Transcript Introduction to Subluxation Theories notes

Theories of Subluxation An
Introduction
Philosophy 114
Victor G. Strang, D.C.
“Theoreticians of spinal manipulation,
at one time or another, have
implicated virtually every anatomical
component of the vertebral motor unit
in their attempts to explain the mode
of action of their therapy.”
Drum, 1975
Some proposed mechanisms:
theory
1. Restore vertebrae to
normal position
author
Galen (1958)
2. Straighten the spine
Pare (1958)
3. Restore blood flow
Still (1899)
4. Relieve nerve
compression
Palmer (1910)
Some proposed mechanisms:
theory
5. Relieve irritation of
sympathetic chain
author
Kunert (1965)
6. Mobilize fixated
vertebral segments
Gillet (1968)
7. Shift fragment of
IVD
Cyriax (1975)
Some proposed mechanisms:
theory
8. Mobilize posterior
joints (z-joints)
author
Mennell (1960)
9. Remove interference
with CSF circulation
DeJarnette (1967)
10. Stretch contracted
muscles
Perl (1975)
Some proposed mechanisms:
theory
author
11. Correct abnormal
Homewood (1963)
somatovisceral reflexes
12. Remove “irritable”
spinal lesions
Korr (1976)
13. stretch/tear adhesions Chrisman (1964)
around nerve roots
Some proposed mechanisms:
theory
author
14. Reduce distortions
Farfan (1973)
of the annulae (annulus
fibrosus
Neurobiologic Mechanisms of Manipulative
Therapy, 1978
Areas of Research Involved in Mechanism of Action of
Adjustments/Chiropractic Corrective Procedures
Adjustment/Corrective procedure
2
Change in the musculoskeletal system
1
3
Change in the nervous system
4
Change in organ dysfunction or
tissue pathology or symptom
complex
Major Subluxation Theories
(Dr. Charles Henderson, PCC Researcher)
• IVF Encroachment
• Altered Sensory Input (dysafferentation)
• Spinal Cord distortion
“Little scientific information is currently
available to resolve the questions of
impact on human health that the FSL
(functional spinal lesion) may have.”
Triano, 1992
How do chiropractors evaluate
individuals clinically to determine the
appropriateness of chiropractic care?
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Biomechanical evaluation
Neurologic evaluation
Trophic assessment
Psychosocial assessment
From Mootz, Chapter 10, Gatterman’s 1995 text;
Foundations of Chiropractic: Subluxation
Biomechanical Evaluation
• Contributing mechanical etiologies: (trauma,
repetitive postural activities, etc..)
• Static asymmetries: (high shoulder, altered
curves, rotated foot, etc…)
• Dynamic asymmetries: (gait, other movements)
• Passive and active individual joint ranges of
motion: (static and motion palpation)
• Imaging procedures used to evaluate the above
(x-ray, static and stress views, videoflouroscopy)
Neurologic Evaluation
• Symptoms (pain and its location and
distribution from patient interview)
• Palpatory tenderness
• Altered muscle tone (palpation, EMG)
• Vasomotor findings (thermography)
• Sudomotor findings (palpation and
galvanic skin response testing)
Trophic Assessment
• Altered tissue texture
• Edema (signs of inflammation)
• Metabolic disturbances
• Nutritional imbalances
These may be signs of aberrant local tissue
metabolism or vascularity; metabolic
disturbances and nutritional factors may
be causative or complicating factors in
somatic disturbances, e.g… “proinflammatory state”
Psychosocial Assessment
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Mental attitude/outlook
Social interactions
Lifestyle habits
Stress
Biomechanical Models of
Subluxation
• Vertebral/spinal misalignment
• Abnormal motion; fixation,
hypermobility, compensation reaction
• Joint dysfunction progressing to
spinal degeneration
Neurological Models
• Neurologic compression/traction/torsion;
affecting nerves, roots, cord
• Neurologic irritation
• Aberrant reflexes
• Deafferentation/dysafferentation
• Neurodystrophic effects
Trophic Models
• Axoplasmic flow mechanisms
• Neurologic ischemia, macro and
micro
• Lymphatic/venous stasis
• CSF flow dynamics
Psychosocial Models
• Psychogenic concepts:
mental/emotional state influence on
structure
• Somatopsychic concepts: structural
influence on mental/emotional states