July 2018

• Infantile Colic, GERD, Failure to Thrive and Breastfeeding Difficulties Helped with Chiropractic
• Neck and Back Pain for Five Years After Car Accident Helped with Chiropractic
• Quality of Life Improved from Chiropractic for Patient with Sjögren’s Syndrome
• Resolution of Adult Attention Deficit Hyperactivity Disorder Following Chiropractic Care
• Doctor Burnout Widespread, Helps Drive Many Medical Errors
• Study: Spinal Manipulation Helps Patients with MRI-confirmed Lumbar Disc Herniation

On June 7, 2018, the Journal of Pediatric, Maternal & Family Health published a case study documenting chiropractic helping an infant suffering with infantile colic, gastroesophageal reflux disease (GERD), failure to thrive, and breastfeeding difficulties.

The study begins by acknowledging that chiropractic is growing in popularity as a non-allopathic form of healthcare. The authors report that most adults seeking chiropractic do so for musculoskeletal type complaints while children who are brought to the chiropractor usually are seeking help for non-musculoskeletal conditions.

It may be common for infants to spit up after a meal, however, frequent vomiting associated with discomfort and difficulty feeding or weight loss is considered more serious and is known as gastroesophageal reflux disease, (GERD). According to the American Family Physician, "Infantile colic, is defined as episodes of crying for more than three hours a day, for more than three days a week, for three weeks in an otherwise healthy child."

The term "failure to thrive" is used when an infant fails to gain weight or experiences an inappropriate weight loss. There are a number of mechanisms that can facilitate this problem including breastfeeding issues which prevent the infant from getting proper nutrition.

In this case, a 3½-month-old infant girl was brought to the chiropractor by her parents. The girl's mother reported that her infant daughter suffered from severe infantile colic, acid reflux, had breastfeeding difficulties, and was medically diagnosed as failure to thrive.

It was reported that starting at 3-weeks of age, the infant began struggling to eat, pulling away from her mother’s breasts, arching her back, and crying inconsolably. Medical physicians prescribed a number of medications that had no effect. At one point, the infant was hospitalized due to her weight loss.

A chiropractic examination was performed which included age and size appropriate spinal palpation with a recumbent postural analysis. Subluxations were determined to be present and a specific pediatric adjustment was given.

Following the infant girl's first chiropractic adjustment, her mother reported that her daughter's breastfeeding latch had improved. After the second adjustment, it was reported that the baby began to play more. By the fourth adjustment, the baby was rolling over, had increased the amount of breast milk she would consume by 50%, and began babbling. Additionally, the baby's acid reflux had improved and she was less fussy. By the eighth visit, the baby had gained enough weight that her pediatrician was no longer concerned about her weight and canceled a referral to a gastrointestinal specialist.

In their conclusion the authors wrote, "We reported the successful chiropractic care of 3½-month old female suffering from acid reflux and medically diagnosed as failure to thrive. This study opens the possibility that similar patients may benefit from chiropractic care. This study provides supporting evidence that infants presenting similarly may benefit from management of vertebral subluxation."

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The Annals of Vertebral Subluxation Research published a case study on June 18, 2018, documenting chiropractic helping a patient suffering for five years with neck and back pain following an automobile accident. The patient also showed documented improvement in telemere length, and their urge to urinate at night.

Human TL length is best explained on the T.A Sciences website, "Telomeres are an essential part of human cells that affect how our cells age. Telomeres are the caps at the end of each strand of DNA that protect our chromosomes, like the plastic tips at the end of shoelaces. Without the coating, shoelaces become frayed until they can no longer do their job, just as without telomeres, DNA strands become damaged and our cells can’t do their job."

This study begins with an explanation of human telomere length (TL), and why this is important. The study notes that human TL is longest at birth and shortens as we get older. Shortened TL are associated with metabolic and inflammatory diseases, pulmonary diseases, cardiovascular problems, psychological and stress disorders, neurodegenerative diseases, cancer, other chronic and serious illnesses, and can affect overall mortality.

In this case study, a 35-year-old woman who worked as an elementary school teacher presented herself for chiropractic with the primary complaint of neck and mid-back pain for five years following a head-on motor vehicle accident. She also complained of nocturnal polyuria, which is an increase production of urine at night causing her to urinate up to four times per night.

A physical and chiropractic examination was performed which included basic information about height and weight, as well as a postural analysis, a standardized health survey, and spinal x-rays. Based upon the results of the examination and x-rays, specific chiropractic care was initiated to create changes in the spinal structures, thus having an effect on the nervous system.

The study results reported that the patient felt significant improvement in all of her symptoms after weeks of chiropractic care. Follow-up examinations confirmed changes in her spinal structure as well as her self-health assessment. A second blood work was performed that showed that her telemere length had actually improved from a previous blood study.  Eventually, the woman reported that she was virtually pain-free and had been able to sleep through the night without having to go to the bathroom to urinate.

In their conclusion, the authors noted the unique findings of the improving of human telemere length by stating, "Our case suggests, for the first time, that cervical spinal alignment and posture may be directly related to TL (health longevity) and that correction thereof may have a directly related effect on health longevity as represented by TL."

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On June 14, 2018, the Annals of Vertebral Subluxation Research published a case study documenting the improvement of heart rate variability and quality of life in a patient with Sjögren’s Syndrome following chiropractic care.

According to the Sjögren's Syndrome Foundation website, "Sjögren's is a systemic autoimmune disease that affects the entire body. Along with symptoms of extensive dryness, other serious complications include profound fatigue, chronic pain, major organ involvement, neuropathies and lymphomas." They estimate that there are more than 4 million people presently living with this condition. Women are nine times more likely to have this problem then are men.

The most common symptoms of Sjögren's Syndrome include dryness of the eyes and mouth due to dysfunctions of the salivary and lachrymal glands. Other serious health issues associated with Sjögren's Syndrome can include lymphoma, neuropathy, gastritis, reflux esophagitis, peptic ulcer, pancreatitis, and autoimmune hepatitis.  

In this case, a 48-year-old woman suffering from pain and numbness in the back of her left leg sought out chiropractic for an evaluation and possible care. Her problems began two years prior with no known causative factors. The numbness had gotten so severe that it prevented her from walking or standing for longer than 30 minutes. She was using over-the-counter medications for this problem, but she reported that it was getting worse. Her history noted that two and a half years earlier, she had been diagnosed with Sjögren's Syndrome. The woman was under the care of her family physician (MD), an orthopedist and a physical therapist, and was given multiple prescriptions. She was also on a gluten-free diet.

A chiropractic examination was performed which included a visual postural inspection, spinal palpation with range of motion, as well as surface EMG, thermal scan, and a heart rate variability test.  Based on the examination findings, spinal x-rays were also performed.

Chiropractic care was started on the woman with multiple visits per week. As care proceeded, the woman noted improvement in many of her symptoms. A follow-up heart rate variability test initially showed a 27% improvement which continued to improve up to 159% after several months of care. Although she still had the diagnosis of Sjögren’s Syndrome, the study reported that her inflammation levels have decreased, as verified by her blood work. The woman reported that she was taking less medication, had less stress in her life, and was experiencing an overall increase in energy.

In their conclusion the authors wrote, "We described the successful care of a patient with symptoms congruent with a diagnosis of Sjögren's Syndrome. This case report provides supporting evidence that spinal adjustments to correct vertebral subluxations can have significant improvements in presenting symptoms associated with Sjögren’s Syndrome and overall improvement in quality of life."

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The Annals of Vertebral Subluxation Research published a case study on June 11, 2018, showing chiropractic facilitating the resolution of adult attention deficit hyperactivity disorder (ADHD).

The study begins by reports that ADHD is one of the most common psychological disorders in children. The study also notes that ADHD cannot be diagnosed in an adult because the diagnostic reference book used to classify metal illnesses, the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5), which states that ADHD must be diagnosed before the age of 12 for it to be considered a true state of the disorder.

It is estimated that between 5% and 8% of children in the U.S have ADHD. The condition is more common in girls than boys. As children develop into adults, many seem to outgrow the symptoms of ADHD. However, estimates are that 40-70% of children will continue to experience symptoms of ADHD as adults. Accordingly, between 3-6% of the adult population is estimated to have adult ADHD. According to WebMD, every adult who is considered to have ADHD had the condition as a child but may not have been diagnosed with it.

Adults with ADHD tend to have more instability at work, higher rates of incarceration, lower socioeconomic status, high rates of divorce as well as more frequent job changes, and more minor violations such as speeding tickets.

In this case, a 38-year-old man presented himself to the chiropractor. The man was suffering with a variety of conditions including adult-onset attention-deficit/hyperactivity disorder, constant headaches, incapacitating low back pain, numbness in the back and sciatica in his left leg. He described his conditions as excruciating and constant, interfering with his daily activities. He was taking several medications including one for his ADHD for the past 13 years.  Even though the criteria for diagnosis of adult ADHD does not exist, his MD diagnosed him with the condition at the age of 23.

A chiropractic examination noted muscle spasms over much of his spine, reduced ranges of motion, and postural abnormalities. A heat reading thermal scan showed significant abnormal variations in surface temperature over his spine.

Based upon the findings of the examination, it was determined that subluxations were present and specific chiropractic spinal adjustments were started. Using a scale of 1 to 100 to rate the patient’s pain, the initial pain rating before chiropractic was 60 out of 100, with 100 being the worst. After chiropractic care was started, the pain rating had dropped to 36 out of 100.  After one month of care, the man’s spinal range of motion had shown significant improvement. There was also a notable decrease in his muscle spasms.

Within a month of beginning chiropractic care, the man reported that he had met his goals of being able to focus and exercise. He reported an 80% improvement of his symptoms. After two months of chiropractic, he had discontinued all his ADHD medication. He commented that he felt more focused and energized than he had ever felt before.

In the authors’ conclusion they wrote, "Patients suffering from ADHD are highly effected by the symptoms that manifest, interrupting their ability to function in any setting. If the removal of vertebral subluxation complexes can be correlated to a reduction or resolution in symptoms, chiropractic could greatly improve the quality of life for ADHD patients."

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The headline above comes from a July 9, 2018, article on HealthDay, and is based on a study published the same day in the Mayo Clinic Proceedings. The Mayo Clinic Proceedings study is titled "Physician Burnout, Well-being, and Work Unit Safety Grades in Relationship to Reported Medical Errors" and listed the study objective as "To evaluate physician burnout, well-being, and work unit safety grades in relationship to perceived major medical errors."

An ABC News article, also on the same day, reported that according to the Institute of Medicine, medical errors account for between 100,000 to 200,000 deaths per year. They define burnout as emotional exhaustion or depersonalization and note that it occurs in more than half of the over 6600 doctor’s surveyed.

Lead study author Dr. Daniel Tawfik, an instructor in pediatric critical care at Stanford University's School of Medicine stated, "Burnout is a reversible work-related syndrome characterized by emotional exhaustion and/or cynicism, often featuring decreased effectiveness." He added, "Although not unique to physicians, it is particularly common in occupations like medicine that feature high levels of stress and intense interactions with people."

In this study, researchers stated that they, "…conducted a population-based survey of US physicians in active practice regarding burnout, fatigue, suicidal ideation, work unit safety grade, and recent medical errors." Researchers at Stanford University School of Medicine collected data from an anonymous survey of 6,686 physicians who were in practice and responded to the survey. The doctors were asked to complete questionnaires that included questions about their levels of burnout, well-being, fatigue and symptoms of depression. They were also asked to grade the safety of their workplace and anonymously give information on any major medical errors they may have made.

The results of the study were shocking. Over 10% of the responding doctors claimed they had made a major medical error in the past three months, with 1 in 20 of these errors being fatal. The study itself reported, "Of 6695 responding physicians in active practice, 6586 provided information on the areas of interest: 3574 (54.3%) reported symptoms of burnout, 2163 (32.8%) reported excessive fatigue, and 427 (6.5%) reported recent suicidal ideation, with 255 of 6563 (3.9%) reporting a poor or failing patient safety grade in their primary work area and 691 of 6586 (10.5%) reporting a major medical error in the prior 3 months."

The medical errors that can occur from medical burnout are not insignificant. Dr. Tawfik noted that, "When a physician is experiencing burnout, a wide range of adverse events may occur. In our study, the most common errors were errors in medical judgment, errors in diagnosing illness, and technical mistakes during procedures."

In their conclusion, the study authors acknowledge the problem and call for a solution. "In this large national study, physician burnout, fatigue, and work unit safety grades were independently associated with major medical errors. Interventions to reduce rates of medical errors must address both physician well-being and work unit safety."

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A study published on May 17, 2018, in the journal Chiropractic & Manual Therapies, showed that spinal manipulation helped patients who had MRI confirmed disc herniations and sacro-illiac problems. The study, which did not involve chiropractors, showed that generalized spinal manipulation helped subjects suffering from back pain who had a disc herniation.

The study starts by noting that low back problems commonly include disc prolapse, spinal stenosis and low back pain. Disc herniations can be categorized into three types. The first is a disc protrusion without tearing of the fibers holding the interior of the disc intact. The second type is an extrusion, where the interior of the disc is pushed out of the disc, but is held in place by the ligaments behind the disc. The third type is called sequestration. This is where the disc materials escape into the spinal canal. Approximately 95% of all low back disc herniations occur at the last two discs in the spine, the L4-L5 level or the L5-Sacrum level.

This study was conducted by the Physical Therapy Department, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, in Iran. The spinal manipulation applied to the subjects was given by physical therapists.

In this study, 11 men and 9 woman who had MRI confirmed disc herniations were included. All subjects had been suffering with pain in their lower back or down their leg for between one and ten months. Prior to any treatment, all patients were examined and rated for pain intensity and functional disability. All patients in this study also had restriction of movement in their sacrto-illiac joints as measured by orthopedic and functional testing.

After the initial examination, the patients received five sessions of spinal manipulation delivered by therapists on alternate days. The type of manipulation given was a generalized, non-specific twisting thrust to the lower spine that can create a popping sound. The outcomes of these treatments were evaluated after the 1st and 5th visits, and then again at a 1-month follow-up.

The results showed a statistically significant improvement for both pain and functional movement seen at the 5th visit, as well as at the 1-month follow-up visit. The orthopedic tests performed also documented objective improvements in the patients.

In their discussion, the authors of the study noted, "Our findings suggest that five sessions of lumbar and SIJ (sacro-iliac joint) manipulation can lead to statistically significant improvement in pain and functional disability, which in turn may restore normal SIJ mobility in these patients."

The authors of the study also noted that spinal manipulation was much safer than other forms of treatment for lower back and leg pains. They reported that "Compared to common treatments for LDH, SMT is reported to be 37,000 to 148,000 times safer than nonsteroid antiinflammatory drugs and 55,500 to 444,000 times safer than surgery."

Dr. Robert Braile, a chiropractor and past president of the International Chiropractors Association commented about this study. "The spinal manipulation in this study was non-specific and not applied by trained Doctor of Chiropractic. Even with this limitation, the results showed that the procedure was effective and safe. One can only imagine the added benefit that would have resulted if trained chiropractors, applying specific spinal adjustments, were utilized in this study. The results would have been even more profoundly positive."

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