news.gif (12017 bytes)Scientific Basis For Subluxation Sprain/Strain

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LibertyYour editor wrote these articles while a student at an accredited Chiropractic Medical School.  During those days, there were only two fully Accredited Chiropractic Schools.  The ACA gave permission to reproduce this research at Chiropractic Colleges.  It was through works like this concomitant with far more talented Doctor's of Chiropractic, which helped the evolution of Chiropractic Medicine; today Chiropractic Colleges are accredited.

The Theory of Chiropractic Trauma, which had eluded scientists for centuries Part 1 Published by the American Chiropractic Association Journal for the Profession, JACA 1980.

INTRODUCTION

     This researcher developed initial theories, at the University of Minnesota and finalized them during my first two terms at the Los Angeles College of Chiropractic.  Our then College Dean/neurologist PhD, and I named the initial theories the "Somato-Neuro-Muscular and Viscero-Neuro-Muscular Pathway" published by the American Chiropractic Profession in their official publication the ACA Journal in 1980 (e.g., Then Los Angeles College of Chiropractic Dean Tran writes, "it is a great pleasure that the college has given you the spirit to make such contributions to the profession.  And I thank you for the college.").  The Somato-Neuro-Muscular pathway explains a mechanism of pain and discomfort via direct trauma to the spine. The Viscero-Neuro-Muscular Pathway circuits the mechanism of subluxation or altered joint dynamics via spasm occurring as a direct result of visceral irritation or disease.

     During my third and forth terms this researcher had written and subsequently published the mechanism of altered joint dynamics via "over exertion" known as the "Physio-Somato-Neuro-Somatic" reflex systems to finalize my investigations in the causality of injury and need for manipulative care.  Today, lets review the Somato-Neuro-Muscular and Viscero-Neuro-Muscular pathway, which follow:

FORENSIC TEXTBOOK SCIENCE

     A subluxation is a partial dislocation of articulating surfaces of joints, distinct from luxation, which is a complete dislocation. When a vertebra has been subluxated, ligaments, muscles and other structure in close and delicate association with the vertebra move.1 Thus, a point in time arose when direct trauma to the spine had occurred from a foreign object or a fall on the spine.  For example, if the fifth vertebra thoracic has been subluxated (joint dynamics have been altered) by trauma or other causes one or more ligaments associated with it will be stretched! Articular capsules, ligamentum flavum, supraspinous and intertransverse ligaments are usually the first ones to develop tension by rotation lateral flexion-rotation of the vertebra. Interspinous, anterior and posterior longitudinal ligaments also are involved. If the tension of ligaments reaches a certain threshold, pressure stimuli will stimulate receptors associated with the ligaments. From the receptor the stimuli will travel in the spinal nerve to its cell body located in the dorsal root ganglion and to its axon, to enter the dorsolateral region of the spinal cord. By following this pathway the stimuli will ascend in the ipsilateral posterior funiculus of the spinal cord. As the primary sensory neuron enters the posterior funiculus, it sends a collateral to the posterior horn.2  This collateral synapses with internuncial neurons associated with the anterior horn, the lateral horn and the areas of the reticular system in the central gray area. This system will be discussed with the pain and temperature pathway.

     The primary neuron which enters the posterior funiculus at this vertebral level (e.g. fifth spinal nerve) would enter the fascicules cuneatus. The fascicules cuneatus ascends to terminate in the low medulla oblongata and synapses with the cell body of the secondary neuron located in the nucleus cuneatus. From the nucleus cuneatus, the secondary neuron decussates to form the internal arcuate fiber into the posterior portion of the medial lemniscus. This neuron now ascends through the pons as part of the medial lemniscus. In the pons, the medial lemniscus rotates so that its posterior portion becomes medial and its anterior portion becomes lateral. The secondary neuron is located in the medial portion of the medial lemniscus. From there, it ascends to terminate in the posteriolateralventral nucleus of the thalamus. The posteriolateralventral nucleus of the thalamus represents the site of the cell body of all tertiary neurons of this pathway. From there, the tertiary neuron ascends through the posterior limb of the internal capsule, through the corona radiata to end in the post central gyrus, also know as the somesthetic cortex, area 3,1,2. At this level the brain would acknowledge the tension of ligaments involved.3

     The primary neuron also synapses with association (internuncial) neurons in the posterior horn. These internuncial neurons will synapse with the reticular neurons located in the reticular core of the central gray area.4 From there, the spinothalmo-reticulo-limbic pathway ascends to higher centers including the hypothalamus. Impulses from the hypothalamus will descend through reticulospinal pathways to the lateral horn and at the anterior horn at the level of the spine. From the lateral horn of appropriate levels stimuli will be carried to the respective organs by way of sympathetic fibers. This preganglionic neuron enters the sympathetic chain ganglia to synapse with a postganglionic neuron. From there, the postganglionic neuron goes to smooth muscles of bloods vessels.5 This may cause vasoconstriction.

     The reticulospinal fibers, which terminate into the anterior horn, will synapse with lower motor neurons. The lower motor neuron goes to striated muscle in the area of the altered joint dynamics (Chiropractic Subluxation) on the ipsilateral side. This innervation increases the tonus of the associated back muscles.6 The muscles increase their energy output which causes an increased contraction of arterial blood vessels, engaging endothelium triggers which release endothelan-1 and prostanoids further causing vascular constrictions, ischemia, increased lactic acid, bradykininn, P factor, hydrogen ions, potassium ions, and metabolites formed by the breakdown of muscle (waste materials), are all produced.7   They subsequently accumulate in the tissue spaces, with resulting increased interstitial fluid colloid osmotic pressure, increased muscle fluid in the interstitial space, increased muscle stiffness, over-stimulation of nerve endings by the presence of trapped metabolites, temporary local soft tissue acidosis resulting from lactic acid and the hydrogen ions, (Please see Part 2.  Subluxation caused by muscular overexertion sprain/strain) pain, muscular spasticity with the resultant altered joint dynamics (again restricted, strained and sprained spinal joints).

     From the stretching of the ligaments associated with the subluxation, Golgi end organs connected with the conscious proprioceptive pathway conduct their impulses to the dorsal root ganglion to enter the central nervous system at the Lissauer’s marginal zone and synapse with the nucleus proprius. From there, the tertiary neuron ascends to the post central gyrus areas 3, 1, 2 of the somesthetic cortex. This tract follows closely the path of the pain and temperature pathway (internal capsule to corona radiata to somesthetic cortex).8

     When the primary neuron synapses with the secondary neuron of the pain and temperature pathways at the spinal level, intersegmental neurons generally carry the impulses from one to two levels above and below the spinal level of origin.9  With several levels stimulated, muscles spasticity may spread to levels above and below the area of altered joint dynamics (Chiropractic Restriction-Subluxation). This condition could lead to subluxations at other levels because increased muscle tonus produces areas of altered joint dynamics (The Chiropractic Subluxation Complex). This cyclic pathway, which has been presented and has stood the test of Judicial Review, Justice Department Review, Scientific Review, and Chiropractic Review is known as the "Somato-Neuro-Muscular Pathway".

     Another common type of back pain manifested by altered joint dynamics (The Chiropractic Subluxation) stems from internal organ irritation. For example, if too much hydrochloric acid has been secreted within the stomach the irritation may stimulate the submocosal sensory fibers of the Meissner’s plexus.10  These pain fibers enter the central neurons system and from the lateral spinothalamic tract, end in the cortex, as previously described. Because the primary neuron of the pain pathway synapses in the posterior horn, it is associated with a circuit connecting internuncial neurons to the lateral horn, anterior horn and to the reticular system.

     Muscles spasticity is produced via the anterior horn connections. Synapses from the lateral horn cause vasoconstriction of blood vessels by the sympathetic system leading to ischemia, increased lactic acid, increased P factor, Hydrogen and Potassium ions, thus an increase in pain. The muscles’ spasticity can cause altered joint dynamics in the back and a vicious cycle results.

     This visceral pathway, which has stood the test of Judicial Review, Justice Department Review, Scientific Review, and Chiropractic review is called the "Viscero-Neuro-Muscular Pathway". Today, we have firmly established that the pancreas can refer pain to the lumbar spine, the Gall Bladder refer to the tips of the scapula, the heart to the Jaw, left shoulder arm and so forth.

DISCUSSION:

     Although Chiropractic Medicine has repeatedly proved itself in practice, this proof should be communicated to the medical world in its own language; a task that can only be accomplished by demonstrating chiropractic principles first in theory, then by clinical trials and by demonstrating said principals in the laboratory.  Thus, through work such as this and laboratory experiments the medical profession and the chiropractic profession will, one day, work together to make the world a healthier place in which to live.

     Look to the "Somato-Neuro-Muscular Pathway" and the "Viscero-Neuro-Muscular Pathway" as the first bridge to new and greater shared communications with our partners in health care, the medical community.  "Health Care is a team effort and should not be divided" (Neff 1980 The Neuroanatomy of Vertebral Subluxations-ACA)".

 Ye shall know the truth, and the truth shall make you free. ”John, viii, 32

REFERENCES:

1.  Gray's Anatomy, 35th British edition, W.B.     Saunders Company, 1978, pp 413-414.

2.  Carpenter:  Human Neuroanatomy, 7th edition, Williams and Williams Company 1977, pp 238-242. Fig 10-1

3.  (i) Gray's Anatomy 35th British edition, W.B. Saunders Company 1978, pp 824-825. (ii) Carpenter: Human Neuroanatomy, 7th edition, Williams and Williams Company, 1977, pp 238-242.

4.  Gray's Anatomy, 35th British edition, W.B. Saunders Company 1978, pp 836-837, 888-890.

5.  Guyton: 5th edition, W.B. Saunders Company 1976, pp 768-773, 776-778.

6.  Carpenter: Human Neuroanatomy, 7th edition, Williams and Williams Company, pp 255-261.

7.  (i) Lewis, T.; Pain, The MacMillan Co., 1943, pp 99-103. (ii) Kor, I.M.: The Neurobiologic Mechanisms in Manipulative Therapy, Plenum Press, 1978, p.457.  (iii) Buergen and Tobis; Approaches to the Validation of Manipulative Therapy, Charles C. Thomas, 1977, p. 191.

8.  Carpenter: Human Neuroanatomy, 7th edition, Williams and Williams Company, 1977, pp 245-248.

9.  Guyton: 5th edition, W.B. Saunders Company, 1976, p. 652.

10.  Guyton: 5th edition, W.B. Saunders Company, 1976, p. 852

EDITORS NOTE:  Looking back, I have noticed a very interesting advertisement on the back side of the facing page of my article within then official publication for the Chiropractic Profession, the Journal of the American Chiropractic Association.  The add is from the "International Academy of Trial Lawyers" for featured speaker, F. Lee Bailey.  Under his picture it is written, Internationally known attorney, author, teacher and lecturer, on "Successful Management of Personal Injury Litigation...."  You just cannot make this stuff up.

by Scott D. Neff, DC CFE DABFE FFABS FFAAJTS

SCIENTIFIC INVESTIGATION INTO SUBLUXATION STRAIN SPRAIN PART TWO BY SCOTT D NEFF, DC DABCO MSOM MPS-BT CFE DABFE FFABS FFAAJTS

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© & TM 1998 American Academy for Justice Through Science. All rights reserved.

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