FROM: ICA International Review of Chiropractic 1992 (Mar): 25-27
Joseph M. Flesia, Jr., D.C.
Authors Note: I have written and lectured extensively over the past 15 years on the five traditional components of the Vertebral Subluxation Complex in an outline format, drawing from over 500 medical/scientific references and textbooks. I refer the reader to this work and, also, to the efforts of Charles Lantz, Ph.D., D.C., Director of the Department of Research at Life Chiropractic College West, whose research has carried the investigation of the Vertebral Subluxation Complex well beyond the traditional five components.
For the first time, I will review the five traditional components of the Vertebral Subluxation Complex from an integrative standpoint, so that we may explore an actual acute traumatic episode of the Vertebral Subluxation Complex, its subsequent stages of healing (without correction of the pathomechanical event) and its consequent residuals.
Perhaps this view will facilitate clinical motivation in the area of prevention of the 'permanent' residuals of uncorrected Vertebral Subluxation Complex through appropriate clinical patient education and appropriate early chiropractic screening on a family basis for a lifetime.
The Five Components
Basic to this integrative review of the components of the Vertebral Subluxation Complex is the component nomenclature involved in the model:
Component #1 Spinal Kinesiopathology spinal pathomechanics, including alignment
and motion irregularities
Component #2 Neuropathophysiology/Neuropathology compressed or facilitated nerve tissue
Component #3 Myopathology muscle spasm, muscle weakness/ atrophy
Component #4 Histopathology inflammation, edema and swelling of tissue,
usually local to the traumatized area
Component #5 Pathophysiology/Pathology pathophysiologic and pathoanatomical changes
due to the previous four components usually seen locally as degeneration, fibrous tissue and/or
erosion local and peripherally as a loss of global homeostasis.
The First Episode
Let us consider the first episode of the Vertebral Subluxation Complex. Simultaneously, the first four components of the Vertebral Subluxation Complex become active: Component #1 Spinal Kinesiopathology occurs; the joint is sprained. Component #4 Histopathology occurs; inflammation, swelling and edema appears around the sprained joint. Metaphorically, consider an inflamed tooth with the local swelling (it looks like a swollen area on the side of the jaw). An area of swelling and malfunction occur at the site of the Vertebral Subluxation Complex. Uncorrected, a cascade of events usually occurs:
The sprained joint is initially hypermobile.
Without care, this heals with fixation (hypomobility).
This is accompanied by fibrosis and, in time, degeneration and remodeling, local to the Vertebral Subluxation Complex site.
Compensation and adaptation occur and the original site of involvement extends to the joint above and occasionally the joint below, to which the entire biomechanics of the spine must adapt forcing a less than optimum spinal biomechanical profile. Once again consider the long term local swelling, translating to fibrotic/calcific enlargement visible initially on MRI studies and later on X-ray imaging.
With repeated episodes of the Vertebral Subluxation Complex, the spine accumulates an increasing number of pathoanatomical sites. MRI studies visualize the soft tissue and calcific/ fibrosed enlarged areas up to one inch thick. From the orthopedic standpoint the repeatedly traumatized spine results in deteriorating spinal function or "abnormal orthopedic functional programs" mediated by gravitational stress (adaptation) and by the adaptational needs of the nervous system.
Component #3 - Myopathology also occurs immediately. Uncorrected, myopathology leads to long term spasm or hypotonicity and atrophy. This causes the spinal biomechanical profile to acquire muscular' sets' which result in long term deeply imbedded neuromuscular habit patterns which are an integral component to the long term orthopedic and neurological damage of uncorrected Vertebral Subluxation Complex.
Component #2 - Neuropathophysiology/ Neuropathology (in cases of the Vertebral Subluxation Complex) also occurs immediately. In addition, there is also nerve damage at the site of the Vertebral Subluxation Complex. This brings into play the various conditions that nerve damage causes, local to the traumatized site and peripherally. Knowing that nerves transmit perceptual and adaptational data from the brain to the body and back, disturbances in this mechanism are clinically significant.
Component #2 - Neuropathophysiology/ Neuropathology uncorrected, leads to a deteriorating whole body homeostasis forcing the body to be a better host for stresses of any kind. Add to this:
Component #4 Histopathology on the neurological level can permanently destroy/alter nerve tissue. With the deteriorating spinal function discussed above and the "remembered" abnormal nerve system habit patterns of spinal function of each succeeding episode and the entire condition takes on a new neurological level of seriousness. After each episode of the Vertebral Subluxation Complex the functional neuromuscular habit patterns compensate/ adapt to the new altered spinal biomechanical profile. In a matter of a few months after each episode, the proprioceptive area, the cerebellum and the local levels of the spinal cord "remember" the new abnormal spinal function habit pattern as normal.
The Dominant Program Concept
Each uncorrected episode of the Vertebral Subluxation Complex carries with it the need for local and global compensation and adaptation, creating a downward spiral of spinal function. This downward spiral can be explained by the "dominant program" concept in neurology. On a holographic basis, persistent new data is perceived and processed in such a way as to create new or altered programs of function (self contained, automatic local and or global responses to specific classes of stimuli).
With each new episode of uncorrected Vertebral Subluxation Complex, new "negative" data is persistently received from the site of the uncorrected injury and a new dominant program of spinal function is created. This new program is reflective of the compensation and adaptation data caused by the uncorrected injury. As a patient sustains multiple spinal injuries (microtraumatic or macrotraumatic) that go uncorrected, from the chiropractic standpoint, spinal function becomes less optimal. Spinal integrity is "permanently" lost and the process of functional degeneration and pathoanatomical changes begin and continue, putting the patient more and more \it risk for further spinal injury and functional collapse.
On a strictly spinal level, the new data from the uncorrected Vertebral Subluxation Complex episode and the subsequent negative dominant programs of spinal function are stored at the spinal cord level in the form of the facilitated segment and persistent reflex arcs, on the cerebellar level causing spinal balance and fine muscle movement to deteriorate as well as in the proprioceptive area of the cerebral hemisphere altering the sense of position from articular proprioception to global spinal positional adaptation.
Component #5 Pathophysiology/Pathology At some point, after the first four components occur the 5th component of the Vertebral Subluxation Complex becomes a clinical reality. In other words, the end result of the Vertebral Subluxation Complex makes itself known. Immediately in the event of an acute traumatic lumbosacral strain/ sprain complex or over a period of time in the case of a significant deterioration of the global and local homeostatic function in the form of spinal degeneration and loss of the normal health index.
The first occurrence of this, possibly serious and degenerative spinal condition, becomes a very significant clinical concern, especially if a preventive program is to be developed. A review of various literature searches indicates that the first episode of spinal injury with nerve damage (Vertebral Subluxation Complex) may occur during the birth process. Here are 12 representative references from varying sources:
"A Literature Review," references #307-348, Renaissance International
Sudden Infant Death Syndrome: A literature review with chiropractic implications, Journal of Manipulative and Physiological Therapeutics, 10 (5) October 1987
Abraham Towbin, M.D. Neuropathologist, Harvard Medical School, "Latent Spinal Cord and Brain Stem Injury in New Born Infants," Develop, Med., Child Neurol, 1966, 11, 54-78
J.M. Duncan, M.D. (1874) "Laboratory Notes on the Tensile Strength of The Fresh Adult Fetus," British Medical Journal, II, 763. This is found as a reference in the above article, and is mentioned in the lower right side of page 6.
"Spinal Injury Related to the Syndrome of Sudden Death (Crib Death) in Infants," Abraham Towbin, M.D., Department of Pathology, Boston University School of Medicine, Mallory Institute of Pathology, Boston, Massachusetts , The American Journal of Clinical Pathology, 49 (4), 1968, Williams & Wilkins Company
Scientist Interviews, January, 1980, Renaissance International, Suzanne Arms, Author, "An Interview"
"Spinal Injury," 2nd ed., David Yashon, M.D., FACS, FRCS (C), Professor of Neurosurgery, Ohio State University, "Birth Injury," Chapter 18, 347-352, Appleton Century Crofts
"Blocked Atlantal Nerve Syndrome in Babies and Infants," G. Gutmann, Manuelle Medizin, 25: 5-10, 1987
"Experimental Models of Osteoarthritis: The Role of Immobilization," T. Videman, Clinical Biomechanics, 2: 223-229, 1987, and the various papers by Videman there referenced.
"Chiropractic and Children," The Journal of the CCA, 23 (3), September 1979. Dr. Joseph Janse quote.
"Disc Regeneration: Reversibility is Possible in Spinal Osteoarthritis," 1989, by O.J. Ressel, B.SC., D.C., ICA Review, March/April 1989
"Subluxation at Birth and Early Childhood," Larry L. Webster, D.C., International Chiropractic Pediatric Association, March 1989
Initial Intensive care this is the length of time it takes to relieve the pain and discomfort and then to stabilize the injured area so the condition will not regress. Frequently, relief takes a few visits and stabilization a few weeks to a few months depending on age of the patient, chronicity and severity of the condition.
Reconstructive/rehabilitative care this is the length of time it takes to rehabilitate function of the spine/body to its maximum level. This includes long term repair of the soft tissues (as much as possible), spinal joint recovery to its maximum, muscular rehabilitation, neuromuscular habit pattern recovery to its maximum and the restoration of long term spinal and whole body homeostasis (as much as possible). True functional rehabilitation (the restoration of the most optimal dominant spinal function program possible) frequently takes many months to years. If the age of the patient, chronicity and severity of the condition are extreme, the internal rehabilitative process is ongoing.
Maintenance care to maintain homeostasis.
Certainly, initial intensive care procedures in chiropractic have been brought to a level of clinical competency that is acceptable by the managing doctor. Continued research designed to improve the clinical management of acute spinal injury is ongoing, It is time to also focus research time and funds on the management responsibilities and procedures for reconstructive/rehabilitative care.
There are various chiropractic clinical procedures that have given the clinician interested in reconstructive/rehabilitative care a valid basis for application and continued investigation. Reconstructive/rehabilitative care should only be employed with the patient who has been thoroughly educated in the nature and present day status of this procedure.
Clinical evaluations should be made at appropriate intervals indicating the spinal biomechanical progress (or lack of) and care continued only when clinical indicators reveal that the reconstructive/rehabilitative care procedures are successful.
That this care may extend beyond the parameters of current medical ICD terminology is only reflective of the current lack of chiropractic penetration in this administrative area and not at all a reflection of the successful rehabilitative chiropractic procedures available to the chiropractic clinician.
Joseph M. Flesia, DC graduated from Palmer College of Chiropractic in 1957. A very successful private practitioner for more than 12 years, he limited his practice to the Vertebral Subluxation' Complex based on an in-depth Well Patient Care patient education program, averaging over 360 patients a day. Currently President of Renaissance International, he presents over 48 complete seminars a year and has more than 40 speaking engagements a year. Dr. Flesia's quest for the global acceptance of chiropractic is legendary and provides the basis for his unbounded energy and enthusiasm.
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