The Concussion-Subluxation Complex
By Charles Masarsky, DC, FICC
In the Aug. 1, 2014 issue of Dynamic Chiropractic, I reviewed some of the literature demonstrating the role of the chiropractic adjustment in post-concussive care.1 A year later, I presented a series of brief cases demonstrating patient improvement in reverse digit span – an outcome measure related to attention span – under chiropractic care.2 This series included patients with and without concussion. In the process of preparing these articles, as well as organizing material for postgraduate courses, I naturally found myself reviewing much of the biomedical and chiropractic clinical literature relevant to concussion and the vertebral subluxation complex (as defined in Redwood, 1997).3 Let's try a few simple thought experiments and then discuss why a new classification term – the concussion-subluxation complex – may be warranted.
Two Thought Experiments
Try these two thought experiments (experiments conducted entirely within the confines of your own mind); I believe the results will speak for themselves.
Rephrasing the Obvious
In your experience (and verified by the exercise above), have you found a concussive injury likely (if not certain) to cause vertebral subluxations and/or exacerbate pre-existing subluxations? Have you found robust clinical overlap between the mechanism of injury, signs and symptoms of the two conditions?
Please pardon me for asking questions with such obvious answers. I do so only because I hope to rephrase the obvious in a way that reveals the non-obvious. To many of our fellow health care providers, the role of the doctor of chiropractic in helping the concussed patient is not obvious. This is also true of many governmental and organizational decision-makers, as well as some members of the general public. To allow such ignorance to sideline the practitioners who can best address the vertebral subluxation complex does a great disservice to the concussion patient. If anything, the role of the doctor of chiropractic as a member of the concussion victim's health care team should be central.
To rephrase what is obvious to us in a way that reveals what is non-obvious to others, I propose the term concussion-subluxation complex. This term is intended to capture the common traumatic origin and interacting pathophysiology of concussion and the vertebral subluxation complex. Combined with educational efforts within and beyond the chiropractic profession, this term may help clarify the unique contribution of chiropractic care for patients with acute concussion and post-concussion chronicity. This clarification may well prove useful in formal research efforts in this field ,as well as the work of explaining the role of chiropractic care to the concussed patient, key health care decision-makers and the general public.
Concussion-subluxation complex: "A constellation of mutually exacerbating pathophysiological manifestations of concussion and vertebral subluxation complex. (The vertebral subluxation complex can be generated by the same trauma that caused the concussion, or a pre-existing vertebral subluxation complex can be activated or exacerbated by this trauma.)"
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