What is the difference between somatic dysfunction and chiropractic subluxation (CS)?

From the Guidelines

Somatic dysfunction and chiropractic subluxation are distinct concepts with different definitions, diagnostic criteria, and treatment approaches, with somatic dysfunction focusing on impaired function of the somatic system and chiropractic subluxation emphasizing the impact on neural integrity and overall health. The key differences between these two concepts lie in their underlying philosophies and the methods used for diagnosis and treatment. Somatic dysfunction, primarily utilized in osteopathic medicine, is diagnosed using the TART criteria: Tissue texture abnormality, Asymmetry, Restriction of motion, and Tenderness, and is treated with various manual techniques such as muscle energy, counterstrain, and myofascial release 1. On the other hand, chiropractic subluxation is identified through observation of posture, palpation for joint restriction and muscle tension, and sometimes imaging studies, and is treated with high-velocity, low-amplitude thrusts (adjustments) to correct subluxations 2.

Key Differences

• Definition: Somatic dysfunction refers to impaired or altered function of related components of the somatic system, while chiropractic subluxation refers to a complex of functional or structural changes that compromise neural integrity.
• Diagnostic Criteria: Somatic dysfunction is diagnosed using the TART criteria, whereas chiropractic subluxation is identified through observation, palpation, and sometimes imaging studies.
• Treatment Approaches: Osteopathic physicians use various manual techniques to address somatic dysfunction, while chiropractors primarily use high-velocity, low-amplitude thrusts to correct subluxations.

Evidence

Studies have shown that spinal manipulation, a technique used to correct chiropractic subluxations, can be effective in treating low back pain, with some trials finding it to be slightly superior to usual care for pain and disability 3, 4. However, the evidence also suggests that the effectiveness of spinal manipulation may not vary significantly depending on the presence or absence of radiating pain or the profession or training of the manipulator 5, 6. Additionally, serious adverse events after spinal manipulation are very rare, with an estimated risk of less than 1 per 1 million patient visits 7.

Implications

The differences between somatic dysfunction and chiropractic subluxation have significant implications for clinical practice, as they influence the choice of diagnostic and treatment approaches. Understanding these differences is essential for healthcare professionals to provide effective and safe care for patients with joint-related problems. In conclusion, while both somatic dysfunction and chiropractic subluxation aim to restore normal function and relieve pain, their distinct definitions, diagnostic criteria, and treatment approaches reflect the unique philosophical and theoretical foundations of osteopathic and chiropractic medicine.

From the Research

Definition and Difference

• Somatic dysfunction is defined as impaired or altered function of related components of the somatic system, including skeletal, arthrodial, and myofascial structures, and their related vascular, lymphatic, and neural elements 8.
• Chiropractic subluxation (CS) is a biomechanical spine derangement thought to produce clinically significant effects by disturbing neurological function 9.
• The key difference between somatic dysfunction and chiropractic subluxation is that somatic dysfunction is a broader term that encompasses a wide range of musculoskeletal disorders, while chiropractic subluxation is a specific concept that is unique to the chiropractic profession 10.

Treatment and Diagnosis

• Osteopathic manipulative treatment (OMT) is used to treat somatic dysfunction, and it involves the use of manually guided forces to improve physiologic function and support homeostasis 8.
• Chiropractic subluxation is typically treated with spinal manipulation, which is a mechanically based therapy that aims to restore normal motion to the spine and improve neurological function 9.
• The diagnosis of somatic dysfunction is based on a structural examination and the presence of tenderness, asymmetry, restricted motion, or tissue texture changes 11, while the diagnosis of chiropractic subluxation is based on a variety of techniques, including spinal manipulation and adjunctive procedures 9.

Comparison and Controversy

• There is controversy surrounding the use of the term subluxation, with some factions within the chiropractic profession holding it to be synonymous with the identity of chiropractic itself, while others argue that it is not a valid or evidence-based concept 12, 10.
• The American Osteopathic Association guidelines for osteopathic manipulative treatment (OMT) for patients with low back pain do not mention chiropractic subluxation, and instead focus on the treatment of somatic dysfunction 8.
• The use of spinal manipulation to treat chiropractic subluxation is not supported by credible evidence, and some studies have raised concerns about the safety and efficacy of this treatment, particularly in pediatric patients 12.