The Intersection between Philosophical and Operational Concepts of Vertebral Subluxation

1. The Intersection between Philosophical and Operational Concepts of Vertebral Subluxation Chiropractic Philosophy in the 21st Century David B. Koch, D.C., Professor of Philosophy, PCC

2. The Problem:Vertebral subluxation as a philosophic concept • Philosophically, vertebral subluxation is a “concept” we believe encompasses an entire class of phenomena • Chiropractic’s vitalistic paradigm creates a holistic perspective on health and function • Existence of the nerve-endocrine-immune system implies that holistic function emerges from internal (cell-cell) and external (organism-environment) communication

3. The Problem • The observation of dysfunction implies the existence of dis-communication (aka interference) • Interference necessarily implies the existence of meaningfulness (information) withinneuro-immuno-endocrine interactions

4. The Problem • Information within any signal is immaterial until received, interpreted and expressed through an appropriate (adaptive) response • Philosophically, vertebral subluxation is a metaphor concerning what we see as a possible source of interference to normal internal/external communication

5. The Problem • At the time the metaphor was created, any definition of how the vertebral column (or any “subluxatable articulation” for that matter) interacted with the neuro-imuno-endocrine system was mainly speculative in light of the minimal knowledge we possessed about the mechanisms of neuro-spinal interaction.

6. Example • A subluxation is the condition of a vertebra (why?) that has lost its proper juxtaposition with the one above, the one below or both (speculation), to an extent less than a luxation (definitional), which occludes an opening (speculation), impinges a nerve (How? When?) and interferes with the transmission of mental impulses (adaptively meaningful efferent (Why not “and/or afferent”?) nerve impulses).

7. The “philosophic definition” • Defining subluxation philosophically is defining subluxation as a concept, not as a phenomenon • The concept exists at a specific “level of abstraction” and should only be as specific as its level of abstraction allows. • This is analogous to defining “cancer” as a disease in which the cells of the body no longer respond to the overall control mechanisms of the body

8. Another Example • A subluxation is a complex of functional and/or structural and/or pathological articular changes that compromise neural integrity and may influence organ system function and general health. • ACC’s Chiropractic Paradigm/Scope & Practice, 1996

9. More Abstract Definition • This definition increases the “level of abstraction” in three ways: • Expands from “vertebral subluxation to “any skeletal subluxation” • Generalizes concerning how the “functional and/or structural and/or pathological articular changes”… “compromise neural integrity” • Introduces holistic outcomes into the conceptual construct of the “subluxation”

10. The Other Side of the ProblemOperational definitions of vertebral subluxation • Scientifically, vertebral subluxation is a phenomenon, worth studying (investing time and $ in) only in proportion to its significance to human life and purposes. • Chiropractors proposed that it held a greater level of significance earlier than any other health care theory

11. The Other Side of the Problem • The possible significance of vertebral subluxation was proposed in the absence of any but the most rudimentary knowledge of both spinal biomechanical function and neuro-imuno-endocrine function.

12. The Other Side of the Problem • Most exploration has been clinical, leading to “operational” definitions of vertebral subluxation • Leg checks, palpable findings, radiographic comparisons, instrumentation readouts • A “subluxation” is what exists in the body when we find these following signs/ indicators/symptoms from the outside

13. Operational Definitions • Operational definitions are mainly phenomenological, not conceptual • What input (specific operation) produces what reproducible outcome (specific change)? • Operational hypotheses are driven to have the fewest variables (limits of the scientific method) • Usually address only one or two aspects of any complex phenomenon (life, VS, disease)

14. Operational Definitions • Most diseases are defined and researched operationally • Most subluxation research has been based on a specific, operational definition of subluxation • Tends to be influenced by ongoing theoretical speculation, lack of scientific rigor and $$$

15. The Other Side of the Problem • The concept of the vitalistic significance of vertebral subluxation (as an energetic challenge to holistic self-awareness and self-regulation) has had to compete with the greatest explosion of biological operationalism (pharmacology and genetic determinism) ever seen

16. The Other Side of the Problem • Aspirin – 1895 • Antibiotics – 1928 • DNA structure – 1953 • Immuno-suppression and organ transplant – 1970’s • Recombinant DNA technology – 1990’s

17. The Other Side of the Problem • Chiropractic’s vertebral subluxation metaphor both defined and alienated the profession • Philosophic paradigm nearly discredited • Philosophic speculation became dogma • The simplicity of the metaphor belies the complexity of the phenomenon itself

18. “Vertebral Subluxation” Today • Explosive increase in both chiropractic subluxation research and interest in the phenomenon by other professions • JMPT, RACI-VIII, CCCR, FCER, JVSR • Multiple technique-driven theories of VS increase research into specific aspects of VS • Osteopathy (Korr – 70’s), physiotherapy, physiatry all exploring neuro-spinal interaction

19. “Vertebral Subluxation” Today The Challenges: • Disconnecting the scientific exploration from narrow historical, philosophical or technique dogmas • Maintaining the value of the VS metaphor while engaged in the open-ended, skepticism-driven process of scientific hypothesis generation and testing

20. “Vertebral Subluxation” Today The Challenges: • Solving the afferent vs. efferent dis-ease problem • Integrating multiple mechanisms into a comprehensive neuro-immuno- endocrine/spinal biomechanical theory of coordination, adaptation and health enhancement

21. Summary • Philosophical definitions of vertebral subluxation serve us well as metaphors, but tend to be too specific and thus too restrictive, or to generalized to research without being operationalized • As scientific research on subluxation progresses, multiple operational definitions, theories and investigative foci tend to develop simultaneously

22. Summary • The challenge is to maintain a simple and clear metaphorical model of vertebral subluxation throughout the skepticism-driven scientific inquiry into its true nature • Ultimately, we should seek to create a comprehensive neuro-immuno-endocrine/ spinal biomechanical theory of the body’s innate intelligence and its relationship to coordination, adaptation and health