vertebral subluxation vertebral subluxation in chiropractic, a vertebral subluxation means pressure on nerves, abnormal functions creating a lesion in some portion of the body, either in its action or makeup (defined by d.d. palmer and b.j. palmer, founders of chiropractic). subluxations are not necessarily visible on x-rays. this article is about the chiropractic concept. for medical subluxations, see subluxation. vertebral subluxationa chiropractor performing a precise vertebral adjustment of the lumbar spine on a patient.alternative therapynccih classificationmanipulative and body-basedlegalitydiffers from country to country this article is part of a series onalternative medicine general information alternative medicine history terminology alternative veterinary medicine quackery (health fraud) rise of modern medicine pseudoscience antiscience skepticism scientific therapeutic nihilism fringe medicine and science acupressure acupuncture alkaline diet anthroposophic medicine 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vertebral subluxation should not be confused with the term's precise usage in medicine, which considers only the anatomical relationships." according to the world health organization (who), a chiropractic subluxation is a "dysfunction in a joint or motion segment in which alignment, movement integrity and/or physiological function are altered, although contact between joint surfaces remains intact". chiropractic subluxation should not be confused with medical condition subluxation, which is a "significant structural displacement" visible on static imaging studies such as x-rays. chiropractic is a field of alternative treatment outside scientific mainstream medicine, whose practitioners (chiropractors) are not medical doctors. history in 1910, d.d. palmer, the founder of chiropractic, wrote: "nerves carry impulses outward and sensations inward. the activity of these nerves, or rather their fibers, may become excited or allayed by impingement, the result being a modification of functionating — too much or not enough action — which is dis-ease." in 1909, d.d. palmer's son, b.j. palmer, incorrectly claimed that chiropractic subluxation caused contagious diseases, writing: "chiropractors have found in every disease that is supposed to be contagious, a cause in the spine. in the spinal column we will find a subluxation that corresponds to every type of disease. if we had one hundred cases of small-pox, i can prove to you where, in one, you will find a subluxation and you will find the same conditions in the other ninety-nine. i adjust one and return his functions to normal... . there is no contagious disease... . there is no infection... . there is a cause internal to man that makes of his body in a certain spot, more or less a breeding ground . it is a place where they can multiply, propagate, and then because they become so many they are classed as a cause." clinical practice definitions chiropractors use and have used various terms to express this concept: subluxation, vertebral subluxation (vs), vertebral subluxation complex (vsc), "killer subluxations," and the "silent killer." chiropractors along with some physical therapists and osteopathic physicians, have also used another term, boop, meaning "bone out of place." the who definition of the chiropractic vertebral subluxation is: "a lesion or dysfunction in a joint or motion segment in which alignment, movement integrity and/or physiological function are altered, although contact between joint surfaces remains intact. it is essentially a functional entity, which may influence biomechanical and neural integrity." the purported displacement is not necessarily visible on static imaging studies, such as x-rays. this is in contrast to the medical definition of spinal subluxation which, according to the who, is a "significant structural displacement", and therefore visible on x-rays. as of 2014, the national board of chiropractic examiners states: "the specific focus of chiropractic practice is known as the chiropractic subluxation or joint dysfunction. a subluxation is a health concern that manifests in the skeletal joints, and, through complex anatomical and physiological relationships, affects the nervous system and may lead to reduced function, disability or illness." in 1996 an official consensus definition of subluxation was formed. cooperstein and gleberzon have described the situation: "... although many in the chiropractic profession reject the concept of "subluxation" and shun the use of this term as a diagnosis, the presidents of at least a dozen chiropractic colleges of the association of chiropractic colleges (acc) developed a consensus definition of "subluxation" in 1996. it reads: "chiropractic is concerned with the preservation and restoration of health, and focuses particular attention on the subluxation. 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. a subluxation is evaluated, diagnosed, and managed through the use of chiropractic procedures based on the best available rational and empirical evidence." in 2001 the world federation of chiropractic, representing the national chiropractic associations in 77 countries, adopted this consensus statement which reaffirms belief in the vertebral subluxation. the acc paradigm has been criticized by chiropractic authors: "all in all, the ambiguities that permeate the acc's statements on subluxation render it inadequate as a guide to clinical research... whether the acc's subluxation claims have succeeded as a political statement is beyond our concern here. these assertions were published as a priori truths (what many chiropractors have traditionally referred to as "principle"), and are exemplary of scientifically unjustified assertions made in many corners of the profession. it matters not whether unsubstantiated assertions are offered for clinical, political, scientific, educational, marketing or other purposes; when offered without acknowledgment of their tentative character, they amount to dogmatism. we contend that attempts to foster unity (among the schools or in the wider profession) at the expense of scientific integrity is ultimately self-defeating. to be sure, the profession's lack of cultural authority is based in part upon our characteristic disunity. however, attempts to generate unity by adoption of a common dogma can only bring scorn and continued alienation from the wider health care community and the public we all serve." in may 2010 the general chiropractic council, the statutory regulatory body for chiropractors in the united kingdom, issued guidance for chiropractors stating that the chiropractic vertebral subluxation complex "is an historical concept" and "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." the chiropractic vertebral subluxation complex has been a source of controversy since its inception in 1895 due to the lack of empirical evidence for its existence, its metaphysical origins, and claims of its far reaching effects on health and disease. although some chiropractic associations and colleges support the concept of subluxation, many in the chiropractic profession reject it and shun the use of this term as a diagnosis. in the united states and in canada the term nonallopathic lesion may be used in place of subluxation. other chiropractors consider subluxation as more of an abstract concept rather than a medical condition. tedd koren says, the vertebral subluxation cannot be precisely defined because it is an abstraction, an intellectual construct used by chiropractors, chiropractic researchers, educators and others to explain the success of the chiropractic adjustment. this is not a unique state of affairs, abstract entities populate many branches of science... subluxations, genes, gravity, the ego and life are all heuristic devices, "useful fictions" that are used to explain phenomenon that are far larger than our understanding. we use them as long as they work for us and discard or limit their application when they become unwieldy or unable to account for new observations... critics of chiropractic have incorrectly assumed that chiropractic is based on the theory or principle that vertebral subluxations cause "pinched" nerves that cause disease. they have it backwards. chiropractic is based on the success of the spinal adjustment. the theory attempting to explain the success of the adjustment (nerve impingement, disease, subluxations) followed its clinical discovery. examples of such erroneous criticisms based on this straw man argument abound in the medical literature. some examples: "the teachers, research workers and practitioners of medicine reject the so-called principle on which chiropractic is based and correctly and bluntly label it a fraud and hoax on the human race." "the basis of chiropractic is completely unscientific." the theory on which chiropractic is based , namely that a "subluxation" of a spinal vertebra presses on a nerve interfering with the passage of energy down that nerve causing disease to organs supplied by that nerve, and that chiropractic "adjustments" can alleviate the pressure thereby treating or preventing such disease. there is no scientific evidence for the validity of this theory." to be fair, statements by some chiropractors have tended to perpetuate this misunderstanding: "pressure on nerves causes irritation and tension with deranged functions as a result." when chiropractors declare that "pinched nerves" "nerve impingement" "spinal fixations" or others mechanisms of action explain how subluxations affect the person and how chiropractic works they are making the same mistake medical critics make – assuming chiropractic is based on theory. mechanisms and theories are useful tools, but their limitations should always be kept in mind. international classification of diseases coding the differences between a medical subluxation and a chiropractic "vertebral subluxation" create confusion and difficulties when it comes to following official icd-9 and icd-10 coding. in a 2014 article in dynamic chiropractic by a chiropractor who is a certified professional coder, these difficulties were discussed in detail. he noted that the who recognizes the differences between the two types of "subluxations", and also pointed out certain difficulties for chiropractors: "...the official definition of 739 codes is "nonallopathic lesions, not elsewhere classified.... in other words, 739 is a code that does not describe a subluxation. it does not even say what the patient has; it says that there is no code to describe what the patient has.... he elusive "vertebral subluxation complex" i learned about in school has no place in the icd-9 code set. all we get is 739, which is a code for conditions that do not have a code." "icd-9 has never provided a code that truly describes this and differentiates between the chiropractic subluxation and the allopathic subluxation. chiropractors have been compelled to try to fit a square peg into a round hole for many years." at the time of writing (august 2014) it was still uncertain which codes in the newer icd-10 would be useful for chiropractors and how they would be interpreted. components traditionally there have been 5 components that