Spinal Adjustment Research Articles

The Effects of Chiropractic Spinal Adjustment on EEG in Adults with Alzheimer's and Parkinson's Disease: A Pilot Randomised Cross-over Trial.

In this study, we explored the effects of chiropractic spinal adjustments on resting-state electroencephalography (EEG) recordings and early somatosensory evoked potentials (SEPs) in Alzheimer's and Parkinson's disease. In this randomized cross-over study, 14 adults with Alzheimer's disease (average age 67 ± 6 years, 2 females:12 males) and 14 adults with Parkinson's disease (average age 62 ± 11 years, 1 female:13 males) participated. The participants underwent chiropractic spinal adjustments and a control (sham) intervention in a randomized order, with a minimum of one week between each intervention. EEG was recorded before and after each intervention, both during rest and stimulation of the right median nerve. The power-spectra was calculated for resting-state EEG, and the amplitude of the N30 peak was assessed for the SEPs. The source localization was performed on the power-spectra of resting-state EEG and the N30 SEP peak. Chiropractic spinal adjustment significantly reduced the N30 peak in individuals with Alzheimer's by 15% (p = 0.027). While other outcomes did not reach significance, resting-state EEG showed an increase in absolute power in all frequency bands after chiropractic spinal adjustments in individuals with Alzheimer's and Parkinson's disease. The findings revealed a notable enhancement in connectivity within the Default Mode Network (DMN) at the alpha, beta, and theta frequency bands among individuals undergoing chiropractic adjustments. We found that it is feasible to record EEG/SEP in individuals with Alzheimer's and Parkinson's disease. Additionally, a single session of chiropractic spinal adjustment reduced the somatosensory evoked N30 potential and enhancement in connectivity within the DMN at the alpha, beta, and theta frequency bands in individuals with Alzheimer's disease. Future studies may require a larger sample size to estimate the effects of chiropractic spinal adjustment on brain activity. Given the preliminary nature of our findings, caution is warranted when considering the clinical implications. The study was registered by the Australian New Zealand Clinical Trials Registry (registration number ACTRN12618001217291 and 12618001218280).

Chiropractic Spinal Adjustment Increases the Cortical Drive to the Lower Limb Muscle in Chronic Stroke Patients.

This study aimed to investigate the effects of a single session of chiropractic spinal adjustment on the cortical drive to the lower limb in chronic stroke patients. In a single-blinded, randomized controlled parallel design study, 29 individuals with chronic stroke and motor weakness in a lower limb were randomly divided to receive either chiropractic spinal adjustment or a passive movement control intervention. Before and immediately after the intervention, transcranial magnetic stimulation (TMS)-induced motor evoked potentials (MEPs) were recorded from the tibialis anterior (TA) muscle of the lower limb with the greatest degree of motor weakness. Differences in the averaged peak-peak MEP amplitude following interventions were calculated using a linear regression model. Chiropractic spinal adjustment elicited significantly larger MEP amplitude (pre = 0.24 ± 0.17 mV, post = 0.39 ± 0.23 mV, absolute difference = +0.15 mV, relative difference = +92%, p < 0.001) compared to the control intervention (pre = 0.15 ± 0.09 mV, post = 0.16 ± 0.09 mV). The results indicate that chiropractic spinal adjustment increases the corticomotor excitability of ankle dorsiflexor muscles in people with chronic stroke. Further research is required to investigate whether chiropractic spinal adjustment increases dorsiflexor muscle strength and walking function in people with stroke.

Sometimes the Best Thing to do is Nothing: A Chiropractic Case Study

The main purpose of care at Hart Chiropractic is to improve the function of the patient’s autonomic nervous system (ANS). In some cases, the ANS is already functioning well even though the patient might have unpleasant symptoms. In such cases, the patient would not receive an intervention such as a spinal adjustment in this ANS-focused practice since the main objective is already met. This report highlights such a case where intervention was not necessary.

Sometimes the Best Thing to do is Nothing: A Chiropractic Case Study

The main purpose of care at Hart Chiropractic is to improve the function of the patient’s autonomic nervous system (ANS). In some cases, the ANS is already functioning well even though the patient might have unpleasant symptoms. In such cases, the patient would not receive an intervention such as a spinal adjustment in this ANS-focused practice since the main objective is already met. This report highlights such a case where intervention was not necessary.

Improvement in Heart Rate Variability Following Spinal Adjustment: A Case Study in Statistical Methodology for a Single Office Visit

Introduction: Statistical analysis is typically applied at the group level. The present study analyzes data during a single office visit as a novel approach providing real-time feedback to the clinician and patient regarding efficacy of an intervention. In this study, heart rate variability (HRV) was analyzed before versus after a chiropractic spinal adjustment. Methods: The patient is an adult female who signed a consent form for the study. HRV was measured twice before a chiropractic adjustment and once afterwards using app-based technology. The three HRV values (two pre and one post) were then statistically analyzed using an online calculator for outliers using Grubbs test. Results: The two pre-adjustment HRV (rMSSD) readings were consistently low: pre 1 = 16.0 milliseconds [ms] and pre 2 = 16.2 ms. The low HRV was an indicator that the patient’s nervous system was not functioning optimally. The patient’s atlas (C1) vertebra was palpated to be slightly out of alignment. These two findings (low HRV and vertebral misalignment) indicated the presence of a chiropractic subluxation (of the atlas vertebra). The subluxation was adjusted and within minutes the HRV increased (improved) to 27.5 ms. This improvement was calculated to be a statistically significant outlier (p &lt; 0.05). Conclusion: This study is an example of how statistical methods can be applied to the level of an individual patient during one office visit to assess neurological effectiveness of a chiropractic adjustment. Since this is a case study, the results may not apply to all patients. Therefore, further studies in other patients, and for longer follow-up times, are reasonable next steps.

The effects of chiropractic spinal manipulation on central processing of tonic pain - a pilot study using standardized low-resolution brain electromagnetic tomography (sLORETA)

The objectives of the study were to investigate changes in pain perception and neural activity during tonic pain due to altered sensory input from the spine following chiropractic spinal adjustments. Fifteen participants with subclinical pain (recurrent spinal dysfunction such as mild pain, ache or stiffness but with no pain on the day of the experiment) participated in this randomized cross-over study involving a chiropractic spinal adjustment and a sham session, separated by 4.0 ± 4.2 days. Before and after each intervention, 61-channel electroencephalography (EEG) was recorded at rest and during 80 seconds of tonic pain evoked by the cold-pressor test (left hand immersed in 2 °C water). Participants rated the pain and unpleasantness to the cold-pressor test on two separate numerical rating scales. To study brain sources, sLORETA was performed on four EEG frequency bands: delta (1–4 Hz), theta (4–8 Hz), alpha (8–12 Hz) and beta (12–32 Hz). The pain scores decreased by 9% after the sham intervention (p < 0.05), whereas the unpleasantness scores decreased by 7% after both interventions (p < 0.05). sLORETA showed decreased brain activity following tonic pain in all frequency bands after the sham intervention, whereas no change in activity was seen after the chiropractic spinal adjustment session. This study showed habituation to pain following the sham intervention, with no habituation occurring following the chiropractic intervention. This suggests that the chiropractic spinal adjustments may alter central processing of pain and unpleasantness.

Cervicogenic Headache Alleviating by Spinal Adjustment in Combination with Extension-Compression Traction

Cervicogenic headache (CGH) is a type of secondary headache where the symptoms originate from a dysfunction in the cervical spine. Mechanical cervical spine pathologies and dysfunction in the neck muscles may lead to CGH. This report presents a case of a female with fluctuating headache related to cervical disorders. Her headache was concurrently eliminated with resolution of the cervical disorder following spinal adjustment in combination with extension-compression traction. The efficacious response was attained over a year after completion of treatment. Strategies to release the strain of the supporting cervical extensors can be beneficial for alleviating CGH.

Inter-quartile analysis of resting heart rate and heart rate variability following spinal adjustment: A case study

Abstract Background: Different clinicians use heart rate tests to answer different questions. The medical doctor for example might use heart rate to diagnose a medical condition. One approach in chiropractic practice is

Subsiding of Dependent Oedema Following Chiropractic Adjustment for Discogenic Sciatica

Background: Subsiding of dependent oedema with chiropractic treatment for sciatica has not been described in the literature. Case presentation: A 40-year-old woman presented with unbearable sciatic nerve pain which restricted her in doing daily activities. She also had bilateral leg swelling for some time and no apparent physical causes could be found after being reviewed by a cardiologist. The patient subsequently sought chiropractic care to relieve her pain. She unexpectedly experienced a beneficial outcome from spinal adjustment in which both sciatic nerve pain and leg oedema were simultaneously resolved. It is reasonable to say that ease of mobility from pain relief and increased lymphatic return from sympathetic responses can help eliminating leg oedema following spinal adjustment. Conclusions: The pathophysiology of oedema formation is multifactorial and the therapeutic role of chiropractic remains inconclusive in this case. Further researches are need in this area before the integration of chiropractic into cardiovascular practice.

A Method to Assess Neurological Effectiveness of a Spinal Adjustment for an Individual Patient: A Descriptive Study

Introduction: A hallmark in health care research is comparison, typically done by comparing groups of patients, e.g., intervention group versus no intervention group. The clinician may be interested in bringing these research methods to the level of the individual patient in practice. Such is done in the present study, where the neurological indicator of resting pulse rate (RPR) is compared pre versus post spinal adjustment, and also compared to instances of no adjustment – for one individual patient. Research indicates that a lower RPR is healthier than a higher RPR. Methods: Neurological disturbance was operationally defined in the present study as at least two increases in RPR on consecutive visits. Based on this criterion, the patient, over hundreds of RPR measures observed over approximately 2 years, had 16 instances of neurological disturbance; in one of these instances a chiropractic spinal adjustment was given. The 15 other instances were used to estimate a predicted post RPR, which was compared to the observed post-adjustment RPR. Results: Post-adjustment RPR was 67.5 beats per minute (BPM) which was only slightly lower than the average predicted post RPR of 68.1 BPM. Conclusion: The method described may help clinicians determine if their intervention was neurologically effective. The method also provides normative RPR data for future comparisons of adjustment versus no adjustment. In the present case, the chiropractic adjustment post RPR was better (lower) than the predicted post RPR, but only slightly so.

Przypadek nagłego zgonu w następstwie pęknięcia tętniaka aorty piersiowej w czasie zabiegu „terapii manualnej” w okolicy kręgosłupa

The reported case concerns the rupture of an aneurysm located in the descending part of the thoracic aorta during the procedure of the so-called "spinal adjustment" performed by a chiropractor. A 45-year-old patient with no significant medical history of cardiovascular diseases visited, along with his wife, one of "manual therapy" practices because of back pain. During the procedure, the patient suddenly lost consciousness. Despite cardiopulmonary resuscitation and emergency assistance given by an ambulance team, the patient died. An autopsy revealed that the cause of death was increasing cardiorespiratory failure secondary to bleeding into the lumen of the left pleural cavity following the rupture of pathologically altered thoracic aortic wall.

Resting Pulse Rate as a Potentially Useful Autonomic Marker for Neurologically-Based Chiropractic Practice

Many chiropractors focus on improving neurological function with their interventions, e.g., spinal adjustment of chiropractic subluxation. By definition, a chiropractic subluxation includes some type of minor biomechanical dis-relationship, e.g., a slight vertebral misalignment along with some type of neurological disturbance, e.g., an autonomic nervous system (also known as “autonomic”) dysfunction. The number of methods for assessing autonomic dysfunction, for the purpose of determining whether or not the patient needs a chiropractic adjustment is currently limited. In this commentary, the author suggests that the manually-palpated resting pulse rate assessment may be a user-friendly option that could be included in the neurologicallybased chiropractic practice to help the chiropractor decide when the patient needs a chiropractic adjustment for the purpose of improving autonomic function.

Assessing joint vibration during spinal manipulation

This IRB‐approved study assessed the relationship between cavitation and zygapophysial (Z) joint gapping following spinal manipulation (adjusting) in 5 healthy volunteers. High signal MRI markers were used to accurately identify the T12, L3, and S1 spinous processes during scout views. Axial images of the L4/L5 and L5/S1 levels were obtained in the neutral supine position. Each subject was then positioned on the side, and accelerometers were placed over the marked spinous processes. Recording from the accelerometers was done from final positioning through adjusting. The subject was then scanned in side posture position (accelerometers removed). Using a digitizer, the greatest A‐P central Z joint articular surface distances were measured on the 1st and 2nd scans; the difference between the 2 measurement values was the gapping difference, GD; a positive value indicating an increase in gapping following the spinal adjustment. GD was compared between up‐side (adjusted), down‐side (non‐adjusted), cavitation, and non‐cavitation joints.ResultsGD was increased in Z joints that were adjusted [0.5 (SE 0.2) mm] vs. non‐adjusted [−0.2 (SE 0.2) mm], and vertebral segments with cavitation gapped more than no cavitation [0.8 (SE 0.4) vs. 0.4 (SE 0.2) mm].ConclusionsA future clinical study is quite feasible. Forty subjects would be needed for appropriate power (0.80). Funding: NIH/NCCAM (#2R01AT000123).

A case series of reduced urinary incontinence in elderly patients following chiropractic manipulation

Objective This report presents a spinal adjustment approach to treat elderly patients with urinary incontinence. Methods This retrospective case series reports the clinical observation of 13 patients with urinary incontinence. They were treated for 1–8 weeks with Pro-Adjuster technique without any other additional drug and physical therapy treatment. The primary outcome measure for this analysis was the frequency of nocturia reported by the patients during each office visit to the chiropractor. Bladder control was reported by the patients as frequency of nocturia or the urgency of urination or instances of leakage, and the number of pad changes per day or a return of the sense of urinary urge. Results A total of 13 patients' data (6 female, mean ages 65.7 ± 12.9 years) were included in the study. After 1–8 weeks of chiropractic adjustments, the urinary frequency at night was significantly reduced from 3.8 to 1.2 time a night (P < 0.001). Three patients improved bladder control with only 2 adjustments. Conclusion The Pro-adjuster treatment program seemed to reduce nocturia in patients with urinary incontinence.

Somatovisceral response following osteopathic HVLAT: a pilot study on the effect of unilateral lumbosacral high-velocity low-amplitude thrust technique on the cutaneous blood flow in the lower limb

Introduction Spinal manipulative treatment is widely used among manual therapists, although knowledge regarding the absolute physiological effects has not been clearly established. In this study, 20 healthy male subjects underwent a unilateral high-velocity low-amplitude thrust (HVLAT) to the lumbosacral junction, while the cutaneous blood flow in the corresponding dermatome of the lower limb was monitored. Methods Subjects underwent a sham manipulation before the actual manipulation and acted as their own control. Laser Doppler flowmetry was used to measure relative changes in the cutaneous blood flow over the L5 dermatome for 5 minutes before the sham manipulation, for 5 minutes between the sham and the actual manipulation, and for 5 minutes after the spinal adjustment. Analysis of variance (ANOVA) and Tukey post hoc analysis was used in the interpretation of the data. Results Twelve nonsmoking subjects, who received a successful HVLAT manipulation, showed a significant increase ( P < .001) in blood perfusion, both ipsilaterally and contralaterally. Six smokers responded with a significant decrease in blood flow ipsilaterally ( P < .01) and contralaterally ( P < .001) after HVLAT manipulation. Conclusion The results from this study support previous published hypotheses that spinal adjustments outside the region of the sympathetic outflow result in an increase in cutaneous blood flow. Further studies will be needed to confirm the outcome of this study, and more knowledge is needed regarding the specific neurophysiological effects of spinal manipulation.

Spinal lesion level, shunt status, family relationships, and psychosocial adjustment in children and adolescents with spina bifida myelomeningocele.

Investigated whether family functioning and child psychosocial adjustment were associated with spinal lesion level and shunt status in 65 children and adolescents with spina bifida myelomeningocele (age range = 8-16). Mothers of children with higher lesion levels (i.e., thoracic level) reported more attachment to their children, less family conflict, and a greater willingness to grant autonomy to their offspring. Such findings support a "marginality" interpretation of the data, insofar as the least physically impaired children with spina bifida exhibited the greatest family difficulties. Based on maternal report, children with shunts performed more poorly in school and exhibited lower levels of cognitive competence than children without shunts. Findings are discussed in relation to literatures on neuropsychological functioning and psychosocial adjustment in children with spina bifida.

Scoliosis secondary to unilateral extraocular muscle paresis (ocular torticollis).

Scoliosis as a compensatory mechanism secondary to extraocular muscle paresis was reported in the French literature as early as 1873 (3, 4). Verzella and his coworkers (15) in describing eight cases of this entity gave credit to von Graefe for being the first who, in 1864, recognized the compensatory mechanism of this type of scoliosis. Cuignet, in describing the manifestations with the cervical vertebrae, coined the term “ocular torticollis,” and this term, together with “spastic torticollis” has been used in the French (1, 3, 4, 15) and British (5, 10, 11, 13, 14) ophthalmologic literature. Cogan (2), in describing congenital palsy of the fourth nerve, emphasized the importance of compensatory head tilt due to ocular paralysis and stated that some patients are reported to have undergone tenotomy of the sternocleidomastoid muscle under the impression that the fault lay in the neck muscles. In an excellent paper Ruedemann (12) again emphasized the association of the ocular paralysis and malalignment of the spine and directed attention to the compensatory scoliosis in the dorsal and lumbar areas. In every case studied to date, bilateral leg measurements have been equal. It is the purpose of the authors to add three cases to the literature and briefly summarize the findings heretofore unreported in the radiological literature. General Features In general, ocular torticollis is due to a congenital vertical deviation and rotation of one eye, and the patient attempts to compensate for the visual disturbance by holding the head obliquely. The ocular abnormality is frequently noted shortly after birth. Because bilateral fixation develops at about five or six months of age (12), the desire for fusion usually appears before the infant can sit or walk. An adjustment is made by the infant in the muscles of the neck and back to permit bilateral fixation and subsequently to maintain vertical body posture required for normal locomotion and balance. If a vertically acting muscle paresis persists, a head tilt will develop and a compensatory scoliosis will be created through the remainder of the axial skeleton. The greater the need for ocular cyclorotation, the greater the necessary head tilt and subsequent spinal adjustment (12). Cogan explained that the head tilt tends not only to decrease diplopia and maintain fusion, but also to reconstitute a normal ophthalmological reflex and binocular alignment of the eyes. Superior oblique paresis also results in extortion of the eye and weakness of downward gaze. Although the great majority of these cases are due to superior oblique muscle paresis, some are also caused by superior rectus muscle paresis. In many instances, according to Ruedemann, two muscles are combined, representing a superior rectussuperior oblique syndrome or an inferior rectusinferior oblique syndrome.