Exploring the Neuromodulatory Effects of the Vertebral

Subluxation and Chiropractic Care.

HEIDI HAAVIK TAYLOR, KELLY HOLT and BERNADETTE MURPHY

Abstract: The elusive vertebral subluxation is the central defining clinical principle of the chiropractic
profession. After almost 115 years of discussion there is still little consensus regarding the nature of the
vertebral subluxation or its potential associated neurological manifestations. Some authors even deny that
the subluxation exists. In this paper a model is presented that assumes that the putative vertebral subluxation
represents a state of altered afferent input which is responsible for ongoing maladaptive central plastic changes
that over time can lead to dysfunction, pain and other symptoms. A growing body of research that investigates
the neuromodulatory effects of chiropractic care supports this model. This paper explores this research and
discusses it in light of the vitalistic principles upon which chiropractic was founded. The model outlined in this
paper may go some way to explain some of the beneficial effects of chiropractic care on nonmusculoskeletal
conditions previously reported in the literature.
INDEX TERMS: MeSH: CHIROPRACTIC; CENTRAL NERV-
OUS SYSTEM; MANIPULATION, SPINAL; PROPRIOCEPTION;
POSTURE; EVOKED POTENTIALS, SOMATOSENSORY;
(Other): SENSORIMOTOR INTEGRATION; FEED FORWARD;
VITALISM. Chiropr J Aust 2010; 40: 37-44.

INTRODUCTION very important role in science by being the science of first

principles, i.e. the fundamental a priori assumptions that lay
The elusive vertebral subluxation is the central defining the foundation for any research programme.4
clinical principle of the chiropractic profession.1 A century
ago the founder of chiropractic, D.D. Palmer, described Over the past century various authors have described the
vertebral subluxations as “slightly displaced vertebrae which vertebral subluxation using a multitude of models that range
press against nerves causing impingements, the result being from theories of pinched nerves within the intervertebral
too much or not enough functionating.”2 Palmer argued foramen (that even D.D. Palmer had discounted by 1910),2,3
that vertebral subluxations cause inflammation which is through to more modern developments of Palmer’s early
stressful to the body and viscera and results in “lowered theories that postulate a neurodystrophic hypothesis where
tissue resistance.”2 He incorporated these concepts into a the vertebral subluxation leads to lowered tissue resistance
metaphysical philosophy of chiropractic which emphasised by modifying hypothalamic function and ultimately immune
the supremacy of vital forces and the concept of the body responses.3 It is interesting to note that after almost 115 years
possessing an Innate Intelligence which is compromised in of discussion there is still little consensus regarding the nature
its ability to care for and direct the vital functions of the body of the vertebral subluxation or its associated neurological
by nerve interference caused by vertebral subluxations.2 The manifestations. Some authors even deny that they exist.1 It
use of this vitalistic paradigm and metaphysical constructs is clear therefore that the chiropractic profession needs to
in his philosophy of chiropractic led detractors to malign continue to invest time and money into subluxation-focussed-
his early theories and accuse him of being unscientific.3 research in order to better understand the clinical entity that
However, others have recognized that metaphysics plays a defines the profession.
Over the past 15 years our research group has been
Heidi Haavik Taylor, BSc (Chiro), PhD conducting a variety of experiments aimed at testing out the
Director of Research, New Zealand College of Chiropractic, Auckland, theory that adjusting subluxations improves central nervous
New Zealand system functioning and overall expression of health and
Kelly Holt, BSc (Chiro), PGDipHSc
well being. To do this the theory was first formulated into
Researcher, Research Department, New Zealand College of Chiropractic, a model (Figure 2) that could be scientifically tested with a
Auckland, New Zealand. programme of research studies. This model became the basis
for the lead author’s PhD research,5 and continues to be a
Bernadette Murphy, DC, PhD foundational premise that our research group is attempting
Associate Professor, Faculty of Health Sciences, University of Ontario
Institute of Technology, Ontario, Canada to elucidate with our work. The model was constructed using
early chiropractic research data and a thorough review of the
This paper was voted best paper at the November 2009 Policy Forum and neurophysiology scientific literature. The model assumes that
Scientific Symposium. the putative vertebral subluxation represents a state of altered
Conflicts of Interest: Funding sources for this study have been afferent input which is responsible for ongoing maladaptive
acknowledged. No conflicts of interest have been identified. central plastic changes that over time can lead to dysfunction,

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Volume 40 Number 1 March 2010 37
 NEUROMODULAtoRY EFFECTS
HAAVIK TAYLOR • HOLT • MURPHY

pain and other symptoms. Thus a potential mechanism adjusting the spine had any lasting central neural effects at
which could explain how chiropractic adjustments improve all. Very limited evidence for this existed 15 years ago.9,10
function is that altered afferent feedback from a vertebral According to our model above, adjusting subluxated spinal
subluxation alters the afferent “milieu” into which subsequent segments should alter sensorimotor processing, sensorimotor
afferent feedback from the spine and limbs is received and integration and motor control.
processed, thus leading to altered sensorimotor integration of 12
the afferent input, which is then normalised by high-velocity, Sensorimotor Integration
low-amplitude adjustments of the vertebral subluxation. Numerous activities of daily living are dependent on
This theory is plausible considering that it is now well appropriate sensorimotor integration. Interactions between
established that the human central nervous system (CNS) sensory and motor systems allow us to engage with our
retains
Figure 1: its ability Subluxation
Vertebral to adapt to its
may ever-changing
lead to alteredenvironment,
sensorimotor integration
environment, they allow us to reach for and grasp an object,
and that both increased (hyperafferentation) and decreased turn towards an auditory stimulus or respond to perturbations
(deafferentation) afferent input leads to changes in CNS Figure
of the 3:environment
Sensorimotor in
integration
order toillustrated
maintain by postural
the Action/Perception Cycle
stability Formatted:
functioning.6-8 and balance.11

Altered
Altered somatosensory
Altered
afferent processing
sensorimotor
input integration

13
Vertebral
subluxation Altered
motor control

Altered function
(pain and disability)
Figure 2: Chiropractic adjustments may normalise afferent input and therefore promote appropriate sensorimotor integration
Figure 1: Vertebral Subluxation may lead to altered sensorimotor
integration

Appropriate
Normal somatosensory
Appropriate
afferent processing
sensorimotor
input integration

Appropriate
Joint Figure 3: Sensorimotor integration illustrated by the Action/Perception
Accurate Cycle
movement
motor control

Good function
Sensorimotor integration involves strong feedback
Spinal connections between different brain structures that are
adjustments associated with numerous, and perhaps all, neuroanatomical
Figure 2: Chiropractic adjustments may normalise afferent input and
subsystems.4 These subsystems interconnect to form a
therefore promote appropriate sensorimotor integration dynamic, multimodal, sensorimotor integrative system.
This system is dependent on motoric responses to reafferent
proprioceptive signals in order to complement and define
further sensory input. This adds organisational complexity
It is the aim of this paper to discuss some of the studies which results in a higher order sensorimotor integrative
conducted by our group over the past 15 years and to consider system that may be said to have emergent properties. 11
how this work relates to our model and its a priori vitalistic This is similar to the emergent properties of consciousness,
assumptions. By developing a greater understanding of where a ‘thought’ is not made up of a single synapse or
the effects of the vertebral subluxation on sensorimotor active neuron but involves a much higher level of processing
integration researchers may be able to help elucidate some of and integration and cannot necessarily be explained by
the many beneficial clinical effects reported by chiropractors its constituent parts.5 A breakdown anywhere in these
in day to day practice. multimodal sensorimotor feedback loops has the potential to
DISCUSSION influence other interconnected neuroanatomical subsystems,
or, perhaps more importantly, the emergent properties of the
To attempt to provide any clarification regarding the higher order system.11 Therefore, if a vertebral subluxation
neurophysiological effects, if any, of adjusting subluxated creates neuroplastic changes (i.e. lasting functional
spinal segments, it was first necessary to explore whether neurophysiological changes) in the CNS due to altered

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38 Volume 40 Number 1 March 2010
 NEUROMODULAtoRY EFFECTS
HAAVIK TAYLOR • HOLT • MURPHY

afferent input, its impact on the higher order sensorimotor of JPS. Recent research, utilising somatosensory evoked
integrative system may have neurological manifestations that potentials61 and transcranial magnetic stimulation,62,63 has
extend well beyond the mechanical site of the lesion. There shown that adjusting vertebral subluxations in the cervical
is, for example, a growing body of evidence that suggests that spine of patients without frank neck pain, but with a history of
sensorimotor integration involves highly complex emergent some form of subclinical neck pain syndrome (SCNPS) (i.e.
properties that are linked to adaptation and homeostasis12 individuals with reoccurring neck dysfunction such as minor
and that chiropractic adjustments influence many of neck pain, ache and/or stiffness, but asymptomatic between
these integrative neural processes such as proprioception, episodes, and who have not considered their symptoms severe
somatosensory processing and feed forward activation.13-15 enough to seek treatment)64,65 can alter cortical somatosensory
processing, sensorimotor integration of input from the
Proprioception upper limb, and motor control of upper limb muscles. It
Proprioception is an important component of sensorimotor is therefore possible that such changes in CNS processing
integration in the CNS. Proprioception includes joint position following cervical adjustments could include alterations in
sense (JPS) and kinaesthesia (the sense of limb movement in proprioceptive processing.
the absence of visual cues). for review see 16 The main source of Somatosensory Gating
afferent information for JPS arises from muscle spindles. for
review see 16
However, both mechanoreceptors in joint capsules Another important property of the CNS is its ability to
and cutaneous tactile receptors may also contribute. for review gate sensory information. It is thought that this is necessary
see 16
Joint position sense has been extensively studied in the for the CNS to maintain the internal representation of its
ankle, knee and hip joints,17-29 particularly to investigate the current posture and to avoid undesirable reactions to external
effects of reconstructive surgery,19,24,25 osteoarthritis,28,30,31 or internal perturbations.65,66 Tinazzi et al have shown that
joint bracing, for review see 26 and various exercise or re-training gating of sensory information is distorted in patients with
programmes.17,18,21,32 Recently there has also been an increased focal hand dystonia.67 The authors argued that there was a
focus in the literature on spinal JPS,33-37 however, much lack of surround-like inhibition (a neural mechanism that
less research has looked at the effect of the spine on limb focuses neuronal activity and is considered a fundamental
JPS.38-40 property of retinal ganglion cells and the circuitry of the visual
system)68 of mainly proprioceptive afferent input in these
Accurate JPS is very important for balance and for patients, and that this inefficient integration could give rise
the regulation of locomotion.41 Impaired balance and to the abnormal motor output and might therefore contribute
locomotion control are known to impact the falls-risk in the to the motor impairment present in dystonia patients.67 Other
elderly,42,43 which is a major health concern for this population groups have also demonstrated that there is a shift in the
group.44-49 Impaired ankle and knee proprioception has been gain of the sensory signals, i.e. a central re-weighting of
demonstrated in elderly populations compared to younger proprioceptive input, in patients with spasmodic torticollis69
groups.50,51 This is thought to negatively impact balance and and low back pain patients.70 A recent study demonstrated that
locomotor control, leading to more falls.50,51 In addition to the adjusting dysfunctional cervical segments in SCNPS patients
sensorimotor system, the vestibular system is vital for good can increase the surround-like inhibition of proprioceptive
balance and reduced risk of falls. However, the function of afferent input,71 again suggesting the possibility of central
the vestibular system is known to decline with age, thus the mechanisms of action for high-velocity, low-amplitude spinal
elderly must rely more heavily on their proprioceptive system adjustments.
to maintain good balance and normal locomotor control.52
There are numerous studies that implicate cervical spine Sensorimotor Processing
impairment in reduced postural control, for example, due to
chronic neck pain,53,54 neck muscle fatigue,55 cervicobrachial Recent research utilising somatosensory evoked potentials
pain syndrome,56 cervical root compression,57,58 head injury (SEPs)61 and transcranial magnetic stimulation (TMS)62,63 has
or whiplash injury.55,59 Therefore, there appears to be a shown that adjusting dysfunctional segments in the cervical
considerable link between cervical function and accurate spine can alter somatosensory processing, sensorimotor
proprioceptive processing and thus postural control. Although integration of input from the upper limb, and motor
most of these previous studies related to significant cervical control of upper limb muscles. These studies have shown
problems, one recent study has demonstrated that changes alterations in the processing of the cortical SEP peaks N20
in head and neck position in a group of subjects without any and N30 following high-velocity, low-amplitude cervical
history of neck pain or injury led to reduced accuracy of adjustments.61 The N20 SEP peak represents processing
elbow joint position sense (JPS).40 The authors of this study at the primary somatosensory cortex72-74 and thus reflects
discussed how accurate execution of movement depends cortical perception. The neural generator(s) of the N30 SEP
on the ability of the CNS to integrate somatosensory, component remains more controversial. Although some
vestibular, and visual information regarding the position of authors suggest this peak is generated in the post-central
the body.40 They argued that placing their subjects’ heads cortical regions (i.e. S1),75-77 most evidence suggests that
in full flexion and rotation could have led to an overload this peak is related to a complex cortical and subcortical
of the computational capacity of the CNS, thus resulting in loop linking the basal ganglia, thalamus, pre-motor areas,
increased JPS error.40 The same group of researchers also and primary motor cortex.78-86 The N30 peak is therefore
demonstrated that people with whiplash associated disorder thought to reflect sensorimotor integration.87 This means that
(WAD) are affected by smaller angles of neck rotation than adjusting cervical vertebral subluxations can alter cortical
individuals who had no history of WAD,60 further suggesting perception and sensorimotor integration of information from
that cervical spine dysfunction leads to reduced accuracy the upper limb. It has also recently been demonstrated that

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NEUROMODULAtoRY EFFECTS
HAAVIK TAYLOR • HOLT • MURPHY

adjusting cervical vertebral subluxations alters cortical upper Feed Forward Activation
limb muscular control in a muscle specific manner.63,88 The
TMS experimental measures utilised in these studies, such as When performing bodily movements, like throwing a ball
short-interval-intracortical-inhibition (SICI), short-interval- for example, the central nervous system will activate a variety
intracortical-facilitation (SICF) and the cortical silent period of postural muscles prior to any movement of the arm in order
(CSP), all reflect sensorimotor integration and are believed to maintain postural stability during the throwing action. This
to reflect processing at the level of the cortex.89-100 process is known as feed-forward activation (FFA). Delays in
FFA are known to occur in individuals suffering from chronic
Muscle perception impairments are also present in chronic low back pain.116 Based on our model, such a delay in muscle
neck pain patients. Impairment of deep cervical neck flexors activation would be an example of altered motor control.
and significant postural disturbances during walking and
standing have been demonstrated in both insidious-onset We were interested to understand what the incidence of
and trauma-induced chronic neck pain conditions.56,101-106 delayed feed-forward activation might be in an asymptomatic
Altered sensitivity of proprioceptors within the neck muscles population and whether this might be related to underlying
has been suggested to be related to the postural (i.e. motor vertebral subluxations. In order to do this, we selected a
control) disturbances seen in these patients.102,106 It has also uniform population of 90 healthy young males who were
been argued that the degree to which proprioceptive input evaluated for delays in FFA of the transversus abdominis
to the central nervous system is disturbed and possibly even muscle and internal obliques when undertaking rapid
more importantly how the CNS processes, interprets and movements of the upper limb. Seventeen subjects had a delay
transforms this afferent information into motor commands in FFA which was reproducible when retested six months
determines the degree to which subjects can successfully later. These subjects were examined by a chiropractor and
execute more challenging balance tasks.65,106 It is therefore were all found to have a sacroiliac joint subluxation on
possible that adjusting vertebral subluxations in patients the side of delayed FFA. Following a single chiropractic
with sub-clinical or chronic neck pain actually alters the adjustment of the subluxated sacroiliac joint the FFA
central processing of proprioceptive information, and that activation time improved by an average of 38%.15 This study
this in part is the mechanism by which high-velocity, low- demonstrated an improvement in central nervous system
amplitude spinal adjustments reduce pain and improve control of muscles associated with the stability of a specific
function in these patient populations. It is possible that joint due to a chiropractic adjustment. Only one prospective
the changes in cortical somatosensory processing,61,107,108 study has investigated the potential role of delayed trunk
sensorimotor integration61-63 and motor control62,63,109-111 that muscle activation in actually predicting low back pain over
have been previously documented following high-velocity, a two year period.117 The authors found that the odds of
low-amplitude spinal adjustments reflect changes in central sustaining a low back injury increased 2.8-fold when a history
processing of proprioceptive afferent input. of low back pain was present and increased by 3% with each
Centrally Modulated Pain millisecond of abdominal muscle shut-off latency. They found
that the latency was an average of 14 milliseconds longer for
The CNS utilises peripheral signals continuously to athletes who sustained low back pain as compared to those
build and maintain an internal reference frame.112,113 Motor who didn’t. Considerably more work needs to be done in this
commands or motor intention (also known as “efference area to determine whether delayed trunk muscle latencies
copies”) are also known to interact with afferent signals may be a marker of disordered sensorimotor integration, and
to generate sensation, and are known to contribute to joint whether the improvement in activation is sustained following
position sense.114 Under normal circumstances there is chiropractic care.
an integration of intention, action and sensory feedback.
Furthermore, in a healthy state there is congruence between Relationship to Observations in Practice
motor intention and sensory experience (both proprioceptive
and visual) when we for example move a limb through space. We are currently developing a questionnaire to measure
Thus goal-directed action requires ongoing monitoring of self-reported “body awareness” which might be linked to
sensorimotor inputs to ensure that motor outputs are congruent impaired sensorimotor integration. This questionnaire could
with current intentions. This monitoring is automatic but be used to assess the incidence of disordered sensorimotor
can become conscious if there is a mismatch between integration in a chiropractic patient group. Some sample
expected and realised sensorimotor states. A recent study has questions which reflect the sort of things that a patient
demonstrated that providing a sensory–motor conflict, i.e. with disordered sensorimotor integration may experience
providing unexpected visual feedback when moving a limb include:
(via hiding a moving limb and/or distorting visual feedback
of the movement of that limb) is sufficient to produce • Have you noticed that you have been hitting your head
additional somaesthetic disturbances, and exacerbation of getting out of the car since your neck has been sore?
pre-existing symptoms in a group of fibromyalgia patients.115
This suggests that a conflict between our expected and • Have you been bumping your wrists or elbows more
realised sensorimotor states can in some individuals produce frequently?
or worsen pain sensations. It is therefore possible that a • Have you had trouble seeing clearly or focusing on
mechanism by which spinal adjustments relieve pain in objects since your neck has been sore?
patients is due to a central effect by improving somatosensory
integration processes and removing the conflict between the • Have you felt clumsy or uncoordinated since your neck
expected and actual sensorimotor state. has been sore?

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40 Volume 40 Number 1 March 2010
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HAAVIK TAYLOR • HOLT • MURPHY

CONCLUSION 9. Pickar JG. Neurophysiological effects of spinal manipulation. Spine

J. 2002;2(5):357-71.
The fact that chiropractic adjustments result in such a
10. Haldeman S. Neurologic Effects of the Adjustment. J Manipulative
plethora of changes to sensorimotor integration is interesting Physiol Ther. 2000;23(2):112-4.
when considering the possible mechanisms associated
with the beneficial clinical effects of chiropractic care. 11. Chen JL, Penhune VB, Zatorre RJ. The role of auditory and
premotor cortex in sensorimotor transformations. Ann N Y Acad Sci.
Researchers from many diverse fields have recently suggested 2009;1169:15-34.
that sensorimotor integration involves multiple layers of
processing that display emergent properties which cannot 12. Poon C-S, Tin C, Yu Y. Homeostasis of exercise hyperpnea and
optimal sensorimotor integration: The internal model paradigm. Respir
be explained by individual neurons and pathways.11,12,118 Of Physiol Neurobiol. 2007;159(1):1-13.
interest when considering the vitalistic principles upon which
chiropractic was founded is that some researchers are now 13. Haavik-Taylor H, Murphy B. Transient modulation of intracortical
inhibition following spinal manipulation. Chiropr J Aust.
proposing that emergent signals from optimal sensorimotor 2007;37(3):106-16.
integration may underlie appropriate adaptation of respiratory
patterns and homeostasis.12 This may go some way to 14. Haavik-Taylor H, Murphy B. Cervical spine manipulation alters
sensorimotor integration: A somatosensory evoked potential study.
explain some of the beneficial effects of chiropractic care Clin Neurophysiol. 2007;118(2):391-402.
on nonmusculoskeletal conditions previously reported in
the literature.119 15. Marshall P, Murphy B. The effect of sacroiliac joint manipulation on
feed-forward activation times of the deep abdominal musculature. J
Many of the studies discussed in this paper show that Manipulative Physiol Ther. 2006;29(3 ):196-202.
chiropractic adjustments result in changes to sensorimotor 16. Gilman S. Joint position sense and vibration sense: anatomical
integration within the central nervous system. What is not organisation and assessment. J Neurol Neurosurg Psychiatry.
yet clear is whether these changes correlate with beneficial 2002;73(5):473-7.
clinical outcomes or not. It is also not clear whether these 17. Tsauo J-Y, Cheng P-F. The effect of sensorimotor training on knee
changes are due to the correction of a vertebral subluxation, proprioceptive and function for patients with knee osteoarthritis: a
therefore normalising aberrant afferent input to the CNS, or preliminary report. Clin Rehabil. 2008;22:448-57.
are they merely due to an afferent barrage associated with 18. Ribeiro F, Mota J, Oliveira J. Effect of exercise-induced fatigue
the adjustive thrust. These questions remain to be answered on position sense of the knee in the elderly. Eur J Appl Physiol.
and are the focus of our ongoing research efforts. 2007;99(4):379-85.

ACKNOWLEDGMENTS 19. Adachi N, Ochi M, Uchio Y, Iwasa J, Ishikawa M, Shinomiya R.

Temporal change of joint position sense after posterior cruciate
The authors would like to thank the following organisations ligament reconstruction using multi-stranded hamstring tendons. Knee
Surg Sports Traumatol Arthrosc. 2007;15(1):2-8.
for providing funding to help conduct their research over the
past fifteen years: Australian Spinal Research Foundation, 20. Okuda T, Ochi M, Tanaka N, Nakanishi K, Adachi N, Kobayashi
the Hamblin Chiropractic Research Fund Trust, the R. Knee joint position sense in compressive myelopathy. Spine.
2006;31(4):459-62.
University of Auckland Vice Chancellors Fund, New Zealand
Tertiary Education Commission Top Achievers Doctoral 21. Hazneci B, Yildiz Y, Sekir U, Aydin T, Kalyon TA. Efficacy of
Scholarship and the Foundation for Chiropractic Education isokinetic exercise on joint position sense and muscle strength
in patellofemoral pain syndrome. Am J Phys Med Rehabil.
and Research. 2005;84(7):521-7.
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39. Knox JJ, Coppieters MW, Hodges PW. Do you know where your arm Clin Neurophysiol. 2007;118(2):391-402.
is if you think your head has moved? Exp Brain Res. 2006;173(1):94- 62. Haavik Taylor H, Murphy B. World Federation of Chiropractic’s
101. Epub 2006 Mar 25. 9th Biennial Congress Award Winning Paper (3rd Prize): Altered
40. Knox JJ, Hodges PW. Changes in head and neck position affect elbow sensorimotor integration with cervical spine manipulation. J Manip
joint position sense. Exp Brain Res. 2005 2005/08//;165(1):107-13. Physiol Ther. 2008;31(2):115-26.
41. Bove M, Courtine G, Schieppati M. Neck Muscle Vibration and Spatial 63. Haavik-Taylor H, Murphy B. Transient modulation of intracortical
Orientation During Stepping in Place in Humans. J Neurophysiol. inhibition following spinal manipulation. Chiropr J Aust. 2007;37:106-
2002;88:2232-41. 16.
42. Gill T, Taylor AW, Pengelly A. A population-based survey of factors 64. Lee HM, Nicholson LLP, Adams RDP, Bae S-SP. Proprioception and
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2005;51(5):340-5. Spine. 2005;30(3):E60-E7.
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44. Walsh MJ, Polus BI, Webb MN. The role of the cervical spine 66. Ivanenko YP, Solopova IA, Levik YS. The direction of postural
in balance and risk of falling in the elderly. Chiropr J Aust. instability affects postural reactions to ankle muscle vibration in
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46. Stephenson S, Langley J, Trotter M. Impact of injury in New Zealand. dystonia. Evidence for sensory overflow. Brain. 2000;123(Pt 1):42-
2nd ed. Dunedin: Injury Prevention Research Unit; 2005. 50.
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49. Hendrie D, Hall SE, Arena G, Legge M. Health system costs of falls of 70. Brumagne S, Cordo P, Verschueren S. Proprioceptive weighting
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50. You SH. Joint Position Sense in Elderly Fallers: A preliminary 71. Haavik Taylor H, Murphy B. First prize award winning paper
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Arch Phys Med Rehab. 2005;86:346-52. Research Agenda Conference: Altered Central Integration of Dual
51. Hurley MV, Rees J, Newham DJ. Quadriceps function, proprioceptive Somatosensory Input Following Cervical Spine Manipulation. J Manip
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110. Suter E, McMorland G. Decrease in elbow flexor inhibition after 115. McCabe CS, Cohen H, Blake DR. Somaesthetic disturbances in
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Book Review

Communication. Core interpersonal skills for health The second section of the book is interesting in that
professional. Gjyn O’Toole. Churchill Livingstone, it discusses developing awareness to achieve effective
Chatswood NSW, 2008. ISBN 978 0 7295 3859 6. communication: awareness of self, of others, and of the
Paperback, 332 pages. RRP $65.00 environment. This ‘reflective practice’ and its importance is
presented and is supported with many activities, questions
Being a student of chiropractic is exhilarating in that we to ask and case studies.
are gaining knowledge and skills in subjects about which
we are passionately interested and can’t wait to get out and The third section of the book covers core skills in
practise in “the real world”. But it can also be a long road communication – active listening, ethical communication,
of late nights, long lists of things to learn and trying to cram non-verbal communication, the impact of stereotypes
12 weeks worth of lectures into one’s head the night before and judgements, culturally appropriate communication,
the final exam (not that I’ve ever done that). It can also be and others. The author asks readers to draw on their own
easy for students to fall into the trap of focusing too much experience in this section.
on the “facts” of our art and science of chiropractic, since it
is on these “facts” that we will be examined, and forget that Both the third and fourth sections of the book may be
one of the fundamental things we need to learn and develop of particular interest to not just students but practising
in ourselves is our ability to communicate with real people, chiropractors as well. The fourth section covers communication
our patients. in many different scenarios, such as people experiencing
strong emotions, people in particular ages of the lifespan,
It is for this reason I was interested in perusing Gjyn people in particular roles, people with particular conditions,
O’Toole’s book on communication in the health professions. people in particular contexts.
Gjyn O’Toole is a lecturer at the School of Health Sciences
at the University of Newcastle (NSW) and teaches students The book is structured in a manner particularly familiar to
from a variety of health science disciplines. and useful for the student; that is a discussion is supplemented
with case studies and is followed by a range of questions
The book is divided into four sections, covering the the reader may ask themselves to reinforce their learning.
significance of interpersonal communication in the health Learning objectives at the beginning of each chapter and a
professions, developing awareness to achieve effective summary at the end further support one’s understanding.
communication, developing core skills in communication,
and the focus of communication in the health professions: Overall this book is a useful tool for students who are not
people. simply interested in learning the facts and figures required to
pass exams but who aim to develop themselves as effective,
The book starts with a discussion of theories about compassionate carers of people.
communication and why it is essential. This section not
only covers why effective communication is essential but
specific aspects for the health professions, such as the
importance of personal introductions, gathering information
in health interactions, and understanding the significance of Elizabeth Borham
comforting. B Econ

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