Subluxation: Chiropractic's Elusive Buzzword
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 proclaimed 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.