Assessment and Correction of Vertebral Subluxation

We are at a critical time in the chiropractic profession. A small minority in the profession have used their positions of power in academia, regulatory boards, and as journal editors and authors to try to move the profession away from its central defining feature, the analysis and correction of vertebral subluxation. This type of lexicon cleansing has been well documented. Not only do we need more articles in the literature documenting the correction and assessment of vertebral subluxation but we also need articles demonstrating the reality that vertebral subluxation continues to be the core of the profession.

The latest article by Dr. Dave Russell is a must read for the chiropractic profession as it establishes the current state of the profession in relation to vertebral subluxation. This includes insights about what still needs to be researched.

The article, The Assessment and Correction of Vertebral Subluxation is Central to Chiropractic Practice: Is there a Gap in the Clinical Evidence? was published in the latest issue of The Journal of Contemporary Chiropractic.

Here are some of the highlights:

• Vertebral subluxation has been central to the chiropractic profession since its inception, and is the basis for the profession’s identity
• Organizations external to the chiropractic profession such as the World Health Organization, Institute for Alternative Futures and Medicare (USA) recognize vertebral subluxation as as a core focus of chiropractic practice
• Though it would be impossible to know the thoughts of all practicing chiropractors, the available evidence does suggest the assessment and reduction/correction of vertebral subluxation is a central theme in clinical chiropractic practice, embraced by the majority of the practicing profession and chiropractic students
• Routinely the public report that they seek chiropractic care is to improve their well-being, beyond the “treatment” of musculoskeletal pain syndromes
• Clinical evidence does show great outcomes of chiropractic care relative to musculoskeletal conditions, non-musculoskeletal conditions and quality of life
• There are commonly use indirect or remote assessments that suggest vertebral subluxation causes alteration in biomechanical and neurological function, but don’t necessarily identify where and in what direction to deliver a chiropractic adjustment. These are reported on in the literature and important.
• Of primary interest in this study are direct indicators of vertebral subluxation, which include tenderness, soft tissue palpation, intersegmental motion palpation, joint play/end feel, leg-length inequality, and special tests including cervical syndrome, Derifield and heel tension, are commonly used in clinical practice, both as generic indicators or as part of specific technique protocols, are used in daily clinical practice to directly determine the site and direction to apply the chiropractic adjustment, and are consistent with the biomechanical and neurological attributes of a vertebral subluxation common to all models.
• Clinical evidence does not seem to reflect the core objective of vertebral subluxation assessment AND reduction/correction. In a review of all clinically oriented studies in chiropractic journals (2017) 70.2% described the assessment of vertebral subluxation using at least one of these indicators. In stark contrast, only 15.4% of the same studies documented a reduction, correction or “elimination” of vertebral subluxation based on the direct indicators documented after a period of care or a clinical trial.
• It is a shame that the very few in the profession publishing research seemed to have lost the core of what it is chiropractors do, and seem to have lost touch with the majority in the profession….It can’t just be assumed subluxation is corrected if we need to check for its existence in the first place, the same reverence should be given to the post care/trial assessment
• Chiropractors in clinical practice, chiropractic clinical educators and chiropractic researchers could address this potential gap in the evidence by documenting the commonly used direct indicators of vertebral subluxation in the initiation of care or a clinical trial and at each progress evaluation or post the completion of clinical trial outcome measurements.

Dr. Russell completed an in-depth survey of the literature including 199 references. The profession should study this paper and the references. Perhaps then we might begin to move forward with a more complete view of the profession and push back against the inaccurate portrayals about vertebral subluxation espoused from the fringes of the profession.