Theories of Subluxation; Introduction by pptfiles

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									Theories of Subluxation An
       Introduction
        Philosophy 114
     Victor G. Strang, D.C.
“Theoreticians of spinal manipulation,
  at one time or another, have
  implicated virtually every anatomical
  component of the vertebral motor unit
  in their attempts to explain the mode
  of action of their therapy.”

Drum, 1975
  Some proposed mechanisms:
   theory                 author
1. Restore vertebrae to   Galen (1958)
   normal position

2. Straighten the spine   Pare (1958)

3. Restore blood flow     Still (1899)

4. Relieve nerve          Palmer (1910)
   compression
  Some proposed mechanisms:
   theory                  author
5. Relieve irritation of   Kunert (1965)
    sympathetic chain

6. Mobilize fixated        Gillet (1968)
   vertebral segments

7. Shift fragment of       Cyriax (1975)
   IVD
 Some proposed mechanisms:
   theory                 author
8. Mobilize posterior     Mennell (1960)
    joints (z-joints)

9. Remove interference    DeJarnette (1967)
   with CSF circulation

10. Stretch contracted    Perl (1975)
    muscles
 Some proposed mechanisms:
  theory                   author
11. Correct abnormal       Homewood (1963)
   somatovisceral reflexes

12. Remove “irritable”    Korr (1976)
   spinal lesions

13. stretch/tear adhesions Chrisman (1964)
    around nerve roots
 Some proposed mechanisms:
  theory                    author
14. Reduce distortions      Farfan (1973)
    of the annulae (annulus
    fibrosus

Neurobiologic Mechanisms of Manipulative
 Therapy, 1978
Areas of Research Involved in Mechanism of Action of
Adjustments/Chiropractic Corrective Procedures
       Adjustment/Corrective procedure
                      2
       Change in the musculoskeletal system
1                     3
       Change in the nervous system
                        4
       Change in organ dysfunction or
       tissue pathology or symptom
       complex
     Major Subluxation Theories
  (Dr. Charles Henderson, PCC Researcher)



• IVF Encroachment

• Altered Sensory Input (dysafferentation)

• Spinal Cord distortion
“Little scientific information is currently
  available to resolve the questions of
  impact on human health that the FSL
  (functional spinal lesion) may have.”

Triano, 1992
How do chiropractors evaluate
individuals clinically to determine the
appropriateness of chiropractic care?

•   Biomechanical evaluation
•   Neurologic evaluation
•   Trophic assessment
•   Psychosocial assessment

From Mootz, Chapter 10, Gatterman’s 1995 text;
  Foundations of Chiropractic: Subluxation
     Biomechanical Evaluation
• Contributing mechanical etiologies: (trauma,
  repetitive postural activities, etc..)
• Static asymmetries: (high shoulder, altered
  curves, rotated foot, etc…)
• Dynamic asymmetries: (gait, other movements)
• Passive and active individual joint ranges of
  motion: (static and motion palpation)
• Imaging procedures used to evaluate the above
  (x-ray, static and stress views, videoflouroscopy)
      Neurologic Evaluation
• Symptoms (pain and its location and
  distribution from patient interview)
• Palpatory tenderness
• Altered muscle tone (palpation, EMG)
• Vasomotor findings (thermography)
• Sudomotor findings (palpation and
  galvanic skin response testing)
        Trophic Assessment
• Altered tissue texture
• Edema (signs of inflammation)
• Metabolic disturbances
• Nutritional imbalances
 These may be signs of aberrant local tissue
  metabolism or vascularity; metabolic
  disturbances and nutritional factors may
  be causative or complicating factors in
  somatic disturbances, e.g… “pro-
  inflammatory state”
    Psychosocial Assessment

•   Mental attitude/outlook
•   Social interactions
•   Lifestyle habits
•   Stress
     Biomechanical Models of
          Subluxation
• Vertebral/spinal misalignment
• Abnormal motion; fixation,
  hypermobility, compensation reaction
• Joint dysfunction progressing to
  spinal degeneration
        Neurological Models
• Neurologic compression/traction/torsion;
  affecting nerves, roots, cord
• Neurologic irritation
• Aberrant reflexes
• Deafferentation/dysafferentation
• Neurodystrophic effects
         Trophic Models
• Axoplasmic flow mechanisms
• Neurologic ischemia, macro and
  micro
• Lymphatic/venous stasis
• CSF flow dynamics
      Psychosocial Models
• Psychogenic concepts:
  mental/emotional state influence on
  structure
• Somatopsychic concepts: structural
  influence on mental/emotional states

								
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