Medical Definition of Subluxation

Once again, I spent my five minutes on Facebook and found a ripe topic to share with you. There is a trend in the subluxation denier movement, to dismiss the chiropractic vertebral subluxation because chiropractors don’t use the standard medical definition of the term “subluxation.” This approach is wrong on several levels most notably that it is ahistorical and lacks adequate evidence. For those of us who aspire to being evidence-informed, this is important to discuss.

The First Call to Dismiss Subluxation because of Medical Definition

Let’s start with the literature. The first time this approach was attempted in the chiropractic literature was 1984 and 1985. That’s right – the tactic is not new. If you care about evidence, you should know your own literature.

If you study Part 9 of my new set of papers on The Chiropractic Vertebral Subluxation, you will read the section called Review of Critical Literature. In that section, I point out that Brantingham proposed that the profession get rid of the term “subluxation,” because the ways in which the profession uses the term did not meet the medical definition. Without demonstrating any real perspective on the chiropractic literature up until that point, by 1988, Brantingham proposed we adopt the osteopathic term, “somatic dysfunction,” and get rid of the term subluxation.

Brantingham’s proposal was refuted by subluxation theorists from that time, namely Lantz and Keating. Lantz called him out in terms of his lack of references. Keating suggested a better approach would be to develop an operational definition of vertebral subluxation.

The Chiropractic Vertebral Subluxation Stands Alone

While the profession still confronts the issues that Keating brought up, effective operational definitions are needed, we also face the same types of unsubstantiated dismissivism as Lantz critiqued.

If you read Part 10 of the papers, you will see Keating’s proposals in more detail, including his call for systematic and well-planned case studies throughout the profession. You will also learn about Boone and Dobson’s idea that we need to start with a functional definition of vertebral subluxation. That will lead to testable and multiple operational definitions. You will also learn about Kent’s proposal that multiple techniques within chiropractic should lead to different operational definitions.

This all leads to the real issue, that the chiropractic profession, which is one of the largest health professions in the world, has developed its own lexicon over the course of 125 years (give or take a few years).

To dismiss the chiropractic vertebral subluxation because you are stuck on the medical definition of the term “subluxation” is an approach lacking in evidence. An evidence-based approach to this question must include reference to the profession’s development of the term. That development is mapped out in the 10 papers, which included a history of theory and research along with the internal debates. Read it. And, don’t confuse the word subluxation with the term “chiropractic vertebral subluxation.”

Some References

Brantingham, J. A review of some current and past literature regarding basic chiropractic hypotheses. Dyn Chiropr, 2 (8) (1984), p. 6

Brantingham, J. A survey of literature regarding the behavior, pathology, etiology, and nomeclature of the chiropractic lesion. ACA J Chiropr, 19 (8) (1985), pp. 65-70

Brantingham, J. A critical look at the subluxation hypothesis. J Manipulative Physiol Ther, 11 (2) (1988), pp. 130-132′

Lantz, C. A critical look at the subluxation hypothesis: to the editor. J Manipulative Physiol Ther, 13 (1) (1990), p. 42

Keating, J. A critical look at the subluxation hypothesis: to the editor. J Manipulative Physiol Ther, 13 (6) (1990), pp. 350-351

Brantingham, J. In reply. J Manipulative Physiol Ther, 12 (2) (1989), p. 154

Senzon, S. Chiropractic Vertebral Subluxation Part 10: Integrative and Critical Literature: 1996-1997. J Chiro Hum. 25(Dec) (2018), pp. 146-168.

Senzon, S. Chiropractic Vertebral Subluxation Part 9: Complexes, Models, and Consensus: 1979-1995. J Chiro Hum. 2018, 25(Dec);, pp. 130-145.

Faulkner, Foley, and Senzon. Palmer Chiropractic Green Books: The Definitive Guide. The Institute Chiropractic. 2018.

Rome, P. Medical evidence recognizing the vertebral subluxation complex. CJA. 2016; 44.

Rome, P. Terminology relating to the vertebral subluxation complex and the manipulative sciences. Part 1. CJA 2017;45:73-89.

Rome, P. Terminology relating to the vertebral subluxation complex and the manipulative sciences. Part 2. CJA 2017;45:90-129.

Kent, C. Models of Vertebral Subluxation: A Review. AVSR. 1

Boone and Dobson. Vertebral Subluxation Model. AVSR. 1-3

Dealing with the Peanut Gallery

A Chiropractic History Lesson

From Simon Senzon

In the last few days I was confronted with some of the latest claims from the chiropractic peanut gallery. I am sure you know what I am talking about.

Two of the claims were from a video posted on Facebook of a chiropractor lecturing to a classroom of chiropractic students. This individual said many things that were biased and incorrect. Two of them stand out for me:

  • He stated that early chiropractic and osteopathy were the same. (That is incorrect.)
  • He also equated subluxation with a belief in God. (This is just absurd.)

Some of the confusion around these questions comes from decades of chiropractic authorities stating their opinions as facts and teaching that to students. Now those students are teaching their versions, without any evidence, to the latest generation. This practice must stop.

Let’s start with the first comment. The fact of the matter is, in the early days of the profession, the chiropractors and the osteopaths were at war for several years. Each accused the other of stealing theories and practices. A few important facts to note:

  1. D.D. Palmer was well-read in the osteopathic literature and thus was able to articulate precise differences between his theories and practices versus osteopathic approaches.
  2. Several of the early chiropractors were trained as osteopaths and found the two sciences distinct.
  3. The defense in the Morikubo trial, which was the landmark case distinguishing the two professions, successfully argued against the prosecution’s osteopathic expert witnesses. The defense demonstrated that chiropractic’s science included a unique view of the nervous system, technique included nerve tracing and a quick thrust to release nerve impingement at the IVF, neither of which was taught by osteopaths, and the philosophy of chiropractic was based on the concepts of Innate and Educated, also not taught in osteopathic schools.

As to the strange notion that vertebral subluxations has something to do with God, that is just ignorance incarnate. Anyone who states something like this demonstrates a lack of evidence about the ubiquity of vertebral subluxation theory across the entire chiropractic profession (every school) for over 100 years. Subluxation has always been viewed as the cornerstone of the profession despite the claims of a vocal minority.

On this point, I’ll refer you to two of the new papers. You should read the Introduction (Part 1), which has a section on Philosophy and Subluxation. Also read Part 8, especially the section on the distinctions made decades ago by the objective “straight” movement. From that point on, subluxation theory should be classified in terms of structure, neurology, and endogenous organization.

In terms of the early philosophical models of Innate Intelligence, psychospiritual health and wellbeing may still be studied in relation to the correction of vertebral subluxation.

Some other claims that popped up on my Facebook feed this week include at least one attempt to conflate all vitalistic perspectives with magical thinking and another attempt to conflate all subluxation-based practitioners with B.J. Palmer’s sacred trust.

Again, claims without sufficient evidence are just opinions. I have written in the past about at least five ways of thinking that might be attributed to chiropractors. I even published a chart conveying this evidence-based approach to perspectives on vitalism. Oversimplifying this issue is never going to move the profession forward. Only by embracing the complexity of these ideas might we begin to have real dialogue.

This also goes for the claims about the sacred trust and how it relates to today’s practitioners.

Finally, one other comment focused on the emphasis of the last few decades by many chiropractic researchers. Here are some additional facts:

  1. Starting in the 1970s and 1980s the research focus of much of the chiropractic profession turned away from somatic relationships between vertebral subluxation and neurodystrophic and neuropathic processes.
  2. The research in the profession up until that point was mainly focused on those areas.
  3. The shift in focus had more to do with politics, insurance reimbursement, and garnering research funding than the objective pursuit of science. (Science is always shaped by social and cultural forces.)
  4. The profession may still examine the myriad hypotheses about vertebral subluxation that have yet to be studied with modern research designs.

Some of these issues and facts were covered in my recent series of papers. Below are links to a few that are relevant. If we don’t confront the peanut gallery with evidence, the small group of academics that keep shouting opinions may impact the future of the profession.

Take care,

Simon Senzon

The Chiropractic Vertebral Subluxation Part 1: Introduction – https://www.sciencedirect.com/…/artic…/pii/S155634991830010X

The Chiropractic Vertebral Subluxation Part 7: Technics and Models From 1962 to 1980 –
https://www.sciencedirect.com/…/arti…/pii/S1556349918300159…

The Chiropractic Vertebral Subluxation Part 8: Terminology, Definitions, and Historicity From 1966 to 1980 – https://www.sciencedirect.com/…/arti…/pii/S1556349918300160

Legacy

I wrote about my chiropractic legacy on my birthday last year. In that post, I reviewed the latest courses, TIC, some background about my previous writings, and an overview of my latest insights. I did not include the publications that were in the works or the newest research. It is amazing how a legacy can be multiplied in just one year!

This year truly marks a transformation for the chiropractic profession. I don’t say this lightly. The new book I just published with Timothy Faulkner and Joseph Foley is groundbreaking. It is the first time the profession might collectively understand The Palmer Chiropractic Green Books. So much is written about these books that is either derogatory or laudatory. Rarely do we get a dispassionate examination of the books. What is in them? Why are they still relevant to practicing chiropractors? What is the point of reading them? The book is a legacy. 

As a tribute to this legacy, we are offering a limited coupon code for 20% off for the entire store. It is good until Feb 8, 2019. (We usually only offer coupons for TIC Members and select events. Legacy is a good reason to offer one!) Just type in: legacy 

Also, in last year’s post, I did not mention the TEN new papers. We are now weeks away from publication. I am pleased to announce that they are coming soon. The papers will be published in the Journal of Chiropractic Humanities. They are in the final stage of layout and design. The topic is The Chiropractic Vertebral Subluxation from 1897-1997. I will do a series of blog posts about these papers and the courses they will inspire in the coming weeks.

Finally, the latest research is really powerful. Last year I started my PhD studies at the School of Health and Human Sciences at Southern Cross University. As I develop this research, I post regular lectures for TIC Members. It is a fascinating project and will surely impact the chiropractic profession (and other professions) for decades to come. I am forever thankful to the Foundation for Vertebral Subluxation for the opportunity. 

As this 48th year of my life unfolds, I look forward to the many ways my legacy in the chiropractic profession will continue. I already have plans to present a keynote address and a workshop at BCC Lyceum and a 12-hour seminar in Paris. Two new sets of online lectures are being developed. I am open to where this goes next!

Thank you for your continued support whether you are a reader, a TIC Member, a student, or a colleague (or all of these).

May your year be bright,

Simon

© 2019 The Institute Chiropractic - Senzon Learning, Inc.