Transcript A Vertebral Subluxation Hypothesis Tree

A Vertebral Subluxation
Hypothesis Tree
Dr. Ed Owens
Dr. David Koch
Dr. Leroy Moore
The mission of research:
Service to the Profession
•Acceptance of chiropractic by patients
and other health care professionals
•Basic science research on the nature of
subluxation and the physiological effects
of adjustments
Jansen, Meeker, Rosner. American Chiropractors’ Research
Priorities. JNMS 1997; 5(4):p144-149.
Paradigm Fit:
Which subluxation paradigm?
• Spinal manipulation for back pain
• Vertebral Subluxation as the cause of all
disease (dis-ease)
• VS correction as preventive maintenance
• VS correction to enhance quality of life
Paradigm Fit:
Which subluxation paradigm?
• Spinal manipulation for back pain
• Vertebral Subluxation as the cause
of all disease (dis-ease)
• VS correction as preventive
maintenance
• VS correction to enhance quality of
life
Patient Base
50-80% (Epi)
80-90% (Epi)
100% (Const)
100% (Const)
Paradigm Colors Interpretation
• Recent high profile RCT’s have not been
favorable for chiropractic efficacy
– Methodological issues
– Paradigm mismatch
• Were Vertebral Subluxations Corrected?
• Were Vertebral Subluxations related to disease?
Many Effects: Many Causes
Vert Sx
Physiology
Genetics
Psychology
Disease
Nutrition
Injury
Another Vertebral Subluxation
Hypothesis
Complex organisms depend on the
bidirectional flow of information
between the central nerve system and
the peripheral cells in order to adapt to
a changing environment in a
coordinated manner.
Distortion of Information:
Disturbed Function
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Metabolic demands
Alcohol
Inflammation
Trauma
Spinal lesion in close
proximity to neural tissue
Vertebral Subluxation
Negative mechanical influences can
occur in the area of the spine and
interfere with information processing.
These are called vertebral subluxations.
Which comes first?
Articular derangement
leads to neurological
involvement.
Neurological
dysfunction leads to
articular derangement.
General Hypotheses
Slight disarticulations in
spinal joints can restrict
nerve transmission by
occluding the IVF
Misalignments of
vertebrae can change the
course of the spinal cord,
producing interference in
the transmission of nerve
impulses.
Articular derangement leads
to neurological involvement.
IVD material can
encroach on the spinal
canal or IVF causing
restriction on the volume
of neural tissue.
Changes in vertebral
mobility can alter joint
loading and
mechanoreceptor output
in such as way as to
disturb spinal reflexes.
More specific hypotheses
Misalignments of
vertebrae can change the
course of the spinal cord,
producing interference in
the transmission of nerve
impulses.
Misalignment can be
measured on x-ray
Sensory nerve
conduction can be
assessed with SSEP
General Hypotheses:
the other limb of the tree
Poor sense of joint strain
leads to improper, or
prolonged loading.
Compression or irritation
of efferent tracts leads to
loss of muscle control.
Neurological dysfunction leads
to articular derangement.
Irritation of sensory tracts
leads to loss of feedback
from joints and muscles.
Improper muscle tone
leads to fixation and
improper instantaneous
axis of rotation.
More global hypotheses
Vertebral subluxations at
any segment will effect
physical functioning.
Subluxation can be
assessed clinically
using a well known
technique.
Protocols
Physical function
can be evaluated
using performance
measures.
Protocols
Subluxation Detection
• Altered neurological
function
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muscle tone
leg length difference
posture/balance
thermography
• Altered articular
function
– X-ray Analysis
– palpation
Validation of Measures
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No gold standard
Hypothetical nature
Sometimes subjective
Covariation of neurological and
articular measures
• Fixed Pattern = Stasis, poor
adaptation
Experimental Design:
VS - Paradigm
1. Test function independent of symptoms
2. Observe structural and articular status
3. Correct structure
4. Re-test function
Using Common VS measures would allow
comparison of techniques for effectiveness
Vertebral Subluxation
Research Agenda
• Develop VS measures
• Effects of VS on quality of life
and function
• Funding from sources sensitive
to our needs