January 2005

The 'unproven theory' of subluxation

by Dr. Terry A. Rondberg

In a recent article for Dynamic Chiropractic, Dr. Joseph Keating and several of his like‑minded colleagues berated the profession for its “traditional dedication to a scientifically unsubstantiated (and largely untested) construct: the subluxation.”

He pointed specifically to the position paper formulated by the Association of Chiropractic Colleges (ACC), which supports the chiropractic focus on subluxation correction ‑‑ and which was approved and signed by every chiropractic college president. It has also been endorsed by nearly all chiropractic organizations (including the World Chiropractic Alliance, the International Chiropractors Association, the American Chiropractic Association and even ‑‑ finally ‑‑ by the World Federation of Chiropractic!)

Yet Keating et.al., in their accumulated wisdom, call this cornerstone document “exemplary of this steadfast adherence to an unproved theory.”

The ACC position paper ‑‑ widely known as the ACC Paradigm ‑‑ states in part:

The practice of chiropractic focuses on the relationship between structure (primarily the spine) and function (as coordinated by the nervous system) and how that relationship affects the preservation and restoration of health... The body's innate recuperative power is affected by and integrated through the nervous system.

Chiropractic is concerned with the preservation and restoration of health, and focuses particular attention on the subluxation.

A subluxation is a complex of functional and/or structural and/or pathological articular changes that compromise neural integrity and may influence organ system function and general health.

A subluxation is evaluated, diagnosed, and managed through the use of chiropractic procedures based on the best available rational and empirical evidence.

Yet, Keating and his co‑authors claim that “the statements concerning subluxation offered by the ACC conflict with commonly accepted scientific standards, and function to diminish the credibility of the profession.”

Since Keating and the others purport to be researchers, it's hard to believe they are unfamiliar with the research available concerning the subluxation.

Not long ago, Matthew McCoy, editor of the Journal of Vertebral Subluxation Research (JVSR) published a list of 10 critical subluxation research references that included citations from JVSR, JMPT and the Conference Proceedings on The Research Status of Spinal Manipulative Therapy.

Apparently, Keating hasn't had time to read those reports. Instead, his time has been spent poring over medical research reports on chiropractic for low back pain. That's why he reaches the conclusion, in the article, that “Although spinal manipulation has enjoyed some considerable success in controlled outcome studies and reviews of its usefulness for patients with low back pain (LBP), neither the cause(s) of LBP nor the mechanism(s) of its relief by adjusting are well‑established. Evidence of the value of spinal manipulation for problems other than LBP is less extensive, and the role that subluxation (or other forms of joint dysfunction) may play in causing and/or providing relief through adjusting is uncertain (emphasis added to make sure you don't miss that part!).

So, doctors, according to Keating, you're only good for one thing and subluxations don't have anything to do with a person's health. Or at least according to the research he pays attention to.

That's a pretty sorry conclusion for a so‑called chiropractic researcher to reach.

But what does it mean, really, to be a chiropractic researcher? In Keating's case, it means marketing yourself to the chiropractic profession, but apparently sharing little of its passion for helping optimize human health potential through chiropractic care.

Keating received his PhD from the State University of New York at Albany, where he was trained in clinical psychology. According to an online biography, his post‑doctoral clinical residency was completed at a physical medicine and rehabilitation specialty hospital and for two years he maintained a collaborative private practice with a urologist, specializing in lower urinary tract dysfunctions. He practiced as a clinical psychologist in California for 16 years.

Although his resume boasts articles in scientific journals such as JMPT, his chiropractic “research” has primarily been concerned with chiropractic history. A Jan. 2004 JMPT article, for instance, was on the “evolution of chiropractic manipulation.” According to the abstract, the gist of the article was that “Manipulative strategies have also been influenced by various instruments for diagnosing (ie, detecting) putative subluxations.”

Putative subluxations. To save you a trip to the dictionary, that means “alleged” subluxations. He can't, it appears, bring himself to utter the dreaded “s” word unless he qualifies it.

When Keating's work does involve the subluxation, the tone is predictable. In another JMPT article, he wrote: “Skepticism...should therefore be a characteristic of workers in the science of chiropractic. When considering subluxation, there is good reason for skepticism.”

That brings me back to my original question of what makes a good chiropractic researcher.

I do not think good chiropractic researchers should merely rubber stamp the theories supported by a century of anecdotal evidence and by existing research findings. However, I do believe that, to help advance the science of chiropractic, they should actively investigate the impact of subluxation on human health and wellness, and not enter into their studies with the foregone conclusion that subluxations are “putative” and unsubstantiated.

Nor do I think that good chiropractic researchers must be chiropractors. There are many dedicated chiropractic supporters who work to prove to the world that chiropractic care does a lot more than relieve lower back pain. They are aware of the existing literature that explores the common denominators in disease processes, and the role of the nervous, immune, and hormonal systems in development of immune related illnesses.

Bob Blanks, PhD, for instance ‑‑ winner of this year's WCA “Researcher of the Year” award ‑‑ is a perfect example. His retrospective study of nearly 3000 chiropractic patients is the largest chiropractic research study ever conducted in the history of the profession. Not only that but his study looked at subluxation correction, quality of life and wellness. (Be sure to check out his research at www.jvsr.com.)

I also don't think that good chiropractic researchers have to be full‑time scientists or academicians. They can, and usually are, field doctors just like you whose every day work with a wide variety of patients forms the basis for their research and case studies. They are the ones who see the first hand impact of subluxations on human subjects, and they are the ones who witness the effects of subluxation correction.

Although it makes me wince a bit, I do have to agree with Keating about one thing. We need more research to validate chiropractic's unique role in health care. That's the only thing that will silence skeptics who continually degrade our profession, labeling it “unscientific” and “unsubstantiated.”

We need to put as much effort into chiropractic research as the pharmaceutical companies do into drug research. Not long ago, Dr. McCoy reported that Pfizer has more than 12,500 people working in its drug research and development section. In 2003, its revenues topped $45 billion.

We have 60,000+ doctors of chiropractic. If just half of them were to get involved in chiropractic research at some level (from conducting research in their offices, submitting case histories, or even just subscribing to research journals like JVSR), we could create a deluge of chiropractic research that would silence the critics and send people flocking to our offices for subluxation care. We could make that $45 billion look like petty cash.

It isn't as intimidating as it might sound. Dr. McCoy and JVSR engage in an active outreach program that provides information and assistance to doctors wanting to become involved in research (which doesn't take a lot of extra time or effort!). I advise everyone to visit the JVSR website (www.jvsr.com) and learn more.

The key is to take back our profession from “researchers” like Keating. We must reclaim our heritage as a healing approach that impacts the very essence of human wellness and has far‑reaching effects on every organ and system in the body.

And, we must accept the fact (and the privilege and responsibility that go with it) that as doctors of chiropractic, we are not solely clinicians but teachers and researchers as well.