A clear scope for this page
Chiropractic care has been used as a conservative, non-drug option for some musculoskeletal problems, particularly low back pain. The science relevant to that history includes anatomy, pain physiology, movement and the ways the nervous system processes sensory input. This is background education, not a diagnosis or a substitute for evaluation of new, severe, progressive or unexplained symptoms.
The practice’s current focus is nutrition and supplement guidance. Spinal manipulation and physical therapy are not services performed by this practice; when appropriate, patients may be referred to a chiropractor, physical therapist or another qualified health professional. A referral decision depends on the person’s evaluation, goals and medical context.
Facet joints, sensory input and receptor fields
Vertebrae are connected by paired facet joints, also called zygapophyseal joints. Their joint capsules contain sensory nerve endings. Histologic studies of human cervical, thoracic and lumbar facet capsules identified mechanoreceptive endings as well as free nerve endings associated with nociception. These structures provide sensory information related to joint movement, position and tissue loading to the central nervous system. [2, 3]
Here, receptor field is used in a practical, anatomical sense: a region of tissue containing sensory receptors and their nerve fibers. A facet-joint capsule is one sensory structure; it is not a stand-alone control center, nor a single “field” that can by itself cause disease in a distant organ. The nervous system integrates input from joints, muscles, skin and other tissues at the spinal cord and brain, including systems involved in movement and balance.
B. D. Wyke’s articular-neurology work helped organize earlier descriptions of joint receptors and reflexes. It remains useful historical background for joint afferent input. Its receptor classifications and clinical inferences need caution: showing that a structure is innervated does not, by itself, show that a particular adjustment corrects a specific disease or restores a specific body function. [4]
Physiological findings are not the same as clinical outcomes
Spinal manipulation and mobilization are physical interventions. Proposed biomechanical and neurophysiologic mechanisms include stimulation of tissues around a joint, changes in pain processing and short-term changes in motor-neuron excitability. These are plausible research areas, not a complete explanation of every person’s response. [5]
Some experimental studies report immediate changes in measures such as H-reflexes, V-waves or voluntary muscle-force measurements after spinal manipulation. The cited studies used small samples, often of healthy or asymptomatic volunteers, and measured short-term physiological outcomes. They do not establish durable gains in strength, prevention of everyday fatigue or treatment of systemic illness. [6, 7]
For a patient, the more relevant question is whether an appropriately selected plan improves pain, function, activity and quality of life, with a suitable safety assessment—not whether one proposed mechanism applies in every case.
Pain, movement and rehabilitation
Pain is an experience shaped by tissue input, nervous-system processing, previous experiences, sleep, stress, activity and other individual factors. In some persistent-pain conditions, central sensitization—heightened responsiveness within parts of the nervous system—can be relevant. This does not mean pain is imagined, and it does not identify one spinal cause for all symptoms. [5]
A musculoskeletal evaluation may consider movement tolerance, joint and muscle function, activity demands and recovery goals. In settings where it is clinically appropriate, care may combine education, exercise, graded activity and coordination among health professionals; manual therapy can be one component of a broader plan. Exercise and rehabilitation are often important in conservative back-pain management.
Pavlov, conditioning and psychoneuroimmunology
Ivan Pavlov’s conditioning research established that learned associations can affect physiological responses. Later, Robert Ader and Nicholas Cohen reported conditioned immunosuppression in a rat model after pairing a taste cue with an immunosuppressive drug. Their work helped launch psychoneuroimmunology: the study of interactions among behavior, the nervous system, endocrine signaling and immune function. [8]
This history is scientifically important, but its limits matter. An animal-conditioning finding does not show that spinal manipulation conditions internal organs, boosts immunity or treats systemic disease. Nothing in the receptor-field, conditioning, bioelectric or nervous-system concepts discussed here supports using those mechanisms to diagnose or treat infections, immune conditions, cancer or other systemic illness. Those concerns need appropriate medical evaluation and evidence-based treatment.
Mechanotransduction and connective tissue: active research
Cells respond to mechanical forces through mechanotransduction, a process in which physical forces are converted into biochemical signaling. Donald Ingber’s review of tensegrity-based mechanosensing describes how cytoskeletal and extracellular-matrix networks may contribute to force transmission across biological scales. It is basic and translational biology, not a clinical trial of chiropractic care. [9]
Helene Langevin and colleagues proposed that rotation of an acupuncture needle may mechanically couple to connective tissue and transmit a signal to cells. A separate anatomical study reported an association between mapped acupuncture points and connective-tissue planes in postmortem arm sections. These papers address hypotheses and anatomy in the context of acupuncture. They do not demonstrate that manual therapy changes gene expression in a way that treats disease, nor do they prove a chiropractic treatment effect. [10, 11]
What clinical evidence supports
For adults with acute, subacute or chronic low back pain, the American College of Physicians guideline includes spinal manipulation among several nonpharmacologic options. It rates the evidence for spinal manipulation as low quality and places it alongside options such as superficial heat, massage, acupuncture, exercise, rehabilitation, mindfulness-based approaches, tai chi, yoga and cognitive behavioral therapy, depending on the presentation. [12]
A 2019 systematic review and meta-analysis of 47 randomized trials involving 9,211 adults with chronic low back pain found effects similar to other recommended therapies for short-term pain relief, with a small improvement in function. The authors advised that patients be informed about potential adverse events. This supports measured, shared decision-making for appropriate low-back-pain presentations; it does not establish superiority over other recommended conservative care. [13]
Safety and timely evaluation
Prompt medical evaluation is important for significant trauma, fever, unexplained weight loss, a history of cancer with new spinal pain, progressive weakness or numbness, bowel or bladder changes, saddle-area numbness, severe unremitting pain or other concerning symptoms. This is not an exhaustive screening protocol. A qualified clinician should consider contraindications, likely benefits, alternatives and potential risks before treatment.
Historical concepts and terminology
Older chiropractic and medical literature used terms such as inefficient motor segment, intervertebral insufficiency, spondylogenic syndromes and subluxation in differing ways. They are part of this page’s historical background, but they are not interchangeable with a modern, evidence-based diagnosis. In particular, the chiropractic use of “subluxation” as an explanation for broad disease should be distinguished from the medical use of subluxation for a partial dislocation.
The modest, evidence-consistent point is that spinal joints and surrounding tissues are innervated; their sensory input contributes to movement and pain processing; and some people with musculoskeletal pain may benefit from a carefully selected conservative plan that can include manual therapy. The broader legacy claims require the review and limitations described below.
Important review issues in the source material
- The historical “receptor field” model should not be presented as an established diagnostic construct or a mechanism for distant organ disease.
- The source links conditioning, psychoneuroimmunology and bioelectricity in ways that can imply systemic treatment. Those implications are not supported by the evidence cited here.
- Claims about fascia, sympathetic tone, fascial contractility, Pacinian corpuscles and visceral ligaments require source-specific review before being used as clinical claims.
- The source’s 1980 Wyke chapter citation and its Schmorl/Junghanns book details need bibliographic verification; the 2002 Langevin/Yandow link in the source was also incorrect and is repaired in the reference list below.
- A fixed count of 48 facet joints, claims of reduced muscle spasm and statements about strength or fatigue should not be carried forward as general patient-benefit claims without appropriate sourcing and study limits.
References
- Original practice resource: “Is there any Scientific Basis for Chiropractic?” (legacy source page; retrieved text preserved below).
- McLain RF. Mechanoreceptor endings in human cervical facet joints. Iowa Orthop J. 1993;13:149–154. PMCID: PMC2328986. PMID: 7820735.
- McLain RF, Pickar JG. Mechanoreceptor endings in human thoracic and lumbar facet joints. Spine. 1998;23(2):168–173. doi:10.1097/00007632-199801150-00004. PMID: 9474721.
- Wyke B. Articular neurology—A review. Physiotherapy.1972;58(3):94–99. PMID: 4604122. Historical articular-neurology reference.
- Srbely J. Chiropractic Science: A Contemporary Neurophysiologic Paradigm. J Can Chiropr Assoc. 2010;54(3):144–146. PMCID: PMC2921779. PMID: 20808613. Editorial, not a clinical effectiveness trial.
- Niazi IK, Türker KS, Flavel S, Kinget M, Duehr J, Haavik H. Changes in H-reflex and V-waves following spinal manipulation. Exp Brain Res. 2015;233(4):1165–1173. doi:10.1007/s00221-014-4193-5. PMID: 25579661.
- Dishman JD, Burke J. Spinal reflex excitability changes after cervical and lumbar spinal manipulation: a comparative study. Spine J. 2003;3(3):204–212. doi:10.1016/S1529-9430(02)00587-9. PMID: 14589201.
- Ader R, Cohen N. Behaviorally conditioned immunosuppression. Psychosom Med. 1975;37(4):333–340. doi:10.1097/00006842-197507000-00007. PMID: 1162023.
- Ingber DE. Tensegrity-based mechanosensing from macro to micro. Prog Biophys Mol Biol. 2008;97(2–3):163–179. doi:10.1016/j.pbiomolbio.2008.02.005. PMID: 18406455; PMCID: PMC2570054.
- Langevin HM, Churchill DL, Cipolla MJ. Mechanical signaling through connective tissue: a mechanism for the therapeutic effect of acupuncture. FASEB J. 2001;15(12):2275–2282. doi:10.1096/fj.01-0015hyp. PMID: 11641255.
- Langevin HM, Yandow JA. Relationship of acupuncture points and meridians to connective tissue planes. Anat Rec.2002;269(6):257–265. doi:10.1002/ar.10185. PMID: 12467083.
- Qaseem A, Wilt TJ, McLean RM, Forciea MA, and Clinical Guidelines Committee of the American College of Physicians. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Ann Intern Med. 2017;166(7):514–530. doi:10.7326/M16-2367. PMID: 28192789.
- Rubinstein SM, de Zoete A, van Middelkoop M, Assendelft WJJ, de Boer MR, van Tulder MW. Benefits and harms of spinal manipulative therapy for the treatment of chronic low back pain: systematic review and meta-analysis of randomised controlled trials. BMJ. 2019;364:l689. doi:10.1136/bmj.l689.
Historical draft and source record
Preserved for comparison, not current clinical guidance
The complete retrieved text below is the historical source material for this migration. It is not publication-ready copy, individual medical advice or an endorsement of its claims. It retains original fragments, dated terminology, unverified statements and citation errors so they are visible rather than silently removed. The source calls itself last updated “09-19”; it should not be relied on without clinical and editorial review.
Read the complete historical draft/source text (review required)
ROBERT W. SMITH, D.C., DABCI
Chiropractic Internist
Baton Rouge Chiropractic and Nutrition 225-291-2626
Is there any Scientific Basis for Chiropractic?
Anatomy and Physiology as it relates to chiropractic paradigm (last update 09-19)
I have written this section for my patients who over the past 30 years have wanted to understand how chiropractic care works. I have been very fortunate to have a diverse patient base, including teenagers, manual labors to college professors and other healthcare providers. All people who wanted to understand the science behind the chiropractic paradigm. To do this, it is necessary to understand that most of the information that now is understood about anatomy and physiology has been updated and revised by current research. Much that I am relating has been published in many different forums from research to clinical observation. I know that some think or believe that most health care interventions are as well grounded in science as what I am estimates of what is currently used routinely in healthcare has double blind studies to substantiate the intervention.
The information below is from generally available references and links that can be found in the library or on the web. There are extensive textbooks and articles on these topics available, but these are usually only found in the bookstores and libraries of chiropractic colleges. (Not a lot of students, other than chiropractic students study the different names of all the joints and articulations involved in the spine or have an interest in the names for each of them.)
So here some of the science of today! (Follow the Blue links or UNDERLINED on PAGES to the science references)
The two joints on the back surface of vertebrae are called a facet or zygapophseal.
in guiding stability of the back and were believed to have a passive role in back activity such as walking and almost everything else.
(Side View of spine-typical)
Upton Sinclair quotes “It is difficult to get a man to understand something, when his salary depends on his not understanding it.”
The typical human spine has 48 joints called facet or zygapophseal joints. Here is the start of some of the more traditional medical doctors explanation of the spine.
The medical description of this phenomenon was described in “The Human Spine in Health and Disease” by Georg Schmorl (5th German edition by Herbert Junghanns). The description was more of a staging of the process of subluxation than an anatomy and physiology description.
The initial localized problem was called an Inefficient Motor Segment (Intervertebral Insufficiency) Definition
Group 1 - Changes and complaints in the immediate vicinity of the disturbed motor segment.
Group 2- Symptoms which are conducted through neural and vascular pathways and which also have been termed as symptoms (spondylogenic) of syndromes of spinal cause.
Group 3- Spondylogenic disease which have become independent and have developed originally from the second group.
The neuroanatomy of the facet or zygapophseal joint was first partially described as the note that there was a nerve that innervated the joint capsule recurrent meningeal nerve or the recurrent nerve of Von Luschka.
This evolved into the frame work of describing a complete classification of the nerve ending (receptor types) that innervate the joint capsule of the (facet or zygapophseal) joint.
Today, the neurological parts of these joints take on a totally different importance; not, just it’s a chiropractor invented term “subluxation” to be dismiss. The claims of several detractor of chiropractic, is that it has no basis in scientific writings. The follow information may lead the cause of the honest intelligent scientist to re-examine that position.
Articular neurology is the classification system devised by BD Wyke.
The next major step is to understand that the joint capsule is a (primary and rudimentary) receptor field and what the implications of that realization means. To begin with a background of receptor field processes is needed to follow the importance.
The idea that we have five senses and the receptor fields are separate and distinct is one of those learned scientific truths that may more accurately describe a built in scotoma (blind spot). The first example that seeing is only with the eyes was challenged with the skin as a surrogate eye study. Then further studies produced this paper the all seeing tongue-taste the light. Exploiting the idea to vision from the tongue has produced Brain Port for vision and after my own heart, balance training with a much larger understanding of the implications of these ideas. Then the idea that the complexities of the nervous system connection, to which the eyes did not need to be in a complex organism.
The typical human spine has 48 joints called facet or zygapophseal joints. The above information can be simple state as the following: The capsular ligament(s) when viewed with an electron microscope reveals the existence of receptors. These receptors classified by Dr B Wyke MD as articular receptors (three different types receptors are in the capsular ligament of spinal facet joints). These rudimentary receptor fields display the same properties, as most receptor fields, and can be conditioned aka Pavlov, convey information to the spinal cord and cerebellum (aka Sc Am. Rethinking the Lesser Brain). Several different mechanisms can influence the function of these receptor fields to generate spasm, splinting and/or pain. Sensory substitution in rehabilitation has since the original research taking on a whole new dimension with its implication for patient directed care. Then the TM Joints (jaw joints) also have receptors (forming a receptor field) which can produce significant problems for patients (most dentists and Otolaryngologists (ear, noise & throat specialist) have seen patients with this problem). If you are a researcher, make sure to read the full PDF of this article, to understand the impact of the joint receptor fields on the muscles involved in mandible function. I am certain that joint function follow parsimony in biology and this is representative of most joint capsule function. This is my current working model and I am providing this information for clarity.
Nerve signal appear to play a significant role in the development of a fetus and even continues to a less degree as we grow into adults. Bioelectric signals (resting
What is even stranger is the Bad field signaling theory may be a precursor to disease Cancer is no more a disease of cells than a traffic jam is a disease of cars. A lifetime of study of the internal-combustion engine would not help anyone understand our traffic problems--
D. W. Smithers
It is almost amusing that you hear, some professors, at some university, call chiropractic voodoo science.
This has produced new insights into many fields of study, including physiology. Forces exerted on a cells structure is propagated through the microstructure architecture and transmitted to receptors. When the cell exerts traction on its relative rigid substrate
The implications of connects between different systems of the body is through an elaborate precise system of feedback. This begins to lay the foundation for understanding of how many different procedures such as: acupuncture, different chiropractic techniques and light effects tissue(s).
Here is a recent addition of information on Articular Neurology and Manipulative Therapy from Donald E. Ingber MD, PhD, at Harvard Medical School
One explanation of how manual therapy works is provided by Donald E. Ingber MD, PhD, at Harvard Medical School (2008) who argues for the concept of cellular mechanotransduction, the process by which cells sense mechanical forces and transduce them into changes in intracellular biochemistry and gene expression. Based on a prolific, federally funded research program over a number of years, Dr. Ingber has been studying cells on the nanometer scale. He views the cytoskeleton as an architectural structure that actively generates tensile forces and distributes them to other components inside the cell. Ingber (2006) suggests that in the living body the process of cellular mechanotranduction might be more a phenomena of structural hierarchies and biological architecture than the action of any single mechanotransduction molecule. This has significant implications for the field of manual therapy. Ingber (2006) states that to seek out and study individual biological parts in isolation without considering contributions of multiscale architecture and invisible internal forces means we will never be able to fully understand how physical forces influence biological form and function.
The cellular/tensegrity research of Ingeber (2008), connective tissue research of Langevin et al. (2001 and 2002), and the fascial research of Schleip (2003) are critical in our understanding of connective tissue and its applications in the manual therapies.
Wykes mechanoreceptor research (1980) has been instrumental in understanding the effects of the manual therapies and in particular joint mobilization/manipulation. Schleip (2003) explains the importance of fascial mechanoreceptors, and with manual changes can occur in the viscosity of the ground substance and a lowering of sympathetic tonus. Schleip (2003) has also found smooth muscle cells in fascia that appear to be involved in active fascial contractility and have only been reported in large fascial sheets. Pacinian corpuscles are also found in the peritoneum (Stilwell in Schleip 2003 page 15) and can be influenced by manual therapy (Schleip 2003}. Mechanoreceptors have been found in the visceral ligaments (Schleip, 2003). The belly (enteric) brain (Gershon in Schleip 2003 p. 17) contains more than 100 million neurons. Many of these sensory neurons function as mechanoreceptors.
Ingber, D.E. (2008) Tensegrity-Based Mechanosensing from Macro to Micro. Progress Biophysics Molecular Biology 97(2-3) pages 163-179
Langevin, H., Churchill, D. Cipolla, M (2001) Mechanical Signaling Through Connective Tissue: A Mechanism for the Therapeutic Effect of Acupuncture. Federation of American Societies for Experimental Biology volume 15, 2275-2281
Langevin, H., Yandow, J., (2002) Relationship of Acupuncture Points and Meridians to Connective Tissue Planes. The Anatomical Record, 269(6) pages 257-265
Wyke, BD. (1980) Articular Neurology and Manipulative Therapy. In Aspects of Manipulative Therapy. Ed. Idezak, R.M. Lincoln Institute of Health Sciences.
These joint receptors also seem to impact neural plastic changes in the nervous system. Producing a stronger contraction and appears to reduce muscle fatigue.
Spinal manipulation can reduce muscle splinting and spasm.
We also now, know the idea of continuous passive motion in the treatment of de-conditioned (out of shape- fat- sickly patients) is not a good match for good outcomes.
This even take a stranger path with the idea of Pain control, treating depression and other problems: without having to enter the Matrix : Choosing the Red Pill and not the Blue Pill!
Next I will discuss the other issues:
Failed back surgery syndrome” is a common problem with enormous costs to patients, insurers, and society. The etiology of failed back surgery can be poor patient selection, incorrect diagnosis, suboptimal selection of surgery, poor technique, failure to achieve surgical goals, and/or recurrent pathology.
A.M.D.G.
View the original practice resource (Reference 1).