Chiropractic Management of Work-related Upper Limb Disorder Complicated By Intraosseous Ganglion Cysts: A Case Report
This case demonstrates successful chiropractic management of a patient with WRULD complicated by ganglion cysts. Further larger-scale studies are recommended to determine if chiropractic management demonstrates positive outcomes for this condition.
Numerous condtions, notably nerve entrapment syndromes, account for symptoms in the upper extremities. Some are quite common and familiar, while others are remote. In this article, an algorithmic approach has been utilized to describe a broad variety of neurological and non-neurological conditions and to provide readers with an overview of each. The algorithm is intended to be used by the non-specialist who is interested in expanding his list of differential diagnoses for a patient’s complaint. It is a reference tool, not a cookbook for diagnosis. Likewise, a planar diagram cannot provide a definitive diagnosis. Common sense and experience will do that.
This study is not the only example of such confusion. A similar study  demonstrates a comparable ignorance of manual medicine diversity, duplicating the methodologic flaws, favorable outcomes, and unfounded conclusions of the study by Balon and others. The researchers in this study compared two forms of manual therapy for the treatment of tension headache. The experimental treatment consisted of standard HVLA chiropractic treatment and deep friction massage, plus trigger point therapy if indicated. The subjects receiving this intervention were designated as the “manipulation” group. The control group received deep friction massage plus low-power laser light (considered not to be efficacious for tension headache). Thus, essentially, one form of manual medicine is again compared to another. The researchers observed that “by week 7, each group experienced significant reductions in mean daily headache hours … and mean number of analgesics per day.”  Because both groups benefited equally, the authors concluded that “As an isolated intervention, spinal manipulation does not seem to have a positive effect on episodic tension-type headaches.” 
Outcomes of Acute and Chronic Patients With Magnetic Resonance Imaging–Confirmed Symptomatic Lumbar Disc Herniations Receiving High-Velocity, Low-Amplitude, Spinal Manipulative Therapy: A Prospective Observational Cohort Study With One-Year Follow-Up
A large percentage of acute and importantly chronic lumbar disc herniation patients treated with high-velocity, low-amplitude side posture SMT reported clinically relevant “improvement” with no serious adverse events.
By adulthood, the IVD is a largely fibrocartilaginous structure that permits limited motion while offering resistance against compressive loading. With degenerative change, there is a disruption in homeostatic regulation of the degenerative/damaged IVD leading to increased levels of catabolic and pain-causing cytokines in addition to granular or scar tissue formation rendering it vulnerable to further injury. With respect to non-operative treatment of spinal pain, numerous studies support the use of SMT and MOB; however, this remains controversial and lumbar disc herniation (LDH) remains the number one malpractice claim made against chiropractors.  Another non-operative treatment for DDD is non-surgical spinal decompression however; there is no mechanistic, biological evidence to support the notion that this form of treatment can re-hydrate a degenerative disc. Therefore, prior to selecting a form of treatment, the clinician should be aware of the biological model of IVD and apply an evidence-based, judicious approach to the management of patients afflicted with these disorders.
Comparison of Outcomes in Neck Pain Patients With and Without Dizziness Undergoing Chiropractic Treatment: A Prospective Cohort Study With 6 month Follow-up
A high proportion of patients with and without dizziness reported clinically relevant improvement at 1, 3 and 6 months. Although neck pain patients with dizziness undergoing chiropractic treatment reported significantly higher pain and disability scores at baseline compared to neck pain patients without dizziness, there were no significant differences in any outcome measures between the two groups at 6 months after start of treatment. Neck pain patients with dizziness were much more likely to be female and females with dizziness report higher levels of depression compared to males with dizziness at all data collection time points.
Outcomes From Magnetic Resonance Imaging– Confirmed Symptomatic Cervical Disk Herniation Patients Treated With High-Velocity, Low-Amplitude Spinal Manipulative Therapy: A Prospective Cohort Study With 3-Month Follow-Up
A high proportion of acute and most importantly subacute/chronic patients with MRI-confirmed symptomatic cervical disk herniations treated with high-velocity, low-amplitude cervical spine manipulation reported clinically relevant improvement at 1 and 3 months after the first treatment. There were no adverse events reported for patients in this study.
The studies included in this guideline indicate that cervical manipulation, mobilization, manual therapy, exercise, and massage can be recommended for the chiropractic treatment of nonspecific, mechanical neck pain. The strongest recommendations are typically made for the primary intervention in combination with another intervention, usually exercise and/or patient education. Owing to conflicting findings in the literature, no recommendation could be made for laser, TENS, or thoracic manipulation in the treatment of chronic neck pain or for the use of thoracic manipulation in the treatment of acute neck pain. There is a lack of evidence to support the use of laser, trigger point therapy, or traction for nonspecific, mechanical neck pain in adults.
Spinal manipulative therapy (SMT) with home exercise resulted in greater pain reduction after 12 weeks of treatment compared with both supervised plus HE and HE alone. Supervised exercise sessions added little benefit to the HE-alone program.
At present there is no satisfactory treatment for non-specific or age related dizziness. However, there is preliminary evidence that physical treatment of the neck may improve balance in neck pain patients. Therefore, it is important to examine the possible therapeutic effect of chiropractic interventions (particularly SMT) directed at the neck in treatment of this condition and prevention of falls in this subpopulation of the elderly. The need for this research is particularly acute given the substantial health and economic costs of falls in the elderly and the aging of the population in the industrialised world. We know that postural stability and motor control relies on integration of proprioceptive vestibular and visual inputs by the CNS, inputs that are widely believed to deteriorate with age. Neck pain is widely believed to be capable of compromising mechanisms of postural balance by distorting the proprioceptive input from the neck to the CNS. It is possible that integration of incongruous inputs by CNS balance centres becomes more challenging as proprioceptive visual and vestibular sensory mechanisms age. Whilst neck manipulation, a commonly practiced treatment by chiropractors, has shown effectiveness for neck pain, it has not been adequately evaluated for non-specific dizziness. However, there is encouraging preliminary data that seems to support the use of neck manipulation in treating this condition. Given that both spinal pain and dizziness are risk factors for balance deficits and falls in the elderly, rigorously designed randomised controlled trials are needed in this area. These trials should focus on both efficacy and effectiveness of the various chiropractic neck manipulation and mobilisation techniques and strategies on: neck pain; non-specific dizziness; dizziness-related disability; and falls frequency in the community dwelling elderly population.
The researchers discovered that children in both age groups were significantly more hyperactive and that they had shorter attention spans if they had consumed the drink containing the additives. The study did not try to link specific consumption with specific behaviors. The study’s authors noted that other research suggested that the hyperactivity could increase in as little as an hour after artificial additives were consumed.
The Chiropractic Care of Children with Attention-deficit/Hyperactivity Disorder: A Retrospective Case Series
A retrospective case series of ADHD patients under chiropractic care is described. This provides supporting evidence on the benefits of chiropractic spinal manipulative therapy. We encourage further research in this area.
Chiropractic Care for Pediatric and Adolescent Attention-Deficit/Hyperactivity Disorder: A Systematic Review
The current finding for this systematic review has been classified as an ‘empty review’. As a result, to date there is no high quality evidence to evaluate the efficacy of chiropractic care for pediatric and adolescent AD/HD. The claims made by chiropractors that chiropractic care improves AD/HD symptomatology for young people is only supported by low levels of scientific evidence. In the interest of pediatric and adolescent health, if chiropractic care is to continue for this clinical population, more rigorous scientific research needs to be undertaken to examine the efficacy and effectiveness of chiropractic treatment for AD/HD. Adequately-sized RCTs using clinically relevant outcomes and standardised measures to examine the effectiveness of chiropractic care verses no-treatment/placebo control or standard care (pharmacological and psychosocial care) are needed to determine whether chiropractic care is an effective alternative intervention for pediatric and adolescent AD/HD.
Effects of a Restricted Elimination Diet on the Behaviour of Children With Attention-deficit Hyperactivity Disorder (INCA study): A Randomised Controlled Trial
In the INCA study, the restricted elimination diet had a significant beneficial effect on ADHD symptoms in 32 (64%) of 50 children, and reintroducing foods led to a significant behavioural relapse in clinical responders. Blood tests assessing IgG levels against foods did not predict which foods might have a deleterious behavioural effect. The effect of the diet was consistent and had a similar effect in reducing both ADHD and oppositional defiant disorder symptoms. Because of the worse prognosis of children with comorbid oppositional defiant disorder compared with those without comorbid disease, interventions that reduce oppositional defiant disorder symptoms have great clinical potential. The number of children with conduct disorder was, in accordance with the young age of the patients, too small to draw conclusions.
Complementary and Alternative Medical Therapies for Children With Attention-deficit/ Hyperactivity Disorder (ADHD)
It is a well-established theory that electronic media can influence children’s development.  Research has shown that early television watching (ages 1-3) is associated with the development of attention problems in children by age seven.  Another study showed that children who watch two or more hours of television per day had increased attention problems in adolescence, suggesting that the adverse effects of television may be cumulative.  One possible explanation for these findings is that television watching replaces other activities that encourage concentration and attention, such as reading. Also, children’s television programs may overstimulate the developing brain of a young child, leading to sensory addiction.  One result of sensory addiction is difficulty coping with slowness. In children, this can manifest as an inability to regulate their own behavior, motivating the need for more stimulus-seeking behavior. Restlessness, anxiety, and impulsivity may result from a perceived lack of stimulation.  Further studies are needed in this field for a fuller evaluation of the association between television and ADHD.  According to a study published in the journal, Epidemiology, children exposed to mobile phones prenatally and, to a lesser extent, postnatally, were 80-percent more likely to exhibit ADHD-type symptoms, such as hyperactivity and behavioral problems, at school-going age.  Although this association has yet to be substantially proven, it does raise cause for concern due to the widespread use of this technology.
Natural light deficiency has been suggested as a risk factor for ADHD.  Exposure to cool-white fluorescent lights appears to affect learning ability in children, and research suggests that it may also be linked with the incidence of attention-deficit disorder and hyperactivity. One study showed that there was a 32-percent reduction in hyperactive behavior in children when fluorescent lighting was removed from their classrooms.  As a result, it has been suggested that radio-frequency (RF)-shielded full-spectrum lighting and/or natural unfiltered daylight preferably be used.  Spending time outdoors in “green” natural settings appears to improve ADHD symptoms.  Moreover, the greener and more natural the environment compared to indoor or relatively built up outdoor settings (e.g., parking lots, downtown areas), the less severe the ADHD symptoms.
In this case study, chiropractic made a demonstrable difference through objective and subjective outcomes. Further investigations using double-blind, cross-over designs with larger samples are warranted.
Comparative Efficacy of Conservative Medical and Chiropractic Treatments for Carpal Tunnel Syndrome: A Randomized Clinical Trial
Carpal tunnel syndrome associated with median nerve demyelination but not axonal degeneration may be treated with commonly used components of conservative medical or chiropractic care.
Numbness in an arm or hand is a common presenting or secondary patient complaint. Carpal tunnel syndrome poses a familiar mechanism and is frequently cited as the cause of the patient’s symptoms. While it may be the most common upper-extremity peripheral nerve entrapment neuropathy, a myriad of other nerve entrapment sites and pathologies are capable of producing upper-limb symptoms. In this article, an algorithmic approach by topographical region is utilized to narrow or expand the diagnostic focus.
There is a high rate of injury to professional classical musicians and teachers that can be disruptive to practice and potentially threatening top careers. Females and string players were discovered to be of particular risk. The majority of injuries were to the shoulder and proximal thoracic spine and the absence of injuries in amateur players suggests a relationship to overuse. The author suggests that the incorporation of postural and ergonomic into musical education and chiropractic treatment programmes for classical musicians and teachers could be of benefit.
Neurodynamic Mobilization in the Conservative Treatment of Cubital Tunnel Syndrome: Long-Term Follow-Up of 7 Cases
This study demonstrated that conservative treatment of CTS may be beneficial for selected patients with mild to moderate symptoms. This study used neurodynamic mobilizations, including sliding techniques and tensioning techniques, which are thought to enhance ulnar nerve gliding and restore neural tissue mobility. Conservative treatment using neurodynamic mobilization with patient education and activity modification demonstrated some long-term positive results.
Substituting Lifestyle Management for Pharmacological Control of Blood Pressure: A Pilot Study in Australian General Practice
The HEART project was conducted in general practice to determine whether lifestyle strategies, aimed at increasing physical activity and dietary modification, can be substituted for drug therapy in patients who have been well controlled on antihypertensive medication. In addition to blood pressure (BP) and risk factor outcomes, lifestyle behaviours, quality of life of patients, and the acceptability of the approach to both general practitioners (GPs) and patients involved in the trial were assessed. Patients (n = 45) with a history of hypertension and who had been well controlled for at least the past 6 months (BP < 160/ 95 mmHg) were randomised to a continued medication (C) group (n = 24) or a withdrawal (W) group (n = 21). Subjects had received antihypertensive therapy for an average of 7.8 years (range 1-28 years). Drug therapy in the W group was recommenced if BP exceeded 160/95 mmHg on two consecutive visits. Both groups were counselled regarding lifestyle behaviour change by their GP throughout the study and were provided with specifically developed self-help materials. Subjects were reviewed at least monthly over a 9-month period. Following randomisation, there were no significant differences between the two groups for BP, heart rate, age, duration of therapy, total cholesterol or body mass index. All but three subjects (one from the W and two from the C group) completed 9 months of monitoring following randomisation and there were no cardiovascular events; 71% of subjects remained off drug therapy and were well controlled at the 9-month follow-up (15/21) with mean BP of 141/85 mmHg (W) and 139/ 86 mmHg (C). Systolic BP tended to increase during the study period in both W and C groups, however, no significant differences were observed in mean systolic or diastolic BP either between the two groups or within each group in comparison to baseline values. Resting heart rate, body mass index and cholesterol levels remained unchanged in both W and C groups after 9 months follow-up. There were no changes attributable to the lifestyle intervention in the subjects continuing drug therapy in BP or lifestyle variables over the study period. However, the group stopping therapy had a 6% reduction in body mass index after 9 months. These data suggest that a proportion of motivated patients willing to trial a lifestyle approach can cease drug therapy and be adequately maintained by the prescription of lifestyle advice via their GP for at least a 9-month period. Cessation of drug therapy may be an important motivating factor to achieve weight loss in this group.
Almost 50 million Americans suffer from high blood pressure (BP), and cardiovascular disease has been the primary cause of death in the U.S. for over 80 years. Studies show that reducing BP reduces risk for heart disease and death, even when lowered by only a small amount. Medications have been shown to lower risk for cardiovascular disease, but because they may have dangerous side effects, aerobic exercise alone can be prescribed to lower BP.
To find out if exercise can reduce BP in all groups of people, the authors of a recent review in the Annals of Internal Medicine examined the results of more than 50 previous studies. They combined the results of these studies (involving a total of about 2,500 individuals) to determine the effectiveness of exercise to reduce BP in various groups, and to determine if specific types of exercise are more effective than others.
Any form of aerobic exercise significantly reduced BP in every type of previously sedentary person, regardless of race, gender, weight, and presence of hypertension (high BP). Frequency and intensity of exercise also did not appear to significantly affect BP.
Even a small decrease in average BP can dramatically lower your risk for cardiovascular disease and death. Whether or not you currently have high blood pressure, maintain a consistent regimen of aerobic exercise to ward off disease, premature death, and obesity.
Lifestyle change, including diet, exercise, and stress management, may contribute significantly to lowering of blood pressure. Supplements such as potassium, magnesium, CoQ10, omega-3 fatty acids, amino acids L-arginine and taurine, and vitamins C and E have been effectively used in the treatment of cardiovascular disease, including hypertension. Botanicals have been used for centuries to treat various diseases including cardiovascular disorders. It is no surprise they have proven effective in lowering blood pressure and improving heart function. Among the most researched and frequently utilized for hypertension are hawthorne, Terminalia arjuna, olive leaf, European mistletoe, yarrow, black cumin seeds, forskolin, Indian snakeroot, and garlic. More research is indicated to determine the full potential that alternative medicine has to offer in the management of hypertension. With the increasing numbers of patients suffering from hypertension and conventional medicine failing to effectively control the problem, alternative therapies offer hope.
The Management of Hypertensive Disease: A Review of Spinal Manipulation and the Efficacy of Conservative Therapeusis
When considering the ailments that plague mankind, certainly one of the enigmatic conditions is hypertensive disease. This perplexing disorder is recognized insidiously in the clinical setting. It is believed to occur because of the complex interactions of a variety of factors which act on the components of the blood vasculature. Although afflicted individuals may appear relatively asymptomatic, the additive influences of such factors eventually culminate in deleterious sequelae. Overall, hypertension appears to be related to stress, diet and lifestyle. The autonomic nervous system, particularly its sympathetic component, appears to mediate such accumulated factors, affecting the overall clinical scenario of hypertension. Although generally aligned with the aging process, this condition also may affect younger individuals. Hypertension, therefore, may be regarded as a prime condition warranting specialized care that includes proper education during the formative years, modification of dietary habits in conjunction with daily exercise regimens, and regular spinal maintenance, all of which are covered by modern chiropractic clinical practice.
The C1 Area of the Brainstem in Tonic and Reflex Control of Blood Pressure. State of the Art Lecture
Recent studies have demonstrated that the neurons of the lower brainstem that are responsible for maintaining normal levels of arterial pressure reside in a specific area of the rostral ventrolateral medulla. In rat, the critical zone corresponds to a small region containing a subpopulation of the adrenergic C1 group, defined immunocytochemically by the presence of the epinephrine-synthesizing enzyme phenylethanolamine N-methyltransferase. Neurons of this region (the C1 area), possibly including the adrenergic neurons, directly innervate preganglionic neurons in the spinal cord, and are tonically active and sympathoexcitatory. The excitatory transmitter released into the spinal cord is unknown. The discharge of C1 area neurons is locked to the cardiac cycle and, in turn, leads to firing of sympathetic preganglionic neurons. The C1 area neurons are inhibited by baroceptor input and mediate the vascular component of baroceptor reflexes. They also mediate somato-sympathetic pressor responses from skin and muscle and participate in reflex responses to hypoxia. The neurons are directly innervated by local neurons containing gamma-aminobutyric acid, acetylcholine, enkephalin, and substance P, all of which modulate arterial pressure. The C1 area is the site of the hypotensive actions of clonidine. Clonidine appears to act on imidazole receptors in the C1 area to lower arterial pressure. The natural ligand for these receptors may be a newly defined substance in brain, clonidine-displacing substance. Neurons of the C1 area appear to be the critical neuronal group governing the normal resting and reflex control of arterial pressure. They may play a critical role in the maintenance of elevated arterial pressure in hypertension and as a site of action of antihypertensive drugs.
This study examined the effects of chiropractic adjustments of the thoracic spine (T1-T5) on blood pressure and state anxiety in 21 patients with elevated blood pressure. Subjects were randomly assigned to one of three treatment conditions: active treatment, placebo treatment, or no treatment control. The adjustments were performed by a mechanical chiropractic adjusting device. Dependent measures obtained pre- and post-treatment included systolic and diastolic blood pressure, and state anxiety. Results indicated that systolic and diastolic blood pressure decreased significantly in the active treatment condition, whereas no significant changes occurred in the placebo and control conditions. State anxiety significantly decreased in the active and control conditions. Results provide support for the hypothesis that blood pressure is reduced following chiropractic treatment. Further study is needed to examine the long-term effects of chiropractic treatment on blood pressure.
The purpose of this study was to evaluate the reliability of clinical blood pressure readings and to begin a series of experiments to determine if chiropractic adjustments cause any significant changes in blood pressure. Seventy-five students undergoing routine chiropractic health care at Palmer College of Chiropractic Clinic volunteered to participate in the blood pressure measurement protocol in one 10-min visit. These subjects were placed into one of two groups, based on the clinical findings from the chiropractic examination. One group, the Experimental group was formed on the basis that they had subluxations in the cervical spine and also were adjusted specifically for them. The Control group was similar but lacked manipulable cervical subluxations on that particular day and were not adjusted. Clinical and experimental procedures were carried out identically on each group. Subjects were examined by standard Gonstead palpatory methods after 5 min of quiet sitting in a cervical chair. Blood pressure was recorded by right arm cuff sphygmomanometer by an experienced chiropractor immediately before and again immediately after either the specific cervical adjustment or the control procedure, which was simply motion palpation. The doctors measuring blood pressures did not know to which group the subject had been assigned. Both systolic and diastolic blood pressures were statistically significantly lowered in the Experimental but not the Control group (p less than 0.01). The difference in the mean blood pressures was small and was brought about by 14 of the Experimental subjects who experienced a clinically relevant 10-20 mm hg drop. Reliability of blood pressure measurements by two doctors was established under similar conditions in an additional 25 subjects.
Time Course Considerations for the Effect of Lower Cervical Adjustments with Respect to the Amelioration of Cervical Lateral Flexion Passive End–range Asymmetries, and on Blood Pressure, Heart Rate, and Plasma Catecholamine Levels
The biomechanical and physiological effects of a single, unilateral lower cervical spinal adjustment delivered to the most restricted side of cervical lateral-flexion passive end-range were examined. Only healthy, asymptomatic male subjects who exhibited goniometrically verified lateral-flexion passive range of motion asymmetries of 10 degrees or greater on the morning of the experiment were chosen for the study. Posttreatment goniometric measurements revealed that in sham-adjusted controls, mean lateral-flexion asymmetries had not changed significantly during the 4-hr time period examined. However, in subjects who received lower cervical adjustments, dramatic ameliorations of asymmetry magnitude were observed which persisted throughout the entire 4-hr posttreatment time period. On the other hand, in the face of this rather robust biomechanical effect, heart rate and blood pressure measurements obtained at -60 and -15 min prior to treatments, and at 5, 30, 60, 120 and 240 min following treatments, revealed no significant differences between adjusted and sham-adjusted subjects at any of the time periods examined. Consistent with this, analysis of the plasma concentrations of norepinephrine, epinephrine and dopamine in serial blood samples collected at these same times also failed to reveal significant differences between treatment groups at any of the time periods examined. The results of this investigation indicate that lower cervical adjustments are capable, at least in asymptomatic subjects, of inducing relatively robust biomechanical effects related to passive cervical end-range capability without simultaneously inducing significant alterations in the overall activity of the sympathetic nervous system.
Significant Changes in Systolic Blood Pressure Post Vectored Upper Cervical Adjustment vs Resting Control Groups: A Possible Effect of the Cervicosympathetic and/or Pressor Reflex
Palpation and vectored adjustment of subjects (n = 40) with putative upper cervical joint dysfunction diagnosed by postural distortions significantly lowered systolic BP both from pretreatment to posttreatment (P < .001) and in comparison with a similar resting control group (n = 40; P < .001). Another test in which subjects (n = 30) were used as their own controls also showed a significant decrease in systolic BP from resting to postadjustment values (P < .001). I propose that the sudden decrease in systolic BP noted in both of these tests was due to stimulation of cervicosympathetic reflexes or possibly to moderation of muscle tone and elimination of the effects of the pressor reflex. This study also found a greater decrease in systolic BP after adjustment in subject patients with increasing age. Associations between the effects of the pressor reflex and thermographic findings and the potential for alterations of visceral physiology in joint dysfunction have been discussed. Further studies involving (1) blinding, (2) testing for direct connections between joint dysfunction, muscle hypertonicity, and the pressor reflex, and (3) the possibility of long-term reduction in systolic BP, are recommended.
Practice-based Randomized Controlled-comparison Clinical Trial of Chiropractic Adjustments and Brief Massage Treatment at Sites of Subluxation in Subjects with Essential Hypertension: Pilot Study
This pilot study elucidated several procedural issues that should be addressed before undertaking a full-scale clinical trial on the effects of chiropractic adjustments at sites of subluxation in patients with essential hypertension. Among the most important of these is using measures to assure comparable groups regarding prognostic variables such as weight. A multidisciplinary approach to recruitment may need to be used in any future efforts due to the limited subject pool of patients who have hypertensive disease but are not taking medications for its control. A 1-week run-in period may be necessary before randomization, to exclude subjects who may only be exhibiting white coat hypertension. Studies such as these demonstrate the feasibility of conducting a full-scale 3-group randomized clinical trial of patients with hypertension in the practice-based setting.
Atlas Vertebra Realignment and Achievement of Arterial Pressure Goal in Hypertensive Patients: A Pilot Study
As discussed in the Methods section of this paper, techniques are now available to screen for atlas misalignment. This type of screening should be the responsibility of the primary care physician and should be performed on patients who have a history of head and neck trauma even if it is deemed insignificant. Those patients who present with pain related to head and neck trauma should not be screened. At a time when the prevalence of hypertension is increasing and its control more difficult due to a variety of factors, linking the correction of C1 misalignment to the subsequent lowering of BP may represent an important advancement in the screening of such patients.
This pilot study has limitations including the fact that it was dependent on the skill of one practitioner to do the manipulation. It was designed, however, to test the concept that nonsurgical manipulation can alleviate elevations in BP, thus it cannot be generalized until confirmed in a larger trial, which is being planned.
Sympathetic and Parasympathetic Responses to Specific Diversified Adjustments to Chiropractic Vertebral Subluxations of the Cervical and Thoracic Spine
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.
It is often said that asthma can be triggered by emotional stress. In fact, traditional Chinese medicine refers to the lungs in connection with grief and sorrow. Asthma patients have been noted to have a more negative affect, and emotional upheavals have been linked to asthma symptom exacerbations. In a recent study, Cetanni et al  examined 80 patients with asthma, 40 patients with either hepatitis B or C, and 40 healthy controls. Significantly greater anxiety and depression were found in asthma patients compared to hepatitis patients and controls. In a study of 230 patients with asthma, 45 percent scored high enough on depression ratings scales to be considered depressed. Those with more depressive symptoms reported worse health-related quality of life than asthma patients without depression.  This begs the question, do a significant number of asthma patients have anxiety and depression because of their asthma, or do these psychological diagnoses predispose one to asthma symptoms? It may be a combination of both. No doubt it is an anxiety-producing feeling when one cannot get enough air. Conversely, intense emotions can bring about asthma symptoms. Increased respiratory resistance, airway reactivity, shortness of breath, and decreased peak expiratory flow rate have been reported after an emotional challenge. [97-99]
Our results show no association between current use of multivitamins and risk of allergic disease but suggest that supplementation with multivitamins during the first years of life may reduce the risk of allergic disease at school age.
The purpose of this randomized patient- and observer-blinded cross-over trial was to evaluate the efficacy of chiropractic treatment in the management of chronic asthma when combined with pharmaceutical maintenance therapy. The trial was conducted at the National University Hospital’s Out-patient Clinic in Copenhagen, Denmark. Thirty-one patients aged 18-44 years participated, all suffering from chronic asthma controlled by bronchodilators and/or inhaled steroids. Patients, or who had received chiropractic treatment for asthma within the last 5 years, who received oral steroids and immunotherapy, were not eligible. Patients were randomized to receive either active chiropractic spinal manipulative treatment or sham chiropractic spinal manipulative treatment twice weekly for 4 weeks, and then crossed over to the alternative treatment for another 4 weeks. Both phases were preceded and followed by a 2-week period without chiropractic treatment. The main outcome measurements were forced expiratory volume in the first second (FEV1), forced vital capacity (FVC), daily use of inhaled bronchodilators, patient-rated asthma severity and non-specific bronchial reactivity (n-BR). Using the cross-over analysis, no clinically important or statistically significant differences were found between the active and sham chiropractic interventions on any of the main or secondary outcome measures. Objective lung function did not change during the study, but over the course of the study, non-specific bronchial hyperreactivity (n-BR) improved by 36% (P = 0.01) and patient-rated asthma severity decreased by 34% (P = 0.0002) compared with the baseline values.
Specific contact short lever arm spinal adjustments may cause a hypotensive effect in a medicated hypertensive patient that may lead to complications (e.g., hypotension). Since a medicated hypertensive patient’s blood pressure may fall below normal while he or she is undergoing chiropractic care, it is advised that the blood pressure be closely monitored and medications adjusted, if necessary, by the patient’s medical physician.
The emergency department (ED) setting offers osteopathic physicians multiple opportunities to provide osteopathic manipulative treatment (OMT) as either the primary therapy or as an adjunct to the intervention. In doing so, osteopathic physicians can decrease or eliminate the morbidity and symptoms associated with protracted dysfunction. Low back pain, chest pain, torticollis, asthma, and sinusitis are some of the illnesses in which OMT should be implemented as part of the management plan, note the authors. They provide a guide to the general usage of OMT when the aforementioned illnesses present themselves in ED patients, but also emphasize the importance of first ruling out any underlying illnesses that could be manifested by musculoskeletal symptoms.
Chronic Pediatric Asthma and Chiropractic Spinal Manipulation: A Prospective Clinical Series and Randomized Clinical Pilot Study
After 3 months of combining chiropractic SMT with optimal medical management for pediatric asthma, the children rated their quality of life substantially higher and their asthma severity substantially lower. These improvements were maintained at the 1-year follow-up assessment. There were no important changes in lung function or hyperresponsiveness at any time. The observed improvements are unlikely to be the result of the specific effects of chiropractic SMT, but other aspects of the clinical encounter that should not be readily dismissed. Further research is needed to assess which components of the chiropractic encounter are responsible for important improvements in patient-oriented outcomes so that they may be incorporated into the care of all asthmatic patients.
The findings in the present study were largely similar to those of the previous Swedish study. A minority of patients with self-reported nonmusculoskeletal symptoms report definite improvement after chiropractic care, and very few report definite worsening. Some factors relating to the chiropractor, the treatment, and the patient were found to be weakly associated with the outcome but these factors “explained” only a small fraction, approximately 3%, of the variance.
It is recommended that further research in this area would concentrate on specific disorders that are most likely to produce positive results, such as specifically identified subgroups of digestive problems or tinnitus, and that such research, whether purely experimental or clinical, use stringent research criteria such as random allocation, objective measurements, sham treatment, and observer blindness.
Asthma is the most common chronic disease in the UK. An inflammatory disorder, it is characterized by increased mucus production and airway hypersensitivity, both of which contribute to a decreased airflow. Common symptoms include shortness of breath, wheezing, coughing and a feeling of chest tightness. This article presents three cases where patients, being treated by conventional pharmacological means, had chiropractic manipulation administered to the upper thoracic spine twice a week for a period of 6 weeks. Objective measurements were collected using a peak flow meter and subjective data using an asthma specific questionnaire. All three cases resulted in increased subjective and objective parameters and suggest the need for larger studies with appropriate methodology.
Chiropractic Care for Nonmusculoskeletal Conditions: A Systematic Review With Implications For Whole Systems Research
Implications for chiropractic practice
We have drawn several conclusions, from a pragmatic perspective, regarding our first specific aim, to evaluate the published evidence on the effect of chiropractic care on patients with nonmusculoskeletal conditions.
The adverse effects reported for SMT for all age groups and conditions were rare and, when they did occur, transient and not severe.
Evidence from both controlled studies and usual practice is adequate to support the “total package” of chiropractic care, including SMT, other procedures, and unmeasured qualities such as belief and attention, as providing benefit to patients with asthma, cervicogenic vertigo, and infantile colic.
Evidence was promising for the potential benefit of manual procedures for children with otitis media and for hospitalized elderly patients with pneumonia.
Evidence did not appear to support chiropractic care for the broad population of patients with hypertension, although it did not rule out the possibility that there may be subpopulations of hypertensive patients who might benefit.
Evidence was equivocal regarding chiropractic care for dysmenorrhea and premenstrual syndrome; it is not clear what level of biomechanical force is most appropriate for patients with these related conditions. It does appear that an extended duration of care, over at least 3 menstrual cycles, is more likely to be beneficial.
There is insufficient evidence to make conclusions about chiropractic care for patients with other conditions.
Implications for whole systems research in chiropractic
Regarding our second specific aim, to identify specific shortcomings with respect to developing a whole-systems approach to research on the effects of chiropractic care, we have identified the following issues:
All studies, from case reports to RCTs, should routinely report adverse effects.
Most published RCTs investigating chiropractic care for nonmusculoskeletal conditions have not relied on usual practice in designing their intervention protocols. Some RCTs were designed without benefit of any published observational studies, case series, or case reports. Even in the absence of observational studies, it is possible to demonstrate that the protocol represents usual practice; for example, the Olafsdottir et al.  infantile colic study used a “reference group” of 14 practicing chiropractors to establish the treatment protocol. We recommend that, in the interest of generalizability, investigators carefully review existing observational studies and reports, as well as consult practitioners with experience treating patients with the condition of interest, and design their intervention protocols to reflect these.
Case series and case reports could increase their utility in several ways:
a. Report patient-based outcomes using validated instruments (rather than focusing on clinician-based outcomes);
b. Specifically address occurrence of adverse effects;
c. Describe patient characteristics in greater detail;
d. Routinely include measures of expectation, satisfaction, and other attitudinal assessments.
The RCT design is not necessarily incompatible with WSR. For example, 1 of 6 RCTs scoring high on conventional RCT checklists also scored high with our preliminary list of WSR considerations. Considerations in designing RCTs that are both rigorous by conventional standards yet are consistent with WSR are as follows:
a. In reporting the results of intervention studies, investigators should specify whether care was provided free of charge and/or patients received incentives for participating. Cost is an important consideration, and free care and/or incentives may affect the generalizability of results.
b. As described above, RCT protocols should have greater reliance on procedures and treatment schedules found in usual practice.
c. “Real-life” comparison groups such as no-treatment or standard care are more generalizable; furthermore, using soft-tissue treatment or other procedures that are also used in everyday practice as shams or placebos may confound results.
d. Routinely including patient-based functional outcome measures, satisfaction, and quality of life provides more multifactorial information on treatment effects.
e. Routinely including measures of patient and practitioner preference and expectation provides important information on psychosocial aspects of the clinical encounter that may affect outcomes.
Educate chiropractic investigators, practitioners, and funding agencies as to the value (or in some cases, the existence of) observational designs such as cohort and case–control studies, to avoid use of scarce resources on premature and sometimes poorly conceived RCTs.
Applied Kinesiology Methods For a 10-year-old Child With Headaches, Neck Pain, Asthma, and Reading Disabilities
After 3 years of neck pain and headaches and 4 years of asthma, reading difficulty, and learning disability, this patient’s symptoms resolved. The patient has remained free of symptoms in these areas of difficulty for 2 years since his initial treatments.
The Chiropractic Care of Patients with Asthma: A Systematic Review of the Literature to Inform Clinical Practice
This systematic review of the literature examined the trials and tribulations of designing a randomized controlled clinical trial with chiropractic SMT and asthma and the important contribution of uncontrolled studies. Chiropractic may offer an alternative care approach for asthmatic patients in an integrative healthcare setting. Further investigations of the chiropractic intervention in the care of patients with asthma should pave the way for higher-level design studies such as randomized controlled clinical trials.
The Use of Spinal Manipulative Therapy For Pediatric Health Conditions: A Systematic Review of the Literature
We conducted a systematic review of 16 clinical trials investigating the use of SMT for pediatric health conditions. None of the 16 studies investigated the effectiveness of SMT for spinal pain among children or adolescents. Studies that monitored both subjective and objective outcome measures of relevance to both patients and parents tended to report the most favorable response to SMT, especially among children with asthma. Five of the six studies investigating the effectiveness of SMT for infantile colic reported favorable results, notwithstanding their methodological deficiencies and small sample size. Going forward, if shown to be a valid theory, studies investigating the effect of SMT on colic ought to better differentiate between subgroups of crying infants, monitor the effect of SMT on larger groups of infants and generally use more robust study methodologies, especially in terms of blinding allocation and avoiding co-interventions and contaminations of other external factors.
With respect to clinical trials investigating the use of SMT for children with asthma, future studies should focus more on daily activity outcome measures (reduction in use of medication), physical outcome measures (breathing ability) and subjective measures (ease of breathing, patient satisfaction) and less on physiological responses (lung function as measured by spirometry).
The findings from our review are comparable, although not identical, to the conclusions provided in the UK Evidence Report authored by Bronfort et al, who stated: “In children, the evidence is inconclusive regarding the effectiveness for otitis media and enuresis, and is it not effective for infantile colic and asthma when compared to sham manipulation.” [12 p.3]
We can do no better than to parrot the conclusions reached by two very different groups of authors separated by a 10 year gap. The first group of authors, the Canadian Paediatric Society, stated in 2001: “Chiropractic treatment for children and adolescents is not uncommon. Open and honest discussions with families using or planning to use chiropractic for their children will, hopefully, bring about a rationale use of this treatment in selected musculoskeletal conditions for which there is proof of efficacy, and enable parents to make informed choices about this form of therapy…[I] deally, collaborative evidence-based research into chiropractic care for diverse paediatric conditions should define those patients best suited for chiropractic therapy.” [49 p.88]
The other group of authors, Ferrance and Miller, reached a similar conclusion in 2010: “The efficacy of chiropractic care in the treatment for non-musculoskeletal disorders has yet to be definitely proven or disproven, with the burden of proof still resting upon the chiropractic profession.” [35 p. 1] We hope that another decade will not pass before the chiropractic research community finally meets the challenges identified by these authors and fills in the glaring evidentiary gap of the use of SMT for pediatric health conditions of all kinds, especially spinal pain.
The present study reviewed the scientific evidence on the benefits of manipulative techniques on children with respiratory diseases. The most common interventions use chiropractic, osteopathy, and massage. However, most studies used distinct administration methods and assessment parameters, and their statistically inconsistent results justify the absolute need of further research in this area.