CommentaryHistorical overview and update on subluxation theories☆
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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Cited by (21)
Prevalence of Chiropractic-Specific Terminology on Chiropractors’ Websites in the United Kingdom With Comparison to Australia: An Analysis of Samples
2021, Journal of Chiropractic HumanitiesCitation Excerpt :Early in the development of the chiropractic profession, practitioners created words, phrases, and usages to express traditional chiropractic-specific theories and concepts that were uniquely different from ones in mainstream health care. These theories and words are still used by some chiropractors.1-3 Maintaining a unique lexicon reinforced the fact that chiropractic was separate and distinct from other health care professions.4
Refining the biopsychosocial model for musculoskeletal practice by introducing religion and spirituality dimensions into the clinical scenario
2019, International Journal of Osteopathic MedicineStraight chiropractic philosophy as a barrier to Medicare compliance: A discussion of 5 incongruent issues
2013, Journal of Chiropractic HumanitiesCitation Excerpt :To most past speculation, a more detailed investigation is required to properly identify potential educational and practice issues that promote noncompliance with Medicare documentation. The purpose of this commentary was not to debate or define the term subluxation; thus, readers are directed to other publications on this topic.30-32 A specific and definitive cause-effect relationship cannot be established to demonstrate that training in chiropractic philosophy and technique play a role in preventing Medicare compliance.
Chiropractic management using a brain-based model of care for a 15-year-old adolescent boy with migraine headaches and behavioral and learning difficulties: A case report
2013, Journal of Chiropractic MedicineCitation Excerpt :Although there are a variety of techniques in chiropractic, there is generally a common thread among them of “adjusting” by hand or instrument. The change in structure or movement caused by the “adjustment” is hypothesized to change nervous system function, resulting in improved health.28 To determine where to manipulate, chiropractic relies on a wide variety of techniques that may include radiographs, biomechanics, leg length, palpation, and many others.29
The prevalence of chiropractic-related terminology on South African chiropractors’ webpages: a cross-sectional study
2023, Chiropractic and Manual TherapiesThe impact and public health response of chiropractors to the COVID-19 pandemic: a survey across four continents
2022, Chiropractic and Manual Therapies
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Previous presentation: Portions of this article were presented at Colloquium on “Reconciling Subluxation and Science,” Canadian Memorial Chiropractic College, October 25, 2009.