1. PHYSIOLOGY 1 LECTURE OUTLINE 19 The Physiology of the Subluxation Complex

2. Physiology of the Subluxation Complex n I. Introduction n Classically the subluxation complex was viewed as an osseous impingement on nerves (Bone on Nerve) that interfered with the proper function of the nerve. In recent years a more comprehensive definition has arisen as our knowledge base increases.

3. Physiology of the Subluxation Complex n The Vertebral Subluxation Complex is a complex model of spinal nervous dysfunction and deterioration which involves all of the associated tissues of the region. It does not necessarily involve impingement of the osseus tissue on the nerve but due to vertebral misplacement may involve partial or full obstruction of the nerve due to inapproate muscle contraction or stretch of the surrounding connective tissue.

4. Physiology of the Subluxation Complex n Therefore, the vertebral subluxation complex involves: n 1. Kinesiological dysfunction - Kinesiopathology n 2. Nerve dysfunction - Neuropathophysiology n 3. Muscle dysfunction - Myopathology n 4. Vascular Pathology n 5. Connective tissue deterioration n 6. Inflammatory response n 7. Pathoanatomy n 8. Pathophysiology n 9. Pathobiochemistry

6. Physiology of the Subluxation Complex n Basic Theory - A vertebral joint becomes immobilized or fixated due to misalignment, twisting, or tilting resulting in a decline or loss of joint articulation. The immobilized joint in turn pinches nerves and blood vessels exiting the area restricting both nerve and blood outflow to the surrounding tissues.

7. Physiology of the Subluxation Complex n Basic Theory (cont.) - Restricted nerve and blood outflow leads to decreased nerve function (decreased velocity of AP conduction) and vascular function (Restriction of blood vessels leads to turbulence and increased arteriosclerotic plaguing resulting in tissue hypoxia). This in turn will lead to deterioration of the tissue beds being supplied and eventually leading to tissue necrosis.

8. Physiology of the Subluxation Complex n II. Kinesiological Dysfunction (Hypomobility) –A. Immobilization degeneration (Fixation) n 1. Lack of movement - misalignment, rotation, tilting, etc. n 2. Stiffness associated with pain n 3. Joint degeneration - increased connective tissue and calcification of the connective tissue n 4. Ultimately fusion by bony ankylosis

10. Physiology of the Subluxation Complex n 2. This stretches or deforms the connective tissue along one side of the vertebral joint, while compressing the opposite side. Even through the bone is not in contact with the nerve the nerve may still be under compressive forces due to the deformation of the connective tissue.

12. Physiology of the Subluxation Complex n 3. Restriction of movement in spinal joint will lead to compensatory changes elsewhere in the spinal column. n 4. Motion segment - Two adjacent vertebrae joined by an intervertebral disk, two posterior articulations with their capsules, several intrinsic ligaments, and may include the muscles and segmental contents of the spinal canal

14. Physiology of the Subluxation Complex n a. Chiropractic evaluative procedures are often directed at determining specific intersegmental motion or positional abnormalities n b. Treatment involves restoring normal motion through adjustment n B. Restoration of normal range of motion restores normal joint function and surrounding tissue physiology

15. Physiology of the Subluxation Complex n 1. Time required to restore full function depends on the time spent immobilized n 2. In extreme cases restoration of full range of motion results in the formation of a new joint. (?) n 3. Forced motion (Chiropractic Thurst) causes physical disruption of adhesions between gross joint structures and leads to the disruption of the intermolecular cross- bridging of the collagen fibers (Calcification)

17. Physiology of the Subluxation Complex n III. Nerve Dysfunction (Neuropathophysiology) n A. Spinal nerves n B. Dorsal root ganglia n C. Articular neurology n D. Pain n E. Viscerosomatic relationships n F. Somatoautonomic relationships n G. The Neurodystrophic hypothesis n H. Trophic influences n I. Neurodiagnosis

18. Physiology of the Subluxation Complex n IV. Muscle Dysfunction (Myopathology) n A. Disuse Atrophy n B. Evaluation Procedures n C. Therapeutic benefits (Physical Therapy)

19. Physiology of the Subluxation Complex n V. Connective Tissue Pathology n A. Joint immobilization n B. Increased calcium crossbridgeing n C.Adhesions between separate joint segments n D. Ligament contracture n E. Diagnostic tests n F. Chiropractic adjustment

20. Physiology of the Subluxation Complex n VI. Vascular Pathology n A. Chiropractic - Osteopathic n B. Blood supply to motion segment n C. Occlusion of spinal veins leads to motion segment stiffness n D. Occlusion of spinal arteries leads to deterioration of the joint n E. Evaluation procedures n D. Therapeutic benefits

21. Physiology of the Subluxation Complex n VII. Inflammatory response n A. General n B. Arthritis n C. Inflammation of nerves and nerve roots n D. Assessing information n E. Managing inflammation

22. Physiology of the Subluxation Complex n VIII. Biochemical changes - Pathobiochemistry n A. Connective tissue n B. Inflammation n C. Endocrinology n E. Pharmacologic Considerations