The American Medical Association, in its Guides to the Evaluation of Permanent Impairment, lists the following as acceptable means to rate impairment: 70
Impairment due to loss of muscle power and motor function,
impairment due to abnormal motion of the spine,
impairment due to loss of motion segment integrity,
impairment due to disc problems,
impairment due to pain or sensory deficit, and segmental instability.
The above are, in fact, components of the Vertebral Subluxation Complex.71,72
The Guidelines for Evaluation and Management Services published by the Health Care Financing Administration of the United States Federal Government and the American Medical Association (May 1997)73 outline what an objective examination should consist of and these include commonly used neuromusculoskeletal exam procedures within chiropractic such as: postural analysis, palpation, assessment for subluxation, range of motion and assessment of muscle tone. All of these are used to assess and manage subluxation and are specifically addressed by the CCP Guidelines.
The Federal Government of the United States specifically defines what chiropractors do as the detection and correction of subluxation under Medicare and Federal worker's compensation laws. Common to all state statutes is the adjustive process being utilized to reduce subluxations and the resultant interference to nerve transmission. A majority of states employ the term adjustment in licensing laws in reference to the procedures applied by chiropractors and others additionally include the concept of manipulation. A majority of states contain specific references to responsibility for neurological complications of biomechanical origin (subluxation) and over half the chiropractic profession practice in these states. In addition, many states specifically discuss the concept of subluxation in their statutes by using the term and for those that do not specifically use the term there is an implied understanding of the concept in their statutes.
The existence of subluxation and its acceptance is spelled out in explicit detail by published policy statements of chiropractic organizations74,75 as well as federal and state laws regulating the practice of chiropractic. The epidemiology of subluxation has been researched since the inception of chiropractic over 100 years ago with basic science and clinical research to further elucidate the nature of it continuing to this day. Considering the centrality of vertebral subluxation to the practice of chiropractic and the profession, the importance of guidelines that specifically address it are clearly needed. This is especially true considering that other guidelines addressing chiropractic practice and procedures either do not address it at all or give only a cursory consideration. 76-78
_________________________________________________________ Council on Chiropractic Practice Clinical Practice Guideline Number 1 Vertebral Subluxation in Chiropractic Practice – 2003 Update & Revision