2018 international vertebral subluxation summit international … · 2018-08-31 · because the...
TRANSCRIPT
2018 International Vertebral
Subluxation Summit
International Chiropractors Association
Cleveland University
Twelve Studies
Dan Murphy, DC
1The Official History Of Chiropractic in Texas
By Walter R Rhodes, DCPublished by the Texas Chiropractic Association
1978
CHAPTER VI:THE THREE GREAT SURVIVAL FACTORS
[Excerpts by Dan Murphy, DC]
“The 1917 - 1918 influenza epidemic swept silently across the world bringingdeath and fear to homes in every land. Disease and pestilence, especially theepidemics, are little understood even now and many of the factors that spread themare still mysterious shadows, but in 1917-1918 almost nothing was known aboutprevention, protection, treatment or cure of influenza. The whole world stood at itsmercy, or lack of it.”
“But out of that particular epidemic, the young science of chiropractic grewinto a new measure of safety. While many struggles would lie ahead this successfulpassage of the profession into early maturity assured its immediate survival andmade the eventual outcome of chiropractic a matter for optimism. If there had beenany lack of enthusiasm among the doctors of chiropractic, or a depleting of thesources of students then the epidemic took care of them too. These chiropracticsurvivors of the flu epidemic were sure, assured, determined, and ready to fightany battle that came up. The effect of the epidemic becomes evident in interviewsmade with old-timers practicing in those years. The refrain comes repeatedly,”
‘I was about to go out of business when the flu epidemic came - but when it was over, I was firmly established in practice.’
“Why?The answer is reasonably simple. Chiropractors got fantastic results from
influenza patients while those under medical care died like flies all around.”
“Statistics reflect a most amazing, almost miraculous state of affairs. Themedical profession was practically helpless with the flu victims but chiropractorsseemed able to do no wrong.”
“In Davenport, Iowa, 50 medical doctors treated 4,953 cases, with 274deaths. In the same city, 150 chiropractors including students and faculty of thePalmer School of Chiropractic, treated 1,635 cases with only one death.”
“In the state of Iowa, medical doctors treated 93,590 patients, with 6,116deaths - a loss of one patient out of every 15. In the same state, excludingDavenport, 4,735 patients were treated by chiropractors with a loss of only 6 cases- a loss of one patient out of every 789.”
2“National figures show that 1,142 chiropractors treated 46,394 patients for
influenza during 1918, with a loss of 54 patients - one out of every 886.”
“Reports show that in New York City, during the influenza epidemic of 1918,out of every 10,000 cases medically treated, 950 died; and in every 10,000pneumonia cases medically treated 6,400 died. These figures are exact, for in thatcity these are reportable diseases.”
“In the same epidemic, under drugless methods, only 25 patients died ofinfluenza out of every 10,000 cases; and only 100 patients died of pneumonia outof every 10,000 cases. This comparison is made more striking by the followingtable:”
Influenza
Cases Deaths
Under medical methods 10,000 950
Under drugless methods 10,000 25
Pneumonia
Cases Deaths
Under medical methods 10,000 6,400
Under drugless methods 10,000 100
“In the same epidemic reports show that chiropractors in Oklahoma treated3,490 cases of influenza with only 7 deaths. But the best part of this is, inOklahoma there is a clear record showing that chiropractors were called in 233cases where medical doctors had cared for the patients, and finally gave them up aslost. The chiropractors saved all these lost cases but 25.”
“Statistics alone, however, don't put in that little human element needed tospark the material properly. Dr. S. T. McMurrain [DC] had a makeshift tableinstalled in the influenza ward in Base Hospital No. 84 unit stationed in Perigau, inSouthwestern France, about 85 kilometers from Bordeaux [during WWI]. Themedical officer in charge sent all influenza patients in for chiropractic adjustmentsfrom Dr. McMurrain [DC] for the several months the epidemic raged in that area. Lt.Col. McNaughton, the detachment commander, was so impressed he requested tohave Dr. McMurrain [DC] commissioned in the Sanitary Corps.”
3“Dr. Paul Myers [DC] of Wichita Falls was pressed into service by the County
Health Officer and authorized to write prescriptions for the duration of the epidemicthere - but Dr. Myers [DC] said he never wrote any, getting better results withoutmedication.”
Dr. Helen B. Mason [DC], whose “son, when only a year old, became very illwith bronchitis. My husband and I took him to several medical specialists withoutany worthwhile results. We called a chiropractor, as a last resort, and were amazedat the rapidity of his recovery. We discussed this amazing cure at length and cameto the decision that if chiropractic could do as much for the health of otherindividuals as it had done for our son we wanted to become chiropractors.”
Dr. M. L. Stanphill [DC] recounts his experiences:
“I had quite a bit of practice in 1918 when the flu broke out. I stayed (in Van Alstyne) until the flu was over and had the greatest success, taking many cases that had been given up and restoring them back to health. During the flu we didn't have the automobile. I went horseback and drove a buggy day and night. I stayed overnight when the patients were real bad. When the rain and snow came I just stayed it out. There wasn't a member of my family that had the flu.”
When he came to Denison he said:“I had a lot of trouble with pneumonia when I first came. Once again took all the cases that had been given up. C. R. Crabetree, who lived about 18 miles west of Denison, had double pneumonia and I went and stayed all night with him and until he came to the next morning. He is still living today. That gave me a boost on the west side of town.”
“And when interviews of the old timers are made it is evident that each stillvividly remembers the 1917-1918 influenza epidemic. We now know about 20million persons [recent estimates are as high as 100 million deaths] around theworld died of the flu with about 500,000 Americans among that number. But mostchiropractors and their patients were miraculously spared and we repeatedly hearabout those decisions to become a chiropractor after a remarkable recovery orwhen a close family member given up for dead suddenly came back to vibranthealth.”
“Some of these men and women were to become the major characters thrustupon the profession's stage in the 20's and 30's and they had the courage, thebackground and the conviction to withstand all that would shortly be thrown againstthem” [including being thrown in jail for practicing medicine without a license].
“The publicity and reputation of such effectiveness in handling flu cases alsobrought new patients and much acclaim from people who knew nothing ofchiropractic before 1918.”
“The Innate Immune System”
Chapter 2
How The immune System Works
By Lauren Sompayrac, PhD
Department of Molecular, Cellular, and
Developmental Biology University of Colorado, Boulder
Blackwell Science
1999 “Until recently, most immunologists didn’t pay much attention to the innate system, perhaps because the adaptive system seemed more exciting. However, studies of the adaptive immune system have led to a new appreciation of the role that the innate system plays, not only as a second line of defense (if we count physical barriers as our first defense), but also as an activator and a controller of the adaptive response.” p. 17
The Sympathetic Nerve—An Integrative Interfacebetween Two Supersystems: The Brain and the
Immune SystemILIA J. ELENKOV, RONALD L. WILDER, GEORGE P. CHROUSOS, AND E. SYLVESTER VIZI1
Inflammatory Joint Diseases Section, Arthritis and Rheumatism Branch, National Institute of Arthritis and Musculoskeletal and SkinDiseases, National Institutes of Health, Bethesda, Maryland (I.J.E., R.L.W.); Pediatric Endocrinology Section, Developmental
Endocrinology Branch, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland(I.J.E., G.P.C.); Department of Pharmacology, Institute of Experimental Medicine, Hungarian Academy of Sciences, Budapest, Hungary
(E.S.V.); and Department of Pharmacology and Pharmacotherapy, Semmelweis University, Budapest, Hungary (E.S.V.)
This paper is available online at http://www.pharmrev.org
Abstract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 596I. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 597
A. Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 597B. Historical perspectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 597
II. Anatomy and physiology of the autonomic nervous system . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 598A. Organization of the autonomic/sympathetic nervous system . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 598B. Role of sympathetic nervous system and hypothalamo-pituitary-adrenal axis in maintaining
basal and stress-related homeostasis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 599III. Autonomic/sympathetic innervation of lymphoid organs: nonsynaptic communication . . . . . . . . . 599
A. Innervation of the thymus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 601B. Innervation of the spleen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 601C. Innervation of lymph nodes and tonsils . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 601D. Innervation of the bone marrow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 601E. Innervation of mucosa-associated lymphoid tissues. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 602F. Coexistence patterns . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 602G. General pattern of the autonomic/sympathetic innervation of lymphoid organs. . . . . . . . . . . . 602H. Spatial relationships with peptidergic innervation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 603I. Neuroimmune connection in nonorganized lymphoid compartments . . . . . . . . . . . . . . . . . . . . . . 603
IV. Nonsynaptic release of norepinephrine in lymphoid organs: presynaptic modulation and effect ofdrugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 603A. Evidence for neural release of norepinephrine (and dopamine) in lymphoid organs . . . . . . . . 603B. Norepinephrine is released and affects immune cells nonsynaptically . . . . . . . . . . . . . . . . . . . . 604C. Presynaptic modulation of norepinephrine release in lymphoid organs: effect of drugs . . . . . 605D. Release of neuropeptide Y and its action on immune cells. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 606
V. Systemic and local effects of cytokines on sympathetic nervous system activity. . . . . . . . . . . . . . . 606A. Systemic effects: long feedback loop between the immune system and the brain. . . . . . . . . . . 606B. Local effects of tumor necrosis factor-! and interleukin-1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 607
VI. Expression of adrenoreceptors on lymphoid cells: signal transduction . . . . . . . . . . . . . . . . . . . . . . . 608A. Expression and distribution of adrenoreceptors on lymphoid cells. . . . . . . . . . . . . . . . . . . . . . . . 608B. Signal pathways and molecular aspects of catecholamines actions . . . . . . . . . . . . . . . . . . . . . . . 609
1. Cyclic adenosine 5!-monophosphate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6092. Intracellular Ca2" . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 610
VII. Role of sympathetic innervation in immune system development and hematopoiesis . . . . . . . . . . 611A. Immune system development . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 611B. Hematopoiesis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 611C. Thymocyte development . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 612
VIII. Sympathetic control of lymphocyte traffic and circulation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 612
1 Address for correspondence: Dr. E. Sylvester Vizi, Department of Pharmacology, Institute of Experimental Medicine, HungarianAcademy of Sciences, H-1450 Budapest, P.O. Box 67, Hungary. E-mail: [email protected]
0031-6997/00/5204-0595$03.00/0PHARMACOLOGICAL REVIEWS Vol. 52, No. 4U.S. Government work not protected by U.S. copyright 41/865371Pharmacol Rev 52:595–638, 2000 Printed in U.S.A
595
11/29/13 3:22 PMAutonomic innervation and regulation of th... [Brain Behav Immun. 2007] - PubMed - NCBI
Page 1 of 2http://www.ncbi.nlm.nih.gov/pubmed/17467231
Brain Behav Immun. 2007 Aug;21(6):736-45. Epub 2007 Apr 27.
Autonomic innervation and regulation of the immune system (1987-2007).Nance DM, Sanders VM.Susan Samueli Center for Integrative Medicine, University of California Irvine, Orange, CA 92868-4283, [email protected]
AbstractSince 1987, only a few neuroanatomical studies have been conducted to identify the origin ofinnervation for the immune system. These studies demonstrated that all primary and secondaryimmune organs receive a substantial sympathetic innervation from sympathetic postganglionicneurons. Neither the thymus nor spleen receive any sensory neural innervation; however, there isevidence that lymph nodes and bone marrow may be innervated by sensory neurons located indorsal root ganglia. There is no neuroanatomical evidence for a parasympathetic or vagal nervesupply to any immune organ. Thus, the primary pathway for the neural regulation of immune functionis provided by the sympathetic nervous system (SNS) and its main neurotransmitter, norepinephrine(NE). Activation of the SNS primarily inhibits the activity of cells associated with the innate immunesystem, while it either enhances or inhibits the activity of cells associated with the acquired/adaptiveimmune system. Innate immune cells express both alpha and beta-adrenergic receptor subtypes,while T and B lymphocytes express adrenergic receptors of the beta2 subtype exclusively, except formurine Th2 cells that lack expression of any subtype. Via these adrenergic receptors, NE is able toregulate the level of immune cell activity by initiating a change in the level of cellular activity, whichoften involves a change in the level of gene expression for cytokines and antibodies.
PMID: 17467231 [PubMed - indexed for MEDLINE] PMCID: PMC1986730 Free PMC Article
Display Settings: Abstract
Images from this publication. See all images (1) Freetext
Publication Types, MeSH Terms, Grant Support
PubMed
5/28/13 4:15 PMPubMed Central, FIGURE 1: Brain Behav Immun. 2007 August; 21(6): 736–745. Published online 2007 April 27. doi: 10.1016/j.bbi.2007.03.008
Page 1 of 2http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1986730/figure/F1/?report=objectonly
FIGURE 1
All primary and secondary immune organs receive a substantial sympathetic innervation from sympatheticpostganglionic neurons. There is no neuroanatomical evidence for a parasympathetic or vagal nerve supply to anyimmune organ. Input to the brain comes from sensory, e.g., dorsal root ganglia, or immune stimuli, e.g., cytokines.The primary pathway for the neural regulation of immune function is provided by the sympathetic nervous systemand its main neurotransmitter, norepinephrine. Activation of the SNS primarily inhibits the activity of cellsassociated with the innate immune system, while it either enhances or inhibits the activity of cells associated with
1 Sympathetic Segmental Disturbances
The Evidences of the Association, in Dissected Cadavers, of Visceral
Disease with Vertebral Deformities of the Same Sympathetic Segments
Medical Times, November 1921, pp. 1-7 Henry Winsor, MD THIS AUTHOR NOTES: “The object of these necropsies was to determine whether any connection existed between minor curvatures of the spine, on the one hand, and diseased organs on the other.” This author used 50 cadavers from the University of Pennsylvania. 49 of the 50 cadavers displayed minor curvatures of the spine, and 1 cadaver displayed the normal “slight smooth lateral curve in the thoracic spine.” This 1 cadaver still showed “very minor visceral pathology in the segments immediately above and below the reported curve,” at “segments which should form compensatory curves.” “All [other] curves and deformities of the spine were rigid, apparently of long duration; irreducible by ordinary manual force: extension, counter-extension, rotation, even strong lateral movements failed to remove them or even cause them to change their relative positions.” Importantly, minor spinal curvatures “their association with disease of organs belonging to the same sympathetic segment is more frequent than with gross curves.” Also importantly, in the 4 spines with gross curvatures “diseased organs were not found to belong to the same sympathetic segments as the gross curves, but were [found at] the same sympathetic segments as the minor compensatory curvatures above and below the greater curves.”
2 Visceral Disturbance Vertebral Curvatures Of
The Same Sympathetic Segment As Visceral Trouble
Sympathetic Connections Between Vertebrae And Diseased Organs
Diseased Thymus #2 C7, T1 #1 T-2-3-4 #1
Inferior Cervical Sympathetic Ganglia
Adhered Pleurae #21 Upper Thoracics #19 Lower Thoracics #2
Upper Thoracic Ganglia Lower Thoracic Ganglia
Lung Diseases #26 Upper Thoracics #26 Upper Thoracic Ganglia Heart & Pericardium Diseases #20
T1-2-3-4-5 #18 C7, T1 #2
Upper Thoracic Ganglia Inferior Cervical Ganglia
Stomach Diseases #9 T5-6-7-8-9 #8 An Adjacent Segment #1
Greater Splanchnic From Thoracics 5-9
Liver Diseases #13 T5-6-7-8-9 #12 An Adjacent Segment #1
Greater Splanchnic From Thoracics 5-9
Gall Bladder Disease #5 T5-6-7-8-9 #5 Greater Splanchnic From Thoracics 5-9
Pancreas Disease #3 T5-6-7-8-9 #3 Greater Splanchnic From Thoracics 5-9
Spleen Diseases #11 T5-6-7-8-9 #10 T10-11-12 #1
Greater Splanchnic From Thoracics 5-9 Lesser Splanchnic Nerves
Inguinal Diseases #2 T12 #2 Ilio-inguinal Nerve Kidney Disease #17 T10-11-12 #14
T5-6-7-8-9 #1 L1-2 #2
Least, Lesser & Greater Splanchnic Nerves Upper Lumbar Ganglia
Prostate & Bladder Disease #8
L1-2-3 #7 T12 #1
Upper Lumbar Ganglia Last Thoracic Ganglia
Uterus Diseases #2 Lumbar Lordosis #2 Lumbar & Sacral Ganglia Total Visceral Diseases #139
Vertebral Curve Of Same Sympathetic Segment As Disease Site #128
Vertebral Curve Of Adjacent Segment #10
“Therefore, in 50 cadavers with disease in 139 organs, there was found curve of the vertebrae, belonging to the same sympathetic segments as the diseased organs 128 times, leaving an apparent discrepancy of 10, in which the vertebrae in curve belonged to an adjacent segment to that which should supply the diseased organs with sympathetic filaments.” [VERY IMPORTANT!] The author then notes that the ten “apparent discrepancies from adjacent segments” can be accounted for by “nerve filaments leaving the spinal cord and traveling for a few segments.” [IMPORTANT]
3 The author then states that if he included the cadaver with “faint curve and slight visceral pathology” that the correlation was 139 out of 139 for 100%. [WOW!] Importantly, the types documented include: Larynx cancer, fatty degeneration of the thymus, pleural adhesions, pleural effusions, pneumonia, tuberculosis, pulmonary edema, pulmonary congestion, lung fibrosis, bronchitis, enlarged lymph nodes, influenza, heart endocarditis, heart dilatation, heart muscle degeneration, pericarditis, aortic aneurysm, liver cirrhosis, liver swelling, liver tumors, enlarged spleen, atrophied spleen, inflamed spleen, pancreas degeneration, cystic kidneys, appendicitis, uterine adhesions, prostate hypertrophy, prostate atrophy, cystitis, hydrocele, osteomyelitis of the tibia, etc. “In general, we found the ordinary diseases of adult life.” In a separate evaluation, these authors found: 221 diseased organs; “Of these, 212 were observed to belong to the same sympathetic segment as the vertebrae in curvature.” “Nine diseased organs belonged to different sympathetic segments from the vertebrae out of line.” “These figures cannot be expected to exactly coincide, for an organ may receive sympathetic filaments from several spinal segments, and several organs may be supplied with sympathetic filaments from the same spinal segments.” “In no instance was a complete sympathetic block observed.” “Sympathetic disturbances are just as likely to cause functional or organic disease in viscera, by altering the blood-supply of viscera, through vaso-motor spasm.” [This is very important because vaso-motor spasm is subsequent to increased sympathetic tone. Sympathetic nerve compression would reduce sympathetic tone. Consequently the nerve interference resulting in visceral pathology in this study is not compression, but rather an irritation that causes increased sympathetic tone, vaso-motor spasm, and reduced blood flow]. In other research, this author has found that: 1) “Irritation of the sympathetic system and disease in the organs supplied by the same sympathetic nerves as the vertebrae affected.” 2) “That it was rare to find an organ diseased which was not supplied by the same sympathetic nerves as the vertebrae in curvature.” 3) “The sympathetic nerves were stretched over bony exudates [bone spurs] which angulated the nerves.” 4) “That even where no bony exudates was found, there was intense rigidity of the segments [sound much like subluxation complex], showing that fibrous or callous exudates could irritate the sympathetic nerves.” [Fibrosis of Repair]
4 5) “The organs were in many instances affected by acute disease, while the deformed vertebrae proved that the curvatures preceded the organic diseases…” [EXTREMELY IMPORTANT] 6) “…though theoretically, reflexes through muscle spasm may reverse the order of precedence.” [WOW!] The author notes that spondylosis is a process, “the last stage being fixation of segments, immobilization of painful joints being one of nature’s later efforts to check disease.” “The disease [process then] going to the point of least resistance, in this instance to the minor curvatures of the spine.” The author describe the spondylosis process as follows: A “sacro-iliac subluxation, an apparent shortening of the leg, comparative elevation of the posterior superior iliac spine of the ilium, combined with lateral curve in the lumbar region, lumbar curve and sacro-iliac subluxation (rotation of the innominate) appear to be interdependent.” [He even uses subluxation in the same context as a chiropractor]. “The stages of the process appears to be: 1) Minor curves, or so-called sacroiliac subluxations; 2) The muscles are converted into ligaments, ligaments to bone. 3) Finally true bony ankylosis occurs.” [This perfectly describes the phases of subluxation degeneration from Renaissance from the 1970s by Feleesia and Riekeman]. “The disease appears to precede old age and to cause it. The spine becomes stiff first and old age follows. Therefore, we may say a man is as old as his spine, the arteries becoming hardened later from constant vaso-motor spasm, following sympathetic irritation.” [Wow, can you believe this?] The author notes that the sympathetic nerves can become entrapped extraspinally, peripherally. “When the lungs were pulled out of the cadavers [of pleurisy patients with pleural adhesions], the adhesions were sufficiently strong to pull the intercostals vessels and nerves” including the sympathetic nerves. This “irritation of the sympathetic nerves causes reflex spasm of the vaso-motors deranging the blood-supply of the organs supplied by the sympathetic segment in curve.” The results are an increase in lung disease, heart disease, and pneumonia [infection]. “Of three cadavers with inguinal disturbances (bilateral hernia, hydrocele, idiopathic bubo or cancer, which had been excised in an old woman), all showed rotation of the twelfth dorsal vertebrae; the connection links being the ilio-inguinal and genito-crural nerves.” [WOW!] “Skin diseases: two cadavers with warts exhibited minor curvatures in the region from which the affected skin derived its nerve supply.” [WOW!]
7 KEY POINTS FROM DAN MURPHY 1) Curvatures of the spine adversely affect the sympathetic nervous system. 2 The sympathetic nervous system controls the blood supply to the viscera, and is therefore related to all manner of visceral diseases and pathology, and specifically, “the ordinary diseases of adult life.” 3) Visceral diseases and pathology can be traced back to the segmental levels of sympathetic involvement with nearly 100% correlation. 4) Prolonged abnormal spinal posture stretches the sympathetic nervous system, firing the sympathetics, causing reduced blood supply to visceral organs, and resulting in visceral pathology. 5) Abnormal spinal curvatures precede organic visceral diseases. 6) The author perfectly describes pelvic-lumbar subluxations, fibrosis, reduced motion, and sympathetic nerve interference adversely influencing blood flow and resulting in visceral pathology. 7) Spinal disease precedes old age and causes old age. 8) Stiff distorted spines cause sympathetic irritation, vascular spasm, arterial hardening, and old age follows. 9) A person is as old as his spine. 10) Postural distortions causing sympathetic dysfunction can be treated with fulcrum-assisted reversal of the postural distortion. [Incredible] 11) This author reverence both osteopathic and chiropractic literature in his bibliography. COMMENT FROM DAN MURPHY I originally saw this article at Renaissance Seminars from Joe Feleesia and Guy Riekeman in the 1970s. Riekeman is now the President of Life University in Georgia. Why don’t chiropractic colleges do more of this type of research?
11/21/14, 1:45 PMThe spinal cord as organizer of disease processes: III. Hyperactivi... - PubMed - NCBI
Page 1 of 1http://www.ncbi.nlm.nih.gov/pubmed/583147
How to join PubMed Commons
PubMed Commons home
J Am Osteopath Assoc. 1979 Dec;79(4):232-7.
The spinal cord as organizer of disease processes: III. Hyperactivity ofsympathetic innervation as a common factor in disease.Korr IM.
PMID: 583147 [PubMed - indexed for MEDLINE]
PubMed Commons
0 comments
Display Settings: Abstract
MeSH Terms
LinkOut - more resources
PubMed
Jpn J Physiol. 1987;37(1):1-17.
The modulation of visceral functions by somatic afferent activity.Sato A, Schmidt RF.
AbstractWe began by briefly reviewing the historical background of neurophysiological studies of thesomato-autonomic reflexes and then discussed recent studies on somatic-visceral reflexes incombination with autonomic efferent nerve activity and effector organ responses. Most of thestudies that have advanced our knowledge in this area have been carried out on anesthetizedanimals, thus eliminating emotional factors. We would like to emphasize again that thefunctions of many, or perhaps all visceral organs can be modulated by somato-sympatheticor somato-parasympathetic reflex activity induced by a appropriate somatic afferentstimulation in anesthetized animals. As mentioned previously, some autonomic nervousoutflow, e.g. the adrenal sympathetic nerve activity, is involved in the control of hormonalsecretion. John F. Fulton wrote in his famous textbook "Physiology of the Nervous System"(1949) that the posterior pituitary neurosecretion system (i.e. for oxytocin and vasopressin)could be considered a part of the parasympathetic nervous system. In the study of bodyhomeostasis and environmental adaptation it would seem very important to further analyzethe contribution of somatic afferent input to the autonomic nervous and hormonal regulation ofvisceral organ activity. Also, some immunological functions have been found to be influencedby autonomic nerves or hormones (e.g. adrenal cortical hormone and catecholamines).Finally, we must take into account, as we have briefly discussed, that visceral functions canbe modulated by somatic afferent input via various degrees of integration of autonomicnerves, hormones, and immunological processes. We trust that such research will beexpanded to higher species of mammals, and that ultimately this knowledge of somato-visceral reflexes obtained in the physiological laboratory will become clinically useful ininfluencing visceral functions.
PMID: 3302431
[Indexed for MEDLINE]
Format: Abstract
PubMed
The modulation of visceral functions by somatic afferent activity. -... https://www.ncbi.nlm.nih.gov/pubmed/3302431
1 of 2 7/3/18, 2:57 PM
1
J Manipulative Physiol Ther. 1995 Nov-Dec;18(9):597-602.
Somatovisceral reflexes.Sato A .
Tokyo Metropolitan Institute of Gerontology, Japan.
AbstractIn experimental animals, both noxious and innocuous stimulation of somatic afferents havebeen shown to evoke reflex changes in sympathetic efferent activity and, thereby, effectororgan function. These phenomena have been demonstrated in such sites as thegastrointestinal tract, urinary bladder, adrenal medulla, lymphatic tissues, heart and vessels ofthe brain and peripheral nerves. Most often, reflexes have been elicited experimentally bystimulation of cutaneous afferents, although some work has also been conducted on muscleand articular afferents, including those of spinal tissues. The ultimate responses mayrepresent the integration of multiple tonic and reflex influences and may exhibit laterality andsegmental tendencies as well as variable excitability according to the afferents involved.Given the complexity and multiplicity of mechanisms involved in the final expression of thereflex response, attempts to extrapolate to clinical situations should probably be eschewed infavor of further systematic physiological studies.
Comment inManual healing diversity and other challenges to chiropractic integration. [J Manipulative PhysiolTher. 2000]
PMID: 8775021
[Indexed for MEDLINE]
Format: Abstract
1
Author information
MeSH terms
PubMed
Somatovisceral reflexes. - PubMed - NCBI https://www.ncbi.nlm.nih.gov/pubmed/8775021
1 of 2 7/3/18, 2:59 PM
1
BACKGROUND:
OBJECTIVE:
DATA SOURCE:
CONCLUSIONS:
J Manipulative Physiol Ther. 2000 Feb;23(2):104-6.
Reflex effects of subluxation: the autonomic nervous system.Budgell BS .
RMIT University-Japan, Tokyo.
AbstractThe collective experience of the chiropractic profession is that aberrant
stimulation at a particular level of the spine may elicit a segmentally organized response,which may manifest itself in dysfunction within organs receiving autonomic innervation at thatlevel. This experience is at odds with classic views of neuroscientists about the potential forsomatic stimulation of spinal structures to affect visceral function.
To review recent findings from basic physiologic research about the effects ofsomatic stimulation of spinal structures on autonomic nervous system activity and the functionof dependent organs.
Findings were drawn from a major recent review of the literature on theinfluences of somatic stimulation on autonomic function and from recent original physiologicstudies concerning somatoautonomic and spinovisceral reflexes.
Recent neuroscience research supports a neurophysiologic rationale for theconcept that aberrant stimulation of spinal or paraspinal structures may lead to segmentallyorganized reflex responses of the autonomic nervous system, which in turn may alter visceralfunction.
PMID: 10714536
[Indexed for MEDLINE]
Format: Abstract
1
Author information
Publication types, MeSH terms
PubMed
Full text links
Reflex effects of subluxation: the autonomic nervous system. - Pu... https://www.ncbi.nlm.nih.gov/pubmed/10714536
1 of 2 7/3/18, 3:05 PM
1
Auton Neurosci. 2001 Aug 13;91(1-2):96-9.
Innocuous mechanical stimulation of the neck and alterations inheart-rate variability in healthy young adults.Budgell B , Hirano F.
College of Medical Technology, Kyoto University, Japan. [email protected]
AbstractThe present study examined the effects of cervical spinal manipulation, a widely applied formof physical therapy, which involves innocuous mechanical stimulation, on heart rate and heart-rate variability, in a cohort of healthy young adults. Using a cross-over treatment design, witha one-week washout period and, in contrast to a sham procedure, the authentic manipulationproduced significant alterations in both heart rate and measures of heart-rate variabilitycalculated from power spectrum analysis. In particular, there was an increase in the ratio oflow-frequency (LF)-to-high-frequency (HF) components of the power spectrum of heart-ratevariability, which may reflect a shift in balance between sympathetic and parasympatheticoutput to the heart.
PMID: 11515806 DOI: 10.1016/S1566-0702(01)00306-X
[Indexed for MEDLINE]
Format: Abstract
1
Author information
Publication types, MeSH terms
LinkOut - more resources
Full text links
PubMed
Innocuous mechanical stimulation of the neck and alterations in hea... https://www.ncbi.nlm.nih.gov/pubmed/11515806
1 of 1 7/3/18, 3:07 PM
3 KEY POINTS FROM DAN MURPHY 1) The spinal adjustments used in this study were to C1-C2 and involved traditional supine rotary maneuver that achieved audible cavitation of the joint. 2) The adjustments were done by a chiropractor. 3) The ECG showed a significant reduction in heart rate as compared to the sham adjustment group, which supports inhibition of the sympathetic nervous system. 4) The results also support that upper cervical spinal adjustments alter the balance between sympathetic and parasympathetic output to the heart. 5) The leading explanation for the observed sympathetic inhibition of heart rate is that it is subsequent to mechanical afferent input from receptors in cervical tissues. 6) Other studies have also shown that innocuous mechanical stimulation of the neck via spinal manipulation is capable of eliciting changes in heart rate and blood pressure.
Behavioral/Systems/Cognitive
The Neurochemically Diverse Intermedius Nucleus of theMedulla as a Source of Excitatory and Inhibitory SynapticInput to the Nucleus Tractus Solitarii
Ian J. Edwards,1* Mark L. Dallas,1* Sarah L. Poole,1 Carol J. Milligan,1 Yuchio Yanagawa,2 Gabor Szabo,3
Ferenc Erdelyi,3 Susan A. Deuchars,1 and Jim Deuchars1
1Institute of Membrane and Systems Biology, University of Leeds, Leeds LS2 9JT, United Kingdom, 2Department of Genetic and Behavioral Neuroscience,Gunma University Graduate School of Medicine, and Solution Oriented Research for Science and Technology, Japan Science and Technology Agency,Maebashi 371-8511, Japan, and 3Department of Gene Technology and Developmental Neurobiology, Institute of Experimental Medicine, H-1450 Budapest,Hungary
Sensory afferent signals from neck muscles have been postulated to influence central cardiorespiratory control as components ofpostural reflexes, but neuronal pathways for this action have not been identified. The intermedius nucleus of the medulla (InM) is a targetof neck muscle spindle afferents and is ideally located to influence such reflexes but is poorly investigated. To aid identification of thenucleus, we initially produced three-dimensional reconstructions of the InM in both mouse and rat. Neurochemical analysis includingtransgenic reporter mice expressing green fluorescent protein in GABA-synthesizing neurons, immunohistochemistry, and in situ hy-bridization revealed that the InM is neurochemically diverse, containing GABAegric and glutamatergic neurons with some degree ofcolocalization with parvalbumin, neuronal nitric oxide synthase, and calretinin. Projections from the InM to the nucleus tractus solitarius(NTS) were studied electrophysiologically in rat brainstem slices. Electrical stimulation of the NTS resulted in antidromically activatedaction potentials within InM neurons. In addition, electrical stimulation of the InM resulted in EPSPs that were mediated by excitatoryamino acids and IPSPs mediated solely by GABAA receptors or by GABAA and glycine receptors. Chemical stimulation of the InM resultedin (1) a depolarization of NTS neurons that were blocked by NBQX (2,3-dioxo-6-nitro-1,2,3,4-tetrahydrobenzo[f ]quinoxaline-7-sulfonoamide) or kynurenic acid and (2) a hyperpolarization of NTS neurons that were blocked by bicuculline. Thus, the InM containsneurochemically diverse neurons and sends both excitatory and inhibitory projections to the NTS. These data provide a novel pathwaythat may underlie possible reflex changes in autonomic variables after neck muscle spindle afferent activation.
Key words: posture; neck; cardiovascular; respiration; medulla oblongata; autonomic
IntroductionReflex changes in cardiorespiratory variables during body move-ments rely on interactions between the somatic and autonomicnervous systems. A prime example of such interaction is the so-matosympathetic reflex, in which stimulation of thinly myelin-ated group III (A!) and unmyelinated group IV (C-fiber) limbmuscle afferent fibers can reflexly increase cardiorespiratory out-put (Potts et al., 2000, 2003; Wilson, 2000). These reflexes aremediated via sensory afferent input to the spinal cord, which isthen relayed to the nucleus tractus solitarius (NTS), a brainstem
site for cardiorespiratory integration (Potts et al., 2003). Cardiore-spiratory changes can also be evoked by stimulation of neck muscleafferents (Bolton et al., 1998; Bolton and Ray, 2000), proposed tocontribute to alterations in cardiorespiratory outflow in preparationfor a change in posture (Bolton and Ray, 2000). In contrast to limbafferents, the sensory signals from these muscles appear to be medi-ated by group IA muscle spindle afferents (Bolton et al., 1998). How-ever, the neural pathways that link these afferent signals to cardiore-spiratory control are completely unknown.
One target for sensory information from neck muscles is thecervical spinal cord where terminations can be found in the dor-sal horn (although sparse) and the central cervical nucleus (CCN)(Bakker et al., 1984; Pfaller and Arvidsson, 1988; Prihoda et al.,1991). The CCN projection is generally considered to underliespinal somatic reflex circuits, such as those for the tonic neckreflex involved in postural control (Wilson et al., 1984; Brink etal., 1985; Hongo et al., 1988; Popova et al., 1995). There is also astrong direct neck muscle afferent projection to the medulla ob-longata where fibers terminate in the external cuneate nucleusand a nucleus located at the lateral edges of the dorsal aspect ofthe hypoglossal motor nucleus (XII), referred to either as the
Received Feb. 13, 2007; revised May 25, 2007; accepted June 20, 2007.This work was supported in part by the Wellcome Trust (C.J.M. and J.D.) and Grants-in-Aid for Scientific Research
from the Ministry of Education, Culture, Sports, Science and Technology and the Ministry of Health, Labor, andWelfare, Japan (Y.Y.). I.J.E. was supported by the Biotechnology and Biological Sciences Research Council. Weacknowledge the contribution of Gareth Dobson, who was an undergraduate project student, to this work.
*I.J.E. and M.L.D. contributed equally and significantly to this work.Correspondence should be addressed to either Jim Deuchars or Susan A. Deuchars, Institute of Membrane and
Systems Biology, Garstang Building, University of Leeds, Leeds LS2 9JT, UK. E-mail: [email protected] [email protected].
DOI:10.1523/JNEUROSCI.0638-07.2007Copyright © 2007 Society for Neuroscience 0270-6474/07/278324-10$15.00/0
8324 • The Journal of Neuroscience, August 1, 2007 • 27(31):8324 – 8333
The Neurochemically Diverse Intermedius Nucleus of the Medulla as a Source of Excitatory andInhibitory Synaptic Input to the Nucleus Tractus Solitarii
The Journal of NeuroscienceAugust 1, 2007
Dorsal MotorNucleusof theVagus
Parasympathetic
Efferents
Heart
Lungs
Stomach
Intestines
Etc.
NucleusTractus
Solitarius
Integrated
Autonomic
And
Cardiorespiratory
Circuits
Parasympathetic
Afferents
From
Thoracic
And
Abdominal
Viscera
Cerebellum
ExternalCuneateNucleus
NucleusIntermedius
CentralCervicalNucleus
Tonic
Postural
Reflexes
UpperCervical
MechanoreceptorsFrom
ChiropracticUpper
CervicalAdjustments
Review
The intermedius nucleus of the medulla: A potential site for the integration ofcervical information and the generation of autonomic responses
Ian J. Edwards, Susan A. Deuchars, Jim Deuchars *
Institute of Membrane and Systems Biology, Garstang Building, University of Leeds, Leeds, LS2 9JT, United Kingdom
Contents
1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1671.1. Nomenclature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1671.2. Insights into function . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167
2. Neurotransmitters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1682.1. Amino acids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1682.2. NOS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1702.3. Peptide transmitters. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 170
3. Calcium binding proteins . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1713.1. Parvalbumin is predominantly found in inhibitory neurones . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1713.2. Calretinin is found within inhibitory and excitatory neurones in the InM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171
4. Receptors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1714.1. Glutamate receptors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171
Journal of Chemical Neuroanatomy 38 (2009) 166–175
A R T I C L E I N F O
Article history:Received 24 September 2008Received in revised form 6 January 2009Accepted 6 January 2009Available online 14 January 2009
Keywords:AutonomicProprioceptionPerihypoglossalBrainstem
A B S T R A C T
The intermedius nucleus of the medulla (InM) is a small perihypoglossal brainstem nucleus, whichreceives afferent information from the neckmusculature and also descending inputs from the vestibularnuclei, the gustatory portion of the nucleus of the solitary tract (NTS) and cortical areas involved inmovements of the tongue. The InM sendsmonosynaptic projections to both the NTS and the hypoglossalnucleus. It is likely that the InM acts to integrate information from the head and neck and relays thisinformation on to the NTS where suitable autonomic responses can be generated, and also to thehypoglossal nucleus to influence movements of the tongue and upper airways.
Central to the integratory role of the InM is its neurochemical diversity. Neurones within the InMutilise the amino acid transmitters glutamate, GABA and glycine. A proportion of these excitatory andinhibitory neurones also use nitric oxide as a neurotransmitter. Peptidergic transmitters have also beenfound within InM neurones, although as yet the extent of the pattern of co-localisation betweenpeptidergic and amino acid transmitters in neurones has not been established.
The calcium binding proteins calretinin and parvalbumin are found within the InM in partiallyoverlapping populations. Parvalbumin and calretinin appear to have complementary distributionswithin the InM,with parvalbumin being predominantly foundwithin GABAergic neurones and calretininbeing predominantly found within glutamatergic neurones.
Neurones in the InM receive inputs from glutamatergic sensory afferents. This glutamatergictransmission is conducted through both NMDA and AMPA ionotropic glutamate receptors.
In summary the InM contains a mixed pool of neurones including glutamatergic and GABAergic inaddition to peptidergic neurones. Neuroneswithin the InM receive inputs from the upper cervical region,descending inputs from brain regions involved in tongue movements and those involved in the co-ordination of the autonomic nervous system. Outputs from the InM to the NTS and hypoglossal nucleussuggest a possible role in the co-ordination of tonguemovements and autonomic responses to changes inposture.
! 2009 Elsevier B.V. All rights reserved.
* Corresponding author. Tel.: +44 113 343 4249.E-mail address: [email protected] (J. Deuchars).
Contents lists available at ScienceDirect
Journal of Chemical Neuroanatomy
journa l homepage: www.e lsev ier .com/ locate / jchemneu
0891-0618/$ – see front matter ! 2009 Elsevier B.V. All rights reserved.doi:10.1016/j.jchemneu.2009.01.001
ORIGINAL ARTICLE
Neck muscle afferents influence oromotor and cardiorespiratorybrainstem neural circuits
I. J. Edwards • V. K. Lall • J. F. Paton •
Y. Yanagawa • G. Szabo • S. A. Deuchars •
J. Deuchars
Received: 9 August 2013 /Accepted: 11 February 2014! The Author(s) 2014. This article is published with open access at Springerlink.com
Abstract Sensory information arising from the upperneck is important in the reflex control of posture and eye
position. It has also been linked to the autonomic control of
the cardiovascular and respiratory systems. Whiplashassociated disorders (WAD) and cervical dystonia, which
involve disturbance to the neck region, can often present
with abnormalities to the oromotor, respiratory and car-diovascular systems. We investigated the potential neural
pathways underlying such symptoms. Simulating neck
afferent activity by electrical stimulation of the secondcervical nerve in a working heart brainstem preparation
(WHBP) altered the pattern of central respiratory drive and
increased perfusion pressure. Tracing central targets ofthese sensory afferents revealed projections to the inter-
medius nucleus of the medulla (InM). These anterogradely
labelled afferents co-localised with parvalbumin andvesicular glutamate transporter 1 indicating that they are
proprioceptive. Anterograde tracing from the InM identi-
fied projections to brain regions involved in respiratory,cardiovascular, postural and oro-facial behaviours—the
neighbouring hypoglossal nucleus, facial and motor tri-
geminal nuclei, parabrachial nuclei, rostral and caudalventrolateral medulla and nucleus ambiguus. In brain sli-
ces, electrical stimulation of afferent fibre tracts lateral to
the cuneate nucleus monosynaptically excited InM neuro-nes. Direct stimulation of the InM in the WHBP mimicked
the response of second cervical nerve stimulation. These
results provide evidence of pathways linking upper cervicalsensory afferents with CNS areas involved in autonomic
and oromotor control, via the InM. Disruption of these
neuronal pathways could, therefore, explain the dysphagicand cardiorespiratory abnormalities which may accompany
cervical dystonia and WAD.
Keywords Proprioception ! Autonomic !Immunohistochemistry ! Electrophysiology
Introduction
The intermedius nucleus of the medulla (InM) is a neuro-
chemically diverse perihypoglossal nucleus (Edwards et al.
2007, 2009) with no known function. Furthermore, verylittle is known regarding the anatomical connectivity of the
nucleus. We have previously identified a monosynaptic
projection from the InM into the neighbouring nucleus ofthe solitary tract (NTS) using electrophysiology (Edwards
et al. 2007), indicating a possible role in autonomic and/or
respiratory control. Direct primary afferent input to theInM arises from upper cervical levels in a number of
I. J. Edwards (&) ! V. K. Lall ! S. A. Deuchars !J. Deuchars (&)School of Biomedical Sciences, University of Leeds,Leeds LS2 9JT, UKe-mail: [email protected]
J. Deucharse-mail: [email protected]
J. F. PatonSchool of Physiology and Pharmacology, Bristol Heart Institute,University of Bristol, Medical Sciences Building, Bristol,BS8 1TD, UK
Y. YanagawaDepartment of Genetic and Behavioral Neuroscience, GunmaUniversity Graduate School of Medicine JST, CREST,Maebashi 371-8511, Japan
G. SzaboDepartment of Gene Technology and DevelopmentalNeurobiology, Institute of Experimental Medicine,Budapest 1450, Hungary
123
Brain Struct Funct
DOI 10.1007/s00429-014-0734-8
5 [an important
role in cardiorespiratory
control]
Oromotor Control
[a pontine viscerosensory
relay]
Orofacial Control
To Phrenic Nerve for
Inspiratory Activity
[fovea, clarity of vision]
Pontine Parabrachial
Nucleus
CN V
CN VII
C4—C5—C6 Motor
Neurons
Eye Position
Hypoglossal Nucleus
NUCLEUS INTERMEDIUS
C1—C3 MECHANOS
Vestibular Nucleus
Tongue, Swallowing,
Airway Patency
Splanchnic Sympathetic
Nerves
Nucleus Ambiguus
Caudal Ventrolateral
Medulla
Nucleus Tractus
Solitarius
Autonomic Innervation to and From the
Viscera
Posture
Muscles of the Soft Palate,
Pharynx, Larynx
Inhibits Sympathetic
Tone and Blood Pressure
The Integratory
Center
Most of the Sympathetic Nerves in the
Body are Splanchnic
Regulation of Reflex
Cardiovascular Activity and Modulate
Respiratory Functions
Respiratory and
Cardiovascular Behaviors
1
J Hum Hypertens. 2007 May;21(5):347-52. Epub 2007 Mar 2.
Atlas vertebra realignment and achievement of arterial pressuregoal in hypertensive patients: a pilot study.Bakris G , Dickholtz M Sr, Meyer PM, Kravitz G, Avery E, Miller M, Brown J, Woodfield C, Bell B.
Department of Preventive Medicine, Rush University Hypertension Center, Chicago, IL, [email protected]
AbstractAnatomical abnormalities of the cervical spine at the level of the Atlas vertebra are associatedwith relative ischaemia of the brainstem circulation and increased blood pressure (BP).Manual correction of this mal-alignment has been associated with reduced arterial pressure.This pilot study tests the hypothesis that correcting mal-alignment of the Atlas vertebrareduces and maintains a lower BP. Using a double blind, placebo-controlled design at a singlecenter, 50 drug naïve (n=26) or washed out (n=24) patients with Stage 1 hypertension wererandomized to receive a National Upper Cervical Chiropractic (NUCCA) procedure or a shamprocedure. Patients received no antihypertensive meds during the 8-week study duration. Theprimary end point was changed in systolic and diastolic BP comparing baseline and week 8,with a 90% power to detect an 8/5 mm Hg difference at week 8 over the placebo group. Thestudy cohort had a mean age 52.7+/-9.6 years, consisted of 70% males. At week 8, therewere differences in systolic BP (-17+/-9 mm Hg, NUCCA versus -3+/-11 mm Hg, placebo;P<0.0001) and diastolic BP (-10+/-11 mm Hg, NUCCA versus -2+/-7 mm Hg; P=0.002).Lateral displacement of Atlas vertebra (1.0, baseline versus 0.04 degrees week 8, NUCCAversus 0.6, baseline versus 0.5 degrees , placebo; P=0.002). Heart rate was not reduced inthe NUCCA group (-0.3 beats per minute, NUCCA, versus 0.5 beats per minute, placebo). Noadverse effects were recorded. We conclude that restoration of Atlas alignment is associatedwith marked and sustained reductions in BP similar to the use of two-drug combinationtherapy.
Comment inBlood pressure lowering effects of non-surgical procedures for vascular decompression: goodnews to be taken with caution. [J Hum Hypertens. 2007]
PMID: 17252032 DOI: 10.1038/sj.jhh.1002133
Format: Abstract
1
Author information
PubMed bakris g and dickholtz
Full text links
Atlas vertebra realignment and achievement of arterial pressure goa... https://www.ncbi.nlm.nih.gov/pubmed/?term=bakris+g+and+dickholtz
1 of 2 7/2/17, 12:32 PM
BACKGROUND:
OBJECTIVE:
METHODS:
RESULTS:
Altern Ther Health Med. 2011 Nov-Dec;17(6):12-7.
Cerebral metabolic changes in men after chiropractic spinalmanipulation for neck pain.Ogura T , Tashiro M, Masud M, Watanuki S, Shibuya K, Yamaguchi K, Itoh M, Fukuda H, Yanai K.
Division of Cyclotron Nuclear Medicine, Tohoku University, Sendai, Japan.
AbstractChiropractic spinal manipulation (CSM) is an alternative treatment for back
pain. The autonomic nervous system is often involved in spinal dysfunction. Although studieson the effects of CSM have been performed, no chiropractic study has examined regionalcerebral metabolism using positron emission tomography (PET).
The aim of the present study was to investigate the effects of CSM on brainresponses in terms of cerebral glucose metabolic changes measured by[18F]fluorodeoxyglucose positron emission tomography (FDG-PET).
Twelve male volunteers were recruited. Brain PET scanning was performed twiceon each participant, at resting and after CSM. Questionnaires were used for subjectiveevaluations. A visual analogue scale (VAS) was rated by participants before and afterchiropractic treatment, and muscle tone and salivary amylase were measured.
Increased glucose metabolism was observed in the inferior prefrontal cortex,anterior cingulated cortex, and middle temporal gyrus, and decreased glucose metabolismwas found in the cerebellar vermis and visual association cortex, in the treatment condition (P< .001). Comparisons of questionnaires indicated a lower stress level and better quality of lifein the treatment condition. A significantly lower VAS was noted after CSM. Cervical muscletone and salivary amylase were decreased after CSM. Conclusion The results of this studysuggest that CSM affects regional cerebral glucose metabolism related to sympatheticrelaxation and pain reduction.
PMID: 22314714
[PubMed - indexed for MEDLINE]
Format: Abstract
1
Author information1
PubMed
Cerebral metabolic changes in men after chiropractic spinal manipu... https://www.ncbi.nlm.nih.gov/pubmed/22314714
1 of 2 2/28/17, 11:33 AM
Evid Based Complement Alternat Med. 2017;2017:4345703. doi: 10.1155/2017/4345703. Epub 2017 Jan 12.
Glucose Metabolic Changes in the Brain and Muscles of Patients withNonspecific Neck Pain Treated by Spinal Manipulation Therapy: A[18F]FDG PET Study.Inami A , Ogura T , Watanuki S , Masud MM , Shibuya K , Miyake M , Matsuda R , Hiraoka K , ItohM , Fuhr AW , Yanai K , Tashiro M .
AbstractObjective. The aim of this study was to investigate changes in brain and muscle glucosemetabolism that are not yet known, using positron emission tomography with[ F]fluorodeoxyglucose ([ F]FDG PET). Methods. Twenty-one male volunteers wererecruited for the present study. [ F]FDG PET scanning was performed twice on each subject:once after the spinal manipulation therapy (SMT) intervention (treatment condition) and onceafter resting (control condition). We performed the SMT intervention using an adjustmentdevice. Glucose metabolism of the brain and skeletal muscles was measured and comparedbetween the two conditions. In addition, we measured salivary amylase level as an index ofautonomic nervous system (ANS) activity, as well as muscle tension and subjective painintensity in each subject. Results. Changes in brain activity after SMT included activation ofthe dorsal anterior cingulate cortex, cerebellar vermis, and somatosensory association cortexand deactivation of the prefrontal cortex and temporal sites. Glucose uptake in skeletalmuscles showed a trend toward decreased metabolism after SMT, although the differencewas not significant. Other measurements indicated relaxation of cervical muscle tension,decrease in salivary amylase level (suppression of sympathetic nerve activity), and pain reliefafter SMT. Conclusion. Brain processing after SMT may lead to physiological relaxation via adecrease in sympathetic nerve activity.
PMID: 28167971 PMCID: PMC5267084 DOI: 10.1155/2017/4345703
[PubMed - in process] Free PMC Article
Format: Abstract
1 2 1 3 4 1 1 14 5 6 1
Author information
18 18
18
Images from this publication. See all images (7) Free text
PubMed
Full text links
Glucose Metabolic Changes in the Brain and Muscles of Patients w... https://www.ncbi.nlm.nih.gov/pubmed/28167971
1 of 2 2/28/17, 11:39 AM
1
2
3
Med Hypotheses. 2015 Dec;85(6):819-24. doi: 10.1016/j.mehy.2015.10.003. Epub 2015 Oct 14.
Measureable changes in the neuro-endocrinal mechanismfollowing spinal manipulation.Kovanur Sampath K , Mani R , Cotter JD , Tumilty S .
Centre for Health, Activity, and Rehabilitation Research, School of Physiotherapy, Universityof Otago, New Zealand. Electronic address: [email protected] for Health, Activity, and Rehabilitation Research, School of Physiotherapy, Universityof Otago, New Zealand.School of Physical Education, Sport and Exercise Sciences, University of Otago, NewZealand.
AbstractThe autonomic nervous system and the hypothalamic-pituitary-adrenal axis have been shownto be dysfunctional in a number of chronic pain disorders. Spinal manipulation is a therapeutictechnique used by manual therapists, which may have widespread neuro-physiologicaleffects. The autonomic nervous system has been implicated to modulate these effects. Atheory is proposed that spinal manipulation has the potential to be used as a tool in restoringthe autonomic nervous system balance. Further, it is also hypothesised that through itsanatomical and physiological connections, the autonomic nervous system activity following athoracic spinal manipulation may have an effect on the hypothalamic-pituitary-adrenal axisand therefore pain and healing via modulation of endocrine and physiological processes. Tosubstantiate our hypothesis we provide evidence from manual therapy studies, basic scienceand animal studies. According to the proposed theory, there will be measurable changes inthe neuro-endocrinal mechanisms following a thoracic spinal manipulation. This has far-reaching implications for manual therapy practice and research and in the integration of spinalmanipulation in the treatment of a wide array of disorders.
Copyright © 2015 Elsevier Ltd. All rights reserved.
PMID: 26464145 DOI: 10.1016/j.mehy.2015.10.003
[Indexed for MEDLINE]
Format: Abstract
1 2 3 2
Author information
PubMed
Full text links
Measureable changes in the neuro-endocrinal mechanism followin... https://www.ncbi.nlm.nih.gov/pubmed/26464145
1 of 2 7/2/17, 12:37 PM
Neuro-Immunology Summary The mechanoreceptors of the spine communicate with the sympathetic nervous system (Jiang, SPINE, 1997). The sympathetic nervous system controls the innate immune response (Elenkov, Pharmacological Reviews, 2000; Nance, Brain, Behavior, and Immunity, 2007). The innate immune response controls the adaptive immune response (Sompayrac, HOW THE IMMUNE SYSTEM WORKS, 2008), i.e. “The Innate System Rules.” The primary cell of the innate immune response is the MACROPHAGE (Sompayrac, HOW THE IMMUNE SYSTEM WORKS, 2008). The best picture to date of the sympathetic nervous system communicating with the MACROPHAGE: (Mathias, AUTONOMIC FAILURE, 2013). The primary player of the innate immune response, the MACROPHAGE, activates the systemic immune response by using the sensory branches of the vagus nerve; these vagus afferents ascend to the nucleus tractus solitarius of the medulla (Tracey, Nature Reviews Immunology, 2009). The nucleus tractus solitarius is disynaptically post-synaptic from the mechanical afferents of the upper cervical spine: (Edwards: Journal of Neuroscience, 2007; Journal of Chemical Neuroanatomy, 2009; Brain Structure & Function, 2015). The sympathetic nervous system and the parasympathetic nervous system (nucleus tractus solitarius) interface in the brain stem for a comprehensive immunological response: (Tracey, Nature Reviews Immunology, 2009). This further supports the anecdotes and science of chiropractic neuro-immunity.
Musculoskeletal
Whole Spine Quote
“We tend to divide the examination of the spine intoregions: cervical, thoracic, and lumbar spine clinical
studies.
This is a mistake.
The three units are closely interrelated structurallyand functionally – a whole person with a whole spine.
The cervical spine may be symptomatic because of athoracic or lumbar spine abnormality, and vice versa!
Sometimes treating a lumbar spine will relieve acervical spine syndrome, or proper management of
cervical spine will relieve low backache.”
Disorders of the Cervical Spine
John Bland, MD
Professor of Medicine, University of Vermont Collegeof Medicine
WB Saunders Company
Page 84
Whole Spine Quote
“Physicians tend to divide the examination of the spine into regions: cervical, thoracic, and lumbar. This is a mistake. The three units are closely interrelated structurally and functionally – a whole person with a whole spine. The cervical spine may be symptomatic because of a thoracic or lumbar spine abnormality, and vice versa. Sometimes, treating a lumbar spine will relieve a cervical spine syndrome, or proper management of cervical spine will relieve low back pain.”
Disorders of the Cervical Spine
John Bland, MD
Professor of Medicine, University of Vermont College
of Medicine
WB Saunders Company 1994
Page 119
1 Low Back Pain and Pain Resulting From Lumbar Spine Conditions:
A Comparison of Treatment Results
The Australian Journal of Physiotherapy September 1969, Vol. 15; No. 3; pp. 104-110
Brian C Edwards This is the first study to compare the results of effectiveness for low back and leg pain treated with mobilization/manipulation compared to those treated with heat, massage and exercise. The study used 184 subjects, half were treated with heat/massage/exercise and half were treated with mobilization/manipulation. KEY POINTS FROM THIS ARTICLE: 1) In this study, “good” and “satisfactory” results meant that the patient can discontinue treatment and return to work. 2) Outcomes:
Group Treatment Acceptable Outcome
Central Low Back Pain Only (n=46)
heat/massage/exercise (n=23)
83%
spinal manipulation (n=23)
83%
Pain Radiation to Buttock (n=46)
heat/massage/exercise (n=23)
70%
spinal manipulation (n=23)
78%
Pain Radiation Down Thigh to Knee (n=46)
heat/massage/exercise (n=23)
65%
spinal manipulation (n=23)
96%
Pain Radiation Down Leg to Foot (n=46)
heat/massage/exercise (n=23)
52%
spinal manipulation (n=23)
79%
2 3) “The difference in the number of patients with ‘acceptable’ results by each method of treatment, in the third [Pain Radiation Down Thigh to Knee] and fourth [Pain Radiation Down Leg to Foot] groups are statistically significant.” [Important] 4) The results “indicate that treatment of low back pain and pain resulting from low back conditions by passive movement techniques of mobilization and manipulation is a more satisfactory method than by standard physiotherapy of heat massage and exercise, as regards both results and number of treatments required.” 5) “The survey also indicated that by using techniques of mobilization good results can be obtained with patients even if neurological signs are present.” [Important]
••••••••••
This study by Edwards was reviewed in the 1990 reference text, White and Panjabi’s Clinical Biomechanics of the Spine. The authors are:
Augustus A. White, MD, DMed Sci Professor of Orthopedic Surgery at Harvard Medical School
Orthopedic Surgeon-in-Chief at Beth Israel Hospital in Boston
Manohar M. Panjabi, PhD Professor of Orthopedics and Rehabilitation and Mechanical Engineering
Director of Biomechanics Research Yale University School of Medicine
Drs. White and Panjabi make the following points pertaining to the Edwards article:
“A well-designed, well executed, and well-analyzed study.”
In the group with central low back pain only, “the results were acceptable in 83% for both treatments. However, they were achieved with spinal manipulation using about one-half the number of treatments that were needed for heat, massage, and exercise.”
In the group with pain radiating into the buttock, “the results were slightly better with manipulation, and again they were achieved with about half as many treatments.”
In the groups with pain radiation to the knee and/or to the foot, “the manipulation therapy was statistically significantly better,” and in the group with pain radiating to the foot, “the manipulative therapy is significantly better.”
3 “This study certainly supports the efficacy of spinal manipulative therapy in comparison with heat, massage, and exercise. The results (80 – 95% satisfactory) are impressive in comparison with any form of therapy.”
It is usual for pain that travels further down an extremity to be associated with greater compression, or a larger disc protrusion. In this study by Edwards, manipulation worked excellently in patients with leg pain radiation, especially when compared to heat/massage/exercise. An explanation for this finding is that in such cases manipulation is superior because of its ability to move the protrusion away from the nervous system and closer to the midline.
Treatment of Intervertebral Disc Herniation WithManipulation
“Manipulation. Some orthopaedic surgeons practicemanipulation in an effort at repositioning the disc. This
treatment is regarded as controversial and a form of quackery bymany men. However, the author has attempted the maneuver inpatients who did not respond to bed rest and were regarded ascandidates for surgery. Occasionally, the results was dramatic.
Technique. The patient lies on his side on the edge of the tablefacing the surgeon, and the uppermost leg is allowed to drop
forward over the edge of the table, carrying forward that side ofthe pelvis. The uppermost arm is placed backward behind the
patient, pulling the shoulder back. The surgeon places one handon the shoulder and the other on the iliac crest and twists the
torso by pushing the shoulder backward and the iliac crestforward. The maneuver is sudden and forceful and frequently isassociated with an audible and palpable crunching sound in the
lower back. When this is felt, the relief of pain is usuallyimmediate. The maneuver is repeated with the patient on the
opposite side.”
“The patient should be cautioned beforehand that themanipulation may make his symptoms worse and that this is an
attempt to avoid surgery.”
Orthopaedics, Principles and Their Applications
Samuel Turek, MDClinical Professor, Department of Orthopedics and Rehabilitation
University of Miami School of Medicine
JB Lippincott Company1977
Page 1335
10/31/13 5:55 PMSpinal manipulation in the treatment of lo... [Can Fam Physician. 1985] - PubMed - NCBI
Page 1 of 1http://www.ncbi.nlm.nih.gov/pubmed/21274223
Can Fam Physician. 1985 Mar;31:535-40.
Spinal manipulation in the treatment of low-back pain.Kirkaldy-Willis WH, Cassidy JD.
AbstractSpinal manipulation, one of the oldest forms of therapy for back pain, has mostly been practicedoutside of the medical profession. Over the past decade, there has been an escalation of clinical andbasic science research on manipulative therapy, which has shown that there is a scientific basis forthe treatment of back pain by manipulation. Most family practitioners have neither the time norinclination to master the art of manipulation and will wish to refer their patients to a skilled practitionerof this therapy. Results of spinal manipulation in 283 patients with low back pain are presented. Thephysician who makes use of this resource will provide relief for many patients.
PMID: 21274223 [PubMed] PMCID: PMC2327983 Free PMC Article
Display Settings: Abstract
LinkOut - more resources
PubMed
1Low back pain of mechanical origin:
Randomized comparison of chiropractic and hospital outpatient treatment
British Medical JournalVolume 300, JUNE 2, 1990, pp. 1431-7
T W Meade, Sandra Dyer, Wendy Browne, Joy Townsend, A 0 Frank
FROM ABSTRACT:
ObjectiveTo compare chiropractic and hospital outpatient treatment for managing low backpain of mechanical origin.
DesignRandomized controlled trial.Patients were followed up for up to two years.
SettingChiropractic and hospital outpatient clinics in 11 centers.
Patients741 Patients aged 18-65 who had no contraindications to manipulation and who hadnot been treated within the past month.
InterventionsTreatment at the discretion of the chiropractors, who used chiropractic manipulationin most patients, or of the hospital staff, who most commonly used Maitlandmobilization or manipulation, or both.
Main outcome measuresChanges in the score on the Oswestry pain disability questionnaire and in theresults of tests of straight leg raising and lumbar flexion.
ResultsChiropractic treatment was more effective than hospital outpatient management,mainly for patients with chronic or severe back pain.
A benefit of about 7 percentage points on the Oswestry scale was seen at twoyears.
The benefit of chiropractic treatment became more evident throughout the follow upperiod.
Secondary outcome measures also showed that chiropractic was more beneficial.
5 “Among those with a previous history of back pain, the improvement in
Oswestry score at three years was 9.7% points greater in patients treated bychiropractic than those treated in hospital.”
Chiropractors and Low Back PainThe Lancet
July 28, 1990, p. 220
The editors of THE LANCET review the June 2nd 1990 British Medical Journal articleby Meade [immediately above], Low back pain of mechanical origin:randomized comparison of chiropractic and hospital outpatient treatment.
The study used 741 patients. The editors of THE LANCET note:
The article “showed a strong and clear advantage for patients withchiropractic.”
The advantage for chiropractic over conventional hospital treatment was “nota trivial amount” and “reflects the difference between having mild pain, the abilityto lift heavy weights without extra pain, and the ability to sit for more than onehour, compared with moderate pain, the ability to lift heavy weights only if they areconveniently positioned, and being unable to sit for more than 30 minutes.”
“This highly significant difference occurred not only at 6 weeks, but also for 1,2, and even (in 113 patients followed so far) 3 years after treatment.”
“Surprisingly, the difference was seen most strongly in patients with chronicsymptoms.”
“The trial was not simply a trial of manipulation but of management” as 84%of the hospital-managed patients had [physiotherapy] manipulations.
“Chiropractic treatment should be taken seriously by conventional medicine,which means both doctors and physiotherapists.”
“Physiotherapists need to shake off years of prejudice and take on board theskills that the chiropractors have developed so successfully.”
KEY POINTS FROM DAN MURPHY
1) “The high incidence of back pain, its chronic and recurrent nature in manypatients, and its contribution as a main cause of absence from work are wellknown.”
2) “For patients with low back pain in whom manipulation is not contraindicatedchiropractic almost certainly confers worthwhile, long term benefit in comparisonwith hospital outpatient management.”
6
3) The benefit of chiropractic is seen mainly in those with chronic or severe backpain.
4) In this study, the authors x-rayed all patients with back pain to rule out majorstructural abnormalities.
5) “Virtually all the patients treated by chiropractors received chiropracticmanipulation with high velocity, low amplitude manipulation at some stage.”
6) “Patients treated by chiropractors received about 44% more treatments thanthose treated in hospital.”
7) In this study on back pain, some chiropractic patients were treated as long as30 weeks.
8) Oswestry scores between the two treatment groups “shows that the changefor those treated by chiropractic was consistently greater than that for thosetreated in the hospital.”
9) Fewer patients treated in the hospital were satisfied with their treatment orrelieved with their symptoms than by those treated chiropractically.
10) If all back pain patients without manipulation contraindications were referredfor chiropractic instead of hospital treatment, there would be significant annualtreatment cost reductions, a significant reduction in sickness days during two years,and a significant savings in social security payments. [Important]
11) “There is, therefore, economic support for use of chiropractic in low backpain, though the obvious clinical improvement in pain and disability attributable tochiropractic treatment is in itself an adequate reason for considering the use ofchiropractic.”
12) “The results leave little doubt that chiropractic is more effective thanconventional hospital outpatient treatment.”
13) “The confidence intervals for the differences in Oswestry scores were wide,but the degree of improvement recorded for many of the secondary outcomemeasures suggests that chiropractic has appreciable benefit.”
14) “The effects of chiropractic seem to be long term, as there was no consistentevidence of a return to pretreatment Oswestry scores during the two years of followup, whereas those treated in hospital may have begun to deteriorate after sixmonths or a year.” [Important]
715) “Chiropractic was particularly effective in those with fairly intractable pain-that is, those with a history of severe pain. Although we have discussed the resultsin terms of differences at the various follow up intervals, the full effects oftreatment are better thought of as an integrated benefit throughout the two yearfollow up period.” [Important]
16) “It is unlikely that the benefits of chiropractic are the result of biased outcomeassessments or of a placebo effect.”
17) “Patients treated by chiropractors were not only no worse off than thosetreated in hospital but almost certainly fared considerably better and that theymaintained their improvement for at least two years.” [Key Point]
18) This article “showed a strong and clear advantage for patients withchiropractic.” The advantage for chiropractic over conventional hospital treatmentwas “not a trivial amount.”
19) “This highly significant difference [of chiropractic over hospital managementof back pain] occurred not only at 6 weeks, but also for 1, 2, and even 3 years aftertreatment.”
20) “Chiropractic treatment should be taken seriously by conventional medicine,which means both doctors and physiotherapists.”
21) “Physiotherapists need to shake off years of prejudice and take on board theskills that the chiropractors have developed so successfully.”
1Kinematic Imbalances Due To Suboccipital Strain In Newborns
Journal of Manual MedicineJune (No. 6) 1992, pp151-156
H. BiedermannThis author is from the Surgical Department of the University of Witten-Herdecke,Germany.
FROM ABSTRACT:
The pathogenic potential of the craniovertebral junction in newborn and young childrenis discussed.
The symptom complex of “kinematic imbalances due to suboccipital strain” (KISSsyndrome) has a wide range of clinical signs and can in many cases be dealt witheffectively with manual therapy.
The main symptoms are torticollis, unilateral face asymmetry, C-scoliosis and motorasymmetries, often accompanied by unilateral retarded maturation of the hip joints andslowed motor development.
Risk factors appear to be intrauterine misalignment, application of extraction aids,prolonged labor and multiple fetuses.
THIS AUTHOR ALSO NOTES:
This paper is based upon the evaluation of more than 600 children, all less than 2years of age.
“The pathogenic importance of asymmetric posture and motion in small children isoften played down if recognized at all.”
This bent posture of babies does not correct when the patients cantilever thebabies during sleep.
Prior studies show that postural correction therapies developed for children withmild cerebral damage “greatly improved the changes of rehabilitation in these littlepatients.”
“In many cases the duration of the treatment can be shortened by combiningand/or replacing it with manual therapy of the suboccipital segments of the uppercervical spine.” [Extremely Important]
Most of the babies in this study had asymmetric posture, and the following:
1) Tilt posture of the head / torticollis.
22) The head is held in extension to the point where the baby was unable to lie onthe back.
3) “Uniform sleeping posture, the child cries if the mother tries to change itsposition.”
4) Asymmetries of movement patterns.
5) Asymmetric posture of trunk or extremities.
6) “Sleeping disorders, the baby wakes up crying every hour.”
7) “Extreme sensitivity of the neck.” [Roy Sweat scanning test]
8) Asymmetry or swelling of the face / head.
9) Asymmetries of the gluteal muscles.
10) “Asymmetric development and range of movement of the hips.” “Retardeddevelopment of the hip joints.”
11) Fever of unknown origin.
12) Loss of appetite.
13) Feet deformities.
14) Pathological reflexes.
15) Mobility of the cervical or other spinal regions spine reduced by more than 30%.
16) The parent reporting that the baby does not eat or drink well.
The suboccipital joints are most likely to be involved when the baby has acombination of asymmetry of motion, facial asymmetry, and sleeping disorders.
The history of the affected babies reveals a high incidence of birth stress/trauma,including multiple fetuses, prolonged labor, and use of extraction aids.
On these babies, “an A-P radiograph of the upper cervical spine is imperative.”
“The radiological evaluation helps to find malformations and aids in determiningthe direction of the manipulation.” [WOW!]
“There is no correlation between the extent of the asymmetry and the symptomsor success of the treatment.”
The treatment of these babies involves “basically an impulse manipulation.”
3“In most cases the direction of the manipulation is determined by radiological
findings (85%).”
“The manipulation itself consists of a short thrust of the proximal phalanx of themedial edge of the second finger.” [Important]
“Selection of the direction of the treatment without x-ray seems the most plausiblecause of the less encouraging results of some colleagues.” [WOW!]
“The [manipulation] technique itself needs subtlety and long years of experience inthe manual treatment of the upper cervical spine.” [WOW!]
“In the hands of the experienced the risk is minimal; we have not yet encounteredany serious complications. Most children cry for a moment, but stop as soon as they arein their mother’s arms. In two cases (of ± 600) these children vomited after treatment;this had no negative effect on the outcome in either case.”
A typical radiographic analysis is included in the article. The authors determinethe direction of the manipulation with an “exact evaluation of the lateral displacement ofatlas and/or axis against the occiput.”[Amazing!]
“In most children, the upper cervical spine remains a weak spot, which is why were-examine them routinely before they start school at the age of 6.”
“Suboccipital strain is not confined to local complaints or even mechanicalsymptoms and is not taken into account when these children show signs of restlessnessand concentration difficulties, etc.” [WOW!]
The author presents 3 case histories successfully treated by specific upper cervicalmanipulation, including:
1) 4 month old with difficulty controlling head position, using her left arm, uniformsleeping position, and asymmetry of face and skull.
2) 5 month old with C-scoliosis, reduced use of left arm, poor muscle tone on left sideof body, poor head control, and asymmetry of face and skull.
3) 6 month old, unable to turn head to left (since birth), pronounced facialasymmetry, cried when picked up, severely retarded movement development, recurrentfever of unknown origin. These problems were resolved within one hour of themanipulation.
This author cites references that “stress the importance of intracerebral damage asthe underlying cause of abnormal posture and asymmetric development.”
“The immense pathogenic potential of the proprioceptive afferents of thesuboccipital region has until now been widely underestimated.”
4[Not True: This has been a primary explanation of the upper-cervicalsubluxation in chiropractic for a century.]
Others have also drawn attention to the pathogenic significance of the cervical-occipital junction. This author uses the term KISS syndrome (kinematic imbalances dueto suboccipital strain) to describe these problems. This syndrome creates a large rangeof clinical problems.
Suboccipital strain does not always lead to clinical symptoms.[Silent Subluxations]
6% of British schoolchildren have significant disorders of their visuomotor system.“How many of these could profit from manual therapy of the suboccipital joints?”[WOW!]
This author notes that babies with a contracted sternocleidomastoid muscle shouldnot be subjected to operative measures to lengthen the muscle because they will nearlyalways respond perfectly to “Manipulation of the upper cervical spine.” [WOW!]
“Head stabilization is a complex process involving the interaction of reflexeselicited by vestibular, visual and proprioceptive signals. Most of the afferentproprioceptive signals originate from the craniocervical junction. [WOW!] Any obstacleimpeding these afferents will have much more extensive consequences for a nervoussystem in formation, which depends on appropriate stimuli to organize itself.[Incredible] Most of the cerebral development [occurs after birth]; this developmentbegins at the head.” [AMAZING!]
Upper cervical “delicate structures undergo considerable stress during delivery.”“The birth canal is one of the most dangerous obstacles we ever have to traverse.”
During delivery, “A majority of newborns suffer from microtrauma of brain stemtissues in the periventricular areas.” Forgotten trauma of early childhood has asignificant impact on “perceptuomotor development.” [WOW!]
“Traumatization of the suboccipital structures inhibits functioning of theproprioceptive feedback loops.” Consequently, the motor development cannot developnormally. “The price for this is a reduced capacity to absorb additional stress later on.These children may show only minor symptoms in the first months of their life” likefixation of the head in one position. “Later on, at the age of 5 or 6, they suffer fromheadaches, postural problems or diffuse symptoms like sleep disorders, being unable toconcentrate, etc.”
This author notes that treating pediatric C-scoliosis and movement asymmetries,that manipulation of the suboccipital region is superior to physical therapy because“suboccipital strain is the leading factor.”
Manipulation of the occipital-cervical region leads to disappearance of problemsthat the parents had not reported because they did not see a connection with the spine.
1Chiropractic treatment of chronic ‘whiplash’ injuries
InjuryVolume 27, Issue 9, November 1996, Pages 643-645
M. N. Woodward, J. C. H. Cook, M. F. Gargan and G. C. BannisterUniversity Department of Orthopaedic Surgery, Bristol, UK
FROM ABSTRACT
Forty-three percent of patients will suffer long-term symptoms following ‘whiplash’injury, for which no conventional treatment has proven to be effective.
A retrospective study was undertaken to determine the effects of chiropractic in agroup of 28 patients who had been referred with chronic ‘whiplash’ syndrome.
The severity of patients' symptoms was assessed before and after treatment usingthe Gargan and Bannister (1990) classification.
Twenty-six (93%) patients improved following chiropractic treatment.
The encouraging results from this retrospective study merit the instigation of aprospective randomized controlled trial to compare conventional with chiropractictreatment in chronic ‘whiplash’ injury.
The Gargan and Bannister Whiplash ClassificationGROUP SYMPTOMS
A NoneB NuisanceC IntrusiveD Disabling
THESE AUTHORS ALSO NOTE:
43% of those injured in whiplash will experience long-term symptoms.
“If [whiplash] patients are still symptomatic after 3 months then there isalmost a 90% chance that they will remain so.”
“No conventional treatment has proven to be effective in these establishedchronic cases.”
The 28 chronic whiplash patients in this study were treated by chiropractor J.Cook, using “specific spinal manipulation, proprioceptive neuromuscular facilitation,and cryotherapy.” The treatment was evaluated by an independent orthopedicsurgeon, M. Woodward, who was blinded as to the treatment.
2“Spinal manipulation is a high-velocity low-amplitude thrust to a specific
vertebral segment aimed at increasing the range of movement in the individualfacet joint, breaking down adhesions and stimulating production of synovial fluid.”
The 28 patients in this study had initially been treated with anti-inflammatories, soft collars and physiotherapy. These patients had all becomechronic, and were referred for chiropractic at an average of 15.5 months (rangewas 3 – 44 months) after their initial injury. 27/28 (96%) patients were classifiedas category C or D symptoms at the time of initial chiropractic treatment.
Following chiropractic 93% of the patients had improved: 16/28 (57%) byone symptom group and 10/28 (36%) by two symptom groups.
DISCUSSION
“The whiplash syndrome is a cause of long-term symptoms for whichconventional medicine has failed to discover an effective treatment.”
Chiropractic has been shown to be advantageous compared to conventionalmedicine in the treatment of low back pain.
“The results of this retrospective study would suggest that benefits can occurin over 90% of patients undergoing chiropractic treatment for chronic whiplashinjury.” [Very Important]
Complications from cervical manipulations are rare, and when they arereported in the literature, they often “arose as a result of spinal manipulationperformed by non-chiropractors, who had been misrepresented in the literature asbeing trained chiropractors.” [Important]
KEY POINTS FROM DAN MURPHY
1) 43% of those injured in whiplash will experience long-term symptoms. In thisstudy, at least one patient had ongoing symptoms 3 years 8 months followingwhiplash injury.
2) “If [whiplash] patients are still symptomatic after 3 months then there isalmost a 90% chance that they will remain so.”
3) “No conventional treatment has proven to be effective in these establishedchronic cases.”
4) “Spinal manipulation is a high-velocity low-amplitude thrust to a specificvertebral segment aimed at increasing the range of movement in the individualfacet joint, breaking down adhesions and stimulating production of synovial fluid.”
1A symptomatic classification of whiplash injury and the implications for
treatment
The Journal of Orthopaedic MedicineVolume 21(l), 1999, pp. 22-25
S Khan, J Cook, M Gargan G BannisterUniversity Department of Orthopaedic Surgery, Bristol, UK
FROM INCLUDED ABSTRACT
Objective:To determine which patients with chronic whiplash will benefit from chiropractictreatment.
Design:Retrospective review by structured telephone interviews of 93 consecutive patientsseen in chiropractic clinic.
Setting:Independent chiropractic clinic in a large city.
Subjects:93 patients, 68 female.
Main outcome measure:Gargan and Bannister grading pre and post treatment.
Results:Three groups of patients were recognized.
Group 1 consisted of patients with isolated neck pain associated with a restrictedrange of neck movement.
Group 2 consisted of patients with neurological symptoms or signs associated with arestricted range of movement.
Group 3 comprised patients who described severe neck pain but all of whom had afull range of neck movement. Patients in this group often described an unusualgroup of symptoms, with a bizarre, non- dermatomal pain distribution.
Conclusion:Whiplash injuries are common.
Chiropractic is the only proven effective treatment in chronic [whiplash] cases.
5“Several recent papers have provided much evidence to support the
conclusion that chronic pain from a whiplash injury is organic, and that this organicpain causes the psychological distress often associated with chronic symptoms,rather than being a result of it.”
“The results from this study provide further evidence that chiropractic is aneffective treatment for chronic whiplash symptoms.”
KEY POINTS FROM DAN MURPHY
1) “Chiropractic is the only proven effective treatment in chronic [whiplash]cases.”
2) The accumulated literature suggests 57% of injured patients will make a fullrecovery. [Implying that 43% do not make a full recovery].
3) The resolution of whiplash symptoms can take two years after injury.
4) Eight (8%) of whiplash patients will remain disabled by their symptoms 2years after injury.
5) “Conventional treatment of patients with whiplash symptoms isdisappointing.”
6) “In chronic [whiplash] cases, no conventional treatment has provedsuccessful.”
7) A retrospective study from the journal Injury in 1996 demonstrated thatchiropractic treatment benefited 26 of 28 patients (93%) suffering from chronicwhiplash syndrome.
8) The chiropractic treatment in this study was a mean of 19.3 treatments(range 1 - 53), over a period of 4.1 months.
9) 72% of whiplash patients with neck pain radiating in a ‘coat-hanger’distribution, associated with a restricted range of neck movement but with noneurological deficit, gained benefit from chiropractic spinal manipulation
10) 94% of whiplash patients with neurological signs and / or symptoms inassociation with neck pain and a restricted range of neck movement, includingtingling, numbness, pins and needles in a dermatomal distribution in the arm orhand as well as both hypo and hyperaesthesia, responded positively to chiropracticmanipulation.
1Heart rate changes in response to mild mechanical irritation of the high
cervical spinal cord region in infants
Forensic Science InternationalVolume 128, Issue 3, August 28, 2002, Pages 168-176
L. E. Koch, H. Koch, S. Graumann-Brunt, D. Stolle, J. M. Ramirez and K. S. Saternus
“In first world countries, sudden infant death (SID) is the most common cause of deathduring the first 12 months of postnatal life.”
In this study, infants between 1 and 12 months of age were given upper neckchiropractic adjustments if they were thought to be at risk of sudden infant syndrome,by noting “asymmetries in the horizontal and sagittal plane of body posture andmotion.” [Postural and segmental chiropractic subluxation complexes]
Asymmetry in the atlanto-occipital-C2 region was determined by x-rays.
“For the chiropractic therapy the infants were positioned on their back while thechiropractor was sitting perpendicular to the child's head. Great care was taken thatthe infant was comfortable before the impulse [adjustment] was administered. Theimpulse [adjustment] was applied to the side of the asymmetry.”
“How safe is chiropractic treatment for young infants?”
“The chiropractic therapy has proven to be a successful technique which can be used totreat disorders, especially cerebral disturbances of motor patterns of various etiology(wryneck, c-scoliosis, irritation of the plexus brachialis), sensomotoric disturbances ofintegration ability (retardation of sensation and coordination), as well as pain relatedentities such as cry-babies with ‘3-month colic’ or hyperactivity with sleeplessness.”
“In older children disturbances of this kind are known as retardation of development inmotor patterns as well as in sensory abilities.”
The epidemiological prevalence of such disturbances is as high as17.8% of children.
“Chiropractic treatment seems to be the most successful therapy which helps to treatsuch disorders.”
“Therefore, chiropractic treatment and manual therapy have become increasinglypopular over the past decade.”
“We can report more that 20,000 children treated without serious complications.”
“Thus, our findings are consistent with the possibility that a minor mechanical irritationof the cervical region may trigger the first step in the events that lead to SID.”
“Children with a disturbed symmetry of the atlanto-occipital region could be of higherrisk for SID.”
1Chronic Spinal Pain: A Randomized Clinical Trial Comparing
Medication, Acupuncture, and Spinal Manipulation
Spine July 15, 2003; 28(14):1490-1502
Lynton G. F. Giles, DC, PhD; Reinhold Muller, PhD
FROM THE ABSTRACT:
Study Design.A randomized controlled clinical trial was conducted.
Objective.To compare medication, needle acupuncture, and spinal manipulation for managingchronic (>13 weeks duration) spinal pain because the value of medicinal andpopular forms of alternative care for chronic spinal pain syndromes is uncertain.
Summary of Background Data.Between February 1999 and October 2001, 115 patients without contraindicationfor the three treatment regimens were enrolled at the public hospital'smultidisciplinary spinal pain unit.
Methods.One of three separate intervention protocols was used: medication, needleacupuncture, or chiropractic spinal manipulation.[THE MANIPULATION WAS DONE BY CHIROPRACTORS]
Patients were assessed before treatment by a sports medical physician for exclusioncriteria and by a research assistant using the Oswestry Back Pain Disability Index(Oswestry), the Neck Disability Index (NDI), the Short-Form-36 Health Surveyquestionnaire (SF-36), visual analog scales (VAS) of pain intensity and ranges ofmovement.
These instruments were administered again at 2, 5, and 9 weeks after thebeginning of treatment.
Results.The highest proportion of early (asymptomatic status) recovery was found formanipulation (27.3%), followed by acupuncture (9.4%) and medication (5%).[WOW!]
Manipulation achieved the best overall results, with improvements of 50% on theOswestry scale, 38% on the NDI, 47% on the SF-36, and 50% on the VAS for backpain, 38% for lumbar standing flexion, 20% for lumbar sitting flexion, 25% forcervical sitting flexion, and 18% for cervical sitting extension.
5KEY POINTS FROM DAN MURPHY
1) It is impossible to reach specific diagnosis for the pathologic cause for 85% ofthose with an episode of spinal pain.
2) Patients with low back pain do exhibit abnormal spinal motion.
3) There is insufficient evidence for the use of NSAIDs to manage chronic lowback pain.
4) The new COX-2 nonsteroidal antiinflammatory (NSAIDs) have problems andsignificant contraindications.
5) Gastrointestinal toxicity induced by NSAIDs is one of the most commonserious adverse drug events in the industrialized world.
6) In this study, in the medication group, more patients experienced adverseevents (6.1%) than recovered from their spinal complaints (5%).
7) Even though the chiropractic treatment group was the most chronic (8.3years), 27.3% recovered with 18 spinal adjustments over a period of 9 weeks, orless. [VERY IMPRESSIVE]This means that better than every fourth patient became asymptomatic with 9weeks or less of chiropractic manipulation, even though they had been chronic formore than 8 years. [WOW!]
8) The chiropractic treatment group showed significantly greater improvement insubjective complaints, functional abilities, objective range of spinal motion, and ingeneral health status than acupuncture and medication.
9) In this study, patient involvement in litigation did not influence the outcomemeasures.
10) In the treatment of chronic spinal pain, chiropractic manipulation is superiorto acupuncture and medication.
6
Chronic Spinal Pain: A Randomized Clinical TrialComparing Medication, Acupuncture, and Spinal
Manipulation
Spine, July 15, 2003; 28(14): 1490-1502
Treatment Drugs(Celebrex or
Vioxx)
Acupuncture ChiropracticAdjustments
Years OfChronic
Spinal Pain
4.5 or 6.4 4.5 or 6.4 8.3
%Asymptomatic
within 9weeks
5% 9.4% 27.3%
% Thatsuffered an
adverse event
6.1% 0% 0%
%Improvement
In GeneralHealth Status
18% 15% 47%
1Cervical spine manipulation alters sensorimotor integration: A
somatosensory evoked potential study
Clinical Neurophysiology
February 2007 Feb;118(2):391-402 Haavik-Taylor H, Murphy B
OBJECTIVE:To study the immediate sensorimotor neurophysiological effects of cervical spinemanipulation using somatosensory evoked potentials (SEPs).
METHODS:Twelve subjects with a history of reoccurring neck stiffness and/or neck pain, butno acute symptoms at the time of the study were invited to participate in the study.
An additional twelve subjects participated in a passive head movement controlexperiment.
Spinal brainstem and cortical SEPs to median nerve stimulation were recordedbefore and for 30min after a single session of cervical spine manipulation, orpassive head movement.
RESULTS:There was a significant decrease in the amplitude of parietal and frontal SEPcomponents following the single session of cervical spine manipulation compared topre-manipulation baseline values.
These changes lasted on average 20min following the manipulation intervention.
No changes were observed in the passive head movement control condition.
CONCLUSIONS:Spinal manipulation of dysfunctional cervical joints can lead to transient corticalplastic changes, as demonstrated by attenuation of cortical somatosensory evokedresponses.
SIGNIFICANCE:This study suggests that cervical spine manipulation may alter corticalsomatosensory processing and sensorimotor integration.
These findings may help to elucidate the mechanisms responsible for the effectiverelief of pain and restoration of functional ability documented following spinalmanipulation treatment.
68) The altered neural processing that occurs as a consequence of jointdysfunction provides a “rationale for the effects of spinal manipulation on neuralprocessing that have been described in the literature.” [Very Important]
9) Spinal dysfunction alters the “balance of afferent input to the central nervoussystem” and this altered afferent input may lead to “maladaptive neural plasticchanges in the central nervous system,” and “spinal manipulation can effect this.”[Very Important]
10) The clinical evidence for joint dysfunction that requires manipulation includes:
A)) Tenderness on joint palpation.B)) Restricted intersegmental range of motion.C)) Palpable asymmetry of intervertebral muscle tension.D)) Abnormal or blocked joint play and end-feel.E)) Sensorimotor changes in the upper extremity.[I recall the teachings of Richard Stonebrink, DC, in the orthopedicdiplomate program 25 years ago, the importance of “always documenting(in our daily records) the evidence that the patient had a manipulatablespinal lesion (subluxation).” His evidence was identical to these. Dr.Stonebrink would stress that such documentation would “always make thecase unique to chiropractic” and consequently make the chiropractor theonly expert in the case.]
11) The most reliable spinal-dysfunction-indicators are tenderness with palpationof the dysfunctional joint, and alterations of segmental range of motion.
12) High velocity, low amplitude thrust spinal manipulation with the head held inlateral flexion, with slight rotation and slight extension “is a standard manipulativetechnique used by manipulative physicians, physiotherapists and chiropractors.”
13) High velocity manipulation alters reflex EMG activity and alters afferent inputto the central nervous system. [Important]
14) High-velocity manipulation causes significant cortical SEP amplitudeattenuation in at least the frontal and parietal cortexes.
15) Passive head movements do not cause changes in cortical firing.
16) “A single session of spinal manipulation of dysfunctional joints resulted inattenuated cortical (parietal and frontal) evoked responses.” These changes “mostlikely reflect central changes.” [Very Important]
17) The cortical function of different individuals responded differently to spinaladjusting. [This indicates that other variables other than the adjustmentitself can influence the cortical responses in a given individual]
718) The significantly decreased somatosensory cortical SEP occurred in all post-manipulation measurements, indicating “enhanced active inhibition” because the“cervical manipulations could have altered the afferent information originating fromthe cervical spine (from joints, muscles, etc.)”
19) “The passive head movement SEP experiment demonstrated that nosignificant changes occurred following a simple movement of the subject’s head.Our results are therefore not simply due to altered input form vestibular, muscle orcutaneous afferents as a result of the chiropractor’s touch or due to the actualmovement of the subjects head. This therefore suggests that the results in thisstudy are specific to the delivery of the high-velocity, low-amplitude thrust todysfunctional joints.” [Extremely Important]
20) “Displacement of vertebrae is signaled to the central nervous system byafferent nerves arising from deep intervertebral muscles,” and this is improved withadjusting the adjacent dysfunctional joint.
21) “Joint dysfunction leads to bombardment of the central nervous system withIa afferent signaling from surrounding intervertebral muscles.” Spinal manipulationreduces excessive afferent signals from adjacent intervertebral muscles whichimproves altered afferent input to the central nervous system. This changes theway the central nervous system “responds to any subsequent input.”
22) Episodes of acute pain following injury induce plastic changes in thesensorimotor system, prolonging the episode of pain and playing a roll inestablishing chronic neck pain conditions. [Very Important] “The reduced corticalSEP amplitudes observed in this study following spinal manipulation may reflect anormalization of such injury/pain-induced central plastic changes, which may reflectone mechanism for the improvement of functional ability reported following spinalmanipulation.” [Extremely Important]
23) “Spinal manipulation of dysfunctional joints may modify transmission ofneuronal circuitries not only at a spinal level but at a cortical level, and possibly alsodeeper brain structures such as the basal ganglia.” [Very Important]
24) Cervical spine manipulation alters cortical [brain] somatosensory processingand sensorimotor integration.
25) These findings may help to elucidate the mechanisms responsible for theeffective relief of pain and restoration of functional ability documented followingspinal manipulation treatment.
COMMENT BY DAN MURPHY
One of the central themes of the neurology diplomate program taught by TedCarrick DC is that chiropractic spinal adjusting influences the cortical brain, creatingplastic changes. This article very much supports that perspective.
1 Early Predictors of Lumbar Spine Surgery after Occupational Back Injury:
Results from a Prospective Study of Workers in Washington State
Spine May 15, 2013; Vol. 38; No. 11; pp. 953-964
Benjamin J. Keeney, PhD, Deborah Fulton-Kehoe, PhD, MPH, Judith A. Turner, PhD, Thomas M. Wickizer, PhD, Kwun Chuen Gary Chan, PhD, Gary M. Franklin, MD, MPH Authors are from Dartmouth Medical School, University of Washington School of Public Health, University of Washington School of Medicine, and Ohio State University College of Public Health KEY POINTS FROM THIS STUDY: 1) This is a prospective population-based cohort study whose objective is to identify early predictors of lumbar spine surgery within 3 years after occupational back injury. 2) Back injuries are the most prevalent occupational injury in the United States. 3) “Back pain is the most costly and prevalent occupational health condition among the U.S. working population.” 4) After adjustment for medical and general inflation, costs for occupational back pain increased over 65% from 1996 through 2002. Spine surgeries represent a significant proportion of these costs. “Spine surgeries are associated with little evidence for improved population outcomes, yet rates have increased dramatically since the 1990s.” 5) “Reducing unnecessary spine surgeries is important for improving patient safety and outcomes and reducing surgery complications and health care costs.” 6) “9.2% of workers receiving temporary total disability compensation soon after an occupational back injury went on to have lumbar spine surgery in the next three years.” 7) The following factors were found to be associated with an increased risk of having back surgery: • Higher Roland Disability Questionnaire scores • Greater injury severity • Missing at least 1 month of work due to a previous occupational injury • Pain radiating below the knee • Receipt of an opioid prescription for the injury • Using tobacco daily • A surgeon as first provider seen for the injury
2 8) “Workers with high baseline Roland Morris Disability Questionnaire (RMDQ) scores had six times the odds of surgery compared with those with low scores.” • Workers with baseline RMDQ scores of 17 or higher on the 0–24 scale had 6 times the odds of surgery, as compared with those with scores of 0–8. [Suggesting we should be doing the Roland Morris Disability Questionnaire on patients] 9) “The RMDQ has also been shown to be predictive of chronic work disability, longer duration of sick leave, chronic pain, and other measures of function.” 10) “Those with greater injury severity and those whose first provider seen for the injury was a surgeon also had significantly higher odds of surgery, after adjusting for all other variables.” 11) The following factors were found to be associated with a decreased risk of having back surgery: • Being under age 35 • Being female • Being Hispanic • “Those whose first provider was a chiropractor.” 12) “Factors associated with significantly reduced odds of surgery included age younger than 35 years, female gender, Hispanic ethnicity, and chiropractor as first provider seen for the injury.” 13) “42.7% of workers who first saw a surgeon had surgery, in contrast to only 1.5% of those who saw a chiropractor.” “There was a very strong association between surgery and first provider seen for the injury, even after adjustment for other important variables.” “It is possible that these findings indicate that “who you see is what you get.” 14) No measures in the employment-related, health behavior, or psychological domains were significant. [Important] 15) Radiculopathy: • Radiculopathy influences back pain outcomes, including surgeries. • Surgeries may be appropriate treatment for radiculopathy. • “Odds of surgery were highest for workers with reflex, sensory, or motor abnormalities.” 16) “In Washington State worker’s compensation, injured workers may choose their medical provider. Even after controlling for injury severity and other measures, workers with an initial visit for the injury to a surgeon had almost nine times the odds of receiving lumbar spine surgery compared to those seeing primary care providers, whereas workers whose first visit was to a chiropractor had significantly lower odds of surgery.” [by 78%]
3 17) “Approximately 43% of workers who saw a surgeon had surgery within 3 years, in contrast to only 1.5% of those who saw a chiropractor.” 18) Previous studies have shown: • Those with occupational back injuries who first saw a chiropractor had lower odds of chronic work disability. • Those seeing chiropractors for occupational back pain had “higher rates of satisfaction with back care.” 19) Hispanic participants had lower odds of surgery (7.4% vs. 11.0% for whites), and these authors cite studies to explain this finding, including: • Cultural barriers • Less willingness to undergo surgeries • Lack of familiarity or understanding of surgery • Fewer physician referrals to surgery • Discouragement of surgery • Lack of information • Employers’ bias COMMENTS FROM DAN MURPHY These authors suggest that it is wise to use a “gatekeeper” for patients who suffer occupational back injury. This article presents substantial reason for why such a gatekeeper to be a chiropractor. The reduction of back surgeries in those consulting chiropractors for back pain represents a substantial costs savings, and also the highest levels of back care satisfaction.
1 The Prevalence, Patterns, and Predictors of Chiropractic Use Among US
Adults
Results From the 2012 National Health Interview Survey
Spine December 1, 2017; VOL. 42; No. 23; pp. 1810–1816
Jon Adams, PhD; Wenbo Peng, PhD; Holger Cramer, PhD; Tobias Sundberg, PhD; Craig Moore, Masters of Clinical Trials Research; Lyndon Amorin-Woods, MPH; David Sibbritt, PhD; Romy Lauche, PhD The aim of this study was to investigate the lifetime and 12-month prevalence, patterns, and predictors of chiropractic utilization in the US general population. The data for this study was from the National Health Interview Survey (NHIS), which is the principle and reliable source of comprehensive health care information in the United States, utilizing a nationally representative sample of the civilian non-institutionalized population of the United States. The NHIS dataset provides a large-scale nationally representative sample regarding chiropractic use. KEY POINTS FROM THIS STUDY: 1) “Chiropractic is one of the largest manual therapy professions in the United States and internationally.” 2) “Chiropractic is one of the commonly used complementary health approaches in the United States and internationally.” 3) “There is a growing trend of chiropractic use among US adults from 2002 to 2012.” 4) Chiropractic: • Uses manual therapy to treat musculoskeletal and neurological disorders. • Is covered by Medicare and Medicaid for all adults in the United States. • Is included in the workers’ compensation systems in most US States. • Has >70,000 practicing providers in the United States. • Total costs for US visits in 2013 is estimated to be more than $10 billion.
2 Findings (rounded)
Percentage that used Chiropractic:
Percentage
In Their Lifetime
24%
In The Past Year
8%
Reason to use Chiropractic
Percentage
For General Wellness or General Disease Prevention
43%
To Improve Energy
16%
To Improve Athletic or Sports Performance
15%
To Improve Immune Function
11%
To Improve Memory or Concentration
5%
Did Chiropractic Motivate to?
Percentage
Exercise More Regularly
22%
Eat Healthier
11%
Cut Back or Stop Smoking Cigarettes
6%
Eat More Organic Food
6%
Cut Back or Stop Drinking Alcohol
3%
Did Chiropractic Lead to?
Percentage
Improve Overall Health and Make You Feel Better
67%
Help to Sleep Better
42%
Help to Reduce Stress Level or to Relax
40%
Make it Easier to Cope With Health Problems
38%
Give a Sense of Control Over Health
32%
Helps to Feel Better Emotionally
27%
3 Improve Attendance at Job or School
17%
Improve Your Relationships With Others
13%
How Important was Chiropractic for Maintaining Health and Well-being?
Percentage
Very Important
48%
Somewhat Important
30%
Slightly Important
14%
Not at All Important
9%
Used Chiropractic for a Specific Top Health Problem
70%
Specific Health Problems Chiropractic Used For
Percentage
Back Pain or Back Problems
63%
Neck Pain or Neck Problems
30%
Joint Pain or Stiffness
14%
Muscle or Bone Pain
9%
Severe Headache/Migraine
5%
Arthritis
5%
Chronic Pain
4%
Chiropractic Helped for Specific Health Problem
Percentage
A Great Deal
65%
Some
26%
Only a Little
6%
Not at All
3%
4
Has Received the Following for the Specific Health Problem for which
Chiropractic Care Was Sought
Percentage
OTC Medication
35%
Prescription Medication
23%
Physical Therapy
23%
Surgery
5%
Mental Health Counseling
2%
Chiropractic Practitioner Was Seen Because
Percentage
Therapy Combined with Medical Treatment Would Help
65%
It Treats the Cause and not Just the Symptoms
62%
It is Natural
38%
Medical Treatments do not Work for Your Specific Health Problem
34%
It Focuses on the Whole Person, Mind, Body, and Spirit
25%
Medications Cause Side Effects
18%
It was Part of Your Upbringing
11%
Medical Treatments Were too Expensive
6%
Chiropractic Was Recommended By:
Percentage
A Family Member
32%
A Friend
26%
A Medical Doctor
18%
A Coworker
11%
5 5) “Back pain (63.0%) and neck pain (30.2%) were the most prevalent health problems for chiropractic consultations and the majority of users reported chiropractic helping a great deal with their health problem and improving overall health or well-being.” 6) “A substantial number of chiropractic users had received prescription (23.0%) and/or over-the-counter medications (35.0%) for the same health problem for which chiropractic was sought and 64% reported chiropractic care combined with medical treatment as helpful.” 7) “A substantial proportion of US adults utilized chiropractic services during the past 12 months and reported associated positive outcomes for overall well-being and/or specific health problems for which concurrent conventional care was common.” 8) The numbers on chiropractic: • 55 million adults in the US have been to a chiropractor. • 19 million adults in the US have consulted a chiropractor within the previous 12 months. • The average number of consultations is 10 visits. • Insurance was involved in 60% of chiropractic visits. •• Insurance covered 100% of the chiropractic costs in 31% of visits. • The average cost per chiropractic visit was US $42. • The average total out-of-pocket costs for chiropractic per year was US $2.2 billion. 9) “Most respondents reported consulting a chiropractor for general wellness or disease prevention (43%), to improve their energy (16%), or to improve athletic or sports performance (15%).” 10) “Many respondents reported positive outcomes of chiropractic utilization agreeing that such care had helped them to improve overall health and make them feel better (67%), to sleep better (42%), and to reduce stress or to relax (40%).” 11) “Back pain or back problems (63%) and neck pain or neck problems (30%) were by far the top specific health problems for which people consulted a chiropractor in the past 12 months, followed by joint pain/stiffness (14%) and other pain conditions. Around two in three users (65%) reported that chiropractic had helped a great deal to address these health problems.”
6 12) “Chiropractic was used mainly because of respondents believing it would help when combined with their medical treatment (65%), owing to a perception that it treated the cause and not just the symptoms of their health problem (62%), and owing to it being considered natural (38%).” 13) “A large proportion of chiropractic users also received over-the-counter (OTC) medication (35%) and/or prescription medication (23%) for the same health problem for which chiropractic was sought and 34% of respondents used chiropractic because they considered medical treatments to not be working for their condition.” 14) “Chiropractic was mainly recommended by family (32%), friends (26%), and medical doctors (18%) in the past 12 months.” 15) “Less than 5% of respondents were worried that their conventional health care provider would discourage their chiropractic use.” 16) “Our analyses show that, among the US adult population, spinal pain and problems - specifically for back pain and neck pain - have positive associations with the use of chiropractic.” 17) “The most common complaints encountered by a chiropractor are back pain and neck pain and is in line with systematic reviews identifying emerging evidence on the efficacy of chiropractic for back pain and neck pain.” [Important] 19) The primary source for chiropractic information by patients is the internet (8%). 20) “Chiropractic services are an important component of the healthcare provision for patients affected by musculoskeletal disorders (especially for back pain and neck pain) and/or for maintaining their overall well-being.”
1 Association Between Utilization of Chiropractic Services for Treatment of
Low-Back Pain and Use of Prescription Opioids
The Journal of Alternative and Complementary Medicine February 22, 2018
[epub, ahead of print]
James M. Whedon, DC, MS; Andrew WJ Toler, MS; Justin M. Goehl, DC, MS; Louis A. Kazal, MD: From Southern California University of Health Sciences and Geisel School of Medicine at Dartmouth, Hanover, NH. The objective of this investigation was to evaluate the association between the utilization of chiropractic services and the use of prescription opioid medications. The authors used a retrospective cohort design to analyze health insurance claims of 6,868 low back pain subjects from New Hampshire. In 2015, New Hampshire had the second-highest age adjusted rate of drug overdose deaths in the United States, a 31% increase from the previous year and more than double the national rate. The subjects were aged 18–99 years. KEY POINTS FROM THIS ARTICLE: 1) There is an epidemic of opioid prescribing in the USA. • “More aggressive pain management efforts that began in the 1990s have led to an epidemic of prescriptions for opioid pain medications in the U.S.” • “More than 650,000 opioid prescriptions are dispensed per day in the United States.” [Crazy] • “One out of five patients with non-cancer pain or pain-related diagnoses is prescribed opioids in office-based settings.” • Opioid “prescribing rates are high among providers of pain medicine, surgery, and physical medicine/rehabilitation.” • “Primary care clinicians account for nearly 50% of opioid prescriptions.” 2) “There is little evidence that opioids improve chronic pain, function, or quality of life.” 3) “Long-term use of opioids is associated with overdose, misuse, abuse, and opioid use disorder.” 4) “Among U.S. adults prescribed opioids, 59% reported having back pain.”
2 5) Opioid drugs also linked to: • Intolerance • Physical dependence • Increased sensitivity to pain [very ironic] • Constipation • Nausea • Vomiting • Dry mouth • Sleepiness • Dizziness • Confusion • Depression • Anxiety • Itching • Sweating • Lower sex drive and energy in men due to reduced testosterone levels • Increased risk of heroin abuse and addiction 6) “After as few as 5 days of taking opioids, the chance of an opioid-naive patient being a chronic opioid user sharply increases.” • 1 day of opioid exposure carries a 6% chance of being on opioids 1 year later. • 8 days of opioid exposure carries a 13.5% chance of being on opioids 1 year later. • 31 days of opioid exposure carries a 30% chance of being on opioids 1 year later. 7) The Opioid Problem: • Prescription opioid consumption and related deaths tripled from 1999 to 2010. • Opioids are involved in about 75% of pharmaceutical overdose deaths. • Opioids account for about 30,000 overdose deaths yearly in the US. • “The economic impact of the opioid epidemic was estimated to be nearly $56 billion in health and social costs in 2007, and since that time the problem has grown considerably.” • “Sales of prescription opioids in the US nearly quadrupled from 1999 to 2014, but without any overall change in the amount of pain patients reported.”
3 • “Efforts aimed at curbing the opioid epidemic (including new prescribing guidelines, monitoring programs, enhanced access to treatment of opioid use disorder treatment, screening protocols, treatment contracts, urine testing, regulatory supervising of pain clinics, and law enforcement strategies) have failed to reduce rates of prescribing, misuse, and overdose.” • Opioid use can lead to self-neglect and neglect of loved ones. • Opioid use can lead to child and elder abuse. • Opioid use can lead to newborn withdrawal. • Opioid use can lead to unemployment and homelessness. • Opioid use can lead to other ill-health effects including HIV, Hepatitis C, liver damage, and heart problems. 8) “Little attention has been paid to the potential of non-pharmacologic pain treatment as an upstream strategy for addressing the opioid epidemic.” 9) “Clinical guidelines from the American College of Physicians recommend non-pharmacologic treatment as the first-line approach to treating back pain, with consideration of opioids only as the last treatment option.” 10) “A recent systematic review and meta-analysis found that for treatment of acute low-back pain, spinal manipulation provides a clinical benefit equivalent to that of NSAIDs, with no evidence of serious harms.” 11) Spinal manipulation is an effective treatment for chronic low-back pain. 12) “A retrospective claims study of 165,569 adults found that utilization of services delivered by Doctors of Chiropractic was associated with reduced use of opioids.” 13) “The supply of chiropractors as well as spending on spinal manipulative therapy is inversely correlated with opioid prescriptions in younger Medicare beneficiaries.” 14) “Pain management services provided by Doctors of Chiropractic may allow patients to use lower or less frequent doses of opioids, leading to lower costs and reduced risk of adverse effects.” 15) “Among New Hampshire adults with office visits for non-cancer low-back pain, the adjusted likelihood of filling a prescription for an opioid analgesic was 55% lower for recipients of services provided by Doctors of Chiropractic compared with non-recipients.”
4 16) “Average charges per person for chiropractic users—for both opioids and office visits for low-back pain—were also significantly lower compared with nonusers over a 2-year period.” [Important] 17) “Among patients with low-back pain, recipients of services delivered by Doctors of Chiropractic have a lower likelihood of using prescription opioids, compared with non-recipients.” [Important] 18) Chiropractic care “could exert a positive impact on patients with low-back pain by reducing unnecessary care, lowering costs, and improving safety.” 19) “Pain relief resulting from services delivered by Doctors of Chiropractic may allow patients to use lower or less frequent doses of opioids, leading to reduced risk of adverse effects.” 20) The filling of a prescription for an opioid analgesic was 55% lower among chiropractic recipients compared with non-recipients. [Key Point] 21) “Conclusions: Among New Hampshire adults with office visits for non-cancer low-back pain, the likelihood of filling a prescription for an opioid analgesic was significantly lower for recipients of services delivered by Doctors of Chiropractic compared with non-recipients.” 22) These authors considered the benefits of receiving chiropractic services for both reduced costs and reduction of opioid use to be “impressive.” COMMENTS FROM DAN MURPHY The National Institute on Drug Abuse of the National Institute of Health (USA) notes (as of March 2018): • Every day, more than 115 people in the United States die after overdosing on opioids (about 42,000 yearly). [If chiropractic care was responsible for at most one patient death per year, the modern opioid epidemic in one year carries the same risk of death as 42 millennia of chiropractic care]. • The Centers for Disease Control and Prevention estimates that the total economic burden of prescription opioid misuse in the US is $78.5 billion a year, including the costs of healthcare, lost productivity, addiction treatment, and criminal justice involvement.
• Yearly, about 2 million people in the US suffer from substance use disorders related to prescription opioid pain relievers, and about 600,000 suffer from a heroin use disorder. • About 80 percent of people who use heroin first misused prescription opioids.
1 A theoretical basis for maintenance spinal manipulative therapy for the
chiropractic profession
Journal of Chiropractic Humanities December 2011; Vol. 1; No. 1; pp.74-85
David N. Taylor DC, DABCN KEY POINTS FROM THIS ARTICLE: 1) The purpose of this article is to discuss a theoretical basis for wellness chiropractic manipulative care. 2) A search of PubMed and of the Manual, Alternative, and Natural Therapy Index System was performed with a combination of key words: chiropractic, maintenance and wellness care, maintenance manipulative care, preventive spinal manipulation, hypomobility, immobility, adhesions, joint degeneration, and neuronal degeneration, 1970-2011. 3) The search revealed surveys of doctors and patients, an initial clinical pilot study, randomized control trials, and laboratory studies that provided correlative information to provide a framework for development of a hypothesis for the basis of maintenance spinal manipulative therapy. 4) “Maintenance care optimizes the levels of function and provides a process of achieving the best possible health. It is proposed that this may be accomplished by including chiropractic manipulative therapy in addition to exercise therapy, diet and nutritional counseling, and lifestyle coaching.” 5) “It is hypothesized that because spinal manipulative therapy brings a joint to the end of the paraphysiological joint space to encourage normal range of motion, routine manipulation of asymptomatic patients may retard the progression of joint degeneration, neuronal changes, changes in muscular strength, and recruitment patterns, which may result in improved function, decreased episodes of injuries, and improved sense of well-being.” 6) “This article considers the scientific basis of the commonly practiced procedure of chiropractic maintenance care and whether a hypothesis of a physiological basis can be generated to explain findings and practice.” Dr. Taylor cites studies to support these concepts: A)) Acute chiropractic care for the management of acute conditions. B)) “Care for chronic/recurrent conditions is defined as medically necessary care for conditions that are not expected to completely resolve, but in which one can provide documented improvement.”
2 [Chronic/recurrent care is medically necessary, even though the condition is not expected to completely resolve] [Use measurement outcomes to document improvements] C)) “Wellness or maintenance care may not be defined as being ‘medically necessary’ for a current condition.” “However, this type of care optimizes the levels of function and provides a process of achieving the best possible function and health. This care includes chiropractic manipulative therapy in addition to exercise therapy, diet and nutritional counseling, and lifestyle coaching.” [Use measurement outcomes to show functional improvement which may qualify such care as being medically necessary] 7) The purpose of chiropractic maintenance care is to optimize spinal function and decrease the frequency of future episodes of back pain. 8) Other definitions for chiropractic maintenance care include: A)) “Appropriate treatment directed toward maintaining optimal body function. This is treatment of the symptomatic patient who has reached pre-clinical status or maximum medical improvement, where condition is resolved or stable.” B)) “A regimen designed to provide for the patient's continued wellbeing or for maintaining the optimum state of health while minimizing recurrences of the clinical status.” 9) The medical profession uses “wellness” as providing diagnostic tests for “early detection of disease processes.”
10) For this article, “maintenance care and wellness care are used synonymously to represent the process of spinal manipulative therapy for an asymptomatic patient or a patient that has reached maximum therapeutic improvement.” 11) Some insurance companies have defined maintenance care as “care provided for a stable condition without any functional improvement of the patient net health outcome over a 4-week period and further determine it as not being medically necessary.”
12) In published surveys, 90+% of chiropractors opined that the purpose of maintenance care was to minimize recurrences or exacerbations; 80+% of chiropractors responded that it would optimize the patients' health.
13) 97% of American and 85% of the Australian chiropractors use manipulative therapy as a component of the maintenance care.
3 14) “95% of chiropractors recommended maintenance care to minimize recurrences or exacerbations of conditions and 90% recommended the care to optimize the health of the patient.” 15) In a study 96% of elderly patients who received maintenance care believed that it was “either considerably or extremely valuable.”
16) “It has been reported that 79% of patients in chiropractic offices are recommended maintenance care and nearly half of those patients elect to receive these services.” 17) In animal studies, fixation of facet joints for 4-8 weeks causes degenerative changes and osteophyte formation of the articular surfaces. “These findings may provide an explanation to the anecdotal findings reported in clinical practice in which patients report increased well-being and decreased incidence of spinal complaints with once per month preventive wellness manipulation.” 18) Sadly, facet articular surface degeneration began at less than 1 week. The “common clinical treatment frequency at every 4 weeks correlates with the findings of the threshold of 4 weeks for irreversible degenerative osteophyte formation.” ”This finding correlates with the common practice pattern of progressive decreasing of the frequency of manipulation as the patients progress in recovery from an acute incident. It also indicates that even when patients present for once per month asymptomatic preventive manipulation, the process of degeneration of the articular surfaces may have already begun.” 19) Facet joint fixation also resulted in synovial fold fibrotic adhesions that “progressed to mild adhesions in 4 weeks, moderate adhesions in 8 weeks, and severe adhesions after 12 weeks.” In humans, “it can be hypothesized that there is a period where the adhesions are forming without clinical symptoms. This would also support the common once per month maintenance spinal manipulation.”
20) It has also been demonstrated that lumbar spinal manipulation gaps the facet joints which may break up adhesions. This “would lend additional support for the once per month clinically recommended spinal manipulative therapy.” 21) Four weeks of joint immobilization has been found to cause a time dependent loss of neurons that becomes progressively worse thereafter. An increase in neurons occurs after release of the fixation. 22) Such immobilization also causes time dependent muscle weakness, atrophy and fatty deposition of the multifidi muscles. The time-dependent factor progressed from normal muscles to mild, moderate, and severe muscular atrophy. 23) “There may also be a possibility of reversal of the neuronal degeneration and muscular weakness through manipulation and remobilization of the joint.”
4 24) These progressive adverse physiological consequences of joint immobility, create a “line of reasoning arises that generates a theoretical framework for a physiological hypothesis of the basis of maintenance manipulative therapy.” 25) Evidence “clearly demonstrates that the clinical consensus of dosage of maintenance manipulative therapy has been found to be most beneficial at an average of once every 2 to 4 weeks. We also see here that it closely correlates with the studies that show onset of facet joint degeneration, neural degeneration, neuroplastic changes, and muscular atrophy and weakness at an average of 2 to 4 weeks.”
26) “Taking into account the neurological and biomechanical consequences of manipulative therapy, it is plausible to hypothesize that monthly manipulative therapy retards the progression of adhesion formation, joint degeneration, neuronal changes, and changes in muscular strength and recruitment patterns. This could result in improved function, decreased episodes of injuries, and improved sense of well-being.” 27) A 2004 chiropractic study of chronic low back pain showed that the group of patients who received 9 months of maintenance manipulation at the frequency of once per every 3 weeks maintained their initial clinical improvement while the control group returned to their previous levels of disability. The authors “concluded that there were positive effects of preventive maintenance chiropractic spinal manipulation in maintaining functional capacities and reducing the number and intensity of pain episodes after the acute phase of treatment of low back pain patients.” 28) Swedish surveys of chiropractors find consensus on providing maintenance care to prevent disability relapses. 29) “There is a common thread of the time dependency noted in all the laboratory and clinical studies. The periods of onset of the anatomical and physiological changes ranged from 2 to 4 weeks. The clinical studies also provided MMT every 4 weeks and noted positive changes in the pain and disability measures. This time interval also correlates with the common recommendations found in the surveys of chiropractic physicians.”
Resources
Dan Murphy, DC PO Box 7044
Auburn, CA 95604 Phone: (530) 878-6869 Fax: (530) 878-6559 www.danmurphydc.com
Email: [email protected]
Seminar Coordinator General Contact and
Professional Assistant: Michelle Schaer DC
(602) 826-2277 [email protected]
Life Chiropractic College West
(510) 780-4500 Bookstore Extension: 4502
Fatty Acid Profile
Omega-6/Omega-3
Cognitive Test
www.brainspan.com/murphy
Use code dmurphy for 50% off enrollment and special pricing.
You must use this code to get special pricing and discounts.
There are a few pricing options that the provider can choose from.
For any questions, priority email is available:
Did You Know? • Spinal stiffness was linked to visceral pathology with nearly 100% accuracy based upon sympathetic innervation. (Medical Times, 1921) • 1,000 capsules of Tylenol in a lifetime doubles the risk of end stage renal disease. (New England Journal of Medicine, 1994) • The average time for a whiplash-injured patient to achieve maximum improvement is 7 months 1 week. (Spine, 1994) • 93% of patients with chronic whiplash pain who have failed medical and physical therapy care improve with chiropractic adjustments. (Injury, 1996) • Taking the correct drug for the correct diagnoses in the correct dose will kill about 106,000 Americans per year, making it the 4th most common cause of death in the US. (Journal of the American Medical Association, 1998) • Nonsteroidal anti-inflammatory drugs for rheumatoid and/or osteoarthritis conservatively cause 16,500 Americans to bleed to death each year, making that the 15th most common cause of death in the US. (New England Journal of Medicine, 1999) • Glutamate and aspartame can cause chronic pain sensitization, and removing them from the diet for 4 consecutive months
can eliminate all chronic pain symptoms. (Annals of Pharmacotherapy, 2002) • Chiropractic spinal adjusting has been shown to be better than 5 times more effective than the NSAIDs pain drugs Celebrex and Vioxx in the treatment of chronic neck and low back pain. (Spine, 2003) • In patients suffering from chronic pain subsequent to degenerative spinal disease, 59% can eliminate the need for pain drugs by consuming adequate levels of omega-3 essential fatty acids. (Surgical Neurology, 2006) • Chiropractic adjustments have been shown to significantly lower blood pressure. (Journal of Human Hypertension, 2007) • The estimated incidence of chronic pain from whiplash trauma is 15-40%. (Jour of the Am Academy of Ortho Surg, 2007) • Meniere’s Disease has been linked to a disorder of the upper cervical spine facet joints. (International Tinnitus Jour, 2007) • Supplementing with vitamin D3 has the potential to reduce cancer deaths in America by 75%. (Ann of Epidemiology, 2009) • Potentially, the largest exposure of Americans to the neurotoxin mercury is through the consumption of products containing High Fructose Corn Syrup. (Environmental Health, 2009) • Those who consumed the highest amounts of nonsteroidal anti-inflammatory pain drugs increased their risk of dementia, including Alzheimer’s dementia, by 66%. (Neurology, 2009) • The newest estimate for the incidence of autism is 1 in 91 US children. (Pediatrics, 2009) These published facts and hundreds more are available through my Article Review Service, now in its 15th year. Reviews are detailed, thorough, timely and cutting-edge, with KEY POINTS summary and chiropractic practical applications. The Reviews are in PDF format for easy printing. They are excellent for educating the chiropractor, staff, patients and for lecture preparation. Sign-up through the website with a credit card, $100.00 per year. The Archives (past years 2001-2013) are available for $150.00. Website: www.danmurphydc.com Assistant: Michelle Schaer, DC (602) 826-2277; [email protected] SUBSCRIBER COMMENTS Dr. Dan, Any chiropractor that truly cares about his patients and not about just making a buck needs to be subscribing to your Article Review Updates. I certainly am going to do my part to see that each chiro I come in contact with knows what an absolutely invaluable resource it is. I sat in amazement at the last two articles you sent regarding antibiotic overuse and atopic disorders. What crucial information to pass on to my practice members. Thanks and keep up the awesome work. Dr. G.M.; August 1, 2002 Dear Dan, I hope you can continue providing this information for many years to come. I have been in practice for 18 years and find these citations to be the most informative, chiropractically relevant information that I have received in my career. I would be willing to pay more for this information to make sure that it keeps coming. Again, thank you!! JR, DC; January 8, 2005
- Dizziness- Headaches- Pain- Low-level laser therapy
- Pediatric books- Vaccine update- Exercise- Fat
- Copper- Lectins- Melatonin- Opiates
- Alzheimer’s- Cervial kyphosis- Short leg syndrome- CSF cork
Copyright 2018 by Mesa Chiropractic & Rehabiliation Center PC all rights reserved
602.826.2277530.878.6559
623 N Parsell
319 10.00