ECU Conference Proceeding’s Abstracts

A Brief History of the European Chiropractic Union (ECU) Conference

The European Chiropractors’ Union (ECU) is a federation of 20 National Chiropractors’ Associations, representing the Chiropractic profession in Europe on a supranational level. Its mission is to promote the development of Chiropractic in Europe as well as to pursue the interests of Chiropractic as a science and a profession by research, teaching, publications and legal activities.

SOT research will be submitted to the ECU Convention in 2015 and in 2015 the ECU Convention will, with the World Federation of Chiropractic Conference, have a joint conference in Athens, Greece. This is considered the key European chiropractic event of the year, comprising the largest international gathering of the chiropractic profession, and traditionally attracting over 500 delegates. SOT has been represented in the 2015 ECU Conference in Athens, Greece, 2014 ECU Conferences in Dublin, Ireland, 2013 in Barcelona, Spain, 2010 in London, England, and 2006 in Stockholm, Sweden.

The following are Abstracts from the joint 2015 Thirteenth WFC Biennial Congress/2015 Annual European Chiropractic Union Conferences in Athens, Greece, May 13-16, 2015.

Bloink T, Blum CL. Chiropractic cranial treatment of a patient with idiopathic intermittent hearing loss: A case report. World Federation of Chiropractic’s 13th Biennial Congress/2015 Annual European Chiropractic Union. Athens, Greece, May 13-16, 2015.

Objectives: The first chiropractic adjustment given by D. D. Palmer to Harvey Lillard in 1895 was reported to have cured his deafness. A 2006 Di Duro study concluded “that manipulation delivered to the neuromusculoskeletal system may create central plastic changes in the auditory system.” A 50-year-old female referred by her dentist for craniomandibular assessment presented with an idiopathic case of intermittent complete hearing loss lasting for over six-years. The hearing loss would often be complete, bilateral or fluctuate between the right and left ears. Prior to presenting for care at this office she was seen by an ENT allopath for two-years with various unremarkable tests performed over that time (e.g., MRI, etc.) and was unresponsive to interventions.

Methods: Chiropractic cranial evaluation revealed a left temporal internal rotation restriction with evidence of clenching and maxillary exostosis. Craniofacial analysis revealed a right inferior maxilla with maxillo-zygomatic compression. Sacro-occipital technique (SOT) category two (sacroiliac joint hypermobility) was found on the left side with a category one (sacroiliac joint fixation) on the right side.

Results: She was treated 2-times a week for 4-weeks at which time she regained consistent normal hearing in the left ear, her most problematic side. At the 4-week period her left ear went from 0-25% to 75-80%, right ear from 0-25% to 80%, and has been stable for the first time in 2-years. She has been recently referred back to her dentist to change her TMJ appliance from an upper to a lower mandibular appliance to limit incisor contact, improve canine guidance, and equilibrate to the bilateral molar contacts.

Conclusion: This case is interesting because of the ongoing unresponsive nature of her condition. The loss of hearing had a profound affect on her ability to function and the temporal nature of her response to the care rendered suggests a relationship.

 

Bloink T, Blum CL. Post concussion syndrome, temporomandibular joint disorders, and chiropractic dental co-treatment: A case report. World Federation of Chiropractic’s 13th Biennial Congress/2015 Annual European Chiropractic Union. Athens, Greece, May 13-16, 2015.

Introduction: The awareness of sports-related concussions with post-concussion syndromes is gaining exposure in the chiropractic profession. The following case describes a 21-year-old female patient who had a concussion with subsequent post-concussion syndrome symptoms that persisted for five months.

Methods: Along with reduced TMJ functioning the patient presented with some altered cranial nerve findings related to photophobia, contrast sensitivity, and convergence insufficiency. Sacro occipital technique category one and two findings relating to pelvic torsion and sacroiliac joint hypo/hypermobility was found and treated along with cranial and TMJ adjusting. A dentist equilibrated the patient’s mandibular occlusal splint over a 9 week period which was immediately preceded by chiropractic care.

Results: As of March 18, 2014 the patient was completely pain free with no symptoms of lightheadedness, brain fog, or nausea. She has been able to exercise, and has been lifting light weights. She was also able to run five miles. This is a significant improvement given that her symptoms and lack of function were consistent since her accident of September 2013.

Conclusion: Further research is needed to determine whether a subset of post-concussion or head trauma patients may have TMD which is limiting their ability to fully recover function and return to their activities of daily living. Collaborative efforts between emergency room doctors, chiropractors and dentists (with TMD care training) with post concussion patients may help ultimately lead to improved patient outcomes.

Boro WJ. Intervention in menorrahagia through chiropractic adjustment and spondylotherapy: a case report. World Federation of Chiropractic’s 13th Biennial Congress/2015 Annual European Chiropractic Union. Athens, Greece, May 13-16, 2015.

Introduction: Low back pain secondary female reproductive problems are the source of frequent consultations to a chiropractor. This case report describes the clinical course, treatment, and response of a female patient suffering from uncontrolled uterine bleeding of over two-weeks duration to the application of sacro occipital technique (SOT) chiropractic adjustments and spondylotherapy. A 37-year-old, nulliparous female presented with a history of back and hip pain, headaches and asthma, as well as nonstop menstrual bleeding for the previous two-weeks that also occurred a few months earlier. The patient indicated that her menstrual cycle has never been “normal”, and since the age of 16 her cycles were of 36-45 days duration with bleeding lasting about seven days. She stated that her periods were often accompanied with migraines and significant cramping. Prior to her visit, she had been seen by her gynecologist with unremarkable findings observed on ultrasound and normal hormone levels, however the patient noted, “it is incredibly uncomfortable to bleed for that long.”

Methods: Three complementary methods were utlized for this patient’s specific menorrahagic condition which included of SOT category-two supine block placement, adjustments (with activator instrument) to the lumbar spine (L1-5) and femoral heads bilaterally. Van Rumpt cranial therapies were used and spondylotherapy was administered to C7 (4-minutes), L3 (2-minutes) and L5 (2-minutes) at a percussive rate of 200-beats-per-minute.

Results: Following the third-office visit the patient reported that the chronic menstrual bleeding had stopped. The patient has returned to this office on 8 other occasions over the past couple years for various reasons (mostly for hip pain), but has had no menstrual or bleeding complaints.

Conclusion: Of interest is that the patient had the menstrual condition for years and her response to care and maintained improvement suggests a causal relationship between her presenting condition and the treatment rendered.

The following are the Abstracts from the 2014 ECU Conference, Dublin, Ireland.

Carroll A, Blum CL, Young M. Treatment of low back pain in pregnancy with Sacro Occipital Technique (SOT): A case report. European Chiropractic Union Conference. Dublin, Ireland, May 2014.

Introduction: Pregnancy related low back pain is a common condition so healthcare providers need to be able to offer low-risk alternatives that would not harm the mother or child while reducing pain and disability.

Objective: The purpose of this paper is to provide information of a potential way of treating pregnant women with low back pain, using Sacro-Occipital Technique (SOT).

Methods: One subject with pregnancy related pelvis instability and prior chronic low back pain presented for care and was treated with Category II Sacro Occipital Technique protocols throughout the course of her pregnancy.

Results: Using Roland-Morris disability index, Oswestry disability index, and the Quadruple Visual Analogue Scale, the patient’s pain levels were monitored throughout the pregnancy before and after treatment. The patient had decreased scores on all scales after SOT treatment was instituted during her pregnancy with stabilization in her last trimester and continued improvement following her pregnancy.

Conclusion: In the case of this patient with chronic low back pain which continued into her pregnancy, SOT category II treatment appeared to have a benefit in reducing her pain levels as scored by Roland-Morris disability index, Oswestry disability index, and the Quadruple visual analogue scale.

Evans AC, Yelverton C. The validity and specificity of the arm fossa test. European Chiropractic Union Conference. Dublin, Ireland, May 2014.

Introduction: Sacroiliac joint dysfunction (SJD) is a common problem in the general population and diagnosis is primarily made with the use of manual orthopedic tests [1,2]. Whether clusters of these tests can be used to accurately diagnose SJD is being studied [3]. This study is designed to assess the validity and specificity of the Arm Fossa Test (AFT), which is part of the Sacro Occipital Technique (SOT) evaluation protocols [4]. This may contribute to the research related to diagnostic tests that assess the specific joint dysfunction related to SJD. An ethics committee at Technikon Witwatersrand (TWR) (now Johannesburg University) approved the study in January 2005.

Methods: To perform the AFT, the examiner tests the responsiveness of the latissimus dorsi muscle on the supine patient, as the examiner successively makes light contact with the upper and lower portions of the left and right inguinal ligaments. The finding of a delayed or slow responding latissimus dorsi muscle is thought to be consistent with sacroiliac hypermobility; whereas a strong muscle points toward either a normal sacroiliac joint or one with sacroiliac hypomobility.

Eighty subjects were selected for the study, 35 females and 45 males. They were sourced from the TWR health clinic. Prior to testing subjects a case history was taken, and they underwent a full sacroiliac regional examination using generally accepted diagnostic techniques. The subjects were then taken to a different room where an assessor tested for SJD using the AFT. This was done by two different assessors, each without knowledge of the other’s results and was therefore double blinded.

Results: Of the 160 sacroiliac joints (right and left side for each of the 80 subjects) evaluated, the AFT correctly evaluated 166 (28 true positives and 88 true negatives). This gives a percentage correlation of 72.5%. The AFT incorrectly evaluated 44 (40 false positive and 4 false negatives) as shown by the misclassification rate of 27.5%. The Kappa Coeffiient, indicated as 0.40, is bordering on a moderate strength of agreement.

Discussion: Since the AFT’s main purpose is to assess the presence of a specific type of SJD hypermobility, it is possible that it is not as sensitive for assessing SJD associated with hypomobility. Yet in several separate studies of various SOT examination procedures including the AFT test, Leboeuf-Yde reported the following for the AFT:

– intraexaminer reliability: high in one study [5] and low in another [6]

– interexaminer reliability: low [6]

– validity: some value in correctly distinguishing a correctly treated from an incorrectly treated group of participants [7]

– validity: in relationship to lumbopelvic pain: sensitivity=54%, specificity=69% [8]

– validity: no relation between side of involved fossa and side of sacroiliac fixation [7].

Conclusion: The AFT clearly has some validity but should not be used on its own as a tool for the diagnosis of SJD but rather as part of a comprehensive diagnostic evaluation of the joint. Further research is needed to determine whether the AFT is better suited for evaluating the subset of patients with SJD that is related to hypermobility or SJD associated with hypomobility.

References: :

1. Arab AM, Abdollahi I, Joghataei MT, Golafshani Z, Kazemnejad A. Inter- and intra-examiner reliability of single and composites of selected motion palpation and pain provocation tests for sacroiliac joint. Man Ther. 2009;14(2):213-21.
2. Hestìk L, Leboeuf-Yde C, Are chiropractic tests for the lumbo-pelvic spine reliable and valid? A systematic critical literature review. J Manipulative Physiol Ther. 2000 (May);23:258–75.
3. Kokmeyer DJ, Van der Wurff P, Aufdemkampe G, Fickenscher TC. The reliability of multitest regimens with sacroiliac pain provocation tests. J Manipulative Physiol Ther. 2002;25(1):42-8.
4. Monk R. Sacro Occipital Technique Manual. Sacro Occipital Technique Organization – USA: Sparta, NC, USA. 2006: 15-87.
5. Leboeuf C, Jenkins DJ, Smyth Ra. Sacro-occipital technique: The so-called arm fossa test. Intraexaminer agreement and post-treatment changes. J Australian Chiropr Assoc. 1988;18(2):67-68.
6. Leboeuf C. The reliability of specific Sacro-occipital Technique diagnostic tests. J Manipulative Physiol Ther. 1991;14(9):512-517.
7. Leboeuf C, Jenkins DJ, Smyth Ra. Sacro-occipital technique: An investigaton i into the relationship between the arm fossa test and certain examination findings. J Australian Chiropr Assoc. 1988;18(3):97-99.
8. Leboeuf C. The sensitivity and specificity of seven lumbo-pelvic orthopedic tests and the arm fossa test. J Manipulative Physiol Ther. 1990;13(3):138-143. br>

Moeller JL, Blum CL. Orofacial myofunctional therapy: A Case Report. European Chiropractic Union Conference. Dublin, Ireland, May 2014.

Introduction: Orofacial myofunctional therapy, a neuro-muscular re-education of the oral facial muscles, is a modality that promotes the stability of the stomatognathic system.

Case Report: The patient was a 48 year old female referred by her chiropractor, who had heard about OMT by his referring functional dentist. Patient was born with a restricted lingual frenum which may have led to her low tongue-rest position and mouth breathing habit. In a craniofacial evaluation she exhibited an open mouth at rest, was clenching and grinding, and had an overbite, chronic sinus infections, vertigo for eight months, earaches, and intermittent tinnitus.

Method/Intervention: Treatment consisted of jaw stabilization exercises, habit elimination and behavior modification, and re-patterning the oral facial muscles and changing their function for optimal rest position, chewing and swallowing. the tongue does not drop into the airway. .

Results: At a one-week follow up visit, after treatment for jaw stabilization, the patient reported that her pain was gone. Structural support incorporating chiropractic adjustments, along with eliminating habits and muscle re-patterning, led to long term stability.

Conclusion: An interdisciplinary team approach for health care is critical for benefit of the patient and treating the cause of TMJ and obstructive sleep apnea (OSA) related disorders.

Blum CL, Griffiths RL. Chiropractic and Dentistry– The Need for Mutual Understanding of TMD Co-treatment: A Case Report. European Chiropractic Union Conference. Dublin, Ireland, May 2014.

Introduction: A 19-year-old male presented with a history of attempting a back flip on a trampoline but landed on his head and compressed his neck. While taking the case history his parent noted that he also had persistent and intense bruxism at night creating significant sounds that would waken others near his room at night.

Methods/Intervention: Evaluation revealed decreased cervical range of motion, category two sacroiliac joint sprain and significant TMJ related findings, relating to a dental class III (protruded) occlusion and concurrent class II (retruded) condylar position. He was treated with sacro occipital technique (SOT) category two block placement, cervical stairstep adjusting, and SOT cranial/TMJ related care.

Results: The cervical spine range of motion and pain improved immediately following the treatment. However the dental presentation suggested a referral to a dentist familiar with functional orthodontics and trained within a dental chiropractic co-treatment methodology.

Conclusion: The purpose of this case report was to illustrate a working treatment program where both chiropractic and dentistry can play an integral part in an attempt to improve patient care and outcomes. Further research is needed to investigate the subset of patients needing chiropractic and dental collaborative care for optimal outcomes.

The following are the Abstracts from the 2013 ECU Conference, Barcelona, Spain.

Shaneyfelt D, Blum CL, Taylor D. Styloid process sensitivity in a patient with low back pain and radicular syndrome: A case report. European Chiropractic Union Conference. Barcelona, Spain. May 2013.

Background: The styloid process projects down and forward from the inferior surface of the temporal bone, and serves as an anchor point for several ligaments and muscles associated with swallowing and vocalization. In the 1950s DeJarnette identified a relationship between styloid process sensitivity and the ipsilateral 5 lumbar vertebra. He found that with L5/S1 decompression there commonly would be an associated reduction or elimination of sensitivity at the ipsilateral styloid process.

Case History: A 57-year-old right-handed white male, presented in our offices with a chief complaint of acute sudden onset left jaw pain. The patient gave a history of a 3-day episode of jaw, neck and ear pain, with no known cause. The patient had a very high pain threshold and rarely complained of pain. There was concern, due to the nature and degree of irritation, that he might possibly have an infective process therefore, dental x-rays were obtained. They were reported as negative for any local infection in the styloid process or from a nearby tooth. Design/Method: Palpation found marked sensitivity of the left styloid, left first rib (scalene muscle attachments), and to the left sternocleidomastoid. The paraspinal muscles throughout the lumbar spine were painful to palpation, with profound guarding and muscle rigidity most specifically within the posterior right lower quadrant. A positive straight leg raise at 45 degrees was noted with exquisite sensitivity along the right sciatic track. Tenderness to palpation was noted in the plantar fascia as well as clubbing of the five toes on the right foot, but not on the left foot. Lumbar ranges of motion were also markedly decreased in all six directions.

Sacro Occipital Technique (SOT) analysis was performed and based on the findings, the patient’s left psoas and diaphragm muscles were released. The patient was treated with category three orthopedic blocking, which utilized the left styloid process as a guide for treatment of L5/S1 discopathy associated sciatic nerve irritation.

Results: As treatment was provided, the sensitivity to the styloid process was rapidly eliminated. Concurrently the right sciatic pain and related muscle tension in the right thigh significantly diminished. Diminished tension in the plantar fascia along with a visualized reduction in clubbing of the right foot was noticed. On standing following treatment, a marked decrease in antalgic position relative to the initial plumb line findings was observed.

Conclusion: In this single subject case report of a patient presenting with acute styloid process sensitivity, differentiating the patient’s presentation was essential. Further studies are needed to determine what subset of the population has this relationship and to facilitate greater communication between professions treating this entity. The temporal nature of the changes to the styloid process’s pain and improvement of the patient’s low-back presentation was noteworthy.

Clinical Implications: With styloid process sensitivity and low-back pain the dental profession might want to consider collaborative care in the absence of any specific local dental findings. Part of any differential diagnosis should rule out ascending myofascial imbalance particularly with patients that have concurrent low-back and styloid process pain.

Rosen MG, Blum CL,Taylor D. SOT chiropractic care of a 47 year-old female with left-sided sciatica caused by a 16mm left paracentral disc extrusion: A case report. European Chiropractic Union Conference. Barcelona, Spain. May 2013.

Background: Lumbar disc injuries to L5-S1 and the accompanying neurological radicular syndrome are one of the most common discogenic injuries to the spine having devastating effects on a patient’s health and well-being. The purpose of this paper is to demonstrate how conservative SOT chiropractic care safely, effectively, and efficiently helped a patient with sciatica believed caused by a 16mm paracentral disc extrusion return to normal functional capabilities in a relatively short period of time with no negative side effects.

Case Study: A 47-year-old female, presented at this clinic with LBP and pain radiated into her left buttock and down her leg to the ankle. She was barely able to walk, could not stand or sit for more than a few minutes. She described the pain as a 9-10 on a pain 1-10 pain scale with 10 being the worst pain imaginable.

Design/Method: Besides the SOT specific protocols, orthopedic, and neurological tests were performed on the patient to determine the most appropriate form of treatment. Upon incorporating the SOT evaluation findings, and the patient’s symptomatology, the determination of an active category three discogenic radicular syndrome with lumbar vertebral involvement was made.

Given the probability of lumbar disc trauma SOT category three pelvic blocking procedures and orthopedic blocking (low force leverage adjusting using pelvic blocks in accordance with SOT indicators) was initiated. Also used was the Step Out Toe Out (SOTO) procedure to determine piriformis involvement and treatment as indicated.

Results: An MRI was performed after 4-weeks to confirm the diagnosis and determine future care. The significant findings of the MRI were: at L3-L4 there is central disc protrusion and annular tear, at L4-L5 a listhesis and disc bulge resulted in mild lateral recess narrowing without significant central narrowing, disc and osteophyte resulting in inferior foraminal narrowing and effacement of fat around the exiting L4 nerve roots and at L5-S1 there was a 16mm left paracentral epidural mass suspicious for disc extrusion, that resulted in effacement of left lateral recess and impingement on the descending left S1 nerve within the lateral recess.

After the initial 2-weeks of care the patient showed marked improvement in her symptomatology and functional ability. By the 3rd-week of care her condition stabilized significantly with 90% reduction of radicular pain. At 1-month the patient continued to make excellent progress, continued to resume normal activities of daily living without pain or discomfort, and 3-months later was able to play golf.

Conclusion: Even with the limitations of this study the significance of the patient’s reduction of pain and improved function, while still having a L5-S1 16mm left paracentral epidural mass, suggests that the care rendered is worthy of further investigation and research.

Clinical Implications: Patients may present with severe LBP and profound limitations and using conservative SOT chiropractic care may help patient’s to recover full function even in the presence of marked MRI findings. Utilizing MRI findings as a means for aggressive high-risk treatment procedures, before instituting chiropractic conservative care, should be reconsidered.

Gerardo RC, Shirazi D, Blum CL, Mason E.Chiropractic and dental care of a patient with temporomandibular and sacroiliac joint hypermobility: A case report. European Chiropractic Union Conference. Barcelona, Spain. May 2013.

Introduction: Generalized joint hypermobility (GJH) is a hereditary connective tissue disorder characterized by lax joints and the presence of musculoskeletal symptoms. The syndrome has been under-recognized and has only recently been taken more seriously. GJH has been considered a predisposing factor for the development of temporomandibular disorders (TMD). The purpose of this case report is to share a novel protocol for chiropractic and dental treatment of a patient with TMD that presented with concurrent hypermobility of the sacroiliac joint (sacro occipital technique’s category two) and TMJ. Pasinato et al., noted that “as more health-care professionals and patients un­derstand TMJ hypermobility, the more contributions we’ll have to develop a more specific preventive approach to the TMD. Thus, the GJH could be included as a standard diagnostic component of this dysfunction.”

Case History: A 47-year-old female patient presented November 2010 with chief complaints of pain when chewing, jaw pain, limited mouth opening range of motion, and TMJ crepitus. Imaging revealed disc displacement without reduction on left TMJ, and early degenerative joint disease (as well). Following dental evaluation and delivery of a daytime repositioning orthotic and a night deprogramming orthotic, the patient was referred for concurrent chiropractic treatment. Chiropractic evaluation noted pain to the jaw, left leg, right hand and sacroiliac joint.

Methods/Intervention: Dental orthotic therapy was initiated within the first two-weeks, with a daytime and night orthotic, to be worn 24-hours. Referral to chiropractic was initiated after orthotic delivery. After approximately 8-week, when it was determined that capsulitis of TMJ was no longer present, procaine injections were initiated at one-month intervals, followed by prolotherapy. SOT chiropractic and cranial technique care was used for the patient for her sacroiliac joint hypermobility syndrome as well as to the craniomandibular system. Dentally the patient received prolotherapy injections every 2-3 weeks on the side of TMJ adhesions and joint restriction, secondary to the hypermobile retrodiscal tissue. The prolotherapy was also used to create increased retrodiscal tissue tension to start a posterior ‘pull’ on the disc, owning to the anteriorly displaced disc.

Results: The patient had good recovery of TMJ function and was mostly pain-free, had full range of motion in the cervical and lumbar spine, negative sacroiliac hypermobility findings, and could open her mouth greater than 42mm (presented with only 27mm) with normal joint tracking and translation. Supportive chiropractic care was needed due to the patient’s chronic jaw clenching habit and without care would have a tendency to relapse.

Conclusion: Much of the interrelationship between dentistry and chiropractic treatment of TMJ conditions involves an interrelationship between posture and occlusion. Head position, TMJ condylar position, airway space, and posture all seem to work together to create a relationship between occlusion and the body’s position in space.

Clinical Implications: Further research is indicated to determine if patients with GHS, TMD, and sacroiliac joint instability may require the need for dental chiropractic interdisciplinary care. GHS may be an important differential diagnostic component for chiropractic treatment since joint instability may lead to modified treatment application and rehabilitation.

The following are the Abstracts from the 2010 ECU Conference, London, England

”Bloink
Part 3: Case studies. Sacro-occipital cranial technique [SOT] and temporomandibular joint [TMJ]therapy for unresolved benign paroxysmal positional vertigo [BPPV]: A case report [case report; meeting abstract] Clin Chiropr: Jun 2010(13:2): 193-194.”]

Introduction: Vertigo, also called dizziness, accounts for about 6 million clinic visits in the U.S. every year, and 17–42% of these patients eventually are diagnosed with benign paroxysmal positional vertigo (BPPV). Within the labyrinth of the inner ear lie collections of calcium crystals known as otoconia. In patients with BPPV, the otoconia are dislodged from their usual position within the utricle and they migrate over time into one of the semicircular canals causing abnormal fluid endolymph displacement with head motions and a resultant sensation of vertigo.

Case Report: A 37-year-old female was seen for acute benign vertigo that was referred by her allopathic physician for an evaluation and determination of the need for chiropractic care. The patient had 2-3 months of constant vertigo which was diagnosed as BPPV. She had been treated with the Epley Maneuver and various medications, however they did not resolve her symptoms. Her vertigo would last the whole day with peaks and valleys related to intensity. This affected her ability to function at home, drive her car and even walk “out of the door” of her home.

Assessment: Patient presented with a category two, right temporal bone with external rotation, and significant malocclusion with clenching and anterior interferences. In evaluating the dental signs of malocclusion it was determined that due to the stress of the anterior interferences, particularly on the right side, that the repetitive stress on occlusion created right temporomandibular (TM) condylar compression stress summating at right temporal fossa.

Treatment: Category two protocols for the pelvis were applied and an intraoral cranial adjustment to the temporal bone, maxilla, sphenoid, and zygoma were performed directed by palpatory pain indicators. Palpatory pain in and around the TM joint (TMJ) was used to help guide treatment as well as ability of patient to achieve sufficient vertical opening. Cotreatment with a dentist was used to help stabilize and maintain the chiropractic cranial and TMJ corrections.

Results: By the 7th office visit (3-4 weeks of care) the patient’s vertigo had resolved. In addition her TM joint translation and opening had improved significantly and pain around the right TM joint and related tissues had been eliminated. The anterior interferences were treated with a nighttime dental appliance that allowed the patient to have bilateral posterior teeth contact and reduced contact to the front teeth.

Discussion: Occlusion and condylar position is purported to be affected by or affects cranial bone distortion patterns. When there is malocclusion affecting the cranial suture and local periosteal tissue, it is theorized that with some patients possibly the internal periosteal dura, CSF circulation, and related cortical region might be affected. On the other hand reliving the stressors of restricted cranial motion and malocclusion could lead to improved cortical function just by reducing global stress to the CNS due to reduce pain and related myofascial tension.

Conclusion: In this case report the patient’s response to care was quite dramatic. She was unresponsive to prior care and her quality of life was profoundly affected. It is difficult to extrapolate from this one case and apply this to the general population however the patient’s rapid response to care suggests that further investigation into this method of care for patients presenting with vertigo be considered.

”Williams
Part 3: Case studies. Plagiocephaly: The oblique skull – a method of chiropractic correction [case report; meeting abstract]. Clin Chiropr: Jun 2010(13:2): 195-196.”]

Introduction: Plagiocephaly is general term used to describe cranial asymmetry. Pathologenically, plagiocephaly is classified as synostotic (SP), caused by abnormal sutural development or deformational (DP) (non-synostotic or positional), caused by external forces acting on the cranium. Commonly accepted treatments for DP include alternate sleeping postures, carefully monitoring the child when placed in a prone position, as well as in resistant cases use of cranial orthoses or helmets. Chiropractic -Sacro Occipital Technique (SOT) cranial care might offer a conservative option that is a bridge between alternate sleeping and use of a helmet.

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Case Report – Assessment: This case report presents a four and a half month old male child presenting at a chiropractor’s office. The child’s working diagnosis was: (1) Occipital condyle compression, (2) Plagiocephaly; and (3) KISS syndrome type 1. Specific SOT cranial treatment was used to correct the child’s presenting plagiocephaly. This patient received 12 treatments over a period of 3 months and showed a significant improvement in head shape.

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Discussion: DP has some concomitant syndromes that might be coincidental or related in a primary or secondary manner, which include scoliosis, KISS, and torticollis. From a biological plausibility standpoint it would seem that allowing the brain to grow in a symmetrical fashion, balanced stress on vascular membranes, and maintaining normal anchoring of muscular attachments would be beneficial. Recent research has indeed found a relationship between DP and neurodevelopmental delays and that posterior DP may even affect visual field development

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Conclusion: The purpose of this paper was to offer an alternative view of how DF might be treated in a chiropractor’s office and at what stage intervention might prove effective. Since parents often are not willing to “just wait and see” and are leaning towards some degree of intervention, chiropractic cranial care appears to be a viable intermediate therapy and may facilitate a reduced need for helmet therapy.

”Blum
Part 3: Case studies. Temporomandibular joint [TMJ] disorders and forward head posture secondary to airway compromise: A case report [case report; meeting abstract]. Clin Chiropr: Jun 2010(13:2): 194-195.”]

Introduction: Obstructive sleep apnea associated with airway compromise has far-reaching social implications. Forward head posture (FHP) also affects a large aspect of the population, and typically is considered associated with the aging process. Various factors have been recently found to be contributory regarding FHP. One in particular is associated with, airway dysfunction contributing to obstructive sleep apnea secondary to temporomandibular joint dysfunction (TMD) and its related myofascial dynamics affecting the oral cavity airway space. The following is a case report of a patient with a complex presentation involving obstructive airway dysfunction, FHP secondary to TMD related and related to ascending and descending patterns of postural influence.

Case Report – The Assessment: 58 year old female was referred for chiropractic care for severe chronic migraines headaches and associated disabilities. She needed daily medication for the headaches (Furinol, Codeine, and Tylenol) which along with prior chiropractic care limited her symptoms but did not resolve them. She had a history of chronic TMJ dysfunction with decades of dental treatment including TM disc implant, multiple tooth implants, and two full mouth reconstructions. Evaluation found significant sacroiliac joint hypermobility syndrome (category two) along with significant apnea associated with an obstructive TMJ dysfunction.

Treatment/Intervention: The treatment involved SOT management of the patient’s primary TMJ dysfunction while stabilizing whole body dynamics and function. SI joint treatment was performed with the patient supine, reducing pelvic torsion and stabilizing the posterior aspect of the SI joint. Cervical treatment involved myofascial balancing methods and cervical stairstep procedures to improve intersegmental cervical function and reducing suboccipital tension. SOT sutural cranial procedures were used to restore symmetrical motion of the craniomandibular muscles. Dental treatment involved developing a nighttime device that assisted in maintaining sufficient airway space associated with mandibular advancing and adequate vertical dimension.

Results: Improved pelvic balance and strength, reduced TM tension, reduced night time apnea episodes associated with reduced FHP were noted by the patient, dentist and chiropractor. Approximately 6-8 weeks into care the patient was able to decrease her medication. With the combined dental and chiropractic care, she was able to reduce chiropractic treatment from 2 times per week for years to 2 times per month. Within 3 months she had eliminated all medications except for occasional flare-ups occurring 4-5 times per year. The goal of having the patient gain independence from chiropractic/dental care with reduced discomfort and increased function was successful.

Discussion: Chiropractors treating both TMD and FHP will need to be able to differentiate the various types of TMD causing airway compromise as well as investigate the various causes of FHP. Patterns of influence to the TMD/FHP can be ascending from the feet, lower extremities, pelvis, spine or neck or descending from the stomatognathic or craniofacial systems, and mediated in either direction by way of visual, vestibular, or somatosensory righting mechanisms. The typical patient that may likely need chiropractic dental co-treatment will have a low pain threshold, low physiological adaptive range, and a history of musculoskeletal joint pain or injuries.

Conclusion: Based on the relationship between the chiropractic and dental approach view of FHP, before dental occlusion or TM condylar modification are performed, reducing ascending postural dysfunction as much possible may optimize dental procedures. Greater research is indicated into the relationship between the various components of FHP to determine if this condition is associated with quality of life and if improvement of the condition will assist the patient with greater function and well being.

Part 2: Poster presentations. Chiropractic care of pediatric nonmusculoskeletal conditions: A case series [meeting abstract]. Clin Chiropr: Jun 2010(13:2): 189.”]

Introduction: There have been inquiries by our scientific community to isolate what subset of patients with nonmusculoskeletal conditions might respond to chiropractic care. This paper attempts to facilitate a glimpse into a chiropractic clinical practitioner’s office where nonmusculoskeletal conditions are routinely being treated. Methods: As standard practice of this office an active group of pediatric patients (2000-07) were (n=127) sent a questionnaire via the mail.   For the purposes of this case series children treated for nonmusculoskeletal symptoms (n=37) out of those who responded to the questionnaire were used for this case series. All pediatric patients were treated by the same clinician utilizing sacro occipital technique and cranial pediatric treatments.

Results: 65/127 parents responded from our standard follow up outreach and 37/65 were treated for nonmusculoskeletal presentations. Of the 37 (17♂, 20♀) nonmusculoskeletal pediatric patients, 5 were treated for immune dysfunction, 7 for developmental delays/dysfunction, 9 for birth trauma, 1 for seizure activity, 4 for learning problems, 3 for endocrine problems, 3 for migraines, 2 gastrointestinal issues, 2 for fussiness/agitated/anxiety, and 1 for enuresis.

Discussion: Developing a pediatric chiropractic evidence base for practicing doctors should start with expanding the doctor’s knowledge of pediatric diagnosis and treatment options. The International Chiropractic Pediatric Association and Sacro Occipital Technique Organization – USA have postgraduate certification programs of value to practioners focusing on pediatric care.

Conclusion: To build a representative evidence base it is essential that research into chiropractic treatment of nonmusculoskeletal conditions incorporates successful chiropractic clinical practices treating this subset of pediatric patient.

The following are the Abstracts from the 2006 ECU Conference, Stockholm, Sweden.

Tellefsen T. Chiropractic management of anterior pelvic girdle pain and instability in pregnancy- A case study, including the management of birth preparation in the Chiropractic setting. European Chiropractic Union Annual Conference, Stockholm, Sweden, May 25-28, 2006.

Anterior pelvic girdle instability is a condition, which often is difficult to recognise, diagnose and manage in the medical and chiropractic field. The author builds on her own clinical experience by using a case study and discussing her theories on the osseous and myo-fascial stabilisation factors acting on the pregnant pelvic girdle. The author discusses the need for clinical guidelines in any medical and caring profession to aid in the assessment, treatment and appropriate advice on daily living for pregnant women suffering with this debilitating condition. The theories of De Jarnette, the founder of the chiropractic philosophy and treatment system the sacro occipital technique (SOT), are discussed. He divided lumbo pelvic conditions into three categories. The second category concerns pelvic instability where the interosseous ligaments of the sacro iliac joints have stretched so that the weight bearing part of the SIJ is affected.

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This ECU Conference Proceeding Compendium of Abstracts and all its contents herein are published by SOTO-USA solely for the purpose of education and should not be used by patients or unlicensed persons to diagnose or treat any condition.

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