|Editorial: Vertebral Subluxation Complex and
Functional Spinal Lesions; Differentiation and the Search for Mechanisms
Chiropractic has been entrenched in philosophy and theory to explain its
role in health care. The philosophy has managed to provide a promissory note
by perpetuating the belief that manipulative intervention plays some role
in general health care. On the other hand, the theory of the subluxation
complex has managed to focus on a single level lesion as the explanation
to the effects of chiropractic intervention
The philosophy has not been able to contribute to the knowledge
base for scientific inquiry. Its role in explaining chiropractic is relegated
to that of philosophy and, as such, asserts a very weak argument in support
of the chiropractic profession as a science discipline
(2). Its role in chiropractic, however, cannot
be dismissed; for, after all is said and done, the philosophy has maintained
the principle idea of an innate function that has sustained the profession
in its struggle to assert its role as a health care discipline. The question
whether both the philosophy and the theory has placed the emphasis in the
wrong areas for inquiry will be left for others to evaluate.
The question for chiropractic is whether the emphasis on inquiry ought to
be placed on a single level subluxation complex or whether a more global
view is needed in the inquiry process. The reductionist theory for scientific
inquiry has forced the chiropractic profession into a very narrow window
for inquiry. The mechano-engineering, structural lesion concept (subluxation)
has forced the profession to maintain its focus on the single level lesion
(subluxation complex) as contributing to neurophysiologic changes within
a wiring system schema. The possibility that a more global approach is needed
can only be suggested by viewing not only technique development
(3) within the chiropractic profession
but the idea contained within Triano's "functional spinal lesion (FSL)
(4)." This term expresses "a spine related
disorder that involves function" as a dynamic model for inquiry as opposed
to the static model of subluxation as structure.
The global approach to inquiry involves functional changes in the body as
representative of more intrinsic function. While much of this is speculative,
a candidate proposal would view a computational model as more realistic in
evaluating the FSL in comparison to a restricted focus on the subluxation
complex of a wiring system schema. The computational model involves analysis
of data as part of an information system in which predetermined parameters
constitute the basis for data extraction and analysis. How this is done is
yet to be determined. It is, however, within a speculative mode that we might
examine the computational model as a possibility.
The mechanistic, engineering principles for inquiry deals with the "real,"
or tangible phenomenon of observable events. In this process, a cause/effect
relationship is established by association of the observable event or phenomenon.
To the linear mind, it is real to the extent that a direct relationship is
immediately apparent. What one sees (or feels), is what one describes as
an objective observation. If, as an example, one looks at the "world is flat"
view of things, one can take a palpatory walk along the spine and readily
see (and feel) an asymmetry of relationships to muscle tonicity that suggests
a subluxation, or "bone-out-of-place." In one sense, the notion of a bone
out of place would certainly suggest that it could be pressing on the muscle
in such a way as to "give the appearance" of a bone out of place (or an
anatomical displacement of structure). A more sophisticated view, however
(one punctuated by scholarly credentials), would assume that most certainly
the process involves more detail of explanation. That's the scientific method.
And it explains things. Or does it? If the arguments for either position
are so secure in their emphasis on the argument, why can replicability not
be produced in the manipulative protocol? Is the linear inquiry a reality?
Or is it an illusion to our senses ... and a delusion to our logical (linear)
If, however, one looks at the "world is round" view of things, one is able
to remove oneself from the immediate focal area and perceive a more global
view of things. In this sense, the computational model for inquiry takes
a perspective slightly removed from the immediate palpatory response that
satisfies our senses ... as well as our logical association of events. It
"zooms out" a little to take an overall perspective of the response. It removes
itself from the immediate sensory/logical pursuit of explanation and inquires
into nonlinear relationships ... that would not ordinarily be perceived by
Rather, in a context more suitable to the concept of functional changes,
the "world is round" view perceives the FSL as a reciprocal response to
adaptative postural mechanisms (in an aberrant behavioral context). It detects
more than one subluxation because it appears to identify the reciprocal groupings
of muscle that are constantly adapting to dynamics of postural change. If
change cannot occur, the FSL becomes recognizable as an aberrant behavior.
It does not permit the complex adaptive system to compromise its integrity
in control. In a sense, it appears to "splint" the area most vulnerable to
an "out of synch" global response. It would appear as a focal point by palpatory
definition and observation. In a broader sense, that local area merely represents
only one area of disturbed synchronization in the neurological control mechanism.
In other words, the computational model for inquiry suggests that the "world
is round" view of things may, indeed, be viewed from a perspective slightly
removed from immediate palpatory confinements. The computational model perceives
the FSL as a representation of aberrant dynamics, but only as a small part
of a chain of events that can only be viewed in an "out of context" relationship.
It cannot be viewed in its entirety without some tool for analysis of correlated
function. The recognition of spatial pattern changes in reflex activity (as
in applied kinesiology, sacro occipital technic, activator, etc.) as somehow
similar to mathematical searches for topographical spatial patterns can only
be suggestive, at this point, that further inquiry into chiropractic methodology
may be part of a computational problem of nonlinear dynamics rather than
a strictly static, linear relationship within reductionist perimeters.
The problem in
A dimensional perspective change (5)
must introduce a method (computation model) whereby data may be extracted.
That physiological response has not been a predictable event from procedural
intervention can be conceded, but reflects another critical problem in the
inquiry phase for epistemologic genesis. This involves the research/treatment
phase in procedural application (intentionality) and recognizes the inability
to format a correct application for the appropriate response. Quite simply,
the research agenda cannot formulate the questions necessary to stage the
experiment to the problem and expect to provide a satisfactory result.
The problem of staging the correct experiment stems from an inability to
understand the exact nature of a manipulative intervention at the various
spinal levels. Intervention at a single level follows neurological reflex
arc concepts that comply with reductionist perimeters of segmental pathways.
That multiple levels could be involved follow some of the concepts in recognition
of primary and secondary lesions as a possibility and may follow propriospinal
pathways. This perspective continues to follow reductionist, anatomical,
static reference points.
Part of the inability to produce a consistent result from experimentation
is the nature of the static reference point and where reductionist method
no longer applies at the staging level. It is at this point where information
strategy (the computational model) must apply its potential as a viable
alternative inquiry in theoretical formatting of experimental design; for
it is here where the attempt to differentiate spinal stresses in a dynamic
mode of evaluation occurs rather than the static mode that is usually represented
by radiographic examination or palpation.
The dynamic mode of evaluation is a pivotal departure from a static mode
of evaluation. It represents the possible ability (through computational
simulation) to differentiate immediate changes from a manipulative procedure
--- as well as contact reflex intervention via the peripheral nervous system.
That it is based upon changes in reflex activity is also a departure from
reductionist strategy and ventures into an abstract, problematic inquiry
that becomes an algorithmic extrapolation of an unknown factor. Whether computer
assisted correlation of reflex pattern changes could provide an ability to
trace sequences of change that might ultimately manifest as a reductionist
phenomenon, the physiological response, has yet to be determined.
The inability to trace pattern changes that result from manipulation as a
neurological perturbational response has prohibited an accurate staging in
experimental design by not being able to see (in a visual sense) the interrelated
effects of a multi level profile to the subluxation complex. It has focused
on the reductionist paradigm of single level lesions and somato visceral
response without understanding that a multi - dimensional organismic response
occurs that transcends the reductionist ability to trace overlapping
perturbational responses. It becomes that elusive, intangible epiphenomenal
variable that randomly produces an effect that is
placebo simply because it cannot be traced as an ordered
event or a reproducible phenomenon.
The implication for staging research inquiry is that, in order to produce
a measurable effect from manipulative procedure, multiple levels of reflex
pathways must be recognized as an integral part of the subluxation complex
and that a sequential decompression pattern could be possible as a prerequisite
for manipulative procedure to manifest an intrinsic effect. This implicates
a sensory dominant response by way of reflex activity and suggests a prominent
consideration in evaluating the subluxation complex.
Proposed Mechanisms of Actions for Chiropractic
Adjustments (These images and mechanisms are property (©) of Dr.
Andrew S. Bonci and are reproduced on the linked site with permission)
Keating JC. A survey of philosophical barriers to research
in chiropractic. J Calif Chiro Assn. 1989;33:4:184-186.
Bergmann TF. "Editorial: various forms of
chiropractic technique." Chiro Technique. 1993;5:53-55.
Triano JJ. The subluxation complex: outcome
measure of chiropractic diagnosis and treatment. Chiro Technique.
Keating JC. Philosophical barriers to technique
research in chiropractic. Chiro Technique. 1989;23-29.