MD, PhD, FMedSci, FSB, FRCP, FRCPEd

The Rubicon Group (TRG) is a collaboration of chiropractic educational institutions, emerging educational efforts and interested parties. The seven institutional members include Barcelona College of Chiropractic (Barcelona, Spain); the Chiropraktik Akademie (Dresden, Germany); Life Chiropractic College West (San Francisco, California, USA); Life University (Atlanta, Georgia, USA); McTimoney College of Chiropractic (Abingdon, Oxfordshire, UK); New Zealand College of Chiropractic (Auckland, New Zealand); and Sherman College of Chiropractic (Spartanburg, South Carolina, USA).

TRG has issued the following statement:

Definition and Position Statement on the Chiropractic Subluxation

The term ‘subluxation’ has been used by the chiropractic profession for over a century.1, 2 It is an important element of chiropractic practice, embedded in legislation and regulation, and its clinical implications have been, and continue to be, scientifically explored.2, 3
The term subluxation, as used by chiropractors, is a researchable concept that is important to health and health care delivery.1, 2, 4 The need to properly define this entity has been widely recognized as a high priority within the profession, as evidenced by the number of groups and organizations who have offered definitions of subluxation.1, 2, 5-10

Many of the past definitions do not provide a testable definition of chiropractic subluxation.11 

Some do not reflect the current research that supports a neurologically-centered model of subluxation. 2 The Rubicon Group (TRG) has utilized the current available scientific evidence to define the chiropractic subluxation. Contemporary neurophysiological language and concepts, based on current scientific publications on the topic, have been used. As this definition is subject to ongoing scientific exploration that is likely to lead to new findings and understandings, modifications may be anticipated. However, this definition reflects what is currently known, and it is congruent with current neurophysiological scientific understanding.

“We currently define a chiropractic subluxation as a self-perpetuating, central segmental motor control problem that involves a joint, such as a vertebral motion segment, that is not moving appropriately, resulting in ongoing maladaptive neural plastic changes that interfere with the central nervous system’s ability to self-regulate, self-organize, adapt, repair and heal.”

(The Rubicon Group, May 2017.)

There are three key elements, namely:

A chiropractic subluxation often relates to the spine and its connecting structures. 1 Chiropractic subluxation assessment generally involves evaluating the pathophysiological consequences of the central segmental motor control problem; 4, 12 these may include pain, asymmetry, biomechanical or postural changes (such as changes in relative range of intervertebral motion), changes in tissue temperature, texture and/or tone, and other findings that can be identified using special tests. 12 Once identified, subluxations are corrected using a variety of techniques including high velocity low amplitude chiropractic adjustments, instrument assisted adjustments, and lower force manual techniques and approaches.13

A growing body of scientific evidence has demonstrated that spinal function impacts central neural function in multiple ways,3, 4, 14-19 and that improving spinal function has an impact on clinical outcomes.20-24 Scientists have known for several decades that neurons continuously adapt in structure and function in response to our ever-changing environment.25-27 This ability to adapt is known as ‘neural plasticity’,27 and it is now well understood that the central nervous system can reorganize in response to altered input.28-35 Examples of increased sensory input that can lead to neural plastic changes include repetitive muscular activity 29, 36-41, such as typing or playing the piano, or repeated tactile sensory input such as occurs with blind Braille readers.42 Similar central nervous system change or reorganization may take place due to a decrease in behavior or activity.+ 32, 43-49 Thus the concept, that alterations in paraspinal muscle function due to abnormal spinal movement patterns are capable of changing central neural function, is totally congruent with current neuroscience understanding, as well as current scientific findings.3, 4, 14-19
[references can be found in the original]

MY COMMENT:

Subluxation is not so much a ‘self-perpetuating motor control problem’ as a self-perpetuating money-maker for chiropractors, it seems to me. The history of the use of this term shows that chiropractors have changed its meaning each time they were unable to deny its nonsensicality. To throw subluxation over board is not an option because chiropractic is at its hear a subluxation cult.

Yet, we have repeatedly been told that chiropractors have all but given up the concept of ‘subluxation’. This is clearly not the case. The above statement of TRG speaks for itself, and so does a recent study showing that “the majority of [North American chiropractic] students would like to see an emphasis on correction of vertebral subluxation”. It is the correction of the non-existent subluxation that stimulates the cash flow of chiropractors, a fact known even to the novices of the cult.

The new definition, it seems to me, is little more than self-serving nonsense. Wikipedia – I know, it’s not always the most reliable source, but in this case it is miles better that TRG – has this to say about subluxation: “In chiropractic, vertebral subluxation is a supposed misalignment of the spinal column leading to a set of signs and symptoms sometimes termed vertebral subluxation complex. It has no biomedical basis and is categorized as pseudoscientific by leading authorities. Traditionally, the “specific focus of chiropractic practice” is the chiropractic subluxation and historical chiropractic practice assumes that a vertebral subluxation or spinal joint dysfunction interferes with the body’s function and its innate intelligence, as promulgated by D. D. Palmer, the inventor of chiropractic.”

Wikipedia furthermore mentions that “in 2015, 8 internationally accredited chiropractic colleges: AECC, WIOC, IFEC-Paris, IFEC-Toulouse, USD-Odense, UZ-Zurich, UJ-Johannesburg and Durban University of Technology made an open statement which included: “The teaching of the vertebral subluxation complex as a vitalistic construct that claims that it is the cause of disease is unsupported by evidence. Its inclusion in a modern chiropractic curriculum in anything other than an historic context is therefore inappropriate and unnecessary”.”

Subluxation currently divides the chiropractic profession as we have seen here, for instance. But it is certainly not a concept that most chiropractors have been wise enough to declare obsolete.

6 Responses to A “self-perpetuating motor control problem”: more from the subluxation cult of chiropractic

  • Spinal displacements present a biomechanical basis to healthcare management and have a scientific basis that has strong inter and intra-reliability with RCT clinical studies supporting spinal manipulation and other non-surgical spinal remodelling rehabilitation techniques, developed by chiropractors and robustly tested by independent Physiotherapist PhDs in the management of chronic musculoskeletal ailments that contribute to many years with disability.

    • @Mr Michael Epstein

      What in the world are you going on about? “Spinal Displacement” is a serious, orthopedic problem that has nothing to do with the “subluxation” hoax that the uneducated magnetic healer DD Palmer invented (not discovered).
      The pseudo-intelligent nonsense you write in this last comment simply shows that you have no idea what you are talking about. The “edumacation” of chiropractors seems even worse than I thought.

  • http://chiropractic.prosepoint.net/149104
    Foundation for Vertebral Subluxation Issues Response to Rubicon Definition of Subluxation

    Wednesday, May 24, 2017 – 20:12
    Foundation for Vertebral Subluxation

    Definition is Flawed and Represents Limited Model of Vertebral Subluxation 
    On May 23, 2017, The Rubicon Group (TRG) issued a definition and position statement on the chiropractic subluxation. The definition states “We currently define a chiropractic subluxation as a self-perpetuating, central segmental motor control problem that involves a joint, such as a vertebral motion segment, that is not moving appropriately, resulting in ongoing maladaptive neural plastic changes that interfere with the central nervous system’s ability to self-regulate, self-organize, adapt, repair and heal.”
    CLICK HERE FOR RUBICON PRESS RELEASE
    The Foundation for Vertebral Subluxation (FVS) participated in the two meetings held in Melbourne and San Francisco where stakeholders were involved in discussing this proposed definition. The FVS expressed its serious concerns about the process and the conclusions before, during and following those meetings. 
    Rubicon purports to be a single unifying group for conservative, traditional chiropractic – unfortunately their definition serves only to alienate numerous practitioners, technique experts, scientists, and academics devoted to the scientific exploration and clinical management of vertebral subluxation. 
    In their release, Rubicon correctly notes that “Many of the past definitions do not provide a testable definition of chiropractic subluxation.” Unfortunately, the definition adopted by Rubicon fails to provide a testable, operational definition and is not congruent with the traditional, scientific, philosophical and artistic (technique) foundations of the chiropractic profession.  Further to this, the TRG definition of chiropractic subluxation is not limited to vertebral subluxation. The Rubicon definition removes “vertebral” from the lexicon and expands the definition of chiropractic subluxation beyond the spine. 
    The Rubicon definition is a description of one putative neurobiological mechanism.  It describes only one model of subluxation focused on joint motion and dysafferentation. Other models of vertebral subluxation are not addressed. These include, but are not limited to: 
    Component models (There are several)
    Spinal degeneration model
    Nerve root compression model
    Neurodystrophic model
    Non-synaptic models
    Spinal cord tension model
    Semiconductor mode
    Axoplasmic flow model
    Segmental facilitation model
    Segmental neuropathy model
    Dysponesis model
    Autonomic dystonia model
    Such models vary in their levels of scientific support. As such, they help identify knowledge gaps which need to be identified for future research. These neurobiological models are not mutually exclusive, and in a given patient, may be present singly or in various combinations. 
    Additionally, there are various technique based models which are described as: 
    Segmental
    Postural
    Tonal
    The definition adopted by Rubicon is limited to the segmental model only and leaves out every other technique model. 
    The definition adopted by Rubicon fails to provide a testable, researchable, operational definition even though TRG states this is one of the reasons for the definition. Assessments of vertebral subluxation should be reliable and valid, particularly if used in a research setting. Assessment of altered joint motion (the model proposed in the definition) poses challenges: 
    The reliability of motion palpation is questionable. Most studies show it to be unreliable. For example, a systematic review of 44 articles reported that only eight reported relatively high levels of reproducibility, and only 4 of these were judged to be of acceptable quality.
    Videofluoroscopy may reliably demonstrate alterations of spinal joint motion, but requires a skilled examiner, appropriate equipment, and imposes a radiation burden that renders it unacceptable for routine pre- and post- adjustment assessments. 
    The argument that the problems facing the profession relative to the subluxation concept are that there is no single agreed upon definition is a Red Herring. There are numerous definitions and models of vertebral subluxation. As Lantz noted, “Common to all concepts of subluxation are some form of kinesiologic dysfunction and some form of neurologic involvement.” Further there are objective, valid and reliable methods to measure these and other components of vertebral subluxation. Taken in context with the totality of the literature there is, in fact, widespread agreement on vertebral subluxation.    
    The proposed definition by Rubicon discusses some possible ramifications of abnormal joint motion, but does not require an assessment of neurological function as part of the analysis. Thus, it fails as an operational definition. 
    The TRG contends that theirs is an “evidenced based definition” however, their contentions are poorly referenced, very limited and the literature chosen is biased toward only one model of chiropractic subluxation (theirs). The scientific research used to buttress the legitimacy of the definition is derived from studies that explore the common domain effects of spinal manipulative therapy on joint dysfunction and central neural function. 
    The fact that a multitude of interventions and daily activities beyond chiropractic may elicit similar responses on central neural function should highlight the danger and foolishness of adopting such a limited definition of the unique underpinnings of the chiropractic profession.     
    Making matters worse are the use of studies that equate the common domain procedure of spinal manipulation with the chiropractic adjustment and vertebral subluxation with joint dysfunction.  This reveals a deep ignorance regarding nomenclature and definitions and it also departs from the historical and philosophical basis of vertebral subluxation theory.  
    An evidence-informed approach to vertebral subluxation requires, minimally: 
    Reliable and valid assessments
    Biological plausibility
    External evidence
    Chiropractor’s knowledge and experience
    Patient preferences
    Congruence with chiropractic philosophy
    Health outcomes
    The Foundation for Vertebral Subluxation has developed a Research Agenda focused on five areas: 
    Research focused on the description and identification of the various operational models of vertebral subluxation. 
    Research focused on the validity and reliability of measures to identify and characterize vertebral subluxation. 
    Research on the epidemiology of vertebral subluxation including its incidence, prevalence, morbidity and mortality. 
    Research on clinical strategies for preventing, arresting, reducing and correcting vertebral subluxations. 
    Research on health outcomes following management of vertebral subluxation.
    Given the nature of vertebral subluxation and the current knowledge base, the approach by the Foundation is inclusive rather than exclusive in terms of researching the various operational models. The proposed definition should be reconsidered. Any definition of vertebral subluxation, be it political, conceptual, or operational needs to be inclusive, rather than focused on a single model. 
    For all the reasons cited above the Foundation for Vertebral Subluxation cannot support or endorse the definition of subluxation adopted by the Rubicon Group and it is our opinion that the adoption of this definition by schools focused on training future generations of chiropractors in the location, analysis and correction of vertebral subluxation does not serve that purpose or mission.

    • No true chiropractor, once again!

    • ‘An epidemiological examination of the subluxation construct using Hill’s criteria of causation’ Mirtz et al ’09.
      This article points out the woeful insignificance of the subluxation within the context and bounds of real science.
      It seems that the pertinent biomechanical research now suggests ‘hyper-mobile’ motion-segments are both rationally connected to pain and with rapid-onset disability e.g. Injury via a motor-control glitch. A “fixation” just can’t be justified. There are valid tests for ‘hyper-mobility” (muscle co-contraction) but none for ‘fixations’.
      And even IF there were Chiropractic fills its coffers with crock-o-shit tests (leg checks, AK, upper cervical, hair analysis and thermography) and wouldn’t be a trustworthy source point for such ‘insight’.
      Additionally vertebra that “seem” tight or fixated (utterly dubious assessment to begin with) couldn’t be safely made to cavitate…and why would you. The more-mobile segment within the local chain will be the one to “pop” under manipulation of course. And WTF good would that do??

  • King of n=1 Matthew McCoy is a joke.
    We attempted to block RubiCON from coming to Australia with the help of FSM. Nice to get support from the critics when dealing with these Douchebags. They are not welcome here.
    I have been informed that student enrollments at Life are falling while Guy Riekeman has promoted himself to “Chancellor” and installed a crony as president. So they have rising executive costs, falling income and grand plans for Rome etc. RubiCON was Guys brain child so if I were a member of RubiCON I would be having second thoughts as Guy is only interested in Guy and runs his own agenda. RubiCON is in all probability a poisoned chalice and those institutions are Guys life boat/suckers.
    @EE
    “But it is certainly not a concept that most chiropractors have been wise enough to declare obsolete.”
    More than you realize or care to admit Edzard and they would appreciate some help. We certainly appreciated FSM’s support.

Leave a Reply

Your email address will not be published. Required fields are marked *

Please answer the following: *

Gravityscan Badge

Recent Comments

Note that comments can be edited for up to five minutes after they are first submitted.


Click here for a comprehensive list of recent comments.

Categories