J Vertebral Subluxation Research 1996 (Aug); 1 (1): 1–12 ~ FULL TEXT
William R. Boone Ph.D, D.C., and Graham J. Dobson, D.C
Irvine CA 92612
Part one of an expanded vertebral subluxation model (VSM) is presented which considers
information from the traditional concept of vertebral subluxation, and other models including; the chiropractic
subluxation complex, the vertebral subluxation complex, and the vertebral subluxation complex
model. Other components, including health assessment and etiology, are to be introduced in the second
part, and appropriate research designs for studying the expanded VSM are to be presented in the third
part. All three parts discuss other models as well as classical and recent research findings which support the
Key Words :Vertebral Subluxation Model (VSM), Early Vertebral Subluxation Model (EVSM),Vertebral Subluxation
Complex (VSC), Chiropractic Subluxation Complex (CSC),Vertebral Subluxation Complex Model (VSCM),
mental impulse, chiropractic.
From the FULL TEXT Article:
This article proposes an expanded vertebral subluxation
model (VSM) based on B.J. Palmer’s concept, contemporary
models, and other information provided through research and
discussion. It is anticipated that the expanded model will stimulate
future research, case studies, and other reports which will
impact on its veracity. This activity will insure that the concept
of vertebral subluxation, and parameters associated with that
condition, are readily available to the scientific community as a
whole, the chiropractic profession specifically, and ultimately the
lay public. Presentation of the VSM is divided into three parts,
each considering pertinent aspects of other contemporary models
as they relate to the VSM. This article deals with the physiological
and biomechanical components which contribute to the
model. The next article will elaborate the health and etiological
components of the proposed VSM, and how the presence and
correction of vertebral subluxation are related to these components.
A third article will present a thorough discussion of current
research methodolgy which permits testing of the VSM.
The development of an expanded VSM is a critical issue. As
acceptance of chiropractic as a non-allopathic health care discipline
broadens, it is essential to develop a model reflecting the
full spectrum of components of the vertebral subluxation. This
will provide a clearer depiction of the concept by incorporating
those aspects of its early theory which have been evidenced, as
well as recent findings which pass the test of repeatability. For
instance, the concept of vertebral subluxation proposed by B.J.
Palmer,  herein referred to as the Early Vertebral Subluxation
Model (EVSM), clearly outlines four fundamental, but hypothetical
occlusion of a spinal or intervertebral foramen,
pressure on nerves, and
interference with the quantity flow of the mental impulse.
literature contains considerable research which impacts positively
and negatively on Palmer’s hypothesis, it would be naive to
categorically accept or negate the theory based on the current
state of investigation regarding its tenets.
Evolving the Early Vertebral Subluxation Model
One purpose of research is to evidence, pro or con, a given
theory (hypothesis). Palmer’s EVSM provides a theory which, to
date, has not been adequately tested. This has been rationalized,
to some extent, by the belief that certain elements of the subluxation
theory are untestable. [2, 3] Based on the counter view that
virtually any theory can be developed into a testable hypothesis,
it is accurate to state that, although certain elements of the subluxation
theory may be untestable by a particular research
approach, those same elements are testable using other
approaches. The challenge is to generate questions which adequately
reflect the hypothesis, and then determine the research
methods most appropriate to investigate those questions. The
third article in this series will describe and discuss research
approaches most applicable to investigating the current VSM,
which incorporates concepts from the EVSM of Palmer as well
as new information.
The rationale for developing an expanded VSM stems from
the observation that the profession, in regard to vertebral subluxation
research, has put the cart before the horse or omitted
the cart or the horse. That is, Palmer’s original concept of the
vertebral subluxation has been redefined and/or remodeled in
the absence of convincing research to justify such change. While
these changes have been discussed by other authors, [4, 5] some
examples are presented here to elaborate the rationale for developing
the VSM presented in this series of articles. However, just
as change to the EVSM in the absence of scientific evidence is
unreasonable, it is also unreasonable to advocate, on philosophical
grounds alone, that the EVSM be accepted. The intent of
developing an expanded model, incorporating traditional concepts
as well as new information, is to re-balance or re-set the
approach utilized in investigating the vertebral subluxation.
In order to advance the profession through appropriate study
of its theoretical tenets, it is essential to establish definitions of
the vertebral subluxation concept which reflect the theoretical
base, not ignore it. Definitions serve the purpose of phrasing
theory in terms that can be ultimately translated into quantifiable
expression. The functional definition thus becomes a basis
for developing operational definitions which describe the
specifics of a concept. Operational definitions are usually the
tool of the researcher. They define in terms of how to measure
the phenomenon under investigation and usually contain a
hypothesis to be tested. Figure 1 shows the continuous relationship
between the formulation of a theory (which would include
its definition), and the research process which provides information
regarding the veracity of its components and affects its evolution.
The importance of definition has created a conundrum for
the profession. Instances of rephrasing the concept of vertebral
subluxation accompanied by redefinition or omission of part of
its theory, have removed it from the overall concept as proposed
by Palmer. This is exemplified by defining its clinical manifestations
as a syndrome, or “...aggregate of signs and symptoms that
relate to pathophysiology or dysfunction of spinal and pelvic
motion segments or to peripheral joints.”  Thus, an interesting
phenomenon has arisen in chiropractic. In the absence of
research to justify the change, several different functional definitions
have been developed which have supplanted the theoretical
definition of Palmer. This is evident when reviewing the
accepted definitions of subluxation by the profession’s two
largest organizations. Although both are functional, neither
reflects the theoretical considerations found in the EVSM of
The first definition has been accepted by the International Chiropractor’s Association since 1987. 
“Any alteration of the bio-mechanical and physiological dynamics of the contiguous spinal structures which can cause neuronal disturbances.”
The American Chiropractic Association has defined subluxation  as follows:
“An aberrant relationship between two adjacent structures that may have functional or pathological sequelae, causing an alteration in the biomechanical and/or neurophysiological reflections of these articular structures, their proximal structures, and/or body systems that may be directly affected by them.”
While no judgment is intended, it is important to draw attention
to these functional definitions in terms of the respective
models each frames for study. The ICA definition implies vertebral
subluxation by restricting the expression of altered dynamics
to the spine and contiguous structures, while the other makes
no mention of the spine or its contiguous structures. However,
the definition adopted by the ICA diverts from specificity by
incorporating the expression “neuronal disturbances” which
could of course include any disturbance. The movement away
from the specificity of Palmer’s EVSM as a condition of the
spine and its contiguous articulations, to any anatomical articulation
is evident in the definition adopted by the ACA, thus
opening the subluxation research direction to include any two
adjacent surfaces. Nevertheless, both definitions recognize that
involvement of the nervous system is essential to a subluxation
definition, albeit the concept of interference to the mental
impulse is omitted or generalized into a melange of other phenomena.
Even if altering the EVSM can be justified for the sake of
framing a model for investigation, a research model reflecting
either of the definitions above still remains incomplete. In both
of these functional definitions, consideration of the mental
impulse is absent. Consequently, the concept has virtually disappeared
from contemporary subluxation research, via the definitions
proposed by these organizations, or been equated with the
action potential.  This omission has been unfortunate, and is not
likely to add light to the problem of elucidating the vertebral
subluxation. Morat,  holding this same view has stated, “...in
science as elsewhere, it is always imprudent to run foul of information given by common sense, and a problem is not solved
when one of the terms is omitted.”
Ironically, the transition away from the EVSM has been fostered
by clarification efforts. The quality work accomplished by
several chiropractors to conceive and describe the Vertebral
Subluxation Complex (VSC), and to arrange it in the form of a
model, has contributed immensely to descriptions of certain
aspects of the EVSM and has elaborated a degeneration sequelae
likely to follow if those aspects remain uncorrected.
However, as will be discussed in this article, the VSC in its current
conceptual and modeled form, lacks inclusion or consideration
of the full spectrum of components originally associated
with the term. Consequently, without a contemporary model to
link current research with the EVSM of B.J. Palmer, the traditional
view of vertebral subluxation is likely to disappear, not as
a result of research failing to demonstrate its veracity, but as a
consequence of remolding and redefining efforts to make it a
more acceptable term for other disciplines.
It has been proposed that an operational definition, beyond
theoretical considerations, be developed by a consensus
approach to establish testable components of the subluxation
theory.  In partial agreement with this perspective, it is apparent
that operational models must be developed from which to
conduct investigative studies. It is suggested, however, that the
operational definitions should be derived from functional definitions
reflecting the theory, not going beyond it or excluding it.
Additionally, rather than develop a profession wide consensus
definition, it seems more appropriate to the research paradigm
for continuous operational definitions to arise as a consequence
of the need to conduct scientific studies involving different
investigative designs. This approach would allow for the testing
of new perspectives and traditional concepts. In this regard, the
current VSM is based on a functional definition which reflects the
components of the original theoretical definition in a manner
providing several areas for operational definitions appropriate for
testing through innovative research. The VSM emerging from
this process will eventually reflect a consensus of appropriately
accumulated research, rather than a consensus of opinion.
In order to properly assess the EVSM, as proposed by Palmer,
as well as evolving new concepts regarding the vertebral subluxation,
it is necessary to investigate all pertinent parameters, theoretical
and demonstrated. It is clear that the onus to conduct
appropriate studies relative to this topic, rests with the institutions
which advocate and educate students in regard to correction
of vertebral subluxation, field practitioners who witness the
health benefits of subluxation correction in their patients, and
technique developers who provide innovative approaches to the
detection and correction of vertebral subluxation. In an attempt
to assist that process, the present and subsequent articles deal
with events and information which impact specifically on the
evolution of the concept of vertebral subluxation. The information
is presented with the anticipation that it will contribute to
a progressive depiction of this condition reflecting the latest
advances in research.
Since there are several well recognized scientific methods of
investigation, which will be discussed in the third part of the
VSM, it is essential that several “operational” definitions which
reflect the full spectrum of vertebral subluxation theory be presented
for study by these methods. As the significance of this
perspective, relative to the development of the proposed VSM, is
presented, the insight of Keating  seems pertinent:
“What of subluxation? Will we ever set aside the political uses of these supposed spinal boo-boos long enough to operationally define and investigate their potential role in health and illness? If we were to cease propagandizing subluxation as “the silent killer” and study it as a serious scientific phenomenon, who knows what we might find? Yet, so long as we insist on emphasizing the chiropractic
lesion as our political “raison d’etre,” the real “tragedy of the subluxation” will continue to be our ignorance of it.”
The present model is designed to accept this challenge. In doing so, it becomes necessary to develop a functional definition
which also encompasses parameters dealing with etiology and health and to include, for scientific investigation, those aspects of
the vertebral subluxation which are likely to impact on these phenomena.
Establishing the Groundwork
A plausible vertebral subluxation model must consider findings
from a combination of research approaches which, through a significant
body of direct or indirect evidence, supports or negates
any proposed components of vertebral subluxation. Among these
are investigations, including descriptive and observational studies,
which evaluate vertebral subluxation theory by testing its
hypotheses; clinical research which investigates the validity, reliability,
and accuracy of techniques; and protocols which affect correction
of the condition. Additionally, appropriately designed and
controlled clinical studies to assess changes in various types of
organismal dysfunction at the biomechanical, physiological, and
biochemical levels, as a function of vertebral subluxation and its
correction, are essential. Also, Self-reported patient outcomes
investigating the efficacy of subluxation correction care are also
important in evaluating changes in health and health-related quality
of life issues “before” and “during” different stages of lifetime
care. A complete model representing a multi-dimensional phenomenon
must also consider epidemiological studies assessing the
etiology of vertebral subluxation as it relates to environmental,
emotional, physical, physiological and biochemical stress. Case
studies which impact on parameters of subluxation-correction
care including etiology, clinical methodology, patient responses to
care in terms of overall health, and reports of interesting reversals
in dysfunction related to vertebral subluxation correction, are tantamount
to the development of a complete VSM.
Because of the multi-dimensional nature of vertebral subluxation,
special attention must be given to the methods used to
assess its presence and arrest, reduce, or correct the condition.
This consideration requires that a VSM include the various techniques
and approaches which are specifically directed at these
objectives. Since subluxation-based chiropractic care is abundantly
endowed with techniques, it is incumbent upon the various
developers and advocates of a particular approach to foster
and conduct research which provides unbiased evaluation of the
technique’s efficacy in regard to the detection and correction of
vertebral subluxation. For those techniques, or other clinical
approaches, which show unbiased evidence of efficacy and positive outcomes, it is then appropriate to include information
which relates the technique to its purported level of intervention
in the VSM.
Since there are acknowledged and documented differences in
clinical objectives, protocols, and practice philosophies within
the profession,  a single functional definition developed to
encompass such a broad base would, of course, lose its specificity.
The VSM presented in this article is, therefore, reflective of the
following functional definition of vertebral subluxation:
A vertebral subluxation is a potentially reversible and/or preventable alteration of the intervertebral relationships of one or more articulations of the spinal column or its immediate weight bearing components of the axial skeleton; accompanied by a change in the morphology of the tissue occupying the neural canal and/or intervertebral foramina; as well as an alteration of neural function sufficient to interfere with the transmission of organizing information, believed to be homologous to the mental impulse, thus contributing to negative health outcomes.
The major contribution to the development of this definition
was made by a group of chiropractors and other educators,
and has been modified and adopted specifically for the current
model.  It is not intended to reflect a profession-wide consensus,
but it does provide testable tenets, serving as a basis for the
development of many different operational definitions. While it
includes the four components of the EVSM, it does not exclude
the advent of additional information, nor suggest a definitive
sequence in which the components develop or are expressed.
The definition includes recognition that neurological function
may be altered at the nerve conduction level, but for a vertebral
subluxation to be present the alteration need only be sufficient
to result in an inhibition or cessation of the flow of “organizing
information,” proposed to negatively affect health. Organizing
information is viewed, in this definition, as being homologous
with the “mental impulse.” A case is made for this position as the
VSM is presented.
The Vertebral Subluxation Model
In developing the present model, it is necessary to first consider
where investigation has led in regard to an understanding
of the traditionally proposed components of vertebral subluxation.
The Early Vertebral Subluxation Model
From the inception of chiropractic in 1895, the groundwork
was established for elucidating the significance of the “adjustment”
performed by D.D. Palmer. The observation that hearing
could be affected by thrusting into the spine still remains a point
of controversy and inquiry. Nevertheless, following that
momentous event, the work of B.J. Palmer led to the development
of a definition of the concept of vertebral subluxation
referred to in this article as the EVSM.
As previously described, the EVSM included four theoretical components;
(1) a vertebra out of normal alignment to its corespondents above and below, which
(2) does occlude a foramen (spinal or intervertebral), which
(3) does produce pressures upon nerves, thereby
(4) interfering and interrupting the normal quantity flow of mental impulse supply between brain and body.
Palmer also added that this condition thus becomes the cause of
all dis-ease. The term dis-ease is described and discussed in the
second article concerning the VSM. Considerable research has
been conducted in a variety of disciplines which impact on the
components identified in the EVSM. Other review articles have
covered and evaluated many of these studies thoroughly. [15–19]
The present article, therefore, refers to a select number of investigations
which, in the opinion of the authors, are especially germane
to the issue of the present VSM.
Static and dynamic elements of vertebral misalignment are
apparent at the gross level through plain film radiographic imaging, [20–22] and segmental and intersegmental movement, in general,
by videofluroscopy, [23, 24] and magnetic resonance imaging. 
Detection of change in vertebral position on static x-ray can be
enhanced by biplanar radiographic analysis,  and dynamics associated
with changes in vertebral position have been well documented
for the cervical spine, described by Jirout as synkinesis, [27–29] and Burns  as coupling of lateral flexion and rotation.
It is important to note that measurement of aberrations in the
millimeter range, or when changes are only separated by a
degree, require a high level of accuracy. While reports [31, 32] vary in
terms of inter-and intra-examiner reliability of various marking
systems, Rochester  found “acceptable” to “very good” inter and
intra-examiner reliability among four practitioners analyzing,
and re-analyzing 10 sets of upper cervical film. Parameters
which were examined included atlas, odontoid, C2 spinous, and
lower angle lateralities as well as other misalignments. Although
examiners used both manual and computer-assisted analysis,
reliability estimates ranged from 0.83–0.96 for all measurements
of laterality, and 0.54 to 0.68 for rotational misalignments.
Other measurements also reflected similar ranges of reliability.
Even in consideration of the ubiquitous presence of human
and mechanical error, it is evident that changes in alignment of
vertebra can be determined with accuracy, precision, and reliability
at the inter- and intra-examiner levels. The detection of
aberrations of vertebral alignment leaves little doubt that misalignment
of vertebral segments exists, and is detectable with
good reliability by skilled chiropractors. It is also evident that
continuing studies in this area are important for assessing quality
control at the practice level and determining the best methods
of detecting vertebral misalignments. Similar studies can also
be used by chiropractic colleges to evaluate the efficacy of this
element of the educational program.
Foraminal Occlusion (Encroachment)
The second component of vertebral subluxation, intervertebral
foraminal occlusion, or encroachment, has been evidenced
by Jackson,  Hadley, [34–36] Breig and Marion,  and Rosomoff
and Rossman  spanning a period of over forty years. The classic
work of Hadley in postmortem studies demonstrated the presence
of foraminal encroachment throughout the spine in a
number of human cadavers. Similar findings have been reported
by Kovacs,  Sunderland,  and Epstein et al.  These studies
indicate that foraminal encroachment is a well accepted phenomenon.
Palmer  also proposed that occlusion could involve the spinal
canal as well as the IVF. In this regard, information which relates
to changes in the spinal canal are considered in the next section.
Neural Pressure and Neural Dysfunction
The studies of Hadley also served to support the concept of
nerve pressure associated with foraminal encroachment.
Although he concluded that nerve pressure was unlikely to arise
in the thoracic spine as a result of foraminal encroachment, due
to the size of the foramina in that region, his studies revealed tissue
damage to the dorsal nerve root epineurium supported by
histological studies showing cellular damage in the cervical, thoracic,
and lumbar spine of cadavers. Similar studies supported by
Hadley’s findings were also performed by Lindbloom and
Rexed.  Even though these studies are not recent, there is no
current information to suggest the findings merit re-evaluation.
Therefore, it is reasonable to accept these studies as support for
the hypothesis that foraminal occlusion can, at least in some
areas of the spine, result in nerve pressure sufficient to cause
observable physical damage at the gross and cellular levels or at
the level of the nerve root. The findings of these studies also suggest
that pressure exerted on neural tissue at the level of the IVF
is compressive in nature.
Additional information relevant to neural pressure has been
provided by Breig.  In his survey of pathological situations
responsible for histodynamic tension in the spinal cord and
nerve roots, he points out that pathologically increased angulation
of two or more vertebrae may be responsible for stretching
or increased tension of the dura leading to neurological manifestations.
This situation is further proposed to be additive since
the caudal end of the dura is anchored in the sacral canal.
Consequently, misaligned vertebrae in the cervical region, and
possibly in the thoracic area, generating dural tension, would
likely transmit this tension to the lumbar region as well.
Sunderland  investigated the relationship between the meninges
internally to the nerve roots, posterior root ganglion, and spinal
nerves in the lower cervical spine of cadavers. He concluded that
considerable freedom of movement was apparent for nerve roots
within their respective IVF’s in the lower cervical region.
However, he also recognized that the continuity of the nerve
sheath with the dural sac, and the plugging action of the dural
funnel at the foramen, would limit the extent of any lateral
movement when abnormal traction was exerted on the spinal
nerve. Other investigators suggest that nerves in the lower cervical
area occupy virtually all of the IVF to percentages ranging
from 10% to 50%. [46–50] Although considerable variation exists
in the estimates of these investigators, it is apparent that the
nerves throughout the spine, are subject to compressive or tension
forces either through changes in the morphology of the
IVF or the spinal canal, or through abnormal lateral traction.
An interesting finding comparing nerve roots and peripheral
nerves, underlies the importance of pressure exerted at the IVF
or spinal canal. Dorsal root ganglia (DRG) have been shown to
be several times more sensitive to mechano-stimulation, such as
generated by compressive forces, than peripheral nerves.  DRG
often remain hyper-excited after the stimulation is ceased,
whereas this phenomenon is not observed for peripheral nerves.  This characteristic of the DRG is likely to account for the production
of pain, as well as facilitated motor responses which
often accompany the pressure resulting from eccentric compression
and chronic irritation or mechanical stimulation. [19 ]
Compressive pressure has also been shown to damage the nerve
root. Lindbloom  demonstrated that among 160 cadavers, ranging
in age from 14 to 87 years, 60 showed nerve root compression.
In another study, Lindbloom and Rexed  showed that
nerve root compression exhibited a direct relationship to the
extent of damage to the nerve root. Additionally, it was observed
that most of the damage was degenerative, and primarily to the
ventral root, although the dorsal root was also involved. These
authors also reported that damage to the DRG was greater
when compression of the nerve root was also noted.
Nerve roots, when under increasing tension, have also been
shown to be more susceptible to loss of structural integrity, followed
by degeneration, than peripheral nerves. [54, 55] This susceptibility
is believed to be due to the parallel arrangement of less
supportive collagen fibers in nerve roots as opposed to peripheral
nerves. This observation, coupled with the fact that nerve
roots lack the tough connective tissue coverings which add to
the structural stability of peripheral nerves, suggests an explanation
as to why they are more sensitive to stimulation and vulnerable
to pressure and increasing tension. In consideration of
the pressures which can be created at the IVF and within the
neural canal from misaligned vertebrae, adhesions, space occupying
lesions, and other structural, physiological, and biochemical
phenomena, it is not difficult to understand the apparent biochemical
(metabolic) changes and/or aberrant neurological
responses which often accompany these phenomena.
Information which relates to the three components thus far
discussed, and hypothesized by Palmer; vertebral misalignment,
foraminal occlusion, and neural pressure have also been considered
in recent models of the vertebral subluxation. Before proceeding
with information relevant to the fourth component, the
mental impulse, an overview of three models is presented.
The Vertebral Subluxation Complex (VSC),
Chiropractic Subluxation Complex (CSC),
and the Vertebral Subluxation Complex Model (VSCM)
In a movement to extend beyond a primarily descriptive
approach of identifying individual subluxation components, the
concept of vertebral subluxation as a complex integrating the
biochmechanical, physiological, neurological, and biochemical
components has been proposed. While the exact origin of the
term “Vertebral Subluxation Complex,” is difficult to trace, it
does appear in a publication by Stiga and Flesia.  The components
of the VSC, however, have been attributed to Homewood and Janse. 
Stiga and Flesia  link considerable medical research, involving
progressive degenerative kinesiopathology of the vertebral
motor unit (referred to by the authors as synonymous with vertebral
subluxation degeneration), to other studies resulting in
neuropathophysiological states, to derive a neurokinesiological
couple. This coupling is postulated to exhibit reciprocal and predictable
sequential degeneration of biomechanical as well as
osseous and soft tissue integrity, constituting the “vertebral subluxation
complex.” These authors further propose that modeling
of the VSC clarifies mechanisms, neuroanatomical impact, and
therapeutic responses, with conclusions being drawn from a survey
of symptomatology depicting the ultimate effects derived
from the VSC.
However, the information regarding the VSC as described by
Stiga and Flesia, makes no reference to which of the several definitions
of vertebral subluxation it is applicable. It appears that
the primary contribution of their literature study has been to
connect existing findings in the medical sciences describing
many forms of dysfunction such as osteoarthritic degeneration,
to what would be expected to occur as a progressive consequence
of such documented phenomena as vertebral misalignment,
and neural encroachment; both of which are accepted
components of vertebral subluxation. For example, it is proposed
by these authors that the progressive phases of the VSC degenerative
processes described categorically as kinesiopathology,
neuropathology, myopathology, histopathology, and biochemical
aberrations, are consistent with medical research findings of the
same categories associated with various diseases and dysfunctional
The work of Stiga and Flesia establishes a link between findings
in one discipline with another. Thus the research accomplished
in medicine, unrelated to the chiropractic concept of
vertebral misalignment and neural encroachment, has done
much to substantiate the likely (but still hypothesized) outcomes
of those phenomena. Reciprocally, the chiropractic perceptions
of structural misalignment and neural encroachment offer logical
explanations for the etiology of degenerative processes documented
by the medical profession.
A subsequent literature review by Dishman  regarding the static and dynamic components of what is termed the “chiropractic subluxation complex” (CSC), covers the same degeneration categories as the VSC, but are referred to as neural, kinesiopathological, muscular, cellular, and biochemical. Dishman does not consider subluxation to be the etiology of the category of degenerative processes, but rather one component of a complex or syndrome of intervertebral dyskinesia, dysarthrosis, or dysfunction in which the biochemical and histological components explain some of the pain mechanisms, tissue changes, and intervertebral fixation. However, as with the VSC, this literature study does not make reference to which definition of subluxation the CSC is applicable. The author does conclude that
information gained from the literature supports the concept of
a “subluxation complex” composed of the five categories related
to a patho-mechanical disease cycle, which, if not corrected,
leads to chronic degeneration. This, the author points out,
explains the need for repeated spinal manipulations and prolonged
Lantz [18, 19] has contributed a vertebral subluxation complex
model (VSCM) which includes the five categories of the original
VSC and CSC, as well as the addition of the inflammatory
response, connective tissue pathology, and vascular abnormalities.
The model draws from basic science, clinical science, chiropractic,
medical and osteopathic literature. The significance of
this model is multifold. It provides insight into the divergent
views regarding the nature of subluxation and suggests an organizational
structure regarding the various components as derived
from contemporary information.
The organizational structure includes cellular components
involving biochemical abnormalities, histopathology, and the
inflammatory response. The tissue level components involve
their own respective pathologies (myopathology, vascular abnormalities,
connective tissue pathology, and neuropathology) ultimately
resulting in kinesiopathology which is considered to be
the functional end-product of the various tissue aberrations.
Lantz elaborates the basic motion segment, fundamental to
the concept of vertebral subluxation, which minimally includes
two adjacent vertebrae, a disc, two posterior articulations, joint
capsules, inter-transverse, and intraspinous ligaments through the
term “Integrated Segmental Unit,” (ISU) referring to:
“...the basic motion segment along with associated spinal
structures, such as the segmental nerves, nerve roots and
dorsal root ganglion, sinu-vertebral nerves, muscles, and
vascular structures, such as the radicular arteries and veins.
It would also include meningeal structures, such as the
dural funnel, and segmental spinal circuitry and reflex arcs.
It must be recognized, too, that regional differences exist
in the spine. In the cervical spine, for example, the ISU
would include the vertebral arteries, and the joints of
Lushka, while in the thoracic spine, it would include the
costal articulations, capsules and associated ligaments.”
The VSCM, proposed by Lantz, bases its central concept on
immobilization degeneration. This connects the “fixation” phenomenon
(viewed as a form of joint immobilization) frequently
found in subluxation assessment with the documented degenerative
processes of muscle, tendon, cartilage, ligaments, articular
capsule, and bone which have been attributed to joint immobilization.
This approach adds further substantiation to the reciprocal
relationship described by Stiga and Flesia when describing
the VSC and degeneration findings of conditions described by
the medical community. The Lantz model of the vertebral subluxation
complex also refers to trophic influences, but overlooks
the significance of research in this area in regard to the EVSM.
This area will be explored further as the expanded VSM is discussed.
Consideration of Current Models of the Vertebral Subluxation
The information that has been published in the context of
the VSC, CSC, and the VSCM has made a major contribution to
understanding three of the four components of Palmer’s subluxation
model. This has been accomplished by substantiating, indirectly,
the hypothesized biomechanical and neurological consequences
of uncorrected vertebral subluxation. By linking this
hypothesis to studies conducted in regard to medical degenerative
disorders, the biomechanics and consequences of vertebral
misalignment, joint immobilization, neural encroachment, and
neurological dysfunctions have been described and supported by
this documentation. Further research in these areas, directly linking
the subluxation to specific degenerative sequelae, will be
necessary to broaden our appreciation of the pathomechanics
and restorative processes which occur in the presence and
absence of vertebral subluxation. Nevertheless, the present evidence
serves the purpose of establishing the necessary credibility
to justify additional research.
While information which demonstrates the progressive
degenerative processes observed in many medical diseases has
been eloquently linked to degeneration sequelae hypothesized
to follow uncorrected vertebral subluxation, two important
points must be considered. First, as a result of clinical observations
of the efficacy of detecting and affecting the correction of
vertebral subluxation, it should not be presumed that all
instances of this condition involve, or will lead to, the degeneration
complex described in the models to date. It would not be
surprising, for example, to observe little to no degenerative
histopathology, myopathology, or neuropathology associated
with vertebral subluxation, unless the uncorrected condition was
initially severe, and/or of a relatively long duration. An analogy
can be drawn from dentistry. A decayed tooth, readily observable
on x-ray, is not likely to be associated with periodontal degeneration
unless it has existed uncorrected for a considerable period
of time. Consequently, while an appropriate model of vertebral
subluxation should include the potential degenerative ramifications
of its chronic presence, these potential effects are a
component part of the model which may not be apparent when
considering the condition relative to its acute or short term
Second, it is important to caution against developing a model
of vertebral misalignment versus a model of vertebral subluxation.
Current models have adopted the viewpoint that the
fourth component of the EVSM, proposed by B.J. Palmer as the
“mental impulse,” is synonymous with the action potential. 
When this assumption is made, it follows that the neurological
dysfunction associated with vertebral subluxation would be
those phenomena attributable to interruption of nerve conduction
via the action potential.  In the models discussed in this
article, this assumption has led to descriptions of myopathology
related to neuropathology emanating from neural conduction
deficits. While it is plausible that the degenerative consequences
of vertebral subluxation, or acute neural impingement as part of
the subluxation, could involve conduction loss with its well
documented sequelae of symptomatology, it does not appear
that loss of nerve conduction via the action potential is what
Palmer was describing as the primary concept of the “mental
This caution is important to subluxation-based chiropractic.
Since the vertebral subluxation models which have emerged
consider only three components; misalignment of vertebra(e),
occlusion or encroachment of the spinal canal or intervertebral
foramen, and pressure affecting neural conduction via the action
potential, then the model is not one of vertebral subluxation, but
rather a “misalignment model” involving hard tissue misalignment
affecting associated soft tissues. Models of this type have
been in existence in the medical profession for some time. For
example, it is well known that a neuropathy could arise from a
cervical hard tissue lesion impinging on the brachial plexus, with
predictable tissue pathology and accompanying symptoms.
Consequently, a vertebral subluxation model limited to these
same parameters would be nothing new, but rather a reiteration
of an existing medical model involving neuropathology,
myopathology, connective tissue pathology, inflammatory
response, vascular response, biochemical responses, histopathology,
and kinesiopathology. Such models, even in the chiropractic
profession would, however, readily fall under the care regimen of
spinal manipulative therapy for the correction of misalignments
and the many symptomatic conditions which would be expected
to accompany this aberration. It is obvious that the manipulation
regimen then simply becomes another way of impacting
on parameters already described and documented as a medical
It is apparent that contemporary depictions of the VSC, CSC,
and the VSCM fall within this concept. Although the term vertebral
subluxation may be applied to these models, it is argued
that the application is inappropriate, as the fourth component of
vertebral subluxation (mental impulse) has either not been considered,
or, unnamed, it has been incorporated into the model as
being synonymous with the loss of neural conduction via the
action potential. While it is apparent that interference to the
nerve impulse (i.e. action potential) could lead to syndromes
manifesting parameters of dysfunction as previously described, it
is important to include the fourth component, the mental
impulse, since it has been proposed that its interference would
result in loss of adaptive potential, ultimately depriving the
organism of its health. 
Organizing or Coordinating Information and the Fourth Component
Stephenson  stated in 1927, that it was not fully clear what the mental impulse was. It was hypothesized however;
(1) that each tissue cell requires specific mental impulses,
(2) that each adaptive change requires specific impulses,
(3) that they are constructive, used only for a particular moment for coordination,
(4) that impulses originate through the expenditure of energy, and are propelled, perhaps through a
physical movement of the cell as a contraction,
(5) that although mental impulses can be radiated, the function of nerves appears to be one of gathering
radiant energy and transforming it to a dynamic or flowing form, and
(6) that mental impulses, also called mental force (ref., p5), are not a physical or a chemical force,
nor a stimulant, and that
(7) the function of the nervous system is to transmit mental force from the brain to the tissue cell and back again.
Granted, Palmer, Stephenson and their contemporaries were
grappling with an advanced concept, which they admittedly did
not fully understand, but nevertheless were compelled to define
or describe. Regardless of their limitations, and perhaps inaccuracies,
a complete VSM must evaluate this concept as to its distinctiveness
from, and its relationship to, the action potential. In
this regard, an immediate question arises; has any information
since the writings of Palmer and Stephenson been presented
which may serve to elucidate the concept of mental impulse?
Several advances and classical concepts in neuroscience provide
considerable information in this regard. Physiologists have
recognized the phenomenon of axoplasmic transport for over
forty years. Studies have shown that various substances “flow”
through the nerve cell in both directions at the same time. [60, 61] These substances include certain informational molecules such
as proteins, neurotransmitters, as well as other “growth factors.” [62–65] The mechanism of propulsion behind axoplasmic flow is
considered to be linked to the presence of actomyosin, a contractile
protein, ubiquitous throughout the animal kingdom. [66, 67]
Other studies suggest that a number of molecules, regardless
of their size, travel at the same rate of approximately 410 ± 50
mm/day independent of the size of the nerve fiber, diameter,
and presence or absence of myelin. These studies suggest that
molecules are exported into nerves fibers from other sites and
then transported along “sliding-filaments,” in a contraction-like
process. [60, 68] The bidirectional movement within the nerve fiber
is referred to as anterograde and retrograde axoplasmic transport.
Anterograde flow is associated with substances necessary for
nerve growth and synaptic membrane maintenance, while retrograde
flow is believed to reflect movement of substances,
exported into the nerve fiber. [65, 69] These substances influence
regulation of enzymes associated with the production of neurotransmitters,  thus implicating these movements as important, if
not essential, to development and maintenance of the neuromuscular
system.  It should be noted that both anterograde and
retrograde axoplasmic flow are constructive in function.
Interestingly, studies have shown that axoplasmic flow can be
blocked by nerve compression. [72–75] Additionally, it has been
shown [50, 76, 77] that axoplasmic flow can be blocked in peripheral
nerves by pressures much less than those required to block nerve
conduction. If axoplasmic flow is assumed to be a subset of or
synonymous with the mental impulse, then it becomes apparent
that the subluxation component of interference to mental
impulses could occur independent of, or in the absence of, interference
to the action potential. Information which has demonstrated
the increased susceptibility of nerve roots to compression,
as opposed to peripheral nerves, further emphasizes the
IVF as a plausible anatomical site for nerve interference not
involving the action potential. Although unsupported by direct
evidence of changes in nerve root morphology following acute
or chronic compression, Luttges and Gerren  have described
several areas of neural activity in the dorsal nerve root which
they believed to be susceptible to compression injury, including
axoplasmic transport and ephapsis. Even though peripheral
nerve axoplasmic transport is more sensitive to blockage by
compression pressure that nerve conduction, additional research
will be necessary to affirm that axoplasmic flow in nerve roots
shows a similar sensitivity.
Additional information which is pertinent to the concept of
the mental impulse has been presented by Kelso,  who proposes
that the reductionist method of explaining macroscopic
events is limited since biological properties which arise at each
level of complexity cannot be predicted from knowledge of
component processes, particularly with regard to self-organization.
For example, research has shown that neurons communicate
by several modes of transmission, and therefore, have functions
other than solely modulating excitatory and/or inhibitory
activities between cells via the action potential.  In this regard,
transmission has been shown to occur ephaptically. The ephapse
exists where two or more axons and/or dendrites touch without
forming a typical synaptic contact.  The ephaptic response
has been observed in chronically denervated muscles, [82, 83] cerebellum,
and in axon tracts affected by demyelination,  the
hypothalamic suprachiasmatic nucleus (site of the circadian
clock),  axon-axon interfaces in post-injury neuromas,  and in
the pre-innervation phase of early radiculopathy.  This finding
is particularly interesting, as it suggests that information flow to
tissues can occur even in the presence of denervation (i.e.total
loss of the action potential). This suggests, that ephaptic transmission
is independent of the action potential, while still utilizing
the nerve for conveyance. Interestingly, this is also a proposed
characteristic of the mental impulse.
Ephaptic responses are not considered to be an artifact,  as
they can be recorded and re-recorded some days later by surface
electrodes. They are believed to be a late potential evoked by
every stimulus or unpredictably with unstable latency periods.
They have been observed following blockage of the action
potential in the suprachiasmatic nucleus in which cellular
integrity was monitored through continued function of the circadian
clock.  Ephaptic responses have also been demonstrated
to be evoked by the electrical activity of muscle, suggesting that
muscles can elicit excitation in nerves creating a reverberating
cycle affecting muscle tone. 
Neurons can also communicate other than through the
action potential by “volume transmission.” This mode of conduction
involves the flow of ionic currents and chemical signals
which are transmitted or radiated from one neuron, through the
fluid-filled space between cells, and received by an appropriate
receptor site on another neuron. The research literature regarding
this topic has been thoroughly reviewed by Agnati, et al. [89, 90]
These reviews suggest that every neuron may function in a dual
mode; the synaptic and the volume transmission mode. Notable
is the observation that neuroendocrine release appears to only
involve volume transmission, including the cerebro-spinal fluid
as a medium. These reviews also point out that the chemical signals
which elicit the release of neuroendocrines, involved in a
wide array of coordinating processes, include the classical transmitters
such as the monoamines, acetylcholine, gamma amino
butyric acid, and glutamate as well as other neuropeptides.
Pert et al  point out that over fifty “informational substances”
have been shown to modulate brain function including behavior
and mood states. These authors indicate that the signal specificity
resides in distinct classes of recognition molecules (receptors),
rather than through the synapse. In addition, neuropeptide
receptors have been shown to occur on mobile cells of the
immune system. [92, 93] Black,  in a discussion of the emerging
field of psychoneuroimmunology, has shown that the brain and
the immune system interact via hormones, neurotransmitters,
and other substances which travel through the blood and nervous
system. Pert et al,  further suggest that neuropeptides and
their receptors join the brain, glands, and immune system in a
network of communication between the brain and the body.
It is also reasonable to assume that a nerve that does not conduct
via the action potential, or conducts improperly, will likely
lose its ability to relay information through the classic concept
of synaptic transmission. This would involve information which
contributes to numerous motor functions. Since many of these
motor events can be invoked voluntarily, or expressed independent
of the conscious mind, interference to the action potential
must, therefore, also interfere to some extent with the transmission
of the mental impulse.  Of interest in this regard, is the
observation that deaffernated DRG can elicit action potentials.
Kirk,  has shown that DRG spontaneously emit impulses following
transection of the ventral root and spinal nerve distal to
the dorsal root, thus isolating it from the periphery. The fact that
afferent transmission can occur, independent of peripheral input,
suggests that organizing information, either originating within
the tissue cells of the DRG or at least arising there as a first level
of tangible expression, is capable of being transmitted to the
brain via the action potential of the nervous system or ephaptic
transmission, as previously discussed. This suggests that one level
of the organizing information loop can be maintained even in
the presence of transection of the physical relationship between
information flowing from the brain to the tissue and back again.
The impression that arises when the information from contemporary
research is sorted relative to the hypothesis of the
mental impulse presented by Palmer and Stephenson, leads to
several insights. First, it appears that axoplasmic flow fulfills many
of the criteria hypothesized as being characteristic of the mental
(1) it involves the transmission of organizing (constructive) or coordinating information,
(2) substances appear to be propelled intracellularly by a contractile process,
(3) it is independent of neural conduction, and
(4) it can be interfered with at pressures lower than required to inhibit or cease neural conduction.
Additionally, several other well documented modes of
non-synaptic communication between cells, including; ephaptic
transmission, volume transmission, field effects mediated by large
extracellular currents, and weaker fields generated by axons during
growth and repair, as well as peptide messengers postulated
through psychoneuroimmunology, clearly demonstrate that
other phenomena play an important role in the transmission of
organizing information. These phenomena are also linked to the
original hypothesis of the mental impulse in that the signals can
be radiated between cells, and the interactions between stimulus
and response is specific to the event. For example, the bidirectional
chemical communication between brain and tissues is
regulated by cortico-trophin releasing factor which is stimulated
by specific thoughts and emotions or immune activation to
influence the hypothalamic-pituitary-adrenal axis and subsequent
release of endocrines which play a major role in many
cellular processes. 
It is also plausible that organizing information derived from
the tissue itself may influence the action potential, as opposed to
being synonymous with it.  In support of such a concept, it
appears possible that denervated muscles can be stimulated
through ephaptic transmission.  Other study suggests that the
muscle electrical activity itself could then act ephaptically, to
induce action potentials in associated nerves.  In this cyclic
manner, even if peripheral nerve stimulation via the action
potential is lost to a muscle, its muscle character and some
degree of tonus, could be retained ephaptically.
One characteristic of the mental impulse described by
Stephenson, is that it is neither a physical nor chemical force.
The implications of that statement are not easily interpreted relative
to the other characteristics appointed to the mental
impulse, which can be linked to physical and/or chemical phenomena.
However, it may be that the mental impulse, as an entity, is undetectable by current technology, and that such processes
as axoplasmic flow, volume transmission, the ephaptic effect,
neurohumoral communication, and the action potential, all represent
various aspects of the physical medium of the nervous system
through which the mental impulse is conveyed.
Nevertheless, substantial information attests to the necessity for
a VSM to recognize that neural expression, relative to the transmission
of organizing information, is not synonymous with only
the action potential. This suggests that a vertebral subluxation
could exist either in the absence of neural conduction pathology,
and other pathological components of the vertebral subluxation
complex and its model, or in the presence of this spectrum
of pathologies. If the latter occurs, it is at that stage that the “misalignment
models” merges with the VSM.
Summary and Conclusions
A VSM has been presented which includes the traditional
concept of vertebral subluxation, as proposed by B.J. Palmer, as
well as new information which reflects on that theory. This
model has been proposed based on the observation that other
contemporary models consider only the misalignment and
nerve interference aspects of Palmer’s theory.
Other aspects of the EVSM are also included in the current
VSM, such as etiology of the vertebral subluxation and its affects
on health. These aspects will be covered in the second part of
Information has been presented to show a variety of ways, in
addition to the action potential, by which neural cells communicate
allowing for a flow of information to tissues and back to
the brain. In consideration of this information, it would appear
to be an oversight to eliminate the concept of mental impulse
from the VSM. Investigating this phenomenon will likely require
techniques aimed at evidencing its presence and influence indirectly.
Research in this regard may be much like the efforts of
physicists to develop methods of observing the atom and subatomic
In order to sustain a VSM which incorporates interference to
the mental impulse (coordinating information), the onus is upon
researchers of the vertebral subluxation to link theorized manifestations
of this interference to emerging models in neuroscience.
This should be an exciting challenge in light of recent
evidence regarding different levels of cell communication, as
well as the ramifications of concepts including inter-relationships
between the mind (CNS) and the immune system [96, 97] and
studies documenting changes in quality of life measures. [98, 99] This
information provides further impetus to link the outcomes of
vertebral subluxation correction to increased health status. An
overview is presented in Figure 2 of the evolution of the components
of vertebral subluxation through the various models
discussed in this article, culminating in the VSM.
A description of appropriate research models for studying the
parameters of the VSM will be presented in the third article of
this series. The research models will be based upon approaches
which impact on all areas of vertebral subluxation including its
etiology, manifestations, and consequences.
The authors would like to thank Marnie Dobson for her timely comments, critique, and assistance in the preparation of this
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