January 2020

• Menstrual Cycle Returns and Low Back Pain Gone with Chiropractic
• Chiropractic Creates Improvement in Strength and Balance in Stroke Patient
• Resolution of Low Back and Pelvic Pain in a Pregnant Woman Under Chiropractic Care
• Study Says Chiropractic More Cost Effective than Physical Therapy for Lower Back Pain
• Elderly Patients with Neck Pain Helped with Chiropractic
• Improvement of Heart Rate Variability in Patients Undergoing Chiropractic

Published in the Annals of Vertebral Subluxation Research on December 5, 2019, is the documented results of chiropractic care helping a woman who was suffering from lower back pain and a chronic loss of her normal menstrual cycle.

Amenorrhea is the absence of a menstrual cycle. This condition is normal when a woman who is of the age to have a regular cycle is either pregnant or nursing. Women who should be having a regular menstrual cycle but who miss three periods are considered to have amenorrhea. The study notes that between 3-4 percent of women are classified as having amenorrhea.

In this case, a 26-year-old woman presented herself for a chiropractic evaluation. The woman was suffering with right rib and low back pain. These pains began after a lifting accident she sustained at work. The woman was employed as a bartender which required her to perform physical activities that were repetitive in nature. Upon taking a history, the woman revealed that she was suffering with amenorrhea for the past several years.

A chiropractic examination was performed which included a physical examination and both motion and static palpation. From the findings, it was determined that subluxations were present, and the recommendation was made that the woman undergo a series of chiropractic adjustments to correct the subluxations.

In simplest terms, a subluxation (a.k.a. vertebral subluxation) is when one or more of the bones of the spine (vertebrae) move out of position and create pressure on or irritate spinal nerves. Spinal nerves are the nerves that come out from between each of the bones in the spine. This pressure or irritation on the nerves causes those nerves to malfunction and interfere with the signals traveling over those nerves.

Since the nervous system controls and coordinates all body function, any interference with nerve transmission can result in parts of the body not functioning properly. The effects of subluxation can be varied and widespread as all bodily function is under nervous system control. Chiropractors have long maintained that they do not specifically treat the conditions caused by subluxations, but rather correct the subluxations so the body's own innate healing abilities can help restore health.

In this case, the woman began a series of adjustments at the rate of three times per week. The study reports that after three weeks of chiropractic care, the woman reported improvement in both her back and rib pain. As a result of correction of subluxations, the woman also reported that she began menstruating normally again.

In their conclusion the authors noted, "This study provided supporting evidence on the possible benefits of chiropractic care in patients with amenorrhea and neuromusculoskeletal pain."

Published in the December 12, 2019, issue of the  Annals of Vertebral Subluxation Research is a case study documenting the improvement of a stroke victim in motor strength and balance after undergoing chiropractic care. 

The study begins by noting that there are two categories of causes of stroke - ischemic and hemorrhagic. A hemorrhagic caused stroke means that there was a rupture in a blood vessel supplying blood to the brain. An ischemic caused stroke, which is far more common accounting for over 80% of all strokes,  is when there is an occlusion in a blood vessel that feeds a part of the brain. 

The study reports that it is estimated that 17 million people suffer a stroke each year world-wide. As a result, approximately 5 million of these people suffer long-lasting physical disabilities following their stroke. They report, "One of the most commonly occurring and long-lasting physical deficits following a strokes is hemiparesis, which can impair limb movement and function and an individual’s ability to stand, balance or walk."

The U.S. Centers for Disease Control and Prevention (CDC) list several facts about stroke in the U.S. which include that "Every year, more than 795,000 people in the United States have a stroke. About 610,000 of these are first or new strokes." Additionally, "Stroke kills about 140,000 Americans each year—that’s 1 out of every 20 deaths. Stroke costs the United States an estimated $34 billion each year. This total includes the cost of health care services, medicines to treat stroke, and missed days of work."

In this case, a non-smoker 40-year-old man was suffering with right-sided lower limb weakness following an ischemic stroke seven years ago, presented himself to a chiropractor. After his stroke, the man received eight months of rehabilitation and Botox therapy to try to help reduce muscle tension. After his therapy, the man still suffered with lower back and right leg weakness. He remained active and continued to go to the gym regularly.

A chiropractic examination was performed which included a postural analysis, palpation, as well as Surface EMG (sEMG) and thermography studies. The determination from these tests was that there were multiple areas of vertebral subluxations present in the man's spine. A series of specific chiropractic adjustments were then started to address the subluxations.

The study states that on his third chiropractic visit, the man reported being aware of greater strength in his right leg, which continued throughout his care. As care continued, he also reported that his balance had improved. On his ninth visit, the man reported that his leg strength had improved to the point that he was able increase the weight he was using in his leg exercises.

In their discussion, the authors of the study stated, "This case documents a course of chiropractic care associated with the improvement in residual lower limb motor weakness and balance in a 40-year-old male who had experienced an ischemic stroke 7-years prior. Chiropractic care focused on the assessment and correction of vertebral subluxation."  The authors further concluded, "This case provides supporting evidence that stroke survivors may benefit from chiropractic care."

The Journal of Pediatric, Maternal & Family Health published the results of a case study on December 18, 2019 documenting the successful outcome following chiropractic care of a pregnant woman suffering with low back pain. Back pain in general is a very common ailment. In pregnancy, it is even more common with back pain expected to occur in between 50 to 70 percent of pregnant women.

Chiropractic care for patients with lower back pain has been well established in research and literature. It is more recently that chiropractic care for pregnant women with lower back pain has shown up in research and has become a more popular form of care. Many pregnant women who suffer from back pain seek chiropractic because they wish to avoid taking any form of medication that could have an adverse effect on their unborn child.

In this case, a 28-year-old pregnant woman sought chiropractic care. The woman was 31 weeks into her second pregnancy and was suffering with lower back pain that radiated from her lower back into her sacroiliac joint. Her pain had started the week before after she had picked up her 2-year-old child. She reported that lying on her back gave her some relief, but she was unable to perform daily chores or lift her child. She rated her pain as a 5 out of 10 (10 worst) with the pain occasionally rising to 7 out of 10.

The woman had not used any medications and was utilizing some heat and stretching exercises that she found online. However, nothing she had attempted was helping.

A chiropractic examination was performed which included a visual inspection. The inspection revealed that the woman was leaning slightly forward, probably in response to her pain. When she was asked to extend backward the woman grimaced in pain. Spinal palpation showed multiple areas of tightness and sensitivity, and her range of motion was generally reduced.

Based on the examination findings, it was determined that subluxations were present. Specific forms of chiropractic adjustments were given to address the woman’s subluxations. These adjustments took into account her pregnancy utilizing special forms of chiropractic adjustments to accommodate her.

The woman reported immediate relief following her first adjustment. She also was able to increase her range of motion. She then rated her pain as a 1 out of 10 with only minor soreness remaining in her right hip.

In many published articles, chiropractic is grouped into the category of non-medical care known as "complementary and alternative medicine" (CAM). This study describes the reasons that many women are turning to chiropractic when suffering with musculoskeletal (MSK) problems. "With concerns of safety and adverse events associated with pain medications during pregnancy, many women are turning to complementary and alternative medicine (CAM) to address pregnancy-related MSK complaints."

In their conclusion the authors noted "…the clinical knowledge showcased in this case report contributes to individual and collective clinical experience in the care of pregnant patients."

A study titled "Treatment of Patients with Low Back Pain: A Comparison of Physical Therapy and Chiropractic Manipulation" was published in PrePrints by the author Nima Khodakarami PhD from Texas A&M University that showed that chiropractic was more a cost effective mode of care for patients with lower back pain than was physical therapy.

This report begins by noting that "Low back pain (LBP) is a chief cause of years lost to disability in the world. In the industrialized countries, LBP causes the high cost of medical expenses and loss-of-work." It is also reported that in the U.S. alone, over $80 billion is spent directly and indirectly on LBP. Of this amount, about $7.4 to $28 billion is the cost of work loss. An additional $26 billion is the spent related to pharmacologic, non-pharmacologic and therapies. This problem is so common that, in the U.S., LBP is the second most common reason for visits to physicians.

The report notes that the common medical approach for LBP is medication and activity. If this approach does not work, physical therapy is usually medically recommended. Previous studies has shown that physical therapy is more effective for LPB than is no care or medical care alone. Similarly, the report states that chiropractic has also been shown to be a more cost effective form of care for LBP than is medical care. However, few studies had previously compared chiropractic care to physical therapy for LBP.

This report compared the two types of care for the short-term results to see which was more effective and cost efficient. The results showed that, on average, chiropractic care required 20 percent fewer visits than physical therapy. They also found that 66 percent of patients who went to the chiropractor experienced complete wellness immediately after their first visit. This was compared to only 56 percent of patients that went to a physical therapist who felt complete wellness after their first visit.

When comparing medical care to non-drug forms of care, the study reports that both "chiropractic care and physical therapy are shown to be the superior nonpharmacologic strategies for treating LBP." When comparing chiropractic care to physical therapy care for the total costs of care for six months, it was shown that chiropractic care was less expensive than was physical therapy care for patient suffering with LBP. Chiropractic care also resulted in less days of disability and work loss.

The conclusion of the report stated, "The findings showed that in the chiropractic group, the total average cost was $48.56 lower than the physical therapy group, and daily adjusted life years (DALY) was 0.0043 higher than the physical therapy group. Chiropractic care was shown to be a cost-effective alternative compared with physical therapy for adults with at least three weeks of low back pain over six months."

A study published on December 18, 2019, in the journal Chiropractic & Manual Therapies looked at the outcomes of chiropractic care for elderly patients who were suffering with neck pain. The study was performed in Australia involving 288 Doctors of Chiropractic who contributed reports on elderly patients suffering with neck pain.

The study authors begin by reporting that "Neck pain, with or without headache or dizziness, is a leading cause of disability affecting over 350 million people worldwide as of 2015." They note that neck pain is particularly prevalent in older adults and has a significant impact on their quality of life. Treating neck pain with medications is common but can lead to a variety of other health issues caused by the medications.

Although not as common as in the United State, chiropractic is popular in Australia. The study states, "Many older adults in Australia suffering from neck pain and associated conditions seek chiropractic treatment. In fact, musculoskeletal complaints, most commonly back and neck pain, account for the vast majority of chiropractic consultations in Australia."

This study was performed by randomly selecting 800 chiropractors in Australia to participate. These chiropractors were emailed a request with a link to the survey. From the original 800 initially sent a request, 288 responded and participated. All identifying information was kept confidential. Of the 288 chiropractors in this study, 207 were male and 81 were female.

The survey itself gathered data on the reported chiropractic care of older adults with neck pain with or without headaches. The survey consisted of 28 questions and gathered information on chiropractors’ demographic and practice characteristics, estimates of how often the chiropractors care for older adults with neck pain, the methods used on the elderly patients, the chiropractor’s estimate of the effectiveness of the care, and estimates of patients usage of other health services by their older patients.

The survey of the Australian chiropractors showed that 28.5% of their patients were elderly. In that population, nearly half of those patients had presented for chiropractic care with neck pain. About a third of the patients with neck pain also suffered from headaches.

Overall, the reported health-related outcomes for neck pain and associated health issues was reported to be favorable for older adults. The number of visits that were needed before the patients considered their issues to be resolved varied but was higher with those patients who also suffered from migraine headaches. It was also noted that the number of visits patients required prior to getting relief from neck pain did not vary between female and male chiropractors.

In their conclusions the authors wrote, "The findings suggest that chiropractors use well-established manual and physical therapy techniques to manage neck pain in older adults. The favourable (sp) outcomes reported by participants highlight a potential role for using nonpharmacological multimodal therapeutic approaches for the management of neck pain in older adults."

In the December 2019 issue of the Chiropractic Journal of Australia are the results of a study documenting that patients who were under continuous chiropractic care showed an improvement in Heart Rate Variability (HRV).

According to Marcelo Campos, MD, in his article in the Harvard Medical School’s Harvard Health Publishing, "HRV is simply a measure of the variation in time between each heartbeat. This variation is controlled by a primitive part of the nervous system called the autonomic nervous system (ANS)." He points out that a high rate of HRV indicates a better ability to adapt and a healthier functioning nerve system. Conversely a lower HRV is associated with conditions such as cardiovascular disease, inflammation, diabetic neuropathy, depression, sleep disorders, and cancer.

As this study points out, vertebral subluxations create nerve system interference that can then affect HRV. The study states, "The primary objective of chiropractic care is to optimize health and wellbeing through the enhancement of nervous system function by reducing nerve interference caused by vertebral subluxations." They continue by noting that the Australian Spinal Research Foundation defines vertebral subluxation as "a diminished state of being, comprising of a state of reduced coherence, altered biomechanical function, altered neurological function and altered adaptability."

In explaining the rational for this study the researcher noted, "Research over the past 2 decades has shown that the chiropractic adjustment (also referred to as chiropractic spinal manipulation in the chiropractic research literature) results in changes in spinal biomechanics and structure, central nervous system function, motor output, and autonomic output. while under chiropractic care."

In this study, 6 patients between the ages of 25 and 55 started chiropractic care for correction of subluxations. The patients were specifically screened to assure that medications or stressful life events would not create any changes in their HRV during this study. The three men and three woman each had their HRV monitored before they started chiropractic, and then routinely every 12 visits to see if correction of subluxations would affect their HRV. These results were also compared to HRVs from control patients who did not receive any chiropractic adjustments.

The results of the study showed a consistent and sustained improvement in HRV in each of the patients who received chiropractic care. There was not only an improvement in their HRV as compared to before starting chiropractic. There was also a demonstratable improvement between the 6 patients receiving chiropractic and the control patients who did not.

In discussing the results of the study, the authors noted, "This case series chronicles HRV changes of 6 adult patients receiving chiropractic care using (specific) adjusting techniques for the correction of vertebral subluxation. The data described here are consistent with immediate and long-lasting neurophysiological changes effected by chiropractic case management."

In the conclusion the authors wrote, "The data presented demonstrate a sustained improvement in HRV over a course of chiropractic care that is consistent with improved health outcomes."