Mel:
Some additional food for thought on subluxation.
*******************************************************
Douglas M. White, PT, OCS
Physical Therapist, Consultant
191 Blue Hills Parkway
Milton, MA USA 02186
P: 617.696.1974
[log in to unmask]
http://DouglasWhite.tripod.com
New data on chiropractic-induced strokes. Researchers representing the
Canadian Stroke Consortium
http://www.strokeconsortium.ca/08-spontads/08iii.sp-update.html have
reported on 98 cases in which external trauma ranging from "trivial" to
"severe" was identified as the trigger of strokes caused by blood clots
formed in arteries supplying the brain. Chiropractic-style neck manipulation
was the apparent cause of 38 of the cases, 30 involving vertebral artery
dissection and 8 involving carotid artery dissection. Other Canadian
statistics indicate the incidence of ischemic strokes in people under 45 is
about 750 a year. The researchers believe that their data indicate that 20%
are due to neck manipulation, so there may be "gross underreporting" of
chiropractic manipulation as a cause of stroke. [Beletsky V. Chiropractic
manipulation may be underestimated as cause of stroke. Presented at the
American Stroke Association's 27th International Stroke Conference, San
Antonio, TX Feb 7-8, 2002] Dr. Stephen Barrett believes that the
chiropractic profession should implement a reporting system that would
enable this matter to be studied more readily.
http://www.quackwatch.com/01QuackeryRelatedTopics/chirostroke.html
Quackwatch Home Page
Chiropractic's Elusive "Subluxation"
Stephen Barrett, M.D.
If you are examined by a chiropractor, you may be told that you have one or
more subluxations of your spine. This article examines what this means and
how you should react.
Chiropractic theory is rooted in the notions of Daniel David Palmer, a
grocer and "magnetic healer" who postulated that the basic cause of disease
was interference with the body's nerve supply. Approximately a hundred years
ago, he concluded that "A subluxated vertebrae . . . is the cause of 95
percent of all diseases. . . . The other five percent is caused by displaced
joints other than those of the vertebral column." [1] He claimed that
subluxations interfered with the body's expression of "Innate
Intelligence"-- the "Soul, Spirit, or Spark of Life" that controlled the
healing process. He proposed to remedy the gamut of disease by manipulating
or "adjusting" the problem areas.
Over the years, chiropractors have gone beyond Palmer's theories, although
some still cling to them for dear life. Some describe subluxations as "bones
out of place" and/or "pinched nerves"; some think in terms of "fixations"
and/or loss of joint mobility; some occupy a middle ground that includes any
or all of these concepts; and a small percentage renounce Palmer's notions
as biotheistic nonsense -- which they were.
Are Subluxations Visible?
Chiropractors also disagree on whether their "subluxations" are visible on
x-ray films. "Straight" chiropractors tend to believe that they cause nerve
interference, are readily visible, and that virtually everyone gets them.
Most other chiropractors (commonly referred to as "mixers") define
subluxations loosely and see them when it suits their convenience.
Chiropractors who reject subluxation theory consider them invisible but have
been forced to acknowledge them to get paid by Medicare. When a respected
chiropractic researcher was asked whether he had ever seen a subluxation on
an x-ray film, he smiled and jokingly replied, "With my eyes closed." [2]
Old chiropractic textbooks show "before and after" x-rays that are supposed
to demonstrate subluxations. In 1971, hoping to get a first-hand look at
such x-rays, I challenged the local chiropractic society to demonstrate ten
sets. They refused, suggesting instead that I ask the Palmer School to show
me some from its "teaching files." When I did, however, a school official
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 [3].
In 1973, Congress authorized payment under Medicare for chiropractic
treatment of "subluxations demonstrated by x-rays to exist." In 1972, to
enable payment, chiropractors held a consensus conference that redefined
"subluxations" to include common findings that others could see. The
document, several pages long, described the supposed x-ray manifestations of
18 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
[4]. I have been unable to determine how many billions of dollars
chiropractors have received from Medicare since the law took effect.
Some of these terms are fancy names for the minor degenerative changes that
occur as people age. The conditions often have nothing to do with a
patient's symptoms and are not changed by chiropractic treatment. Some, as
acknowledged by the conferees, are not even visible on x-ray films. In 1997,
Congress amended the law to permit payment for subluxations diagnosed by
other means -- a policy scheduled to take effect on January 1, 2000.
Chiropractors also differ about how to find "subluxations" and where they
are located. In addition to seeing them on x-ray films, chiropractors say
they can find them by: (a) feeling the spine with their hand, (b) measuring
skin temperature near the spine with an instrument, (c) concluding that one
of the patient's legs is "functionally" longer than the other, (d) studying
the shadows produced by a device that projects a beam of light onto the
patient's back, (e) weighing the patient on special scales, and/or (f)
detecting "nerve irritation" with a device. Undercover investigations in
which many chiropractors have examined the same patient have found that the
diagnoses and proposed treatments differed greatly from one practitioner to
another.
Subluxation is also a medical term. The medical definition is incomplete or
partial dislocation -- a condition, visible on x-ray films, in which the
bony surfaces of a joint no longer face each other exactly but remain
partially aligned. No such condition can be corrected by chiropractic
treatment.
Elastic Definition
Two years ago, in an attempt to "unify" chiropractic terminology, the
Association of Chiropractic Colleges issued the following definition:
A subluxation is a complex of functional and/or structural and or
pathological articular changes that compromise neural integrity and may
influence organ system and general health.
In 1997, the Foundation for Chiropractic Education and Research issued a
pamphlet called "Subluxation: What It Means to You," which states:
What the above means is that a subluxation is a joint problem (whether a
problem with the way the joint is functioning, a physical problem with the
joint, or a combination of any of these) that affects the function of nerves
and therefore affect the body's organs and general health.
This "definition" is still poppycock because the vast majority of spinal
problems do not affect the body's organs or general health. (In addition, it
makes no sense to use the consensus process to try to define something that
is not a valid concept [5]. If you'd like to have some fun, ask a
chiropractor to list the diseases or general health problems that spinal
manipulation can cure.
The Silent Killer?
In the late 1980s, the Vertebral Subluxation Research Institute (VSRI) was
launched by Terry Rondberg, D.C., of Chandler, Arizona. Rondberg is
president of the World Chiropractic Alliance (WCA), a group that promotes
subluxation-based practice and is president of Chiropractic Benefit
Services, a malpractice company that insures subluxation-based
chiropractors. He also publishes The Chiropractic Journal (a newspaper for
chiropractors), the Journal of Vertebral Subluxation Research and Health
Watch (a newsletter that attacks what it considers to be "the dangers and
abuses of medical and drug interests."). VSRI taught chiropractors how to
recruit "research volunteers" and convert them into lifetime chiropractic
patients. Its chiropractor clients were instructed to use telemarketing and
other approaches to ask people to volunteer for a nationwide study on spinal
conditions. During the first office visit they would be examined and given a
brochure -- "The Silent Killer" -- which explains how subluxations can be
caused by physical, chemical, and emotional trauma. (The brochure claimed,
for example, that food additives, air pollutants, spoiled food, fear, worry,
hate, greed, sadness, grief, emotional shock, and severe disappointment can
cause muscle spasms that result in subluxations.) During the second visit,
they would be advised to have their subluxations treated. TheVSRI program
was concluded in 1991 [6]. A subsequent WCA survey found that 65% of members
who responded said that their patient education material referred to the
vertebral subluxation as the "silent killer."
The above ad from a recent telephone directory purports to show how
misaligned spinal bones cause subluxations. A distributor of the poster to
the right calls it "the most powerful single visual aid available." The
poster to the far right, distributed during the mid-1980s, states that
"chiropractic subluxations can be your health's worst enemy" and that
"spinal adjustments wipe out this enemy."
A 1992 WCA training manual, written for chiropractic assistants by
Rondberg's wife Cindy, describes how the subluxation concept can be
explained to patients:
When -- through physical, mental, or chemical stress -- one of the 24
vertebrae in the spinal column becomes slightly misaligned, it's called a
subluxation. When a subluxation occurrs, it puts pressure on delicate
nerves, and the organ or body part at the other end of the nerve does not
receive the proper messages it's so dependent on. This has been compared to
someone stepping on a water hose, interfering with the flow of water. The
vertebral subluxation does precisely the same thing, interfering with the
messages from the brain to the body. When the communication from the brain
to the organ is broken down, there is a malfunction and disease may
eventually develop [7].
Patient Media, Inc., a company that markets patient education materials
offers a subtler but still scary approach. Its "Subluxation" pamphlet
states:
Subluxations are serious!
However, the most important aspect of a subluxation is its affect on your
nervous system. Compromising the way your nervous system controls and
regulates your body can have grave consequences. Distorted communications
between your brain and your body can cause all kinds of health problems
beyond just headaches and backaches. . . .
There are three basic causes of subluxations. Physical causes include
slips and falls, accidents, repetitive motions and improper lifting. Stress,
anger and fear are examples of emotional causes of subluxations. Alcohol,
drugs, pollution and poor diet can be chemical causes of subluxations. . . .
You can have subluxations and not even know it. Like tooth decay or
cancer, subluxations can be present before any warning signs appear. The
results of a thorough examination can show the location and severity of any
subluxations you may have [8].
Pending FTC Action
Warnings about "subluxations" predate VSRI and still apear in many ads,
brochures, and office posters. For example, a widely distributed pamphlet
from Koren Publications warns:
A vertebral subluxation is a spinal abnormality that interferes with
your nerves. It can create dis-ease, lowered resistance to disease, pain,
imbalance, fatigue and can pave the way for ill health. It is sometimes
called the "silent killer" because it can slowly eat away at your health and
vitality without your having the slightest awareness of it. . . .
Subluxations are so very common they can be considered an epidemic --
nearly everyone has them.
Subluxations can undermine your health just as termites can undermine
the foundation of your home. . . . By the time symptoms appear a certain
amount of the damage caused by longstanding subluxations may be
irreversible.
For that reason periodic spinal examinations to locate and correct
vertebral subluxations should be part of every family's health routine.
Correcting silent subluxations today could save you and your family from
diseases that, later in life, could not possibly be ignored [9].
Company president Tedd Koren, D.C., is a 1977 graduate of Sherman College of
Chiropractic, the "straightest" of the chiropractic colleges. The company
publishes a large line of subluxation-based patient-education brochures
which suggest that spinal manipulative care can help nearly the entire gamut
of health problems. A 1998 flyer for Koren's 12-hour seminar on "The Natural
Superiority of Chiropractic" states that a total of 24 million of these
brochures have been distributed worldwide.
Claims made in some of Koren's brochures were challenged by the Federal
Trade Commission. In a 1998 catalog, Koren stated:
The FTC claims that chiropractors can only tell patients that chiropractic
care can be beneficial for low back pain. Nothing else, not subluxations,
wellness, headaches, sciatica, allergies, children's health, ear infections,
whiplash, etc. Although Koren Publications' literature states that
chiropractic is not the treatment of diseases but the correction of
vertebral subluxations, the FTC doesn't like the "impression" we're giving
the public and patients [10].
In October 1998, Rondberg filed a lawsuit intended to stop the FTC action
against Koren and other likeminded providers. Asserting that Koren's
publications (and therefore his own) should be protected by the
Constitutional right to free speech, the suit papers stated:
In or about mid-1998, the FTC concluded that Dr. Koren's activities
constitute false advertising and or deceptive trade practices. The FTC sent
him a proposed consent order and a proposed administrative complaint. The
FTC said sign the consent order or face a lengthy and costly administrative
proceeding. The proposed consent agreement basically prohibits Dr. Koren
from making any public claims about the benefits of chiropractic unless the
claims are supported by scientific studies which the FTC believes to be
authoritative or valid. . .
Although Dr. Koren's specific message is somewhat different from Dr.
Rondberg's, their activities are quite similar. Both sell books and
pamphlets which sometimes are distributed by chiropractors, and both are
strong advocates of the benefits of chiropractic care. . . .
Dr. Rondberg does not believe that chiropractic is a direct cure or even a
treatment for any disease or condition other than vertebral subluxation.
However, all chiropractors believe that keeping the spine healthy and
correcting spinal nerve interference can have a beneficial effect, and may
sometimes lead to a resolution of some medical conditions. But Dr. Rondberg
stresses that the purpose of chiropractic is to correct spinal nerve
interference, not to treat any disease or medical condition [11].
Rondberg's attorney was Richard A Jaffe, of Houston, Texas. On November 16,
1999, a federal judge granted the FTC's motion to dismiss their suit.
In 2001, the FTC abandoned its effort to limit Koren's claims. The FTC
itself made no public statement, but articles in chiropractic publications
describe a six-year investigation that ended in June 2001 [12].
Not all chiropractors regarded the FTC investigation as unwarranted. John
Triano, D.C., Ph.D., one of chiropractic's most respected researchers,
described certain of Koren's claims as "afflicted by absence of scientific
merit." In a1998 news report, he said, "Perhaps those who are calling for
donations to Dr. Koren's legal defense would be better served to invest in
donations to chiropractic research so that we may produce effective evidence
for what we do." [13]
I agree with Dr. Triano. I also believe that a consent agreement as broad as
the one described above would have had greater significance than any other
health-related settlement in the FTC's history. I suspect that the FTC
dropped the case because it concluded that the brochures were
"patient-education" materials rather than advertising and thus were immune
to federal regulation. Koren has notified me that my "conjecture" is
incorrect [14], but he has refused three requests from me to state what he
believes is correct.
The Bottom Line
My advice about "subluxations" is very simple. If a chiropractor purports to
locate and fix them -- "killer" or otherwise -- seek treatment somewhere
else.
References
1.. Palmer DD. The Science, Art and Philosophy of Chiropractic. Portland,
Oregon: Portland Printing House Company, 1910.
2.. Weiss R. Bones of contention. Health 7(4):44-53, 1993.
3.. Frogley R. Letter to Stephen Barrett, M.D., 1971.
4.. Schafer RC (editor). Basic Chiropractic Procedural Manual, fourth
edition. Arlington, Va.: American Chiropractic Association, 1984.
5.. Nelson C. The subluxation question. Journal of Chiropractic Humanities
7:46-55, 1997.
6.. Bodney DJ. Letter to Stephen Barrett, M.D. May 20, 1998.
7.. Rondberg C. The CA Advisor Training Manual: Basic Training for
Chiropractic Assistants. Chandler, AZ: World Chiropractic Alliance, 1992.
8.. Esteb W. What patients want to know about subluxations. Denver CO:
Patient Media Inc., 1999.
9.. Koren T. What Is a Subluxation?, Philadelphia: Koren Publications,
1995.
10.. Chiropractic Wellness: The Practice Building Journal from Koren
Publications. Volume 1, 1998-1999, back cover. Distributed October 1998.
11.. Rondberg vs. Federal Trade Commission, filed Oct 28, 1998.
12.. Feds drop Dr. Koren's case: First amendment rights of health care
professionals were at stake. Dynamic Chiropractic, Aug 2001.
13.. FTC questions Koren's claims. Is Koren Publications Just the
Beginning? Dynamic Chiropractic, Sept 21, 1998, pp 1,17,42,49.
14.. Koren T. E-mail message to Dr Stephen Barrett, September 13, 2001.
For Additional Information
To what extent can chiropractors help people? Does it ever make sense to
seek chiropractic care? If so, how can a reliable chiropractor be found?
These questions -- which are not simple to answer -- are thoroughly
discussed in Chiropractic: The Victim's Perspective (1995), written by
George J. Magner, III, and Inside Chiropractic: A Patient's Guide (1999), by
Samuel Homola, D.C. Both were edited by me and published by Prometheus
Books. Together they provide the most detailed analysis of the chiropractic
marketplace ever published. Comprehensive information is also available on
Chirobase, our skeptical guide to chiropractic history, theories, and
current practices.
Reader Comments
The degree to which some chiropractic students are brainwashed with
subluxation philosophy is demonstrated by email messages I get from time to
time. The first message below came in February 1998 from a student at Parker
Chiropractic College. The second came in March 1998 from a student at Life
University. The third came in May 1998 from a recent graduate from Cleveland
College. The fourth came in August 1998 from a Parker College intern who
didn't specify which article(s) on Quackwatch had bothered him.
1. In order to bash something, you have to know what it is first. ALL
chiropractors know that we can't heal anything, it is the body that does the
healing. All we do is help the body maintain its normal function. In order
to function normally, the nervous sytem must be able to flow freely, because
it is the nervous system that basically controls everything else in the
body. Whether it directly controls something such as muscles, or indirectly
like enzyme release, it does effect every part of the body. In the course of
the entire body, it is possible for the nerve to be compressed, either by
bone directly, or by surrounding soft tissue. This works just like stepping
on a water hose. If you step on a hose, the water coming out the end slows,
and if you step hard enough, it stops. The same is basically true of nerves.
If the nerve is compressed, then the nerve impulse is inhibited, if not
completely stopped, thus affecting the area innervated by that nerve.
Hopefully you will agree that if a specific muscle or other tissue loses its
innervation, it will begin to atrophy, and can possibly die completely. All
chiropractors do is move the surrounding bone and or soft tissue to relieve
the compression on the nerve, thus allowing it to flow freely. The body can
heal itself better than any drug can, and I think you know that.
2. As you well know, the body is an amazing example of communication
and efficiency in that millions of cells are working together to achieve
optimum function. Is the heart beating too fast? How much glucose is needed
for the secretion of insulin? How much sodium in the blood stimulates the
osmoreceptors in the HYPOTHALMUS to activate ADH? The answer is that
communication between the BRAIN and the organs, glands, and cells of the
body through the SPINAL CORD is needed for these functions to exist. How
else would a structure in the brain (the hypothalmus) know that these
processes are going on? Do subluxations cause an interference with this
communication, that is the million dollar question. It is a theory, our
theory, and it makes sense. I object to you calling us quacks and endorsing
a closed minded approach to healing.
In general, western medicine's philosophy of health in a pill is
over-prescribed and harmful. . . . Millions are seeking alternatives, there
is an innate healing power of the body, and chiropractors are well trained,
intelligent health care providers. Much of the physiology of the body is
still unknown, open your mind to new possibilities or you will be left
behind.
3. I have never told my patients that I would be able to 'cure' them
or their ailments. I have only tried to inform them that if their condition
is being affected by pressure on a nerve (or group of nerves) that I may be
able to help them by removing pressure (usually indirect pressure caused by
the contents of the IVF when a vertebra is not moving properly) and allowing
the nerve or nerves to function properly. [Editor's note: IVF stands for
intervertebral foramen, the space between the spinal bones through which the
spinal nerves emerge.]
4. If you believe that I am a "quack" for studying the amazingly
wonderful entity of the anatomical human body and for learning the
tremendous power that it possesses to both monitor and even heal itself
(optimized by the removal of interference and toxins), then I must admit
that I would never expect a doctor of your accomplishments and status to
repeatedly express such a feeble, closed mind. My only goal as I enter
practice will be to help everyone that I treat to obtain the maximum
quantity and quality of life possible -- the way the good Lord intended --
without blindly accepting unnecessary poisonous drugs and surgery at the
drop of a hat. Those things should be the final alternative, not the first
and/or only choice. The Power that made the body heals the body. The
problems should be addressed primarily, rather than the symptoms.
----- Original Message -----
From: <[log in to unmask]>
To: <[log in to unmask]>
Sent: Monday, February 11, 2002 10:22 PM
Subject: [PHYSIO] Subluxation Paradox: PP126
| Here is another "Puzzle & Paradox" for rumination:
|
| INTRODUCTORY NOTE
|
| For newcomers to this forum, these P&Ps are Propositions, not facts or
| dogmatic proclamations. They are intended to stimulate interaction among
| users working in different fields, to re-examine traditional concepts,
foster
| distance education, question our beliefs and suggest new lines of research
or
| approaches to training. We look forward to responses from anyone who has
| views or relevant information on the topics.
|
| PUZZLE & PARADOX 126: SUBLUXATION PARADOX
|
| We constantly hear from colleagues and some therapists that someone's
spine
| or neck is "out of alignment" or that the bones in some or other part of
the
| body are "subluxated" (or held in a prolonged state of chronic partial
| dislocation or "mal-location"). At the same time research informs us that
| the ligaments and connective tissues involved with those joints are
extremely
| tough, only slightly extensible and resist deformation very powerfully.
|
| Even outside the body in being tested in vitro, ligaments and fasciae have
to
| be subjected to considerable force to produce significant extension for
even
| short periods, so how is it possible for apparently resting levels of
muscle
| tension to produce sufficient force to maintain persistent "subluxation"?
| Of course, if the connective tissues concerned are actually damaged or
| herniated, then dislocation may be one of the well-known consequences, but
if
| the alleged deformation is not of that magnitude, then how can a "partial"
| dislocation be maintained.
|
| Naturally, the use of therapy to "release" the hypothetical tension
assumes
| that these viscoelastic tissues, despite prolonged imposition of tension,
| display perfect hysteresis and return to their pre-pathological state
| immediately after manipulation or whatever treatment is deemed to be
| appropriate.
|
| How can one reconcile these diametrically opposed views? Are there any
| radiological scans or other studies which have confirmed the existence of
| "subluxations" or low level connective tissue disturbances which allow
| "partial dislocations" or "misalignments" to occur chronically, even
though
| powerful muscles contractions from adjacent muscles may override the
alleged
| chronic tension produced by tissues which are hypothesized to maintain
those
| alleged displacements?
|
| -----------
|
| Dr Mel C Siff
| Denver, USA
| http://groups.yahoo.com/group/Supertraining/
|
|
