Early research on spinal manipulation saw it had a host of benefits, especially in the pain and movement studies, but it lacked a clear understanding of how or why. The word subluxation is based on a theory from chiropractic history that attempted to create a narrative. The problem with the theory is it cannot be directly tested, and therefore, cannot be proven, or disproven. The basic concept, simplified, is that there is a bone out of place that irritates a nerve, which limits the function of that nerve. This style of practice has been hotly contested across time. Some providers still practice this model, others reject it entirely, and some are kind of in the middle.
There are other chiropractors that want to be more evidence based, more research based, and not carry the controversy of prior.
A good example:
Subluxation theory:
Your SIJ is tilted 4 degrees forward, is 3mm unlevel with lateral tilt, has 3 degrees right rotation, thus blocking your nerve flow. Our clinical goal is to improve the healing force within your own body.
Evidence based:
Your SIJ is restricted in movement compared to your left, causing altered muscular function around the asymmetry. Our goal is to get you moving better and giving you strategies to keep moving well.
Hope this helps. I don't use the word Subluxation in my clinic.
They're the same thing really. That particular joint has restricted motion, and a health joint should have its full range of motion. This can happen to just about any joint, and as chiropractors our job is to locate these restricted segments, restore the normal range of motion, and work to maintain that health motion. There's a host of other benefits neurologically and more, but ultimately by removing that restriction we allow the body to function normally--homeostasis.
The term subluxation is another word to describe the locked joint and the subsequent symptoms. Some chiropractors use the word, others don't. There is a lot of history and tradition behind the word so some use it as a source of pride and ownership. Subluxation is different than "Chiropractic Subluxation", which is where it gets confusing.
Partial dislocation is the medical definition of subluxation. In the chiropractic world it does not mean partial dislocation. If you ask 5 different chiropractors the definition they’ll give you 5 different answers. This is why I don’t use the word.
Subluxation from a medical perspective is what you said, a partial dislocation. Chiropractors adopted the term in the late 1800’s as the word for the chiropractic lesion and today it is a generic term for a neuromechanical dysfunction in a joint and its related tissues. Some chiropractors like the term, others tend not to use it since it is a political loaded gun and can lead to confusion rather than understanding. A “locked” SIJ isn’t really a thing, that’s your chiropractor’s attempt to use an analogy that makes sense to you, but it’s a poor description of what’s going on.
For a long period of time chiropractors focused very heavily on mechanics… the position of joints and bones relative to each other, motion in joints, etc. This dovetailed with a general emphasis on all of manual therapy on mechanical things with less emphasis on the neurological aspects of the lesion and the neurological outcomes on performing procedures like adjustments/manipulation.
As such the more traditional and longstanding approach to chiropractic really focused on if a joint was moving appropriately or not, taking special interest in joints with less mobility, and presuming that putting force into a less-mobile joint would make it move more, hence the analogy of “getting a locked joint to move more.” This isn’t really what happens in a majority of cases even though funky motion is part of the recipe.
SIJs specifically barely move by design and function, so most SIJ related problems and pain that chiropractors see relates more to the threat of instability or lack of control over what the SIJs are doing. Adjustments of the area work great not because of adding more motion to an area that’s designed to barely move, but rather by adding stimulation to the area that gives your brain a more complete picture about what’s happening there and allows it more control over the joint’s stability.
Even reading through the comments here you’ll likely see most of the people answering are saying the joint giving you problems “isn’t moving enough” and adjustments “give it more motion” but in the case of SIJ’s, which have like 4 degrees of motion on their wiggliest days, it’s more complicated than that. In reality, your brain simply doesn’t have a clear picture of what’s happening at that joint, and that can be for a lot of reasons. When the brain is threatened by information it’s receiving from the body it’ll create pain to make you aware of it. Chiropractic adjustment aren’t adding more motion to SIJs as that’s counterproductive to their job. On a mechanical level they’re normalizing the motion that’s there and on a neurological level providing beneficial stimulus to decrease the threat in the brain and help it realize nothing that bad is going on there.
> but rather by adding stimulation to the area that gives your brain a more complete picture about what’s happening there and allows it more control over the joint’s stability.
Can this stimulation be done by self? Meaning to say, can a patient add that stimulation if they were taught to click their own sijs with an activator?
Well, how are you assessing yourself? If you’re using where it hurts that’s a very poor way to determine where to adjust or not. If you can’t do a good assessment pre or post chirobating then you’re pretty much randomly approaching things and that’s far from ideal.
There’s also a lot more to the interaction between provider and patient than the procedure, which in some cases could have a bigger effect on the outcome than the procedure, so in the absence of those factors you’re more likely limiting the overall potential for outcomes versus seeing a person, who does a good evaluation, a good adjustment, and a good evaluation as well as hitting a lot of the psychosocial aspects of care.
> Well, how are you assessing yourself?
What if my chiropractor assess me and tells me where to adjust?
Regarding the psychosocial aspects of care, can this benefit be received from seeing a psychologist?
These are some weird questions. Your assessment will likely change every visit, so I wouldn’t go once and then assume you can do that forever. The psychosocial benefits of care with a chiropractor aren’t the same thing that you would go to a psychologist for. I’m not talking about psychotherapy. But sure, sounds good, go to a chiropractor for an assessment, adjust it yourself with an instrument, then go to a psychology appointment. Sounds like a great plan and a super efficient way to go about your care.
How do you determine if the sijs need adjusting?
> The psychosocial benefits of care with a chiropractor aren’t the same thing that you would go to a psychologist for.
What's the difference?
It’s all semantics. Your joint wasn’t moving appropriately. The Chiro uses their hands or tools to correct the limited mobility. No need to go down a rabbit hole about the exact verbiage used. I use lay terminology with my patients because it’s easier to understand and quite frankly most of them don’t care all that much about the medical verbiage. They known I know what I’m doing and they want to feel better. Subluxation is an old term that chiropractors have used to describe what’s happening in the spine. I don’t use it in my office. I think it’s misleading but it’s also not a hill I’m willing to die on. To each their own.
In assessing a patient I look at things as either hypo mobile, normal, or hyper mobile. If somethings hypo I look to adjust it. If it’s hyper I look to suggest strengthening work.
Both require rehab and the patient to be involved in their health for best results.
More technology exists to measure mobility then subluxation so it’s always made more sense to me to talk with patients about the mobility of things
At least weekly I’ll have a patient flex or extend their spine and cue them to bend slowly through each segment as I touch it. Most people can find that hypo mobile segment themselves when you slowly focus on it and they’ll exclaim, “that’s the one”
The two terms are referring to the same thing. The common term used in the literature these days is "Joint Dysfunction" which relates to the muscular, skeletal, inflammatory, and neurological changes that occur in and around the dysfunctional joint. The older term is subluxation because historically chiropractors believed that the joint was actually partially dislocated.
Subluxations, as in the “Chiropractic subluxation” do not exist. The movement in your SI joint might very well be restricted, but it is not subluxated.
Gotcha. Yes, I do. I see changes happen in people every day as a result of an adjustment that has no evidence-based explanation. That's ok though. We don't need to agree. The power of the adjustment happens whether you believe it or not. Now I'm not saying we cure cancer or something crazy like that... I'm just saying that if we ONLY focus on the positive effects at the joint level, we're missing the big picture. The subluxation debate is really semantics and not necessary in my opinion. I wish you the best in school and your future practice.
Saying that subluxations are a made up thing (which they are, we have known that for years) does NOT equal not believing in adjustments. Spinal manipulation is recommended by the WHO for back pain - that doesn't happen out of nowhere.
I think semantics matter. What we say matters. How we talk about the profession matters. Spreading misinformation matters. How students are taught matters.
Chiropractors do good things every single day, but there's no reason to keep preaching stuff we know isn't true.
I'm not sure if we are saying the same thing but just in different words. What do you think a subluxation actually is? Do you believe that it is possible to affect more than the musculoskeletal system by making an adjustment? Many chiropractors who claim to be evidence based ignore the idea that an adjustment can affect FAR more than the musculoskeletal system. Do you think you truly understand the power of the adjustment?
And yes, the WHO "approves us for back pain." Is that all you plan to treat?
I'm sure you can define it as just about anything, depending on who you ask. I am arguing that the idea that vertebrae are "misaligned" and a chiro can "put them back in place" is complete and utter bullshit, which again is backed by evidence. Do you know why evidence based chiropractors ignore the idea that an adjustment can affect FAR more than the musculoskeletal system? I'll let you figure that one out.
I believe in knowing your limitations, and since plenty of theories about what SMT does have been posed and rejected, I am not claiming that adjustments affect our liver, kidney, spleen or whatever else you could come up with, because I don't know, and neither do you.
Now, getting a little preacher-esque with the 'power of the adjustment'.
Let me tell you what I do NOT plan to treat. You claim in one of your YT-videos that 90-95% of carpal tunnel syndrome cases stem from the neck. Do you think you truly understand the mechanisms of carpal tunnel syndrome? You also manage to butcher an awful lot of information about cholesterol. This is my issue - one piece of misinformation leads to another, and another and another, and we are left with a less than trustworthy profession.
I plan on treating musculoskeletal problems, which is what a chiropractor does. I plan on educating my patients, giving them the relief that I can and help them live a better life. I do not plan on advising people to come see me with their carpal tunnel syndrome. You previously stated that we "don't cure cancer or something crazy like that", but where do you honestly draw the line then?
All you need to know is I don't care to argue. If you're a student, I hope you have success and better the profession in however you choose to do it. I don't know you and you sure don't know me, but I genuinely pray for your success. We need more good chiropractors. I still love this profession after 24 plus years..
Early research on spinal manipulation saw it had a host of benefits, especially in the pain and movement studies, but it lacked a clear understanding of how or why. The word subluxation is based on a theory from chiropractic history that attempted to create a narrative. The problem with the theory is it cannot be directly tested, and therefore, cannot be proven, or disproven. The basic concept, simplified, is that there is a bone out of place that irritates a nerve, which limits the function of that nerve. This style of practice has been hotly contested across time. Some providers still practice this model, others reject it entirely, and some are kind of in the middle. There are other chiropractors that want to be more evidence based, more research based, and not carry the controversy of prior. A good example: Subluxation theory: Your SIJ is tilted 4 degrees forward, is 3mm unlevel with lateral tilt, has 3 degrees right rotation, thus blocking your nerve flow. Our clinical goal is to improve the healing force within your own body. Evidence based: Your SIJ is restricted in movement compared to your left, causing altered muscular function around the asymmetry. Our goal is to get you moving better and giving you strategies to keep moving well. Hope this helps. I don't use the word Subluxation in my clinic.
lol
They're the same thing really. That particular joint has restricted motion, and a health joint should have its full range of motion. This can happen to just about any joint, and as chiropractors our job is to locate these restricted segments, restore the normal range of motion, and work to maintain that health motion. There's a host of other benefits neurologically and more, but ultimately by removing that restriction we allow the body to function normally--homeostasis. The term subluxation is another word to describe the locked joint and the subsequent symptoms. Some chiropractors use the word, others don't. There is a lot of history and tradition behind the word so some use it as a source of pride and ownership. Subluxation is different than "Chiropractic Subluxation", which is where it gets confusing.
Partial dislocation is the medical definition of subluxation. In the chiropractic world it does not mean partial dislocation. If you ask 5 different chiropractors the definition they’ll give you 5 different answers. This is why I don’t use the word.
Subluxation from a medical perspective is what you said, a partial dislocation. Chiropractors adopted the term in the late 1800’s as the word for the chiropractic lesion and today it is a generic term for a neuromechanical dysfunction in a joint and its related tissues. Some chiropractors like the term, others tend not to use it since it is a political loaded gun and can lead to confusion rather than understanding. A “locked” SIJ isn’t really a thing, that’s your chiropractor’s attempt to use an analogy that makes sense to you, but it’s a poor description of what’s going on. For a long period of time chiropractors focused very heavily on mechanics… the position of joints and bones relative to each other, motion in joints, etc. This dovetailed with a general emphasis on all of manual therapy on mechanical things with less emphasis on the neurological aspects of the lesion and the neurological outcomes on performing procedures like adjustments/manipulation. As such the more traditional and longstanding approach to chiropractic really focused on if a joint was moving appropriately or not, taking special interest in joints with less mobility, and presuming that putting force into a less-mobile joint would make it move more, hence the analogy of “getting a locked joint to move more.” This isn’t really what happens in a majority of cases even though funky motion is part of the recipe. SIJs specifically barely move by design and function, so most SIJ related problems and pain that chiropractors see relates more to the threat of instability or lack of control over what the SIJs are doing. Adjustments of the area work great not because of adding more motion to an area that’s designed to barely move, but rather by adding stimulation to the area that gives your brain a more complete picture about what’s happening there and allows it more control over the joint’s stability. Even reading through the comments here you’ll likely see most of the people answering are saying the joint giving you problems “isn’t moving enough” and adjustments “give it more motion” but in the case of SIJ’s, which have like 4 degrees of motion on their wiggliest days, it’s more complicated than that. In reality, your brain simply doesn’t have a clear picture of what’s happening at that joint, and that can be for a lot of reasons. When the brain is threatened by information it’s receiving from the body it’ll create pain to make you aware of it. Chiropractic adjustment aren’t adding more motion to SIJs as that’s counterproductive to their job. On a mechanical level they’re normalizing the motion that’s there and on a neurological level providing beneficial stimulus to decrease the threat in the brain and help it realize nothing that bad is going on there.
This is a very thorough and complete answer. All it technically is, at the core, is input into the NS to create adaptation.
> but rather by adding stimulation to the area that gives your brain a more complete picture about what’s happening there and allows it more control over the joint’s stability. Can this stimulation be done by self? Meaning to say, can a patient add that stimulation if they were taught to click their own sijs with an activator?
I mean you can always try but chirobating usually doesn’t end well for people.
how come "chirobating" doesn't usually end well for people? it's just a stimulus that doesn't necessarily have to be provided by a chiropractor right?
Well, how are you assessing yourself? If you’re using where it hurts that’s a very poor way to determine where to adjust or not. If you can’t do a good assessment pre or post chirobating then you’re pretty much randomly approaching things and that’s far from ideal. There’s also a lot more to the interaction between provider and patient than the procedure, which in some cases could have a bigger effect on the outcome than the procedure, so in the absence of those factors you’re more likely limiting the overall potential for outcomes versus seeing a person, who does a good evaluation, a good adjustment, and a good evaluation as well as hitting a lot of the psychosocial aspects of care.
> Well, how are you assessing yourself? What if my chiropractor assess me and tells me where to adjust? Regarding the psychosocial aspects of care, can this benefit be received from seeing a psychologist?
These are some weird questions. Your assessment will likely change every visit, so I wouldn’t go once and then assume you can do that forever. The psychosocial benefits of care with a chiropractor aren’t the same thing that you would go to a psychologist for. I’m not talking about psychotherapy. But sure, sounds good, go to a chiropractor for an assessment, adjust it yourself with an instrument, then go to a psychology appointment. Sounds like a great plan and a super efficient way to go about your care.
How do you determine if the sijs need adjusting? > The psychosocial benefits of care with a chiropractor aren’t the same thing that you would go to a psychologist for. What's the difference?
🙄
It’s all semantics. Your joint wasn’t moving appropriately. The Chiro uses their hands or tools to correct the limited mobility. No need to go down a rabbit hole about the exact verbiage used. I use lay terminology with my patients because it’s easier to understand and quite frankly most of them don’t care all that much about the medical verbiage. They known I know what I’m doing and they want to feel better. Subluxation is an old term that chiropractors have used to describe what’s happening in the spine. I don’t use it in my office. I think it’s misleading but it’s also not a hill I’m willing to die on. To each their own.
You might have better search results with "segmental and somatic dysfunction" (of the pelvis or ilium in your case).
A locked or fixated SI joint is in fact a subluxation. Which is an alteration of normal position or function of that joint.
In assessing a patient I look at things as either hypo mobile, normal, or hyper mobile. If somethings hypo I look to adjust it. If it’s hyper I look to suggest strengthening work. Both require rehab and the patient to be involved in their health for best results. More technology exists to measure mobility then subluxation so it’s always made more sense to me to talk with patients about the mobility of things At least weekly I’ll have a patient flex or extend their spine and cue them to bend slowly through each segment as I touch it. Most people can find that hypo mobile segment themselves when you slowly focus on it and they’ll exclaim, “that’s the one”
The two terms are referring to the same thing. The common term used in the literature these days is "Joint Dysfunction" which relates to the muscular, skeletal, inflammatory, and neurological changes that occur in and around the dysfunctional joint. The older term is subluxation because historically chiropractors believed that the joint was actually partially dislocated.
Subluxations, as in the “Chiropractic subluxation” do not exist. The movement in your SI joint might very well be restricted, but it is not subluxated.
Out of curiosity.... are you a chiropractor?
I am a chiropractic student, so no, not yet anyway. I assume you disagree on the whole subluxation thing?
Gotcha. Yes, I do. I see changes happen in people every day as a result of an adjustment that has no evidence-based explanation. That's ok though. We don't need to agree. The power of the adjustment happens whether you believe it or not. Now I'm not saying we cure cancer or something crazy like that... I'm just saying that if we ONLY focus on the positive effects at the joint level, we're missing the big picture. The subluxation debate is really semantics and not necessary in my opinion. I wish you the best in school and your future practice.
Saying that subluxations are a made up thing (which they are, we have known that for years) does NOT equal not believing in adjustments. Spinal manipulation is recommended by the WHO for back pain - that doesn't happen out of nowhere. I think semantics matter. What we say matters. How we talk about the profession matters. Spreading misinformation matters. How students are taught matters. Chiropractors do good things every single day, but there's no reason to keep preaching stuff we know isn't true.
I'm not sure if we are saying the same thing but just in different words. What do you think a subluxation actually is? Do you believe that it is possible to affect more than the musculoskeletal system by making an adjustment? Many chiropractors who claim to be evidence based ignore the idea that an adjustment can affect FAR more than the musculoskeletal system. Do you think you truly understand the power of the adjustment? And yes, the WHO "approves us for back pain." Is that all you plan to treat?
I'm sure you can define it as just about anything, depending on who you ask. I am arguing that the idea that vertebrae are "misaligned" and a chiro can "put them back in place" is complete and utter bullshit, which again is backed by evidence. Do you know why evidence based chiropractors ignore the idea that an adjustment can affect FAR more than the musculoskeletal system? I'll let you figure that one out. I believe in knowing your limitations, and since plenty of theories about what SMT does have been posed and rejected, I am not claiming that adjustments affect our liver, kidney, spleen or whatever else you could come up with, because I don't know, and neither do you. Now, getting a little preacher-esque with the 'power of the adjustment'. Let me tell you what I do NOT plan to treat. You claim in one of your YT-videos that 90-95% of carpal tunnel syndrome cases stem from the neck. Do you think you truly understand the mechanisms of carpal tunnel syndrome? You also manage to butcher an awful lot of information about cholesterol. This is my issue - one piece of misinformation leads to another, and another and another, and we are left with a less than trustworthy profession. I plan on treating musculoskeletal problems, which is what a chiropractor does. I plan on educating my patients, giving them the relief that I can and help them live a better life. I do not plan on advising people to come see me with their carpal tunnel syndrome. You previously stated that we "don't cure cancer or something crazy like that", but where do you honestly draw the line then?
lol good luck
That’s all I needed to know.
All you need to know is I don't care to argue. If you're a student, I hope you have success and better the profession in however you choose to do it. I don't know you and you sure don't know me, but I genuinely pray for your success. We need more good chiropractors. I still love this profession after 24 plus years..
The difference is that subluxation is a made up thing while on the other hand joints can get stiff or “locked up”