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Chiropractic and Spinal Pain
A Chiro.Org article collection
Enjoy this collection of articles that reviews chiropractic's impressive impact on pain.
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Non-musculoskeletal Disorders and Chiropractic
A Chiro.Org article collection
Enjoy this collection of articles discussuing chiropractic results with non-musculoskeletal complaints.
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Vertigo, Balance and Chiropractic
A Chiro.Org article collection
Review this collection of studies that details chiropractic's impact on dizziness, balance and vertigo.
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Neuroconceptual Models of Chiropractic
Chapter 5 from: “Basic Principles of Chiropractic Neuroscience”
By Richard C. Schafer, D.C., FICC and the ACAPress
The structural spinal fault, the associated nerve involvement, and the ensuing functional alterations comprise classic chiropractic subluxation concepts. In contrast, limited concepts of spinal biomechanical faults, modes of possible nerve involvement, and etiologic rationales of functional changes promote narrow viewpoints, disciplines, and therapeutic approaches, as well as foster empiricism and dogma. Awareness of the varied concepts of structural lesions, neuroinsults, and the causes of abnormal functional changes promotes wider perspective for intuitive practices, multifaceted observations, and fewer practices with reliance on empiricism that is dictated by dogmatic frameworks.
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Neuromechanical Responses to Spinal Manipulation and Mobilization: A Crossover Randomized Clinical Trial
NCT02660801
J Manipulative Physiol Ther 2022 (Jan); 45 (1): 1–8 ~ FULL TEXT
In a controlled environment, the delivery of a thoracic spinal manipulation in participants with chronic midback pain resulted in an immediate decrease in thoracic pressure-provoked pain intensity but not spinal stiffness. Spinal mobilization has no effect on these 2 outcomes and generates lower thoracic muscle response than a spinal manipulation.
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The Potential Mechanisms of High-Velocity, Low-Amplitude, Controlled Vertebral Thrusts on Neuroimmune Function:
A Narrative Review
Medicina (Kaunas) 2021 (Jun); 57 (6): 536 ~ FULL TEXT
There is substantial evidence suggesting that the nervous system, the hormonal system and the immune system communicate with one another and are intimately linked in their functions. [70, 93–97] This communication is essential for the body’s ability to protect itself and involves a variety of immune mediators, including cytokines, neurotransmitters, hormones, and humoral factors. [67, 68, 70, 94, 116, 117, 164, 234] Furthermore, the prefrontal cortex is critically involved in regulating the autonomic nervous system, the HPA axis, and the immune system. [94, 144–154] Neuro-immune communication is affected by emotional or pain-related stress. [69, 144, 151, 195, 260–262] Stress activates the SNS and HPA axis to increase inflammation in the body. Stress also suppresses the prefrontal cortex, which in turn reduces its inhibitory control on the HPA axis and inhibits the anti-inflammatory PNS activity.
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The Effects of 4 Weeks of Chiropractic Spinal Adjustments
on Motor Function in People with Stroke:
A Randomized Controlled Trial
NCT03849794
Brain Sciences 2021 (May 21); 11 (6): 676 ~ FULL TEXT
Improvements in motor function were observed when chiropractic care was added to 4 weeks of physical therapy care in people with subacute or chronic stroke. These improvements were statistically significant and a post-hoc responder analysis suggested they were also likely to be clinically significant. Chiropractic spinal adjustments may therefore be beneficial for people with motor impairments associated with subacute or chronic stroke. Further research, involving larger group sizes and longer-term follow-up and intervention periods, is required to corroborate these findings and further investigate the impacts of chiropractic care on motor function in people with stroke.
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The Contemporary Model of Vertebral Column Joint Dysfunction
and Impact of High-velocity, Low-amplitude Controlled
Vertebral Thrusts on Neuromuscular Function
European J Applied Physiology 2021 (Oct); 121 (10): 2675–2720 ~ [Epub Jun 23] ~ FULL TEXT
Spinal adjustments of CSMC problems impact motor control in a variety of ways. These include increasing muscle force and preventing fatigue. These changes in neuromuscular function most likely occur due to changes in supraspinal excitability. The current contemporary model of the a central segmental motor control (CSMC) problem, and our understanding of the mechanisms of spinal adjustments, provide a biologically plausible explanation for how the vertebral column's central neural motor control can dysfunction, can lead to a self-perpetuating central segmental motor control problem, and how HVLA spinal adjustments can improve neuromuscular function.
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Neurophysiological Mechanisms of Chiropractic
Spinal Manipulation for Spine Pain
European Journal of Pain 2021 (Mar 31); [EPUB] ~ FULL TEXT
This narrative review highlights the most relevant mechanisms of pain relief by spinal manipulation and provides a perspective for future research on spinal manipulation and spine pain, including the validation of placebo interventions that control for placebo effects and other non-specific effects that may be induced by spinal manipulation.
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Physiological Responses Induced by Manual Therapy in
Animal Models: A Scoping Review
Frontiers in Neuroscience 2020 (May 8); 14: 430 ~ FULL TEXT
Physiological responses related to manual therapy (MT) treatment have been investigated over decades using various animal models. However, these studies have not been compiled and their collective findings appraised. The purpose of this scoping review was to assess current scientific knowledge on the physiological responses related to MT and/or simulated MT procedures in animal models so as to act as a resource to better inform future mechanistic and clinical research incorporating these therapeutic interventions.
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Low Back Pain: The Potential Contribution of Supraspinal
Motor Control and Proprioception
Neuroscientist 2019 (Dec); 25 (6): 583–596 ~ FULL TEXT
Research in the past two decades has provided important evidence how motor control adaptions in LBP might contribute to pain chronification through effects on spinal tissue loading, associated itself with degeneration of intervertebral discs and other tissues. However, the underlying biological and psychosocial interactions are still poorly understood and seem to vary across individuals, reflected in the modest effect sizes of motor control exercises, spurring a call for personalized interventional therapies [van Dieën and others 2018a]. Yet, to unleash the full potential of personalized treatments, more basic research on motor adaptions in LBP is mandatory, especially when considering the evolving evidence of cortical circuits in driving motor control adaptions during the course of LBP. Complementary findings from behavioral and neuroimaging studies underscore the prominent role of aberrant sensory processing in LBP.
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The Effect of Spinal Manipulation on Brain Neurometabolites
in Chronic Nonspecific Low Back Pain Patients:
A Randomized Clinical Trial
Systematic Reviews 2019 (Nov 8); 8 (1): 267 ~ FULL TEXT
The current study was the first to investigate the metabolites of the brain following lumbopelvic manipulation in patients with NCLBP. The limitations of the current study were its high cost, being time-consuming, and 1.5-T magnetic field strength MRI. It is suggested that 3-T MRI be employed in future studies to measure glutamine and glutamate levels separately. Furthermore, another limitation is that we did not record psychosocial information to evaluate its relationship to changes of metabolites and pain. It is further recommended that the effect of other treatments (thermal therapy, physical therapy, exercise therapy, acupuncture) with spinal manipulation be evaluated on CNS by the 1H-MRS technique in patients with nonspecific chronic low back pain (NCLBP).
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Proposed Neurobiological Processes Associated with Models of
Vertebral Subluxation: Dysafferentation, Dyskinesia,
Dysponesis, Dysautonomia, Neuroplasticity and
Ephaptic Transmission
Archives in Neurology & Neuroscience 2018 (Apr 4); 3 (1): 1–3 ~ FULL TEXT
Correction or reduction of vertebral subluxation facilitates the restoration of proper tone throughout the nervous system. Alterations in the tone of the somatic system may be objectively evaluated using surface EMG. Altered autonomic tone may be evaluated using skin temperature measurements. Changes in ranges of motion may be measured to assess dyskinesia. Such objective assessments have the potential to make correction of vertebral subluxation an important strategy in salutogenic healthcare. Additional ewsearch in this area may lead to improved clinical strategies.
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The Effects of a Single Session of Spinal Manipulation
on Strength and Cortical Drive in Athletes
Eur J Appl Physiol 2018 (Apr); 118 (4): 737-749 ~ FULL TEXT
A single session of SM of dysfunctional spinal and pelvic joints increased muscle strength and cortical drive to ankle plantar flexor muscles in elite Taekwondo athletes. The increased MVC force lasted for 30 min and the cortical drive increase persisted for at least 60 min. Further research is now required to determine whether the observed changes are important for athletic performance.
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Subclinical Recurrent Neck Pain and its Treatment Impacts Motor
Training-induced Plasticity of the Cerebellum and Motor Cortex
PLoS One. 2018 (Feb 28); 13 (2): e0193413 ~ FULL TEXT
The presence of neck pain alters both neck and limb sensorimotor function and motor control [9], and even milder forms of neck dysfunction can impact sensorimotor function. [21, 22] These studies were performed with subclinical neck pain participants, or people with untreated mild-to-moderate recurrent neck pain. [23, 24] Such recurrent pain represents a promising model to investigate long term consequences of altered sensory input from the neck on SMI. Whether subclinical recurrent neck pain alters motor learning is currently unknown. If this is the case, it could help explain why maladaptive motor patterns are maintained, potentially setting up a cycle of recurrent and chronic pain. There is a large body of evidence that reveals structural and functional changes within the CNS of people with chronic musculoskeletal disorders. [25] These changes may initially be beneficial, but as they persist they are thought to be influential in the pathophysiology of the condition and the developmental recurrence and maintenance of chronic symptoms. [25] Neuroplastic changes within different areas of the CNS are likely to help explain the transition from acute to recurrent to chronic conditions, sensory-motor findings, perceptual disturbances, why some individuals continue to experience pain when no structural cause can be discerned and why some fail to respond to conservative interventions in subjects with chronic musculoskeletal disorders. [25]
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Association of Subclinical Neck Pain With Altered
Multisensory Integration at Baseline and 4-Week
Follow-up Relative to Asymptomatic Controls
J Manipulative Physiol Ther. 2018 (Feb); 41 (2): 81–91 ~ FULL TEXT
This is the first study to report that people with subclinical neck pain (SCNP) have slower visual and multisensory response times than asymptomatic individuals. These differences persist over 4 weeks, suggesting that the multisensory technique is reliable and that these differences in the SCNP group do not improve on their own in the absence of treatment.
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Sustained Improvement of Heart Rate Variability in
Patients Undergoing a Program of Chiropractic Care:
A Retrospective Case Series
Chiropractic Journal of Australia 2018; 45 (4): 338–358 ~ FULL TEXT
Patients receiving continuous chiropractic care to correct vertebral subluxation demonstrated a sustained improvement in heart rate variability (HRV). This novel finding objectively demonstrates long-term change consistent with improved neurophysiological regulation, adaptability and resilience in patients undergoing chiropractic care, and suggests the utility of chiropractic care for outcomes greater than only musculoskeletal improvements.
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Unravelling Functional Neurology: A Scoping Review of
Theories and Clinical Applications in a Context of
Chiropractic Manual Therapy
Chiropractic & Manual Therapies 2017 (Jul 18); 25: 19 ~ FULL TEXT
Functional Neurology (FN) gives the impression to be a complex alternative to the old variant of the chiropractic subluxation model, in which the vertebral subluxation is replaced by "physiological lesions" of the brain, and the treatment, spinal adjustments, are complemented by various neurological stimuli. Both models purport to treat not the symptoms but the cause. We conclude there is a need for more scientific documentation on the validity of FN.
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Effect of Radiofrequency Denervation on Pain Intensity
Among Patients With Chronic Low Back Pain:
The Mint Randomized Clinical Trials
JAMA. 2017 (Jul 4); 318 (1): 68–81 ~ FULL TEXT
In 3 randomized clinical trials of participants with chronic low back pain originating in the facet joints, sacroiliac joints, or a combination of facet joints, sacroiliac joints, or intervertebral disks, radiofrequency denervation combined with a standardized exercise program resulted in either no improvement or no clinically important improvement in chronic low back pain compared with a standardized exercise program alone. The findings do not support the use of radiofrequency denervation to treat chronic low back pain from these sources.
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Effects of 12 Weeks of Chiropractic Care on Central
Integration of Dual Somatosensory Input in Chronic
Pain Patients: A Preliminary Study
J Manipulative Physiol Ther. 2017 (Mar); 40 (3): 127–138 ~ FULL TEXT
The dual SEP ratio technique appears to be sensitive enough to measure changes in cortical intrinsic inhibitory interactions in patients with chronic neck pain. The observations in 6 subjects revealed that 12 weeks of chiropractic care improved suppression of SEPs evoked by dual upper limb nerve stimulation at the level of the motor cortex, premotor areas, and/or subcortical areas such as basal ganglia and/or thalamus. It is possible that these findings explain one of the mechanisms by which chiropractic care improves function and reduces pain for chronic pain patients.
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Glucose Metabolic Changes in the Brain and Muscles of Patients
with Nonspecific Neck Pain Treated by Spinal
Manipulation Therapy: A [18F]FDG PET Study
Evid Based Complement Alternat Med. 2017 (Jan 12); 2017: 4345703 ~ FULL TEXT
Changes in brain activity after SMT included activation of the dorsal anterior cingulate cortex, cerebellar vermis, and somatosensory association cortex and deactivation of the prefrontal cortex and temporal sites. Glucose uptake in skeletal muscles showed a trend toward decreased metabolism after SMT, although the difference was not significant. Other measurements indicated relaxation of cervical muscle tension, decrease in salivary amylase level (suppression of sympathetic nerve activity), and pain relief after SMT.
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Cervical Spine Disorders and its Association with Tinnitus:
The "Triple" Hypothesis
Med Hypotheses. 2017 (Jan); 98: 2–4 ~ FULL TEXT
Conceivably, cervical spine disorders could trigger a somatosensory pathway-induced disinhibition of dorsal cochlear nucleus (DCN) activity in the auditory pathway; furthermore, CSD can cause inner ear blood impairment induced by vertebral arteries hemodynamic alterations and trigeminal irritation.
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Impact of Spinal Manipulation on Cortical Drive to Upper
and Lower Limb Muscles
Brain Sci. 2017 (Jan); 7 (1): 2 ~ FULL TEXT
Spinal manipulation may therefore be indicated for the patients who have lost tonus of their muscle and/or are recovering from muscle degrading dysfunctions such as stroke or orthopaedic operations and/or may also be of interest to sports performers. These findings should be followed up in the relevant populations.
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The Physiological Role of Tumor Necrosis Factor in
Human Immunity and Its Potential Implications
in Spinal Manipulative Therapy
J Chiropractic Medicine 2016 (Sep); 15 (3): 190–196 ~ FULL TEXT
Physiological roles of tumor necrosis factor (TNF) have recently regained attention in the biomedical research community; new findings, particularly with the discovery of the interaction between TNF and Tregs, offer new insights to understanding human immunophysiology. This progress may provide a new paradigm in understanding SMT.
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Effectiveness of Chiropractic Care to Improve Sensorimotor
Function Associated With Falls Risk in Older People:
A Randomized Controlled Trial
J Manipulative Physiol Ther. 2016 (May); (39) 4: 267–278 ~ FULL TEXT
Over 12 weeks, the chiropractic group improved compared with the control group in choice stepping reaction time (119 milliseconds; 95% confidence interval [CI], 26–212 milliseconds; P = .01) and sound-induced flash illusion (13.5%; 95% CI, 2.9%–24.0%; P = .01). Ankle joint position sense improved across the 4- and 12-week assessments (0.20°; 95% CI, 0.01°–0.39°; P = .049). Improvements were also seen between weeks 4 and 12 in the SF–36 physical component of quality of life (2.4; 95% CI, 0.04–4.8; P = .04) compared with control.
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Manipulation of Dysfunctional Spinal Joints Affects
Sensorimotor Integration in the Prefrontal Cortex:
A Brain Source Localization Study
Neural Plast. 2016 (Mar 7); 2016: 3704964 ~ FULL TEXT
This study resulted in two major findings. Firstly, this study reproduced previous findings of SEPs studies that have shown that adjusting dysfunctional spinal segments alters early sensorimotor integration (SMI) of input from the upper limb (as evidenced with a decrease in N30 SEP complex amplitudes). [3, 6, 21]
The second major finding of this study was that we were able to show, using dipole source localization, that this change in SMI that occurs after spinal manipulation predominantly happens in the prefrontal cortex.
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Joint Position Sense Error in People With Neck Pain:
A Systematic Review
Man Ther. 2015 (Dec); 20 (6): 736–744
Several studies in recent decades have examined the relationship between proprioceptive deficits and neck pain. However, there is no uniform conclusion on the relationship between the two. Clinically, proprioception is evaluated using the Joint Position Sense Error (JPSE), which reflects a person's ability to accurately return his head to a predefined target after a cervical movement.
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Neural Responses to the Mechanical Characteristics of High
Velocity, Low Amplitude Spinal Manipulation:
Effect of Specific Contact Site
Man Ther. 2015 (Dec); 20 (6): 797–804 ~ FULL TEXT
This animal study showed that contact site for an HVLA-SM can have a significant effect on the magnitude of sensory input arising from muscle spindles in the back.
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Paraspinal Muscle Spindle Response to Intervertebral Fixation
and Segmental Thrust Level During Spinal Manipulation
in an Animal Model
Spine (Phila Pa 1976) 2015 (Jul 1); 40 (13): E752–759 ~ FULL TEXT
Intervertebral fixation decreases muscle spindle discharge during target HVLA-SM in a cat model. While HVLA-SM target accuracy maximizes spindle response, non-target thrust muscle spindle response is substantial and possibly provides a neurophysiological rationale for clinical efficacy despite low levels of inter-examiner reliability in determining optimal specific sites for HVLA-SM.
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Changes in H-reflex and V-waves Following Spinal Manipulation
Exp Brain Res. 2015 (Apr); 233 (4): 1165–1173 ~ FULL TEXT
This study is the first to indicate that the chiropractic adjustments of the spine can actually induce significant changes in the net excitability for the low-threshold motor units, and/or alters the synaptic efficacy of the Ia synapse with these low-threshold homonymous motoneurons. The study also indicates that spinal manipulation can improve the confidence of the subject to activate his/her muscle as evidence with the increase in the SEMG signals and force during MVC, and/or alters motor neuron recruitment patters. The results suggest that the improvements in MVC following spinal manipulation are likely attributed to the increased descending drive and/or modulation in afferents. They also indicate that spinal manipulation prevents fatigue. Spinal manipulation may therefore be indicated as part of the medical treatment for the patients who have lost tonus of their muscle and or are recovering from muscle degrading dysfunctions such as stroke or orthopedic operations. These results may also be of interest to sports performers. We suggest these findings should be followed up in the relevant populations.
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Spinal Manipulative Therapy-specific Changes in Pain
Sensitivity in Individuals with Low Back Pain
Journal of Pain 2014 (Feb); 15 (2): 136–148 ~ FULL TEXT
Participants receiving the SMT and placebo SMT received their assigned intervention 6 times over 2 weeks. Pain sensitivity was assessed prior to and immediately following the assigned intervention during the first session. Clinical outcomes were assessed at baseline and following 2 weeks of participation in the study. Immediate attenuation of suprathreshold heat response was greatest following SMT (P = .05, partial η2 = .07). Group-dependent differences were not observed for changes in pain intensity and disability at 2 weeks. Participant satisfaction was greatest following the enhanced placebo SMT.
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Alterations in Cortical and Cerebellar Motor Processing
in Subclinical Neck Pain Patients Following
Spinal Manipulation
J Manipulative Physiol Ther. 2013 (Oct); 36 (8): 527–537 ~ FULL TEXT
The subclinical neck pain (SCNP) group showed a significant improvement in task performance as indicated by a 19% decrease in mean reaction time (P < .0001), which occurred concurrently with a decrease in cerebellar inhibition (CBI) following the combined spinal manipulation and motor sequence learning intervention (F1,6 = 7.92, P < .05). The control group also showed an improvement in task performance as indicated by a 25% increase in reaction time (P < .001) with no changes to CBI.
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Effects of Cervical Joint Manipulation on Joint Position
Sense of Normal Adults
J Phys Ther Sci 2013 (Jun); 25 (6): 721–723~ FULL TEXT
Cervical joint manipulation reduced JPE and improved joint position sence. Therefore, we consider its application to the treatment of patients with cervical problems in clinical practice is desirable.
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Visceral Responses to Spinal Manipulation
J Electromyogr Kinesiol. 2012 (Oct); 22 (5): 777–784 ~ FULL TEXT
While spinal manipulation is widely seen as a reasonable treatment option for biomechanical disorders of the spine, such as neck pain and low back pain, the use of spinal manipulation to treat non-musculoskeletal complaints remains controversial. This controversy is due in part to the perception that there is no robust neurobiological rationale to justify using a biomechanical treatment of the spine to address a disorder of visceral function. This paper therefore looks at the physiological evidence that spinal manipulation can impact visceral function. A structured search was conducted, using PubMed and the Index to Chiropractic Literature, to construct of corpus of primary data studies in healthy human subjects of the effects of spinal manipulation on visceral function.
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The Decreased Responsiveness of Lumbar Muscle Spindles to
a Prior History of Spinal Muscle Lengthening is Graded
with the Magnitude of Change in Vertebral Position
J Electromyogr Kinesiol. 2012 (Dec); 22 (6): 814–820 ~ FULL TEXT
Stability, robustness and performance are attributes of the lumbar spine as a mechanical system that depend upon of a variety of biological mechanisms [McGill et al, 2003, Reeves et al, 2007, Solomonow 2011]. Which mechanisms become engaged depends upon both the biomechanical behavior of the spine’s passive components (connective tissue comprising the intervertebral disc, tendons, ligaments, fascia, and non-contractile elements within paraspinal muscles) and the physiological behavior of the spine’s active components (paraspinal muscle’s contractile capacity and neural elements that control the recruitment, timing and magnitude of this contractile capacity) [McGill et al, 2003, Panjabi 1992, Reeves et al, 2007, Solomonow 2011]. A locus of direct interface between these two components is at receptive nerve endings in peripheral tissues. Somatosensory feedback signals are initiated here when these endings respond to their local biomechanical, thermal, or chemical environments. It has been suggested that feedback signals can become corrupted when biomechanical conditions adversely affect the mechanical behavior of the spine’s passive components [Reeves et al, 2007, Solomonow 2011]. For example, creep in the lumbar tissues from prolonged cyclic and static loading alters the normal activity of multifidus muscle and potentially compromises spinal stability [Solomonow et al, 2003].
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The Role of Spinal Manipulation in Addressing Disordered
Sensorimotor Integration and Altered Motor Control
J Electromyogr Kinesiol. 2012 (Oct); 22 (5): 768–776 ~ FULL TEXT
This review provides an overview of some of the growing body of research on the effects of spinal manipulation on sensory processing, motor output, functional performance and sensorimotor integration. It describes a body of work using somatosensory evoked potentials (SEPs), transcranial magnetic nerve stimulation, and electromyographic techniques to demonstrate neurophysiological changes following spinal manipulation. This work contributes to the understanding of 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.
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Spinal Manipulative Therapy and Somatosensory Activation
J Electromyogr Kinesiol. 2012 (Oct); 22 (5): 785–794 ~ FULL TEXT
The goal of this article is to briefly update our knowledge regarding several physical characteristics of an applied SMT, and review what is known about the signaling characteristics of sensory neurons innervating the vertebral column in response to spinal manipulation. Based upon the experimental literature, we propose that SMT may produce a sustained change in the synaptic efficacy of central neurons by evoking a high frequency, bursting discharge from several types of dynamically-sensitive, mechanosensitive paraspinal primary afferent neurons.
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Cerebral Metabolic Changes in Men After Chiropractic
Spinal Manipulation for Neck Pain
Altern Ther Health Med. 2011 (Nov); 17 (6): 12–17 ~ FULL TEXT
Research on chiropractic spinal manipulation (CSM) has been conducted extensively worldwide, and its efficacy on musculoskeletal symptoms has been well documented. Previous studies have documented potential relationships between spinal dysfunction and the autonomic nervous system and that chiropractic treatment affects the autonomic nervous system. The authors hypothesized that CSM might induce metabolic changes in brain regions associated with autonomic nervous system functions as assessed with positron emission tomography (PET). PET is a nuclear medicine imaging technique that allows quantification of cellular and molecular processes in humans such as cerebral glucose metabolism which is thought to reflect regional neuronal activities.
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Cortical Changes in Chronic Low Back Pain: Current State
of the Art and Implications for Clinical Practice
Man Ther. 2011 (Feb); 16 (1): 15–20 ~ FULL TEXT
There is increasing evidence that chronic pain problems are characterised by alterations in brain structure and function. Chronic back pain is no exception. There is a growing sentiment, with accompanying theory, that these brain changes contribute to chronic back pain, although empirical support is lacking. This paper reviews the structural and functional changes of the brain that have been observed in people with chronic back pain. We cast light on the clinical implications of these changes and the possibilities for new treatments but we also advise caution against concluding their efficacy in the absence of solid evidence to this effect.
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Subclinical Neck Pain and the Effects of Cervical
Manipulation on Elbow Joint Position Sense
J Manipulative Physiol Ther. 2011 (Feb); 34 (2): 88–97 ~ FULL TEXT
These results suggest that asymptomatic people with a history of subclinical neck pain (SCNP) have reduced elbow JPS accuracy compared to those with no history of any neck complaints. Furthermore, the results suggest that adjusting dysfunctional cervical segments in people with SCNP can improve their upper limb JPS accuracy.
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Spinal Motor Neuronal Degeneration After Knee Joint
Immobilization in the Guinea Pig
J Manipulative Physiol Ther. 2010 (Jun); 33 (5): 328–337 ~ FULL TEXT
After various periods of knee joint immobilization, a variety of features of motor neuronal degeneration were observed. Specific characteristics included gradual increases in the expressions of neuronal nitric oxide synthase and ultrastructural changes in affected motor neurons including reduction of cell organelles, indentation of the nuclear envelop, and small compact clumps of chromatin in the nuclei. We conclude that motor neuronal degeneration in the spinal cord and axons in this study was the result of knee joint immobilization. Increases in motor neuronal nitric oxide-mediated oxidative stress level after reduction of target tissue activity may contribute to the mechanism for degenerative changes in the motor neurons in adult spinal cord of the guinea pig.
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The Effects of Spinal Manipulation on Central Integration
of Dual Somatosensory Input Observed After Motor Training:
A Crossover Study
J Manipulative Physiol Ther. 2010 (May); 33 (4): 261–272 ~ FULL TEXT
These findings may help to clarify the mechanisms responsible for the effective relief of pain and restoration of functional ability documented after spinal manipulation and the mechanism involved in the initiation of overuse injuries.
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Altered Central Integration of Dual Somatosensory Input
After Cervical Spine Manipulation
J Manipulative Physiol Ther. 2010 (Mar); 33 (3): 178–188 ~ FULL TEXT
This study suggests that cervical spine manipulation may alter cortical integration of dual somatosensory input. These findings may help to elucidate the mechanisms responsible for the effective relief of pain and restoration of functional ability documented after spinal manipulation treatment.
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Exploring the Neuromodulatory Effects of the Vertebral
Subluxation and Chiropractic Care
Chiropractic Journal of Australia 2010 (Mar); 40 (1): 37–44 ~ FULL TEXT
Over the past 15 years our research group has been conducting a variety of experiments aimed at testing out the theory that adjusting subluxations improves central nervous system functioning and overall expression of health and well being. To do this the theory was first formulated into a model (Figure 2) that could be scientifically tested with a programme of research studies. This model became the basis for the lead author’s PhD research, [5] and continues to be a foundational premise that our research group is attempting to elucidate with our work. The model was constructed using early chiropractic research data and a thorough review of the neurophysiology scientific literature.
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Positive Patient Outcome After Spinal Manipulation in a Case
of Cervical Angina
Man Ther. 2009 (Dec); 14 (6): 702–705 ~ FULL TEXT
This case identified an individual with the under diagnosed phenomena of cervical angina. This patient demonstrated a sustained improvement up to 11 weeks following a brief trial of SMT directed to the cervicothoracic region, suggesting a mechanically based, musculoskeletal etiology to her presentation. Future prospective studies are needed to assess the viability of a course of SMT management, and the consideration of related treatments such as grade I–IV joint mobilisation for patients who have tested negative for true angina, but continue to present with unrelenting atypical chest and upper extremity pain prior to directing them for surgical management.
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Spinal Manipulative Therapy Has an Immediate Effect on
Thermal Pain Sensitivity in People With Low Back Pain:
A Randomized Controlled Trial
Phys Ther. 2009 (Dec); 89 (12): 1292–1303 ~ FULL TEXT
Hypoalgesia to A-delta fiber-mediated pain perception was not observed. Group-dependent hypoalgesia of temporal summation specific to the lumbar innervated region was observed. Pair-wise comparisons indicated significant hypoalgesia in participants who received SMT, but not in those who rode a stationary bicycle or performed low back extension exercises. Psychological factors did not significantly correlate with changes in temporal summation in participants who received SMT.
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The Mechanisms of Manual Therapy in the Treatment of
Musculoskeletal Pain: A Comprehensive Model
Man Ther. 2009 (Oct); 14 (5): 531–538 ~ FULL TEXT
Prior studies suggest manual therapy (MT) as effective in the treatment of musculoskeletal pain; however, the mechanisms through which MT exerts its effects are not established. In this paper we present a comprehensive model to direct future studies in MT. This model provides visualization of potential individual mechanisms of MT that the current literature suggests as pertinent and provides a framework for the consideration of the potential interaction between these individual mechanisms.
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Sympathetic and Parasympathetic Responses to Specific
Diversified Adjustments to Chiropractic Vertebral
Subluxations of the Cervical and Thoracic Spine
J Chiropractic Medicine 2008 (Sep); 7 (3): 86–93 ~ FULL TEXT
Diastolic pressure (indicating a sympathetic response) dropped significantly postadjustment among those receiving cervical adjustments, accompanied by a moderate clinical effect (0.50). Pulse pressure increased significantly among those receiving cervical adjustments, accompanied by a large effect size (0.82). Although the decrease in pulse pressure for those receiving thoracic adjustments was not statistically significant, the decrease was accompanied by a moderate effect size (0.66).
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Immobilization Induces Changes in Presynaptic Control
of Group Ia Afferents in Healthy Humans
J Physiol. 2008 (Sep 1); 586 (Pt 17): 4121–4135 ~ FULL TEXT
Although the present study involved limb immobilization in able-bodied subjects, the findings may also be of clinical relevance. This is especially the case in relation to neurological disorders leading to physical inactivity. It is noteworthy that the findings of increased H-reflexes, decreased GABAergic presynaptic inhibition and decreased post-activation depression following immobilization to some extent matches the findings of previous studies in spastic patients and it is worth considering the effects of reduced physical activity in itself. As mentioned previously, it is possible that the decreased presynaptic inhibition and post-activation depression observed in patients with cerebral or spinal lesions may at least in part be a consequence of the disuse of motoneurons and Ia afferents.
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Preliminary Morphological Evidence That Vertebral Hypomobility
Induces Synaptic Plasticity in the Spinal Cord
J Manipulative Physiol Ther. 2007 (Jun); 30 (5): 336–342 ~ FULL TEXT
These preliminary data suggest that chronic vertebral hypomobility (fixation) at L4 through L6 in the rat affects synaptic density and morphology in the superficial dorsal horn of the L2 spinal cord level. Morphological parameters that appear to be affected include synaptic curvature, type of postsynaptic profile, and perforations of the PSD. Additional more definitive studies are warranted, and the biologic significance of these finding should be investigated.
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A Hypothesis of Chronic Back Pain: Ligament Subfailure Injuries
Lead to Muscle Control Dysfunction
European Spine Journal 2006 (May); 15 (5): 668–676 ~ FULL TEXT
A new hypothesis of chronic back pain based upon muscle system dysfunction due to ligament injuries is described. Subfailure injuries of the ligaments and embedded mechanoreceptors generate corrupted mechanoreceptor signals. Consequently, the neuromuscular control unit produces corrupted muscle response pattern, resulting in excessive loading and, possibly, injuries of the spinal structures, including additional injuries of the mechanoreceptors. The hypothesis accounts for many of the common and important experimental observations and clinical findings seen in low back pain and whiplash patients.
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Cervical Spine Manipulation Alters Sensorimotor Integration:
A Somatosensory Evoked Potential Study
Clin Neurophysiol. 2007 (Feb); 118 (2): 391–402
Spinal manipulation of dysfunctional cervical joints can lead to transient cortical plastic changes, as demonstrated by attenuation of cortical somatosensory evoked responses. This study suggests that cervical spine manipulation may alter cortical somatosensory processing and sensorimotor integration. These findings may help to elucidate the mechanisms responsible for the effective relief of pain and restoration of functional ability documented following spinal manipulation treatment.
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Areas of Capsaicin-Induced Secondary Hyperalgesia and
Allodynia Are Reduced by a Single Chiropractic Adjustment:
A Preliminary Study
J Manipulative Physiol Ther. 2004 (Jul); 27 (6): 381–387
The results confirmed that topical capsaicin induced inflammatory reactions based on occurrence of hyperalgesia and allodynia, augmented pain perception, and increased blood flow following capsaicin application compared with the control session. When compared with N-SMT, spontaneous pain was rated significantly lower post-SMT (P <.014). In addition, areas of both secondary hyperalgesia and allodynia decreased after SMT (hyperalgesia: P <.007; allodynia: P <.003). However, there was no significant treatment effect for local blood flow. These results suggest hypoalgesic effects following a single SMT. As local vascular parameter was not affected by the single SMT, the hypoalgesic effects appear to be due to central mechanisms.
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Biomechanical and Neurophysiological Responses to
Spinal Manipulation in Patients With
Lumbar Radiculopathy
J Manipulative Physiol Ther. 2004 (Jan); 27 (1): 1–15 ~ FULL TEXT
Because spinal manipulation (SM) is a mechanical intervention, it is inherently logical to assume that its mechanisms of therapeutic benefit may lie in the mechanical properties of the applied force (mechanical mechanisms), the body's response to such force (mechanical or physiologic mechanisms), or a combination of these and other factors. Basic science research, including biomechanical and neurophysiological investigations of the body's response to SM, therefore, should assist researchers, educators, and clinicians to understand the mechanisms of SM, to more fully develop SM techniques, to better train clinicians, and ultimately attempt to minimize risks while achieving better results with patients.
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Neuromechanical Characterization Of In Vivo Lumbar
Spinal Manipulation. Part II.
Neurophysiological Response
J Manipulative Physiol Ther. 2003 (Nov); 26 (9): 579–591
Spinal manipulative thrusts resulted in positive electromyographic (EMG) and compound action potential (CAP) responses that were typically characterized by a single voltage potential change lasting several milliseconds in duration. However, multiple EMG and CAP discharges were observed in numerous cases. The temporal relationship between the initiation of the mechanical thrust and the neurophysiologic response to internal and external spinal manipulative therapy (SMT) thrusts ranged from 2.4 to 18.1 ms and 2.4 to 28.6 ms for EMG and CAP responses, respectively. Neurophysiologic responses varied substantially between patients. Vertebral motions and resulting spinal nerve root and neuromuscular reflex responses appear to be temporally related to the applied force during SMT. These findings suggest that intersegmental motions produced by spinal manipulation may play a prominent role in eliciting physiologic responses.
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Chiropractic Subluxation Assessment:
What the Research Tells Us
J Canadian Chiropractic Assoc 2002; 46 (4): 215–220 ~ FULL TEXT
When you speak of subluxation, the first description that often jumps to mind is the traditional misalignment, occlusion of a foramen, pressure on a nerve and interference (MOPI) model proposed by B.J. Palmer. [2] In fact there are several modern models currently in use as well. Some are conceptual models, such as the Vertebral Subluxation Complex model of Faye and Lantz, [2] which proposes as many as nine components interacting in a complex.
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Neurophysiological Effects of Spinal Manipulation
Spine J (North American Spine Society) 2002 (Sep); 2 (5): 357–671 ~ FULL TEXT
Biomechanical changes caused by spinal manipulation are thought to have physiological consequences by means of their effects on the inflow of sensory information to the central nervous system. Muscle spindle afferents and Golgi tendon organ afferents are stimulated by spinal manipulation. Smaller-diameter sensory nerve fibers are likely activated, although this has not been demonstrated directly. Mechanical and chemical changes in the intervertebral foramen caused by a herniated intervertebral disc can affect the dorsal roots and dorsal root ganglia, but it is not known if spinal manipulation directly affects these changes.
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Effect of Chiropractic Treatment on the Endocrine and
Immune System in Asthmatic Patients
Proceedings of the 2002 International Conference on Spinal Manipulation
The broad aims of this FCER funded study is to determine whether stress is a factor in the pathophysiology of asthma and to determine if chiropractic management of asthmatics can alleviate stress induced asthma. More specifically for this meeting, our study aims to determine whether chiropractic treatment has beneficial effects on the endocrine system through measurement of salivary cortisol and on the immune system via salivary IgA determination.
You can review other articles on this topic at the Chiropractic and Asthma Page.
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The Effects of Mild Compression on Spinal Nerve Roots
with Implications for Models of Vertebral Subluxation
and the Clinical Effects of Chiropractic Adjustment
J Vertebral Subluxation Research 2001 (May); 4 (2): 1–13
There is evidence of nerve compression at the level of the intervertebral foramen (IVF) occurring anywhere from 15.4% to 78% of levels inspected. Most of the spines inspected were already prescreened to eliminate those that were definitely known to have nerve compression problems. Pressures as little as 10 mm Hg can alter the nerve root and dorsal root ganglion’s abilities to function normally. In the normal range of motion the pressures generated in the IVF may exceed 30 mm Hg. When considering the concept of a joint fixated in a diminished sphere of its normal range of motion in conjunction with the mild pressure increases, it becomes apparent that nerve function can be significantly altered.
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Response of Muscle Proprioceptors to Spinal Manipulative-like
Loads in the Anesthetized Cat
J Manipulative Physiol Ther. 2001 (Jan); 24 (1): 2–11 ~ FULL TEXT
The data suggest that the high-velocity, short-duration load delivered during the impulse of a spinal manipulation can stimulate muscle spindles and Golgi tendon organs more than the preload. The physiologically relevant portion of the manipulation may relate to its ability to increase as well as decrease the discharge of muscle proprioceptors. In addition, the preload, even in the absence of the impulse, can change the discharge of paraspinal muscle spindles. Loading of the vertebral column during a sham manipulation may affect the discharge of paraspinal proprioceptors.
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Mechanical Force Spinal Manipulation Increases Trunk Muscle
Strength Assessed By Electromyography:
A Comparative Clinical Trial
J Manipulative Physiol Ther. 2000 (Nov); 23 (9): 585–595 ~ FULL TEXT
The results of this preliminary clinical trial demonstrated that MFMA SMT results in a significant increase in sEMG erector spinae isometric MVC muscle output. These findings indicate that altered muscle function may be a potential short-term therapeutic effect of MFMA SMT, and they form a basis for a randomized, controlled clinical trial to further investigate acute and long-term changes in low back function.
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Neurophysiologic Response to Intraoperative
Lumbosacral Spinal Manipulation
J Manipulative Physiol Ther. 2000 (Sep); 23 (7): 447–457 ~ FULL TEXT
During the active trials, mixed-nerve root action potentials were observed in response to both internal and external spinal manipulative thrusts. Differences in the amplitude and discharge frequency were noted in response to varying segmental contact points and force vectors, and similarities were noted for internally and externally applied spinal manipulative thrusts. Amplitudes of mixed-nerve root action potentials ranged from 200 to 2600 mV for internal thrusts and 800 to 3500 mV for external thrusts.
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Neurologic Effects of the Adjustment
J Manipulative Physiol Ther. 2000 (Feb); 23 (2): 112–114 ~ FULL TEXT
This paper discusses the several theories pertaining to the chiropractic adjustment, including the nerve compression theory, reflex theories, and pain relief theories. There is now sufficient scientific research to consider these theories reasonable working models to explain the effects of the adjustment but insufficient to consider them valid.
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The Reflex Effects of Subluxation:
The Autonomic Nervous System
J Manipulative Physiol Ther 2000 (Feb); 23 (2): 104–106 ~ FULL TEXT
There is no shortage of theories to explain the role of subluxation in disease and the effect of adjustment in relieving symptoms. The autonomic nervous system has often been invoked in constructing mechanisms to account for the effects of spinal dysfunction; recent investigations justify the attention that has been focused on this component of the nervous system. Recent neuroscience research supports a neurophysiologie rationale for the concept that aberrant stimulation of spinal or paraspinal structures may lead to segmentally organized reflex responses of the autonomic nervous system, which in turn may alter visceral function.
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Mechanisms of Neurovascular Compression Within the Spinal
and Intervertebral Canals
J Manipulative Physiol Ther 2000 (Feb); 23 (2): 107–111 ~ FULL TEXT
Stenosis of the spinal and intervertebral canal neurovascular structures can be caused by various bony and soft-tissue structures. Stenosis can be related to osteophytosis of the vertebral body, uncoverte-intervertebral disc protrusion, ossification of the posterior longitudinal ligament, and ligamentum flavum hypertrophy or buckling. nbsp; Various forms of spinal and intervertebral canal stenosis can cause compression of neurovascular structures that may, in turn, be responsible for symptomatology. Of course, autopsy findings cannot be equated with painful syndromes in patients.
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The Somatosensory System of the Neck and its Effects
on the Central Nervous System
J Manipulative Physiol Ther. 1998 (Oct); 21 (8): 553–563
Studies involving human and nonhuman vertebrates have provided considerable information about the anatomy of the sensory receptors located in the neck and about where information from these receptors is relayed in the spinal cord and brain. Physiological experiments involving electrical and natural stimulation of the head and neck regions have identified a role for some of these receptors in neck-evoked reflexes. It is clear that in addition to signaling nociception, the somatosensory system of the neck may influence the motor control of the neck, eyes, limbs, respiratory muscles and possibly the activity of some preganglionic sympathetic nerves.
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Dysafferentation: A Novel Term to Describe the Neuropathophysiological
Effects of Joint Complex Dysfunction. A Look at Likely
Mechanisms of Symptom Generation
J Manipulative Physiol Ther 1998 (May); 21 (4): 267–280 ~ FULL TEXT
Since the founding of the chiropractic profession, very few
efforts have been made to thoroughly explain the mechanism(s) by
which joint complex dysfunction generates symptoms. Save for a
few papers, only vague and physiologically inconsistent
descriptions have been offered. The purpose of this article is to propose a precise and physiologically sound mechanism by which symptoms may be generated by joint complex dysfunction.
This thought provoking FULL TEXT article was released exclusively to Chiro.Org by National College of Chiropractic and JMPT.
You may also enjoy this response from another chiropractic researcher.
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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
J Manipulative Physiol Ther 1995 (Jul); 18 (6): 379–397
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.
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