Thanks to Today's Chiropractic for permission to reproduce this article!
By Malik Slosberg, D.C., MS
subluxation has been defined and explained in many ways over more than a century
of chiropractic history. How do we best communicate to patients today what we do
and why, so that they understand the goals of chiropractic, are compliant with
plans for care and receive the best possible outcomes we can offer?
models of the subluxation and goals of care have evolved as our understanding of
the biomechanics and neurology of joints has expanded. The database available to
the chiropractor today is much larger and more accurate scientifically than what was
available to our profession’s pioneers when they originally formulated
subluxation theories in the late 19th and early 20th centuries. In addition,
recent chiropractic patient surveys reveal more clearly what benefits patients
hope to gain by receiving chiropractic care. This information gives us new
insights as to how to direct our explanations to best fulfill our patients’
In recent publications there have been various attempts to clarify
the meaning of the subluxation and the goals of chiropractic care. The Institute
for Alternative Futures concluded that “Chiropractic needs to champion health
promotion… An important focus should be performance enhancement and proactive
wellness services.”  The Association of Chiropractic Colleges’ Paradigm of
Chiropractic, which was approved internationally by the World Federation of
Chiropractic in 2001 states, “The purpose of chiropractic is to optimize
health.”  Goals of care such as promotion and optimization of health expand the
purpose and meaning of correcting subluxations into a realm that is more
directly relevant to patients’ concerns. After all, our primary goal is to
improve and maintain patient well-being in the present and for a lifetime, not
to convert them to a certain philosophical viewpoint.
chiropractic’s consistently acknowledged positive qualities is a
patient-centered approach to health care. We offer a positive approach to health
in which we assist our patients in moving toward optimal function, fitness and
well-being rather than a negative model directed at eliminating symptoms. From
our perspective, patients and their health related quality of life are the focus
of care, not a diagnosis or symptoms. The purpose of care is to restore and
maintain the health of the whole person and not just treat isolated symptoms or
diseases. Chiropractic helps create the potential for well-being and improve
quality of life, rather than just focusing on illness.
There have been
several excellent contemporary paradigms of subluxation recently published 
which provide chiropractors with a clear model of what the problem is, what we
do about it, and why preventive care may help maintain function, restore
well-being, and reduce the risk of recurrences and future problems from
A good explanation of the subluxation today is a dynamic
model in which the involved joint and its associated structures (bones, nerves,
muscles, ligaments, discs) do not “function well” resulting in loss of motion,
pain, discomfort, muscle weakness and/or spasm, and changes in motor control. It
is important for patients to understand that such loss of function can manifest
itself in many ways and may develop gradually without any obvious symptoms. In
addition, patients should understand that such problems may not only precede,
but also predispose a future increased risk of injury, pain and degeneration. As
a traditional chiropractic explanation explains, “Pain is often the last to
come. What comes first is declining function and disturbed biomechanics which
increase the risk of injury and pain developing.”
Over time, due to a
gradual, asymptomatic decline in function and biomechanics, joints become more
likely to perform poorly, they develop symptoms and degenerate. Such changes can
occur rapidly, as a result of an acute injury, but much more commonly, develop
insidiously as a consequence of sedentary lifestyles, sedentary work, lack of
exercise and aging. In fact, in the recent literature there is a consensus that
“the injury model itself is flawed and outmoded...back pain typically does not
have any obvious traumatic precedent.”  The underlying factors, which
eventually result in symptoms and injury, although asymptomatic, are pervasive
in our society and gradually and subtly erode the integrity and resistance to
injury of the involved structures.
The current research views the
symptomatic presentation of back and neuromusculoskeletal problems as more a
result of improper function of the joint complex and a reduced ability to
tolerate the stresses of everyday life and work rather than unusual or excessive
loading. As Waddell explains, “If the problem is dysfunction, then symptoms can
persist for as long as dysfunction continues. Since dysfunction may be
self-sustaining, symptoms may persist indefinitely.”  Therefore, the purpose of
care is “to restore normal function.”
Because poor function, repetitive
stress and aging result in wear and tear, but are not necessarily acute or
painful, patients are unaware of this gradual decline and increased
vulnerability to injury and pain. We want our patients to understand that a
major focus of chiropractic care is preventive. Chiropractors check the spine on
a regular basis, whether there are symptoms or not, in order to identify
disturbed kinematics, loss of motion, and other indications of dysfunction at an
early, asymptomatic stage.
Chiropractic adjustments are used to help
restore function before symptoms ever arise. It is important that patients
understand that in our daily lives at work, at home and at play we are exposed
to many repetitive, as well as sometimes abrupt, stresses and strains that can
cause injury and tissue damage, especially when tissue integrity is compromised.
The goal is not just to fix things that are broken, but to restore and preserve
function so tissues can tolerate the repetitive stresses of everyday life. We
want our patients to appreciate that chiropractors have specialized palpatory
skills and carefully evaluate the mechanics and movements of individual joints
in order to identify when these structures do not work normally. This kind of
examination and analysis is wholly absent from traditional medical exams. 
The chiropractic adjustment which is specifically applied to areas
involved—the subluxated joints—produces both mechanical and neurological
benefits which help overcome abnormal restrictive barriers such as scar tissue,
muscle spasm, swelling and pain. The high-velocity, low-amplitude force of the
adjustment also rapidly stretches joint capsules, ligaments and local muscles to
produce a barrage of sensory input,  which may recruit receptors to fire and
prevent receptors from atrophy.  This sensory stimulation restores normal
sensory input and awareness in space, relaxes tight muscles, improves range of
motion and flushes out excess extracellular and extravascular fluid.  Many
patients find that not only is pain reduced and range of motion improved, but
there is often a sense of relief, a reduction in tension, and often an enhanced
sense of well-being.  Very recent research suggests that adjustments may
affect blood flow and even improve cognitive processing in the brain. [13-15]
Explanations to patients should be patient-centered; that is, they
should address the issues most important to them. An effective explanation helps
patients appreciate not only the subluxation as a dysfunctional joint, but its
evolution and consequences—how it may develop without obvious symptoms, how it
may increase the risk of injury and pain, how it may disrupt our general health.
In addition, our explanations should help patients recognize the value of the
chiropractic adjustments and their impact on function, health-related quality of
life, and our sense of well-being. Patients who are well informed and appreciate
that chiropractic may improve their lives will also be most enthusiastic and
respond best to care. Moreover, such patients become excellent referral sources;
no one is more certain of something than those who have experienced its impact
on their own lives.
Dr. Malik Slosberg, who has been in private
practice for 20 years, lectures throughout the United States for many state
associations and as a postgraduate faculty member of 10 chiropractic colleges.
He has lectured internationally and is a professor at Life West. He has been
selected for inclusion in Who’s Who Among America’s Teachers, and in 1995
received the Chiropractor of the Year award from the Parker Resource Foundation.
Dr. Slosberg graduated from Life Chiropractic College and holds a Masters of
Science degree from California State University in clinical counseling and is a
founding board member of the National Institute of Chiropractic
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