The subluxation definition differs among chiropractors today.
Definition of Subluxation
Subluxation, broadly defined, means “an incomplete or partial dislocation of a joint or organ”. The chiropractic and medical definitions of subluxation are both recognized by the World Health Organization (WHO). Subluxation is a term used by many healthcare professionals. The orthopedic subluxation refers to a joint that needs relocation. The elbow, fingers, shoulders, kneecaps, ankles, wrists, and hips are often impacted. Subluxation in the spine can “impinge on spinal nerve roots”, leading to “symptoms in the areas served by those roots”. Causes of these kinds of displacements include falls and fractures, rheumatoid arthritis and osteoarthritis, and other traumas. Patients with Ehlers-Danlos syndrome are prone to frequent subluxations, and they are “hypermobile”.1
Subluxation Medical Definition in Other Specialties
The subluxation definition, with regard to medical doctors, is generally thought of in terms of orthopedics, as noted earlier; however, the term is also used in ophthalmology and dentistry. Ectopia lentis is an ophthalmologic subluxation, and it refers to a malpositioned or displaced lens in the eye. This can be caused by trauma or systemic disorders such as those with Ehlers-Danlos syndrome, Loeys-Dietz syndrome, Marfan syndrome, or homocystinuria. Sometimes the subluxated lens will need removal, if they “float freely” or if they have become “opacified to form cataracts”. In dentistry, a subluxation is a “traumatic injury in which the tooth has increased mobility”, but it hasn’t yet been displaced from the maxilla or mandible. This condition is a common traumatic disorder seen by dentists. Conservative measures, such as practicing good oral hygiene, using a chlorhexidine gluconate mouthwash, eating a cold and soft diet, and not smoking can resolve this condition. If there is a lot of pain, dentists may splint the injured teeth to provide relief. Another dental situation is subluxation of the mandible.2
Vertebral Subluxation Definition
Chiropractors have used a subluxation definition to mean the “altered position of the vertebra and subsequent functional loss” so that the proper location for the “spinal manipulation” treatment can be found. Some chiropractors expand the definition to mean that there is a vertebral subluxation complex (VSC), which includes “an alteration of the biomechanical and physiological dynamics of contiguous structures which can cause neural disturbances”. With VSC, many symptoms can result. Blood may not flow normally (leading to hyperemia, minute hemorrhages, or local ischemia), toxins arise to irritate the nerves and muscles (congestion), fluid builds up in the tissues (edema), scarring and adhesions develop in the tissues, tendons, ligaments, and muscles (resulting in fibrosis or tissue rigidity), or the muscle shrinks (atrophy). Spinal subluxation has several categories, according to the Houston Conference Classification: static intersegmental subluxation, kinetic intersegmental subluxation, sectional subluxation, and paravertebral subluxation. There are many subcategories, including anterolisthesis, retrolisthesis, hypomobility, hypermobility, scoliosis, and sacroiliac subluxation.3 Some chiropractors define subluxation to include a “visceral component”, which means that the “dysfunction actively alters neurological functioning”. The WHO separates the medical and chiropractic definitions of subluxation: medical refers to “significant structural displacements” and chiropractic suggests that the “segment, whether displaced significantly or not, should be referred to as a subluxation”. Historically, the VSC had been considered the “underlying cause of ill health” and that it “can be corrected with spinal adjustments”.4
Components of the VSC
The vertebral subluxation complex, by simplest definition, is when the vertebrae move out of place and irritate spinal nerves by putting pressure on them. This is thought to affect many systems in the body. There are 5 components of VSC: bone, nerve, muscle, soft tissues, and chemical. The bone (osseous) component is where the spinal bones are out of place, not moving right, or are degenerating. This is also called kinesiopathology. The nerve component, or neuropathology, involves the nerve malfunctioning. The muscle component, or myopathology, refers to how muscles hold vertebrae in their place and nerves control the muscles. Soft tissues are also altered in the VSC (histopathology). When the VSC acts on the body, there is also thought to be a chemical component (biochemical abnormalities). It is believed by some chiropractors that the nervous system needs to be “free of interference from subluxations”; treatment with chiropractic adjustments, therefore, can allow the “body to return itself to the highest level of health possible”.5
Straight vs. Mixer Chiropractors
The definition of subluxation for chiropractors depends on the type of chiropractor seen. There are two kinds of chiropractors: straights and mixers. The straights follow in “Palmer’s doctrine” that subluxations can contribute to or cause most disorders. While they do not treat or diagnose diseases, they “detect and cure subluxations”. “Only about 15%” of chiropractors identify as “straight chiropractors”. The straights believe their practice involves spinal anatomy, addressing the vertebral subluxation condition, and educating patients about subluxations. Mixers feel that diseases can arise from causes such as bacteria, viruses, and other situations. They do feel, however, that subluxations affect the body’s ability to fight off diseases. The vertebra, being out of position, “may cause a neurological imbalance”, leading to “lowered resistance”. The majority of chiropractors are mixers, and their practice is broader than just vertebral subluxation. Many of these chiropractors incorporate other methods into their practice such as providing nutritional supplements, homeopathic medications, vitamins, and dietary advice, as well as other treatment options, like Ayurveda, Chinese medicine, naturopathy, massage, and other bodywork and healing methodologies.6 Mixers are more likely to include acupuncture and physical therapy into their practices, as well. They might use x-rays and other tools and tests, and they are “generally more comfortable with using modern diagnostics and with the concepts of evidence-based medicine”. There are some commonalities between straight chiropractors and mixer chiropractors. Correcting spinal misalignment is key, both promote “prevention and healthy lifestyle habits”, and natural methods are preferred over surgery and medications.7
There is still debate in chiropractic about the VSC and whether or not to “keep it in the chiropractic paradigm”. Some chiropractic schools teach the “traditional/straight subluxation-based” option, while others have “moved towards an evidence-based chiropractic”. Today, chiropractic is common in the US, Australia, and Canada, and many of the chiropractors use techniques that overlap with other manual therapies, “including massage therapy, osteopathy, and physical therapy”. Chiropractic is also used in sports medicine. The most typical things that chiropractors are seen for are back pain, neck pain, and low back pain, although some patients seek chiropractic care for “ailments other than musculoskeletal issues”. Chiropractors can diagnose patients with tactile assessments, observation, skeletal imaging, and “orthopedic and neurological evaluation”. The general treatment techniques involved are spinal manipulation, health promotion and lifestyle advice, electrical modalities, rehabilitative exercises, manual therapies, and other complementary procedures. Spinal manipulation includes the high-velocity, low-amplitude (HVLA) thrusts, and hands-on techniques that “manipulate, massage, mobilize, adjust, stimulate, (and) apply traction to…the spine and related tissues”. There are many treatment methods chiropractors could use, including the Diversified, Activator, Thompson, Gonstead, Cox/flexion-distraction, Sacro-Occipital, and Nimmo Receptor-Tonus techniques. Many chiropractors co-manage patients with other healthcare providers. The scope of practice varies by state. In most states, chiropractors cannot prescribe medications. States also differ about diagnostic and treatments that are allowed. New Mexico was the first state to let chiropractors write prescriptions for “certain medications”. Oregon allows chiropractors to “perform minor surgery and to deliver children via natural childbirth”.8
Learn more about subluxation.