Abstracts for Vertebral Subluxation Research Conference, Oct 2000
Contents
Edward Owens, MS, DC
"The Relationship Between Science, Philosophy, and Art in Chiropractic Research"
Simon A. Senzon, MA, DC
"The Theory of Chiropractic Pattern Analysis Based on the New Biology"
Roy Sweat, DC
"Structural Abnormalities and Aberrancies at the Base of the Skull and Cervical Spine: Congenital and Acquired"
Bryan J. Salminen, DC
"Inter- and Intra-examiner Reliability of the Tytron C-3000"
Illya Kondratyev MD, ND
"Point Testing to Localize Lumbo-Pelvic Fixations"
Michael J. Clemen, DC
"Mechanically Assisted Mobilization Adjustment of the Lumbar-Pelvic Zone"
Alan Hartley, PhD, DC
"Dissecting the Prone Leg Check"
Gary A. Knutson, DC
"The Functional "Short Leg"; Physiological Mechanisms And Clinical Manifestations"
Meridel Gatterman, D.C.
"Relating Patient-Centered Evidence-Based Guidelines to Subluxation-Based Practice"
Kathryn T. Hoiriis, BS, DC
"Chiropractic and The Immune Response: A Literature Review"
Mike Clusserath, DC
"Rationale for Multiple Common Indicators of Vertebral Subluxation"
Rob Kessinger, DC
"A New Approach to the Upper Cervical Specific, Knee Chest Adjusting Procedure"
John Hart, DC
"Comparison of X-ray Listings and Palpation Listings of the Upper Cervical Spine"
Mike Clusserath, DC
"The VSC Model and the Philosophy of Chiropractic"
Susan H. Brown, PhD, DC
"Comparison of Radiographic Analysis for Two Upper Cervical Specific Techniques"
Comparison of Radiographic Analysis for Two Upper Cervical Specific Techniques
Susan H. Brown, Ph.D., Roger Hinson, D.C., and Edward F. Owens, M.S., D.C.
Introduction: Upper cervical specific chiropractic techniques rely on radiographic analysis to determine the line of drive for correcting misalignments of the first cervical vertebra (C1). Different techniques propose different models for how C1 moves, and use different anatomical landmarks for determining its position. We evaluated the laterality of C1 as determined by two upper cervical specific techniques, the Blair technique and the Grostic procedure.
Methods: Twenty subjects were recruited for the study. Each subject received five radiographs: lateral cervical, nasium, base posterior, and left and right condylar views. The radiographs were analyzed independently according to the Blair technique and the Grostic procedure to obtain a listing for the misalignment of C1. Laterality of C1 was compared between the two methods using the Kappa statistic.
Results: For 11 of the 20 subjects (55%), laterality was the same between the two techniques (Kappa = 0.08).
Conclusions: The Blair technique uses an articular model for determining the laterality of C1, whereas the Grostic procedure is an orthogonally- based method. In this study, agreement of C1 laterality between the two techniques was only slightly more than would be expected due to chance. We conclude that the determination of C1 misalignment is highly dependent on the model used to describe the normal anatomical relationship of the bony structures in the upper cervical area.
Mechanically Assisted mobilization Adjustment of the Lumbar-Pelvic Zone
Michael J. Clemen, D.C.
OBJECTIVE: To identify the most current technologies for the delivery of mobilization adjustments to subluxations in lumbar and sacroiliac areas.
BACKGROUND: In Full Spine Technique, the most difficult procedures to perform, include the moves for mobilization adjustments of lumbar and sacroiliac segments. Often, physical strength and near athletic skill and speed are required for these moves to be consistent and effective. Technology is available that gives the clinician control of the most critical elements of the adjustic procedure. Technology is in tables that precisely position, in up to three vectors, the area to be adjusted. Drop sections are friction free and calibrated to weight. The new technology in adjusting instruments is computer assisted. Factors controlled include: Thrust volume and frequency. Forces and preloads. Monitoring changes during mobilization. Automatic thrust termination.
METHOD: Corrective moves, using the new technologies, are described for typical lumbar and pelvic misalignments. The approach is integrated to fit various technique systems.. The advantages that special tables have over totally manual moves are explained. Only computerized adjusting instruments that have the capacity for mobilization adjustments are described.
CONCLUSIONS: Patients expect their doctors to utilize the most advanced technologies available. Treatment is more agreeable and results are better. Clinicians may use technologically advanced tables to enhance their manual skills, and deliver adjustments that are otherwise not possible. In many cases, todays advanced computerized instruments can do it better than by hands only. Using these technologies in combination will likely fit into most technique systems.
Rationale for Multiple Common Indicators of Vertebral Subluxation
Mike Clusserath, DC
The research agenda of Sherman College includes developing vertebral subluxation (VS) measures and determining the effect of VS on quality of life. The VS measures and experimental design of Sherman College suggest using common measures that would allow for comparison of techniques for effectiveness in location and analysis of vertebral subluxation. (1) The reasons stated for the use of common, multiple measures are as follows. There is no irrefutable standard and the measures used commonly are hypothetical and subjective. There is a covariance of neurologic and articular function that leads to confusion about the reliability of specific measures. Until research into the reliability of a specific technique to measure the VS becomes more prevalent, it would be logical to use multiple indicators for analysis of the presence and location of a subluxation. (2) These indicators, to be useful, would have minimal overlap in the structure or functional attributes being investigated. For example, the palpation of the boney processes of the spine and the use of instrumentation are clearly different in technique and in the effects of subluxation being measured. (3) The motion of a joint and the x-ray analysis of the segment being palpated provide different measures that could both, arguably, be strong measures of the subluxation, or aspects of the subluxation. The combination of analysis is superior at the determination of the presence and location of subluxation when compared to any single method of analysis.
VALIDITY
Validity is a strong reason for the lack of consensus as to the appropriate or best indicators of vertebral subluxation. The difficulty in establishing a very strong standard of measure lies in the lack of a clear definition of the subluxation and the varying talents of those who have become experts in specific measuring techniques. There is no profession wide consensus as to the definition of a subluxation. There is a range of views of what a subluxation is: from a simple fixation to a vertebral subluxation complex including several components to a misalignment that causes interference to the mental impulse acting through the nerve system. The choice of indicators to determine the presence, location and analysis of the vertebral subluxation clearly would depend on the chosen definition of subluxation. A particular indicator, for example static palpation, may be relatively invalid should the chosen definition of subluxation be exclusively based on joint fixation. (4,5,6)
RELIABILITY
There is clearly a wide diversity in analyses, which may lead to the conclusion of a weakness in the underlying premise of the presence of subluxation, and the chiropractor’s ability to recognize and analyze and potentially correct it. The opposite view makes more sense to experienced practitioners in most professional fields. That is: there is no absolutely irrefutable models or applications. All professionals must take the best available models, science, technology, and practical circumstances and use their knowledge, understanding and experience to provide their patient or client with the best possible outcome. The indicators of vertebral subluxation that are used presently, specifically at Sherman College, are consistent with the common, widely used and institutionally accepted methods currently in the profession. Palpation (motion, static, muscle), x-ray, instrumentaion, posture, and balance are very common and well established methods for analysis of the subluxation. These indicators are also consistent with one of the more prevalent definitions in the profession; that a subluxation consists of both an articular and neurological component. There is a misalignment to the vertebra creating aberrant joint mechanics, and neurologic effects which may be detected on thermographs. There are also biomechanical effects that cause leg length discrepancies and muscle imbalances. (7,8,9,10)
The indicators used to detect a pattern (or lack of pattern) of neurologic, biomechanical, functional, and articular change from the presence (or absence) of subluxation can also be studied and compared. The use of ‘pattern’ work helps separate the purposes of various methods of analysis. The presence or absence of subluxation can be studied separately from the location and specific analysis; and the reliability and validity of each method and its purpose can be analyzed more clearly and effectively.
Some examples of methods used to detect patterns are thermographs, leg length differences, SEMG, and general paraspinal muscle tone. (11,12,13,14) The location of a vertebral subluxation may be detected by x-ray, palpation (motion, static, muscle), and leg length changes. (15,16,17) The listings and specific technical parameters used to produce a specific force for the correction of the vertebral subluxation are varied. (18,19,20) Palpation and x-ray are used commonly in specific listing systems. There is overlap in function between the various methods of analysis. Also there may be conflicting determinations of listings due to differences in technique in the emphasis of one VS definition over another.
As stated above, the use of more than one indicator is prudent due to the weaknesses cited above: lack of a definition of vertebral subluxation, no clear standard, the hypothetical nature of analysis, subjectivity, and the neurologic and articular covariance. The consistent use of more than one indicator in a practice or an institutional setting provides a basis for further investigation and advancement of techniques used to detect and analyze the vertebral subluxation. (21,22,23,24,25)
CONCLUSION
The philosophy of chiropractic provides a basis for a common and comprehensive definition of subluxation, the interference to the expression of life due to aberrant or unintended nerve signals at the vertebral level. The measures of subluxation currently in use and under study at Sherman College will continue to aid in understanding the indicators of vertebral subluxation. It is suggested that further study and comparison of various techniques and their reliabilities be continued. Technology, reliability, pervasiveness in the profession, category of structural or functional measure, structural and functional covariance, and research support for the techniques of analyses are some of the factors that need to be considered in such study. The validity of any method or indicator of vertebral subluxation will depend on the definition being used.
Both reliability and validity of indicators to determine vertebral subluxation need to be considered in any study that investigates those indicators. A standard and irrefutable approach to the analysis of vertebral subluxation, which is universally known, accepted and in use may ultimately consist of a combination of indicators of vertebral subluxation as there seems to be no obvious superior singular method. (26)
The VSC Model and the Philosophy of Chiropractic
Mike Clusserath
The vertebral subluxation complex (VSC) model includes general categories that can be related to the philosophy of chiropractic. The primary component of the VSC that can be included in the classical philosophy of chiropractic is the neuropathological component and its relationship to the overall function of the body. The mechanisms of the interference of the nerve system due to vertebral subluxation are explained and investigated in the VSC model. The model further categorizes many other effects of the vertebral subluxation. The implication of the model is that the effects of subluxation can be known and related to a significant degree to the life sciences. The model attempts to provide a pathophysiological derivation of most of the known pathological changes present with a subluxation. The unknown, subclinical, unmeasurable changes from subluxation are not significantly addressed in the model. It is presumed that there needs to be significant scientific evidence supporting a particular effect (or category of the model) for the effect to rise to the level of importance as to be included in the VSC model. (1,2,3)
The philosophy of chiropractic makes no assertion regarding the specific correlation of vertebral subluxation to the life sciences or pathophysiologic changes in the body when a vertebral subluxation is corrected, except to state that the innate intelligence is superior at determining what is needed in the body and the entire body functions at a higher level when vertebral subluxation is corrected. The individual and their own body’s intelligence should necessarily have the final determination for what their body needs and when the interference to the mental impulse is removed the body adapts and functions better. (4,5)
The comparison of the VSC model to the philosophy of chiropractic brings up several issues. The first is the definition of the vertebral subluxation. It has been asserted that the VSC model does not define the vertebral subluxation except through components. The next issue is whether the VSC requires proof in excess of that required by the definition of vertebral subluxation as presented by the founders and developers of the philosophy of chiropractic. The pervasiveness of the subluxation is also considered with the implication of the VSC model being that vertebral subluxation is less common than it is as defined by the philosophical model. Indicators of vertebral subluxation are one of the obvious derivations of the VSC model, it is suggested that this may not be very useful due to a lack of value assigned to each component of the subluxation. The final issue to be compared is the concept, long held within the philosophy of chiropractic, that the difference between a disease and the appropriate expression of intelligence is best left to the intelligence of the body, not an expert in the scientific concepts of the VSC model. Each of the comparisons is considered in far too briefly a manner as follows.
DEFINITION
The VSC is defined by components, rather than as a specific entity. The effects of the VSC are described in minute detail relative to known, primarily pathophysiologic, changes in the body. A concise definition of the vertebral subluxation, for inter and intra professional communication, does not seem possible with the VSC model. The phrase ‘vertebral subluxation complex’ implies a set of numerous and varied characteristics. The vertebral subluxation that was defined prior to VSC in chiropractic may be considered a precursor to the VSC that has been described in chiropractic related literature. (6) Literature pertaining to the VSC does not provide a definition and can only be characterized from other scientific disciplines, i.e. myology, kinesiology, neurology, histology, etc. (3,7) The authors of the VSC model refrain from assigning a value to the various components. The lack of an assigned value for the VSC or its components may not be helpful for defining the central area of interest of any profession (i.e. mycology, neurology, etc.) including chiropractic. Professions are defined by central area of interest, and the vertebral subluxation has always been chiropractics’.
The VSC may be a useful term to those inclined to study the causes and effects of vertebral subluxation, however those categories of effects could not replace the central defining purpose of a profession or express the value of aiding the body in the correction of vertebral subluxation. The serious nature of the vertebral subluxation could be implied simply from the numerous components of the VSC. The proponents may also be asserting that all of the components could be occuring whenever a subluxation is present. We can only guess since there is no apparent literature of the model that articulates this issue.
PROOF AND PERVASIVENESS
The description and categories of the VSC imply the necessity of scientific proof of the effects of vertebral subluxation. The description also implies that since it is complex it may be less than common. Both of these implications are contrary to the definition of subluxation as articulated by some the founders and refined by many in the profession. By definition the mental impulse is not measurable and the attributes of vertebral subluxation used to determine its presence are not completely understood or quantified, i.e. palpation, thermography, SEMG. Therefore it may not be under the disciplines of science only. The definition of vertebral subluxation as a spinal articular and neurological derangement from the body’s norm implies its pervasive and common nature in the population. An articular abnormality with nerve interference could be caused by something as simple as shoveling dirt or vacuuming the carpet, while the categories of the VSC taken together, most likely, would only take place after some major trauma, or long term consistent micro trauma. The implication of the VSC model is that there is some major causative factor, and clinically obvious effect, taking place in the body. How could there be kinesiopathology and myopathology and histopathology and neuropathology and pathophysiology without obvious clinical symptoms or signs? (2)
The VSC model also implies that to determine clinically the presence of the VSC, an extensive evaluation is required. Otherwise, how could the components of the VSC be differentiated from a simple muscle strain, or rehabilitation from a fall, or even from the effects of sleeping with poor posture? The VSC model requires diagnosis and treatment because it is primarily ‘pathological’ in nature.
INDICATORS AND/OR EFFECTS
The VSC model might be used to help develop techniques of analysis and location of the vertebral subluxation. However, since the VSC model does not make a value judgment as to the relative importance of a particular effect of subluxation it is relatively ineffective in providing a framework for indicators of subluxation and an approach to intervention. The philosophy of chiropractic provides a contextual model, and a generalized rationale to determine indicators of vertebral subluxation. The structural and neurologic derangements are the focus of subluxation in a philosophical framework and the indicators need some coherence to these factors. (8) The VSC model has no clear priority or road map for the practical application of correction of the vertebral subluxation. The components are many and too varied to have any consistency or prioritization, at least not as the model currently exists. The definition of vertebral subluxation as a misalignment, occlusion of an opening, nerve impingement, and interference to the mental impulse is consistent and provides a prioritization, albeit with controversy, for the indicators of subluxation.
A possible alternate way to label the VSC model, as it is proposed in the literature, is as a description of some of the effects of vertebral subluxation. An articulation of the effects would not be less effective simply because it does not contain the word ‘complex’. The terms ‘complex’ and ‘syndrome’ have been used so often as to render them somewhat meaningless. The ability of a professional to provide service and education to clients or patients or practice members is not diminished if they understand more than a phrase – ‘VSC’. The reductionist approach to understanding how the body is created and animated, its structure and function, is helpful to illucidate the numerous effects of subluxation and the scientific evidence which supports the existence of these effects. This could be helpful for exposing and helping to clearly define the importance and various aspects of the vertebral subluxation.
An articulation of the effects of vertebral subluxation can help provide a much needed bridge from the known, better understood aspects of subluxation to the unknown, yet to be understood attributes of the vertebral subluxation, i.e. energy blockages, neurological imbalances, mental impulses, information transfer, and long term detrimental effects.
DISEASE AND/OR EXPRESSION OF INTELLIGENCE
Finally, the implication that the VSC will lead to disease and that we can know absolutely that a particular aspect of VSC is harmful to the body seem to be somewhat dangerous and insupportable. The appropriate expression of the intelligence of the body and the sign of a subluxation is the difference that we are looking for. The signs of subluxation lead us to our purpose, the location, analysis, and contribution to the correction of vertebral subluxation. The expression of the intelligence of the body is appropriately left alone, or left to an individuals discretion as to a particular non-chiropractic course of action. Our philosophy, science and art help us make the distinction. When to apply a force into the spine and when not to, both of value, are our purpose according to the philosophy of chiropractic. (5)
The proponents of the VSC model have attempted to map the VSC from basic science knowledge to evaluative procedures to interventions. The only item missing from this mapping is a way to determine which road of the map to take. Should we go down the histological highway or the myological highway or both, and what about the neurological road? There is no reference point or directions because there is no clear definition of vertebral subluxation and no value placed on it, or on a particular component. (3) The VSC model, for purposes of evaluation and intervention for a patient, needs a correlation to philosophy. That does not seem to be present in the model. (1)
The component pathologic changes of the VSC model, individually or taken together in any combination, could be considered precursors of a future serious disease. The VSC model implies a preponderance of a cure, or at minimum a treatment of disease, and a means of prevention rather than a contribution to the body’s ability to heal itself. An understanding of the power of healing in the body, when compared to the ability to cure from outside the body, is not enhanced with the VSC model. The VSC, if it were to be the new model of the core purpose of chiropractic, would tend to remove individual autonomy in health related decisions. It would tend to be another form of disease treatment and would encourage the one ‘cause’ (VSC) and one ‘cure’ (adjustments) model.
CONCLUSION
The VSC model seems to provide a useful model that can help organize and determine a scientific approach to the exploration of the effects of the VS. The model is limited in its scope due to the implied necessity of scientific evidence necessary for correlation of a category of the life sciences and VS. This could also be considered a strength in that the model can be tested, which may help support the proposition that subluxation is serious.
The philosophy allows for deficiency in the scientific models and provides a platform for intervention and a basis for discrimination and understanding of the scientific facts, theories and evidence. The philosophy also starts with a realistic assumption and derives a logical conclusion that is the vertebral subluxation. (4) This provides a broader framework within which to learn and understand the vertebral subluxation and chiropractic. The VSC model appears to this author to be strictly scientific in its purposes and is not a substitute for a logical, philosophical approach to the derivation of the vertebral subluxation. The VSC model that deviates from a scientific description of the effects of vertebral subluxation into an attempt to provide a framework for evaluation and intervention would quickly dilute a clear, consistent, effective objective for the chiropractic profession. (9)
A profession that supplies a valuable service to the public needs to be willing to place a value on the service, at the very least be willing to assert a clear definition. If that is not present, the remains are confusion and the inability to educate the public about the professions central area of interest. The ability to articulate and advance the principles of chiropractic and to improve the quality of chiropractic care will be increased with a willingness to assert a definition of vertebral subluxation and by refraining from using short phrases when attempting to describe the numerous and varied effects that might take place with vertebral subluxation. (10)
Relating Patient-Centered Evidence Based Guidelines to Subluxation Based Practice
by
Meridel I. Gatterman, MA, DC, MEd Process Consultant Portland, Oregon
A three-tiered process to revise the current Oregon Practice and Utilization Guidelines is described. The focus of this process is patient-centered and evidence-based. The new guidelines will make recommendations to guide patients and practitioners in making appropriate health care decisions. Where strong evidence exists, standards of quality that address minimum competency will also be included. While guidelines are designed to be flexible and non-binding educational tools, standards of quality provide administrative tools on which to base peer review criteria. The strength of this process is that it is profession-initiated with broad representation and it differentiates guidelines from standards of quality.
INDEX TERMS: MeSH: CHIROPRACTIC, STANDARDS; EVIDENCE-BASED; GUIDELINES; PATIENT-CENTERED CARE; OREGON; QUALITY ASSURANCE; HEALTH CARE.
Comparison of X-ray Listings and Palpation Listings of the Upper Cervical Spine
by
John Hart, D.C. and others*
April 2000
This study compared the inter-examiner reliability of two approaches for determining vertebral alignment of the upper cervical spine: 1. by x-ray and 2. by palpation. The study also compared final x-ray listings to final palpation listings. A statistical analysis was performed for the individual parameters for both x-ray and palpation. Twenty out of a total of thirty (66.6%) x-ray paramters had acceptable percent agreement (Po) scores compared to eight out of thirty-five (22.8%) for palpation that had acceptable percent agreements (Po). Six out of the thirty x-ray parameters had acceptable kappa scores. There were no palpation scores that had acceptable kappa scores. There were 15 segments listed according to x-ray out of a total of 62 (24.1%) possible segments (atlas and axis for 31 patients) that had very good agreement between x-ray examiners for a final listing. There were 6 out of 62 (9.6%) segments for palpation that had very good agreement between the palpation examiners for a final listing. There was one segment (out of 62) where both x-ray examiners agreed with each other for a final axis listing, and where the palpation examiners also agreed with each other for their final axis listing, but between the x-rayers and the palpators, there was not such an agreement for this segment. There were 19 out of 31 atlases (61.2%) where the x-ray examiners agreed on laterality-only, compared to 12 out of 31 (38.7%) for palpation. There were 16 out of 28 (57.1%) axes where the x-ray examiners agreed on axis body laterality, compared to 8 out of 31 (25.8%) agreement between palpators. In this study, x-ray was a little more reliable than palpation.
* Acknowledgement of others who participated in this research:
Sherman faculty who performed either the x-ray analysis (x) or the palpation analysis (p) along with the number of cases examined:
Joseph Donofrio, D.C.Sherman interns who performed either the x-ray analysis (x) or palpation analysis (p):
Kyle MartinSherman interns, and their patients, for agreeing to participate in this study.
Ed Owens, D.C. for his advice concerning the scientific method for this project.
Sherman College administration for their support of this project.
Dissecting the Prone Leg Check
Alan Hartley
According to theory, the presence of Leg length Inequality (LLI), barring physical defect, is indicative of an asymmetry in the underlying neuromuscular tone of the body, supposedly caused by the presence of vertebral subluxation. While much effort has been expended in assessing the intra- and inter-examiner reliability of the prone leg check, we contend that it is, at present, an interesting clinical observation that requires accurate description before its significance can be explored.
Most descriptions of the prone leg check include the application of a slight cephalad force through the long axis of the legs. We have developed a system to measure these forces using calibrated force transducers (LBC-100, Transducer Techniques) affixed to the heel and through which the cephalad force is applied for each leg. In a pilot study, comprising six DCs, three student doctors and 6 randomly selected patients; we found the average force applied was 5.54 lb to the left leg and 5.64lb to the right leg. The range of force used by different doctors was 0.75lb to 11.14lb. The slight right-sided bias may reflect the handedness of the doctor (all but one doctor was right handed). The doctors were internally consistent, most operating within +/- 0.5lb difference left to right. We found no statistical relationship between side of perceived LLI and side of greatest force application. The amount of force required to cause previously unbalanced legs to become balanced was significantly larger (by a factor of 10) than the average difference in applied force left to right.
Chiropractic and The Immune Response: A Literature Review
Kathryn T. Hoiriis, BS, DC, David Edenfield, BA
Abstract
Objective: This review of the literature focuses on published research in which immune response to nervous system influence has been observed. The primary objective of this review is to investigate and document the scientific evidence that supports a correlation between subluxation, chiropractic adjustments and the immune system.
Data source: Online searches were performed using National Library of Medicine PubMed, Mantis and world wide web medical and non-medical search engines using key words of chiropractic, chiropractic adjustment, spinal manipulation, mechanical stimulation, neuroimmunology, and immunology.
Study selection: To date, twenty-eight research articles have been retrieved from the search. Three animal studies were included in this review. At least seven articles report on clinical trials with relevant findings to the specific effects of nervous system by quantifiable methods i.e. detecting concentrations of cells and/or soluble factors of immunity. Other articles have reported on various biological rationales for neuroimmune mechanisms and the relationship to the spine. Twenty-one percent (6/28) of the articles selected were found in the Journal of Manipulative and Physiological Therapeutics. Some additional sources were the Chiropractic Research Journal, Spine, Annals of Neurology, Journal of Neuroscience, and Medical Times.
Discussion: This investigation was aimed at identifying whether there is evidence to demonstrate a cause and effect relationship between subluxation and immunologic function and further, whether chiropractic spinal adjustment positively influences the immune response. Our evaluation of the literature is in progress.
A New Approach to the Upper Cervical Specific, Knee Chest Adjusting Procedure
Robert Kessinger, DC
Dessislava Boneva, DC
Abstract
Purpose: The purpose of this paper is to outline an original upper cervical knee chest adjusting procedure for correction of the atlas and axis subluxation.
Methods: A retrospective study has been performed on a random selection of patients receiving the upper cervical knee chest adjusting procedure outlined in this presentation. Pre and post examinations have been performed on various patients. These examinations include x-rays (Blair Protracto views and neutral lateral views), infra-red spinal thermography, leg length equality, computerized dual inclinometry range of motion and muscle testing, and various laboratory observations.
Results and Conclusions: The findings of this retrospective study lends validation to the proposal that the upper cervical specific, knee chest adjusting procedure presented is a viable method for correction of the upper cervical subluxation.
The functional "short leg"; physiological mechanisms and clinical manifestations
Leg length inequality (LLI) is one of the most common subluxation/postural analysis checks used by chiropractors. This presentation seeks to expose and examine the complexities of LLI, propose a mechanism of action, outline suggestive evidence and present possible clinical manifestations.
LLI is divided into two groups; anisomelia or actual anatomic asymmetry (aLLI) due to injury, disease and developmental asymmetry, and physiologic/postural or functional (fLLI) which is suspected of being due to hypertonicity in supra-pelvic and pelvic muscles (1-5).
In most examinations of the LLI phenomenon, anatomic and functional are not differentiated from one other. However, these two types of LLI differ as to their cause and may be expected to produce dissimilar signs and symptoms.
Radiographic and orthopedic methods have been developed to determine LLI. Orthoroentgenography, a radiographic technique that measures actual bony leg length, is the preferred method when planning for surgical equalization of leg lengths of children and young adults (6). Studies done using orthoroentgenography have found anatomic LLI to be both frequent (6) and, when less than 19mm (~¾ in), not related to chronic back pain (6-8). This data lends credence to the belief that anatomic LLI is so common as to be a normal variant (9).
Pelvic x-ray of femoral head height as a method to determine aLLI is often flawed due to patient positioning, central ray location and biomechanical alterations of foot structure (2). Pelvic x-ray results also differ significantly compared with orthoroengenography in determining aLLI (7).
Non-weight bearing leg check tests are thought to be demonstrative of functional LLI. These tests have the advantage of being technologically simple, have been shown to be inter- and intra-examiner reliable (10-13), and are thought to assess activity of pelvic and supra-pelvic muscles.
Initially, the idea of muscular contraction causing fLLI looks simple and straightforward. However, difficult questions remain to be answered; for instance, how can muscles hypothetically causing fLLI stay tonically active for long periods of time? Long-term muscle contraction is a problem with functional leg length inequality that is often overlooked, but one that must be addressed.
Prolonged muscle contraction depends, in part, on the type fibers that make up the muscle. Type II fibers provide for fast, powerful contractions. An example would be the gastrocnemius muscle – think sprinter. Type I muscle fibers allow for slow, sustained contractions that may not be subject to fatigue (14). An example muscle would be the soleus, a postural muscle – think marathoner
In erector muscles, including longissimus, iliocostalis and multifidus, there is a general trend (54-73%) towards increased concentrations of the slow, postural type I fibers (15). Interestingly, the rhesus monkey has a lower proportion of type I fibers in the back muscles when compared with the human. The monkey is mainly quadrupedal, with the vertebral column mostly in a horizontal position, so fewer type I fibers are required for postural tone and balance (15).
Muscle fibers, in order to undergo contraction, need blood flow for nutrient supply and waste removal. Yet contraction itself reduces vascular flow. How can the muscle fibers get blood flow during contraction, especially if that contraction has to be endured for long periods of time?
There is a phenomenon called sub-maximal contraction in which the intramuscular blood supply has the capability of supplying a muscle contracted at a low level. Contraction intensity above the sub-maximal level – called the critical force point – causes ischemia and loss of the muscle’s ability to continue the contraction. Typically, sub-maximal contraction amounts to a 30% maximal voluntary contraction (MVC) (16) or less in most muscle, to 40% MVC or less in erector muscles (17). Another way to maintain steady contraction is through substitution/rotation of muscle fasciculi (18-20).
As a muscle contracts, the metabolites generated signal the CNS initiating what is called the pressor reflex which alters physiology in order to increase blood pressure, thus forcing blood through the contracted muscle (21-23). The pressor reflex is powerful. An experiment in which the metabolic products of contraction were trapped in the flexor muscles of the little finger there was an overall increase in systolic blood pressure of 70 mm Hg (22). The pressor reflex in response to muscle contraction metabolites causes changes in blood pressure by altering the heart rate (21,24,25), lung (21,24) kidney (26,27) and adrenal gland function (28), skin (24,25,29), and spleen blood flow (30) and sympathetic stimulation of the glucoregulatory system (31).
Given Type I muscle fibers and the pressor reflex, long-term sub-maximal contractions that could produce fLLI are physiologically possible. Indeed, there are several lines of evidence for the existence of long-term sub-maximal muscle contraction, including clinical case studies of reversible long-term postural distortion (32,33). The stiffness and tension of the erector spinae in subjects with chronic back pain (34) implies long-term sub-maximal contraction. Postural reflexes have been shown to cause long-term tonic changes in muscle tone (e.g., tonic neck reflexes) (35-37). Some EMG studies have demonstrated chronic sub-maximal contraction in subjects with back pain (38-41). Muscle damage and wasting, noted in chronic back pain, is associated with ischemia (42-45), as is muscle weakness/fatigue (46,47). A most interesting possible sign of chronic sub-maximal muscle contraction is the alleviation of organic symptoms potentially related to the pressor reflex (48-50), which, as outlined above, can alter a wide variety of organic functioning.
Clinically, chronic sub-maximal contraction and the effects of the pressor reflex may be noted in patient examination. Recall that the physiology of critical force or sub-maximal contraction involves a dynamic equilibrium between sufficient and insufficient (causing ischemic pain) blood supply to the working muscle. Signs and symptoms of long-term muscular contraction include complaints of pain during extended resting (e.g. sitting for long periods of time, lying in bed); any active sub-maximal contraction unopposed by motion/stretching could lead to metabolic build-up and ischemic pain. Other signs include the rapid onset of pain with strenuous exercise (e.g. intermittent claudication). In the case of sub-maximal contraction, the muscles are already partially contracted, and as they are more heavily worked, blood flow is further reduced causing pain. Pain from chronic sub-maximal contraction is often relieved with stretching and mild motion/exercise/massage that acts to increase blood flow. Pain relief also comes with heat that promotes vascularity. Finally, a symptom of chronic sub-maximal muscle contraction may be organic symptoms due to the effects of the pressor reflex, including chronic changes in the blood pressure, heart, lungs, kidneys, spleen and glucoregulatory system.
Chronic sub-maximal muscle contractions are physiologically possible, and signs of such contractions, while mostly indirect, are abundant. Such muscular contractions may be responsible for the postural distortion of functional leg length inequality and for a variety of somatic and organic signs and symptoms.
Bibiolography
Point Testing to Localize Lumbo-Pelvic Fixations
Illya Kondratyev MD, ND
BACKGROUND: Fixation is a component of the Vertebral Subluxation Complex that causes dysfunction of lumbo-pelvic motor units. Lesions that produce motion restriction may be located in the soft tissues of the muscles, joints and discs. Chiropractors have traditionally examined joints for subluxation restrictions. Muscular tissues are part of the motor unit and may contain lesions that should be corrected as part of a complete adjustment.
OBJECTIVE: To review both manual and computerized methods for analyzing specific fixation lesions in lumbar and pelvic motor units. Since corrective procedures are applied to precise points, testing will be directed towards locating these points or zones. Both segmental and postural considerations will be made in demonstration of this analysis procedure.
DISCUSSION: Joint fixations are intersegmental. Muscular fixations may be either intersegmental or zonal. Observations of posture and movement suggest areas of involvement. Manual palpation and special compliance testing instruments can locate exact levels and side of joint fixation. These same methods may be used to pinpoint muscular restrictions such as myofascial lesions, trigger points and tendonopathy.
CONCLUSIONS: The lumbo-pelvic area is the spine=s foundation and the location of the body center of gravity. All types of motion restrictions in this area should be located and effectively mobilized for the spine to be in proper compensation. Points of fixation in joints and muscles can be located by both manual and instrument methods. The testing procedure is fast and precise, so checking should also be done after adjustment to confirm results.
Improvement in Paraspinal Muscle Tone, Autonomic Function and Quality of Life in Four Children with Cerebral Palsy Undergoing Subluxation Based Chiropractic Care: Four Retrospective Case Studies
Dr. Matthew McCoy, Dr. Ekaterina Malokhova, Dr. Yuri Safronov
Regional Center for Chiropractic "Spine"
Vladivostok, Russia
Objective: To present results experienced by 4 patients with cerebral palsy who underwent chiropractic care to reduce vertebral subluxation.
Clinical Features: 4 children previously diagnosed with cerebral palsy secondary to birth trauma. All four demonstrated evidence of vertebral subluxation.
Interventions and Outcomes: Chiropractic care directed at reduction of subluxation was undertaken. Paraspinal Surface Electromyography and Thermography readings were taken prior to the initiation of care and approximately one month (12 visits) later. The mothers and care providers in each case monitored changes in activities of daily living and quality of life.
All four children showed improvement in paraspinal muscle tone (improved symmetry and decreased amplitude) as well as a decrease in the number of levels of abnormal thermography readings. All four children showed improvement in activities of daily living including mobility, feeding, and postural control.
Conclusion: Improvement in muscle tone and autonomic function coupled with improvement in activities of daily living occurred in these four patients undergoing chiropractic care for reduction of subluxation. It is suggested that larger studies of this nature be carried out.
The relationship between science, philosophy, and art in chiropractic research: the three-legged stool revisited
Ed Owens
The profession of chiropractic has been defined in many different ways and from various perspectives throughout its 105 year history. For example the definition of straight chiropractic used at Sherman College is "a vitalistic philosophy of life and health, and the art and science of locating and correcting vertebral subluxations in accordance with that philosophy. "
Other definitions may stress a scientific approach rather than a philosophic approach to patient care, but most descriptions concede that science, philosophy and art all play a part in the practice of chiropractic. This presentation will lay out a model of the interrelationships between philosophy, science and art in straight chiropractic as they apply to research and practice. Of particular interest are the interfaces between the approaches, areas where conflict and interchange arise.
Philosophy, particularly its branches of metaphysics and epistemology helps guide practitioners and research and gives meaning to the knowledge gained through scientific research. Ethics, another branch of philosophy, helps guide the daily practice of the chiropractic arts of locating and correcting vertebral subluxations.
Science interacts with philosophy in the way that deductions and approaches can be tested through an inductive process. Conflicts arise when the findings of science seem to contradict philosophic views. Science also interacts with the art of chiropractic in the way that scientific knowledge is applied in daily evaluation and care of patients.
Art is a cornerstone of chiropractic practice as it involves the patient to doctor interactions, particularly in the way that doctors use their sensitivity and experience to locate and correct subluxations. In many instances the doctor uses palpatory and communication skills that are crucial to the doctor patient interaction, but are very difficult to quantify from a scientific standpoint. Hence there are often conflicts between what is scientifically known or measureable, and what is felt by the doctor and patient. An evidence base that does not allow for the inclusion of the art in chiropractic may miss a most important aspect of the practice.
Using all three legs of the "three legged stool" allows us to derive a balanced definition of chiropractic that reflects the familiar elements of straight chiropractic: Chiropractic is the philosophy, art and science of the location, analysis and correction of vertebral subluxations in order to promote health.
The Theory of Chiropractic Pattern Analysis Based On The New Biology
Simon A. Senzon, M.A., D.C.
Abstract
It is a common practice amongst chiropractors to monitor physiological patterns of the body in order to decide when a chiropractic adjustment is necessary. A pattern is defined as when the body is not adapting to its environment in a regular, dynamic and healthy way. Some pattern findings related to vertebral subluxation are measurement of leg length, sacroiliac motion, spinal palpation, and thermographic and infrared imaging.(1) B.J. Palmer,(2) promoted pattern analysis in the 1930’s, based on the teachings of his father D.D. Palmer.(3) This form of analysis is taught at Sherman College of Straight Chiropractic. It is also common practice in several forms of chiropractic analysis such as Pierce Results System,(4) Thompson, Gonstead, Network Spinal Anaylsis,(5) BioGeometric Integration,(6) and Logan Basic,(7) to name a few. There is evidence that current biological theories such as dissipative structures,(8) self-organization,(9) autopoiesis,(10) structural coupling,(11) and morphological formation(12) are congruent with chiropractic theories.(13, 14, 15) This paper will explain the rationale for the SCSC pattern analysis, and the other chiropractic models as one theory, based on the vertebral subluxation model.(16) By applying the newer theories of biological organization in support of pattern analysis as a practice, a link will be made. It will be hypothesized that the term "alexithymia,"(17) be used in reference to the hyperaroused state of the autonomic nervous system which may be related to the vertebral subluxation, and hence present as a systemic and fixed tonic pattern that the cortex is dis-connected from. This dis-connection may be related to the vertebral subluxation.
Key Words: Chiropractic Pattern Anaylsis, Vertebral Subluxation Model, Self-Organization, Dissipative Structures, Autopoiesis, Structural Coupling, Morphological Formation, Alexithymia, Chiropractic Philosophy.
Inter- and Intra-examiner Reliability of the Tytron C-3000
Bryan J. Salminen, DC
Tunu Misra, MS
Objective: We tested the inter- and intra-examiner reliability of doctors scanning subjects using the Tytron C-3000.
Methods:
Patient Selection: We selected 5 healthy subjects between the ages 20 – 45.
Protocol: Subjects were asked not to utilize procedures that can affect vasculature changes as per standard operating procedures set by the Tytron manual. One subject at a time entered the examining room, which was partitioned for their privacy. Each subject was set up for a full spine graph and set in a posture constant chair. The total number of scans collected from the 5 subjects was 45. Each doctor performed 3 scans on each of the subjects for a total of 15 scans per doctor. No marks were made on subjects, as the study attempted to determine the doctors’ ability to successfully reproduce start and end points.
Discussion
All data for this study has been collected. We will complete the analysis by the middle of June. This study will assess the ability of doctors to reproduce results from single samples by comparing the graphic output for each subject’s scan by each doctor. Second, the study will compare reproducibility between doctors for each patient.
Analysis: We plan to use a data analysis which includes the comparison of delta T values. The following will be evaluated: A. Slope Comparison D. Stewart Boone Method of Analysis.
Acknowledgement: We would like to recognize the co-operative effort by Sherman College with aiding of the computer analysis of the thermal graphs.
Structural Abnormalities And Aberrancies At The Base Of The Skull And Cervical Spine: Congenital And Acquired
Roy Sweat
Matthew Sweat
This lecture will show examples of structural abnormalities that may appear in radiographic studies of the occiput and upper cervical spine. Structural abnormalities may be congenital, acquired through trauma, or due to surgical intervention. The radiographic presentation of each abnormality will be shown using radiographs from the authors’ patient files. The clinical presentation will be discussed along with modifications to the care plan and adjusting strategy that may be required to accommodate for these aberrancies.
Outline of structural abnormalities to be covered: