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A Vertebral Subluxation Hypothesis Tree

A Vertebral Subluxation Hypothesis Tree. Dr. Ed Owens Dr. David Koch Dr. Leroy Moore. The mission of research: Service to the Profession. Acceptance of chiropractic by patients and other health care professionals

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A Vertebral Subluxation Hypothesis Tree

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  1. A Vertebral Subluxation Hypothesis Tree Dr. Ed Owens Dr. David Koch Dr. Leroy Moore

  2. The mission of research:Service to the Profession • Acceptance of chiropractic by patients and other health care professionals • Basic science research on the nature of subluxation and the physiological effects of adjustments • Jansen, Meeker, Rosner. American Chiropractors’ Research Priorities. JNMS 1997; 5(4):p144-149.

  3. Paradigm Fit:Which subluxation paradigm? • Spinal manipulation for back pain • Vertebral Subluxation as the cause of all disease (dis-ease) • VS correction as preventive maintenance • VS correction to enhance quality of life

  4. Spinal manipulation for back pain Vertebral Subluxation as the cause of all disease (dis-ease) VS correction as preventive maintenance VS correction to enhance quality of life Paradigm Fit: Which subluxation paradigm? Patient Base 50-80% (Epi) 80-90% (Epi) 100% (Const) 100% (Const)

  5. Paradigm Colors Interpretation • Recent high profile RCT’s have not been favorable for chiropractic efficacy • Methodological issues • Paradigm mismatch • Were Vertebral Subluxations Corrected? • Were Vertebral Subluxations related to disease?

  6. Many Effects: Many Causes Vert Sx Physiology Genetics Psychology Disease Nutrition Injury

  7. Another Vertebral SubluxationHypothesis Complex organisms depend on the bidirectional flow of information between the central nerve system and the peripheral cells in order to adapt to a changing environment in a coordinated manner.

  8. Distortion of Information:Disturbed Function • Metabolic demands • Alcohol • Inflammation • Trauma • Spinal lesion in close proximity to neural tissue

  9. Vertebral Subluxation Negative mechanical influences can occur in the area of the spine and interfere with information processing. These are called vertebral subluxations.

  10. Which comes first? Articular derangement leads to neurological involvement. Neurological dysfunction leads to articular derangement.

  11. General Hypotheses Misalignments of vertebrae can change the course of the spinal cord, producing interference in the transmission of nerve impulses. Slight disarticulations in spinal joints can restrict nerve transmission by occluding the IVF Articular derangement leads to neurological involvement. Changes in vertebral mobility can alter joint loading and mechanoreceptor output in such as way as to disturb spinal reflexes. IVD material can encroach on the spinal canal or IVF causing restriction on the volume of neural tissue.

  12. More specific hypotheses Misalignments of vertebrae can change the course of the spinal cord, producing interference in the transmission of nerve impulses. Sensory nerve conduction can be assessed with SSEP Misalignment can be measured on x-ray

  13. General Hypotheses: the other limb of the tree Compression or irritation of efferent tracts leads to loss of muscle control. Poor sense of joint strain leads to improper, or prolonged loading. Neurological dysfunction leads to articular derangement. Irritation of sensory tracts leads to loss of feedback from joints and muscles. Improper muscle tone leads to fixation and improper instantaneous axis of rotation.

  14. More global hypotheses Vertebral subluxations at any segment will effect physical functioning. Subluxation can be assessed clinically using a well known technique. Physical function can be evaluated using performance measures. Protocols Protocols

  15. Altered neurological function muscle tone leg length difference posture/balance thermography Altered articular function X-ray Analysis palpation Subluxation Detection

  16. Validation of Measures • No gold standard • Hypothetical nature • Sometimes subjective • Covariation of neurological and articular measures • Fixed Pattern = Stasis, poor adaptation

  17. Experimental Design:VS - Paradigm • 1. Test function independent of symptoms • 2. Observe structural and articular status • 3. Correct structure • 4. Re-test function Using Common VS measures would allow comparison of techniques for effectiveness

  18. Vertebral Subluxation Research Agenda • Develop VS measures • Effects of VS on quality of life and function • Funding from sources sensitive to our needs

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