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Chiropractic Journal of Australia : CJA March 2013
4 Chiropractic Journal of Australia Volume 43 Number 1 March 2013 and in all degrees. When the dislocation is so slight as not to affect the spinal cord, it will still produce disturbances in the spinal nerves…. He later refers to these as 'common subluxations' and 'fner displacements.” 28 Maigne also recognised sacroiliac subluxations (p390) and refers to subluxations as "minor intervertebral derangements." (p27) He associates manipulation of this "anatomopathology" with various "functional disturbances manifesting as organic conditions."29 Finnesson discusses a "Manipulable Spinal Lesion" but recognises that it is euphemistically called a subluxation, osteopathic lesion, vertebral fxation, blockage and somatic dysfunction. Further, he does acknowledge vertebral malposition and abnormal vertebral motion amongst other characteristics of the clinical fnding.30White and Panjabi recognise the hypothesis of the chiropractic subluxation and note that "In order for manipulation to be successful, (manipulators) must somehow produce improvement using mechanical alteration..." 31 Gray's Anatomy Noted signifcance however, has to be attributed to Gray’s Anatomy where it is stated in reference to the sacroiliac joint that “locking may occur…” and that "This so-called subluxation of the sacro-iliac joint causes pain" and that “reduction by forcible manipulation may be attempted.” 32 Magnuson and Coulter had earlier described sacroiliac strains and subluxations as far back as 1920.33 Medical interest in spinal manipulation for vertebral subluxations-related disorders, so-called visceral disorders, has been documented over some decades.34-36 Indeed the medical literature is not devoid of usage of the term subluxation in the chiropractic sense. Medicine has not devised or persisted with a distinct term to describe this complex phenomenon noted in its own literature. It has however, adopted terms used in chiropractic and osteopathy, such as spinal dysfunction. The clinical fnding that chiropractors called a subluxation since 1895 has been called by a wide variety of terms -- almost 300 have in fact been identifed. It has been established that there are at least some 296 synonyms for the subluxation. Of these over 50% are derived from medical authors. The rest are made up from chiropractic, osteopathic and physiotherapy origins.5 OTHER EVIDENCE World Health Organisation The vertebral subluxation has already been recognised by the World Health Organisation (WHO) in its publication, World Classifcation of Diseases (ICD-10), which classifes “Biomechanical lesions, not elsewhere classifed” as item M99. It further sub-classifes the VSC as item M99.1 – "Subluxation complex (vertebral)". Item M99.0 is designated "Segmental and somatic dysfunction". These come under the broader heading of "Diseases of the musculoskeletal system and connective tissue" - (M00-M99), and "Other disorders of the musculoskeletal system and connective tissue" - (M95- M99).37The US Medicare Offce (Centers for Medicare and Medicaid) recognises the term subluxation in relation to spinal care provided by chiropractors.38 The US Agency for Healthcare Research and Quality also recognise the "vertebral subluxation in chiropractic practice -- noted as the VSCP.39 Numerous published clinical studies with positive outcomes must indicate that spinal adjustments which address the VSC do infuence patients’ comfort and well being. Patient demand and a growing profession would tend to endorse that observation, as well as the plethora of anecdotal studies and the refereed literature which also supports the hypothesis.35 In China, the Traditional Chinese Medicine Manipulative Orthopedics Department at the PLA GeneralAir Force Hospital in Beijing is "Based on the hypothesis of pathomechanics of vertebral subluxation.” It originally centred on Professor Feng's hypothesis (Feng's Spinal Manipulation - FSM) and “…was scientifcally proved with the help of advanced modern equipment such as CT, MRI, thermograph and image analyzing computer software, etc. FSM therapy has been systemically and scientifcally developed ever since it was medically approved and has spread over mainland China and some other countries in Asia as well now.” 40 THE SPECIOUS LOGIC Some have questioned the use of the term subluxation, or indeed proof of its existence. However, such reservations raise a number of queries. If those questioning a lack of proof comprise a splinter group of chiropractors, then • On what basis did they enter the profession in the frst place, and what did they understand to be the fundamental premise upon which chiropractic was based when they practise the profession? • If there is no proof that the VSC exists, what clinical entity do they address when they 'manipulate' a patient, and how does it differ from other segments in that spine? • If there is no proof that the VSC exists, what do they call the lesion that they, and other professions manipulate? • If there is no proof that the VSC exists , how do they explain the difference between a normal spine and one that they 'manipulate'? • If there is no proof that the VSC exists, how do they differentiate between a spine without clinical signs and which is asymptomatic, with one that presents 'dysfunctional' segment-related symptoms? • Why is palpation a standard diagnostic tool for chiropractors, and what are they seeking in conducting palpation? • What is the difference between a vertebral segment which changes its state as a result of an adjustment/ manipulation, and one regarded as 'normal' which does not change its physiological state? How do they determine that one segment is different, if there is no 'proof'? COMMENTARY ROME
CJA December 2012
CJA June 2013