The Effects of Chiropractic Adjusting      

This section is compiled by Frank M. Painter, D.C.
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Basic Science Research Related to Chiropractic Spinal Adjusting:
The State of the Art and Recommendations Revisited

FROM:   J Manipulative Physiol Ther. 2006 (Nov);   29 (9):   726–761


Biomechanics is the study of the effects of loads applied to biologic cells, tissues or systems. Biomechanics has its origins from Galileo's studies of mechanics in general and his creation of the term mechanics as a subtitle of his book "Two New Sciences" (1638) to refer to force, displacement, and strength of materials. Arguably, the “father of biomechanics” is Giovanni Alfonso Borelli, who published in "De Motu Animalium" (1681) the principles of muscle movements based on statics and dynamics. However, the word “biology” and its concept as the study of living organisms did not occur until 1802 when the German naturalist, Gottfried Reinhold Treviranus, published his first volume "Biologie; oder die Philosophie der lebenden Natur". To rigorously understand SM and its effects requires an understanding of the principles of biomechanics.

Manipulation Forces

Since the publication of the first white paper in 1997, there have been several important studies that have further clarified the loads that are applied during SM, and especially during high-velocity, low-amplitude (HVLA) SM. Triano and Shultz [150] measured the total force that was transmitted through the body during a side-lying lumbar or lumbosacral HVLA SM. The transmitted forces were similar to the applied forces for their temporal history, but the transmitted forces and moments were shown to vary substantially based on patient positioning. Herzog et al [151] measured the force distribution during thoracic HVLA SM and concluded that there was an important distinction between the total and effective applied forces, with the latter being much smaller than the total applied force. They found that the total peak force was being applied over a mean contact area of 34.8 cm2, but for the thoracic spine, the physiologic contact area of the transverse processes was only 0.25 cm2 (less than 1/100 of the total contact region). Hence, most of the total peak force was being applied to soft tissues (eg, skin, muscle, and fat), and only a small portion (~5 N) was being applied to the transverse process. A similar finding was reported by Kirstukas and Backman, [152] who reported that the “intense contact area” was on the order of 10 cm2 during thoracic HVLA SM. Clearly, the effective applied force during HVLA SM in general will vary based on the contact area of the manipulator's hand and the aspect of the vertebra, but in general, the effective force will be less, and sometimes substantially so, than the applied force.

The 3-dimensional force applied during HVLA SM of the cervical, thoracic, and sacroiliac regions has now been measured. [153] The 3-dimensional data showed that forces in plane with the back (ie, Fx and Fy or shearing forces) always occurred during the SM, which was dominated by the normal (ie, Fz or perpendicular) applied force. The shearing forces were considerable in magnitude, ranging from a low mean of 15% (at T4–5) to a high of 29% (at sacroiliac) of the peak Fz force. As has been previously reported by others, [154] there was a consistent drop in the preload force magnitude just before the impulse portion of the HVLA SM, which is speculated to be due to a “countermovement” affect.

The role of sex in developing force magnitude has been investigated. [155] The only previous report that compared male and female manipulators found no significant differences during HVLA SM using a patient simulator. [156] Forand et al [155] used an experienced matched group (range, 1–24.5 year of experience) of female and male chiropractors (14 per group) and found that there were no significant differences between sexes in thoracic HVLA SM forces. The one exception was that, in the lower thoracic spine, men applied significantly greater preload than did women.

Another type of SM is mobilization or low-velocity low-amplitude SM, which is commonly used by physical therapists as well as other health professionals, including chiropractors. The general approach is to apply an increasing force over 5 to 10 seconds to determine the “end feel,” and then so calibrated, to apply a slow oscillation (~1 Hz for 10 seconds) about a mean graded force (I–IV arbitrary scale), which is less than the end feel. [157] Using an instrumented mobilization table, it was found that there was considerable variation in the force magnitudes used by experienced therapists for end feel, as well as grades I–IV mobilizations of L3 vertebra in healthy subjects. [157] When comparing treatment of younger vs older healthy subjects, it was found that, although mean forces were similar, smaller amplitudes and higher frequency of oscillations were used with older patients. [158] In a study of patients with nonspecific low back pain, there was considerable variation in the magnitudes of forces used, but the variation was strongly influenced not by the patient's severity of complaint but by the physical therapist's training. [159]

Effects of External Loading on Vertebral Displacements

Our understanding of the kinematics of SM has been increased by 2 different types of investigations. First, Keller et al [160–162], have published 2 studies using mechanical force, manually assisted, short-lever SM (ie, Activator [Activator Methods International, Phoenix, Ariz] or very HVLA [VHVLA]) in vivo on patients undergoing lumbar surgery. Using forces ranging from 30 N (lowest setting) to 150 N (maximum setting) on the adjusting instrument, the vertebra where the force was applied had peak displacements of approximately 0.5 mm occurring within 10 milliseconds. Intersegmental displacements occurred of similar magnitudes but with large oscillations lasting 2 to 3 times longer (ie, 20–30 milliseconds), but all oscillations appeared to have damped out within 100 milliseconds. In a second in vivo study, they found that the vertebral displacements due to the Activator instrument were slightly larger (mean, ~0.62 mm) and did not vary significantly, depending on whether the instrument was positioned over the spinous process or facet joint (left or right). [163]

0 Second, using intact cadaveric human lumbar spine specimens, Ianuzzi and Khalsa [164] simulated lumbar HVLA SM while measuring vertebra kinematics and facet joint capsule strain. During simulated HVLA SM, the applied loads were within the range measured during in vivo HVLA SM. Vertebral translations occurred primarily in the direction of the applied load and were similar in magnitude (on order of 1–2 mm) regardless of manipulation site. Vertebral rotations (on order of 1°–3°) and facet joint capsule strain magnitudes (on order of 5%) during simulated HVLA SM were within the range that occurred during physiologic motions. [165] At a given facet joint capsule, distal manipulations induced capsule strains similar in magnitude to those that occurred when the manipulation was applied proximally.

The mobility of lumbar vertebrae in healthy volunteers during mobilization has been assessed using dynamic MRI. Powers et al [166] found that applying a 10-second grade IV posterior to anterior (PA) mobilization (~100 N force) at the spinous process of a lumbar vertebra produced an extension of the vertebra ranging from a mean of 1.2° at L2 to 3.0° at L5. Using plain film radiographs, Lee and Evans [167] found similar displacements for a 150 N PA mobilization at L4. Kulig et al, [168] also using dynamic MRI, found that applying a PA mobilization induced intersegmental motion in all lumbar vertebrae, caudal and cranial, to the site of applied force. This is consistent with the findings of Ianuzzi and Khalsa [164] who also found that simulated HVLA SM at a single vertebra induced motion in all other lumbar vertebrae. Thus, it is not possible to move only a single vertebrae with SM (high or low velocity) because the spine is a linked and coupled structure.

Other effects

HVLA SM is commonly associated with a “cracking” sound, which has previously been shown to be associated with a cavitation phenomenon in the facet joints. [169, 170] In healthy volunteers, Ross et al [171] found that single HVLA SM were typically associated with multiple cavitations (ranging from 2 to 6), which were from nearby vertebrae. This was consistent with the findings of Beffa and Mathews, [172] who found no significant relationship between the location of the cavitation and HVLA SM of the L5 or sacroiliac joint in asymptomatic volunteers. There is some question as to whether HVLA SM can actually induce motion into the sacroiliac joint, as Tullberg et al, [173] using stereo radiography, were unable to measure any significant motion of the sacrum relative to the ilium after a combination of HVLA and mobilization SM in patients with “subluxated” sacroiliac joints. Furthermore, Flynn et al [174] found no association between an “audible pop” and improvement in ROM, pain, or disability in patients with nonradicular low back pain.

Measures of Pathologic States

An intriguing question has begun to be answered relating to whether changes in intersegmental stiffness can be discerned using clinically available tools. Colloca et al [175] measured intersegmental impedance (dynamic stiffness) of lumbar vertebrae and correlated it with characteristics of vertebral height and IVD height measured from plain film radiographs. They found that there was a correlation between decreased disk height at L5–S1 and increased dynamic stiffness at the same segment. These findings were analogous to those of Kaigle et al [176] who, using a porcine model, also observed increased spine dynamic stiffness associated with degenerated disks, compared with normal controls.

Using ultrasound indentation, another noninvasive approach, Kawchuk et al [177] also found that IVD degeneration in a porcine model resulted in decreased indentation for the same applied load. This is an analogous metric as spine stiffness. The use of ultrasound indentation in this animal model had high sensitivity (75.0%), specificity (83.3%), and accuracy (77.1%), compared with other approaches (arthroscopy, MRI, and plain film radiography).

Two biomechanics studies have been performed to examine the effects of fixation (ie, a hypomobile subluxation) of the lumbar spine. Cramer et al [13] used a rat model of fixation in the lumbar spine by externally fixating the spinous processes of L4–L6 for up to 8 weeks. A principal finding due to the fixation was the development of osteophytes and degenerative articular changes of the facet joints within a few weeks. Reversal of some of the degeneration was observed for joints that were fixated for a short term (~1 week), but after 4 weeks, no reversal was observed. Little et al [178] simulated a hypomobile subluxation in intact, cadaveric human lumbar spine specimens by screwing a plate into the left anterior aspect of the L4 and L5 vertebral bodies. During physiologic motions of the fixated spine specimens for flexion, extension, and lateral bending, the motions at L4–5 were significantly decreased, whereas below and above that level, intersegmental motions were significantly increased. Correspondingly, the plane strains of the facet joint capsules were significantly decreased and increased at and above/below the site of fixation, respectively.

Diagnostic tools or outcome measures

The principal biomechanical “tool” still used by most chiropractors is palpation. As such, there has been a continued investigation into factors that change what is felt during palpation. Humans are relatively good at discriminating different magnitudes of stiffness for purely “elastic” materials. [179] However, the human spine responds as a viscoelastic system, in which the speed of force application changes the apparent stiffness. Nicholson et al [180] have shown that the relatively poor ability of clinicians to accurately estimate spine stiffness magnitudes is likely due to a 50% poorer ability to discriminate viscous components of viscoelastic systems. Latimer et al [181] found that therapists used different forces to discern spine stiffness and, hence, had different internal perceptual scales. By training therapists to use a calibrated stiffness instrument, discrimination of PA stiffness in the spine can be done with relatively high interexaminer reliability. [182] Furthermore, objective instruments have been developed that can reliably measure PA spine stiffness. [183] Perhaps, the most important aspect of using palpation to detect subluxations (ie, a “manipulable lesion”) is standardization of training. [184] When examiners are trained in a standardized fashion, they are able to obtain relatively high interexaminer reliability (? = 0.68) for detecting cervical fixations.

Stiffness of the spine is influenced by many factors. If the ribcage is constrained, then the stiffness measured at T12–L4 can be significantly increased. [185] Change in orientation of an applied load to the spinous process can have small yet significant changes in objectively measured stiffness. [186] Furthermore, because the spine is a viscoelastic system, there will be a preconditioning effect when applying loads, such that after preconditioning the spine with standard mobilization SM, there will be no measurable change in stiffness. [187] There has also begun to be a growing appreciation for the natural (and normal) variability in spine stiffness as assessed by standard ROM tests during a physical examination. Christensen and Nilsson [87] found that in asymptomatic volunteers during a 3-week period, there was an intrinsic variability in ROM of the cervical spine of ± 20°, ± 14°, and ± 12° for flexion/extension, lateral bending, and rotation, respectively. In contrast, repositioning the head to the neutral position, which is related to proprioception, is done with relatively high fidelity over the same period. [188] Asymptomatic volunteers were able to reachieve the neutral zero position of their heads with a mean difference of 2.7°, 1.0°, and 0.7° for the sagittal, horizontal, and frontal planes, respectively.

Using a case study approach, Lehman and McGill [189] observed that a single HVLA SM session in the lumbar spine caused notable changes in biomechanical factors associated with a complex task (ie, a golf swing in an experienced golfer who had chronic low back pain). In addition to changes in vertebral kinematics, they observed decreased electromyographic (EMG) responses of the associated lumbar muscles. In a subsequent study, Lehman and McGill [190] found that lumbar HVLA SM in patients with low back pain resulted in variable changes in lumbar ROM and associated muscle EMG. The largest changes were associated with patients with the greatest reported pain. In a review of the available literature. Lehman [191] reported that, currently, the best way to discriminate between normal and low back patient groups was using biomechanical tests that assessed “higher-order kinematics during complex movement tasks.” Simpler end ROM tests had poor predictive ability.

Another commonly performed clinical test is measuring leg lengths, especially in the prone position. Using a special designed table to minimize friction and allow independent loading of each leg, Jansen and Cooperstein [192] determined that the prone leg length test was reliable for detecting non–weight-bearing asymmetry in leg lengths. Nguyen et al [193] found that there was reasonable concordance (? = 0.6) in determining whether a short leg was present using the Activator protocol. Cooperstein et al [194] found that it was possible to detect a leg length difference of 1.9 mm but recommended that only differences of greater than 3.7 mm should have confidence associated with them.

Mathematical and Computational Models

One of the signs of maturity of any field is the ability to produce predictive models. In spine biomechanics, most models are computationally based and either use finite element approaches [195] or optimization with minimization of an objective function. Analytical approaches have also been performed, which include a linear elastic model of a lumbar motion segment. [196] This model successfully predicted loads born by various ligaments under physiologic loads. Solinger [197] created a model that predicted the dynamic response of L2–L3 to impulsive loads on the order of those used in VHVLA SM. Using a lumped parameter approach, Keller and Colloca [198] created an analytical model that predicted the frequency dependent response of the human lumbar spine to PA forces applied to the spinous processes, as is done during low velocity and low amplitude (ie, mobilization), HVLA, and VHVLA (ie, Activator). An alternative approach was adopted by Dulhunty [199] who modeled force transmission in the cervical spine to predict whether parallel forces or concurrent forces are the optimization function. A relatively new approach in spine modeling, especially in the lumbar spine, is to incorporate what are called “follower loads” for muscles. The issue is that the ex vivo (cadaveric) intact lumbar spine will buckle under compressive loads of ~100 N, whereas in vivo, the lumbar spine easily supports compressive loads of ~1000 N (ie, 10 times greater). Patwardhan et al [200] found that by modeling muscle activation so that their loads followed the tangent of the lumbar lordosis, their model would approximate the in vivo condition.

A couple of new comprehensive models have been advanced to explain how the spine becomes subluxated in the first place and how SM can restore it to “normal.” Triano [201, 202] has advocated a mechanical model based on the concept of intersegmental buckling, which was based on original observations by Wilder et al [203, 204] and fluoroscopic recordings of a buckling event in a weightlifter by Cholewicki et al [205] and Cholewicki and McGill. [206] Essentially, this model proposes that there is a balance point between each pair of vertebrae that under certain loading conditions can suddenly shift, which then results in increased tissue strain of associated soft tissues (eg, facet joint capsule). The increased tissue strain can result in small tears and associated biologic inflammatory response. Evans et al [207] have proposed an optimization model where the spine system is biased toward minimizing the mechanical energy associated with loading the spine. Their model is described for the case of linear elasticity, although they claim it is also apropos of nonlinear elasticity. As with any theory (or model), the value of these new theories is really found in their predictive ability and how well their predictions are validated by experimental data. So far, neither of these theories has been tested to any degree.

Instrumented Manipulation

Passive devices have been used for many decades to treat patients with back disorders. Recently, a simple distraction device, Rola Stretcher (Unique Relief, Inc, Davenport, Iowa), designed to be used at home without supervision, was tested to determine whether it showed any lengthening of the spine subsequent to its use. Devocht et al [208] tested 12 asymptomatic adults and found a significant increase in sitting height after 10 minutes of lying supine on the device. They concluded that it at least temporarily lengthened the spine, presumably by increasing the intervertebral disk height.

In addition to the activator adjusting tool, which has had increasing amounts of scientific study, [160–163] the PulStar computer-assisted, differential compliance spinal instrument has been developed, and a few studies on it have appeared. [209, 210] This latter device also applies an impulse load (up to ~150 N), although the duration of the impulse has not been characterized in articles available in the indexed peer-reviewed literature. The device also incorporates a sensor to measure the compliance of the material that it loads, and hence, the compliance of the paraspinal region can be assessed as well as loaded with the same device. A case study has reported that the instrument was used to treat the spines of infants having colic. [210]

F.   Recommendations and Action Steps

  1. Determine (quantify) the biomechanical basis of the subluxation.

    1. Determine the parameters that dictate whether a given vertebra should be manipulated.

    2. Determine the parameters that will guide the optimal approach to administering the manipulation.

  2. Determine the effects of manipulation on tissues of the spine.

    1. Which ligaments (including facet joint capsule) sustain the largest strains due to SM

    2. The influence of the vector direction of a given type of SM on ligament strains

    3. Measure the effects of SM on change in tissue characteristics (eg, ligament modulus of elasticity) and cellular response to SM.

  3. Quantify the biomechanical safety of SM in fracture, disk lesions, ligament strains, muscle, and tendon strains.

  4. Develop comprehensive models of the spine that predict how it responds to physiologic and SM loads.

  5. Determine the biomechanical parameters of SM that dominate the neurophysiologic beneficial effects of SM.

   The Effects of Chiropractic Adjusting   

Subluxation–based Guidelines
A Chiro.Org article collection

Please review this collection of treatment guidelines from the
International Chiropractors Association (ICA) and the Council on Chiropractic Practice (CCP).

The About Chiropractic Adjusting Page
A Chiro.Org article collection

Review a variety of articles about chiropractic adjusting (aka spinal manipulation).

The Cost-Effectiveness of Chiropractic Page
A Chiro.Org article collection

These studies suggest that spinal adjusting (or manipulation if you prefer) and chiropractic management is both highly effective and cost-effective in comparison to standard medical management for neck and low back pain and for headaches.

The Patient Satisfaction With Chiropractic Page
A Chiro.Org article collection

These studies reveal that chiropractic care is much more popular with patients than standard medical management for neck and low back pain, or for headaches.

Elevated Production of Nociceptive CC-chemokines and sE-selectin
in Patients with Low Back Pain and the Effects of Spinal
Manipulation: A Non-randomized Clinical Trial

Clin J Pain. 2018 (Jan); 34 (1): 68–75 ~ FULL TEXT

The production of chemotactic cytokines is significantly and protractedly elevated in LBP patients. Changes in chemokine production levels, which might be related to SMT, differ in the acute and chronic LBP patient cohorts.

Attenuation Effect of Spinal Manipulation on Neuropathic
and Postoperative Pain Through Activating Endogenous
Anti-Inflammatory Cytokine Interleukin 10 in
Rat Spinal Cord

J Manipulative Physiol Ther 2016 (Jan); 39 (1): 42–53

Our results showed that repetitive ASMT significantly suppressed neuropathic pain after CCD and the postoperative pain after de-CCD, reduced the increased excitability of CCD and de-CCD DRG neurons, attenuated the DRG inflammation, and inhibited induction of c-Fos and expression of PKC in the spinal dorsal horn. Most interestingly, ASMT significantly increased level of the anti-inflammatory cytokine IL-10 in the spinal cord and reduced level of IL-1? in DRG in CCD and de-CCD rats. These results suggest that ASMT may attenuate neuropathic pain through, at least partly, activating the endogenous anti-inflammatory cytokines IL-10.

Neural Response During a Mechanically Assisted Spinal
Manipulation in an Animal Model: A Pilot Study

J Nov Physiother Phys Rehabil. 2015 (Sep);   2 (2):   20–27 ~ FULL TEXT

This pilot study demonstrates feasibility of recording in vivo muscle spindle response during spinal manipulation using clinical mechanically-assisted spinal manipulation devices. It also demonstrates that extremely short duration manipulative thrusts (<5ms) of equivalent forces to that delivered to the human cervical spine can have an immediate and/or perhaps a prolonged effect (> 40s) on paraspinal muscle spindle discharge. While the clinical relevance of how mechanoreceptor stimulation or inhibition related to spinal manipulation modulates central nervous system activity remains to be clarified, determining how various mechanoreceptors respond during and following spinal manipulative thrusts in a clinically relevant fashion is an important step toward achieving this goal.

Does Inter-vertebral Range of Motion Increase After
Spinal Manipulation? A Prospective Cohort Study

Chiropractic & Manual Therapies 2014 (Jul 1); 22: 24 ~ FULL TEXT

Of importance is the finding that sagittal plane hypomobile segments were not significantly more prevalent in patients than in controls, casting doubt on the relevance of sagittal plane hypomobility in patients with relatively mild non-specific neck pain. However, this may not be the case in other populations and planes of motion. Indeed, such hypomobility may be of importance only in a subgroup of neck patients.

Biomechancial Quantification of Pathologic Manipulable
Spinal Lesions: An In Vivo Ovine Model of
Spondylolysis and Intervertebral Disc Degeneration

J Manipulative Physiol Ther 2012 (Jun); 35 (5): 354–366 ~ FULL TEXT

Using a previously validated ovine lumbar degenerative disc lesion model and a novel ovine spondylolysis lesion model, surgically induced spinal lesions were prospectively tracked histologically and radiologically through a 6-month follow-up. Objective evidence of an increase in dynamic spinal stiffness, as well as reductions in vertebral displacements occurring in response to SM, were observed in the spondylolysis and disc degeneration groups compared with their age-matched and exposure level controls. Histologic evidence of pathology consistent with an alteration of spinal stiffness accompanied by alterations in the neuromuscular system provides novel insights into quantifying manipulable spinal lesions as well as a means to biomechanically assess SMT outcomes.

Cerebral Perfusion in Patients with Chronic Neck
and Upper Back Pain: Preliminary Observations

J Manipulative Physiol Ther. 2012 (Feb); 35 (2): 76–85 ~ FULL TEXT

Group 1 (mild) consisted of 14 patients. Cerebral perfusion measured by SPECT was normal in all 8 brain regions.

Group 2 (moderate) consisted of 16 patients. In this group, a decrease in cerebral perfusion was observed (range, 20%–35%), predominantly in the parietal and frontal zones.

Group 3 (severe) consisted of 15 patients. In this group, the decrease in cerebral perfusion observed was from 30% to 45%, again predominantly in the parietal and frontal zones.   A significant difference was found between NDI groups ("moderate" and "severe" showed significantly greater hypoperfusion than "mild").   Total blockage score correlated with SPECT scores at r = 0.47, P = .001. In a multivariate analysis, NDI scores contributed 39% of the variance of SPECT scores.

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.

Elevated Production of Inflammatory Mediators Including
Nociceptive Chemokines in Patients With Neck Pain:
A Cross-Sectional Evaluation

J Manipulative Physiol Ther. 2011 (Oct); 34 (8): 498–505 ~ FULL TEXT

Production of inflammatory mediators was consistently elevated in NP patients in this study, both in vitro and in vivo, and activation of inflammatory pathways was accompanied by up-regulation of CC chemokine synthesis. This suggests that, in NP patients, CC chemokines may be involved in regulation of local inflammatory response through recruitment of immune cells to the inflamed tissue and exert pronociceptive effects.

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.

Increased Multiaxial Lumbar Motion Responses During
Multiple-Impulse Mechanical Force Manually Assisted
Spinal Manipulation

Chiropractic & Osteopathy 2006 (Apr 6);   14 (1):   6 ~ FULL TEXT

Knowledge of the vertebral motion responses produced by impulse-type, instrument-based adjusting instruments provide biomechanical benchmarks that support the clinical rationale for patient treatment. Our results indicate that impulse-type adjusting instruments that deliver multiple impulse SMTs significantly increase multi-axial spinal motion.
There are more articles like this at our Instrument Adjusting Page.

The Efficiency of Multiple Impulse Therapy
for Musculoskeletal Complaints

J Manipulative Physiol Ther 2006 (Feb);   29 (2):   162 ~ FULL TEXT

Response of patients in the study sample to multiple impulse therapy for symptoms of low back and neck pain appeared to be considerably faster than that obtained in 3 recent studies.

Self-reported Nonmusculoskeletal Responses to
Chiropractic Intervention: A Multination Survey

J Manipulative Physiol Ther 2005 (Jun); 28 (5): 294–302 ~ FULL TEXT

Positive reactions were reported by 2% to 10% of all patients and by 3% to 27% of those who reported to have such problems. Most common were improved breathing (27%), digestion (26%), and circulation (21%).

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 ~ FULL TEXT

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.

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.

Chronic Pediatric Asthma and Chiropractic Spinal Manipulation:
A Prospective Clinical Series and Randomized Clinical Pilot Study

J Manipulative Physiol Ther 2001 (Jul); 24 (6): 369–377 ~ FULL TEXT

After 3 months of combining chiropractic SMT with optimal medical management for pediatric asthma, the children rated their quality of life substantially higher and their asthma severity substantially lower. These improvements were maintained at the 1-year follow-up assessment.

Epilepsy and Seizure Disorders: A Review of Literature
Relative to Chiropractic Care of Children

J Manipulative Physiol Ther 2001 ( Mar); 24 (3): 199–205 ~ FULL TEXT

Chiropractic care may represent a nonpharmaceutical health care approach for pediatric epileptic patients. Current anecdotal evidence suggests that correction of upper cervical vertebral subluxation complex might be most beneficial. It is suggested that chiropractic care be further investigated regarding its role in the overall health care management of pediatric epileptic patients.

The Short–Term Effect of Spinal Manipulation in the
Treatment of Infantile Colic: A Randomized Controlled
Clinical Trial with a Blinded Observer

J Manipulative Physiol Ther 1999 (Oct); 22 (8): 517–522 ~ FULL TEXT

By trial days 4 to 7, hours of crying were reduced by 1 hour in the dimethicone group compared with 2.4 hours in the manipulation group (P = .04). On days 8 through 11, crying was reduced by 1 hour for the dimethicone group, whereas crying in the manipulation group was reduced by 2.7 hours (P = .004). From trial day 5 onward the manipulation group did significantly better that the dimethicone group. The authors then conclude: Spinal manipulation is effective in relieving infantile colic.
  You will also enjoy FCER's review of this article.

Endometriosis and the Anterior Coccyx:
Observations on 5 Cases

Research Forum 1985 (Summer); 1 (4): 120–122 ~ FULL TEXT

This case review involves five women presenting with medically-diagnosed endometriosis. All five women had been advised that they were surgical candidates. Relief of symptoms is effected by adjusting the anteriorally displaced coccyx. The author suggests a relationship between the displaced coccyx and endometriosis and counsels upon the recognition of same.


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