Vertebral subluxation represents the heart and soul of chiropractic. It is our “raison d’etre” as a profession. Yet, to many chiropractors, it remains a clinical conundrum. I believe that the controversy and confusion surrounding the chiropractic concept of vertebral subluxation is due to the lack of an operational definition which is compatible with most techniques.
A review of models of vertebral subluxation has been published elsewhere (1). However, regardless of the elegance of a theoretical model, it must be capable of being operationalized if it is to be used to develop clinical strategies.
The three-dimensional model was developed as an initial step in the operational definition of vertebral subluxation. It incorporates traditional chiropractic constructs, and serves as a bridge to contemporary technology.
As Lantz noted, “Common to all concepts of subluxation are some form of kinesiologic dysfunction and some form of neurologic involvement.” (2)
The 3-D model of vertebral subluxation has three components. Each component may be reliably measured using appropriate instrumentation. These measurements provide objective evidence concerning manifestations of vertebral subluxation. The three components are:
1. DYSKINESIA. Dyskinesia refers to distortion or impairment of voluntary movement (3). Spinal motion may be reliably measured using inclinometry (4). Alterations in regional ranges of motion are associated with subluxation (5).
2. DYSPONESIS. Dysponesis is abnormal involuntary muscle activity. Dysponesis refers to a reversible physiopathologic state, consisting of errors in energy expenditure which are capable of producing functional disorders. Dysponesis consists mainly of covert errors in action potential output from the motor and premotor areas of the cortex and the consequences of that output. These neurophysiological reactions may result from responses to environmental events, bodily sensations, and emotions. The resulting aberrant muscle activity may be evaluated using surface electrode techniques (6). Typically, static SMEG with axial loading is used to evaluate innate responses to gravitational stress (7).
3. DYSAUTONOMIA. The autonomic nervous system regulates the actions of organs, glands, and blood vessels. Acquired dysautonomia may be associated with a broad array of functional abnormalities (8,9,10,11,12.13). Autonomic dystonia may be evaluated by measuring skin temperature differentials (14). Uematsu et al determined normative values for skin temperature differences based upon asymptomatic “normal” individuals. The authors stated, “These values can be used as a standard in assessment of sympathetic nerve function, and the degree of asymmetry is a quantifiable indicator of dysfunction…Deviations from the normal values will allow suspicion of neurological pathology to be quantitated and therefore can improve assessment and lead to proper clinical management.” (15) Skin temperature differentials are associated with vertebral subluxation (16).
This three-dimensional model may be used with any technique which has, as its objective, the detection, management, or correction of vertebral subluxation. Correction of vertebral subluxation facilitates the restoration of proper tone throughout the nervous system.
Health is dependent upon maintaining appropriate tone in the nervous system. As D.D. Palmer explained, “Life is action governed by intelligence. Intelligent life, the soul, depends upon the execution of functions. Functions performed by normal energy is health. Disease is the result of the performance of functions above or below a normal degree of activity. Impulses properly transmitted through nerves, result in functions being normally performed, a condition which results in health.” (17)
The ability to maintain tone requires a nervous system free of interference. Restoration of tone is dependent upon correction of vertebral subluxations. Alterations in the tone of the somatic system may be objectively evaluated using surface EMG. Altered autonomic tone may be evaluated using skin temperature measurements. Changes in ranges of motion may be measured to assess dyskinesia. Such objective assessments have the potential to make chiropractic the dominant strategy of 21st century health care.
References
1. Kent C: “Models of vertebral subluxation: a review.” Journal of Vertebral Subluxation Research 1996;1(1):11.
2. Lantz CA: “The subluxation complex.” In: Gatterman MI (ed): “Foundations of Chiropractic Subluxation.” Mosby, St. Louis, MO, 1995.
3. “Dorland’s Pocket Medical Dictionary.” 25th edition. WB Saunders Company. 1995.
4. Saur PM, Ensink FB, Frese K, et al: “Lumbar range of motion: reliability and validity of the inclinometer technique in the clinical measurement of trunk flexibility.” Spine 1996;21(11):1332.
5. Blunt KL, Gatterman MI, Bereznick DE: “Kinesiology: an essential approach toward understanding the chiropractic subluxation.” Chapter 11. In: Gatterman MI (ed): “Foundations of Chiropractic Subluxation.” Mosby, St. Louis, MO. 1995.
6. Whatmore GB, Kohi DR: “Dysponesis: a neurophysiologic factor in functional disorders.” Behav Sci 1968;13(2):102.
7. Kent C: “Surface electromyography in the assessment of changes in paraspinal muscle activity associated with vertebral subluxation: a review.” Journal of Vertebral Subluxation Research 1997;1(3):15.
8. Backonja M-M: “Reflex sympathetic dystrophy/sympathetically mediated pain/causalgia: the syndrome of neuropathic pain with dysautonomia.” Seminars in Neurology 1994;14(3):263.
9. Goldstein DS, Holmes C, Cannon III RO, et al: “Sympathetic cardioneuropathy in dysautonomias.” New Engl J Med 1997;336(10):696.
10. Vassallo M, Camilleri M, Caron BL, Low PA: “Gastrointestinal motor dysfunction in acquired selective cholinergic dysautonomia associated with infectious mononucleosis.” Gastroenterology 1991;100(1):252.
11. Baron R, Engler F: “Postganglionic cholinergic dysautonomia with incomplete recovery: a clinical, neurophysiological and immunological case study.” J Neurol 1996;243:18.
12. Soares JLD: Disautonomias. “Acta Medica Portuguesa” 1995;8(7- 8):425. Written in Portuguese. English abstract.
13. Stryes KS: “The phenomenon of dysautonomia and mitral valve prolapse.” J Am Acad Nurse Practitioners 1994;6(1):11.
14. Korr IM. The Collected Papers of Irvin M. Korr. American Academy of Osteopathy. Indianapolis, IN. 1979.
15. Uematsu S, Edwin DH, Jankel ER, et al: “Quantification of thermal asymmetry.” J Neurosurg 1988;69:552.
16. Kent C, Gentempo P: “Instrumentation and imaging in chiropractic: a centennial retrospective.” Today’s Chiropractic 1995;24(1):32.
17. Palmer DD: “Text-book of the Science, Art and Philosophy of Chiropractic for Students and Practitioners.” Portland Printing House Company. Portland, OR. 1910. Page 661.
