This article is the seventh of a series relating to Sacro Occipital Technique and Cranial Manipulation. Please use this for educating insurance companies, the judiciary, the legislature, the colleges and the interested public.

Sacro Occipital Technique (SOT) practitioners have powerful tools in their possession. These tools are:

(1) our understanding of the functional anatomy of the body specifically the nervous system with the circulation of the cerebrospinal fluid (CSF) and tensions upon the meningeal system.

(2) our understanding of SOT pattern distortions from the category systems with its adjunctive techniques and its methods of treatment, utilizing blocks and awareness of associated fascial restrictions.

(3) our understanding of viscerosomatic / somatovisceral reflexes through Chiropractic Manipulative Reflex Technique (CMRT), neurolymphatics, neurovasculars, five element theory and its affect on the nervous system, endocrine system and occipital fiber / transverse process reflex system.

(4) our understanding of the various patterns and reflex systems from trapezius fibers, occipital fibers, temporosphenoidal line, extremity technique, R + C factors (commonly known as Lovett Brother relationships) and many others.

(5) finally our understanding of cranial manipulative therapy makes us unequaled in the chiropractic profession from its basic techniques with its depth of care, to SOT’s advanced cranial techniques which are being, shared, researched and investigated.

This all brings me to this “article of interest” which will present a few issues at hand, the first an interesting article that was published in the May 1999 issue of Chiropractic Technique and comments by Dr. Daniel Cherkin key author of the article entitled, “A comparison of physical therapy, chiropractic manipulation, and provision of an educational booklet for the treatment of patients with low back pain”. Also two very interesting articles are presented: one by Dr. Unger relating to SOT block placement and protocol and muscle strength published in the November 1998 issue of Chiropractic Technique. The other one by Dr. Blum, concerning a patient he treated successfully who had serious cardiopulmonary difficulties believed to be secondary to his Down’s Syndrome condition, which was published in May 1999 issue of Chiropractic Technique.

In the December 14, 1998 issue of Dynamic Chiropractic an interesting article entitled “Dr. Cherkin Responds to Critiques of His NEJM Study”. [check it out at] The study was published as follows: Cherkin D, Deyo R, Battie M, Street J, Barlow W.A., “A comparison of physical therapy, chiropractic manipulation, and provision of an educational booklet for the treatment of patients with low back pain”. New England Journal of Medicine, 1998; 339:1021-9. This study was a less than supportive study for the chiropractic profession evaluating the effectiveness of chiropractic manipulation for low back pain.

On page 24 of the December 14, 1998 Dynamic Chiropractic article Dr. Cherkin responds to a couple criticisms to his NEJM study:

(1) ” ‘ In this trial only one high-velocity technique (side posture) was applied’ [Dr. Cherkin’s reply] ‘We intentionally restricted the study to the chiropractic manipulative technique that our chiropractic advisers indicated was used most commonly by chiropractors, at least in Washington state. Discussions with the chiropractors invited to participate in the study confirmed that the side-posture high velocity thrust technique was in fact the one they used most often for low back pain.’ “

(2) ” ‘Doctors of chiropractic were limited in the types of treatment they could provide, while McKenzie practitioners were allowed full scope of therapy options and specially trained for the purpose of the project by Robin McKenzie’ [the partial reply by Dr. Cherkin] ‘The chiropractors in our study were selected because they were experienced providers (6-14 years in practice) who relied heavily on side posture, high-velocity thrusts as their primary method of treatment. While it is true that the study’s chiropractors were unable to use physical therapy modalities, this constraint was imposed by Washington state law and not by the study design. We tried to make it clear to readers that this was a study of chiropractic manipulations and not chiropractic care.’ “

My point in presenting these comments and reply by Dr. Cherkin is to point out the value of SOT care. SOT care does sometimes use side posture adjustments, however the specificity and the variety of other SOT procedures allows SOT to treat a multitude of low back conditions. To SOT practitioners a low back pain has many flavors and a rainbow of colors. Accordingly so does the treatment and protocol vary with SOT, allowing for a greater depth of understanding of the human body and treatment of low back pain.

Our depth of understanding in the use of block placement techniques allows SOT practitioners to treat conditions from CSF stagnation to sacroiliac sprains to disc herniations with spinal stenosis. In an excellent study by Dr. Joseph F. Unger, Jr in the November 1998 issue of Chiropractic Technique he related category II pelvic blocking and muscle strength.

SOT practitioners might want to look at the comments and study of Dr. Cherkin,, and instead of seeing them as a condemnation of chiropractic and its treatment of low back pain, they might want to see them as an “indirect” supportive statement of the value of SOT protocol and its therapies. At the very least Cherkin’s study has shown the worthiness of investigating alternative procedures such as those provided by SOT. Those of us who practice SOT know its value and effectiveness for the treatment of low back pain. Now might be the time for the chiropractic profession to embrace SOT and evaluate its methods as well.

Please see: Unger JF, Jr, “The effects of a pelvic blocking procedure upon muscle strength: A pilot study” Chiropractic Technique , 1998 :10 (Nov), 150-5.

“The objective of the article was to evaluate muscle strength due to a specific chiropractic adjustive procedure. The study was performed using multiple subjects during their routine office visit in a private office setting. A category II blocking procedure, according to standard SOT guidelines, was performed until all category II indicators were eliminated. Muscle strength evaluations were performed on each of eight major muscle groups bilaterally with pre- and post-treatment procedures while the patients were still supine on the treatment table. In data from sixteen subjects, fifteen of the sixteen muscles tested demonstrated a statistical difference of better that (p=0.02). It was concluded that the study demonstrates a degree of objective evidence of change produced by a chiropractic treatment procedure. It suggests a methodology that may be used for further investigations and indicates that need for further investigations into the effects of the techniques used [SOT category II blocking].”

Blum, C. L., “Cranial therapeutic treatment of Down’s syndrome” Chiropractic Technique , 1999; 11(May), 66-76. This article’s objective was to discuss the chiropractic management (specifically SOT), via cranial therapy, of a child suffering from Down’s syndrome. The child was born with trisomy 21, suffered from failure to thrive, history of chronic pneumonia, tachypnea, fever, and possible atrial septal defect. The initial recommendations by medical professionals were to undergo open-heart surgery, but with surgery not imminent, the parents decided to investigate conservative care. This care consisted of nutritional and cranial therapeutic therapy, which alleviated many of the symptoms that the patient suffered. Presented in this article are overviews of cranial therapeutic approaches to sphenobasilar patterns of distortion and balancing of CSF pulsations, which were effective in treatment of this child with Down’s syndrome.

SOT research or related papers have been in each issue of Chiropractic Technique from May 1998 to the current May 1999 issue. That is one paper in May 1998, two in August 1998, two in November 1998, two in January 1999, two in May 1999, and one in November 1999.