Editor’s Note: April 2012
By Maria DiDanieli
By Maria DiDanieli
Medicine defines a subluxation structurally – a partial dislocation of a joint.
Medicine defines a subluxation structurally – a partial dislocation of a joint. Stedman’s Medical Dictionary (7th Ed., 2012) adds that, “although a relationship is altered, contact between joint surfaces remains.” Chiropractic has developed a definition that is functionally oriented – classifying a subluxation (specifically, a vertebral one) as a physiological dysfunction within a joint involving “a restriction of motion or abnormal position…” – and further suggests that compromise of neural integrity may be involved. This can also be found in a medical dictionary (Dorland’s, 31st Ed., 2007). In addition, many within the chiropractic profession have postulated that the presence of a vertebral subluxation may impact overall health. The medical and chiropractic perspectives demonstrate an agreement that there is a joint issue present, but diverge in their description of its nature and the potential scope of its consequences.
Although this may appear as a viable forum for investigation, it actually represents a struggle that began in1895 and continues to divide an otherwise vibrant profession. One reason for this division is that, for chiropractic, the term subluxation was traditionally associated with somewhat mystical concepts. Today, many DCs find that honouring that interpretation buoys their purpose as practitioners but their adherence to the resulting practice model appears to conflict with accepted scientific health-care ideology.
However, even the more clinically-oriented definition has eluded a scientifically verifiable description. It has been argued that reasons for this include inadequate research to elucidate the concepts in question and not, necessarily, that the concepts are invalid. But enhanced research literacy within the profession, coupled with a broadened scope of accepted research methods, have not necessarily inspired further work in defence of a chiropractic notion of the term. Instead, its continued use causes discomfort to many within the profession. The question of whether to retain and scientifically elucidate it, or relinquish it and, thus, avoid any association with its historical scientific fallibility – as well as its dissonance to the accepted medical definition – has, for the profession, become the proverbial “elephant in the room.”
In short, the division surrounding the term subluxation would be misunderstood if it were explained in semantic terms only. It is actually a fulcrum on which teeter the values of chiropractic practitioners, and the direction in which these values tip informs clinical practice as well as strategies for inclusion into mainstream health care. This is not, therefore, a trivial battle.
It is my observation that, in this controversy, the profession tends toward an either/or stance. Although some are quite happy with the neologism(s) created by stretching the term subluxation beyond a strictly structural definition – and would support developing its scope in a systematic manner – many tend to wield their interpretation of it like a firebrand at their perceived (and usually internal) enemy. My feeling is that, instead, continued constructive debate and targeted investigation could foster the advancement of concepts that, though perhaps untenable in their original form, could be evolved into verifiable models in a continuum paralleling the maturation of other areas of study.
Despite internal struggles and external controversy, chiropractic has had the tenacity to hold on to – and continue to study – the term subluxation. As a result, Dorland’s Medical Dictionary, a reputable source, now recognizes a chiropractic definition of subluxation. I wonder, now: although the term should be deployed thoughtfully by DCs, what might be the consequences of discarding it too soon?
Bien à vous.