Objective: The aim of this study is to investigate the percentage of asymptomatic subluxations in patients presenting to chiropractic offices in Germany.
Data Collection: Data was collected via email questionnaire sent out to 25 German chiropractors. The chiropractors were asked to estimate the number of their patients who present with subluxations that were not conscious to the patient and not symptomatic before detection by the managing chiropractor. They were also asked to estimate the number of patients visiting their office per week.
Results: 19 of the 25 chiropractors receiving the questionnaire provided data. The 19 participating chiropractors together see an estimated average of 3,100 patients per week. The estimated number of patients presenting with at least one asymptomatic subluxation ranged between 60% to 100%. On average, 93.73% of patients presented with asymptomatic subluxations. The average number of patients seen per week was 172.2.
Conclusion: Our data demonstrated that 93.73% of the patients presenting to 19 chiropractic offices in Germany had asymptomatic subluxations. This lends support to the widespread view among chiropractors that patients should be checked for subluxations regardless of symptoms being present.
Key words: Chiropractic, vertebral subluxation, epidemiology, Germany, adjustment, spinal manipulation
Introduction
It is a widespread belief among chiropractors that patients
should be checked for subluxation regardless of symptoms.
The position paper of the International Federation of
Chiropractors and Organizations (IFCO) states in part: “The
correction of vertebral subluxation is appropriate for anyone
exhibiting evidence of its existence regardless of the presence
or absence of symptoms and/or disease. Therefore, the
determination of the presence of vertebral subluxation stands
as a sole rationale for care.”
1 The Council on Chiropractic
Practice states “Vertebral subluxation may be asymptomatic,
yet still exert various physiological effects.”
2
Research has shown that noxious stimuli do not necessarily
result in conscious symptoms. Chestnut reviews the scientific
research supporting the assumption that dysfunction and
disease can be present without conscious perception of pain or
other symptoms.3
Chestnut states “Chronic increased nociceptive input results
in a chronic increased stress response and stress related
adaptation and disease susceptibility (increased allostatic
load) in the host which often take place in the absence of
conscious pain.” 3
Seaman states “Inflammation, nociception and muscle spasm
are physiological processes and do not require the
involvement of our brain in a conscious fashion.”4
A large number of studies have shown that severe
degeneration of joints and associated structures like discs can be present without any conscious perception of symptoms by
the host.5-9 Research by Gore at al. has also shown that the
degenerative changes and also the incidence of symptoms,
increase with time.10
Mierau has shown that the prevalence of subluxation of the
sacroiliac joints in children increase with age. Also with
increased age the number of symptomatic versus
asymptomatic children with sacroiliac-joint dysfunction
becomes greater with more children developing low back
pain.
11 This supports the assumption that dysfunction can be
present long before conscious symptoms arise.
Various studies have shown that hypomobility of a joint leads
to degenerative changes in the joint and related structures.12-15
It has also been demonstrated that chiropractic adjustments
effectively reduces hypomobility16-21 among other positive
effects on health and function. Trierweiler et al. have
demonstrated in a rat model that chiropractic adjustments can
significantly reduce local allodynia after immobilization.22
Hannon found in an extensive review of the available
literature that chiropractic adjustments have multiple health
benefits in asymptomatic patients.23
It has not been investigated yet how many patients visiting a
chiropractic office present with asymptomatic subluxations.
Subluxation in this context is defined as follows “A
subluxation is a complex of functional and/or structural and/or
pathological articular changes that compromise neural
integrity and may influence organ system function and general
health“.24 Kinesiopathology, meaning decreased motion in
joints and tissues along with changes in muscle tone are
integral components of the subluxation that are palpated by the
chiropractor.
Our paper attempts to investigate the percentage of patients
presenting in a chiropractic office with subluxations that were
asymptomatic to the patient before detection by the treating
chiropractor. We are not concerned with completely
asymptomatic patients. This paper aims at evaluating how
many patients generally present with asymptomatic
subluxations potentially among other symptomatic ones.
Methods
To evaluate the percentage of asymptomatic subluxations in
chiropractic patients, we sent out an email questionnaire to 25
German chiropractors. The authors of this study also
contributed their own data. The chiropractors of the group
questioned are experienced practitioners in Germany.
The questions asked were:
1. According to your personal estimate, how many of the
patients that you treat every day have asymptomatic
subluxations? This means how many patients have
possible symptomatic subluxations and/or subluxations
that they didn't notice themselves, but show to be clearly
subluxated in your evaluation/palpation and are
noticeable/painful to the patient on palpation (but not
before).
2. How many patients do you see per week?
Results
19 of the 25 chiropractors responded to the questionnaire and
provided data. These 19 chiropractors treat a total estimate of
3,100 patients a week. This is an average of 172.2 patients per
chiropractor per week. The range of patients treated per week
was 45-500.
The lowest estimate for percentage of patients presenting with
asymptomatic subluxations was 60%. The highest was 100%.
Interestingly, out of the 19 chiropractors providing data 10
answered that 100% of their patients present with
asymptomatic subluxations. The majority estimates the
number of patients presenting with asymptomatic subluxations
as well over 90%.
The diagram (Chart 1) shows the different estimates of
percentage provided by the 19 chiropractors. These data reveal
an average of 93.73% of patients presenting with
asymptomatic subluxations among this group of 19 German
chiropractors.
Limitations
Our study has limitations. The data collected were from an
estimate of the chiropractors questioned. Since an estimate can
not show the actual numbers, the precise percentage remains
unknown. There was no data available regarding the precise
evaluation and palpation techniques to locate subluxation of
the participating chiropractors. Differences in practice could
lead to different estimates.
A different aim in practice could also lead to different
estimates. If the chiropractors aim is mainly to treat pain,
many subluxations could be overlooked because they may be
located in body-regions not described as painful by the patient
in his initial exam.
Future Research
Future studies could build upon our results to create a study
design capable of obtaining more precise data. The actual
number of asymptomatic subluxations in a group could be
collected. The evaluation techniques could be defined more
clearly.
Conclusion
From the analysis of the collected data it appears that
asymptomatic subluxations that are not consciously perceived
are common among patients presenting in chiropractic offices
in Germany. This lends support to the widespread belief
among chiropractors that people should be checked for
subluxations regardless of conscious symptoms being present.
Funding Sources and Potential Conflicts of Interest
No funding sources or conflicts of interest are reported for this
study.
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