MD, PhD, FMedSci, FRSB, FRCP, FRCPEd.

Subluxation is … a displacement of two or more bones whose articular surfaces have lost, wholly or in part, their natural connection. (D. D. Palmer, 1910)

The definition of ‘subluxation’ as used by chiropractors differs from that in conventional medicine where it describes a partial dislocation of the bony surfaces of a joint readily visible via an X-ray. Crucially, a subluxation, as understood in conventional medicine, is not the cause of disease. Spinal subluxations, according to medical terminology, are possible only if anatomical structures are seriously disrupted.

Subluxation, as chiropractors understand the term, has been central to chiropractic from its very beginning. Despite its central role in chiropractic, its definition is far from clear and has changed significantly over time.

DD Palmer (the guy who invented chiropractic) was extremely vague about most of his ideas. Yet, he remained steadfast about his claims that 95% of all diseases were due to subluxations of the spine, that subluxations hindered the flow of the ‘innate intelligence’ which controlled the vital functions of the body. Innate intelligence or ‘inate’, he believed, operated through the nerves, and subluxated vertebra caused pinched nerves, which in turn blocked the flow of the innate and thus led to abnormal function of our organs. For Palmer and his followers, subluxation is the sole or at least the main cause of all diseases (or dis-eases, as Palmer preferred).

Almost exactly 4 years ago, I published this post:

Is chiropractic subluxation a notion of the past? SADLY NOT! 

In it, I provided evidence that – contrary to what we are often told – chiropractors remain fond of the subluxation nonsense they leant in school. This can be shown by the frequency by which chiropractors advertise on Twitter the concept of chiropractic subluxation.

Today, I had another look. The question I asked myself was: has the promotion of the obsolete subluxation concept by chiropractors subsided?

The findings did not surprise me.

Even a quick glance reveals that there is still a plethora of advertising going on that uses the subluxation myth. Many chiros use imaginative artwork to get their misleading message across. Below is a small selection.

Yes, I know, this little display is not very scientific. In fact, it is a mere impression and does not intend to be anything else. So, let’s look at some more scientific data on this subject. Here are the last 2 paragraphs from the chapter on subluxation in my recent book on chiropractic:

A 2018 survey determined how many chiropractic institutions worldwide still use the term in their curricula.[1] Forty-six chiropractic programmes (18 from US and 28 non-US) participated. The term subluxation was found in all but two US course catalogues. Remarkably, between 2011 and 2017, the use of subluxation in US courses even increased. Similarly, a survey of 7455 US students of chiropractic showed that 61% of them agreed or strongly agreed that the emphasis of chiropractic intervention is to eliminate vertebral subluxations/vertebral subluxation complexes.[2]

Even though chiropractic subluxation is at the heart of chiropractic, its definition remains nebulous and its very existence seems doubtful. But doubt is not what chiropractors want. Without subluxation, spinal manipulation seems questionable – and this will be the theme of the next chapter.

[1] https://chiromt.biomedcentral.com/articles/10.1186/s12998-018-0191-1

[2] https://www.ncbi.nlm.nih.gov/pubmed/25646145

In a nutshell: chiros cannot give up the concept of subluxation because, if they did, they would be physios except with a much narrower focus.

24 Responses to Chiropractic ‘subluxation’ is by no means a notion of the past

  • Carpet bombing again Edzard.

  • Just recently a manuscript was published that examines the concept of chiropractic subluxation. This RCT measures the changes in central conduction time and neuroplastic changes when abnormal spinal alignment is improved and nerve conduction is compared. If I may use vitalistic language, it appears that warm streams of healing energy and innate intelligence improve when abnormal cervical spinal alignment is improved towards normal. For your information, physios performed the research but the design of the research was by a chiropractor.https://www.nature.com/articles/s41598-021-94548-z.epdf?sharing_token=mNbqAclvf4VOOZx6iZCnqNRgN0jAjWel9jnR3ZoTv0P89jA8PEek0-VRFxcUAQO_C-sM3rLRppXXw1yp-VndWdtNZ8MXdyi_58I-jVzfTpFEjK1_U1JeFuCn48muv-o2dgpYRzkBXjMFXLGtMuv_qwIw61Wv5bqYQbt9nupG_mM%3D

    • Conclusion We identified a reduced cervical lordosis and anterior head translation is associated with differences in neural activity at several regions (cortical and subcortical) of the somatosensory system. Restoration of the cervical sagittal alignment, in terms of cervical lordosis and anterior head translation, has a direct influence on the central conduction time. Clinical interventions directed at improving central processing through restoring the normal sagittal alignment could be added to clinical interventions targeting specific spinal disorders.

  • Mr Epstein:
    “If I may use vitalistic language, it appears that warm streams of healing energy and innate intelligence improve when abnormal cervical spinal alignment is improved towards normal.”

    What on earth does this mean?

    Why do you want to use ‘vitalistic language’ on a blog site which is dedicated to critial thinking and rational evidence based health care?

    What is this fifth form of energy to which you refer, and which has never ben plausibly identified?
    Do you mean ‘excessive applied imagination’?

    • I’m just entertaining you. The research speaks for itself but my colourful language is for the social media masses. By the way, it’s Dr Michael Epstein, Chiropractor

      • What is your medical degree, Dr Epstein, and at which medical school did you study for it? If one may ask?

        • I think I made it clear that I’m a chiropractor when using the courtesy title, Dr. In Australia I am legally able to use the title Dr by the government regulator, AHPRA. Next relevant question?

          • Thank you for your response. I didn’t think you made anything clear. That’s why I asked. You wrote:

            “By the way, it’s Dr Michael Epstein, Chiropractor”.

            In the context of a medical blog (and, indeed, of an office/treatment room with a plaque on the wall), if you call yourself “Dr”, you will likely lead people to assume that you have a medical degree – that your Doctorate is in medicine. (See the comments of Mr John Lawler’s family in this regard, commented upon here:

            https://respectfulinsolence.com/2019/12/02/lawlor-death-by-chiropractic-neck-manipulation/ )

            I was interested to read comments in this Blog, about New South Wales:
            https://earnestkookaburra.blogspot.com/2012/01/can-anyone-can-call-themselves-doctor.html

            I am not quite sure what you mean by “courtesy title”. Am I right in thinking that, like me, you have no medical degree and that your full medical title, therefore is Mr, not Dr?

            I don’t mind if you want to give me the courtesy title of Dr, but I don’t offer anyone any medical treatment.

          • There are several professions that use the title doctor which aren’t earned from a medical college: dentists, optometrists, physical therapists.

            Within chiropractic, when we advertise, at least in the USA, we are required to identify that we are a doctor of chiropractic.

            Of course the word doctor originally was used by a religious sect but the medical profession decided they wanted it.

          • this is what I published about this issue almost 20 years ago
            https://pubmed.ncbi.nlm.nih.gov/14694709/

  • I find it interesting that the two groups that seem the most fixated on the word subluxation are skeptics and chiropractic fundamentalists.

    DD thought he was adjusting a medical subluxation. He later admitted that what he was adjusting is what the medical profession called a sprain.

    By then the word subluxation was entrenched in the profession and was kept.

    • “DD thought he was adjusting a medical subluxation. He later admitted that what he was adjusting is what the medical profession called a sprain.”
      fact or myth?
      EVIDENCE PLEASE

      • Some samples from his book:

        TEXT-BOOK OF THE
        SCIENCE, ART AND
        PHILOSOPHY
        OF
        CHIROPRACTIC
        FOR STUDENTS AND
        PRACTITIONERS
        BY
        D. D. PALMER
        THE ONE WHO DISCOVERED THE BASIC PRINCIPLE OF
        CHIROPRACTIC, DEVELOPED ITS PHILOSOPHY,
        ORIGINATED AND FOUNDED THE SCIENCE
        AND ART OF CORRECTING ABNORMAL
        FUNCTIONS BY HAND ADJUSTING,
        USING THE VERTEBRAL
        PROCESSES AS
        LEVERS
        ———
        FOUNDED
        ON
        TONE
        ———
        PORTLAND, OREGON
        PORTLAND PRINTING HOUSE COMPANY
        [1910]

        “As I have said before, the M. D.’s sprain is the subluxation of the Chiropractor.” page 209

        “While the fifth cervical vertebrae may be the most liable to complete displacement, I find the atlas and third cervical are much oftener subluxated—sprained.” page 211

        “An M. D.’s sprain is known to a Chiropractor as a displacement…” page 214

        “The physician’s sprain is the Chiropractor’s tension, the stretched condition of the nervous tissue, which causes not only pain, but functions to be performed in an unusual manner.” page 596

        “The M. D.’s wrenches and sprains of the back are Chiropractic luxations.” page 611

        “There is no difficulty in handling sprains of the back satisfactorily if the adjuster knows what vertebra is displaced, and how to adjust it.” page 648

        “Remember that what a physician calls a sprain is a Chiropractic subluxation.” page 651

        “The conditions which physicians call wrenches and sprains of the back are Chiropractic luxations.” page 661

        “That which is known to a physician as a sprain, to a Chiropractor is a partial dislocation, a sub-luxation of vertebrae.’ page 786

        • DD was such a notorious waffler of utter idiocies that there are dozens of his quotes that contradict these notions.

          • Regardless, he states several times that the chiropractic subluxation is a sprain.

          • you convinced me.
            now explain why chiros have not concurred and agree ‘subluxation = sprain, therefore the term is obsolete”?

          • “Several authors have recently lamented the continued chiropractic inclination to use outdated and anatomically incorrect language to describe the nature of the manipulable lesion (“subluxation”) and the method of treatment (“adjustment”).2,3,11 J Chiropr Educ. 2020 Oct; 34(2): 172–176.

            Why some continue to use the term varies from habit to dogma.

          • nothing to do with chiro ‘philosophy’ that you need to differentiate yourselves from physios?

          • Comes down to patient preference. Around here it can take a few weeks to see a PT. PTs tend to be more expensive and that can be a barrier for those without insurance. Sometimes a PT requires a referral from a MD which adds delay and costs. PTs typically cannot order and read imaging which is a hassle for the patient.

            I have no issue with PTs, some do good work. I just referred a patient to PT this morning.

            But based on the current global burden of back pain it appears there are not enough PTs to handle the load, or they aren’t doing a very good job.

            Perhaps someday chiropractic will become obsolete but I doubt it will happen in our lifetime.

          • “Perhaps someday chiropractic will become obsolete but I doubt it will happen in our lifetime.”
            I agree, progress is too slow

          • Yah, in the USA, after 100 years, PTs can order imaging in only three states. Still require referrals for some populations/conditions and visit limits for specific interventions. Slow to catch up to chiropractors.

          • Regrettably, DD cannot defend comments you attest he has said because he is dead. Let’s discuss the paper I brought to your attention. Everyone associated with the manuscript is alive.

          • DD left us more writings than anyone could wish for, and they give ample evidence in support of my statement.
            https://edzardernst.com/2020/02/david-daniel-palmer-the-life-of-a-genius-or-the-career-of-a-charlatan/

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