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Chiropractic Journal of Australia : CJA March 2013
Chiropractic Journal of Australia Volume 43 Number 1 March 2013 3 evidence that it does. That evidence will be summarised in this paper. THE DEFINITION OF A VSC It must be noted that addressing the VSC is just one part of management under chiropractic health care15-18 and that a number of defnitions of a VSC have been proffered over the years. However, this paper is not seeking to establish a defnition, as that would seem a more controversial task than this subluxation debate.3 There is already an over-abundance of polemics on the topic. THE FOUNDING PRINCIPLE The founding principle of chiropractic may be summarised as that interosseous articulations -- especially of vertebrae, may undergo physiological change, that is, functional and/ or structural change which may affect other elements, particularly neural structures and neural function -- pathoneurophysiology.19 It is surprising that a base of mere opinion by some could ignore or deny a signifcant pathophysiological neurovertebral articular complex without evidential support from formal research, particularly when it comes to patient health, well- being, and comfort. THE SCIENTIFIC EVIDENCE Examples: "In contrast to the impressive body of knowledge concerning the effects of visceral afferent activity on autonomic functions, there is, generally speaking, much less information available on the refex regulation of visceral organs by somatic afferent activity from skin, the skeletal muscle and their tendons, and from joints and other deep tissues. Sato A, Sato Y, Schmidt RF.20"The elucidation of the neural mechanisms of somatically induced autonomic functions, usually called somato-autonomic reflexes, is essential to develop a truly scientifc understanding of the mechanisms underlying most forms of physical therapy, including spinal manipulation and traditional as well as more modern forms of acupuncture and moxibustion." Kimura A, Sato A21. "Spinal manipulative therapy can affect the resting status of somatic stru ctures via mechanical and neurological (somato-somatic refex) mechanisms, and this can cause a change to the afferent arm of the somato-visceral refex. It is likely that supraspinal infuences play a major role in this effect.(and further) Such changes can occur by the direct action of a somatovisceral effect at the segmental level.” Pollard H.22 Degrees of evidence in support of the VSC have existed for decades. In-depth research on the subluxation hypothesis appears to add to its previously observed significance and understanding. There are some 39 papers in refereed chiropractic journals which support the neurological ramifcations of the VSC. Some 23 of these are listed on PubMed. Further, there are at least 21 of these papers published in medical journals. At least 7 have medical researchers as the lead author; others are chiropractic researchers who have published in these medical journals. (Appendix 1) In recent years, substantiating research has been published by Cramer, Henderson, Bolton, Haavik, Pickar, and especially the neurophysiologists Sato et al., - to list a few. (Appendix 1) No formal research could be located to challenge their fndings of somatic infuence from the VSC upon the ANS. It has been demonstrated independently by Japanese medical researchers that facet joint infammation - somatic, can affect spinal nerve roots and cord refexes.20,21,23 Two other early medical authorities recognise the vertebral subluxation. Hadley24 referred to vertebral displacement and dysfunction in 1976; and in 1971, Schmorl and Junghanns recognised it as a separate entity to the medical subluxation, referring to it as a "vertebral locking".25 (See Table 1.) In 1995, Pikalov outlined the widespread use and scientifc justifcation for manipulative methods in Russia. He claimed that some 5,000- 6,000 MDs were certifed in manual therapy in that country and many were well published in the Russian medical literature.26 These developments tend to further emphasise the contradiction between European medical attitude to the subluxation and chiropractic methods compared to western attitudes. HISTORICAL MEDICAL PRECEDENTS Watkins states that in 1746 Hieronymus wrote: "Subluxation of joints is recognized by lessened motion of the joints, by slight change in position of the articulating bones and by pain...most displacements of vertebrae are subluxations rather than luxations."27 Warbasse, a medical doctor, described the chiropractic model of a 'subluxation' in his text as early as 1918. He used the term to describe the vertebrogenic neurological implications of this clinical finding. He stated that "subluxations of vertebrae occur in all parts of the spine Table 1 OTHER MEDICAL TEXTBOOKS WHICH RECOGNISE BIOMECHANICAL SPINAL LESIONS 'Manual Therapy in Children' -- Biedermann H. 2004 'Spinal manipulation' - Bourdillon JF, Day EA. 1988 'Manual of medical manipulation' -- Burn L. 1994 'Textbook of orthopaedic medicine; Vol II: Treatment by manipulation and massage. - Cyriax. J. 1965 ‘Musculoskeletal Manual Medicine’ - Dvorˇák J. 2008 'Managing Low Back Pain.' Kirkaldy-Willis WH, Bernard TN. 1999 'Manipulative therapy in rehabilitation of the locomotor system.' -- Lewit K. 1999 'Manipulative therapy: Musculoskeletal medicine.' - Lewit K. 2009 'Orthopaedic medicine: A new approach to vertebral manipulations. - Maigne R. 1972 'The science and art of joint manipulation. v2. The spinal column.- Mennell JM.1952 'Clinical biomechanics of the spine.' -- White AA, Panjabi MM. 1978 'Spinal manipulative therapy: Russian approach.' - Pikalov A. 1995 COMMENTARY ROME
CJA December 2012
CJA June 2013