Subluxation: A language, a biomechanical process, and an untenable theory with real pathophysiological effects.

LANGUAGE

All words belong to a language, or often multiple languages, can have very singular meanings or have many meanings and interpretations. Such is the case concerning the term subluxation. It is a term that belongs to many languages, be it the language of allopathic physicians, chiropractors or historians, and has multiple meanings and interpretations, whether as a word belonging to multiple languages or different interpretations within the same language. As the great Stephen Fry and Hugh Laurie said “we are talking about language” (1). As noted by Budgell (2015), the medical community used the term subluxation long before chiropractic adopted it, but over time the interpretation and meaning of the word separated between the two professions and perhaps most importantly within the profession of chiropractic itself (2). The potential interpretations and meanings of the term subluxation will be discussed in the following section.

 

BIOMECHANICS 

The bone out of place belief held by the professions founders, was actually relatively in line with what the medical community was using the term subluxation for (3). In fact in many ways it is exactly the same; as luxation means dislocation, sub meaning less than, in which case sub-luxation literally means less than a dislocation, referring to a bone out of place but not so out of the place to be dislocated. This description is the exact description of a subluxation used by many chiropractors, in essence a bone out of place not appreciable on a radiograph, yet still clinically significant.

 

PATHOPHYSIOLOGICAL EFFECTS

The original pathophysiological belief or interpretation of subluxation was Above Down Inside Out or ADIO (3). The biomechanical event is centered around a vertebra out of place, thus blocking nervous flow (3). This theory has no supporting evidence and should be largely credited solely as historical fact and precedence, yet unfortunately may chiropractors and chiropractic colleges choose to subscribe, in spite of the evidence, to this concept as aged as bloodletting. According to Ross there are six other theories, and the likliehood is that all of them contribute to some degree (3). In short, the six theories involve the following elements; activation of golgi tendon organs and muscle spindles, simulation of mechanoreceptors, the breaking of joint adhesions, the freeing of trapped meniscoid, the restoration of movement along with joint lubrication, and the release of endorphins (3). My own personal experience would lead me to believe certainly in the release of endorphins and the restoration of movement and joint lubrication.

 

Clinical Syndromes and Possible Effects of the Adjustment

There are many theories as to the effects of the adjustment, and as reiterated by Ross, they all may play a contributing part to the total effects of synovial joint adjustment (3). Elements of the various theories include: stretching of intrafusal fibers against muscle spindles, the stimulation of relexogenic effects, the suppression of pain via multiple pathways, such as the aforementioned impulse of endorphins, the breaking of joint adhesions or the freeing of a trapped meniscoid (3). To summarize, say “Adieu!” to the ADIO theory, and be prepared to accept the reality of the constant search for answers and the power and wisdom contained in the literature of today and our future.

 

REFERENCES

  1. A Bit of Fry and Laurie. BBC; 1995.
  2. Budgell B. A linguistics perspective on the word subluxation in the chiropactic literature. Lecture presented at; 2015; CMCC.
  3. Ross K. The Chiropractic Theories. Presentation presented at; 2017; CMCC.
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