Models

Psychogenic concepts: how Psychogenic concepts: how mental/emotional state influences mental/emotional state influences structure (a structure (a causecause of VSC) of VSC)

Somatopsychic concepts: how Somatopsychic concepts: how structure (VSC) influences structure (VSC) influences mental/emotional states (mental/emotional states (effectseffects of of VSC)VSC)