On the left-hand toolbar of our Blog the recent addition of links to the rest of our sections on the PAGES section.

When the Blog replaced our original home page, traffic to the Blog did increase…but, unfortunately at the cost of reduced traffic to the various sections which actually contain the thousands of research articles we have been collecting (in archive fashion) since 1995.

Because of Google, some of those isolated pages continue to increase traffic (like the Diagnosis Page, or the Outcome Assessment Page), but many other equally important pages like the Low Back Pain and Chiropractic page, the Whiplash Page, and Attention Deficit page have experienced diminished traffic, even though these pages are the principal respository for the research that matters to DCs.

I have noticed a significant bump in traffic to all those sections since I moved them into plain view in the Pages section. Thanks to all of you who have noticed those links and taken the time to explore them!

All these sections continue to add materials by the day, week or month. The original home page is regularly updated, and provides the drop down tools to access all of our sections.

Some of you might prefer to use the Site Map to locate materials of interest to you.

Finally, the Search Section is a very convenient way to locate specific materials.

I encourage all of you to explore our sections. No other chiropractic website contains the breadth of materials, presented in such a non-partisan fashion. Our commitment is to provide information of value to the profession, with no thought of reward. That was our vision when Ed Merrifield started this site in March of 1995, and that remains as our sole objective today.

It was called House Bill 127 (HB 127) and with it, the New Mexico State Senate considered legislation to permit limited prescription drug rights to a group of “Advanced Practice” Chiropractors. The bill passed the house but not the full senate. The chiropractic formulary was to include some anti-inflammatories, a common muscle relaxer, and several other topical and internal substances. Proponents said this law would permit chiropractors to help with the drastic shortage of PCP’s in NM and also help patients reduce their medication usage. Opponents said this law flew in the face of our chiropractic forefathers who fought hard to preserve our drugless profession.

A blog article on this topic on the RochesterChiro blog attracted some heated debate and strong opinion. For more depth on this issue, podcast host Dr. Brett Kinsler contacted two people who testified at the hearings in New Mexico concerning this bill:  Dr. James Winterstein, president of National University of Health Sciences and Dr. Gerry Clum, recently retired president of Life College of Chiropractic West.

Listen on iTunes or at the podcast website.

SOURCE: Dynamic Chiropractic

By Richard C. Schafer, DC, FICC

This series has strived to define certain general principles that underlie almost all chiropractic adjustive technics. Parts I and II reviewed depth of drive, the articular snap, segmental distraction, timing, the advantages of placing the patient’s spine in an oval posture, correct table height, and patient positioning objectives.
Part III summarized the factor of time in the clinical approach and its underlying biomechanical principles of tissue viscoelasticity, fatigue, creep, and relaxation. Part IV and V reviewed the need to visualize the loading effects on articular cartilage, joint lubrication, action of the intra-articular synovial tabs, the articular planes, the fundamental types of contact, contact points and their options, securing the contact hand, and the direction of drive. Part VI offered a rationale on adjustive velocity, and this concluding column on this subject describes various types of adjustive thrusts.

Types of Adjustive Thrusts

Test Thrusts

Test thrusts are mild preliminary thrusts applied before an actual corrective thrust is delivered. They have a twofold purpose: first, to acquaint the adjuster with the structural resistance present and patient response to the pressure applied; second, to acquaint the patient with what to expect. Surprise lowers a patient’s pain threshold.

Leverage Thrusts

The term leverage move refers to the use of counter pressure or contralateral stabilization. It is applied to prevent the loss of applied force, secure the most work with the least amount of energy expenditure, and concentrate the movement or force at the directed point of contact. Visualize! Only enough counter pressure is used to balance the force of the adjustive thrust. Leverage thrusts are the most commonly applied technic used in chiropractic.

Impulse Thrusts

An impulse thrust is the application of a short, sharp force without recoil. The hands adopt a preset tension in the line of drive, and the impulse is characterized by a high-velocity low-depth thrust.

Recoil Thrusts

The classic recoil thrust is applied against a spinous process or lamina with a pisiform contact. After the contact has been accurately taken and secured, the correct stance must be assured and the elbows must be completely relaxed. At the instant of almost maximum patient exhalation, the adjuster’s extensor muscles of the arms and pectorals are suddenly and simultaneously contracted. As the elbows are in line with each other and in the same plane, this spasmodic-like contraction adducts the elbows and produces the thrust. So the force of the adjustment will not go in the opposite direction (i.e., toward the ceiling), the adjuster must contract his abdominal, thoracic, and neck muscles at the same time the force is delivered. This maintains a rigid trunk, and the adjuster’s body weight will concentrate the force on the spinous process being adjusted. Visualize!

The force of a recoil adjustment should be applied equally with both arms, at the same instant after the adjuster positions the trunk so that the force of the adjustment will be applied in a straight line from the episternal notch to the point of contact. The proper position, therefore, is to have the episternal notch directly over the point of contact. Another factor of importance is for the adjuster to position the elbows at right angles to the line of drive and bent only to the extent that allows the entire force of the adjustment to be delivered in a short, swift manner. Immediately after the adjustment is delivered, the adjuster’s hands should “recoil” away from the patient’s spine.

A thoracolumbar recoil adjustment delivered to a patient in the prone position should not be applied on a hard surface table. Injury to the patient’s chest or abdomen may result because of the velocity and force associated with this type of thrust. The table should have a spring support in which the tension is relaxed, yet there must be resistance under the patient’s thighs and upper thorax.

Body Drop Thrusts

A body drop thrust is usually associated with Willard Carver’s technic. The adjuster centers trunk weight over the contact hand(s) and raises his body between the shoulders using straight arms. The adjuster’s trunk is then allowed to drop to apply a short, sharp impulse. The force is delivered through the straight arms (elbows locked). This method is not to be confused with that of dropping the body by bending the knees as is occasionally used in lumbar side posture adjusting. The Carver body drop must be used cautiously with children, the elderly, osteoporotics, etc. Less forceful technics are usually more applicable in these cases.

Rotary Thrusts and Rotary Breaks

A rotary thrust, with accompanying joint distraction, is administered to correct either local or area rotary fixations. The direction of drive is clockwise or counterclockwise and parallel to the plane of articulation. Visualize! A rotary break is the addition of a force to open thinned disk space on the contralateral side of rotation fixation. The technic is commonly applied in the cervical area, with the patient supine or prone; or in the lumbar position with the patient in the lateral recumbent position (e.g., million dollar roll).

Spear’s Multiple-thrust Technic

The major objective of multiple-depth thrusts is to permit a gradual increase in force, prolong the relief on compressed discs and articular cartilage, allow time to compensate for the applied force, and permit the application of a summing force that can be equal to or greater than that used in a single thrust, thus reducing patient discomfort.

A classic example of a multiple-thrust technic would be the application of Leo Spears’ double-transverse contact, which is applied to the spine with thenar contacts in a deep, low-velocity, alternating, rhythmic fashion to obtain patient relaxation and to stretch perispinal and intersegmental adhesions and other taut tissues before more specific spinal therapy. It has been described as a continuous “down light, down medium, down heavy” multiple thrust in which each non-jerky thrust (without relaxing the pressure between the multiple thrusts) applies progressive pressure after tissue adaptation. These progressively increasing forces must be made in a smooth, steady manner so that patient relaxation will not be disturbed to the point of producing perivertebral contraction. Visualize what is occurring and why.

This full-spine technic, applied from T1 to the sacrum, is extremely beneficial in spinal cord diseases (e.g., acute poliomyelitis) and situations where either cerebrospinal or axoplasmic fluid flow has been restricted or requires enhancement. Although this “stretching-milking” technic is not designed to reduce severe subluxations, numerous secondary muscles fixations will be gently removed and frequent articular snaps will be felt and heard after the technic has been applied to the thoracolumbar spine for a minute or two. This is also an excellent initial technic to use in conditioning the spine preparatory to a more forceful technic. This technic has a direct effect on axoplasmic flow, intervertebral foramen (IVF) contents, the costovertebral articulations, and cerebrospinal fluid (CSF) circulation. It has an indirect effect of massaging (pumping) the lungs, mediastinum, heart, and upper-abdominal viscera. In many instances, it is the only technic applicable to the geriatric patient.

Objective-oriented Approaches

Most chiropractic adjustive technics have the common objectives of freeing restricted mobility and releasing impinged or stretched nerves. Added factors are the expansion or compression of deformed IVFs and IVDs, the elongation of shortened tendons and ligaments, the release of adhesions, and the enhancement of cerebrospinal and axoplasmic fluid circulation.

It can be generally stated that joints and nerves become painful only when nociceptors are stretched, compressed, or chemically irritated. In adjusting acute lesions, proper analysis consists of the localization of fixations as well as the determination that these conditions produce the nociceptive input experienced by the patient in pain.

You may also enjoy RCs article: The Art of Pioneer Chiropractic Technic,

which is just one of 42 free articles available in the Rehabilitation Monograph Series

These articles are archived on the: Chiropractic Technique Page

Richard C. Schafer, D.C., F.I.C.C.
Oklahoma City, Oklahoma

SOURCE: Dynamic Chiropractic

By Richard C. Schafer, DC, FICC

The aim of this series is to define certain general principles that underlie almost all chiropractic adjustive technics. Parts I and II reviewed depth of drive, the articular snap, segmental distraction, timing the advantages of placing the patient’s spine in an oval posture, correct table height, and patient positioning objectives. Part III summarized the factor of time in the clinical approach and its underlying biomechanical principles of tissue viscoelasticity, fatigue, creep, and relaxation. Parts IV and V reviewed the need to visualize the loading effects on articular cartilage, joint lubrication, action of the intra-articular synovial tabs, the articular planes to deliver a corrective thrust most effectively. The fundamental types of contact, contact points and their options, securing the contact hand, and direction of drive were described. This column summarizes the rationale of adjustive velocity.
Background

One’s preference in technic can be clinically justified as long as biophysical and physiologic principles are followed. In health care, however, we are not dealing with purely mechanical principles. We are dealing with patients, sensitive human beings, who are often already in pain, and we should not wish to induce any more discomfort during a correction than is necessary.

Thrust technics applied to an articulation can be divided into two categories: low-velocity technics (LVTs) and high-velocity technics (HVTs), and each has various subdivisions depending on the joint being treated, its structural-functional state, and the primary and secondary objectives to be obtained. The term adjustment velocity refers to the speed at which the adjustive force is delivered. In either low-velocity or high-velocity technics:

The force applied may be low, medium, or high.

The duration of the force may be brisk or sustained.

The amplitude (distance of articular motion) may be short, medium, or long.

The direction of the force may be straight or curving and/or perpendicular, parallel, or oblique to the articular plane.

Overlying soft-tissue tension may be mild, medium, or strong.

Primary or secondary leverage may be applied early, synchronized, or late.

Contralateral stabilization may or may not be necessary.

Thrust onset may be slow, medium, or abrupt.

Articular fixations may be produced by such restricting factors as perivertebral fascial adhesions, ligamentous contractures, IVD dehydration, fibrosed muscle tissue, spondylosis, or meningeal sclerosis and adhesions. An excessively forceful dynamic thrust to these conditions may result in increased mobility by stretching shortened tissues and breaking adhesions, but there is always some danger of osseous avulsion or tearing of meninges as scar tissue has a much higher tensile strength than osseous or nerve tissue. Because of this, therapy may have to progress over several months.

Low-Velocity Technics (LVTs)

The category of low-velocity adjustments contains applications that apply slow stretching, pulling, compression, or pushing forces. Sustained or rhythmic manual traction or compression and procedures to obtain proprioceptive neuromuscular facilitation (PNF) are typical examples. Many leverage techniques advocated to reduce intravertebral disc (IVD) protrusions and functional spondylolisthesis can be placed in this category.

High-Velocity Technics (HVTs)

The category of high-velocity adjustments holds the applications of classic dynamic-thrust (direct, rotary, or leverage) chiropractic adjustment technics that are applied to a vertebra’s transverse or spinous process or a lamina, with various degrees of counterleverage and/or contralateral stabilization. Contact pressure is usually firm, if the underlying tissues are not acutely painful, when the contact is to be maintained at a specific point and the thrust delivered in a precise direction — which is common.

A dynamic thrust against a point of articular resistance is an effective method of imposing the force necessary to produce adequate mobility to initiate the recovery process. Especially when leverage is applied before the application of a corrective impulse, considerable skill and caution are necessary to avoid iatrogenic trauma. The same is true if motion beyond the physiologic limit (e.g., overextension, overflexion, excessive rotation) is used.

A dynamic thrust starts a momentary myotactic stretch reflex even faster than a slow stretch, via the low-threshold stretch circuit, but, if delivered properly, a dynamic thrust will also excite the higher threshold Golgi tendon apparatus that initiates the inverse myotatic reflex to cause associated contracted muscle fibers to give way suddenly (clasp-knife reflex). By holding a finger near a colleague’s contact hand while a dynamic adjustment is given to a patient, the quick contraction followed by relaxation of the underlying muscle can be sensed. This phenomenon, autogenic inhibition, has many applications in correcting muscular fixations and relaxing splinted muscles.

The objective of almost all HVTs is to release instantly the fixated articulation (increase joint mobility). How this is executed has not been specifically determined because more is involved than the application of a mechanical force against a resistance. The most common theories are:

The mobilization of fixated articular surfaces. Apophyseal joints can become fixated because of the effects of joint locking (e.g., traumatic), muscle spasm, degeneration, an entrapped meniscoid or other loose body, capsular fibrosis, intra-articular “gluing” or adhesions (e.g., postsynovitis, chronic rheumatoid conditions), bony ankylosis, facet tropism, etc.

The relaxation of the perivertebral musculature. While a high-velocity force that suddenly stretches muscles spindles in primary muscle spasm will increase the spasm, the same force applied to a segment when its related muscles are in secondary or protective spasm produces relaxation if the impulse succeeds in removing the focal stimulus for the reflex.

The shock-like effect on the CNS. Shock-like forces (1) are known to have a normalizing effect on noxious self-sustaining CNS reflexes; (2) are stimulative to the neurons involved, resulting in increased short-term neural and related endocrine activity; and (3) set up postural and muscle-tone-normalizing cerebellar influences via the long ascending and descending tracts of the cord.

Indirect Techniques

Manual mobilization and thrust techniques are direct approaches to relieving articular fixations. Indirect functional approaches are often used when the cause of fixation has been determined to be essentially muscular in origin or when any form of manipulation would be contraindicated. Within this category fall many manual light-touch cutaneous reflex techniques, meridian therapeutic vibration, isometric and isotonic contraction, etc. It is theorized that these procedures produce much of their effects because of their influence on the gamma-loop system, and/or by the superiority of mechanoreceptor input on nociceptive input.

You may also enjoy RCs article: The Art of Pioneer Chiropractic Technic,

which is just one of 42 free articles available in the Rehabilitation Monograph Series

These articles are archived on the: Chiropractic Technique Page

Richard C. Schafer, D.C., F.I.C.C.
Oklahoma City, Oklahoma

SOURCE: Dynamic Chiropractic

By Meridel I. Gatterman, MA, DC, MEd

Risk factors come in a variety of distinctions, from those for cardiovascular disease and some forms of cancer to those less than life-threatening but nonetheless undesirable conditions affecting the quality of a person’s life. A risk factor causes a person to be particularly vulnerable to an unwanted, unpleasant or unhealthful event. Risk factors predispose individuals to developing specific conditions. It has been suggested spinal subluxation could be considered such a risk factor. [1]

Subluxation As a Risk Factor

The following questions should be examined if the concept of subluxation as a risk factor is considered:

1. Is subluxation of one region of the spine a risk factor for different signs and symptoms as opposed to a subluxation in another spinal area?
2. If so, does a subluxation in one area create a different syndrome than when it occurs in a different region?
3. Does clinical observation suggest there are different subluxation syndromes associated with different spinal areas? [2]
4. Does a subluxation in the upper cervical region cause a different syndrome than a subluxation in the lower cervical region, and does a subluxation of the sacroiliac joint cause a different syndrome than one at a costovertebral joint? Does a patient’s symptomatic complaints and observable signs lead you to suspect a subluxation of one spinal region as opposed to another?

Subluxation Syndromes

A subluxation syndrome has been defined as an aggregate of signs and symptoms that relate to pathophysiology or dysfunction of spinal and pelvic motion segments or to peripheral joints. [3] While the signs and symptoms characteristic of subluxation syndromes are not always due to a subluxation, when they are, the condition commonly is responsive to adjustive and manipulative procedures. It is important the examination of patients be inclusive of the clinical indicators that identify subluxations. The components of the PARTS exam, developed by Bergmann [4] and included in the Medicare Benefit Policy Manual that covers medical and other health services, [5] commonly is used to identify subluxations.

Subluxation of the Upper Cervical Vertebrae

Headaches from subluxations in the upper cervical vertebrae are responsive to adjustive and manipulative procedures. [6] Cervicogenic headache is the term most frequently used to describe the syndrome characterized by neck and suboccipital pain that might project to the forehead, temples, vertex and ears. [7] The pain might increase with specific posture and movement. When examination findings reveal cervical motion segment misalignment, restricted segmental motion, muscle hypertonicity, and/or tenderness, it is suggestive of vertebrogenic pain. [7]

Cervicogenic headaches can be caused by vertebral subluxation (vertebrogenic headache) [8] and muscle hypertonicity (muscle tension headache). [9] Studies suggest both cervicogenic and tension-type headaches are appropriately treated with manipulative therapy. [9-11] It also has been demonstrated that migraine (vascular) headaches respond to manipulation of the upper cervical vertebrae. [12-14] These results suggest subluxation might play a reflex role in the mechanism of migraine that warrants further investigation. If subluxation is a risk factor for migraine headaches, manipulation might serve as a prophylaxis in the prevention of this debilitating condition. [15]

Subluxation of the Lower Cervical Vertebrae and the First Rib

Subluxations of the lower cervical vertebrae and the first rib generally affect the ipsilateral upper extremity. [7] Symptoms are characteristic of thoracic outlet syndromes and might include numbness, tingling and vascular changes. A careful differential diagnosis that identifies subluxation of this region is necessary since there are a number of sites at which dysfunction can cause these symptoms. [16-18] Victims of whiplash injuries might develop symptoms in the upper extremities from subluxation of the lower cervical spine and first rib that can be considered risk factors for thoracic-outlet-type problems. [16]

Subluxation of the Thoracic and Costovertebral Motion Segments

Among the least-recognized subluxation syndromes are those caused by subluxation of the thoracic and costovertebral motion segments. Failure to diagnose these conditions causes untold anxiety and suffering because the main symptom is chest pain, which can be mistaken for a sign of a heart attack. [19] The sharp pain that accompanies thoracic and rib subluxations is aggravated by movement, respiration, coughing or sneezing. [7] Examination reveals palpable muscle spasm, motion-segment misalignment, restricted motion, and/or localized tenderness and loss of joint play at the costovertebral joint, with failure of the rib cage to open and close at the rib angle that corresponds to the subluxated rib. [2] Needless fear and expense can be prevented if subluxation of the thoracic and costovertebral motion segments is recognized as a possible risk factor for chest pain.

Subluxation of the Zygapophyseal Joints

A more precise diagnosis of low back pain involves recognition of subluxation of the zygapophyseal (posterior) joints of the spinal motion segment. [20] Subluxation of the spinal facet joints can occur in all regions of the spine, causing pain, and is common in the lumbar region. In this region of the spine, provocation of pain on axial compression on extension and rotation, with pain relieved on distraction, is indicative of spinal facet joint involvement. Subluxations of the posterior joints are recognizable through palpable muscle spasm, motion segment misalignment, restricted motion and/or tenderness. Adjustment and manipulation of subluxation of the posterior facet joints has been demonstrated to be effective in the relief of low back pain. [21] It is suggested that the more than 10 studies which have demonstrated the benefit of manipulation in the treatment of low back pain are describing the removal of subluxation of the posterior (zygapophyseal) joints.

Sacroiliac Joint Subluxation

Sacroiliac subluxation has been recognized as a cause of low back pain. [20-21] The pain is described as dull, radiating into the ipsilateral buttock, and made worse by sitting. [7] It can refer into the medial thigh and lateral leg. Examination should differentiate between radiating and radicular pain and rule out myofascial pain from direct pressure on the sciatic nerve by the piriformis muscle. Palpation reveals tenderness and loss of play over the joint at the posterior superior iliac spine. Manipulation brings prompt relief.

Subluxation syndromes are not widely recognized. The extent to which subluxations are risk factors for various conditions has not been sufficiently studied. Somatovisceral syndromes caused by subluxation have not been addressed in this column, and the potential for subluxations to be risk factors for these conditions is even less recognized. If pattern recognition of the signs and symptoms that characterize subluxation syndromes were part of the first phase of the diagnostic workup of many patients, much needless suffering could be prevented. Many chiropractic practitioners have observed the signs and symptoms that characterize these syndromes and have treated them effectively. The question is, do we recognize subluxation as a risk factor predisposing the patient to these conditions? If subluxation syndromes were more widely recognized, the benefit to patients and society from more effective health care and decreased costs could be significant.

This is just one of many articles archived in the:
Chiropractic Subluxation and Neurology Articles Section

References:

1.   Hawk C. “Is It Time to Adjust Our Thinking About Subluxation?” JACA, 2006;43(5):20.
Cooperstein R. Chiropractic Philosophy and Clinical Technique.” JACA, 2006;43(6):13.

2.   Gatterman MI. Introduction to Part 3. Principles of Chiropractic: Subluxation. 2nd ed. St Louis: Mosby, 2005 373.

3.   Gatterman MI, Hansen D. Development of chiropractic nomenclature through consensus.
J Manipulative Physiol Ther, 1994;17(5):302.

4.   Bergmann TF. Chiropractic Spinal Examination. In: The Chiropractic Neurological Examination, Ferezy JS, Ed. Gaithersburg Md.: Aspen Publications, 1992.

5.   Covered Medical and Other Health Services Medicare Benefit Policy Manual, Chapter 15.

6.   Vernon H. Headaches. In: Fundamentals of Chiropractic, Redwood D, Cleveland C, Eds. St Louis: Mosby, 2003, p. 497.

7.   Gatterman MI. Appendix A. Principles of Chiropractic: Subluxation. 2nd ed. St Louis: Mosby, 2005, 557.

8.   Vernon HT Vertebrogenic Headache. In: Upper Cervical Syndrome: Chiropractic Diagnosis and Management, Vernon HT, Eds. Baltimore: Williams and Wilkins, 1998.

9.   Boline P, et al. Spinal manipulation vs. amitriptyline for the treatment of chronic tension type headaches: a randomized clinical trial.
J Manipulative Physiol Ther 1995 (Mar); 18 (3): 148–154

10.   Nilsson N. A randomized controlled trial of the effect of spinal manipulation in the treatment of cervicogenic headache.
J Manipulative Physiol Ther. 1995 (Sep);   18 (7):   435—440

11.   Nilsson N Christensen HW, Hartvigsen J. The effect of spinal manipulation in the treatment of cervicogenic headache.
J Manipulative Physiol Ther 1997 (Jun);   20 (5):   326–330

12.   Bove G, Nilsson N. Spinal manipulation in the treatment of episodic tension-type headache: a randomized controlled trial. N Engl J Med, 1998;280:1576.

13.   Parker GB, Tupling H, Pryor DS. A controlled trial of cervical manipulation for migraine. Aust NZ J Med, 1978;8:589.

14.   Parker GB, Pryor DS, Tupling H. Why does migraine improve during a clinical trial? Further results from a trial of cervical manipulation. Aust NZ J Med, 1980;10:589.

15.   Nelson CF, et al. The efficacy of spinal manipulation, amitriptyline and the combination of both therapies for the prophylaxis of migraine headaches.
J Manipulative Physiol Ther 1998 (Oct);   21 (8):   511–519

16.   Gatterman MI, Panzer DM. Disorders of the Cervical Spine. In: Chiropractic Management of Spine Related Disorders. 2nd ed. Baltimore: Lippincott, Williams, and Wilkins, 2003, p. 229.

17.   Szaraz Z. The thoracic Outlet Syndrome: First Rib Subluxation Syndrome. In: Principles of Chiropractic: Subluxation. 2nd ed.: Gatterman MI, Ed. St Louis: Mosby, 2005, p. 457.

18.   Lindgren K, Leinio E. Subluxation of the first rib: a possible thoracic outlet syndrome mechanism. Arch Phys Med Rehabil, 1988;69:692.

19.   Arroyo JF, Jolliet P, Junod AF. Costovertebral joint dysfunction: another misdiagnosed cause of atypical chest pain. Post Grad Med J, 1992;68:655.

20.   Kirkaldy-Willis WH, Hill RJ. A more precise diagnosis for low back pain. Spine, 1979;4:102.

21.   Kirkaldy-Willis WH, Cassidy JD. Spinal manipulation in the treatment of low back pain. Can Fam Physician, 1985;31:535.

22.   Don Tigny RI. Mechanics and treatment of the sacroiliac joint. J Manual Manipulative Ther, 1993;1:3.

23.   Gatterman MI. In the Patient’s Interest. In: Chiropractic Management of Spine Related Disorders. 2nd ed. Baltimore: Lippincott, Williams, and Wilkins, 2003.

24.   Gatterman MI, Panzer DM. Sacroiliac Subluxation Syndrome. In: Principles of Chiropractic: Subluxation. 2nd ed. St Louis: Mosby, 2005

SOURCE: Dynamic Chiropractic

By Meridel I. Gatterman, MA, DC, MEd

The term subluxation has been used to describe the lesion treated by chiropractors since its inception. D.D. Palmer [1] described it in 1910 as “a partial or incomplete separation, one in which the articulating surfaces remain in partial contact.” Because of confusion by other professions, some within the chiropractic profession would have us abandon the term.

Others have promoted a teaching paradigm: the vertebral subluxation complex (VSC), which has grouped various components in a model focused around the dynamic component of the subluxation. Based on the works of Homewood, [2] Janse, [3] and Faye, [4] this model began being taught at CMCC in the mid-1970s and was later popularizing through the Motion Palpation Institute. [5] Other authors have revised Faye’s early model. The vertebral subluxation complex forms a paradigm for teaching the basic principles of chiropractic theory. By taking the VSC model one step further, the vertebral subluxation syndrome can be used to describe the primary clinical entity treated by chiropractors.

Syndrome has been traditionally used to describe the aggregate of signs and symptoms associated with any morbid process and constituting together the picture of disease. [10] The focus for chiropractors today should not remain the terminology used to describe the vertebral subluxation syndrome, but rather the specific mechanisms whereby this complex aggregate of signs and symptoms is produced by altered spinal joint motion.

Recently, the primary fibromyalgia syndrome has replaced the controversial term fibrositis used to describe a condition that has been written off as psychological at best, with the physiological manifestations either denied or ignored. [11] When the multiple complaints and varied systemic complaints of this condition were recognized as a syndrome, objective investigation was fostered to the benefit of the many patients suffering from the condition.

Viewing the classic chiropractic subluxation in a similar manner would allow us to develop and objectively test the diagnostic features of the vertebral subluxation syndrome.

Table 1: Reported Diagnostic Features of the Vertebral Subluxation Syndrome

Feature               Palmer 1   Homewood 2   Janse 3   Sandoz 12   Faye 14   Haldeman 15 

Altered alignment       X            X           X         X          X  
Aberrant motion         X            X           X         X          X           X 
Palpable changes        X            X           X         X          X           X 
Localized/referred

pain                    X            X           X         X          X           X 
Altered physiological

function                X            X           X         X          X           X 
Reversible with

adjustment/

manipulation            X            X           X         X          X           X 
Focal tenderness        X            X           X         X          X           X

Identification of conditions resulting from vertebral subluxation then becomes the criteria for diagnostic indexing. Examples might include vertebral subluxation syndrome: headache; or vertebral subluxation: low back pain. The ultimate goal is directing the patient to appropriate therapy following identification of the vertebral subluxation syndrome.

This is just one of many articles archived in the:
Chiropractic Subluxation and Neurology Articles Section

References:

1.   Palmer DD: Textbook of the Science, Art, and Philosophy of Chiropractic. Portland, Portland Printing House, pp 490, 1910.

2.   Homewood AE: The Neurodynamics of the Vertebral Subluxation, Ed. St. Petersburg, Fl., Vlkyrie Press, 1977.

3.   Janse J: Principles and Practice of Chiropractic. Hildebrandt Ed. National College of Chiropractic, Lombard, Il. 1976.

4.   Faye LJ: Lecture Notes, Motion Palpation, Canadian Memorial Chiropractic College, 1976.

5.   Faye LJ: Motion Palpation of the Spine. Motion Palpation Institute, Huntington Beach, Ca., 1981.

6.   Dishman R: Review of the literature supporting a scientific basis for the subluxation complex.
J Manipulative Physiol Ther. 1985 (Sep); 8 (3): 163-74

7.   Dishman RW: Static and dynamic components of the chiropractic subluxation complex: a literature review.
J Manipulative Physiol Ther. 1988 (Apr); 11 (2): 98-107

8.   Gatterman MI: Chiropractic Management of Spine Related Disorders. Williams & Wilkins, Baltimore Md., pp 40-49, 1990.

9.   Lantz CA: The vertebral subluxation complex. ICA Int’l Rev of Chiropractic, pp 37-61, Sept/Oct, 1989.

10.   Stedman’s Medical Dictionary, 25th ed, Williams and Wilkins, Baltimore Md., pp 334, 1494, 1522. 1990.

11.   Smythe H: Tender points: evolution of concepts of the fibrositis/fibromyalgia syndrome.
Am J Med. 1986 (Sep 29); 81 (3A) :2-6

12.   Sandoz R: A Classification of Luxations, Subluxations, and Fixations of the Cervical Spine. Swiss Annals VI, 219-276, 1976.

13.   Sandoz R: The natural history of a spinal degenerative lesion. Swiss Annals IX, 149-197, 1989.

14.   Schafer RC, Faye LJ: Motion Palpation & Chiropractic Technique Principles of Dynamic Chiropractic, 2nd ed. MPI, Huntington Beach, Ca.

15.   Haldeman S: Spinal manipulation therapy in the management of low back pain. In Finneson BE, Ed. Low Back Pain, 2nd ed. JB Lipincott, Toronto, 1973.

M.I. Gatterman, M.A., D.C.
Canadian Memorial Chiropractic College
Toronto, Ontario
Canada