April 2019

• Chiropractic Linked to Quicker Reaction Times
• Headaches and Neck Pain Gone in Patient with Rheumatoid Arthritis
• Chiropractic Care and Human Performance
• Resolution of Breech Presentations Confirmed by Ultrasound Following Chiropractic Care
• Man Suffering from Nausea, Fatigue, Gastric Reflux, Dizziness, and Migraines Helped with Chiropractic
• Efficacy of Chiropractic Care for Back Pain: A Clinical Summary

This headline comes from a March 13, 2019, article published by the Australian Spinal Research Foundation. The article reviews recent research showing that reaction times are improved for healthy individuals under chiropractic care. The article also reviewed previous research that also supports quicker reaction time with chiropractic.

The article begins by reporting on the latest research: "A 2019 study is the latest to add to the evidence in the field of chiropractic care and human performance. The study, a randomized controlled trial conducted at an Army Hospital, looked at the effect of ‘chiropractic manipulative therapy’ on reaction times in special operations forces military personnel."

The research reported on in this article was published in the BioMed Central journal Trials, on January 3, 2019. In this research, the authors of the study describe the background of the study by saying, "Chiropractic manipulative therapy (CMT) has been shown to improve reaction time in some clinical studies. Slight changes in reaction time can be critical for military personnel, such as special operation forces (SOF). This trial was conducted to test whether CMT could lead to improved reaction and response time in combat-ready SOF-qualified personnel reporting little or no pain."

The study was performed at Blanchfield Army Community Hospital, Fort Campbell, KY. Subjects in the research included 77 United States special operations forces (SOF) male personnel over the age of 19. These servicemen were divided into two groups. One group received four chiropractic adjustments, described in the study as CMT (chiropractic manipulative therapy), over a four-week period while the control group did not. On each visit, reaction times using three specific tests were performed before and after each adjustment for the chiropractic group. The control group had reaction times measured for each visit both initially, and then remeasured after a five-minute waiting period.

The results showed that for each of the tests, the group that received a chiropractic adjustment showed faster reaction times when compared to the control group. In their conclusion the researchers noted, "A single session of CMT was shown to have an immediate effect of reducing the time required for asymptomatic SOF qualified personnel to complete a complex whole-body motor response task."

The implications of these findings were explained by the researchers when they stated, "United States military special operation forces (SOF) personnel are required to maintain high levels of physical fitness and the ability to perform activities requiring quick reactions to diverse situations, including those that can be life-threatening. Therefore, a high level of neurological function is one necessary component of maintaining the combat readiness of SOF personnel."

In the study, the adjustments given would have been focused toward the correction of subluxations. Since subluxations cause interference that can affect nerve function, correction of subluxations should lead to improved nervous system function, and in this study, quicker reaction times. In the Australian Spinal Research Foundation article conclusion, the author broadens the implication of the study findings by stating, "It is exciting to see yet more research indicate that a well-tuned nervous system is one that can assess, adapt and respond to the world around it more quickly than a nervous system in which subluxations may still exist."

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A case study published in the Journal of Upper Cervical Chiropractic Research on March 14, 2019, documented the resolution of headaches and neck pain in a patient with rheumatoid arthritis who underwent chiropractic care. People suffering with rheumatoid arthritis often have a variety of symptoms associated with pain and discomfort.

The Arthritis Foundation describes rheumatoid arthritis (RA) on their website by stating, "Rheumatoid arthritis (RA) is an autoimmune disease in which the body’s immune system – which normally protects its health by attacking foreign substances like bacteria and viruses – mistakenly attacks the joints. This creates inflammation that causes the tissue that lines the inside of joints (the synovium) to thicken, resulting in swelling and pain in and around the joints. The synovium makes a fluid that lubricates joints and helps them move smoothly."

The author of the study notes that the chronic systemic inflammation from RA can damage a variety of body systems including the skin, eyes, lung, heart, and blood vessels. The condition typically begins between the ages of 40-60 years and is first noticed as pain in the hands and feet. Later, the effects of the condition can then travel more toward parts nearer the center of the body.

In this case, a 59-year-old man went to the chiropractor for pain in his neck and headaches. For the previous 15 years, he was under the care of a rheumatologist for RA. His additional symptoms included ringing in his ears, foot pain, low back pain, and pain in his elbows, hands, hips, knees, legs, and feet bilaterally in addition to swollen joints.

The man’s occupation was as a brick-layer which was very physically demanding. His past medical care included anti-inflammatory medications, prednisone shots, prescription pain killers, and muscle relaxers. On two occasions, he had been given epidural steroid injections in his back for the pain.

A chiropractic examination and x-rays were performed to determine the presence of subluxation in the man’s spine. Based on the determination that subluxations were present, specific chiropractic adjustments were started to address the findings.

Several follow-up examinations showed improvements in the testing procedures as compared to when the man was initially examined. On a self-evaluation form given at one of the updates, the man noted significant improvement and reported that his neck pain and headaches were now rated as a zero, meaning completely resolved. Additionally, the man commented that since starting chiropractic care, his "posture was better", and he was "Not taking Tramadol for pain of RA." He rated his overall improvement to be at 90% and self-rated his recovery as "excellent."

In the conclusion, the author summed up this case by stating, "The symptoms this patient was experiencing in this case have been improved 90% since the first (specific chiropractic) adjustment. This was a case where the patient had been diagnosed with rheumatoid arthritis and was on pain medication for the pain associated with that RA while simultaneously suffering from neck pain and headaches at the same time. This patient has had no headaches or neck pain since the first adjustment and has not had to take any pain medication for his RA since the first adjustment."

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The title above comes from a February 15, 2019, article published by the Australian Spinal Research Foundation. The article compares several research papers showing that chiropractic can improve human performance. The implications of this research for top level athletes are profound.

Athletic performance depends upon the ability to properly coordinate movement, endurance, and strength. These functions are all controlled by the nervous system. The brain generates the intent and sends the signals to the individual muscles to perform the activity intended. It is therefore essential that the signals generated in the brain are transmitted clearly and cleanly to the intended muscles. Only then can those muscles perform the complex and exact movements for athletic performance. If the signals sent from the brain arrive clearly and without any changes, the muscles can perform at their highest abilities. Any interference with nerve signals will decrease the athlete's ability to perform at the highest competitive level.

This article points out that research showing chiropractic having a positive effect on movement has been around for over a decade. The author reports that back in 2006, some preliminary studies were able to quantitatively show that chiropractic "could indeed help lift certain areas of human performance."

Over the years, there has been a volume of reports and case studies of athletes who were either injured or struggling physically, who were returned to peak level performance, thanks to chiropractic care. The article notes that more modern scientific studies on athletes have been able to show that, because of chiropractic, "There was an increase of almost 60% in the electrical activity readings from specifically targeted muscles, a 16% increase in absolute force measures, and a 45% increase in the drive from the brain to their muscle."

As a result of the findings from the studies, the article stated, "it was now clear that chiropractic care changed the structure and function of the brain. It was also clear that it could reduce fatigue and increase drive to the muscles."

The article also noted that "…chiropractic care for the cervical spine could increase maximal bite force." Additionally, they point to studies that show chiropractic can have a much broader effect on human function, "This adds to a growing evidence bank showing many non-musculoskeletal benefits of chiropractic care – from cerebellar function and sensorimotor integration to reduced falls risk and increased ability to perform mental rotation tasks."

At the conclusion of the article, the author sums up his findings by saying, "This is slowly but surely coming together to show us the mechanisms behind why chiropractic works. We have further to go of course, but we can now see that when we adjust, we change the structure and function of the brain. We can increase some brain signals, and allow them to reach their destination sooner. We can remove distortion, which may mean less fatigue and more strength. As our understanding of the vertebral subluxation grows, so too does our knowledge of the flip-side – what happens when we remove it. Those results are proving encouraging indeed."

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On March 11, 2019, the Journal of Pediatric, Maternal & Family Health published a case series showing the results of pregnant women whose breech pregnancies were resolved under chiropractic care and were then able to give birth normally.

The study begins by describing the importance of the position of the fetus for a normal birth. "It is extremely important for a baby to be positioned correctly before delivery for the safety of the mother and child as well as for ease of delivery. The correct position for a baby is the head down, or vertex position. When a baby does not attain this position, but is instead in the buttocks or feet down orientation, this is referred to as the breech position."

It is estimated that about 3-4% of pregnancies become breech presentations. The study authors report that in 1970, the percentage of breech pregnancies that resulted in caesarian birth was about 14%. This number has risen to where currently about 95% of breech presentations result in cesarean delivery. Studies have shown that vaginal births are less likely to have serious negative outcomes than cesarean births.

The medical approach to try to correct breech presentation is to perform External Cephalic Version (ECV). This procedure involves the doctor physically trying to externally push the baby back into a vertex position. This process has only a 65% success rate and severe associated risks including umbilical cord entanglement, premature separation of the placenta from the uterus, premature rupture of the membranes, and preterm labor.

This study reviewed five separate case studies of woman with breech presentations late in their pregnancies. In the first case, a 40-year-old woman, 36-weeks pregnant, was referred for chiropractic care by her obstetrician, because of pelvic pain and both of her hands being numb. Chiropractic care over a three-week period in this case resulted in the woman’s symptoms being helped and her baby returning to the normal vertex, head down position. The findings were confirmed by ultrasound.

In the second case, a 30-year-old woman went to the chiropractor with a breech pregnancy presentation. She had also been suffering with chronic headaches for years. After four chiropractic visits, the woman’s obstetrician had confirmed that her baby had turned and was in a normal position. After continued chiropractic care, her headaches were also resolved.

Three additional cases were also reviewed in this study. In each case, a chiropractic analysis was performed, and subluxations were determined to be present. The chiropractic care consisted of specific adjustments and the inclusion of the "Webster technique." The results in all these cases were that after a short amount of time each of the pregnancies went from breech to normal vertex positioning.

In the study conclusion, the authors summed up the cases by saying, "We describe the positive health outcomes confirmed by ultrasound of five women with breech presentations where vertex positions were assumed following chiropractic care. Additional positive health outcomes included decreased back, pelvic and head pain.

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A case study published on March 18, 2019, in the Annals of Vertebral Subluxation Research documented the improvement through chiropractic of a patient suffering from nausea, fatigue, gastric reflux, dizziness and migraines, who had just recently had surgery for removal of a vestibular schwannoma.

According to the U.S. Department of Health & Human Services - National Institute on Deafness and Other Communication Disorders, "A vestibular schwannoma (also known as acoustic neuroma, acoustic neurinoma, or acoustic neurilemoma) is a benign, usually slow-growing tumor that develops from the balance and hearing nerves supplying the inner ear."

Vestibular schwannomas effect one in 100,000 people each year. Some of the key symptoms of vestibular schwannoma include one-sided hearing loss, ringing in the ears, and a loss of equilibrium. Additional less frequent symptoms can include face numbness, headaches, visual changes, and earaches. Medical care for this condition varies depending on size and location of the tumor. Surgery is one of the typical forms of care but can result in a number of other symptoms affecting the patient’s quality of life.

In this case, a 37-year-old man presented himself for chiropractic care. The man was suffering from nausea, dizziness, and digestive system dysfunction four years following the surgical removal of a right-sided vestibular schwannoma. His initial symptoms prior to surgery included right-sided hearing loss, ear-aches, and an accumulation of pressure within the ear. After an MRI confirmed a large vestibular schwannoma, surgery was performed. Due to the location of the vestibular schwannoma, the surgeon removed the entire vestibular nerve resulting in permanent right ear hearing loss.

The surgery exacerbated many of his health issues and created several additional health issues. These previously existing and newer issues included: dizziness, headaches, migraines, TMJ issues, neck pain and stiffness, sinus problems, numbness in arms and hands, stomach disorders with irritable bowels, hip and lower back pain with numbness in legs and feet, multiple joint pains, nervousness, and gastric reflux.

The man received a thorough history and chiropractic examination, as well as a thermal instrumentation analysis, x-rays, and motion spinal x-rays known as videofluoroscopy. It was determined from these procedures that subluxations were present and specific forms of chiropractic adjustments were started.

After 9 visits, the patient was re-evaluated, and it was reported that he had improved significantly in many of his symptoms including 100% improvement in dizziness, migraines, and nausea. A Health, Wellness, and Quality of Life (HWQL) survey was also used to determine the man’s progress under chiropractic care. The results of this self-survey showed a vast improvement in all areas measures with a most significant degree of improvement in the areas of mental and emotional stress.

In the study conclusion the authors wrote, "The case presented in this study displayed how specific chiropractic care helped improve both QOL and post-surgical symptomatology." They also commented, "Subluxation based chiropractic care has the potential to not only improve the QOL and vestibular dysfunction in VS patients, but any post-operative procedure, and therefore must be further researched."

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An article with the above title was published in the March 2019 issue of Practical Pain Management. The article gave an updated overview on low back pain management and was written by researchers who had been involved in previous studies on lower back pain and chiropractic.

The article begins by noting how common back pain is. "A 2018 Gallup study found that over 60% of US adults report having experienced back or neck pain severe enough to require care from a healthcare provider at some point in their lives, with 25% seeking such care within the past year." The article points out that lower back pain, (LBP) is the most common musculoskeletal condition that triggers medical treatment.

Unfortunately, the authors point out that medical care usually consists of NSAIDs, steroid injections, spinal surgery, and opioids, all of which have been shown to not be very effective and which carry significant side effects. With the current opioid crisis getting worse, alternatives are being seriously considered. The article reports, "Spurred on primarily by the resultant opioid crisis, many government and private organizations, including the FDA, the Joint Commission, and the American College of Physicians are now recommending the use of non-drug, non-surgical therapies for chronic pain, including low back pain." Chiropractic is one of those recommended strategies of care.

Currently, Doctors of Chiropractic are licensed as primary portal of entry health care practitioners in all 50 U.S. states. This means that it does not require a referral to seek care from a chiropractor. Chiropractic care does not involve medications or surgery of any kind. According to the article, a recent Gallup study showed that over half of U.S. adults have received chiropractic care at some point, with approximately 15% having seen a chiropractor within the past year.

One of the studies reviewed in the Practical Pain Management article was a clinical trial titled "Effect of Usual Medical Care Plus Chiropractic Care vs Usual Medical Care Alone on Pain and Disability Among US Service Members with Low Back Pain." This study, which was conducted at three military locations, was published in the Journal of the American Medical Association Network Open.

At each of the military locations, 275 volunteers were divided into two groups. One group got usual medical care, while the other group also received chiropractic care. At all three sites, the results of the study showed that those who also got chiropractic care did statistically better that those that only received medical care. It should be noted that the study did not include a group that only received chiropractic care without the addition of medical care. There are those that would argue that medication could actually slow the progress of patients under chiropractic care. They maintain that chiropractic by itself may have gotten better clinical results for patients than when combined with medications.

In their discussion, the authors of the article noted, "These findings have the potential to impact clinical practice by strengthening the scientific literature regarding the use of chiropractic care in patients with LBP in the military and beyond." They concluded, "This large multi-site pragmatic comparative effectiveness study found that adding chiropractic care to usual medical care resulted in better participant outcomes."

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