Joint Dysfunction. A 21st Century Concept.

I’m sure many of you therapists who perform any type of high or low thrust manipulation to the low back or neck always get the question, “this feels like I’m at the chiropractor”, “are you giving me an adjustment”, or some saying to that degree.  Even if you don’t thrust, the ‘million-dollar-roll’ approach can be of imitation to manipulative techniques.

The next question usually is, “whats the difference between DC and PT?”.  Well, this question can be answered in many ways concerning our education, clinical training, history, philosophies, goals, treatment approaches, etc.  The full discussion is not the scope of this post. However, I usually answer the simple question along the lines of what we are correcting, or attempting to correct.

Note the term correct, not adjust.  Physical therapists do not treating motor vehicles.  So, what is my approach?

My approach is to translate the condition as a joint dysfunction, not a subluxation needing adjustment.  The latter was claimed to be the underlying principle in 1895 and still is, over 115 years later.  Don’t get me wrong, not all chiropractors use this principle but is still very much the basis behind treatment.

What are the subluxation and adjustment constructs?  Palmer proposed three relationships:

1.  There is a fundamental and important relationship between the spine and health that is mediated through the nervous system.

2.  Mechanical and functional disorders of the spine or subluxations can have a deleterious effect on health status.

3.  Correction of the spinal disorders by way of adjustments may restore health.

The above has never been proven and is definitely not the framework behind physical therapy’s movement dysfunction mold.   The General Chiropractice Council in UK even published a new statement on the subluxation complex:

“The chiropractice vertebral subluxation complex is a historical concept but it remainds a theoretical model.  It is not supported by any clinical research evidence that would allow claims to be made that it is the cause of disease or health concerns”

So, what is a joint dysfunction?

-Basically, it is a joint that is not moving correctly.  It is as easy as that.  No economic means or conflicting theories.  Hate to say it, but do we really need a doctorate to relay this information?

For more info on examples, review a past post on joint dysfunction here.

Bottom Line:

Let’s get in the 21st century and out of the 19th century.

This post is not intended to disgrace or vilify the chiropractic profession or its background.  It is of personal intentions to educate our patients of the treatment approach that I currently provide.  As a clinician, I want to give the more evidenced-based, but also honest opinion of the problem to my patients.

Huijbregts PA.  Chiropractic Legal Challenges to the Physical Therapy Scope of Practice: Anybody Else Taking the Ethical High Ground?  Editorial in JMMT. Vol 15, No 2. 2007, 69-80.

Keating JC et al.  Subluxation: dogma or science? Chiropractice & Osteopathy.  2005, 13:17.

Nasel D, Szlazak M. Somatic dysfunction and the phenomenon of visceral disease simulation: a probable explanation for the apparent effectiveness of somatic therapy in patients presumed to be suffering from true visceral disease. J Manipulative Physiol Ther. 1995;18:479-397.