What is a Subluxation? Breaking Down Chiropractic Terminology

For individuals suffering from back pain, can knowing basic chiropractic terminology help in understanding diagnosis and treatment plan development?

Chiropractic Terminology

The chiropractic principle is that a properly aligned spine positively affects an individual’s overall health. One of the main aspects of chiropractic care is applying calculated force to the spinal joints to restore correct spinal alignment. Chiropractic terminology describes specific types of techniques and care.

General Subluxation

A subluxation can mean different things for various doctors. In general, a subluxation is a significant structural displacement or an incomplete or partial dislocation of a joint or organ.

• To medical doctors, a subluxation refers to a partial dislocation of ​a vertebrae.
• This is a serious condition, usually brought on by trauma, that can result in a spinal cord injury, paralysis, and/or death.
• X-rays show a conventional subluxation as an obvious disconnect between the vertebrae.

Chiropractic Subluxation

• The chiropractic interpretation is more subtle and refers to the misalignment of adjacent spinal vertebrae.
• Subluxations are the main pathology treated by chiropractors. (Charles N.R. Henderson 2012)
• Subluxation in this context refers to position changes in the joints and soft tissues of the spine.
• Vertebral misalignment is believed to lead to pain and abnormal intervertebral joint motion.
• This difference between the serious subluxation medical condition and the chiropractic version may cause individuals to dismiss seeking back pain treatments.

Motion Segment

• Chiropractors and surgeons use it as a technical term.
• Motion segment refers to two adjacent vertebrae and the intervertebral disc between them.
• This is the area chiropractors assess and adjust.

Adjustment

• The chiropractor performs a spinal manual adjustment to realign joint subluxations.
• Adjustments involve applying force to motion segments to bring them back into a centered alignment.
• The goal for adjustments and realigning the vertebrae includes:
• Nerves can transmit signals without interruption.
• Positively affects overall health. (Marc-André Blanchette et al., 2016)

Manipulation

Spinal manipulation is a technique used by chiropractors to provide relief for musculoskeletal pain related to the back and neck. Manipulation provides mild to moderate relief and works as well as some conventional treatments like pain-relieving medications. (Sidney M. Rubinstein et al., 2012)

• Spinal manipulation is divided into grades of mobilization.
• Depending on their training, practitioners of various medical disciplines may be licensed to perform grade 1 to grade 4 mobilizations.
• Only physical therapists, osteopathic physicians, and chiropractors are licensed to perform grade 5 mobilizations, which are high-velocity thrust techniques.​
• Most massage therapists, athletic trainers, and personal trainers are not licensed to perform spinal manipulations.

Based on a systematic review, the effectiveness of these treatments found that there is quality evidence that manipulation and mobilization can help reduce pain and improve function for individuals with chronic low back pain, with manipulation appearing to produce a more profound effect than mobilization. Both therapies are safe, with multimodal treatments potentially being an effective option. (Ian D. Coulter et al., 2018)

As with any treatment, results vary from person to person and with different chiropractors. There are also potential risks with spinal manipulation. Though rare, cervical, carotid, and vertebral artery dissections have occurred with cervical/neck manipulation. (Kelly A. Kennell et al., 2017) Individuals with osteoporosis may be advised to avoid chiropractic adjustments or manipulation because of the increased risk of injury. (James M. Whedon et al., 2015)

Many individuals choose chiropractic treatment for a variety of conditions. Understanding chiropractic terminology and reasoning allows individuals to ask questions as they discuss their symptoms to develop a personalized treatment plan and restore function and wellness.

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References

Henderson C. N. (2012). The basis for spinal manipulation: chiropractic perspective of indications and theory. Journal of electromyography and kinesiology : official journal of the International Society of Electrophysiological Kinesiology, 22(5), 632–642. doi.org/10.1016/j.jelekin.2012.03.008

Blanchette, M. A., Stochkendahl, M. J., Borges Da Silva, R., Boruff, J., Harrison, P., & Bussières, A. (2016). Effectiveness and Economic Evaluation of Chiropractic Care for the Treatment of Low Back Pain: A Systematic Review of Pragmatic Studies. PloS one, 11(8), e0160037. doi.org/10.1371/journal.pone.0160037

Rubinstein, S. M., Terwee, C. B., Assendelft, W. J., de Boer, M. R., & van Tulder, M. W. (2012). Spinal manipulative therapy for acute low-back pain. The Cochrane database of systematic reviews, 2012(9), CD008880. doi.org/10.1002/14651858.CD008880.pub2

Coulter, I. D., Crawford, C., Hurwitz, E. L., Vernon, H., Khorsan, R., Suttorp Booth, M., & Herman, P. M. (2018). Manipulation and mobilization for treating chronic low back pain: a systematic review and meta-analysis. The spine journal : official journal of the North American Spine Society, 18(5), 866–879. doi.org/10.1016/j.spinee.2018.01.013

Kennell, K. A., Daghfal, M. M., Patel, S. G., DeSanto, J. R., Waterman, G. S., & Bertino, R. E. (2017). Cervical artery dissection related to chiropractic manipulation: One institution’s experience. The Journal of family practice, 66(9), 556–562.

Whedon, J. M., Mackenzie, T. A., Phillips, R. B., & Lurie, J. D. (2015). Risk of traumatic injury associated with chiropractic spinal manipulation in Medicare Part B beneficiaries aged 66 to 99 years. Spine, 40(4), 264–270. doi.org/10.1097/BRS.0000000000000725