December 2019

• Chiropractic Maintenance Care Research
• Improvement in Breathing, Sleeping, and Infections in Cystic Fibrosis Patient Under Chiropractic
• Scheuerman's Disease with Low Back Pain and Headaches Helped by Chiropractic
• Resolution of Breastfeeding Difficulties Following Chiropractic
• Chiropractic Services for the Active Military
• Resolution of Chronic Gastroesophageal Reflux Disease and Constipation with Chiropractic

The scientific periodical Chiropractic & Manual Therapies published an open access article in their November 21,2019, journal that reviewed scientific evidence of the benefits of chiropractic maintenance care and the reasons that patients receive this care. The authors of the study explain chiropractic maintenance care by stating, "Maintenance Care is a well-known concept in the chiropractic profession, describing continued care beyond that of reducing symptoms."

The study reports that generally chiropractors describe two scenarios that are both referred to as maintenance care. "Some chiropractors appear to have recommended Maintenance Care as a form of precaution to keep the patient healthy, regardless of symptoms and patient history. Others though, seem to have used it to 'keep patients going', when they had chronic or recurring problems." The first of the two descriptions is also known as "wellness care" in many chiropractic offices.

This study noted that in the past, there was a lack of consensus or clear research evidence on the concept of chiropractic maintenance care. To help do more research on the subject and possibly add more clarity, the Nordic Maintenance Care Program was started. This research program explored maintenance care among chiropractors in Denmark, Sweden, Finland, and Norway.

The study authors performed a search for all studies on chiropractic with the terms chiropractic or manual therapy and maintenance care or prevention included. However, the term wellness was specifically excluded. The study identified 14 articles that were published between 2008 and 2018 on the subject of maintenance chiropractic, including four from Canada, the U.S. and Egypt.

One of the studies looked at the patient’s rationale for receiving chiropractic maintenance care. In this study, it was reported that "…patients stated that the purpose was to prevent recurrences (78%) and to remain pain-free (68%). A few patients (17%) echoed the holistic view expressed by some chiropractors, i.e. that maintenance care was used to prevent disease in general, a wellness approach."

Another study included in this paper showed that maintenance chiropractic was more prevalent in the practices of experienced chiropractors and those who were graduates of chiropractic schools in the United States. In the Nordic countries, it was reported that about 30% of chiropractic patients are receiving maintenance care.

In their conclusion, the authors wrote, "Knowledge of chiropractic Maintenance Care has advanced. There is reasonable consensus among chiropractors on what Maintenance Care is, how it should be used, and its indications. Presently, Maintenance Care can be considered an evidence-based method to perform secondary or tertiary prevention in patients with previous episodes of low back pain, who report a good outcome from the initial treatments." They go on to state, "Back pain is a chronic disease for most, with episodes at short or long intervals. A preventive approach such as Maintenance Care, therefore, makes sense."

The Annals of Vertebral Subluxation Research published a case study on October 28, 2019, documenting the improvement of a patient with cystic fibrosis while under chiropractic care. Cystic Fibrosis Foundation defines the condition on their website. "Cystic fibrosis is a progressive, genetic disease that causes persistent lung infections and limits the ability to breathe over time."

The Mayo Clinic website described Cystic Fibrosis (CF) by explaining, "Cystic fibrosis affects the cells that produce mucus, sweat and digestive juices. These secreted fluids are normally thin and slippery. But in people with cystic fibrosis, a defective gene causes the secretions to become sticky and thick. Instead of acting as a lubricant, the secretions plug up tubes, ducts and passageways, especially in the lungs and pancreas."

In this case, a 34-year-old woman who had been medically diagnosed with CF went to the chiropractor in the hopes of increasing her overall wellness and possibly boosting her immune system. She had been diagnosed with CF ten years prior to her visiting the chiropractor. Since the age of 12, the woman had been suffering with a persistent cough that was thought to be allergies. When she was in college and participated in athletic activities, she seemed to get worse and experienced periodic episodes of shortness of breath with a persistent productive cough.

Prior to starting chiropractic, the woman was suffering with upper respiratory and sinus infections once every 2-3 months which required prescription antibiotics. Unfortunately, as soon as she stopped taking the antibiotics, she would get worse again. She reported that her condition was affecting her sleep and her overall quality of life.

A chiropractic examination revealed postural irregularities and increased muscular tension in her upper back area. Both static and motion palpation of the spine revealed spinal segmental issues were present. Thermography (heat readings) of the spinal also confirmed spinal issues. Spinal x-rays were also taken.

Based on the findings of the examination, vertebral subluxations were determined to be present. Specific chiropractic adjustments were started to address the subluxations.

A full follow-up was performed after 12 months of chiropractic care. In that reassessment, the woman reported that she had not required prescription antibiotics since she started chiropractic unlike previously when she required antibiotics every 1-3 months to address her CF.

The woman stated that she was experiencing "less dramatic ups and downs" since being on chiropractic care. The woman also stated that she was able to engage in more aerobic activities with an increased ability to perform such things as running with much less difficulty breathing. She also reported that she was sleeping better.

In their conclusion, the authors of the study summed up the case by saying, "We described the chiropractic care of an adult CF sufferer resulting in improvements in her CF symptoms and overall quality of life."

Published in the Journal of Physical Therapy Science on November 26, 2019, is a case study documenting the improvement of spinal curvatures, posture, lower back pain, and headaches in a patient with Scheuerman's disease. According to the publication Spine-Health, "Scheuermann's Disease is a growth condition in which the normal curve in the upper spine is increased, forming a hunched back. The disease also called Scheuermann's Kyphosis typically occurs in the thoracic spine when the front does not grow as fast as the back of the spine, so that the vertebrae become wedge-shaped."

This study begins by noting the impact that poor posture can have on overall health and quality of Life. "Many studies have determined that postural misalignment or spinal subluxation is associated with pain and disability. Recently, in fact, it has been reported that those with poor posture had a significantly poorer quality of life scores as measured by the SF-36 questionnaire (a self-evaluation questionnaire) than those with various other well-known diseases including self-reported arthritis, chronic lung disease, diabetes and congestive heart failure."

Many people think of poor posture as a bad habit of how a person stands or sits. In fact, many cases of poor posture have a structural or anatomical reason based in the spine. Scheuerman's disease is one of the anatomical spinal changes that can create a hunched back appearance and result in poor posture.

In this case, an 18-year-old man brought himself to a chiropractor for issues of lower back pain that was radiating down into his right hip and knee for the past several years. The man explained that the pain was constant and was made worse from movement as well as daily activities such as sitting, standing or sleeping. He also reported that he occasionally suffered from mild mid back pain, neck pain and headaches.

The examination of the patient revealed pain on spinal palpation along with taut muscles. Some of the man’s spinal ranges of motion were abnormal, and orthopedic tests were unremarkable. Spinal x-rays were taken which showed several areas of mispositioned vertebrae noted as subluxations. Based on the findings of the examination and x-rays, specific chiropractic care was started.

A re-assessment was performed after 14 weeks of chiropractic care. At that time, the man reported total relief from LBP and headaches. He did still experience some occasional mid-back pain if he sat for too long. All of his ranges of motion had returned to normal and did not cause any discomfort.

Follow-up spinal x-rays showed a significant improvement in the man’s mid-back and neck curvatures. The neck curvature had increased to a closer to normal forward curve, and the previously increased mid-back curve had been reduced closer to a normal curvature.

In their conclusion, the authors summed up the positive changes by stating, "This case adds to the accumulating evidence demonstrating (Chiropractic) methods offers an effective approach to reduce the burden of postural disorders including those with Scheuermann's disease."

The Journal of Pediatric, Maternal & Family Health published the results of a case on November 14, 2019, describing how an infant (just hours old) was helped by chiropractic after a traumatic birth process. Birth trauma can be the result of several factors including deliveries by forceps, excessive pressure, multiple births, or an unusual position of the head during delivery.

A study on birth trauma published on September 11, 2019, on the National Center for Biotechnology Information website noted that mechanically assisted birth was a prime factor for birth trauma. However, the study noted that there had been a reduction in mechanically assisted birth with a correlated reduction in birth trauma. They reported that the birth trauma rate fell from 2.6 per 1000 live births in 2004 to 1.9 per 1000 live births in 2012.

Asynclitism is when the infants head is angled in such a way as to make vaginal delivery difficult or require a cesarean. The results of birth trauma often range from spinal subluxations to a malformed head shape known as deformational plagiocephaly. When this condition is present, birth trauma will often result.

In this case, a 6-hour-old boy was assessed by a chiropractor who was present during the birthing process. As described in the study, the infant had a traumatic birth due to an oblique position of his head during the birth process. The result was his head was elongated and swollen and he was crying as if in pain. He had significant trouble breastfeeding and was only able to partially do so on one side.

A chiropractic examination showed stiffness in the infant’s ability to move his neck, and palpation of his neck elicited a pain response. When performing any motion of his neck, the infant would pull his hands back to his head and cry. The infant’s hands were clinched into fists around his thumbs.

The chiropractor determined that subluxations were present and specific age and size appropriate forms of chiropractic adjustments were given. Immediately after his adjustment, it was noted that his musculature began to relax, and his hand opened up. The infant was then able to breast feed without pain on either side. The infant’s neck was able to move normally and did not illicit pain or crying.

In their conclusion the authors wrote, "This case report provides supporting evidence that patients suffering from birth trauma may benefit from subluxation-based chiropractic care."

The journal Chiropractic & Manual Therapies published a research review article in their 27:45 issue of their 2019 journal that reviewed a number of prior studies on chiropractic care for active military in order to see the results and satisfaction level active military personnel had with available chiropractic services.

The study begins by pointing out, "Musculoskeletal injuries significantly affect the health and operational readiness of active military personnel. They are one of the most prevalent battle and non-battle related injuries in theatre." Musculoskeletal injuries are predominantly those injuries that create pain and affect movement and function. Neck and back pain are the most common of these types of injuries.

The study reports that data from the United States Navy Physical Evaluation Board between February 2005 and February 2006 showed that musculoskeletal diagnoses were common, representing 43% of all diagnosis. Of these, back pain was the most common being 29% of all diagnosis. Similar findings were also seen in other militaries reviewed in the study including the Canadian Armed Forces, the Swedish Air Force, and the Royal Air Force of Britain.

After reviewing 674 articles related to chiropractic in the military, only 20 met the criteria for inclusion into this study. In most cases, chiropractic care was only available to military personnel after a referral from a gatekeeper, who was usually a medical physician. Most patients were primarily seen for musculoskeletal conditions. In many cases, the referral for chiropractic occurred only after other medical treatments had failed to help the patient.

In most countries, chiropractic care was delivered off base by practicing chiropractors. The study notes, "We found that chiropractic services are provided to active duty military in on-base clinical facilities in only one country, the US; this is driven by US legislation."

The results of the studies reviewed were that most patients were satisfied with their chiropractic care. In Canada, 94.2% were satisfied with their chiropractic care. One of the studies reported that participants pain was completely gone in 73% of their cases.

In their conclusion the authors wrote, "Our scoping review found the majority of published articles described chiropractic services in the active duty military in the US setting. Recent RCTs (randomized clinical trials) suggest a benefit of including chiropractic care to usual medical care in managing back pain in active duty military."

On November 4, 2019, the Journal of Pediatric, Maternal & Family Health, published a case study documenting the resolution of chronic gastroesophageal reflux (GER) and constipation in an infant following chiropractic care.

The study begins by explaining, "Gastroesophageal reflux (GER) or acid reflux is a common occurrence in infancy with up to 65% of infants regurgitating their stomach contents at least once a day at age of 3 to 6 months" Many of these cases are self-correcting by age one. When a child is brought to a medical physician, the typical mode of treatment is some form of anti-GER medication.

In this case, a 2-month-old baby girl was brought to the chiropractor by her parents for chiropractic consultation and possible care. The baby was suffering with severe acid reflux and constipation. Her mother reported that the girl’s problems seemed to begin at birth and were very noticeable when she was one week old. At two weeks old, the baby was taken to a pediatrician who prescribed Prilosec for her acid reflux and Miralax for the constipation.

The acid reflux medication seemed to give some temporary relief; however, the symptoms would get worse with intense spitting up when the medication was stopped. The girl's mother did not give her daughter the constipation medication. The girl’s problems continued to get worse with her not being able to sleep for more than 30 minutes.

The infant’s parents reported that their daughter refused to be held or lay on her back. They indicated that the infant would cry and scream in agony when touched on the back. On examination, it was obvious that the baby was agitated, and in distress. During an attempt to palpate the baby’s spine, the child winced and started crying.

Based upon the chiropractic examination, specific chiropractic care was initiated for correction of subluxations. After the first adjustment visit, the girl’s parents reported that their baby daughter seemed more peaceful and was able to be held while feeding. They also reported that their baby slept through the night continuously for a 6-hour period.

After the third adjustment visit, it was observed that the girl was no longer straining to have a bowel movement and the bowel movements were more regular. By the fifth visit, the parents made the decision that their daughter no longer needed the medication she was on, and with the supervision of the infant’s pediatrician, the girl was taken off her medication. From this point on, the girl did not need medication, only occasionally had a minor spit-up, and was no longer suffering from constipation.

The authors summed up the results of this case study by stating in their conclusion, "This case report provides an educational vehicle and evidence on the successful chiropractic care of infants with a history of medical care for acid reflux."