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Fall 2018
0 Science the Philosophy of the VSC Study

Guide Fall 18
NBCE Part II and Final

Exam Study Guide
TRI 6 CLASS FALL 2018
SPVSC
Guide Fall 18
Contents
ACC & Paradigms..................................................................................................................................................... 2
Study Guide Questions..................................................................................................................................... 4
Axonal Aberration/ Trophic Models............................................................................................................... 6
Questions............................................................................................................................................................... 7
References................................................................................................................................................................. 9
Questions............................................................................................................................................................ 11
Inflammation Theory......................................................................................................................................... 13
Multiple Choice Questions........................................................................................................................... 16
Immobilization degeneration/stability....................................................................................................... 18
Study Guide Questions.................................................................................................................................. 21
Instability Hypothesis........................................................................................................................................ 23
Myelopathy............................................................................................................................................................. 28
Multiple Choice Question............................................................................................................................. 30
Neuroimmune Hypothesis............................................................................................................................... 32
Study guide questions:.................................................................................................................................. 34
Neuropathology/Neural compression/traction models/LMNL.......................................................35
Multiple Choice Questions........................................................................................................................... 37
Proprioceptive Insult/Dysafferentation..................................................................................................... 39
Multiple choice questions:........................................................................................................................... 41
Segmental Dysfunction and Sympatheticotonia...................................................................................... 43
Spinal buckling/Biomechanical Models:.................................................................................................... 51
VSC 5 Faye Model................................................................................................................................................. 65
Possible Questions of VSC 5........................................................................................................................ 68
Guide Fall 18
ACC & Paradigms

History
The ACC paradigm was founded in 1966 by presidents of existing colleges in North
America as an educational model. The paradigm states, “Chiropractic is a health-care
discipline that emphasizes the inherent recuperative power of the body to heal itself
without the use of drugs or surgery.” The collaboration of the presidents wanted to make
sure that this paradigm focused on the relationship between structural and functional
issues and how it leads to the overall health of the patient. In 1996 the ACC paradigm
wanted to come up with a definition of “subluxation” to end all discussion and confusion on
what it really meant to be subluxated. It was their goal to come up with a definition that
was easily understandable not only to the chiropractic profession but to all other health-
care professions as well. They stated their definition as, “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.” This definition by
the ACC was endorsed by the ACA, ICA, COCSA and the WFC. To this day, the definition of
“subluxation” created by the ACC is the best way the chiropractic profession defines and
explains what a subluxation is in the human body.
Summary
As the ACC recognized the need for some level of consistency throughout
Chiropractic in order to have a more uniform appearance to the world, their paradigm was
proposed and adopted, providing a unity that hasn’t previously been reached. While the
uniqueness associated with the art of Chiropractic is a beautiful thing, moving forward and
growing our relations with other healthcare providers will be aided in the unity
“theoretical, educational, legislative, research, and clinical practice goals.” The ACC
paradigm shows it as foundational to work with other healthcare practitioners when that is
in the patient’s best interest and at its core states the purpose of Chiropractic is to optimize
the health of the patient.
The biopsychosocial model assumes health as the natural state for a human being.
Any departure from that health, regardless of its presentation (sickness, emotional distress,
etc.), will show an impact on the other areas and is a result of that individual’s inability to
adapt to life’s stressors.
Patient-centered paradigm goes further than recognizing the connectedness of the
body because it involves the care of the total person and also puts the patient in a position
of control of their care. Both involving them in the decisions around their care and
encouraging them to be consciously aware of their health rather than accepting the excuse
that life or bad health “happened to them.”
Chiropractic Relevance
This is relevant to chiropractic because, in the ACC paradigm, it is the responsibility
as a portal of entry doctor to know when and why to refer a patient out and co-manage with
other healthcare professionals. This is the way that our healthcare system is moving and it
is important that we move with it.
Guide Fall 18
The biopsychosocial paradigm is relevant to chiropractic because it explains how

every system is connected to one another. Poor health in one area, let's say its
psychological, can result in poor overall health. This is very similar to the basis of
chiropractic itself and can be a good way to help our patients understand chiropractic more
easily.
Lastly, the patient-centered paradigm is relevant to chiropractic because it is
historically the basis of other healthcare professions and like stated above, we need to move
with the flow of the industry. Chiropractors can use this paradigm to have a more
cooperative relationship with their patients.
Main idea of ACC, patient-centered, and biopsychosocial

Patient-Centered Paradigm is a traditional approach to patients and their care, which is
observed primarily by non-doctors of Chiropractic.
Biopsychosocial Paradigm includes all the basic chiropractic premises with additional
emphasis on the social and spiritual dimensions of health, the cooperative nature of the
chiropractor-patient relationship, and the value of health-promoting self-care activities
such as diet and exercise.
ACC Paradigm is an educational model developed in 1996 by consensus of the presidents
of all existing North American chiropractic colleges.
More about ACC, patient-centered, and biopsychosocial

The Patient-Centered Paradigm was agreeably defined by chiropractors and non-
chiropractors alike by nominal panels as well as a 60-member multidisciplinary Delphi
panel. It provides a worldview which entails how chiropractic science can grow to better
serve the interests of patients. The paradigm embodies the 6 doctrines that form the
principles and philosophy of traditional chiropractic: vitalism, holism, naturalism,
humanism, conservatism, and rationalism. The patient-centered paradigm of chiropractic
revolves around recognizing the whole person and their innate organization and its ability
to adapt as well as their values, beliefs, expectations and health care needs. It highlights the
importance of personal responsibility while utilizing minimally invasive, conservative
methods of care. Ultimately, the patient and the patient-centered health care professionals
are partners in the entire process of the patient’s care.
In addition to the basic chiropractic premises, the Biopsychosocial Paradigm centers
around the idea that health is the natural state of all individuals. It proposes that both the
internal environment and external environments have effects on health, which is expressed
biologically, psychologically, socially and spiritually. It is when the individual is unable to
adapt to these variables that the expression of disease and illness manifest.
The ACC’s statement of philosophy reads, “Chiropractic is a healthcare discipline
that emphasizes the inherent recuperative power of the body to heal itself without the use
of drugs or surgery…” Adhering to that philosophy, the ACC “Purpose” of Chiropractic is to
optimize health and the “Practice” is to establish a diagnosis, facilitate both neurological
and biomechanical integrity via appropriate case management and, ultimately, to promote
health. The paradigm highlights the “Principle” that the body’s innate recuperate power is
affected by and integrated through the nervous system.
Guide Fall 18
Terminology
● Subluxation - an articular lesion less than a dislocation
● Subluxation syndrome - an aggregate of signs that relate to pathophysiology or
dysfunction of spinal and pelvic motion segments or to peripheral joints
● Manipulation - a manual procedure that involves a directed thrust to move a joint
past the physiological ROM without exceeding the anatomical limit
● Adjustment - any chiropractic therapeutic procedure that uses a controlled force,
leverage, direction, amplitude, and velocity directed at specific joints or anatomic
regions
Study Guide Questions with answer key for review purposes

1. Which of the following is NOT included in the ACC Practice of Chiropractic?
a. Establish a diagnosis
b. Facilitate neurological and biomechanical integrity through appropriate case
management
c. Promote health
d. Treat patients via chiropractic adjustments
2. How is the ACC paradigm relevant to chiropractic?
a. It recognizes the value of co-management of a patient with other
healthcare professionals
b. It reveals a bias towards only chiropractic care for a patient
c. It reveals a biased towards only traditional medicine practices
d. It isn’t relevant
3. Which paradigm is observed primarily by non-doctors of Chiropractic?
a. Biopsychosocial Paradigm
b. ACC Paradigm
c. Subluxation Paradigm
d. Patient-Centered Paradigm
4. The ACC paradigm focuses on the relationship between (?) and (?) issues and
how they lead to the overall health of the patient.
a. Structural / Functional
b. Functional / Psychological
c. Structural / Chemical
d. Chemical / Functional
5. Which of the following do chiropractors not treat/correct/effect?
a. Manipulable lesion
b. Allopathic subluxation
c. Subluxation complex
d. Spinal motion segment
2 Essay Questions
Guide Fall 18
● List the six (6) doctrines that form the principles and philosophy of traditional
chiropractic.
○ Vitalism, holism, naturalism, humanism, conservatism, and rationalism
● Describe three (3) of the characteristics of the patient-centered care
paradigm.
○ Recognition and facilitation of the Innate organization and adaptation of the
person
○ Recognition that care should ideally focus on the total person
○ Acknowledgment and respect for the patient’s values, beliefs, expectations,
and health care needs
○ Promotion of the patient’s health through a preference for drugless,
minimally invasive and conservative care
○ A proactive approach that encourages patients to take responsibility for their
health
○ The patient and patient-centered practitioner act as partners in decision
making, emphasizing clinically effective and economically appropriate care
based on various levels of evidence
References
Gatterman, M. I. (Ed.) (2005). Foundations of Chiropractic: Subluxation (2nd ed.) St. Louis:
Mosby.
Leach, Robert A., and Reed B. Phillips. The Chiropractic Theories: a Synopsis of Scientific
Research. Williams & Wilkins, 1986.
Redwood, Daniel, et al. Fundamentals of Chiropractic. Mosby, 2003.

Guide Fall 18
Axonal Aberration/ Trophic Models

Definition:
Axonal Aberration is the transport and exchange of macromolecular materials with the
axon that can be affected by mechanical and/or chemical stresses. In addition to proteins,
glycoproteins, and neurotransmitters, constituents that are required for proper nerve growth and
maintenance are mobilized by axoplasmic transport (AXT) (Leach, 2004). Anterograde axonal
transport is quicker, has trophic requirements, and is essential in neuromuscular maintenance.
Retrograde axonal transport is slower and controls the making of enzymes for neurotransmitter
synthesis. Research has shown that even moderate compression or intermittent irritation can
significantly block or alter AXT in spinal nerves. The actual axoplasmic aberration hypothesis is,
“that AXT may be altered in certain cases in which the spinal nerve roots or spinal nerves are
compressed or irritated by intervertebral subluxation or facilitation.” (Leach, 2004)
History:
The effects of trauma on the neural mechanism of AXT was first noted by Osteopathic
researchers in 1962. At the University of Colorado, chiropractic researchers have also done very
in-depth work in documenting and quantifying the effects of trauma on the neural mechanism of
AXT. There is no primary proponent for AXT (Leach, 2004).
Summary:
Evidence has recently suggests that AXT may be significant not only in development and
maturation of the nervous system but in sensory signaling and modulation of inflammatory
processes as well. There are fast and slow AXT fibers, these fibers travel in opposite directions
on the nerve fiber. AXT can also be termed as neuroplasmic transport. The axoplasmic aberration
hypothesis appears to be valid, in that when spinal nerves or roots are compressed or irritated by
intervertebral subluxation or segmental facilitation, AXT could be changed with substantial
consequences (Leach, 2004).
Chiropractic Relevance:
Research has provided evidence that pressure of even 50 mm/Hg on the vagus nerve for
2 hours could cause altered sensory fast AXT input. These studies presented that the pressure
needed to alter the anterograde nerve flow vary depending on the diameter of the nerve and the
extent of time it was compressed; the longer a nerve was compressed the longer it took to return
to normal (Leach, 2004). Even a dysfunction in the ion gradients or local ischemia could “block”
the flow of the nerve. Thus, if there is pressure on a nerve due to a musculoskeletal cause,
chiropractors should have ability to locate and correct for this compression. Chiropractic can
help treat and prevent compression on nerves. It can also help the body function to its optimal
level so that the ion balance is ideal for that there is no impediment to FAXT.
Explanation of Physiological Attributes:

There are two proposed mechanisms of how a nerve obtains the proper nutrients to grow
and uphold proper function: the actomyosin theory and the sliding filaments theory. The
actomyosin theory is considered to account for nearly all intra and extracellular movements and
is found universally in eukaryotic cells. The sliding filament mechanism states that constituents
Guide Fall 18
bind to a transport filament that is transported by connecting cross-bridges along the

microtubules and/or neurofilaments of the nerve fiber. This mechanism is believed to be the
action that explains slow AXT due to the slower transportation rate of 1-3 mm/day (Leach,
2004).
Compare and Constant other Relevant theories
Segmental Dysfunction
 They differ in the way that they are impacted - Segmental dysfunction is produced by
fixation of a single motion segment and isn't causing compression on a nerve directly.
AXT is affected due to compression that doesn't permit for the maintenance and growth
of a single nerve.
 Segmental dysfunction is like axonal aberration in that a single nerve root/nerve will be
affected, thus representing as a single nerve pathology.
 Exams to differentiate them would be NVC for AXT and chiropractic evaluation for
segmental dysfunction.
Neuropathology
 Similar signs or symptoms is that they both are affected by nerve compression
 AXT is directly related to nerve compression so it won’t effect on nerve conductivity but
the effects of neuropathology decrease of conductivity.
 Things that separate AXT from this theory is the words: anterograde/retrograde
movement or the patient stating that the pain “moves”
Patient Presentation:
Patient will present with unilateral radiating pain moving in different areas of the body,
thus not following a specific dermatome. It is possible to see both upper and lower motor neuron
signs in AXT.
Exam Findings:
While taking the patient’s history, they may describe the pain as “moving around”. Blood
work would show a higher number of trophic factors, such as nerve growth factor (NGF).
Imaging used for the theory:

As of now, there is no imaging modality that can help diagnosis AXT. The only time it has been
observed was in research situations using an electron microscope.
Special Tests:
NVC or EMG
Questions:
1. Which of the following chiropractic theories could be considered to explain why pain
“moves” from distal to proximal on a patient?
Guide Fall 18
A. Axonal Aberration
B. VSC 5 Model
C. Dural Torque
D. Proprioceptive insult
2. True or False: Axonal Aberration provides reasoning for the trophic needs to tissue.
3. Patient explains that their pain seems to be moving from their toes and up their leg. What
theory best represents this symptom?
A. Neuroplasmic Transport
B. Axoplasmic Aberration
C. Dural Torque
D. Somatosomatic Reflex
4. When a nerve is damaged or compressed, it undergoes a specific process that involves
Schwann cells recruiting macrophages to clear up the debris while also releasing growth
factors to create a favorable environment for nerve regrowth. What is the name of this
process?
A. Wallerian Degeneration
B. Proprioceptive Insult
C. Pruning
D. Neurotrophic Aberration
5. Both anterograde and retrograde AXT occurs. Which of the two involves a greater
number of constituents and is faster?
A. Retrograde
B. Anterograde
Answer Key
1. A
2. A
3. B
4. D
5. B
Essay Questions
1. Describe the five main points that Korr and other osteopathic investigators discovered
when it comes to axoplasmic aberration association with protein, muscles, and nerves.
Spikes and waves of axoplasmic transport can be observed, and each of four waves
carries different types of proteins. Transfer of proteins from nerve to muscles varies from
nerve-to-nerve transport. Transfer of proteins across the junction is selective. The neuron
supplies protein for muscles that is not found in the muscle. Thus, some proteins
synthesized in nerve are destined for muscle, others for nerves.
2. How does nerve compression play a significant role in aberrant AXT? FAXT block by
nerve compression is the possibility that local ischemia or changes in the ionic
environment dramatically alter the normal AXT mechanism. This is consistent with the
fact that alteration of the ionic balance within the neurons can block FAXT. It has also
Guide Fall 18
been shown that damaged nerves do not regain normal internodal spacing, which may be
associated with decreased nerve conduction velocities.
References
Leach, R. A. (2004). The Chiropractic Theories. Baltimore, Maryland: Lippincott Williams & Wilkins.
Guide Fall 18
SPVSC Final Project- Dural Torque

Ashley Kelley, Kyle Hurst, Corey Sharp, James Crawford, William Faulk
Definition: Dural Torque- Dural Torque is described as the dentate ligament, cord
distortion theory. In addition, it is mainly pursued by chiropractors who only specializes in
the upper cervical region.
History: There was no main proponent of this theory. However, B.J Palmer advocated that
no vertebral subluxation could exist below the axis. Thus, he believed that no subluxation
could be given below the axis to get sick people well. He remained very adamant about this
idea for 20 years. There is much research done on this topic. Grostic discusses the strength
of dentate ligaments in the upper cervical region and how the possibilities of spinal cord
distress can contribute to upper cervical misalignments. There have also been studies that
discuss how cord distraction produces a conduction block.
Summary: This theory is trying to convey the importance that the upper cervical region
has on dentate ligaments as well as the CSF flow. Those components play a major roll in
how upper cervical misalignments can occur as well as conduction of nerve impulses. The
upper cervical region in this theory is priority to the entire body functioning.
Key Terms/Concepts
1. Dentate Ligament
2. CSF
3. Pia Mater
4. Dura Mater
Chiropractic relevance
Why/how does this theory matter/apply to a practicing chiropractor and the profession?
The theory of Dural torque directly applies to the practicing chiropractor. The theory and
foundation of chiropractic was found upon subluxation of the vertebral spine and that
subluxation will create dis-ease in the body. The hypothesis of Dural torque states that
subluxation of the upper cervical spine will cause distortion of the spinal cord which will
then affect the dentate ligament and the CSF. In theory, this issue will also cause a decrease
in nutritional supply to the CNS.
Patient Education- Use simplified language to explain this theory in a manner anyone could
understand or relate to without having any sort of education past 7 th grade.
The spinal cord begins in the top of the neck and extends down to the upper-lower portion
of your back. If the bones in the top of the neck become misaligned or stop moving properly
this could affect the supporting structures and functions of the spine of the spine not only
in the neck but also further down the back.
Explain the Physiological Attributes of the Chiropractic Theory (put N/A if not
relevant)
Neurologic Components / Systems

The Dural torque theory states that patients will have an upper cervical and craniosacral
issues that will mimic symptoms of myelopathy.
Vascular Components (if applicable)
Dural torque theory states that it can be brought on via venous occlusion, local blood stasis
& ischemia of the upper cervical spine
Guide Fall 18
Biomechanical / Anatomical Components

Dural torque hypothesis says that It can be achieved via biomechanical faults with direct
mechanical irritation via dentate ligament traction Dural torque also states that with
movement the cord will approximately be a 30 mm change in the length of the spinal canal
from full extension to full flexion. It also states that an average of 3 mm lateral displacement
between skull & atlas of 3 degrees produces an approx. 3 mm lateral displacement of the
atlas.
Compare and contrast:
Similar signs or symptoms can be that the patient can mimic Myelopathy s/s:
Headache, numbness, tingling, and paresthesia’s. Dural Torque specifically is different
because of irregular Neuro Findings, Not necessarily bilateral. Can have similar signs and
symptoms as VBI as well. The Dura pulls on an upper cervical subluxation causing some
venous occlusion, local blood stasis and ischemia. Difference is that for VBI, there are many
different signs and symptoms that can occur including headaches, drop attacks, dizziness.
X-ray may show that all three have Upper Cervical subluxations. X-ray may also be a
differentiating factor in that for myelopathy it could show a canal stenosis. A CT would be
another differentiating factor. For myelopathy there could be a central disc prolapse or
herniation found. Also, with myelopathy there can be torticollis in children. For VBI you can
get a better look at the blood vessels to see what is happening.
Issues with the CSF or dentate ligament would lean more toward Dural Torque. Drop
attacks are pathognomonic for VBI. Having more of a cord involvement and bilateral
symptoms would push more towards the Myelopathy Theory.
Clinical / Patient Presentation
Signs and symptoms could be headaches, numbness, tingling, and paresthesia. Signs and
symptoms can be bilateral or unilateral. Also, there will be irregular neuro findings. Not
specific to any age group or sex. Not any history indicators. It is associated with upper
cervical subluxations. If there are problems with CSF flow or the meninges, it will most
likely fall underneath this theory.
Exam Findings
Exam findings could be +orthos for myelopathy such as Lhermitte’s, and pathological reflex such as
Babinskis because it does affect the cord. Although not identical to myelopathy because it is affecting the
dura findings are similar. Paleness or turgor may be noted in the upper cervical region as well due to
ischemia. X ray findings could be lateral displacement of the atlas as well as canal stenosis. Since this is
not affecting the osseous structures other than bone alignment there most likely will not be visible x ray
findings related to Dural torque.
Questions:
CSF stasis leads to:

A. Increased nutritional value B. Decreased nutritional value
C Increased blood supply D. Decreased blood supply
Which layer(s) are involved in Dural torque theory? Maca

A. Pia B. Arachnoid
Guide Fall 18
C Dura D. subdermal
Which ligament could cause cord dysfunction?
A. Interspinal B. dentate
C sacrotuberous D. Alar
Which ways can the dentate ligament adversely influence the conduction of neural
impulses?
Which portion of the spine is greatly affected by the dentate ligament?

References:
Gatterman M.I. (2005). Foundations of Chiropractic: Subluxation (2 nd edition). St. Louis, MO:
Elsevier Mosby. p. 238,302-303
Guide Fall 18
Inflammation Study Guide for SPVSC
Greg Bell
Ronnie Chiasson
Colby Espenas
Abby Key
Daniel J. Perkins
Inflammation Theory
“Tissue and cellular responses to injury in the spine includes infiltration of histamine,
protein-derived factors, eicosanoids, proinflammatory cytokines, nitric oxide,
degradative enzymes, and substance P, and pre-stages development of spinal lesions.”
(Leach, 11t)
History
 Primary Proponent = Charles “Skip” Lantz

 Historical View = Chronic (≥72 hours) Acute (≤72 hours)
o Chronic can occur from the beginning. Chronic inflammation will show
increased lymphocytes and macrophages, angiogenesis, proliferation of
connective tissue. Examples: arthritis, damage to vascular tissues
o Acute is marked by Swelling, Heat, Loss of Function, Redness, Pain. It
usually occurs after a trauma
o Portion of VSC 1. Dvorak, Mense, Gatterman-Goe, and Evans are
proponents for inflammation in the SDF model.
o The process can be linked to the immune response and is considered the
first step in the healing process (Leach, 131)
Summary
Inflammation is the body’s response to insult or injury. It is vital for the repair
process of tissue, but if uncontrolled can be more destructive than the original trauma
that triggered it (Leach, 131). Inflammation can be chronic or acute. Acute inflammation
is what we typically think of with an injury. The five signs are: rubor, calor, dolor, tumor,
and loss of function. These five cardinal signs are caused by the three phases of acute
inflammation. First the tissue level response associated with reddening and swelling as
capillaries increase permeability and cause pain and swelling in the affected area. Then
the cellular level response releases histamine granules and causes a contraction in the
endothelial cells lining the capillaries so leukocytes can travel through the capillary
walls. This is known as diapedesis or transmigration. It attracts macrophages by means
Guide Fall 18
of chemotaxis to clean up any bacteria or debris. Enzymes finally clear the area of
inflammatory stimulants during the biochemical response. If acute inflammation does
not resolve it can lead to the accumulation of leukocytes and macrophages and can
eventually lead to chronic systemic inflammation (Leach, 132). Management of the
inflammatory process is vital to proper recovery and we as chiropractors will be seeing it
on a daily basis.
The majority of chiropractic practice is treating and managing the inflammatory

process. Musculoskeletal and joint pain originate from the inflammatory process, the
body’s natural response to injury, and can be addressed through adjustments, passive
modalities, nutritional decisions and mental health practices. Chiropractic care offers
patients a conservative approach to managing and treating pain and loss of activities of
daily living caused by inflammation. These approaches should be a daily occurrence
and the heart of a chiropractic practice.
relevant)
 Neurologic Components / Systems: Substance P, superoxide, lysosomal

enzymes are released by neurons and are a portion of the mediation of the
inflammatory process. (Leach, 134)
 Vascular Components: The vascular component is the most easily recognized
portion of inflammation and is known to define it. Local inflammatory tissue
mediators like fibroblasts, matrix proteins, and local messengers are the main
vascular components that produce the marked rubor, tumor, calor, and dolor
response. A list of these components can include the following: histamine,
protein-derived factors, eicosanoids, platelet-activating factors, cytokines, nitric
oxide, free radicals, substance P, etc. (Leach, 132-134)
 Biomechanical / Anatomical Components: Prolonged inflammation can result
in inflammatory types of arthritides affecting discs, bone, joint spaces, cartilage,
and ligamentous structures.
Compare and contrast the chiropractic theory with 2 other relevant theories.
Joint Immobilization or the lack of movement in a joint has been associated with
chronic inflammation. It was proposed by Skip Lantz that immobilization will lead to
localized venous stasis, thus creating a negative venous pressure that will eventually
lead to improper venous drainage and ensuing inflammation (Bergmann, 46).
Inflammation has its place amongst the other theories and is a component of nearly all
of them. Inflammation theory portrays inflammation as the primary component of the
dysfunctions rather than an assistant to an alternate primary
Guide Fall 18
 Somatoautonomic reflex theory along with inflammation share prolonged

afferent input that triggers a segmental cord response that results in
sensitization and nociception (Bergman, 45).
 Inflammation theory and Neuroimmune hypothesis are linked according to
Hans Selye. Neuroimmune hypothesis displays a relationship between
the nervous system and the immune system rather than the immune
system and inflammation.
The classic presentation of inflammation is the acronym S.H.L.R.P. which occurs

typically in the acute stage of inflammation which is less than or up to 72 hours post
trauma. It stands for swelling caused by a buildup of fluid, heat due to the excess blood
within the affected area, loss of function and mobility in the region affected, redness
caused by the capillaries in the area being filled with more blood than usual, and pain
due to nerve stimulation via release of inflammatory chemicals. Inflammation can also
have associated flu-like symptoms such as: fever, fatigue, joint pain, chills, muscle
stiffness, and headaches.
 Patient history indicators:
Past trauma and diagnosis of an arthritic condition
 Pathognomonic traits / characteristics:
Acute Inflammation = accumulation of neutrophils
Chronic Inflammation = accumulation of lymphocytes and macrophages
accompanied by angiogenesis and connective tissue proliferation.
Exam Findings
The exam findings for inflammation would be in line with the classic acute
presentation which would be noticeable swelling of the tissue caused by histamine,
bradykinin, and prostaglandins that causes blood vessels to leak fluid into the affected
tissue, at the location of the injury the skin will also be warm and painful to the touch
with noticeable skin redness. The only sign that continues from the acute phase to the
chronic phase is decrease in function of the affected joint and loss of mobility.
Laboratory findings for inflammation would be an increase in ESR, C-reactive protein,
interleukin-6, and white blood cell count.
 Physical, Ortho, and Neuro:
Ortho - decreased ROM
Physical - pain, redness edema, heat, and bogginess
Imaging
Imaging that is appropriately used in the inflammation model is MRI and CT.
These images are best to visualize swelling in the tissue and structural changes that
could be occurring.
Exams
Guide Fall 18
When inflammation is occurring, one should always run blood work to determine
the cause. There are certain exams that should be performed. When someone has
inflammation, it could be due to diseases which could be determined with a CRP Blood
Test. ESR Blood Test could also be performed to determine inflammation. Both tests are
used to measure proteins in the blood.
Study Guide Questions with answer key for review purposes (if they are well
written questions, they could appear on the final).
 Multiple Choice Questions- with 4 answer choices

1) Which of the following is found in chronic inflammation?
a) Neutrophils
b) Heat
c) Redness
d) Angiogenesis
2) Two days ago a patient fell down a small hillside while hiking and comes to your
office. While examining their back, you notice several scratches (most likely from
branches and rocks while the patient slid) the scratches are red and swollen. Who’s
theory would best fit?
a) Seyle
b) Lantz
c) D.D. Palmer
d) Gatterman-Goe
3) Which phase of the VSC model does the Inflammation Hypothesis by Skip Lantz fall
under?
a) Phase 2
b) Phase 1
c) Donald Trump’s twitter account
d) Phase 3
4) ____________ is/are often the first chemical mediator to affect the inflammatory
process.
a) Histamine
b) Leukocytes
c) Platelets
d) Prostaglandins
5) Which of the following is a stage of Acute inflammation?

a) Tissue repair following injury
b) Final step in the immune response
c) Day to day maintenance
d) Long term changes due to stressors
Guide Fall 18
 Two essay questions -These cannot be “compare and contrast” or patient

presentation from the bullet points above.
1. Using Lantz’s model, explain how rheumatoid arthritis can affect joint
alignment.
2. Explain why immobilization initiating the inflammatory response is relevant

in today’s society and what can be done to combat the situation.
References:
1. Bergmann, Thomas R. and David H. Peterson (1993). Chiropractic Technique:

Principles and Procedures (3 ed.) p.45-48. Mosby.
rd
2. Leach, Robert A. (2004). The chiropractic theories: a textbook of scientific

research (4th ed.) p.131-136. Lippincott Williams and Wilkins.
3. Nordqvist, C. (2017, November 24). Inflammation: Causes, symptoms, and
treatment. Retrieved from
https://www.medicalnewstoday.com/articles/248423.php
4. Sack, U., Biereder, B., Elouahidi, T., Bauer, K., Keller, T., & Tröbs, R. B. (2006).
Diagnostic value of blood inflammatory markers for detection of acute
appendicitis in children. BMC surgery, 6, 15. doi:10.1186/1471-2482-6-15
Guide Fall 18
Immobilization degeneration/stability
By: Cody Elenz, Shelby Franklin, Derek Hines, Kara Penson and Abigayle Welch
Definition: “Partial or total fixation, or immobilization of the spinal joints, especially when
combined with trauma, commonly promotes pro-inflammatory changes, cartilage and disc
destruction, and osteophytic bony and architectural changes” (Leach, 236).
Primary Proponent: Leach and Lantz
o What was the historical view, if any, of this idea?

1. 4 Phase Model (Sandoz)
a. Articular Overstress
b. Insufficiency and instability
c. Episodic fixations
d. Stabilization
2. 3 Phase Model (Kirkaldy-Willis)
a. Dysfunction: SDF
b. Unstable: Instability hypothesis
c. Stabilization: Appearance of radiographic signs of degeneration
o Any other relevant historical concepts or ideas.

- Langworthy, Paxson, and Smith: modernized chiropractic
- Gillet: Belgian Chiropractic Research Notes, tests opposite PSIS and sacrum
- Schafer and Faye: Motion palp, first VSC in which restricted motion is key
o Summary
o What question is/was the theory trying to answer/explain?
- Partial or total fixation or mobilization of the spinal joints
- “Use it or lose it” - prolonged immobilization
o Key terms or concepts that go with this theory. These may be in bullet point or list
format.
- Use it or Lose it
- Questions will reference a motion palpation finding
- VSC phase 3
- Can “skip” phase 2
- VSC phase 1 can progress directly to phase 3
- Prolonged immobilization leads to permanent impairment
o Chiropractic relevance
o Why/how does this theory matter/apply to a practicing chiropractor and the profession?
- Movement is life
- Use it or lose it
- Adjustments help restore motion and prevent premature degeneration
Guide Fall 18
o Patient Education- Use simplified language to explain this theory in a manner anyone
could understand or relate to without having any sort of education past 7 th grade.
- When an old car sits for a long time, without any use, it becomes hard to start.
Things start to rust over and are no longer functional, making it harder for the car to
start. The same idea applies to your body.
o Explain the Physiological Attributes of the Chiropractic Theory (put N/A if not relevant)
o Neurologic Components / Systems
- Inflammation is induced by lack of mobility
o Vascular Components (if applicable)

o Biomechanical / Anatomical Components
- Partial or total fixation of immobilization
o Compare and contrast the chiropractic theory with 2 other relevant theories.
- Proprioceptive Insult and SDF
o What are the similar signs or symptoms?

- Fixation from surgery causes adhesions which restrict movement and induces
immobilization (PI)
- SDF can lead to immobilization by subluxation (SDF)
- Decreased motion segments can lead to immobilization (SDF)
- Pain is present
o What are the different signs or symptoms?

- Surgery is the precursor to the immobilization instead of natural causes (PI)
- Prolonged immobilization is irreversible, while SDF is a lack of range of motion
- Facilitation leads to sympatheticotonia
- Immobilization is irreversible damage
o What special tests or imaging studies would differentiate them? Include findings on
these tests or imaging.
- X-Ray
- Immobilization: loss of joint spaces, degeneration of the spine, and
osteophytes
- PI: previous surgical scars, congenital anomalies
- SDF: looking for soft tissue changes and inflammation
o Are there any pathognomonic traits or characteristics that would differentiate them?
- Immobilization: chronic problem
- SDF: sympatheticonia and facilitation
- PI: previous surgery and congenital anomaly
Guide Fall 18
o Signs and symptoms, age/sex

- The patient is typically 55+ yoa and findings are confirmed by x-ray. They may have
headaches, neck pain, chronic pain, shoulder tension or strained muscles. Patient
can present with poor posture and/or spinal subluxations.
1. Phase 1
a. pain with movement
2. Phase 2
a. pain with prolonged standing or weight bearing actions (Leach, 244)
b. Catching or clicking when after coming up from flexion (Leach, 244)
3. Phase 3
a. Muscle tenderness, stiffness, reduced movement, and scoliosis (Leach, 244)
b. Temporary immobilization within range of motion of a joint (Leach, 244)
4. Phase 4
a. Painful stiffness, restricted range of motion (Leach, 244)
o Patient history indicators
- 55+ yoa
- Trauma
- Pain with weight bearing activities, catching or clicking with movement, chronic
back pain (Leach, 244)
o Pathognomonic traits / characteristics
- Chronic
- “Use it or lose it.”
- Prolonged immobilization leads to permanent impairment.
o Exam Findings
- X-ray findings of degeneration, space narrowing, arthritis.
o Physical, Ortho, and Neuro.
1. Physical
a. Decreased passive and active RoM.
b. Observed muscle atrophy/surgical scars.
c. Increased muscle tonicity.
d. Weak muscle tests.
e. Fixation with motion palpation.
2. Orthos
a. Amoss’ sign to detect if ankylosing spondylitis could be present and to assess
mobility of the thoracolumbar spine.
b. Schober’s test can be used to measure the RoM of the lower back and if
contracture of the paraspinals is present, causing low back immobilization.
c. Adam’s forward bend test to check if scoliosis is present.
d. Spurling’s/Kemp’s for possible degenerative changes affecting the nerve
roots following immobilization.
3. Neuros
- None
Guide Fall 18
o Imaging used for the theory with findings (if any)

1. X-ray
a. Phase 1: hyperlordosis, gapping of disc space (Leach, 244)
b. Phase 2: Instability present on stress films, lateral shift, rotation, and tilt
misalignments (Leach, 244)
c. Phase 3: loss of disc height, osteophytes, scoliosis (Leach, 244)
d. Phase 4: Uncovertebral arthrosis in the cervical spine, disc space narrowing,
osteophytes (Leach, 244)
- Degenerative Disc Disease on x-ray
- Changes in curves (hypo or hyper)
- Spondylolisthesis
o Special Exams with findings (if any)
- None
Study Guide Questions with answer key
1) What two prominent Motion Palpation founding fathers first used the idea that
restricted motion is the key?
a) Langwothy and Paxson
b) Gillet and Smith
c) Schafer and Faye (found on the Immobilization Degeneration Hypothesis
Slide)
d) BJ and DD Palmer
2) What is the most important premise that prolonged immobilization lead to?
a) Reduced range of motion
b) Paraesthesia
c) Permanent Impairment (Found on the Immobilization Degeneration Slides)
d) Radiculopathy
3) Which phase in the Sandoz Model should you adjust on?
a) Articular overstress
b) Insufficiency & Instability
c) Episodic Fixations (Found on the Immobilization Degeneration Slides)
d) Stabilization
4) What class of structures is most known for demonstrating change following
immobilization?
a) Connective tissue (Found on the Immobilization Degeneration Slides)
b) Bones
c) Blood
d) Joints
5) What Phase does Immobilization Degeneration fall under in the VSC Model?
a) VSC 1
b) VSC 2
c) VSC 3 (Found on the Immobilization Degeneration Slides)
Guide Fall 18
d) VSC 4
Correct Answers:
1. C
2. C
3. C
4. A
5. C
Essay Questions
Explain why degeneration happens when a person undergoes surgery or fusion in their
spine?
In the presence of a surgical fusion the joint segments that typically took on motion
are now fused together. Well that new motion loss will be placed on the adjacent segments
above and below the fused vertebrae. The increase in motion in these adjacent joints will
make them hypermobile causing the body to want to turn them hypomobile which will lead
to degenerative changes.
Explain what you need to do as a doctor in order to properly diagnose degeneration in a

joint? And explain your reasoning.
In order to properly diagnose degenerative changes in your patient you would

motion palpate the joint segments that you believe may be restricted and degenerative.
Upon finding the restriction and taking a thorough history of your patient you need to take
x-rays in order to properly diagnose degeneration.
References:
Leach, R. A. (2004). The chiropractic theories: A textbook of scientific research. Philadelphia,
PA: Lippincott Williams & Wilkins.
Guide Fall 18
Instability Hypothesis/Theory Study Guide

Dayana Bucarello, Crystal Huddleston, Chance Shearwood, Kindry Kirbo and Nick Nolen
Science Philosophy of the VSC
CHSC 6307
Fall 2018
December 1, 2018
Dr. Dana Hollandsworth

Guide Fall 18
o Instability Hypothesis Definition (Leach, pg. 207)

o “Severe or repeated trauma and postural stresses, with subsequent collagenous
scarring of ligamentous, capsular, and discal tissues, results in instability and/or
misalignment that may be observed with imaging procedures, that predisposes the
spine to painful episodes and disability, and that ultimately leads to premature
stabilization of the involved motion segments.”
o History
o Proposed in the Kirkaldy-Willis theory as the “unstable phase” of the degenerative
disease process and the Sandoz theory as the “insufficiency and instability phase.” The
definition for instability comes from these models. It is defined by medical x-ray criteria
including flexion/extension views and stress studies. It is the only model to fall into VSC
phase 2.
o B.J Palmer established the 1st radiograph protocols. There are different techniques
that can be used to evaluate x-rays and determine if instability is present.
o Key terms or concepts that go with this theory:
o Traumas
o Abnormal curves
o Spondylolisthesis
o Retrolisthesis
o Idiopathic scoliosis
o Cervical hypolordosis
o Innominate tilt
o Upper cervical subluxation
o Developmental factors
o Erosive arthritides
o Infections
o Ligament instability
o Congenital anomalies
o Chiropractic relevance
o The Instability Hypothesis generally provides a very intuitive mechanistic
explanation by which a proper conceptualization of the second phase of the
vertebral subluxation complex and its consequent implications may be
communicated succinctly and effectively across many strata of theoretically
applicable patient presentations. The necessity of radiographic verification
exponentiates the degree of simplicity by which this theory may be illustrated
given the inherency of the diagnosis’ visual demonstration.
Guide Fall 18
o The effective remediation of this theoretical premise for purposes of patient

education may be satisfied through descriptive means such as: “Hi, how are you
doing today (patient’s name)? As it turns out you appear to be suffering from
(named unstable condition), if you’ll take a look at your X-ray with me for a
moment, you can see right over here (point to causal mechanism). These (angles,
translation, rotation, tilt, curve, etc.) shows stress being placed on your tissues,
creating an unstable environment for your body when performing many of the
activities you engage in your daily life.”
o The Physiological Attributes of the Chiropractic Theory
o Might only be necessary to correlate physiology if the qualifying
instability stands in direct consequence of something analogically congruent with
systemic infection.
o Neurologic Components / Systems o Vascular Components
o There are no such components other than to say that such instability might
implicate compromise to vascular or neurological structures when considering
unstable presentations such as those patients presenting treatment contra-
indicative radiographic atlantodental interval margins.
o Biomechanical / Anatomical Components
o This theory is founded upon notions of anatomical compromise, it is the
mechanism by which the global unsteadiness implied by the term instability
manifests. This mechanism may geographically localize to any axial/appendicular
structures in the form of traumatic devastation, abnormal spinal curvature,
spondylolisthesis proper, retrolisthesis, idiopathic scoliosis proper, cervical
hypolordosis proper, innominate tilt, upper cervical subluxation, auxiliary
developmental aberration; if not present globally in terms of erosive arthritides,
infections, disc degeneration, ligamentous instability, or effective congenital
anomalies.
o Compare and contrast with Proprioceptive Insult and Immobilization Degeneration:
o Similarities:
▪ Congenital anomalies
▪ Both degeneration and Instability can be determined via medical x-rays
▪ Premature degeneration can occur due to instability in order to immobilize
which can appear are decreased in range of motion.
o Differences:
▪ Immobilization Degeneration skips VSC phase 2 which is the instability
phase.
▪ Immobilization Degeneration involves restricted movement
Guide Fall 18
▪ Surgery is involved with proprioceptive insult but not necessarily

instability. In fact, surgery can be a way of addressing instability.
▪ Instability is more predominant in the upper cervical spine.
o Special tests or imaging studies to differentiate them?
▪ History, X-ray films and ortho test to determine the severity, grade, and
level. It would be difficult to differentiate whether the instability or the
degeneration came first. If there is a history of surgery or a congenital
anomaly is known, then that points more to proprioceptive insult.
Degeneration can cause instability at other levels and instability can cause
premature degeneration process.
o Clinical / Patient Presentation (Leach, pg. 209)
▪ Signs and symptoms include when a patient moves and reports feeling a
catch type of pain. Pain is reported when returning to the proper posture.
Patient seeking compensation for pain. Neuromotor deficits.
▪ Signs and symptoms of instability and insufficiency would be any type of
injury that results from failure (i.e. a disc failing to hold the vertebrae
together, or a dislocation).
▪ There is a prevalence towards the elderly (>50 years of age), but it can
occur in young individuals. There is no prevalence towards sex.
▪ Indicators include postural issues the patient is experiencing. Postural
problems put stress on the spine that results in subluxation or instability.
▪ Recent trauma in the patient history could indicate instability problems
such as car wrecks or recent falls.
▪ Unexplained weight loss or history of cancer. Drug or alcohol abuse.
Corticosteroids. Recent visit for same problem unresolved.
▪ Infections (i.e. temperature greater than 100) and ligamentous instability
both will cause instability.
▪ Congenital anomalies such as Klippel Feil syndrome, where the patient
suffers from two cervical vertebrae fused together will result in instability.
▪ Erosive arthritides cause subluxation; The primary disease that goes with
erosive arthritides is rheumatoid arthritis.
▪ Instability causes infections. The vertebral subluxation has been shown to
decrease a patient’s immune system thus resulting in infections, fever and
others. The specific infections are rheumatic fever, cervical gland
infection, pharyngitis, retropharyngeal abscess, and influenza.
Guide Fall 18
▪ Ligamentous instability has also been linked to instability. Posterior

ligament instability results in anterior subluxation.
o Imaging, Exams, and Findings
o In order to access the instability model, it is recommended to utilize spinography.
Spinography assesses the postural and biomechanical issues within the spine.
o Radiographs are used to determine where instability lies as well as determine the
amount of premature degeneration.
▪ Cervical series should be utilized with emphasis on flexion/ extension
views to assess the integrity of the transverse ligament.
• AP films look for lateral shift, rotation, or any abnormal tilt.
• Oblique films look at the opening of the facets.
• Lateral films look for spondylolisthesis, retrolisthesis, foraminal
encroachment, and abnormal disc opening.
▪ Imaging findings may include a grade 3+ spondylolisthesis, type 2 dens
fracture, multiple posterior body collapses, etc.
o Physical findings found during an orthopedic exam would include a positive
Sharp-Purser test.
o Multiple Choice Questions :
o What is the only theory that is unique to Phase 2 of VSC?
A. Immobilization Degeneration
B. Inflammation
C. Instability
D. Spinal Buckling
o How is confirmation of the Instability Hypothesis found?
A. Medical X-ray
B. Lateral flexion views
C. Stress studies
D. A and C
E. All of the above
o All of the following are radiographic signs see on an AP film of the VSC phase 2,
except:
A. Rotation
B. Lateral Shift
C. Asymmetry
D. Abnormal tilt
o 2 Essay Questions:
o Why is there currently no universal definition for the instability hypothesis?
o Describe what physical and imaging findings you may see with a patient that
walks into your office in the VSC phase 2.
Guide Fall 18
Myelopathy
History:
Myelopathy is also known as Cord Compression or Compressive Myelopathy. Quoted by
Robert Leach, myelopathy “refers to destruction of spinal cord tissue typically caused by
pressure from neoplasms, hematomas, and other masses” (Leach, Pg 311). The primary
proponent of this theory was B.J. Palmer. His years of clinical research with the Hole in One
Technique (HIO) was the suggested method for myelopathy (Leach, pg 311).
Summary: Myelopathy hypothesis is defined as “Intervertebral subluxation may, in some severe

cases (and even in the absence of fracture – dislocation), irritate, compress, or destroy the spinal
cord”. With BJ Palmer the founder of HIO technique as the primary proponent of the myelopathy
hypothesis he believed that with upper cervical compromise or subluxation it could lead to cord
compression and UMN signs and symptoms with LMN signs at the involved level.
Key Terms:
Myelopathy Torticollis Osteophytes
UMNL Fracture Ischemia associated with
Ligament laxity Dislocation Spondylosis
Cord compression Trauma Tumor
HIO Technique Transverse Ligament Headache
Downs Syndrome SIDS Numbness
Spastic Paralysis Sleep Apnea Tingling
Hyperreflexia Breech Deliveries Paresthesis
Pathological Reflexes Atlas Inversion Quadraplegia
Clonus Central Disc Herniation Transiet Paraplegia
Paresis Congenital Canal Stenosis
Chiropractic Relevance:
This theory applies to the practicing chiropractor because patient’s will present to your office
with signs and symptoms relating to myelopathy. It is then your job as a practicing physician to
be able to recognize the signs and symptoms in order to localize the lesion and provide the
patient with the most appropriate care.
Myelopathy can occur to patients of all varieties and is not restricted to a specific patient
population. What myelopathy is is when the is an problem with the the brain or spinal cord
causing the patients to experience symptoms and it is the job of their doctor to recognize these
symptoms and localize the area that the problem is stemming from.
Clinical / Patient Presentation:

Myelopathy is not restricted to a certain age or sex. It can be seen in all varieties of individuals.
Upper motor neuron signs are what a patient may present with as described below under exam
findings.
Exam Findings:
Spastic Paralysis Hyperreflexia Pathological Reflexes
Guide Fall 18
Clonus Paresis
Increased ROM
Torticollis
Positive Valsalva
Positive Slumps Test
Positive Compression Test
Positive Distraction Test
Muscle Atrophy if Chronic
Muscle Weakness
30 Science the Philosophy of the VSC Study Guide Fall 18
Physiological attributes of the chiropractic theory:

 Neurologic Components/Systems (Leach, pg. 317)
o Upper Motor Neuron Lesion signs and symptoms include:
 Spastic paralysis
 Hyperreflexia
 Pathological reflexes
 Clonus
 Paresis
o Possible Lower Motor Neuron Lesion signs AT THE level of the lesion
 Vascular Components
o Not Applicable
 Biomechanical/Anatomical Components (leach, pg. 318)
o Upper Cervical Compromise
 Ligament Laxity
Compare and contrast:
 Similarities with Neuropathology and AXT
All present with lower motor neuron signs and symptoms at the level of lesion. MRI or a CT is the
best way to view for neuropathology and myelopathy. All three concepts some part of the nerve is
affected.
 Differences with Neuropathology and AXT
Neuropathology and AXT are unilateral presentation while Myelopathy is bilateral.
Neuropathology is a posterolateral disc herniation and Myelopathy is a posterior central disc
herniation. The pain presentation moves with AXT and stays at the same level of the lesion for
Neuropathology and Myelopathy.
Special tests and Imaging:
 MRI and CT will be the best for seeing lesions and being able to differentiate between the
3 theories (Leach, pg 317).
 Dejerine triad and Valsalva are two key tests to help differentiate if the disc is involved or
it would just be the nerve or nerve rootlet. A positive test plus the patient history and
presentation of being unilateral versus bilateral will help to differentiate between
Myelopathy, Neuropathology, and AXT. Tests like Spurling or Jackson compression test
could help differentiate a nerve root issue. Slump and Straight Leg Raise will help
differentiate a nerve root compression in the lumbar spine.
Pathognomonic characteristics:
 Spondylosis with degenerative and arthritic changes (Leach, pg 317), tumor (Leach, pg
320).
References:
Leach, Robert A. The Chiropractic Theories: a Textbook of Scientific Research. Lippincott
Williams & Wilkins, 2004.
Multiple Choice Question:

1. 57 year old male presents to your clinic with insidious onset of debilitating low back pain.
After further examination you reveal the patient has presence of a babinski, hoffman, and
chaddock reflex. All lower extremity reflexes are 3+ and strength is ⅗. Which hypothesis
as discussed in class relates to our patient?
a. Neuroimmune
b. Proprioceptive Insult
c. Myelophathy
d. Viscerosomatic Reflex
2. When dealing with SIDS patients that have a cervical subluxation, most of the time they
have _______ atlas, causing myelopathy.
a. Inverted
b. Lateral
c. Posterior
d. Retroverted
3. Who is the primary proponent of the myelopathy theory?
a. DD Palmer
b. BJ Palmer
c. Skip Lantz
d. Hans Selye
4. What was the primary proponent of myelopathy responsible for creating?
a. Hole in One
b. Delivering the first adjustment
c. The Drop Table
d. The Activator
Essay Question:
1. If a patient presented with signs and symptoms of an upper motor neuron lesion name three
things that one may find on this patient’s imaging?
a. Osteophytes
b. Central Disc Herniation
c. Spinal Cord Tumor
2. What are the 2 names myelopathy may be referred to as?
a. Compressive Myelopathy
b. Cord Compression
Neuroimmune Hypothesis
Group Members:
Ryland Weum, Ralph Estevan Martinez, Jaylee Greanead, Asef Aghapour Maleki and
Melissa Perez
Theory Name:
Neuroimmune Hypothesis - AKA: Neuroimmunomodulation and Neurodystrophy
Theory Definition:
Spinal joint lesions may, through largely sympathetic mediated influences, modify
nonspecific and specific immune responses, and alter trophic function of the involved nerves.
History:
Hans Selye was a Canadian endocrinologist who first described the G.A.S. (General
Adaptation Syndrome) in 1936 and was initially laughed at. He was eventually able to separate the
physical effects of stress from other physical symptoms. General adaptation syndrome has three
stages: alarm, resistance and exhaustion.
G.A.S. 3 stages:
 Alarm stage → First exposed to the stressor
 Resistance stage → The body tries to fight back
o Results in:
 Physiologic Adaptation Syndrome
 Disease of Adaptation
 Exhaustion/Adaptation stage → if the immune system fails, it results in disease of
adaptation
Summary:
Hans Selye was trying to determine whether or not a patient having a subluxation can
cause them to get sick, and vise-versa, adjusting a sick patient can increase their immune function.
Key terms for neuroimmune hypothesis:

 Patient has a fever
 Decreased resistance
 Stress induced immune suppression
 Antibody production
 Allergies / allergic reaction
 Neuroimmunomodulation
 Burnet's clonal selection theory → most widely accepted theory of immunity
Chiropractic relevance:
This theory is important because it could be the solution for a patient that comes in that
have not been feeling well, with a fever, or they have just been stressed out recently. This theory
suggests that a subluxation could be the cause for a patient's illness.
Physiological attributes of neuroimmune hypothesis:

The nervous system controls our body’s immune system. Therefore, if our nervous system
is not functioning properly due to a misalignment of the spine, it could cause our immune system
to not function properly, causing sickness.
Compare & contrast neuroimmune hypothesis with 2 other relevant theories:
 Inflammation Hypothesis: The inflammation hypothesis is much like to the neuroimmune

Hypothesis. These two hypothesis are similar because of direct linkage of inflammation to
the immune system and occurrence of inflammatory response as a part of immune body
immune system function. There are many signs and symptoms which are described in the
inflammation hypothesis can be seen and described in neuroimmune hypothesis too,
including; swelling, heat, and redness. These two hypothesis will be differ because the
inflammation hypothesis is only dealing with the body's inflammatory response and how
this response and reaction affects the musculoskeletal system of the body. However, these
two differ because inflammation hypothesis specifically only deal with the inflammatory
response of the body and how it affects musculoskeletal system. While; the neuroimmune
hypothesis refers and includes the inflammatory reaction but this theory doesn’t absolutely
depend on it. Based on neuroimmune theory the patient can be sick but may or may not
have an inflammatory reaction and response.
 Somato-Autonomic Reflex Hypothesis: Another hypothesis which is very similar to

neuroimmune hypothesis is the somato-autonomic reflex hypothesis. Based on the
sympathicotonia hypothesis which was used to support the somato-autonomic reflex theory
and studied immune competence, the spinal subluxation was associated with occurrence of
changes in blood chemistry. This shows a direct relationship of immune function of body
and neurology. However, both hypotheses refer to reflexes of blood chemistry affecting
spinal structures, where neuroimmune dystrophy more likely refers to how spinal
subluxations affect the immune process via neurological innervation.
Patient presentation:
The patient will present complaining of being stressed out recently, not feeling well, having
a fever, and other signs and symptoms of being sick. No specific age or sex is indicated.
Exam findings:
Physical → patient will most likely present being sick, with possible fever.
Labs → Increased cortisol levels, increased IgG
Imaging used: None

Study guide questions:
1. Neuroimmune hypothesis is also known as? MACA

a. Neurodystrophy
b. Neuroimmunity
c. Neuroimmunomodulation
d. Weak immune system theory
2. This hormone is increased with neuroimmune hypothesis?

a. Glucose
b. Adrenaline
c. Cortisol
d. Estrogen
3. What lab finding is increased when a patient has neuroimmune hypothesis?

a. IgG
b. IgA
c. IgF
d. IgH
Answer key:
1. A, C
2. C
3. A
Essay Questions:
1. List and describe the 3 stages of the General Adaptation Syndrome (G.A.S.) of the
neuroimmune hypothesis.
2. The neuroimmune hypothesis suggest that a subluxation might cause an illness such as:
fever, drowsiness, or other illnesses. How might a subluxation cause such issues?
3. How should the future research need to focus on the neuroimmune hypothesis regarding to
drive a preventive/curative treatment via chiropractic care?
References:
“Chapter 16.” The Chiropractic Theories: a Synopsis of Scientific Research, by Robert A. Leach
and Reed B. Phillips, Williams & Wilkins, 1986.
Neuropathology/Neural compression/traction
models/LMNL
Jordan Hines, Jacob Wilson, Nathan Worden, Stephen Hamilton
Neuropathology
“Intervertebral subluxations may interfere with the normal transmission of nerve energy by
irritating or compressing spinal nerve roots.” (Leach Pg. 251)
History
The historical proponent of this theory was DD Palmer. The Theory has also been known
as the Neural Compression theory. This was a theory that was around however he placed
a new spin on it. He thought that there was an alteration of tonus. This would be a case of
too much or too little nerve function would lead to a disease state. He felt that this was
caused by a “bone out of place and lead to the development of the neuroimmune
hypothesis. The theory of the pinched nerve was investigated by many researches that
tried to discover the cause of the problem. People believed it was caused by
intervertebral subluxations or a disc herniation. This was a foundation theory for
chiropractic and many different people have investigated it over the last hundred years
but has been shown to be largely incorrect.
Summary: With the theory of Neuropathology, D.D. Palmer was trying to answer the
question of how a bone out of place or subluxation, effects a spinal nerve. D.D. Palmer
theorized that a bone out of place, due to accidents or poisons puts pressure on a spinal
nerve thereby increasing or decreasing its flow of nerve energy (Leach).
 Bone out of place
 Pressure on a nerve
 Increased or decreased flow of energy
 Lower motor neuron lesion
 Nerve root compression
Chiropractic Relevance: Although D.D. Palmers theory of neuropathology was later

disproved, it had a large impact on the chiropractic profession because it laid the
groundwork for further research into the subject. After further research of the anatomy of
the IVF and nerve roots it was found that nature has provided mechanisms to avoid direct
pressure from the bone pressing on the nerve root. This matters to chiropractic
professionals because it is the foundation of all that we do. Our adjustments are meant to
affect the nervous system and it is important for us as practitioner to understand exactly
what those affects are.
This theory can be related to a kink in a water hose. When you put a kink in a water hose
you stop the flow of water out of the hose. This is what theorized in neuropathology, when
a bone gets out of place it puts pressure on a nerve root thereby interrupting its flow of
energy.
Physiological Attributes: Subluxation is the restriction of motion in a segment in the

vertebra. This restriction is due to the body adapting to its internal and external
environments. Subluxation adds to the stress response of the body, which diverts energy
away from the immune system, reproductive system, and gastrointestinal system; and re-
allocates that energy to the skeletal muscles, as well as the heart. Lack of motion could
also interfere with the neuronal information traveling down from the brain to the
autonomic nervous system, which controls bodily functions such as breathing, heart rate,
and the digestive processes.
Mild nerve compression, for a brief period, can cause demyelination of a nerve. It can
also cause edema, and/or hemorrhage in the endoneurial space of the dorsal root
ganglia. Edema can be more pronounced after a rapid onset of compression to the nerve.
Chronic nerve compression has been shown to cause edema. Transient severe nerve
compression has demonstrated proximal edema with fiber disarray; and Wallerian
degeneration distally down the nerve fiber. It has been shown that chronic severe nerve
compression will produce edema, and due to that, the nerve escapes the perineurium to
develop new pathways or will cause the nerve to remyelinate (Leach pg. 264).
Neurological Components/Systems: LMNL, flaccid paralysis, fasciculations, decreased

DTRs, muscle weakness, and/or hypoesthesia
Vascular Components: inflammation, ischemia, or edema
Biomechanical/Anatomical Components: tension from traction can lead to

compression and pressure on nerve roots or rootlets
Compare and Contrast:
The Neuropathology Hypothesis can be closely related to the Myelopathy Hypothesis and
Axoplasmic Transport Hypothesis.
Myelopathy Hypothesis:
Both neuropathology and myelopathy state that the cause of interference

with normal nerve transmission is segmental dysfunction and may lead to other
symptoms. Though there are few things that are the same. There are many differences
between the two different theories. Neuropathology says that the only part of the nerve
being interfered with is the nerve root. The interference at the nerve root causes unilateral
LMNL signs and symptoms due to compression of just the nerve roots. On the other-hand
the myelopathy theory states that instead of compression of the nerve root, the spinal
cord is compressed causing bilateral UMNL signs and symptoms. For clinical findings
there would likely be numbness, motor weakness, paresthesia, transient paraplegia.
When looking at imaging, MRI will show spinal cord compression and an x-ray may show
rotation, at the atlas, that can cause compression of the cord.
Axoplasmic Aberration Hypothesis

These two theories are very similar in a couple ways. Both theories state
that altered nerve conduction is due to compression on a nerve. The compression will
likely exhibit unilateral LMNL’s signs and symptoms. There are a few differences between
the two theories. For AXT, there is compression at the nerve root, rootlet, or compression
anywhere along the nerve. The pain can also move along the path of the nerve, the
movement can be anterograde (forward) or retrograde (backward). Neuropathology has
compression only at the nerve root and the pain will not travel along the path of the
nerve. Clinically you may find that a patient with AXT will have certain neuro findings such
as hyporeflexia, decreased MSR’s, decreased muscle strength and may have decreased
sensory findings. Blood work can display a higher number of trophic factors which help in
aiding growth of nerves (NGF). At this moment there is no specific imaging that can help
diagnose AXT.
Clinical/Patient Presentation
Signs and Symptoms: sciatica, limitation of back mobility, depressed or absent ankle
reflexes, diminished or absent patellar reflexes, weakness or atrophy of certain muscles,
or paresis of the quadriceps and hamstrings (Leach pg. 256)
Patients History Indicators: MOI with rotation, compression, and/or torsional forces
Exam Findings: loss of DTRs, weakness, numbness in a dermatomal distribution,

fasciculations
Imaging None
Special Exams with findings: Nerve compression tests such as Maximal foraminal
compression, SLR, Lesgues, Nerve tension signs.
Multiple Choice Questions:
1. Who was the primary proponent of the neuropathology hypothesis?

A. Skip Lantz
B. D. D. Palmer
C. B. J. Palmer
D. George Goodheart
2. A patient presents with pain that radiates down a dermatomal pattern. Which
model does this associate with?
A. Neuropathology
B. Neuroimmune
C. Segmental dysfunction
D. Myelopathy
3. Which of the following is a sign of a LMN lesion?

A. Hyperreflexia
B. Pathological reflexes
C. Clonus
D. Hyporeflexia
4. Which of the following are most vulnerable to avulsion/tension?

A. Disc
B. Spinal Cord
C. Dentate ligaments
D. Nerve rootlets
Answers:
1. B
2. A
3. D
4. D
Essay Questions:
Discuss what one might expect to find in the acute cases of neuropathology.
In the acute case, one should expect irritation and hyperesthesia.
Discuss what one might expect to find in chronic cases of neuropathology.

In a chronic case, one should expect compression and hypoesthesia.
Proprioceptive Insult/Dysafferentation
Emily Dubrick, Chad Kirkpatrick, Chris Mata, Alexandria Miller, Stephany Uc
History:
Primary Proponent: N/A
Historical View: It is a subcomponent of the somatosomatic reflex model.
Any other relevant historical concepts or ideas: It can also be known as
“mechanoreceptor funk.”
Summary:
What question is/was the theory trying to answer/explain? It is trying to explain that
altered biomechanics results in altered proprioception
Key terms or concepts that go with this theory: post traumatic, post surgical,
congenital anomaly, such as congenital blocked-vertebra, hemi-vertebra, sacralization,
lumbarization, surgical fusions
Why/how does this theory matter/apply to a practicing chiropractor and the
profession? It allows them to see that it is a biomechanical aberration, where there is
sensory flood in the posterior horn affecting interneuron pools
Patient Education- Use simplified language to explain this theory in a manner
anyone could understand or relate to without having any sort of education past 7 th
grade.
If there is something in the body that normally wouldn't be there then the risk of body
awareness can decrease. This can stem from extra anatomy or fusions that you were born
with or from surgical interventions like hip replacement. The alteration from normal affects
the ability to maintain optimal stability and motion in the body. This sometimes is shown by
a clumsy nature or altered sensation to touch.
Explain the Physiological Attributes of the Chiropractic Theory (put N/A if not relevant)
Neurologic Components / Systems: Increased/abnormal input into the cord (posterior
horn) or brainstem (upper cervical spine) causing aberrant interpretation or processing of
proprioceptive information
Vascular Components (if applicable): N/A
Biomechanical / Anatomical Components: Altered biomechanics resulting in altered
proprioceptive input. This typically applies with post traumatic or post surgical
biomechanical aberrations. Congenital anomalies such as hemi-vertebra, congenital
fusion, etc., may predispose someone to this phenomenon.
Proprioceptive Insult Korr Fixation Theory
Applies with congenital anomalies (hemi- Hypomobility of a motor unit causes

vertebra, congenital fusion), post traumatic or hypermobility above & below. This causes
post surgical biomechanical aberrations segmental facilitation (excess sensory input
resulting in altered proprioceptive input. This into cord). The posterior horn interneuron pools
causes increased/abnormal input to posterior are “flooded.” The lateral “fires up” causing
horn or brainstem causing aberrant sympatheticotonia causing abnormal
processing of proprioceptive information. “reflexes”/sympathetic response.
“Garbage in, garbage out.”
What are the similar signs or symptoms? Altered biomechanics altering

sensory input.
What are the different signs or symptoms? Proprioceptive insult affects the
posterior horn, causing abnormal sensory input which will cause abnormal output.
Whereas, in Korr Fixation Theory, the posterior horn is flooded from excess
sensory input, causing the lateral horn to “fire up” and cause sympatheticotonia.
What special tests or imaging studies would differentiate them? Include
findings on these tests or imaging. Altered biomechanics, fusions, traumas can
be seen on x-ray. It would be difficult to see abnormal sensory input, but MRI
would be best when looking at sections/cuts of the spinal cord, where we may see
abnormalities in posterior/lateral horn of the spinal cord.
Are there any pathognomonic traits or characteristics that would
differentiate them? With Korr Fixation Theory, we are seeing excess sensory
input causing an increase in sympathetic response and aberrant reflexes, whereas
with proprioceptive insult, it’s more-so saying that bad sensory input = bad motor
output, not an excess sympathetic response.
Proprioceptive Insult Spinal Buckling
Applies to congenital anomalies and post Caused by a structural failure leading to

surgical/ posttraumatic disorders. These unacceptable deformation or separation. This
variances cause biomechanical aberration to then leads to functional failure. Prolonged static
the posterior horn, which then affects posture and/or load may lead to a phenomenon
interneuron pools. Another way of describing known as creep deformity. Creep deformity can
the effects of this insult is “Mechanoreceptor lead to spinal buckling. Manipulation may alter
Funk.” the dynamics of the buckled region.
What are the similar signs or symptoms? Altered segmental positioning can be
present in both theories which leads to functional failure as well as altered sensory
input.
What are the different signs or symptoms? Proprioceptive insult results from a
congenital or surgical cause where spinal buckling results from prolonged static
posture/load. The history should indicate which theory applies.
What special tests or imaging studies would differentiate them? Include
findings on these tests or imaging. Both congenital anomalies and spinal
buckling may be seen on x-ray imaging. Congenital anomalies will be noticed as
variances in normal anatomy. Spinal buckling needs to be more severe to be
noticed on film. If it is not a severe change in position, palpation may be the only
indication of abnormal positioning.
Are there any pathognomonic traits or characteristics that would
differentiate them? With proprioceptive insult we are looking for a history of
surgery or a known congenital anomaly. If one of these is in the history and we
notice altered sensory input, we would attribute this to proprioceptive insult. In the
case of spinal buckling postural changes may be an immediate sign when
accompanied by functional failure (Hollandsworth).
Clinical / Patient Presentation:
o Uncoordinated movements or clumsy nature. Person could have poor posture.

Anyone is susceptible to this theory.
o Patient history indicators is anyone with congenital anomalies or past surgical
interventions.
o Mainly non life threatening.
Exam Findings: Positive Adam’s forward bending test, and altered dermatomal sensations
(pinwheel & cotton ball).
Imaging used for the theory with findings (if any): X-ray, CT, MRI
Special Exams with findings (if any): Bent forward scoliometer test. Positive findings are
horizontal unleveling. Inclinometry measurement of the thoracic and lumbar spine. Decreased
ROM would be indicative of additional anatomy.
Multiple choice questions:
1. Select which conditions will be a cause of proprioceptive insult (MACA).

a. Incomplete Lumbarization
b. Pancoast Tumor
c. Hemi-Vertebra
d. Hip Replacement
2. It appears that you have 6 lumbar vertebrae on a recent x-ray. What theory can this be?
a. Proprioceptive insult
b. Axoplasmic Transport
c. A&B
d. All of the above
3. Which of the following is another way to describe proprioceptive insult?

a. UMNL
b. Mechanoreceptor Funk
c. LMNL
d. A & C
4. A patient presents to your office with signs of altered sensory input. What would be important to
ask in the history for this patient to confirm that this is caused by what you assume is
proprioceptive insult? (MACA)
a. Have you been drinking enough water?
b. Have you been involved in any car accidents lately?
c. Have you had any recent surgeries?
d. Do you have any congenital anomalies that you are aware of?
Answers:
1. A, C, & D
2. A
3. B
4. C & D
Essay Questions:
1. Describe how you would take a history for a patient if you suspected that
proprioceptive insult was involved in their current presentation.
 Ask if they have any congenital anomalies that they are aware of.
 Ask for a full traumatic injury history.
 Ask for a full surgical and hospitalization history.
 Palpate and observe for any obvious signs of surgery or trauma such as scars or
altered skin pigmentation.
2. Describe the concept of proprioceptive insult as you would to a patient if you were
trying to help them understand the cause of their pain.
 There is garbage in your nervous system that we need to remove so that your
body can function properly.
 The surgery/trauma/anomaly you have is interfering with your body’s
communication system. Follow with an explanation of how your nervous system is
your bodies communicating system and how it is used to heal itself.
 Your body is having a hard time sensing itself and its surroundings due to _____.
We are going to try and help your body heal itself to correct this through
chiropractic care.
 Safety pin example.
REFERENCES:
Hollandsworth, Dr. Dana, D.C. Powerpoint on Proprioceptive Insult. Presentation from Parker
University, SPVSC, Fall 2018.
Hollandsworth, Dr. Dana, D.C. Powerpoint on Segmental Dysfunction. Presentation from

Parker University, SPVSC, Fall 2018.
Leach, Robert A. The Chiropractic Theories: A Textbook of Scientific Research. LLW, pages
192-194.
Correlating Chapter(s) in Reference Texts:

CH 9 - Leach
CH 19 - Gatterman
CH 8 - Redwood p.164
CH 7 - Bergmann
Segmental Dysfunction and Sympatheticotonia

Malik Abdullah, James Cox, Jasmine Denton, Leslie Keehne, Olena Vaughan
Segmental Dysfunction
Segmental Dysfunction (SDF) or “segmental facilitation” is equated to abnormal or
irregular spinal function in the form of an “incomplete luxation” or “dislocation” that is
limited to a single motion segment where the contact between the joint surfaces becomes
altered. A single motion segment is consistent of both somatic and viscera, the intervertebral
disc, nerve which innervates and any connecting soft tissue. (Leach page 137 and Redwood
page 115)
“This term is often utilized by chiropractors to describe a spinal lesion as if fits within the
acceptance of Medicare guidelines within the United States.” (Hollandsworth SDF)
SDF = lack of ROM
VSC Phase 1
History (Leach Chapter 9)

Early Proponents: 1906 Langworthy, Smith, and Paxson
*Modernized Chiropractic Textbook*
Early Research/Views
In 1940 a group of Osteopathic researchers used thirty young men to explain the
theory of “facilitation”. The research noted that when pressure even as small as 1Kg was
applied directly over the spinous process hyperexcitability could be observed in either one or
both sides of the erector spinae muscles. Furthermore, their research noted that even when
pressure was applied to distal segments spikes in excitability could be seen. Their research
determined that the areas had become “facilitated” therefore resulting in them having a
lower threshold to activity.
There are several neurobiologic models (subsets) of non-inflammatory and Inflammatory

models which all lead to or contribute to “segmental facilitation”.
Non-inflammatory Models (2)
Non-inflammatory models are identified as afferent inputs which have resulted in sustained
alterations leading to neural excitability in the spinal pathways.
1. Korr: Fixation theory (Evolves into Sympathecotonia with CNS involvement.)
2. Patterson - Steinmetz: Spinal Learning - (Leads to Neuroplasticity.)
Inflammatory Models (4)
Inflammatory models result in nerve propagation alterations seen in spinal reflexes resulting
from peptides or inflammatory changes from tissue trauma.
1. Dvorak: postural muscles
2. Gatterman - Goe: Myofascial trigger points
3. Mense: local muscle tender to palpation
4. Evans: Minimal Energy Hypothesis
Segmental dysfunction summary

SDF includes many components on dysfunction signs and symptoms of the spine. SDF
looks at how a misaligned vertebral segment may cause abnormal joint function. The theory
of SDF modernized chiropractic, and the dysfunction model is most commonly used for
chiropractors. The main concept is that there a several proponents that can lead to
dysfunction, but myopathology is a precursor to SDF at a motion segment.
SDF Key Terms

Triad of signs of SDF: Components lead to Segmental Facilitation
Segmental Dysfunction: VSC Phase 1.

Abnormal spinal function that is limited to a single motion segment. SDF and Fixation
may be used interchangeably.
▪Motion segment examples: 2 adjacent vertebrae, intervening vertebral disc,
or soft tissue that connect two segments.
Segment includes the spinal nerve and all the tissues it innervates, both
somatic and visceral.
Neurobiological model
● Triad of signs of SDF
○ 1. Spinous tenderness/point tenderness to adjacent paraspinals
○ 2. Aberrant/ loss of normal motion
○ 3. Abnormal contraction of tension within adjacent paraspinal
● Physiological components of SDF

○ 1.Locked joint/ trapped menisci
○ 2.Abnormal muscle function
○ 3.Abnormal synovial joint biochemistry
Non-inflammatory
Korr: Fixation Theory-Pathway from start to finish 1. Hypomobility of motor unit 2.
Hypermobility above and below 3. Segmental facilitation excess sensory input into the cord
4. Posterior horn interneuron pools flooded 5. Lateral horn fires up 6. Sympatheticotonia
abnormal reflexes/sympathetic response.
▪ Sympatheticotonia
Patterson-Steinmetz: Adjustments highly effective here but may not be easily

removed. Spinal learning- spinal fixation generated by central/cortical or peripheral input to
segment, Reflex can be created in short time with sufficient stimulus, increased excitability
outlasts spinal transection and prolonged periods of otherwise normal activity.
▪ Neural scar
▪ Neuroplasticity
Inflammatory
Dvorack: SDF creates mechanical and chemical stimulation thus activating

nociception and spinothalamic tract activity.
▪ Joint complex dysfunction
▪ Postural muscles
▪ Increase muscle spindle activity
▪ Histochemical changes
▪ Relative hypoxemia and muscular dysfunction causing disturbed
joint movement.
Gatteman-Goe: proposed traumatic or postural strain of skeletal muscle could

generate a myofascial trigger point
▪ Myofascial trigger points
▪ Tissue damage caused inflammatory response
▪ Sustained local contraction leads to depletion of ATP
▪ Leading to progressive failure of relaxation and thus contracture
of muscle
▪ Self-perpetuating cycle, painful, resists stretching, decrease ROM
in adjacent joints
Mense: Muscle over exerction of a mechanical spinal lesion.

▪ Tenderness to palpation
▪ Focuses more on the sequelae of SDF rather than the cause of the
mechanical spinal lesion
▪ Help explain modification of afferent bombardment of dorsal horn
Evans: The spine will seek optimal minimal energy configuration, if constraints are
removed
● Minimal energy Hypothesis
● Evans invented the PulStarFRAS
● Constraints preventing optimal minimal energy configuration.
o Joint fixation caused by inflammation in and about the
spine
o Muscle spasms
o Fibro-adipose tissue and scar tissue
o Ultimately degeneration
Segmental Facilitation: Part of the biomechanical and neurological aspect of SDF

Muscle spindle primary: “coordinators” of segmental facilitation.
Sympatheticotonia: The result of SDF
o Cup of water analogy
Gamma motor neurons: Innervate intrafusal fibers of the muscle spindle- monitor stretch
Golgi tendon organ: Stimulation as the corrective component
Sympatheticotonia - (Leach, page 274,275)

Sympatheticotonia is a subset of SDF. It is also referred to as Reflex Sympathetic

Dystrophy (RSD). Initially it starts out as the Fixation Theory but evolves into
sympathicotonia with CNS involvement. CNS involvement is facilitated as the posterior horn
interneuron pool becomes bombarded leading to the lateral horn becoming “fired up”. Thus,
via paravertebral ganglia the innervated organ or tissue becomes sympathetically facilitated
with aberrant reflexes.
History
There are a multitude of studies regarding Hypertension, Thyroid related issue, along with
Vascular functions.
“Medical Physiologist Arthur C. Guyton in his studies became convinced that when it
came to Hypertension it was the result of excessive sympathetic activity, which resulted in a
renal weakness” (Leach)
Raynaud’s Syndrome is another example of Sympatheticotonia.
Sympatheticotonia summary
The theory of sympatheticotonia is a component of Korr’s SDF and Korr’s Fixation Theory.
Korr explained that there is a neurological component to Segmental dysfunction, and that
can be explained by the concept of segmental facilitation. Segmental Facilitation is a result of
the sympathetic system being overstressed. The Sympathetic nervous system is housed in
the thoracic spine T1-L2, and when the body is undergoing stress, muscle tightness/tension
fires up the sympathetics which can cause the thoracic spine to no longer function properly,
which will result in decrease ROM and malaise. The body can no longer handle the stress,
and the result is a sympathetic facilitated state. Individuals undergoing excess stress are
more likely to be affected by sympatheticotonia.
Sympatheticotonia Key terms

Sympatheticotonia: The result of segmental facilitation, abnormal reflexes/sympathetic
responses
Facilitation: according to Korr “Tissues innervated from the lesioned segment are sensitized
to all the influences operating within and outside an individual”
Segmental Facilitation: Part of the biomechanical and neurological aspect of SDF
Muscle spindle: Primary coordinator of segmental facilitation
Cup of water analogy: The body can only handle so much stress before the system
succumbs to the effects, and begins to show signs of segmental facilitation
■ Example given: pour a liter of water into a cup, it will allow as much as
it can hold, but will eventually spill over.
This theory applies to the chiropractor in a segmental dysfunction way. If there is a
spinal lesion it could cause abnormal motion or no motion at all.Paxson, Langworthy and
Smith felt as though all subsets lead to segmental facilitation. There are many subsets within
SDF but there are two neurobiological models. The first is Non-inflammation where Korr
describes fixation model/sympatheticotonia and Patterson talks about spinal learning. The
second in inflammation where Dvorak focuses on postural muscle, Goe talks about trigger
points, Mense refers to trigger points. Also, Evans focuses his energy on multiple adjusting
instruments.
Patient Education
This concept is very simple for patients to understand. This theory allows patients to
picture the positioning of dysfunction. I would explain that SDF can lead to a spinal lesion
which creates abnormal motion or no motion at all which is called fixation. Then would
explain that if we treat them with chiropractic care we can alter postural muscles, decrease
trigger points and tenderness in the segment. So that SDF remain won’t t remain in the body.
Physiological Attributes of the Chiropractic Theory

● Neurologic Components / Systems
○ Hormones and peptides that controls inflammation
○ Hyper/Hypo joint mobility and dysfunction
○ Noninflammatory response
■ Sympatheticatonia (Korr)
■ Segmental Facilitation
■ Neuroplasticity (Patterson-Steinmetz)
● Vascular Components
○ Inflammation secondary to trauma
■ Inflammation affects nerve propagation
● Biomechanical / Anatomical Components
○ Loss of range of motion
○ Joint hypo/hyper mobility
○ Ligaments or muscle hyper/hypotonicity
○ Pain on palpation
○ Restricted motion due to pain
Compare and Contrast the chiropractic theory with 2 other relevant theories.
We are comparing this theory with Neuropathology theory and Myelopathy theory.
What are the similar signs or symptoms?

Similar for all these theories are: presence of subluxation (segmental dysfunction),
joint hypo/hyper mobility, pain on palpation, loss of range of motion, restricted motion.
Common also that all of them could have a facilitation.
What are the different signs or symptoms?

The different signs will be in Myelopathy theory cases will be present signs of UMNL
(muscle hypertonicity, hyperreflexia, loss of sensory), in Neuropathology theory will be
present signs of LMNL on nerve root level. (hyporeflexia, muscle atrophy, flaccid paralysis).
In Korr theory the nervous system component could not be present at all. Pain during
Myelopathy cases could be absent. Pain in Neuropathology cases distributed segmentaly on
involved dermatomes. Pain in Korr theory mostly local.
What special tests or imaging studies would differentiate them?

Special tests will be useful take in MRI if we are suspect Myelopathy (to see a
compression of spinal cord). X-ray could be useful for Neuropathology theory cases (could
see a disc herniation). Stretching nerve roots tests will be pathognomonic for
Neuropathology theory. EMG will be very accurate to diagnosis a nerve root entrapment for
Neuropathology theory cases.
Pathognomonic traits or characteristics that would differentiate them?

Stretching nerve roots test- for Neuropathology.
UMNL signs- Myelopathy.

Signs and symptoms, age/sex.
Age and sex do not have any prevalence. Could be in any ages and any sex. The signs
and symptoms are:
1. Abnormal joint motion, muscular and connective tissue changes,

vascular, inflammatory, and biochemical changes.
2. Most significantly the associated neurologic manifestations, may result
in symptoms locally or at segmentally innervated anatomic levels (i.e.,
dermatomes, myotomes) far from the point of vertebral dysfunction.
Triad of Signs (classic as evidence for a manipulable lesion of SDF) are:

1. Spinous tenderness/point tenderness to the adjacent paraspinal musculature
2. Aberrant/Loss of normal motion (in 1 or more planes)
3. Abnormal contraction or tension within adjacent paraspinal musculature
Patient history indicators

Could be a previous history of trauma.
Pathognomonic traits / characteristics

Triad of signs: Spinous tenderness/point tenderness to the adjusted paraspinal
musculature; loss of normal motion in one or more planes; abnormal contraction or tension
within adjacent paraspinal musculature.
Exam Findings
Physical, Ortho, and Neuro.
Exam finding will be a decreased AROM and PROM, orthopedic findings will be found
based on level of SDF, neurological exam could be without any pathological finding or with
dermatomes and myotomes of involved vertebral level segment
Imaging used for the theory with findings

Imaging, such an X-ray could be useful more for differential purpose than diagnostics.
Special Exams with findings

Not any special exams or findings.
Study Guide Questions with answer key for review purposes
1.) Who formed the theory of SDF?

A) Paxson
B) Smith
C) Langworthy
D) all the above*
2) All subset of SDF leads to what?

A) inflammation
B) Non-inflammation
C) Fixation
D) Facilitation *
3) What is the precursor to facilitation?

A) Hypermobility
B) Hypomobility
C) Somatosensory
D) Myopathy*
Two essay questions:

1.Can segmental dysfunction be used to effectively explain how chiropractic technique works
on the human body in a court setting? If so how?
2. Give 3 examples of a patient who presents with segmental dysfunction and what you
would do to treat them.
References
Dana Hollandsworth lecture notes “Segmental Dysfunction SPVSC” fall tri 6 lecture notes
Dana Hollandsworth lecture notes “The Chiropractic Theories SPVSC” fall tri 6 lecture notes
Leach, R. A. (2004). The chiropractic theories: a textbook of scientific research (4th ed.).
Philadelphia, PA: Lippincott Williams & Wilkins.
Redwood, Daniel, and Carl S. Cleveland. Fundamentals of Chiropractic. 2nd ed. N.p.: Mosby,
n.d. Amazon Digital Services, Inc., 21 Aug. 2003. Web.
Spinal buckling/Biomechanical Models:
-Definition: A mechanical phenomenon associated with a local, uncontrolled mechanical

response to spinal loading results in a confluence of tissue reactions that can become
symptomatic
-History:
Who: Triano
Idea: As a joint or system of joints is confronted with unacceptable deformation, a
local uncontrolled mechanical response occurs that may irritate surrounding tissues and
lead to motion changes, altered tone, pain and paresthesia, swelling, tissue degenerative
changes, radicular or sclerotogenous referral, and/or spasm. Forces from manipulation can
then alter the dynamics of the buckled region.
Other relevant info: Creep alters the constitutive properties of the tissue and the
relative critical load. Under the right conditions, even a small additional load will cause the
joint to buckle. Creep deformity occurs during prolonged postural changes > small amount of
force or quick posture change > buckling.
-Summary:
What question was trying to be answered?
The point of this is possibly do answer the question of how sometimes the function of the
spine seems to get injured when doing very small movements like picking up your shoe or
bending over to tie it.
Key Terms:
Triano
Functional spinal lesion
Creep
Vibration
Spinal buckling
Discopathy
Tissue deformation
Motion segment buckling
-Chiropractic Relevance
Why does this matter/apply to chiropractic? As chiropractors, we see patients with a
broad range of back issues and biomechanical changes. Spinal buckling can occur
from prolonged postural changes, and we have the knowledge to rehab the
components affecting posture, i.e. muscles, ligaments, joints. Altered biomechanics
or joint dynamics can be restored or increased through chiropractic care.
Chiropractors can focus on functional movements of key stabilizing muscles to
decrease the effects of spinal buckling.
Patient Education: This model can affect patients who are in careers where they sit
at desks for extended periods of time, or are hunched/bent over while carrying
heavy loads can really benefit from chiropractic care to prevent spinal buckling.
This can be explained to patients that our bodies were not meant to be flexed
forward because after awhile we lose the ability and strength to remain upright,
causing our back muscles to get weak. Also, being in a flexed posture we decrease
the ability to be under a load of pressure comfortably. For example, it is easier and
healthier on the body for someone to pick up a heavy box with the back and chest
upright than bent over at the waist. We can educate the importance of good posture
and how it affects long term biomechanics and overall spinal health.
-Explain the Physiological Attributes of the Chiropractic Theory: Several tissues are
involved in spinal buckling because of the anatomical and biomechanical changes to
the spine. Nerves and nerve roots can becomes irritated due to spinal changes
causing presentation of tingling, numbness, and other paresthesias. Osseous
structures are affected because of the articular changes in the joints and facets.
-Compare and contrast with 2 other relevant theories.

53
Science the Philosophy of the VSC Study Guide Fall 2018
Spinal Buckling Instability Hypothesis
Defined via medical x-

ray criteria
MOI: single overload event, Symptoms: catch on
prolonged static posture movement and pain on
(creep) followed by an returning to upright
incremental load. posture
Etiology: Posture,
No imaging studies are used to
Immobilization/prolo trauma, disc
differentiate.
nged static posture. degeneration, erosive
Unacceptable deformation Pain arthrotides, infection,
Inflammation congenital anomalies,
Symptoms/signs: facet, disc, Tissue degeneration abnormal curves,
nerve, ligament, or muscle. spondylolisthesis,
Motion changes, radicular or retrolisthesis, cervical
scleratogenous referral, hypolordosis.
and/or spasm. hemivertebra
Inflammation may be present VSC phase 2
or not. Kirkaldy-Willis
“unstable phase.
Primary proponent: Triano
Spinal Buckling Immobilization Degeneration
VSC Phase 3…”Use it or lose

MOI: single overload event, it.”
prolonged static posture Partial or Total fixation or
(creep) followed by an Prolonged immobilization of the spinal
incremental load. Immobilization joints
Degeneration
No imaging studies are used to Pain Motion Palpation Findings
differentiate.
Immobilization leads to
Unacceptable deformation Premature Degeneration
Prolonged Immobilization
Symptoms/signs: facet, disc,
leads to Permanent
nerve, ligament, or muscle.
Impairment
- Motion changes, radicular or
scleratogenous referral, Due to: trauma, old age,
and/or spasm. chiropractic subluxations that
eventually lead to loss of
Inflammation may be present movement
or not.
Sandoz & Kirkaldy – Willis
Primary proponent: Triano models
A process of progression
from phase 1 to 3. That may
54

Signs and symptoms: motion changes, radicular pain, scleratogenous pain,
spasms
Age/sex: any.
Patient history indicators: prolonged immobilization. Ex: sitting hunched
forward for long period of time and suddenly standing up / riding a
motorcycle for long period of time.
Pathognomonic traits / characteristics: creep, deformation, functional
spinal lesion, discopathy, Vibration- decreases fatigue of intrinsic muscles &
lowers threshold of buckling. Intrinsic muscles act as interconnected links &
must stabilize & stiffen spine
-Exam Findings
Since spinal buckling is correlated with prolonged fixation, prolonged
exposure to vibration, or sudden axial loading the symptoms may arise locally or
peripherally. Symptoms are usually correlated to the specific segment that is
involved in buckling. Example; tissue involved, facet involved, disc involved. Refered
pain, reflex response or neural inflammation can be expressed.
-Physical, Ortho, and Neuro:
N/A
-Imaging Needed
N/A
-Special Exams with findings
N/A
Study Guide Questions with answer key

o Multiple Choice--with 4 answer choices
1) Who was the primary proponent of the spinal buckling model?

a) Triano
b) BJ palmer
c) Penn and teller
d) Grostic
55
2) When irritated surrounding tissues lead to motion changes, altered tone,
parastishia, radicular or scleratogenous referral, and/or spasm. This is evident of?
a) Neuropathology
b) Segmental dysfunction
c) Segmental buckling
d) Dural torque
Rationale for this answer is that “Tissue deformation” (in this case “surrounding
tissues lead to”…)altered mechanics. Whereas segmental dysfunction is dealing with
“a single motion segment” or involves a vertebra that has an altered field of motion.
Not Tissue damage with altered whaterver.
3) Fill in the blank _____a_________ Multifidus, rotators, intertransversarii.

and________b______ are Abdominals, quadratus lumborum, longissimus, intercostals.
a) Local stabilizers
b) Regional stabilizers
c) Local antagonist
d) Reginal synergist
Rationale. There are Two functional stabilizing systems.Local segmental stabilizing
muscles(mult), Broad regional muscles(ABS, ect). Systems coordinate function to
avoid reaching injury threshold.
Failure of coordination can lead to a local buckling event.
o Two essay--no “compare and contrast” or patient presentation from

above
1. Describe creep and how it pertains to spinal buckling.

2. Why is it important to instruct your patients on proper ergonomics/posture
all the time not just when you back is hurting?
Sources:
1. Gatterman, M.I. (2005). Foundations of chiropractic: Subluxation. St. Louis:
Mosby.
2. Leach, R. A. (2004). The chiropractic theories: A textbook of scientific
research(4th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.
56
Marisabelle Trevino, Tadd Terry, Jeffery Brown, Alicia Rodriquez
Spinal Reflex and Somatoautonomic Reflex
Spinal Reflex:
“A basic chiropractic hypothesis holds that abnormal spinal biomechanics and
muscle dysfunction have effects, via the nervous system, throughout the body and
that the chiropractic adjustment is applied not only to restore range of motion and
alignment, but also to cause or relieve reflex effects in the nervous system.”
Somatoautonomic reflex:
“Spinal joint lesions may trigger facilitation-induced reflexes that impair or disturb
visceral function.”
History:
oWho is the primary proponent:
Langworthy, Paxon and Smith
oWhat was the historical view, if any, of this idea?:
Originally this idea was not accepted because it didn’t align with D.D.
Palmer’s pinched nerve theory.
Other relevant historical concepts or ideas:

Gillet was an early proponent
Summary:
o What question is/was the theory trying to answer/explain?:
How chiropractic helped with visceral dysfunction
o Key terms or concepts that go with this theory.
SNS and PNS balance, most widely accepted hypothesis relating
chiropractic and viscera dysfunction or “global effects” of VSC,
sympathecotonia- reflex sympathetic dystrophy, cental and peripheral
modulation
As far as somatoautonomic reflexes go, it is the most widely accepted

hypothesis that correlates the chiropractic adjustment and visceral functions. Spinal
reflexes are important because they are what keeps us safe when certain parts of the
musculoskeletal system breaks down. They are both very important to chiropractic
because they widen the view of what the chiropractic adjustment can do. Patient
education for both of these topics can be done through a poster, and xray, or just by
showing models of the spine. The poster that everyone knows shows the spine and
links each segment to particular organ functions within the body. This allows us to
show each patient where their spinal dysfunction is, and it proves to them the
57
certain visceral dysfunction that they have been having is linked. Through
chiropractic adjustments, we will hopefully restore function in the spinal segments
which restores the organ function. The physiological components for
somatoautonomic dysfunction has to do with the body’s parasympathetic and
sympathetic body functions. Spinal reflexes have to do more with the nerves that
innervate the musculoskeletal system.
Somatoautonomic Reflex vs Segmental Dysfunction, Fixation Theory
Theory Similarities Differences Special test Pathognomoni

or imaging c traits
Somatoautnomic Affects SNS and Subluxation Palpation Visceral

Reflex PNS affects SNS Imbalance
resulting in
excessive
perspiration
(SNS)
Segmental Sympathecotoni Non- Palpation High blood

Dysfunction a inflammatory pressure
and
inflammatory
Fixation Theory Hyper and Joint play Motion Sympathetic

Hypomobility palp responses
analysis
technique
“hard end
feel”
o Clinical / Patient Presentation

o Imbalance between PNS and SNS as a factor in various disease process, Not
specific to age/sex
o Patient’s present with Subluxations cause dysfunction and result in illness
o Each vertebrae correlates with a specific visceral dysfunction
o Exam Findings
o Physical exam shows POP, hyperemia; Ortho exam none; Neuro none
O There is no imaging used for this theory

O Palpation is a special exam that can be used for this theory.
o Study Guide Questions with answer key for review purposes
58
What is the most widely accepted hypothesis relating chiropractic and visceral
dysfunction?
A. Neuropathology
B. Myelopathy
C. Somatoautonomic Reflex
D. Segmental Dysfunction
Who receives credit for Somatoautonomic Reflex?

A. Korr
B. Langworthy, Paxton, Smith
C. Gatterman-Goe
D. B.J. Palmer
Patient present with gallstones and presents with right shoulder pain. What reflex is
this?
A. Viscerosomatic
B. Somatosomatic
C. Viscerovisceral
D. Somatoviseral
Essay Questions
How will SAR help you in your practice and if not explain why this theory doesn’t
apply.
As a profession, this is a widely accepted theory about chiropractic. What can we do

to make this more than just a theory?
Reference:
Leach, R. A. (2004). The Chiropractic Theories: A Textbook of Scientific
Research(4th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.
59
Study Guide: Vertebral Basilar Insufficiency
By Yadira Hernandez, Reinaldo Rodriguez, Juan Barbosa, Aaron Henckel, Guillermo

Vazquez
Name
Vertebral Basilar Insufficiency (VBI): Drop attacks = Pathognomonic
History
None available
Summary
Cervical spinal joint lesions may compromise the vertebral arteries, especially in the
presence of anomalies within the vertebrobasilar system
Key terms or concepts
Drop Attacks=Pathognomonic
VSC phase 2 instability
Osteophyte, subluxation (VSC 2), or fracture-dislocation of cervical vertebra (C1/2 or
C5/6)When signs of VBI are present: stop adjusting, observe pt. for resolution and refer
pt. if signs do not subside
Signs of VBI
5 D’s and 3 N’s:

Diplopia
Dizziness
Drop attacks
Dysarthria
Dysphagia
Nausea
Numbness
Nystagmus
Ataxia
Falling to one side
60
Visual disturbance
Vomiting
The stroke issue
F: face
A: Arms
S: Speech
T: Time
Why/how does this theory matter/apply to a practicing chiropractor and the profession?
It is the practicing chiropractors responsibility to be aware of the signs and symptoms of

Vertebral Basilar Insufficiency and to know when care is contraindicated. Because
adjusting, in this case, can be life threatening, it is imperative that the chiropractor know
when to refer the patient out for immediate proper emergency care.
Patient Education - use simplified language to explain this theory in a manner anyone
could understand or relate to without having any sort of education past 7th grade.
The Vertebral Arteries carry blood to your brain. They run through your vertebrae on
both sides of your neck. If your bones are out of place, or you have something that is
pressing on these arteries, then your brain will not be able to receive blood and this
situation can be life threatening. It is important before performing an adjustment, to
make sure that your vertebral arteries are not in any danger.
relevant)
Neurologic Components / Systems
The Vertebral arteries supply the brainstem and the cranium with blood flow. Without
proper blood flow, the patient can experience double vision, dizziness, difficulty with
speech, difficulty swallowing, nausea, numbness, uncontrolled eye movements, loss of
body movements, and difficulty keeping balance.
Vascular Components (if applicable)
The vertebral arteries run through the transverse foramen on the top six vertebrae of the
cervical neck. They arise cephalad from branches of the subclavian arteries. After
61
traveling through the transverse foramen, they enter the cranium through the foramen
magnum. At the base of the medulla, these arteries come together to form the basilar
artery. The cerebellum and the cortex are then supplied from further branches.
Vertebral Basilar Insufficiency hypothesis can incorporate aspects of Instability

hypothesis of VSC Phase II as contributing or provoking factors of the signs and
symptoms associated with restricted blood flow to the brain. Both theories attribute their
respective signs and symptoms in part to traumas including whiplashes and sports injuries
resulting in subluxations, fractures and dislocations. In the case of VBI, these lesions are
hypothesized to compromise the vertebral arteries leading to the aforementioned signs
and symptoms while in Instability theory they lead to global spinal and body pain,
disability and degeneration. Also both theories attribute exacerbation of signs and
symptoms to congenital anomalies or malformation.
However, while VBI is focused on the implications of osseous interference to vascular

flow, instability theory looks at how traumas lead to degenerative states of discs, joints,
bone and how this ultimately leads to premature stabilization of the involved segments.
Another theory sharing similarities with VBI is B.J. Palmer’s myelopathy hypothesis
which like VBI focuses on the cervical spine. Signs and symptoms of compressive
myelopathy can include anything but most notably headaches, numbness, tingling,
paresthesia, torticollis and any number of neurologic findings as a result of fractures,
dislocations, subluxations, pathology creating pressure on the brainstem. Myelopathy
hypothesis is also heavily implicated in SIDS which may further link the two theories as
SIDS is believed to be the result of hypoxia perhaps in part as result of decreased blood
flow.
However, while many of these signs and symptoms overlap with those of VBI,
myelopathy hypothesis focuses of vertebral interference to nerve signals not necessarily
to vascular flow.
What special tests or imaging studies would differentiate them? Include findings on these
tests or imaging.
62
Tests or imaging for VBI may include thermographic patterns as manifestation of uneven
vasoconstriction from right side of the body to left. Usually a half degree difference is
considered substantial. Transcranial doppler sonography is the imaging modality of
choice to detect VBI and can be coupled with high resolution MR to provide a clear
visualization of a blocked vessel. Myelopathy hypothesis and instability theory would
both employ x-ray or CT imaging to arrive at upper cervical specific listings or to look at
disc space degeneration. In addition, upper cervical would also employ thermographic
pattern analysis.
Are there any pathognomonic traits or characteristics that would differentiate them?
VBI symptoms can occur immediately after manipulation and be life-threatening.

Warning signs of a stroke include face droop, slurred speech and lack of voluntary
movement. Distinguishing characteristics of myelopathy hypothesis and instability theory
are torticollis and premature segmental stabilization, respectively.
Clinical/ patient presentation
Signs and symptoms, age/sex
According to Robert A. Leach in “the chiropractic theories” the signs and symptoms of VBI are as follows
Ataxia, diplopia, dizziness, drop attacks, dysarthria, dysphagia, falling to one side, nausea, numbness,
nystagmus, visual disturbance, vomiting. (Leach, 2004). These symptoms fall under the chiropractic VSC
phase 2 model. The most common age is 3135 years of age with no sex predilection.
Patient history indicators
The pathognomonic trait or characteristic for VBI are “drop attacks”
Exam findings
Examine and observe for nystagmus and diplopia. Neurologic examinations such as tandem gait and
Romberg tests.
Orthopedic test
De Kleyn test.
Imaging used for the theory with findings (if any)
Transcranial doppler sonography is the modality most sensitive to diagnose VBI.
Magnetic resonance angiogram reveals abnormal circle of Willis.
63
Special Exams with findings
Transcranial Doppler sonography has been advocated for identification of patients with vertebrobasilar
compromise
Study Guide Questions with answer key for review purposes (if they are well

written questions, they could appear on the final).
Multiple Choice Questions with 4 answer choices
1. A patient presents to your office. He says he needs an adjustment because of neck pain.
After the adjustment, you notice 3 signs of VBI. What should you do?
a. Call 911
b. Adjust the other side
c. Trigger Point Therapy
d. Stop Adjusting
1. Which one is NOT a cause of VBI?
a. Instability
b. Asymmetry of Arteries
c. Cervical Spondylosis
d. Vasodilation
1. What VSC phase is VBI a part of?
a. VSC 1
b. VSC 2
c. VSC 3
d. VSC 4
2. Which is NOT a DDX for VBI?
a. Meniere Disease
b. Brain Tumor
c. Lateral Atlas Subluxation
d. ALS
3. What is a pathognomonic symptom associated with VBI
a. Dizzy
b. Nystagmus
c. Drop attack
d. Diplopia
Two essay questions -These cannot be “compare and contrast” or patient

presentation from the bullet points above.
1. Write and Explain the steps to identifying the most common symptoms of a
stroke. FAST (Explain every warning)
64
2. List the signs of VBI.

a. Ataxia
b. Diplopia
c. Dizziness
d. Drop attacks
e. Dysarthria
f. Dysphagia
g. Falling to one side
h. Nausea
i. Numbness
j. Nystagmus
k. Visual disturbance
l. Vomiting
Sources
Souza, T. A. (2009). Differential Diagnosis and Management for the Chiropractor:
Protocols and Algorithms (4th ed.). Sudbury, MA: Jones and Bartlett Publishers, pp. 49-
68
65
VSC 5 Faye Model

Laura Nelson, Skylar Cagle, Lana Rondeau, Keagan Smallwood, Taylor Davis
This model presents subluxation as a complex clinical entity comprising one

or more of the following components:.Neuropathophysiology(Abnormal nervous
system function),Kinesiopathology(Abnormal motion or position of
vertebra),.Myopathology(Abnormal muscle function),.Histopathology(Abnormal soft
tissue function), and.Biochemical Component/Pathophysiology(Abnormal function
of the spine and body).
The model was created in 1967 by Dr. Leonard Faye D.C., he wanted to shift
the idea of static palpation model (bone out of place) to a dynamic subluxation
complex model(focused on basic joint motion and the five things that can inhibit
that). It is important we visualize this as a conceptual model and not a definitive
model. Historically this changed the way we think of subluxations because it added a
component that made the joint visible as a motion piece not static. It is important to
note that it is not a definitive model that exists only if all components are present, it
can be one or more.
The five components are all connected by the general idea of function but
furthermore break down in specificities that make up the subluxation complex.
According to Faye, an adjustive force can remove fixation on a joint. This fixation
could be causing one or more of the dynamic components of the VSC 5 model. The
key components this model is trying to answer is how does subluxation fixation
contribute to other body processes than just bone out of place.
Key Terms:
● Subluxation complex
● Neuropathophysiology
● Kinesiopathology
● Myopathology
● Histopathology
● Biochemical
● Dynamic
● Fixation
-Why/how does this theory matter/apply to a practicing chiropractor and the

profession?
Within this theory the term fixation refers to any physiologic mechanism or physical
function, that produces a loss of segmental mobility. A practicing chiropractor would
utilize this theory whenever he or she identifies a hypomobility and corrects it using
adjustive procedures. Feyes model consists of five different components
representing a complex clinical entity including neuropathology, kinesiopathology,
myopathology, histopathology and biochemical/pathophysiology. One or more of
66
these concepts may present within a single vertebral subluxation complex/patient.
So not only does the Feye model apply to the dis-ease component of the VSC but
applies to its correction as well. The actual CMT applies to the kinesiopathology
component of this model, so a practicing Chiropractor utilizes aspects of this modal
constantly.
-Patient Education- Use simplified language to explain this theory in a manner

anyone could understand or relate to without having any sort of education
past 7th grade:
When you run into something and hit your arm or leg, you might get a bump or a cut.
This is an example of your body’s local inflammatory response to injury. The bruise
or the scrape you develop some time after is a process called local adaptation
syndrome and represents the histopathologic component to Feye’s model of the
Vertebral Subluxation Complex(VSC). Your spine has multiple joints that are made to
function and move in a specific way. If they are not moving properly the body sees
this as an “injury” or “VSC” and will respond in similar ways. You may see the
“injury” manifest in different places of the body like muscle cramps, stomach or
bathroom habit changes, or difficulty moving or sitting a certain way. In the same
way you take a multivitamin or exercise to stay healthy, chiropractic treatment
works positively with your body. For example, in the same way you take a
multivitamin to stay balanced nutritionally, a chiropractor will apply adjustive
thrusts into the joints of the spine to help your body balance out the VSC or “injury”
the body develops throughout life.
-Explain the Physiological Attributes of the Chiropractic Theory (put N/A if not
relevant)
According to the fifth component of the Faye model, pathophysiology occurs as a
result of nervous system dysfunction. Imbalances within the autonomic nervous
system can present either in a sympathetic or parasympathetic state and can affect
organ systems. Pre Inflammatory stress can induce hormonal and chemical
imbalances such as the production of histamine, prostaglandin, and bradykinin. If
the body is under stress for an extended period of time local adaptation syndrome
can develop into General Adaptation syndrome (GAS). GAS consists of three
progressive stages beginning in an alarm/fight or flight state. Next the body
develops resistance via the parasympathetic nervous system attempting to balance
the body. Finally the body gets exhausted and becomes susceptible to disease.
-Neurologic Components / Systems or Vascular Components (if applicable)

The Neuropathophysiology component of VSC 5 implies abnormal nervous system
function, due to a “fixation” within the normal range of motion of a vertebra within a
joint in the spine. The nervous system can be affected by compression or mechanical
insult to the contents of the IVF. Disruption of IVF components cause irritation to the
nerve tissue and can decrease axoplasmic flow of neurotrophic substances leading
to nervous system dysfunction. More effects of IVF dysfunction include abnormal
muscle, soft tissue, spine and body function.
67
-Biomechanical / Anatomical Components

Within this model the term fixation is referring to a hypomobility within 20-80% of
the normal range of motion for that joint. This hypomobility can lead to segmental
kinematic hypermobility of the joints around the fixation and these imbalances can
lead to or be caused by abnormal muscle function. Chiropractic manipulative
therapies are used to treat these manifestations.
-What are the similar signs or symptoms?

All three models agree: Subluxation complex is viewed as a pathology, which
represents cell and/or tissue changes or adaptations that are no longer normal.
VSC 5 Faye Model: Inhibition of movement cause abnormal rotation and translation
causing physiologic and pathologic dysfuntions.
Korr Model: fixation/dynamic model focused on the neurological effects of the SDF.
There is a hyper-response input by the neurons. “Facilitation means that the tissues
innervated from the lesioned segment are sensitized to all influences operating
within and outside the individual” (Sep 11, 2018 class ppts). The golgi tendon organ
(GTO) is a corrective component by preventing too much tension.
Neurobiologic Model (Patterson-Steinmetz): The body obtains a neural scar causing
abnormal segmental reflex circuit even after the stimulus stops. The spine learns a
new normal in a short amount of time.
-What are the different signs or symptoms?

VSC 5 Faye Model is a concept.
Korr Model: Sympathicotonia (abnormal reflexes), as a person ages, they handle
stress better. Dimmer Switch of muscle spindles being coordinators of segmental
facilitation and gamma motor neurons innervate muscle spindles were shown
scientifically.
Neurobiologic Model (Patterson-Steinmetz): Spinal learning (CNS neuroplasticity),
the body accepts it as the new normal, has been shown with body adaptation ex:
scoliosis.
-What special tests or imaging studies would differentiate them? Include

findings on these tests or imaging.
Muscle Biopsies, EMG testing, xray, MRI, and CT scan for changes in the soft tissue,
joints, and skeletal systems.
-Find altered stimulus, abnormal findings for cells, tissues, muscle function, and
bone.
-Are there any pathognomonic traits or characteristics that would differentiate

them?
VSC 5 Faye Model: Conceptually the body would get better if adjusted.
Korr Model: When the golgi tendon organs and gamma motor neurons are
stimulated, the body will adjust (CMT) easier.
68
Neurobiologic Model (Patterson-Steinmetz): The body after staying in a position for
so long, accepts its new position as being the new normal. Adjusting (CMT) the body
would be harder the longer the body was in this new normal position.
-Clinical/Patient Presentation
A patient will typically present with general back pain located anywhere in
the spine. The patient doesn’t have to be any particular age or sex. The pain can be
from a recent trauma such as a car accident or falling. The pain can also come on
gradually without any specific causal event. Often times a patient will complain of
radiating symptoms such as numbness and tingling, or dull achy pain that follows
nerve distribution patterns, or even visceral dysfunction related to the affected
nerve root level, depending on which segment is affected.
The main patient history indicators would be any sort of neurological
symptoms that occur in tandem with any sort of presentation of back or neck pain.
This may be, as stated before, any sort of numbness or tingling following nerve root
distributions, as well as any muscle spasms or muscle atrophy, or even visceral
disfunction or decreased efficiency of visceral function.
As far as physical exams, orthopedic exams and neurological exams, pay
attention most to your ortho’s relating to facet syndromes or muscle strain/sprain,
your sensory, motor and msr neuro exams, and your motion palpation findings.
Specific ortho’s may include Jackson’s compression test, or Spurling’s compression
test. You can also do SLR, O’Donehue’s, and any ULNT tests. These all help to evoke
neurological symptoms related to segmental disfunction, and will help to guide
which nerve roots to test in your neurological exam. The neuro exam will consist of a
sensory exam testing vibratory sense, light touch, and pain, along with motor exams
and MSRs. Once these have been performed, static and motion palpation to confirm
findings and specific segments involved that are producing the presenting
symptoms.
o Clinical / Patient Presentation

o Exam Findings
o Physical, Ortho, and Neuro.
o Imaging used for the theory with findings (if any)
o Special Exams with findings (if any)
Possible Questions of VSC 5:
1. Which of the following is NOT apart of the 5 component model of the VSC?
A. Kinesiopathology
B. Histopathology
C. Biochemical Component/pathophysiology
69
D. Surgicopathology
2. Which of the follow best describes Hilton’s law?

A. The nerve supplying a joint, muscle which moves the joint, and the skin that
covers the insertions of the muscle
B. The nerve supply only supplies the joint and not the muscles or skin around
the joint
C. The nerve supplies only the muscle
D. The nerve does not supply the muscle or the joint
3. Which of the follow law’s is defined as “Bone will adapt to the loads under which
it is placed”?
A. Weigert’s Law
B. Wolff’s Law
C. Hilton’s Law
D. Newton’s Law
Essay Question 1:
Please describe how Kinesiopathology affects a patients, and how it can be fixed?
Essay Question 2:
Please give an describe and give an example of Wolff’s law?

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Fall 2018

0 Science the Philosophy of the VSC Study

NBCE Part II and Final

ACC & Paradigms

The biopsychosocial paradigm is relevant to chiropractic because it explains how

Main idea of ACC, patient-centered, and biopsychosocial

More about ACC, patient-centered, and biopsychosocial

Study Guide Questions with answer key for review purposes

Research. Williams &amp; Wilkins, 1986.

Redwood, Daniel, et al. Fundamentals of Chiropractic. Mosby, 2003.

Axonal Aberration/ Trophic Models

Explanation of Physiological Attributes:

bind to a transport filament that is transported by connecting cross-bridges along the

Compare and Constant other Relevant theories

Imaging used for the theory:

SPVSC Final Project- Dural Torque

Neurologic Components / Systems

Biomechanical / Anatomical Components

CSF stasis leads to:

Which layer(s) are involved in Dural torque theory? Maca

Which portion of the spine is greatly affected by the dentate ligament?

Inflammation Study Guide for SPVSC

 Primary Proponent = Charles “Skip” Lantz

The majority of chiropractic practice is treating and managing the inflammatory

 Neurologic Components / Systems: Substance P, superoxide, lysosomal

 Somatoautonomic reflex theory along with inflammation share prolonged

Clinical / Patient Presentation

The classic presentation of inflammation is the acronym S.H.L.R.P. which occurs

 Multiple Choice Questions- with 4 answer choices

5) Which of the following is a stage of Acute inflammation?

 Two essay questions -These cannot be “compare and contrast” or patient

2. Explain why immobilization initiating the inflammatory response is relevant

1. Bergmann, Thomas R. and David H. Peterson (1993). Chiropractic Technique:

2. Leach, Robert A. (2004). The chiropractic theories: a textbook of scientific

o What was the historical view, if any, of this idea?

o Any other relevant historical concepts or ideas.

o Vascular Components (if applicable)

o What are the similar signs or symptoms?

o What are the different signs or symptoms?

Clinical / Patient Presentation

o Signs and symptoms, age/sex

o Imaging used for the theory with findings (if any)

Study Guide Questions with answer key

Explain what you need to do as a doctor in order to properly diagnose degeneration in a

In order to properly diagnose degenerative changes in your patient you would

Instability Hypothesis/Theory Study Guide

Dr. Dana Hollandsworth

o Instability Hypothesis Definition (Leach, pg. 207)

o The effective remediation of this theoretical premise for purposes of patient

▪ Surgery is involved with proprioceptive insult but not necessarily

▪ Ligamentous instability has also been linked to instability. Posterior

Summary: Myelopathy hypothesis is defined as “Intervertebral subluxation may, in some severe

Clinical / Patient Presentation:

Physiological attributes of the chiropractic theory:

Multiple Choice Question:

Key terms for neuroimmune hypothesis:

Physiological attributes of neuroimmune hypothesis:

Compare & contrast neuroimmune hypothesis with 2 other relevant theories:

 Inflammation Hypothesis: The inflammation hypothesis is much like to the neuroimmune

 Somato-Autonomic Reflex Hypothesis: Another hypothesis which is very similar to

Imaging used: None

Study guide questions:

1. Neuroimmune hypothesis is also known as? MACA

Research. Williams & Wilkins, 1986.