By Malik Slosberg, D.C., MS
The subluxation has been defined and explained in many ways over more than a century of chiropractic history. How do we best communicate to patients today what we do and why, so that they understand the goals of chiropractic, are compliant with plans for care and receive the best possible outcomes we can offer?
Our models of the subluxation and goals of care have evolved as our understanding of the biomechanics and neurology of joints has expanded. The database available to the chiropractor today is much larger and more accurate scientifically
than
what was available to our profession’s pioneers when they originally formulated
subluxation theories in the late 19th and early 20th centuries. In addition,
recent chiropractic patient surveys reveal more clearly what benefits patients
hope to gain by receiving chiropractic care. This information gives us new insights
as to how to direct our explanations to best fulfill our patients’ needs.In recent publications there have been various attempts to clarify the meaning of the subluxation and the goals of chiropractic care. The Institute for Alternative Futures concluded that “Chiropractic needs to champion health promotion… An important focus should be performance enhancement and proactive wellness services.”i The Association of Chiropractic Colleges’ Paradigm of Chiropractic, which was approved internationally by the World Federation of Chiropractic in 2001 states, “The purpose of chiropractic is to optimize health.”ii Goals of care such as promotion and optimization of health expand the purpose and meaning of correcting subluxations into a realm that is more directly relevant to patients’ concerns. After all, our primary goal is to improve and maintain patient well-being in the present and for a lifetime, not to convert them to a certain philosophical viewpoint.
One of chiropractic’s consistently acknowledged positive qualities is a patient-centered approach to health care. We offer a positive approach to health in which we assist our patients in moving toward optimal function, fitness and well-being rather than a negative model directed at eliminating symptoms. From our perspective, patients and their health related quality of life are the focus of care, not a diagnosis or symptoms. The purpose of care is to restore and maintain the health of the whole person and not just treat isolated symptoms or diseases. Chiropractic helps create the potential for well-being and improve quality of life, rather than just focusing on illness.
There have been several excellent contemporary paradigms of subluxation recently publishediii which provide chiropractors with a clear model of what the problem is, what we do about it, and why preventive care may help maintain function, restore well-being, and reduce the risk of recurrences and future problems from developing.
A good explanation of the subluxation today is a dynamic model in which the involved joint and its associated structures (bones, nerves, muscles, ligaments, discs) do not “function well” resulting in loss of motion, pain, discomfort, muscle weakness and/or spasm, and changes in motor control. It is important for patients to understand that such loss of function can manifest itself in many ways and may develop gradually without any obvious symptoms. In addition, patients should understand that such problems may not only precede, but also predispose a future increased risk of injury, pain and degeneration. As a traditional chiropractic explanation explains, “Pain is often the last to come. What comes first is declining function and disturbed biomechanics which increase the risk of injury and pain developing.”
Over time, due to a gradual, asymptomatic decline in function and biomechanics, joints become more likely to perform poorly, they develop symptoms and degenerate. Such changes can occur rapidly, as a result of an acute injury, but much more commonly, develop insidiously as a consequence of sedentary lifestyles, sedentary work, lack of exercise and aging. In fact, in the recent literature there is a consensus that “the injury model itself is flawed and outmoded...back pain typically does not have any obvious traumatic precedent.”iv The underlying factors, which eventually result in symptoms and injury, although asymptomatic, are pervasive in our society and gradually and subtly erode the integrity and resistance to injury of the involved structures.
The current research views the symptomatic presentation of back and neuromusculoskeletal problems as more a result of improper function of the joint complex and a reduced ability to tolerate the stresses of everyday life and work rather than unusual or excessive loading. As Waddell explains, “If the problem is dysfunction, then symptoms can persist for as long as dysfunction continues. Since dysfunction may be self-sustaining, symptoms may persist indefinitely.”v Therefore, the purpose of care is “to restore normal function.”
Because poor function, repetitive stress and aging result in wear and tear, but are not necessarily acute or painful, patients are unaware of this gradual decline and increased vulnerability to injury and pain. We want our patients to understand that a major focus of chiropractic care is preventive. Chiropractors check the spine on a regular basis, whether there are symptoms or not, in order to identify disturbed kinematics, loss of motion, and other indications of dysfunction at an early, asymptomatic stage.
Chiropractic adjustments are used to help restore function before symptoms ever arise. It is important that patients understand that in our daily lives at work, at home and at play we are exposed to many repetitive, as well as sometimes abrupt, stresses and strains that can cause injury and tissue damage, especially when tissue integrity is compromised. The goal is not just to fix things that are broken, but to restore and preserve function so tissues can tolerate the repetitive stresses of everyday life. We want our patients to appreciate that chiropractors have specialized palpatory skills and carefully evaluate the mechanics and movements of individual joints in order to identify when these structures do not work normally. This kind of examination and analysis is wholly absent from traditional medical exams.vi
The chiropractic adjustment which is specifically applied to areas involved—the subluxated joints—produces both mechanical and neurological benefits which help overcome abnormal restrictive barriers such as scar tissue, muscle spasm, swelling and pain. The high-velocity, low-amplitude force of the adjustment also rapidly stretches joint capsules, ligaments and local muscles to produce a barrage of sensory input,vii which may recruit receptors to fire and prevent receptors from atrophy.viii This sensory stimulation restores normal sensory input and awareness in space, relaxes tight muscles,ix improves range of motionx and flushes out excess extracellular and extravascular fluid.xi Many patients find that not only is pain reduced and range of motion improved, but there is often a sense of relief, a reduction in tension, and often an enhanced sense of well-being.xii Very recent research suggests that adjustments may affect blood flow and even improve cognitive processing in the brain.xiii, xiv
Explanations to patients should be patient-centered; that is, they should address the issues most important to them. An effective explanation helps patients appreciate not only the subluxation as a dysfunctional joint, but its evolution and consequences—how it may develop without obvious symptoms, how it may increase the risk of injury and pain, how it may disrupt our general health. In addition, our explanations should help patients recognize the value of the chiropractic adjustments and their impact on function, health-related quality of life, and our sense of well-being. Patients who are well informed and appreciate that chiropractic may improve their lives will also be most enthusiastic and respond best to care. Moreover, such patients become excellent referral sources; no one is more certain of something than those who have experienced its impact on their own lives.
Dr. Malik Slosberg, who has been in private practice for 20 years, lectures throughout the United States for many state associations and as a postgraduate faculty member of 10 chiropractic colleges. He has lectured internationally and is a professor at Life West. He has been selected for inclusion in Who’s Who Among America’s Teachers, and in 1995 received the Chiropractor of the Year award from the Parker Resource Foundation. Dr. Slosberg graduated from Life Chiropractic College and holds a Masters of Science degree from California State University in clinical counseling and is a founding board member of the National Institute of Chiropractic Research.