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The Intersection between Philosophical and Operational Concepts of Vertebral Subluxation. Chiropractic Philosophy in the 21st Century David B. Koch, D.C., Professor of Philosophy, PCC. The Problem: Vertebral subluxation as a philosophic concept.
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The Intersection between Philosophical and Operational Concepts of Vertebral Subluxation Chiropractic Philosophy in the 21st Century David B. Koch, D.C., Professor of Philosophy, PCC
The Problem:Vertebral subluxation as a philosophic concept • Philosophically, vertebral subluxation is a “concept” we believe encompasses an entire class of phenomena • Chiropractic’s vitalistic paradigm creates a holistic perspective on health and function • Existence of the nerve-endocrine-immune system implies that holistic function emerges from internal (cell-cell) and external (organism-environment) communication
The Problem • The observation of dysfunction implies the existence of dis-communication (aka interference) • Interference necessarily implies the existence of meaningfulness (information) withinneuro-immuno-endocrine interactions
The Problem • Information within any signal is immaterial until received, interpreted and expressed through an appropriate (adaptive) response • Philosophically, vertebral subluxation is a metaphor concerning what we see as a possible source of interference to normal internal/external communication
The Problem • At the time the metaphor was created, any definition of how the vertebral column (or any “subluxatable articulation” for that matter) interacted with the neuro-imuno-endocrine system was mainly speculative in light of the minimal knowledge we possessed about the mechanisms of neuro-spinal interaction.
Example • A subluxation is the condition of a vertebra (why?) that has lost its proper juxtaposition with the one above, the one below or both (speculation), to an extent less than a luxation (definitional), which occludes an opening (speculation), impinges a nerve (How? When?) and interferes with the transmission of mental impulses (adaptively meaningful efferent (Why not “and/or afferent”?) nerve impulses).
The “philosophic definition” • Defining subluxation philosophically is defining subluxation as a concept, not as a phenomenon • The concept exists at a specific “level of abstraction” and should only be as specific as its level of abstraction allows. • This is analogous to defining “cancer” as a disease in which the cells of the body no longer respond to the overall control mechanisms of the body
Another Example • 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. • ACC’s Chiropractic Paradigm/Scope & Practice, 1996
More Abstract Definition • This definition increases the “level of abstraction” in three ways: • Expands from “vertebral subluxation to “any skeletal subluxation” • Generalizes concerning how the “functional and/or structural and/or pathological articular changes”… “compromise neural integrity” • Introduces holistic outcomes into the conceptual construct of the “subluxation”
The Other Side of the ProblemOperational definitions of vertebral subluxation • Scientifically, vertebral subluxation is a phenomenon, worth studying (investing time and $ in) only in proportion to its significance to human life and purposes. • Chiropractors proposed that it held a greater level of significance earlier than any other health care theory
The Other Side of the Problem • The possible significance of vertebral subluxation was proposed in the absence of any but the most rudimentary knowledge of both spinal biomechanical function and neuro-imuno-endocrine function.
The Other Side of the Problem • Most exploration has been clinical, leading to “operational” definitions of vertebral subluxation • Leg checks, palpable findings, radiographic comparisons, instrumentation readouts • A “subluxation” is what exists in the body when we find these following signs/ indicators/symptoms from the outside
Operational Definitions • Operational definitions are mainly phenomenological, not conceptual • What input (specific operation) produces what reproducible outcome (specific change)? • Operational hypotheses are driven to have the fewest variables (limits of the scientific method) • Usually address only one or two aspects of any complex phenomenon (life, VS, disease)
Operational Definitions • Most diseases are defined and researched operationally • Most subluxation research has been based on a specific, operational definition of subluxation • Tends to be influenced by ongoing theoretical speculation, lack of scientific rigor and $$$
The Other Side of the Problem • The concept of the vitalistic significance of vertebral subluxation (as an energetic challenge to holistic self-awareness and self-regulation) has had to compete with the greatest explosion of biological operationalism (pharmacology and genetic determinism) ever seen
The Other Side of the Problem • Aspirin – 1895 • Antibiotics – 1928 • DNA structure – 1953 • Immuno-suppression and organ transplant – 1970’s • Recombinant DNA technology – 1990’s
The Other Side of the Problem • Chiropractic’s vertebral subluxation metaphor both defined and alienated the profession • Philosophic paradigm nearly discredited • Philosophic speculation became dogma • The simplicity of the metaphor belies the complexity of the phenomenon itself
“Vertebral Subluxation” Today • Explosive increase in both chiropractic subluxation research and interest in the phenomenon by other professions • JMPT, RACI-VIII, CCCR, FCER, JVSR • Multiple technique-driven theories of VS increase research into specific aspects of VS • Osteopathy (Korr – 70’s), physiotherapy, physiatry all exploring neuro-spinal interaction
“Vertebral Subluxation” Today The Challenges: • Disconnecting the scientific exploration from narrow historical, philosophical or technique dogmas • Maintaining the value of the VS metaphor while engaged in the open-ended, skepticism-driven process of scientific hypothesis generation and testing
“Vertebral Subluxation” Today The Challenges: • Solving the afferent vs. efferent dis-ease problem • Integrating multiple mechanisms into a comprehensive neuro-immuno- endocrine/spinal biomechanical theory of coordination, adaptation and health enhancement
Summary • Philosophical definitions of vertebral subluxation serve us well as metaphors, but tend to be too specific and thus too restrictive, or to generalized to research without being operationalized • As scientific research on subluxation progresses, multiple operational definitions, theories and investigative foci tend to develop simultaneously
Summary • The challenge is to maintain a simple and clear metaphorical model of vertebral subluxation throughout the skepticism-driven scientific inquiry into its true nature • Ultimately, we should seek to create a comprehensive neuro-immuno-endocrine/ spinal biomechanical theory of the body’s innate intelligence and its relationship to coordination, adaptation and health