Chapter 1 What’s in a Word?

Key Words

The word subluxation has been daubed in a kaleidoscope of colors and embodied with a multitude of meanings by chiropractors during the past 100 years. To some, it has become a holy word,¹ to others, an albatross to be discarded.² Currently, subluxation continues to be the most loved and hated, hotly debated, and consecrated term used by chiropractors. To add to the confusion, more than 100 synonyms for subluxation have been used (Table 1-1). If the term has become so “overburdened with clinical, political, and philosophical meaning and significance for chiropractors, that the concept that once helped to hold a young besieged profession together”¹ now divides and keeps it quarreling over basic semantics, why do we persist in using it? The obvious answer is provided by Terrett³: The concept of vertebral subluxation is central to chiropractic.

^{Table 1-1} Subluxation Synonyms to 1993

The notion that changing the word subluxation to another term will somehow change the clinical, political, and philosophical connotations is simply not rational. Changing the term used for the articular lesion treated by chiropractors (subluxation) does not eradicate the clinical, political, and philosophical issues that surround the construct—it evades them.^2,3 We have found it expedient to clearly and simply define the term subluxation and to objectively address issues surrounding the construct. The conceptual definition of subluxation has been the foundation on which chiropractic science has stood. It is time to provide an operational definition of subluxation by identifying the testable components of misalignment, aberrant motion, and dysfunction included in the definition. With these components delineated, we can examine current data and further study the topic of our discourse.

Defining Subluxation

The definitions of subluxation and related terms used in this book were developed by consensus methods that used an algorithm developed by Gatterman and Hansen⁴ (Figure 1-1). These terms were agreed on through both nominal and Delphi methods that included broad geographic, philosophical, and political representation. This project was funded and supported by the Consortium for Chiropractic Research (CCR). Included in the 60-member Delphi panel were members of the American Chiropractic Association (ACA) Council on Technique, which adopted the terms in 1993. Subsequently, the House of Delegates of the ACA endorsed the terms that are now included in a number of leading chiropractic textbooks.^5–9 The field of terms includes subluxation, the articular lesion that is less than a dislocation; manipulable subluxation, a lesion amenable to chiropractic manipulation; subluxation complex, the theoretical model that describes the widespread effects of subluxation; and subluxation syndrome, the clinical manifestations that include the associated symptoms and physical signs of a subluxation. Each term is expanded on in relation to the principles of chiropractic, and support for these principles is the subject matter of this text. Essential for the definition of subluxation has been clarification of the terms motion segment and spinal motion segment. Definitions of therapeutic procedures used by chiropractors include the terms manual therapy, manipulation, mobilization, and most important, adjustment. To arrive at consensus for terms commonly used by chiropractors, the origin of each term was examined relative to the concepts that underlie the profession. (See Figure 1-1.)

Figure 1-1 Terminology assessment model.

Origin of the Word Subluxation

The root words for the term subluxation come from a combination of the Greek sub and lux, meaning “less than a dislocation.” In 1746 Hieronymus¹⁰ identified characteristics of a subluxation, stating the following:

…subluxation of joints is recognized by lessened motion of the joints, by slight change in position of the articulating bones and pain…

His characterization does not differ significantly from the consensus definition of the nominal and Delphi panels of the CCR that defined subluxation as follows:

subluxation a motion segment in which alignment, movement integrity, and/or physiologic function are altered although contact between the joint surfaces remains intact.

Subsequent to the conclusion of the CCR consensus process, Swere¹¹ suggested that the word “partially” be added for clarity:

subluxation a motion segment in which alignment, movement integrity, and/or physiological function are altered although contact between the joint surfaces remains partially intact.

The CCR definition of subluxation allows for physiologic dysfunction, which was described in 1821 by Harrison¹² as follows:

When any of the vertebrae become displaced or too prominent, the patient experiences inconvenience from a local derangement in the nerves of the part. He, in consequence, is tormented with a train of nervous symptoms, which are as obscure in their origin as they are stubborn in their nature….

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