Jeffery Clayton, DC
William J Owens Jr, DC, DAAMLP, CPC
Mark E Studin, DC FASBE©, DAAPM, DAAMLP
A recent study published in 2012 looked at the correlation between cerebral perfusion (blood flow to the brain), a chiropractic exam, and the neck disability index (a multiple choice self-assessment test of neck pain). The authors stated “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.” (pg 1) The amount of blood flow to the brain is vital in delivering oxygen and other nutrients and the healthy human body will tightly regulate this pressure since too little pressure can cause cellular death. A lowering of the blood to the brain after a traumatic brain injury has been associated with higher morbidity and mortality rates.
This study took 45 individuals that had chronic neck or upper back pain for more than 3 months with exacerbations during the last 4 years. They excluded patients that had known risks for cerebral perfusion changes. These participants all took the neck disability index’s 10 question self-assessment exam for neck pain. They were then divided according to their neck disability index scores into mild, moderate and severe groups. The groups all had an even mixture of participants with no significant differences with respect to age.
The groups then underwent a chiropractic exam to assess any possible neck, upper back or rib joint dysfunctions. A joint dysfunction was defined as a painful joint that was restricted in its full range of motion during examination. There were 2 separate chiropractic examinations performed within a 5-minute interval. The amount of joint dysfunctions were averaged between the two exams.
The moderate and severe groups showed a significantly larger amount of joint dysfunction compared to the mild group. There was an increased amount of joint dysfunction in the severe group compared to the moderate group, but this increase was not statistically significant. This shows that a chiropractic exam can accurately distinguish a mild neck disability index score from a moderate and severe score.
The next step is to see how accurately the neck disability index and the chiropractic examination can predict blood flow to the brain. Blood flow to the brain can be visualized with a single-photon emission computer tomography (SPECT). All three groups were given a SPECT test within 1-3 days after the neck disability index test and chiropractic examination. The mild group showed normal blood flow levels in all 8 brain regions on all participants. The moderate and severe groups showed a significant drop in the normal level of blood flow to the brain. The loss of blood flow in the moderate and sever groups favored the parietal and frontal regions of the brain.
This study not only showed that a chiropractic examination correlates to the neck disability index, but that both the neck disability index and chiropractic examinations correlate independently to blood flow to the brain. Although more research is needed this study begs the question would treatment that lowered the neck disability index or lowered the amount of painful spinal dysfunction increase the blood flow to the brain? Finally the authors state “We report here, for the first time, a correlation in patients with chronic neck pain between scores of self-rated disability (NDI), painful spinal joint dysfunction, and brain hypoperfusion [decreased blood flow]. These findings further strengthen our understanding of the perceptions of patients with neck pain regarding their activities of daily living. They also provide preliminary evidence of a role for painful spinal joint dysfunction and a possible role for the sympathetic innervation of the cranial vasculature in the causal nexus of neck pain.” (pg 10)
Reference:
Bakhtadze, M. A., Vernon, H., Karalkin, A. V., Pasha, S. P., Tomashevskiy, I. O., & Soave, D. (2012). Cerebral perfusion in patients with chronic neck and upper back pain: preliminary observations. Journal of manipulative and physiological therapeutics, 35(2), 76-85.
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