Editing Chiropractic (section)

=== "Subluxation" as a Vitalist concept ===
{{Main|Vertebral subluxation}}
{{distinguish|text=[[subluxation]], the medical condition}}

In science-based medicine, the term "subluxation" refers to an incomplete or partial [[dislocation (medicine)|dislocation]] of a [[Joint dislocation|joint]], from the Latin ''luxare'' for 'dislocate'.<ref name="Merriam-Webster">{{cite web | title=Subluxation | website=Merriam-Webster | url=https://www.merriam-webster.com/dictionary/subluxation | access-date=January 4, 2018}}</ref><ref>{{cite web |url=https://www.etymonline.com/word/luxation#:~:text=luxation%20(n.),a%20word%20of%20uncertain%20origin |title=luxation (n.) |work=Online Etymology Dictionary |access-date=July 28, 2021 |url-status=live|archive-url=https://web.archive.org/web/20190501165646/https://www.etymonline.com/word/luxation |archive-date=2019-05-01 }}</ref>  While medical doctors use the term exclusively to refer to physical dislocations, Chiropractic founder D. D. Palmer imbued the word ''subluxation'' with a metaphysical and philosophical meaning drawn from pseudoscientific traditions such as [[Vitalism]].<ref name=Keating1995 />

Palmer claimed that ''vertebral subluxations'' interfered with the body's function and its inborn ability to heal itself.<ref name=History-PPC>{{cite book|vauthors= Keating JC Jr|chapter= A brief history of the chiropractic profession|pages=23–64|title= Principles and Practice of Chiropractic|edition=3rd|veditors = Haldeman S, Dagenais S, Budgell B |publisher=McGraw-Hill|year=2005|isbn=978-0-07-137534-4|display-editors=etal|author-link= Joseph C. Keating, Jr}}</ref> D. D. Palmer repudiated his earlier theory that vertebral subluxations caused pinched nerves in the intervertebral spaces in favor of subluxations causing altered nerve vibration, either too tense or too slack, affecting the tone (health) of the end organ.<ref name=Keating1995 /> He qualified this by noting that knowledge of innate intelligence was not essential to the competent practice of chiropractic.<ref name=Keating1995>{{cite web|url=http://chiro.org/Plus/History/Persons/PalmerDD/PalmerDD's_Forgotten_Theories1995.pdf |archive-url=https://web.archive.org/web/20070710071140/http://www.chiro.org/Plus/History/Persons/PalmerDD/PalmerDD's_Forgotten_Theories1995.pdf |archive-date=2007-07-10 |url-status=live|title= D. D. Palmer's forgotten theories of chiropractic|last=Keating |first=J. C. Jr|publisher= [[Association for the History of Chiropractic]]|year=1995|access-date=2008-05-14}}</ref> This concept was later expanded upon by his son, B. J. Palmer, and was instrumental in providing the legal basis of differentiating chiropractic from conventional medicine. 

[[File:Xray Machine Champion Chiropractic.jpg|thumb|right|alt=|Chiropractors use [[x-ray radiography]] to examine the bone structure of a patient.]]
Vertebral subluxation, a core concept of traditional chiropractic, remains unsubstantiated and largely untested, and a debate about whether to keep it in the chiropractic paradigm has been ongoing for decades.<ref name=Keating-subluxation /> In general, critics of traditional subluxation-based chiropractic (including chiropractors) are skeptical of its clinical value, [[dogmatic]] beliefs and metaphysical approach. While straight chiropractic still retains the traditional vitalistic construct espoused by the founders, evidence-based chiropractic suggests that a mechanistic view will allow chiropractic care to become integrated into the wider health care community.<ref name=Keating-subluxation>{{cite journal |vauthors=Keating JC, Charlton KH, Grod JP, Perle SM, Sikorski D, Winterstein JF | title = Subluxation: dogma or science? | journal = Chiropractic & Osteopathy| volume = 13 | page = 17 | date = August 2005 | pmid = 16092955 | pmc = 1208927 | doi = 10.1186/1746-1340-13-17 | doi-access = free }}</ref> This is still a continuing source of debate within the chiropractic profession as well, with some schools of chiropractic still teaching the traditional/straight subluxation-based chiropractic, while others have moved towards an [[evidence-based]] chiropractic that rejects metaphysical foundings and limits itself to primarily neuromusculoskeletal conditions.<ref>{{cite journal|journal=Journal of Chiropractic Education|year=2000|volume=14|issue=2|pages=71–77|title=A survey of the use of evidence-based health care in chiropractic college clinics|vauthors=Rose KA, Adams A|doi=10.7899/1042-5055-14.2.71 |url=http://www.journalchiroed.com/2000/JCEFall2000Rose.PDF|archive-url=https://wayback.archive-it.org/all/20081002073736/http://www.journalchiroed.com/2000/JCEFall2000Rose.PDF|archive-date=2008-10-02}}</ref><ref>{{cite journal|journal=Journal of Manual & Manipulative Therapy|year=2006|volume=14|issue=2|pages=E14–18|title=Can chiropractors and evidence-based manual therapists work together? an opinion from a veteran chiropractor|author=Homola S|url=http://jmmtonline.com/documents/HomolaV14N2E.pdf |archive-url=https://web.archive.org/web/20070710071140/http://jmmtonline.com/documents/HomolaV14N2E.pdf |archive-date=2007-07-10 |url-status=live|doi=10.1179/jmt.2006.14.2.14E|citeseerx=10.1.1.366.2817|s2cid=71826135}}</ref>

In 2005, the [[vertebral subluxation|chiropractic subluxation]] was defined by the [[World Health Organization]] as "a lesion or dysfunction in a joint or motion segment in which alignment, movement integrity and/or physiological function are altered, although contact between joint surfaces remains intact.<ref name=WHO-guidelines /> It is essentially a functional entity, which may influence biomechanical and neural integrity."<ref name=WHO-guidelines /> This differs from the medical definition of subluxation as a significant structural displacement, which can be seen with static imaging techniques such as [[Radio diagnostics|X-rays]].<ref name=WHO-guidelines>{{cite book |author= World Health Organization|year=2005|title= WHO guidelines on basic training and safety in chiropractic|publisher=World Health Organization |url=https://www.who.int/medicines/areas/traditional/Chiro-Guidelines.pdf|isbn= 978-92-4-159371-7|archive-url=https://web.archive.org/web/20220313162309/https://www.who.int/medicines/areas/traditional/Chiro-Guidelines.pdf |access-date=2008-02-29|archive-date=2022-03-13 }}</ref> The use of X-ray imaging in the case of vertebral subluxation exposes patients to harmful [[ionizing radiation]] for no evidentially supported reason.<ref>{{cite journal|last1=Jenkins|first1=H. J.|title=Awareness of radiographic guidelines for low back pain: a survey of Australian chiropractors.|journal=Chiropractic & Manual Therapies|date=5 October 2016|volume=24|page=39|doi=10.1186/s12998-016-0118-7|pmc=5051064|pmid=27713818 |doi-access=free }}</ref><ref name=Ammendolia /> The 2008 book ''[[Trick or Treatment]]'' states "X-rays can reveal neither the subluxations nor the innate intelligence associated with chiropractic philosophy, because they do not exist."<ref name=Trick-or-Treatment>{{cite book|pages=145–90|chapter=The truth about chiropractic therapy|title=Trick or Treatment: The Undeniable Facts about Alternative Medicine |last1=Singh |first1=S. |last2=Ernst |first2=E. |year=2008|publisher=W. W. Norton|isbn=978-0-393-06661-6}}</ref> [[Attorneys in the United States|Attorney]] David Chapman-Smith, Secretary-General of the [[World Federation of Chiropractic]], has stated that "Medical critics have asked how there can be a subluxation if it cannot be seen on X-ray. The answer is that the chiropractic subluxation is essentially a functional entity, not structural, and is therefore no more visible on static X-ray than a [[limp]] or headache or any other functional problem."<ref>{{cite book|page=160|chapter=Principles and Goals of Chiropractic Care|title=The Chiropractic Profession: Its Education, Practice, Research and Future Directions|author=David Chapman-Smith|year=2000|publisher=NCMIC Group|isbn=978-1-892734-02-0}}</ref> The [[General Chiropractic Council]], the statutory regulatory body for chiropractors in the United Kingdom, states that the chiropractic vertebral subluxation complex "is not supported by any clinical research evidence that would allow claims to be made that it is the cause of disease."<ref>{{cite web |url=http://www.gcc-uk.org/files/link_file/Guidance_on_claims_made_for_the_chiropractic_VSC_18August10.pdf |archive-url=https://www.webcitation.org/5xywlByZ0?url=http://www.gcc-uk.org/files/link_file/Guidance_on_claims_made_for_the_chiropractic_VSC_18August10.pdf  |archive-date=2011-04-16 |title=Guidance on claims made for the chiropractic vertebral subluxation complex |publisher=General Chiropractic Council |access-date=2010-09-30 }}</ref>

As of 2014, the US [[National Board of Chiropractic Examiners]] states "The specific focus of chiropractic practice is known as the chiropractic subluxation or joint dysfunction. A subluxation is a health concern that manifests in the skeletal joints, and, through complex anatomical and physiological relationships, affects the nervous system and may lead to reduced function, disability or illness."<ref name="NBCE_about_chiro">{{Citation |last=NBCE |date=2014 |title=About Chiropractic |publisher=[[National Board of Chiropractic Examiners]] |url=http://www.nbce.org/about/about_chiropractic/ |access-date=February 1, 2015 |archive-url=https://web.archive.org/web/20150619234625/http://www.nbce.org/about/about_chiropractic/ |archive-date=June 19, 2015  }}</ref><ref name=History-Primer2 />