World Chiropractic Alliance

Responding to
Eight Chiropractic Issues

Issue 5: Diagnosis of Vertebral Subluxation

Some critics maintain that the diagnosis of vertebral subluxation and measurement of its reduction cannot be done. Numerous issue related to this have already been discussed. What these critics really refer to is, in more modern terms, the concept of Outcome Assessment.

Vertebral subluxations have general effects on the mechanics and physiology of the spine and body:

A. Immediate local effects which may include irritation, inflammation, and degeneration at the vertebral level.

B. Mechanical effects which include aberrations in motion, posture and overall mechanical function of the spine.

C. Physiologic effects which especially include disturbances in the nervous and circulatory systems.

These general effects of the vertebral subluxation are focused into five categories with specific outcomes measures that are used to determine whether or not the patient is getting better, staying the same or getting worse in terms of their subluxation outcome. All of the following are taught in the curriculum of accredited chiropractic college programs:

1. Spinal Kinesiopathology which generally refers to the abnormal position and motion of the vertebra involved in the subluxation. Outcomes assessment parameters here would include:

·                     Palpation analyses

·                     X-ray analyses,

·                     Computed tomography

·                     MRI imaging

·                     Postural aberrations

·                     Goniometric assessment,

·                     Videofloroscopic analyses

·                     Range of motion assessment

·                     Leg length check analyses.

2. Neuropathophysiology refers to abnormal nervous system function which is the most significant component of the vertebral subluxation. Assessment criteria here would include:

·                     Somatic pain

·                     Paresthesia, hyperesthesia, hypesthesia through case history and questionnaire determination

·                     Somatic motor assessment through muscle analyses and complete neurologic assessment of the neuraxis as well as complete afferent and efferent assessment.

·                     MRI and CT Scans provide evidence of nerve structural damage which correlates with the neuropathophysiologic component.

·                     Visceromotor determinations via heat sensitive devices, thermography and thermometry.

3. Myopathology refers to the abnormal changes in muscle function due to the vertebral subluxation. Outcomes assessment criteria here include:

·                     Palpation

·                     Dynamometer testing

·                     Surface EMG

·                     Neuropressure algometry and pain sensitivity,

·                     Range of motion determination

·                     Paraspinal tissue compliance

4. Histopathology represents the abnormal changes to soft tissues involved in the vertebral subluxation. Assessment protocols here primarily include the determination of disc and ligament-integrity by means of X-ray and other imaging methods.

5. Pathophysiology refers to the generalized abnormal changes generated in the spine and body as a consequence of the vertebral subluxation. Spinal pathophysiology is assessed primarily through radiographic, and other imaging determinations of bone degeneration.

The basic chiropractic analysis consists of manual palpation of the bony elements of the spine, manual assessment of the motion of the spine and individual vertebra, and palpation of the numerous muscles which attach and control spine and vertebral motion.

Additional analytic tools for the field chiropractor would include X-ray, devices to assess spinal and vertebral motion and posture, as well as instruments used to assess muscle function and skin temperature.