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Reflex effects of subluxation: the autonomic nervous system
Abstract
The 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 that level. This experience is at odds with classic views of neuroscientists about the potential for somatic stimulation of spinal structures to affect visceral function.
To review recent findings from basic physiologic research about the effects of somatic stimulation of spinal structures on autonomic nervous system activity and the function of dependent organs.
Findings were drawn from a major recent review of the literature on the influences of somatic stimulation on autonomic function and from recent original physiologic studies concerning somatoautonomic and spinovisceral reflexes.
Recent neuroscience research supports a neurophysiologic rationale for the concept that aberrant stimulation of spinal or paraspinal structures may lead to segmentally organized reflex responses of the autonomic nervous system, which in turn may alter visceral function.
... Research studies on the effects of spinal manipulative therapy suggest that chiropractic care may influence the autonomic nervous system (24,25,77). Outcomes such as heart rate variability (HRV) and skin conductance have been shown to change following a chiropractic adjustment or osteopathic manipulation (24,25,78). ...
... The research utilizing adjustments to the cervical spine more consistently demonstrate decreases in BP following manipulative therapy (28,62,88,(90)(91)(92)94,95,100,104,105,107,(110)(111)(112)119). The anatomic, HRV and electrodermal literature seem to support the cervical spine as an intervention point to influence the autonomic nervous system, although the electrodermal research seems counter to the HRV literature relative to which autonomic system is activated (24,25,77,78,(85)(86)(87). One cervical manipulation and HRV study by Budgell et al. does show an increase in low frequency response, which is often attributed to sympathetic activation; however, increased sympathetic activation would suggest a blood pressure increase (121). ...
... The results of the present review were mixed. While the research examining manual therapy to the cervical spine were the most supportive of chiropractic care as an intervention to lower blood pressure, evaluation of the ANS responses to cervical manipulation were only supportive in the HRV literature (24,25,77,78). The inconclusiveness related to manual therapy as a proposed intervention for blood pressure regulation has also been supported in other literature reviews (26,27,122). ...
Background and aim:
Hypertension is a multifactorial condition that is among the leading causes of mortality worldwide. Regulation of blood pressure greatly depends upon the activity of the autonomic nervous system. Alterations in the autonomic nervous system can lead to hypertension. In addition to nervous system control and individual physiologic state, various genes can directly influence autonomic responses. The complexity of blood pressure control is reflected in the 20-30% of individuals resistant to traditional pharmacological treatment, this indicates the need for alternative interventions. This article provides an integrative review and discussion of the key neurophysiologic and genetic factors that contribute to blood pressure regulation, the autonomic nervous system (ANS) and manual therapy literature, and the manual therapy and blood pressure literature.
Methods:
To assess the effects of chiropractic on the management of hypertension we searched articles published from 1980 to 2019 in PubMed, the Index to Chiropractic Literature and CINAHL, using the keywords: chiropractic, spinal manipulation, hypertension, and blood pressure.
Results:
We found 38 original studies that analyzed the effect of chiropractic therapy on hypertension. Of these studies, 10 were case reports and the statistical significance of the effects of chiropractic on blood pressure was not evaluated on these articles, so we focused on the remaining 28 articles.
Conclusions:
The results of the review relative to chiropractic care were promising, but often contradictory, suggesting more research should be done. In consideration of the complexity of ANS blood pressure control, an evaluation of patient presenting physiologic and genetic characteristics is recommended and could provide valuable insight relative to the likelihood of patient blood pressure related responsiveness to care.
... In addition to these shortened muscles their antagonistic muscles weaken. (Scully and Barnes 1989) Previous studies have shown that adjusting the specific spinal level of innervation of a certain organ or muscle had an effect on that structure due to reflex responses resulting from the adjustment (Budgell 2000). ...
... This might be because the stretching and the adjustments are working against each other. Previous studies have shown that adjusting the specific spinal level of innervation of a certain organ or muscle had an effect on that structure due to reflex responses resulting from the adjustment (Budgell 2000;Bray 1999 andPollard andWard 1997). It might be that the reflex response created by the spinal adjustment works in competition with the stretch reflex that occurs in muscles when being stretched, possibly because of the fact that "autogenic inhibition" is the general function of the GTO excitation and involves the inhibition of the contraction of the muscle within which it is found in order to help prevent damage due to overloading of the muscle tissues (Knutson and Owens 2003). ...
... The autonomic nervous system has been invoked in constructing mechanisms that account for the effect of spinal dysfunction. 6 Previous studies documented a potential relationship between the vertebral subluxation complex and the function of the autonomic nervous system. 1,[6][7][8][9][10][11][12][13] These studies mainly discussed the autonomic effects on cardiovascular function in relation to CSM. 9,[11][12][13] A recent study using heart rate variability analysis documented that chiropractic adjustment affects the autonomic nervous system. ...
... 6 Previous studies documented a potential relationship between the vertebral subluxation complex and the function of the autonomic nervous system. 1,[6][7][8][9][10][11][12][13] These studies mainly discussed the autonomic effects on cardiovascular function in relation to CSM. 9,[11][12][13] A recent study using heart rate variability analysis documented that chiropractic adjustment affects the autonomic nervous system. 13 However, literature search showed no study using positron emission tomography (PET) to examine regional cerebral metabolic changes related to autonomic responses resulting from CSM. ...
Chiropractic spinal manipulation (CSM) is an alternative treatment for back pain. The autonomic nervous system is often involved in spinal dysfunction. Although studies on the effects of CSM have been performed, no chiropractic study has examined regional cerebral metabolism using positron emission tomography (PET).
The aim of the present study was to investigate the effects of CSM on brain responses 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 twice on each participant, at resting and after CSM. Questionnaires were used for subjective evaluations. A visual analogue scale (VAS) was rated by participants before and after chiropractic 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 metabolism was 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 life in the treatment condition. A significantly lower VAS was noted after CSM. Cervical muscle tone and salivary amylase were decreased after CSM. Conclusion The results of this study suggest that CSM affects regional cerebral glucose metabolism related to sympathetic relaxation and pain reduction.
... Thus with maximal stimulatory input into the spinal cord segmental level from the sensory input arising out of the paraspinal tissues, the maximum neurological reflex stimulation / inhibition occurs in the spinal cord, which then results in an effect on the autonomic nervous system and can alter end organ function. Sympathetic outflow is inhibited by non-noxious (non-painful) stimulus to the paraspinal tissues and noxious (painful) stimulus has a stimulatory effect (Korr, 1979b; Bergmann, 1992; Budgell, 2000; Pickar, 2002). Conversely the parasympathetic outflow is stimulated by non-noxious stimuli and inhibited by noxious stimuli (Sato, 1992). ...
... Conversely the parasympathetic outflow is stimulated by non-noxious stimuli and inhibited by noxious stimuli (Sato, 1992). The influence of these effects has been shown to change heart rate; blood pressure; pupillary diameter; distal skin temperature; as well as endocrine and immune system (Korr, 1979b; Bergmann, 1992; Slosberg, 1998; Murphy, 1999: Budgell, 2000 Pickar, 2002; Fryer, 2003; Welch and Boone, 2008). ...
The Effect of Cervical and Thoracic Spinal Manipulations on Blood Pressure in Normotensive Males. BACKGROUND A distinguishing feature of chiropractic is manipulation that is a load delivered by hand, to specific tissues (usually a short lever bony prominence) with therapeutic intent. Chiropractic spinal manipulation results in somatovisceral reflexes, which can affect the cardiovascular system and thereby reduce blood pressure. Areas of the spine known to cause such effects are the upper cervical region and the upper thoracic region. Increased blood pressure/hypertension is a global disorder. The incidence is increasing and leads to complications of cardiovasular disease and cerebral vascular accidents OBJECTIVES The objectives of the study were to determine whether spinal manipulation evokes somatovisceral reflexes and causes a reduction in blood pressure following an atlanto-axial (C0/C1), and Thoracic segments one to five manipulations (T1-T5). METHODS Forty, asymptomatic, normotensive males between the ages of 20 – 35 years of age participated in the study. All subjects underwent four consecutive days of intervention. Day one was sham laser. Day two was C0/C1 spinal manipulation. Day three was T1-T5 thoracic manipulation. Day four was a combination of C0/C1 and T1-T5 spinal manipulations. RESULTS The results of this study suggest that blood pressure decreases following a cervical or a thoracic manipulation, however a combination of the manipulations does not have a significant cumulative effect on the reduction of blood pressure. iv CONCLUSIONS Somatovisceral reflexes are evoked following a spinal manipulation, causing a reduction in blood pressure after an upper cervical or upper thoracic manipulation. Neurophysiological effects occurring as a result of spinal manipulation may inhibit or excite somatosomatic reflexes, which changes heart rate and blood pressure. Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Durban University of Technology, 2009. Aaron Bear Foundation
... [23][24][25][26] These spinal reflexes span the visceral organs and have been investigated by many researchers including Sato 27 and others. [28][29][30][31] Although this work is of good quality, it is not the validation that is often portrayed by many in the chiropractic profession. ...
... Much work has already begun into the somatovisceral reflex. Work by Sato,27,28 Budgell,28,29 and Bolton 30,31 is being followed by other research groups, including groups from Japan and Australia. However, much of this research appears to focus on the spinal aspects of the somatovisceral reflex with the supraspinal aspects largely ignored. ...
From the conclusion in 2005 .....
"Chiropractic is at a crossroad in its development in many ways. With regard to the type O disorder rather than the profession developing an almost dualistic support for the type O/type M vitalistic/mechanistic approaches to management, there exists an acceptable model to act as a bridge between the collective treatment impasse. The embrace of the supraspinal influences inherent in the biopsychosocial model may serve us well when investigating the enigma that is evidence-based practice."
... In addition to sensorimotor control influences, several studies show that the cervical receptors and the sympathetic nervous system have direct interactions [22][23][24]. However, there is limited evidence suggesting that the autonomic nervous system is sensitive to alterations in articular afferent input driven by thoracic hyper-kyphosis and joint dysfunction [22,23,25]. ...
There is great interest in thoracic kyphosis, as it is thought to be a contributor to neck pain, neck disability, and sensorimotor control measures; however, this has not been completely investigated in treatment or case control studies. This case control design investigated participants with non-specific chronic neck pain. Eighty participants with a defined hyper-kyphosis (>55°) were compared to eighty matched participants with normal thoracic kyphosis (<55°). Participants were matched for age and neck pain duration. Hyper-kyphosis was further categorized into two distinct types: postural kyphosis (PK) and Scheuermann’s kyphosis (SK). Posture measures included formetric thoracic kyphosis and the craniovertebral angle (CVA) to assess forward head posture. Sensorimotor control was assessed by the following measures: smooth pursuit neck torsion test (SPNT), overall stability index (OSI), and left and right rotation repositioning accuracy. A measure of autonomic nervous system function included the amplitude and latency of skin sympathetic response (SSR). Differences in variable measures were examined using the Student’s t-test to compare the means of continuous variables between the two groups. One-way ANOVA was used to compare mean values in the three groups: postural kyphosis, Scheuermann’s kyphosis, and normal kyphosis group. Pearson correlation was used to evaluate the relationship between participant’s thoracic kyphosis magnitude (in each group separately and as an entire population) and their CVA, SPNT, OSI, head repositioning accuracy, and SSR latency and amplitude. Hyper-kyphosis participants had a significantly greater neck disability index compared to the normal kyphosis group (p < 0.001) with the SK group having greatest disability (p < 0.001). Statistically significant differences between the two kyphosis groups and the normal kyphosis group for all the sensorimotor measured variables were identified with the SK group having the most decreased efficiency of the measures in the hyper-kyphosis group, including: SPNT, OSI, and left and right rotation repositioning accuracy. In addition, there was a significant difference in neurophysiological findings for SSR amplitude (entire sample of kyphosis vs. normal kyphosis, p < 0.001), but there was no significant difference for SSR latency (p = 0.07). The CVA was significantly greater in the hyper-kyphosis group (p < 0.001). The magnitude of the thoracic kyphosis correlated with worsening CVA (with the SK group having the smallest CVA; p < 0.001) and the magnitude of the decreased efficiency of the sensorimotor control measures and the amplitude and latency of the SSR. The PK group, overall, showed the greatest correlations between thoracic kyphosis and measured variables. Participants with hyper-thoracic kyphosis exhibited abnormal sensorimotor control and autonomic nervous system dysfunction compared to those with normal thoracic kyphosis.
... [22][23][24] However, there is limited evidence suggesting that the autonomic nervous system is sensitive to alterations in articular afferent input driven by thoracic hyper-kyphosis and joint dysfunction. [22][23] [25] It is known that thoracic hyper-kyphosis is related to a patients' pain, disability, shoulder kinematics, and general health status. [26][27][28][29][30][31] The threshold for hyper-kyphosis has been reported to be 45° on x-rays (T4-T12 and T5-T12) for pain and disability [26] [27] while the 60° value has been reported to be the threshold for more severe disability as in adult spine deformity cases. ...
There is great interest in thoracic kyphosis as it is thought to be a contributor to neck pain, neck disability, and sensorimotor control measures; though this has not been completely inves-tigated in treatment or case control studies. This case control design investigated participants with non-specific chronic neck pain. Eighty participants with a defined hyper-kyphosis (> 55°) were compared to 80 matched participants with normal thoracic kyphosis (< 55°). Participants were matched for age and neck pain duration. Hyper-kyphosis was further categorized into two distinct types: postural kyphosis (PK) and Scheuermann’s kyphosis (SK). Posture measures included formetric thoracic kyphosis and the craniovertebral angle (CVA) to assess forward head posture. Sensorimotor control was assessed by the following measures: smooth pursuit neck torsion test (SPNT), overall stability index (OSI) and left and right rotation repositioning accuracy. A measure of autonomic nervous system function included the amplitude and latency of skin sympathetic response (SSR). Differences in variable measures were examined using the Student’s t-test to compare the means of continuous variables between the two groups. Pearson correlation was used to evaluate the relationship between participant’s thoracic kyphosis magnitude (in each group separately and as an entire population) and their CVA, SPNT, OSI, head repositioning ac-curacy, and SSR latency and amplitude. Hyper-kyphosis participants had a significantly greater neck disability index compared to the normal kyphosis group (p < 0.001) with the SK group having greatest disability (p < 0.001). Statistically significant differences between the two kyphosis groups and the normal kyphosis group for all the sensorimotor measured variables were identified with the SK group having the most decreased efficiency of the measures in the hyper-kyphosis group, including: SPNT, OSI and left and right rotation repositioning accuracy. Also, there was a signif-icant difference in neurophysiological findings for SSR amplitude (entire sample of kyphosis vs. normal kyphosis, p < 0.001), but there was no significant difference for SSR latency (p = .07). The CVA was significantly greater in the hyper-kyphosis group (p < 0.001). The magnitude of the thoracic kyphosis correlated with worsening CVA (with the SK group having the smallest CVA; p < 0.001) and the magnitude of the decreased efficiency of the sensorimotor control measures and the amplitude and latency of the SSR. The PK group, overall, showed the greatest correlations between thoracic kyphosis and measured variables. Participants with hyper-thoracic kyphosis exhibited abnormal sensorimotor control and autonomic nervous system dysfunction compared to those with normal thoracic kyphosis.
... Furthermore, a complex network of neurophysiological connections between cervical spine mechanoreceptors and the sympathetic nervous system exists [30][31][32]. Though the effects of autonomic system activity on musculoskeletal function has been extensively studied, there is a paucity of research demonstrating that the autonomic nervous system is intimately responsive to changes in the afferent articular input due to spine joint dysfunction [33]. Alterations in afferent articular input driven by spine joint aberrant movement (altered kinematics) and subtle or overt tissue damage is generally referred to as 'dysafferentation' in the literature. ...
Increasingly, there is more attention being directed to the role that full spine sagittal alignment plays in causing or exacerbating a variety of musculoskeletal disorders. Similarly, spinal displacements, termed subluxation, are thought to cause dysfunctions in the entire neuromusculoskeletal system that may lead to altered neurophysiological function, abnormal sensorimotor control, and altered autonomic nervous system function. Abnormalities in neutral upright spine alignment (sagittal translation or flexion deformities) are known to increase mechanical loads (stresses and strains) on the central nervous system. These increased mechanical loads may subtly or overtly impair neurophysiological function as measured with evoked potentials in terms of latency and amplitudes of potentials. Proprioceptive afferentation from spine ligaments, muscles and discs are considered a major component of sensorimotor control. The voluminous mechanoreceptors in spinal muscles, ligaments, and discs plays an intimate role, providing the necessary neurophysiological input in a feed forward and feedback system for sensorimotor control via connections to the vestibular, visual and central nervous systems. Of particular interest, a network of neurophysiological connections between spine mechanoreceptors and the sympathetic nervous system has been documented. This chapter explores the hypothesis and evidence that restoring normal posture and spine alignment has important influences on neurophysiology, sensorimotor control and autonomic nervous system functionality. There is limited but high-quality research identifying that sagittal spine alignment restoration plays an important role in improving neurophysiology, sensorimotor control, and autonomic nervous system function. Accordingly, in the current chapter, we review this work in hopes of stimulating further investigations into structural rehabilitation of the spine and posture.
... The parasympathetic nervous system regulates the upper cervical region, so a cervical manipulation or adjustment results in a parasympathetic response (lowering of heart beat, reduction of blood pressure, pupil constriction) (4), whereas manual adjustment of spinal regions with significant sympathetic innervation, i.e. the upper thoracic and lumbar regions, produces a sympathetic response (heart beat stimulation, blood pressure increase, pupil dilation). Many studies have explored chiropractic cranial and vertebral adjust-ments, and spinal manipulative therapy in relation to autonomic functions (31). ...
Background and aim:
Major depressive disorder is associated with an autonomic nervous system imbalance. All the symptoms of depression (high cortisol, high adrenalin, insomnia, agitation, anxiety) can probably be attributed to over-activation of the sympathetic nervous system. We performed this review in order to highlight the possible links between chiropractic intervention, its potential molecular effects and its possible outcomes on patients with depression.
Methods:
We performed a literature search for all the relevant manuscript regarding the effects of chiropractic and depression on the autonomic nervous system.
Results:
Chiropractic care and spinal manipulation regulate the autonomic nervous system at peripheral level and its projections to the central nervous system. In particular, they may activate the parasympathetic system to counterbalance the activity of the sympathetic system. Vagal parasympathetic stimulation is also considered an effective therapy for major depression as it releases neurotrophins essential for anti-depressive therapies, including brain-derived neurotrophic factor and nerve growth factor.
Conclusion:
Chiropractic and spinal manipulative therapies along with vagal nerve stimulation may therefore be regarded as treatment options for depression.
... Collectively, the results from these studies suggest that reflex responses after manual SMT are both local and nonlocal in addition to being reproducible both within and between participants. Nonlocal effects after manual SMT, that is, effects that occur in tissues not directly related to the target area, have also been reported elsewhere in the literature, 16,17 and the hypothesis that there is a connection between the autonomic nervous system and pain perception after SMT has been investigated. 18,19 Reports of changes in skin conductance, respiratory rate, blood pressure, and heart rate in healthy populations after mobilization or manipulation of specific areas of the spine support this hypothesis. ...
Objective:
The purpose of this research was to determine the extent of reflex responses after spinal manipulative therapy (SMT) of the cervical and upper thoracic spine.
Methods:
Eleven asymptomatic participants received 6 commonly used SMTs to the cervical and upper thoracic spine. Bipolar surface electromyography electrodes were used to measure reflex responses of 16 neck, back, and proximal limb muscles bilaterally. The percentage of occurrence and the extent of reflex responses of these muscles were determined.
Results:
Reflex responses after cervical SMT were typically present in all neck and most back muscles, whereas responses in the outlets to the arm and leg were less frequent. This trend was similar, although decreased in magnitude, after thoracic SMT.
Conclusion:
Reflex responses were greatest after upper cervical SMT and lowest with thoracic SMT.
... 4 Despite the accumulating body of literature demonstrating the significant impact of somatosensory input on autonomic regulation, the underlying physiologic mechanisms of this phenomenon are still poorly understood. 5 Research with animals 2 and humans 6,7 demonstrates that noxious input from both cutaneous and deep somatic tissues evokes systematic autonomic responses. Animal models demonstrate that pain arising from incision of the hindpaw leads to persistent colonic hypersensitivity. ...
Objective: Central sensitization has been associated with the pathophysiology of somatoautonomic responses however, the causal role of central sensitization in the clinical manifestation of somatoautonomic responses has not previously been demonstrated in humans. The purpose of this study was to test the hypothesis that a temporal relationship exists between experimentally induced central sensitization and skin temperature change within neurosegmentally linked dermatomes in young healthy humans. Methods: A total of 15 test (8 males, 7 females; age 21.2(1.3) years) and 12 control (5 males, 7 females; age 21.2(1.3) years) subjects were assessed. Central sensitization was induced using topical capsaicin (Zostrix, 0.075%), targeting the C3-C5 spinal levels in test subjects; controls received a non-sensitizing placebo cream. Skin temperature changes in segmentally linked versus segmentally distinct dermatomes were compared between groups at baseline, 10, 20 and 30 minutes post-sensitization, using infrared thermography. Results: Significantly greater decreases in average skin temperature were observed in the segmentally-linked dermatomes of test subjects versus controls at all time intervals (10, 20, 30 minutes) post-sensitization (p<0.001). Significantly decreased average skin temperatures were also observed in the segmentally linked dermatomes versus segmentally distinct dermatomes of test subjects, at all time intervals (P<0.050); these differences were not observed in controls. Conclusion: Our findings demonstrate neurosegmentally distributed skin temperature changes after experimental induction of central sensitization in healthy humans. These are the first observations in humans that offer support to the theory that central sensitization may be a contributing physiologic mechanism in the clinical expression of somatoautonomic responses in humans.
... 39,41 Other studies have reported similar results of both excitatory (increased force production or increased EMG mean/peak amplitudes) and inhibitory (decreased EMG amplitudes) responses after manual and mechanically assisted SM. 15,30,41,42 Spinal manipulation has further been shown to produce these effects through a complex process of positively altering somatosomatic reflexes. 2,[43][44][45][46][47] These results might offer additional insight into the differences in subjects' torque measurements within the current study beyond the variability inherent in any form of strength testing. ...
Objective:
The purpose of this study was to investigate the effect of manual manipulations targeting the lumbar spine and/or sacroiliac joint on concentric knee extension and flexion forces. Torque production was measured during isometric and isokinetic contractions.
Methods:
This was a randomized, controlled, single-blind crossover design with 21 asymptomatic, college-aged subjects who had never received spinal manipulation. During 2 separate sessions, subjects' peak torques were recorded while performing maximal voluntary contractions on an isokinetic dynamometer. Isometric knee extension and flexion were recorded at 60° of knee flexion, in addition to isokinetic measurements obtained at 60°/s and 180°/s. Baseline measurements were acquired before either treatment form of lumbosacral manipulation or sham manipulation, followed by identical peak torque measurements within 5 and 20 minutes posttreatment. Data were analyzed with a repeated measures analysis of variance.
Results:
A statistically significant difference did not occur between the effects of lumbosacral manipulation or the sham manipulation in the percentage changes of knee extension and flexion peak torques at 5 and 20 minutes posttreatment. Similar, nonsignificant results were observed in the overall percentage changes of isometric contractions (spinal manipulation 4.0 ± 9.5 vs sham 1.2 ± 6.3, P = .067), isokinetic contractions at 60°/s (spinal manipulation - 4.0 ± 14.2 vs sham - 0.3 ± 8.2, P = .34), and isokinetic contractions at 180°/s (spinal manipulation - 1.4 ± 13.9 vs sham - 5.5 ± 20.0, P = .18).
Conclusion:
The results of the current study suggest that spinal manipulation does not yield an immediate strength-enhancing effect about the knee in healthy, college-aged subjects when measured with isokinetic dynamometry.
... Néanmoins, ces expériences ne sont pas transposables à l'homme et la question de leur retentissement éventuel sur le fonctionnement organique chez l'être humain ne peut faire l'objet de conclusions dans l'état actuel des connaissances. » (Budgell 2000) Les définitions actuelles de la profession par les instances Franco-Européennes L'Académie Nationale de Médecine a publié un rapport sur « Ostéopathie et Chiropraxie » (Bull. Acadmed. ...
... Approximately two-thirds of chiropractors in North America address a condition known as subluxation (McDonald et al., 2004) which in concept includes a neurological component (Chiropractic, 2013). Consequently, the mechanism for a possible beneficial effect on hypertension from adjusting subluxation presumably pertains to neurological pathways in the spine and peripheral nervous system (Bolton, 2000;Budgell, 2000). ...
As concentration (dose) of health care providers increases, health outcomes (responses) are expected to be favorable (e.g., decrease in mortality rates). Accordingly, this data-driven, ecological study compares hypertension mortality rates in the U.S. by state to concentrations of doctors of chiropractic (DC) and medical doctors (MD). DC and MD concentrations (per 10,000 population) were separately compared to 2008 hypertension death rates using Spearman correlation analysis and linear regression (where appropriate). DC concentrations revealed a stronger beneficial association with hypertension death rates (r = -0.430, p = 0.0020) compared to MD concentrations (r = -0.029 with an observed outlier, and r = -0.085 without the outlier; both coefficients not statistically significant). Linear regression revealed that an average national decrease of approximately one hypertension death per 100,000 population (95% CI = -1.4 to -0.4) would be expected with an increase of one DC per 10,000 population within the range in this study (1.0 to 5.2 DCs per 10,000 population). Since this is an observational study, causal inference is not claimed. The study is intended as a first step to research having other designs such as case-control.
... A relationship between somatic and autonomic nervous system function has featured in several manual therapy theories to explain the effects of spinal manipulation on visceral function [9,31]. Work on experimental animals has shown that somatovisceral responses are consistently evoked through stimulation of C-fibres by noiciception, and through hyperstimulation of proprioceptors through movement of joints beyond their normal physiological range, as is common during joint manipulation [32]. Evidence of altered sympathetic activity has also been reported in humans after mobilisation of the elbow in lateral epicondylagia [33]. ...
Hypotheses on somatovisceral dysfunction often assume interference by stretch or compression of the nerve supply to visceral structures. The purpose of this study is to examine the potential of pelvic visceral movement to create tension of the loose connective tissue that contains the fine branches of the inferior hypogastric nerve plexus.
Twenty eight embalmed human cadavers were examined. Pelvic visceral structures were displaced by very gentle 5 N unidirectional tension and the associated movement of the endopelvic fascia containing the inferior hypogastric plexus that this caused was measured.
Most movement of the fascia containing the inferior hypogastric plexus was obtained by pulling the rectosigmoid junction or broad ligament of the uterus. The plexus did not cross any vertebral joints and the fascia containing it did not move on pulling the hypogastric nerve.
Uterine and rectosigmoid displacement produce most movement of the fascia containing the hypogastric nerve plexus, potentially resulting in nerve tension. In the living this might occur as a consequence of menstruation, pregnancy or constipation. This may be relevant to somatovisceral reflex theories of the effects of manual therapy on visceral conditions.
... The original idea (in modern terms) that central sensitization resulting from chronic spinal pain includes a domain of clinical effects based on disturbed segmentally organized sympathetic outflow remains elusive to investigation and clinical acceptance. Tantalizing evidence of this has been presented by Sato et al, 75,76 Sato and Swenson, 77 Budgell et al, [78][79][80][81][82][83] Fujimoto et al, 84 and Bolton et al. [85][86][87] The idea that sympathetic activation from spinal pain or stimulation of spinal sympathetic ganglia can be associated with or even cause cerebral hypoperfusion also has a long history (posterior cervical sympathetic syndrome of Barré,88,89 cervical migraine, and vertebrogenic migraine). [90][91][92] Nociceptive stimuli from dysfunctional motion segments of the spine activate the segmental sympathetic nervous system, and these somatic afferent stimuli will cause reactions in the preganglionic sympathetic neurons both segmentally [77][78][79][80][81]85 and suprasegmentally. ...
The purpose of this study was to determine the correlation between cerebral perfusion levels, Neck Disability Index (NDI) scores, and spinal joint fixations in patients with neck pain.
Forty-five adult patients (29 were female) with chronic neck/upper thoracic pain during exacerbation were studied. The subjects were grouped according to NDI scores: mild, moderate, and severe. The number of painful/blocked segments in the cervical and upper thoracic spine and costovertebral joints, pain intensity using the visual analog scale, and regional cerebral blood flow of the brain using single-photon emission computed tomography (SPECT) were obtained. The SPECT was analyzed semiquantitatively. Analysis of variance tests were conducted on total SPECT scores in each of the NDI groups (P < .05). Univariate correlations were obtained between blockage, pain, and SPECT scores, as well as age and duration. A multivariate analysis was then conducted.
Group 1 (mild) consisted of 14 patients. Cerebral perfusion measured by SPECT was normal in all 8 brain regions. Group 2 (moderate) consisted of 16 patients. In this group, a decrease in cerebral perfusion was observed (range, 20%-35%), predominantly in the parietal and frontal zones. Group 3 (severe) consisted of 15 patients. In this group, the decrease in cerebral perfusion observed was from 30% to 45%, again predominantly in the parietal and frontal zones. A significant difference was found between NDI groups ("moderate" and "severe" showed significantly greater hypoperfusion than "mild"). Total blockage score correlated with SPECT scores at r = 0.47, P = .001. In a multivariate analysis, NDI scores contributed 39% of the variance of SPECT scores.
In this group of patients with neck and/or upper back pain, NDI scores strongly predicted cerebral hypoperfusion. Spinal joint dysfunction may be involved via hyperactivity in the regional sympathetic nervous system.
... These patterns were highly variable between individuals but they were also stable and reproducible over several months. This is in agreement with the review by Budgell (2000) who found a link between noxious stimulation of spinal tissues and segmentally organised autonomic responses. Budgell also considered "innocuous" stimuli but failed to observe a link. ...
A theoretical framework for the role that fascia may play in apparently diverse passive manual therapies is presented. The relevant anatomy of fascia is briefly reviewed. Therapies are divided into myofascial ('soft tissue') and manipulative ('joint-based') and comparisons are made between them on a qualitative basis using measures of pain, function and 'autonomic activation'. When these three outcomes are evaluated between therapies it is observed that they are usually comparable in the quality, if not the quantity of the measures. Viewed from a patients' perspective alone the therapeutic benefits are hard to distinguish. It is proposed that a biologically plausible mechanism which may generate a significant component of the observed effects of manual therapies of all descriptions, is the therapeutic stimulation of fascia in its various forms within the body. Such considerations may help explain why diverse therapies apparently give comparable results.
... It should come as no surprise that neuroscience is one of the most important subjects in chiropractic schools because such basic knowledge may provide possible explanations underpinning chiropractic practice. 11 However, through an Internet search, we found that most of the chiropractic schools did not offer independent neurosciences courses. In the two schools that offered independent neurosciences courses, the total teaching hours were significantly less than the other basic science courses. ...
Most chiropractic colleges do not offer independent neuroscience courses because of an already crowded curriculum. The Palmer College of Chiropractic Florida has developed and implemented an integrated neuroscience program that incorporates neurosciences into different courses. The goals of the program have been to bring neurosciences to students, excite students about the interrelationship of neuroscience and chiropractic, improve students' understanding of neuroscience, and help the students understand the mechanisms underpinning the chiropractic practice. This study provides a descriptive analysis on how the integrated neuroscience program is taught via students' attitudes toward neuroscience and the comparison of students' perceptions of neuroscience content knowledge at different points in the program.
A questionnaire consisting of 58 questions regarding the neuroscience courses was conducted among 339 students. The questionnaire was developed by faculty members who were involved in teaching neuroscience and administered in the classroom by faculty members who were not involved in the study.
Student perceptions of their neuroscience knowledge, self-confidence, learning strategies, and knowledge application increased considerably through the quarters, especially among the 2nd-year students.
The integrated neuroscience program achieved several of its goals, including an increase in students' confidence, positive attitude, ability to learn, and perception of neuroscience content knowledge. The authors believe that such gains can expand student ability to interpret clinical cases and inspire students to become excited about chiropractic research. The survey provides valuable information for teaching faculty to make the course content more relevant to chiropractic students.
... 12 Biomechanical dysfunction of the spine and the ribcage can also present with a symptomatic picture easily confused with gastrointestinal problems through, for example, somatovisceral reflexes, referred pain, or reflex-induced muscle spasm. 13,14 Although the appropriate diagnosis (GERD) was missed by the first chiropractor, he suspected that something else was causing the complaint. These suspicions urged the doctor of chiropractic to refer the patient to a more specialized colleague. ...
To present the diagnosis and management of gastroesophageal reflux disease found in a pediatric patient, to discuss the importance of a detailed case history, and to bring forward some of the most important clues, both verbal and nonverbal, that can lead to the diagnosis.
An 8-year-old boy was brought to a chiropractic clinic by his mother complaining of headache and neck pain. Based on the history and physical examination, a diagnosis of cervicogenic headache was made.
Treatment consisted of chiropractic manipulation of the upper cervical spine in combination with cranial treatment was applied in addition to dietary advice. The headache returned and the patient was then referred to a colleague for a second opinion. Based on a detailed history, gastroesophageal reflux disease was diagnosed and the patient was referred to a specialist for suitable treatment.
Because of the position as first-line health practitioners, it is inevitable that doctors of chiropractic will be faced with complaints of a nonbiomechanical nature. It is important to recognize conditions, such as gastroesophageal reflux, at an early stage and to refer appropriately.
L’utilisation des manipulations articulaires dans la prise en charge de certains troubles musculosquelettiques est ancienne, répandue et soutenue par la littérature scientifique. Cependant, les mécanismes d’action des différentes techniques de manipulation sont mal compris. Le potentiel effet des manipulations articulaires sur l’activité autonome est une composante fondamentale de théories relatives à leurs mécanismes d’action. Une de ces théories propose l’activation, par les manipulations articulaires, du système inhibiteur descendant de la douleur via la stimulation de la substance grise périaqueducale, une structure qui participe à la coordination de la modulation de la douleur et de l’activité autonome. Cette théorie a toutefois été peu explorée dans la littérature. Le premier objectif de cette thèse était d’évaluer les effets spécifiques des différentes techniques de manipulation articulaire sur les marqueurs de l’activité autonome en réalisant une revue systématique de la littérature. Le second objectif était d’évaluer (i) l’effet spécifique d’une manipulation vertébrale avec impulsion sur l’activité autonome cardiovasculaire et sur le seuil de douleur à la pression, ainsi que (ii) la relation entre ces deux variables. Notre évaluation de la littérature suggère que certaines techniques de mobilisation articulaire, les mobilisations avec oscillations, produisent probablement, par rapport au placébo, une augmentation statistiquement significative de l’activité sympathique cutanée. Les manipulations vertébrales avec impulsion ainsi qu’une autre technique de mobilisation vertébrale pourraient, quant à elles, ne pas avoir d’effet spécifique sur l’activité autonome. Les résultats de notre essai expérimental suggèrent que l’application d’une manipulation vertébrale avec impulsion n’a pas d’effet spécifique sur l’activité autonome cardiovasculaire ni sur le seuil de douleur à la pression. De plus, nous n’avons pas mis en évidence de relation entre la modulation de la douleur et la modulation de l’activité autonome après l’intervention. Ainsi, ces données expérimentales ne sont pas en faveur de l’activation du système inhibiteur descendant de la douleur par ce type de manipulation. Pour conclure, nous suggérons de nouveaux travaux expérimentaux et cliniques dans ce domaine de recherche. Plusieurs recommandations sont formulées dans ce sens.
Objective:
The purpose of this study was to analyze the influence of thoracic spinal manipulation (SM) on autonomic modulation and heart rate in patients with rotator cuff tendinopathy.
Methods:
The design of the study was quasi-experimental. Participants were divided into 3 study groups: the asymptomatic group (n = 30), which received SM; the tendinitis group (TG, n = 30), which received SM; and the placebo group (PG, n = 30), which received placebo manipulation. Heart rate variability was analyzed with an electrocardiogram before and after intervention. For intragroup analysis, the paired Wilcoxon test was used to compare the means (pre vs post) of sex and age divided into 5 age groups. The Kruskal-Wallis test was employed for analysis between the groups, and a significance level of 5% was adopted.
Results:
The TG demonstrated an increase in respiratory rate (mean of the selected intervals corresponding to parasympathetic activity) post intervention for both sexes (P = .04). Heart rate exhibited reduction post intervention in women in the TG (P = .05). The PG demonstrated an increase in respiratory rate post intervention for both sexes (female P = .01; male P = .02). In the age groups, only the PG presented any difference in the 40- to 50-year and 50- to 60-year age groups (P = .03) for the same variable. Heart rate exhibited a reduction post intervention in women in the PG (P = .01) and a reduction in the 50- to 60-year age group (P = .04). No difference in the studied variables was observed in the asymptomatic group, and there were no differences among the groups.
Conclusions:
Upper thoracic SM does not directly influence autonomic modulation or heart rate.
Whether you initiate alternative therapies for children, or simply need to respond when asked for information or advice, it's crucial to have the most current, evidence-based information so that you can safely and effectively integrate CAM therapies with conventional treatment. This innovative and reliable reference is the ideal resource to have at hand. With its focus on integrating conventional medicine with the best complementary therapies for children, it familiarizes you with the scientific evidence and rationales for various CAM therapies, and clearly describes how to use them, in conjunction with conventional medicine. You'll find the information you need to distinguish among those therapies with good evidence, those that are safe but not yet proven to be effective, and those contraindicated for certain conditions. Covers a wide range of complementary and alternative therapies, focusing on those most often utilized with children: mind-body approaches (hypnosis, mind/body, probiotics, spirituality); manual therapies (chiropractic, massage, osteopathy, psychological); lifestyle approaches (nutrition, Qigong); alternative systems (homeopathy, naturopathy); energy medicine (acupuncture, aromatherapy, herbal, laser, magnets); and biological agents (Chinese and Western herbs and probiotics). 57 of the most common pediatric conditions are comprehensively discussed, first with a focus on conventional diagnostic and treatment information, then with authoritative information on the most effective and evidence-based CAM therapies available for treatment of the condition. Presents an integrative approach, combining conventional and alternative therapies. Helps you answer questions relevant to today's patients, such as giving echinacea for a cold, the use of acupuncture to treat ADHD, and which alternative therapies may be used to avoid side effects of conventional medication.
Spinal manipulation has shown to have neurophysiological effects on central nervous system, both nociceptive at a mechanical and autonomic level, but its mechanisms remain unknown. Recent studies suggest that spinal manipulation has widespread rather than local effects on pain perception, and in some variables dependent on the autonomic nervous system.
The aim of this study is to test whether a spinal manipulation of a thoracic dysfunction may decrease pain in a lumbar segment in the short term, in patients with chronic low back pain. Forty eight patients with chronic low back pain were randomized into three groups (n = 16 per group) in which a dorsal, lumbar manipulation or a placebo was performed. Patients had to climatize to the room temperature for a period of 16 minutes. Measurements of pain with visual analog scale (VAS), heart rate and blood oxygen saturation with a pulse-‐oximeter and paraspinal skin temperature with a handheld thermographic scanner TyTron C-‐5000 were recorded. Measurements were performed before and immediately acer the manipulation and without the patient getting up from the table throughout the procedure.
Perception of pain decreased significantly acer thoracic manipulation (p=0.02) and low back manipulation (p<0.01) compared to placebo. No statistically significant differences were found in measures of heart rate (p=0.93) and oxygen saturation (p=0.62), although heart rate decreased after manipulations and increased in the control group. Paraspinal skin temperature was found not to have statistically significant results. The results confirm that spinal manipulation has widespread effects on pain perception, but not on the autonomic nervous system. Mechanisms of action must continue to be investigated, although probably a decrease in sensitization of supraspinal processing centers and pain modulation take place. This may raise the pain threshold of all body segments. However, it remains unknown whether these effects on sensitization of supraspinal centers accumulate over several manipulations, reducing nociceptive afferents from other distal segments.
Objective:
The purpose of this study was to compare the effects of 2 different cervical manipulation techniques for mechanical neck pain (MNP).
Methods:
Participants with MNP of at least 1 month's duration (n = 65) were randomly allocated to 3 groups: (1) stretching (control), (2) stretching plus manually applied manipulation (MAM), and (3) stretching plus instrument-applied manipulation (IAM). MAM consisted of a single high-velocity, low-amplitude cervical chiropractic manipulation, whereas IAM involved the application of a single cervical manipulation using an (Activator IV) adjusting instrument. Preintervention and postintervention measurements were taken of all outcomes measures. Pain was the primary outcome and was measured using visual analogue scale and pressure pain thresholds. Secondary outcomes included cervical range of motion, hand grip-strength, and wrist blood pressure. Follow-up subjective pain scores were obtained via telephone text message 7 days postintervention.
Results:
Subjective pain scores decreased at 7-day follow-up in the MAM group compared with control (P = .015). Cervical rotation bilaterally (ipsilateral: P = .002; contralateral: P = .015) and lateral flexion on the contralateral side to manipulation (P = .001) increased following MAM. Hand grip-strength on the contralateral side to manipulation (P = .013) increased following IAM. No moderate or severe adverse events were reported. Mild adverse events were reported on 6 occasions (control, 4; MAM, 1; IAM, 1).
Conclusion:
This study demonstrates that a single cervical manipulation is capable of producing immediate and short-term benefits for MNP. The study also demonstrates that not all manipulative techniques have the same effect and that the differences may be mediated by neurological or biomechanical factors inherent to each technique.
Objective: To present a case report which describes a reduction in the clinical episodes of neurogenic (vaso-vagal) syncope in a 22 month old female under chiropractic management, and to provide the reader with information to assist in management of paediatric syncope in the chiropractic clinic. Clinical Features: A 22 month old female presented for assessment regarding recurrent, spontaneous loss of consciousness occurring since 16 months age. Thorough medical testing had revealed no pathology, and a presumptive diagnosis of neurogenic (vaso-vagal) syncope had been made. On examination an upper cervical subluxation was diagnosed using defined and reproducible criteria. Intervention and Outcome: A specific chiropractic adjustment was applied, resulting in an immediate reduction in the number of the syncopic episodes. A later relapse occurred, with repeated adjustment, leading to continued reduction in the number of episodes. Conclusions: Chiropractic management resulted in a reduction in the frequency of syncope episodes in a 22 month female. Further studies are required to elucidate possible mechanisms for the resolution in this case. Clinical management strategies are discussed to assist the chiropractor with clinical decision making in the child with syncope.
To develop a theoretical and clinical model based on tangential (follower) loading as a method of optimal force transmission in the spine to explain the traditional chiropractic concept of a vertebral subluxation and as a description and rational for the clinical entity that has been the object of chiropractic manipulative therapy (adjustment). Method: A brief review of the literature and relevant texts relating to the application of the mechanical concept of follower and tangential loads to the spine and the chiropractic concept of the vertebral subluxation was undertaken to determine common factors and inter-related components. Results: Relevant information from the literature relating to follower and tangential loading of the spine, vertebral subluxations and manipulation was correlated and synthesised into a model describing normal spinal mechanics and the loss of mechanical integrity of the spine. The model was developed as a theoretical basis for the chiropractic concept of the vertebral subluxation and as a mechanical rationale for spinal manipulation. Three key components were identified that were common to follower and tangential loads, subluxations and manipulation of the spine and were incorporated into the model. These involved active components, passive elements and feedback mechanisms previously described by Panjabi. Conclusion: The mechanical concepts underlying tangential loading of the spine have been applied to the chiropractic concept of the vertebral subluxation and spinal adjustment. Load theory and research provides chiropractic with a testable hypothesis for the clinical response to the adjustment and a theoretical basis for the subluxation as a clinical entity.
Chiropractic care includes a variety of minimally invasive approaches, with both treatment and prevention as essential elements of clinical practice. Although chiropractic adjustment (manipulation) is the signature therapy and best-known identifier of the profession, the practice of chiropractic involves more than manual therapeutics. In general, chiropractors seek to bring a holistic worldview to the doctor—patient encounter, seeking not only to relieve pain and restore neuromusculoskeletal function but also to support the inherent self-healing and self-regulating powers of the body. Aside from applying their diagnostic training to the evaluation of a variety of physical disorders and delivering manual adjustments and related therapeutic interventions, many chiropractors encourage patients to take an active role in restoring and maintaining health, with particular emphasis on doctor-guided self-care through exercise and nutrition. In this review, the authors summarize the peer-reviewed literature on chiropractic and prevention, describe health promotion and wellness approaches currently taught at chiropractic colleges and used in chiropractic clinical settings, discuss duration of care, emphasize the importance of interprofessional cooperation and collaboration, and address the hypothesis that chiropractic adjustments yield preventive effects.
Spinal manipulation is a safe and effective therapy for spinal pain disorders of mechanical origin, and has been identified as a treatment of choice for certain conditions. Chiropractic is the health profession that most commonly delivers spinal manipulation. Chiropractors are highly educated and receive thorough training in spinal manipulation. Many chiropractors use evidence-based protocols for the conservative treatment of spinal pain disorders. In practice, however, the conventional medical community as a whole has exhibited reluctance to accept chiropractic. A patient who presents to the emergency department with back or neck pain may be a candidate for spinal manipulation. Emergency department staff should have a basic understanding of the risks and benefits of spinal manipulation, and should be able to identify patients likely to benefit from referral to a chiropractor.
The animal model Caenorhabditis elegans was employed to study polyphenol- and humic substances-induced hormetic changes in lifespan. A detailed insight into the underlying mechanism of hormesis was uncovered by applying whole genome DNA microarray experimentation over a range of quercetin (Q), tannic acid (TA), and humic substances (HuminFeed(®), HF) concentrations. The transcriptional response to all exposures followed a non-linear mode which highlighted differential signaling and metabolic pathways. While low Q concentrations regulated processes improving the health of the nematodes, higher concentrations extended lifespan and modulated substantially the global transcriptional response. Over-represented transcripts were notably part of the biotransformation process: enhanced catabolism of toxic intermediates possibly contributes to the lifespan extension. The regulation of transcription, Dauer entry, and nucleosome suggests the presence of distinct exposure dependent differences in transcription and signaling pathways. TA- and HF-mediated transcript expression patterns were overall similar to each other, but changed across the concentration range indicating that their transcriptional dynamics are complex and cannot be attributed to a simple adaptive response. In contrast, Q-mediated hormesis was well aligned to fit the definition of an adaptive response. Simple molecules are more likely to induce an adaptive response than more complex molecules.
A hierarchy of survival reflexes for prioritising assessment and treatment in patients with pain of insidious onset is hypothesised. The hierarchy asserts that some systems are more vital than others and that the central nervous system (CNS) prioritises systems based on their significance to survival. The hypothesis suggests that dysfunction in more important systems will cause compensation in less important systems. This paper presents studies examining these effects for each system, arguing that each section of the hierarchy may have effects on other systems within the hierarchy. This concept is untested empirically, highly speculative and substantial research is required to validate the suggested hierarchical prioritisation by the CNS. Nonetheless, the hierarchy does provide a theoretical framework to use to exclude contributing systems in patients with pain of insidious onset.
Objectives
The objectives of this study were to report on and evaluate the results of chiropractic treatment of patients referred from an ear, nose and throat (ENT) department with neck/jaw-related symptoms.
Methods
The target group consisted of 46 consecutive patients who had experienced a long period of diversified symptoms relating to neck and jaw dysfunction. Clinical and neurological examinations by an ENT specialist revealed no pathology; further, skeletal radiography and magnetic resonance imaging findings were normal. Diagnoses prior to referral to an ENT department were diverse, but all had neck and/or jaw complaints.
Chiropractic examination indicated that the patients had neck/jaw dysfunction and related compensatory biomechanics. According to predetermined inclusion and exclusion criteria, all patients were treated at the chiropractor's clinic. The mean follow-up period was two years.
Results
All but six patients benefited from the treatment, and there was a clear reduction in sick leave among the patients compared with conventional medical treatment.
Conclusions
To our knowledge, this is the first report on the work of a chiropractor participating on the initiative of ENT staff within an ENT department of a Norwegian hospital and an ENT specialist's private clinic. The results might hopefully increase referrals to chiropractors in the treatment of patients with neuromusculoskeletal dysfunction. Based on our experience, we believe that the presented collaboration should encourage closer relations between ENT physicians and chiropractors, and hopefully encourage further research on the topic.
Objective: Pulse oximetry is used regularly to assess oxygen saturation levels. The objective
of this commentary is to discuss a rationale for using pulse oximetry in chiropractic practice.
Discussion: Pulse oximetry may offer doctors of chiropractic a way to monitor patients' oxygen
saturation levels. Quantification of saturation values with heart rate may give clinical aid to the
management of chiropractic patients.Markedly reduced saturation levels may necessitatemedical
referral, whereas mildly reduced levels could lead to changes in chiropractic management.
Conclusions: Pulse oximetry has the potential to be an integral part of chiropractic practice.
Chiropractors are aware that body wall or somatic symptoms may be caused by visceral disorders. This single case study reports on a patient whose longstanding neck and shoulder region discomfort, whilst relieved by regular chiropractic care, disappeared after she underwent a cholecystectomy. The surgery followed an episode of acute biliary pain caused by obstruction of the biliary duct by a large gallstone; the first and only indication of her having a gall bladder disorder. This case raises the question of to what degree asymptomatic disorders of the viscera are responsible for or contribute to other somatic disorders chiropractors commonly manage.
Objective: To present two case studies in which the complete resolution of infantile colic and associated symptoms was achieved with chiropractic treatment. This case series supports the aetiological mechanism of an imbalanced autonomic nervous system, via somatovisceral reflexes secondary to regional cranial and spinal dysfunction. In addition, they provide support towards the birth process being a causative factor in the development of colic.Design: A case series.Setting: Private chiropractic practice.Subjects: The first case involved a 7-week-old male infant presenting with medically diagnosed colic, with associated reflux and disturbed sleep, all of which were persistent since birth. The second infant, aged 10 weeks, had suffered maternally diagnosed colic for approximately 1 month. Associated symptoms included some vomiting and asymmetry with breast-feeding. Both infants demonstrated many typical colic characteristics and had experienced birth trauma. Upper cervical, mid thoracic, sacroiliac and cranial dysfunction was recorded in both cases.Methods: Each infant received diversified paediatric chiropractic manipulation to the areas diagnosed as dysfunctional. Treatment was provided over a 3-week period, though the intensity differed for the two infants.Results: Complete resolution of all presenting symptoms was achieved in both instances.Conclusion: These cases suggest a possible association between birth trauma; the development of cranial and spinal segmental dysfunction and consequential manifestation of symptoms of infantile colic. Secondly, they demonstrate chiropractic treatment successfully restoring correct spinal and cranial motion, with an associated resolution of symptoms.
This paper discusses the several theories pertaining to the chiropractic adjustment, in- cluding the nerve compression theory, reflex theories, and pain relief theories. There is now sufficient scientific research to consider these theories reasonable working models to explain the effects of the adjustment but insufficient to consider them valid. (J Manipulative Physiol Ther 2000;23:112-4) Key Indexing Terms: Chiropractic; Neurology; Pain
Pulse oximetry is used regularly to assess oxygen saturation levels. The objective of this commentary is to discuss a rationale for using pulse oximetry in chiropractic practice.
Pulse oximetry may offer doctors of chiropractic a way to monitor patients' oxygen saturation levels. Quantification of saturation values with heart rate may give clinical aid to the management of chiropractic patients. Markedly reduced saturation levels may necessitate medical referral, whereas mildly reduced levels could lead to changes in chiropractic management.
Pulse oximetry has the potential to be an integral part of chiropractic practice.
The origins of chiropractic therapyOsteopathic beginningsRelationship among chiropractors, osteopaths and the medical professionPrinciples of manipulative therapiesIndications for manipulationPotential benefits of spinal manipulationRisks and complications associated with manipulative therapiesSummaryReferences
Resumen: OBJETIVOS: Comprobar la influencia que tiene la movilización vertebral con el método Praxis Vertebral sobre la presión arterial sanguínea. DISEÑO: Este ensayo clínico compara el comportamiento entre un grupo de pacientes clasificados con presión sanguínea Normal – Pre hipertensión (hasta 140 mmHg) versus otro clasificado en Estadio 1 y 2 de Hipertensión (más de 140 mmHg) antes y después de aplicada la praxis. El estudio fue llevado a cabo en el Centro Integral Doctor Pistacchia en la ciudad de Tres Arroyos, Buenos Aires, Argentina. PARTICIPANTES: Fueron enrolados ciento cincuenta y seis individuos de ambos sexos, comprendidos entre 15-90 años de edad con presión sanguínea Normal – Pre-hipertensión y Estadio 1 y 2 de Hipertensión. Todos los participantes completaron el estudio. INTERVENCIONES: Un protocolo de intervención con movilización vertebral, método Praxis Vertebral administrado por un doctor en kinesiología, en una sola sesión. RESULTADOS: Las mediciones iniciales en la frecuencia cardiaca, presión sanguínea sistólica y diastólica fueron comparadas con otras, luego de haber realizado la praxis. 2 En el grupo de Normotensos o en Pre-Hipertensión, los cambios en la frecuencia cardiaca fueron estadísticamente significativos. Mientras que no se registraron cambios significativos tanto en la presión sanguínea sistólica como diastólica. Para el grupo de Hipertensos en Estadios 1 y 2, los cambios fueron estadísticamente significativos tanto en la frecuencia cardiaca como en la presión sanguínea sistólica, mientras que no fueron significativos en la presión sanguínea diastólica. CONCLUSIONES: En los individuos hipertensos la Praxis Vertebral mostró una disminución en los valores de la presión sanguínea sistólica de 9 mmHg dentro de los 10 primeros minutos de realizada la práctica, mostrando una tendencia a normalizar la presión sanguínea.
The purpose of this study was to investigate the short-term effects of spinal manipulation applied to a hypomobile segment of the upper thoracic spine (T1-T6), on plasma concentrations of norepinephrine (NE) and epinephrine (E) in asymptomatic subjects, under strictly controlled conditions.
Fifty-six asymptomatic subjects were randomly assigned to receive either a chiropractic manipulative intervention or a sham intervention in the upper thoracic spine. A 20-gauge catheter fitted with a saline lock was used to sample blood before, immediately after, and 15 minutes after intervention. Plasma NE and E concentrations were determined using an enzyme-linked immunosorbent assay. Changes in plasma catecholamine concentrations were analyzed within and between groups using 1- and 2-sample t tests, respectively.
The plasma samples of 36 subjects (18 treatment, 18 control) were used in the analysis. Mean plasma concentrations of NE and E did not significantly differ between the 2 groups at any time point and did not change significantly after either the manipulative or sham intervention.
The results of this study indicate that a manipulative thrust directed to a hypomobile segment in the upper thoracic spine of asymptomatic subjects does not have a measurable effect on the plasma concentrations of NE or E. These results provide a baseline measure of the sympathetic response to spinal manipulation.
In addition to impacting the affected child and his/her family's quality of life, recent estimates place the lifetime cost for an individual with ASD at 35 billion for the entire birth cohort. Given the clinical heterogeneity of ASD, treatment approaches are multidisciplinary including alternative therapies, particularly when no pharmaceutical agent is effective for the core symptoms of ASD. Chiropractic is a popular alternative therapy for children. A systematic review of the literature was performed to provide context for future research endeavors in this field.
A systematic review of the literature on the chiropractic care of patients with ASD utilized 8 databases. Eligibility criteria for inclusion included: (1) the study was a primary investigation/report published in an English peer-reviewed journal; (2) the study involved patients ≤18 years; and (3) patients are diagnosed with autism, Asperger's Syndrome, PDD-NOS, or ASD.
Our systematic review of the literature revealed a total of five articles consisting of three case reports, one cohort study and one randomized comparison trial. The literature is lacking on documenting the chiropractic care of children with ASD.
At the heart of the core symptoms of ASD (ie, impaired social interactions, deficits in communication and repetitive or restricted behavioral patterns) is abnormal sensory processing. Preliminary studies indicate that the chiropractic adjustment may attenuate sensorimotor integration based on somatosensory evoked potentials studies.
We encourage further research for definitive studies on chiropractic's effectiveness for ASD. However, given the ineffectiveness of pharmaceutical agents, a trial of chiropractic care for sufferers of autism is prudent and warranted.
The aims of this study were to investigate the response of the autonomic nervous system based upon the area of the spine adjusted and to determine if a cervical adjustment elicits a parasympathetic response and if a thoracic adjustment elicits a sympathetic response.
Forty patients (25-55 years old) met inclusion criteria that consisted of normal blood pressure, no history of heart disease, and being asymptomatic. Patients were evaluated pre- and post-chiropractic adjustment for the following autonomic responses: blood pressure and pulse rate. Seven patients were measured for heart rate variability. The subjects received either a diversified cervical segment adjustment or a diversified thoracic segment adjustment.
Diastolic pressure (indicating a sympathetic response) dropped significantly postadjustment among those receiving cervical adjustments, accompanied by a moderate clinical effect (0.50). Pulse pressure increased significantly among those receiving cervical adjustments, accompanied by a large effect size (0.82). Although the decrease in pulse pressure for those receiving thoracic adjustments was not statistically significant, the decrease was accompanied by a moderate effect size (0.66).
It is preliminarily suggested that cervical adjustments may result in parasympathetic responses, whereas thoracic adjustments result in sympathetic responses. Furthermore, it appears that these responses may demonstrate the relationship of autonomic responses in association to the particular segment(s) adjusted.
Research concerning the development of low back pain (LBP) has traditionally focused on risk factors in search of explanations. This review focuses on comorbidity as a first step in identifying a frail subpopulation with a higher risk of developing low back pain, in particular persistent low back pain. Research into comorbidity might yield a greater understanding of the underlying mechanism for low back pain. Data sources Medline was searched from the beginning of the data base to December 2000, followed by a search through the authors' personal collections of epidemiologic literature regarding low back pain. All articles written in English were included if they related LBP to at least one other physical disorder. Articles were excluded if the prevalence of such disorders could not be compared to that of a control group or to the expected prevalence in a normal population. Data extraction The retrieved articles were evaluated for quality based on predefined methodological criteria, whereupon information about associations between low back pain and other physical disorders was extracted.
Twenty-three articles were included. They showed positive associations to all disorders investigated (headache/migraine, respiratory disorders, cardiovascular disease, general health, and others) with the exception of diabetes. There was very little information regarding temporality, therefore there are no clues as to causal mechanisms.
The literature leaves no doubt that diseases cluster in some individuals and that low back pain is part of this pattern. However, the nature of the relationship between low back pain and other disorders is still unclear.
To review written resources disclosing reliable facts and knowledge in chiropractic services in cancer pain management.
Conventional and biomedical and complementary and alternative medicine journals, electronic media, full text databases, electronic resources, books in print, and newsletters.
The judicial use of chiropractic services in cancer patients appears to offer many economical and effective strategies for reducing the pain and suffering of cancer patients, as well as providing the potential to improve patient health overall.
Clinicians should assess and support the use of chiropractic services in cancer patients. Chiropractic is one of the leading alternatives to standard medical treatment in cancer pain management.
Farmers report more low back pain (LBP) than rural referents. We have previously demonstrated that the difference in reporting rate cannot be fully explained by known risk factors such as physical work exposures, psychosocial factors and lifestyle. Other etiological factors must be involved. In this cross-sectional population-based study, we investigate LBP comorbidity in terms of coexistent symptoms. A total of 1,013 male farmers, 40-60 years old, and 769 matched rural referents participated in an extensive health survey. Information on causes of primary health care and hospital admissions, symptoms, lifestyle factors, physical work exposures and psychosocial factors were gathered through standardized interviews and questionnaires. In the combined farmer-referent group, the prevalence of LBP was associated with musculoskeletal symptoms other than LBP, chest discomfort, dyspepsia, symptoms from eyes, nose and throat mucous membranes, skin problems, work-related fever attacks, and primary care appointments due to digestive disorders. The associations were independent of age, educational level, smoking habits, body mass index, physical work exposures and psychosocial factors. Presence of both respiratory and digestive disorders doubled the LBP prevalence. Significant associations between LBP and digestive and respiratory disorders were revealed, indicating that LBP and these disease entities may have etiological factors in common.
It is well established that the vestibular system influences the sympathetic nervous system and the respiratory system; presumably, vestibulosympathetic and vestibulorespiratory responses participate in maintaining stable blood pressure and blood oxygenation during movement and changes in posture. Many brainstem neurons that generate vestibulospinal reflexes integrate signals from the labyrinth and neck muscles to distinguish between head movements on a stable body and whole body movements. In the present study, responses were recorded from the splanchnic (sympathetic), hypoglossal (inspiratory) and abdominal (expiratory) nerves during stimulation of the C2 dorsal root ganglion or C2 or C3 nerve branches innervating dorsal neck muscles. Stimulation of neck afferents using low current intensities, in many cases less than twice the threshold for producing an afferent volley recordable from the cord dorsum, elicited changes in sympathetic and respiratory nerve activity. These data suggest that head rotation on a stable body would elicit both cervical and vestibular inputs to respiratory motoneurons and sympathetic preganglionic neurons. The effects of cervical afferent stimulation on abdominal, splanchnic and hypoglossal nerve activity were not abolished by transection of the brainstem caudal to the vestibular nuclei; thus, pathways in addition to those involving the vestibular nuclei are involved in relaying cervical inputs to sympathetic preganglionic neurons and respiratory motoneurons. Transection of the C1-3 dorsal roots enhanced responses of the splanchnic and abdominal nerves to pitch head rotations on a fixed body but diminished responses of the hypoglossal nerve. Thus, neck and vestibular afferent influences on activity of respiratory pump muscles and sympathetic outflow appear to be antagonistic, so that responses will occur during whole body movements but not head movements on a stationary trunk. In contrast, neck and vestibular influences on tongue musculature are complementary, presumably to produce tongue protrusion either during movements of the head alone or of the whole body.
Arterial tonometry was used to continuously monitor the effects on heart rate and blood pressure of a series of innocuous mechanical stimuli applied to the neck in conscious humans. The stimuli used were derived from procedures commonly employed in clinical examination and physical therapy of the neck. In alert subjects, the stimuli used generally caused small and sometimes statistically significant decreases in heart rate, systolic pressure and diastolic pressure. In alert subjects, statistically significant decreases in systolic and diastolic pressure were particularly associated with stimuli which involved full rotation of the neck. In the course of the prolonged series of stimuli, some subjects slept or reported being on the verge of sleep. In these subjects, the same stimuli produced mixed effects on heart rate and increases in systolic and diastolic pressure which were significantly different from the effects obtained in fully alert subjects.
The effects of mechanical stimulation of the spine on blood pressure, heart rate and the activity of selected sympathetic nerves (renal and adrenal) were examined in alpha-chloralose/urethane anesthetized rats. Spinal segments from T10 to T13 or from L4 to L7 were isolated from surrounding muscle and the upper and lower segments of the four segment units were fixed by means of spinal clamps. Forces from 0.5 to 3.0 kg were applied to the lateral aspect of the two mobile segments. Stimulations of the thoracic or the lumbar region produced large decreases in blood pressure (-29.8 +/- 3.1 mmHg) along with small decreases in heart rate (6.1 +/- 1.6 beats/min). Additionally, large and immediate decreases were observed in renal nerve activity. While responses attenuated during the course of stimulation, they generally outlasted the stimulus. The adrenal nerve, after an initial decline in activity, showed subsequent increases which were attributed to baroreceptor effects, since bilateral lesion of the vagi and carotid sinus nerves abolished them. After baroreceptor denervations only initial decreases in activity were observed by mechanical stimulation of the spine. The observed responses were found not to be due to spinal cord compression, but rather were ascribed to afferent fiber mediated reflexes. Cutting dorsal (sensory) roots T10 to L2, bilaterally, abolished the response to lower lumbar stimulation. Additionally, in recording from the peripheral end of the severed dorsal roots, large increases in afferent activity were observed by spine stimulation. The present study has demonstrated potent somatovisceral reflexes from mechanical stimulation of the spinal column. These results are discussed in relation to other studies of somatovisceral responses and with regard to various clinical reports.
The effects of passive movements of normal and inflamed knee joints on blood pressure and heart rate were recorded in baroreceptor denervated cats anesthetized with halothane, and these effects were compared with those obtained by severe noxious squeezing of the hind paw. Rhythmic flexions and extensions as well as rhythmic inward and outward rotations of a normal knee joint in its physiological working range did not have any significant influence on blood pressure and heart rate. However, on the inflamed side, the same movements caused definite increases in blood pressure and heart rate (e.g. mean increases for flexion-extension movements were 13 mmHg and 4 beats/min, respectively, P less than 0.01). Static outward rotations in the normal working range were ineffective in both joints, but as soon as these static rotations were extended into the noxious range significant increases in blood pressure and heart rate were elicited. The respective mean increases induced from the normal and inflamed sides were 17 and 38 mmHg for the blood pressure and 4 and 8 beats/min for the heart rate. The increases in blood pressure and heart rate induced by noxious outward rotation of the inflamed joint regularly exceeded those elicited by noxious squeezing of the hind paw. It is concluded that impulses in articular nociceptors and possibly other fine articular afferent units activate sympathetic outflow to the cardiovascular system, and that these effects are particularly prominent when the joint receptors are sensitized by
In cats anesthetized with chloralose and urethane graded electrical stimulation of cutaneous and muscle nerves of the fore- and hindlimb was performed and the resulting changes in heart rate and blood pressure were recorded. The vagus nerves were cut and the right carotid artery was tied off. The left carotid sinus was intact. Repetitive stimulation of cutanous group II afferents did not change the heart rate nor the blood pressure. Cutaneous group III afferent activity led to an increased heart rate in about 70% of all trials. Very consistent increases in heart rate were always seen when repetitive group IV cutaneous volleys were elicited. Volleys in group I and II muscle afferents were ineffective. With group III muscle volleys bradycardiac (in about 40% of all trials) or tachycardiac (in about 30%) responses were observed. The nature of the response depended on the experimental situation but was difficult to predict or to modify. Stimulation of group IV muscle afferents always induced definite increases in heart rate. The latency for the onset of the heart rate changes was of the order of 3-10 s, and the time to peak during prolonged stimulation was about 20-30 s. There was a marked early and a small late response adaptation during prolonged repetitive stimulation, but the control heart rate was only reached some 40-65 s after the end of the stimulation. For group IV volleys the minimal effective frequency of the repetitive stimulation was between 0.25 and 1.0 Hz, the.
The effects of noxious mechanical stimulation of various segmental areas on heart rate and mean arterial blood pressure (MAP), as well as cardiac and renal sympathetic nerve activities were examined in anesthetized rats with the central nervous system (CNS) intact or acutely spinalized at the cervical level. In CNS-intact rats, pinching for 20 s applied to any segmental skin area, but particularly that of the paw, produced an increase in heart rate, blood pressure and the sympathetic nerve activities. In acutely spinalized rats, pinching the chest, abdomen and back of the body produced large increases, while hindlimb and perineum stimulation induced only a small increase or no increase in heart rate, blood pressure and the sympathetic nerve activities. Stimulation of the right side produced particularly large responses in heart rate and stimulation of the ipsilateral side produced large responses in cardiac and renal sympathetic nerve activities in spinalized rats. These results suggest the existence of the two types of reflex responses, supraspinal and propriospinal, in the somatocardiovascular reflex. The supraspinal one has characteristics of diffuse reflex organization, while the propriospinal one has strong segmental and lateral organization.
In urethane-anesthetized Wistar rats, the responses of adrenal sympathetic nerve activity and catecholamine secretion were measured following chemical stimulation of lumbar and thoracic interspinous tissues. Injection of normal saline into the lower lumbar or lower thoracic interspinous tissues produced no changes in adrenal sympathetic nerve activity or catecholamine secretion. On the other hand, the injection of capsaicin produced protracted increases in adrenal nerve activity and catecholamine secretion both in CNS-intact animals and in animals acutely spinalized at the Cl-2 level. Repetitive electrical stimulation of the medial branch of a lumbar primary dorsal ramus, the nerve which provides sensation to the lumbar interspinous tissues, produced A- and C-reflex discharges, mediated at the spinal and supraspinal levels, in the adrenal sympathetic nerve.
To determine the effects of somatic stimulation, including noxious chemical stimulation of interspinous tissues, on bladder motility in the anesthetized rat.
Changes in pressure in the previously quiescent bladder were measured in anesthetized adult female Wistar rats after various forms of noxious and innocuous somatic stimulation, including injection of the thoracic and lumbar interspinous tissues with capsaicin. Measurements were taken in both central nervous system-intact and spinalized animals, as well as in animals in whom the pelvic nerves had been transected bilaterally. Changes in bladder pressure were also measured in response to electrical stimulation of the primary dorsal ramus of lumbar spinal nerves.
Noxious and innocuous stimulation of the fore- and hindpaws and the skin overlying the sacrum generally failed to elicit discernible changes in bladder pressure. However, capsaicin injection of thoracic and lumbar interspinous tissues produced profound and long-lasting increases in bladder pressure. There were no significant differences in the responses to thoracic, as opposed to lumbar, stimulation. Spinalization above the level of stimulation abolished the response to capsaicin injection, as did bilateral transection of the pelvic nerves.
In general, pressure in the quiescent bladder was relatively insensitive to somatic stimulation. However, noxious chemical stimulation of the interspinous tissues produced a nonsegmentally organized, supraspinal, parasympathetically mediated reflex increase in bladder tone.