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Palmer Recruiting for Next Blood Pressure Study

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Palmer Recruiting for Next Blood Pressure Study

The Chiro.Org Blog

The Palmer Center for Chiropractic Research is recruiting subjects with high blood pressure to participate in a clinical research study designed to evaluate the potential impact of chiropractic care on hypertension.

The Chiropractic for Hypertension in Patients (CHiP) study, a collaborative investigation involving the Palmer Center, Mount Sinai Medical Center in Miami, Fla., and Trinity at Terrace Park Family Practice in Bettendorf, Iowa, is one of three research projects to emerge from a $2.8 million grant awarded to the Palmer Center in 2008 by the National Institutes of Health to create a multidisciplinary Developmental Center for Clinical and Translational Science in Chiropractic.

“More than 50 million Americans suffer from high blood pressure, making it the most commonly diagnosed disease in the United States,” said Dr. Christine Goertz, vice chancellor for research and health policy at the Palmer Center and lead investigator on the hypertension study. “Although many medical treatments for diagnosed hypertension are available, only about 30% of patients achieve blood pressure goals. Many patients report that they are unable to tolerate medication side effects and find it difficult to sustain significant lifestyle changes. Thus, a non-pharmacological therapy that lowers blood pressure could become an attractive option to many patients and their physicians.”

Leading the study along with Dr. Goertz are Gervasio Lamas, MD, a cardiovascular scientist at Mount Sinai with considerable experience conducting large, multisite clinical trials; Joseph Bergstrom, DO, director of medical education for the Trinity Terrace Park family practice residency program; and Quad-City cardiologist Dr. Michael Giudici, serving on the study’s Data and Safety Monitoring Committee.

“The concept that manipulation of the upper cervical spine could reduce blood pressure is both novel and appealing at the same time,” said Dr. Lamas. “It is novel because of its originality of thought, and because it is backed up by preliminary data. It is appealing because any treatment for high blood pressure that does not expose patients to drugs and their side effects should be investigated.”

“This should be an interesting trial,” added Dr. Giudici. “Work to date has shown that blood pressure responds to other non-pharmacologic interventions such as diet, weight loss, exercise, stress reduction and yoga, [and] there is also some interesting early data on blood pressure response to slowing respiratory rate.”

The “preliminary data” Dr. Lamas mentions undoubtedly includes the landmark 2007 pilot study, conducted at the University of Chicago, in which a one-time specialized chiropractic adjustment, delivered to patients suffering from high blood pressure and misaligned C1 vertebrae, resulted in significant reductions in diastolic and systolic BP compared to controls – reductions deemed equivalent to that seen with concurrent administration of two blood pressure drugs.

For the current study, the Palmer Center is recruiting 165 hypertension patients (21-65 years of age); qualifying patients will be randomly assigned to one of three upper cervical treatment groups, all of whom will receive chiropractic care at the Palmer Research Clinic for eight weeks (the same time frame as the Chicago pilot investigation). Blood pressure will be monitored at various points during the study period.

Thanks to Dynamic Chiropractic for access to this material!

UPDATE:   Evidently this trial was modified and only examined the effect of Toggle Recoil upper cervical adjusting.   According to ClinicalTrials./gov [Last updated: September 3, 2015], the Chiropractic for Hypertension in Patients (CHiP) Trial has been completed and should be heading towards publication.

About the Author:

I was introduced to Chiro.Org in early 1996, where my friend Joe Garolis helped me learn HTML, the "mark-up language" for websites. We have been fortunate that journals like JMPT have given us permission to reproduce some early important articles in Full-Text format. Maintaining the Org website has been, and remains, my favorite hobby.


  1. Chiropractor Pittsfield December 24, 2009 at 10:22 pm

    So, if Palmer Chiropractic research proves the effectiveness, do you think the insurance companies will start giving people 1 visit a week to decrease hypertention?

    Scott Garber
    Chiropractor Pittsfield

    RESPONSE from Frank:

    I believe the pilot study showed sustained reductions at 8 weeks.

    The interesting thing about this study is that the author has made comments (in the press) that only NUCCA doctors could get these type of results, when in fact, this Palmer study will be the first to pit 3 different upper cervical (UC) techniques against one another. So, I guess we’ll finally see if one technique IS superior to another.

  2. Dr. Mario Hermida December 26, 2009 at 4:20 am

    This is great for Chiropractic world wide.

    Question– When will we be able to study real time multisystem physiology, and structure as related to the adjustment?

    and most of all,

    Hat´s off and a million thanks to all those that contributed in making this great research possible. Felizes Fiestas!!!! mh

  3. John December 27, 2009 at 1:02 pm

    I huge thanks should be given to the upper cervical docs and advocates who spent their own hundreds of thousands of dollars to do what has already been done in research for upper cervical. Also, it is great because if we look at risk analysis the orthogonal approaches are gentle and the toggle and blair are fairly gentle too.

    RESPONSE from Frank:

    There’s a long list of Upper Cervical (UC) approaches that evolved from Palmer’s original HIO (aka Toggle-recoil, aka upper cervical specific) technique.

    Some of them use high-velocity, low amplitude (HVLA) impulses, some use low- or -no velocity, and some use instruments rather than the hand (pisiform) to apply the adjusting thrust. Some use side-posture tables, some use knee-chest apparatus.

    All of them evolved from Palmer’s “line analysis” of x-rays to determine the Atlas (or Axis) misalignment, and to determine the line of correction required for correction.

    What must be emphasized is, at this point, none of these techniques can be considered “superior” to another, because this trial, planned by Palmer, will be the first to compare (at least) 3 of them head-to-head.

    A non-exhaustive list of upper cervical techniques includes:

    Toggle recoil
    Atlas Orthogonal


    Upper-cervical Technique, Historically Considered
    Journal of the American Chiropractic Association 2003 (March)

  4. chiropractor pittsfield December 27, 2009 at 10:45 pm

    Any idea what upper cervical techniques they will be using for this study? I was aware of the NUCCA claims and think that’s what keeps getting chiropractors in trouble. My patients heard about the study and kept coming in to ask me what was different about that technique, and the one I use? I believe you can get the same results with a Gonstead atlas adjustment, and the study should not be techniques specific.

    RESPONSE from Frank:

    It’s quite reasonable to compare different upper cervical techniques, to see if there actually is a difference in results. If one approach was markedly better, wouldn’t you want to offer that to your patients?

    By the way, I just discovered a recent article that details the
    history and diversity of upper cervical adjusting. It’s now permanently archived on our Chiropractic Technique Page

  5. Matthew Loop December 28, 2009 at 9:54 am

    Just Tweeted this post for you. This should be another great study that will show even more effectiveness of chiropractic care 🙂

  6. Marco J. La Starza, D.C. January 4, 2010 at 8:40 pm

    Let me know how the study goes

  7. Acupuncture Clinic February 8, 2010 at 7:49 am

    ChiroOrg Blog is an excellent site and I have to say that I am really impressed.

  8. I realize I’m late to this conversation, but after reading
    I feel compelled to comment. When we perform an adjustment
    it activates joint receptors, which in turn increase the frequency
    of firing (f.o.f.) of that primary afferent. That increase in
    frequency up results in an increased f.o.f. of the brain on the
    opposite side of the adjustment. The brain then increases the
    f.o.f. of the pontomedullary junction which results in decreased
    blood pressure and heart rate.

    It has nothing to do with technique. Any appropriate stimuli
    to the brain will accomplish the same thing.

  9. Frank September 13, 2010 at 3:05 pm

    Dr. Ned

    That’s an interesting theory, but is not the only one, and may not necessarily be true.

    Your comment about technique, as of now we don’t know if one may be superior to another, although some techniques make that claim (NUCCA in particular), so I am excited to see it put to the test.

    I have to disagree with your comment “Any appropriate stimuli to the brain will accomplish the same thing.” if you meant that any stimulus will work, as opposed to any of “a variety of chiropractic techniques”.

    Here’s a paragraph from an interesting recent work:

    Activation of neck muscle spindle afferents via neck flexion can initiate an increase in heart rate, muscle sympathetic nerve activity, and arterial blood pressure (Kuwagata et al., 1991; Shortt and Ray, 1997). This reflex sympatho-excitation has been attributed to the activation of the otolith organs in the vestibular system (Yates and Miller, 1994); however, it is likely that there is another component to the reflex because it is still evident where the vestibular system is inactive, such as in brain-dead patients (Kuwagata et al., 1991). This component has been suggested to arise from the dorsal neck musculature, with stimulation of nerves arising from these muscles causing a reflex increase in splanchnic, hypoglossal, and abdominal nerve activity (Bolton et al., 1998). Furthermore, the stimulus intensities used were consistent with those that would activate muscle spindle and Golgi tendon organ afferents. Because this cervico-sympathetic reflex appears to originate from muscle spindles in the dorsal neck musculature, it is very likely that the suboccipital muscle group is involved in the reflex because these muscles have an extremely high muscle spindle content (Richmond and Abrahams, 1975; Kulkarni et al., 2001). Additional evidence for the involvement of the suboccipital muscle group in the cervico-sympathetic reflex comes from changes in blood pressure associated with chiropractic manipulations of the C1 vertebrae (McKnight and DeBoer, 1988; Knutson, 2001), which would result in altering the length of fibers in the suboccipital muscle group. The projection from the InM to the NTS identified in this study therefore places it in an ideal position to mediate cardiorespiratory changes to neck muscle afferent stimulation, because the NTS is a major integratory area for autonomic control circuits (Potts, 2002). Future studies are therefore required to examine the role of these neck afferents in cardiorespiratory regulation. [1]

    1. The Neurochemically Diverse Intermedius Nucleus of the Medulla as a Source of Excitatory and Inhibitory Synaptic Input to the Nucleus Tractus Solitarii
    J Neurosci 2007 (Aug 1); 27 (31): 8324-8333

  10. seattle chiropractor November 8, 2010 at 5:59 am

    If patients have high blood pressure, there is a high liklihood they need an Atlas adjustment.

    RESPONSE from Frank:

    I look at it like this: If the patient’s Atlas is subluxated, then correcting it *may* have an impact on lowering their BP.

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