PHYSIOLOGY 1 LECTURE OUTLINE 19 The Physiology of the Subluxation Complex.

PHYSIOLOGY 1PHYSIOLOGY 1

LECTURE OUTLINE 19LECTURE OUTLINE 19

The Physiology of the Subluxation The Physiology of the Subluxation ComplexComplex

Physiology of the Subluxation Physiology of the Subluxation ComplexComplex

I. IntroductionI. Introduction Classically the subluxation complex was Classically the subluxation complex was

viewed as an osseous impingement on viewed as an osseous impingement on nerves (Bone on Nerve) that interfered nerves (Bone on Nerve) that interfered with the proper function of the nerve. In with the proper function of the nerve. In recent years a more comprehensive recent years a more comprehensive definition has arisen as our knowledge definition has arisen as our knowledge base increases.base increases.


The Vertebral Subluxation Complex is a The Vertebral Subluxation Complex is a complex model of spinal nervous dysfunction complex model of spinal nervous dysfunction and deterioration which involves all of the and deterioration which involves all of the associated tissues of the region. It does not associated tissues of the region. It does not necessarily involve impingement of the necessarily involve impingement of the osseus tissue on the nerve but due to osseus tissue on the nerve but due to vertebral misplacement may involve partial vertebral misplacement may involve partial or full obstruction of the nerve due to or full obstruction of the nerve due to inapproate muscle contraction or stretch of inapproate muscle contraction or stretch of the surrounding connective tissue.the surrounding connective tissue.


Therefore, the vertebral subluxation Therefore, the vertebral subluxation complex involves:complex involves:

1. Kinesiological dysfunction - Kinesiopathology1. Kinesiological dysfunction - Kinesiopathology 2. Nerve dysfunction - Neuropathophysiology2. Nerve dysfunction - Neuropathophysiology 3. Muscle dysfunction - Myopathology3. Muscle dysfunction - Myopathology 4. Vascular Pathology4. Vascular Pathology 5. Connective tissue deterioration5. Connective tissue deterioration 6. Inflammatory response6. Inflammatory response 7. Pathoanatomy7. Pathoanatomy 8. Pathophysiology8. Pathophysiology 9. Pathobiochemistry9. Pathobiochemistry


Basic Theory - A vertebral joint Basic Theory - A vertebral joint becomes immobilized or fixated due becomes immobilized or fixated due to misalignment, twisting, or tilting to misalignment, twisting, or tilting resulting in a decline or loss of joint resulting in a decline or loss of joint articulation. The immobilized joint in articulation. The immobilized joint in turn pinches nerves and blood vessels turn pinches nerves and blood vessels exiting the area restricting both nerve exiting the area restricting both nerve and blood outflow to the surrounding and blood outflow to the surrounding tissues.tissues.


Basic Theory (cont.) - Restricted nerve Basic Theory (cont.) - Restricted nerve and blood outflow leads to decreased and blood outflow leads to decreased nerve function (decreased velocity of AP nerve function (decreased velocity of AP conduction) and vascular function conduction) and vascular function (Restriction of blood vessels leads to (Restriction of blood vessels leads to turbulence and increased arteriosclerotic turbulence and increased arteriosclerotic plaguing resulting in tissue hypoxia). plaguing resulting in tissue hypoxia). This in turn will lead to deterioration of This in turn will lead to deterioration of the tissue beds being supplied and the tissue beds being supplied and eventually leading to tissue necrosis.eventually leading to tissue necrosis.


II. Kinesiological Dysfunction II. Kinesiological Dysfunction (Hypomobility)(Hypomobility)– A. Immobilization degeneration (Fixation)A. Immobilization degeneration (Fixation)

1. Lack of movement - misalignment, 1. Lack of movement - misalignment, rotation, tilting, etc.rotation, tilting, etc.

2. Stiffness associated with pain2. Stiffness associated with pain 3. Joint degeneration - increased connective 3. Joint degeneration - increased connective

tissue and calcification of the connective tissue and calcification of the connective tissuetissue

4. Ultimately fusion by bony ankylosis4. Ultimately fusion by bony ankylosis


2. This stretches or deforms the 2. This stretches or deforms the connective tissue along one side of the connective tissue along one side of the vertebral joint, while compressing the vertebral joint, while compressing the opposite side. Even through the bone is opposite side. Even through the bone is not in contact with the nerve the nerve not in contact with the nerve the nerve may still be under compressive forces may still be under compressive forces due to the deformation of the due to the deformation of the connective tissue.connective tissue.


3. Restriction of movement in spinal joint 3. Restriction of movement in spinal joint will lead to compensatory changes will lead to compensatory changes elsewhere in the spinal column.elsewhere in the spinal column.

4. Motion segment - Two adjacent 4. Motion segment - Two adjacent vertebrae joined by an intervertebral disk, vertebrae joined by an intervertebral disk, two posterior articulations with their two posterior articulations with their capsules, several intrinsic ligaments, and capsules, several intrinsic ligaments, and may include the muscles and segmental may include the muscles and segmental contents of the spinal canalcontents of the spinal canal


a. Chiropractic evaluative procedures a. Chiropractic evaluative procedures are often directed at determining are often directed at determining specific intersegmental motion or specific intersegmental motion or positional abnormalitiespositional abnormalities

b. Treatment involves restoring normal b. Treatment involves restoring normal motion through adjustmentmotion through adjustment

B. Restoration of normal range of B. Restoration of normal range of motion restores normal joint function motion restores normal joint function and surrounding tissue physiologyand surrounding tissue physiology


1. Time required to restore full function 1. Time required to restore full function depends on the time spent immobilizeddepends on the time spent immobilized

2. In extreme cases restoration of full range 2. In extreme cases restoration of full range of motion results in the formation of a new of motion results in the formation of a new joint. (?)joint. (?)

3. Forced motion (Chiropractic Thurst) 3. Forced motion (Chiropractic Thurst) causes physical disruption of adhesions causes physical disruption of adhesions between gross joint structures and leads to between gross joint structures and leads to the disruption of the intermolecular cross-the disruption of the intermolecular cross-bridging of the collagen fibers (Calcification)bridging of the collagen fibers (Calcification)


III. Nerve Dysfunction (Neuropathophysiology)III. Nerve Dysfunction (Neuropathophysiology) A. Spinal nervesA. Spinal nerves B. Dorsal root gangliaB. Dorsal root ganglia C. Articular neurologyC. Articular neurology D. PainD. Pain E. Viscerosomatic relationshipsE. Viscerosomatic relationships F. Somatoautonomic relationshipsF. Somatoautonomic relationships G. The Neurodystrophic hypothesisG. The Neurodystrophic hypothesis H. Trophic influencesH. Trophic influences I. NeurodiagnosisI. Neurodiagnosis


IV. Muscle Dysfunction (Myopathology)IV. Muscle Dysfunction (Myopathology) A. Disuse AtrophyA. Disuse Atrophy B. Evaluation ProceduresB. Evaluation Procedures C. Therapeutic benefits (Physical C. Therapeutic benefits (Physical

Therapy)Therapy)


V. Connective Tissue PathologyV. Connective Tissue Pathology A. Joint immobilizationA. Joint immobilization B. Increased calcium crossbridgeingB. Increased calcium crossbridgeing C.C. Adhesions between separate joint Adhesions between separate joint

segmentssegments D. Ligament contractureD. Ligament contracture E. Diagnostic testsE. Diagnostic tests F. Chiropractic adjustmentF. Chiropractic adjustment


VI. Vascular PathologyVI. Vascular Pathology A. Chiropractic - OsteopathicA. Chiropractic - Osteopathic B. Blood supply to motion segmentB. Blood supply to motion segment C. Occlusion of spinal veins leads to C. Occlusion of spinal veins leads to

motion segment stiffnessmotion segment stiffness D. Occlusion of spinal arteries leads to D. Occlusion of spinal arteries leads to

deterioration of the jointdeterioration of the joint E. Evaluation proceduresE. Evaluation procedures D. Therapeutic benefitsD. Therapeutic benefits


VII. Inflammatory responseVII. Inflammatory response A. GeneralA. General B. ArthritisB. Arthritis C. Inflammation of nerves and nerve C. Inflammation of nerves and nerve

rootsroots D. Assessing informationD. Assessing information E. Managing inflammationE. Managing inflammation


VIII. Biochemical changes - VIII. Biochemical changes - PathobiochemistryPathobiochemistry

A. Connective tissueA. Connective tissue B. InflammationB. Inflammation C. EndocrinologyC. Endocrinology E. Pharmacologic ConsiderationsE. Pharmacologic Considerations

PHYSIOLOGY 1 LECTURE OUTLINE 19 The Physiology of the Subluxation Complex.

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