October 2008

Rethinking the subluxation

by Dr. John F. Markham

The subluxation is the cornerstone of the chiropractic profession. If there is no subluxation, our profession has no reason for its standing as a separate profession. The most significant problem we face in attaining full recognition is filling in the scientific gaps in our model and properly explaining our philosophy.

The subluxation has typically been modeled as a localized spinal joint malfunction that impacts the neurology with both local and systemic consequences. The founders often expressed it as a misaligned bone that altered the tone (or tension) on the neuro-mechanical structures of the body and reduced the flow of vital life force which caused the system to fail to properly adapt to changes in the internal and external environmental changes.

While we have made some progress demonstrating the effectiveness of our patient care methods, the methods of detecting the subluxation remain scientifically problematic although they perform well clinically. The paradox of having exemplary clinical outcomes while having largely unreliable indicators presents a huge problem for a science-based approach.

These "un-reliable and un-validated" clinical indicators that lead us to diagnose and adjust specific segments have proven their worth in the experience of countless doctors and patients. It may well be that there are many access points to shifting dynamic tensions within the bio-tensegrity matrix or perhaps the doctor is using these indicators to remap their own sub-threshold impressions using such interactive methods. The answer remains to be determined.

We must be cautious of the curse of answered prayer. If a valid, reliable documentation of a "subluxated" segment can be found, we may find that adjusting according to that parameter alone would fail to produce the results we now enjoy. Perhaps there is more to our service and science than what we presume to know.

Dr. Charles Herring, president of the FCER, pointed out some real problems we face with sustaining ourselves in the "Evidence-Based Practice" and "Best Practice" era. He asserts we are lacking the research foundation to demonstrate our science and value in the published literature. The task is made doubly challenging because we need more time to simply sort out the subluxation and how to define it and measure it. Unfortunately, we don't have the research available to make our case today and time is running out. My grave concern is that we may have too many assumptions and emotional attachments to models of the subluxation that may need to be improved upon or discarded in order to make progress.

One question we need to answer: Is the subluxation is a local entity or a systemic condition? We have assumed it is a local lesion because we have produced enviable outcomes using that model. Consider the following.

HB Logan and BJ Palmer each defined and analyzed and adjusted the subluxation about as opposite as any in the profession, yet both achieved enviable outcomes. How could this occur? If HB was really right, then BJ should have gotten poorer results. If BJ was right, then HB should have gotten poorer results.

Think of the contradictions that are made apparent as we compare and contrast Gonstead and Toftness, BEST and Nimmo, Thompson and DNFT, Activator and Atlas Orthogonal. We have to answer the question how it is that these techniques explain and locate the "subluxation" in wildly different ways and all get great results. Not one of them has a credible scientific claim to using valid and reliable methods of detecting the subluxation, yet each produces amazing outcomes on certain groups of patients. Why? In short, it seems obvious that none of the methods or explanations are more right or wrong than the other. There may be an overarching principle that each taps into and utilizes to get great results.

If the subluxation is a systemic condition, not a localized lesion, the patient is subluxated, not the joint. (Meaning the patient's homeostatic system is not adapting at full capacity due to sub-clinical distortions locked in the neuro-mechanical matrix of the body.) It will always be important to use well thought out and researched strategies to select the optimal points of adjustment. The success of the adjustment will be determined by how effectively we return the system to its full adaptive capacity (i.e. correct the subluxated condition).

The "evidence-based" among us look with disdain at the "philosophically based" and the "philosophically based" consider the "evidence-based" to be vacuous and haughty. This Gordian Knot could be untangled by a bold redirection of the profession to re-state our philosophy in modern language and re-define the subluxation to be first and foremost a systemic functional neurological condition -- and demonstrate its existence with scientifically valid instrumentation that is available now.

In a chess game one player hits the clock and it is the other player's move. Destiny has hit the clock. Time is running. It is our move.

(Dr. John Markham is the director of Level III Clinics at Life University, and director of the Life University Clinic P.E.A.K. Program. He practices in Kennesaw, Georgia.)