The types and frequencies of improved nonmuskuloskeletal symptoms reported after chiropractic spinal manipulative therapy

Objective: To investigate the frequency and types of improved nonmuskuloskeletal symptoms reported after chiropractic spinal manipulative therapy. Design: Retrospective information obtained by chiropractors through standardized interview of patients on return visit within 2 weeks of previous treatment. Setting: The private practice of 87 Swedish chiropractors (response rate 81%). Subjects: Twenty consecutive (presumably naïve) patients per chiropractor (1504 valid questionnaires returned, 86% of optimal number of replies). Intervention: Spinal manipulation with or without additional therapy provided by chiropractors. Main Outcome Measures: Self-reported improved nonmuskulo-skeletal symptoms (reactions). Results: At least 1 reaction was reported after the previous treatment in 21% to 25% of cases. Of these responses, 26% were related to the airway passages (usually reported as “easier to breathe”), 25% were related to the digestive system (mostly reported as “improved function”), 14% were classified under eyes/vision (usually reported as “improved vision”), and 14% under heart/circulation (about half of these reported as “improved circulation”). The number of spinal areas treated was positively associated with the number of reactions. Conclusion: A minority of chiropractic patients report having positive nonmuskuloskeletal reactions after spinal manipulative therapy but such reports cluster predominantly around specific symptoms. It would be interesting to find out if these can be verified objectively and, if so, to investigate if they are caused by the treatment or if they are signs of natural variations in human physiology. (J Manipulative Physiol Ther 1999; 22:559–64)     

A randomized controlled trial of chiropractic spinal manipulative therapy for migraine

OBJECTIVE: To assess the efficacy of chiropractic spinal manipulative therapy (SMT) in the treatment of migraine. DESIGN: A randomized controlled trial of 6 months' duration. The trial consisted of 3 stages: 2 months of data collection (before treatment), 2 months of treatment, and a further 2 months of data collection (after treatment). Comparison of outcomes to the initial baseline factors was made at the end of the 6 months for both an SMT group and a control group. Setting: Chiropractic Research Center of Macquarie University. PARTICIPANTS: One hundred twenty-seven volunteers between the ages of 10 and 70 years were recruited through media advertising. The diagnosis of migraine was made on the basis of the International Headache Society standard, with a minimum of at least one migraine per month. INTERVENTIONS: Two months of chiropractic SMT (diversified technique) at vertebral fixations determined by the practitioner (maximum of 16 treatments). MAIN OUTCOME MEASURES: Participants completed standard headache diaries during the entire trial noting the frequency, intensity (visual analogue score), duration, disability, associated symptoms, and use of medication for each migraine episode. RESULTS: The average response of the treatment group (n = 83) showed statistically significant improvement in migraine frequency (P < .005), duration (P < .01), disability (P < .05), and medication use (P< .001) when compared with the control group (n = 40). Four persons failed to complete the trial because of a variety of causes, including change in residence, a motor vehicle accident, and increased migraine frequency. Expressed in other terms, 22% of participants reported more than a 90% reduction of migraines as a consequence of the 2 months of SMT. Approximately 50% more participants reported significant improvement in the morbidity of each episode. CONCLUSION: The results of this study support previous results showing that some people report significant improvement in migraines after chiropractic SMT. A high percentage (>80%) of participants reported stress as a major factor for their migraines. It appears probable that chiropractic care has an effect on the physical conditions related to stress and that in these people the effects of the migraine are reduced.     

The assessment of cervical intersegmental mobility before and after spinal manipulative therapy.

The objective of this study is to assess the changes in cervical intersegmental spinal mobility before and after the use of spinal manipulative therapy (SMT). Two systems of mensuration are utilized in 58 case studies. The results are then compared to previously defined normal values and the efficacy of SMT is objectively assessed. Of the 58 case studies presented, results reveal that post-SMT mobility is significantly (p less than .05) greater than the pre-SMT data, with exception of the C1 segment of both the male and female treatment groups utilizing the Henderson et al. mensuration method. Although both systems displayed improved post-SMT scores, one system appeared to be a more sensitive form of mensuration, while the other is more inclusive, not depending on radiographic findings alone.     

Recovery pattern of patients treated with chiropractic spinal manipulative therapy for long-lasting or recurrent low back pain

OBJECTIVE: To investigate the recovery pattern in chiropractic patients being treated for long-lasting or recurrent low back pain; in particular, to identify the minimum number of required treatments and the minimum number of days from the beginning of treatment to the occurrence of improvement. DESIGN: Prospective, uncontrolled multicenter study. SETTING: Private practice. PARTICIPANTS: Each of 19 selected Norwegian chiropractors provided 10 consecutive patients; each of the latter fulfilled a set of criteria (low back pain, a present episode longer than 2 weeks in duration, a total of more than 4 weeks of low back pain in the preceding year, no chiropractic treatment during the preceding 6 months, and suitability for manipulation). Response Rate: Data were collected on 164 patients (86% of the optimal study sample), 6 of whom were excluded. This left 158 patients for the analyses. Main Outcome Measures: Information on low back pain status was collected on each visit (maximum, 12 visits) through use of both a 10-point numeric pain rating scale and a global improvement scale (for the question "Do you feel that you have improved since you began receiving chiropractic treatment?," 5 answers were possible, ranging from "Yes, definite improvement" to "No, I am worse now than when the treatment started"). With respect to the numeric pain rating scale, "improvement" was defined as the point at which the score reached 2 for the first time or, if the initial score was 2, the point at which the score reached 1 for the first time. With respect to the global improvement scale, "improvement" was defined as the point at which the patient first answered "Yes, definite improvement." RESULTS: Approximately 50% of patients reported that they had "improved" at the 4th visit and within 2 weeks. After this time, fewer new cases of "improvement" occurred for every visit or day since the first treatment. At the 12th visit (earlier if treatment was concluded before the 12th visit), approximately 75% of the patients reported that "improvement" had occurred. CONCLUSION: There is a large group of chiropractic patients with relatively long-lasting or recurrent low back pain who report "improvement" early in the course of treatment.     

Treatment of severe glaucomatous visual field deficit by chiropractic spinal manipulative therapy: a prospective case study and discussion

OBJECTIVE: To discuss the case of a patient with severely reduced visual fields arising from terminal glaucomatous retinal damage and the treatment of this condition by spinal manipulation. CLINICAL FEATURES: A 25-year-old uniocular female patient with congenital glaucoma sought chiropractic treatment for spinal pain, headache, and classic migraine. Advanced optic disk cupping was present, and loss of vision was near complete. A 3-degree island of central vision and a small area of peripheral light sensitivity had remained relatively stable for 3 years after a trabeculectomy procedure that had resulted in intraocular hypotony. INTERVENTION AND OUTCOME: It was considered possible that chiropractic spinal manipulative therapy may have a positive outcome in visual performance. Before commencing chiropractic spinal manipulative therapy, an ophthalmologic examination was performed, and visual performance was monitored through a course of treatment. Immediately after the first treatment, significant visual field improvement was recorded in the remaining eye. Maximal improvement of vision was achieved after 1 week (4 treatment sessions). Total monocular visual field had increased from approximately 2% to approximately 20% of normal. Corrected central acuity had improved from 6/12 to 6/9. Independent reexamination by the patient's regular ophthalmic surgeon confirmed the results. CONCLUSION: Recovery of vision in this patient was an unexpected and remarkable outcome, raising the question of whether chiropractic spinal manipulative therapy may be of value in the management of glaucomatous visual field loss. More intensive research is required.     

The effect of duration and amplitude of spinal manipulative therapy (SMT) on spinal stiffness

The aim of this study was to determine the effect of spinal manipulative therapy (SMT) force magnitude and force duration on the spinal stiffness of a feline preparation. A mechanical device performed simulated SMTs at the L6 spinous process in 22 anesthetised felines. Animals were divided into four groups. Two groups (no preload, preload) received SMT having maximal displacements of 1.0 mm, 2.0 mm and 3.0 mm of total displacement (displacement control). In two other groups (preload, no preload), SMTs were applied with maximal loads of 25%, 55% and 85% body weight (force control). Each of the SMTs were applied in order of increasing displacement or force amplitudes, at increasing durations ranging from 25 to 250 ms. Spinal stiffness was quantified by applying an indentation load to external surface of the back. Linear mixed effects models were fit for post-SMT stiffness variables. When SMT was applied under displacement control with and without a preceding preload, a significant interactive effect occurred between force magnitude and force duration (p ≤ 0.05) for some of the stiffness variables. The findings from this experiment demonstrate that spinal stiffness in a feline model was affected by the interaction of the force amplitude and force duration parameters but the exact nature of this interaction remains unclear. This study provides guidance for further investigation given other SMT parameters not tested here may facilitate the ability of SMT to alter spinal stiffness.     

Compression fractures in patients undergoing spinal manipulative therapy.

Increasing numbers of elderly patients are currently seeking chiropractic care. One condition commonly seen in the elderly is osteoporosis of the spine, which carries with it the risk of compression fractures. We present four cases in which patients were noted to have compression fractures following chiropractic adjustments. In each of these cases, serious questions are raised concerning the relationship between the adjustment and the occurrence of fracture. What is clear is that failure to diagnose a compression fracture, together with the application of adjustment into the area of fracture, can increase symptoms and prolong disability. It is recommended that patients with osteoporosis who have suffered a fall or injury be X rayed before treatment is given. In addition, special care should be exercised in elderly patients with osteoporosis.     

Internal forces sustained by the vertebral artery during spinal manipulative therapy

BACKGROUND: Spinal manipulative therapy (SMT) has been established as a clinically effective modality for the management of several musculoskeletal disorders. One major issue with the use of SMT is its safety, especially with respect to neck manipulation and the risk of stroke in the vertebrobasilar system. OBJECTIVES: Our objectives were to quantify the strains and forces sustained by the vertebral artery (VA) in situ during SMT. Study Design: This was a cadaveric study. METHODS: Six VAs were obtained from 5 unembalmed postrigor cadavers. The cephalad/distal (C0-C1) and caudad/proximal (C6-subclavian artery) loops of the VA were carefully exposed and instrumented with a pair of piezoelectric ultrasonographic crystals. The strains between each crystal pair were recorded during range of motion testing and diagnostic tests and during a variety of SMT procedures. The VA was then dissected free and strained on a materials testing machine until mechanical failure occurred. RESULTS: SMT performed on the contralateral side of the cervical spine resulted in an average strain of 6.2% +/- 1.3% to the distal (C0-C1) loop of the VA and a 2.1% +/- 0.4% strain to the proximal (C6) loop. These values were similar to or lower than the strains recorded during diagnostic and range of motion testing. Failure testing demonstrated that the VAs could be stretched to 139% to 162% of their resting length before mechanical failure occurred. Therefore the strains sustained by the VA during SMT represent approximately one ninth of the strain at mechanical failure. CONCLUSIONS: SMT resulted in strains to the VA that were almost an order of magnitude lower than the strains required to mechanically disrupt it. We conclude that under normal circumstances, a single typical (high-velocity/low-amplitude) SMT thrust is very unlikely to mechanically disrupt the VA.