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Immune Responses to Spinal Manipulation
By Malik Slosberg, DC, MS
For many years, chiropractors have observed in their own practices that their patients sometimes demonstrate improvements of complaints related to immune problems: the disappearance or lessening of allergy symptoms, quicker recovery from or less frequent and severe colds and other respiratory infections, and so on.In the scientific literature, there have been occasional case reports that corroborate such findings, but no sound evidence to really document their veracity. These clinical observations remain suspended in that grey area unsubstantiated by scientific data to confirm their validity. Significant limitations of changes attributed to spinal manipulation in individual patients include 1) there is never a control group; 2) there is no blinding; 3) the improvement may simply be due to time; 4) they may be a nonspecific effect of care and attention; 5) it may be a regression to the mean; or 6) the result may be due to something other than spinal manipulation.
In some large studies, it has been found that chiropractic care for nonmusculoskeletal conditions is only weakly to moderately successful, but rarely harmful1-2 The most recent and thorough systematic literature review found that the evidence for effectiveness of spinal manipulation was inconclusive for nonmusculoskeletal conditions.3
Despite the lack of evidence of clinical effectiveness for nonmusculoskeletal conditions, a series of recent studies from several international research groups is systematically building the case that spinal manipulation appears to reduce the production of pro-inflammatory cytokines and increase the blood levels of immunoregulatory cytokines. Cytokines are small cell-signaling protein molecules that are secreted by numerous cells of the immune system and are a category of signaling molecules used extensively in intercellular communication.
The accumulation of data from these studies suggests that a possible benefit of spinal manipulation is related to neuroimmunological effects. Of course, this is an exciting proposition for clinicians who have seen such changes in their own patients. Let's review some of the research exploring the connections between spinal manipulation and functional changes in the immune system.
Early Research on Manipulation and the Immune System
Research in the 1990s laid the groundwork for the more recent papers published in the past five years. Brennan, et al.,4 published a paper demonstrating that upper thoracic spinal manipulation resulted in markers indicating significant increased phagocytic activity of neutrophils and monocytes compared to a sham manipulation or soft-tissue treatment. The findings suggest that a certain force threshold was needed to elicit the response.
In a second study, Brennan, et al.,5 concluded that their data suggests spinal manipulation, which generates a force over a certain threshold, elicits viscerosomatic responses that affect both neutrophils and mononuclear cells phagocytic activity, at least over the short term. And in a very small 1994 study,6 the study authors concluded that upper cervical adjustments increased CD4 "helper" T-cell counts, which initiate the body's response to viruses in HIV-positive subjects, by 48 percent over the six-month duration of the study.
Neural immunoregulation: Communication Between the Immune and Nervous Systems
These earlier papers have now been followed-up by a series of recent studies within the past five years. Teodorczyk-Injeyan, et al.,7 described the interplay between the nervous system and immune system as neural immunoregulation. The authors note that immune homeostasis is based on the reciprocal communication between the immune and the nervous systems executed by the actions of cytokines and neurotransmitters. In addition, the paper explains the close association of autonomic nerve terminals with macrophages and lymphocytes, which facilitates a chemically mediated transmission between nerves and immune cells.
This research group has published a series of papers that explores the relationship of spinal manipulation, spinoautonomic reflexes and their influence on activity of cells involved in immune and/or inflammatory responses. These interconnections may have great clinical relevance because studies8 on the pathophysiology of discogenic low back pain, sciatica, and ligamentous tissue damage-related pain9 reveal that the production of pro-inflammatory mediators, such as tumor necrosis factor alpha (TNF-a) and interleukin-1 beta (IL-1ß), are major factors in the genesis of pain and functional changes in neural activity. Furthermore, studies of the hypoalgesic effects of spinal manipulation have already been reported in the literature, suggesting that an anti-inflammatory mechanism might be activated by spinal manipulation.10-11 Recent clinical studies have shown that chemical blockage of TNF-a is highly effective in reducing sciatic pain.12
Reduced Pro-Inflammatory Cytokines After Spinal Manipulation
In the first of their studies, the authors report that a single bilateral hypothenar upper-thoracic HVLA thrust resulted in the reduction of in vitro inflammatory cytokines, TNF-aand IL-1ß in blood samples activated with lipopolysaccharide taken before, 20 minutes and two hours after spinal manipulation. TNF-a and IL-1ß significantly declined in asymptomatic subjects assigned to manipulation with cavitation/audible, whereas in the sham and control groups, TNF-a and IL-1ß levels increased significantly after exposure to lipopolysaccharide.
The paper's conclusion states that manipulation-related down-regulation of inflammatory-type responses occurred via an unknown central mechanism. These findings suggest that a single thoracic manipulation effectively ameliorates the physiological responses of blood cells to an inflammatory stimulus and that spinovisceral reflex effects may alter the functional activity of cells in the immune and/or inflammatory systems. Based on these findings, the paper notes that spinal manipulation is likely to present a noninvasive and efficacious alternative to drug therapies for reducing inflammation and resultant pain.
A 2009 paper from the Hungarian National Institute for Rheumatology and Physiotherapy13 reported a dramatic and significant reduction in both debilitating cervicogenic headaches (before treatment 3-6 times a week lasting a total of 31-36 hours a week), neck stiffness and TNF-a after manual therapy in two women who suffered post-whiplash, MRI-documented C4-5 disc herniation.
Previous trials of conservative care (analgesic infusions, physical therapy) had failed. Both patients, after a neurological consult, were recommended to have a discectomy, but both opted for a trial of manual therapy (two times a week for 4-8 weeks) first. After manual therapy, surgery was unnecessary because both women became headache-free with a normal range of cervical motion. In addition, both patients experienced a dramatic reduction in TNF-a (reduced by more than half).13
The medical researchers conclude that pro-inflammatory substances secreted by the nucleus pulposus are likely involved in symp-tomatic disc herniation. In addition, TNF-a, interleukin-1ß and interleukin-10 may be involved in the pathogenesis of migraine at-tacks. After restoring spinal segmental motion and reducing pathologic mechanical irritation/compression, TNF-a levels were mark-edly reduced and symptoms were eliminated. In 2010, Roy,14 et al., followed up these two studies by evaluating pre- and post-intervention measures from blood samples detecting pro-inflammatory cytokines interleukin 6 (IL-6) and C-reactive protein (CRP) after a series of nine chiropractic manipulations from T12-L5 using the an adjusting instrument and related protocol in 10 chronic low back pain patients and 10 healthy subjects. Once again, the introduction notes that low back pain is often associated with an inflammatory process and increased production of several pro-inflammatory cytokines including IL-6 and CRP. IL-6 is the main mediator of the acute phase of pro-inflammatory cytokines and results in a marked increase in liver cell synthesis of CRP.
This trial found that a series of nine thoracic manipulations resulted in a reduction of both IL-6 and CRP; that is, a normalization response. Both IL-6 and CRP levels were reduced toward the values in the healthy subjects. IL-6 and CRP were elevated in chronic LBP patients pre-intervention, but post-intervention differences were smaller, suggesting that nine manipulations are capable of attenuating the inflammatory response. The authors opine that it is plausible the inflammatory process was being reversed in those who received the adjustments.
Immunoregulation, Interleukin 2 and Spinal Manipulation
Another related avenue of research on neural immunoregulation evaluates the effects of spinal manipulation on the production of interleukin 2 (IL-2) – an immunoregulatory (not pro-inflammatory) cytokine and signaling molecule, instrumental in the body's response to microbial infection and for the body's ability to discriminate between foreign (non-self) and self. IL-2 is a pivotal cytokine in T-cell-dependent immune responses and plays a major role in the development, maintenance and survival of regulatory T cells. Thus, it is of critical importance in induction and sustenance of immune tolerance.
Seventy-six asymptomatic subjects15 were randomized to receive an upper thoracic manipulation with cavitation or without cavitation, or were included in a control group. All subjects had their blood drawn before, 20 minutes and two hours after the intervention. Production of IL-2 in mononuclear cell cultures was activated with staphylococcal protein A (SPA). Induced secretion of IL-2 increased significantly in manipulation with and without cavitation. The paper concludes that in vitro T lymphocyte response to a SPA stimulus became enhanced after spinal manipulation. Therefore, this effect may be independent of joint cavitation/audible. This finding suggests manipulation may influence IL-2 immune-regulated biological responses.
In 2010, Teodorczyk-Injeyan, et al.,16 continued with this research on induction and regulation of immune responses related to interactions between the immune and nervous systems mediated by actions of neurotransmitters and immunoregulatory cytokines. To this end, the researchers followed the subjects from the previous study to determine if the increased production of interleukin-2 as a result of a single thoracic manipulation is associated with increased antibody synthesis from monocytes.
The paper reports that there were indeed significantly increased synthesis of immunoglobulin G (IgG) and immunoglobulin M (IgM) antibodies induced in cultures of peripheral blood mononuclear cells in subjects who received thoracic manipulation, particularly in those who had an associated cavitation. The paper concludes that antibody synthesis (IgG and IgM) induced by interleukin-2 can be, at least temporarily, increased after manipulation. This is additional direct evidence that thoracic manipulation may influence interleukin-2 immune-regulated biological responses.
The Take-Home Message
The studies described above demonstrate an accumulation of evidence that indicates spinal manipulation may influence the immune system's response to various stimuli. Three of the studies suggest that manipulation consistently reduced the production of pro-inflammatory mediators associated with tissue damage and pain from articular structures. Two studies provide evidence that manipula tion consistently reduced the production of pro-inflammatory mediators associated with tissue damage and pain from articular structures. Two studies provide evidence that manipulation may induce and enhance production of the immunoregulatory cytokine IL-2 and the production of immunoglobulins as well.
We must acknowledge that these results are preliminary because most are performed on asymptomatic subjects and the duration of the effects so far have only been demonstrated to be short-lived. Nevertheless, this research opens the door to further exploration of the possible neuroimmunoregulatory effects of spinal manipulation and confirms what many of us have observed in practice: Adjustments reduce pain and inflammation, and may improve immunoregulatory function.
- Leboeuf-Yde C, et al. Self-reported nonmusculoskeletal responses to chiropractic intervention: a multination survey. JMPT, 2005;28(5):294-302.
- Leboeuf-Yde C, et al. The types and frequencies of improved nonmusculoskeletal symptoms reported after chiropractic SMT. JMPT, 1999;22(9):559-64.
- Bronfort G, Haas M, Evans R, Leiniger B, Triano J. Effectiveness of manual therapies: the UK evidence report. Chiropr Osteopat, 2010;18:3.
- Brennan PC, et al. Enhanced phagocytic cell respiratory burst induced by spinal manipulation: potential role of substance P. JMPT, 1991;14:399-408.
- Brennan PC, et al. Enhanced neurtophil respiratory burst as a biological marker for manipulation forces: duration of the effect and association with substance P and tumor necrosis factor. JMPT,1992;15:83-9.
- Selano JL. The effects of specific upper cervical adjustments on the CD4 counts of HIV positive patients. Chiro Res J, 1994;3:32-9.
- Teodorczyk-Injeyan JA, et al. SMT reduces inflammatory cytokines but not substance P production in normal subjects. JMPT, 2006;29:14-21.
- Fiorentino PM, Tallents RH, Miller J-nH. Spinal interleukin-1B in a mouse model of arthritis and joint pain. Arthritis Rheum, 2008;58:3100-9.
- King K, Davidson B, Zhou BE, Lu Y, Solomonow M. High magnitude cyclic load triggers inflammatory response in lumbar ligaments. Clin Biomech, 2009;25:792-98.
- Terrett Ac VH. Manipulation and pain tolerance. Am J Phy Med, 1984;63:217-25.
- Giles LG, Muller R. Chronic spinal pain: a randomized clinical trial comparing medication, acupuncture, and spinal manipulation. Spine, 2003;28:1490-502.
- Mohammadian P, Gonsalves A, Tsai C, Hummel T, Carpenter T. Areas of capsaicin-induced secondary hyperalgesia and allodynia are reduced by a single chiropractic adjustment: a preliminary study. JMPT, 2004;27:381-7.
- Omos G, MD, et al. Reduction in high blood TNF-a levels after manipulative therapy in 2 cervicogenic headache patients. JMPT, 2009;32(7):586-91.
- Roy RA, Boucher JP, Comtois AS. Inflammatory response following a short-term course of chiropractic treatment in subjects with and without chronic low back pain.Journal of Chiropractic Medicine, 2010;9:107-114.
- Teodorczyk-Injeyan JA, Injeyan HS, McGregor M, et al. Enhancement of in vitro interleukin-2 production in normal subjects following a single spinal manipulative treatment. Chiropr Osteopat, 2008;16:5.
- Teodorczyk-Injeyan JA, et al. Interleukin-2 regulated in vitro antibody production following a single spinal manipulative treatment in normal subjects.Chiropr Osteopat, 2010;18:26.
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The New Science of Spinal Regeneration
June 11 2005 | 19,690 views | + Add to Favorites
By Dr. Ben Lerner and Dr. Fred Dideminico
Everything from standing upright, to sleeping, to going to the bathroom is under direct control of the spinal column and the nervous system it encases. Yet, not very much medical or media attention is focused on sustaining this all-important area of the human body. As a result of the neglect, abuse and poor focus both the spine and nervous system receive, most people suffer greatly with the results of deterioration in this area at some point in their lives.
Patients and doctors alike are under the misconception that once a spinal condition exists -- including disc and nerve damage -- you need surgery or are forced to live with pain, weakness and organ malfunction for the rest of your life.
However, the truth behind today’s spinal treatments bears that while the spine can easily degenerate, it can also regenerate. Therefore, conditions once believed to be permanent can actually be not only healed, but reversed.
To receive spinal regeneration, you must go to a chiropractor trained in this area of spinal care. Similar to the medical field, chiropractic has also become highly specialized. While the mass majority of chiropractors today are essentially “general practitioners,” certain doctors of chiropractic have higher levels of training in neurology and spinal correction as well as pediatrics, pregnancy and over all health and wellness.
A View From the Inside
A review of published literature indicates that the upright adult spine loses up to 20 mm (slightly more than 3/4 inch) of vertical height each day due to loss of fluid from the disc. The sleep cycle allows the unloaded discs to regain most, but not all, of their fluid and height by the reabsorption of fluid surrounding the discs (Kapandji, 1974).
Since all the fluid and disc height is not regained, the spine becomes shorter starting around age 30. It is common to lose up to 2 inches of stature by age 60 due to the loss of disc fluid. In addition, loss of disc fluid and height compromise spinal form and function with lateral and rotatory postural deviations of the hips and shoulders (Kapandji, 1974).
The discs are comprised of 88 percent water. Proper hydration is essential for nourishment, lubrication and function of all joint cartilages, tendons, ligaments and spinal discs’ nutrition delivery and waste elimination. When the body dehydrates, it pulls water out of the “white tissues” first, meaning the ligaments and tendons of the body (i.e. vertebral discs). If the body continues to dehydrate, the body will pull water next out of the organs, eventually the brain and then you will die.
A loss of only 12 percent of the water out of the disc will reduce the disc height by 50 percent.
Surprisingly, the loss of 1 mm of height in a cervical disc and 1.4 mm loss of height in the lumbar disc will cause the same amount of neurological compression and IVF encroachment equal to an 8-degree rotation. (It takes a 3-degree rotation to cause IVF encroachment and neurological compromise). So you can see that it doesn’t take much water loss in the body to start affecting your discs and the function of your nervous system.
How does the water get lost? Between ages 12-14, the spinal discs’ blood nutrition supply and waste elimination system atrophies. That means the discs will have to receive their necessary water, nutrients and waste elimination from osmosis and imbibation (intersegmental motion of the spinal vertebrae that pump fluids, nutrients and waste in and out of the discs).
This becomes a challenge because, as people get older, they may become more sedentary, develop advancing spinal and postural degenerative conditions and ultimately lose the intersegmental motion of their spine. Once they lose this motion, the discs quickly dehydrate and lose height. This leads to IVF encroachment and chronic pain syndromes that soon advance to visceral and organic conditions leading to disease.
Chiropractors involved with spinal correction and rehabilitation can detect levels of disc degeneration and correct spinal displacements that are causing IVF encroachment, thus allowing the nervous system to function optimally and keep the body healthy. Until recently, it had been thought, once a disc was degenerated and lost height it could not be restored. It had also been thought that loss of disc height could not be prevented. These assumptions are no longer true.
Can the intervertebral discs rehydrate and regenerate? The discs need three things to regenerate:
Let’s look at the first two for now.
Research has shown, if we can create loading and unloading cycles in the spine, we can literally “suck” water back into the disc and rehydrate it predictably. So what are loading and unloading cycles? Loading and unloading cycles are consecutive alternating compression and traction movements. Repetitive traction (elongation) followed by compression of the discs produce “imbibation and osmosis” of water into the disc rehydrating or regenerating the disc height.
In addition to disc rehydration, the loading and unloading cycles reduce up to 95 percent of the elastic energy in the spine. The soft tissues have an inherent elastic, rebound energy and reflexes that return the body to its original position after a trauma. This elastic energy must be reduced if we are to achieve spinal correction. The loading and unloading cycles that reduce the elastic energy of the body is called hysteresis.
Hysteresis is essential for spinal correction because the structure of the spine is controlled by the soft tissues, the shape of the discs. The discs are like a hard Jell-O. They have a lot of tensile strength and a lot of rebound, elastic energy.
When a force is applied to the spine to change the structure, the elastic properties will rebound against that force and the hard Jell-O consistency of the disc will continue to maintain the current spinal structure. Hysteresis, repetitive traction and compression cycles liquefy the Jell-O like consistency, reduce the rebound energy by up to 95 percent and decrease muscle spasms to help the doctor achieve an easier adjustment as well as rehydrating the disc.
When the spine is soft, it is easier to mold the spine into a new structure. The newly liquefied disc will require 16-20 minutes to harden like Jell-O again. Once the spine is adjusted and the structure is corrected, the spine can be molded and hardened into its new structure.
The Pettibon System
For this reason, pre-adjustment warm-ups become essential for spinal correction and regeneration. The Pettibon System is a chiropractic system that can do this predictably. Here are some of the benefits of loading and unloading cycles.
The avascular discs ligaments and tendons are nourished and metabolic wastes are eliminated.
The visco-elastic properties of the discs, ligaments and tendons that hold the vertebral units out of their normal position are progressively less resistant to spinal corrective adjusting.
Up to 95 percent of the force needed to adjust or manipulate is reduced by these repetitive cycles.
Rehydrate the disc and increase disc height.
Increase disc and tendon strength.
Decrease the potential for injury or severity of injury from sudden applied forces.
Lubrication for spinal joints and nourishment for their cartilage.
Prevention of adhesions during healing and improved joint integrity of healed joints.
Development for “core” basis for further strength, endurance and agility training.
Rehabilitative exercise is an extremely valuable tool to aid the doctor in the management of both acute and chronic musculoskeletal conditions.
The Pettibon Chiropractic program is a program that offers a cervical decompressive type of tractioning along with a lumbar motion device designed to restore spinal curvatures and bring motion and fluid back to the cervical and lumbar discs. The safety and effectiveness of this type of program are far superior to any type of surgery. Any time you can avoid surgical intervention or drugs, you are far better off.
When accompanied with the right nutrients and additional exercises shown to you by your corrective care chiropractor, all of the elements necessary for spinal regeneration are there. At any age, with any level of degeneration, the potential for some degree of correction and healing is possible.
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Sensory Integration for Sensational Kids
Sensory Processing Disorder affects on average 1 in 20 children. 1 in 6 children have sensory challenges present in their every day lives. 1 in 100 children are diagnosed with Autism.
Children learn through their sensory systems. Everything they see, smell, taste, and touch is taken into their brain. Every movement of their body is registered. Neurosensory integration is the ability of the brain and body to take in, process, organize and integrate sensory information so we can feel safe and secure in our environment. This allows us to respond appropriately to situations and requests so proper social and academic learning can occur. The integration of the sensory systems beings when the baby is developing in the womb and the first year of life is a critical time for brain pathways to develop.
When a baby is born, they are pre-programed with primitive reflexes, which are automatic reactions to a specific stimuli. For example, have you ever stroked a baby's cheek and noticed that they automatically turn their head and open their mouth? This is an example of a primitive reflex that helps them learn to eat. These reflexes protect them from harm and help them learn how to live outside the womb. These reflexes should disappear after a few months as higher brain functioning takes over.
For some kids these reflexes do not disappear completely, meaning the child retains the primitive reflex and higher brain functioning does not take over as it should. Why this happens in one child and not another is still unknown, however many theories exist.
Symptoms of a retained reflex depend on which of the many reflexes still exist. Some common symptoms are:
Many children with these traits are labeled with Autism, Sensory Processing Disorder (SPD), Attention Deficit Disorder (ADD) and Attention Deficit Hyperactivity Disorder (ADHD).
Dr. West offers a unique neurodevelopmental program in her office that combines chiropractic care with neurointegrative exercises and nutritional counseling. Dr. West is a board certified Pediatric Chiropractor who has advanced education working with the specific needs of these fantastic kids!
Each child is evaluated for subtle misalignments in their spine and pelvis. These misalignments can be created in utero, through the birth process or as the result of physical trauma. Physical trauma can happen as they are learning to walk or ride a bike and take a few falls. As they play in sports or on the playground. The brain and body need to be in constant communication through the nervous system, which is supported by the skull and spine. A misalignment in the spine can slow this communication creating an immaturely functioning nervous system. The sensory information that comes into the body and the commands down from the brain will be delayed. The chiropractic adjustment helps to stimulate the nervous system and remove blockages in this flow of information.
Numerous studies have shown that kids with neurodevelopmental disorders have chronic gut inflammation. This inflammation can contribute to picky eaters, repeated illnesses and behavior problems. Dr. West works to help correct the source of the gut problem, not just covering the symptoms. Through specific dietary changes and supplements it is possible to heal the intestines, leading to happier and healthier children.
Neurointegrative exercises help to restore the brain-body connection. Each child has their own exercise program developed specifically for their needs. The program works to integrate any retained primitive reflexes, while helping the child develop their sensory skills.
If you think your child may benefit from our program please call us at the office today!
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A New Frontier for Caring for the Child With ADHD and Sensory Integration Dysfunction
By Claudia Anrig, DC
For doctors of chiropractic who serve the challenged child segment, it is not uncommon to hear, "Doctor, can chiropractic help my child with ADHD?" In my personal practice, I have seen many children helped with these disorders, and I have spoken to colleagues worldwide who shared their personal success stories. However, in all honesty, these success stories do not necessarily mean we can produce repeatable "breakthrough" results.
Over the years, I have never seen any specific technique, system of chiropractic analysis, protocol of care or adjunctive therapy (e.g., exercise, nutrition) to treat such challenging disorders. Now, however, the wait finally may be over. Monika Buerger, DC, and Robert J. Melillo, DC, DABCN, each have established timely, instructional programs for those seeking to serve these challenged pediatric population groups.
Dr. Buerger has been in private family practice for 15 years, specializing in sensory integration disorders in children. In her experience, she has found that many children who are diagnosed with ADD/ADHD, dyslexia, and various other autism spectrum disorders and learning disorders have an underlying problem with sensory integration dysfunction (SID). She notes that many of these children are being prescribed unnecessary medications and/or are not receiving proper treatment.
Sensory integration is the ability to take in, process, organize and assimilate sensory information so that we feel comfortable and secure; we then can respond appropriately to given situations and demands. All forms of learning occur through this process. Children with sensory SID experience a "disconnect" between the brain and the body (PNS and CNS) and have difficulty processing sensory information. Two rarely known senses are vestibular and proprioceptive sensations, both of which commonly function improperly among children with the above disorders.
Several years ago, Dr. Buerger became interested in this area and began extensive research, attending various seminars and workshops. Most sensory integration work has been performed in the occupational therapy arena; however, knowing the great impact chiropractic plays on the occulomotor, vestibular and proprioceptive systems, not to mention the entire nervous system, she knew the chiropractic profession needed to be a vital component in the treatment of these children. The more she researched and began to work in this field, it seemed to her that the neurological basis for SID was written for the chiropractic profession. Armed with a DC degree and a bachelor's degree in exercise physiology from California State University, Fresno, she began developing a program in her office for children with ADD and ADHD. As the children's success became known in her community, this area of her practice grew and began to include a variety of children with learning disorders. She also began to develop programs for local elementary schools.
Dr. Buerger is on the postgraduate faculty of several chiropractic college and is an instructor with the ICPA. She is also a contributing author to Pediatric Chiropractic. She shares a mission to teach doctors vital information regarding the treatment of children. As part of this mission, she developed a sensory integration program for the doctor of chiropractic, integrating the neurological principles of SID and those of chiropractic. The program in now offered through the ICPA and teaches how to perform a specific and detailed history, including what she calls a sensory and academic profile (SAP), a detailed neurological and sensory analysis and evaluation, specific short-lever adjustment protocols, home, school, and recreational recommendations, nutritional and biochemical considerations, and specific sensory exercise programs that are "graduated" in difficulty as children progress.
The program also discusses ways to implement a sensory integration program into your practice at any level, depending on how much space you have in your office, how much time you want to spend with patients, and how much you want to invest financially. The program is designed to give the doctor of chiropractic a firm understanding of the fundamental principles of neurosensory disorders and how they relate to children with ADD, ADHD, dyslexia, autism spectrum disorders, and various other learning and behavioral disorders. Its neurological basis gives the doctor of chiropractic a solid understanding as to why these children need chiropractic and its value as part of a drug-free treatment approach.
At the University of Bridgeport College of Chiropractic, Dr. Robert J. Melillo has been working with children in the area of neurobehavioral disorders like ADHD, dyslexia, learning disabilities, and autism for more than 10 years. He started to research the problem in 1995; at that time, the statistics showed a 250 percent increase in the use of Ritalin between 1990 and 1995. With these disturbing facts in mind, Dr. Melillo chose to devote much of his professional career toward trying to understand not only what causes ADHD and other neurobehavioral disorders, but also what can be done to correct these problems on a long-term basis, without the use of medication.
In 2004, Dr. Melillo published a textbook titled Neurobehavioral Disorders of Childhood - An Evolutionary Perspective, which describes what he believes to be the primary neurophysiologic mechanism that produces many of the most common neurobehavioral disorders. Applying this neurophysiologic mechanism to chiropractic, he focuses on three main areas: sensory/motor systems, biomechanical/nutritional, and neuropsychological, with the main concept revolving around hemispheric balance. His belief is that most of the symptoms seen in children with ADHD can best be explained by decreased activity in one hemisphere in the brain, often caused by an imbalance in the way that postural, vestibular and occulomotor information is being sent to the brain. As a result, one hemisphere is underactive, preventing the proper synchronization of the two hemispheres, which is necessary to properly share and process information.
From a chiropractic standpoint, an imbalance in postural muscle tone producing an observable subluxation complex may result in more gross postural disturbances, such as head tilts, which also could have central neurological consequences affecting and involving cognitive and behavioral functions.
Dr. Melillo recognizes that each child is different and should therefore be treated specifically; however, he has made his courses and treatment approaches more protocol-driven throughout the years for teaching purposes. He has developed specific protocols that involve not only precise adjustments, but also particular nutritional-, sensory-, motor- and cognitive-based protocols as well. The key, as he sees it, is to get the doctors to start seeing results, and protocols are the best means to that end.
A graduate education in neurology is not necessary for chiropractors wishing to take either of these new programs. The courses provide the chiropractor with all of the information necessary to treat children with ADHD and to help them feel comfortable interacting with other professionals such as teachers, occupational therapists, psychologists, and optometrists who also treat these children. To learn more about these programs, contact Monika Buerger, DC, at www.icpa4kids.com or Robert Melillo, DC, DABCN, atwww.carrickinstitute.org.
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The chiropractic profession has always relied on clinical research and experimentation and chiropractic research is occurring around the world. Also, the chiropractic colleges are active in research as are several excellent research organizations which adhere to the strictest scientific standards. Here are a sampling of some of the most noteworthy research studies conducted since 1980.
|Oakland University Study
At Michigan's Oakland University, Miron Stano, Ph.D. compared the health care costs for medical and chiropractic patients. By reviewing the insurance claims paid, Dr. Stano concluded that patients who received chiropractic care, either alone or in conjunction with medical care, experienced health care costs that were $1000 lower on average than those who received only medical care. Total insurance payments for patients who received only medical care were thirty percent higher than those who were under the care of a chiropractor. This lower cost was attributed to lower in-patient and out-patient costs and showed that "the chiropractic care substitutes for other forms of out-patient care.
|The Manga Report
"The Manga Report, from the University of Ottawa, reviewed all the international evidence on the management and low cost of back pain care. Pran Manga, Ph.D. concluded that significant cost savings would occur if the management of low back pain were transferred from physicians to chiropractors. He determined that chiropractic is safer than medical management of low back pain. "Many medical therapies are of questionable validity or are dearly inadequate. Chiropractic care is greatly superior to medical treatment interms of scientific validity, safety, cost effectiveness and patient satisfaction." Dr. Manga concluded that "chiropractic should be fully insured (and) fully integrated into the Ontario health care system."
|The British Medical Research Council
The British Medical Research Council documented a ten-year study which compared chiropractic and hospital out-patient management of seventy-four (74) patients with acuteand chronic mechanical low back pain. The results showed that chiropractic care was significantly more effective than medical treatment for patients with chronic and severe pain. Furthermore, these results were long-term and remained consistent throughout the two-year follow-up period. Chiropractic was also shown to save the British more than 10 million pounds a year by having hospital out-patients with low back pain under chiropractic care.
|New Zealand Study
These findings reinforced the conclusions of the New Zealand Report (377 pages) which was one of the most thorough and positive studies of chiropractic care on record. The twenty-month project was conducted by a government commission.
It concluded that spinal adjusting is a vital, very safe and clinically effective form of health care. Chiropractors have more thorough training in spinal mechanics and spinal carethan any other health professional. Furthermore, chiropractic is scientifically based and must be made an integral part of all hospital care. Finally, the report said that "modern chiropractic is a soundly based and valuable branch of health care in a specialized area neglected by the medical professional."
J. S. Wright, D.C., conducted a study and reported to the Journal of Chiropractic that 74.6 percent of patients with recurring headaches, including migraines, were either curedor experienced reduced headache symptoms after receiving chiropractic adjustments. Daniel C. Cherkin, Ph.D. and Frederick A. MacCormack, Ph.D., a survey in 1989 that concluded that patients who were receiving care from health maintenance organizations (HMOs) in Washington State were 3 times as likely to report satisfaction with chiropractic care as they were from other physicians. The patients also reported they believed that their chiropractor was concerned about their welfare.
|AV MED HMO Study
AV MED, a large HMO in the southeast, wanted to see if it could save money by having patients visit chiropractors for back pain. They chose one-hundred patients, eighty of whom had already been treated medically--without results. In each case, the patient had been seen by an average of 1.8 M.D.s. After receiving chiropractic adjustments, not one of the 100 patients had to have surgery. Furthermore, 86 percent of them got better and none of them got worse. Herbert Davis, M.D., the medical director of AV MED, said that chiropractic care saved the HMO $250,000 in surgical costs alone!
|Nevada Worker's Compensation Study
The State Industrial Insurance Systems (SIIS) in Nevada compared the average medical and chiropractic care for patients who suffered industrial injuries from 1988-1990. The results showed that 24.4 percent were back injuries but they accounted for more than 50 percent of all medical costs. Over the three-year period, the average medical cost per patient was $2,142 which was 260 percent higher than the average chiropractic cost per patient of $892; Loss of work time under chiropractic care is less than one-third that for medical care. Furthermore, injured workers are able to continue working while receiving chiropractic care which may not be an option for medical care patients who are advised to have bed rest and medication. The Nevada Worker's Compensation Study emphasized that chiropractic eliminates the concern and expense of inappropriate hospitalization, unnecessary surgery, improper use of medication including the high dosage of narcotic painkillers.
|University of Saskatchewan Study
In 1985, the University of Saskatchewan Study monitored 283 patients "who had not responded to previous conservative or operative treatment" and who were initially classified as totally disabled. The study revealed that after daily spinal adjustments were administered, "81 percent ...became symptom-free or achieved a state of mild intermittent pain with no work restrictions.
|The Bristish Medical Journal
The British Medical Journal reported in the June 2, 1990 issue that T.W. Meade, M.D. studied patients over a two-year period. Dr. Meade found that "for patients with low-back pain in whom spinal adjustments are not contraindicated, chiropractic almost certainly confers worthwhile, long-term benefit in comparison with hospital outpatient management."
In 1991, Steve Wolk, Ph.D., studied 10,652 worker's compensation cases in Florida. The results reported by the foundation of' Chiropractic Education and Research concluded that: "A claimant with back-related injury, when initially cared for by a chiropractor versus a medical doctor, is less likely to become temporarily disabled, or if disabled, remains disabled for a shorter period of time; and claimants treated by medical doctors were hospitalized at a much higher rate than claimants care for by chiropractors."
|The Gallup Study
The Gallup Organization conducted a demographic poll in 1991 which revealed that ninety percent of chiropractic patients felt their care was effective. More than eighty percent were satisfied with the care they received and almost seventy-five percent felt most of their expectations had been met during chiropractic visits.
Also in 1991, Joanne Nyiendo, Ph.D., conducted a worker's compensation study in Oregon. She concluded that the median time loss in days for comparable injuries on any case was 9.0 days for patients who received chiropractic care as compared to 11.5 days for those who received medical treatment.
|Saskatchewan Hospital Study
Two years later, in 1993, researchers at the Royal University Hospital in Saskatchewan concluded that "the care of lumbar intervertebral disk herniation by side posture adjustments is both safe and effective." The researchers involved in the report, J. David Cassidy, D.C.; Haymo Thieli D.C.; M.S. and W. Kirkaldy-Willis, M.D., are all on staff at the hospital's Back Pain Clinic.
|Journal of American Health Policy
A 1992 review of data gathered from over two million users of chiropractic care in the United States appeared in the Journal of American Health Policy. It stated that "chiropractic users tend to have substantially lower total health care costs". The data also indicated that chiropractic care reduces the need for both physician and hospital care.
|The Agency for Health Care Policy and Research (AHCPR) issues guidelines for low back problems.
The U.S. agency for Health Care Policy and Research (AHCPR) formed a 23-person panel to find out the best ways to care for low back problems in adults. These health care professionals, including experts in orthopedic surgery, family practice, internal medicine, physical and rehabilitative medicine, emergency medicine, neurosurgery, rheumatology, and many other disciplines reviewed more than 3,900 studies on the topic. These guidelines released in December 1994 verified what chiropractors had been saying for years:surgery and medication should be a last resort treatment for most cases. Moderate exercise and chiropractic adjustments are far more effective and less risky.
Philip R. Lee, M.D. assistant secretary for health and director of the Public Health Service, said, "By encouraging people with acute Holow back problems to resume normal activities, using only those treatments that have been scientifically shown to be effective, these guidelines could save Americans considerable anguish time and money now spent on unneeded or unproven medical care."
One clear message from all these studies is that chiropractic remains a cost effective and efficient method of healing that is, in many instances, equal or superior to medical care. The studies, which have often been conducted by state health or workers compensation agencies, have shown that chiropractic is often less expensive, significantly reduces the time away from work and often eliminates the dangers of drugs and surgery.
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