September 2012
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Biomechanical Lesion: A Better Diagnostic Term for the Profession

By John R. Bomar, DC
Source Dynamic Chiropractic

For those who may not be aware, the World Health Organization’s latest revision of the International Classification of Diseases (ICD-10) uses a new primary term to describe the major condition treated by chiropractic physicians.

The new term is biomechanical lesion and the code is M99, with decimal designations used for various sections of the body – e.g., M99.01, Biomechanical lesion, cervical region. It is thought that the ICD-10 system will be required sometime in 2014.

More than a few chiropractors, myself included, feel this change in nomenclature is much-needed. The present term, non-allopathic lesion (739 series), completely fails to communicate the nature of the problems we address daily in our offices, and the term non-allopathic implies the concept of “non-medical,” as if what we treat has little to do with a person’s health. Such a maldescriptive phrase does nothing to clear up the confusion and misconceptions associated with our work – misconstructions that only contribute to the apprehension and fear many feel when considering our profession.

Such vague and indistinct terminology also discourages appropriate referral from other health care providers. Important also is the current void in understanding that exists between chiropractic providers and the insurance industry. Complicating all this is the insistence by some in our profession that others conform to our definition of the word subluxation, which is in conflict with the accepted medical definition. The natural reaction in others to such uncertainty, obscurity, confusion and doubt is a hesitancy to involve oneself in such dealings, further isolating our profession and hindering growth.

Biomechanical

The term biomechanical is defined as “the study of the mechanics of a living body, especially of the forces exerted by muscles and gravity on the skeletal structures.” The word biomechanics developed during the early 1970s, and was the application of engineering mechanics to biological and anatomical systems. Mechanical engineering disciplines such as continuing mechanics, mechanism analysis, structural analysis, kinematics and dynamics play prominent roles in the study of human biomechanics. Above all else biomechanics is the study and appreciation of functional order (and disorder) of the human locomotion system.

Interestingly, biological systems are usually considered much more complex than man-built systems. And as we know, the biomechanics of the spine are the most complex of all the body’s regions.

In the past several decades, a great amount of research has been done in the field of sports biomechanics, with emphasis on reducing injury, rehabilitation following injury, and enhancing sports performance. The biomechanics of the human being is a core part of the study of kinesiology. Disturbed biomechanics is an integral part of determining permanent impairment following trauma such as motor vehicle crash.

In short, biomechanical is now a widely understood and easily comprehended term with 40 years of usage; there is no ambiguity or uncertainty in its definition.

Lesion

The term lesion is defined as “any pathological or traumatic discontinuity of tissue or loss of function of a part.” Note again the use of the word function. Additionally, lesion is derived from the Latin word laesio, which means “injury.” The term is used with an almost unlimited number of conditions and is universally understood to imply some form of gross anatomical abnormality. It is interesting to note that in describing the conditions they treat with manual methods of adjustment and mobilization similar to ours, our philosophical cousins, osteopathic physicians, have long used the term osteopathic lesion.

Biomechanical Lesion

The term spinal biomechanical lesion then would imply a pathological condition involving discontinuity (loss of cohesion) of tissue, and loss of normal vertebral joint function (kinesio-pathology) that often has injury as its cause. It is a very descriptive term, and one that should be well-understood by any and all who have training and study in the field of medical terminology. It’s a phrase that is easy to get your head around, no matter your particular discipline.

The Subluxation

Unfortunately, there will be those within the chiropractic profession who will resist, if not vehemently oppose, the use of this new diagnostic term. They will insist that any deviation from using the term subluxation is professional heresy and that any who propose such a change are working against the best interests of the profession. One even hears of individuals who brag that as chiropractors, we “own” the word subluxation.

What these well-intended “defenders of the faith” fail to acknowledge is that, regrettably, subluxation is both ambiguous and misleading, and has led to much confusion and controversy in the larger health care world. In conventional terms the word refers to a “significant structural displacement of bone” that is clearly visible on X-ray. As we know, this is simply not the case for the conditions we commonly treat.

Conclusions and diagnoses drawn from minuscule differences in measurement of anatomical landmarks taken from neutral-static X-ray images (methods many of us were taught in school) have little or no basis in science. Such anatomical measurements are, for the most part, simply not reliable in identifying regions of functional loss and biomechanical lesion formation. One must rely on skilled, experienced and artful palpation to discern regions of biomechanical impairment in the spine or elsewhere, perhaps aided by weight-bearing X-ray imagery. (Lines of mensuration on functional or motion studies to determine ligamentous laxity and permanent biomechanical impairment, and standard orthopedic lines of normal positional relationships and angles, are exceptions.)

I am sympathetic to those who want to prosper the word because of its supposed connection to the concept of somatovisceral reflex. I too believe that what we do affects the nervous and organ systems of the body in a positive way, and that many disorders and pathological processes have their root cause in spinal “impingements” from biomechanical cause. But without using the bewildering and perplexing term subluxation complex, one could, for example, easily describe a “biomechanical lesion formation at the upper cervical region which is possibly etiologic for pathological somatovisceral reflex and sympathetic vasomotor dysfunction, resulting in migraine-type headache syndrome.”

Again, it is easy to understand those who feel a strong affinity for the term subluxation; however, the sad truth is the word has outlived its usefulness in today’s world of mass communication and instantaneous Google searching. The profession can no longer afford to embrace a primary diagnostic term that only adds to the confusion and distrust of our motives and methods. Quibbling over semantics in disregard of harsh, punishing reality makes absolutely no sense.

There is already enough misunderstanding, distrust and misconception about what we do. Why add to the confusion? This is especially true as regards interprofessional communications and relations.

Please forgive me for observing, but in the larger world of health care delivery, beyond the somewhat narrow and at times myopic confines of chiropractic circles, the term subluxation has become a millstone, if not an albatross around our necks. Clearly, it is time to put the term to rest.

9 comments to Biomechanical Lesion: A Better Diagnostic Term for the Profession

  • Christopher Kent

    Vertebral subluxation has nothing to do with faith. ICD-10 includes the following codes: M99.1 Subluxation complex (vertebral),M99.2 Subluxation stenosis of neural canal, and
    M99.6 Osseous and subluxation stenosis of intervertebral foramina.

    Who says vertebral subluxations are real?

    *Medicare. Correction of a subluxation of the spine is the only chiropractic procedure covered under Medicare.

    *World Health Organization. Included in Guidelines for Basic Training and Safety in Chiropractic.

    *The Joint Commission. A chiropractor is recognized as a physician only to correct a subluxation of the spine.

    *Association of Chiropractic Colleges.

    *At least 4 peer reviewed journals.

    *Textbooks from major medical publishers.

    *Nearly 90% of chiropractors surveyed in a study published by Ohio Northern University.

    Those who week to jettison the term vertebral subluxation are the outliers.

    See:
    http://www.dynamicchiropractic.com/mpacms/dc/article.php?id=53701
    http://www.dynamicchiropractic.com/mpacms/dc/article.php?id=55080

  • This sounds really good, but I wonder what effect it will create with insurance re-imbursements? Do you think it will make any difference or will it be too complicated for the insurance industry?

  • Chiropractic should always have an association with the word subluxation but should not be nailed to it as the only thing we treat.
    Based upon the works of DD Palmer and latter chiropractors the cause of disease is too much or to little nerve force and this is caused by structural,chemical and emotional imbalances.
    If as a profession we say we treat the cause of dis-esae than if you only adjust [which is the last thing I do for every patient, no matter what other methods I may use] than you are not treating the cause but only the effect.
    some chiro technics that address these factors [ak,ck,sot,net,tbm,netwwork and many more]

  • I think this is way overdue. I have NEVER used the term “subluxation” with a patient in my 12-years in practice, unless they actually have a partial dislocation (which is of course the most commonly used definition).

    Any effect on reimbursement would be a separate issue, but I think it’s high time we got the terminology right.

    I actually wrote an article on this topic recently: http://www.austinspineandsport.com/spinal-adjustments-are-they-addicting-the-truth-finally/

    We have a wonderfully effective and safe treatment tool in our toolbag. Let’s not weaken it by overprescribing or inappropriately prescribing it.

  • To quote the noted author Meridel I. Gatterman, MA, DC, MEd:

    The notion that by changing the word subluxation to another term we will somehow change the clinical, political, and philosophical connotations of the concept central to chiropractic practice is simply not rational. Changing the term used for the articular lesion treated by chiropractors (subluxation) does not eradicate the clinical, political, and philosophical issues that surround the construct; it obviously evades the issues. [30]

    http://www.chiro.org/wordpress/?p=12728

  • I agree that subluxation is what chiropractic is founded on and changing the name of subluxation to spinal lesion still does not educate the community on what we actually do and why.

  • Frank, I agree that changing the word does not change what we do.

    I do think that the words we choose matter, however.

    I just want the words we choose to describe what we do to be unambiguous and clear.

    And while the adjustment may be our “signature” treatment tool, it’s only one tool out of many in our arsenal, and I don’t want to define myself by it. That would be like an astronaut saying he was was a button-pusher. While pushing buttons may be part of his job, it doesn’t begin to describe his job or the importance of it.

    I am a sports medicine and rehab specialist. I learned the skills that I have through my chiropractic education. Spinal manipulation is just one tool in my toolbag, and it’s a tool I use only when it’s needed, which ends up being about 15% of the time with my patients. Choosing to define myself as an “adjustor” would not only be inaccurate, it would be misleading.

    In the larger picture, what we as chiropractors are able to offer is a holistic approach (meaning, we consider any and all organ systems that could be contributing to a particular condition) as well as an alternative treatment system (meaning, other than drugs or surgery) — for musculoskeletal conditions.

    This is how we are different from other providers, and this is how we are valuable.

    Let’s not oversimplify what we bring to the table, and let’s not pretend that one of our treatment tools is a “cure-all”, either.

    Our skills are many and varied. Let’s use them all.

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