Download Lec. 16new_04 - Physio. of the Subluxation

PHYSIOLOGY 1
LECTURE OUTLINE 16
The Physiology of the Subluxation
Complex
Physiology of the Subluxation
Complex
Objectives: Completion of this
material should provide the student
with a basic understanding of:
 1. What the vertebral subluxation
complex is
 2. The components of the vertebral
subluxation complex
 3. The basic physiology of the vertebral
subluxation complex
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Physiology of the Subluxation
Complex
4. How spinal immobilization (fixation)
leads to tissue deterioration
 5. How improving the spinal alignment
(adjustment to restore normal
movement) relieves the tissue damage
and aids in repair)
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Physiology of the Subluxation
Complex
I. Introduction
 Classically the subluxation complex was
viewed as an osseous impingement on
nerves (Bone on Nerve) that interfered
with the proper function of the nerve. In
recent years a more comprehensive
definition has arisen as our knowledge
base increases.
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Physiology of the Subluxation
Complex
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The Vertebral Subluxation Complex is a
complex model of spinal nervous dysfunction
and deterioration which involves all of the
associated tissues of the region. It does not
necessarily involve impingement of the
osseus tissue on the nerve but due to
vertebral misplacement may involve partial or
full obstruction of the nerve due to
inapproate muscle contraction or stretch of
the surrounding connective tissue.
Physiology of the Subluxation
Complex
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Therefore, the vertebral subluxation
complex involves:
1.
2.
3.
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5.
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9.
Kinesiological dysfunction - Kinesiopathology
Nerve dysfunction - Neuropathophysiology
Muscle dysfunction - Myopathology
Vascular Pathology
Connective tissue deterioration
Inflammatory response
Pathoanatomy
Pathophysiology
Pathobiochemistry
Physiology of the Subluxation
Complex
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Basic Theory - A vertebral joint
becomes immobilized or fixated due to
misalignment, twisting, or tilting
resulting in a decline or loss of joint
articulation. The immobilized joint in
turn pinches nerves and blood vessels
exiting the area restricting both nerve
and blood outflow to the surrounding
tissues.
Physiology of the Subluxation
Complex
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Basic Theory (cont.) - Restricted nerve
and blood outflow leads to decreased
nerve function (decreased velocity of AP
conduction) and vascular function
(Restriction of blood vessels leads to
turbulence and increased
arteriosclerotic plaguing resulting in
tissue hypoxia). This in turn will lead to
deterioration of the tissue beds being
supplied and eventually leading to
Physiology of the Subluxation
Complex
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II. Kinesiological Dysfunction (Hypomobility)
– A. Immobilization degeneration (Fixation)
 1. Lack of movement - misalignment, rotation,
tilting, etc.
 2. Stiffness associated with pain
 3. Joint degeneration - increased connective
tissue and calcification of the connective tissue
 4. Ultimately fusion by bony ankylosis
Physiology of the Subluxation
Complex
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2. This stretches or deforms the connective
tissue along one side of the vertebral joint,
while compressing the opposite side. Even
through the bone is not in contact with the
nerve the nerve may still be under compressive
forces due to the deformation of the connective
tissue.
Physiology of the Subluxation
Complex
3. Restriction of movement in spinal joint will
lead to compensatory changes elsewhere in the
spinal column.
 4. Motion segment - Two adjacent vertebrae
joined by an intervertebral disk, two posterior
articulations with their capsules, several
intrinsic ligaments, and may include the
muscles and segmental contents of the spinal
canal
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Physiology of the Subluxation
Complex
a. Chiropractic evaluative procedures are often
directed at determining specific intersegmental
motion or positional abnormalities
 b. Treatment involves restoring normal motion
through adjustment
 B. Restoration of normal range of motion
restores normal joint function and surrounding
tissue physiology
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Physiology of the Subluxation
Complex
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1. Time required to restore full function depends on
the time spent immobilized
2. In extreme cases restoration of full range of
motion results in the formation of a new joint. (?)
3. Forced motion (Chiropractic Thurst) causes
physical disruption of adhesions between gross joint
structures and leads to the disruption of the
intermolecular cross-bridging of the collagen fibers
(Calcification)
Physiology of the Subluxation
Complex
III. Nerve Dysfunction (Neuropathophysiology)
 A. Spinal nerves
 B. Dorsal root ganglia
 C. Articular neurology
 D. Pain
 E. Viscerosomatic relationships
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Physiology of the Subluxation
Complex
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F. Somatoautonomic relationships
G. The Neurodystrophic hypothesis
H. Trophic influences
I. Neurodiagnosis
IV. Muscle Dysfunction (Myopathology)
A. Disuse Atrophy
B. Evaluation Procedures
C. Therapeutic benefits (Physical Therapy)
Physiology of the Subluxation
Complex
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V. Connective Tissue Pathology
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A. Joint immobilization
B. Increased calcium crossbridgeing
C. Adhesions between separate joint
segments
D. Ligament contracture
E. Diagnostic tests
F. Chiropractic adjustment
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Physiology of the Subluxation
Complex
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VI. Vascular Pathology
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A. Chiropractic - Osteopathic
B. Blood supply to motion segment
C. Occlusion of spinal veins leads to motion
segment stiffness
D. Occlusion of spinal arteries leads to
deterioration of the joint
E. Evaluation procedures
D. Therapeutic benefits
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Physiology of the Subluxation
Complex
VII. Inflammatory response
 A. General
 B. Arthritis
 C. Inflammation of nerves and nerve roots
 D. Assessing information
 E. Managing inflammation
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Physiology of the Subluxation
Complex
VIII. Biochemical changes - Pathobiochemistry
 A. Connective tissue
 B. Inflammation
 C. Endocrinology
 E. Pharmacologic Considerations
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Physiology of the Subluxation
Complex
SUMMARY
 1. What is the Lantz model of the subluxation
complex and how does it differ from the
original model?
 2. What is the causative event of the
subluxation complex?
 3. What is the order of progression of the SLC?
 4. What does the chiropractic adjustment do to
correct the problem?
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Physiology of the Subluxation
Complex
SUMMARY Cont.
 5. What is Wolf’s law and how does it apply to
the SLC?
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