What is a Chiropractic Subluxation?

Central to the science, art and philosophy of Chiropractic is the Subluxation. The meaning of a subluxation as defined by the chiropractic profession is not necessarily completely understood by the people seeking chiropractic care. Nor is the term utilized in the same manner by medical doctors to portray the same meaning of the word.

Therefore, a more complete explanation can shed light on this misunderstood concept the whole chiropractic profession is based on, within the context of the English language, and more so within the healthcare delivery system.

Perhaps another way to think about this word is to understand that within the umbrella term “Alternative Medicine”, a profession like Chiropractic can have an alternative meaning to the same word. “Subluxation”.

A subluxation is a mechanical disturbance and or misalignment of the spinal column, not necessarily visible on X-rays, that disrupts the functioning of your nervous system, surrounding joints and/or tissues. As well hinder full and complete range of motion of your spinal column.

Manipulation, or manual therapy are terms that usually accompany any discussion on subluxations because the common and conventional treatment of a subluxation is hands-on therapy, aka – Manipulation.

Manipulable and Non-manipulable Subluxations

Not all subluxations respond to manipulation; in fact, those subluxations most often seen on radiographs are often non manipulable or pathologic subluxations that are not reversible or that require surgical repair.

It is important that when defining a subluxation the discussion be broad enough to include the medical concept of subluxation that is severe enough to be visible on radiograph, as well as the more subtle manipulable subluxation detected by palpation as commonly incorporated by the chiropractor for diagnostic purposes. The manipulable subluxation is further defined as:

Manipulable subluxation – A subluxation in which altered alignment, movement, or function can be improved by manual thrust chiropractic procedures. Can be evaluated for on an x-ray, but more commonly diagnosed with manual palpation of the spine by the hands of a skilled chiropractor.

Moving beyond subluxation is exclusively a joint phenomenon and addressing the complex of neurologic effects theorized to be caused by articular subluxation, the term subluxation complex is used. This has been defined as:

Subluxation complex – A motion segment dysfunction (subluxation) in the spine that incorporates the complex interaction of pathologic changes in nerve, muscle, ligamentous, vascular, and connective tissues.

The subluxation complex is a theory that the chiropractic spinal adjustment (manipulation) restores normal joint motion, which in turn normalizes physiologic function and decreases pain.

Subluxation syndrome is the term used to describe the clinical manifestations of subluxation (articular lesion). Most widely recognized among these syndromes are mechanical back pain, neck pain, and vertebrogenic headaches. Subluxation syndrome is defined as:

Subluxation syndrome – An aggregate of signs and symptoms that relate to pathophysiology or dysfunction of spinal and pelvic motion segments or to peripheral joints

The terms subluxation complex and subluxation syndrome are used as a means of broadening the idea of the effects of subluxation without attaching untested theories to the description of the articular lesion that responds to manipulation.

In any definition, words or phrases that need clarifying must be clearly stated. So it is with the term motion segment. The need for a term that can be applied to peripheral joints as well as to spinal joints fostered the following definition:

Motion segment – A functional unit made up of two adjacent articulating surfaces and the connecting tissue binding them to each other.

The following definition is more specifically related to the joints of the spine:

Spinal motion segment – Two adjacent vertebrae and the connecting tissue binding them to each other.

Defining Chiropractic Treatment Methods

Chiropractic treatment has been directed traditionally to the restoration of function within the spinal motion segment and has not been designed solely to relieve pain. Just as the primary lesion treated by chiropractors has been subluxation, the primary chiropractic technique has used manual procedures to treat the body. As with the term subluxation, much confusion and controversy has surrounded the use of terms and definitions used to describe chiropractic treatment methods. To clarify the procedures used by chiropractors, the terms manual therapy, manipulation, mobilization, and adjustment were subjected to the consensus process. The definitions arrived at are as follows:

Manual therapy – Procedures by which the hands directly contact the body to treat the articulations or soft tissues. Generally applying the force to the spinal motion segment.

The term manual therapy generated little controversy, but it is included because of the use by some of the terms manipulation and spinal manipulative therapy synonymously with manual therapy. By using these terms inclusive of manual procedures, mobilization becomes a form of manipulation. It is necessary to differentiate manipulation for mobilization because recent studies have indicated the greater effectiveness of thrust procedures (manipulation), for example, in the treatment of back pain. Early studies did not make this distinction when producing equivocal data as to the effectiveness of manipulation. As more studies are undertaken, many more may show different effects from thrust versus non-thrust procedures, making this distinction even more critical. Unknowing patients may assume that they have received manipulation when indeed they have not when mobilization is considered a form of manipulative therapy, that’s denying them the possible added benefits of thrust techniques.

Based on the 1991 RAND study (12)  that looked at the appropriateness of spinal manipulation for low back pain that defined manipulation as a thrust procedure, the following definition reached consensus:

Manipulation – A manual procedure that involves a directed thrust to move a joint past the physiologic range of motion without exceeding the anatomic limit.

To differentiate manipulation from non-thrust mobilization, the following definition was agreed on:

Mobilization – Movement applied singularly or repetitively within or at the physiologic range of joint motion, without imparting a thrust or impulse, with the goal of restoring joint mobility.

Next to the term subluxation, the use of the word adjustment has sparked the most heated debate. It was agreed that chiropractors applying the adjustment intend to influence more than joint mechanics and related pain. The resultant definition that reached consensus therefore includes reference to changes in a neurophysiologic function. Although some believe that the adjustment should be restricted to specific short-lever, high-velocity, low-amplitude  thrust techniques, it was agreed to define the term broadly enough to not exclude those procedures routinely used by chiropractors that fall outside of this narrow category. The resultant definition is as follows:

Adjustment – Any chiropractic therapeutic procedure that uses controlled force, leverage, direction, amplitude, and velocity directed at specific joints or anatomic regions. Chiropractors commonly use such procedures to influence joint and neurophysiologic function.

The reference to neurophysiologic function in the definition of adjustment and not in that for manipulation is not intended to imply that such neurophysiological effects do not occur with manipulation, that is, thrust procedures. On the contrary, it may be demonstrated that manual thrust procedures through reflex mechanisms produce widespread effects. These mechanisms are the subject of Part 2,  in which data are discussed that support Palmer’s later contention that the body is not a simple machine but rather a complex interaction of systems mediated by the nervous system.

To those traditionalists who want chiropractors to use only the term adjustment as opposed to manipulation, It is noted that D. D. Palmer used the term manipulation to describe his early techniques, and not until later in the twentieth century was the term adjustment used for Palmer’s other unique style of manipulation.

D. D. Palmer was the founding father of Chiropractic, which commenced in 1895. His son B.J. Palmer carried the profession forward and is considered the developer of modern day Chiropractic.

Today, the profession of chiropractic is licensed in all 50 states and enjoys the lowest malpractice insurance premiums of most other healthcare professions.

Chiropractic is efficacious, safe and results oriented. Dr. Alex Kaminsky is a licensed chiropractor since the year 2000 and operates a full time practice in New York City combining craniosacral Therapy and Pranic Healing to achieve maximum results in the shortest amount of time possible.