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1| Vol. 2018, Issue-0101 Jou Neu Psy Brain Res. JNPB-103
Name of The Journal Ksmos Publishers
Review Article Jou Neu Psy Brain. JNPB-103
Chiropractic and Mental Health: History and Review of Putative
Neurobiological Mechanisms
1. Keywords
Chiropractic, history, mental health, vertebral
subluxation, manipulation, depression, anxiety,
addiction, hospitals, autonomic nervous system,
biological oscillators, neuroplasticity, polyvagal
theory, neurovisceral integration, heart rate
variability, resiliency, adaptability, salutogenesis
2. Introduction
Musculoskeletal conditions are the predominant
reason persons seek chiropractic care. The top five
reported reasons for attending chiropractic care are
low back pain/back pain, neck pain, extremity
problems, wellness/maintenance and hip pain. The
top five reasons for pediatric cases to attend
chiropractic care are musculoskeletal conditions,
excessive crying, neurological conditions,
gastrointestinal conditions, and ear, nose, and throat
conditions [1]. Although many chiropractors and
those they serve tend to focus on disorders associated
with the physical body, abnormal nervous system
function may also affect emotional and psychological
health. The author completed a brief historical
overview of chiropractic and mental health [2]. This
work represents expansion of that paper, and
inclusion of putative neurobiological mechanisms.
Name of The Journal…
Journal of Neurology, Psychiatry
and Brain Research
Christopher Kent*
Director of Evidence-Informed Curriculum and Practice, Sherman College of Chiropractic, Spartanburg, South
Carolina, USA
*Corresponding author: Christopher Kent, Director of Evidence-Informed Curriculum and Practice, Sherman College
of Chiropractic, Spartanburg, South Carolina, USA. Tel: +18645788770; Email: ckent@sherman.edu
Citation: Kent C (2018) Chiropractic and Mental Health: History and Review of Putative Neurobiological Mechanisms.
Jou Neuro Psy An Brain Res: JNPB-103.
Received Date: 20 July, 2018; Accepted Date: 1 August, 2018; Published Date: 13 August, 2018
Abstract:
The chiropractic profession has a long history of acknowledging the relationship between nervous system function and
mental health. This paper reviews the history of chiropractic involvement in mental health issues, chiropractic institutions
specializing in the care of mental health problems, and the putative neurobiological mechanisms associated with vertebral
subluxation and dysregulation of the autonomic nervous system.
Citation: Kent C (2018) Chiropractic and Mental Health: History and Review of Putative Neurobiological
Mechanisms. Jou Neuro Psy An Brain Res: JNPB-103.
2 | Vol. 2018, Issue-01 Jou Neu Psy Brain Res. JNPB-103
3. History
D.D. Palmer founded the chiropractic profession
123 years ago. He described vertebral subluxations as
“slightly displaced vertebrae which press against
nerves causing impingements, the result being too
much or not enough functioning” [3]. According to
his son, B.J. Palmer, "D.D. Palmer was the first man
to discover that insanity was caused by displaced
cervical vertebrae, that by replacing them the patient
could be restored to normal condition" [4]. B.J. also
described his expert testimony in a case where he
stated, "If an atlas is subluxated it makes abnormal
the functions of the brain." In answer to the question,
"What is to be done in insanity?" he admonished his
reader to "Go back to cause. Adjust that and return
that brain to its normal capacity and capability" [5].
Another pioneer in the field of mental health and
chiropractic was attorney and chiropractor Willard
Carver. Carver authored the book, Pyscho-Bio-
Physiology, and wrote, “Between the Psychology and
the Physiology I have built the Biologic bridge that
scientifically connects these two very important
departments of human experience” [6].
In the 1920s, several inpatient mental health
facilities were established where chiropractic
adjustments were the dominant clinical service
provided. Two of these were located in Davenport,
Iowa. In 1922, the Chiropractic Psychopathic
Sanitarium was established. The facility was later
known as Forest Park Sanitarium. North Dakota
Judge A. W. Ponath noted that at the North Dakota
state mental hospital, the "cure and discharge rate"
ranged from 18-27%, compared to 65% at Forest
Park [7]. The second facility, Clear View Sanitarium,
was established in 1926. In 1951, Clear View was
acquired by the Palmer School of Chiropractic.
Chiropractor W. Heath Quigley, who directed the
sanitarium, described the clinical protocol: "Each
day, each patient was examined with the
neurocalometer (NCM). If the clinician interpreted
the NCM to indicate nerve impingement, the patient
was adjusted." Quigley reported that the rooms were
"sunny and bright," and that meals included "large
servings of fresh vegetables...from a garden" [8].
Unfortunately, both institutions closed, (Forest Park
in 1959 and Clear View in 1961) in large measure
because of third party pay issues. Insurance
companies often refused to pay the costs of care.
Furthermore, Iowa statutes at the time did not provide
for licensing specialized hospitals; only full service
medical hospitals were eligible for licensure. Clear
View was not licensed as a hospital, and functioned
legally as a nursing home [9].
The 1970s saw a renewed interest in chiropractic
care and mental health issues. In 1973, Chiropractor
Herman S. Schwartz edited a book titled "Mental
Health and Chiropractic: A Multidisciplinary
Approach." Contributors included Nobel Laureates
Rene Dubos and Linus Pauling, and such notables as
Scott Haldeman, A.E. Homewood, Joseph Janse,
Alexander Lowen, and Thomas Szasz [10]. In 1949,
Schwartz had published a preliminary report of 350
patients afflicted with a "nervous or mental disorder"
and reported that the majority of them showed
improvement under chiropractic care [11]. Schwartz
was active in the ACA Council on Mental Health
(formerly Council on Psychotherapy), which
survived through the '70s, but no longer exists. In
1983, Quigley authored an article describing a four
decades period where "treatment of the mentally ill
was a highly motivated discipline within the
chiropractic profession" [12]. In 1988, Goff wrote a
review of the theory and practice of "chiropractic
treatment for mental illness" [13]. Interest in this field
continues. Blanks, Schuster and Dobson [14]
published the results of a retrospective assessment of
subluxation based chiropractic care on self related
health, wellness and quality of life. This is, to the
authors’ knowledge, the largest study of its kind ever
undertaken regarding a chiropractic population. After
surveying 2,818 respondents in 156 practices, a
strong connection was found between persons
receiving Network Spinal care (a chiropractic
technique) and self reported improvement in health,
wellness and quality of life.
A systematic review was published which
examined psychological outcomes in randomized
controlled trials of spinal manipulation The study
concluded that “There was some evidence that spinal
manipulation improved psychological outcomes
compared with verbal interventions…The clinical
implications are that physical treatments, such as
spinal manipulation have psychological benefits”
[15]. Genthner et al [16] reported on a series of 15
patients with a history of depression. The Beck
Depression Inventory II (BDI-II) was used to
Citation: Kent C (2018) Chiropractic and Mental Health: History and Review of Putative Neurobiological
Mechanisms. Jou Neuro Psy An Brain Res: JNPB-103.
3 | Vol. 2018, Issue-01 Jou Neu Psy Brain Res. JNPB-103
measure the baseline level of depression and any
post-chiropractic care changes following
orthospinology care, a chiropractic technique focused
on correcting misalignments of the craniocervical
junction. A paired t-test demonstrated significant
improvement in depression test scores. A study
evaluating the role of chiropractic care in persons
undergoing inpatient addiction care consisted of a
three arm randomized clinical trial with two control
groups (one receiving usual medical care, and the
other placebo controlled). This was a single blind
study utilizing subluxation-centered chiropractic care,
Torque-Release technique, implemented in a
residential addiction care setting. The active group
showed a significant decrease in anxiety while the
placebo group showed no decrease in anxiety [17].
Other articles addressing mental health issues and
chiropractic care have been published, ranging from
single case reports to randomized clinical trials.
Favorable responses were reported in persons with
conditions including depression [18], ADHD [19],
autism [20], dyslexia and learning disabilities [21].
Additionally, published papers report changes in
general health measures in chiropractic patients using
the RAND-36 and Global Well Being Scale (GWBS)
[22], changes in domains of health related quality of
life among public safety personnel undergoing
chiropractic care [23], and chiropractic care in
patients with cancer-related traumatic stress
symptoms [24].
4. Salutogenesis
Chiropractic care incorporates a salutogenic
approach. Sociologist Aaron Antonovsky coined the
term salutogenesis in 1979. It is derived from salus,
Latin for health, and genesis, meaning to give birth.
Salutogenesis, the study of the origins and creation of
health, provides a method to identify an
interconnected way to enhance well-being.
Salutogenesis provides a framework for a method of
practice to promote health [25].
Salutogenic theory goes to the very essence of
neurobiology. It has been noted that neurological
processes (as well as anatomical structures) are
remodeled by sensory input. These processes,
collectively termed neuroplasticity, are operative at
all levels of the nervous system. Smith [26] described
the range of these mechanisms: "From the afferent
(incoming) activity of peripheral sensory receptors to
the efferent (outgoing) activity directed toward
neuroendocrine organs, blood vessels, and muscles.
Although the selectivity of perception probably
makes it impossible to be aware of everything that is
happening throughout the body, it is evident that
these regulatory processes are essential for one's
health, and that they provide the basis for functional
salutogenic mechanisms of the brain." Smith further
noted, "An organism with a salutogenic brain would
experience the world as manageable and coherent ...
with a self-perpetuating cycle for enhancing self-
confidence and well-being."
5. Stress Responsivity
Hans Selye [27] pioneered investigations of the
biological effects of stress in 1936 with the
publication of his paper, "A syndrome produced by
diverse noxious agents." Since then, more than
100,000 articles and books have been written on the
subject. Selye describes stress as the nonspecific
response to any demand. Although many individuals
have concluded that stress is inevitably destructive,
this view is incorrect. Selye noted, "Stress is not
necessarily bad for you. It is also the spice of life, for
any emotion, any activity causes stress...the same
stress that makes one person sick is an invigorating
experience for another...Complete absence of stress is
incompatible with life since only a dead man makes
no demand on his body or mind." Selye described
two types of stress: Dis-stress -- from the Latin "bad,"
as in dissonance, and Eu-stress from the Greek "true"
or "good," as in eutonia. Whether we experience a
pleasant or unpleasant result from an event depends
upon how our nervous system perceives, processes,
and interprets that event. More than 15 years before
Selye's historic publication, B.J. Palmer and J.H.
Craven [28] described a similar concept: concussion
of forces. This term refers to the meeting of external
invasive forces and internal resistive forces. Just as
stress may be destructive or beneficial, concussion of
forces may produce or reduce vertebral subluxation.
The result is dis-ease or ease. "That which caused the
normal cycle to become abnormal was a concussion
of forces centering at some point in the spinal column
causing a subluxation...tissues do not nor cannot
express their normal function." Palmer [29] quotes
Webster's definition of adaptation: "To make
suitable; to fit; or suit; to adjust; alter so as to fit for a
new use." More than 60 years later, Selye [30] wrote,
Citation: Kent C (2018) Chiropractic and Mental Health: History and Review of Putative Neurobiological
Mechanisms. Jou Neuro Psy An Brain Res: JNPB-103.
4 | Vol. 2018, Issue-01 Jou Neu Psy Brain Res. JNPB-103
"Every living being has a certain innate amount of
adaptation energy or vitality." When a concussion of
forces is corrective, Palmer [29] noted the following
changes: "Perversion changed to verification; abuse
to proper natural use; abnormal interpretation to
normal interpretation; distortion to healthful
manifestation; corruption to correction." Although it
is unlikely that Selye was familiar with the writings
of Palmer and Craven, the similarities are striking:
Stress and concussion of forces; eu-stress and ease;
dis-stress and disease. The practical application of
these concepts requires a working definition of
health. The World Health Organization (WHO) [31]
defines health as "A state of complete physical,
mental, and social well-being and not merely the
absence of disease or infirmity." In this context,
Selye [30] wrote, "The secret of health and happiness
lies in successful adjustment to the ever-changing
conditions on this globe; the penalties for failure in
this great process of adaptation are disease and
unhappiness."
6. Putative Neurobiological Mechanisms
6.1. Vertebral Subluxation
In 1906, DD Palmer and BJ Palmer [32] defined
subluxation as follows: “A (sub)luxation of a joint, to
a chiropractor, means pressure on nerves, abnormal
functions creating a lesion in some portion of the
body, either in its action, or makeup”. Lantz [33]
noted, “Common to all concepts of subluxation are
some form of kinesiologic dysfunction and some
form of neurologic involvement”. Mechanical and
degenerative changes associated with vertebral
subluxation may result in a variety of neurological
consequences:
Cord compression and adverse cord
tension: Compression of the spinal cord
may result from disc protrusion, ligamentum
flavum hypertrophy/corrugation, or
osteophytosis. Myelopathy may result in
cord pressure and/or pressure which
interferes with the arterial supply [34-39].
Nerve root compression: Compromise of
the nerve roots may develop following disc
protrusion or osteophytosis [40]. Spinal
nerve roots are exquisitely sensitive to
compression [41-43].
Local irritation: This includes irritation of
mechanoreceptive and nociceptive fibers
within the intervertebral motion segments
[44].
Vertebral artery compromise: MacNab
advises that osteophytes may cause vertebral
artery compression [45].
Autonomic dysfunction: Symptoms
associated with the autonomic nervous
system have been reported in patients with
cervical spine trauma. The Barre’-Lieou
syndrome includes blurred vision, tinnitus,
vertigo, temporary deafness, and shoulder
pain. This phenomenon is also known as the
posterior cervical syndrome [46] Stimulation
of sympathetic nerves has been implicated in
the pathogenesis of this syndrome [47].
Coherence and oscillatory patterns:
Coherent oscillations are a characteristic of
the human brain. [48] Furthermore, it has
been proposed that synchronization of
multiple rhythms is an essential
manifestation of living processes [49].
Epstein describes wave activity association
with Network Spinal care, a chiropractic
technique involving light touches to the
spine. According to Senzon, Epstein and
Lemberger, “The network wave occurs at a
higher self-organizational threshold, in the
absence of significant adverse mechanical
cord tension, and with enhanced self-
regulation of the spinal subsystems. With
the onset of central pattern generation,
modulated through the network wave,
reorganizational behavior may emerge in the
individual's spine and life as a whole” [50].
6.2. Operational Model of Vertebral Subluxation
The author has proposed an operational model for
the assessment of neurological dysregulation
associated with vertebral subluxation [51]. The four
components of this model include:
Dysafferentation: The intervertebral motion
segment is richly endowed with nociceptive and
Citation: Kent C (2018) Chiropractic and Mental Health: History and Review of Putative Neurobiological
Mechanisms. Jou Neuro Psy An Brain Res: JNPB-103.
5 | Vol. 2018, Issue-01 Jou Neu Psy Brain Res. JNPB-103
mechanoreceptive structures [52-57]. As a
consequence, biomechanical dysfunction caused
by vertebral subluxation may result in altered
nociception and/ or mechanoreception.
Dyskinesia: Dyskinesia refers to distortion or
impairment of voluntary movement [58]. Spinal
motion may be reliably measured using
inclinometry [59]. Alterations in regional ranges
of motion may be associated with vertebral
subluxation [60].
Dysponesis: Dysponesis is evidenced by
abnormal tonic muscle activity. Dysponesis
refers to a reversible physiopathologic state
consisting of errors in energy expenditure, which
is capable of producing functional disorders.
Dysponesis consists mainly of covert errors in
action potential output from the motor and
premotor areas of the cortex and the
consequences of that output. These
neurophysiological reactions may result from
responses to environmental events, bodily
sensations, and emotions. The resulting aberrant
muscle activity may be evaluated using surface
electrode techniques [61,62]. Typically, static
surface electromyography (sEMG) with axial
loading of the spine is used to evaluate innate
responses to gravitational stress [63].
Dysautonomia: The autonomic nervous system
regulates the actions of organs, glands, and blood
vessels. Acquired dysautonomia may be
associated with a broad array of functional
abnormalities [64-70]. Sympathetic tone may be
evaluated by measuring skin temperature
differentials using paraspinal infrared
thermography [71]. Such techniques have been
used to monitor changes in neurological function
associated with vertebral subluxations [72].
7. Autonomic Dysregulation and Mental
Health
Variability in heart rate reflects the vagal and
sympathetic function of the autonomic nervous
system, and is used as a monitoring tool in clinical
conditions characterized by altered autonomic
nervous system activity. Spectral analysis of beat-to-
beat variability is a simple, non-invasive technique to
evaluate autonomic dysfunction. Vertebral
subluxations are changes in the position or motion of
a vertebra, which result in the interference with nerve
function. Vertebral subluxations may result in altered
autonomic nervous system activity. Heart rate
variability is a reliable and valid tool that may be
used to assess the changes in autonomic activity
associated with the reduction and correction of
vertebral subluxations [72]. Recent studies have
reported the potential utility of HRV in the evaluation
of conditions and states associated with autonomic
dysregulation. These include carotid intima media
thickness [73], prediction of mortality [74], multiple
sclerosis [75,76], eating behavior [77], burnout and
depression [78], chronic posttraumatic stress disorder
[79], working memory performance [80], dementia
[81], inflammation in rheumatoid arthritis [82],
insulin resistance and metabolic syndrome [83], type
1 diabetes [84], cardiac autonomic nerve function in
obese school-age children [85], cancer prognosis
[86,87] and cognition [88,89]. In the mental health
field, associations have been identified between
cardiac vagal activity, immunometabolic risk factors,
and depression [90]. Higher Beck Depression
Inventory-II (BDI-II) scores were associated with
decreased HRV [91]. Oh and Chae [92] note that
HRV may be a crucial marker for mental health.
They report that “HRV properties might be related to
the degree of optimistic perspectives on life, and
suggests that HRV markers of autonomic nervous
system function could reflect positive human mind
states.” Fiskum et al [93] state, “Internal
psychopathology and dysregulated negative affect are
characterized by dysregulation in the autonomic
nervous system and reduced heart rate variability
(HRV) due to increases in sympathetic activity
alongside reduced vagal tone…Higher informational
entropy was related to less psychopathology and less
negative effect, and may provide an index of the
organizational flexibility of the neurovisceral
system.”
Polyvagal theory (PVT), proposed by Porges [94]
posits that physiological state limits the range of
behavior and psychological experience. Porges notes,
“The theory links the evolution of the autonomic
nervous system to affective experience, emotional
expression, facial gestures, vocal communication,
and contingent social behavior. In this way, the
theory provides a plausible explanation for the
reported covariation between atypical autonomic
regulation (eg, reduced vagal and increased
Citation: Kent C (2018) Chiropractic and Mental Health: History and Review of Putative Neurobiological
Mechanisms. Jou Neuro Psy An Brain Res: JNPB-103.
6 | Vol. 2018, Issue-01 Jou Neu Psy Brain Res. JNPB-103
sympathetic influences to the heart) and psychiatric
and behavioral disorders that involve difficulties in
regulating appropriate social, emotional, and
communication behaviors.” Sullivan et al [95]
explain that “PVT links the evolution of the
autonomic nervous system to the emergence of
prosocial behaviors and posits that the neural
platforms supporting social behavior are involved in
maintaining health, growth and restoration. This
explanatory model which connects
neurophysiological patterns of autonomic regulation
and expression of emotional and social behavior, is
increasingly utilized as a framework for
understanding human behavior, stress and illness.”
The authors describe how PVT is related to self-
regulation, resilience, and adaptability. Smith et al
[96] proposed the neurovisceral integration (NVI)
model to explain observed relationships between
peripheral physiology, cognitive performance, and
emotional and physical health. This model is
supported largely from studies examining cardiac
vagal control. An expanded model describes the
multilevel structure and function of vagal control.
Higher levels are associated with
cognitive/attentional responses, regulation based on
perceptual representation of one's current
somatic/visceral state, regulation based on
conceptualization of sensory input and past
experience, and amplifying, maintaining, or
suppressing representations based on current goals. In
reviewing the literature concerning HRV and
chiropractic care, Kent concluded, “Case reports
suggest that favorable changes in heart rate
variability may follow reduction or correction of
vertebral subluxations. Higher quality studies of
larger populations should be conducted. It is
biologically plausible that the changes in autonomic
nervous system function following reduction or
correction of vertebral subluxation may be
objectively assessed using heart rate variability” [72].
8. Conclusion
Chiropractic care is concerned with the totality of
the human experience. Vertebral subluxations may
result in autonomic dysregulation, compromising the
adaptive capacity of the organism. By analyzing and
correcting vertebral subluxations, a patient is placed
on a more optimum physiological path, potentially
increasing resilience and adaptability. Further
research into the effects of vertebral subluxations on
mental health, the neurobiological mechanisms
involved, and the use of reliable and valid outcomes
assessments should be undertaken. It is biologically
plausible that vertebral subluxations compromise
nervous system function and affect mental health.
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