SUBLUXATIONS OF SPINAL and EXTREMITY JOINTS

Sometimes, people get confused about what "subluxations" are. Technically, using medical jargon, a subluxation would be a misarticulation of a joint, which is short of being a full dislocation, or complete loss of proper articulation. From a completely anatomical, structural standpoint, most anatomists and medical practitioners would agree with Doctors of Chiropractic, that subluxations exist. Indeed, there are diagnostic codings in the standardized coding system which describe or address such entities.

Where disagreements arise, is primarily in what the various disciplines ascribe as the outcome of the existence of subluxations, especially of the spinal joints and vertebrae.

Chiropractic talks about subluxations not only from a purely anatomical standpoint, something for example that could be seen possibly on a standard, static, plain film x-ray, but indeed, goes into further depth in including the dysfunctional motion of the joint which is subluxed, and in particular, the changes or degradation in nerve function that can be the rfesult of a subluxation of the spinal joint.

For example, most radiologists will freely describe "foraminal stenosis" or a narrowing of the space for the nerve root as it exits through the intervertebral foramina. Early on, it was felt that this decrease in space for the nerve would create an increase in the partial pressures being exerted on the nerve root.

In Chiropractic school, I recall the statement that an increase in pressure equal to the weight of a penny, could have an adverse effect on nerve functioning. A penny can weigh (in general) between 2.42 Grams to 3.18 grams . Let's take 3 grams as an average. Three grams is not much weight.

Now, to be fair, we should look at the literature in the area of the effects of pressure on the nerve root, and to really be fair, we must include studies that seem to disprove our hypothesis as well as those that sustain or bolster it.

From http://www.medscape.com/viewarticle/557944_4

"Using MRI and MRM, we found a high incidence of foraminal narrowing and course abnormalities of the corresponding nerve roots in the foramens, especially at the L4-L5 and L5-S1 levels. As is the case at other sites in the nerve pathway, neither foraminal narrowing nor course abnormalities in the corresponding root is likely to be the source of the patient's pain. Sato and Kikuchi reported, from an anatomic study,[21] that indentation on the DRG was most frequently seen at L4, but the incidence in that study was much lower than in ours: approximately 10% in the L4 and 7% in the L5 roots. This difference may be due to definition of the abnormality.
There are several radiologic reports of edema in symptomatic nerve roots. Most of these studies were limited to nerve roots in patients with herniation of the nucleus pulposus and focus on the radiologic appearance of nerve roots in the dura mater or nerve root sleeve.[22-25] The nonspecific clinical relevance of nerve root enhancement and its multifactor origins on contrast-enhanced MRI have been reported by several groups.[26-28] Jinkins[28] undertook gadolinium-enhanced MR evaluation in 7 adult patients with central canal stenosis and found that 5 of them (71%) showed abnormal multisegmental intrathecal enhancement, possibly due to inflammation and/or degeneration of the nerve root, or vein dilatation. Heithoff,[29] based on his experience with noncontrast CT scans, stated, Postimpingement swelling of the spinal nerve, as it leaves the canal and passes downward (along the ventral surface of the sacral ala, in the case of L5) may occur in patients with lateral stenosis and is a reliable radiologic sign, virtually always correlating well with the clinical symptoms. Heithoff[29] did not discriminate between lateral recess stenosis and foraminal stenosis. It seems probable that most of his patients with postimpingement swelling of the spinal nerve had symptomatic foraminal stenosis. In a recent MRM investigation, Filler et al[13] used a method of image interpretation similar to that of the present study but did not define their criteria of swelling. In their study, foraminal stenosis was diagnosed in 14 of 239 patients (6%) with sciatica when standard diagnosis and treatment failed to effect improvement. The incidence of MRM abnormalities in asymptomatic nerve roots was not assessed."

With regard to their last statement, I should like to see what the incidence of MRM abnormalities in asymptomatic nerve roots would be.

Further down in the previously referenced article we read (Ibid)
"
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Discussion
Using MRI and MRM, we found a high incidence of foraminal narrowing and course abnormalities of the corresponding nerve roots in the foramens, especially at the L4-L5 and L5-S1 levels. As is the case at other sites in the nerve pathway, neither foraminal narrowing nor course abnormalities in the corresponding root is likely to be the source of the patient's pain. Sato and Kikuchi reported, from an anatomic study,[21] that indentation on the DRG was most frequently seen at L4, but the incidence in that study was much lower than in ours: approximately 10% in the L4 and 7% in the L5 roots. This difference may be due to definition of the abnormality.
There are several radiologic reports of edema in symptomatic nerve roots. Most of these studies were limited to nerve roots in patients with herniation of the nucleus pulposus and focus on the radiologic appearance of nerve roots in the dura mater or nerve root sleeve.[22-25] The nonspecific clinical relevance of nerve root enhancement and its multifactor origins on contrast-enhanced MRI have been reported by several groups.[26-28] Jinkins[28] undertook gadolinium-enhanced MR evaluation in 7 adult patients with central canal stenosis and found that 5 of them (71%) showed abnormal multisegmental intrathecal enhancement, possibly due to inflammation and/or degeneration of the nerve root, or vein dilatation. Heithoff,[29] based on his experience with noncontrast CT scans, stated, Postimpingement swelling of the spinal nerve, as it leaves the canal and passes downward (along the ventral surface of the sacral ala, in the case of L5) may occur in patients with lateral stenosis and is a reliable radiologic sign, virtually always correlating well with the clinical symptoms. Heithoff[29] did not discriminate between lateral recess stenosis and foraminal stenosis. It seems probable that most of his patients with postimpingement swelling of the spinal nerve had symptomatic foraminal stenosis. In a recent MRM investigation, Filler et al[13] used a method of image interpretation similar to that of the present study but did not define their criteria of swelling. In their study, foraminal stenosis was diagnosed in 14 of 239 patients (6%) with sciatica when standard diagnosis and treatment failed to effect improvement. The incidence of MRM abnormalities in asymptomatic nerve roots was not assessed.

In the present study, edema was evaluated in the spinal nerve where impingement was absent. A visual evaluation of edema at the site of impingement is difficult because the nerve root exhibits a combination of enlargement due to edema and narrowing due to impingement.[11] Spinal nerve swelling was almost always associated with an abnormal course (96%), and always with narrowing of the corresponding foramens (100%). Spinal nerve swelling was highly associated with symptomatic DRG compression (17 of 25) (68%).

Although it was not statistically significant, patients with foraminal stenosis and spinal nerve swelling tended toward shorter duration of leg symptoms and more severe leg and low back pain.
In 2 foraminal stenosis patients, MRM was first used for unrelated leg symptoms before the onset of foraminal stenosis (1 and 3 years, respectively); spinal nerve swelling was observed before and after onset of leg pain. Spinal nerve swelling, occurring as a result of DRG compression, may precede clinical symptoms in some patients.

The association of spinal nerve swelling and DRG compression may be attributed to the histologic properties of DRGs.[30-39] Rydevik et al[37] applied acute compression to rat DRGs and found an almost threefold increase in endoneural fluid pressure.

They suggested that this elevation in DRG pressure could be the mechanism underlying the production of nerve root pain. In chronic cauda equina or nerve root compression, on the other hand, edema is not a prominent feature of nerve roots.[40,41] Chronic compression of the DRG has been extensively studied by LaMotte et al.[42,43] They hypothesized that chronic compression of the DRG after certain injuries or diseases of the spine may produce, in neurons with intact axons, abnormal ectopic discharges that originate from the ganglion and potentially contribute to low back pain, sciatica, hyperalgesia, and tactile allodynia. No report to date has described changes in the spinal nerve in chronic DRG compression models.'

To my mind, edema is going to result in an increase in partial pressures. It is intuitive that nerve tissue will certainly respond in SOME fashion to a chronic increase in partial pressures being exerted on the surface. We know for example that spinal cords will respond to chronic pressure by a herniated disc that is exerting frank pressure, not just on the thecal sac, but that is flattening the cord, by generating the development of myelomalacia, or softening of the cord.

Constant pressure on living tissue has an effect, some effects may be positive, some may be negative, but it is counterintuitive to believe chronic pressure above and beyond what is the norm, especially on delicate neural tissue, will have NO effect.

Thus, let's more on to another source. http://www.laserspineinstitute.com/back_problems/foraminal_stenosis/

"Click here to learnabout yourarthroscopicalternative to correctForaminal StenosisConstriction of the nerve roots leaving the spine in the foraminal canal is typically caused by bone spurs, a herniated or bulging disc, scar tissue, arthritis or ligament thickening. Foraminal Stenosis can also be caused by enlargement of a joint (the uncinate process) in the spinal canal.
Symptoms of Forminal Stenosis
FREE - MEDICAL REVIEW AND SECOND OPINION
Fax your MRI REPORT to LSI and a qualified member of our staff will call you to discuss your condition(s) and what treatment may be effective. This review is at no cost to you, with no obligation and is kept completely confidential between you and the LSI staff. A personal consultation and/or written evaluation can only be provided if you are examined by a doctor at Laser Spine Institute, at which time there will be an appointment charge.
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Foraminal Stenosis can produce a type of pain called radicular pain which is pain that radiates into the lower extremity (the thigh, calf, and may spread to the foot) directly along the course of a specific spinal nerve root. It is often deep, steady and reproducible with certain activities such as sitting or walking, and follows the involved area of distribution of the leg covered by the specific nerve. It can be accompanied by numbness and tingling, muscle weakness and loss of specific reflexes.

The most common cause of radicular pain is sciatica (pain that radiates along the sciatic nerve - down the back of the thigh and calf into the foot).

Radicular pain is secondary to compression, inflammation and/or injury to a spinal nerve root. "

Thus, for this source, it is more clear cut. Compression of the nerve root has a bad outcome, plain and simple, though, for them, they see a bleak future for any therapy save the one they specialize in, i.e. foraminotamy.

Now, for a more "Chiropractic" perspective, let's turn to Dr. Christopher Kent's page.

http://www.worldchiropracticalliance.org/tcj/1995/dec/dec1995kent.htm

"December 1995
Nerve compression physiology
by Dr. Christopher Kent
Compression of spinal nerves has traditionally been proposed as a mechanism associated with spinal subluxation.[1] Although contemporary research has demonstrated that other mechanisms may induce neuronal disturbances, nerve compression has also been explored in relation to nerve dysfunction. The modern chiropractor should be familiar with this literature, and understand its clinical implications.
Attempts have been made to discredit the premise that subluxations cause nerve interference by mechanical compression.[2] Animal studies of nerve compression reported that pressures ranging from 130 mm Hg to over 1000 mm Hg were required to produce a significant compression block.[3,4,5] However, these older studies dealt with peripheral nerves, not spinal roots.
Sunderland and Bradley reported that spinal roots may be more susceptible to mechanical effects because of their lack of the perineurium and funicular plexus formations present in peripheral nerves.[6] However, few experimental studies involving compression of nerve roots were reported in the literature.[7] Those which were reported were criticized.[8]
In 1975, Seth Sharpless, a neuropsychologist at the University of Colorado, reported the results of a series of animal experiments to determine the susceptibility of spinal roots to compression block. These investigations were supported by the ICA and the ACA. The results were published in a monograph by the National Institutes of Health. Sharpless described his results as "astonishing" and "spectacular."
According to the report, "A pressure of only 10 mm Hg produced a significant conduction block, the potential falling to 60% of its initial value in 15 minutes, and to half of its initial value in 30 minutes. After such a small compressive force is removed, nearly complete recovery occurs in 15 to 30 minutes. With higher levels of pressure, we have observed incomplete recovery after many hours of recording."[8]
Physiologist I.M. Korr listed factors which render nerve roots more vulnerable to mechanical effects than peripheral nerves [9]:
1. Their location within the intervertebral foramen is in itself a great hazard.
2. Spinal roots lack the protection of epineurium and perineurium.
3. Since each root is dependent on a single radicular artery entering via the foramen, the margin of safety provided by collateral pathways is minimal.
4. Venous congestion may be more common in the roots because the radicular veins would probably be immediately compressed by any reduction in foraminal diameter. There is also the possibility of reflux from the segmental veins through pressure damaged valves; and venous congestion would have additional consequences because the swelling, being within the foramen, would contribute to compression of the other intraforaminal structures.
5. Circulation to the dorsal root ganglion is especially vulnerable.
Contemporary papers have been published concerning nerve root compression. Rydevik reported "Venous blood flow to spinal roots was blocked with 5-10 mm Hg of pressure. The resultant retrograde venous stasis due to venous congestion is suggested as a significant cause of nerve root compression. Impairment of nutrient flow to spinal nerves is present with similar low pressure."[10]
Hause reported that compressed nerve roots can exist without causing pain. Also described in the paper is a proposed mechanism of progression, where mechanical changes lead to circulatory changes, where inflammatogenic agents may result in chemical radiculitis. This may be followed by disturbed CSF flow, defective fibrinolysis and resulting cellular changes. The influence of the sympathetic system may result in synaptic sensitization of the CNS and peripheral nerves, creating a "vicious circle" resulting in radicular pain.[11]
Kuslich, Ulstrom, and Michael reported on the importance of mechanical compromise of nerve roots in the production of radicular symptoms. Their human surgical studies revealed that "Stimulation of compressed or stretched nerve root consistently produced the same sciatic distribution of pain as the patient experienced preoperatively...we were never able to reproduce a patient's sciatica except by finding and stimulating a stretched, compressed, or swollen nerve root."[12]
The importance of asymptomatic lesions was reported by Wilberger and Pang who followed 108 asymptomatic patients with evidence of herniated discs. They reported that within three years, 64% of these patients developed symptoms of lumbosacral radiculopathy.[13]
Schlegal et al, Kirkaldy-Willis and Manelfe report that subluxation of the facet joints may be associated with nerve root entrapment and spinal stenosis, particularly when degenerative disease is present. The degenerative changes are described as a progressive "cascade."[14,15,16]
Nerve root compression is one of many mechanisms of neural disruption which may be associated with vertebral subluxation. While some may criticize the "garden hose" model as being overly simplistic, the nerve root compression hypothesis is far from obsolete.
References
1. Palmer BJ: "Chiropractic Proofs." Davenport, IA, 1903. Reproduced in Peterson D, Wiese G (eds): "Chiropractic: An Illustrated History." Mosby, St. Louis, MO, 1995. Page 78.
2. Crelin ES: A scientific test of the chiropractic theory. Am Sci 61(5):574, 1973.
3. Meek WJ, Leaper WE: "The effect of pressure on conductivity of nerve and muscle." Amer J Physiol 27:308, 1911.
4. Bentley FH, Schlapp W: "The effects of pressure on conduction in peripheral nerves." J Physiol 102:72, 1943.
5. Causey G, Palmer E: "The effect of pressure on nerve conduction and nerve fiber size." J Physiol 109:220, 1949.
6. Sunderland S, Bradley L: "Stress-strain phenomena in human spinal roots." Brain 84:121, 1961.
7. Gelfan S, Tarlov IM: "Physiology of spinal cord, nerve root and peripheral nerve compression." Amer J Physiol 185:217, 1956.
8. Sharpless SK: "Susceptibility of spinal roots to compression block." The Research Status of Spinal Manipulative Therapy. NINCDS monograph 15, DHEW publication (NIH) 76-998:155, 1975.
9. Korr IM: Discussion. The Research Status of Spinal Manipulative Therapy. NINCDS monograph 15, DHEW publication (NIH) 76-998:203, 1975.
10. Rydevik BL: "The effects of compression on the physiology of nerve roots." JMPT 15(1):62, 1992.
11. Hause M: "Pain and the nerve root." Spine 18(14):2053, 1993.
12. Kuslich S, Ulstrom C, Michael C: "The tissue origin of low back pain and sciatica: a report of pain response to tissue stimulation during operations on the lumbar spine." Ortho Clinics of North America 22(2):181, 1991.
13. Wilberger JE Jr, Pang D: "Syndrome of the incidental herniated lumbar disc." J Neurosurg 59(1):137, 1983.
14. Schlegel JD, Champine J, Tayler MS et al: "The role of distraction in improving the space available in the lumbar stenotic canal and foramen." Spine 19(18):2041, 1994.
15. Kirkaldy-Willis WH: "The relationship of structural pathology to the nerve root." Spine 9(1):49, 1984.
16. Manelfe C: "Imaging of the Spine and Spinal Cord." Raven Press, New York, NY, 1992."

Now, granted, as I write this, this article is now twelve (12) years old. Were this an article about computer processing power, it would be more antiquated than it is. The human body is not evolving quite as fast as computer processing power, so the notion that Moore's law has any application to human physiology is pretty silly.

But, I do agree that we SHOULD try to get the most recent research possible.

Thus, we move forward a decade to 2005 with this article.
http://www.emedicine.com/radio/topic884.htm

"Author: Andrew L Wagner, MD, Assistant Professor of Radiology, Instructional Faculty, University of Virginia School of Medicine; Director of Neuroradiology, Department of Radiology, Rockingham Memorial Hospital"

"Multiple causes of radiculopathy have been discovered. Pressure on the nerve may result in an autoimmune response that can elicit pain. Because the venous drainage lies on the outside of the nerve, pressure on the nerve increases the venous pressure, causing a compartment syndrome within the substance of the nerve. This syndrome causes ischemia and pain within the nerve root, and the pain can be referred along the dermatome for the particular root.
Phospholipase A has been implicated in radiculopathy as well. This chemical, the production of which is stimulated by extruded nucleus pulposus material, causes inflammation and pain in the adjacent nerve, even when no compression is present. Because steroids have anti-inflammatory actions, injections around the nerve root may reduce the inflammation, decreasing or eliminating the pain.
Although an epidural steroid injection may produce the same effect, a SNRB is a more elegant and focused injection that has more diagnostic value than an epidural injection, particularly in surgical planning. When the 2 techniques are compared, injections of a large amount of steroid throughout the epidural space (epidural injections) are mostly of use when the pathology is located centrally in the spinal canal (eg, central disk extrusion) or when 1 or 2 individual nerves cannot be identified as the most likely source of the symptoms during physical examination or imaging studies.
Epidural injection can be compared to a "shotgun blast" of steroids, covering a wide range of levels but placing only a small amount of steroid at each level. SNRB is more of a "sniper rifle" approach, with the injection of a relatively large amount of steroid around a specific nerve root. SNRB is useful when 1 or 2 nerve roots are considered to be the likely cause of the patient's symptoms.
Nerve root blocks are useful primarily in the following subsets of patients with radiculopathy:
After diskectomy in patients who have recurrent radiculopathy but no recurrent disk herniation, symptoms are often caused when scar tissue tethers the nerve. Many patients can be treated successfully by using SNRB, although some may require a repeat injection.
Patients with disk herniations can be helped with nerve root blocks. Since the body naturally resolves 90% of disk herniations when given enough time, pain relief is important to try to avoid surgery. Because the pain is believed to result from an inflammation of the nerve root and not directly from the pressure of the disk (which by itself causes numbness but not pain), steroid injections can reduce inflammation and pain in many patients.
Nerve root blocks can help patients with symptoms related to a nerve root but who have no definite radiologic diagnosis explaining the symptoms or who have so many abnormal MRI findings that confirming the origin of the symptoms is difficult. Included in this group are patients with subcostal pain from thoracic nerve roots, many of whom have undergone cholecystectomies or have been treated with acid inhibitors without success. In patients with uncertain pain etiology, SNRB is an effective and accurate means of determining if a certain nerve root is the source of the symptoms. The procedure is often curative as well. "

From the above, we pjull out ths quoite :

"Pressure on the nerve may result in an autoimmune response that can elicit pain. Because the venous drainage lies on the outside of the nerve, pressure on the nerve increases the venous pressure, causing a compartment syndrome within the substance of the nerve. This syndrome causes ischemia and pain within the nerve root, and the pain can be referred along the dermatome for the particular root. "

OK, in ten years, it looks like we are back to a simple idea, that is, pressure on a nerve root, above and beyond the normal partial pressures in the environment, can generate a pain response as the ultimate outcome of the cascade of intermediate steps .

Let's move forward in time to 2006.
Spine. 31(26):3076-3080, December 15, 2006.Morishita, Yuichiro MD; Hida, Shinichi MD, PhD; Naito, Masatoshi MD, PhD; Arimizu, Jun MD, PhD; Matsushima, Ushio MD; Nakamura, Atsuhiko MD

"Methods. The local pressure of the intervertebral foramen was continuously measured while the lumbar spine posture was changed in 66 vertebral foramens. In addition, 20 L5 nerve roots were electrophysiologically evaluated using the compound muscle action potentials (CMAPs) from tibialis anterior (TA) muscle after L5 nerve root stimulation.
Results. The local pressure of the intervertebral foramen was significantly increased during lumbar spine extension (P <>Conclusions. Our findings suggested that a double compression of the nerve root exists in lumbar spinal stenosis with lumbar spine extension, which includes the spinal canal and the vertebral foramen."

From a peer reviewed scientific journal, here is another article.
http://www.jvsr.com/abstracts/4201-0017_alderson.htm

"Literature ReviewThe Effects of Mild Compression on Spinal Nerve Roots with Implications for Models of Vertebral Subluxation and the Clinical Effects of Chiropractic Adjustment [May 2001, Vol 4, No.2] R. Scott Alderson, D.C.Bio, George J. Muhs, D.C., DABCN, CCN Bio Abstract
Abstract - This review attempts to analyze the clinical relevance of nerve compression as a component of the vertebral subluxation and if the chiropractic adjustment can lead to the correction of the nerve pressure. Literature searches were conducted on the World Wide Web at the Pub Med website.
There is evidence of nerve compression at the level of the intervertebral foramen (IVF) occurring anywhere from 15.4% to 78% of levels inspected. Most of the spines inspected were already prescreened to eliminate those that were definitely known to have nerve compression problems. Pressures as little as 10 mm Hg can alter the nerve root and dorsal root ganglion’s abilities to function normally. In the normal range of motion the pressures generated in the IVF may exceed 30 mm Hg. When considering the concept of a joint fixated in a diminished sphere of its normal range of motion in conjunction with the mild pressure increases, it becomes apparent that nerve function can be significantly altered.

The chiropractic adjustment can effect a restoration of normal H-reflex in compressed nerve roots without altering the H-reflex at uninvolved levels. The major variables of compression are the rate of onset, the amount of pressure generated, and the time maintained. Another major variable in the recovery is age. The younger the nerve tissue the better chance for a full recovery. The concept that a vertebral subluxation can induce pressure increases at the level of the IVF is supported by the literature. This increase, though seemingly mild, is enough to alter nerve function. The garden hose theory or hard bone - soft nerve explanation of vertebral subluxation is considered by some to be archaic but appears to be a valid entity at least in the lower cervical spine. More research is needed to decipher the susceptibility to mild pressure increases throughout the spine.Key Words: Spinal nerve root, compression, dorsal root ganglia, chiropractic, adjustment, vertebral subluxation, manipulation "
AND, http://www.jvsr.com/headlines/20010905a.htm
"The study titled: "The Effects of Mild Compression on Spinal Nerve Roots With Implications for Models of Vertebral Subluxation and the Clinical Effects of Chiropractic Adjustment: A Review of the Literature" was authored by Scott Alderson D.C., a private practitioner and George Muhs D.C., D.A.B.C.N.,C.C.N. Assistant Professor of Clinical Services at the University of Bridgeport College of Chiropractic.
Chiropractic theory maintains that spinal vertebrae can become misaligned and/or not move properly, which could place abnormal pressure on nerves and then cause interference with how those nerves work. Chiropractors call these misalignments and neurological alterations vertebral subluxations.
According to the authors their review of the research shows that "These alterations would therefore alter the quality and/or quantity of the message sent. At the tissue and cellular level, the message received would not be adequate for the function the body demands. The entire body could then theoretically be affected."

The authors also discuss the possibility that subluxations can go unnoticed for long periods of time since they may not be severe enough in the beginning stages to create outward signs and symptoms. According to the authors this makes the "healing process age and degree dependent. One must consider the age of the person with a vertebral subluxation, the younger they are, the better the chance for a complete correction."

"This review of literature is extremely comprehensive in nature and adds a mountain of evidence to some of the fundamental positions chiropractors have long maintained. That subluxations don't always cause symptoms and that the longer you have them the worse they get and the more difficult they are to correct. This is another strong argument for having children checked by chiropractors at a young age for vertebral subluxation" stated Dr. Matthew McCoy Editor of the Journal of Vertebral Subluxation Research. ".

So, contrary to the "pressure on the nerve" theory being an outmoded, quaint idea from a non-scientific group of cultists, it appears that the fact that nerves, such as nerve roots, are adversely affected by pressure or an increase in the partial pressures acting on the nerve, continues to be borne out in peer reviewed scientific literature and studies. As it has been said,
"Facts are stubborn things."

Now the corollary that follows is this. If nerves branching off the spinal cord may be adversely affected by increased pressure, can the organs or organ systems innervated by these nerves, also be adversely affected? Well, although purists of the study of physiology may cringe, I think a simple analogy is useful. As humans in the 21st century, often we understand more about electricity in our homes, than the bioelectrical functions and biochemical functions of our body.

Or, we may even be even more familiar with our home stereos. Changing the amperage or voltage or other parameters of the energy supply to a system can definitely negatively affect the output of the speakers. Function is directly proportional to receiving the proper supply of energetic stimulation. Far too much, or far too little can and does negatively impact system output.

Let's examine a more peripheral example of this. Carpal tunnel syndrome is a pathological condition involving altered functioning of the median nerve, secondary to pressure increases in the carpal tunnel. I am not presently aware of serious challenges to the pathogenesis of carpal tunnel syndrome as a result of pressure effects on the median nerve. In this case, we are dealing with skeletal muscle tissues. I believe that it is not a great leap to understanding that the histological effects of altered nerve function of the nerves, for example, supplying the liver, may alter the ability of the liver to function properly.

If we look at the field of psychoneuroimmunology, the ease of understanding this dynamic is even clearer.

Wikipedia defines this discipline as http://en.wikipedia.org/wiki/Psychoneuroimmunology

"Psychoneuroimmunology (PNI) investigates the relations between the psychophysiological and immunophysiological dimensions of living beings. PNI brings together researchers in a number of scientific and medical disciplines, including psychology, neuroscience, immunology, physiology, pharmacology, psychiatry, behavioral medicine, infectious diseases, and rheumatology.
The profound interest of PNI is in interactions between the nervous and immune systems, and the relation between behavior and health. Despite the protean approach to research, the outcome common to all research endeavors is the discovery of new information, or novel evidence, which contributes to the continuing and cumulative generation of knowledge.
It deals with, among other things, the physiological functioning of the neuroimmune system in states of both health and disease; malfunctions of the neuroimmune system in disorders (autoimmune diseases, hypersensitivities, immune deficiency), the physical, chemical and physiological characteristics of the components of the neuroimmune system in vitro, in situ, and in vivo.
PNI also involves endocrinology and is sometimes referred as psychoendoneuroimmunology (PENI)."

Chiropractic doctors have , for some time, postulated that the adverse effects of pressure on spinal nerves as they exit through the lateral foramen or IVF, may include a reduction in immune status functioning, and that, as a result, one may become more susceptible to pathogens.

None other than Claude Bernard was a pioneer in the idea that it is the internal environment and its susceptibilty or weakness of immune function, that really determines whether or not, if you are exposed to a particular pathogen, whether you will fall prey to illness.
http://findarticles.com/p/articles/mi_qa4054/is_200502/ai_n13640250
"From its inception, the field of physiology has dealt with the abilities of animals to cope with environmental change. Claude Bernard was the first to recognize that the internal environment (milieu interior) of an animal was distinct from that of the external environment (milieu exterior). " Bernard stressed that it is the failure of the immune system to prevent pathogens from taking root and multiplying. He called the internal mileu, the "terrain".

Many have lauded Louis Pasteur for his "germ theory" which later caught hold in the modern allopathic paradigm, and carried even further in the form of "Koch's postulates" .

But, apparently, Pasteur, on his death bed, recanted the Germ theory and agreed that the "terrain's the thing".
http://www.mnwelldir.org/docs/terrain/lost_history_of_medicine.htm
"The Germ Theory
Everyone has heard of Louis Pasteur. He is considered the father of the Germ Theory of Medicine and he invented the process of pasteurization. Despite the simple fact that the Germ Theory of Medicine was at least a hundred years older than Pasteur, his experiments that supposedly "proved" this theory have established him as a cornerstone in Modern Medical History.
Too bad much of his work was plagiarized and totally unscientific.
What most of us don’t know about Pasteur is that throughout his career, he too often doubted his assumptions. On his death bed, he even recanted saying the Germ Theory was all wrong: "It’s the terrain, not the germ."
But did we hear his last words? No.
Was he speaking of the immune system? If we have a strong immune system, the germ doesn’t matter, does it?
Wrong, he was not speaking of the immune system. As Dr Young points out in Sick and Tired, the immune system’s function of fighting off germs is its secondary job. If you’re immune system is battling off bugs, you’re driving on a "spare tire," according to the good doctor."

This brief review of a handfull of articles certainly does not prove or disprove Chiropractic principles or theories, but it does indicate the viable nature and physiological basis of them.

SUBLUXATIONS OF SPINAL and EXTREMITY JOINTS

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