The Evolution of the Subluxation Theory      

This section is compiled by Frank M. Painter, D.C.
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Radiologic Manifestations of Spinal Subluxations
Chapter 6 from:   Basic Chiropractic Procedural Manual

By Richard C. Schafer, D.C., FICC and the ACAPress
This chapter describes the radiologic signs that may be expected when spinal subluxations are demonstrable by radiography. Through the years, there have been several concepts within the chiropractic profession about what actually constitutes a subluxation. Each has had its rationale (anatomical, neurologic, or kinematic), and each has had certain validity contributing to our understanding of this complex phenomenon.

General Causes and Potential Effects of the Subluxation Complex
Chapter 6 from:   Basic Principles of Chiropractic Neuroscience

By Richard C. Schafer, D.C., FICC and the ACAPress
Until the last 2 decades, most evidence about the success of chiropractic adjustments on the correction of vertebral subluxations and their related functional disturbances was empiric. The gap between controlled research documentation and frequent clinical observation still exists, but it has greatly narrowed in recent years. The greatest concern today is not is it effective but why is it effective and why is it effective in some cases but not in others that appear almost identical? Added to these can be the questions: what causes the positive effects in a specific body area that result from spinal adjustments that cannot be explained on an anatomical basis and what causes the indirect, far-reaching, diverse improvement in function so often witnessed?

Specific Potentialities of the Subluxation Complex
Chapter 7 from:   Basic Principles of Chiropractic Neuroscience

By Richard C. Schafer, D.C., FICC and the ACAPress
This chapter describes the primary neurologic implications of subluxation syndromes, either as a primary factor or secondary to trauma or pathology, within the cervical spine, thoracic spine, lumbar spine, and pelvic articulations.

Basic Spinal Subluxation Considerations
Chapter 19 from:   Chiropractic Management of Sports and Recreational Injuries

By Richard C. Schafer, D.C., FICC and the ACAPress
The concept that an "off centered" vertebral or pelvic segment parallels a unique effect upon the neuromuscular bed which may be the cause of, aggravation of, or "triggering" of certain syndromes is a major contribution to the field of functional pathology and clinical biology by the chiropractic profession. This section discusses the basic biomechanics and effects of vertebral subluxations as related to the management of sports-related and recreational injuries.

Chiropractic Lexicon: Useful or Not?
Asia Pacific Chiropractic Journal 2023; 3.3 ~ FULL TEXT

Obtaining an ultimate definition of this ‘something’ we have been addressing, successfully, for over 125 years is elusive, yet this allows flexibility when defining it within different contexts. This provides space for chiropractors to do this (both consciously and subconsciously) every day in practice, and over time to use their growing experience to add complexity and subtlety to their conceptual framework, and their application of their science and art. Millions of patients over the years would attest to the value in that.

A History of the Idea of Subluxation:
A Review of the Medical Literature
to the 20th Century

J Contemporary Chiropractic 2022; 5 (1): 150–170 ~ FULL TEXT

We have presented this combined report of our individual searches exploring a history of the idea of subluxation. In particular our findings show that the idea of small spinal dysfunctions, amendable to intervention, emerged in Western medical writings from the 14th Century and by the 19th Century and Harrison they were termed subluxation. Quite a number of medical practitioners explored the idea and by the 1850s had introduced the term ‘spinal irritation’. We acknowledge the much earlier appearances of the idea in Egyptian and Greek medical writings.

The Chiropractic Subluxation: Medical Evidence
in Support of the Subluxation Construct

Asia Pacific Chiropractic Journal 2023; 3.3 ~ FULL TEXT

The vertebral subluxation concept is similar to the terms spinal dysfunction, somatic dysfunction, segmental dysfunction or the vague vertebral lesion. These terms are primarily used by osteopaths, physiotherapists and medical doctors to focus their manipulative techniques, but they relate primarily to the physical-mechanical aspects. In this respect, these terms are limited in what they signify. The implication of just plain osseous biomechanical dysfunction does not incorporate the wider ramifications of integrated neural, vascular, and internal associations which may involve greater ramifications, and should be more appropriately referred to as a vertebral subluxation complex (VSC).

The Chiropractic Vertebral Subluxation Part 10:
Integrative and Critical Literature From 1996 and 1997

J Chiropractic Humanities 2018 (Dec); 25: 146–168 ~ FULL TEXT

The purpose of this paper is to review and discuss the history of chiropractic vertebral subluxation (CVS) during 1996 and 1997. The literature during this period offered critical and integrative models emphasized by a need for research into operational and functional definitions. Several integrative approaches emerged, from Rome’s 296 synonyms to Bergman’s Pain/Tenderness, Asymmetry/Alignment, Range of Motion Abnormality, Tissue Tone, Texture, Temperature Abnormality, and Special Tests (PARTS) analysis adopted by the profession in the United States. Other noteworthy contributions included Ruch’s Atlas of Common Subluxations, Epstein’s introduction of network spinal analysis, and Kent’s review of CVS models. Boone’s introduction of the J Vertebral Subluxation Research was accompanied by his 3-part model with Dobson. These years also included the paradigm statement of the Association of Chiropractic Colleges, which was adopted by the American Chiropractic Association, International Chiropractors Association, and World Federation of Chiropractic. Two other papers included Nelson’s critique of the CVS paradigm and Keating’s 1996 “Hunt for the Subluxation.”
You may also enjoy The Chiropractic Vertebral Subluxation: Parts 1–9

The Chiropractic Subluxation:
Implications for Manual Medicine

J Manual & Manipulative Therapy 2016; 13 (3): 139–141 ~ FULL TEXT

But perhaps the greatest lesson to be learned here is a caveat. Nobody benefits if we spend too much time on constructing theoretical models with poor operational definitions and hidden elements of dogmatic thinking. Maybe it is time to critically evaluate the diagnostic value of clinically unquantifiable manual medicine concepts such as endfeel. Maybe it is time to question clinical but unproven constructs such as the capsular pattern and its diagnostic and therapeutic implications. Maybe it is time to clearly and quantifiably define what we consider a positive finding on our tests of segmental motion and stability. Or maybe it is time to discard the unproven emphasis we place on these poorly operationalized segmental tests. Instead, we could focus our efforts on establishing clinical decision rules for manipulative interventions using tests with a clear operational definition while at the same time establishing outcomes with reliable, valid, and responsive outcome tools that can be used by any practitioner unrelated to their level of experience. Maybe it is time to demystify manual medicine as an approach only for the duly initiated and let it truly enter the era of evidence-based medicine?

Use of the Term Subluxation in Publications During the
Formative Years of the Chiropractic Profession

J Chiropractic Humanities 2011 (Dec); 18 (1): 1–9

The term subluxation has come to have different meanings for different health care professions in the United States for over the past century. This controversy has resulted in some contention both internal and external to the chiropractic profession. Some current factions within the chiropractic profession hold the term subluxation to be synonymous with the identity of chiropractic itself; however, this term was not solely used by chiropractic during its formative years. The purpose of this article is to look at uses of the term by various professions (osteopathy, medicine, and chiropractic) at the turn of the century, a time in which the chiropractic profession was developing.

The Great Subluxation Debate: A Centrist's Perspective
J Chiropractic Humanities 2010 (Jun); 17 (1): 33–39 ~ FULL TEXT

The long-standing debate regarding the chiropractic subluxation has created substantial controversy within the profession. Currently, this phenomenon can be compared with a country with a 2-party system that has a large silent majority sitting between the 2 factions. It is argued that the position held by those in the middle (the centrists) may be the most rational view when considering all of the available evidence. It is also suggested that the subluxation construct is similar to the Santa Claus construct in that both have a factual basis as well as social utility.   Ultimately, the centrists must become proactive if they want to protect the profession and further advance the evidence in regard to the subluxation. They must not only engage in the debate, but fund the research that will investigate various aspects of the subluxation and then help disseminate this evidence to fellow doctors of chiropractic, other practitioners, health care policy makers, and society at large.

Subluxation Reviewed, Revisited, Revitalized
Dynamic Chiropractic (March 12, 2010) ~ FULL TEXT

Our understanding of the biomechanics and neurology of the subluxation continues to evolve as more research is published which helps explain the nature of this lesion. Historically, the subluxation has been at the heart of the identity and purpose of the chiropractic profession. Contemporary models provide new insights into this elusive and sometimes mysterious problem which we attempt to find by various clinical means and correct by the application of high-velocity, low-amplitude thrusts. Let's review past models, but focus primarily on the latest evidence concerning the subluxation published in the recent scientific literature in order to improve our understanding, insight, and application of clinical interventions to improve patient outcomes with chiropractic care.

Neurovertebral Influence Upon the Autonomic Nervous System:
Some of the Somato-Autonomic Evidence to Date

Chiropractic Journal of Australia 2009 (Mar); 39 (1): 2–17 ~ FULL TEXT

The volume and variety of evidence presented in this cursory overview, would tend to suggest there should be open mindedness when considering the possibilities of manual management of a number of somatovisceral conditions. An attitude of outright rejection may tend to limit chiropractic within a musculoskeletal field. This could deny science a whole area of opportunity, and deprive certain patients of options for a potential source of minimally invasive natural health management. Once all the available evidence is considered, and further research has had the opportunity to explain the clinically observed phenomenon of positive outcomes, proper assessment can then take place. Despite the material presented here, one is still reticent in making broad claims..

Survey of US Chiropractor Attitudes
and Behaviors about Subluxation

J Chiropractic Humanities 2008; 15 (1): 19–26 ~ FULL TEXT

Comprehensive, biopsychosocial approaches to care of the chiropractic patient have added utility for addressing a multitude of complex multi-causal health disorders. Our survey findings lend support to the notion that the typical doctor of chiropractic is not a simplistic ideologue in their clinical approach. Rather, our findings support and we respect the suggestion that contemporary practicing chiropractors are capable of reconciling complex notions of health, well-being, and dysfunction, by tailoring specific care for specific disorders in specific patients. [11] An agenda for further advancing chiropractic as a clinical discipline and chiropractic as a valued health care choice should also include attention to developing more fully all clinical skill sets that are requisite to successful delivery of a comprehensive biopsychosocial approach to health care.

Modernized Chiropractic Reconsidered:
Beyond Foot-on-Hose and

J Manipulative Physiol Ther 2006 (May); 29 (4): 253–254 ~ FULL TEXT

Theories and testable hypotheses are important components of science. Some people are uncomfortable with the term ‘theory,’ possibly because it may be inferred that this term implies quackery by being an unaccepted law or unfounded truth. However, it is important to recognize that theories are essential to scientific method and provide an opportunity for us to test ideas, gather more knowledge, and continue to improve healthcare. If we disallow ourselves to consider and test a theory, then we are restraining the analysis of thought and generation of knowledge. Challenging, testing, accepting, or rejecting theories based upon sound methods allows us to obtain a more complete picture of what is the best way to provide healthcare to our patients. Therefore, instead of fearing theories, we should embrace them.

Chiropractic Theory in Research:
Subluxation Theory Finally Gets the Attention It Deserves

Dynamic Chiropractic (April 16, 2006)

Theories are designed to explain observable phenomena. In actuality, the "subluxation model" that postulates a relationship between body structure, physiological function and health is an inherently viable one. The precise biomechanical, neurophysiological and/or psychosocial mechanisms that may or may not come into play remain to be elucidated through research. As more becomes known, chiropractic models should rightly be refined to better explain clinical observations. Well-developed theories help pose research questions and study designs that do a better job at finding out information that can improve our practices and benefit the patients we are here to serve.

A Series of Subluxation Articles By Meridel I. Gatterman, MA, DC, MEd

Thanks to
Dynamic Chiropractic!

   The Vertebral Subluxation Syndrome

   Is the Spinal Subluxation a Risk Factor?

   Separated by a Common Language: Its Time to Develop Chiropractic Nomenclature

Dump Subluxation? Give Me a Break!
Dynamic Chiropractic ~ November 1, 1999

The front-page headline of the September issue (volume 13, no. 12) of the Chiropractic Journal reads "Research Conference Urges Profession to Dump Subluxation." Well, I'm here to tell you that nothing even remotely of the kind happened, and I still find it hard to understand why one person, Matthew McCoy, chose to spin the story so inaccurately, especially after (silently) sitting through only one morning of an extensive three-day meeting at my invitation (and Palmer's expense). A responsible journalist who didn't hear the whole story would have checked not only his facts, but his context as well.

Models of Vertebral Subluxation: A Review
Journal of Vertebral Subluxation Research 1996; 1 (1): 1–6 ~ FULL TEXT

Enjoy this Adobe Acrobat file (59 KB) from the first issue of JVSR, a review of clinical models of the vertebral subluxation, including neurobiological mechanisms. Models reviewed include the subluxation complex model, subluxation degeneration, nerve compression, dysafferentation, the neurodystrophic model and segmental facilitation. Clinical models, including the segmental, postural, and tonal approaches are discussed.

A Review of the Evolution of Chiropractic Concepts of Subluxation
Topics in Clincial Chiropractic 1995: 2 (2): 1–10 ~ FULL TEXT

This particular review traces the evolution of the subluxation concept within the context of the chiropractic profession. There is a growing body of evidence, from both within and outside the discipline, that supports many of chiropractic's basic concepts. Evidence regarding the contribution of spinal joint derangement to a number of significant health problems becomes more compelling as more is learned. The role of manual procedures, especially as performed by chiropractors, becomes more prominent each year. A new environment without the overt ostracism of political medicine and a burgeoning research enterprise within chiropractic academia and practice are helping to poise the profession for greater contributions to the health care of society as chiropractic enters its next century.

A Series of Subluxation Articles By Joseph M. Flesia, Jr., D.C.

Thanks to the ICA for access to these articles!

   The Vertebral Subluxation Complex: An Integrative Perspective
       ICA Int Rev Chiro 1992 (Mar): 25–27 ~ FULL TEXT

   The Vertebral Subluxation Complex Part II: An Outline
       ICA Int Rev Chiro 1992 (Oct): 19–23 ~ FULL TEXT

   The Vertebral Subluxation Complex Part III: Pathogenesis
       ICA Int Rev Chiro 1992 (Oct): 45–47 ~ FULL TEXT

   The Vertebral Subluxation Complex Part IV: Pathogenesis (Continued)
       ICA Int Rev Chiro 1993 (Mar): 37–41 ~ FULL TEXT

The Vertebral Subluxation Complex Part 2:
The Neuropathological and Myopathological Components

Chiropractic Research Journal 1990; 1 (4): 19–38 ~ FULL TEXT

The neurological component of the Vertebral Subluxation Complex (VSC) is, for many, the cornerstone of chiropractic theory. [1] For those who see beyond the application of chiropractic and other manipulative procedures as merely a means of relieving head ache and low back pain, the nervous system is the mediator of vitality and health to the individual organs and tissues. [2] Today, more than ever before, basic scientific and medical research supports this fundamental concept of chiropractic. [3–7] In chiropractic clinical practice, the prominence of the nervous system is unquestionable.

The Vertebral Subluxation Complex Part 1:
An Introduction to the Model and Kinesiological Component

Chiropractic Research Journal 1989; 1 (3): 23–36 ~ FULL TEXT

The concept of subluxation has been a cornerstone of the theory and practice of chiropractic since its founding by D. D. Palmer [1] in 1895. It is one of the most controversial concepts in health care today, and finds its supporters and critics both within and outside the chiropractic profession. The original concept of the subluxation was that of a slightly misaligned vertebra, not sufficient to be qualified as a true luxation or dislocation but substantial enough to impinge on the segmental nerves associated with it. [1] While this original concept requires some modification in light of current research findings, there has been a wealth of knowledge accumulated in the past two decades that supports the concept of vertebral subluxations as a real entity. [2–9] It must be stressed that from the contemporary, scientific chiropractic point of view, the subluxation is a dynamic process, involving several tissue levels and integrative components.

Review of the Literature Supporting a Scientific Basis
for the Chiropractic Subluxation Complex

J Manipulative Physiol Ther 1985 (Sep); 8 (3) Sep: 163–174 ~ FULL TEXT

A review of the literature reveals strong evidence for both the mechanical model of disease production (structural) and the neurobiological model (functional). Outdated models which attempt to describe a scientific basis for chiropractic theory are inadequate and indeed harmful to the progress and acceptance of chiropractic.


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