Beyond the Pinched Nerve
by William D. Esteb
There was a time when chiropractic had to be presented simplistically because patients had little formal education, put doctors on a pedestal, and were willing to comply simply because the doctor said to. Not so today. Today's baby boom generation is the most educated ever (25% have college degrees), they tend to question authority, and are increasingly seeking second opinions. The "pinched nerve" subluxation model of the past doesn't work like it used to.
Moreover, without a complete description and understanding of the nature and severity of their problem, patients don't take their condition seriously and ignore recommendations for the ongoing chiropractic lifestyle (maintenance care) necessary for the management of the chronic spinal problems many adults present.
The five components of the Vertebral Subluxation Complex accurately describe the multi-faceted condition that patients present in your office. It is a more accurate term than "subluxation" and "vertebral subluxation" presented to chiropractic patients and laughed at by medical doctors who have assailed the linguistics of the concept over the years.
The Vertebral Subluxation Complex as confirmed by medical researchers consists of spinal kinesiopathology (abnormal motion or position of spinal bones), neuropathophysiology (abnormal nervous system function), myopathology (abnormal muscle function), histopathology (abnormal soft tissue function), and pathophysiology (abnormal function of the spine and body). These five components occur simultaneously and are reduced with appropriate chiropractic care. There are six compelling reasons why this model should be presented to today's patients.
1. It's real. Review contemporary medical research and the physiological impact of aberrant spinal mechanics are revealed. While some of the researchers haven't used the identical terms used here, their description of these component parts correlate precisely.
Interestingly, in the recent attempts at merger between the ACA and the ICA, the respective parties did agree on the component basis of the Vertebral Subluxation Complex.
Sadly, chiropractic research is still suspect as a justification of chiropractic care. The medical community, which garners the most respect has already conducted the research affirming these five component parts. Review the books listed later for your own study and verification.
2. It overcomes the unscientific image of chiropractic. Chiropractic has been hurt by not having accepted scientific nomenclature to describe what chiropractic care does. The coronary patient can better describe a triple bypass heart surgery than most chiropractic patients can the purpose of their repeated visits!
The Vertebral Subluxation Complex takes patients beyond the notion of just a bone out of place. Using the names of the components as appropriate can linguistically substantiate the patient's perception that what's wrong with them has a name, is serious, and their Doctor of Chiropractic is knowledgeable in its treatment. Continuing to use the simplistic, vague, and non-scientific term of "subluxation" to refer to this multi-faceted condition undermines patient confidence. Today's patient, weaned on medical tests administered with the accuracy of three places to the right of the decimal, yearns for a scientific basis to chiropractic.
Don't be put off thinking patients can't understand myopathology or histopathology! Ask any new patient what a hysterectomy, appendicectomy, or an electroencephalogram is and most can tell you, or at least they've heard of them before. These $50 words can help validate chiropractic to a group of patients who want assurance that they've made the right decision by consulting your office.
3. It provides a structure for your report of findings. The Vertebral Subluxation Complex supplies an organized structure for explaining to patients what's wrong with them. Each of the five components has identifiable symptomatology associated with it, even though not present in every case. Explain the patient's examination findings using the five components as an outline. This results in a clearer, more concise report of findings without the usual tangents and meanderings.
Using the five components as a guide avoids the X-ray view box monologue that plagues all too many reports. After all the hand waving and explanations of gas bubbles in the intestines, patients emerge from your X-ray explanation with one major idea: bone out of place. This perception sabotages the notion of long term care because most patients can tell that you "put the bone back" on their first adjustment. They could even hear it!
Doctors using the component basis for their reports spend less time dealing with symptoms and more time focused on the patient's real problem and its correction.
4. It describes what Doctors of Chiropractic treat. In the past, the strength of chiropractic has been largely based on a strong philosophical foundation and the successful relief of pain and other symptoms. When combined with this new scientific reality, today's Doctor of Chiropractic has an exciting opportunity to change a patient's health attitude.
First, by pointing to these components, doctors can make a strong case that they don't treat "headaches" or low back pain" or other obvious spinal-related conditions. "I'm delighted you've consulted our office Mrs. Jones, however you need to know we don't treat the symptoms that you've presented here. We help locate and reduce the Vertebral Subluxation Complex, the underlying cause of a variety of health problems. Let me explain..."
Secondly, since pain or other obvious symptoms may not always be present when the Vertebral Subluxation Complex exists, it can be an excellent springboard for confronting the prevailing health attitude that the lack of symptoms means you're healthy. Relating the Vertebral Subluxation Complex to cancer or heart disease while pointing out the bone spurs and disc narrowing that have gone undetected for years puts needed chiropractic care in the proper framework.
5. Simplifies depositions. If you've done any personal injury work you know how the medical "experts" called on by the insurance company like to pounce on the pinched nerve model of chiropractic. And with good reason. Research suggests that 15% or less of chiropractic cases present themselves with a compressive lesion. The more common facilitative lesion has an entirely different physiology.
Even worse, when chiropractors are asked to show the "pinched nerve" on X-rays, the diagnostic tool many chiropractors hang their hat on, they can't. Of course they can't. X-rays only show the osseous component (spinal kinesiopathology--abnormal motion or position of spinal bones).
Abandoning the old "subluxation" model in favor of the Vertebral Subluxation Complex is not only more accurate, it can avoid much of the legal arena confrontation a generation of chiropractors have experienced.
6. It provides a model for the necessity of wellness care. Mitch Kapor who wrote one of the most successful programs ever, the Lotus 1-2-3 spreadsheet software, observed that "If you can genuinely present a picture that makes sense to people that unifies the seemingly separate elements of their experience; if you can give people something that they can resonate with because it's meaningful to them, they'll be immensely responsive to it." If a subluxation is a bone out of place pinching a nerve, how come "it keeps going out?" Until you supply the explanation of long term muscle damage, soft tissue damage, and joint degeneration that accompanies aberrant spinal biomechanics, chiropractic care beyond pain relief doesn't make sense.
While Doctors of Chiropractic can take comfort in the existence of research that proves what they've known all along, substantial benefits can be reaped by developing communication strategies for sharing this information with patients.
Doctors unaware of the component basis of the Vertebral Subluxation Complex will be interested to read further.
W. H. Kirkaldy-Willis, M.A., M.D., F.R.C.S., Managing Low Back Pain, Churchill-Livingstone, 1988.
Abraham Towbin, M.D. Neuropathologist, Harvard Medical School, Latent Spinal Cord and Brain Stem Injury in Newborn Infants, Develop. Med. Child Neurol., II:54-86, 1969.
Dvorak & Dovark, M.D., Manual Medicine, Thieme-Straton, 1984.
F. J. Kottke, M.D., G. K. Stillwell, M.D., J. F. Lehmann, M. D., Krusen's Handbook of Physical Medicine and Rehabilitation, W.B. Sanders Co., 1982.
J. A. Gould, III, P.T., G. J. Davies, P.T., Orthopedic and Sports Physical Therapy, Volume II, C. V. Mosby Co., 1985.
Alf Brieg, M.D., Adverse Mechanical Tension of the Central Nervous System, John Wiley & Sons, 1978.
Beighton, Grahme, Bird, M.D.'s, Hypermobility of Joints, Springer-Verlag, 1983.
Augustus White, III, Manohar Panjabi, Clinical Biomechanics of the Spine, J. B. Lippincott Co., 1978.
Karel Lewit, M.D., Sc. D., Manipulative Therapy in Rehabilitation of the Locomotor System, Butterworth's Publishing Co., 1985.
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My Report of Findings
Originally published in 1993
240 Pages
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