Commentary
Historical overview and update on subluxation theories

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Abstract

Objective

This article presents a personal view of the historical evolution of theories of subluxation in the chiropractic profession.

Discussion

Two major themes emerge from this review: those related to the mechanical behavior of the spine and those related to the neurologic implications of these mechanical issues. Chiropractic subluxation theory is one of the few health-related theories whereby these mechanical and neurologic theories have been unified into a comprehensive theory of disorder of spinal function. For this disorder, doctors of chiropractic have used the term subluxation. These theories, and their unification in the “subluxation concept,” have undergone evolution in the profession's history.

Conclusion

The “subluxation concept” currently faces challenges, which are briefly reviewed in this article. The only way forward is to strengthen our efforts to investigate the “subluxation concept” with high-quality scientific studies including animal models and human clinical studies.

Introduction

Manual therapy has, arguably, best been described by a Polish medical manipulation practitioner, Arkuszewski,1 as “a mechanical therapy with reflex effects.” The phrase mechanical therapy can be further characterized by noting that it is performed in the musculoskeletal (MSK) system. The phrase reflex effects can be further qualified, at the very least, to indicate that these are “health-beneficial.” Therefore, a revised version would read as follows:

“a manually-performed mechanical therapy to the MSK system with health-beneficial reflex effects.”

This formulation also provides a basis for describing the primary disorder posited by chiropractic theory: subluxation. Recognizing that, for chiropractic, the subluxation has always been viewed as the “thing for which adjustment (manual therapy) is done,” a first-pass definition of subluxation, a la Arkuszewski, would be “a mechanical problem in the musculoskeletal system with health-deleterious reflex effects.”

Since the founding of chiropractic and the other manual therapy professions, 2 fundamental issues have vexed us:

  • 1.

    What kind and location of mechanical problem in the MSK system qualifies as a subluxation (or any of the other terms used as synonyms within and outside of chiropractic)?

  • 2.

    What kind of health-deleterious effects are specifically associated with subluxation?

The author recognizes that numerous others have attempted to review the subluxation concept, including recent excellent reviews by Gatterman,2 Peters,3 and Ebrall.4 These previously published discussions are not reviewed here. What follows is a nonsystematic overview of selected developments in the profession that have addressed these 2 questions.

Section snippets

Discussion

The archetypical and founding event in the history of the chiropractic profession is Daniel David Palmer's first treatment of Harvey Lillard. From Palmer's original work,5 he describes his thinking leading up to this event as:

“Displacement of any part of the skeletal frame may press against nerves, which are the channels of communication, intensifying or decreasing their carrying capacity, creating either too much or not enough functionating [sic], as aberration known as disease.”

“Pressure on

Conclusion

These challenges to the “subluxation concept” are in their early days and, in many instances, are based on only one or a few studies. In several instances, these studies have involved healthy subjects or those with relatively mild symptom severity. In several studies, the manual therapy intervention might be regarded as nonspecific and, therefore, would not qualify as an “adjustment.” On the other hand, critiques could be made of the quality of many of the studies that formed the basis for what

Funding sources and conflicts of interest

No funding sources or conflicts of interest were reported for this study.

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