The Mechanism of the Chiropractic

Spinal Adjustment/Manipulation:

Ligaments and the Bio-Neuro-Mechanical Component

Part 2 of a 5 Part Series

By: Mark Studin

William J. Owens

A report on the scientific literature

Citation: Studin M., Owens W., (2017) The Mechanism of the Chiropractic Spinal Adjustment/Manipulation: Ligaments and the Bio-Neuro-Mechanical Component, Part 2 of 5, American Chiropractor 39 (6), pgs. 22,24-26, 28-31

Introduction

When we consider the mechanism of the spinal adjustment/manipulation as discussed in part 1 of this series, for clarity for the chiropractic profession, it will be solely referred to as a chiropractic spinal adjustment (CSA) so as not to confuse chiropractic treatment with either physical therapy or osteopathy. In analyzing how the CSA works, we must go beyond the actual adjustment or thrust and look at the tissue and structures that “frame” the actions. Although there are osseous borders and boundaries, there is a significant network of connective tissue that plays a major role in the CSA. We will focus this discussion on the ligaments that both act as restraints to the human skeleton and also function as sensory organs, we will also examine the role of the muscles and tendons that interact with the ligaments. It is critical to realize that muscles act as active and amplified restraints in the spinal system.

The neurological innervations of the ligaments play a significant role in influencing the central nervous system, both reflexively and through brain pathways. Those innervations either support homeostasis in a balanced musculoskeletal environment or creates confusion in a system that has been impaired either post-traumatically or systemically. The human body does not discriminate the etiology of biomechanical failure, it only reacts to create a “low energy” or neutral state utilizing the lowest amount of energy to function.  This balanced or “low energy state” is considered the most optimal function state as nervous system function is not compromised by aberrant sensory input, this is why a “low energy state” is considered the highest function state.

With understanding the full functional and resultant role of the ligaments and other connective tissues in either macro or repetitive micro traumas, bio-neuro-mechanical failure (something we have historically called vertebral subluxation) occurs. This is the basis for chiropractic care and explains why immediate (pain management), intermediate (corrective) and long-term (wellness or health maintenance) care are necessary to reintegrate the bio-neuro-mechanical system of the human body. Often, the best we can accomplish as practitioners is to support compensation secondary to tissue failure to slow down the resultant joint remodeling and neurological corruption/compromise.

Ligamentous Function

Solomonow (2009) wrote:

The functional complexity of ligaments is amplified when considering their inherent viscoelastic properties such as creep, tension–relaxation, hysteresis and time or frequency-dependent length–tension behavior. As joints go through their range of motion, with or without external load, the ligaments ensure that the bones associated with the joint travel in their prescribed anatomical tracks, keep full and even contact pressure of the articular surfaces, prevent separation of the bones from each other by increasing their tension, as may be necessary, and ensuring stable motion. Joint stability, therefore, is the general role of ligaments without which the joint may subluxate, cause damage to the capsule, cartilage, tendons, nearby nerves and blood vessels, discs (if considering spinal joints) and to the ligaments themselves. Such injury may debilitate the individual by preventing or limiting his/her use of the joint and the loss of function…Dysfunctional or ruptured ligaments, therefore, result in a complex- syndrome, various sensory–motor disorders and other long-term consequences, which impact the individual’s well-being, his athletic activities, employer, skilled work force pool and national medical expenses. (p. 137)

Ligaments are closely packed collagen fibers that are helical at rest in a crimp pattern. This crimp pattern allows the ligament to recruit other fibers when stressed to support the joint and helps prevent ligamentous failure or subfailure (tearing of the ligament). They are comprised of collagen and elastin which give them both tensile strength and elasticity with no two joints being alike in composition.  Each joint has a specific biomechanical role and varies depending upon the needs of that joint.

Solomonow (2008) continued:

As axial stretching of a ligament is applied, fibers or bundles with a small helical wave appearance straighten first and begin to offer resistance (increased stiffness) to stretch. As the ligament is further elongated, fibers or fiber bundles of progressively larger helical wave straighten and contribute to the overall stiffness. Once all the fibers are straightened, a sharp increase in stiffness is observed. (p. 137)

Solomonow (2008) later stated:

Over all, the mostly collagen (75%), elastin and other substances structure of ligaments is custom tailored by long evolutionary processes to provide various degrees of stiffness at various loads and at various ranges of motion of a joint, while optimally fitting the anatomy inside (inter-capsular) or outside (extra-capsular) a given joint. The various degrees of helical shape of the different fibers allows generation of a wide range of tensile forces by the fiber recruitment process, whereas the overall geometry of the ligament allows selective recruitment of bundles such as to extend function over a wide range of motion. The large content of water (70%) and the cross weave of the long fibers by short fibers provides the necessary lubrication for bundles to slide relative to each other, yet to remain bundled together and generate stiffness in the transverse directions.(p. 137)

Solomonow (2008):

Length–tension and recruitment: The general length–tension (or strain–stress) behavior of a ligament is non-linear…The initial [reports] demonstrate rather large strain for very small increase in load. Once all the waves in the collagen fibers of the ligament have been straightened out, and all of the fibers were recruited, additional increase in strain is accompanied with a fast increase in tension…

Creep: When a constant load is applied to a ligament, it first elongates to a given length. If left at the same constant load, it will continue to elongate over time in an exponential fashion up to a finite maximum…

Tension–relaxation:When ligaments are subjected to a stretch and hold over time (or constant elongation) the tension–relaxation phenomena is observed. The tension in the ligament increases immediately upon the elongation to a given value. As time elapses, the tension decreases exponentially to a finite minimum while the length does not change…

Strain rate: The tension developed in a ligament also depends on the rate of elongation or strain rate (Peterson, 1986). In general, slow rates of elongation are associated with the development of relatively low tension, whereas higher rates of elongation result in the development of high tension. Fast stretch of ligaments, such as in high-frequency repetitive motion or in sports activities are known to result in high incidents of ligamentous damage or rupture…Fast rates of stretch, therefore, may exceed the physiological loads that could be sustained by a ligament safely, yet it may still be well within the physiological length range. Development of high tension in the ligaments may result in rupture and permanent sensory–motor deficit to the joint in addition to deficit in its structural functions. (p. 137-139)

Author’s note: A fast strain rate within the physiological limit may also cause ligamentous damage as the ligament hasn’t had enough time to adapt (stretch) to its new tensile demand and this is called a “sub-failure.”
“This phenomenon is associated with repetitive motion when a series of stretch-release cycles are performed over time (Solomnow, 1008, p. 140).

Ligament Reaction to Trauma and Healing

Solomnow (2008) stated:

Ligament Inflammation: Inflammatory response in ligaments is initiated whenever the tissue is subjected to stresses which exceed its routine limits at a given time. For example, a sub-injury/failure load, well within the physiological limits of a ligament when applied to the ligament by an individual who does not do that type of physical activity routinely. The normal homeostatic metabolic, cellular, circulatory and mechanical limits are therefore exceeded by the load, triggering an inflammatory response…

Another case where acute inflammation is present is when physical activities presenting sudden overload/stretch cause a distinct damage to the tissue which is felt immediately. Such cases, as a sudden loss of balance, a fall, collision with another person, exposure to unexpected load, etc., may result in what is called a sprain injury or a partial rupture of the ligament. Acute inflammation sets in within several hours and may last several weeks and up to 12 months. The healing process, however, does not result in full recovery of the functional properties of the tissue. Mostly, only up to 70% of the ligaments original structural and functional characteristics are attained by healing post-injury (Woo et al. 1990)...
Chronic inflammation is an extension of an acute inflammation when the tissue is not allowed to rest, recover and heal. Repetitive exposure to physical activity and reloading of the ligament over prolonged periods without sufficient rest and recovery represent cumulative micro-trauma. The resulting chronic inflammation is associated with atrophy and degeneration of the collagen matrix leaving a permanently damaged, weak and non-functional ligament (Leadbenter, 1990). The dangerous aspect of a chronic inflammation is the fact that it builds up silently over many weeks, months or years (dependent on a presently unknown dose-duration levels of the stressors) and appears one day as a permanent disability associated with pain, limited motion, weakness and other disorders (Safran, 1985). Rest and recovery of as much as 2 years allows only partial resolution of the disability (Woo and Buckwalter, 1988). Full recovery was never reported. (p. 143-144)

Hauser et al. (2013) reported that once a ligament is overloaded in either a failure or subfailure, then the tissue fails which results in partial or complete tears known as a sprain. When this occurs, the body “attempts” to repair the damaged ligament, but cannot completely.

Hauser et al. (2013) wrote:

With time, the tissue matrix starts to resemble normal ligament tissue; however, critical differences in matrix structure and function persist. In fact, evidence suggests that the injured ligament structure is replaced with tissue that is grossly, histologically, biochemically, and biomechanically similar to scar tissue. (p. 6)

Hauser et al. (2013) also stated:

The persisting abnormalities present in the remodeled ligament matrix can have profound implications on joint biomechanics, depending on the functional demands placed on the tissue. Since remodeled ligament tissue is morphologically and biomechanically inferior to normal ligament tissue, ligament laxity results, causing functional disability of the affected joint and predisposing other soft tissues in and around the joint to further damage. (p. 7)

Hauser et al. (2013) further said:
In fact, studies of healing ligaments have consistently shown that certain ligaments do not heal independently following rupture, and those that do heal, do so with characteristically inferior compositional properties compared with normal tissue. It is not uncommon for more than one ligament to undergo injury during a single traumatic event. (p. 8)

Author’s note: Ligaments are made with fibroblasts which produce collagen and elastin, and model the ligament throughout puberty. Once puberty is over, the fibroblasts stop producing any ligamentous tissue and remain dormant. Upon injury, the fibroblast activates, but now can only produce collagen, leaving the joint stiffer and in a biomechanically compromised functional environment. The above comment verifies that in the literature.

Hauser et al. (2013) explained:
Osteoarthritis [OA] or joint degeneration is one of the most common consequences of ligament laxity. Traditionally, the pathophysiology of OA was thought to be due to aging and wear and tear on a joint, but more recent studies have shown that ligaments play a crucial role in the development of OA. OA begins when one or more ligaments become unstable or lax, and the bones begin to track improperly and put pressure on different areas, resulting in the rubbing of bone on cartilage. This causes the breakdown of cartilage and ultimately leads to deterioration, whereby the joint is reduced to bone on bone, a mechanical problem of the joint that leads to abnormality of the joint’s mechanics.

Hypermobility and ligament laxity have become clear risk factors for the prevalence of OA. The results of spinal ligament injury show that over time the inability of the ligaments to heal causes an increase in the degeneration of disc and facet joints, which eventually leads to osteochondral degeneration. (p. 9)

Ligaments as Sensory Organs
Spinal pain and the effects of the chiropractic spinal adjustment is both central and peripheral in etiology. According to Studin and Owens (2016), the CSA also affects the central nervous system with systemic sequelae verifying that chiropractic supports systemic changes and is not comprised solely of “back pain providers.” Although chiropractic is not limited to pain, chiropractors do treat back pain, inclusive of all spinal regions. Regarding pain, much of the pain generators originate in the ligaments.

Solomonow (2009) wrote:While ligaments are primarily known for mechanical support for joint stability, they have equally important sensory functions. Anatomical studies demonstrate that ligaments in the extremity joints and the spine are endowed with mechanoreceptors consisting of: Pacinian, Golgi, Ruffini and bare nerve endings. (Burgess and Clark, 1969; Freeman and Wyke, 1967a,b; Gardner, 1944; Guanche et al., 1995; Halata et al., 1985; Jackson et al., 1966; Mountcastle, 1974; Petrie et al., 1988, Schulz et al. 1984, Sjölander, 1989; Skoglund, 1956; Solomonow et al., 1996; Wyke, 1981; Yahia and Newman, 1991; Zimney and Wink, 1991). The presence of such afferents in the ligaments confirms that they contribute to proprioception and kinesthesia and may also have a distinct role in reflex activation or inhibition of muscular activities.(p. 144)

Dougherty (n.d.) reported:
Pacinian corpusclesare found in subcutaneous tissue beneath the dermis…and in the connective tissues of bone [ligaments and tendons], the body wall and body cavity. Therefore, they can be cutaneous, proprioceptive or visceral receptors, depending on their location…

When a force is applied to the tissue overlying the Pacinian corpuscle…its outer laminar cells, which contain fluid, are displaced and distort the axon terminal membrane. If the pressure is sustained on the corpuscle, the fluid is displaced, which dissipates the applied force on the axon terminal. Consequently, a sustained force on the Pacinian corpuscle is transformed into a transient force on its axon terminal. The Pacinian corpuscle 1° afferent axon response is rapidly adapting and action potentials are only generated when the force is first applied. (http://neuroscience.uth.tmc.edu/ s2/chapter02.html)

Dougherty (n.d.) stated: 

TheRuffini corpusclesare found deep in the skin…as well as in joint ligaments and joint capsules and can function as cutaneous or proprioceptive receptors depending on their location. The Ruffini corpuscle…is cigar-shaped, encapsulated, and contains longitudinal strands of collagenous fibers that are continuous with the connective tissue of the skin or joint. Within the capsule, the 1° afferent fiber branches repeatedly and its branches are intertwined with the encapsulated collagenous fibers. (http://neuroscience.uth.tmc. edu/s2/chapter02.html) “Ruffini corpuscles in skin are considered to be skin stretch sensitive receptors of the discriminative touch system. They also work with the proprioceptors in joints and muscles to indicate the position and movement of body parts” (Dougherty, http://neuroscience.uth.tmc.edu/s2/chapter02.html).

Dougherty (n.d.) stated:
Golgi tendon organsare found in the tendons of striated extrafusal muscles near the muscle-tendon junction…Golgi tendon organs resemble Ruffini corpuscles. For example, they are encapsulated and contain intertwining collagen bundles, which are continuous with the muscle tendon, and fine branches of afferent fibers that weave between the collagen bundles…They are functionally "in series" with striated muscle. (http://neuroscience.uth.tmc.edu/s2/ chapter02.html)
“TheGolgi tendon organis a proprioceptor that monitors and signals muscle contraction against a force (muscle tension), whereas the muscle spindle is a proprioceptor that monitors and signals muscle stretch (muscle length)” (Dougherty, http://neuroscience.uth.tmc.edu/ s2/chapter02.html).

Dougherty (n.d.) stated:
…free nerve endings of 1° afferents are abundant in muscles, tendons, joints, and ligaments. These free nerve endings are considered to be the somatosensory receptors for pain resulting from muscle, tendon, joint, or ligament damage and are not considered to be part of the proprioceptive system. [These free nerve endings are called nociceptors.]

Solomonow (2009) commented:
The presence of such afferents in the ligaments confirms that they contribute to proprioception and kinesthesia and may also have a distinct role in reflex activation or inhibition of muscular activities…
Overall, the decrease or loss of function in a ligament due to rupture or damage does not only compromise its mechanical contributions to joint stability, but also sensory loss of proprioceptive and kinesthetic perception and fast reflexive activation of muscles and the forces they generate in order to enforce joint stability…

It was suggested, as far back as the turn of the last century, that a reflex may exist from sensory receptors in the ligaments to muscles that may directly or indirectly modify the load imposed on the ligament (Payr, 1900)…A clear demonstration of a reflex activation of muscles was finally provided in 1987 (Solomonow et al., 1987) and reconfirmed several times since then (beard et al., 1994; Dyhre-Poulsen and Krogsgard, 2000; Raunest et al., 1996; Johansson et al., 1989; Kim et al., 1995). It was further shown that such a ligamento-muscular reflex exists in most extremity joints (Freeman and Wyke, 1967b; Guanche et al., 1995, Knatt et al., 1995; Schaible and Schmidt, 1983; Schaible et al., 1986; Solomonow et al., 1996; Phillips et al., 1997; Solomonow and Lewis, 2002) and in the spine (Indahl et al., 1995, 1997; Stubbs et al., 1998; Solomonow et al., 1998). (p. 144).

“Ligamento-muscular reflexes, therefore, may be inhibitory or excitatory, as may be fit to preserve joint stability; inhibiting muscles that destabilize the joint or increased antagonist co-activation to stabilize the joint” (Solomonow, 2009, p. 145).
Spinal Stabilization and Destabilization

Panjabi (2006) reported:
1. Single trauma or cumulative microtrauma causes subfailure injury of the spinal ligaments and injury to the mechanoreceptors [and nociceptors] embedded in the ligaments.
2. When the injured spine performs a task or it is challenged by an external load, the transducer signals generated by the mechanoreceptors [and nociceptors] are corrupted.
3. Neuromuscular control unit has difficulty in interpreting the corrupted transducer signals because there is spatial and temporal mismatch between the normally expected and the corrupted signals received.
4. The muscle response pattern generated by the neuromuscular control unit is corrupted, affecting the spatial and temporal coordination and activation of each spinal muscle.
5. The corrupted muscle response pattern leads to corrupted feedback to the control unit via tendon organs of muscles and injured mechanoreceptors [and nociceptors], further corrupting the muscle response pattern. (p. 669)

The above stabilization-destabilization scenario is the foundation for why a CSA is clinically indicated for short, intermediate and long-term treatment (biomechanical stabilization) as clinically indicated. It also clearly outlines what the goal of the CSA is, to integrate the bio-neuro-mechanical system to bring the human body to utilize its lowest form of energy for homeostasis or as close to normal as tissue pathology allows.
This is part 2 of a 5-part series where part 1 covers the osseous mechanics of the chiropractic spinal adjustment. This part covered the ligamentous involvement from a supportive and neurological perspective. The topic of part 3 will be spinal biomechanics and their neurological components in addition to how the chiropractic spinal adjustment makes changes bio-neuro-mechanically. Part 4 will be an in-depth contemporary comparative analysis of the chiropractic spinal adjustment vs. physical therapy joint mobilization. The final part will be a concise overview of the chiropractic spinal adjustment.

References:

1. Solomonow, M. (2009). Ligaments: A source of musculoskeletal disorders.Journal of Bodywork and Movement Therapies,13(2), 136-154.

2. Ziv, I. (n.d.). Ligaments and tendons [PowerPoint slides]. Retrieved from https://wings.buffalo.edu/eng/mae/courses/417-517/Orthopaedic%20Biomechanics/Lecture%203u.pdf

3. Hauser, R. A., Dolan, E. E., Phillips, H. J., Newlin, A. C., Moore, R. E., & Woldin, B. A. (2013). Ligament injury and healing: A review of current clinical diagnostics and therapeutics.The Open Rehabilitation Journal,6, 1-20.

4. Solomonow, M. (2006). Sensory–motor control of ligaments and associated neuromuscular disorders.Journal of Electromyography and Kinesiology,16(6), 549-567.

5. Studin M., & Owens W. (2016). Chiropractic spinal adjustments and the effects on the neuroendocrine system and the central nervous system connection. The American Chiropractor, 38(1), 46-51.

6. Dougherty, P. (n.d.). Chapter 2: Somatosensory systems. Neuroscience Online. Retrieved from  http://neuroscience.uth.tmc.edu/s2/chapter02.html

7. Panjabi, M. M. (2006). A hypothesis of chronic back pain: Ligament subfailure injuries lead to muscle control dysfunction.European Spine Journal,15(5), 668-676.

Share this

Regaining Arms, Legs, Hands and Feet Function Through Chiropractic Care: The Brain Connection

A report on the scientific literature 

By Mark Studin DC, FASBE(C), DAAPM, DAAMLP

Frank was an innocent victim of a drive by shooting that left him a quadriplegic, 20+ years ago. This author was asked if I could help make him a little more comfortable as his neck was tight from being locked in one position for a lifetime and I made house calls for 2 weeks to see if I could help reduce some of the neck tightness. After the first adjustment, he regained some use of his right hand and a few fingers and I never had an explanation as to why because I didn’t treat the specific spinal segments connected to those fingers. From what I recall, Frank went on to become a computer programmer. On the opposite end of the spectrum, Rob was a defensive tackle for an NFL football team playing at an all-star level. He came to see me because his back was sore from the pounding of a life of football. After 3 months of care, he reported that his time in the 40 yard dash decreased, his vertical jump increased and he was able to lift more weights in both his arms and legs than before. All things for which I had no explanation for all those years ago.  

We are now starting to get answers and reasons for what were once considered “miracles.” The research has verified that the chiropractic adjustment does not deliver miracles, it only helps the body work better and we now know why. This article could easily be titled, "Regaining All Movement and Function with the Chiropractic Spinal Adjustment," and would not be inflammatory based upon the scientific evidence being published today. With an aging population reaching 35,000,000 in 2030 according to Kleinpell, Fletcher, and Jennings (2015), and a mobile society that often gets injured, a key component to health is one of function. In the musculoskeletal genre, functioning is the ability to move and perform activities that range from those required of professional athletes and artists to those of the elderly such as simply walking or writing. In every society, people need to be able to move and function to experience life at its fullest. 

According to Haavik and Murphy (2012) “There is growing body of research on the effects of spinal manipulation (chiropractic spinal adjustments) on sensory processing, motor output, functional performance and sensorimotor integration…how an initial episode(s) of back or neck pain may lead to ongoing changes in input from the spine which over time lead to altered sensorimotor integration of input from the spine and limbs” (p. 768). What this simply means is that chiropractic spinal adjustments change how the brain gets its information, how it processes that information and then how it sends it back to the different regions of the body so that we can function and move better. In addition, the research has given evidence that these brain changes cause pain to decrease as a result of the chiropractic spinal adjustments and this can affect all of the limbs.

Haavik and Murphy (2012) went on to say, “What has also become apparent is that these plastic changes may occur in a manner that is subjectively positive for the individual, such as with motor learning to enable complex finger movement (e.g. playing the piano). This is known as adaptive neuroplasticity (the brain adapting better.) However, studies are also showing that these plastic changes may occur in a manner that has decidedly negative subjective outcomes for the individual, known as maladaptive neural plastic changes. There is a growing body of literature that demonstrates maladaptive plastic changes are present in a variety of pain conditions/syndromes and musculoskeletal dysfunction and that such adaptive changes can occur remarkably fast following an injury” (p. 769).

What this means is that injuries play a significant role in function and individuals can lose function very quickly, but a chiropractic spinal adjustment can help regain that function. The research also suggests that because this is an issue with the brain losing correct information from the limbs, parts not injured also lose function and conversely, when unaffected areas get treated, the brain makes adaptive changes and resolves pain in multiple areas.

“Numerous activities of daily living are dependent on appropriate interaction between sensory and motor systems allow us to engage with our environment. It allows us to reach for and grasp objects, detect and turn towards an auditory stimuli or respond to perturbations from the environment in order to maintain postural stability, balance and locomotion. A breakdown anywhere in these multimodal sensorimotor feedback loops has the potential to greatly affect other interconnected neuroanatomical subsystems, in either an adaptive or maladaptive manner” (Haavik & Murphy, 2012, p. 769).

Gay, Robinson, George, Perlstein, and Bishop (2014) reported that chiropractic spinal adjustments create functional changes in multiple regions of the brain based upon multiple outcome measures. In the study by Gay et al. (2014), this was measureable and reproducible. In addition, this has far reaching affects in setting the foundation for understanding how the adjustment works in systemic and possibly autonomic changes by being able to measure and reproduce functional changes within the brain as direct sequellae.

We also know that chiropractic is one of the safest treatments currently available in healthcare and when there is a treatment where the potential for benefits far outweighs any risk, it deserves serious consideration.  Whedon, Mackenzie, Phillips, and Lurie (2015) based their study on 6,669,603 subjects after the unqualified subjects had been removed from the study and accounted for 24,068,808 office visits. They concluded, “No mechanism by which SM [spinal manipulation] induces injury into normal healthy tissues has been identified (Whedon et al., 2015, p. 5).

References:

1. Kleinpell, R., Fletcher, K., Jennings, B. M. (2008). Reducing functional decline in the elderly. Retrieved from http://www.ncbi.nlm.nih.gov/books/NBK2629/
2. Haavik, H., & Murphy B. (2012). The role of spinal manipulation in addressing disordered sensorimotor integration and altered motor control. Journal of Electromyography and Kinesiology, 22(5), 768-76.
3. Gay, C. W., Robinson, M. E., George, S. Z., Perlstein, W. M., & Bishop, M. D. (2014). Immediate changes after manual therapy in resting-state functional connectivity as measured by functional magnetic resonance imaging in participants with induced low back pain. Journal of Manipulative and Physiological Therapeutics, 37(9), 614-627.
4. Whedon, J. M., Mackenzie, T. A., Phillips, R. B., & Lurie, J. D. (2015). Risk of traumatic injury associated with chiropractic spinal manipulation in Medicare Part B beneficiaries aged 66-69 years. Spine, 40(4), 264-270.

Share this

Pregnancy and Chiropractic: Care and Safety

“A Report on Midwives & Chiropractic”

A report on the scientific literature 

By: Mark Studin DC, FASBE(C), DAAPM, DAAMLP

Being a chiropractor for 34 years, I have treated hundreds of pregnant patients in my career for a host of “pregnancy related spinal conditions.” The impetus for conservative chiropractic care was in part because the pregnant patient could not utilize drugs as a result of contraindications with pregnancy and also in part because of the positive experiences both patients, midwives and obstetricians have observed through the years. It has been my persona observation that chiropractic is a safe alternative for pregnant patients and should always be the first option for anyone (pregnant or not) before the utilization of drugs, making them needless if a non-drug approach delivers positive outcomes. 

According to Mullen, Alcantara, Barton and Dever (2011) “Chiropractors and midwives, with their conservative approach to patient care grounded in a holistic and vitalistic philosophy, share many common ideals in the care of patients. In the age of evidence based practice with an emphasis on an integrative approach to patient care, chiropractors and midwives have a unique opportunity to develop partnerships in this regard.” They found “that 57% of their nurse-midwife responders recommended chiropractic to their pregnant patients to address pregnancy-related neuromusculoskeletal (NMS) complaints, sciatica and fetal malposition. In a survey of both lay-midwives and nurse-midwives on their use of CAM (complementary and alternative medicine)  therapies, found chiropractic was the most popular CAM therapy to address musculoskeletal back pain. There are also indicators that chiropractors advocate for a strong working relationship with midwivesparticularly in addressing fetal malposition during pregnancy.” Pg. 135

Mullen Et. Al went on to report that 98.9% of midwives were aware that chiropractors worked with “birthing professionals” and 92.5% were knowledgeable about chiropractic’s role in prenatal care. 88.8% had an experience with chiropractors and 97% was positive. In addition, 94.5% of those had chiropractors treated their children and had a positive experience.  The most revealing statistic is one of safety as 100% of midwives questioned answered that chiropractic was safe for their pregnant patients. 

We are now starting to get answers from disparate sects of healthcare that verify what was once considered “miracles” with maladies such as fetal repositioning during pregnancy. These research findings verify that the chiropractic adjustment does not deliver miracles, it only helps the body work better and we now know why. 

We also know that chiropractic is one of the safest treatments currently available in healthcare and when there is a treatment where the potential for benefits far outweighs any risk, it deserves serious consideration.  Whedon, Mackenzie, Phillips, and Lurie (2015) based their study on 6,669,603 subjects after the unqualified subjects had been removed from the study and accounted for 24,068,808 office visits. They concluded, “No mechanism by which SM [spinal manipulation] induces injury into normal healthy tissues has been identified (Whedon et al., 2015, p. 5) 

References:

1. Mullin, L., Alcantara J., Barton D., Dever L. (2011) Attitudes and Views on Chiropractic: A Survey of United States Midwives, Complementary Therapies in Clinical Practice 17 (2011) 135-140
2. Whedon, J. M., Mackenzie, T. A., Phillips, R. B., & Lurie, J. D. (2015). Risk of traumatic injury associated with chiropractic spinal manipulation in Medicare Part B beneficiaries aged 66-69 years. Spine, 40(4), 264-270.

Share this

Research Proves Chiropractic Adjustments Affect Multiple Areas, Not Just the Area Treated: THE BRAIN CONNECTION

(i.e.) Neck Treatment Reduces Pain in Low Back

A report on the scientific literature 

By: Mark Studin DC, FASBE(C), DAAPM, DAAMLP

William J. Owens DC, DAAMLP

It is a very common scenario historically and in contemporary chiropractic offices where patients come to get treated for one body part and another body part feels better. To be more specific a patient will come in with neck pain as their primary complaint and upon treating that neck problem with chiropractic spinal adjustment their low back feels better. Through the years many patients have considered this a “miracle” and the doctor of chiropractic simply accepted this clinical finding as an everyday experience with no concrete answers. Thanks to contemporary research, there are answers.

Coronado et al. (2012) reported that, “Reductions in pain sensitivity, or hypoalgesia, following SMT [spinal manipulative therapy or the chiropractic adjustment] may be indicative of a mechanism related to the modulation of afferent input or central nervous system processing of pain” (p. 752). This indicates that the chiropractic spinal adjustment reduces pain by effecting the thalamus and descending central pain pathways and effects multiple areas of the body, not just the area directly treated.

One of the main questions asked by Coronado et al. (2012) “…was whether SMT (chiropractic adjustments) elicits a general response on pain sensitivity or whether the response is specific to the area where SMT is applied. For example, changes in pain sensitivity over the cervical facets following a cervical spine SMT would indicate a local and specific effect while changes in pain sensitivity in the lumbar facets following a cervical spine SMT would suggest a general effect. We observed a favorable change for increased PPT [pressure pain threshold] when measured at remote anatomical sites and a similar, but non-significant change at local anatomical sites. These findings lend support to a possible general effect of SMT beyond the effect expected at the local region of SMT application (p. 762).

Reed, Pickar, Sozio, and Long (2014) reported:

…forms of manual therapy have been clinically shown to increase mechanical pressure pain thresholds (i.e., decrease sensitivity) in both symptomatic and asymptomatic subjects.Cervical spinal manipulation has been shown to result in unilateral as well as bilateral mechanical hypoalgesia. Compared with no manual therapy, oscillatory spinal manual therapy at T12 and L4 produced significantly higher paraspinal pain thresholds at T6, L1, and L3 in individuals with rheumatoid arthritis. The immediate and widespread hypoalgesia associated with manual therapy treatments has been attributed to alterations in peripheral and/or central pain processing including activation of descending pain inhibitory systems. Increasing evidence from animal models suggests that manual therapy activates the central nervous system and, in so doing, affects areas well beyond those being treated. (p. 277)

We are now starting to get answers and reasons for what was once considered “miracles.” The research has verified that the chiropractic adjustment does not deliver miracles, it only helps the body work better and we now know why.

We also know that chiropractic is one of the safest treatments currently available in healthcare and when there is a treatment where the potential for benefits far outweighs any risk, it deserves serious consideration.  Whedon, Mackenzie, Phillips, and Lurie (2015) based their study on 6,669,603 subjects after the unqualified subjects had been removed from the study and accounted for 24,068,808 office visits. They concluded, “No mechanism by which SM [spinal manipulation] induces injury into normal healthy tissues has been identified (Whedon et al., 2015, p. 5) 

References:

1. Coronado, R. A., Gay, C. W., Bialosky, J. E., Carnaby, G. D., Bishop, M. D., & George, S. Z.
2. Reed, W. R., Pickar, J. G., Sozio, R. S., & Long, C. R. (2014). Effect of spinal manipulation thrust magnitude on trunk mechanical activation thresholds of lateral thalamic neurons. Journal of Manipulative and Physiological Therapeutics, 37
3. Whedon, J. M., Mackenzie, T. A., Phillips, R. B., & Lurie, J. D. (2015). Risk of traumatic injury associated with chiropractic spinal manipulation in Medicare Part B beneficiaries aged 66-69 years. Spine, 40(4), 264-270.

Share this

THE BRAIN CONNECTION:

Research Proves Chiropractic Adjustments Affect Emotions, Learning, Memory, Consciousness, Motivation, Homeostasis, Perception, Motor Control, Self-Awareness, Cognitive Function, Voluntary Movement, Decision Making, Touch and Pain

A report on the scientific literature 

By: Mark Studin DC, FASBE(C), DAAPM, DAAMLP 

William J. Owens DC, DAAMLP

For decades chiropractors and their patients have been experiencing many positive outcomes that have gone well beyond the pain treatment they originally sought. This author has been practicing for 34 years and has witnessed what many thought were miracles, but the seasoned chiropractor simply called it an everyday occurrence, albeit lacking in an explanation that was verified through research and published in a universally accepted forum, the scientific literature. Notwithstanding, we practitioners and our patients have persevered for over 115 years having to rely simply in results. 

In 2014, Gay and fellow researchers concluded “…pain-free volunteers processed thermal stimuli applied to the hand before and after thoracic (mid-back) spinal manipulation (chiropractic spinal adjustment)).  What they found was that after thoracic manipulation, several brain regions demonstrated a reduction in peak BOLD [blood-oxygen-level–dependent] activity. Those regions included the cingulate, insular, motor, amygdala and somatosensory cortices, and the PAG [periaqueductal gray regions]” (p. 615). In other words, thoracic chiropractic adjustments produced direct and measureable effects on the central nervous system across multiple regions, which is responsible for the processing of emotion (cingulate cortex, aka limbic cortex) and the insular cortex, which also responsible for regulating emotion as well has homeostasis. The motor cortex is involved in the planning and execution of voluntary movements, the amygdala’s primary function is memory and decision making (also part of the limbic system), the somatosensory cortex is involved in processing the sense of touch (remember the homunculus) and, finally, the periaqueductal gray is responsible for descending pain modulation (the brain regulating the processing of painful stimuli).

The following regions of the brain are affected and the following functions are affected:

We are now starting to get answers and reasons for the results that was once considered “miracles.” The research has verified that the chiropractic adjustment does not deliver miracles, it only helps the body work better and we now know why. 

We also know that chiropractic is one of the safest treatments currently available in healthcare and when there is a treatment where the potential for benefits far outweighs any risk, it deserves serious consideration.  Whedon, Mackenzie, Phillips, and Lurie (2015) based their study on 6,669,603 subjects after the unqualified subjects had been removed from the study and accounted for 24,068,808 office visits. They concluded, “No mechanism by which SM [spinal manipulation] induces injury into normal healthy tissues has been identified (Whedon et al., 2015, p. 5) 

Reference:

1. Gay, C. W., Robinson, M. E., George, S. Z., Perlstein, W. M., & Bishop, M. D. (2014). Immediate changes after manual therapy in resting-state functional connectivity as measured by functional magnetic resonance imaging in participants with induced low back pain. Journal of Manipulative and Physiological Therapeutics, 37
2. Whedon, J. M., Mackenzie, T. A., Phillips, R. B., & Lurie, J. D. (2015). Risk of traumatic injury associated with chiropractic spinal manipulation in Medicare Part B beneficiaries aged 66-69 years. Spine, 40(4), 264-270.

Share this

Neck Pain (Torticollis), Headaches, Dizziness, Radiating Pain, Nausea, Depression, Confusion, Ringing in the Ears Show Good Outcomes With Chiropractic Care

A report on the scientific literature 

By: Marc D. Weiss, D.C., DAAMLP

Mark Studin DC, FASBE(C), DAAPM, DAAMPL

Although neck pain is the number one bodily injury or pain complaint from the general population in the west, many studies verify that chiropractic care for common neck pain has been effective.  It has also been generally recognized that chiropractic care has helped a myriad of maladies and we are just starting to see those outcomes or positive results in the scientific literature to verify what both chiropractors and their patients have been reporting for over 100 years. The following study looks at outcomes of chiropractic treatment for neck pain and concurrent complaints throughout the Netherlands.

Rubenstein ET. Al (2007) used 79 chiropractors who each recruited approximately 10 patients. The patients were between the ages of 18-65 and had not received treatment 3 months prior to beginning this study. Participants who were treated for neck pain in this study all had different levels and frequency of visits with the chiropractor. Chiropractic spinal adjustments were the primary form of treatment. Each patient was asked a series of questions to assess their treatment success during each visit as well as during follow up appointments at 3 months and 12 months. Every symptom, including fatigue, headaches, nausea, and depression, significantly decreased from visit to visit, and significantly increased after the visits ceased.

This study covered a large area of patients with varying degrees and specifics of neck pain, as well as chiropractors with varying methods of treatment. Unlike many studies that gather data on effectiveness of treatments, especially pharmaceutical companies, this study showed statistics of both success in curing neck pain as well as adverse effects that arose during and after treatment. Only 5 of 4891 patients in the study group reported worsening of pain at the end of the study, which was 12 months after treatment. Also, only 2 of 4891 patients reported worsening of pain at the 3 month mark, which is when treatment for neck pain stopped.

The most prevalent improvement of neck pain in patients occurred during their first three visits. Additionally, most symptoms other than neck pain also improved during the first 3 months of treatment. Almost 50% of the patients were fully recovered when interviewed at their fourth visit. Almost 75% of the patients were fully recovered when interviewed at the three and twelve month follow up visits.

The following graph was presented by Rubenstein ET. Al (2007)

As you can see from the above graph, by the 2nd visit to a chiropractor, there has been significant improvement that continues to improve by the 4^th visit. Although these patients initially sought care for neck pain, this study shows that many complaints respond favorably to chiropractic care and each complaint requires more independent research. The most impressive stastistic was 99.4% of people in the study would visit a chiropractor again at the 2nd visit and 98.7% at the 4th visit. That alone gives more insight than most other variables. If it wasn't successful, those numbers would not be there. 

Chiropractic is one of the safest treatments currently available in healthcare and when there is a treatment where the potential for benefits far outweighs any risk, it deserves serious consideration.Whedon et al. (2014) based their study on 6,669,603 subjects after the unqualified subjects had been removed from the study and accounted for 24,068,808 office visits. They concluded,“No mechanism by which SM (spinal manipulation) induces injury into normal healthy tissues has been identified.(Whedon et al.,2014, p. 5) 

Reference:  

1. Rubinstein S., Lebouf-Yde C., Knol D., de Koekkoek T., Pfeifle C., van Tulder M., (2007) The Benefits Outweigh The Risks For Patients Undergoing Chiropractic Care For Neck Pain: A Prospective, Multicenter, Cohort Study, Journal of Manipulative & Physiological Therapeutics 30(6) page 408-418
2. Whedon, J. M., Mackenzie, T. A., Phillips, R. B., & Lurie, J. D. (2014). Risk of traumatic injury associated with chiropractic spinal manipulation in Medicare Part B beneficiaries aged 66-69.Spine,[Epub ahead of print]1-33.

Share this