September 2005

The asymptomatic subluxation

by Dr. Christopher Kent

Ten years ago, I was surprised by an exchange of online posts on a chiropractic newsgroup. A heated debate was underway concerning the issue of the asymptomatic subluxation.

One of the participants stated that he did not "believe" in the asymptomatic subluxation. His choice of terms shocked me, since the existence of subluxation is a clinical issue, not a matter of faith or belief. My first thought was to suggest that he consider joining the Flat Earth Society ‑‑ group of folks who "believe" that the world is flat, despite overwhelming evidence to the contrary.

In previous columns, I have addressed neurobiological mechanisms associated with vertebral subluxation which involve processes other than nociception and pain perception. These include: nerve root compression [1]; dysafferentation [2]; autonomic changes [3]; and dysponesis [4]. Furthermore, comprehensive reviews of these and other mechanisms have been published in peer‑reviewed journals [5,6].

Hause reported that compressed nerve roots can exist without causing pain and described a mechanism of progression where mechanical changes lead to circulatory changes, and where inflammatogenic agents may result in chemical radiculitis.

This may be followed by disturbed CSF flow, defective fibrinolysis and resulting cellular changes. The influence of the sympathetic system may result in synaptic sensitization of the CNS and peripheral nerves, creating a "vicious circle" resulting in radicular pain. [7]

The importance of asymptomatic lesions was reported by Wilberger and Pang who followed 108 asymptomatic patients with radiological evidence of herniated discs. They reported that within three years, 64% of these patients developed symptoms of lumbosacral radiculopathy. [8]

Whatmore and Kohi described an important neurophysiologic factor in functional disorders which they termed "dysponesis."

Dysponesis refers to a reversible physiopathologic state consisting of errors in energy expenditure, which are capable of producing functional disorders. Dysponesis consists mainly of covert errors in action potential output from the motor and premotor areas of the cortex and the consequences of that output.

These neurophysiological reactions may result from responses to environmental events, bodily sensations, and emotions. The resulting aberrant muscle activity may be evaluated using surface electrode techniques. [9]

A comprehensive review of the evidence supporting vertebral subluxation is beyond the scope of this article. Readers should consider adding the following to their libraries:

"Upper Cervical Subluxation Complex: A Review of the Chiropractic and Medical Literature." Kirk Eriksen. Lippincott Williams & Wilkins. 2004. ISBN 0 7817 4198 X. Available at http://www.lww.com.

"Somatovisceral Aspects of Chiropractic: An Evidence Based Approach." Edited by Charles S. Masarsky and Marion Todres Masarsky. Churchill Livingstone. 2001. ISBN 0 443 06120 3. Available at http://www.amazon.com.

"Atlas of Common Subluxations of the Human Spine and Pelvis." William J. Ruch. CRC Press. 1997. ISBN 0 8493 3117 X. Available at http://www.amazon.com.

"The 14 Foundational Premises for the Scientific and Philosophical Validation of the Chiropractic Wellness Paradigm." James L. Chestnut. The Wellness Practice. 2003. Available at http://www.thewellnesspractice.com.

It is obvious that vertebral subluxation, like breast cancer and hypertension, may be asymptomatic. It is the responsibility of the chiropractor to detect and correct vertebral subluxations, based upon objective criteria, whether symptomatic or not. Those who refuse to accept the responsibility to assess subluxation do so at their peril, and the peril of their patients.

Their delusions are a public health menace.

References

1. Kent C: "Nerve compression physiology." The Chiropractic Journal, (December 1995).

2. Kent C: "Dysafferentation & VS." The Chiropractic Journal. (June 1996).

3. Kent C: "Beyond bad backs." The Chiropractic Journal. (September 1995).

4. Kent C, Gentempo P: "Dysponesis: chiropractic in a word." The Chiropractic Journal. (September 1994).

5. Kent C: "Models of vertebral subluxation: a review." Journal of Vertebral Subluxation Research. Vol. 1, No. 1 (August 1966).

6. Dishman R: "Review of the literature supporting a scientific basis for the chiropractic subluxation complex." J Manipulative Physiol Ther 8(3):163, (1985).

7. Hause M: "Pain and the nerve root." Spine 18(14):2053, (1993).

8. Wilberger JE Jr, Pang D: "Syndrome of the incidental herniated lumbar disc." J Neurosurg 59(1):137, (1983).

9. Whatmore GB, Kohi DR: "Dysponesis: a neurophysiologic factor in functional disorders." Behav Sci 13(2):102, (1968).

(Dr. Christopher Kent, president of the Council on Chiropractic Practice, is a 1973 graduate of Palmer College of Chiropractic. The WCA's "Chiropractic Researcher of the Year" in 1994, and recipient of that honor from the ICA in 1991, he was also named ICA "Chiropractor of the Year" in 1998. He is director of research and a co‑founder of Chiropractic Leadership Alliance. With Dr. Patrick Gentempo, Jr., Dr. Kent produces a monthly audio series, "On Purpose," covering current events in science, politics and philosophy of vital interest to the practicing chiropractor. For subscription information call 800/892‑6463.)