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Chiropractic Journal of Australia : CJA March 2013
Chiropractic Journal of Australia Volume 43 Number 1 March 2013 5 • If there is no proof that the VSC exists, how does a healthy spine differ from one with mechanical symptoms? • If there is no proof that the VSC exists, how do they explain medical manipulation as espoused by medical manipulators? • If there is no proof that the VSC exists, how would one determine if a spine does have a mechanical abnormality? • If there is no proof that the VSC exists, how do they explain the apparent clinical results published in refereed journals and reported by patients -- as shown by patient demand for their services? • Why do they not call a subluxation by that name when it is recognised by so many synonyms as that term in refereed papers and medical textbooks? • Why do they not call a subluxation or VSC by name when there are so many references to that term in refereed chiropractic papers and textbooks? • What right do they have to call themselves chiropractors -- or claim to teach chiropractic, if they do not adhere to what text books, history and the vast majority of the profession stand by? • If there is no proof that the VSC exists, how do they explain or justify manipulative treatment for cervicogenic headaches, lumbogenic sciatica, and thoracogenic intercostal neuralgia? • Where is the research cited or conducted by critics that justifes their stand that subluxations do not exist? What effort has been made to research that opinion? (To date, it seems that it is just unsubstantiated opinion, and reviews of opinions.) • If there is no proof that the VSC exists, what is the difference between a subluxated vertebral segment which changes its state due to an adjustment/ manipulation, and manipulating one regarded as 'normal' in its physiological state? One would have to be suspicious that a degree of selective unawareness exists - either deliberate or accidental, for there to be claims that there is no scientifc basis for a hypothesis underlying the subluxation, as indicated under the scientifc evidence mentioned earlier. It can be stated that if there was no neurological involvement in a VSC, even at a most fundamental level, there would be no associated pain or symptom awareness, not to mention other signs and disorders identifable by a qualifed practitioner. As such, a luxation by defnition, would not have associated symptoms, as it must involve more than just displacement of a bone. It is submitted that only a dry skeleton can exhibit a subluxation without neurological (and other soft tissue) sequelae. As such, there is a need for a clear and specifc term to cover the clinical entity designated here as a VSC. Given the clinical evidence, the previous studies, as well as the ongoing research into this clinical entity, it seems impossible to deny that an identifable, specifc clinical entity exists, and that it differs from normal invertebral segmental function. THE CONTRADICTIONS While some may question the existence, theory, or evidence which supports 'subluxation' hypotheses, one could wonder if such an attitude is more political than scientifc. Although healthy debate is welcome and stimulating, it seems highly incongruous for individuals to enter the century- old profession of chiropractic based on what they initially understood chiropractic to be, then for them to turn around and substantially try to alter the founding precepts and general understanding of the profession. Such incongruity would apply particularly to any splinter groups whose opinions are seen as being out-of-step with the vast majority of the profession. It would be far more appropriate for them to establish their own profession under a different name. As noted above, one would have to be suspicious that a degree of selective unawareness exists. It seems unethical and even suggestive of an inappropriate agenda for any chiropractic program, let alone a peer-reviewed, indexed journal purporting to be a chiropractic journal, to actively discourage and avoid use of the term subluxation. It may be seen as somewhat misleading for the word to be removed by editors from papers submitted for consideration to publish with the result being an artifcial fltering of knowledge dissemination perhaps with the intent of eradicating a sub-class of terminology from an establish health profession. Simplistically resorting to vague terminology such as "manipulative procedures" does not clarify exactly what is being manipulated. An asymptomatic and clinically 'normal' spine would hardly be manipulated as there would be no indications to do so.41-44 It seems nebulous for any chiropractic journal to acknowledge the subluxation (VSC) by stating that "In reality it’s a theoretical construct.”45 This statement is in keeping with aspects of the various construct theories of medicine, and cannot be seen as denying the existence of, or clinical benefts reported by patients. It must also be recognised that the there are still unknowns about how aspirin and anaesthetics work. But these are now established in medicine because 'they work'. A recent study claimed that 3 of 16 chiropractic colleges in the US did not use the term subluxation in their academic catalogues. However, in using the search box on the website of those same three institutions, numerous instances of use of the term were found.46 For any institutional chiropractic program to discourage or ban45 use of the chiropractic term subluxation that has been central to the chiropractic profession's nomenclature for over 100 years seems rather undermining. It appears to be further contradictory when papers in such a journal associated with the administrators of that program, have published using the term.46 Such a policy would seem inconsistent with that of the vast majority of chiropractic colleges and associations in the world. COMMENTARY ROME
CJA December 2012
CJA June 2013