Talk:Vertebral subluxation/Archive 1

Title

The title should be Vertebral (not Vetebral) subluxation. Sebastjan

Spondylolisthesis?

Is v. subluxation the same as spondylolisthesis??

yes and no, spondylolisthesis is a medical condition (not "chiropractic") where one vertebrae has moved anteriorly in relation to the one below it. depending on one's definition of chiropractic, this would be a subluxation in the classical sense of the word

Unless I'm mistaken (and I've had anterior vertebrae, but I might be wrong), what you've mentioned is just one part of subluxation. A subluxation can be one of several things, though this is one of the more painful forms I've had. -- ConSeeDed

My initial percursory review of your emendations, while substantially improved, leaves me breathless with this "intro:

A vertebral subluxation is theorized to affect one spinal disc (i.e. degenerative disc disease), a section of the spine, or the entire spine. For example, a functional scoliosis or abnormal curvature of the spine, viewed in chiropractic terms, may be due to a subluxation of one vertebra that causes a distortion of the entire spine.

"Degenerative disc disease" is a medical diagnosis, often, but not always, including spondylolytis. But no chiropractor in my fulsome experience has EVER equated the two. In fact, chiropractors go to extremes to deny any correlation. DDS is a medical diagnosis, however amorphous it may be in medical pathology, but no chiropractor has ever suggested a vertebral subluxation is in any way similar to DDS. YOU must remove the impression (intended or otherwise) that ANY correlation exists, because it does not. If chiropractors reject the correlation, why is Wiki suggesting otherwise? Dshsfca 02:37, 1 February 2007 (UTC)dshsfca

Merge discussion

See here. -- Fyslee 22:08, 11 February 2006 (UTC)

END DISCUSSION. THIS ENTRY IS SPECULATIVE METAPHYSICS. Maybe an entry in Wikitionary, but not in Wikipedia. DEMAND removal of this entry.

~dshsfca

"Paraphrasing"?

Whatever the merits of "paraphrasing" in literary theory, hermeneutics, or philology, "science" does not paraphrase. No hypothesis of paraphrase can undergo the scientific tests of the scientific method.

As to "syndromes," AIDS is a genuine "syndrome," predicated on an actual and demonstrable retrovirus. But when did "syndrome" morph into an all-inclusive "kitchen-sink" of possibilities? No probability theory, much less "syndrome-theory" allows all sorts of possibilities (including phrenology, astrology, or reflexology) to substitute "syndrome" for something of empirical "substance." I'll cut chiropractic metaphysicans some slack, but even Aquinas and Aristotle could define "angels" and "unmoved mover." Why can't chiropractors define "vertebral subluxation?" But deferring to metaphysical "syndromes," is question-begging in the worst of all case scenarios. Dshsfca 02:48, 1 February 2007 (UTC)dshsfca

"I think it is missing the point by paraphrasing. This is a bit better." - Levine2112's edit summary.

There was no paraphrasing at all. On the contrary, there was a careful choice of passages expressly approved by Tedd Koren, ultraconservative chiro and arch enemy of Stephen Barrett. He was amazed I could get right to the point, leaving out the (for this article) unnecessary "fluff," and that I even understood it. I happen to know chiropractic theory, philosophy, and history so well that I can argue on both sides of these issues as well as or better than most chiros, so this was a piece of cake, and he approved the quote as I contributed it, and he gave no permission for the use of other parts of the article. By (especially without authorization) adding more you draw attention away from the point (is that your intent?) and also make the quote unnecessarily long.

You may find it surprising that I, with my viewpoints, can cooperate with Koren, who is at the opposite end of the chiropractic spectrum (in fact he just won a case with Barrett), but that's no problem for me. I'm interested in finding the facts and viewpoints and making sure they get represented for what they are - viewpoints and opinions. They must be presented, but - per NPOV policy - neutralized, IOW they must not argue the point as if it were true, but simply present it as an opinion. In contrast with many common chiropractic viewpoints, the scientific viewpoint is the majority viewpoint, and is thus per Wikipedia policy automatically NPOV. Other, especially unusual, viewpoints, bear a stronger burden of proof, and cannot be allowed to stand alone unchallenged and without opposing viewpoints. -- Fyslee 10:58, 15 February 2006 (UTC)

Interesting! Readers take note. The referee "can cooperate" with Koren, an extremist (by his own admission), but won't allow any contrary views, even other chiropractor's "scientific" views. PURITY, the referee claims. Cooperation has reached a new apogee, even if "putative" readers might find the deference disturbing.

If anyone understands the casusitry (above), and cannot understand why the article is NOT stripped of overt POV, explain it to the rest of us. This should alert Wiki readers to bias not only in the submissions, but in the referee's discretion. This entire entry is an unsupported POV, but the referee "can cooperate." So can the devil. It does not matter that devils and subluxations don't exist. The referee's "farie" raison d'etre to justify this entry should cause skepticism, but since PURITY counts more than EVIDENCE, who will know?

~~dshsfca

It would help mightily if, as you seem to claim to be able to do, you could come up with some fairly robust references and definitions about Chiro. Rolinator 09:29, 14 April 2006 (UTC)

Anything particular you have in mind? Just ask. -- Fyslee 22:48, 14 April 2006 (UTC)

There were and are paragraphs and sentences left out in between what you selected from the article. I consider that paraphrasing. I like very much what this article is saying. I feel that the idea that "subluxation" is a useful theory to explain the effects of adjustments is a good one but it is a very confusing notion. The references to gravity, atomic theory, et cetera help clarify what Koren is saying. That's why he included it there. Levine2112 00:30, 16 February 2006 (UTC)

Paraphrasing is where one uses one's own words to express another person's quote (and a citation must still be given, otherwise it's called plagiarism). I knew that Koren had expressed the concept better than anyone I know of in chiropractic. Since I couldn't have said it better myself, I consulted him and he approved of the choice of sections to quote. He did not give permission for the use of other parts, and since too long a quote wouldn't be very proper here, the quote is short enough to still get the point across. The other stuff is fine in his original article, but it's not essential or needed here. We need the essential part, and he not only approved of it the way it is, but was amazed that I had gotten to the "gist of the matter."

I'm rather surprised that you aren't tickled pink that I give Barrett's arch enemy and conservative chiropractor number one a chance to voice his views here. Of course I could just delete the quote entirely, but that would be too bad, since no one says it better (and he was very pleased I chose to quote him). I could also choose to quote Jarvis, Barrett, or Homola. Since they are nationally recognized as experts on quackery and chiropractic, they have much to say about the matter, but I doubt that you'd appreciate them being quoted here....;-) -- Fyslee 12:15, 16 February 2006 (UTC)

I don't want a semantic debate over the definition of paraphrasing. That's great that Koren gave his approval. I'm sure he would give his approval for that other paragraph that you keep deleting (which I believe is essential in understanding what Koren is describing). He is calling Vertebral Subluxation a theory that explains the results of a chiropractic adjustment. Well, I don't (and neither would the average Wikipedian) fully understand Koren's implication without the example he makes to the other scientific theories... gravity, etc. If it help to explain a complicated supposition (and it is a direct quote that was stripped out of the direct quote that is there know), I really don't see the big deal in adding it. And please don't threaten me with what you may or may not add to the article. It makes you seem like a WikiBully. Levine2112 18:50, 16 February 2006 (UTC)

I reiterate the issue mentioned above: Syndrome (manifestation of signs and symptoms) are tied to an empirical reality, i.e., the retrovirus HIV. This virus manifests itself in a plehtora of signs and symptoms, and thus the appropriate use of "syndrome." But here the process is reversed. A descriptive metaphysics of putative physiological features ("normal" or "abnormal" not distinguished) in which the signs and symptoms purport the causative agent: VS. But AIDS has a known, clinically-demonstrated causative agent for the syndrome of symptoms: HIV. VS has no evidence of even existing, except putatively as the imagined causative agent behind a manifestation of rather ordinary physiological features that descriptively and cummlatively hypothesize its "existence." Granted, the signs/symptoms of AIDS preceded the evidence of the retrovirus, but the diagnosis "AIDS" came only after a verifiable causative agent was found. (Ditto Down's Syndrome, etc.)

"Syndrome" used in this backwards way by chiropractic is meaningless. For example: I have a collection of properties and I call this collection of properties a "syndrome." A syndrome of WHAT? According to chiropractic, of a putative "VS." What causes what (direction of fit)? And what IS a VS? Does the syndrome "cause" VS, or the VS cause the syndrome? Where's the physical phenomena that lends evidence to these "syndromes?" Pointing to another "syndrome" as cause of another "syndrome" is circular and regressive. Cause? Effect? Which of which? Based on what physical manifestations? Dshsfca 21:40, 1 February 2007 (UTC)dshsfca

Tag

Replaced two tags with one. The article is filled with false anatomical chiropractic POV. It needs to be documented and sourced. The article needs heavy editing to remove this stuff. If any of it is preserved (as it could be) it should be accompanied with qualifiers to make sure no one happens to believe this as if it were fact. -- Fyslee 21:54, 12 April 2006 (UTC)

Removal from category:pseudoscience

Chiropractic is metaphysics. (Bad metaphysics, IMHO.) It does not even approach "psuedoscience." This entry should be deleted. If Wikitionary wants to include an entry for metaphysical concepts, then "vertebral subluxation," like "angels," is suitable place to do that. It must be removed until more basic questions are settled. The reasons are obvious to everyone but the referee. Chiropractic's unsubstantiated claims are hardly the only problem. Here are others.

From semiotics: Where’s the “signified” behind the “signifiers?” From philosophy of language: It’s all connotation, without detonation. From legal theory: “Rules of evidence,” “rules of evidentiary admission,” and “reliability.” From logic: Vicious circularity, not mere circularity. From science: What evidence? What phenomenon(a)? Verification? No independent review. Inability to falsify. Hypothesis posits phenomena (reverse science).

These “objections” arise both within and outside the chiropractic profession. Part of the problem originates within chiropractic itself. No consensus exists for what chiropractic is, what it does, and why it does what it purports to do. The “straight” vs. “mixer” vs. “medical” vs. “dogmatic straight” vs. “natropath” etc., illustrate the tension within chiropractic. For survival, compromise has held tensions at bay, but the professional associations, American Chiropractic Association (largest), International Chiropractors’ Association, World Chiropractic Federation, World Chiropractic Congress, Council on Chiropractic Education (the only federally-recognized entity), Association of Chiropractic Colleges, etc. have wildly-divergent and incompatible positions on the scope and practice of chiropractic, for obvious reasons. No consensus exists for chiropractic "philosophy," and no evidence exists for chiropractic "claims." For example, the ACC’s “scope and practice” statement is so vague, so amorphous, so broad as to be entirely meaningless. What possibly might “spinal hygiene” mean?

According to an article in JMPT – the only refereed indexical journal of chiropractic research -- the traditional chiropractic hypothesis that [the hypothesis of] vertebral subluxations causes [the hypothesis] of neurological interference which results [in the hypothesis] of disease, dysfunction, disorder, illness, etc., are hypotheses that remain controversial (I have cited the JMPT article, but the referee keeps deleting it.). The reason these multiple hypotheses are controversial is that: (1) one hypothesis posits yet another hypothesis, etc., endlessly regressive and circulatory; (2) no known phenomenon(a) correspond to any of the hypotheses; (3) no evidence supports, verifies, or even lends credibility to any one of the hypotheses. The referee even accepts the JSVR's putative claim to be "scientific." Does EVIDENCE count for anything?

Let’s examine just two of chiropractic's unproven hypotheses: (1) vertebral subluxations [itself a hypothesis] causes neurological interference; (2) neurological interference results, cause, has the consequence of disease. Ignore the hypothesis of putative “vertebral subluxations” for the sake of specificity. Does anything cause “neurological interference” (other than amputation, or surgical removal of organs, tissue, or cells)? The concept is itself ambiguous. Is “distortion” of cybernetic transmission implied or entailed (the least extreme interpretation of the hypothesis)? Can nerve impulse(s) be distorted? Elementary neuroanatomy and neurophysiology have demonstrated at least six functional types of nerves to exist: (i) somatic afferent, (ii) visceral afferent, (iii) visceral efferent, (iv) somatic efferent, (v) specialized visceral efferent, (vi) special afferent. Which of these nerves, if any, are “distorted?” How are they “distorted?” Neurons vary in function and type depending on anatomy. Neuron types also vary according to structure, e.g., (i) bipolar neurons, (ii) unipolar neurons, (iii) receptive segment in mulitpolar neurons, (iv) initial segment in the trigger zone of the neuron, (v) conductive segment, or axon, (vi) transmissive, or effector, segment. What type of neuron types is affected, if any? Where in the structure/action does the “interference” occur? Is the “interference,” as claimed by B. J. Palmer, along the transmission line from the Central Nervous System to the Peripheral Nervous System, or from the PNS to the Motor Nervous System (a subsidiary of the PNS)? These are basic and elementary questions. Nothing complex about them (Introductory college courses in anatomy and physiology discuss these concepts.)

Multiply this type of basic and elementary question and apply it to the further hypothesis that, if the hypothesis of a phenomenon called “neurological interference” is proven to occur (from whatever situation other than “physical” amputation or tissue and visceral removal), what consequences or effects might follow? (We can lbael this second hypothesis as the “neurological-interference theory.”) Does the hypothesis of “neurological interference,” if it could be verified to exist, in turn cause disease? (Extrapolate to allow the most possibilities. Perhaps not "disease;” maybe “disorder,” “dysfunction,” or “illness” or any pathology.) Would any of these or similar consequences follow, if the hypothesis of “neurological interference” could be demonstrated to be true? Is there any evidence of any kind to suggest that disease (disorder, dysfunction, etc.) could be caused by a neurological “distortion?” (Not from amputation. Not from a true “impingement.” These are within surgery’s domain for known and observable phenomena.) But a lesser-purported phenomenon is involved and questioned, the hypothesis that cybernetic “interference” or “distortion,” if true, would result in “disease?” (broadly speaking)? If this hypothesis, called the "neurological-interference of disease hypothesis," could be substantiated, then chiropractic’s other myraid hypotheses, such as that of “vertebral subluxation,” could possibly be another hypothesis to prove, but only if these “meta-chiropractic” hypotheses pass the test of coherency and consistency.

Meta-questions are common to metaphysics as a prelude (or to override, discount “evidentiary” claims). Since chiropractic's hypotheses have no evidence, these questions hlep us ask in the abstract in order to find “coherence” to a particular conceptualization (it has nothing to do with “evidence” or “phenomena,” since chiropractic's hypotheses lack these properties). Meta-questions are especially useful in evaluating chiropractic’s hypotheses, since no observable phenomena are known to support any of its manifold hypotheses. But it seems the first meta-questions to settle are the two hypotheses here: (1) the conception of “neurological interference” as distortion of cybernetics -- excluding physical removal of tissue, viscera, etc.; and (2) if the conception of “neurological interference” could be demonstrated, what, if anything, might follow? (E.g., disease?) Could such a “disturbance” of neurological impulse, if proven, have a pathological consequence? Ignore the hypothesis of “vertebral subluxation.” That hypothesis is premature and needs first-order questions addressed first. Before crossing that bridge, first determine whether the neurological disturbance of the kind chiropractic claims is actually feasible, and if it is feasible, if it has any effect at all, is pathology (in any sense) one of the consequences?

Given this state of affairs, the entry of “vertebral subluxation” and all the casuistical claims should be removed until the more fundamental questions are answered. If those higher-ordered claims can be substantiated, perhaps the lower-ordered “debate” about the hypothesis of “vertebral subluxations” can enter the fray. Otherwise, it is only a "cause" of endless speculation about speculations. Casuistry is not a substitute for EVIDENCE. REMOVE this ENTRY.

~~dshsfca

Chiropractic does not meet the qualification of pseudoscience. My reasoning is as below;

• Chiropractic, while a descriptive and holistic treatment for an admittedly vaguely described 'illness' (ie; Vertebral Subluxation, hereafter VS) meets the standards of the scientific method, namely
  • It is descriptive; chiropractic describes symptomatic manifestations and interprets these as being due to VS
  • Predictive. Chiropractic treatment s proven to be effective at alleviating some symptoms, such as back pain. Treatment is given, and research is conducted, to discern the effects of VS in secific areas of the spine on various symptoms
  • Control over symptoms is proven, even if it is qualitatively proven by interviews with patients.
  • Understanding of the symptoms and their treatment is gained; even if this is not fuly understood. Chiro doesn't pretend to know everything and, as scientists, neither should conventional medical practitioners portray their profession as having all the answers even to well understood diseases. Ergo, chiro is of equivalent scientific merit to a lot of symptomatic treatments offered by the medical profession (analgesics to treat migraine pain, not the underlying cause)

• Chiropractic meets the criteria of being a scientific profession in that it has
  • Peer reviewed journals. Even if other branches of the scientific profession do not agree with the conclusions and practice of chiropractic, similar to arguments about intelligent design, simply the presence of controversy does not invalidate chiropractic's arguments or theories. Additionally, those from outside a profession and unschooled in a profession may not offer substantive peer review (for instance, engineers reviewing medicine) because it requires a certain level of knowledge of the subject in order to critically examine and review within a field.
  • Standards of ethics and conduct; even if they are not always maintained as this is no different than any other profession maintained by human beings, least of all the medical profession.
  • Chiropractic is taught as a degree and diploma level accredited course within medical and science faculties at recognised and accredited institutions; it is a recognised effective alternative medical treatment, similar to acupuncture. However, reiki and aromatherapy are not taught to a disciplined level and do not adhere to peer review, ethical standards, nor any hint of the scientific method.

I can see why people think that chiropractic is pseudoscience.

Firstly, there's the demarcation dispute between orthodox medicine and complementary medicines, in which either side vies for market share via slanging matches and misinformation.

Secondly, there's the history of Palmer and the early chiropractic profession. However, we should not forget that in the 1700's and 1800's the medical profession was still treating phrenology and craniometry as very real medical science, that leeches were still used to treat fevers, and that the ideas of "innate intelligence" were hardly an invention of Palmer and were hardly much different than "swamp humours" and other such theories used to categorise and explain medical phenomena. If chiropractic gains the tag of pseudoscience due to its 19th century origins, medicine itself should be classified as pseudoscience for the same reason.

Thirdly, much medicine has as little to do with science in its common daily application, or even less so, than chiopractic. Chiropractic diagnosis is more rigorous than most medical diagnoses done at a general practitioners, where often the only diagnosis performed is an oral query of the patient and then assessment of symptoms. Nerological and biomechanical assessments performed by chiropractic are at least as rigorous, and the nly difference is in interpretation.

Finally, the majority of correlation between chiro and pseudoscience, on the web, is associated with American websites and discourse, which means it is primarily a single cltural artefact of the American political and cultural landscape. I cannot reasonably speak of other nations and cultures with much authority, however in Australia chiro is considered a viable complementary therapy and alternative medicine and is not branded "pseudoscience". So, although there's certainly an element of tinfoil hat brigade driving the POV here, I do not believe it is valid, due to the above.

Rolinator 02:35, 15 April 2006 (UTC)

Rolinator, the above demonstrates an uncanny ability to look at things objectively and sort things out on an unemotional level. I thank you for your professionalism, unlike the very emotional anti-chiropractic editing that some are guilty of here.

I hope you stay around for a while to help maintain the NPOV. Steth 11:11, 15 April 2006 (UTC)

Hi Rolinator,

Sorry to have drawn my nemesis to you. You will note that Steth wrote the above after my remarks below, which were written in a very civil manner. Steth has an uncanny ability to follow me around and try to damage my reputation by poisoning the well. I hope you can see his ingratiating remarks for what they are. He had just attacked me (for the umpteenth time) rather viciously, just before coming here to smear me (again!). I hope you can avoid being infected by his antagonistic spirit, because I am certainly willing to cooperate with any editor, even pro-chiropractic editors. I just want civil discourse and cooperation (which I don't get from Steth). -- Fyslee 12:37, 15 April 2006 (UTC)

I think that Fyslee may be prone to paranoid delusions with the above post. The 'Vertebral Subluxation' page is on my watchlist, so whenever anyone adds their comments to the Talk page, I go to it and check it out. Just like everyone else does.

I come across Rolinator's brilliant assessment of things, pay him a compliment, and Fyslee takes this as a personal affront to his 'reputation'. Going back in history, I see that he seems to have a bad boy history of rubbing people the wrong way, like AED and Levine2112, for example.

Talk about glass houses!? Go figure. Steth 15:08, 15 April 2006 (UTC)

Now, now, lets not get bitchy. Rolinator 00:37, 17 April 2006 (UTC)

Yeah. What have I done to rub people the wrong way? That's like the pot calling the kettle "black". -AED 19:25, 17 April 2006 (UTC)

Much editing based on a misunderstanding

Much hard work and sincere editing efforts are being wasted.

This edit needs citations, or should be edited and some deleted:

A number of irrelevant links added here. They deal with chiropractic, but not specifically VS, and thus don't belong in this article, and in fact, after much discussion about too many links at the chiropractic article, don't belong there either.

The editing starting here, while interesting and often correct, reveals a confusion between the subject of this article - VS - and chiropractic. They are two different articles. The editing from that point onwards needs to be greatly reduced, redone, and much deleted as inappropriate for this article, which isn't a textbook in chiropractic procedures, but an overview of VS.

Another external link that is irrelevant to the content of the article.

The removal of the pseudoscience category tag is explained well, but reveals a confusion between the subject of chiropractic and VS. They are of course intertwined to such a degree that VS is the very foundation of chiropractic, but it is VS, not chiropractic, that is pseudoscience, and thus the tag belongs at this article, but not at the chiropractic article.

Another good link, but also irrelevant, in keeping with comments above.

More of the same. Should be removed.

Much of this content does not belong in this article. The chiropractic article would be the place for it, but much of it has been or already is there, and such large edits would violate the collaborative efforts to create the article. Sometimes one sentence at a time is easier to manage, and even small changes of wording can create edit wars and much wasted time.

Your efforts and sincerity are appreciated, but I fear that your misunderstanding of the purpose and very specific subject matter of this article has led you to do a lot of editing to no avail. I suggest that you revert back to where you started, and - keeping in mind the problems I've pointed out above - that you proceed very slowly. Keep in mind that this is a collaborative effort. If you make too many changes at once, the only way for other editors to ensure that problematic ideas, wording, or other aspects don't get introduced is to simply delete everything you've just added, and that would be too bad, because you have used a lot of time and energy on editing the article.

I'm not interested in an edit war here and would rather that you do the reverting, and will welcome discussion here. Just stayed focused on VS, not generally about chiropractic. Here is a logical place to revert to.

The Pseudoscience category tag also needs to be restored. It's VS, not chiropractic, that is the pseudoscience.

Another thing to keep in mind is that this article and the Subluxation article must not be blended together, which would create confusion. They are two different things. This article deals exclusively with the chiropractic concept. As such the article is allowed here at Wikipedia because of the subject's historical nature and because it is the foundation of a whole profession. If that were not the case, it wouldn't be legitimate to have an article on it here at Wikipedia, because Wikipedia forbids the publication of original research. If a subject isn't verifiable, then it doesn't belong here at Wikipedia, and VS hasn't been proven to exist as yet. It is only allowed here because of its significant position in chiropractic.

Here are some tidbits (chiropractic sources) you might find interesting. It might be good to read them before editing:

• Subluxation: dogma or science?

• A comment on the article above

• Some interesting observations

• Chiropractic as spine care: a model for the profession

• The Specter of Dogma

• It Works, It Works, It Works!

Other significant articles on the subject:

• Chiropractic's Elusive Subluxation

• How Chiropractic Subluxation Theory Threatens Public Health

• Analysis of a Misleading Chiropractic Article in a Major Medical Journal

• Serious pseudoscience

• Subluxations not backed up by proof

Good reading! -- Fyslee 10:13, 15 April 2006 (UTC)

JVSR and VS

The Wiki referee will not abide by the EVIDENCE. The Journal of Vertebral Subluxation Research is NOT accepted as a putative "scientific journal" from the chiropractic profession. Only Wiki's referee accepts JVSR self-validation as "scientific," despite EVIDENCE from National University of Health Sciences (cited) and the American Chiropractic Association, which states unequivocally that the Journal of Manipulative and Physiological Thereputics is the ONLY journal accepted for chiropractic research. The Wiki referee persists in his beliefs. The JRSR is a professional soapbox making unsubstantiated claims that the profession does NOT accept, but the Wiki referee does.

DEMAND Wikipedia DELETE this entire entry, which is nothing but a casuistical and highly speculative piece of metaphysics. If Wikitionary wants to include a definition of this wildly speculative hypothesis, let it find one. ~dshsfca

I reply with;

• Journal of Vertebral Subluxation Research, quote " a peer reviewed scentific journal devoted to the research of vertebral subluxation". You may disagree about the concept or presence of VS, but the fact there is a scientific research journal which is devoted to researching the condition is, well, proof enough of what I say. If there is peer review, randomised clinical trials, and the ability for criticism and testing of the hypotheses, then it's not pseudoscience. It's science. I am not a chiro or a doctor, so I can't judge the quality of the research (though reading Chochrane Collaboration, its clear there is some efficacy, though the resarch wasn't of highest standards, but even Cochrane Collaboration says that even low-quality research is not useless).

Rolinator 02:36, 16 April 2006 (UTC)

The JVSR isn't taken seriously (in fact it's pretty much unknown) in scientific circles, or even by many chiropractors. It is the publication of a fringe group (mostly ICA and WCA members) in the profession, that happens to call its own publication "peer reviewed." The description (VS and "scientific" in the same sentence) is considered an oxymoron. This is an illustration of the debasement of the term "peer reviewed," where nearly anyone can now call their own private publication "peer reviewed." A sad sign of the times and an attempt to dumb down medicine.

To get a more accurate view of the picture, one needs to get outside viewpoints, and not depend exclusively on the viewpoints of the believers. They will naturally claim their belief is scientific. It simply 'can't be any other way! To illustrate (no offense intended to JWs), if one were to claim that Jehovah's Witnesses were a religious sect or cult, and the source you could find that claimed they weren't a cult or sect was "The Watchtower" magazine..... You get the picture? Such a source cannot be used to decide the question, and in fact would be disqualified as a source to decide its own fate. Outside sources need to be consulted on the question. The parallel is not even illustrative, but exact.

You mention RCTs and the Cochrane Collaboration. You also added a general link (not specifically VS, and thus must be deleted): Cochrane Collaboration Reviews of therapies for spinal or back pain. Is there something there that deals with chiropractic Vertebral subluxations? I'd like to see what you're referring to. Maybe you're thinking of orthopedic subluxations? Everyone is agreed on their existence, while it is only chiropractors, Chiropractic Assistants, their patients, and maybe a few (primarily European) DOs, who believe in chiropractic VS.

If you can find any non-chiropractic sources confirming the existence of the chiropractic Vertebral subluxation, I'd very much appreciate adding them to my chiro archives. I have chiropractic sources that discount the concept. The article quotes the absolutely staunchest believer and defender of VS, Tedd Koren, and even he admits that "it is an abstraction, an intellectual construct....." It is not an anatomically confirmable entity, because it is much more than an orthopedic subluxation. It also includes metaphysical and philosophical aspects, and is the very foundation of chiropractic. -- Fyslee 22:59, 16 April 2006 (UTC)

OK, one thing confuses me; for someone whose userpage is chock-full of claims of skepticism, fine. Be skeptic like you claim. But where's the NPOV with you and chiro/subluxation? You apparently have a considerably stocked bandwagon you're pulling here. For someone who claims to be NPOV, you a) didn't do much to actually define VS in tems used by those evil "religious" chiropractors, b) consistently refer to chiro/VS as pseudoscience without outlining why, and essentially want the article to conform to your aesthetics and worldview. Which is fine, if you want to give equal treatment.

I'm not suggesting that this turn into a bulletpoint bitchfest, but its obvious you've never had back pain and never had it relieved by a chiropractor. I have. I don't believe that treating VS, regardless of whether it's true or a complete load of ass, will give me "innate intelligence" but like I said, I also don't believe the star regulus is the way to alchemical creation of gold, nor do I believe in phrenology, and since I know a few things, I don't believe in abiogenic petroleum origin or magmatic coal. I do know what treatment of my "vertebral subluxation" has achieved for me, and I am skeptical enough to wonder if my mild scoliosis can be cured, but I can also tick the boxes for what my chiro said would improve and has improved, and certainly some of the back pain and muscle spasms can be eliminated in an instant by treating the VS, so I have observed the effects firsthand. You may think I'm a dupe and I'll be singing DD Palmer's religious hymns, but I'm not a big enough dupe to be reading Intelligent Design, so you have tobalance healthy skepticism with an open mind. If as Koren says V.S. is an abstraction, its a pretty good theory or model of the symptomatic complex which is called VS, which is treated by chiro. Its similar to gravity being an abstraction; we can see its effects but we can't photograph it or bottle it. And I suppose you are in favor of editing gravity off wiki too?

Cochrane is a valid reference because it is a resource where back pain (which VS is associated with; don't believe me, fine, you're a skeptic so you disbelieve everything, right?) treatments have been assessed statistically to compare results of RCT's, including manipulative therapies such as chiropractic. Readers can go there and find out for themselves and access further resources to make up their own minds. So what's the problem with leaving it in? Is there a risk people will find out the facts?

You can't divorce chiropractic from V.S. You cannot eliminate the substantial connection between chiropractic and the condition which chiropractic assesses and treats, and you cannot completely explain one without the other. You also cannot make claims of one thing being a pseudoscience if you don't at least back it up with some facts. In my appreciation of the issue, sure, there's a lot of weird shit about VS and chiro, but it doesn't qualify as pseudoscience because it is very much a mainstream profession with several peer reviewed journals, regardless of quality (which I'm not qualifiedto judge), etc etc. I know this rankles you, but if you're really a champ of NPOV, you'll wait out till someone else who can judge the scientific quality of these things comes along. Someone apart from you.

Finally, yes, I will formally state my POV and bias, as this is something we should all do. My POV is that VS is a good working hypothesis, needs some work, but in the very least treatment (in my own observations) does what was advertised, and is as effective as physio and medication. Rolinator 01:11, 17 April 2006 (UTC)

Again, well said, Rolinator! I have often wondered how someone like Fyslee who claims to be so totally and completely devoted to chiropractic hatred, can seriously claim to add anything resembling a NPOV around here. Go figure. Steth 02:42, 17 April 2006 (UTC)

What a significant improvement overall, folks. By the way, I have suffered disabling low-back pain after 40 years of chiropractic treatment, which several physicians suggest chiropractic may have precipitated, not alleviated. (Are you aware of self-eliminating disorders? Placebo effect?) Also, "straight chiropractors" make some pretty outrageous claims, such as curing schizophrenia, multple scelorsis, and even diabetes. When pressed, they insist the body always heals, they just release Innate Intelligence through spinal adjustment, and Innate cures. Fairly curious stuff, IMHO.

My own knowledge of anatomy and physiology is limited to a few college courses (including Palmer College of Chiropractic, Davenport, which is laughably inferior to any "college" I've attended; btw, Virgil Strange was one smart anatomist, however strange his chiropractic philosophy). But anyone who has even a rudimentary knowledge of neurophysiology knows that misaligned spinal segments (VS) cannot alter the function of splanchnology -- what a great idea if it were true! And the VS is integral to the "neurological cause of disorders" per B. J. Palmer's chiropractic metaphysics (they are mutually entailed, not independent). Why else adjust vertebrae, unless it does something useful? The problem is that no one knows what it does, if it does anything at all, but it cannot alter neurocybernetics that in turn affect autonomic nerves, viscera, or splanchnology.

I do believe that the overall entry is significantly improved, but I lament the omission of Karl Popper's quotes, who, as a philosopher of science, enhanced evidence-based scientific understanding. Metaphysics has a place in some explanations, but not as a substitute for evidenced-based "health care." B.J. Palmer offered his hypothesis over sixty years ago, so one might reasonably expect that such services that chiropractors offer would have some evidence to support its claims. It has "none." Even scientists fairly ridicule the "neurological interference theory of dysfunction." If such concepts cannot be falsified, much less verified, they're not scientific. I think this feature is clearer than the initial entry. Thanks. Dshsfca 07:17, 27 January 2007 (UTC)dshsfca

Dshsfch, thanks for that. I certainly heard what you had to say and appreciate that your experience had value in improving the article. Placing that with the experience of others, we get closer to might be the "truth". Scientific investigation will most certainly help us answer the questions that still remain, but that doesn't change the history that preceded it and that is what is necessary for us to document as well. The way I see it, VS was just a model that DCs use to try and explain what they thought they saw. Over the years the model has changed to reflect what scientific investigation has proven (or not proven). At this point, it is likely that VS is more of a political entity that holds the profession together against a mighty foe, but that is just my speculation that means absolutely noting;) Maybe if DD would never had gone to jail in 1904, the word VS would never had been invented and DD's and Andrew Still's methods would have just been part of a larger system of people helping people get better. Funny what money does to people and their ideas - on all sides. Thanks to you. I do hope that all has turned out well with your spine as well. --Dematt 16:37, 27 January 2007 (UTC)

If one assembles a peer of astrologers, will that count as evidence? Maybe phrenologists and reflexologists can be "peer supports" when the JVSR needs "peers" as their inital supply goes on an intergalactical journey.

All modern, scientific hypotheses are postulated, and are either verified, or rejected. But assembling a peer group of occultists may "prove" the occultist have members, since no empirical proofs are available. They may publish a "peer-reviewed" journal and report their occult experiences in their "peer-reviewed" journal, but the DIFFERENCE, is that ALL other peer-review journals must have EVIDENCE, something that they can empirically point to. Here, I am thinking of anatomists, physiologists, biochemists, physicists, and those who really have something genuine to "point to." If this "journal" counts as "scientifically peer-reviewed," then the Heaven's Gate folk have proven intertestial death is an illusion (Star Trek fans may be disappointed, but at least they won't follow the prescription). Dshsfca 03:01, 1 February 2007 (UTC)dshsfca

Blending chiropractic into the article

Heaven forbid we "introduce" chiropractic and "adulerate" the article! For referee Fyslee, PURITY is more important! Nevermind that the hypothesis of "vertebral subluxation" is a CHIROPRACTIC hypothesis (unproven, to be sure, but it belongs to chiropractic, and no one else). Literary theorists, don't despair! Yes, CONTEXT continues to be important, even if Fyslee proscribes it. Read the adulterated entry "chiropractic," and ignore the speculative metaphysics in this entry, since PURITY trumps context, evidence, and reason. Let's not confuse readers. PURITY is its own raison d'etre. (Don't quarrel with the referee's similarities to that OTHER purist in Germany, circa 1935. Any similarities are intended to be coincidental). On the evidentiary side of things, remember: "Since this is a metaphysical concept, the religious dimensions are also appropriate here. Palmer wrote extensively on those aspects, and they are verifiable." Yep, the referee makes THIS claim.

~dshsfca

In my original message above, I mentioned that you had blended a lot of chiro stuff and links into the article that don't directly relate to the subject of the article. It still needs to be deleted. -- Fyslee 23:00, 16 April 2006 (UTC)

I agree. I will check who added all the chiro stuff and exclude it if I find that its a one-mans job. Moreover, it's not properly sourced. ackoz 11:44, 22 April 2006 (UTC)

Suggestion: Rename this article to "Chiropractic vertebral subluxation" and create a new one "Orthopedic vertebral subluxation". ackoz 11:50, 22 April 2006 (UTC)

I did that awhile back. It was a very confusing article with the two different concepts blended together. Now they are separated into this one and subluxation.

As to cleaning up this one, it was a one-man job. I suggested a revert point above. Be my guest. It's a matter of keeping on-topic. This is not the chiropractic article, nor a place to defend or sell it. It should provide information about the chiropractic VS and its role in chiropractic, not necessarily about its treatment (that would be the job of the spinal adjustment article. Treatment should only get short mention here. Since this is a metaphysical concept, the religious dimensions are also appropriate here. Palmer wrote extensively on those aspects, and they are verifiable. -- Fyslee 23:13, 22 April 2006 (UTC)

Reverted, WP:NOT advertising chiropractic, off-topic etc. ackoz 23:27, 22 April 2006 (UTC)

Sourcing Information

I reverted a large section of unsourced POV edits by an anonymous user. Please discuss below. Levine2112 21:45, 1 July 2006 (UTC)

I have reverted the same information, this time add by Dshsfca. The information that you are adding is unsubstatiated opinions, but you are not presenting it as such. Please only add documentable research. If you are adding an opinion, please be sure to label it as such. Levine2112 01:05, 4 July 2006 (UTC)

I find it outside "normal" sourcing to use circular sources. If A claims X and supports X from A's evidence, that's incestuous. If ANY evidence existed in ANY way, then such claims within a "proven" system are cut some slack. JPMT is not an "impartial" source, being the publication of the ACA. If one calls Scientology's assertions into question, is Ron Hubbard the only authority to substantiate his own claims? Dshsfca 21:44, 1 February 2007 (UTC)dshsfca

BOLD revert

I reverted the bold texting throughout the article. Though it was a fun experiment in editing, it didn't have the wikipedia look. Thanks! --Dematt 20:07, 6 July 2006 (UTC)

Had to revert again, bold just isn't working. Dshfsca, please discuss your reasoning. It might even make sense to me, otherwise this is looking like vandalism.--Dematt 22:47, 6 July 2006 (UTC)

I've been trying to discuss this very same thing with Dshfsca on his user talk page. He is a new user and though I've instructed him to discuss his edits, he seems a bit reluctant. I think we all go through this when we first join Wikipedia. Hopefully, he will get the hang of it. Levine2112 23:29, 6 July 2006 (UTC)

Gotcha. I'll hang back. --Dematt 03:05, 7 July 2006 (UTC)

Dshsfca comment

This phrase might warrant a dictionary entry (if a definition can be pinned down), but it should be removed from the encyclopedia.

There is too much highly speculative dribble over a controversial hypotheses (neurological interference theory of disease) about putative phenomena (vertebral subluxation) that "may" or "does" result in disease, that the article devolves into numerous equivocations, lack of conditonal terminology such as "may" (as appropriate for a hypothesis) instead of "can," the misstatement of facts (Andrew still coined the neologism "subluxation" which means something entire different to chiropractor's "vertebral subluxation," coined by B. J. Palmer) the article is an incoherent and unintelligible morass. If chiropractors cannot agree, much less don't know, what a vertebral subluxation is -- as evidenced in different places and in different contexts to refer to "putative phenomenon," then to "putative phenomena," then to a "putative syndrome," which is "treated adjusting bones," -- compounded by the string of Virgil Strange's speculative hypotheses, the hypothesis of "vertebral subluxation" remains too amorphous, too controversial, and too often denied -- including by chiropractors -- to merit consideration in the encyclopedia. Let it be debated elsewhere. Let's stick to evidentiary claims, not speculations on speculation.

DshsfcaD.S.H.

Hey Dshsfca, thanks for your input. (I hope you don't mind, I moved this to the bottom of the page so we can follow the discussion) You make a very good point here on the vertebral subluxation page and I hope you stick around and help us get it right. I am going to disagree with you about deleting the article, but I respect your right to voice your opinion. However, I do think we need some good references on this page, both pro and con. This information is stated too much as if it is fact rather than a model. If it were referenced, then at least the weight of the evidence could fall on the sources rather than looking as though it is common knowledge. I know sometimes it can look like a page is totally biased, and sometimes it is, mostly because your POV has not yet been presented. I have no problem with what you seem to be saying, I am more confused by how you are saying it. My main concern was that bold is not a good way to get your point across. Also, go slow. A lot of people have been working months and sometimes years on these things. Take your time and let people digest your ideas. --Dematt 05:34, 8 July 2006 (UTC)

As a chiroskeptic I tend to favor your basic views, but I side with Dematt on this one and will vigorously defend this article's right to exist here, just as I would the right of the article on fairies or other such ideas (to name undocumented but claimed phenomena ...;-) to exist here at Wikipedia. One cannot discuss or understand chiropractic without an understanding of this claimed dysfunction, so it must be discussed, and its claims and history documented, as well as the criticisms. Of all the chiropractic articles here, it could deserve to be the largest one, in keeping with its importance! -- Fyslee 14:54, 8 July 2006 (UTC)

YOU are creating an untenable situation. In another section, you prohibit other "chiropractic" hypotheses that provide "context" to this wildly-speculative hypothetical "concept." Yet you permit totally unsubstantiated claims about a putative phenomenon, that some chiropractors "hypothesize," but no one else fathoms (lack of phenomena will ALWAYS cause difficulties).

Worse, you decline ALL other submissions, including those by scientists, including an article by a chiropractor in the ONLY scientific journal accepted by chiropractic, because they did not fit your PURE conception of a concept in an undefined context.

Spencer's "Farie Queen" justifies an entry in Wiktionary to explicate possible meanings of "farie." Because we KNOW faries don't really exist, no caveats or conditional are needed. This article, however, makes hypothetical claims about putative phenomena that "must" exist that don't. The CONTEXT is totally different. And since you will not allow contrary "scientific entries," only putative unsubstantiated opinions from chiropractors about PURE hypotheses, this entry elevates "vertebral subluxation" ABOVE faries. Scientists would never write like the contributors to this article. They'd write with caveats and conditionals, like "may" "suggests" "possibly" etc. But these assertions are CLAIMED, with no evidence to support them. Mutatis mutandis, "vertebral subluxation" justifies an entry (if a definition can be determined) to provide "context." But you refuse even THAT!

But encyclopedias have a higher standard for "entries." "Faries" are understood to be mythical, "vertebral subluxations" are just as mythical, but the entry, as you allow, does not reflect THAT. Hypotheses of hypotheses, in which casuistry replaces reason, and nary a verified fact nor empirical evidence appears, might disqualify an "entry." Faries might exist in literature, which justifies an explanation, but not a JUSTIFICATION. The literature purporting vertebral subluxations are also myths, and if contrary "science" was allowed, would become obvious. But because you prohibit any contrary evidence, in order to achieve PURITY of thought, the consequence is PROPAGANDA. That's a distinction with a difference, a distinction you refuse to consider, and DESPITE protests, refuse to reconsider.

Vertebral subluxation are not JUST such an instance of speculation on speculation about a hypothesis that no one other than chiropractic, and even chiropractors, don't accept. Since you won't allow other chiropractors' rebuttal to this mental masturbation, the result is PROPAGANDA. We logicians call this "circularity," "undemonstrated," "incoherent," "inconsistent," and "elusive" to use Barrett's word. In the final analysis, though, it is unadulterated propaganda!

If YOU really believe this elusive metaphysical conception deserves further "discussion," then move it to a sub-section under "chiropractic" where at least readers will have a CONTEXT, where skepticism is ALLOWED and VOICED, and where the "complexities" of the metaphysics is attenuated. Insisting on this preposterous, dogmatic, and casuistical entry, and then refusing ALL counter-evidence, ALL discussion, and EVEN doubt, sabotages Wiki's NPOV.

DshsfcaD.S.H.

Dshsfca, I do owe you an apology. I think I am beginning to see what you are saying. I've re-read some of your edits and they are finally getting through my thick head:) I did edit it some to make it a little more succinct. I still have some question about this statement in the paragraph about JMPT;

• The phrase appears to have multiple meanings, given different contexts.

Do you have some reference as to what the "multiple-meanings" might be? Either we could state a few or consider just taking this sentence out. We might want to move it to a different spot where it won't interupt the flow of thought that you are trying to present about JMPT. Let me know what you think.--Dematt 13:33, 9 July 2006 (UTC)

---

Moved from its inapropriate placement at the top:

WARNING: SCIENCE FICTION READERS ONLY

The following is CRITICAL to understand why this entry even exists:

When I came across an entry of an entirely speculative nature, "vertebral subluxation," lacking in any and all empirical evidence, I first disputed the claims, then disputed the entry. Such speculative metaphysics, I claimed, should be "marked" as such, and more importantly, the empirical claims (as much as anyone can) should be excluded, because they cannot be demonstrated. At the least, allow a rebuttal to the irrational and unverified speculation and its attendant claims.

My first submission, as rebuttal, was based on scientific and logical criteria. It was rejected by the referee. "Opinion," he screached. "Not exactly, I retorted, each proposition of mine can be verified, while none of the article's claims can be. So it isn't just opinion." The referee further insisted on "purity." Purity, I howled, what has 'purity' to do with anything?" Okay, maybe hygienic standards crossover to an intellectual discussion of metaphysics. So, I referenced (i.e., cited) every sentence I wrote. How pure is that? Not pure enough. Here's the referee's "final decision:"

"Since this is a metaphysical concept, the religious dimensions are also appropriate here. Palmer wrote extensively on those aspects, and they are verifiable. -- Fyslee."

What? Seriously? I can hear Gilbert Ryle exclaiming: "Category mistake!"

The entry makes "emprical" claims, admittedly based on a metaphysical concepts. But it is the emprical claims I questioned, not the metaphysical ones. But when did metaphysical concepts become verified? If verified, they become empirical. If unverified, then they are metaphysical. The words themselves define the two different, indeed opposite, situations. But the referee claims the metaphysical concepts have been verified! The words are antithetical! A distinction with a enormous difference not only lost on the referee, but refuted by the referee!

Even more incredulously, the referee will not relent! He insists his own claim is also verified. Now, we are beyond metaphysics, we are in science fiction. We cannot even "reason" together, because his POV (point of view) is beyond reason. It does not merely defy reason, it is irrational.

While the CONTROVERSIAL warning appears on the discussion page, it disappears on the article page. Shouldn't readers, not just contributors, encounter the warning? IRRATIONAL should also be added. -- Dshsfca 04:58, 9 July 2006

Unworthy of a reply. -- Fyslee 13:37, 11 July 2006 (UTC)

specificity

Hey guys, Fyslee made a much needed edit;

• It could be said the one thing that separates the chiropractic adjustment from other manipulative techniques is the aim toward specificity.
• It could be said the one thing that separates the chiropractic adjustment from other manipulative techniques is the aim toward specific treatment of subluxations.

When I read the original sentence, I thought it was talking about the difference between what is claimed to be the more generalized osteopathic manipulative techniques that "crack" them all vs the claim to adjust just the specific subluxation necessary. This new sentence seems to say that they only treat subluxations. Is that what we meant? And is that what we want? And if so, maybe we can add the comparison with the osteopath. --Dematt 22:33, 8 July 2006 (UTC)

My edit summary:

"undocumented assumption reworded to accurate description"

I attempted to resolve a problematic wording by replacing it with something that was at least accurate, even if it might have changed the originally intended (and undocumented) assumption (meaning). Maybe I interpreted it incorrectly. I hoped to create a wording that could stand up to scrutiny. The original was lacking - in my opinion. -- Fyslee 22:44, 8 July 2006 (UTC)

That will work, but its my understanding that historically manipulations of the spine consisted of a general force being applied to an area, ie. the upper thoracic region, whereas the chiropractor will (attempt) to contact the third thoracic, specifically, as an example. I'd have to look for an O.D. or P.T. instruction manual or something to back that up though. As you said, times have changed, so maybe thats no longer true, but was at one time. Arn't you a PT Fyslee, what do they teach? --Hughgr 02:20, 10 July 2006 (UTC)

Yes, I'm a PT and have been taught (and still am in continuing education....;-) both general and specific manipulation techniques. This is also being discussed here. -- Fyslee 05:01, 10 July 2006 (UTC)

Role of the NS

I changed Fyslee's "many" to most. I can give you Guyton's Textbook of Medical Physoiology exact paragraph if you want.--Hughgr 22:27, 10 July 2006 (UTC)

No problemo. As long as the "the" is gone.....;-) It sounded like what I often read on chiro websites - that the NS is THE controller, as if there aren't any other ones. -- Fyslee 13:40, 11 July 2006 (UTC)

Orthopedic subluxation

This sentence is in the intro.

• It should not be confused with the orthopedic subluxation, which may or may not cause nerve interference.

Do orthopedists believe that subluxations may cause nerve interference? I thought the defining difference was that they did not believe the nerve interference part. And if they do, we need to clarify or it sounds like orthopedists really believe in the chiropractic subluxations. You can't have it both ways. --Dematt 12:57, 11 July 2006 (UTC)

By "nerve interference" (I just used the term that was in use there) I mean that a nerve can be affected when touched or pinched. We see this all the time from myriad possible causes, for example: osteoarthritis, osteophytes, disc herniations or protrusions, muscular tension that squeezes discs so much that slight cervical extension and then bending to one side can immediately cause paraesthesia all the way down to the fingers, etc.. MDs and PTs don't deny that nerves can be affected by reduced space in the intervertebral foramina, or by stretching or pinching them in other locations. This is considered so basic as to be assumed unnecessary of comment. David Butler's work is important in this connection:

• David Butler graduated Bachelor of Physiotherapy from the University of Queensland in 1978. In 1985 he completed the Graduate Diploma in Advanced Manipulative Therapy and in 1996 a Masters by research at the University of South Australia. In 1991 he wrote the best selling Mobilisation of the Nervous System, published by Churchill Livingstone and in 2002 The Sensitive Nervous System, published by NOI Publications.

A true orthopedic subluxation is objectively visible on x-ray, and is symptomatic. If not symtomatic, it won't get treated, as it would then likely be a longstanding condition which has become "normal" for that person. It might even be an anomaly.

Note that this nerve affection causes symptoms, but not organic disease. It will not cause (or its reduction affect) diabetes, cancer, MS, Parkinsons, etc. Of course in the pelvic region there are several functions (other than musculoskeletal ones) that can be affected by pinching a nerve. Many variations on the cauda equina syndrome theme come to mind, some with very disturbing outcomes (LDS). -- Fyslee 14:10, 11 July 2006 (UTC)

You have to admit that sounds an aweful lot like chiropractic:) --Dematt 14:38, 11 July 2006 (UTC)

I don't see it that way at all. The difference between DCs on the one hand, and the rest of the medical world on the other, is that many different variations will be called a "subluxation" by a DC, while an MD or PT will call them all by their "right name." I'll try to find a quote on this from a reform chiro.

Here it is:

• “I have never used the term 'subluxation' in regards to a patient's complaints. I almost did once with respect to a degenerative laterolisthesis in an elderly gentleman, thinking that this could almost be described as a 'bone out of place', the dreaded BOOP. However, I thought, if I have to teach him a new term to describe his complaint, why not just tell him what it is actually called? I explained what was going on and said, as an aside, what it was called in medical terms.”

-- Fyslee 16:54, 11 July 2006 (UTC)

I'm confused. If you can concede that subluxations can cause nerve interference in other parts of the body, then why not in the spine? And then you have to ask yourself, "If nerve interference can be symptomatic in other parts of the body, then why not at the level of the spine?" And if it is at the level of the spine - the nervous system's all important relay mechanism - then what greater magnitude of symptoms could subluxation there cause? Anyhow - enough soapboxing (sorry) - if there is truly a difference between the chiropractic and the orthopedic definitions of subluxation, we should most certainly disambiguate here. Levine2112 17:10, 11 July 2006 (UTC)

You shouldn't be surprised or confused. I have just described affection (not necessarily caused by subluxation) of the nerve roots, giving rise to symptoms in other parts of the body. That's about as close to the level of the spine as one can get. This idea is definitely not unique to chiropractic. It's standard medical neurology, sans BJ or DD. (BTW, The disambiguation is already accomplished by having two separate articles.) -- Fyslee 18:24, 11 July 2006 (UTC)

On the other hand, I can understand your confusion, if you have been trained in the chiropractic understanding of the word. The medical definition is a narrow one, strictly limited to partial joint dislocation that is objectively verifiable, whereas the chiropractic definition goes much, much further, including asymptomatic and unverifiable subluxations that "exist" only because of the declaration of a DC, and accepted on faith by the "educated" patient.

Most of what DCs call "subluxations" do not fall under the medical definition, but are other conditions that already have their own names and diagnoses. Therefore communication between medical professionals and chiropractors is often difficult and confusing, since they are using different definitions for the same word. If chiropractors didn't mean anything more than "partial dislocation" when they used the word "subluxation" there would be no problem, but we know that that's not the case. The chiropractic profession has fought over the matter of definitions for the last 111 years. Since there is so much subjectivity in their use of the word, they can't come to agreement. The closest they have come is when they, during the last few years, have publically used the same wording as the medical definition (while privately still holding onto all the other aspects regarding undocumented effects). It's called PR......;-)

The history of these definitional problems is interesting, since legal demands required some kind of written definition. This forced the profession to get quite creative (and deceptive), which has only contributed to the confusion:

THE HISTORY OF THE MEDICARE/SUBLUXATION LAW OF 1972

As far as the history of the law, here is what George Magner says in his book, “Chiropractic: The Victim’s Perspective”:

The Medicare Paradox

Richard D. Lyons, a staff writer for the New York Times, has poignantly described the events leading to chiropractic inclusion under Medicare:

After seven years of ceaseless lobbying, chiropractors have finally succeeded in getting themselves included in the multibillion-dollar Medicare program through a series of events that offers a view of the workings of Washington in microcosm. The cast of characters involves the small but determined band of chiropractors, their patients, lobbyists for and against their cause, Senators and Representatives, federal officials, campaign contributions, and tens of thousands if not millions of pieces of mail. . . .

Staff aids at the two congressional committees that dealt with the chiropractic legislation . . . expressed astonishment over the sacks of mail that never seemed to diminish, in contrast to other issues that peaked and were then forgotten. [154]

The law, which was enacted in 1972 and took effect in 1973, limited coverage to manual manipulation of the spine for "subluxations demonstrated by x-rays to exist." Since the chiropractic "subluxation" is visible only to chiropractors, this could have posed a serious problem. But federal officials concluded that Congress intended Medicare to pay for something and accepted a loosely worded chiropractic "definition" of subluxations for which payment could be made: "an incomplete dislocation, off-centering, fixation or abnormal spacing of the vertebrae . . . demonstrable . . . to individuals trained in the reading of x-rays." A New York Times editorial called the enactment of Medicare coverage "the most shocking victory for special-interest lobbyists" and added that "the scientific basis of the chiropractic cult is highly dubious" [103].

Also: Are Chiropractic Subluxations Visible?

In 1964, when asked to demonstrate that its subluxations actually show on x-ray films, chiropractic failed miserably. During the early 1960s, the National Association of Letter Carriers (NALC) included chiropractic in its health plan, with coverage limited to "spinal adjustments by hand for the treatment of vertebral subluxations or misalignments." In 1966, NALC's director of health insurance reported:

Almost from the inception of the program, we encountered trouble with chiropractic claims. Expenses were submitted for x-rays that could not be interpreted, due to the poor technical quality of the films; claims were made for the treatment of measles, mumps, heart trouble, mental retardation, female disorders and sundry other ailments. None of these conditions has any medical relationship to vertebral subluxations or spinal misalignments. . . .

The leaders of both the ACA and ICA made repeated efforts to impress upon their membership the gravity of the situation, and the need to halt and prevent further abuses of insurance benefits. For reasons I can’t explain, these efforts produced no discernible improvement. . . .At our invitation, representatives of both the ACA and ICA met in our office with one of the most reputable radiologists in the area, whom we had engaged on a temporary consultant basis. Our doctor (medical) presented 20 sets of x-rays that had been submitted by chiropractors. Each film was purported to show a subluxation; in several instances, four to six subluxations had been diagnosed in a single x-ray. One after another, each film was placed in the view box. The chiropractic representatives, including a radiologist of their own selection, were invited to point out the subluxations. Not a single one was identified. Nor did the chiropractic representatives offer a solitary comment. [62]

In 1971, Dr. Barrett challenged a local chiropractic society to produce ten sets of "before and after" x-rays that demonstrate the effect of chiro-practic treatment. The chiropractors refused and suggested that he contact the Palmer School of Chiropractic to inspect some from its "teaching files." When he did, however, Palmer vice president Ronald Frogley, D.C., replied:

“Chiropractors do not make the claim to be able to read a specific subluxation from an x-ray film. [They] can read spinal distortion, which indicates the possible presence of a subluxation and can confirm the actual presence of a subluxation by other physical findings.”

Despite all this, in 1972, Congress passed a law enabling chiropractors to collect from Medicare for "manual manipulation of the spine (to correct a subluxation demonstrated by x-ray to exist)" [234]. A few weeks after the law was passed, Doyl Taylor, head of the AMA Department of Investigation, told Barrett that when chiropractic inclusion appeared inevitable, the "subluxation" language was inserted with the hope of preventing chiropractors from actually being paid. The idea's originator thought that since chiropractic's traditional "subluxations" were visible only to chiropractors, this provision would sabotage their coverage. After the law was passed, however, two things happened to enable payment. First, chiropractors held a consensus conference that redefined "subluxations" to include common findings that others could see. Second, according to Taylor, the government officials responsible for interpreting the new law "decided that Congress intended chiropractors to be paid for something." The regulators then defined subluxation as "an incomplete dislocation, off-centering, misalignment, fixation, or abnormal spacing of the vertebrae" and stipulated that the "primary diagnosis" must be a subluxation. The consensus conference, held in Houston in November 1972, resulted in the following statement:

"A subluxation is the alteration of the normal dynamics, anatomical or physiological relationships of contiguous articular structures. In evaluation of this complex phenomenon, we find that it has - or may have - biomechanical, pathophysiological, clinical, radiologic, and other manifestations." [211]

The document, several pages long, described the supposed radiologic manifestations of eighteen types of "subluxations," including "flexion malposition," "extension malposition," "lateral flexion malposition," "rotational malposition," "hypomobility" (also called "fixation subluxation"), "hypermobility," "aberrant motion," "altered interosseous spacing," "foraminal occlusion," scoliosis, and several conditions in which "gross displacements" are evident. Some are fancy names for the minor degenerative changes that occur as people age; they often have nothing to do with a patient's symptoms and are not changed by chiropractic treatment. Some, as acknowledged by the Houston conferees, are not even visible on x-ray films. Labeling them "subluxations" is simply a device to get paid. Since 1973, Medicare has paid more than two billion dollars for treating chiropractic "subluxations"! Topflight academic chiropractors regard “subluxations" more realistically. In 1987, Williams & Wilkins, a prominent medical textbook publisher, issued "the most comprehensive chiropractic radiology text ever published!" Titled Essentials of Skeletal Radiology, the book was produced by professors who teach radiology at chiropractic colleges. It contains over three thousand illustrations and reads like a standard medical text [271]. When Barrett scanned it and inspected its index, he was unable to find a single mention of the word "subluxation."

An equally interesting observation was made during a recent interview of John J. Triano, D.C., a chiropractor with a degree in neuro-physiology who teaches and conducts research at National College of Chiropractic. When an astute reporter asked whether Triano had ever seen a subluxation on an x-ray film, he smiled and jokingly replied, "With my eyes closed" [259].

End quote.

This law has since been changed. In January 2000, the requirement for x-ray documentation was dropped. Now there is no control at all.

The following two tables describe the problem quite well:

Table 1

Confusing features of chiropractic subluxation

[1] An articular phenomenon that may or may not be of clinical significance.

[2] May or may not be palpable (felt on examination).

[3] May or may not be identifiable on x-ray.

[4] May or may not be treatable by spinal manipulation.

[5] May or may not produce visceral disease.

[6] May be hypermobile, hypomobile, or be normal.

[7] May or may not have biomechanical properties of an unspecified nature.

[8] The presence or absence of any characteristic is not predictable.

[9] All tissue types in the spinal vicinity contribute to subluxations although the precise nature of these contributions cannot be stated.

[10] A wide range of clinical conditions, both spinal and extra-spinal, are associated with subluxations.

[11] These wide range of clinical conditions cannot identify the exact nature, causal or otherwise, of this subluxation relationship.

[12] Is described by a variety of theoritical models, few which appear to be testable.

Table 2

Further confusing features of "chiropractic subluxation"

[1] Is believed to be present in all individuals regardless of health status, age, race, sex, or creed.

[2] May or may not have a measurable (whether questionable) overt or local neurological dysfunction or effect.

[3] May or may not have an anatomical component (misalignment)

[4] Is believed to be linked to past, present, and future health status including death.

[5] May or may not have a metaphysical component (Innate Intelligence)

[6] Imperative that correction be applied via adjustment (manipulative thrust) with or without cavitation (audible "click")

[7] Only a chiropractor and no one else can determine if "chiropractic subluxation" is present or absent.

[8] Only a chiropractor and no one else can assess if correction of "chiropractic subluxation" has occurred.

[9] Imperative that all people be "checked" for "chiropractic subluxation".

[10] Is believed to be created during birth process (gestational phase) and/or birth delivery and ended when death occurs.

[11] No two subluxations are the same or can be described in any consistent shape, form or fashion.

[12] Subluxation of any spinal area has yet to be systematically categorized, agreed upon, and consistent for any given condition or population for any disease or non-disease state.

[13] Persons may or may not have primary, secondary, or tertiary subluxations in any consistent shape, form, or fashion at any given time.

[14] Any "chiropractic" adjustive method is said to correct "subluxation" even those systems which are diametrically opposite to each other.

Source: Mirtz et al. "NACM and it's argument with mainstream chiropractic." Journal of Controversial Medical Claims. 2002;9:11-18.

Some interesting quotes:

The NACM's position regarding the "chiropractic subluxation" is the unvarnished and straightforward truth:

“The first and foremost requirement for membership in the NACM is that a Doctor of Chiropractic Medicine renounce the chiropractic hypothesis and/or philosophy; that is, the tenets upon which their scope of practice is based. The original chiropractic hypothesis, stated simply, is that "subluxation is the cause of dis-ease." Modern day chiropractic associations may have expanded and changed this simple statement for the public, but the reality is that this remains the backbone of chiropractic education and practice to this day. In clarification, the term "subluxation" has never been defined by the profession in a way as to have universal acceptance within the chiropractic profession. Chiropractic "subluxation" is not the same as medical subluxation, which represents a partial dislocation of joint structure and would be a contraindication to "adjusting" or "manipulating" the joint structures. Chiropractic "subluxation," not having universal definition, and, thereby, not having received universal scientific status of existence, has evolved into a metaphysical status. Further, the profession has neither defined nor outlined what disease or "dis-ease" that the correction of the "subluxation" might cure or affect. Because the hypothesis has found no validity in universally accepted, peer-reviewed, published scientific journals, belief in the hypothesis, then, is essentially a theosophy. Science has not found any organ system pathology which "adjustment" or "manipulation" of spinal joint structures has effect; that is, no disease or "dis-ease" process is affected.” http://www.chiromed.org/

In an article in the Boston Globe, Ron Slaughter, DC - the current president of the NACM - is quoted:

“The debate over subluxations has been so heated that, over a decade ago, chiropractor Ron Slaughter and like-minded souls founded their own group, the National Association for Chiropractic Medicine, to renounce what Slaughter calls 'the historical, philosophical hypothesis that subluxation is the cause of all disease, which it surely is not. Subluxation is a metaphysical disease. . .and consequently, chiropractic today is practically a religion.'” http://www.boston.com/globe/search/stories/health/health_sense/062397.htm

“Given the lack of evidence to substantiate the subluxation complex, efforts to promote chiropractic by association with this elusive spinal target seem like folly. The subluxation complex may not be real, in which case mounting a PR campaign organized around the VSC amounts to building a house of cards. Even if chiropractors are some day able to validate some version of the subluxation complex, to promote the (currently unproved) construct now is unethical.

“Members of scientific professions ought not make claims for unproved theories and methods. Dr. Koch recommends that the profession proclaim "Chiropractic: Correcting Subluxations Since 1895," but is this true? Given the legitimate uncertainty about subluxation complex, should the profession hang its hat on this hypothetical construct? Should marketing needs supercede scientific and professional values?”

Joseph C. Keating Jr.,PhD Professor, Los Angeles College of Chiropractic http://www.chiroweb.com/archives/17/23/26.html

Even Anthony Rosner, a believer in subluxations, has this to say:

"2. Subluxation may be a useful and possibly defining concept of chiropractic, but it is premature to accept it as a clinical reality. One must be both prepared and willing to modify (and possibly relinquish) it as a model should it become incompatible with new evidence as it becomes available."

Synopsis of Research Agenda Conference IV: Arlington Heights, IL, July 23-25, 1999 Anthony Rosner,PhD, director of research, Foundation for Chiropractic Education and Research (FCER) http://www.chiroweb.com/archives/17/20/17.html

-- Fyslee 18:33, 11 July 2006 (UTC)

Okay, I don't disagree with any of that, considering the POV. And I assume you're saying that orthopedic subluxations are not the above listed stuff. But, the way the sentence is written now, it sounds like the orthopedic subluxation "may or may not" encompass that stuff.

• "It should not be confused with the orthopedic subluxation, which may or may not cause nerve interference."

Maybe it should say something more like,

• "It should not be confused with the orthopedic subluxation which never causes organ dysfunction."

Or something that more specifically seperates the two.

--Dematt 20:10, 11 July 2006 (UTC)

Hmmmm......I see what you mean. It's not clear as it is. I meant that an orthopedic spinal subluxation (which is very rare and much more severe than most chiropractic VS) could well pinch or affect a nerve if it was adjacent to one. If no nerve was present (non-spinal subluxaton), then it could exist without affecting any nerve. The chiropractic VS is claimed to affect nerve function. Oops! Have to run. -- Fyslee 20:44, 11 July 2006 (UTC)

So how can we best disambiguate this as it is confusing? Levine2112 21:57, 11 July 2006 (UTC)

It seems like Fyslee is talking about a luxation (dislocation) which is very severe, no matter where its found, but especially true of the spinal region due to the nervous system. But that in no way helps define what an orthopedic subluxation is, and how they would treat it.--Hughgr 23:55, 11 July 2006 (UTC)

Or is it that there really is a lot of overlap here. For example, there is no reason why a mildly degenerative joint with a lateral flexion misalignment cannot be both a chiropractic and an orthopedic subluxation. However, I would presume an orthopedic subluxation definition would not include a "normally" aligned joint that is hypomobile (which a chiropractor would still call a subluxation). Note that in the second example, a chiropractor would consider that the hypomobility of the joint affects the nervous system and therefore diminishes health without pinching anything. If we want to use this sentence, we have to determine what it is that makes them different?--Dematt 03:38, 12 July 2006 (UTC)

Overlap may well be part of the problem. Since the chiropractic definition is broader, it overlaps with the medical one. I have rarely encountered the term during my years of practice, except in relation to shoulders, elbows, and patellas. If one does a Google search that eliminates most chiropractic uses, one finds a very different pattern of use than is found doing a chiropractic search. That may provide some clues. Even BJ came to the realization that it was pretty much impossible to subluxate vertebrae, except C1, C2. From that realization came his Hole In One (HIO) theory and practice. Unfortunately, while it's true that subluxations can occur there, it's also the most dangerous place to manipulate/adjust. True subluxations elsewhere in the spinal column would usually not be amenable to manipulation/adjustment, in fact they would be contraindicated. -- Fyslee 08:14, 12 July 2006 (UTC)

I agree. In fact, I'm not sure that I ever actually heard it called orthopedic subluxation until I started editing here. It was just subluxation and we all knew that if it came from an orthopedist, it was not the same thing we were talking about and excused it as that. I think that for many years the medical profession ingnored subluxation because it was too close to unscientific practice, so subluxation was dropped from their thought process for so many years. They haven't actually defined it specifically. But we probably should make an attempt.--Dematt 14:45, 12 July 2006 (UTC)

A few thoughts...... The only reason I call it an "orthopedic" subluxation is to distinguish the two from each other. They overlap, but are not the same, which is the whole point. The major difference is not so much in the actual physical bony position, although there is certainly disagreement there (things that are not subluxated at all being called subluxations). No, the greatest difference is the consequences that are proposed, with chiros proposing vast and far reaching consequences, most of which are unproven conjecture.

MDs don't usually make a distinction. When they say "subluxation," they merely mean a partial luxation, with the local and well-documented effects such can have, and don't even consider the chiropractic definition at all. In fact, many - if not most - MDs aren't even aware that when a chiropractor says "subluxation," it is being used with a whole mindset behind it that differs from the MD mindset. This leads to confusion, since it is normally verbotten to use the same word (brand name) for two different "products." The chiropractic use is simply a misuse of the word. If the chiropractic definition and use had been limited to the legal limits set by the original 1972 law ("subluxations demonstrated by x-rays to exist"), it would have been a subluxation in the sense understood by the rest of the medical world - a partial luxation verifiable by x-ray, but we know that never happened in practice. That law was rarely obeyed or enforced. Once passed it was largely ignored in practice, but care was taken to use the correct billing codes to "keep up appearances." Chiros continued to adjust without providing x-ray proof, and they still got compensated. The existing violations of the law were legalized in 2000 by a simple legal maneuver - the x-ray requirement was removed. (A similar tactic as decriminalizing drug use by legalizing the drug.) -- Fyslee 20:41, 13 July 2006 (UTC)

Lets start with this. Keep talking and lets see where it ends up.

• While the conventional medical definition of subluxation includes misalignment and sometimes nerve damage, medicine disavows the chiropractic contention that minor misalignments can cause organic disease.

--Dematt 23:12, 13 July 2006 (UTC)

I think that sounds about right. -- Fyslee 19:22, 14 July 2006 (UTC)

Okay, I put it in. Made a couple changes to get it to fit without changing the meaning. That was a tough one. Let's do an easy one next:) --Dematt 01:07, 17 July 2006 (UTC)

And then there's my 2 cents;

Medicare used to pay me about $23 for a $76 visit. Combine that with a $75 deductible and nopay for examination or xray and limit that to 12 visits a year and that is 23 X 12 = 246 - 75 = $171 for about$1000 worth of care. I did have several occasions that I had to send in my xrays to prove I took them and that they showed the subluxations. I had to quit seeing medicare patients as I could no longer afford to treat them. I'm pretty sure PT's get paid a whole lot more with pretty much the same objective outcome scores and orthopedists make a fortune with whole lot less satisfactory objective outcomes. I think ole Doyl Taylor got what he wanted. No, I don't think it's chiropractors that are criminals, but that's another article;) --Dematt 00:29, 14 July 2006 (UTC)

Nerve interference

It is chiropractic "doctrine number one" that subluxations cause nerve interference, and it is usually inferred that the presence of nerve interference indicates the presence of subluxations.

What about nerve interference in the absence of subluxations? Opinions please. -- Fyslee 19:29, 14 July 2006 (UTC)

The metaphysics of a "vertebral subluxation syndrome" is incoherent, senseless, and unintelligible without B. J. Palmer's "neurological interference of Innate Intelligence hypothesis of disorder/dysfunction/disease." Why would anyone suggest that moving vertebral segments (if in fact, anyone can do it) be pragmatically useful, unless some over-reaching hypothesis couples vertebral subluxation into the metaphysics of disease? The ONLY plausible explanation for "adjusting vertebral segments" is owed to B. J.'s hypothesis that the CNS and PNS are "interrupted" at the VS. B. J. insisted in hypothesis, that ALL the body's disorders occur because the Innate Intelligence residing in the CNS is compromised at the transmission to the PNS through the vertebral column.

It's beyond silly that chiropractors ascribe ALL disease/dysfunction to a VS (a "syndrome," of course, because no one can find such a metaphysical thing, mind you). But the VS is still a second-class metaphysical syndrome that only has value if B. J.'s hypothesis about "nerve interference in the spine" actually generates all bodily disfunctions and disorders, as he hypothesized. Without B. J.'s hypothesis the VS that putatively "blocks" nerve transmission between the CNS and PNS just falls into incoherence, and with it all the metaphysical syndrome speculations that it "causes disease" through occult wishful thinking. Why else claim "adjusting" vertebral segments has ANY relevance to anyone? Only because, the VS hypothesis is needed to justify the neurological hypothisis (not vice versa). If the NITD is outside credible question and belief, it really does not matter whether or not a VS "syndrome" hovers in space in search for a solution, or whether Heaven's Gate's followers found nirvana.

NO ONE in any field of human physiology, biochemistry, anatomy gives this "neurological interruption" at the vertebrae hypothesis ANY credibility, not even chiropractors (except the snake-oil metaphysicians). It's laughable, if it weren't complicated with deleterious consequences. So, if B. J.'s hypothesis about "nerve interference" at the junction of the verebrae is incredulous, why should anyone "accept" the VS hypothesis, the sole purpose of which is to justify the original metaphysics? Dshsfca 03:30, 1 February 2007 (UTC)dshsfca

Of course there can be other causes, although most of them are very rare. A good history and NMS exam can typically reveal differences, but there are always exceptions and you can have more than one thing going on at the same time. :) This approach does not infer the cause of all nerve interferrence to be from a vertebral subluxation.--Hughgr 22:07, 14 July 2006 (UTC)

That is a really good question. On the wrote level, I do agree with Hughgr. Metabolic and diabetic neuropathies, vascular deficiencies, space occupying lesions, upper motor neuron diseases and a whole boatload of CNS disorders are a few examples that come to mind that fall into the bracket of conditions that cause "nerve interference". Some do have signs and symptoms that can mimic dermatomal or somatic referral patterns and require careful history and examination. All of this would be in the everyday practice of chiropractic as well as conventional medicine. But, this type of "nerve interference" does not result in the classical hypothetical visceral dysfunction that seems to be described in chiropractic literature. That would have to involve the autonomic ns. So, are there times when there is "interference" with the autonomic ns without subluxation? That is a really good question. An internet search gives sites for autonomic nervous system diseases with lists like this. The list does look reasonable when compared to the list of chiropractic claims. We also have to acknowledge mental and emotional relationships to the autonomic ns as well. --Dematt 04:32, 15 July 2006 (UTC)

Dr. James Cyriax, MD, among others, early on understood and discussed the problem:

"The difficulty in distinguishing between visceral disease and root pressure set up by a thoracic disc lesion is responsible for many diagnostic errors. This has served to strengthen laymen's (Cyriax word for non-MDs, and in this case especially DCs and DOs) claims that visceral disease results from vertebral displacements and is curable by their reduction. The osteopath or chiropractor is himself misled when the patient, after his spine has been manipulated declares that his, say 'cholecystitis' or 'angina' has ceased. A doctor (an MD) has diagnosed visceral disease. Finding that his spinal treatment has relieved it, the manipulator naturally imagines that he has really cured a visceral disorder; so does the patient. In consequence, all sorts of theories exist on the effect of vertebral manipulation on the autonomic system.

"The many vocal and satisfied patients of lay manipulators -- most of them by no means the neurotics so often supposed -- combine to show how often a thoracic disc lesion remains unsuspected." Dr. James Cyriax, MD. Textbook of Orthopaedic Medicine, Vol. 1.

What has been a long-recognized phenomenon in medical circles is only recently being addressed in chiropractic circles. But the way many chiropractors react to this disconcerting "heresy" is disturbing.

In 1995, two chiropractic professors, Nansel and Szlazek, wrote an article (JMPT 1995 Jul-Aug;18(6):379-97)) regarding somatic (usually muskuloskeletal system) disorders mimicking visceral (internal organ) pain syndromes. The article suggested that the apparent improvement (measured by lessened pain symptoms) in so-called visceral disorders following manual therapy, may actually never have happened because there may never have been any visceral pathology to start with. This is a plausible explanation of the anecdotal evidence that chiropractors have been touting for years. It is very easy to link cause and effect in practice because of what is seen. This does not make the correlation correct and may mislead patients and practitioners alike.

This undermines the traditional chiropractic claim, that it is possible to treat organic disorders using manual therapy of the spinal column. This false conclusion would be very natural to jump to, since the pain (assumed to be of visceral origin) is sometimes relieved by manual therapy. Since D.D. Palmer was a self-taught man, he built some of his basic theories on this error. This is a good example of the old adage: "A little knowledge is a dangerous thing."

There are several lessons to be learned from this:

(1) Somatic referred pain can mimic pain of organic disease (which does not exist) and can be relieved by manual therapy. This often permanent relief can lead to the following delusion:

(a) that an organic disease has been healed using manual therapy.

This misunderstanding can be dangerous, since it can later lead to the deliberate treatment of real organic illness with unsuitable manual therapeutic methods.

(2) Real organic disease can produce somatic referred pain. These symptoms can often be temporarily relieved by manual therapy, but the organic disease will be unaffected. This temporary relief can then lead to the two following delusions:

(a) that the organic disease causing the pain has been healed;

(b) that it was not an organic disease after all, but was somatic referred pain.

These last two misunderstandings, by not recognizing the continued existence of a real organic illness, can possibly lead to fatal consequences, since they delay or prevent treatment with proper methods by an MD. Based on the apparent (temporary) improvement in symptoms, recommendations to stop taking medications may then be given, with disastrous results.

The way to avoid this danger, whenever there are symptoms that mimic visceral disorders, is to consult with an MD before using manipulative therapy as pain relief. If the possibility of an organic disease is then ruled out by the MD, it might then be appropriate to treat the symptoms as somatic symptoms, for which manual therapy often is the treatment of choice.

This knowledge explains why it can be unsafe to start a treatment with manipulation of the spine. Doing so

(1) makes it hard to discover the cause of the pain, and

(2) the cause may be completely misunderstood. It would be tantamount to starting treatment by giving a strong pain medication, waiting 30 minutes, and then examining the patient to determine the nature of their problem.

The two approaches can lead to these two, equally ludicrous, conclusions:

(1) since manipulation of the spine relieved the symptoms, the problem must have been of spinal origin;

(2) since pain medication relieved the symptoms, the problem was caused by a pain medication deficiency.

A little more from Nansel and Szlazak, who also wrote in regard to false chiropractic theories:

“In spite of this, such theories (claims) are still rather dogmatically reinforced by more than just a few chiropractic colleges and by a number of chiropractic continuing education relicensure seminars or may even be found conspicuously displayed in many chiropractor’s offices or contained in various patient ‘education’ brochures.” JMPT 1995 Jul-Aug;18(6):383

-- Fyslee 19:14, 15 July 2006 (UTC)

Yes, somatic can appear as visceral, which means there is a percentage of medical patients taking drugs and having surgery for somatic problems, and can possibly lead to fatal consequences. Problems which could have been taken care of by a chiropractor, or OD, or PT. But the author states its unsafe to start? What about after a medical diagnsis? Would it be safe then? Cheers.--Hughgr 00:50, 16 July 2006 (UTC)

Safe? Yes:

"The way to avoid this danger, whenever there are symptoms that mimic visceral disorders, is to consult with an MD before using manipulative therapy as pain relief. If the possibility of an organic disease is then ruled out by the MD, it might then be appropriate to treat the symptoms as somatic symptoms, for which manual therapy often is the treatment of choice."

An interesting situation (but fortunately not dangerous in its consequences) is when muscular tension in the neck and shoulder girdle can cause referred pain in the head and forehead, with resulting tension around the eyes, causing affection of vision: slurred vision, "tired" eyes, etc.

The patient presents with complaints that include eye trouble. Physical exam also reveals tense neck muscles. Now does the patient really have an eye problem, or is it a problem referred from the tense muscles? Hmmmm.... Well, since no danger is involved, a short trial (1-3 treatments) with moist heat, massage, and stretching of the involved muscles can be tried. If it doesn't help the eye complaint, the patient is then referred to an eye specialist. If they can't find anything wrong with the eyes, then followup treatments may be in order.

The problem often works the other way around - it starts with the eyes (for example, the patient needs new glasses) and creates tension in the neck. The patient may not recognize the beginning eye tiredness, and only focuses on and complains about the tense neck muscles. If muscular treatment doesn't help - off to the optician. -- Fyslee 08:47, 16 July 2006 (UTC)

Your example is how the majority of chiropractors practice. Is your main problem with the objective straights approach?--Hughgr 17:10, 16 July 2006 (UTC)

When it gets right down to it, many of the things PTs (who specialize in manual therapy, like myself) do are similar to what DCs do. If you're wondering what "problems" I have with chiropractic, yes, I find the objective-straight approach to be problematic, but there are many other factors that I find problematic. -- Fyslee 17:47, 16 July 2006 (UTC)

Do you think the main difference is the mechanistic vs vitalistic views of physiology? And, does vitalism bother you?--Hughgr 01:06, 17 July 2006 (UTC)

Hmmmm.....that certainly is a difference, but I have a hard time reconciling physiology with vitalism. One is biology, and the other is a religious/metaphysical concept. I can understand a belief system that blends the two. I believe vitalism should be clearly labeled as metaphysics, and not included in treatments paid for by insurance or Medicare. What I advocate is truth in advertising. As long as accountable adults know what they're getting and are willing to pay for it themselves, it's their choice. I won't stand in the way. I believe in freedom of religion, and separation of church and state. Nonbelievers should not be forced to pay (through their insurance premium or taxes) for religiously motivated treatments.

I consider objective straights to be "real" chiropractors. They are holding the flag high and aren't compromising the original intentions of DD Palmer. I can respect that, even if I disagree. If chiropractic survives as a unique profession, it will be this aspect (and VS) that is unique. Everything else is already shared with other professions. -- Fyslee 15:59, 17 July 2006 (UTC)

scientific investigation

I've added a subcatagory and will divide it further into the different areas of research. Any comments or suggestions are appreciated.--Hughgr 22:27, 2 August 2006 (UTC)

I've just started by adding some relevent research I've found, this is very interesting but I haven't figured how to summerize it.[2]

NPOV warning

I was the first to cite the Bolton article from the ACA's JMPT. All the "conditional" clauses make for highly "indefinite" indeterminancy. How many "mays" before the statement is meaningless speculation? NOT ONE citation is "outside" the profession's own propaganda operation. Surely, the ACA and ICA have financed researchers from reputable colleges and universities (U of Colo, 1970s), where are "independent" sources of validation? Dshsfca 21:53, 1 February 2007 (UTC)dshsfca

This article is pathetically POV in the pro-subluxation camp. "Researchers" at chiropractic schools are being cited as secondary sources, biasing the article to sound as if the chiropratic establishment is the final word. --Davidstrauss 01:41, 21 August 2006 (UTC)

Hi Davidstrauss, Please feel free to add whatever verifiable and reliable resources you feel will help the article. Thanks for coming! --Dematt 13:21, 21 August 2006 (UTC)

Agreed. It's not enough to slap a tag on a page then cut-and-run. Who couldd be more of a primary source of Vertebral Subluxation than the leading chiropractic pblications, researchers and institutions. Additionally, the critques section includes criticisms from leading critics. DavidStrauss, if you'd like to add more, please do so. Levine2112 16:58, 21 August 2006 (UTC)

That's the problem. The chiropratic organizations are the organizations affiliated with pushing the idea of vertebral subluxation. Hence, they are not credible secondary sources. You can say "Chiroprators say..." with them. That's it. Primary sources are generally inferior. Read about it. --Davidstrauss 20:52, 21 August 2006 (UTC)

Until we have more sources here on this topic, chiropractic organization will remain the primary source. Who else can possibly know more about the topic than the very profession which defines and employs it? But please feel free to use other sources in this article. Add to it, rather than slapping on the banner at the top. This is collaborative - as you know - and this article is just a fledgling. Levine2112 21:05, 21 August 2006 (UTC)

What do you not understand? It is unacceptable to cite primary sources as fact, regardless of how familiar they are with the topic. There will also never be an abundance of sources from the medical community because the medical community thinks this is pseudoscience. --Davidstrauss 21:19, 21 August 2006 (UTC)

Incorrect. The medical community does no think this is pseudoscience. Some members of the medical community thinks it to be so, but it doesn't make it so. See the subtle difference? Levine2112 21:32, 21 August 2006 (UTC)

Show me a credible, non-chiropractic, peer-reviewed journal that says anything positive about vertebral subluxations. --Davidstrauss 21:38, 21 August 2006 (UTC)

I'm not sure we can consider those sources reliable outside their field of expertise. The link that you provided above notes:

• A source is more reliable within its area of expertise than out of its area of expertise.

I think the only credible, peer reviewed and reliable source that says anything about vertebral subluxations would have to be published in a chiropractic journal such as JMPT. Perhaps we should look there. --Dematt 23:27, 21 August 2006 (UTC)

Excelent point. I did a search on JMPT for vertebral subluxation and here's the first abstract that came on.

Reflex effects of vertebral subluxations: the peripheral nervous system. An update

Presented as an invited presentation at the World Federation of Chiropractic Congress, Auckland, New Zealand, May 20, 1999.

Philip S. Bolton a

Received 29 June 1999;

Abstract

Background: The traditional chiropractic vertebral subluxation hypothesis proposes that vertebral misalignment cause illness, disease, or both. This hypothesis remains controversial. Objective: To briefly review and update experimental evidence concerning reflex effects of vertebral subluxations, particularly concerning peripheral nervous system responses to vertebral subluxations. Data source: Information was obtained from chiropractic or, scientific peer-reviewed literature concerning human or animal studies of neural responses to vertebral subluxation, vertebral displacement or movement, or both. Conclusion: Animal models suggest that vertebral displacements end putative vertebral subluxations may modulate activity in group I to IV afferent nerves. However, it is not clear whether these afferent nerves are modulated during normal day-to-day activities of living end, if so, what segmental or whole-body reflex effects they may have. (J Manipulative Physiol Ther 2000;23:101–3)

First one off the bat seems to support that vertebral subluxation in animal models affect nerve activity. There are more I can pull, but you are only asking for one. I hope this satisfies you as you had stated above. Levine2112 00:45, 22 August 2006 (UTC)

I've updated the scientific evaluations section to begin with the AMA's stance and clarify that all the other sources are chiropractic-affiliated. --Davidstrauss 21:38, 21 August 2006 (UTC)

You are citing the AMA's stance as of 1979. How about something more current.

And in response to your request for non-chiropractic sources, I hope the following is an adequate start...

For Acute Low-Back Problems:

"For patients with acute low-back symptoms without radiculopathy, the scientific evidence suggests spinal manipulation is effective in reducing pain and perhaps speeding recovery within the first month of symptoms." - Clinical Practice Guidelines, AHCPR (1994)

For Long-Term Low-Back Problems:

"There is strong evidence that manipulation is more effective than a placebo treatment for chronic low-back pain or than usual care by the general practitioner, bed rest, analgesics and massage." - Spine, Van Tulder and Bouter et al. (1997)

"...improvement in all patients at three years was about 29% more in those treated by chiropractors than in those treated by the hospitals. The beneficial effect of chiropractic on pain was particularly clear." - British Medical Journal, Meade et al. (1995)

"Manipulative therapy and physiotherapy are better than general practitioner and placebo treatment. Furthermore, manipulative therapy is slightly better than physiotherapy after 12 months." - British Medical Journal, Koes et al. (1992)

For Pain:

"...patients suffering from back and/or neck complaints experience chiropractic care as an effective means of resolving or ameliorating pain and functional impairments, thus reinforcing previous results showing the benefits of chiropractic treatment for back and neck pain." - Journal of Manipulative and Physiological Therapeutics, Verhoef et al. (1997)

"...for the management of low-back pain, chiropractic care is the most effective treatment, and it should be fully integrated into the government's health care system." - The Manga Report (1993)

For Headaches:

"Cervical spine manipulation was associated with significant improvement in headache outcomes in trials involving patients with neck pain and/or neck dysfunction and headache." - Duke Evidence Report, McCrory, Penzlen, Hasselblad, Gray (2001)

"The results of this study show that spinal manipulative therapy is an effective treatment for tension headaches. . . Four weeks after cessation of treatment . . . the patients who received spinal manipulative therapy experienced a sustained therapeutic benefit in all major outcomes in contrast to the patients that received amitriptyline therapy, who reverted to baseline values." - Journal of Manipulative and Physiological Therapeutics, Boline et al. (1995)

For the Elderly:

"[Elderly] chiropractic users were less likely to have been hospitalized, less likely to have used a nursing home, more likely to report a better health status, more likely to exercise vigorously, and more likely to be mobile in the community. In addition, they were less likely to use prescription drugs." - Topics in Clinical Chiropractic, Coulter et al. (1996)

For Containing Costs and Getting Workers Back on the Job:

"The overwhelming body of evidence" shows that chiropractic management of low-back pain is more cost-effective than medical management, and that "many medical therapies are of questionable validity or are clearly inadequate." - The Manga Report (1993)

First contact chiropractic care for common low back conditions costs substantially less than traditional medical treatment and "deserves careful consideration" by managed care executives concerned with controlling health care spending. - Medical Care, Stano and Smith (1996)

Synopsis of Cost Effectiveness Research

Manga, Pran. "Enhanced chiropractic coverage under OHIP (Ontario Health Insurance Plan) as a means for reducing health care costs, attaining better health outcomes and achieving equitable access to health services." Report to the Ontario Ministry of Health, 1998.

This study demonstrates the ways in which individuals in Ontario are deterred from the use of chiropractic care because it is not covered under OHIP. Greater chiropractic coverage under OHIP would result in a greater number of individuals visiting chiropractors and going more often. The study shows that despite increased visits to DCs, this would result in net savings in both direct and indirect costs. It is very costly to manage neuromusculoskeletal disorders using traditional medicine. If individuals were able to visit chiropractors under OHIP a great amount of money would be saved by the government. Direct savings for Ontario's healthcare system could be as much as $770 million and at the very least $380 million.

Manga, Pran; Angus, Doug; Papadopoulos, Costa; Swan, William. "The Effectiveness and Cost-Effectiveness of Chiropractic Management of Low-Back Pain." Richmond Hill, Ontario: Kenilworth Publishing, 1993

This study demonstrates that an increase in use of chiropractic care to manage low back pain would save an enormous amount of money. The study reveals that if management of low back pain was taken from physicians and given to chiropractors there could be a potential savings of millions of dollars every year. The study also revealed that spinal manipulation is both safe and more effective than drugs, bed rest, analgesics, and general practice medical care for managing low back pain.

Levine2112 21:56, 21 August 2006 (UTC)

Regardless of the effectiveness of chiropractic, none of the quotes above say anything about vertebral subluxation. Some are so general as to include even AMA-endorsed physical therapy, so there's not much they really prove. --Davidstrauss 01:34, 22 August 2006 (UTC)

You can't disregard effectiveness, because it is all based on VS. But if you want to discount those, how about this from JMPT?

Abstract Background: The traditional chiropractic vertebral subluxation hypothesis proposes that vertebral misalignment cause illness, disease, or both. This hypothesis remains controversial. Objective: To briefly review and update experimental evidence concerning reflex effects of vertebral subluxations, particularly concerning peripheral nervous system responses to vertebral subluxations. Data source: Information was obtained from chiropractic or, scientific peer-reviewed literature concerning human or animal studies of neural responses to vertebral subluxation, vertebral displacement or movement, or both. Conclusion: Animal models suggest that vertebral displacements end putative vertebral subluxations may modulate activity in group I to IV afferent nerves. However, it is not clear whether these afferent nerves are modulated during normal day-to-day activities of living end, if so, what segmental or whole-body reflex effects they may have. (J Manipulative Physiol Ther 2000;23:101–3)

Levine2112 02:25, 22 August 2006 (UTC)

Here are some case studies and RCTs that I pulled up as well:

• Chiropractic care of a patient with vertebral subluxation and Bell’s palsy There are indications that patients suffering from Bell’s palsy may benefit from a holistic chiropractic approach that not only includes a focus of examination and care of the primary regional areas of complaint (eg, face, TMJ) but also potentially from significant vertebral subluxation concomitants.
• Chiropractic Care of a Geriatric Patient with an Acute Fracture-Subluxation of the Eighth Thoracic Vertebra This case report describes the clinical features, care, and results of 1 geriatric patient with a thoracic compression fracture-subluxation treated with specific chiropractic procedures. The patient had an apparent decrease in pain as a result of the treatment. Due to the inherent limitations of a case report, it is inappropriate to generalize this outcome.
• Epilepsy and seizure disorders: A review of literature relative to chiropractic care of children Chiropractic care may represent a nonpharmaceutical health care approach for pediatric epileptic patients. Current anecdotal evidence suggests that correction of upper cervical vertebral subluxation complex might be most beneficial. It is suggested that chiropractic care be further investigated regarding its role in the overall health care management of pediatric epileptic patients.
• Treatment of severe glaucomatous visual field deficit by chiropractic spinal manipulative therapy: A prospective case study and discussion Recovery of vision in this patient was an unexpected and remarkable outcome, raising the question of whether chiropractic spinal manipulative therapy may be of value in the management of glaucomatous visual field loss. More intensive research is required.
• Chiropractic Care of a Patient with Low Back Pain Associated with Subluxations and a Malgaigne-Type Pelvic Fracture The patient was cared for with contact-specific, high-velocity, low-amplitude adjustments to sites of vertebral and sacroiliac subluxations. The patient's response to care was positive, receiving great pain relief. Less than 3 months after initiating care, the patient returned to work on regular duty. There are indications that patients suffering from the injuries described above may derive benefits from chiropractic care. The practitioner must pay careful attention to issues of biomechanical and vascular stability and adjustment modifications in these types of patients.
• Chiropractic care of a patient with temporomandibular disorder and atlas subluxation High-velocity, low-amplitude adjustments (ie, Gonstead technique) were applied to findings of atlas subluxation. The patient’s symptoms improved and eventually resolved after 9 visits. The chiropractic care of a patient with temporomandibular disorder, headaches, and subluxation is described. Clinical issues relevant to the care of patients with this disorder are also discussed.
• Chiropractic care of a patient with vertebral subluxations and unsuccessful surgery of the cervical spine The patient reported a decrease in neck pain and left arm pain after chiropractic intervention. The patient also demonstrated a marked increase in range of motion (ROM) of the left glenohumeral articulation. The chiropractic care of a patient with neck pain and left upper extremity radiculopathy after cervical diskectomy is presented. Marked resolution of the patient's symptoms was obtained concomitant with a reduction in subluxation findings at multiple levels despite the complicating history of an unsuccessful cervical spine surgery. This is the first report in the indexed literature of chiropractic care after an unsuccessful cervical spine surgery.
• Acceleration/deceleration injury with angular kyphosis This study provides support for the use of upper cervical chiropractic management in cervical spine trauma cases. The clinical work-up consisted of physical examination, radiographic analysis, computer-administered and scored cognitive function testing, and audiometric examination. After conservative care, these examinations were repeated and demonstrated that the objective findings concurred with the subjective improvements reported by the patient.
• Chiropractic management of a patient with myasthenia gravis and vertebral subluxations Contact specific, high-velocity, low-amplitude adjustments were applied to sites of patient subluxation. Myasthenia gravis is no longer debilitating to the patient; he is medication free and has resumed a "normal life." The clinical aspects of the disease, including the possible role of chiropractic intervention in the treatment of patients suffering from myasthenia gravis, are also discussed. This case study encourages further investigation into the holistic approach to patient management by chiropractors vis-à-vis specific adjustments of vertebral subluxation.

There is so much more... but I stop here and let you review. I have given you more that what you have asked for; about 10 pieces of scientific, peer-reviewed research supporting verterbal subluxation from a non-chiropractic journal and about 10 citations from non-chiropractic sources that support chiropractic's effectiveness. Levine2112 23:46, 22 August 2006 (UTC)

"[The] Journal of Manipulative and Physiological Therapeutics (JMPT) is dedicated to the advancement of chiropractic health care." It has their stance on whether chiropractic treatment works right in the description of the journal. That discredits them as a secondary source. They remain a good primary source.

Say I created a journal dedicated to the "advancement of trackballs on laptops." Would you trust my journal to evaluate whether laptop trackballs are good things? --Davidstrauss 00:16, 23 August 2006 (UTC)

I'll play:)

Only if I wanted to know what a trackball was. Then I would go to the journal about "fingerpads on laptops" and read what they had to say about fingerpads. Then I would read about what the trackball people said about the fingerpads, then I would read about what the trackball people had to say about the fingerpads. Then I would decide what I wanted. Something tells me that if all the information I had about trackballs came from the fingerpad people, I wouldn't be getting all the information. That's a pretty good way of thinking about it. So we need both sides of the story.

Lets make it a little more complicated, too. Suppose I heard something about germ theory and wanted to know more. Should I read a magazine that is dedicated to the advancement of antibiotics or one that is dedicated to the advancement of vitalism. I think that most would get more information from the antibiotics journal. Though to get the full picture, they should read both. And that is what WP is all about; allowing the reader to have both sides in one place.

I won't even start to talk about an article written about Catholics using a Protestant magazine.

I see no other way to present these concepts than to use JMPT and other chiropractic sources. Personally, Levine, I don't think you need to add all those research studies. What we're looking for is an example of where the state of the research is to date. Obviously, the subject is not closed, so we need to find sources that give the reader an idea of what needs to be further investigated. We then need to present any other significant POV. That includes the sPOV and possibly the medical POV, which aren't necessarily the same thing. So if we can find some studies that refute these findings, we can stick those in, too. The best is if we can also cite a peer reviewed article that takes a rational skeptical stance. Then the reader can decide. The neat thing is that we are all welcome to work our own POV's into the article as well. The end result should be something that cannot be found anywhere else. --Dematt 01:56, 23 August 2006 (UTC)

Did you guys look at the [editorial board at JMPT]? I see reputable scientists, PhDs, MDs, doctors of medical science, and suprisingly very few DCs. Once again, what's the problem with the JMPT? Levine2112 06:47, 23 August 2006 (UTC)

I don't see a problem with JMPT, it's difficult to see an objective reason for excluding it, and plenty of medical journals are run by societies that have advancing medicine as part of their mission. However, the studies quoted in the list directly above are all individual case reports and one review of case reports; that I think merits citing as a secondary source though the review is of rather few cases; however its conclusions seem wholly reasonable in stressing the nature of the evidence (anecdotal) and expressing the conclusions carefully and conservatively Chiropractic care may represent a nonpharmaceutical health care approach for pediatric epileptic patients. Current anecdotal evidence suggests that correction of upper cervical vertebral subluxation complex might be most beneficial. It is suggested that chiropractic care be further investigated regarding its role in the overall health care management of pediatric epileptic patientsGleng 12:39, 23 August 2006 (UTC)

I just checked out that editorial board. Fewer than a quarter of the members have any degree listed at all. --Davidstrauss 20:22, 3 September 2006 (UTC)

Amount of medical community that disputes vertebral subluxation

The AMA's official stance on chiropractic (as a whole) is quite negative. According to the article on the AMA, they represent "the largest, most influential voice for physicians in the United States." Hence, a statement by the AMA should qualify as at least representing "many" if not "most" physicians. It is deceptive to represent the AMA's stance as representing only "some" of the medical community. --Davidstrauss 01:51, 22 August 2006 (UTC)

This means that you can state that AMA stance on chiropractic is quite negative. Although you should source something more recent that 1979 from the AMA. Preferabley something in this century. The AMA is a political lobby machine and doesn't necessarily accurately reflect every view of all of its members. Levine2112 02:28, 22 August 2006 (UTC)

David, I couldn't find the AMA's 'official stance' on chiropractic. Could you please point me there? Also this article is about Vertebral Subluxation. Does the AMA have an 'official stance' on this?

I have heard/read in the past that less than half of all MDs are members of the AMA. Is this true? Does anyone know where to find this out as it would be relevent to David's statement above and might only represent "some" of the medical community. Thanks Steth 02:43, 22 August 2006 (UTC)

Here it is:

• The group still represents less than 30 percent of the more than 800,000 doctors in the United States. The rest of the article is pretty good, too. We should all read it.[3]

Apparently they're having trouble because doctors think they are out of touch. I think that statement is certainly over the top, I'm sure they are very much in touch. --Dematt 03:23, 22 August 2006 (UTC)

Here are some figures (2005?) from a chiropractic source:

FACTS Licensed DCs: 60,000

• ACA 18,000
• ICA 8,000
• WCA 250?? undocumented

Licensed PTs: 203,261

• APTA 66,000

Licensed MDs: 583,000

• AMA 275,000
• AOA 1,200

[4]

It has been estimated that the NACM has about as many members as the WCA, but they can also hold membership in other organizations at the same time.

It looks like neither a majority of MDs, DCs, or PTs are members of the national organizations. They may still be members of local and state organizations.

Just to show how confusing the numbers game is, here's another estimate:

• "Oddly enough, the national organizations only represent a fraction of all Chiropractors. Believe it or not, the ACA, ICA and WCA together have fewer than ten thousand members, collectively. That means that there are 50,000 DC.s in America alone who belong to nothing!" [5]

All these organizations are political and may or may not represent the views of a majority of members. It is possible for them to be "out of touch" with the membership. Just take the basic views of the WCA, a very small organization, often very vocally at odds with the ACA. Its views are apparently believed by a majority of chiropractors. -- Fyslee 11:47, 22 August 2006 (UTC)

So obviously, I think the only thing we can say about any of these associations (AMA and Chiropractic) is that their views reflect the majority of the board members and their purpose is to politically advance their agendas. Depending on their political aspirations, in most cases they oppose each other, while they occasionally agree (socialized medicine, HMOs,etc.) Doctors of all sorts are well aware of the need to be united on certain issues whether you agree with everything the association says it stands for. The article I linked above described how when the membership began to dwindle, the insurance lobby was able to create cuts. IOW, we have to assume that if an association says something, it is only because it is good for their business. If the AMA says chiropractors are quacks, it's because it's good for business. If the WCA says medications will kill you, it's because it's good for business. It is hardly objective to use either as a source for either. --Dematt 14:02, 22 August 2006 (UTC)

Journals of chiropractic are NOT reliable secondary sources

The whole "chiropractic journals are the only ones with the expertise to talk about chiropractic issues" is a worthless argument. You can justify any silly idea by saying only the supporters are the ones with the experience to talk about it. The statement on WP:RS about preferring sources from within their field of expertise only applies if a source could possibly furnish useful information.

If we don't have many good secondary sources (not chiropractic-based) for vertebral subluxation, there are a few options:

• Shorten the article/remove current factual claims
• Clarify that the article mostly aggregates primary sources
• Give up on a verifiable, NPOV article for vertebral subluxation and merge into chiropractic

An unacceptable option is using "straight" chiropractic/subluxation journals to back up the statements. They are not ever going to say anything negative about their field's essential tenets, and that discredits them. They also don't meet the normal standards for peer review. --Davidstrauss 00:03, 23 August 2006 (UTC)

Please explain how JMPT and JVSR don't meet the normal standards for peer review.

Also, please know that there is very little research - if any - outside of the chiropractic world specifically dealing with vertebral subluxation. For years, skeptics claimed that there wasn't any scientific evidence, so chiropractic worked and worked to establish research and journals and provided the supportive research. Now the skeptics are claiming it isn't reliable research? Come on! I think I fianlly understand the definition of Truzzi's pseudoskepticism now. This is plain old stubborness. Levine2112 06:34, 23 August 2006 (UTC)

There remains very little research because the scientific community thinks vertebral subluxation is hogwash. It's also your burden to prove that those journals meet normal peer review standards. Do they send articles out to M.D.s for evaluation or only other chiropractors? The reason chiropractic journals got started is the "research" probably wasn't getting accepted into existing (read: credible) peer-reviewed journals. --Davidstrauss 22:09, 23 August 2006 (UTC)

Again; I see no objective reason to exclude JMPT. It is indexed in Current Contents and Index Medicus and is on PubMed. It is peer reviewed, and the editorial board includes MDs and PhDs; I looked at the current issue, it seems to me that all the published articles are from academic addresses, most are jointly authored by chiropractors and authors from apparently conventional academic affiliations, there are a few from chiropractic affiliations alone and about as many from conventional academic institutions alone. The journal is international, is listed in ISI, and has an impact factor of 0.75 which I would consider very low in my field, but is actually not bad for its field - in the category Health Care Sciences it is ranked 39 of 52, and the leading journal has an IF of only 1.4. I'd be very careful indeed on these grounds, the Journal of the Royal Society of Medicine has an impact factor of only 0.65. So where exactly would you set the bar for a RS? You can't reasonably exclude it from a chiropractic article just because it's a chiropractic journal without equally excluding medical journals from medical articles.Gleng 14:34, 30 August 2006 (UTC)

Thanks Gleng. That says a lot and I think, though we still have to be careful anytime we cite from a journal, JMPT is obviously noteworthy RS for our purpose here. --Dematt 15:00, 30 August 2006 (UTC)

It's definitely a RS as far as chiropractic opinion is concerned, and as a source of chiropractic research, sometimes of reasonably good quality. It doesn't give as much priority to case studies as it once did, and that's a good thing. Its peer review process has been questioned because of the inclusion of chiropractic research and case studies where the conclusions ignored or undermined the actual results. This phenomenon is classic for CAM research, especially that coming out of NCCAM, where results that clearly spell "d e f e a t" are never acknowledged, but are nearly always concluded with words such as "promising," "inconclusive," "needs more research," etc.. Honesty would often lead to a conclusion that "the results simply do not support the use of this chosen method of quackery," (my sarcasm....;-).

JMPT is getting better and better as a source of chiropractic research, but one must still keep in mind that it's an industry journal. In tact with the slowly growing numbers of chiropractors who are qualified to do good research, we are seeing more real research that doesn't start with the assumption that "we already know the truth, we just need to prove it," which still reigns in other chiropractic journals, especially the Journal of Vertebral Subluxation Research (JVSR).

Although many skeptics question the use of the term "peer review" in connection with the JMPT, it does approach what is meant by peer review in medical journals, It's not a sham and joke like the claimed "peer review" status of the JVSR, which just goes to show that a claim of "peer review" is not itself a guarantee of legitimacy, since practically anyone can name and start a journal nowadays, including super ultra straights like the editor, who has even started the RCS scam [6], [7], [8]. -- Fyslee 20:34, 30 August 2006 (UTC)

• "It's definitely a RS as far as chiropractic opinion is concerned" = Primary Source. I said secondary. --Davidstrauss 21:08, 30 August 2006 (UTC)

Thanks David, you are absolutely correct and I stand corrected. Chiroweb has a large database of subluxation papers that reference JMPT and other scholarly articles. We can start here I suppose. Chiro.org also has secondary sources. You might also try the school websites like CMCC. Go for it Hughgr. You're doing a great job. --Dematt 03:50, 31 August 2006 (UTC)

Why are you putting the burden on my lap Dematt! :) Fyslee, when you said "This phenomenon is classic for CAM research" is a way biased statement. Trying to imply that only CAM doesn't shout out their research "failures" is frankly not true. One only has to look at the vioxx fiasco to see they did the same thing.

What I was hoping to do in the Vertebral Subluxation articles science section was to only include research that deals with "can misaligned vertebra cause interferrence to the nervous system". All the other research dealing with conditions being treated etc. should go in the chiro article. IMO of course. What do ya'll think?

Also, in thinking about the "opening paragraph" for the science section, I was wondering what some of the limitations are. Off the top of my head I can think of "Difficulty in determining what is normal vs. abnormal nerve activity". Gleng, have any thoughts on others?

Shouldn't the burden fall on Davidstrauss to look for secondary sources. :)--Hughgr 05:27, 31 August 2006 (UTC)

But you were doing such a great job! :) You know I'll help you out! --Dematt 14:19, 31 August 2006 (UTC)

I think there is a misunderstanding here about what constitutes a secondary source; sorry for not noticing it. It is nonsese to categorise any journal as a primary or secondary source; a primary source is an original research report published in a RS - and that might be in Nature or it might be in JMPT though obviously the authority will differ. A secondary source is a review of the literature about a topic, and is more useful for WP as it will both be peer reviewed itself, and cover a wide range of peer reviewed literature from a range of authors with some expected objectivity. As JMPT publishes occasional reviews I see no reason why these should not be cited as secondary sources. In this area I suspect you will find few good secondary sources and so will have to use mainly primary sources, but if you find reviews within JMPT that are relevant, then fine.Gleng 09:14, 31 August 2006 (UTC)

Moved from article: "scientific evaluations" section

Scientific investigation of vertebral subluxation

"Conclusions: Joint complex dysfunction should be included in the differential diagnosis of pain and visceral symptoms because joint complex dysfunction can often generate symptoms which are similar to those produced by true visceral disease."[9]

A 2004 reasearch team at the National University of Health Sciences evaluated changes of the lumbar vertebral column following fixation (hypomobility). Their findings indicate that fixation results in time-dependent degenerative changes of the zygapophysial joints.[10]

Researchers at the RMIT University-Japan, Tokyo studied reflex effects of subluxation with regards to the autonomic nervous system. They found that "recent neuroscience research supports a neurophysiologic rationale for the concept that aberrant stimulation of spinal or paraspinal structures may lead to segmentally organized reflex responses of the autonomic nervous system, which in turn may alter visceral function."[11]

Professor Philip S. Bolton of the School of Biomedical Sciences at University of Newcastle, Australia writes in JMPT, "The traditional chiropractic vertebral subluxation hypothesis proposes that vertebral misalignment cause illness, disease, or both. This hypothesis remains controversial." His objective was, "To briefly review and update experimental evidence concerning reflex effects of vertebral subluxations, particularly concerning peripheral nervous system responses to vertebral subluxations. Data source: Information was obtained from chiropractic or, scientific peer-reviewed literature concerning human or animal studies of neural responses to vertebral subluxation, vertebral displacement or movement, or both." He concluded, “Animal models suggest that vertebral displacements end putative vertebral subluxations may modulate activity in group I to IV afferent nerves. However, it is not clear whether these afferent nerves are modulated during normal day-to-day activities of living end, if so, what segmental or whole-body reflex effects they may have.”

This only quotes POV-pushing "scientific" journals. My attempt to add the AMA's statement was reverted. My attempt to properly label the stances of the journals (pro-chiro) and the some of the colleges (pro-chiro) was also reverted. Finally, my POV warning template to the section was reverted. This section will not re-enter the article until these problems are resolved. --Davidstrauss 06:19, 23 August 2006 (UTC)

Hi David, I was the one who started adding, then Levine helped with some, but I do agree with what your saying. I've been busy and haven't been able to finish what I started. :) I do have a plan, just haven't had the time lately. I appreciate your patience. Cheers--Hughgr 17:00, 23 August 2006 (UTC)

Edits against policy

Removal of verifiable information:

• [12]

In case Steth (talk · contribs) had actually read it, he/she would have noticed that the page said, "In 1987, federal court judge Susan Getzendanner concluded that during the 1960s 'there was a lot of material available to the AMA Committee on Quackery that supported its belief that all chiropractic was unscientific and deleterious.'"

The judge's statement makes it quite clear that, not only did the AMA hold a position that "all chiropractic was unscientific and deleterious" but that the AMA adequately defended that position. The page links to other case files to substantiate the quotation.

Furthermore, the age of the AMA's statement does not invalidate it. Unless the chiro POV-pushers here have anything more recent from the AMA, the statement is going back in. --Davidstrauss 06:33, 23 August 2006 (UTC)

Hi David, this is from 1992:

"It is ethical for a physician to associate professionally with chiropractors provided that the physician believes that such association is in the best interests of his or her patient. A physician may refer a patient for diagnostic or therapeutic services to a chiropractor permitted by law to furnish such services whenever the physician believes that this may benefit his or her patient. Physicians may also ethically teach in recognized schools of chiropractic. (V, VI)" [[13]]

And, in 1997, the following statement was adopted as policy of the American Medical Association (AMA) after a report on a number of alternative therapies:[14]

Specifically about chiropractic it said,

"Manipulation has been shown to have a reasonably good degree of efficacy in ameliorating back pain, headache, and similar musculoskeletal complaints."

Those are the most recent AMA quotes on chiro I could find, if you have anything newer, please share.--Hughgr 17:34, 23 August 2006 (UTC)

Thanks Hughgr. Now at least we have an updated version of the AMA's stance (instead of their view from nearly 40 years ago. Levine2112 18:16, 23 August 2006 (UTC)

First, the efficacy of manipulation statement says nothing about the means of efficacy. You cannot infer that the AMA meant vertebral subluxation is a valid concept. Also, what's "ethical" about referring patients has nothing to do with scientific evaluation. The original AMA statement remains basically unsuperceded. --Davidstrauss 22:06, 23 August 2006 (UTC)

The original statement that you put in there said that the AMA considers chiropractic "unscientific and deleterious". This was their position in the 1960's. More recently they made the statements inferring that they no longer consider it to be so. How could they instruct their members that it is ethical to refer their patients to a practice which they consider to be "unscientific and deleterious". They couldn't. Thus, the AMA no longer considers chiropractic to be "unscientific and deleterious". Making that claim here as anything more than a historical statement is entirely invalid. As for the AMA's position on the efficacy of chiropractic care with back pain, headache, and similar musculoskeletal complaints... that's just gravy on our point. The AMA considers chiropractic care effective for some conditions... the ones which patients most often seek out a chiropractor for. So how could the AMA consider soemthing to be effective and still deleterious? They can't. And they don't. Levine2112 23:18, 23 August 2006 (UTC)

Functional theories of VS

I am bringing this to the talk page so we can make sure we have it sourced correctly:

There are several hypotheses on how a misaligned vertebra may cause interference to the nervous system.

• Nerve compression hypothesis: suggests that when the vertebrae are out of alignment, the nerve roots and/or spinal cord can become pinched or irritated. While the most commonly referenced hypothesis, and easiest for a patient to understand, it may be the least likely to occur.
• Proprioceptive insult hypothesis: focuses on articular alterations causing hyperactivity of the sensory nerve fibers.
• Somatosympathetic reflex hypothesis: all the visceral organ functions can be reflexly affected by cutaneous or muscular stimulation.
• Somatosomatic reflex hypothesis: afferent impulses from one part of the body can result in reflex activity in other parts of the body.
• Viscerosomatic reflex hypothesis: visceral afferent fibers cause reflex somatic problems.
• Somatopsychic hypothesis: the effects of a subluxation on the ascending paths of the reticular activating system.
• Neurodystrophic hypothesis: focuses on lowered tissue resistance that results from abnormal innervation.
• Dentate ligament-cord distortion hypothesis: upper cervical misalignments can cause the dentate ligaments to put a stress on the spinal cord.
• Psychogenic hypothesis: emotions, such as stress, causing contraction in skeletal muscles.

Do all of these come from the same book?

--Dematt 15:29, 31 August 2006 (UTC)

Yes--Hughgr 17:53, 31 August 2006 (UTC)

Lead: part 1

Any problems with this statement?

• The concept of chiropractic vertebral subluxation remains a chiropractic construct that does not enjoy full mainstream medical support, mostly because there is no clear scientific consensus to support its existence.

--Dematt 16:50, 31 August 2006 (UTC)

yes. full is unnecessary. either support is there or it's not. you know as well as anyone that a tiny minority may differ. q then is that minority notable. answer no. mostly because is not encyclopedic language. better to simply state the facts. I have to revert I'm afraid. your edit summary suggesting loosening is unhelpful and an unencyclopedic attitude. Mccready 17:21, 31 August 2006 (UTC)

I agree with full. agree with mostly because. So lets just take those out. --Dematt 17:32, 31 August 2006 (UTC)

Any statement thus far concerning scientific support has been strictly editorial. I suppose without sourcing, it should be:

• The concept of chiropractic vertebral subluxation remains a chiropractic construct that does not enjoy full mainstream medical support.

Any other problems? --Dematt 17:50, 31 August 2006 (UTC)

Just curious: don't Doctors of Osteopathy have similar constructs? best, Jim Butler^(talk) 18:58, 31 August 2006 (UTC)

They did have. They have moved on and adopted medical definitions. European osteopaths are not doctors nor have they moved on. They are very much alternative. -- Fyslee 19:28, 31 August 2006 (UTC)

Yes, American D.O.'s are basically M.D.'s who also train in manipulation. I've been treated by and have referred patients to them, and vice-versa. They used to have a term "osteopathic lesion", and googling it looks like it's been superseded by "somatic dysfunction", which I've seen on insurance billing and which has a series of ICD codes (thoracic, cervical etc.) - e.g. link, link. Does this sound at all similar to vert sub? cheers, Jim Butler^(talk) 22:27, 31 August 2006 (UTC)

American DOs are not MDs. --Davidstrauss 21:36, 1 September 2006 (UTC)

He didn't say they were MDs, nor are they "basically M.D.'s who also train in manipulation." They are DOs who are trained more like MDs than they were earlier, and most of them don't use manipulation very much, if at all. The DO profession and education should be eliminated and DO schools actually transformed into MD schools, with the same admission requirements (they have lower admission standards than MD schools). Right now the existence of DOs as a separate profession serves as an excuse for some DOs to continue holding onto the profession's quackish roots and use various forms of dubious practices, such as cranial osteopathy. These types of DOs (who are similar to the European ones) function more like Naturopaths, who embrace about every form of quackery known to man. (Joseph Mercola is an outstanding (infamous) example.) You should read this:

• Dubious Aspects of Osteopathy -- Fyslee 21:57, 1 September 2006 (UTC)

Either infamous or famous depending on your POV, huh. --Dematt 22:14, 1 September 2006 (UTC)

I "adjusted" the first sentence again:) Let me know if you don't like it. --Dematt 20:49, 31 August 2006 (UTC)

I like it, but I suggest dropping the first sentence as being too simplistic and incomplete. Here's the original:

Vertebral subluxation is a chiropractic term which means a vertebra of the spine is misaligned and can interfere with the nervous system. The Association of Chiropractic Colleges, representing all chiropractic colleges, unified the definition as, "a complex of functional and/or structural and/or pathological articular changes that compromise neural integrity and may influence organ system function and general health." The Federation of Straight Chiropractors and Organizations defines it as "a condition in which a vertebra has lost its proper juxtaposition with an adjacent vertebra (to an extent less than a luxation) in such a way as to alter nerve function"

Here's the lead without the first sentence and therefore slightly reworded:

Vertebral subluxation is a chiropractic term defined as "a complex of functional and/or structural and/or pathological articular changes that compromise neural integrity and may influence organ system function and general health." It is also defined as "a condition in which a vertebra has lost its proper juxtaposition with an adjacent vertebra (to an extent less than a luxation) in such a way as to alter nerve function"

How's that sound? Here I place the wordy names of the defining organizations in the references. -- Fyslee 21:12, 31 August 2006 (UTC)

I'm okay with it, though I put the names in the sentences more to satisfy David's concern about primary sources. By attributing the definition to the association, I was hoping to show that it was their "opinion." I like it better without. --Dematt 21:58, 31 August 2006 (UTC)

I took out the FSCO part because it's saying the same thing. Fyslee, your point of the objective straights "believing" in VS more is not enough to include their def, which is really saying the same thing. And the "objective straight" schools signed the ACC position paper also...they're already included by default.--Hughgr 22:05, 31 August 2006 (UTC)

Good points. Since the lead isn't supposed to be just a definition, but a short summation of the important points of the article, it's fine to include just the one definition.

I still have the same objections to the first sentence, in fact even more so with the word "simply" being added. The chiropractic concept of VS is far more than what is represented in that sentence, and since the ACC definition covers it better, that should be enough, as far as a definition goes. The rest of the lead should then mention the articles other high points. -- Fyslee 04:52, 1 September 2006 (UTC)

This is the current:

• Vertebral subluxation is a chiropractic term which simply means a vertebra of the spine is misaligned and can interfere with the nervous system. The Association of Chiropractic Colleges, representing all chiropractic colleges, unified the definition as, "a complex of functional and/or structural and/or pathological articular changes that compromise neural integrity and may influence organ system function and general health."

Realistically, VS means different things to different types of chiropractors.

How about something like this:

• Vertebral subluxation is a chiropractic term that is used by chiropractors to describe a myriad of signs and symptoms that occur as a result of a misaligned or dysfunctional spinal segment. Since its conception, the definition has made many transformations in an effort to describe the conditions that chiropractors treat. The Association of Chiropractic Colleges, representing all chiropractic colleges, unified the definition as, "a complex of functional and/or structural and/or pathological articular changes that compromise neural integrity and may influence organ system function and general health."

Dematt, that is simply beautiful! You have caught the essence of the reality of the situation. One correction will make it perfect - to NPOV it by adding "...symptoms that are believed to occur as a result...." Right now it posits that it's a fact, but we know that it's quite disputed. Another addition - in recognition of the changing nature of the definition - would be to add the date: "In 2005(?) the ACC...." -- Fyslee 12:51, 1 September 2006 (UTC)

I actually had something like that in there then I realized that when we say; "signs and symptoms are believed to occur", that just says that the signs (like tight spots, swelling, painful ranges of motion, etc.) and symptoms (things the patient tells them - pain, numbness) are the objective and subjective findings that do not have anything to do with what the chiropractor "believes." The "belief" is in the consequences of VS, right? --Dematt 13:57, 1 September 2006 (UTC)

Maybe I'm too tired, but you'll have to run that by me again. -- Fyslee 18:53, 1 September 2006 (UTC)

I disagree that the definition has transformed, I think refined may be better, IMO. I do like, "misaligned or dysfunctional spinal segment". I couldn't find the year for the ACC def either, but I know it was recent. I got tired of googling. :)--Hughgr 18:51, 1 September 2006 (UTC)

OK, hack away! :)--Hughgr 19:12, 1 September 2006 (UTC)

It's one of the best descriptions I've ever read, and when it's finished it should be included in the Chiropractic article. Since this is Wikipedia, it still needs to be NPOV'ed in some way, such as by adding "...symptoms they believe occur as a result...." This version makes it clear who believes it. -- Fyslee 19:50, 1 September 2006 (UTC)

"...signs and symptoms thought to occur as a result from a misaligned or..." [15] That's an improvement. I'm not sure of the grammar, since my English is rusty after living here for the last 23 years, but wouldn't "of" be better than "from"? -- Fyslee 20:54, 1 September 2006 (UTC)

No doubt! --Dematt 20:58, 1 September 2006 (UTC)

What? U no say my inglesh es no good? LOL--Hughgr 23:59, 1 September 2006 (UTC)

Not as bad as your spanish, or german, or whatever that is;) haha --Dematt 00:17, 2 September 2006 (UTC)

Functional scoliosis

Hi Dematt, you tagged this sentence with citation needed.

"For example, a functional scoliosis, viewed in chiropractic terms, may be due to a vertebral subluxation manifesting as an arch or abnormal curvature."

While it was already in the article when I modified it, I felt it was in the realm of "common sense" but nevertheless I checked on some refs. This isn't research but says, "The patient with suspected functional scoliosis should be evaluated for leg-length inequality or pelvic distortion. Frequently, these scoliosis can be corrected by spinal and pelvic adjusting." And then there's [16] and [17] which don't give conclusive results, only saying chiropractic manipulation seems to help reduce cobb angles but more research is necessary. Hence, I feel the sentece is accurate because it says, "may be due to..." Any thoughts?--Hughgr 23:14, 31 August 2006 (UTC)

I checked those sources out. The first one is thorough and a good rational analysis from a chiropractors POV of the various scoliosis differential diagnoses. I can't believe he didn't give his references, because he obviously used reliable sources including medical references. If he had, we could definitely use it as a secondary source. We could use it for now, but lets keep looking for more scholarly articles, especially from any of the schools or those have been published in JMPT or better. The other two would still be considered primary sources as far as I can see. If someone has cited these experiments and then put it together with other experiments and opinions, it would also be a good secondary source. Otherwise, we can still make the statement, but have to qualify it somehow as to the quality of the source. Any other input? --Dematt 15:32, 1 September 2006 (UTC)

Just a word from a PT.... A scoliosis wouldn't be considered a misalignment or subluxation, but this is a chiropractic article, and it's the chiropractic POV that needs to be described accurately. -- Fyslee 20:27, 1 September 2006 (UTC)

A scoliosis isn't considered a subluxation, but rather a possible result of a subluxation. If a vertebra is misaligned (ie. tilted), then the body attempts to adapt, resulting in a lateral curvature (scoliosis). Albeit there are various types of scoliosis, hence my origional clarification of that sentence by adding functional. Other types are differentiated here--Hughgr 22:27, 1 September 2006 (UTC)

OOOOHHH, I was reading that wrong, too. I thought it was trying to say that the whole curve was a subluxation (I thought it was a Palmer thing:) I'm going to change the sentence just a little to make sure nobody else was thinking that and then I'll take off the citation needed because, your right, that is common knowledge. Sorry for making you work more! --Dematt 04:50, 2 September 2006 (UTC)

This is where our different "spectacles" and definitions create different POV. To me, a spine could be twisted in a corkscrew (a little exaggeration....;-), and yet not contain a single subluxation (in the medical sense), while to a chiropractor, a spine can be perfectly straight (with normal curves), and still contain vertebral subluxations (in the chiropractic sense).

To me a vertebra can be wedge shaped (a common cause of a structural scoliosis), resulting in a deviation from the normal ideal curves, and still not contain any subluxations. The medical definition focuses strictly on the single joint in question, allowing for various "crooked" osseous anomalies, and accepting that what is normal for that person - even when the result of heredity or disease - is within normal limits for that person and therefore is not considered a subluxation. OTOH, if a joint is actually partially out of joint because of trauma, heredity (Inuits have congenital spondylolisthesis at a rate of 30-50%), or degenerative changes that create instability, such as degenerative spondylolisthesis caused by arthritic changes, then it gets called a subluxation. A medical subluxation will nearly always be symptomatic, and/or be objectively identifiable by multiple third parties, not just by the single practitioner who is treating the patient. (David Seaman has proposed a solution to the disagreements about all this. More later.)

Hughgr, you should know a bit about the Inuit situation. I've worked in Greenland where I got pretty proficient at diagnosing stable and unstable spondylolistheses. It was extremely common. Sometimes asymptomatic, but usually - at least by the time they got sent to me - they were symptomatic. (Why does everyone that comes to the clinic have pain or some other symptom?....;-)

These animations are great: Blacklisted link removed. Someguy1221 (talk) 05:50, 13 February 2008 (UTC) . -- Fyslee 07:12, 2 September 2006 (UTC)

Fyslee, you're correct in that a spine may be a perfect adaptation to something. Another example is a lateral compression fracture or the premature stoppage of a growth center. That same person may or may not have a subluxation in their spine somewhere else and even if they did, an adjustment wouldn't "correct" that type of scoliosis. Spondylolisthesis would rarely result in a lateral curvature. One of my friends has a grade two spondy from motocross. It is my understanding that a "normal" spine has a certain degree of lateral curvature that when looked at 3 dimensionally with the a-p lordosis and kyphosis, a "spring" like shape is seen. But this is off track. The sentence is merely saying that some funtional scoliosis' are due to subluxations. Perhaps Dematt can change it to better reflect that. And on your example of a "straight" spine having a subluxation, maybe its straight when it should have a few small curves. ;) --Hughgr 07:44, 2 September 2006 (UTC)

I agree with that. Also, a "perfectly" shaped spine could still have hypomobile segments that would be amenable to manipulation. It may also have hypermobile segments that should not be manipulated but would be amenable to other forms of adjustment. Both would be considered subluxations.

The real significance of lateral spinal curvatures is more in the potential for functional stress at the apecies of the curvatures. It is in these areas that discs tend to deform laterally and perhaps bulge or prolapse on the convex side, while exponentially increasing axial loading forces on the facet cartilages and boney structures on the concave side. Muscular adaptations and contractures as well as changes in facet capsular elasticity result in hypomobile segments and regions with chronicity. These, too, would be considered subluxations, painful or not. In this case, manipulation may be contraindicated, particularly into the concave side of the curvature or you may actually increase the curve, depending on the cause. Though there are other forms of treatment that might be appropriate, i.e. modified cox procedures, heel lifts, exercises, certain types of EMS, postural and proprioception exercises. These I would consider part of the adjustment.

I also agree that a corkscrew spine may not have subluxations. The question is whether you or I would treat it. I think a chiropractor would be more likely to consider treating if there are any factors that may have a chance of reducing those curves in a effort to "prevent" future problems. In fact, there are techniques that their entire purpose is to straighten curves. Again, the question is if the curves matter, or if it is a good idea to straighten them.

I'm not sure how to put that in words, though. --Dematt 04:51, 3 September 2006 (UTC)

I think were hitting on the "straight/mixer" problem. Using extremes, an obj. st. would say the curves may be a perfect adaptation or they may not be, there is really no way to tell for sure so let the MD's worry about it. A reformer would likely follow the medical mindset taking into account things like the age of the pt., whether or not the curvature was increasing, etc. So should we explain both, or just keep it simple?

On the notion of "preventing future problems", that is another one of the great divisions. If you have a hypomobile/fixation that is not displaying any noticable symtoms, but may lead to degenerative changes in the future if not corrected, should you do something about it now? What if the effects now are less than "noticable"? If something is not done now, will future problems be permanent?--Hughgr 20:19, 3 September 2006 (UTC)

Lead: part 2

The second paragraph ends with this statement:

• "While the orthopedic and medical definition of a subluxation includes misalignment and sometimes nerve damage, it is considered an uncommon occurrence." (Emphasis mine, since it's this part I will refer to below.)

This is good, but the whole lead will be strengthened by making the contrast clear. This can be done with a parallel phrase in the first paragraph (addition emphasized below):

• "...result of a misaligned or dysfunctional spinal segment. They consider it to be ubiquitous in all vertebrates. Since its conception, the definition ..."

This wording even includes veterinary chiropractic, which we haven't dealt with yet, but should mention at some point, possibly in a separate article. -- Fyslee 20:12, 1 September 2006 (UTC)

I'd consider ubiquitous to be redundant and thus not necessary. I recall a discussion about why humans are more prone to sublux than other animals and the main point was being upright vs. quadraped, due to the design of the spine (ie. the shape of the facets, gravitational pull in upright position). Intersting point about vet. chiro. It should have it's own article, although I'm not very familiar with it, I know it's done and with the same principles as "human" chiropractic. :)--Hughgr 20:23, 1 September 2006 (UTC)

Good point. "Ubiquitous" and "all" in the same sentence...hmmm. How about "omnipresent" or "normative"? We can leave the "vertebrates" out for now. Another article can take care of veterinary chiro. -- Fyslee 20:31, 1 September 2006 (UTC)

Ubiquitous is such a great word. It makes the point, but will the average reader know what it means? The more I think about it, the more it works for me. It basically says that everybody has them. Keep trying to use it. --Dematt 20:40, 1 September 2006 (UTC)

That's why I used it. But it's true that many won't understand it. A synonym might be better, therefore the suggestions of "omnipresent" or "normative." I favor "normative" or "normally occurring in all people," -- Fyslee 20:58, 1 September 2006 (UTC)

On this note, I don't think ubiquitous fits. Highly prevelant perhaps, but not in everybody, all the time. That would be a misnomer.--Hughgr 07:53, 2 September 2006 (UTC)

That all depends on what type of chiro you talk to. Most will consider VS to be a legitimate diagnosis for most patients coming through the door. That's their legal scope of practice, and without a subluxation diagnosis they would have to deny treatment. Ultra straights will consider it to be univerally ubiquitous in all vertebrates, and possibly invertebrates. (A little jab at the ultras, sometimes made by chiropractors themselves....;-)

In practice you won't find many chiropractors who don't find a subluxation at every treatment session. Of course there are exceptions, and chiropractors who manipulate for basically the same reasons PTs and MDs do, without using any kind of subluxation rationale. This difference in treatment rationale among chiropractors should be pointed out in the article, if it is to completely cover the subject. -- Fyslee 09:24, 2 September 2006 (UTC)

It seems that what you are talking about should go in a different article, like the Spinal adjustment or chiropractic article.--Hughgr 02:08, 3 September 2006 (UTC)

Alright, alright, we'll find someplace to put it:) (but its such a good word) MAYBE UNIVERSAL INTELLIGENCE! That's UBIQUITOUS! --Dematt 04:21, 3 September 2006 (UTC)

Only if you believe it!--Hughgr 20:00, 3 September 2006 (UTC)

Lead: part 3

"...unified the definition...." ?? Can't we find another wording here? -- Fyslee 20:22, 1 September 2006 (UTC)

consolidated?..--Dematt 20:31, 1 September 2006 (UTC)

As in "consolidated the previous definitions as... (or "into this wording")"....? Or are there some other hidden agendas or history I'm forgetting here? Spell it out for me. -- Fyslee 20:37, 1 September 2006 (UTC)

Nah, not consolidated..

• In 1996, the Association of Chiropractic Colleges, representing all chiropractic colleges, accomodated previous definitions with, "a complex of functional and/or structural and/or pathological articular changes that compromise neural integrity and may influence organ system function and general health."

"...synthesized previous definitions into "a complex of ...." ? -- Fyslee 21:19, 1 September 2006 (UTC)

I think that was mine. :) I might be getting caught up in all the talking about unity within the profession...:) But on retrospect, that was one of their objectives, I believe, to have a "unifying" def for the whole profession to agree on. I think the WFC held out the longest.--Hughgr 22:35, 1 September 2006 (UTC)

Why didn't you say that!:) We could have gone on forever;) --Dematt 23:58, 1 September 2006 (UTC)

I wanted to keep ya guessing! :)--Hughgr 00:35, 2 September 2006 (UTC)

References

Remember to keep this section here when archiving.

marginal research sentence

This sentence:

• There is marginal evidence that the chiropractic vertebral subluxation may influence the nervous system, [18] [19],

but the majority of recent chiropractic research has been directed at conditions that may be helped through chiropractic care.

I am not sure we can even call those two sources marginal. The sPOV would consider them junk science. Lets see what we can do. I know there are sources out there! Either that or we have to create a new sentence. --Dematt 05:30, 2 September 2006 (UTC)

David Seaman on VS

I mentioned above that I'd write something about Seaman. He has proposed a solution to the disagreements about chiropractic VS and medical subluxation. As a chiroskeptic, I follow Seaman with great interest. He has often written about VS and has criticized chiropractic research on the subject many times.

Of the many objections that the medical profession and chiroskeptics have against the profession, to me there are two that stand out:

• 1. Belief in the vertebral subluxation.
• 2. Quackery in the profession.

A resolution of these two problems would remove 80% of the objections and liberate the profession from multiple weights chained to its legs. Then it could progress relatively unhindered by external criticism and internal strife.

This article deals with the first point, and my comments here should not be considered part of the article, but might point out some aspects that could be used in a section, using Seaman's proposal as a future possibility to counter criticism of the concept of VS.

He writes here (2006):

We now know that subtle misalignments in the spine have no clinical consequences. We also know that they are not corrected after adjustments, even though symptomatic and diagnostic indicators improve. We know that the neurocompressive model described by Stephenson is a rare or nonexistent clinical entity, and chiropractic authorities have ask that it be abandoned so as to allow the profession to move into the future (see review by Leach). And, we have numerous more tenable models of subluxation to investigate which more accurately account for the pain and visceral symptoms that reduce after an adjustment.

Seeing Both Sides?

Readers should realize there are not two sides to this argument that should be considered. The curse of chiropractic is not a side that exists and has merit – it is a false reality; it is a fairy tale, like "The Emperor's New Clothes."

Hasn't the double-edged curse of chiropractic plagued us long enough? We need to eliminate the curse and should only consider theories of subluxation that are based in reality; these currently are found in several texts such as The Chiropractic Theories and Foundations of Chiropractic: Subluxation. - (Subluxation Issues: The Genesis of the "Curse of Chiropractic" (Check out the references there.))

In 1998, Seaman and Winterstein proposed a "replacement" solution:

In a recent article, the term joint complex dysfunction was suggested as a replacement for subluxation complex. Joint complex dysfunction refers to pathological and functional changes that occur in joint complex structures including (a) the negative effects of hypomobility/immobility, (b) functional imbalances such as muscle tightening or shortening and (c) myofascial trigger points. In short, the article demonstrated how the term joint complex dysfunction allows for a more descriptive and pathophysiologically precise discussion of spinal dysfunction compared with the term subluxation/subluxation complex. The author also proposed that the chiropractic profession adopt the term "dysafferentation" to describe the neuropathophysiological effects of joint complex dysfunction that act to generate symptoms. - ("Dysafferentation: A Novel Term to Describe the Neuropathophysiological Effects of Joint Complex Dysfunction. A Look at Likely Mechanisms of Symptom Generation" - David R. Seaman, D.C. and James F. Winterstein, D.C., [PubMed ID 9608382])

This significant replacement in terminology would effectively severe the ties to the metaphysical and pseudoscientific underpinnings of the belief in the chiropractic Vertebral Subluxation Complex (VSC), and open the doors to real scientific research of testable hypotheses and ideas, using valid medical terminology, and freed from vitalistic beliefs in Innate Intelligence. It would accept the medical definition of "subluxation," and then move on to research whatever it is that DCs, PTs, MDs, and DOs are affecting and effecting when they manipulate a joint. It would increase (establish?!) the credibility of chiropractic research, by making it possible for DCs and non-DCs to communicate and work together in research situations for the common good. The products of such research would benefit all of the medical field by building our common knowledge base. It would not be characterized by the all too common tradition in chiropractic research, to pat itself on the back by confirming its existing biases, with research that no other profession considers to be worthy of the name. True scientific research is open-ended, IOW it is not tied down by obligations to confirm preexisting biases. It seeks new direction and information, and is willing to abandon concepts and hypotheses that have earlier been considered to be true. Self-confirmation bias is not a legitimate part of scientific research.

I propose we add a section to this article that deals with this internal criticism of VS, and the proposal to abandon the concept and replace it with terminology and research that "eliminat[s] the curse":

• "We need to eliminate the curse and should only consider theories of subluxation that are based in reality;..." - David Seaman, DC

-- Fyslee 08:31, 2 September 2006 (UTC)

No doubt, when I read that paper, ("Dysafferentation: A Novel Term to Describe the Neuropathophysiological Effects of Joint Complex Dysfunction. A Look at Likely Mechanisms of Symptom Generation" - David R. Seaman, D.C. and James F. Winterstein, D.C., [PubMed ID 9608382]) it all came together. Hughgr, if you haven't read it, you really need to from top to bottom! You actually referenced it somewhere. He had neurologically documented the "subluxation" theory. I have no trouble with the new terminology. It makes sense. I also have no trouble holding on to "subluxation" either. They are all just words to describe a phenomenon. Why not hold on to the one thing that has held it together. If one day you were able to prove there was a God, would you stop calling him God, just because all the na-sayers suddenly agree Alah exists:) (That was a bad example, but you get the picture;). But, if you have a good reason, I would be interested in hearing it. --Dematt 04:08, 3 September 2006 (UTC)

Wouldn't the new terminology merely be better describing an already exisiting phenomenon.--Hughgr 20:23, 3 September 2006 (UTC)

Re- add?

This paragraph was removed from the history section:

"The search for subluxations has led to one of the most significant contributions of the chiropractic profession to the health sciences: radiography. In an attempt to visualize and analyze spinal misalignment, chiropractors embraced and provided initial interest in an emergent technology that used radiation from a high voltage emitter to produce a shadow of dense bone tissue on light sensitive plates. This allowed the establishment of a stable network of suppliers for hardware, films and chemicals that are now widely used by medical science. Nowadays, xray analysis still provides diagnostic and analytic information to chiropractors."

I found this from Vol 24 pg 279:

"The PSC Commercial X-ray Laboratories were first to expose, develop, and interpret 8 x 36 full-length, single-exposure spinographs. It was so new that Eastman would not “play with” idea of making experimental films that size; said single X-ray exposures that size“couldn’t be done.” Buck was willing to experiment with us—so today they have lion’s share of that business. Before 8 x 36 full-length, single-exposure spinographs, we had been taking spinal columns in sections, usually three separate films, which we tried to piece together, end for end, section for section. This was never satisfactory. Reason for an all-length single film spinograph was to see what single film full-length revealed. Were spinal columns straight? Were they curved? Were they full of curvatures? Were the curves, if any, adaptative? Were they fixed or subject to rules of floating conditions? What were percentages of each?"

Is the old paragraph worded correctly?--Hughgr 04:18, 4 September 2006 (UTC)

I got lost in the technical jargon the first time around, maybe trim it to:

• The search for subluxations has led to one of the most significant contributions of the chiropractic profession to the health sciences: radiography. In an attempt to visualize and analyze spinal misalignment, chiropractors provided initial interest in the emergent x-ray technology. This was followed by the establishment of a stable network of suppliers for hardware, films and chemicals that are now widely used by medical science. Chiropractors and medical doctors continue to utilize radiology in diagnostic and analytic capacities.

Something like that. Also, depending on what book that is from, it might be more appropriate to note this as an opinion by prefacing it with - "BJ Palmer said" (or something to that effect. --Dematt 05:18, 4 September 2006 (UTC)

How about a citation? Radiology and radiography don't say anything about a chiropractic origin. --Davidstrauss 12:03, 4 September 2006 (UTC)

Good idea, that would be best. Then we can also update the radiology page. They need some references, too. --Dematt 13:58, 4 September 2006 (UTC)

How about something like: Chiropractors were eager users of x-ray technology and were the first to use full-length x-rays. -- Fyslee 05:09, 5 September 2006 (UTC)

Thanks for correcting my cut/paste error Fyslee. :) I think a bit more than that would be important. x-rays were a valuable contribution to chiropractic analysis.--Hughgr 19:59, 5 September 2006 (UTC)

Indeed, and that could certainly be mentioned. They have used it more than any other profession to my knowledge. We just need to get away from the original (no doubt unintentional) implication that chiropractic nearly invented it. -- Fyslee 20:58, 5 September 2006 (UTC)

I didn't get the impression that chiro nearly invented it. I'm guessing your problem is with this sentence, "This allowed the establishment of a stable network of suppliers for hardware, films and chemicals that are now widely used by medical science.". I'll have to look up medical use of x-rays around the same time for a comparsion, but would that count as OR?--Hughgr 23:21, 5 September 2006 (UTC)

I was referring to this sentence:

"The search for subluxations has led to one of the most significant contributions of the chiropractic profession to the health sciences: radiography."

It sure looked to me like chiropractic was being credited with the invention ("contribution") of radiography. Or is there another meaning to "radiography" that I'm not aware of? It was actually the other way around. The technology was invented and then used by the medical profession, but chiropractic quickly discovered that it was very useful for their purposes and chiropractors became great (in volume) and innovative (full spine) users. The rest is history, with any innovations being in terms of interpretations of the images (not actual new innovations in x-ray techniques), with all kinds of lines and angles being drawn on the x-ray films, to document the presence of supposed subluxations ("The search for subluxations"). -- Fyslee 05:40, 6 September 2006 (UTC)

Copied from vol. 25:

X-rays went thru the same searching development for variables. —We demanded an X-ray equipment which would make possible flat or stereo precise-duplication of a posture-constant at any and all future times on same case; —that spinographs FOCALIZE to occipito-atlantal-axial region, or entire spinal column, head-to-hips in a single exposure on a single or stereo film. —that spinographs be brilliantly clear in sharp detail WITHOUT distortion —that entire spinographic sets of A-P Natural (1), Lateral Natural (2), A-P Stereo (3-4), Diagonal Stereo (5-6), BP Stereo (7-8), 8x36 Stereo (9-10) be made to match each with the other, with PERFECT precision. —that stereoscopic spinograph sets MATCH line for line, blending one into the other without distortion, or portray true third and fourth dimension directions. —that entire set of ten spinographs of one person, made at previous date, precisely match entire set of ten spinographs of same person taken at later date, regardless of whether that be 2 weeks or 2 years. Before-and-after sets required to perfectly match without distortion. —that a posture-constant be established which could be mechanically duplicated, wherein future sets match past sets of same person. —that spinographs so made would be so perfectly matched that overlapping graphs could be made which would be true, to prove mathematical changes in position of segments subsequently existing as result of action previously adjusted upon segments analyzed in spinographs. ———— In this way, we know precisely —what has mathematically happened to individual subluxation —whether it has been mathematically corrected from abnormal to normal position —whether it has been mathematically made worse, from normal to abnormal position —whether it has been moved from wedge to no-wedge —whether it has been moved into wedge and made worse —whether we have moved correct vertebra, or incorrect one —if it has moved mathematically, and in which direction —if it has not moved, why not —as time proceeds, what effects its change has had on balance of spine contours, if any. ———— No such equipment existed, so we proceeded to make it —10 years and $50,000—we now have it. Each case has a check set —every two weeks —our gross average number of spinographs per case, since opening of Clinic, August 5, 1935, is 21.85. —greater than any other Clinic in the world.

Wow, they took a lot of films per patient! Who invented stereo films?--Hughgr 18:46, 6 September 2006 (UTC)

Another tidbit from later in the same book pg 557:

Today picture changes. Spinograph cannot show, prove, or give knowledge of location of ANY SUBLUXATION in fact. SPINOGRAPH cannot bring to our eye any knowledge of location of ANY subluxation. We once thot it could. We do not think so now. Others still think it does. Others emphasize, as proof of their conclusion, that they have taken X-ray pictures. We base our denial on what is safe to say covers over one million and a half X-ray films PLUS much other additional Chiropractic information secured from other CHIROPRACTIC sources that is vitally essential to settle ANY Chiropractic subluxation conclusion. Could you, looking at two spinographs, tell which one, or whether either, was taken of a live man or dead? We present TWO spinographs. Which was taken of a live man; which of a dead man; or were both alive or dead? A spinograph is as reliable, in recording misalignments in dead man as live one. An X-ray can radiograph a fracture in dead man as well as live one. For this reason, spinographs do NOT record SUBLUXATIONS. SUBLUXATIONS exist only in LIVE people. A Chiropractor cannot ADJUST a DEAD man; there is no SUBLUXATION to adjust; and even tho he thot he could, it would do no good, for LIFE isn’t there. Spinograph records POSITION of segments. It can do this as well in dead as living. We have taken both dead and living, and it is effective in one or both, for nobody can tell difference, by plate or film, whether it was taken in life or death. NCM is useless on a DEAD body. It IS applicable and practical and CAN BE USED on LIVE body. It ALONE proves presence or absence of LIFE; interference to flow OF LIFE; and after an adjustment has been given TO LIVE MAN, it proves whether IT WAS adjustment or not, by whether it restores transmission OF LIFE or not; or whether pressure was increased and transmission decreased, or not.

I think that explains PCC's position even today.--Hughgr 19:12, 6 September 2006 (UTC)

You're kidding. The reason we can't see subluxations on xray is because the spine is no different on a dead person! They sure took a lot of xrays to figure that out! --Dematt 20:54, 6 September 2006 (UTC)

Please keep in mind I'm cutting and pasting what I'm feeling is the most relevant or interesting point and leaving out probable clarifiers. Those quotes are from ~pg7 then skipping to pg 557. :) Generally speaking, his point is that an x-ray only shows the misalignment, not any physiologic changes. Thus, by itself only represents one part of a subluxation (the bones position) so it can't be relied upon to say conclusivly that a misalignment seen on an x-ray is a subluxation. He proves his point by showing that a live vs. dead persons x-ray look the same. He does say that x-rays were initially used to confirm or deny palpation findings and that they showed how often palpation was wrong compared to what was actually seen on the film. And remember, this is BJ's POV from 1952 and he was still heavily promoting HIO and the NCM. Thank your for understanding. PS- I bolded the "revelant" part in the above paragraph that I was trying to get across :) --Hughgr 21:54, 6 September 2006 (UTC)

Very interesting. I think those points are absolutely necessary as they explain a whole lot (not to the xray info - but certainly the subluxation concept). BJ may have been trying to deny that there was any other way to find a subluxation without the NCM (that he had the exclusive patent for)? Not that I would have any reason to think BJ would sabotage other's efforts. ;) --Dematt 22:11, 6 September 2006 (UTC)

Yea, a little off topic eh. :) I did a google search on stereo x-rays and they've been used in many diff areas. I'm wondering if spinal stereo x-rays were solely a chiropractic endevor....--Hughgr 22:25, 6 September 2006 (UTC)

Scientific investigation of vertebral subluxation 2

This section is kind of a copy-and-paste mess. I've attempted to turn a couple of bits of research into something applicable to the subject at hand. Any other help here would be appreciated. Also, I am unsure where the first sentence in this section (about the first use of X-rays) comes from. Hughgr? Any idea? Levine2112 22:53, 15 September 2006 (UTC)

I've been thinking about it. We should start from the beginning. Palpation, meric system, x-ray, NCM...........That way it would flow. Anyhow, I'll get back to it on Monday, and thanks for your effort. :) --Hughgr 22:13, 16 September 2006 (UTC)

This is a good development. The important thing (to justify the existence of this article) is to establish the difference between the medical subluxation and the chiropractic vertebral subluxation. Establishing this difference is implied in Levine2112's statement above ("I've attempted to turn a couple of bits of research into something applicable to the subject at hand.") He has provided links to research related to medically documented pressure on nerves, which in some cases can be caused by medical subluxations of spinal vertebra, a rare occurrence. Pressure on spinal nerves, OTOH, is medically recognized as a common occurrence, with obvious symptoms. (MDs and PTs treat such symptomatic nerve pressure many times a day, just as many DCs do.)

There is a progression of steps to be taken in this process, consisting of at least these following steps:

1. State the existence of medical (orthopedic) subluxations. (You don't need to "establish" or "document" this fact, as it's not questioned by anybody. A wikilink should be enough.)
2. State that medical (orthopedic) subluxations can sometimes impinge on nerves. (You don't need to "establish" or "document" this fact, as it's not questioned by anybody.)
3. Document with a couple good refs how impingement of spinal nerves by medical subluxations can be measured. (That's what Levine's references above do)
4. Document with a couple good refs that this impingement by a medical subluxation can cause localized pathologies and symptoms. (That should be easy to do. The medical literature is full of this.)
5. Document with good, representative, quotes from straight chiropractic sources (the ICA and WCA websites should be good sources) that chiropractor's believe that this impingement can affect general health, including a referenced list of the conditions it is claimed to affect. (This is disputed by medical science, which certainly believes that such impingement can cause various local problems, but has not scientifically established that it can cause general health problems such as reduced immune function, to name one example commonly claimed by chiropractors.)
6. Document, using similarly referenced quotes, how vertebral subluxations are claimed to be located by chiropractors in the absence of any objective criteria, as is commonly claimed.
7. Document how such objectively unverified "subluxations" can then affect general health, and list the claims made from chiropractic sources. If you can find ACA sources, that would be great.
8. Clearly document that the fundamental difference between a "medical subluxation" and a "chiropractic subluxation" is not the existence of subluxation or impingement on nerve roots, but the claimed general health consequences of such, as made by chiropractors, above and beyond any commonly documented claims made by the medical community for nerve root impingement.
9. It would be helpful, and a great service to readers, if what is actually common chiropractic practice is documented, which is the treatment of a myriad of conditions that are claimed to be caused by spinal "misalignments," in the absence of any objective proof that those misalignments exist in those cases, and that MD radiologists would not agree that they were real "misalignments," but were just normal variations that are not considered misalignements by MDs, and certainly do not come under any medical definition of an orthopedic subluxation. This discussion would clearly establish the biggest difference between the medical and chiropractic concepts, and more importantly, chiropractic as it is commonly practiced, regardless of what is claimed.
10. Since the very need for this article is based on the disputes related to the existence of the chiropractic vertebral subluxation, its claimed effects, and the absence of its use in the medical world, documentation needs to be presented for the criticisms and their history, both within and outside of the profession.

I hope this sequence sounds logical and will help to make this article an excellent part of the series of chiropractic articles here at Wikipedia. It should present the subject from all angles, presenting accurately the various chiropractic viewpoints and the viewpoints of others on the subject. No one who has read this article should be surprised by anything they read on the subject outside of Wikipedia. They should be able to say "So what. I already read about that at Wikipedia. I'm already familiar with the existence of that viewpoint. Now I can make up my own mind and develop an informed opinion based on all that great information and the resources provided and linked to there."

This is actually the most important article, second only to the main chiropractic article, since belief in the vertebral subluxation is the very foundation of chiropractic. "No vertebral subluxation, no chiropractic." -- Fyslee 09:12, 17 September 2006 (UTC)

It sounds like a good plan. I think the difficulty will be with defining a "medical" subluxation. If we are going to try and differentiate the two, we have to V RS define it. The challenge is that chiropractors consider what you are calling "medical" subluxation as one of the subset of the chiropractic vertebral subluxation complex (VSC), and because they are symptomatic, that is what 95% (I think the new Danish study says 99.9%) of what chiropractors treat. IOW, they are certainly treating the same things, though some/most/all chiropractors make health related claims to go along with it. Then we can get into the more so-called preventative treatment measures that claim that adjustments can keep you healthy, etc.

Do you have any resources that define a "medical" subluxation of the spine? I'll look, too. --Dematt 13:00, 17 September 2006 (UTC)

Oooor, since medicine does not use the term subluxation much, we could show how medical diagnoses such as sprain/strain, intervertebral disc syndrome with and without myelopathy, sciatica, cervicalgia, cervicogenic headache, etc., etc. and how they are related to the vertebral subluxation. Those we can show some good research for, treatments, etc. Then add the additional claims that go along with VSC.

This site describes the vertebral subluxation complex simplified. Does everybody agree that this is what the subluxation is?--Dematt 14:01, 17 September 2006 (UTC)

Ummm, Fyslee correct me if I'm wrong, but what you've outlined is already in the general article. Perhaps not as extensivly explained as you did, or as it could be. But that is beside the point, we are trying to focus on the scientific study of the vertebral subluxation. There will be some medical studies included that are relevent, but I don't think that will confuse the reader. The difference is already explained in the lead, but we can expand further if you want.

For an opening paragraph of the science invest. section, how about something like-

The investigation of vertebral subluxations has been ongoing since it was first postulated in 1895. The early practioners used palpation and the anatomy of the nervous system as a guide (meric system). In their efforts to be more specific, they seized the newly discovered X-ray technology and introduced the neurocalometer (a heat sensing device). It was during those early years that the medical establishment first criticized the chiropractic profession, saying that the conditions that those early chiropractors were treating were only psychophysiologic disorders. To prove that chiropractic patients had real conditions, BJ Palmer opened a research clinic as a part of the Palmer College of Chiropratic. When a patient entered the clinic, they were first examined by medical doctors and a diagnosis was formulated. They were then sent to the chiropractic part of the clinic, treated, and sent back to the medical doctors for evaluation. Since then, chiropractors have sought a greated understanding of the mechanisms and effects of the vertebral subluxation. Today we see motion x-rays, surface EMG, and digital thermography.

If you need references for anything, they are coming. And that last sentence needs work, I know. :)--Hughgr 20:48, 18 September 2006 (UTC)

I like that. I think it says a lot. It's chronological and it is to the point. It is definitely chiropractic as well. Put it in and then we can work with it. --Dematt 23:49, 18 September 2006 (UTC)

OK, and I cut this out...it could be used as a reference for the intro of x-rays. Introduction of X-rays: "The first use of the X-ray was to verify or deny palpation findings and to verify or deny proof of the existence of vertebral subluxations".vol 22 pg196 --Hughgr 23:58, 18 September 2006 (UTC)

In Scientific investigation, it leads with "Today we see motion x-rays, surface EMG, and digital thermography though none of these methods have been proven to be reliable or valid in the detection of vertebral subluxations." Umm, couldn't it just as easily (and more accurately IMO) say "Today we see motion x-rays, surface EMG, and digital thermography though none of these reliable and valid methods have been able to prove the existence of vertebral subluxations." AndroidCat (talk) 15:58, 4 October 2009 (UTC)

Scientific Investigation section neccessary?

First, I just polished some of the other sections. It seemed every section had a closing sentence that was a critque questioning the existence of VS. I removed these, as this is clearly stated in the intro paragraph and even better handled in the critques section.

Dshsfca 03:57, 1 February 2007 (UTC)dshsfca

When I initially challenged the whole entry under "vertebral subluxation," my sole purposes was to get chiropractors to face either the fact that their "evidence" required more than some archaic metaphysics, or to tank this whole fraud as snake-oil. I actually believed the chiropractic profession could, and would, produce some form of evidence. How many researchers had the ICA and ACA hired to "demonstrate" chiropractic's claims, from U. of Colorado's biochemist in 1970s?

Watching the unfolding and unmasking of a farce was not at all in my design. I was confident that the profession could meet the challenge, even if my own skepticism and harms were the exceptions. We've all participated in the effort to get this scheme to get "science," and even with federal research dollars, even with the biggest fraud of practioners, even with no "evidence" of anything, even granting a grand metaphysics, B. J.'s hypothesis may still be the profession's "paradigm," because they have NOTHING to fall back on. LACC. NCC, NWCC, and other chiropractic colleges that "claim" a scientific basis are now into more occultism, repudiating the B. J. hypothesis, while they teach even stranger schemes. Look at the ACC "paradigm," and tell the rest of us what such an amorphous, incoherent set of nonsense gets credit for "existing."

Katrina, Iraq, Medicare Part D, and other incredulous acts are all a part of the same scheme to defraud, just as chiropractic's "vertebral subluxation syndrome," and B. J.'s "neurological interference theory of dysfunction," and the Evangelical mantra that "Jesus saves." Even if others miss the exploitation of their resources, I appreciate Wiki defending this "matrix" of occultists. The broad relief of the fraudulent is that some enable, some are so gullible, and some of us walk with integrity. I may walk alone, but I walk sure that these other frauds are not mine. Small, but inportant, consolation. Thanks for pushing the envelope. (I believe chiropractors would like you to now delete this entry, as I long ago suggested, but at least they'll have to live with YOUR choices.) Dshsfca 03:57, 1 February 2007 (UTC)dshsfca

Onward to the Scientific Investigation section...

It is still a mess of copy-and-pasting from actual research on the vertebral subluxation. Clearly, these all go to say that the are, in fact, clinical studies and research which support the existence of the chiropractic vertebral subluxation and its effects on the rest of the body. Here's the latest... another bit of research showing how VS could be responsible for Vertigo symptoms in some people and how adjustments can help alleviate these symptoms. [20] Anyhow, instead of gathering and summarizing all of the research which is out there that supports VS and its detrimental effect on the body, perhaps it would be better just to state that this evidence does exists. Perhaps we can even find a source of someone who says so... but clearly - even without that quote - the studies, the research and the evidence do exist. Thoughts? Levine2112 00:38, 11 November 2006 (UTC)

For the record, here's some more of the latest research regarding the existence of VS and it's effect... Clinical Efficacy of Chiropractic Care on Children with Autism Improvement in Depression Following Reduction of Upper Cervical Vertebral Subluxation Levine2112 00:46, 11 November 2006 (UTC)

After seeing that all the work on chiropractic article was demolished because it got too long, then seeing all the work on safety really boiling down to a bunch of different sources saying similar things, I don't see why we can't make it one short paragraph stating a synopsis of the status. We could use references for as many citations as we like if we want; we just don't have to turn them into sentences in the article. --Dematt 14:37, 11 November 2006 (UTC)

I think there should be something about chiropractic attempts to (using scientific means) verify the existence of VS, and to measure its supposed effects. Such attempts have been made, so they need mentioning. A synopsis with references could be a way to do it, but it risks OR problems, so it needs to be worded in a very NPOV manner. -- Fyslee 20:16, 11 November 2006 (UTC)

I agree, we can make it work. You guys give it a shot and when I get back out of the woods with my kids I'll see if I see anything that doesn't work for me. --Dematt 20:21, 11 November 2006 (UTC)

On this particular topic I'll be a better editor than writer, so I'll let others start it, and I'll then check it afterwards. (Not that I couldn't play devil's advocate....;-) -- Fyslee 20:43, 11 November 2006 (UTC)

History section

I took out this whole history section from the VS page. There really is no link to osteopathy with VS that has anything to do with this article. In the context of chiropractic, yes, but inthe discussion of subluxation - the concepts and treatments were different. Osteopaths manipulated vertebrae and all the soft tissues of the involved organs, arms, legs and whatever Still felt was necessary in an effort to affect blood and nerve supply. The VS is just manipulation of the vertebrae to affect the nervous system and therefore health, period. The relationship is mentioned in the chiro history if anyone is interested.

• In its chiropractic context, the term "subluxation" was first described by Daniel David Palmer, who was possibly inspired by osteopath Andrew Still. Still's model was a disturbance of blood flow to various organs from what he termed "osteopathic lesions", resulting in weakening of tissues and organs. Palmer's understanding, based on the scientific knowledge of the time, was that a disturbance of nerve supplies to the same tissues and organs more readily explained the changes produced after correction ("adjustments") of misaligned spinal bones.

• The original investigation and research into this newly described entity are shrouded in confusion, due to lack of formal notes, and the political struggle that ensued to establish a stable fountainhead for the entire chiropractic profession. A popular version was that Palmer restored long-lost hearing to a janitor by realigning bones of his spine. Sources from the period claim that chiropractic as a treatment form gained notoriety during the 1918 Flu Epidemic, when it was alleged that patients receiving "adjustments" had significant lesser mortality than those treated with conventional medical treatments of the day.

• Osteopath Irwin Korr investigated and said he confirmed the influence of nerve involvement in the mechanism of health and disease. However, osteopathic and chiropractic have diverged in their scope and focus. Whereas chiropractors have retained as their main goal the detection and correction of subluxations, some osteopaths have shifted toward a more medical approach to care.

Dematt 23:20, November 22, 2006

Comments

Article could greatly benefit from a separate "References" seciton. John Carter 01:23, 12 July 2007 (UTC)

Cleanup of article

Hello,

As per our cleanup of the main chiropractic wiki, I am engaging in a similar edit here to make the article more clear, consice, accurate, relevant and formal. All POV will be presented, including those from traditional, mixer, reformer as well as critics within and outside the profession. Scientific inquiries (and lack thereof) will be investigated as well. Excessive redundancies will be cut out as it makes the article too long. Any suggestions are welcomed. References will be added shortly, as per my standard of editing. EBDCM (talk) 05:51, 13 February 2008 (UTC)

Ummmm.....just FYI, your "cleanup" is disturbing an otherwise stable article that was created by consensus among editors of very opposing POV, and very careful wording has been chosen. You're upsetting the applecart by solo editing without discussion, and unnecessary changes aren't always welcome. If you find something that is really "that bad", then discuss it and improvements can be made. Solo editing is what's creating lots of problems for you, and why you're running into disputes all over the place. Consider existing articles on chiropractic to be preciously guarded jewels protected and preserved by numerous editors who have arrived at a solution that amounts to a truce. Any move by anyone immediately sets off edit wars because it upsets the balance. Only those who have edited these articles for a long time can be expected to understand that, but that's just the way it is. These are extremely touchy subjects and editors on one or the other side are bound to find changes that make the article acceptable to your POV as unwelcome and unnecessary changes. -- Fyslee / talk 07:11, 13 February 2008 (UTC)

What Fyslee says is true. It took a ton of effort by many of us to get where we are today. Things may not be perfect but his suggestion of using the talk page first for major changes is the ideal way to handle these pages where edit wars are tiresomly too common. If you have an idea of what you want, just post it in a new section and wait a couple days for editors to comment. ;) --Hughgr (talk) 06:28, 14 February 2008 (UTC)

I apologize for rocking the boat; my intents to improve any article I edit are sincere. I hope that my most recent edit would be considered balanced and objective and minor enough not to warrant significant objections. Feel free, as always to improve my edits, and thanks for steering me in the right direction, Fyslee and Hughgr —Preceding unsigned comment added by EBDCM (talk • contribs) 22:20, 14 February 2008 (UTC)

No problemo. I have no doubt about your sincere intentions. Little could you know that "the encyclopedia which anyone can edit" could be an invitation to enter a war zone! Unfortunately that is sometimes the case. There actually are articles that are relatively pain free to edit, but many are not. If you find one of your edits is reverted, then the next step is often to take it to the talk page and discuss it. One can also go directly to the talk page of the user who reverted and ask them in a nonconfrontational manner. There may be a long history behind the edit. New users may not realize that a small phrase can have a history that includes 3-6 months of edit warring, many blocked and several banned users, RfCs, ArbCom cases, legal threats, cyberstalking, death threats, loss of jobs, and even suicides. That's not an exaggeration. It happens in real life, all because of edit warring over a small phrase at Wikipedia! If you think Wikipedia is about "truth", forget it. The following page is very interesting reading, and very informative: Wikipedia:Rouge admin. While obviously written in a tongue-in-cheek style, it's deadly serious and is worth reading a couple times while checking out the wikilinks.

I do have some concerns about some of your edits. Some are fine, while others (those where a lot of changes are made at one time) are problematic. I'm not much for just reverting such edits because then an edit war can ensue. It's much easier to deal with edits where only a single or small change is made. Large edits are often best to avoid for this reason. It's easier to discuss simple edits, than single edit with lots of changes. The ones I find problematic are these: [21], [22], [23], and this single one [24] by Hughgr. -- Fyslee / talk 03:33, 15 February 2008 (UTC)

The further reading should be restored as you suggested. We can discuss the other changes here and hopefully it's just a matter of clarifying some semantics. Above all, we just have to make sure that readers can understand what the arguments are and not present too much jargon that unnecessarily leads to confusion. EBDCM (talk) 19:29, 15 February 2008 (UTC)

POV dispute

Mccready,

Why did you slap on the POV tag? I was editing NPOV and even writing for the enemy. You can't just slap on a POV tag because someone makes legitimate, good faith edits that improves the quality, content and flow of the article. Please elaborate on your actions so I know where you're coming from before I proceed with alternative measures. Thanks. EBDCM (talk) 06:16, 13 February 2008 (UTC)

VSC the lesion vs VSC theory

Does anyone feel that there should be some kind of mention and differentiation of VSC the mechanical lesion and VSC the theory? I think it might be important to clarify this issue as it has been a longstanding source of confusion amongst those outside the profession. I know a few DCs in town who call joint dysfunction 'subluxation' but do not imbue it with the philosophical connotations that Palmer et al. attached to it. Thoughts? EBDCM (talk) 02:26, 15 February 2008 (UTC)

I think I know what you are thinking, but perhaps you could spell it out here first. Like a new section or modifying the lead or ??? :) --Hughgr (talk) 02:53, 15 February 2008 (UTC)

I would prefer not to mess around with the lead too much as it a major source of contention and think a new section would be more appropriate at this time. It should be closer to the top though, so readers and laypeople can have more context as they read the rest of the article.EBDCM (talk) 03:27, 15 February 2008 (UTC)

Sounds interesting. I have a feeling I know where you're going, but let's see what you've got. Start right here and let's work it out. You are right about not playing with the LEAD, since the LEAD always reflects the article, IOW article content comes first, and first then a short, summary mention in the LEAD may be warranted. -- Fyslee / talk 03:37, 15 February 2008 (UTC)

Sources

It's time this article get some much needed professional help! There's a lot of high quality sources that aren't being used here and would provide a much needed boost to verify a lot of the claims made (on either side)

Chiropractic subluxation Chiropractic Theories

CorticoSpinal 17:19, April 24, 2008