Vertebral subluxation, the basic premise of chiropractic, is wrong. D.D. Palmer's second chiropractic theory, from which the traditional beliefs of the chiropractic profession are drawn, has never been scientifically validated, yet the majority of chiropractors today profess faith in its fundamental truth. On posters and in advertisements, chiropractors sometimes portray subluxations as "the silent killer," inferring an only-your-chiropractor-knows-for-sure argument that regular chiropractic visits are necessary to remain subluxation free, thus ensuring health and longevity.
Left: This depiction of a vertebral subluxation is fiction. Normal nerves exiting from the spinal canal are shown at A and C. At B there is a pinched nerve exiting from behind a subluxated vertebra. The vertebra appears to have slipped backward slightly. The nerve is portrayed as withered, as if the supposedly subluxated bone has squeezed the life out of it. (Photo courtesy of Joseph Keating, Ph.D.)
The concept of the subluxation is at the core of chiropractic. It is the vertebral subluxation that defines the profession and differentiates it from other healing professions that perform spinal manipulation, mainly osteopaths and physical therapists. As first conceived by D.D. Palmer, a subluxation is a small misalignment of a vertebra which causes interference to the flow of energy, “Innate Intelligence,” from the brain through the spinal cord to the nerve adjacent to the misaligned bone. This causes dysfunction, which Palmer called“dis-ease,” and can eventually result in disease in the nerve’s target organ or tissue. Chiropractors believe vertebral subluxations are pandemic. It is highly unusual for a chiropractor not to find one or more subluxations when examining someone’s spine, but even if one chiropractor doesn't find any you can be sure that the chiropractor in the next block will.
Subluxation is a medical term that chiropractors have applied to their own ideology. To a medical physician, a subluxation is a minor dislocation of a joint, at least when compared to a full dislocation. If your shoulder joint is dislocated, a luxation, the head of the humerus (1) is completely disengaged from its socket. If it is subluxated, the joint surfaces are still in partial contact. These kinds of subluxations usually occur as a result of trauma. They can be very painful. A subluxation is serious insofar as the muscles, tendons, and ligaments are usually injured when the bones are misaligned. A spinal subluxation, especially in the neck, is a serious concern because the instability thus created threatens injury to the spinal cord. Subluxations can also occur in people with osteoarthritis, rheumatoid arthritis, hip dysplasia, spondylolisthesis, and Ehlers-Danlos syndrome. They are most often diagnosed by imaging, usually x-ray but also CT and MRI scans. Imaging studies provide objective evidence of subluxations, so one would expect a high degree of concurrence between doctors who read the same imaging study. Treatment consists of restoring normal alignment either by manual manipulation—a closed reduction—or surgically, what’s called an open reduction, although some subluxations reduce on their own. Immobilization is usually necessary for a time while muscles, tendons, and ligaments heal and the joint regains stability.
Evidence for the existence of subluxations (in the chiropractic sense of the term, which henceforth will be the meaning of this term unless identified as a medical subluxation) is scant, as is scientific confirmation of their adverse affects on health and the benefits of correction by spinal adjustments, but lack of evidence has had little effect on chiropractors’ beliefs in subluxation theory.
Nearly 3,000 chiropractors, a representative sample of all US DCs, responded to a survey of their attitudes and behaviors about subluxation (2). As seen in Table 1, the majority of respondents were subluxation oriented.
Strongly or Moderately Agree
Slightly Agree or Disagree
Strongly or Moderately Disagree
The detection and resolution of subluxation guides my clinical care of patients.
My most important clinical decisions are about subluxation.
Generally, I consider my clinical approach to be “subluxation-centered.”
I use the term “subluxation” when discussing or explaining a patient’s condition to them.
Table 1. Survey of Chiropractors about Subluxation. Adapted from Survey of US Chiropractor Attitudes and Behaviors about Subluxation (2).
In another survey, nearly 700 chiropractors in North America (the US, Canada, and Mexico (3)) responded to similar items (4). This survey found that over 88% favored retaining the term vertebral subluxation complex (a variant of the term subluxation.) In response to the question,”Should the adjustment be limited to musculoskeletal conditions?” nearly 90% answered no, signifying the importance of adjustments to visceral (i.e., internal organ) problems. The surveyed chiropractors also believed that in about 62% of visceral ailments vertebral subluxations were a significant contributing factor. A large majority stated that adjustments usually elicited improvements in the four non-musculoskeletal conditions listed in Table 2.
Percentage of "yes" responses
Table 2. Percent of surveyed chiropractors indicating that adjustments usually elicit improvements in four non-musculoskeletal conditions. Adapted from How Chiropractors Think and Practice: The Survey of North American Chiropractors (4).
Why are chiropractors so certain that subluxations exist, that they cause or are involved with many if not most health problems, that diseases of internal organs can be helped by correcting them with chiropractic adjustments? What evidence do chiropractors cite as justification for their beliefs? Part 2 of The Silent Killer speaks to these issues.
The upper arm bone back
Smith M, Carber L. Survey of US Chiropractor Attitudes and Behaviors about Subluxation. Journal of Chiropractic Humanities. 2008;15:19–26. back
Well over 90% were US chiropractors; Canadian DCs accounted for 8%; only 0.3% of respondents (i.e., 2 chiropractors) were from Mexico. back
McDonald, W. Durkin, K. Pfefer, M. How Chiropractors Think and Practice: The Survey of North American Chiropractors. Seminars in Integrative Medicine 2004, 2 (3), 92–98. back