Find Formula And Show Several Level Curve Of The Fuction Understanding the Chiropractic Subluxation

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Understanding the Chiropractic Subluxation

It is axiomatic that consistently accurate clinical decisions are irrevocably linked to the understanding that subluxation is not a random, unpredictable biomechanical phenomenon. But rather, a neuropathological condition that exhibits multiple, measurable manifestations in the neuromusculoskeletal system that occur in patterns as predictable as mathematical formulas.

The role of the chiropractor, then, is not simply the mobility of a stuck joint’ as some have mistakenly imagined, but the correction of patterns of functional neuropathology. In this, the chiropractor must make a carefully weighted decision in each and every patient consultation, keeping accurate and detailed records to facilitate the identification of recurrent patterns of subluxation.

That functional neuropathology accompanies disease and organic imbalance, and that freedom from such neuropathology is necessary for the individual to enjoy the benefits of homeostasis, has always been, and always will be, the fundamental philosophical foundation upon which the science and art of chiropractic is predicated (Palmer 1910).

The relentless search for the specific in each individual that, when corrected, will result in the eradication of neuropathology, and the restoration of homeostasis (Strang 1984) remains the fundamental prerogative of the chiropractor.

The subluxation complex is based on a precise, predictable pattern of neuropathology, kinesiopathology and compensatory patterns (Lantz 1995). Each of these elements of the subluxation complex must be present every time and in every case before a precise chiropractic adjustment of the subluxation complex can occur.

The inherent importance of the above rule is that it provides for a specific subluxation diagnosis. Working in this way and specifically allowing neuropathology to guide the examination and diagnosis provides for the treatment of a subluxation complex and not of multiple compensators that exhibit all the properties necessary for a subluxation diagnosis.

In addition, precise and predictable patterns allow testing and verification of subluxation correction before any care is implemented. The Neuropathology of the Subluxation Complex, includes a synthesis of four neuro-physiological mechanisms that provide an explanation for the neurological effect that subluxation has on neurological function.

Mechanism #1: Effect of dural stress

The major mechanical attachments of the dura are to the cranium, upper cervical spine, and lumbar-sacral junction and are attached to the occiput, ligamentum flavum, rectus capitis posterior minor, directly to C2 and C3, and to L5 and sacral via Hoffman’s and Trolard’s ligaments. (Snell 1992, Barbaix et al. 2000, Wadhwani et al. 2004).

Cerebro-spinal fluid flow is dependent on, among others, the appropriate function of the contractile meninges (Greitz 1993). If the biomechanical lie of the dura is altered due to aberrant kinesiology, the contractile function of the meninges is impaired and thus contributes to changes in CSF flow, changes CSF pressure and affects the function of many central nervous system structures.

Kinesiopathology results in changes in the lie of the dura, and is associated with changes in CSF pressure. This results in unpredictable reticular formation activity leading to the processing of inappropriate neurological signals that reach the cerebral cortex and must be processed into meaningful efferent output.

The cerebral cortex is also challenged by changes in CSF pressure and thereby fails to adequately synthesize sensory information resulting in what is known as deafferentation (Seaman 1998, Knutson 1999).

Mechanism #2: Noxious mechanoreceptor input from the dura

The major innervation of the dura is through slow-reacting type C fibers and fast-reacting type A fibers, mainly at the cervical-scapular junction ( Snell 1992 ). In addition, the ventral dura is heavily innervated by the sinuvertebral nerve plexus and several perivascular nerve plexi ( Groen et al. 1988 , Fricke et al. 2001 ).

As with any ascending sensory information, the ascending pathway for the transmission of nociceptive information is primarily through the spinothalamic tract. This tract communicates directly with the thalamus but also sends some fibers through the reticular formation. The spinoreticular tract is also thought to be involved in nociception (Mense 2004).

If dural tension is created by aberrant kinesiology the contractility of the meninges will be affected (Greitz 1993) and nociceptor stimulation will occur. This creates noxious input from the dural system to the central nervous system creating a kind of sensory overload. Sensory information must be adequately processed by the reticular formation and thalamus so that the cortex receives the appropriate sensory information.

Failure to adequately process sensory information into appropriate affective information is called dysafferentation.

Mechanism #3: Noxious mechanoreceptor input from the facet joints

Facet joints are innervated by different types of nerve endings. Mainly I,II, III and IV have been identified (Mclain 1994, Mclain and Pickar 1998, Snell, 1992). The type IV nerve ending is a free nerve ending and is particularly relevant to nociception.

The mechanoreceptor pathways that feed into the CNS are the spinothalamic and spinocerebellar tracts and the posterior column. This contribution of sensory information is transmitted through a number of central nervous system structures, including the cerebellum, reticular formation, and thalamus.

Aberrant kinesiopathology, alters the orientation of the facet joint and its capsule and may expose the synovium to mechanical stress (Inmi et al. 2000). Aberrant lateral positioning and physiological irritation of anatomical structures may result in sensory overload discussed in Mechanism 2.

Mechanism #4: Aberrant sympathetic activity

The upper cervical gland communicates with the upper four cervical nerves via the gray rami communicantes (Snell 1992). Furthermore, sympathetic fibers communicate with the ventral nerve plexus that surrounds the vertebral column (Gron et al. 1990).

The sympathetic nervous system has many functions but of particular relevance to central nervous system function is the control of cerebral hemodynamics, including the circle of Willis. The circle of Willis provides blood supply to the cerebral cortex.

Aberrant sympathetic activity can result in vasoconstriction and changes in cerebral hemodynamics caused by excessive peripheral irritation (Suseki et al. 1996) or, in more extreme cases, prolonged stress (Kadojic et al. 1999).

If this is the case, the already challenged cerebral cortex will again be negatively affected and add to the inability to adequately synthesize information into appropriate (motor) output.

Common elements

Each of the discussed neurological mechanisms contributes to the neuropathology of subluxation. Each mechanism results in a process called DYSAFFERENTATION and is important to understanding the neurological impact of the subluxation complex.

In addition, all sensory pathways decussate. This means that adverse sensory events initiated on the left side of the body are interpreted by the right brain and vice versa. Finally, the effect on the autonomic nervous system is noted by the reticular formation and interconnections of the superior cervical ganglia.

Chiropractic adjustments

Chiropractic adjustments are a precise and specific intervention in the nervous system. Delivering any adjustment thrust, and in particular, repeated adjustment thrusts to compensatory areas of the spine or extremities, should always be diligently avoided if inappropriate neurological input is to be avoided.

Repeated adaptive thrusts put the patient at risk of developing iatrogenic hypermobility syndrome at that level (Cox 1997). Chiropractic adjustments can be seen as a kind of reset mechanism of the nervous system. It overrides the gating mechanism and activates specific neurological pathways (Carrick 1997).

Subluxation-compensation relationship

One of the most poorly understood clinical correlates is the compensatory response to subluxation. Compensation is a biomechanical deviation that is always devoid of the full complement of physical examination findings that define it as subluxation (Herbst 1968) and will manifest as a predictable pattern of movement loss, hypermobility or both (Davis 2000). ability to cause neuropathology (Plager 1993).

Compensatory subluxation is a kinesiopathologic response and may involve a single motion segment or the entire region of the spine (Gatterman 1995).

Compensation is often found distal to the subluxation such as the occiput from the sacrum. Compensatory kinesiopathologic response to subluxation can be demonstrated in postural assessment and motion palpation examination with the elements most reliably visible on X-rays showing primary curve contours and disc shape.

When is a Subluxation actually a Subluxation?

The essence of sound decision-making in chiropractic is the result of a process of clinical logic and deductive reasoning that takes into account all available physical evidence. The conclusion that a chiropractic adjustment is an appropriate clinical intervention should be arrived at when sufficient evidence of all five basic aspects of subluxation can be demonstrated.

Deciding to ‘adjust’ a given spinal motion segment is illogical when only hypomobility, for example, can be demonstrated. Such hypomobility, present in the absence of other findings, almost certainly represents compensation (Davis 1997).

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