Axial Subluxation: Understanding Causes, Symptoms, and Treatment

What is axial subluxation?

Axial subluxation refers to a partial dislocation or misalignment of a joint within the axial skeleton, most commonly affecting the vertebral column. While the joint surfaces remain in partial contact, their altered position can lead to pain, restricted movement, and potential interference with neurological function.

Understanding the Axial Skeleton

The axial skeleton forms the central axis of the human body, providing essential support, protection, and stability. It comprises the skull, the vertebral column (spine), the rib cage, and the sternum (breastbone). These structures are crucial for posture, protecting vital organs, and facilitating movement of the head and trunk. Joints within this framework, such as those between vertebrae, are designed for specific ranges of motion while maintaining structural integrity.

Defining Subluxation

In the context of musculoskeletal health, subluxation describes a partial or incomplete dislocation of a joint. Unlike a full dislocation (luxation), where the articulating bone surfaces are completely separated, in a subluxation, they remain in partial contact but are no longer properly aligned. This misalignment can disrupt normal joint mechanics, place abnormal stress on surrounding tissues like ligaments and muscles, and potentially impinge on nerves.

What is Axial Subluxation?

When subluxation occurs within the axial skeleton, it is termed axial subluxation. The most frequent and clinically significant form of axial subluxation involves the vertebral column. Each vertebra articulates with its neighbors above and below via intervertebral discs and facet joints. An axial subluxation, or vertebral subluxation, signifies a minor misalignment or altered positional relationship between adjacent vertebrae.

This subtle shift can lead to:

• Altered Biomechanics: The joint no longer moves optimally, leading to compensatory movements or restricted range of motion.
• Soft Tissue Stress: Ligaments and muscles surrounding the affected joint may be stretched, strained, or shortened, causing pain and spasm.
• Nerve Irritation/Compression: In some cases, the misalignment can irritate or compress nearby spinal nerves as they exit the vertebral column, leading to symptoms like numbness, tingling, or weakness in areas supplied by that nerve (radiculopathy).

While any part of the spine can be affected, axial subluxations are commonly discussed in relation to the cervical spine (neck), thoracic spine (mid-back), and lumbar spine (lower back). Specific examples include atlanto-axial subluxation (between the first two cervical vertebrae) or sacroiliac joint subluxation (between the sacrum and ilium).

Common Causes of Axial Subluxation

Axial subluxations can arise from various factors, often involving a combination of acute trauma and chronic postural stressors:

• Acute Trauma:
  • Falls: Landing awkwardly or directly on the spine.
  • Sports Injuries: Contact sports, sudden twists, or hyperextension/hyperflexion.
  • Motor Vehicle Accidents: Especially whiplash injuries to the neck.
  • Sudden, Awkward Movements: Lifting heavy objects incorrectly or sudden twists.
• Repetitive Stress and Poor Posture:
  • Prolonged Sitting: Especially with poor ergonomic setup.
  • Occupational Hazards: Jobs requiring repetitive bending, twisting, or heavy lifting.
  • Poor Sleeping Positions: Contributing to neck or back stiffness.
  • Chronic Muscle Imbalances: Leading to uneven forces on the spine.
• Degenerative Conditions:
  • Osteoarthritis: Wear and tear on facet joints can lead to instability.
  • Degenerative Disc Disease: Loss of disc height can alter vertebral alignment.
• Congenital Anomalies:
  • Rarely, individuals may have structural abnormalities in their vertebrae or joints that predispose them to subluxation.

Signs and Symptoms

The symptoms of axial subluxation vary depending on the location and severity of the misalignment, as well as whether nerve structures are involved. Common signs and symptoms include:

• Localized Pain: Sharp or dull pain directly at the site of the subluxation.
• Referred Pain: Pain that radiates from the affected area to other parts of the body (e.g., from the neck to the arm, or lower back to the leg).
• Restricted Range of Motion: Stiffness and difficulty moving the head, neck, or trunk through its full range.
• Muscle Spasm and Tenderness: Tight, tender muscles surrounding the affected joint.
• Headaches: Particularly common with cervical subluxations.
• Neurological Symptoms: If a nerve is compressed or irritated, symptoms may include:
  • Numbness or tingling (paresthesia)
  • Weakness in the limbs
  • Altered reflexes
• Postural Imbalances: Visible asymmetry or altered posture.
• Clicking or Popping Sensations: During movement, though not always indicative of subluxation.

Diagnosis and Professional Assessment

Diagnosing axial subluxation requires a thorough evaluation by a qualified healthcare professional, such as a physician, chiropractor, or physical therapist. The diagnostic process typically includes:

• Detailed Patient History: Gathering information about symptoms, onset, previous injuries, and lifestyle.
• Physical Examination:
  • Palpation: Feeling the spine for tenderness, muscle spasm, and alignment abnormalities.
  • Range of Motion Assessment: Evaluating the flexibility and limitations of the spine.
  • Neurological Examination: Testing reflexes, sensation, and muscle strength to assess nerve involvement.
  • Postural Analysis: Observing overall body alignment.
• Imaging Studies:
  • X-rays: Can reveal bone alignment, disc space, and rule out fractures or severe dislocations.
  • MRI (Magnetic Resonance Imaging): Provides detailed images of soft tissues, including intervertebral discs, ligaments, and nerves, helpful for identifying nerve compression.
  • CT Scan (Computed Tomography): Offers cross-sectional images of bone structures, useful for complex cases.

Management and Implications

The management of axial subluxation focuses on restoring proper joint function, alleviating pain, and preventing recurrence. The approach is typically conservative and multidisciplinary:

• Manual Therapy:
  • Chiropractic Adjustments: Specific, controlled forces applied to misaligned vertebrae to restore proper motion and alignment.
  • Physical Therapy/Osteopathic Manipulation: Techniques to mobilize joints, stretch tight tissues, and reduce muscle guarding.
• Physical Therapy and Rehabilitation:
  • Therapeutic Exercises: Strengthening weak core and postural muscles, stretching tight muscles, and improving spinal stability.
  • Postural Education: Learning and practicing correct posture during daily activities.
  • Ergonomic Advice: Modifying workspaces and habits to reduce spinal stress.
• Pain Management:
  • Over-the-Counter Medications: NSAIDs (non-steroidal anti-inflammatory drugs) for pain and inflammation.
  • Heat/Cold Therapy: To reduce pain and muscle spasm.
• Lifestyle Modifications:
  • Activity Modification: Temporarily avoiding activities that exacerbate symptoms.
  • Stress Management: Reducing muscle tension often linked to stress.
• Surgical Intervention: Extremely rare for simple axial subluxation. It is typically reserved for cases involving significant instability, severe nerve compression with progressive neurological deficits, or when conservative treatments have failed for a prolonged period.

From an exercise science perspective, corrective exercise, under the guidance of a qualified professional, is paramount in the long-term management and prevention of recurrent axial subluxations. This involves addressing underlying muscle imbalances, improving neuromuscular control, and enhancing overall spinal stability.

Differentiating from Dislocation

It is crucial to understand the difference between subluxation and dislocation. While both involve joint displacement, a subluxation is a partial displacement where the joint surfaces remain in some contact. A dislocation (luxation) is a complete separation of the joint surfaces, often accompanied by more severe pain, obvious deformity, and complete loss of joint function. Dislocations typically require immediate medical reduction.

When to Seek Medical Attention

If you experience persistent neck or back pain, stiffness, or any neurological symptoms such as numbness, tingling, or weakness in your limbs, it is important to consult a healthcare professional. Prompt diagnosis and appropriate management can help alleviate symptoms, restore function, and prevent long-term complications associated with axial subluxation.