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Chiropractic Journal of Australia : CJA March 2013
2 Chiropractic Journal of Australia Volume 43 Number 1 March 2013 The title of this essay was chosen deliberately as it conveys a message similar to that of medicine demonstrating that medicine is also based on theory. The term "theory of medicine" is still in current usage. In relation to the vertebral subluxation, the term theory was used in the title as the vertebral subluxation qualifes more as a hypothesis, which is defned as "a suggested explanation for a group of facts, accepted either as a basis for further verifcation or as likely to be true.”1 Models of the vertebral subluxation hypothesis underpinning chiropractic as a profession, have been discussed in detail over the years.2,3 There are however reservations in some quarters as to the veracity of this basic principle of chiropractic, despite well documented research and clinical results.4 The vertebral subluxation has been widely acknowledged in the bioscience literature, chiropractic colleges, in legislation, and by the major health professions - including medicine. This acknowledgement takes a variety of designations and similes,5 suggesting that the chiropractic subluxation takes into consideration a broader pathophysiological and clinical perspective than just a mechanical displacement; thus the more comprehensive designation of a complex -- the appellation Vertebral Subluxation Complex, (VSC).6 It is noted that physiology of joints refers to normal joint movement7 so that pathophysiology is but one factor in the complex. Regardless of the name used for this clinical fnding, the evidence is overwhelming that 'something' exists which is associated with recognised and recognisable signs and symptoms of certain spine-related conditions presenting in patients. THE PROBLEM In essence, some parties including a splinter group of chiropractors, seem to claim that there is no proof that the vertebral subluxation exists. They seem to ignore the tenet that "absence of proof is not proof of absence."8 "Even worse is to ignore the evidence and declare that there is none, or to hide a political agenda behind a pseudoscientifc argument.”9 An authority on the topic,Gatterman,2 has addressed the issue on a number of occasions. Her insightful paper in 2009 provides a solid case for the retention of the term subluxation.9 This could be in the modifed form of a Vertebral Subluxation Complex (VSC), which is arguably the most widely accepted alternative. She cites Terret as stating "The concept of vertebral subluxation is central to chiropractic.”10 Peter L Rome Further, she notes that Keating, Charlton, et al, state that “There is nothing Inherently dogmatic or anti-scientifc in the notion that an articular lesion may have health consequences, or that correction of joint dysfunction may relieve symptoms and/or health.”11 The aim of this paper is to broaden and clarify what Gatterman called the "clinical, political, and philosophical issues that surround the construct" of the subluxation.9 It is also designed to emphasize awareness of the anatomical, physiological, pathophysiological and scientifc connotations associated with it as well. THE CONTROVERSY One area of misunderstanding that has led to some misapprehension concerning the term subluxation in that there are two differing interpretations of the term. The traditional medical term is defned as less than a luxation or less than a dislocation; while the chiropractic definition is much broader as it involves the clinical, neural, physiological, and anatomical ramifcations of the entity. In some ways, it was perhaps unfortunate that Palmer nominated the term subluxation over a century ago. If he had designated differently, it may well have avoided the confusion and opposition to the term adopted.12,13 However, it is not the first word, or indeed the first 'medical' term to have more than one meaning -- such terms as appendix, cervical, and articulation would be examples of this. An alternative term, somatic dysfunction also has other interpretations. The dilemma is highlighted by the fact that in journal publications, use of the term subluxation in the MeSH and Key Words sections tends to confound and complicate the system, confuse search engines, and adds to misunderstanding and misinterpretations between health professionals. Despite oft-repeated medical criticism of this concept of VSC, there has never been any formal medical research of the clinical entity as there has been into other evolving concepts -- some of which have been adopted by medicine with a limited evidence base, after having been initially rejected, e.g. medical acupuncture, integrative medicine, nutritional medicine, complementary medicine, and homeopathy. Incongruously, there appears to have been no formal research underpinning the adoption of the doctrine of manipulative medicine, it just seems to have subtly entered the allopathic fold -- despite the claim that chiropractic does not have an evidence base. Some have raised another issue as to whether the VSC in its various forms even exists.l4 This is despite ample COMMENTARY: A BASIS FOR THE THEORY OF A CENTRAL CHIROPRACTIC PRINCIPLE -- THE VERTEBRAL SUBLUXATION
CJA December 2012
CJA June 2013