June 2020

• Resolution of Breech Presentation Confirmed by Ultrasound Following Chiropractic
• Chronic Opioid Use for Back Pain by US Veteran Helped by Chiropractic
• Review of Chiropractic, Vertebral Subluxation and Immune Function
• COVID-19 Lockdowns Worsen Childhood Obesity, Study Finds

The Journal of Pediatric, Maternal & Family Health published the results of a case study on May 14, 2020, documenting the resolution of a breech presentation pregnancy following chiropractic care utilizing the Webster technique. The normal position for a fetus prior to birth is with the head downward, known as the "vertex position." When the fetus has the head upward, it is known as breech.

According to the study "The most common fetal malposition is breech. About 30% of all fetuses will present as breech before 28 weeks of gestation, but by the 34th week a majority will flip to vertex presentation, the ideal position for delivery."  When discovered, most breech presentations result in a cesarean birth instead of the vaginal one.

The medical approach to turning a fetus when the mother is close to birth is a procedure known as external cephalic version (ECV). This is when the physician physically pushes the baby inside the mother in an attempt to return the baby to a normal position. This procedure is not without a high risk of complications and, according to the study, has a fairly low success rate.

In this case, a 28-year-old woman in the 33rd week of her pregnancy went to the chiropractor to see if she could get some help with her breech pregnancy. The woman had been seeing a midwife who was present when the woman came to the chiropractor. This was the woman’s first pregnancy, and she had never experienced chiropractic care before. The woman was also suffering from hip pain on both sides.

A chiropractic examination was performed which included a visual postural inspection, range of motion examinations, spinal palpation, a temperature thermal scan, and a surface EMG scan of the woman’s spine. The woman was also analyzed using the Webster Technique analysis.

With the determination of the presence of subluxations, specific adjustments utilizing the Webster technique were performed on the woman on a series of visits. After eight visits, the woman reported that the fetus had turned head down into the normal vertex position. The woman continued her chiropractic care through her pregnancy and was able to deliver her baby vaginally.

In the discussion section of the study, the authors explain chiropractic care for pregnancy by saying, "Chiropractic has a history of benefit to the pregnant woman. Chiropractic adjustments are intended to remove or reduce vertebral subluxations from the spine." They continue the explanation, "Chiropractors determine the subluxations through appropriate instrumentation, objective and subjective analysis. Chiropractic subluxations can have health alterations present with and without symptoms."

In their conclusion the authors wrote, "Over a one-month period the fetus turned from breech presentation to vertex presentation with the only change in care being the addition of chiropractic adjustments. After 7 chiropractic adjustments it was confirmed by ultrasound the fetus had moved to a vertex position. Continuing under chiropractic care the mother went on to have a normal vaginal birth without complications."

The Journal of Contemporary Chiropractic published the results of a case study on May 18, 2020, documenting the improvement under chiropractic care of a U.S. veteran with lower back pain who had previously been using opioids for ten years to manage his pain.

In the opening of the study, the authors clearly state their objective. "To demonstrate the ability for a patient with chronic mid and low back pain to make significant improvements, both in pain score and quality of life, under chiropractic care, even after a decade of management using daily opioids."

It is obvious to everyone that there is an opioid problem in the United States and around the world. This awareness has caused a shift in the thought of how to best address back issues. Because of this, the American College of Physicians (ACP) updated their Clinical Practice Guideline for the Treatment of Chronic Low Back Pain in 2017 to state that their first recommendation for chronic lower back pain (LBP) was to use spinal manipulation, exercise, and multidisciplinary rehabilitation prior to pharmaceutical intervention as a first line of defense. Only after several trials of unsuccessful conservative management for LBP was medical treatment with opioids to be considered.

In this case, a 50-year-old male veteran went to the chiropractor, seeking help for chronic mid and low back pain that radiates into his legs. He had been seeing medical physicians through the Veterans Affairs, who had been treating him with opioids in the form of hydrocodone and morphine for the past 10 years. He was forced to discontinue activities such as biking and weightlifting due to his pain. During flair-ups, he was given a cane and crutches to help him get around.

The man's pain was so unremitting that he stated that he was also having "fatigue and lack of desire to do things." The only care that he was offered during this 10-year period was in the form of opioid therapy. Eventually, he sought care at the Veterans Affairs Medical Center chiropractic clinic.

The chiropractic evaluation of the man’s spine showed a full range of motion, but with pain being created in almost all movements. MRI’s of the man’s lower back showed a disc protrusion in the lower lumbars. Chiropractic care was then started to address his spinal issues. He was also given some home exercises and procedures to follow.

After his sixth visit, the man reported on a re-evaluation that he felt improvement and was able to move better with less pain. After 3 months of chiropractic care, he reported a 50% reduction of pain as well as a "significant increase in his functionality and quality of life." He was able to discontinue the use of opioid medications and only occasionally utilized an over-the-counter drug as needed.

In the discussion, the authors of the study stated, "This case report portrays the ability for a patient with chronic thoracic and low back pain for over a decade, who was previously medically managed for 10 years with daily opioids, to achieve significant improvements with autonomous management of pain, increased functionality, and improved quality of life with a trial of 6 visits of chiropractic care."

A thorough review of existing scientific literature on chiropractic and the effect on immune function was published in a report on May 18, 2020, in the journal Annals of Vertebral Subluxation Research. The purpose of the study was to review existing scientific literature on chiropractic and immune function in order to shed light on the subject and determine the need and direction of future research.

Recently, with the COVID-19 pandemic, there has been much discussion about possible ways to help defend yourself against getting the virus. Obviously, a heightened immune system would go a long way to prevention of infections in individuals and society in general. Chiropractors have traditionally stated that they do not treat infectious diseases. They have, however, stated that chiropractic care, by correcting nerve system interference, does help bolster the body’s immune capabilities. This concept has drawn criticism from both traditional critics of chiropractic and some forces within the profession.

The study begins by noting the connection between nerve system function and immune function. "It is well established that the nervous system controls and coordinates all functions and systems of the human body including immunity and the immune system. Many in chiropractic consider that this relationship confers salutogenic benefits in people undergoing chiropractic care."

In explaining this further, the authors point out that proper nerve function is essential for proper immune system function. This is how chiropractic can indirectly have a positive impact on immune function. "The original chiropractic theory is centered on the principle that obstruction or interference in the nervous system caused by vertebral subluxation can affect internal physiological function and the propagation of mental impulses and therefore plays a role in pathophysiology and dis-ease." 

The report authors reviewed 125 scientific papers from published sources that had relevance to the subject of immune function and chiropractic. All of the studies and reports that were reviewed showed in some way that chiropractic had a positive effect on nerve system function and thereby immune function.

One of the earliest reports reviewed was from the 1918 pandemic which compared medical care to chiropractic care in Iowa for those suffering with the Spanish flu. The results of that care were reported in this report. "In the state of Iowa, medical doctors treated 93,590 patients, with 6,116 deaths - a loss of one patient out of every 15. In the same state, excluding Davenport, 4,735 patients were treated by chiropractors with a loss of only 6 cases - a loss of one patient out of every 789."  The study also noted, "In Davenport, Iowa, 50 medical doctors treated 4,953 cases, with 274 deaths. In the same city, 150 chiropractors including students and faculty of the Palmer School of Chiropractic, treated 1,635 cases with only one death."

In the conclusion of the report, the authors note that there is an abundance of evidence showing that chiropractic care has a positive effect on immune function. They call for more research along specific guidelines to end any controversy on this subject. "The results of this research demands that we further explore the neuro-immuno-regulatory effects of chiropractic, adjustment and spinal manipulation and it provides a starting point for doing so. While adjustments reduce pain and inflammation, they also improve immune-regulatory function."

Above is the headline of a June 3, 2020, article in Science Daily reporting on a study published on April 30th by the University of Buffalo in the research journal Obesity. It is well established that childhood obesity is a significant health issue in the U.S. and in other developed nations. This study looked at the effect the stay-at-home lockdown has had on children and their eating habits.

According to the U.S. Centers for Disease Control and Prevention, "Childhood obesity is a serious problem in the United States putting children and adolescents at risk for poor health. Obesity prevalence among children and adolescents is still too high." On the CDC website, they note that prevalence of obesity is 18.5% and affects about 13.7 million children and adolescents. The breakdown shows that obesity affects 13.9% of 2- to 5-year-olds, 18.4% of 6- to 11-year-olds, and 20.6% of 12- to 19-year-olds.

The study was conducted in Verona, Italy, where there was a significant lockdown during the COVID-19 pandemic. This pandemic has had far reaching health, social, and economic implications. It has closed schools around the world leaving children at home where their diets were not regulated by school programs.

A total of 41 children and adolescents with obesity were included in the study. The researchers initially collected information on each participant's lifestyle including diet, daily activity, and sleep behaviors. This information was later collected again at three weeks into the lockdown to see if there was a significant change due to the lockdown.

The results of the study showed that there was an increase in the number of meals eaten per day by the children while at home.

 This increase showed that more than one additional meal was eaten each day. Although there was an increase in the amount of meals eaten, there was no increase in the amount of vegetables eaten. One possible benefit was that there was an increase in fruit consumption. Unfortunately, there was also a significant increase in the consumption of potato chips, red meat, and sugary drink during the
lockdown.