In chiropractic, a vertebral subluxation is an unintentional mistaken of the spine, not always seen in X-rays, leading to a set of signs and symptoms sometimes called complex subluxation subluxation . It has no biomedical basis, has no clinical significance, and is categorized as pseudoscientific by a leading chiropractic authority. Traditionally, the "special focus of chiropractic practice" is the subluxation of chiropractic and the practice of chiropractic historically assumes that vertebral subluxation or spinal cord dysfunction interferes with the functioning of the body and its innate intelligence, as promulgated by D. D. Palmer, chiropractic inventor.
The chiropractic subluxation is the heart of the split between "straight" chiropractors and "mixers". Chiropractors continue to follow Palmer's vitalistic tradition, claiming that subluxation has considerable health effects and also adds visceral components to the definition, while the mixer, as exemplified by the British Chiropractic Council, considers it a historical concept with no evidence to identify it. causes of disease.
In the chiropractic tradition, the vertebral subluxation complex is believed to be a dysfunctional biomechanical spinal segment that actively alters neurological function, which, in turn, is believed to cause neuromusculoskeletal and visceral disorders. WHO recognizes this difference between the medical and chiropractic definitions of subluxation: doctors refer only to "significant structural displacements" as subluxations, whereas chiropractors show that dysfunctional segments, whether displaced significantly or not, should be referred to as subluxations. This distinction has been noted in the proceedings of the chiropractic profession Consensus Conference of the Mercy Center : "Chiropractic profession refers to this concept as 'subluxation' This uses the word
The vertebral chiropractic of complex subluxation has been the source of controversy since its foundation in 1895 because of the lack of empirical evidence for its existence, its metaphysical origin, and claims of far reaching effects on health and disease. Although some chiropractic associations and colleges support the concept of subluxation, many of the chiropractic professions reject it and avoid using this term as a diagnosis. In the United States and in Canada the term nonallopathic lesions may be used instead of subluxation .
In 2015, the internationally accredited chiropractic college from Bournemouth University, the University of South Wales, the University of Southern Denmark, the University of ZÃÆ'¼rich, the Franco-Europà © à © en de Chiropraxie and the University of Johannesburg made an open statement which included: "The teaching of the vertebral subluxation complex as a construct vitalistic 2 which claims that it is the cause of the disease is not supported by the proof of its inclusion in the modern chiropractic curriculum in any case other than the historical context is therefore inappropriate and unnecessary. "
Video Vertebral subluxation
History
In 1909 B. J. Palmer wrote that:
- "Chiropractors have found in every infectious disease, a spinal cord In our vertebral column will find subluxations corresponding to each type of disease If we have a hundred cases of smallpox, I can prove to you where, on the one, you will find the subluxation and you will find the same conditions in the other ninety nine. I adjust one and restore its function to normal.... No infectious disease.... No infection....There are internal human causes that make from its body in certain place, more or less as breeding ground for microbes. places where they can multiply, spread, and then because they become so numerous, they are classified as causes. "- BJ Palmer, The Philosophy of Chiropractic , V. Davenport, IA: Palmer School of Chiropractic; 1909
Maps Vertebral subluxation
Definitions
Definition and status
The WHO definition of chiropractic spinal subluxation is:
- "A lesion or dysfunction in a joint or motion segment in which alignment, integrity of movement and/or physiological functions are altered, even though the contact between the joint surfaces remains intact.This is essentially a functional entity, which may affect biomechanics and integrity nerves. "
Acknowledged displacements are not always seen in static imaging studies, such as X-rays. This is in contrast to the medical definition of spinal subluxation which, according to WHO, is "significant structural displacement" , and therefore seen in X-rays.
In 2014, the National Chiropractic Examiner Council states:
- "The specific focus of chiropractic practice is known as chiropractic subluxation or joint dysfunction Subluxation is a health problem manifested in bone joints, and, through complex anatomical and physiological relationships, affects the nervous system and may lead to reduced function, defects , or illness. "
In 1996 a formal consensus definition of subluxation was formed. Cooperstein and Gleberzon have described the situation: "... though many in the chiropractic profession reject the concept of" subluxation "and avoid the use of this term as a diagnosis, the president of at least a dozen chiropractic colleges of the Association of Chiropractic Colleges (ACC) developed the definition of" subluxation "consensus" in 1996. It reads:
- "Chiropractic is concerned with the preservation and recovery of health, and focuses particular attention on subluxation Subluxation is a functional and/or structural functional and/or pathological pathological change that compromises the integrity of the nerves and may affect the functioning of the organ system and general health. Subluxation is evaluated, diagnosed, and managed through the use of chiropractic procedures based on the best available rational and empirical evidence. "
In 2001, the World Federation of Chiropractic, representing a national chiropractic association in 77 countries, adopted this consensus statement that reaffirmed belief in vertebral subluxation.
The ACC paradigm has been criticized by chiropractic writers:
- "Overall, the ambiguity that seeps into the ACC statement on subluxation makes it inadequate as a guide to clinical research... Whether ACC subluxation claims have succeeded because political statements are beyond our concern here, statements published as a priori truth (what many chiropractors are traditionally referred to as "principles"), and is an example of a scientifically unjustifiable statement made in many professions.It is important not whether unproved statements are offered for clinical, political, scientific, educational, marketing or other purposes, when offered without recognizing their tentative character, they amount to dogmatism. We argue that efforts to cultivate unity (between schools or in the wider profession) at the expense of scientific integrity ultimately harming oneself ensuring, the lack of professional cultural authority is equal n is based on the disunity of our characteristics.However, the effort to produce a union by adopting a general dogma can only bring about the ridicule and continuing alienation of the broader health care community and the communities we all serve. "
In May 2010, the Chiropractic Council General, the legal regulatory body for chiropractors in the United Kingdom, issued a guide for chiropractors stating that the complex subluxation of the chiropractic spine "is a historical concept" and "not supported by clinical research evidence that would allow claims to be made that it is the cause of disease or health problems. "
ICD coding
The distinction between medical subluxation and chiropractic "vertebral subluxation" creates confusion and difficulty when it comes to following official ICD-9 and ICD-10 codes. In a 2014 article on Chiropractic Dynamics by chiropractors who are certified professional coders, these difficulties are discussed in detail. He noted that the WHO recognizes the distinction between two types of "subluxation", and also points out certain difficulties for chiropractors:
- "... the official definition of 739 code is" nonallopathic lesion, not classified elsewhere.... In other words, 739 is a code that does not describe subluxation. It does not even say what the patient has; he says that there is no code to describe what the patient has.... [T] he is elusive "vertebral subluxation complex" I learned about in school not having a place in the ICD-9 code set. What we got is 739, which is code for conditions that do not have code. "
- "The ICD-9 never gives code that really describes this and distinguishes between chiropractic subluxation and allopathic subluxation.Chiropractors have been forced to try to adjust the square peg into round holes for years. "
At the time of writing (August 2014) it is uncertain which code in the newer ICD-10 will be useful for chiropractors and how they will be interpreted.
Components
Traditionally there are 5 components that make up chiropractic subluxation. The vertebral subluxation complex is distinguished by the fifth component, a common secondary systemic disorder to spinal misalignment (vertebral subluxation).
- Spinal Kinesiopathology
- Neuropathophysiology/Neuropathology
- Myopathology
- Histopathology
- Pathophysiology/Pathology
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Historically, spinal misalignment detection (subluxation) by the chiropractic profession has relied on X-ray findings and physical examination. At least 2 of the following 4 physical signs and/or symptoms should be documented to be eligible for replacement:
- Pain and tenderness
- Asymmetry/misalignment
- Range of motion abnormalities
- Network/tone changes
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It has been suggested that negative vertebral subluxation can affect general health by altering neurological communication between the brain, spinal cord and peripheral nervous system. Although individuals may not always be symptomatic, chiropractors directly believe that the presence of vertebral subluxation is itself a justification for correction through spinal adjustment.
The vertebral subluxation chiropractic treatment focuses on providing chiropractic adjustment which is a high-speed low amplitude (HVLA) thrust into the dysfunctional spinal segment to help repair the chiropractic subluxation complex. Spinal adjustment is the main procedure used by chiropractors in adjustment. Adjustment/manipulation has been shown to help with low back pain, neck pain and tension headache, but further research is inconclusive about the use of spinal manipulation outside the treatment of neuromusculoskeletal disorders.
Rationale and dispute
In 1910, D.D. Palmer, founder of chiropractic, writes:
- "Physiologists divide the nerve fibers, which form the nerves, into two classes, afferent and efferent." Impressions are made at the ends of peripheral afferent fibers, creating a sensation transmitted to the central nervous system. "The efferent nerve fibers carry an outlet impulse from center to end Most of them get into the muscles and therefore are called motor impulses, some of which are secretions and enter the glands, some inhibit their function to withstand secretions, outgoing impulses and inward sensations.This activity of the nerves, or more precisely the fibers, can become excited or healed by impingement, the result is a modification of the function - too much or not enough action - uncomfortable. "/dd>
Chiropractors use and have used various terms to express this concept: subluxation, vertebral subluxation (VS), vertebral subluxation complex (VSC), "killer subluxation," and "silent killer."
They, along with some physical therapists and osteopathic doctors, have also used another term, BOOP, which means "bone is out of place."
Some chiropractors have described the disagreement in the profession of the concept, and have skeptically written about BOOP as an ancient idea. In 1992 one wrote:
- "The main problem we often face is the concept of bone out of place (BOOP).It seems we somehow stepped on our feet when we describe the spine as a functioning entity rather than a pile of bones that can move back and forth to the ideal configuration The concept of BOOP will eventually fade, and we are grateful for its contribution to chiropractic, for decades, it offers models to work out of this model has been updated by other healing professions, but the chiropractors have been hesitant to let this ancient model go. in the profession we hold on to this model with religious fervor.The chiropractic profession has moved on to the new age.The concept of BOOP has been renewed and science has been in us in 90. Let's start asking more questions and encourage chiropractic professions that kick and shout into the 21st century. "
One wrote in 1994 about "brutal civil war":
- "According to various chiropractic gossip columnists, our profession seems to be presently engaged in a brutal civil war between practitioners of BOOP (bone-out-places) and low-back pain practitioners.Not to be known that BOOPers incorrectly call themselves practitioners based on sub-lxation My experience has shown that BOOPers do not know enough about subluxation to call themselves chapopractors based on subcapulation.We should not be a BOOP-based subluxation, it is known that this so-called war is really a dramatized battle between vocal BOOPers and theoretical group of DC anti-chiropractic.I have never met this DC anti-chiropractic.Unfortunately, BOOPers seems to think that those who do not embrace the totality of the BOOP philosophy are non-BOOPERs who are still very pro-chiropractic and appreciate chiropractic philosophy from a contemporary and non-perspectival perspective -dogmatis. "
Ten years later (in 2004) he was openly dismissive of the notion that "modern proponents of this concept are still saying":
- "... it is basically impossible to have a nervous breakdown.To summarize, neurological disorders are described, by the modern proponents of this concept, as the reduction of nerve or mental impulses, which occurs in response to bone-out-of subluxation (BOOP)... Obviously, the model of BOOP subluxation fails miserably when considered in light of the facts of basic neuroscience... BOOP subluxationists become angry and defensive when the BOO model of subluxation is criticized... The particular reactionary nature of the BOOP's subluxology is to accuse them who did not buy the BOOP model as anti-chiropractic - a surprising leap of ignorance, to say the least.Next, anyone who does not buy into the model is trying to "treat chiropractic" - another example of low IQ thinking, and if tears do not rise in the eyes When you hear the phrase, "The power that makes the body, heals the body," you are accused of not having passion for chiropractic - still another example of d activated front lobe activity. Worse, if you do not buy into any strange, New Age, the tree-embracing the idea that comes a spear and circular tied to subluxation, you will be accused of being an atheist - a very good example of the psychiatrists and medicines they prescribe. "
Functional hypothesis
V. Strang, D.C., explains some hypotheses about how a parallel vertebra can cause a nervous system disorder in his book, Chiropractic Important Principles :
- The nerve compression hypothesis: shows that when the vertebrae are not parallel, the nerve roots and/or spinal cord can be pinched or irritated. While the hypothesis is most often referenced, and the easiest to understand by the patient, perhaps the most likely to occur.
- The proprioceptive avoidance hypothesis: focuses on the articular changes that lead to hyperactivity of sensory nerve fibers.
- Somatosympathetic reflex hypothesis: all visceral organ functions can be reflexively affected by skin or muscle stimulation.
- The somatosomatic reflex hypothesis: the afferent impulse of one part of the body can produce reflex activity in the rest of the body.
- The viscososomatic reflex hypothesis: the visceral afferent fibers cause a reflex somatic problem.
- Somatopsychic hypothesis: the effect of subluxation on the ascending path of the reticular activating system.
- Neurodystrophic hypothesis: focuses on the reduction of tissue resistance resulting from abnormal innervation.
- Hypothesis deviation of dentate ligaments: upper cervical misalignment may cause dentate ligaments to cause pressure on the spinal cord.
- Psychogenic hypothesis: emotions, such as stress, cause contraction of the skeletal muscle.
Vertebral subluxation has been described as a syndrome with signs and symptoms that include: altered alignment; deviant movement; soft tissue change is palpable; localized pain/referral; muscle contraction or imbalance; changes in physiological function; reversible with adaptation/manipulation; focal softness.
Scientific investigation
Believers in the chiropractic tradition affirm that the health and function of the spine are directly related to general health and wellbeing, including visceral disorders, but the effectiveness and validity of spinal manipulation to address visceral disorder systems remains a source of controversy in the chiropractic profession. Although research is ongoing on this topic, the conclusions that support the usefulness of spinal manipulation for organic disorders remain to be seen. In addition, to complicate matters, chiropractic professors and researchers, Nansel and Szlazak, found that:
Appropriate diagnosis of somatic (musculoskeletal) vs. visceral (organ) dysfunction is a challenge for medical doctors and chiropractic. The mechanism of afferent convergence, which can create signs and symptoms that are virtually indistinguishable with respect to their somatic vs. visceral ethology, suggests it is unreasonable that the mimicry of this somatic visceral disease could severely explain the "cure" of suspected organ disease that has been observed during many years in response to various somatic therapies (eg spinal manipulation, acupuncture, Rolfing, Qi Gong, etc.) and may represent a common phenomenon that has led to "holistic" health care claims in sections such as clinical discipline.
Considering this phenomenon, Seaman suggests that the chiropractic concept of complex (somatic) joint dysfunction should be incorporated into the differential diagnosis of visceral pain and symptom as this dysfunction often produces symptoms similar to those produced by genuine visceral disease and notes that this mimicry leads to a surgical procedure and unnecessary drugs.
Other chiropractic researchers also questioned some of the claimed effects of vertebral subluxation:
The literature supports the existence of somatovisceral and viscerosomatic reflexes, but there is little or no evidence to support the idea that spinal disorders (often referred to as subluxation by chiropractors) may cause a prolonged release of this reflex. Equally unsupported in the literature is the notion that the prolonged activation of this reflex will manifest into the pathological state of tissue, and most relevant, that the application of spinal manipulative therapy may alter prolonged reflex discharge or be associated with reversal of pathological degeneration of reflexes or tissues exposed. The evidence collected is largely anecdotal or case report and has attracted many intra-disciplinary debates because it is often associated with certain approaches to management (commonly described as traditional or "philosophical").
Still other chiropractic researchers state directly:
... the early chiropractic philosophy... is considered the outcome disease of spinal cord dysfunction caused by misplaced (subluxation) of the spine. Although rejected by medical science, this concept is still [2000] accepted by a small part of chiropractors... Indeed, many progressive chiropractive have rejected the historical concept of chiropractic subluxation in favor of those who more accurately describe the nature of complex joints. the dysfunction they are treating. "
Professor Philip S. Bolton of the School of Biomedical Sciences at the University of Newcastle, Australia wrote in the Journal of Manipulative and Physiological Therapeutics, "The traditional chiropractic spinal subluxation hypothesis suggests that vertebral misalignment causes disease, disease, or both." The hypothesis is controversial. The aim is, "To briefly review and update experimental evidence about the reflex effects of vertebral subluxation, particularly concerning the peripheral nervous system response to vertebral subluxation Source: Information obtained from chiropractic or scientifically reviewed literature on studies in humans or animals from "Animal models show that vertebral displacement and vertebral subluxation are thought to modulate activity in Group I to IV afferent nerves, but it is unclear whether afferent nerves are modulated during normal daily life activities and, if so, what segmental or whole body reflex effects they may have. "
Criticism
Edzard Ernst has stated that "the core concepts of chiropractic, subluxation and spinal manipulation, are not based on sound science."
An area of ​​debate among chiropractors is whether "vertebral subluxation" is a metaphysical concept (as assumed in the chiropractic philosophy of B. J. Palmer) or a real phenomenon.
In an article on vertebral subluxation, chiropractic writers wrote:
Subluxation syndrome is a valid theoretical construct, potentially testable, with little experimental evidence. Acceptable as a hypothesis, a broad statement of the clinical significance of this idea brings the ridicule of the scientific community and health care and confusion in the chiropractic profession. We believe that the orientation of evidence between chiropractors requires that we distinguish between subluxation of dogma vs. subluxation as a potential focus of clinical research. We lament the effort to generate unity in the profession through consensus statements about the dogma of subluxation, and believe that cultural authority will continue to avoid us as long as we affirm the dogma as if it were validated clinical theories.
From the beginning, the concept of vertebral sublucation has become the source of the definition debate. Tedd Koren, DC offers this explanation as a possible cause of confusion:
Vertebral subluxation can not be defined precisely because it is an abstraction, an intellectual construct used by chiropractors, chiropractic researchers, educators and others to explain the success of chiropractic adjustment.
This is not a unique state, abstract entities fill many branches of science...
Subluxation, gene, gravity, ego and life are all heuristic devices, "useful fiction" used to explain phenomena far greater than ours. We use them as long as they work for us and discard or restrict their applications when they are laborious or unable to explain new observations...
Chiropractic critics have mistakenly assumed that chiropractic is based on the theory or principle that vertebral subluxation causes the nerve to be "pinched" that causes disease. They have it backwards. Chiropractic is based on the successful adjustment of the spine. The theory that tries to explain the success of adjustment (nerve impingement, disease, subluxation) follows its clinical findings.
Examples of false criticisms based on the straw man argument are abundant in the medical literature. Some examples: "Teachers, research workers, and medical practitioners reject the so-called principle in which chiropractic is based and rightly and bluntly renamed it as deceit and deceit in the human race." "The basis of chiropractic is totally unscientific." The underlying theory of chiropractic [is false], namely that the "subluxation" of the spinal vertebra suppresses the nerves that interfere with the downward energy flow causing nerves to the organs supplied by the nerve, and chiropractic "adjustment" can relieve the pressure thereby curing or preventing the disease. There is no scientific evidence for the validity of this theory. "
To be fair, statements by some chiropractors tend to perpetuate this misunderstanding: "Pressure on the nerves causes irritation and tension with mad functions as a result."
When chiropractors state that the "pinched nerve" "nerve impaction" "spinal fixation" or other mechanism of action explains how subluxation affects people and how chiropractic works they make the same mistakes of medical criticism - chiropractic assumptions are based on theory. Mechanisms and theories are useful tools, but their limitations must always be remembered.
Other chiropractors have declared their unproven status as an area to reform:
Some may suggest that chiropractors should promote themselves as experts in "correcting vertebral subluxations." However, scientific literature has failed to show the existence of subluxation. Until and unless sound research published in credible journals indicates the existence and identification of reliable vertebral subluxations, and vertebral subluxation is found to be an important public health problem, the general population will not be concerned with its improvement. Thus, "subluxation correction" alone is not an appropriate choice for the future of chiropractic.
Beth Israel Deaconess Medical Center article illustrates the ultimate understanding of vertebral subluxation theory:
From its origin, chiropractic theory has based itself on "subluxation," or vertebra that has shifted position in the spine. This subluxation is said to inhibit the flow of nerves and cause disease in various organs. Chiropractic treatment should "restore" this "emerging" vertebra. For this reason, this is called "adjustment."
However, no concrete evidence has ever been presented which suggests that certain chiropractic treatments alter the position of any vertebrae. In addition, there is no concrete evidence that neural tube disorders are a major contributor to a common disease, or spinal manipulation alters the nerve flow in such a way that it affects organ function.
In 2009, four academic chiropractors concluded that epidemiological evidence does not support the most basic theory of chiropractic. From the beginning, most chiropractors have postulated that "subluxation" (misalignments) are the underlying causes or causes of ill health and can be corrected with "adjustment" of the spine. After searching the scientific literature, chiropractic authors conclude:
No supporting evidence was found for chiropractic subluxation associated with disease processes or creating suboptimal health conditions requiring intervention. Regardless of the popular appeal, this leaves the construction of subluxation in the area of ​​unsupported speculation. This lack of supporting evidence suggests that subluxation constructs have no valid clinical application.
In 2005, four prominent chiropractic researchers voiced a strong critique of chiropractic dogma:
Finally, the ACC claims that chiropractors use the 'best rational and empirical evidence' to detect and repair subluxations. It attacks us as pseudoscience, because the ACC does not offer any evidence for the statements they make, and since the amount of all the evidence we are aware of does not allow conclusions about the clinical significance of subluxation. To our knowledge, the available literature does not lead to the preferred method of detection and corrective subluxation, or clinical practical methods for measuring compromised "neural integrity" or any health benefits that may result from subluxation correction.
In 2015, the internationally accredited chiropractic college from Bournemouth University, the University of South Wales, the University of Southern Denmark, the University of ZÃÆ'¼rich, the Franco-Europà © à © en de Chiropraxie and the University of Johannesburg made an open statement which included: "The teaching of the vertebral subluxation complex as a construct vitalistic 2 which claims that it is the cause of the disease is not supported by the proof of its inclusion in the modern chiropractic curriculum in any case other than the historical context is therefore inappropriate and unnecessary. "
References
External links
- Vertebral Subluxation in Chiropractic Practice - Chiropractic Practice Board
- Vertebral Subluxation Models: Review - Christopher Kent, DC
- Subluxation of Elusive Chiropractic - Stephen Barrett, M.D.
- Subluxation - The Silent Killer - Ronald Carter, DC, MA, Past President, Canadian Chiropractic Association
Source of the article : Wikipedia
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