You are on page 1of 3

Student: Ferzin Mahava #117401

Tutor: Dr. Vanessa Petrini

November 16, 2015


CP 1102 Assignment #4

One of the most practiced therapeutic interventions in the chiropractic profession is spinal
manipulation therapy (SMT), also termed adjustment or manipulation (1). The fundamental
assumption of SMT is the presence of a lesion, known as a joint dysfunction or subluxation (2).
When chiropractors find lesions in the joints, they apply loads or forces to the dysfunctional area
with the intention of producing normal behaviour and movement (2). Therefore, by reducing the
unhealthy effects of the dysfunction, SMT restores and maintains both equilibrium and stability
in an individual (2).
Linguistics of Subluxation
Similar to all disciplines, chiropractic uses a distinctive dialect not often used by other
professions (3). In this language, the term subluxation is often used, which can be referenced
back many years when D.D. Palmer, the founder of chiropractic, had his first subluxation
experience with patient Harvey Lillard, whose hearing was restored immediately following
Palmers adjustment to the spine (3). When Palmer first adopted the term subluxation, it meant
the vertebrae were out of place and consequently pinched adjacent nerves, causing disease or
dysfunction in the areas of the body served by that nerve (3). The concept of subluxation has
been continuously redefined since Palmers time, to a more modern understanding of what
causes subluxations and its effects on the body (3). Although, the definition of subluxation has
evolved, the mentality behind it has not and is therefore not always used in practice or education
of chiropractic today (4).
Biomechanics
As previously mentioned, the notion of homeostasis in the human body is seen through
equilibrium and stability through the biomechanics of the body (2). Static loads applied to the
body are transmitted and distributed to various tissues (2). If loads applied are excessive, the
tissue can fail based on two biomechanical theories (2). In the first, the body will experience a
deformation leading to dysfunction (2). This is termed buckling behaviour. In reference to the
spine and subluxation, the buckling behaviour in the vertebrae represent local, uncontrolled and
mechanical responses to spinal loading (2). Symptoms that result from spinal buckling can be
local or remote from the spine (2). There are numerous properties that can affect the tissue and
its associated symptoms, and these properties govern the amount of strain the tissue will
experience on any given load (2). In the second, the tissue will tear or fracture, and these
biomedical alternations in the body are outside the chiropractic scope of practice (2).
Pathophysiology
There are numerous theories and hypotheses explaining the cause and effects of joint
dysfunction (5). Although there are many theories with little evidence to back up the
understanding and science of subluxations, there are six theories that have been researched
extensively (1). These theories often do not stand alone, and work simultaneously with each
other to improve joint movement in the spine (1).
The first theory of subluxation is to overcome muscle spasm by resetting muscle spindles
(1). In this theory, the goal of SMT would be to relax the muscle (1). In the second theory, there
would be stimulation of the mechanoreceptors that facilitate movement in joints (1). These
receptors work with the nervous system to facilitate a variety of effects, which will later be
discussed (1). The third theory of SMT would look at breaking scar tissue in joints, as the scar
1

Ferzin Mahava #117401


tissue restricts joint movement (1). Less limitation for the patient should occur following a
manipulation to the restricted joint (1). The fourth theory suggests that restricted joints have a
trapped meniscoid, a structure that allows better contact between bones, which can occasionally
become locked (1). When SMT is used, the structure becomes free and allows for normal
motion of the joint (1). Fifth, synovial fluid, which lubricates the joint will only work
appropriately if there is regular movement in the joint (1). Hence, regular joint movement
improves joint nutrition and lubrication (1). Finally, the sixth theory suggests that subluxations
restrict endorphin release from the central nervous system that reduce the pain experience in
individuals (1).
Mechanical Effects of SMT
In the human spine there are mechanoreceptor types associated with a joint capsule, the
site of subluxations (1). When a chiropractor performs a manipulation on a subluxation in
reference to the theory of stimulating mechanoreceptors that act on a joint, three possible effects
can occurs (1). First, reflexogenic effects occur when inflammation either signals the muscle to
tighten as a protective spasm or could send inappropriate signals, which could also cause the
muscle the spasm (1). Therefore, SMT could decrease muscle spasm or increase muscle tone in
the joint (1). Second, manipulations can cause perceptual effects whereby removing
inflammation through improving movement in the joint, causing inhibition of inappropriate
firing of mechanoreceptors and restoring normal posture (1). Finally, SMT can suppress pain,
also known as the gate control theory (1). If the joint has no or little movement, the
mechanoreceptors are not stimulated, and therefore are not inhibiting the signals from pain
receptors (1). SMT will restore movement to the joint and inhibit signals from pain receptors by
stimulating inhibitory receptors (1). It is possible that further mechanical effects are present
during SMT, however, further research is required (1).
Clinical Syndrome
A joint dysfunction is an abnormal biomechanical function (4). Clinically, it is often
associated with stiffness, muscle spasm, pain or discomfort, limited range of motion, muscle
guarding, and/or an inflammatory response in either the joint its affecting or relating to adjacent
joints (4,5). SMT provides a manual mechanical therapy to the musculoskeletal system with
beneficial clinical effects (4). Furthermore, subluxations, draws both mechanical and
neurological theories to explain the disorder of spinal functions (4). Throughout time, clinical
diagnosis of a subluxation have been based on the following factors: the affected segment of the
spine must be specific, the patients pain is further deepened when specific tests affect the
segment, and stressing nearby joints does not reproduce the same level of pain as the specified
joint (4).
In conclusion, it appears as though there is no single definition of a subluxation or the
mechanics behind the dysfunction and treatment of subluxations. As a chiropractor it is important
to evolve the definition of subluxation with time, as it underlies one of our primary treatment
options.

References
2

Ferzin Mahava #117401


1. Ross K. The chiropractic theories: how does spinal manipulation exert its clinical effect?
PowerPoint presentation presented at CMCC; 2015; Toronto, Canada.
2. Triano J. The theoretical basis for spinal manipulation. In: Haldeman S, editor. Principles and
practice of chiropractic. 3rd ed. New York: McGraw-Hill, Medical; 2005.
3. Course notes: a linguistics perspective on the word subluxation in chiropractic literature. 2015.
Foundations of chiropractic principles and practice course. Budgell, B. CMCC.
4. Vernon H. Historical overview and update on subluxation theories. J Chiropr Humanit.
2010;17(1):22-32.
5. Leach, RA. Introduction to subluxation theories. In: The chiropractic theories: a textbook of
scientific research. 4th ed. Lippincott Williams & Wilkins; 2004.