In chiropractic circles, the topic of subluxation is core business. We check for subluxation. We adjust subluxation. We research its identification and impact. While some people believe it to be some mystical figment of the imagination, the truth is that subluxation is something that can be reliably detected using varying methods – and adjusting it can have widespread effects on the nervous system as we allow optimal communication between the brain and body – both of which are the mechanisms through which we experience life.
The chiropractic adjustment has been shown to impact everything from mechanical back pain to strength, neuroplasticity, pelvic floor function, cortical drive to lower limb muscles and the ability to perform mental rotation tasks. To provide optimal care for our practice members, chiropractors need to identify and adjust areas of subluxation accurately. [1] Reliable detection of subluxation areas is fundamental to this approach.
Whilst a number of definitions exist for subluxation, ASRF defines it as a “diminished state of being, comprising a state of reduced coherence, altered biomechanical function, altered neurological function, and altered adaptability” [2]. Here at the Australian Spinal Research Foundation, we are passionate about furthering research into the full neurological and biomechanical impacts of subluxation. We know a lot more than we used to, but we are still at the beginning of what could be in terms of the impacts of chiropractic. The reliable detection of subluxation is one of these areas.
We currently have a small handful of studies indicating that reliable detection of the subluxation is possible. These include the a multidimensional battery of tests [3], Objective Synchronous Test [4], Thermal measures, [5] and a number of other studies in process.
A study published in The Journal of the Canadian Chiropractic Association investigates the reliability of ultrasound imaging for measuring spinous process separation in the lumbar spine. This research aims to evaluate the reliability of ultrasound for measuring spinous process separation in a prone position.
A cohort of 15 healthy individuals without low back pain participated in this reliability study. Participants were recruited from a university campus and underwent a screening process to ensure suitability. Ultrasound imaging of the lumbar spinous processes was conducted in a prone (flat on the stomach) position before and after a brief walking interval. The sonographer used diagnostic ultrasound and specialised software to measure the distances between the vertebrae.
The results concluded that ultrasound imaging provides excellent reliability in measuring the distance between lumbar segmental interspinous processes. Ultrasound can potentially be an imaging tool for the understanding of biomechanical changes seen in the lumbar spine. [6, 7, 8] These results are consistent with those findings.
Ultrasound is a cost-effective and non-invasive imaging modality that is widely accessible. Although it may not provide optimal visualisation of facet joints, its ability to image spinous processes and interspinous spaces makes it a valuable diagnostic tool in chiropractic care. The full extent of this measurement is unknown, but further research is needed to explore the biomechanical mechanisms of spinal adjusting to optimise chiropractic treatment and patient outcomes.
Another landmark study from the Centre for Chiropractic Research in New Zealand revealed that we can reliably detect vertebral subluxations. The study found a high level of agreement between examiners in detecting vertebral subluxations using a multidimensional battery of tests. The examiners agreed on the same motion segment in 63.3% of cases. This suggests that subluxations can be reliably and objectively identified. The study also highlights the importance of a multidimensional approach to subluxation assessment. [3]
A further study has examined the inter-rater reliability of a specific technique – Advanced Biostructural Correction (ABC). ABC is a manual therapy method practised by 1.5% of all chiropractors registered in Australia, and the technique focuses on the manual correction of posture from anterior to posterior. [4]
This study investigated the intra- and inter-examiner reliability of the objective synchronous test OST used in ABC protocol to assess dysfunction, particularly at the L5 vertebrae. According to the paper, static identification of the L5 spinous process to be as low as 45% when compared to radiographic analysis. [4] A simple summary of the findings concluded that based on statistical analysis, the researchers could support the reliability of OST for testing L5.
We are thrilled by this advancement in reliably identifying areas of subluxation through many techniques. It aligns with our ongoing efforts to investigate and resolve the questions surrounding this vital aspect of our field. While there are more studies to come, we now have at least three pieces of research that confirms that subluxation can be reliably detected.
This offers us not just more confidence and certainty, but credibility for our practice members. And that is always a worthwhile investment.
References
- ASRF Staff, (2019) Chiropractic and Consciousness: Part 2 – What the research says about chiropractic and the brain.” Australian Spinal Research Foundation. https://spinalresearch.com.au/chiropractic-and-consciousness-part-2-what-the-research-says-about-chiropractic-and-the-brain/
- The ASRF Board, (2022). The definition of subluxation.” Australian Spinal Research Foundation, https://spinalresearch.com.au/research/
- Holt K, Russell D, Cooperstein R, Young M, Sherson M, and Haavik H, (2018), “Interexaminer reliability of a multidimensional battery of tests used to assess for vertebral subluxations,” CJA, Vol 46, Number 1
- Woods, B., Thomas, N., Stanner, M., & Holt, K., (2023). Reliability of the Objective Synchronous Test as Used in Advanced Biostructural Correction to Assess for L5 Dysfunction (ROOSTA-L5). Journal of Contemporary Chiropractic. 6, Iss. 1, January 4, 2023, https://journal.parker.edu/article/78094
- Ebrall, P., Iggo, A., Hobson, P., & Farrant, G., (1994). Preliminary Report: The Thermal Characteristics of Spinal Levels Identified as Having Differential Temperature by Contact Thermocouple Measurement (Nervo Scope). Chiropractic Journal of Australia. 24, Number 4., Dec 1994. https://spinalresearch.com.au/wp-content/uploads/2024/01/LG2003-1.pdf
- Tozawa R, Katoh M, Aramaki H, Kumamoto T, Fujinawa O. Reliability and validity of an ultrasound-based imaging method for measuring interspinous process distance in the lumbar spine using two different index points. J Phys Ther Sci. 2015;27(7): 2333-2336. doi:10.1589/jpts.27.2333
- Tozawa R, Katoh M, Aramaki H, et al. Absolute and relative reliability of lumbar interspinous process ultrasound imaging measurements. J Phys Ther Sci. 2016;28(8): 2210-2213. doi:10.1589/jpts.28.2210
- Tozawa R, Katoh M, Kawasaki T, Aramaki H, Kumamoto T, Fujinawa O. Reliability of ultrasound to measure the distance between lumbar interspinous processes. Med Eng Phys. 2022;99: 103740. doi:10.1016/j. medengphy.2021.103740
- Woods B, Thomas N, Stanners M, Holt K. RELIABILITY OF THE OBJECTIVE SYNCHRONOUS TEST AS USED IN ADVANCED BIOSTRUCTURAL CORRECTION TO ASSESS FOR L5 DYSFUNCTION (ROOSTA-L5). Journal of Contemporary Chiropractic. 2023;6(1):1–7.
- Wu A, March L, Zheng X, Huang J, Wang X, Zhao J, et al. Global low back pain prevalence and years lived with disability from 1990 to 2017: estimates from the Global Burden of Disease Study 2017. Annals of Translational Medicine. 2020;8(6):299–9.
- Merz O, Wolf U, Robert M, Gesing V, Rominger M. Validity of palpation techniques for the identification of the spinous process L5. Man Ther. 2013;18:333-338. DOI: 10.1016/j.math.2012.12.003
