February 2018

• Study Shows Chiropractic Helps Improve Quality of Life in Children
• US Child Mortality Ranks Worst Among Wealthy Nations
• Neck Pain and Pain Down Arm Helped with Chiropractic
• Female Veterans' Neck Pain Improved Following Chiropractic According to Study
• Raynaud’s Disease & Cervical Curve Improved Following Chiropractic
• Idiopathic Scoliosis and Musculoskeletal Complaints Improved with Chiropractic

The Journal of Alternative, Complementary & Integrative Medicine published a study on December 20, 2017, showing that children under chiropractic care experience an improved quality of life on multiple levels as measured by standard tests. According to the Oxford dictionary, quality of life (QoL) can be defined as, "The standard of health, comfort, and happiness experienced by an individual or group."

The study authors begin by noting that chiropractic care has become very popular for the pediatric population. They cite one study in 2007 which estimated that there were approximately 86 million pediatric visits made annually to chiropractors. Part of the conclusion from the previous study was that "...chiropractic care of children represents a significant aspect of not only the practice of chiropractic but also pediatric healthcare in general."

Historically, chiropractic care for the pediatric population has been for a wide range of issues from chronic illness to wellness care. The researchers stated, "The treatment of musculoskeletal disorders such as neck pain and lowback pain as well as the promotion of health and wellbeing has been reported to be common motivations for seeking chiropractic care of children. However, studies that evaluated the frequency of, reasons for, and factors influencing CAM use and specialty pediatrics within the same geographic locale have also found evidence of the utilization of chiropractic care for children with chronic disease, including cancer, gastrointestinal disorders, cardiac problems, and neurological problems." The term "CAM" is used in scientific literature to mean "complimentary and alternative medicine" in which chiropractic is included.

This study focused on the pediatric population between the ages of 8 and 17. This study used standardized tests that measured many factors to determine the QoL for the pediatric population who were under chiropractic care. A standardized questionnaire known as PROMIS, short for Patient Reported Outcomes Measurement Information System, was given to the participants or their parents to be filled out. Then this information was scored to see if there was an effect on QoL from chiropractic care.

The data was collected by 88 chiropractors from practices all over the U.S. In total, 881 children participated with 467 being females and 414 being males. The mean age for children in this study was 12.49 years. Approximately 49% of the children were brought to the chiropractor for purely wellness purposes, while 27% were brought in for  musculoskeletal conditions, and 23% for a variety of other health issues.

The study showed that 58% of the patients or their parents did not tell their medical doctor that they were receiving chiropractic care. Only 2% of the children were actually referred to the chiropractor by their medical doctor. Of the children in the study, 75% had not received medical care for the issue they sought chiropractic for, 15% had received prior medical care but were no longer under medical care for their issue, and 10% were receiving both chiropractic and medical care.

The results showed that the children were less likely to suffer from symptoms of depression, anxiety, fatigue, and pain interference after starting chiropractic care. According to the scores measured by the PROMIS survey, the children improved in all aspects of the QoL.

In their discussion, the authors noted that the study not only showed an improvement in the quality of life of children under chiropractic care, but it also gave some insight into why children are brought to the chiropractor. "In addition to determining the QoL of children under chiropractic care, this study also provided some interesting insights into the patterns and utilization of chiropractic services by this patient population." They concluded, "The QoL of children improved with chiropractic care as measured by PROMIS."

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US Child Mortality Ranks Worst Among Wealthy Nations

A study published in Health Affairs in January 2018 reports that the U.S. ranks last among 20 wealthy nations in child mortality. The report was covered by multiple news outlets including a January 8, 2018, CNN news story titled, "Among 20 wealthy nations, US child mortality ranks worst, study finds."

The Health Affairs report begins by stating, "The United States has poorer child health outcomes than other wealthy nations despite greater per capita spending on health care for children." The study looked at child mortality rates between 1961 and 2010 in the U.S. and compared this data to 35 other similar wealthy nations. 

Some of the other countries included in this study were Australia, Austria, Belgium, Canada, Denmark, Finland, France, Germany, Iceland, Ireland, Italy, Japan, the Netherlands, New Zealand, Norway, Spain, Sweden, Switzerland and the United Kingdom.

Dr. Ashish Thakrar, lead author of the study and an internal medicine resident at Johns Hopkins Hospital and Health System in Baltimore noted, "This study should alarm everyone. The U.S. is the most dangerous of wealthy, democratic countries in the world for children." Dr. Thakrar continued, "We were surprised by how far the U.S. has fallen behind other wealthy countries. Across all ages and in both sexes, children have been dying more often in the U.S. than in similar countries since the 1980s."

The study noted that childhood mortality had improved in all countries, but that the rate of improvement for the U.S. was slower than the other countries. The study also showed that the rate of child mortality for the U.S. and New Zealand were disproportionably higher than the rate for the other countries in the study. It should be noted that the United States and New Zealand are the only two countries where direct-to-consumer (DTC) advertising of prescription drugs is legal.

The study showed just how bad the numbers are for children in the U.S., reporting that from 2001 to 2010, the risk of death for infants in the U.S. was 76 percent greater than for infants in other countries. Additionally, the death rate for children ages 1–19 was 57 percent greater in the U.S. One of the more disturbing findings was that U.S. children between the ages 15–19 were eighty-two times more likely to die from gun violence than children in the other nations. When projecting over a 50 year period of the study, the researchers determined that the U.S. suffered about 600,000 excess deaths of children from all causes.

In the CNN story, Dr. Thakrar further explained, "Existing research has shown that infants die more frequently in the U.S., but this was the first time we were able to see that this trend started decades ago. We were also surprised by how much more often US adolescents, in particular boys, are dying from injuries," he said. "The most disturbing new finding of this study was that a 15- to 19-year-old in the U.S. is 82 times more likely to die from gun violence in the U.S. than in any other wealthy, democratic nation."

"In as much as health policies will have an effect on infant and child mortality, it should be noted that the U.S. also has the highest rate of intervention in all processes of birth, and medical procedures and in the rate of citizens taking prescription medications." said Dr. George Curry, President of the International Chiropractors Association. He continued, "Perhaps, as a society, we should step back and ask the very pertinent question.  Is this very system that is suppose to be protecting our health, contributing to these excess deaths?"

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The Annals of Vertebral Subluxation Research published a case study on January 4, 2018, documenting the improvement in neck pain and arm pain in an elderly patient undergoing chiropractic care. The term used in this study for this condition is radiculopathy.

The word radiculopathy comes from two Greek and Latin words meaning root, and illness. In this usage, it means a pain that originates at a nerve root and runs away from that origin, typically down an arm or leg. Cervical radiculopathy means that the problem has its origin in the neck. According to WebMD, "Cervical radiculopathy is the damage or disturbance of nerve function that results if one of the nerve roots near the cervical vertebrae is compressed. Damage to nerve roots in the cervical area can cause pain and the loss of sensation along the nerve's pathway into the arm and hand, depending on where the damaged roots are located."

The researchers in this study note that, "In younger people cervical radiculopathy is often caused by a disc herniation or some form of trauma which directly impacts on the nerve in the intervertebral foramina (IVF)." The IVFs are the openings between each vertebra where the nerves exit from the spinal column. They report that in older patients, pressure on nerves at the IVF typically occurs from degenerative or arthritic changes with a narrowing of the IVF known as stenosis.

In this case, a 74-year-old woman suffering from the symptoms of cervical radiculopathy presented herself for chiropractic care at a teaching clinic in New Zealand. Her symptoms included pain for several years, with numbness and tingling down her left arm that had gotten worse in the last few weeks. She was also complaining of weakness in her left arm and the inability to grasp heavy objects with her left hand.

One year prior to her chiropractic visit, her MD took neck x-rays which showed calcium buildup and disc degeneration in her neck. At that time, she did not consider her symptoms to be affecting her daily life so no care was rendered.

A chiropractic examination was performed, and it was noted that her cervical range of motion was limited in all directions. Neck rotation did cause an increase in pain and numbness in her left arm and hand. She also exhibited a decrease in the ability to feel sensations along portions of her left arm. Her finger grip strength on her left side was significantly reduced.

The findings were consistent with the presence of vertebral subluxation, and specific chiropractic adjustments were started at the rate of twice per week. By the 11th visit, the woman started noticing a decrease in the frequency of episodes of pain and numbness in her left arm. She reported that her problems were no longer present 24 hours per day and was only exacerbated during lifting her arm for long periods. She also reported an improvement in the quality of her sleep. A progress examination was performed, which included neurological testing, which showed further improvement in sensory ability of the C6 and C7 dermatomes on her left arm.

In their conclusion, the authors wrote, "Cervical foraminal stenosis causing radiculopathy is a problem that affects a large portion of the older population. This case study, and previously reported research, suggests that chiropractic care may benefit some people suffering from radiculopathy."

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A study published in the journal, Complementary Therapies in Clinical Practice, on February 2018 reports neck pain improving with chiropractic care on female veterans being treated in a VA hospital. The study begins by reporting that neck pain is a common problem among active military and veterans.

Contributing factors for neck pain in military personnel can range from trauma related to combat situations to office work, not unlike that seen in civilian populations. Musculoskeletal conditions are the leading health issue in female veterans, with women being more likely to experience neck pain than men.

The study notes the need for a non-drug approach to helping women veterans with pain, especially in light of the growing concern over opioid addiction, and the fact that opioid medications have a greater negative effect on women than men. A recent study showed that since 1999, there has been a 265% increase in overdose deaths in men, while during that same period there has been a 400% increase in overdose deaths among woman.

Currently, VHA patients are being referred to chiropractic services for a variety of musculoskeletal complaints, with neck conditions accounting for 24.3% of all these referrals. This study was conducted by reviewing the records of female veterans between the ages of 18 and 89 who were suffering from neck pain and met the inclusion criteria and follow through for this study. A total of 34 woman met all criteria and completed the questionnaire. These veterans were all suffering with neck pain and were seen by a chiropractor for more than two visits between the years 2009 and 2015.

A numerical rating scale (NRS) was used to rate pain. The NRS is a point system assessment for pain severity with 0 representing no pain and 10 representing the "worst pain imaginable." The study also used the Neck Bournemouth Questionnaire (NBQ) which not only looks at pain, but also questions the patient as to how the pain affects their daily lives and their mental attitude because of the pain. The NBQ has a total score of between 0 and 70 with 70 being the most severe with the worst effect on the person’s life.

The study showed that after chiropractic care was given to the female veterans, there was a significant improvement as recorded by both the NRS and NBQ scores. The NRS score decreased from 6.3 down to 3.5 on average. The NBQ score also improved, showing a decrease from 37.6 before chiropractic to 23.9 after chiropractic. The study also recorded that there were no significant adverse events or side effects reported for any of the patients in this study group.

In their discussion, the authors noted that regardless of the overall health assessment of the women veterans in this study "…female veterans in the present study receiving chiropractic management for neck pain had demonstrable improvement which was statistically and clinically significant." They also reported that the results of this study on women showed results that were consistent with prior studies conducted primarily on male veterans.

In their conclusion, the authors wrote, "Female veterans with neck pain included in this study experienced statistically and clinically significant reductions in NRS and NBQ scores over a short course of chiropractic management with a mean of 8.8 treatments. Chiropractic management may be an effective treatment strategy for female veterans with neck pain complaints."

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From the January 22, 2018, edition of the Annals of Vertebral Subluxation Research comes a case study documenting the improvement under chiropractic of a patient suffering from Raynaud’s Disease, as well as chronic upper back and lower back pain.

According to the Mayo Clinic, Raynaud’s Disease, also known as Raynaud’s syndrome or Raynaud’s phenomenon, is a condition that "…causes some areas of your body — such as your fingers and toes — to feel numb and cold in response to cold temperatures or stress. In Raynaud's disease, smaller arteries that supply blood to your skin narrow, limiting blood circulation to affected areas." Typically, during a flair up the fingers turn white, then blue with tingling and a cold feeling. Raynaud’s is more common in woman than men, occurring at between 4-6% of the female population.

In this case, a 29-year-old woman went to the chiropractor for consultation and care. The woman was suffering with cold, stiff, and cramping hand pain along with purple discoloration. She had been experiencing these symptoms of Raynaud’s phenomenon for over ten years. Additionally, she was now suffering with pain in the upper back, intermittent lower back pain, and dizziness.

After a full case history, a chiropractic examination was performed which included spinal thermographic heat readings and spinal x-rays. The initial x-rays showed a decrease from the normal forward curvature of the neck. As a result of the findings, a determination of the presence of subluxation was made, and specific forms of chiropractic adjustments were started.

After 11 weeks of chiropractic care, a re-evaluation was done to access the progress. At that time, it was recorded that the thermal scans had returned to normal and the neck x-rays had shown an improvement in the curvature. The patient reported a resolution of the symptoms of Raynaud’s, including her hands being warm again as well as a decrease in the cramping and stiffness. Additionally, she reported that her upper and lower back pain were gone.

The authors explained the purpose of chiropractic care in these types of cases by saying, "The Gray’s Anatomy textbook states that the role of the nervous system is to control and coordinate every function of the body. Therefore, the main objective of subluxation-based chiropractic care is to achieve optimal functioning of the nervous system. Regardless of the health condition, the role of the chiropractor is to reduce neurological interference within the body by locating, assessing and reducing vertebral subluxation, utilizing specific chiropractic adjustments."

In the conclusion of the study, the authors further explained their results by saying, "This case report shows improvement in the symptomatic presentation of Raynaud’s Phenomenon in a 29-year-old female after 11 weeks of subluxation-based chiropractic care. The patient had been suffering from symptoms of RP for over 10 years and was seeking an alternative solution. Subluxation-based chiropractic care, used to address neurological disturbances caused by vertebral subluxation, can lead to positive outcomes in chronic symptomatic cases."

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A case study documenting chiropractic helping to improve a patient suffering with idiopathic scoliosis and musculoskeletal complaints was published in the January 25, 2018, issue of the Annals of Vertebral Subluxation Research. The patient also experienced an improved state of well-being as a result of the chiropractic care.

The word scoliosis comes from the Greek word skolios, which means twisted or crooked. A diagnosis of scoliosis only means that there is an abnormal curvature of the spine from side to side of more than 10 degrees. Adolescent idiopathic scoliosis (AIS) is a spinal curvature that shows up about the onset of puberty but before maturity.

AIS shows up at a rate of up to 5.2% of the adolescent population with girls having this issue more commonly than boys. Measuring spinal curvature requires a specific procedure that results in a measurement known as the Cobb angle.

The authors of this study also reviewed other studies on scoliosis and chiropractic. These studies also showed improvement of scoliosis with chiropractic as measured using the Cobb angle. In one case, a 15-year-old girl improved from a Cobb angle of 46º to 30º in 18 months, and she was able to avoid a planned surgical intervention. Another case involved an 10-year-old girl whose curve improved from 35º down to 25º as verified by an independent medical radiologist. Overall, in the 12 studies that the authors of this study reviewed, all showed a significant reduction of the Cobb angle after several months of chiropractic care.

In this case, a 21-year-old woman presented herself for chiropractic care. She was complaining of low back pain with radiating numbness into legs and feet when lying on her back, as well as daily headaches. She reported that the problems began four years earlier while she was a cheerleader and doing gymnastics in high school. Standing, sitting, bending, and lifting all seemed to make her problems worse. On a scale of 0 to 10, with 10 being the worst, she rated her lower back pain as an 8. When she would lie down for over an hour, she would experience numbness in her legs and feet. Her headaches would occur about three times per week. X-rays she had done a year prior showed a scoliosis with a Cobb angle of 20º.

Based upon a chiropractic examination which included palpation, range of motion, thermal studies and a sEMG of the woman’s spine, it was determined that subluxations were present. Regular specific chiropractic adjustments were started to address the findings.

Five months after chiropractic care was started, follow-up x-rays were taken at the same facility as the original studies were done. The x-rays showed a reduction of the curvature from 20º to 12.5º. Additionally, the patient reported much improvement in all of her pain symptoms.

The authors of the study explained how the correction of subluxations can have a positive effect on the body. "Regardless of the technique used, a majority of chiropractors are focused on detecting and correcting vertebral subluxations to improve function."

In their conclusion, they wrote, "The results of this case study suggest that chiropractic adjustments… …can help reduce the scoliotic curvature of the spine of a female with adolescent idiopathic scoliosis, improve other attending or compensatory curves and postural faults, as well as improve state of well-being and musculoskeletal complaints."

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