Something to consider...
"There have been no well-designed published clinical studies (including case studies) in peer-reviewed journals on subluxation and adjustment of the cervical, thoracic or lumbar spine."
DEVELOPING A CASE STUDY PROTOCOL FOR SUBLUXATION SYNDROMES
Christopher Good, D.C., M.A. (Ed) and Gerard Rosney, B.Sc., D.C. (candidate)
Introduction: The Chiropractic profession has provided patient care for the detection and
removal of vertebral subluxations since DD Palmer's landmark adjustment over 100 years ago.
Yet despite the growing acceptance of the profession, it is still claimed that little published
research evidence exists that establishes the "chiropractic subluxation" as a valid or significant
clinical entity (1,2, 3). Additionally, the word subluxation has been defined in many different
ways by various health care professions and this has led to much confusion and disagreement (4,
5). And given that only 16-23% of the population seek the services of a chiropractor (6), the
public as well as other health care professions, governmental agencies and insurance companies
do not appear to fully acknowledge the clinical importance of subluxation.
The objectives of this investigation were to review the literature in regards to the use of
the term subluxation, review the literature in regards to the clinical evidence concerning the
validity of subluxation, and if warranted, establish a research protocol to study subluxation in a
Methods: A literature search was performed utilizing the words subluxation, joint dysfunction,
joint pain, manipulation, clinical studies and case studies that involved the Index Medicus and
MANTIS databases and a chiropractic library. A review was then done to determine the number
and quality of studies specifically related to the treatment of subluxation in a clinical setting. A
second literature review examined common patient outcome measures for spinal pain and
disability. A final literature review was performed to determine which valid and reliable
subluxation analysis methods exist. The above information was utilized to determine a specific
research protocol to study subluxation in a clinical environment.
Results: It is clear that US chiropractors want to retain the term vertebral subluxation complex,
and that they educate their patients about subluxation (7). A consensus project established the
term "subluxation syndrome" as the clinical entity that chiropractors treat (8) and attempts have
been made to further classify spinal subluxation syndromes in order to facilitate clinical
investigation and understanding (Table 1) (4).
There have been no well-designed published clinical studies (including case studies) in
peer-reviewed journals on subluxation and adjustment of the cervical, thoracic or lumbar spine.
However, there are at least 73 randomized clinical trials related to spinal pain or headaches and
treatment by manipulation (9).
Quality outcome measures that measure spinal pain and disability do exist, especially in
regards to patient questionnaires, some orthopedic tests and digital algometers. There are a
number of commonly used subluxation analysis methods, yet none have good interexaminer
reliability, while some appear to have fair to good intraexaminer reliability (10,11).
Discussion: "Subluxation syndrome" seems the most suitable term/concept to utilize in clinical
investigations as it allows the systematic categorization of subluxations by region of the spine
and by well-established signs and symptoms. Given the scarcity of clinical studies, a well-
designed protocol for studying patients with subluxation syndromes should be developed and
implemented, but development of reliable and valid subluxation analysis methods would have to
occur. Subluxation analysis findings could then be monitored in conjunction with changes in
valid and reliable clinical outcome measures; this would begin to validate various subluxation
syndromes as real clinical entities that are important to treat.
While large randomized clinical trials provide the greatest level of clinical evidence, the
best initial investigations appear to involve a time series case study format (12, 13). Outcome
measures utilized would include active range of motion, pressure algometry, pain rating scales
and an impairment questionnaire such as the Bournemouth Questionnaire for neck pain patients
(14). Subluxation analysis tools would include static palpation for misalignment and pain,
passive osteokinematic motion palpation, joint endfeel challenge with patient input, postural
analysis and x-ray analysis (if films were clinically indicated).
Conclusion: There is a paucity of published clinical evidence in regards to subluxation
syndromes and a series of well-designed case studies would be an important contribution to the
literature. Establishing subluxation syndromes as significant clinical entities that respond well to
manipulative adjustments may well impact the future health care of society as well as the future
of the chiropractic profession.
2004 International Research and Philosophy Symposium: A Conference on Vertebral Subluxation