November 2020

• Resolution of Chronic Temporomandibular Disorder with Chiropractic
• Oxygen Levels Increased in Newborn After Chiropractic Adjustment
• Cervical Dystonia Helped with Chiropractic – A Case Study
• Chiropractic Does Better Than a Multidisciplinary Pain Team for Chronic Spinal Pain

On October 15, 2020, the Journal of Upper Cervical Chiropractic Research published the results of a case study documenting the resolution of chronic temporomandibular disorder with chiropractic care. Temporomandibular disorders are problems typically involving pain of the temporomandibular joints, commonly referred to as the TMJ.

According to John Hopkins Medical website, "Temporomandibular disorders (TMD) are disorders of the jaw muscles, temporomandibular joints, and the nerves associated with chronic facial pain. Any problem that prevents the complex system of muscles, bones, and joints from working together in harmony may result in temporomandibular disorder."

Some of the more common symptoms of TMD are pain in and around the TMJ, headaches, abnormal jaw movement, or clicking sounds upon opening or closing the mouth. The study reports that about 30% of the adult population is affected by TMD at some time in their lives, with women, typically in the ages of 25 to 44, having this issue more commonly than men.

In this case, a 36-year-old woman went to the chiropractor because she was suffering with left sided TMJ pain. She reported that she had hit herself in the jaw while weightlifting several years earlier severely enough to break several teeth. The woman described her constant pain as "deep, sharp, and heavy." She rated the intensity as 7 out of 10 (10 worst), with the pain rising to 9 out of 10 with certain activities. The pain was progressively getting worse and was aggravated by movement, sleeping and straining. She was taking some non-steroidal anti-inflammatory drugs (NSAIDs) to try to get some relief.

A chiropractic examination noted that her head was in a forward position as well as being tilted to the left with shoulder height asymmetry. Her TMJ was tender to palpation. From these and other procedures, it was determined that subluxations were present.

Regular chiropractic adjustments were started on the patient. After several weeks, the study noted that adequate progress had not been made on her condition. Changes to her chiropractic care were made to attempt to improve the patient’s issues.

The changes in her care showed a positive result as several days later the woman returned and reported that she had eaten almonds for the past three days without having any pain. From that point forward, the woman was able to eat normally with only occasional discomfort. With continued chiropractic care, the woman continued to improve until she could report that her TMJ pain was reduced to mostly a 0 out of 10, only occasionally rising to 2 out of 10.

The Journal of Pediatric, Maternal & Family Health published a case study on October 8, 2020, that documented the improvement of oxygen levels in a newborn immediately following a chiropractic adjustment. The improvement was measured in real-time using a pulse oximeter.

The study begins by noting that "Pulse oximetry (PO) is routinely used in neonatal evaluation to assess for congenital heart disease (CHD)." According to Nationwide Children’s Hospital, "The pulse-oximetry test can help identify infants with low levels of oxygen in their blood and may help diagnose critical CHD (congenital heart disease) before an infant becomes sick." The study reports that CHD is one of the most common birth defects affecting nine out of every 1000 newborns.

Pulse oximetry has become a common non-invasive test used shortly after birth to help reduce the risk of CHD by early detection. The study reported how common the PO test has become by noting, "Recently the Canadian Cardiovascular Society and the Canadian Pediatric Cardiology Association issued a position statement strongly recommending that PO evaluation be done in all healthy newborns, and multiple states in the United States have made PO evaluation of neonates mandatory."

In this case, an 8-pound female infant was born at home with the assistance of a certified midwife. The pregnancy was full-term and had no complications. Immediately after the birth, the midwife performed an evaluation of the infant which included a pulse oximeter being placed on the infant’s right foot. After three minutes, the PO reading was 73%. A normal reading for an infant should be above 95%.

Due to the low oxygen level, the infant was administered oxygen which caused the PO reading to rise to 93%. However, when the oxygen was removed, the PO reading would once again drop down to 85%. Because of this situation, and in accordance with state protocol, the midwife informed the parents that their newborn might need to be transported to the emergency room due to the possibility of Congenital Heart Disease.

A pediatric chiropractor was asked to evaluate the infant for the presence of vertebral subluxations. Subluxations, especially in the upper neck, are a common concern due to possible trauma during the birth process. An examination of the infant’s neck was performed which showed some segmental mobility issues. With this finding as well as other chiropractic checks, it was determined that a subluxation was present in the infant at the top of the neck area.

An age and size appropriate specific chiropractic adjustment was given to the infant using a sustained pressure at the area of subluxation. The study reported that, in-real-time, the pulse oximetry (PO) reading returned to a normal 95% immediately upon the infant getting the chiropractic adjustment. The PO reading continued to remain normal for the entire time the midwife monitored the newborn. Due to this immediate and positive change, the midwife determined that the infant would not need to be taken to the hospital.

In their conclusion the authors of this study wrote, "This case study provides supporting evidence of the benefits of subluxation-based chiropractic care in the improvement of pulse oximetry readings in neonates. Obstetric health care providers must be aware of cases like this, as low-risk interventions such as pediatric chiropractic could prevent more invasive medical treatments for patients."

The Journal of Upper Cervical Chiropractic Research published a case study on October 1, 2020, that documented a patient under chiropractic care receiving significant relief from neck pain and torticollis.

Cervical dystonia is also sometimes known as spasmodic torticollis. The Mayo Clinic describes this condition on their website by saying "…a painful condition in which your neck muscles contract involuntarily, causing your head to twist or turn to one side. Cervical dystonia can also cause your head to uncontrollably tilt forward or backward."

Cervical dystonia is rare, occurring at any age and affects more women than men. Typical medical treatment involves physiotherapy and muscle relaxant drugs. In some cases, intramuscular injection of botulinum neurotoxin is used to try to correct the problem.

In this case, a 14-year-old girl was brought to the chiropractor. The girl was suffering from a head tilt to her right and neck pain on both sides of her neck. She also reported a feeling of tremor and neck pulling from time to time. Because of her condition, the young girl was withdrawn, socially anxious and unhappy about how she looked.

For the past year, the girl was unsuccessfully being treated medically for her painful situation. She had received three botulinum toxin injections at 3-month intervals, along with physiotherapy and acupuncture. She was currently being medically treated with muscle relaxers which were not giving the girl any relief.
A chiropractic examination noted the head tilt and the spasm of neck muscles. The girl had a limited range of motion in her neck, which produced pain on certain movements. X-rays of the girl’s neck showed asymmetry of the position of the vertebrae at the top of her neck.

Regular chiropractic care was started daily for the first week. During that initial time, the girl reported significant relief of her pain. After the first week, care was rendered three time per week for the following three months.

The results of the care documented a significant reduction of the girl’s pain, elimination of spasm of her neck muscles, and an improvement in the position of her head. She also reported not having any more headaches. After nine months of care, the study reports that the girl was symptom free. This caused a positive change in her mood and she regained her self-confidence.

The Journal of Primary Care & Community Health published in Volume II:1-6 of their journal and accepted on August 5, 2020, a study that showed chiropractic care ranked better that a multidisciplinary pain team in the care of chronic spinal pain.

In explaining the background for this study, the authors state, "Chronic spinal pain is one of the most common diseases in the United States. Underserved patients are most affected, and disproportionately may use opioid medications as they lack access to other therapies." The authors go on to say, "In the United States, 20.4% (50.0 million) adults suffer from chronic pain, and 8.0% (19.6 million) of U.S. adults have high-impact chronic pain (chronic pain limiting life and work activities)."

Lower back pain in the most common spinal pain and causes the most years of disability globally. Neck pain ranks fourth in years of disability. It is also reported that those that live in poorer communities are more likely to have disability from spinal pain than those in more affluent areas.

This study was conducted in a healthcare center in St. Louis, Missouri. In that center, two types of care were given to patients with chronic pain. One type of care was given by a multidisciplinary chronic pain team, and the other type of care was chiropractic care. The team rendering multidisciplinary chronic pain care consisted of a primary care physician (PCP), a behavioral health consultant, a clinical nurse, and a clinical pharmacist. The chiropractic care was given by faculty professors and students from Logan University, a chiropractic college in Chesterfield, Missouri.

Patients entering the study were referred to either type of care or both, based on the patient’s preference and recommendation of their provider. The pain team care was largely reimbursed by insurance while the chiropractic was paid by the patients. A "PDQ" (Pain Disability Questionnaire) was used to measure the results of the participants in each of the groups.

There were 20 participants who received chiropractic care and 12 who were treated by the pain team. The study itself was scheduled to run for a longer period of time with more participants but was cut short due to the COVID-19 pandemic. The results of those who were able to complete the study showed that the chiropractic group had significantly more improvement that the pain team group after care was rendered by the respective groups.

The authors reported in their study that, "…enrollment in the chiropractic team (P = .01) were associated with a larger improvement in PDQ after intervention." They noted that chiropractic care should be included in healthcare centers to make it easier for those in underserved areas to receive chiropractic care.