While sitting at my desk last week waiting for therapy to expire on several patients who were to subsequently receive my adjustments, an older friend of mine from another small Mississippi town called to drop me a hint. It seems that he had been revisiting his Palmer collection (i.e., Dr. B.J. Palmer's so-called "green books"), reading a work by R.W. Stephenson, The Art of Chiropractic. Obviously a fan of Dr. Palmer, he said that Stephenson's principles should be updated in light of what we now know from modern research.
My friend said he couldn't think of anyone better qualified to do that updating than me, given that I had written a textbook about modern chiropractic research. I told him that I appreciated his confidence in me, and that I would look into the matter.
Arriving home for lunch, I quickly perused the book (only 72 pages), noting the definitions of science, philosophy, and definitions on the normal and abnormal positions of vertebrae. Later, I took the time to re-read the 1947 revised edition in more detail. On page 3 Dr. Stephenson defined, abnormal positions of vertebrae:
"A vertebra is in an abnormal position when it is out of proper alignment with the vertebra above or the one below or both; so that its articulations are not in proper apposition. These are classified as three kinds, according to degree; namely, fractures, dislocations, and subluxations. Fractures and dislocations are not in the realm of Chiropractic. Subluxations are the physical representations of the cause of dis-ease. Innate's opinion is the criterion of abnormal positions, or of normal positions."1
On page four we have the definition of subluxations:
"A subluxation is the condition of a vertebra that has lost its proper juxtaposition with the one above or the one below or both; to an extent less than a luxation (dislocation); which impinges nerves and interferes with the transmission of mental impulses ... unless it is the cause of dis-ease it is not a subluxation."1
There are so many important topics, from "Innate Intelligence is the Adjustor," to "Nerve Tracing," to the last topic, "Spinographs," that they cannot be adequately discussed in a brief manner. We will instead focus on perhaps the most important single issue Dr. Stephenson addressed, what we now refer to as vertebral subluxation complex (VSC).
The first edition of Dr. Stephenson's work appeared in 1927. We have to remember that at that time there was no cineradiography. Important discoveries in spinal reflexes and facilitation were years away, as were a complete knowledge of CNS phenomena like descending inhibition and neuronal pools. Melzack and Wall's, "Gate Control Theory of Pain" would not appear until two decades after his 1947 revised edition was released.
Finally, tests of inter- and intra-rater agreement for reliability of x-ray interpretation, palpation for tenderness, examination for range of motion asymmetry, thermography, electromyography, leg length inequality, and other clinical tests associated with analysis of VSC were not begun until the last decade.
Therefore, in the context of what was known at the time, a good argument can be made that despite the protestations of some of Dr. Stephenson's contemporaries to the effect that VSC is a dynamic lesion, as opposed to static one, there was no solid scientific evidence yet available counter to his or Palmer's view.
But as we begin our second century of drugless health care, we must now finally and totally reject their hypothesis, even as Catholics now universally accept that Galileo was right about the earth being round. There is simply no point in putting people to the stake over this one anymore. There is now overwhelming evidence that VSC is a dynamic lesion.2
The definition of subluxation first described by chiropractors Solon Langworthy, Oakley Smith and Minora Paxson in the first chiropractic textbook, Modernized Chiropractic (1906), is worth repeating here:
"A simple subluxated vertebra differs from a normal vertebra only in its field of motion and the center of its field of motion; because of its being subluxated, its various positions of rest are differently located than when it was a normal vertebra ... its field of motion may be too great in some directions and too small in others."3
In retrospect, a triad of findings reported by chiropractors and osteopaths early in the century appear to best fit with current findings of clinical research of reliability and validity of a number of tests we use in chiropractic practice. The triad of findings attributable to so-called phase 1 (pre-radiographic) spinal lesions (segmental dysfunction) includes: restricted motion, paraspinal and/or spinous tenderness, and taut muscle (or spasm).
It seems that we should follow the advice of our esteemed scientific friend (or heretic, according to some in our midst) Dr. Joseph Keating Jr., when he proclaims: "Skepticism ... should therefore be a characteristic of workers in the science of chiropractic. When considering subluxation, there is good reason for skepticism."5
Although it may be disparaging to think that Dr. Stephenson could have been so totally wrong about VSC, stay tuned for later visitations of his work that point to ideas that may prove more tenable. And remember, in science, as in baseball, it ain't over 'til the fat lady sings!
References
When sports chiropractors first appeared at the Olympic Games in the 1980s, it was alongside individual athletes who had experienced the benefits of chiropractic care in their training and recovery processes at home. Fast forward to Paris 2024, where chiropractic care was available in the polyclinic for all athletes, and the attitude has now evolved to recognize that “every athlete deserves access to sports chiropractic."
It is estimated that 61% of patients with CTS avoid taking surgical options due to postoperative complications and costly surgical procedures. Chiropractic care offers a comprehensive and effective treatment for carpal tunnel syndrome, addressing the condition from multiple angles. Recent studies also have unveiled a game-changing adjunct to chiropractic treatments for CTS: nerve flossing.
Some doctors thrive in a personality-based clinic and have a loyal following no matter what services or equipment they offer, but for most chiropractic offices who are trying to grow and expand, new equipment purchases help us stay relevant and continue to service our client base in the best, most up-to-date manner possible. So, regarding equipment purchasing: should you lease, get a bank loan, or pay cash?
