The Rubicon Group, in cooperation with its member programs and institutions, is pleased to present a series of discussions on the COVID-19 global pandemic and its interface with the global chiropractic community. These discussions are intended to provide feedback to the chiropractic community as we continue caring for patients and our broader communities during these unusual times.

The key messages we wish to emphasize include the following:

• The need to be aware of and follow guidance from the World Health Organization (WHO) as well as that of the authorities in the jurisdiction of practice
• The need to provide accurate, up-to-date and fact-based information, to the best of our ability and experience, with respect to all health-related matters, especially COVID-19 issues
• The need to provide information about the basic science mechanisms associated with chiropractic care that could impact the infectious disease response of the human organism as well as the need to acknowledge inadequate evidence upon which to base any clinical claim associated with chiropractic care in this environment
• The need to reflect upon evidence-based best practices that aim to enhance host resilience by identifying health facilitators, as well as disease risk factors, in applying clinical interventions and self-care / lifestyle-related advice
• The need to provide guidance and counsel to the chiropractic community regarding the best approaches from a health, public safety and community responsibility perspective to be used at this time.

The Rubicon Group, is pleased to present the work-product of a year-long development process related to an evidence-based definition and contextual statement related to the term: chiropractic subluxation.

Download paper here.

The following statement was unanimously adopted by the member institutions of The Rubicon Group

Definition and Position Statement on the Chiropractic Subluxation

The term ‘subluxation’ has been used by the chiropractic profession for over a century.^{1, 2} It is an important element of chiropractic practice, embedded in legislation and regulation, and its  clinical implications have been, and continue to be scientifically explored.^{2, 3}

The term subluxation, as used by chiropractors, is a researchable concept that is important to health and health care delivery.^{1, 2, 4} The need to properly define this entity has been widely recognized as a high priority within the profession, as evidenced by the number of groups and organizations who have offered definitions of subluxation.^{1, 2 5-10}

Many of the past definitions do not provide a testable definition of chiropractic subluxation.¹¹ Some do not reflect the current research that supports a neurologically-centered model of subluxation.²The Rubicon Group (TRG) has utilized the current available scientific evidence to define the chiropractic subluxation. Contemporary neurophysiological language and concepts, based on current scientific publications on the topic, have been used. As this definition is subject to ongoing scientific exploration that is likely to lead to new findings and understandings, modifications may be anticipated. However, this definition reflects what is currently known, and it is congruent with current neurophysiological scientific understanding

 “We currently define a chiropractic subluxation as a self-perpetuating, central segmental motor control problem that involves a joint, such as a vertebral motion segment, that is not moving appropriately, resulting in ongoing maladaptive neural plastic changes that interfere with the central nervous system’s ability to self-regulate, self-organize, adapt, repair and heal.” (The Rubicon Group, May 2017.)

There are three key elements, namely:

Click for large image.

A chiropractic subluxation often relates to the spine and its connecting structures.¹ Chiropractic subluxation assessment generally involves evaluating the pathophysiological consequences of the central segmental motor control problem;^{4, 12} these may include pain, asymmetry, biomechanical or postural changes (such as changes in relative range of intervertebral motion), changes in tissue temperature, texture and/or tone, and other findings that can be identified using special tests.¹²Once identified, subluxations are corrected using a variety of techniques including high velocity low amplitude chiropractic adjustments, instrument assisted adjustments, and lower force manual techniques and approaches.¹³

A growing body of scientific evidence has demonstrated that spinal function impacts central neural function in multiple ways,^{3, 4, 14-19} and that improving spinal function has an impact on clinical outcomes.^20-24 Scientists have known for several decades that neurons continuously adapt in structure and function in response to our ever-changing environment.^25-27 This ability to adapt is known as ‘neural plasticity’,²⁷ and it is now well understood that the central nervous system can reorganize in response to altered input.^28-35 Examples of increased sensory  input[1] that can lead to neural plastic changes include repetitive muscular activity ^{29, 36-41} such as typing or playing the piano, or repeated tactile sensory input such as occurs with blind Braille readers.⁴² Similar central nervous system change or reorganization may take place due to a decrease in behavior or activity.[2] ^{32, 43-49} Thus the concept, that alterations in paraspinal muscle function due to abnormal spinal movement patterns are capable of changing central neural function is totally congruent with current neuroscience understanding, as well as current scientific findings.^{3, 4, 14-19}

[1] In the scientific literature, this can be known as hyperafferentation. Hyper–meaning increased, and afferentation – meaning the afferent nerves, which are the ones that go to the brain with information.

[2] In the scientific literature, this is often called deafferentation.

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