No universally agreed upon description exists for the ubiquitous chiropractic diagnosis of “Subluxation”. Chiropractors believe that subluxations are complex functional and structural problems that create neuromusculoskeletal irritation capable of influencing organ system function and general health (1).
For the purpose of this discussion, lumbar subluxation will be defined as “spinal segmental joint dysfunction characterized by altered joint alignment, motion, or physiologic function in an intact spinal motion segment.” (2) This mechanical intersegmental joint dysfunction (ISJD) most commonly results in local non-radiating discomfort.
Research suggests two basic origins of ISJD, mechanical and reflexive. Mechanical dysfunction arises from an outside force acting on a segment for either; a brief trauma or an extended period of overuse. Janda has suggested that the latter cause of altered joint mechanics may begin from an imbalance between the associated muscle groups (3). Lower crossed syndrome is a common example of muscular imbalance or postural strain, that may lead to ISJD. ISJD might also arise from sustained visceral nociceptive irritation triggering reflexive segmental muscular guarding, resulting in altered joint mechanics. Psychological and emotional factors may contribute.
ISJD primarily affects the synovial facet joints. Hypomobility of these joints is thought to produce concurrent increased local nociceptive activity and diminished mechanoreceptive input (4,5,6,7). ISJD may give rise to a self-perpetuating cycle of discomfort in which the negative effects of hypomobility are perpetuated by inflammation, muscular hypertonicity (via Hilton’s Law) and imbalance. ISJD is rarely an isolated event as dysfunction in one segment often leads to involvement of other segments and the spine as a whole (3). Longstanding joint dysfunction results in premature degenerative change (8,67).
While it is difficult to estimate the prevalence of lumbar intersegmental joint dysfunction (L-ISJD), the symptom of low back pain is extremely common, reaching nearly epidemic proportions in Western society. The incidence, duration, disability, and costs of lower back pain are unparalleled. Research suggests that approximately 80% of adults will experience lower back pain at some point in their lifetime, and the one-year incidence of low back pain is up to 36% (9,10). Lower back pain is the most costly benign condition and is the single most common source of disability in workers under the age of 40 (9,11).
The peak prevalence of lower back pain is in the age group between 45 and 60 with the first episode likely to occur in the second or third decade. The condition is equally prevalent in males and females. The cumulative lifetime incidence is higher in whites (11).
Most risk factors for LBP are only weakly associated with its development (13,83). A “history of LBP” is the single greatest risk factor for a subsequent episode of LBP. (83) Factors that may possibly influence the onset and course of lower back pain include: age, physical inactivity, obesity, smoking, alcohol drinking, narcotic use, heavy manual labor, repetitive bending, twisting and lifting, static postures, short sleep duration, and exposure to whole body vibration- i.e. operating a motorized vehicle. Psychosocial factors such as stress, anxiety, depression, dissatisfaction with one’s job, and low educational status are known risk factors (10,12,50,57,64). Fear avoidance behaviors, including an attitude that back pain is particularly harmful or a negative attitude toward treatment, may prolong the course of lower back pain. Patients with vitamin D deficiency or insufficiency are more likely to exhibit LBP than subjects with normal serum 25-hydroxivitamin D3 concentration. (79)
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What we do in our office to help this condition:
1. Perform a detailed exam, assessing the alignment of the spine. Due to the fact that the nerves exiting the spine in the low back branch off and go to the pelvis, groin, hips, knees, ankles, and feet, improper alignment in any of these areas may be detrimentally affecting the lumbar spine and its surrounding tissues.
2. As indicated, adjust areas of spinal subluxations (misalignments), restoring proper alignment and nerve system function, which facilitates healing.
3. Apply electrical stimulation and heat to the muscles of the low back. Applying an electrical current helps strengthen muscles, block pain signals, and improve blood circulation.
4. If there is degeneration or herniation of the disc that is compressing a nerve, we will recommend sessions on the decompression table. Spinal decompression is a non-invasive form of traction treatment that calls for the use of a special motorized table to relieve pressure, give spacing back to the spinal discs, and promote natural healing. When the pressure on the disc is decreased or relieved, it can often return to its normal position and stop the pain.
5. Prescribe stretches and exercises in conjunction with chiropractic care to strengthen the soft tissues of the low back, core, and lower extremities.