2016 SOT Research Conference Proceedings Abstracts

Introduction:  A 59-year-old male began to experience intermittent diplopia 50% of the time, which after three-days became constant. He consulted with an ophthalmologist and was diagnosed with afourth-cranial nerve palsy, given prism glasses to correct the displacement, and presented 02-17-15 at this clinic.

Methods:  Patient was treated using sacro-occipital technique (SOT) protocols to investigate cranial bone, and TMJ imbalance. Examination noted TMJ anterior displacement with reduction of right TMJ disc, decreased joint translation, and other findings indicating the need for dental modification of the dental occlusal splint he was using. The patient was treated for a total of six-visits between 02-17-15 – 04-23-15.

Results: By the third-chiropractic office visit the patient noted reduced neck pain, antalgia, significantly improved cervical ranges of motion, and a 70% reduction in diplopia, so was referred to have the splint dentally equilibrated. By the third-dental visit on 04-02-15 he stopped needing prism glasses. Follow-up ophthalmology exam in May 2015 found no evidence of diplopia.

Conclusion:  It is difficult to generalize from case reports, however the ongoing nature of the patient’s condition and the temporal relationship between the care received and his response warrants further study.

Introduction: A 47-year-old female woke up with darkness and limited vision in the right eye, which after consulting an ophthalmologist was diagnosed with an orbital pseudotumor, unresponsive to steroidal anti-inflammatories.  She presented at this office with chronic intermittent headaches in the orbital region with flashes of light affecting her vision, then becoming centralized blind spots.

Methods: Examination noted obstructive airway compromise with maxillary deficiency, maxillary exostosis and mandibular tori. She presented with pelvic torsion and left SI joint instability (SOT category-two).  At the first office visit she was told to stop using the upper nightguard, since this can further compromise her airway space. She was treated with SOT and cranial techniques for eight-visits.

Results: After her fourth-visit she noted reduced eye symptomatology and was no longer waking up with the prior headache related visual symptoms.  She was referred to her ophthalmologist who determined a 65% improvement in her pseudotumor. She is currently scheduled for dental co-treatment to better maintain her reduced craniomandibular distortions.

Conclusion:  It is difficult to generalize from case reports, however the ongoing nature of the patient’s condition and the temporal relationship between the care received and his response warrants further study.

Introduction: A 27-year-old male rock and boulder climber presented for care because he had noticed weakness and discomfort upon shoulder loading, particularly when climbing but also with other activities necessitating the engagement of his shoulder joint.  This was a gradual onset chronic type injury, taking place over 6-9 months of elite indoor and outdoor rock climbing.

Intervention/Methods: Treatment essentially consisted of sacro occipital technique (SOT) and extremity technique care to reduce the anterior and posterior fascial lines to minimize the effect of his FHP on any thoracic outlet syndrome, repositioning the humeral head in a P/A position, kinesiotape to stabilize the shoulder joint, and exercises to stretch the anterior shoulder girdle and strengthen the posterior scapula stabilizers.

Results: Following the initial office visit the patient reported having improved strength and could sleep without pain or shoulder positions.  The patient was treated in this manner two times a week for two weeks, and then once a week for two weeks at which time he was able to return to rock climbing.

Conclusion: This case study presents a patient with gradual onset, chronic shoulder weakness and pain secondary to rock climbing successfully treated with a conservative method of chiropractic care.

Introduction: The purpose of this survey study was to evaluate what proportion of sacro occipital technique (SOT) chiropractors treated pediatric patients, and amongst those what types of presentations were most common.

Methods: The survey was to determine what proportion of patients seen by SOT practitioners were pediatric patients, and of those pediatric patients what proportion were infants, children, or young adults. Additionally, what proportion of those patients were treated for musculoskeletal, non-musculoskeletal, or for wellness care.

Results: There were 326 responders they were SOT practitioners who treated pediatrics the majority noted that pediatrics averaged between 5-30% of their patient population. The responses for those who treated pediatric patients appeared to be evenly distributed amongst infants (0-3 years old), adolescents (4-11 years old), and young adults (12-17 years old). Treatment of pediatric patients for musculoskeletal, non-musculoskeletal, and preventative care was also evenly distributed amongst the responders.

Conclusion: Greater study into how the chiropractic profession might help the pediatric segment of the population, and what place chiropractic care might play in musculoskeletal, non-musculoskeletal, and preventative care is needed.

Introduction: In 1995 Porges introduced a new theory relating to the autonomic nervous system that consider two parts to the vagal or parasympathetic nervous system called the polyvagal theory.

The Polyvagal Theory: The mammalian vagus is neuroanatomically linked to the cranial nerves that regulate social engagement via facial expression and vocalization. This “face-heart” relationship has been studied by investigating the polyvagal theory as it relates to cardiac vagal tone (CVT) and heart rate variability (HRV).

Polyvagal and Psychological issues: Since psychological and social awareness can affect emotional dysregulation, all possible interventions that might help a child in their formative years would be advantageous. Sacro occipital technique (SOT), incorporates both spinal and cranial adjusting components to address autonomic imbalances. SOT cranial care attempts to affect the parasympathetic nervous system by balancing sacral parasympathetics as well as supporting cranial vagal function.

Conclusion: The polyvagal theory supports the rational for a mind-body support team for the care of patients with social behaviors affected by reduced vagal and parasympathetic function.

Introduction: Since neurological symptoms after surgical removal of astrocytoma and laminectomy are not considered unusual and the most common treatment is anti-inflammatory and antidepressant drugs, investigation of an approach to get at the root of the problem is in order.

Objective: The purpose of this report is to describe the clinical course, treatment and immediate response of a patient suffering from buzzing paresthesia secondary to surgical removal of thoracic astrocytoma and laminectomy which was relieved by Category I Sacro Occipital Technique™ block placement.

Methods: Treatments consisted of adjustments as needed to cervical, thoracic and lumbar spine, in addition to specific Sacro Occipital Technique™ Category I block placement in the pelvis.

Results: Patient reports the cessation of buzzing within 5 minutes of Category I block placement, which lasts up to 24 hours or more.

Discussion: It is suggested that one of the values of Category I placement is to reduce dural tension and torque in the spinal cord. As the success of other spinal adjustments in reducing or eliminate the buzzing sensation were hit and miss, it was noteworthy to observe that Category I block placement produced repeated and immediate relief of these paresthesias.

Conclusion: This case report describes an alternative approach, based on neuro-physiology, as an alternative to the standard pharmaceutical treatment of paresthesias.

Introduction: This case report discusses the integration of various chiropractic manipulative treatment and assessment strategies for the care of a patient presenting with SIJ pain. A 51-year-old female overweight patient presented to this office with SIJ and related hip pain for months. She reported the SIJ pain as being a “constant dull aching pain” at a five on a 1-10 scale, with 10 being most painful.

Methods:  The patients was assessed and treated with integrative chiropractic methodologies incorporating the work of DeJarnette (sacro occipital technique), Goodheart (applied kinesiology), Cates, and Zindler.  Novel usage of pelvic block placements were used along with the leg weights placed over the pelvis to augment the gravitational forces upon the lumbosacral joint

Results: Improvement was noted following the first treatment and by the 12th visit (fourth week), the patient reported having no pain or functional limitations.

Conclusion: This case illustrates chiropractic integrative manipulative strategies and conservative care that appeared to successfully manage a patient presenting with chronic SIJ pain.

Objective: The primary goals of this study were to do a systematic review of the literature and perform meta-analyses on patient sub-groups on the location of the iliac crest in imaging (Tuffier’s Line) vs. palpation studies; and to rate the quality of the included literature.

Methods: Relevant citations were retrieving by searching biomedical databases, and rated for quality using the QUADAS instrument for palpation studies, and the Arrivé instrument for the imaging studies. Meta-analyses were performed on the full datasets as well as for subsets based on various patient demographics.

Results: Despite the fact that our study found the imaged crest 0.3 levels more caudal in females, the palpated crest is almost the same for both genders, at the L3-4 interspace.  It remains possible to use the palpated iliac crest level, so long as it is understood to identify L3 on average rather than L4 or L4-5.

Conclusion: This analysis confirmed the imaged iliac crests lie closest to the L4-5 interspace in females, and the L4 spinous process in males; whereas the spinal level corresponding to the palpated iliac crest is on average the L3-4 interspace for both males and females.

Introduction: It is well-understood that Sacro-Occipital Technique (SOT) aims to diagnose and treat not only somatic pain complaints, but also disturbances in organ function.

The making of a dilemma: This emphasis on systemic conditions risks creating the impression that SOT does not concern itself very much with neuromusculoskeletal (NMS) conditions, with patient pain complaints apparently resulting from mechanical lesions that are amenable to manual therapy. A practice-based research network (PBRN) is a group of practices devoted principally to the care of patients and affiliated for the purpose of examining the health care processes that occur in practices.

Proposed shift in emphasis for SOT research: To reflect the preponderance of NMS patient complaints, and to clarify whether SOT effectively addresses these complaints, more studies should be done focusing on somatic pain complaints.  Morevoer, to improve the strength of evidence, resources should be shifted from simple case reporting to the construction of an SOT PBRN in which participating doctors can contribute data on many patients.

Conclusion: The construction of an SOT PBRN would go a long way toward elevating the stature of SOT methods, while increasing the professional respect of colleagues and patient populations. This could increase the inclusion of SOT in teaching curricula, and ultimately increase the number of patients who receive elements of SOT practice methods.

Introduction: A 19-year-old male presented with trauma induced severe refractory motion sickness disorder where slight movements could cause nausea and vomiting. His condition began following repeatedly swinging a baseball bat in a batting cage. Due to the severe and unresponsive nature (over two-years) of other interventions for this patient’s presentation, chiropractic manipulative treatments for sensory conflict and proprioceptive dysfunctions associated with the patient’s nausea were considered.

Methods: Patient was treated with sacro-occipital and cranial techniques as well as home rehabilitative methods.  The patient was also assessed functionally, incorporating an activator instrument to help adjust vertebra and extremities in a variety of positions, such as sitting, standing, walking, and particularly in sports-specific stances.

Results:  Over the course of 6-months of care cranial and spinal nerve dysfunctions resolved.  While not fully recovered for the first time in close to three-years the patient could begin to move and function without causing nausea and vomiting. By 6-months of care his last motion sickness assessment questionnaire scoring was 18.1, a significant improvement over the initial score of 45.8.

Conclusion: Future research could include helping to determine what subset of patients presenting with motion-induced nausea may be responsive to chiropractic interventions.

Introduction: This case report focuses on a retired professional football player who reported experiencing repeated head trauma and receiving a significant number of concussions during his high school, college, and professional football-playing career.

Case History: A 56-year-old male retired professional football player sought treatment at this office for what he believed were late gradual onset of post-concussion sequelae particularly associated with the temporomandibular joint dysfunction (TMD) and sleep apnea.

Methods/Intervention: He was treated with sacro occipital technique (SOT) pelvic block placements and cranial manipulative care to reduce any “downward and backward craniofacial growth and development” as well as reduce his forward head posture (FHP) and stomatognathic related obstructive apnea.

Results: Following the second/third treatments the patient’s response to care was dramatic and for the first time in year’s he was able to sleep for 2-3 nights in succession without issue. Affects of the treatment would be sustained for approximately three days, ultimately necessitating a referral for dental co-treatment.

Conclusion: This study presented a patient who suffered multiple concussions and TBI secondary to playing profession football that appeared to be related to the development of his subsequent TMD and OSA.  SOT chiropractic and cranial care were applied to affect the stomatognathic myofascia and related craniofacial structures and the patient had improvement in his symptoms, though temporary.

Introduction: This paper is a retrospective analysis of how patients presenting with a specific selection criteria, cervical forward flexion (CFF), responded to a one-time anterior thoracic adjustment (ATA) intervention.

Method: The data [n-24] collected in this study was obtained during one office visit. Pre- and post CFF assesments were performed using a goniometer to measure any changes following the ATA intervention.

Results: Twenty-three of 24 patients showed improvement in CFF following ATA with the majority in the ranges of 6-20 degrees.

Conclusion: The CFF assessment appears to be a helpful method to monitor the functional improvement of the cervical spine before and after a successful ATA. The ATA may also appear to improve some cervicothoracic symptoms that accompany limitations in CFF.

Introduction: Sacro occipital technique (SOT) adjustments are based on a specific SOT indicator system that identifies the appropriate, of three, SOT categories most in need of treatment. Because SOT is a system method of chiropractic, assessment-oriented and reasoning-based, a suitable recording system becomes a necessity.

Discussion:  Key SOT indicators can be recorded for each category are analyzed at each patient office visit in order to reaffirm the existing category or to determine if a new category is most in need of care. Some adjustments within each category can also be altered based on the findings. Information exchanged at each visit should be recorded at every visit. The patient’s concerns and comments, any action you have taken, information you have shared and decisions you have made, should all be recorded. Recording from visit to visit helps maintain an open dialogue with the patient and sustains a record of the patient’s progress.

Conclusion: All healthcare providers need a recording system that can provide accurate and objective recording as well as is ethical, legal and professional.

Introduction:  For many years the author has identified specific patterns of postural and neuromusculoskeletal compensations in the general population.  The almost universal presence of these chronic compensatory patterns indicates that typical interventions are not effective in removing them.  Similar patterns (e.g., SOT Category-I and Category-II) observed by DeJarnette (1984) are frequently resistant to correction.

Case History:  A male in his mid-70s presented as a new patient with acute low back pain.  His history included a severe head-on MVA in his mid-40s that required eight facial surgeries, bypass heart surgery, left knee replacement, and COPD.  He stated that he had had intermittent back pain for over a decade, but it was not disruptive to his ADL and he had never sought treatment.

Method/Intervention: The initial evaluation found a short right leg, flaccid right Gluteus maximus, and other symptoms frequently observed in SOT Category I and Category II.  Those evaluation results and other findings were also consistent with typical indicators of cranial sphenobasilar (SB) Right Torsion, SB Left Lateral Strain, and chronic musculoskeletal dysfunctions frequently observed by this author and other structural practitioners. The treatment plan was a protocol of novel structural cranial procedures to release the chronic aspect of the SB strain patterns and the compensatory musculoskeletal patterns identified in the examination and to relieve the patient’s presenting back and knee pain.

Results:  The patient’s presenting back and knee pain were both resolved by the end of the second visit.  The common patterns of SB, postural, and neuromusculoskeletal compensations that were identified in the initial evaluation were also resolved.  The outcomes were re-evaluated during a follow-up session by repeating the original tests.  The common chronic NMS patterns and SOT Category-I and Category-II were no longer present.

Conclusion:  The unique cranial techniques produced successful resolution of the identified chronic cranial and NMS patterns, including those associated with Category I and Category II, as was confirmed in post-treatment evaluations.  The patient’s symptoms were also resolved, and functional improvements appear to be durable, as they were maintained through typical ADL.

Objective: Therapy localization demonstrates a change in muscle function when a patient’s hand is placed over an area of suspected involvement. In manual muscle testing, is there agreement between examiners (reliability) and is there instrumental confirmation (validity) of their muscle classifications produced by therapy localization?

Methods: Three diplomates in applied kinesiology performed manual muscle tests of the middle deltoid of 30 volunteers with or without neck pain to assess the degree of examiner concurrence and documentation by surface electromyography. An additional 5 patients with neck pain were tested by the same protocol by 2 diplomates to assess forces applied with a clench transducer, degree of arm movement with an electrogoniometer, and vibration of the middle deltoid by vibro- myography.

Results: Statistical tests revealed no significant differences among examiners in their muscle classifications or in the forces applied during muscle testing. Clear distinctions between weak and strong muscle classifications both in the absence or presence of therapy localization were shown by both electrogoniometry and vibromyography. The presence of neck pain was associated with a significantly greater presence of therapy localization.

Conclusions: In manual muscle tests of the middle deltoid performed by applied kinesiologists, both the reliability and validity were supported by concurrence among examiners and correlations with the results shown with clench transducers, electro- goniometry, and vibromyography.

Introduction: The patient was an 18-year old female, semi-pro sprinter. She started experiencing insidious unremitting right lateral knee pain eight months prior to her first visit. She had attempted self-care directed by her coach, and physical therapy that included stretching and rehab based exercises for the knee. Additionally, she had visited a medical doctor who ruled out major structural damage, and had received a series of twelve visits with a Rolfer (deep tissue directed massage) with no change in her symptoms.

Intervention: The patient was treated using sacro occipital technique (SOT) category two and SOT extremity technique protocols along with Vector Point Cranial techniques.

Results: Directly following her first treatment she was asked to walk, and then run in the hallway outside of the office. Walking caused no pain, but running in the hallway still produced minor pain in her right lateral knee. One week later on her follow up visit she reported that she felt a subjective improvement of 60% and after the 3rd office visit was able to return to normal activities for the first time in 8 months.

Conclusion: In this case study intervention using SOT pelvic stabilization and extremity technique, and Vector Point cranial technique appeared to produce significant and rapid results (3 office visits) that enabled the athlete to get back to her activities.

Introduction: This case report describes a 63-year-old  male patient seen for a primary complaint of acute TMJ pain, closed lock without disc recapture, and chronic tinnitus.

Intervention: Of significance on testing TMJ translation the patient couldn’t open his jaw more than two fingers width without intense pain. The patient was treated using sacro occipital technique (SOT) and Vector Point7 cranial analysis protocols with a focus on his pelvic instability and TMD.

Results: After the first office visit the patient was able to open and close without pain and stated that only a small amount of tension and soreness remained in his jaw. He returned for a follow up office visit five days later and reported that the soreness in his TMJ was gone, though his tinnitus was unresponsive.

Conclusion: If pain and loss of function persists following a TMD episode ideally conservative care such as what was rendered in this case that is low risk and cost effective would be optimal.

Objective:  To present a case of successful a multimodal therapy for the treatment of a torn medial meniscus of the knee.  The meniscal tear was documented by magnetic resonance imaging (MRI).

Clinical Features:  A 35-year-old male landscaper in excellent health suffered a severe, traumatic onset meniscus tear while practicing Capoeira.  He lost all of his athletic capabilities as a result of his injury.  He was recommended for meniscectomy by an orthopedist, but the patient chose of his own accord to pursue a conservative approach.

Intervention and Outcome:  The patient received 24 treatments combining Sacro-Occipital Technique, Activator Methods Chiropractic Technique, Hendrickson Method, and Cold Laser and experienced a near full recovery.

Conclusion:  A multimodal approach combining chiropractic techniques and soft tissue work with the addition of ancillary therapies such as cold laser can be a therapeutically useful, cost effective therapy for patients with meniscus tears.