Benefits of Chiropractic
over 95% according to recent surveys in North America
and Europe, first consult chiropractic physicians for
musculoskeletal pain, the majority for back pain or neck pain/headache.
This is the core of chiropractic practice, which is now well-supported by
evidence and well-accepted by the medical profession. Articles in journals such
as the Journal of Family Practice, and the Annals of Internal
Medicine, the official publication of the American
College of Physicians, now encourage
physicians to refer patients to chiropractors who treat "mainly
musculoskeletal disorders with manual manipulative techniques."
However many of these patients experience secondary health benefits in systems apparently
remote from the spine and musculoskeletal system, for example, improved
breathing and digestion, or resolution of pelvic or visual or circulatory
problems. This is not so strange to chiropractors, neurologists, osteopaths and
others who understand the intimite relationship between the spine and the
central nervous system. However, it seems very strange to the average family
physician and member of the public.
A weakness for the chiropractic profession has been little research documenting
the nature and frequency of these non-musculoskeletal benefits following
chiropractic treatment. Up until this point there have been numerous case
studies and much anecdotal evidence. We now offer the following recent
The first such study has been published in the Journal of Manipulative and
Physiological Therapeutics, with most interesting results. This is a national
survey of 1504 patients of 87 members of the Swedish Chiropractors'
Association, and it reports the following:
- About 1 in 4 (23%) of adult
patients consulting for neuromusculoskeletal (NMS) conditions experienced
positive Non-NMS benefits after chiropractic adjustment/manipulation.
- Positive reactions were most commonly grouped
under the respiratory system (26%), the digestive system (25%), the
circulation/heart (14%), and eyes/vision (14%)
By itself, this research proves little. And
because of medical skepticism and the present lack of a strong body of
scientific evidence in this area of the wider potential health benefits for
chiropractic care, this important study could prove harmful if used
irresponsibly. Recommendations are:
- This form of research should be
repeated in other countries to see if these results are repeatable.
- The study should be used to generate interdisciplinary
clinical research. Medical specialists in those fields should be
encouraged to arrange for a series of suitable patients to be provided
with a chiropractic spinal evaluation and, where necessary, trials of
separate ad concurrent chiropractic management.
This is what happened 20 years ago for back
pain. This study, when combined with other published work, now provides a
credible basis for medical collaboration in other non-musculoskeletal areas.
Source: The Chiropratic Report, Editor: David Chapman-Smith LL.B.
(Hons.), March 2000, Vol. 14, No. 2.
Articles On Non-musculoskeletal Benefits of Chiropractic
Atlas vertebra realignment and achievement of arterial
pressure goal in hypertensive patients: a pilot study.
Bakris G, Dickholtz M Sr, Meyer PM, Kravitz G, Avery E, Miller M, Brown J, Woodfield C, Bell B. Department of Preventive Medicine, Rush
of Human Hypertension 2007 May;21(5):347-52. Epub 2007 Mar 2.
abnormalities of the cervical spine at the level of the Atlas vertebra are
associated with relative ischaemia of the brainstem circulation and increased
blood pressure (BP). Manual correction of this mal-alignment has been
associated with reduced arterial pressure. This pilot study tests the
hypothesis that correcting mal-alignment of the Atlas vertebra reduces and
maintains a lower BP. Using a double blind, placebo-controlled design at a
single center, 50 drug naïve (n=26) or washed out (n=24) patients with Stage 1
hypertension were randomized to receive a National Upper Cervical Chiropractic
(NUCCA) procedure or a sham procedure. Patients received no antihypertensive
meds during the 8-week study duration. The primary end point was changed in
systolic and diastolic BP comparing baseline and week 8, with a 90% power to
detect an 8/5 mm Hg difference at week 8 over the placebo group. The study
cohort had a mean age 52.7+/-9.6 years, consisted of 70% males. At week 8,
there were differences in systolic BP (-17+/-9 mm Hg, NUCCA versus -3+/-11 mm
Hg, placebo; P<0.0001) and diastolic BP (-10+/-11 mm Hg, NUCCA versus -2+/-7
mm Hg; P=0.002). Lateral displacement of Atlas vertebra (1.0, baseline versus
0.04 degrees week 8, NUCCA versus 0.6, baseline versus 0.5 degrees , placebo;
P=0.002). Heart rate was not reduced in the NUCCA group (-0.3 beats per minute,
NUCCA, versus 0.5 beats per minute, placebo). No adverse effects were recorded.
We conclude that restoration of Atlas
alignment is associated with marked and sustained reductions in BP similar to
the use of two-drug combination therapy.
Spinal manipulative therapy reduces inflammatory cytokines but not
substance P production in normal subjects.
Teodorczyk-Injeyan JA, Injeyan HS, Ruegg R. Division of Research, Canadian Memorial Chiropractic
College, Toronto, Ontario, Canada.
J Manipulative Physiol Ther. 2006 Jan;29(1):14-21
OBJECTIVE: To examine the effect of a single spinal
manipulation therapy (SMT) on the in vitro production of
inflammatory cytokines, tumor necrosis factor alpha, and interleukin (IL)
1beta, in relation to the systemic (in vivo) levels of neurotransmitter
substance P (SP). METHODS: Sixty-four asymptomatic subjects were assigned to
SMT, sham manipulation, or venipuncture control group. SMT subjects received a
single adjustment in the thoracic spine. Blood and serum samples were obtained
from subjects before and then at 20 minutes and 2 hours after intervention.
Whole-blood cultures were activated with lipopolysaccharide (LPS) for 24 hours.
Cytokine production in culture supernatants and serum SP levels were assessed
by specific immunoassays. RESULTS: Over the study period, a significant
proportion (P </= .05) of sham and control subjects demonstrated progressive
increases in the synthesis of tumor necrosis factor alpha and IL-1beta.
Conversely, in a comparable proportion of cultures from SMT-derived subjects,
the production of both cytokines decreased gradually. Normalization of the
observed alterations to reflect the changes relative to self-baselines
demonstrated that, within 2 hours after intervention, the production of both
cytokines increased significantly (P < .001 to .05) in both controls. In
contrast, a significant (P < .001 to .05) reduction of proinflammatory
cytokine secretion was observed in cultures from SMT-receiving subjects.
In all study groups, serum levels of SP remained unaltered within 2 hours after
intervention. CONCLUSIONS: SMT-treated subjects show a time-dependent
attenuation of LPS-induced production of the inflammatory cytokines unrelated
to systemic levels of SP. This suggests SMT-related down-regulation of
inflammatory-type responses via a central yet unknown mechanism. (Manipulation lowered the body’s
· Enhancement of in vitro
interleukin-2 production in normal subjects following a single spinal
Teodorczyk-Injeyan JA, Injeyan HS, McGregor M,
Harris GM, Ruegg R. Division
of Foundational and Professional Education, Canadian Memorial Chiropractic
ABSTRACT: BACKGROUND: Increasing evidence supports
somato-visceral effects of manual therapies. We have previously demonstrated
that a single spinal manipulative treatment (SMT) accompanied by audible
release has an inhibitory effect on the production of proinflammatory cytokines
in asymptomatic subjects. The purpose of this study is to report on SMT-related changes in the
production of the immunoregulatory cytokine interleukin 2 (IL-2) and to
investigate whether such changes might differ with respect to the treatment
approach related to the presence or absence of an audible release (joint
cavitation). METHODS: Of 76 asymptomatic subjects, 29 received SMT with
cavitation (SMT-C), 23 were treated with SMT without cavitation (SMT-NC) and 24
comprised the venipuncture control (VC) group. The SMT-C and SMT-NC subjects
received a single, similar force high velocity low amplitude manipulation, in
the upper thoracic spine. However, in SMT-NC subjects, positioning and line of
drive were not conducive to cavitation. Blood and serum samples were obtained
before and then at 20 and 120 min post-intervention. The production of IL-2 in
peripheral blood mononuclear cell cultures was induced by activation for 48 hr
with Staphylococcal protein A (SPA) and, in parallel preparations, with the
combination of phorbol ester (TPA) and calcium ionophore. The levels of IL-2 in
culture supernatants and serum were assessed by specific immunoassays. RESULTS:
Compared with VC and their respective baselines, SPA-induced secretion of IL-2
increased significantly in cultures established from both SMT-C and SMT-NC
subjects at 20 min post-intervention. At 2 hr post-treatment, significant
elevation of IL-2 synthesis was still apparent in preparations from SMT-treated
groups though it became somewhat attenuated in SMT-NC subjects. Conversely,
IL-2 synthesis induced by TPA and calcium ionophore was unaltered by either
type of SMT and was comparable to that in VC group at all time points.
No significant alterations in serum-associated IL-2 levels were observed in any
of the study groups. CONCLUSION: The present study demonstrates that, the in
vitro T lymphocyte response to a conventional mitogen (SPA), as measured by
IL-2 synthesis, can become enhanced following SMT. Furthermore, within a
period of time following the manipulative intervention, this effect may be
independent of joint cavitation. Thus the results of this study suggest
that, under certain physiological conditions, SMT might influence
IL-2-regulated biological responses.
- The types and frequencies of
improved nonmusculoskeletal symptoms reported after chiropractic spinal
Leboeuf-Yde C, Axen I, Ahlefeldt G, Lidefelt P, Rosenbaum A, Thurnherr T.
Medical Research Unit, Amtsradhuset, Torvet, Denmark.
J Manipulative Physiol Ther 1999 Nov-Dec;22(9):559-64
OBJECTIVE: To investigate the frequency and types of improved nonmusculoskeletal
symptoms reported after chiropractic spinal manipulative therapy. DESIGN:
Retrospective information obtained by chiropractors through standardized
interview of patients on return visit within 2 weeks of previous
treatment. SETTING: The private practice of 87 Swedish chiropractors
(response rate 81%). SUBJECTS: Twenty consecutive (presumably naive)
patients per chiropractor (1504 valid questionnaires returned, 86% of
optimal number of replies). INTERVENTION: Spinal manipulation with or without
additional therapy provided by chiropractors. MAIN OUTCOME MEASURES:
Self-reported improved nonmusculoskeletal symptoms (reactions). RESULTS:
At least I reaction was reported after the previous treatment in 21% to
25% of cases. Of these responses, 26% were related to the airway passages
(usually reported as "easier to breathe"), 25% were related to
the digestive system (mostly reported as "improved function"),
14% were classified under eyes/vision (usually reported as "improved
vision"), and 14% under heart/ circulation (about half of these
reported as "improved circulation"). The number of spinal areas
treated was positively associated with the number of reactions.
CONCLUSION: A minority of chiropractic patients report having positive
nonmusculoskeletal reactions after spinal manipulative therapy but such
reports cluster predominantly around specific symptoms. It would be
interesting to find out if these can be verified objectively and, if so,
to investigate if they are caused by the treatment or if they are signs of
natural variations in human physiology.
- Indigestion and heartburn: a
descriptive study of prevalence in persons seeking care from
Bryner P, Staerker PG
J Manipulative Physiol Ther 1996 Jun;19(5):317-23
OBJECTIVE: To determine the prevalence of indigestion and mid-back pain in
persons seeking chiropractic care. DESIGN: A cross-sectional survey using
a self-report questionnaire. SETTING: Three primary care private
chiropractic practices in metropolitan Perth, Australia. SUBJECTS: Persons
seeking chiropractic care during a 1-month period. INTERVENTION: None.
OUTCOME MEASURES: Six-month prevalence of indigestion and mid-back pain,
rate of association between indigestion and mid-back pain, and
distribution of thoracic dysfunction and manipulation. Proportion who
report relief from manipulation. OBSERVATIONS: Of 1567 persons who
consulted 8 chiropractors on 2974 occasions during November 1994, 1494
responses were obtained. There were 119 first-time consultations. The mean
age of respondents was 41 yr (range 10-94); 57% were women. Fifty-seven
percent reported indigestion infrequently or more and 71% reported
mid-back pain during the previous 6 months. Forty-six percent experienced
both symptoms during this time. Of these, 36% reported the symptoms
together at some time. Twenty-two percent of those with indigestion
reported some relief after chiropractic care. Compared with those
reporting no relief, mid-back pain was more common among those reporting
indigestion. The level at which the manipulation was given was unrelated
to relief. No major differences were noted between the three clinics in
patient demographics or the main outcome measures.
CONCLUSIONS: Indigestion and mid-back pain are commonly experienced in
this population. A person with indigestion is more likely to report
mid-back pain. Relief of indigestion by manipulation is more common among
those who report mid-back pain. Further research is needed to understand
differences between subgroups and differences compared with other studies.
- Somatic dysfunction and the
phenomenon of visceral disease simulation: a probable explanation for the
apparent effectiveness of somatic therapy in patients presumed to be
suffering from true visceral disease.
Nansel D, Szlazak M. Department of Life Sciences and Clinical Diagnosis,
Palmer College of Chiropractic-West San Jose, CA 95134, USA.
J Manipulative Physiol Ther 1995 Jul-Aug;18(6):379-97
BACKGROUND AND OBJECTIVES: Several theories have been put forth in
attempts to explain the possible mechanisms by which patients presumed to
be suffering from any of a variety of internal organ diseases are
occasionally found to respond quickly and dramatically to therapies
delivered to purely somatic structures (e.g., spinal manipulation). The
purpose of this review is to examine the scientific bases upon which these
sorts of clinical phenomenaight be interpreted. DATA SOURCES: A review was
conducted of over 350 articles that have appeared in the scientific
literature over the last 75 years. Initially, a MEDLINE search was
performed; however, because of the variability of indexing terms employed
by investigators within a wide variety of biomedical disciplines, most of
this literature had to be located article by article. DATA SYNTHESIS: At
present, there have been no appropriately controlled studies that
establish that spinal manipulation or any other form of somatic therapy
represents a valid curative strategy for the treatment of any internal
organ disease. Furthermore, current scientific knowledge also fails to
support the existence of a plausible biological mechanism that could
account for a causal segmentally or regionally related
"somato-visceral disease" relationship. On the other hand, it
has now been firmly established that somatic dysfunction is notorious in
its ability to create overt signs and symptoms that can mimic, or simulate
(rather than cause), internal organ disease. CONCLUSIONS: The proper
differential diagnosis of somatic vs. visceral dysfunction represents a
challenge for both the medical and chiropractic physician. The afferent
convergence mechanisms, which can create signs and symptoms that are
virtually indistinguishable with respect to their somatic vs. visceral
etiologies, need to be appreciated by all portal-of-entry health care providers,
to insure timely referral of patients to the health specialist appropriate
to their condition. Furthermore, it is not unreasonable that this somatic
visceral-disease mimicry could very well account for the "cures"
of presumed organ disease that have been observed over the years in
response to various somatic therapies (e.g., spinal manipulation,
acupuncture, Rolfing, Qi Gong, etc.) and may represent a common phenomenon
that has led to "holistic" health care claims on the part of
such clinical disciplines.
- Bilateral simultaneous optic
nerve dysfunction after periorbital trauma: recovery of vision in
association with chiropractic spinal manipulation therapy.
Stephens D, Pollard H, Bilton D, Thomson P, Gorman F. Macquarie University
School of Chiropractic, Sydney, Australia.
J Manipulative Physiol Ther 1999 Nov-Dec;22(9):615-21
OBJECTIVE: To discuss the recovery of optic nerve function after
chiropractic spinal manipulation in a patient with loss of vision as a
result of facial fracture from a fall. CLINICAL FEATURES: In a fall down a
stairwell, a 53-year-old woman with migraines fractured her right
zygomatic arch, which was later treated surgically. Approximately 3 weeks
after the accident, vision in her contralateral eye became reduced to
light perception. Electrophysiologic studies revealed that the function of
both optic nerves was diminished, the right significantly more than the
left. Single photon emission tomography showed pancerebral ischemic foci.
INTERVENTION AND OUTCOME: Chiropractic spinal manipulation was used to aid
recovery of vision to normal over a course of 20 treatment sessions. At
times, significant improvement in vision occurred immediately after spinal
manipulation. Progressive recovery of vision was monitored by serial
visual field tests and by electrophysiologic studies. Unfortunately, the
patient refused a further single photon emission tomographic study when
visual recovery was complete. CONCLUSION: This case report adds to
previous accounts of progressive and expeditious recovery of optic nerve
function in association with spinal manipulation therapy.
- The step phenomenon in the
recovery of vision with spinal manipulation: a report on two 13-yr-olds
Stephens D, Gorman F, Bilton D
J Manipulative Physiol Ther 1997 Nov-Dec;20(9):628-33
OBJECTIVE: To discuss the immediate increment of improvement in vision
that occurs when the spine is manipulated. CLINICAL FEATURES: Two juvenile
patients (13-yr-old female cousins) were found to have constricted visual
fields and diminished visual acuities. INTERVENTION AND OUTCOME: Spinal
manipulation was associated with recovery of normal vision over seven
treatment sessions. It was noted that significant improvement in vision
occurred immediately after the spinal manipulation treatments. Full
recovery of vision was attained by series of these steps. In addition,
both patients reported significant constitutional benefits after the
treatment in addition to the improved vision. CONCLUSION: The change in
visual function immediately related to spinal manipulation has been
described as the "step phenomenon." The step phenomenon raises
questions about the nature of the condition that may be treated by spinal
manipulation and the method of action of the treatment. A vascular hypothesis
is mentioned that could explain these events. The consistent occurrence of
the step phenomenon indicates that spinal manipulation may have an effect
on brain function.
- Monocular visual loss after
closed head trauma: immediate resolution associated with spinal
J Manipulative Physiol Ther 1995 Jun;18(5):308-14
OBJECTIVE: To discuss the case of a patient who demonstrated that spinal
injuries may cause both cortical and ocular visual loss that was
ameliorated by manipulative care. CLINICAL FEATURES: The patient suffered
separate incidents of binocular and monocular loss of vision. A female
child, aged 9 yr, presented with bilateral concentric narrowing of the
visual fields that returned to normal immediately after spinal treatment.
Approximately 1 yr later, she returned with monocular loss of vision after
she was struck on the head by a ball. INTERVENTION AND OUTCOME: The child
was treated by spinal manipulation under anesthesia; the vision was found
to be normal on awakening from the anesthesia. Both visual recoveries were
authenticated by an independent ophthalmic specialist. CONCLUSIONS: This
case history adds to the other recorded occasions in which vision is noted
to improve when the spine is manipulated. Discussion is directed to the
basic pathogenesis: is her condition a form of psychoneurosis, is it a
variant of migraine, or could it be a combination of both conditions?
- Cervicogenic hearing loss.
[Article in German] Hulse M. Abteilung fur Phoniatrie, Padaudiologie und
Neurootologie, Fakultat fur Klinische Medizin Mannheim, Universitat
HNO 1994 Oct;42(10):604-13
Existing investigations of cervical hearing disorders have been carried
out predominantly in patients in whom those with vertebrobasilar
insufficiencies (VBI) could not be distinguished from patients suffering
from functional deficit of the upper cervical spine. Since two different
syndromes exist, no statement can be made about cervical hearing
disorders. That deafness can occur in VBI is uncontested. In contrast,
there remains a dispute whether a "vertebragenic hearing
disorder" exists. This latter disorder is believed accompanied by
tinnitus, a feeling of ear pressure, otalgia and deafness as symptoms of a
functional deficit of the upper cervical spine. In reviewing the medical
findings of 259 patients with well-defined functional deficits of the
upper cervical spine and symptoms of cervical vertigo, subjective hearing
disorders occurred in 15%. Audiometric threshold shifts of 5-25 dB, most
often in lower frequencies, were observed in 40%. Additionally, results of
click-evoked otoacoustic emissions (OAE) were negative in spite of
approximately normal hearing. Findings in 62 patients suffering from
vertebragenic hearing disorders are reported before and after chiropractic
management. Results indicate that these hearing disorders are reversible,
as demonstrated by audiometry and OAE. The therapy of choice is
chiropractic manipulation of the upper cervical spine. The commoness
of vertebragenic hearing disorders emphasizes their clinical and forensic
- Chronic tonsillitis and the
upper cervical spine.
[Article in Czech] Lewit K, Abrahamovic M
Sb Lek 1975 Jan;77(1):30-2
The authors investigated 46 patients with chronic tonsillitis. Only in 5
(11% blockage in the craniocervical junction were absent. The most
frequently affected segment was between the occipital bone and the atlas
(in 36 patients), between the atlas and axis in two and between the axis
and C3 in three patients. In 28 treatment was only surgical. There
blockage disappeared only in four, in two blockage developed operation.
Five patients were treated before operation also by manipulation. There
the blockage relapsed only once. In 10 treatment was by manipulation only.
During the observation period (from 3-9 months) not a single relapse of
blockage or tonsillitis was observed during the winter period.
- Functional nocturnal enuresis
J Manipulative Physiol Ther 1994 Jun;17(5):335-8
OBJECTIVE: To discuss a patient with primary nocturnal enuresis whose
symptoms resolved following manipulation. CLINICAL FEATURES: An 8-yr-old
boy with a history of primary functional nocturnal enuresis was under care
at this office. The patient's clinical examination was benign. He had
several areas of lumbar segmental dysfunction. The patient's medical
history was unremarkable except for childhood asthma. INTERVENTION AND
OUTCOME: The patient's lumbar spine was manipulated once, and at a 1 month
follow-up there was complete resolution of enuresis. The patient had
several recurrences of bed-wetting, all of which were associated with
minor injury to the lower back. The patient responded positively to
subsequent manipulation. CONCLUSION: This patient's enuresis resolved with
the use of manipulation. This happened in a manner that could not be
attributed to time or placebo effect.
- Use of spinal manipulative
therapy in the treatment of duodenal ulcer: a pilot study.
Pikalov AA, Kharin VV. Division of Research, Cleveland
Chiropractic College, Kansas
City, MO 64131.
J Manipulative Physiol Ther 1994 Jun;17(5):310-3
OBJECTIVE: To evaluate the effectiveness of spinal manipulative therapy
(SMT) in the treatment of an internal organ disorder. DESIGN: Clinical
trial. SETTING: Medical hospital. PATIENTS: Eleven adult men and women
ranging in age from 18-44 yr with endoscopically confirmed diagnosis of
ulcer disease took part in the study as an experimental group. The outcome
of 24 cases of uncomplicated ulcerous disease treated by usual medical
methods was analyzed as a control. INTERVENTIONS: The experimental group
received spinal manipulative therapy (SMT) treatment from 5-22 days with a
range of 3-14 procedures. The control group received traditional medical
treatment (drug therapy and diet). The dietary regimen was standard for
both groups. MEASUREMENTS: The effectiveness of the treatment was
evaluated using clinical parameters and endoscopic examination performed
weekly. MAIN RESULTS: The use of SMT resulted in pain relief after 1-9
(avg. 3.8) days and clinical remission an average of 10 days earlier than
traditional care. CONCLUSIONS: Chiropractic practice often includes
patients with gastrointestinal problems who report some relief of their
symptoms after treatment; however, the physiological basis for these
results has yet to be established. The normalization in segmental trophic
innervation of the mucosal layer of the intestine, and positive reaction
of the whole body, are under discussion as a possible mechanism for the