Association of Chiropractic Colleges Educational Conference Proceeding’s Abstracts
A Brief History of the Association of Chiropractic Colleges (ACC) Educational Conference
In March 1994, the ACC held its first educational conference to promote educational research and to educate the educators on new pedagogical techniques. Since that time, the size and quality of the ACC Educational Conference has continued to improve. Over the years, the conference and the educational, basic science, and clinical research presentations have grown in quality and representation.
The ACC Educational Conference promotes institutional and academic excellence and learning and focuses on two areas, the bringing together of staff, administration, and faculty in a collaborative fashion to discuss various topics at group meetings and the presentation of peer-reviewed papers in poster or platform presentations.
The following are Abstracts from the 2018 ACC RAC Accepted Papers
Bloink T, Blum CL. Chiropractic care for TMJ and extreme tongue fatigue
A case report. J Chiropr Edu. 2018;32(1):53.
Objective: A 57-year-old male presented to this office with extreme tongue fatigue and significant neck pain.
Clinical Features: A month-prior the patient saw his general practitioner who prescribed antibiotics for possible throat infection and then 2-weeks later was seen by neurologist who diagnosed a cervical spine dysfunction and prescribed muscle relaxants, without any relief. Due to this condition lasting over a month, aside from coming to this office, he was referred to the UCSF neurology department to be assessed for amyotrophic lateral sclerosis (ALS). A few-years-prior he had extensive dental restorations, with bridgework, implants, and an over-the-counter bite-guard.
Interventions/Outcome: Treatment consisted of sacro occipital technique category one (pelvic torsion reduced sacral nutation), left-temporal internal rotation, sphenomaxillary craniopathy, and TMJ care for significant malocclusion – co-treated with dentist to develop/fabricate a lower dental splint. The patient was treated for 9-office visits for two-months and received the dental care (1-visit per week for 3-weeks) in the first-month. At 2-months the patient’s symptoms had completely resolved and ALS was ruled out.
Conclusion: Further research is needed to determine if this type of chiropractic care might be helpful for similar types of presentations, working closely with neurologists and dentists.
Blum CL. The polyvagal theory
A rational for psychological and chiropractic interdisciplinary care. J Chiropr Edu. 2018;32(1):69.
Objective: An integrative review was performed of Porges’ polyvagal theory relating to the autonomic nervous system, which considers there are two-parts to the vagal or parasympathetic nervous system.
Data Sources/Selection: Searches were made for polyvagal theory, parasympathetic, vagal, autonomic, chiropractic, cranial manipulation, and temporomandibular joint disorders through PubMed, ChiroIndex, and ChiroAccess search engines.
Results and Conclusions: Porges’ polyvagal theory suggests 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). Some studies have found chiropractic interventions may have a therapeutic effect on autonomic nervous system function, which may theoretically aid patients with compromised social interaction secondary to vagal compromise. Sacro occipital technique (SOT) attempts to incorporate both spinal and cranial adjusting components to address autonomic imbalances. Aspects of SOT cranial care focus on balancing cranial and sacral parasympathetics and specifically supporting balanced vagal function. Porges’ polyvagal theory suggests a rational for a body-mind support team that would include chiropractors (physical interventions) and psychologists/psychiatrists (psychological interventions) related healthcare practitioners may warrant further study.
Blum CL. Sacroiliac joint hypermobility syndrome and a chiropractic
A preliminary survey. J Chiropr Edu. 2018;32(1):70.
Objective: Sacro occipital technique (SOT) has long discussed how the anterior and posterior aspects of the sacroiliac joint (SIJ) are completely different in their anatomy and function, leading to differences in assessment and treatment. Research has also found that 20% of the population has joint hypermobility syndrome and may be an important factor for chiropractic assessment and treatment modalities.
Method: A small sampling preliminary survey was taken of SOT practitioners (N=53) and practitioners not familiar with SOT (N=11) via online-internet groups to determine the value of larger study. Questions related to whether the doctor practices SOT or not and what percentage of patients they see have hypermobile-versus-fixated SIJs.
Results: From this pilot survey, SOT chiropractors more commonly found patients with hypermobile SIJs, whereas chiropractors without an SOT bias, more commonly found patients with fixated SIJs.
Conclusion: Another survey with a larger sampling would yield greater information and if the results are similar to this one, then determining whether SOT practitioners find SIJ hypermobility suspiciously often or whether practitioners not trained in SOT under-report it, would be an important consideration. Whether-or-not hypermobile/fixated SIJ assessments and treatments lead to different outcomes will also be important to determine.
Blum CL. A preliminary survey of chiropractic college use of table sanitizers in their clinic
Are there green alternatives? J Chiropr Edu. 2018;32(1):69.
Objective: The chiropractic profession in recent years has been studying the need for chiropractic table sanitization, with studies noting gram-positive and negative bacteria (cocci and bacilli) – such as: Methicillin-resistant S. aureus, S. epidermidis, S. saprophyticus and S. aureus.
Methodology: A 2014 informal telephone survey to all 16-chiropractic college clinics within the United States asked what do they use to sanitize their treatment tables. Some responses were obtained over the telephone and other through email.
Results: From the response it was noted that the various sanitizers (ammonium chloride derivatives) used at the college clinics offer some risk to the practitioner during application via skin contact/inhalation, the patient via direct prolonged skin contact, and environmentally through patient’s clothing or when disposing of cloth/paper towel applier.
Conclusion: Healthcare encounters should at all times minimize risk. Discussed is the research relating to aqueous ozone, which has been found to function as sanitizer comparable to those currently used in the college clinics. It may be possible through the use of aqueous ozone the chiropractic profession could study the use of a green technology, to prevent the spread of infection while reducing any toxic load on the doctor, patient, and environment.
Blum CL. Chiropractic care of a rock climber’s shoulder with FHP (forward head posture)
A case report. J Chiropr Edu. 2018;32(1):53.
Objective: A 27-year-old male rock/boulder climber presented for chiropractic care due to weakness and discomfort upon shoulder loading, particularly when rock-climbing.
Clinical Features: This was a gradual onset chronic type injury, taking place over 6-9 months of elite indoor and outdoor rock climbing. Rock-climbing typically causes overuse syndromes affecting the myofascia of the anterior shoulders and cervicothoracic regions leading to FHP presentations and secondary cervicobrachial type syndromes.
Intervention/Outcome: Treatment essentially consisted of sacro occipital technique (SOT) and extremity techniques to reduce the anterior/posterior fascial line tensions to minimize the FHP presentation on any thoracic outlet syndrome, re-position the humeral head in a posterior/anterior position and stabilize with, kinesiotape, and exercises to stretch the anterior shoulder girdle and strengthen the posterior scapula stabilizers. Following the initial office-visit the patient reported improved strength and could sleep without pain or stressed 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.
Comments: If a platform presentation isn’t available a poster presentation would be acceptable.
Blum CL. Study on inducing fifth lumbar vertebra malposition by M. B. DeJarnette
Historical development of sacro occipital technique. J Chiropr Edu. 2018;32(1):69.
Objective: It is helpful to understand the historical development of chiropractic manipulative techniques since they helped form the foundation of chiropractic in its early years. One technique developer (DeJarnette) of Sacro Occipital Technique (SOT) attempted a research project, however flawed, that gives us a glimpse into his development of as aspect of his technique.
Data Sources and Selection: In DeJarnette’s 1952 text, he described a 1941 research study involving subject recruitment from his patient base (target ages 18-50 years old/no low-back pain). Over 200-subjects were examined with 16 fitting his inclusion criteria. Each of the 16-subjects received an adjustment to place a strain on the fifth-lumbar directing the spinous process towards the right and repeated daily for four-days. During the next two years DeJarnette followed their health status.
Results: One consistent finding was that each of the 16 subjects developed palpatory pain over the left transverse of their atlases. None of the 16 had such pain prior to the first experimental adjustment.
Conclusions: DeJarnette attempted to employ research methodologies to study and investigate his interventions. While this study was fraught with design flaws and would never receive IRB approval, it nonetheless shares his thought process.
Blum CL, Benner CD. A survey of sacro occipital technique (SOT) practitioners
Pediatric patients and their presenting symptoms. J Chiropr Edu. 2018;32(1):69.
Objective: Does a chiropractic technique determine what types of patients and conditions a chiropractor might see?
Methods: The survey was disseminated via SOT doctor e-mails lists, internet chiropractic groups, and chiropractic Facebook groups as a “Survey Monkey” survey. Respondents included doctors from United States, South America, Australia, and Europe. The goal was to determine what proportion of patients seen by SOT practitioners were pediatric patients, and of those patients what proportion were infants, children, or young adults. Additionally, what proportion of those patients were treated for musculoskeletal, non-musculoskeletal, or for preventative care.
Results: There were 326 responders stating they were SOT practitioners who treated pediatrics, with the majority noting 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: It may be of value to assess the chiropractic profession at large or subsets based on technique preference to help determine what place chiropractic care might play in pediatric musculoskeletal, non-musculoskeletal, and preventative care.
Edwards E, Ohm J, Blum CL, Union A. Identifying the frequency of perinatal sacroiliac hypermobility indicators in a chiropractic clinic
J Chiropr Edu. 2018;32(1):72.
Objective: Increased psoas-tension (PT) changes biomechanics during pregnancy, and several sources suggest a correlation between PT in non-pregnant adults and persistent, subacute sacroiliac joint hypermobility (SIJH). The relationship between stabilizing relaxin-induced perinatal SIJH (P-SIJH) and preventing PT remains under-investigated. Sacro Occiptal Technique’s (SOT) screening protocol for addressing SIJH/pain related to hypermobility may complement the Webster Technique (WT), a popular, specific chiropractic sacral analysis and diversified adjustment that doesn’t assess P-SIJH. We examined the frequency of four-SOT indicators in a cohort of perinatal chiropractic patients under WT care.
Methods: A retrospective review of 170 visits (January 2016) identified 17-perinatal patients presenting with LBP/SIJ pain who also met the criteria for potential P-SIJH identified by SOT but not WT.
Results: At least one indicator of P-SIJH was observed in all 17-assessments. Failing an arm fossa challenge (9), standing lateral sway (8), and unilateral scalenus muscle tension (5) were present in concert with knee tenderness that resolved upon SIJ stabilization (17) 75% of the time. Two indicators were detected more frequently than three or four.
Conclusion: SOT identified potential P-SIJH in 10% of the cohort under WT care. The uncorrected P-SIJH/PT relationship in pregnancy may warrant further investigation.
Gleberzon B, Roecker C, Blum CL, Good C, Cooperstein R. Toward the Development of a Standardized Chiropractic Technique Program
Workshop – Association of Chiropractic Colleges 25th Educational Conference and Research Agenda Conference. March 8-10, 2018.
Chiropractic is one of the least standardized of all professions, and this lack of standardization may frustrate the development of a unified position statement that clearly defines its cultural authority. The tremendous degree of variability between chiropractors is a reflection of the variety of different educational models available to students, especially within chiropractic technique programs.
In 2014 we laid the ideological foundation upon which a profession-wide chiropractic technique program ought to be constructed. In 2016, an inventory of diagnostic procedures was created. This process unveiled a few areas of discrepancy, specifically with regards to the use of thermography/surface EMG and x-ray line marking analysis.
The purpose of a 2018 Workshop is to address these areas of discrepancy in diagnostic procedures and to developing an inventory of what therapeutics procedures ought to be taught within chiropractic technique programs, based on the best available evidence consisting of published studies of clinical effectiveness and safety, patient preference and clinical experience.
Hamel R. SOT cranial therapy for the treatment of abnormal sensations of the tongue, tinnitus, TMD and neck pain
J Chiropr Edu. 2018;32(1):56.
Objective: A 34-year-old male patient presented to this office for care of a chronic TMJ dysfunction, neck pain, tinnitus and abnormal tongue sensations.
Clinical Features: The patient reported a four-month history of abnormal tongue sensations, tinnitus, clenching/bruxism, paresthesia in fingers and toes, muscle fasciculation, headaches, fatigue, IBS, anxiety, hiatal hernia and right quadratus lumborum myofascial pain radiating along the kinematic chain to ipsilateral shoulder and cervical spine.
Intervention/Outcome: Examination revealed narrow dental arches with an anterior premature contact, poor TMJ translation, and evidence of clenching/bruxism. Palpatory pain was noted in the muscles of mastication and cranial assessment revealed left temporal bone and spheno-maxillary imbalance. Prior history of a dental upper night-guard and Invisalign was noted. Treatment consisted of five chiropractic treatments (over 4-weeks) incorporating sacro occipital technique (SOT) cranial, craniobiotic technique and craniofacial adjustments. Following care the patient reported significant reduction in all symptoms, no tinnitus, tongue sensations normalized, and improved outcome assessment scores on the Central Sensitization Inventory and TMD Disability, Symptom Intensity and Symptom Frequency Scales.
Conclusion: Greater study is needed to identify if other patients presenting with chronic complex TMJ, facial, and tongue disorders might benefit from SOT and cranial/craniofacial adjusting interventions.
Hamel R. SOT cranial therapy with an occlusal splint for the treatment of low back, leg and neuropathic pain
A chiropractic dental co-treatment case report. J Chiropr Edu. 2018;32(1):73
Objective: A 25-year-old female patient presented with chronic back, leg, and neuropathic pain was co-treated with chiropractic and dental interventions.
Clinical Features: The patient reported a five-year history of low-back pain, hip pain, pulsing pain into her left-leg, decreased coordination and loss of feeling to her left-foot despite L5-S1 micro-discectomy and use of medication. She also experienced dizziness, headaches once-a-week, and TMJ crepitus.
Intervention/Outcome: Examination revealed left-foot paresthesia, left-SIJ instability with palpatory pain and swelling, decreased left L5/S1 deep tendon reflex, decreased L2/3 and L5/S1 myotome strength, palpatory pain along L1-5 spinous processes and left quadratus lumborum. Dentally she was she had underdeveloped dental arches with anterior premature contact, poor TMJ translation, and evidence of clenching/bruxism. Treatment consisted of ten sacro occipital technique (SOT) cranial dental appointments (over 6-weeks) incorporating SOT, neuro emotional technique (NET) and craniofacial adjustments and a lower occlusal dental splint. Following care the patient reported significant reduction in all symptoms, stopped medications, was able to return to hiking and horseback riding, sleeping better, improved posture and improved Oswestry score.
Conclusion: Greater study is needed to identify the subset of low back patients with neuropathy that could benefit from this approach.
Lane J, Union A, Edwards J. Chiropractic care of a pediatric patient with twin to twin transfusion syndrome
J Chiropr Edu. 2018;32(1):69.
Objective: To describe the care of an infant patient with twin to twin transfusion syndrome.
Clinical Features: A 3.5-month-old infant girl presented with her mother with a medical diagnosis of Twin to Twin Transfusion Syndrome. Her chief complaints were hypotonia of the head and trunk, suspected food sensitivities, the inability to latch and breastfeed, difficulties bottle-feeing, and infrequent bowel movements.
Intervention and Outcome: The patient received care utilizing a combination of Sacro Occipital Technique, Logan Basic Technique, and Thompson. Notable improvement were observed within the first visits and within one month of chiropractic care, the patient was able to meet developmental milestones such as rolling over, a milestone her patients were told it would take years to meet.
Conclusion: This case study suggests that individuals diagnosed with Twin to Twin Transfusion Syndrome may benefit from chiropractic care.
Mersky JA, Blum CL. Dizziness in a patient with airway compromise and TMD
A case report. . J Chiropr Edu. 2018;32(1):77.
Objective: A 38-year-old patient presented November-2016 for care with an array of symptoms (autoimmune disorders, dizziness, obstructive sleep apnea – OSA, etc.).
Clinical Features: The onset of his condition began eight-years-prior following a surfing accident (fell on left shoulder) and removal of wisdom teeth. After these events, he began experiencing syncope, brain fog, dizziness, and movement/vertigo, all worsened when sitting on soft seats or when hunching over or with his head tilted up or down. He described his condition as debilitating, relentless, and life-altering preventing him from being able to work. Prior to being seen at this office he was seen by 28-other-physicians and was primarily diagnosed with OSA, vestibular dysfunction, vascular headaches/migraines, and cervico/thoracic enthesopathy.
Interventions/Outcome: Treatment focused on SOT/SOT-cranial chiropractic interventions, nasal-balloon methods for craniofacial sinus expansion, and supplementation with B12/methylated folic acid (to facilitate red blood cell oxygen uptake). The patient was treated November-2016 through March-2017. By early 2017 his eight-year bout with dizziness was reduced and he could function in most activities of daily living.
Conclusion: It was difficult to directly assess what aspects of his presentation were genetic, macrotrauma-induced, or the result from microtraumas, though the care rendered appeared effective regardless.
Perry K. Unresponsiveness to sacro occipital technique (SOT) procedures suggested possible pathological contribution to patient presentation
A case report. J Chiropr Edu. 2018;32(1):63.
Objective: When a patient does not respond as expected the possibility that pathology might be contributory should be a consideration.
Clinical Features: A 63-year-old male presented with low back/hip pain, difficulty walking, sleeping, and lower-extremity weakness after driving his truck (his occupation). A prior lumbosacral MRI was unremarkable.
Intervention/Outcome: The patient’s pelvis/lumbosacral region was treated with SOT care and his condition stabilized after three office-visits (2-weeks) incorporating the use of an SI support belt. He continued to drive his truck (financial reasons) though it would worsen his condition, leading to return office-visits. After one-month he had a flare-up with bilateral leg weaknesses/falls and was referred for another lumbosacral MRI that was unremarkable.
At two-months he also had upper-left posterior thoracic pain with thoracic palpation-pressures worsening his lower-extremity condition. Due to his lack of responsiveness to the SOT care and thoracic spine sensitivity, an immediate referral for a thoracic CT scan was made, revealing a thoracic space-occupying lesion. Within 24-hours the space-occupying lesion was surgically removed with immediate reduction in pain and improvement in lower extremity strength.
Conclusion: Unresponsiveness to care that usually leads to positive outcomes may suggest the need for ruling out possible pathology.
Serola R, Blum CL. Sacroiliac joint myoligamentous interrelationships
Implications of sacral nutation dysfunction on whole body kinematics. J Chiropr Edu. 2018;32(1):65.
Objective: Muscles have recently been found to both move and stabilize the sacroiliac joint (SIJ), however generally this muscular component has attained minor relevance in SIJ diagnostic protocols.
Data Sources and Selection: Multiple Pub Med literature searches were made for search terms such as “sacral nutation AND musc*,” “sacral nutation and kinematic chain,” and “sacroiliac and musc*.” Abstracts were reviewed to determine which papers were pertinent for this review.
Results and Conclusion: The SIJ related muscles (e.g., iliacus, piriformis, etc.), have an interrelationship with ligaments affecting the SIJ. The SIJ is considered a “core-structure” for much of body’s kinematic chain so it would be anticipated that the whole musculoskeletal system might be affected by SIJ imbalance. Therefore preliminary evidence suggests that the movements at the SIJ (sacral nutation and counternutation) may influence the entire structure.
Axial forces induce SIJ nutation and excessive loading forces will tend to lead to sacral nutative sprain compromising ligamentous support. Theoretically a protective ligamento- muscular reflex is initiated to limit nutation on the side of SIJ compromise. A compensatory adaptation process occurs altering posture and joint angles, leading to asymmetrical patterns of motion and positioning affecting the musculoskeletal kinematic chain.
Shirazi D, Del Torto D, Blum CL. Dental chiropractic non-surgical interdisciplinary care of a 48-year-old male patient with a deviated septum, headaches, and TMJ dysfunction
A case report. J Chiropr Edu. 2018;32(1).
Objective: A 48-year-old male presented for care due to complaints of a deviated septum, headaches, and TMJ dysfunction.
Clinical Features: The patient noted occluded nasal breathing rated at 1-2 on a 1-10 scale with full airway function at a 10 (10 representing full airway function). He also had right-sided suboccipital migranous headaches occurring once-a-week, lasting 24-48 hours. The headaches were relatively unresponsive to medication and rated at an 8 on a pain scale of 1-10 with 10 being most painful possible. Visual inspection revealed a left nose deviation and TMJ deflection with crepitus.
Intervention/Outcome: The patient’s initial chiropractic care included 17 cranial facial release (CFR) nasocranial balloon treatments, sacro occipital technique (SOT), and a SIJ support belt. The dentist prescribed a TMD/OSA night and daytime appliances, acupuncture, and cold laser therapy. Patient was referred to another chiropractor for SOT cranial and chiropractic manipulative reflex technique (CMRT) care (6-office visits). The patient responded favorably to the interdisciplinary care and noted increased/improved nasal breathing rated at 7 with associated significant reduction in headache frequency/intensity.
Conclusion: Two chiropractors (CFR, SOT, Cranial, and CMRT) and a dentist/acupuncturist treated this patient leading to improved nasal breathing and reduced TMD/headaches.
The following are Abstracts from the 2017ACC RAC WFC Accepted Papers
Benner CD, Blum CL. CMRT and acupuncture in the treatment of dysmenorrhea (oligomenorhea): A case report. J Chirop Ed. 31(1):49-50.
Objective/Clinical Features: A 31-year-old female patient presented initially to this office for low back and foot pain 5 years prior and wanted preventative wellness care. Approximately 5-years into care, February 2008, the patient discussed the possibility of utilizing acupuncture to help her cope with an irregular menstrual cycle, having only light periods (1-2 days) 2-3 times a year for over 10-years or more.
Interventions/Outcome: The patient was assessed and treated using sacro occipital technique (SOT) chiropractic, chiropractic manipulative reflex technique, and acupuncture protocols. Following one-year of integrating sacro occipital technique (SOT) chiropractic manipulative reflex technique (CMRT) for liver (T8), adrenals (T9), and acupuncture her condition has been consistently improving and her cycle has been regulating with periods of monthly cycling and with only 3-months of amenorrhea one-time during a time of high stress and anxiety.
Conclusion: The chronicity of the patient symptoms, over 10-years, and the temporal relationship between treatment and response to care is of interest. It is also of interest that the patient was receiving chiropractic care on an ongoing preventative basis but not until the treatment changed to include CMRT and acupuncture was there a change in her symptomatology.
Bloink T, Blum C. Chiropractic care of a 52-year-old female patient presenting with cervical spine disc replacement surgery with complications: A Case Report. J Chirop Ed. 31(1):30-31.
Objective/Clinical Features: A 52-year-old female who was suffering from significant neck pain, which radiated down her right arm to her second-third fingers with paresthesia and muscle weakness. Disc replacement surgery was performed April-2015 to the C5-C7 discs and initially her symptoms resolved and then returned with symptoms on the contralateral side. An MRI was ultimately negative, however her neurologist was attempting to rule out multiple sclerosis or dural fistula. The patient had significant TMJ dysfunction with pain to palpation in the craniofacial sutural regions, hypertonic muscles of mastication, TM disc disorder, clenching/bruxism, and malocclusion. Cervical antalgia, limited range-of-motions with pain on motion and palpation along with related musculature weakness.
Intervention/Outcomes: The patient was treated (10-visits) March-2016/May-2016 with prone SOT category one blocking, intra-oral cranial adjusting, and TMJ balancing, Following the 1st-three visits she was seen by her dentist to balance a lower occlusal splint. By May-2016 her VAS constant pain levels decreased from a 8-9/10 to 3/10, paresthesia significantly decreased with normal ranges-of-motion, and muscles strength had returned. Follow-up MRI was unremarkable for any prior suspicious lesion.
Conclusion: This case suggests a relationship between the patient’s TMJ disorder and cervical spine limited function and pain.
Thomas Bloink, Charles Blum. Chiropractic care of a 30-year-old male patient presenting with cervical spine disc replacement surgery with complications: A Case Report. J Chirop Ed. 31(1):50.
Objective/Clinical Features: A 30-year-old male presented at this office July-2016, 1½-years following C-5/6 disc replacement surgery for a ski-related injury with loss of sensation/function of his right 3rd-4th fingers. Three-months following surgery he felt fine but then noted significant pain in the right neck, scapula, and arm, and occasionally on the left. December-2015 MRI was negative for pathology and was prescribed Neurontin, which helped somewhat. He was using a mandibular mouth-guard since April-2016. He had been an avid runner but couldn’t run and only walk ½-mile.
Intervention/Outcomes: He was assessed with a TMJ disorder: clenching, malocclusion, and craniofacial sensitivities along with cervical spine antalgia, limited ranges-of-motion with pain and weakness of related musculature. Patient was treated with prone SOT pelvic block placement (category-one), intraoral cranial adjustments, and co-treated with a dentist immediately following care. Following the 4th-office-visit he could hike at Yosemite National Park for 10-miles, the first time in over 2-years. By his 11th-office-visit (September-2016) he was able to run 1-mile, had normal cervical ranges-of-motion, no medication, and only occasional pain in his right scapula.
Conclusion: This case suggests a relationship between the patient’s TMJ disorder and cervical spine limited function and pain.
Bloink T, Blum C. Chiropractic as part of an interdisciplinary team for the care of a patient with an orbital pseudotumor: A case report. J Chirop Ed. 31(1):50-51.
Objective/Clinical Features: A 47-year-old female woke up over a year prior to seeking care at this office with darkness and limited vision in the right eye lasting two-hours. Her ophthalmologist diagnosed her with an orbital pseudotumor, which was unresponsive to treatment (steroidal anti-inflammatories). A year later the patient presented at this office reporting chronic intermittent headaches in the orbital region worse upon awakening. Her headaches included flashes of light that would become centralized blind spots, and also had a history of tinnitus and bruxism.
Interventions/Outcome: The patient was found to be a “heavy clencher” with anterior interference malocclusion causing significant forces into the cranium, face and orbits. She presented with an upper dental splint, which was substituted to a mandibular splint, without incisor contact, to relieve compression/pressure. The cranial-dental co-treatment at this office consisted of four-visits (once-per-week) with a dentist, preceded by cranial treatment the same day. She received a total of 10-treatments and following care her symptoms had completely resolved, sustained 1-year post-treatment.
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.
Blum C. Chiropractic conservative care of a patient presenting with carpal tunnel syndrome: A case report. J Chirop Ed. 31(1):51.
Abstract: Objective: Effective conservative care of patients presenting with carpal tunnel syndrome may play an important part of improving a patient’s ability to return to work, activities of daily living, and quality of life.
Clinical Features: A 42-years-old female patient presented with carpal tunnel syndrome of 6-month duration unresponsive to rest, splinting, and anti-inflammatory medications. Of significance was her reduced grip strength with pain limiting her activities and worse when arising in the morning.
Intervention/Outcome: Sacro occipital technique (SOT), SOT extremity techniques, kinesiotaping, and rehabilitative exercises were used to treat the patient’s presenting symptomatology. The patient’s kinematic chain was assessed and balanced from her lumbopelvic, cervical, thoracic outlet, shoulder, elbow and to her wrist. Her wrist was supported functionally in slight extension with kinesiotape and given exercises using a rubber band to stimulate her forearm extensor muscular, as a means to relax her flexor overuse, was utilized. Her symptoms completely resolved with a return to full grip strength in 3-office visits during a two-week period, and has sustained itself for 2-years.
Conclusion: Chiropractic with extremity adjusting, kinesiotaping, and rehabilitative exercises may be an important consideration for the conservative treatment of patients presenting with carpal tunnel syndrome.
Blum C. B6 hypervitaminosis during pregnancy with neurological symptoms: A case report. J Chirop Ed. 31(1):51.
Objective: With pregnant patients taking high levels of vitamin B6 and presenting with neurological symptoms, B6 hypervitaminosis may be an important, though rare clinical consideration.
Clinical Features: A female patient (40-years-old) who was experiencing nausea during her 3rd-pregnancy was advised to take a daily prenatal supplement (Bnexa) that had 100mg of vitamin B6. She took the 100mgs for 2-months, then switching to a 25mg B6 supplement. Within the first 2-months of taking the supplement she began to notice neurological symptoms such as burning behind her eyes, eye floaters, and paresthesia into her arms, wrists and fingers. After multiple evaluations by various doctors a blood test was taken that indicated abnormally high levels of B6. Once she stopped the vitamin supplement her symptoms decreased but had not completely resolved and therefore sought care at this clinic.
Intervention/Outcome: Sacro occipital (SOT) and cranial techniques were used to assess and treat this patient and during the course of care 2-months. The residual signs of her neurological disorders, which had not changed in 6-months, resolved during the 2-months of care.
Conclusion: B6 hypervitaminosis may be an important part of a differential diagnosis for pregnant/post-partum patients with un-explained neurological symptomatology.
Boro W. Relief of neurological symptoms secondary to surgical removal of thoracic astrocytoma and laminectomy by category I block placement: a case report. J Chirop Ed. 31(1):51.
Objective: To describe the clinical course, treatment and immediate response of a patient suffering from buzzing paresthesia secondary to surgical removal of thoracic astrocytoma, which was relieved by Category I Sacro Occipital Technique™ block placement.
Clinical Features: A 27 year-old nulliparous female had 4” thoracic pilocytic astrocytoma, between T4-T7, surgically removed. Six months of PT provided little improvement and she presented to my clinic with the following symptoms: lower back pain, neuropathy, paresthesias and visceral dysfunction, pain and numbness in both legs, pins and needles and buzzing sensation in both legs. Post-surgery she was unable to walk for 2 weeks and stated that she feels a continuous “buzzing” in her legs. She had difficulty getting in and out of car, sitting at a table, pushing, it was painful to stand more than an hour, and she needed to use a walker.
Intervention and Outcome: Success was achieved in reducing many of the presenting symptoms. However, Category I block placement produced repeated and immediate relief of paresthesias within 5 minutes of placement, lasting up to 24 hours or more.
Conclusion: This report describes patient response to Category I blocking and suggests a rationale for its success.
Esposito V Sr., Esposito V Jr., Blum C. Trauma induced severe refractory motion sickness disorder treated with sacro occipital technique, applied kinesiology, and cranial chiropractic care: A case report. J Chirop Ed. 31(1):57.
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.
Ferranti M, Anastasio B, Varnum C. Chiropractic management of a 6-month-old male with deformation plagiocephaly facial asymmetry, delayed constriction, and abdominal rigidity. J Chirop Ed. 31(1):57-58.
Objective: To discuss the case of an infant with right-sided cranial asymmetry, abdominal rigidity, and vertebral subluxations.
Features: A 6-month-old male had deformation plagiocephaly, left eye facial asymmetry, delayed constriction of the left eye, abdominal rigidity, and refusal to be in the prone position.
Intervention and Outcome: An inter-professional referral for a consult within our teaching clinic was used. Static and motion palpation along with nervoscope evaluation revealed vertebral subluxation at C1, T5, and sacrum. SOT methods were employed to address cranial plagiocephaly. Abdominal rigidity was no longer present after the third treatment. The left eye appeared more symmetrical, improved sleeping was noted, and the tolerance of tummy time and lying in the prone position was seen. The patient experienced improvements to the deformational plagiocephaly, and was told by a pediatric neurologist that a molding cranial helmet was not required.
Conclusion: This case study demonstrates the effectiveness of chiropractic care in correcting vertebral subluxation. Positive improvements of deformational plagiocephaly for the child were observed. More research is warranted to investigate the outcomes of chiropractic care for other cases with similar presentations.
Getzoff H, Blum C. Anterior Thoracic Adjusting and the Relationship to Cervical Flexion: A Retrospective Case Study of Twenty-Four Patients. J Chirop Ed. 31(1):59-60.
Objective: 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. In general, the ATA is believed to be used predominately for hypokyphotic thoracic spines and related to two factors: a) the vertebral subluxation felt anterior (spinous) and b) the adjustive thrust was applied anteriorly. Clinically, in this study, the CFF is used as a pre- and post-adjustment assessment to identify the effectiveness of the ATA.
Methods: The data [n-24] collected in this study was obtained during one office visit. Pre- and post CFF assessments were performed using a goniometer to measure any changes in CFF 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. The one-patient that showed no improvement in CFF at the post-adjustment measurements had a significant scoliotic spine.
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.
Gleberzon B, Blum C, Good C, Roecker C, Cooperstein R. Toward a Standardized Chiropractic Technique Program: Consensus Results of Two Inter-Collegiate Workshops. J Chirop Ed. 31(1):60.
Objective: We report the consensus opinions of two inter-collegiate workshops that sought to develop a standardized chiropractic technique program.
Methods: The authors of this study facilitated small groups of attendees tasked with answering Seed Statements during Workshops held during ACC-RAC conferences in 2014 and 2016.
Results: Overall, attendees reported that it was acceptable to rely on clinical experience and patient preference when providing patient care, even in the absence of research evidence, provided procedures are safe and biologically plausible. Selection of curricular content should not be based on tradition alone or ritualistic dogma, but sometimes this appears to still be the case. Licensing bodies should not be involved in this process.
Attendees reported diagnostic procedures either do or should include static and motion palpation, postural and gait analysis, joint springing palpation, ranges of motion and functional (orthopedic) testing. There was no consensus with respect to teaching leg length analysis, x-ray film line marking analysis and thermography.
Conclusion: This information is an important first step in developing a standardized chiropractic technique program for all teaching institutions. Future workshops will focus on resolving areas of disagreement as well as reaching consensus on what therapeutic procedures ought to be taught.
Hagen C. Chest Pain and Posterior Rib Misalignment: A Differential Diagnosis. J Chirop Ed. 31(1):62.
Objective: This case study is meant to add a valuable differential diagnosis to patients that present with chest pain. Ruling out myocardial infarction is necessary in certain circumstances, but not the most cost effective choice in certain presentations.
Clinical Features: Middle aged male presents with chest pain in the sterno-clavicular joint area and was concerned that he might be having a “heart attack.” No history of injury other that manual labor. No shortness of breath. Decreased localized rib motion noted in inspiration and expiration. Patient rated pain an 8 out of 10 on the VAS.
Interventions/Outcomes: Sacro occipital technique (SOT) trapezius fiber analysis was used along with palpation to localize a posterior rib fixation, which was corrected and his chest pain decreased to a 2 out of 10 on the VAS in 24 hours.
Conclusion: Posterior rib dysfunction can present itself as chest pain, mimicking a myocardial infarction, and chiropractic care could have a place in a cardiac interdisciplinary setting, when a myocardial infarction has been ruled out but the pain remains.
Hamel R, Rahimi M, Blum C. Sacro occipital technique (SOT) cranial therapy with an occlusal splint for the treatment of fibromyalgia and obstructive sleep apnea with blocked sinus. J Chirop Ed. 31(1):62.
Objective/Clinical Features: A 47-year-old female patient presented for chiropractic care with a thirteen-year history of TMJ pain, vision disturbances, deviated septum, fibromyalgia, chronic fatigue, excessive daytime sleepiness, chronic headaches, cognitive impairments, insomnia, chronic myofascial neck and shoulder pain, low back pain with radicular syndromes. She has also taking amitryptiline medication for thirteen-years.
Interventions/Outcome: Examination revealed narrow dental arches with an anterior premature contact, poor TMJ translation, and evidence of clenching and bruxism. Palpatory pain noted in the muscles of mastication and cranial assessments revealed left temporal bone and spheno-maxillary imbalance. Treatment consisted of eight-SOT cranial dental appointments (over 5-weeks) incorporating SOT intraoral and sphenomaxillary adjustments in conjunction with a lower occlusal dental splint. Following care the patient reported significant reduction in all symptoms without the need of medication, sleeping 7-hours without interruption, breathing freely, and exercising for first time in 13-years. Sleep studies were performed one prior to instituting care (without a dental appliance) and another 6-weeks after instituting care (dental appliance in her mouth) with the post-study noting a significant clinical improvement.
Conclusion: Greater study is needed to identify the subset of apnea patients with fibromyalgia that could benefit from this approach.
Holbeck M. Chiropractic treatment of a post-concussion syndrome secondary to volleyball injury in a 14-year-old female: A case report. J Chirop Ed. 31(1):64.
Objective/Clinical Features: A 14-year-old female was stroke in the frontal bone (glabella) by a volleyball with impact (March-2012) from inferior to superior, while she was twisting to the left. She was seen by pediatrician and neuro-pediatrician, told to take Tylenol, and rest. She presented at this office on July-2012 with no memory of the volleyball game, decreased visual fields, dizziness, nauseated, extreme fatigue, and headaches since impact with pain in occipital and glabella being dominant. Due to her symptomatology she was unable to attend school.
Intervention/Outcomes: The patient was treated with SOT category two supine block placement, cervical stairstep adjustments, and parietal sagittal suture release cranial techniques. Following the first treatment she was able to return to school since the injury and pain in her occipital region had subsided. She was seen for three more visits with the focus on cranial adjusting of the craniofacial region and by August-2012 she was symptom free. Until she was treated there had been no change in symptoms with consistent improvement noted following each visit.
Conclusion: Based on the finding of this case report SOT and cranial treatment for the care of post-concussion syndromes in athletes warrants further study.
Klingensmith RD, Blum CL. Chiropractic manipulative reflex technique (CMRT) treatment for GERD of a 3 year old male child: A case report. J Chirop Ed. 31(1):66.
Objective/Clinical Features: This is a single case study involving a 3-year old male being treated medically for gastroesophageal reflux disease with various prescription antacids since the age of 2-months and Prilosec since 24-months-old. Sacro occipital technique (SOT) and chiropractic manipulative reflex techniques (CMRT) were used to treat the patient’s gastroesophageal reflux disease (GERD) presentation.
Interventions/Outcome: The patient received 5-treatments of CMRT protocol for occipital fiber-3, line-2 T5 which consisted of occipital fiber manipulation, vertebral adjustment and the stomach reflex manipulated at intervals of one-day and then every 3-days. By the fifth-visit, two-weeks after the initial treatment, the mother reported the child appeared to have no reflux pain, sleeping well, no “belly aching,” and that she had discontinued the Prilosec after the second treatment
Conclusions: Positive outcomes such as this offer the incentive to warrant further pediatric studies to determine consistency of outcome with chiropractic interventions and particularly CMRT for GERD. While it is essential to determine what subset of pediatric patients with GERD may benefit from this care a short period of trial therapy may function as a diagnostic test and a viable option to GERD that is unremitting in a young child.
Rosen M, Blum C, Rosen E. Resolution of a left sided 5th phalangeal 2nd inter-phalangeal joint stenosing tenosynovitis (trigger finger) in a 2 1/2 year-old female: A case report. J Chirop Ed. 31(1):74.
Objective/Clinical Features: While a condition such as stenosing tenosynovitis (trigger finger) is not usually considered neurological or musculoskeletal in nature it is relevant that in this case standard chiropractic care applied mainly at the spinal level appeared to facilitate a complete resolution of the patient’s trigger finger. A 2 ½ year old female was seen for her first chiropractic evaluation on June 22, 2012 presenting with stenosing tenosynovitis (trigger finger), unresponsive to prior care (e.g., medication, injections, and physical therapy) and parents were hoping for an alternative to surgery.
Intervention/Outcomes: Based upon the examination findings and previous treatment history, chiropractic adjustments using sacro occipital technique (SOT) protocols were directed to C4, T6, left scapula, left 1st rib-head and left wrist. After seven chiropractic adjustments this 2 1/2 year-old child’s trigger finger was 80-90% resolved. At 6-month follow-up the mother indicated the child’s trigger finger had continued to improve following care and was completely resolved.
Conclusion: Because allopathic intervention for this condition appears tos have questionable outcomes and risks, chiropractic care may be a viable and safe initial conservative first step to take before exploring the more invasive and costly options.
Rosen M, Blum C, Rosen E. Chiropractic care of a two year-old diagnosed with gastroesophogeal reflux (GER) and a hiatal hernia (HH): A case report. J Chirop Ed. 31(1):74.
Objective/Clinical Features: A one-year-old female was seen at this office reported with esophageal reflux, hiatal hernia, not sleeping more that 1.5-hours at a time, wouldn’t eat solid food, didn’t crawl as an infant, wouldn’t lay prone/supine, ongoing vomiting, and was irritable and inconsolable.
Intervention/Outcomes: Analysis and treatment utilized Sacro Occipital Technique (SOT) spinal, cranial and chiropractic manipulative reflex technique (CMRT) adjusting protocols. After the first 3-4 visits the patient’s symptoms began to subside, she did not cry in pain as often, her reflux and vomiting reduced dramatically, she no longer needed to take the prescribed medications and she was able to sleep through the night without waking up crying in pain. After 4-weeks of care, the patient started crawling for the first time in her life and a couple months later began eating solid foods with any nausea.
Conclusions: It is possible the child might have outgrown her condition but the temporal nature of her response to care compellingly coincided with her ability to eat, sleep and cease medication. The findings from this study suggest that a subset of pediatric patients with GER/HH may benefit from SOT, CMRT, and cranial care.
Scoppa J. Treatment of knee pain in an athlete sprinter with sacro occipital technique and cranial techniques. J Chirop Ed. 31(1)74.
Objective/Clinical Features: 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, physical therapist guided rehab-based exercises, saw a medical doctor who ruled out major structural damage, and received a series of twelve-visits with a Rolfer with no change in symptoms.
Interventions/Outcomes: The patient was treated using sacro occipital technique (SOT) category two and SOT extremity technique protocols along with cranial techniques. 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 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.
Scoppa J. Treatment of acute TMJ pain and dysfunction with sacro occipital technique and cranial techniques. J Chirop Ed. 31(1):74.
Objective/Clinical Implications: A 63-year-old male patient was seen for acute unremitting TMJ pain (closed lock without disc recapture), which started insidiously a few days prior to his first office-visit. His VAS for his TMJ (dull pain) was 4/10 at rest, which became (sharp pain) a 8/10 when he attempted to open his mouth or move his neck. For three-days prior to the initial office visit chewing had become impossible so he had resorted to a liquid diet.
Intervention/Outcomes: His TMJ translation was limited and the patient was unable to open his mouth more than two-fingers-width. The patient was treated using sacro occipital technique (SOT) and cranial protocols. After the first office visit the patient was able to open him mouth without pain and noted 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 VAS for his TMJ was 0/10 and his TMJ was functioning normally.
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.
Shirazi D, Gerardo R, Blum C. Dental chiropractic interdisciplinary care of three patients with different conditions yet similar symptom presentation: A case series. J Chirop Ed. 31(1)76-77.
Objective/Clinical Features: Three cases presented with jaw pain, limited cervical range-of-motion, and some related headaches. Patient A was a “cervical primary,” Patient B was a primary “temporomandibular joint (TMJ) and cranial,” and Patient C was a “TMJ primary.” In these three cases each patient presented with jaw, head, and neck pain but with each case the treatment varied.
Interventions/Outcomes: The dentist prescribed a nighttime deprogramming orthotic. The chiropractor focused on sacro occipital technique (SOT) and cranial/TMJ treatments. Six-months post-treatment commencing the patient no longer had any jaw pain or had TMD, improved posture, and improved CO/C1/C2 space. Patient B: The dentist prescribed a daytime and nighttime deprogramming orthotic. The chiropractor focused on SOT and cranial/TMJ treatments. Five-months post-treatment was initiated the patient had no TMJ pain and improved stability with improved spinal posture and reduced cervical spine pain. Patient C: The dentists prescribed a daytime and nighttime deprogramming orthotic. The chiropractor focused on SOT and cranial/TMJ treatments. Five-months post-treatment commencing treatment the patient had no TMJ pain and improved stability with greater cervical posture and no headaches.
Conclusion: This study suggests that patient’s with both musculoskeletal and dental issues may need a referral for co-treatment.
Sundy D, Blum C. A Multimodal Approach to the Conservative Management of Meniscus Tear. J Chirop Ed. 31(1)78.
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 with his knee “locked” in 20° of flexion. He had seen an orthopedist who recommended partial meniscectomy and warned of eventual knee replacement. However the patient chose to seek a conservative approach and had unsuccessful treatments with a Rolpher, Acupuncturist, and Chiropractor prior to being seen at this office.
Intervention and Outcome: The patient received 24-treatments combining Sacro-Occipital Technique, Activator Methods Chiropractic Technique, Hendrickson Method, and Cold Laser. Pre and post-assessments found significant pain relief and improved function as demonstrated with a near full recovery and markedly improved knee injury and osteoarthritis outcome scores (KOOS).
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 conservative option, offering cost effective therapy for patients with meniscus tears.
Tuttle D, Hochman J, Sullivan S, Hosek R. Sacro-Occipital Technique care alters frontal, temporal, parietal, and occipital brain electrical activity: A randomized controlled clinical study. J Chirop Ed. 31(1):79.
Objective: This study sought to evaluate the effects of chiropractic care o brain function by analyzing scalp electrical activity using quantitative electroencephalography (qEEG).
Methods: Thirty participants were randomize into 3 groups: SOT®, sham or control group (10 per group), EEG recordings were obtained from 19 recording sites set up according to the 10/20 system. Readings were taken at baseline, immediately post intervention and one week later. SOT participants were adjusted using DeJarnette blocks and an Activator® II was set to zero and was applied to all subjects identically. ASEBA questionnaires were completed at baseline and one week points.
Results: The SOT group demonstrated statistically significant changes (p<.001) for care in frontal, temporal, parietal, and occipital brain regions: 2HzF7; 4Hz:C4,P4,Pz; 2Hz:T4; 14Hz:T3; 8Hz:Fpl,F3,F7,T6,O1; 9Hz:F3,F4,Fz,F7,T3. Sham participation had no statistically significant changes. The control group experienced significant change in the frontal region; 19Hz:F4; 23Hz:Fz. ASEBA results showed change in externalizing behaviors in the SOT group (p=.041).
Conclusion: Treatment with SOT chiropractic showed significant change in brain function and self-reported behavior, especially when comparing baseline brain activity to 1-week follow-up.
Woodward-Terranova P. Blum C. Resolution of adult gastroesophageal reflux disorder following chiropractic care: A case series. J Chirop Ed. 31(1):62.
Objective: This case series attempts to investigate whether a relationship may exist between vertebral subluxation, particularly in the mid-thoracic spine, and the presence of gastroesophageal reflux disorder (GERD) symptoms. More importantly, it presents a retrospective review of patients presenting with GERD who had a temporal relationship between a resolution of their symptomatology, which coincided, with the correction of the spinal misalignment.
Clinical Features: Eight-women, six of which were pregnant, presented with GERD symptoms amongst other musculoskeletal concerns. Increased erector spinae tone was present in all patients, typically on the right side in the mid-thoracic spine.
Intervention and Outcomes: Each patient was analyzed according to a combination of Activator and SOT trapezius fiber analysis and adjusted using instrument-assisted adjusting. Patients were seen between 10-30 visits, and six of eight-reported improvement in GERD symptoms following 1-2 adjustments of the T5 vertebra. This corresponded with decreased indicators of T5 subluxation.
Conclusion: While it is difficult to generalize from a small case series such as this, documentation of clinical relationships between symptom resolution and improved spinal alignment is important in order to options for patients suffering from non-musculoskeletal symptomatology since this may offer patients low-risk conservative options for care.
The following are the Abstracts accepted for the 2016 ACC Conference, Las Vegas, Nevada.
Cuthbert S, Blum C. A potential clinical prediction rule for 52 patients with headache and cranial dysfunctions: A retrospective case-series report. J Chirop Ed. 2016; 30:1:72.Cuthbert S, Blum C. A potential clinical prediction rule for 52 patients with headache and cranial dysfunctions: A retrospective case-series report. J Chirop Ed. 2016; 30:1:72.
Introduction: To propose a potential diagnostic and prognostic clinical prediction rule (CPR) related to the non-pharmaceutical management of adults with headache and cervico-cranial dysfunctions utilizing the assessment and treatment methodology of two chiropractic techniques, Applied Kinesiology and Sacro Occipital Technique
Methods: 52 sequential patient files with headache (HA) (48 females, and 4 males) were retrospectively examined.
Results: Muscle dysfunctions (inhibition) were found to be associated with HA in these patients as follows: sternocleidomastoid, 42 patients; deep neck flexors, 33 patients; anterior scalenes, 24 patients; upper trapezius, 24 patients; and 3 patients with HA had no muscle inhibition. Cranial and upper cervical dysfunctions were found in 49 and 52 patients respectively. Following a series of chiropractic treatments the initial Visual Analog Scale of Neck and Associated Pain scale changed from an average of 6.75 to an average of 0.49.
Conclusion: This pilot study suggests that muscle dysfunctions arising from, or part of the etiology of cranial dysfunctions, could be used as a CPR to isolate subsets of HA patients that may respond to chiropractic care. The manual muscle test may be able to function as part of an assessment and treatment CPR for patients with HA.
Colby-Allen S, Blum C. Sacro occipital technique and autism spectrum disorders: A case series. J Chirop Ed. 2016; 30:1:71.
Introduction: The efficacy of chiropractic care (sacro occipital technique-SOT) to treat autism spectrum disorders (ASD) is discussed and procedures outlined. This is a case series of five-ASD patients that had been diagnosed prior to beginning chiropractic care.
Methods: The methods used include cranial adjustments, CMRT, spinal adjusting in a particular sequence. Also used were allergy elimination, emotional clearing, and trans-cranial ultrasound.
Results: In general, every patient in this case series demonstrated improvements in gastrointestinal health, decreased self injurious behaviors as well as an overall calming effect, improved verbal communication, cognition, and eye contact, decreased rigidity around routines, and increased quality of life for the entire family. Family members, caregivers, and school instructors noted these improvements and along with improved Autism Treatment Evaluation Checklist (ATEC) scores, suggested that the care received was efficacious.
Conclusion: It is hypothesized that improving spinal cranial balance as well as aiding organ function, that this may improve gut and brain function, which could be associated with the observed improved changes in this study’s ASD patients. Further research is needed to determine if there is a specific subset of ASD patients that may be responsive to the protocols used in this study.
Cashman S, Blum C. Trapezius fibre muscle analysis: An inter/intra-examiner reliability study. J Chirop Ed. 2016;30:1:54.
Introduction: The trapezius fibre technique, a diagnostic/treatment method within sacro occipital technique (SOT) was first described by DeJarnette as a way of detecting and locating vertebral dysfunction through the presence of palpable nodules in the trapezius muscle. DeJarnette postulated that the specific position of a muscular nodule in the trapezius relates to a specific level of vertebral dysfunction. While this technique is widely utilised for various musculoskeletal conditions, little research has been conducted to date. Our aim was to evaluate the inter/intra-examiner reliability in detecting these nodules in the trapezius.
Methods: IRB approval was granted by Macquarie University Ethics Review Committee and 36-subjects were enrolled in an inter/intra-examiner reliability study with three examiners proficient in SOT.
Results: It was found that in 72% of cases there was a level of inter-examiner agreement. In the intra-examiner study there was faultless agreement in 56% of cases, rising to 89% for a minimum level of agreement.
Conclusion: This study suggests that experienced practitioners have a clinically viable level of agreement in locating these nodules in the trapezius muscle. Greater research is indicated into trapezius fibre analysis and treatment with studies investigating the validity of this outcome assessment tool.
The following are the Abstracts accepted for the 2015 ACC Conference, Las Vegas, Nevada.
Bloink T, Blum CL, Rahimi M. Integration of SOT cranial therapy with an occlusal splint for the treatment of obstructive sleep apnea: A case report. . Chiropr Edu. 2015;29(1):92.
Introduction: A 56-year-old female patient presented for chiropractic and dental care with persistent symptoms of sleep apnea, excessive daytime sleepiness, short-term memory loss, foggy-headedness, TMJ pain, chronic myofascial neck and shoulder pain, fatigue, and vertigo.
Methods/Intervention: Cranial-dental exam revealed a dental-class-II, narrow arches and premature anterior contacts with clenching and bruxism. The sleep study revealed a Respiratory Disturbance Index (RDI) of 17.1 and Apnea Hypopnea Index (AHI) of 16.3, with the lowest oxyhemoglobin saturation (SaO2) of 89% during sleep. Six-treatments over a 3-4 week period of time consisted of sacro-occipital technique (SOT) and cranial care with dental care to facilitate occlusal balancing.
Results: Following the 6-office visits the patient reported significant reduction of all symptoms. Follow-up polysomnogram was performed one-month following prior study and with the dental appliance in her mouth. RDI and AHI were both reduced to 2.9 and lowest Sa02 was 92% during sleep. Due to her increased ability to sleep and increased oxygenation, she had less daytime fatigue and greater function.
Conclusion: The persistent nature of the patient’s apnea, the pre and post-sleep study objective findings, and the patient’s significant reduction in pain and improved function are compelling features of this case.
Gerardo RC, Blum CL, Shirazi D. Chiropractic and dental care of a patient with temporomandibular and sacroiliac joint hypermobility: A case report. Chiropr Edu. 2015;29(1):96.
Introduction: The purpose of this case report is to share a novel protocol for the treatment of chiropractic and dental treatment of a patient with TMD that presented with hypermobility of the sacroiliac joint (sacro occipital technique – category two) and TMJ.
Case History: A 47-year-old female patient presented with chief complaints of pain when chewing, jaw pain, limited mouth opening, and TMJ crepitus. Following dental evaluation and delivery of dental orthotics the patient was referred for concurrent chiropractic, which found indicators of a category two.
Methods/Intervention: Following orthotic and chiropractic care at 8-weeks, the capsulitis of TMJ was no longer present and procaine injections were initiated at one month intervals, followed by prolotherapy. Chiropractic and dental care was continued over a 10-month period.
Results: Following concluding treatment the patient is free of most pain, has full range of motion in the cervical and lumbar spine, negative sacroiliac hypermobility findings, and can open her mouth greater than 42mm (initially presented with 28mm opening) with normal joint tracking and translation.
Conclusion: Concurrently her sacroiliac joint hypermobility syndrome and related soft tissue tension patterns in the lower extremity, cervical spine, and jaw region have also significantly improved.
dal Bello F, Bergesch P, Blum CL. The influence of the chiropractic treatment in patients with insulin resistance associated with diabetes type 2: A case series. Chiropr Edu. 2015;29(1):94.
Introduction: High plasma levels of insulin and glucose due to insulin resistance are a major component of the metabolic syndrome, a syndrome with a group of risk factors that raises the risk for heart disease and other conditions, such as Diabetes Mellitus (DM) type-2 and stroke. Since some low-level evidence has found chiropractic care may demonstrate some influence in non-musculoskeletal interactions such as in DM individuals this study was performed to analyze any possible influence of chiropractic treatment for patients with DM and insulin resistance.
Methods: Four patients with DM type-2 with insulin resistance were selected by an allopathic diabetes specialist to participate in this study. The treatment consisted of eight chiropractic office visits that incorporated adjustments to the spine and chiropractic manipulative reflex technique (CMRT) to balance viscerosomatic/somatovisceral autonomic reflexes. Laboratory blood tests were taken on the second and eighth office visits, before and after the chiropractic adjustment.
Results: After the eight-visits, the levels of insulin resistance, following chiropractic care, decreased significantly when compared to prior to the chiropractic intervention.
Conclusion: Further research is needed in this arena to determine which subset of patients and type of chiropractic care would achieve the optimal results.
Boro WJ. Intervention in menorrahagia through chiropractic adjustment and spondylotherapy: A case report. Chiropr Edu. 2015;29(1):92.
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/Intervention: 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.
Tuttle D, Hochman J, Sullivan S, Hasek R. Quantitative assessment of changes in brain activity after a chiropractic adjustment. J Chiropr Edu. 2015;29(1):106.
Background: The effects of chiropractic adjustments on brain function is a largely understudied area, perhaps due to the lack of cost-effective, objective measures of brain functions. Quantitative electroencephalography (qEEG) is a technique that allows for an in-depth analysis of brain electrical activity before, during, and after a chiropractic adjustment.
Methods: A female patient aged 33 years received a preliminary qEEG assessment. One week later, a follow-up qEEG was conducted before and after receiving a chiropractic adjustment, sacro occipital technique category two supine pelvic block placement.
Results: Analysis using LORETA z scores showed a 2.27-SD increase in values in the delta (1 Hz) band. Raw value changes with value of p<.05 were increased at more sites post adjustment as compared to preliminary assessment.
Discussion: Changes in qEEG were markedly more significant following a chiropractic adjustment as compared to changes seen over a 1-week period with no intervention.
Conclusion: While the results demonstrate definite qEEG changes following adjustment, further work must be done to determine the most effective way to utilize this technology.
Cooperstein R, Young M, Haneline M. Criterion validity of static spinal palpation compared to a reference standard. J Chiropr Edu. 2015;29(1):74.
Background: Anesthetists and manual therapist are the main healthcare specialties to have studied the accuracy of palpatory procedures for identifying spinal segments. Accuracy is essential to the practice of anesthesiology to ensure optimal anesthesia/analgesia. Manual therpists continue efforts to optimize the site of care through both motion and static palpation.
Objective: The authors’ primary goal was to write a systematic review of the aricles that addressed the accuracy of spinal palpation in relation to an acknowledged reference standard.
Methods: To be included, a study had to address the ability of examiners to accurately identify, through manual palpation single or multiple spinal levels in relation to an acknowledged reference standard, usually but not always an imaging procedure. Cadaveric and non-English studies were excluded.
Results: The initial search retrieved 1084 studies, 62 abstracts were read, 41 full-txt articles were retrieved, and 24 were deemed to satisfy the inclusion criteria.
Discussion: Although accuracy for identifying exact segments I often very low, a more liberal definition of accuracy consisting of +/- 1 level is usually very high, up to 100%.
Conclusion: Future studies should determine the extent of which accurate level estimates are necessary for good clinical outcomes. Ultimately this study found that palpating the crest heights corresponded to L3 and not L4, and palpating the inferior scapulae corresponded to T8 and not T7.
The following are the Abstracts accepted for the 2014 ACC Conference, Orlando, Florida.
Benner CD, Blum CL. SOT chiropractic and acupuncture for SLAP tear: A case report. J Chiropr Educ. Spr 2014;28(1).
Introduction: While arthoscopic surgery is a common occurrence with SLAP lesions the purpose of this paper was to investigate whether conservative care, which utilized sacro occipital technique (SOT) chiropractic care and acupuncture, could facilitate recovery with a patient presenting with a SLAP lesion.
Case History: 42 year old male, in good overall health, injured right shoulder while doing boxing training on an ‘upper-cut bag’. An MRI was taken which revealed a SLAP tear which was unresponsive to prior conservative care interventions for 8 months.
Methods/Intervention: Chiropractic SOT and acupuncture were instituted to treat kinematic chain asymmetry and improve shoulder healing.
Results: By the first treatment an immediate improvement in range of motion and a substantial decrease in pain were found. Following 5-visits over a 2-month period of time the patient was able to return to prior boxing training and had full shoulder strength and flexibility.
Conclusion: The chronicity of the patient symptoms, over 8 months, and the temporal relationship between treatment and response to care is of interest. Research should be performed to evaluate whether a subset of patients may be better suited for this alternative method of care or whether this case was an anomaly.
Moeller JL, Blum CL. Orofacial myofunctional therapy: A Case Report. J Chiropr Educ. Spr 2014;28(1).
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.
Boro WJ. Chiropractic Intervention of Zenker’s Diverticulum: A case report. J Chiropr Educ. Spr 2014;28(1.
Introduction: Zenker’s diverticulum is a blind sac (pouch) that branches off the esophagus at the upper esophageal sphincter. While surgery is a common treatment for ZD, the purpose of this paper was to investigate whether Sacro-Occipital Technique (SOT) chiropractic care and soft tissue therapies could facilitate recovery of a patient. .
Methods/Intervention A 71 year old male, 6’1”, weighing 191 pounds presented at this office with chief complaint of difficulty swallowing, associated with coughing when swallowing, and a diagnosis of ZD. Treatment utilized DeJarnette’s sutural protocol, adjustment to the cervical spine (cervical stairstep), shoulder girdle, category II block placement, lumbar adjustment, soft tissue release to the pharynx/larynx area, and modified Van Rumpt hiatal hernia release.
Results: Four treatments were given over a period of two weeks. Symptoms were improved after the first treatment and significantly by the second treatment. Between the second and third treatment session the patient underwent a laryngoscopy and was told that the ZD was not of sufficient size as to require surgery.
Conclusion: While there have been no studies reported utilizing conservative chiropractic methods and the treatment of ZD, it appears that such treatment in some instances may provide therapeutic benefit to those suffering from this disorder.
dal Bello F, Bergesch P, Blum CL. The influence of chiropractic treatment in patients the insulin resistance associated with diabetes type II: A case series. J Chiropr Educ. Spr 2014;28(1.
Introduction: High plasma levels of insulin and glucose due to insulin resistance are a major component of the metabolic syndrome, a syndrome with a group of risk factors that raises the risk for heart disease and other conditions, such as Diabetes Mellitus (DM) type-2 and stroke. Since some low-level evidence has found chiropractic care may demonstrate some influence in non-musculoskeletal interactions such as in DM individuals this study was performed to analyze any possible influence of chiropractic treatment for patients with DM and insulin resistance.
Methods: Four patients with DM type-2 with insulin resistance were selected by an allopathic diabetes specialist to participate in this study. The treatment consisted of eight chiropractic office visits that incorporated adjustments to the spine and chiropractic manipulative reflex technique (CMRT) to balance viscerosomatic/somatovisceral autonomic reflexes. Laboratory blood tests were taken on the second and eighth office visits, before and after the chiropractic adjustment.
Results: After the eight-visits, the levels of insulin resistance, following chiropractic care, decreased significantly when compared to prior to the chiropractic intervention.
Conclusion: Further research is needed in this arena to determine which subset of patients and type of chiropractic care would achieve the optimal results.
The following are the Abstracts from the 2013 ACC Conference, Washington, DC.
Shelley JR, Blum CL. Pregnancy, sacroiliac joint laxity, and the SOT category two pelvic distortion: A case series. J Chiropr Educ. Spr 2013;27(1): 99.
Introduction: Sacroiliac (SI) joint laxity associated with pregnancy and delivery is purported to cause objective findings of an sacro occipital technique (SOT) category two pelvis. SOT describes a category of pelvic girdle pain and/or low back pain (PPLP) associated with increased posterior SI joint ligamentous laxity called category two. This IRB approved retrospective case series study involved 103 pregnant women from 21-32 years old seen at this clinic from 1979-83.
Methods: Patients were evaluated via SOT diagnostic protocol, which included the SOT arm fossa test, increased unilateral or bilateral iliopsoas tension, palpation for pelvic torsion, leg length differentials, and Moiré contour photography.
Results: 95% of the patients had Arm Fossa Test positive (AFT+) findings, with 5 of the 103 patients having an Arm Fossa Test negative (AFT-). AFT- findings were associated with reduction or elimination of pelvic or inguinal pain, improvement of muscle strength and ability to rise from seated position as well as lift or carry objects, and improved sleeping and restfulness.
Conclusion: Treating a pregnant patient in a supine position using gravity and pelvic wedges may offer a viable treatment method for pregnant related PPLP.
Blum CL, Griffiths RL. Chiropractic and Dentistry– The Need for Mutual Understanding of TMD Co-treatment: A Case Report. J Chiropr Educ. Spr 2013;27(1): 88.
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.
Getzoff H. Sitting disc technique and the relationship to the straight leg raise: A retrospective case series of thirty patients. J Chiropr Educ. Spr 2013;27(1): 89-90.
Introduction: The purpose of this study was to determine if a chiropractic intervention, the sitting disc technique (SDT), could be used in coordination with a common orthopedic/neurological test, the straight leg raise (SLR).
Case Series: A retrospective study of 30 sequential patients treated at one practitioner’s office that, following assessment and evaluation, were determined to have a positive SLR bilaterally, and then were adjusted with the SDT and then reassessed utilizing the SLR (measured with a flexometer). To qualify for the study all 30 patients had to have similar SLR findings on both leg lifts, pain in the lumbosacral area with some pelvic area pain, unilateral lower extremity pain but not below the knee, and with pain localizing to the leg contralateral to their antalgic lean.
Results: Improvement immediately followed care in 27 or 30 cases with the least improvement by 4 patients at 5°, maximum at 35° by one patient and the majority showing improvement between 10-25°.
Conclusion: The SLR appeared to be a helpful method to monitor the functional improvement of the lumbar spine after successful SDT adjustments. The SLR also appeared to parallel positive symptomatic changes that accompanied lumbar spine improvement following the SDT applications.
Cooperstein R, Blum CL, Cooperstein E. The correlations of the arm-fossa test with other sacroiliac findings: A feasibility study. J Chiropr Educ. Spr 2013;27(1): 64-65.
Introduction: The arm-fossa test (AFT) is a sacroiliac test used by practitioners of Sacro-Occipital Technique (SOT). A positive test is thought to correlate with sacroiliac mobility or sacroiliac hypomobility. We hypothesized that the finding of the fixation using the Gillet text would predict a negative AFT.
Methods: A convenience sample of college students enrolled in a weekend SOT seminar received the AFT from 2 examiners and a battery of orthopedic and motion tests from another examiner, including the Gillet test of sacroiliac motion. Kappa values were computed among the pairwise combinations of tests given.
Results: Results: Highest kappa value was for the AFT of examinare 1 and the Gillet test: k=.55, which corresponds to “moderate agreement.” Sensitivity of a negative AFT for fixation = 0.88, specificity=0.67, diagnostic accuracy=0.79.
Discussion and Conclusion: Pilot data support the hypothesis that a positive AFT is consistent with (but does not confirm) sacroiliac ligmentous laxity. This prelude to future full study suggests it should include a greater mix of symptomatic and asymptomatic participants, examiner training, and a more selective inclusion of orthopedic exams.
Lee A, Mok W, Siu K, Kwan H, Li L. Differences in clinical approach between dentists and chiropractors analyzing the same set of temporomandibular joint dysfunction cases. J Chiropr Educ. Spr 2013;27(1): 72-73.
Objective: To evaluate the similarities and differences of a dental vs. chiropractic approach in the management of 2 temporomandibular joint dysfunction (TMD) cases.
Methods: Following research ethics board approval, 10 dentists and 10 chiropractors agreed to review 2 TMD cases retrieved from the peer-reviewed literature. Subjects were intereviewed using standardized questions relating to the clinical management of each case, and their responses were recorded and transcribed. Cluster analysis and centering resonance analysis were preformed on the transcribed responses using Crawdad Analysis Software (version 2.0) to determine if consistency existed within or across professions and to identify influential words and word pairings.
Results: The responses analyzed clustered by profession and not by the management of the 2 cases. The main distinctions in clinical approach between professions were the treatment methods employed and referral co-managment practices. The dentists interviewed reported that they would co-mange TMD with oral surgeons whereas the chiropractors considered collaboration with dentists.
Conclusion: The 2 professions were able to identify the problem associated with the TMJ in both cases. Although each profession differed in their approach to each case, the management was similar among their peers within the same group.
Enix D. Mechanical behavior of sacral and iliac cartilage under compression. J Chiropr Educ. Spr 2013;27(1): 67.
Introduction: Articular cartilage is a complex viscoelastic macromolecular material that acts as a low-friction surface to absorb and distribute the shearing forces that cross the sacroiliac joint under axial loading.
Methods: A finite element model of sacral and iliac cartilage was developed from a cadaveric specimen to examine compressive shearing forces on sacroiliac joint cartilage during angular rotation. A 1.81 mm and 0.80 mm layer of sacral and iliac cartilage was modeled as linear elastic material with 1.2 MPa Young’s modulus and Poisson’s ratio of 0.049. a 445 N vertical load was placed across the sacroiliac joint, compressing layers of sacral and iliac cartilage against nondeformable sacral bone.
Results: Axial loading creates a lateral displacement of the sacrum and high shearing stresses at the sacral/iliac cartilage and cartilage bone borders. Angular rotation from 11.4° to 21.0° created Poisson effect deformation of 0.08 MPa for sacral cartilage and 0.010 MPa for iliac cartilage.
Discussion: These angular stresses create irregular changes in cartilage that follow the geometric articular surface topography.
Conclusion: As the pelvis rotates anteriorly, sacral cartilage contact stresses decrease and iliac cartilage increases. Von Mises stresses, however, increase on both sacral and iliac cartilage during rotation.
The following are the Abstracts from the 2012 ACC Conference, Las Vegas, Nevada.
Blum CL, Warshel CD, Khan S, Cassa T. Supine and prone SOT pelvic block placement: A comparative analysis of position by MRI. J Chirop Ed. Spr 2012;26(1):118.
Introduction: Pelvic blocks or wedges have been utilized in the sacro occipital technique (SOT) method of chiropractic since the 1960s with a rational for both supine and prone block placements.
Methods: Four same-subject MRIs were taken supine and prone, two with pelvic blocks and two without pelvic blocks (control).
Results: Comparing control and intervention sequences, there does not appear to be any measurable anatomical changes in the sacroiliac joints between the control studies and the blocked studies.
Discussion: Research has noted that with pelvic block use functional changes such as reduced pain, improved range of motion, and muscle strength has been found; yet this may be due to neuromuscular and not mechanical effects. This study had limitations and future studies should utilize greater field strength magnets for better resolution, visualize the whole bony pelvis instead of isolating the sacroiliac joint, and incorporate more extensive 3-dimensional analytic technology.
Conclusion: The positive clinical functional changes associated with SOT pelvic block placement may be due to neuromuscular factors and not solely mechanical. Future research utilizing the information learned from this study may yield a clearer picture of what is taking place with pelvic block placement(s).
Thompson JE, Bockhold H, Blum CL. Sacro Occipital Technique: Occipital Fiber Technique on Canine. J Chirop Ed. Spr 2012;26(1):135.
Introduction: Integrative healthcare for animals is increasing yet there is limited research specifically identifying the use of chiropractic in the canine. This case report utilizes a chiropractic technique called occipital fiber analysis and treatment (OFT), used within sacro occipital technique (SOT) to analyze and treat spinal dysfunction.
Case Report: A 10-year-old female cattle canine with known chronic symptoms of bloating, mood changes, joint pain, and chronic psoas tension, unresponsive to prior interventions, presented for chiropractic care.
Methods and Intervention: OCT was applied to a female 10-year-old canine and treatment consisted of chiropractic manipulative reflex technique (CMRT). The procedure was performed at the main campus of Options for Animals College of Animal Chiropractic; with the owner’s consent.
Results: Following the OCT/CMRT procedure the reflex pain areas were significantly diminished and the canine was relaxed, with decreased bloating, joint pain, and the psoas tension was notably less.
Conclusion: This case report had limitations because it is based upon the owner’s and consulting veterinarian’s interpretation. However it did appear from the canine’s significant response that there was a positive correlation between OFT and CMRT typically applied to humans when applied to the canine in this study.
Butafava J, Dal Bello F, Blum CL. The alterations of the dyspeptic signs and symptoms of patients with gastritis following chiropractic treatment: A small randomized controlled study. J Chirop Ed. Spr 2012;26(1):85.
Introduction: The purpose of this study was to investigate whether chiropractic care, specifically sacro occipital technique (SOT) chiropractic manipulative reflex technique (CMRT) for the upper gastrointestinal system could be an effective method of care for patients presenting with dyspetic signs or gastritis.
Methods: The sample was composed of fifteen subjects, medically diagnosed with gastritis randomly divided into three groups of five: one group was the control which received no treatment, one group was treated with traditional pharmaceutical interventions, and one group was treated with chiropractic. Endoscopy evaluation was performed before and after the chiropractic treatment and a clinical outcome assessment questionnaire was used to determine any changes in a subject’s clinical symptoms.
Results: While the control group had some decrease of endoscopic gastritis signs, compared with traditional pharmacological treatment and control group, the chiropractic group had the greatest positive clinical response with improved endoscopic and quality of life findings.
Conclusion: Further research with large study samples are needed to determine if there is a subset of patients with gastritis or dyspepsia that may respond to CMRT care and mitigate the need for medications or more invasive procedures that offer risk.
Rosen MG, Blum CL. Case Management of a 2 1/2 Year Old Female with a Thirty-five Degree Scoliosis and Two Hemivertebra: A Case Report. J Chirop Ed. Spr 2012;26(1):85.123.
Introduction: A 2-1/2 year-old female during a routine physical examination at age 6-months by her pediatrician was determined to have adolescent idiopathic scoliosis and two hemivertebra.
Methods: Ultrasound, x-rays, MRI, and Moire study(s) performed noted a 35° thoracic curve. Due to the progression of the scoliosis an orthopedic consult was made who suggested a surgical spinal fusion. Prior to surgery the patient was examined and treated at this office using specific sacro-occipital technique (SOT) and cranial protocols. The patient was put on a six-week intensive care program at 2 visits-per-week for the first 6-weeks.
Results: Six-weeks after her initial chiropractic adjustment the patient was re-examined by the orthopedic surgeon and the evaluation and follow-up Moire study revealed a significant reduction in the scoliosis. Surgery was postponed and the orthopedic surgeon directed follow-up Moire studies every six months for four years. Her last Moire study showed almost complete resolution of her scoliosis, kyphosis and lordosis.
Conclusion: During those periods of time when the medical physician is only monitoring the patient or preparing for possible surgical intervention, this would provide the optimal opportunity for a trial period of conservative chiropractic care.
Blum CL, Gerardo RC. Cervical traction, TMJ disorders, chiropractic and dental co-treatment: A case report. J Chirop Ed. Spr 2012;26(1):85.118.
Introduction: The patient presented as a 66-year-old female with significant pain and stiffness in her neck and crepitus when using her jaw. Her dentist referred her to this office for cranial and sacro occipital technique (SOT) treatment for conditions interrelated to her TMJ disorders. She could not tolerate cervical manipulation.
Methods/Intervention: Evaluation of patient’s cervical range of motion was found to be reduced by 30 % of normal and radiographic analysis revealed moderate degenerative joint disease in the lower cervical spine from C4-C6. Treatment consisted of cervical traction utilizing the Pronex Cervical (non-mandibular) Traction, SOT procedures; particularly cervical stairstep corrections and cranial therapeutic techniques for the TMJ.
Results: Following treatment the patient had a marked increase in cervical range of motion (normal levels) and a 90% decrease in pain and tension on palpation. The ability to treat the cervical spine also appeared to aid the treatment for TMJ related tension and pain.
Conclusion: The purpose of this case was to explore the efficacy of using cervical traction without pressure to the jaw to support chiropractic treatment as well as to facilitate a patient’s ability to receive care for neck and jaw pain and stiffness.
Benner CD, Blum CL. CMRT and acupuncture in the treatment of dysmenorrhea (oligomenorhea): A case report. J Chirop Ed. Spr 2012;26(1):85.117.
Introduction: A 31-year-old female patient presented initially to this office for low back and foot pain 5 years prior and wanted preventative wellness care. Approximately 5-years into care, February 2008, the patient discussed the possibility of utilizing acupuncture to help her cope with an irregular menstrual cycle, having only light periods (1-2 days) 2-3 times a year for over 10-years or more.
Methods/Intervention: The patient was assessed and treated using sacro occipital technique (SOT) chiropractic, chiropractic manipulative reflex technique, and acupuncture protocols.
Results: Following one-year of integrating sacro occipital technique (SOT) chiropractic manipulative reflex technique (CMRT) for liver (T8), adrenals (T9), and acupuncture her condition has been consistently improving and her cycle has been regulating with periods of monthly cycling and with only 3 months of amenorrhea one-time during a time of high stress and anxiety.
Conclusion: The chronicity of the patient symptoms, over 10 years, and the temporal relationship between treatment and response to care is of interest. It is also of interest that the patient was receiving chiropractic care on an ongoing preventative basis but not until the treatment changed to include CMRT and acupuncture was there a change in her symptomatolgy.
Beck CA, Blum, CL. Vision induced chronic low back pain: A case report. J Chirop Ed. Spr 2012;26(1):85.116.
Introduction: A 34-year-old female patient presented with a history of low back pain (dull, achy, and non-radiating) that has been present for nearly two-years.
Methods: The patient reported complete relief of her chronic low back pain with her eyes closed or in a darkened room, whereas the pain would return when opening her eyes and particularly in a lightened room, with or without eyeglasses.
Treatment: Osteopathic manipulative therapy (OMT) to the full body and cranium was applied with the patient’s eyes opened, closed, and eyeglasses on and off. Modifications were made to the optometric prescription and eyeglasses to optimize body and cranial function as well as to reduce her low back pain.
Results: The patient noted considerable relief in her low back pain with the new eyeglass prescription, and this relief was sustained regardless of eyes open or closed, and particularly with her eyeglasses on.
Conclusion: This case study illustrates that a subset of patients may present with a clinical condition that either affects vision or the vision affects the condition called a visual somatic strain. This demonstrates how collaborative efforts might be made to develop co-treatment opportunities between osteopaths, chiropractors, ophthalmologists, and other allied professionals.
Provencher S. Sacro occipital technique craniopathy strain correction in a 2-year-old female with nonsynostotic deformational plagiocephaly and right ventriculoperitoneal shunt: A case report. J Chirop Ed. Spr 2012;26(1):131.
Case History: A 2-year-old female with a right ventriculoperitoneal (VP) shunt placed at 3 days of age demonstrated motor and speech impairments persisting since birth. She was engaged in concurrent care with a neurologist and pediatrician since birth and physical therapist for the prior year.
Methods and Interventions: On examination, the patient demonstrated a cranial strain pattern consistent with nonsynostotic deformational plagiocephaly. Sacro Occipital Technique (SOT) and chiropractic craniopathic strain corrective technique were utilized along with a Logan Basic Technique sacrum adjustment.
Results: After the initial SOT and chiropractic cranial treatment, the patient started to mumble words and on the trip home she was very talkative for 3 hours. The next day she continued to improve with more vocabulary and by walking on her own with less difficulty.
Conclusion: It is theorized that this child’s cranial strain determined by SOT chiropractic craniopathy may have contributed to meningeal stress and compromise of the vascular membranes, causing neural entrapment or cerebral spinal fluid stagnation. Further study is needed to determine if the findings in this one case report can offer options for other children with similar types of presentations.
Averion E, Radpasand M. Cervicogenic headache etiology: Cadaveric study of the connection between suboccipital structures and the cervical dura mater. J Chirop Ed. Spr 2012;26(1):83.
Objectives: This cadaveric observational case series examined the connection between cervical dura and suboccipital structures, rectus capitus posterior minor/major (RCPmi/ma), and ligamentum nuchae (LN), to provide essential evidence relating cervicogenic headache to cervical spine joint complex dysfunction.
Methods: Four total cadavers were used. Deep dissections of the suboccipital regions were performed investigating the dura-muscular-ligamentous connections between RCPmi/ma, LN, and posterior cervical dura. Full Institutional Review Board approved was granted for this study.
Results: All four cadavers exhibited firm attachments between RCPmi/ma and LN to the posterior dura. Manual traction of individual structures resulted in direct movement of cervical dura at the atlanto-axial interspace and adjacent C0/C1 and C2/C3 interspaces.
Conclusion: Cevicogenic headache is referred to the head from either soft tissues or bony structures of the cervical region. Sensory fibers from upper cervical nerve roots interact with sensory fibers in the descending tract of the trigeminal nerve permitting referral of pain sensation between the neck region and sensory receptive fields in the face and head. An anatomical appreciation of suboccipital, structures and their connection to posterior cervical dura will provide support for clinicians implementing a conservative and effective treatment protocol such as chiropractic manipulation, appropriate for cevicogenic headaches.
Enix D, Smith D. Nonuniform compression of sacral cartilage during angular rotation. J Chirop Ed. Spr 2012;26(1):87.
Introduction: Axial loads transmitted through the geometrically complex sacral articular surface are not evenly distributed throughout, having unequal loads and moments between the left and right , and are dependent on joint angulations.
Methods: Polymer replicas of 10 auricular surfaces of human (7 male/3female) cadaveric sacrum’s were made. Laser isarthmic scans created three-dimensional digital mesh models of the joint cartilage using Matlab processing. Nonlinear hyperelastic and linear elastic material properties replicating soft tissue and bone were added then analyzed as a finite element structure. Von-Mises stresses on the cartilage were analyzed during sacral rotation from 11.4° to 21.0°.
Results: The sacral cartilage deformed in a nonuniform manner as pelvic anteriority increased, with the greatest compression on the superior articular cartilage and the peak stresses occurring around the edge and deeper recesses of the surfaces. Large variations were found between the shape of the fibrocartilage of left and right sacroiliac joints.
Discussion: Compressive forces during angular rotation of the sacral surface create uneven changes in cartilage thickness. The stress contours for the cartilage appear to follow the geometric articular surface contours.
Conclusion: This geometrically irregular shaped joint has a complex patter of load distribution characteristics resulting in nonuniform deformation of cartilage with the greatest compression on the superior articular surfaces.
Erwin WM, Islam D, Effekarpour E, Inman R, Fehlings M. Intervertebral disc-derived stem cells: Implications for regenerative medicine and neural repair. J Chirop Ed. Spr 2012;26(1):88.
Introduction: Cervical spondylotic myelopathy is most commonly caused by advanced degenerative disc disease and may lead to tetraparesis or even death. We elected to test the hypothesis that progenitor cells within the nucleus pulposus (NPPCs) would differentiate within neural niche into neural precursor cells for use in neural repair.
Methods: We developed self-renewing cell colonies from canine intervertebral discs and evaluated them for the expression of stemness genes; capacity to differentiate along chondrogenic, adipogenic, osteogenic, and neurogenic lineages to vitro; as well as in vivo differentiation capacity within the compact myelin-deficient shiverer mouse brain.
Results: NPPC’s express stemness genes such as Sox2, Oct4, Nanog, CD133, Nestin, and NCAM and can differentiate into chondrogenic, adipogenic, and neural lineages in vitro. Within the shiverer mouse brain, NPPCs differentiate into neuron, astro-glial cells, and demonstrate immunoreactivity to CNPase and myelin basic protein (markers of oligodendrocyte precursor cells).
Discussion: Progenitor cells obtained from the intervertebral disc (IVD) have the capacity to be used not only for cartilage and IVD repair, but also for neural repair strategies and, most important and of profound potential significance, they offer the possibility of use in the case of the injured spinal cord.
Murphy D, Hurwitz E, Hart B. Comparison of findings of active straight leg raise test in patients with lumbar versus sacroiliac pain. J Chirop Ed. Spr 2012;26(1):100.
Introduction: The active straight leg raise (ASLR) test is designed to assess load transfer through the pelvis. It is associated with posterior pelvic pain. It is unknown whether the findings of this test specifically identify pelvic instability or a generalized lumbopelvic dysfunction. The purpose of this study is to assess the association of the ASLR test in patients with sacroiliac pain versus lumbar pain.
Methods: The protocol was approved by the Institutional Review Board of New York Chiropractic College. The location of the pain (sacroiliac or lumbar) and the results of three tests of dynamic instability, including ASLR were recorded. ASLR was performed with patients and when they noted pain in their low back, the doctor would compress their iliums against their sacrum to stabilize their sacroiliac joint. When this reduced pain the patient was considered to have sacroiliac pain versus lumbar pain.
Results: There was substantially greater odds of a positive ASLR in patient with sacroiliac pain versus lumbar pain (OR = 5.03; 95% CI 2.55-9.33; p<.0001). Both the hip extension test and segmental instability test had greater associations with lumbar pain versus sacroiliac pain.
Conclusion: A positive ASLR is substantially more common in patients with sacroiliac pain than in patients with lumbar pain. However, it is unlikely that this suggests that the ASLR identifies pelvic versus lumbar dynamic instability given what is known about motor control mechanisms in the lumbopelvic spine.
The following are the Abstracts from the 2011 ACC Conference, Las Vegas, Nevada.
Mitchell GA, Blum CL. Sacro Occipital Technique Treatment of Hiatal (Hiatus) Hernia Presentation: A Case Report. J Chiro Ed. Spr 2011;25(1):114.
Introduction: A hiatal hernia (HH) is the protrusion of the upper part of the stomach into the thorax through a tear or weakness in the diaphragm. Chiropractic techniques such as sacro occipital technique have some specific methods to conservatively treat gastroesophageal reflux and HH symptoms.
Case Report: A 54 year old male patient presented with severe pain in the epigastric area worse with deep breathing, eating any food, and sensations of unremitting persistent upper abdominal aching. The condition had persisted for three days before he sought treatment.
Intervention: Treatment involved adjusting T11-12 “anteriorities,” releasing of diaphragmatic tension, sacrooccipital technique (SOT) chiropractic manipulative reflex technique (CMRT) HH release technique (gently pulling stomach downwards during exhalation) and solar plexus technique.
Results: Immediately upon pulling the stomach downward the patient sighed and said he could breathe comfortably for the first time in three days. Approximately 2 minutes following the adjustment he reported the constant tension in the epigastric region was gone. At three, six, and twelve-month follow-ups the patient indicated no reoccurrence or residual discomforts.
Discussion: In healthcare risk benefit ratios need to be applied so that most conservative care such as chiropractic treatment for HH may offer a viable alternative.
Conclusion: SOT – CMRT has multiple methods for treating HH and this could offer an excellent opportunity for interdisciplinary treatment of HH between the fields of chiropractic and allopathic gastroenterology. Future research should involve determining which subset of patients could benefit from chiropractic care of HH symptomatology.
Rosen MG, Blum CL. Chiropractic care of pediatric nonmusculoskeletal conditions: A case series. J Chiro Ed. Spr 2011;25(1):116.
Introduction: 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, five were treated for immune dysfunction, seven for developmental delays/dysfunction, nine for birth trauma, one for seizure activity, four for learning problems, three for endocrine problems, three for migraines, two gastrointestinal issues, two for fussiness/agitated/anxiety, and one 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.
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.
Borilli F, Dal Bello F. Research on the effects of the chiropractic treatment on individuals with malocclusion as an aid to the orthodontic treatment. J Chiro Ed. Spr 2011;25(1):108.
Introduction: Malocclusion is the second cause related to TMJ pain complaints. Improper occlusion and condylar position of the TMJ will provoke the individual’s adaptation leading to dysfunctional symptomatologies. Dental orthopedics/orthodontics is the conventional approach used to treat this condition.
Methods: The patients of this study were referred for chiropractic treatment by their orthodontist before continuing with orthodontic treatment. All patients had a diagnosis of malocclusion and related TMJ pain. The orthodontist evaluated each individual before and after chiropractic treatment. To be able to evaluate the orthodontic profession’s opinion about the effects of the chiropractic treatment a satisfaction questionnaire was used.
Results: The research showed that in 50% of the orthodontic cases there was a positive response in relations to the patient’s occlusal condition. In 66% of the cases the orthodontist found a positive relationship with chiropractic treatment and the patient’s reduced malocclusion. Lastly in 83% of the cases the orthodontist found that the chiropractic treatment was a positive tool to facilitate orthodontic treatment.
Conclusion: The results suggests the chiropractic treatment when allied to the orthodontic profession could help facilitate improved patient outcomes and promote a greater quality of life to the individual with occlusion disorders.
Hochman J. Postmigraine chronic daily headache releived with coccygeal and sphenoidal manipulation: A case report. J Chiro Ed. Spr 2011;25(1):110.
Introduction: This is a summary of the findings and possible anatomical and physiological basis of successful chiropractic intervention on a patient with head pain of 7 years duration. The pain had been diagnosed as migraine and trigeminal neuralgia and been previously treated pharmaceutically and physically, including with chiropractic. All previous treatments were unable to alleviate pain.
Case Report: A 32-year-old male patient with a history of phsyical injury to both the coccyx area and the skull presented for care for chronic daily head pain of 7 years duration.
Intervention: The coccyx and sphenoid where manipulated using diversified and sacro occipital technique procedures.
Discussion: Possible reasons for success in treatment are offered, including mobilization of the sphenoid and coccyx, which may have affected the maxillary nerve. The propriospinal basis of the so-called Lovett brother arrangement is also discussed.
Conclusion: Some cases of unsuccessfully treated head pain may be helped with cranial and/or coccyx manipulation.
Seekins S, Provencher S, Unger Jr JF. Temporal-occipital cranial strain: A case of pediatric stuttering. J Chiro Ed. Spr 2011;25(1):117.
Background: A 7-year-old male with stuttering, poor social interactions, poor pronunciation, and a diagnosis of autism spectrum disorder presented seeking a second opinion. The child had no physical trauma, no family history of stuttering, and no significant birth trauma, and had been undergoing speech therapy for a year.
Methods: Chiropractic craniopathy assessment was performed and revealed a cranial strain and loss of normal motion. Sacro occipital technique (SOT) chiropractic category II pelvic blocking for sacroiliac hypermobility syndrome and spinal adjustments were also performed. A specific cranial procedure described by De Jarnette as Area 3 Spread, was utilized with cerebrospinal fluid directed to Broca’s motor area of speech.
Results: The mother noted a 50 to 75% improvement of the stuttering symptoms after the first treatment. Then, following a motor vehicle accident, seven additional treatments were required to return the child to the pre-injury status with little to no stuttering or stammering. At 3 months post-treatment, the child continued 95%+ improved in coordination and development.
Conclusion: This case report demonstrates that plausibility that a cranial strain might have adversely affected this patient’s language skill and development. Greater research study is needed to determine if the findings in this one report can offer options for other children with similar types of presentation.
The following are the Abstracts from the 2010 ACC Conference, Las Vegas, Nevada.
Thompson JE, Bockhold H, Blum CL. Sacro Occipital Technique: Occipital Fiber Technique on Equine. J Chirop Edu. 2010 24(1):142.
Introduction: Integrative health for animals is increasing yet there is limited research specifically identifying the use of chiropractic in the equine and canine. In this case report we utilized a chiropractic technique called occipital fiber analysis and treatment (OFT), which is a method within SOT used to analyze and treat thoracic, lumbar, and sacral segments. The rational for using OFT is to find regions of the body that have some interrelationships through direct musculoskeletal, and indirect reflex, to the occipital region, spine, and possibly to visceral referred pain pathways. This study investigated whether the OFT could be found in equines and whether a treatment based on OFT would yield any response.
Case Report: A 10-year-old gelding quarter horse with known symptoms of anxiety and stress induced behavior changes described by the owner as the appearance of “worry and/or unhappiness” presented for chiropractic care.
Methods and Intervention: OFT was applied to a female 10-year-old quarter horse and treatment consisted of chiropractic manipulative reflex technique (CMRT). The procedure was performed at the main campus of Options for Animals at the College of Animal Chiropractic, with the owner’s consent.
Results: Following the occipital analysis and treatment procedure the reflex pain areas were significantly diminished except the left lateral and posterior iliac crest. The occipital fiber was no longer swollen or boggy. After the treatment the horse was very relaxed, calm, and more tolerant during the post exam. Bowel sounds were now more progressively motile.
Discussion: Of interest is whether these reflexes could be found in quadrupeds and if these reflexes were similar to what has been found clinically in bipeds. It did appear from the horse’s response that there was a positive correlation between OFT and CMRT typically applied to humans when applied to the horse in this study.
Conclusion: This case report had limitations because it is based on the owner’s interpretation of the horse’s response before and after treatment there was reason to believe that some positive change had occurred. Due to these findings it is reasonable to assume that further investigation into the use of OFT and CMRT for equines and possibly other animals is warranted.
Cooperstein R. The short-leg question in chiropractic: Qualitative clinical research on the signficiance of the type of “short leg.” J Chirop Edu. 2010 24(1):123.
Introduction: Several primary studies have shown that an anatomical short leg predicts an anterior rotation on the ipsilateral ilium and posterior rotation of the ilium on the long-leg side. This is opposite the patter of pelvic torsion commonly thought to be associated with a (functional) short leg. It is necessary to explore the consequences of this paradox for the manual therapy professions, including chiropractic.
Methods: Chiropractic technique systems are identified that treat patient according to the “short leg = PI ilium rule.” Taking into account the incidence of anatomical short leg, making some assumptions as to what proportion of patients are symptomatic versus asymptomatic, and another assumption on how often leg checking is accurate, an inference may be drawn on how often appropriate mechanical vectors are used for sacroiliac adjusting.
Results: With perfectly accurate leg checking, in a patient population evenly divided between symptomatic and asymptomatics, a manual therapist uses an appropriate line of drive line than half the time. Paradoxically, the more accurate leg checking is, the more accurate leg checking is, the more often an inappropriate vector is uses.
Discussion and Conclusions: It is necessary to use a mix of physical examination methods (radiological, tape measure methods, block indirect method, and sitting-standing indirect method) to distinguish anatomical from functional short leg to derive appropriate mechanical vectors for sacroiliac interventions. Other physical examination methods may be preferred to leg checking to derive appropriate vectors.
Chapman C, Bakkum B. Chiropractic management of a patient with an anatomic anomaly of the piriformis muscle: A case study. J Chirop Edu. 2010 24(1):87-8.
Objective: The objective of this article is to present and discuss a case of an anatomical anomaly of the piriformis muscle in a chiropractic clinic setting.
Clinical Features: A 32-year-old male patient presented in a chiropractic clinic with a chief complaint of low back pain that radiated into his right buttock, right posterior thigh, and right posterior calf. MRI demonstrated a mild decreased intradiscal T2 signal with shallow central subligamentous disc displacement and low-grade facet arthopathy at L5/S1, a hypolordotic lumbar curvature, and accessory superior bundles of the right piriformis muscle without morphologic MRI evidence of piriformis syndrome.
Interventions and Outcomes: The patient received lumbar and sacral spinal manipulation with soft tissue massage to associated musculature and home exercise recommendations. Variations from routine care included proprioceptive neuromuscular facilitation stretches, electric muscle stimulation, acupressure point stimulation, Sacro Occipital Technique pelvic blocking, Craniosacral therapy, and an ergonomic evaluation.
Conclusion: This patient’s low back pain and any associated piriformis syndrome has been managed quite successfully with conservative chiropractic care, although the underlying cause of the piriformis syndrome still exists.
Enix D, Smith D. Variability in the morphology of the articular surface of the sacroiliac joint. J Chirop Edu. 2010 24(1):91.
Introduction: Variations in morphology of the articular surface of the sacroiliac joint result from congenital and acquired changes. The pelvis is subject to compressive and vertical shearing forces transmitted primarily through the layer of cortical bone to the sacroiliac joint and the surrounding stabilizing ligament system. These stresses put the sacroiliac joint under unequal loads, placing ligaments to a state of constant tension resulting in the gradual formation of joint osteophytes and ligament ossification.
Objective: To document anatomical variations in articular surface topography of the sacroiliac joint and changes to surrounding ligaments in human cadavers.
Methods: Fourteen human cadaveric specimens (nine males and five females), with a mean age of 61.7 ± 12.9 were fully dissected, revealing ligaments and osseous structures of the sacroiliac joint. Impressions of the articular surface of the sacrums were cast with a synthetic polymer for future examination.
Results: Sacral morphology varied greatly without apparent correlation to other factors; 50% were straight, 33% were concave, and 17% showed a convex configuration, and 43% had a transitional segment on at least on side. The mean ± SD of articular surfaces angles for the right sacral angle was 70.8 ± 9.3 and 75.6 ± 6.8 for the left sacral angle. Mild osteophytic bridging was seen in 85.7%, while 7.2 were moderate or severe.
Conclusions: The sacroiliac joint presents to wide variations in joint surface morphology and ligament histopathology. A previously undocumented partial insertion of dorsal sacroiliac ligament fibers to the sacral articular cartilage was noted in several specimens.
Pohlman KA, Hondras MA, Haan AG, Long CR. Job analysis of chiropractors with a diplomate in pediatrics. J Chirop Edu. 2010 24(1):138.
Introduction: There are two postgraduate pediatric diplomate programs in chiropractic. We conducted a comprehensive cross-sectional job analysis survey for this population.
Methods: Two hundred and seventeen chiropractors with a pediatric diplomate were invited to take part in our survey, using both web-based and mailed survey methods. The survey was designed to compare our data with the job analysis of all chiropractors performed by the National Board of Chiropractic Examiners (NBCE) and with a National Health Statistics Report (NHSR).
Results: A total of 135 chiropractors responded (62.2% response rate) and were predominately female (74%) and white (94%). Techniques most commonly used were Diversified, Activator, cranial, extremity adjusting, and Thompson Adjustive therapies commonly provided to patients include activities of daily living corrective or therapeutic exercise.
Conclusion: The majority of chiropractors with a pediatric diplomate were females with >30% of their patient base <12 years of age. They were more likely to use cranial adjusting techniques and treated young patients with back or neck pain, head or chest colds, colic, constipation, ear infections, and upper respiratory infections. They often referred patients to massage therapy, but did not typically refer to midwives, pediatricians, or family physicians.
McElvey SE, Bull P. The chiropractic comanagement of asthma: A clinical research approach. J Chirop Edu. 2010 24(1):135.
Purpose: The purpose of the research was to examine the benefits of chiropractic in the individual asthma suffers without a concurrent medical management model. The aims of the research were to establish a number of outcome measurements that were patient centered individuality based recordings of health changes within asthma.
Methods: There were a total of 19 participant chiropractors and their “live” practice settings) where the clinical research was conducted; there were four groups involved as research subject asthma participants (in total 142 involved in the clinical trial). The accepted techniques include high velocity low amplitude spinal adjustments, diversified, passive wedge (SOT), and activator methods. The benefits of the comanagement of asthma with a chiropractic program of care were measured by changes in a set of clinical outcomes. The clinical trial used a set of outcomes measurements to show changes in the individual health status of the asthmas sufferer. First, there were patient centered questionnaires; disease specific, individual environmental factors. SF-36 (quality of life), and emotional well-being (Depression and Anxiety Stress Scales). Second, a set of laboratory-based physiological markers of immune responsiveness (IgA) and stress response levels (cortisol) were used to access any physiological changes that may contribute to any measurable benefits of the chiropractic clinical application. The clinical trial also encouraged patient involvement with self-managed recordings of hand-held peak flow meter readings to monitor lung function.
Results/Discussion: The results of this clinical trial indicate that a time-dependent physiological factor may be involved in some of the therapeutic benefit observed in this clinical trial of asthma and chiropractic comanagement.
Dal Bello F, Dal Bello Veronica, Raupp JM, Santos LN. Alterations of dyspepetic signs and symptoms in patients presenting with gastroesophageal reflux disease following chiropractic treatment. J Chirop Edu. 2010 24(1):124.
Introduction: An important aspect of gastroesophageal reflux disease (GERD) is how it can compromise the patient’s quality of life. Recently there has been some research indicating that chiropractic treatment can affect the function of internal organs through autonomic nervous system stimulation. The objective was to investigate the alterations of dyspeptic signs and symptoms in patients presenting with GERD following chiropractic treatment.
Methods: This was a pilot study with a sample composed of 10 individuals. High digestive endoscopy exam was performed on all individuals before and after eight sessions of chiropractic treatment. The treatment was a sacro occipital technique-based viscerosomatic technique called chiropractic manipulative reflex technique (CMRT). A gastroesophageal reflux disease symptom’s questionnaire was used to evaluate dyspeptic signs and symptoms.
Results: At the end of chiropractic treatment, a statistically significant global reduction of GERD symptoms was observed (p = .0002), especially on the evaluation of pre and posttreatment postprandial pyrosis data (p = .000004). Through endoscopic examinations on the 10 patients, the findings noted a 58% improvement of esophagitis caused by GERD.
Discussion: There is some research to suggest that chiropractic treatment can improve visceral conditions, possibly affecting various visceral systems. The stimulation of spinal structures may have a connection with reflex responses of the autonomic nervous system.
Conclusion: Aat the end if was concluded that in these 10 cases chiropractic treatment (CMRT) was efficient in improving symptoms caused by GERD, as well as improving esophagitis signs secondary to GERD, shown by a high digestive endoscopy exam.
Provencher S, Unger Jr JF. Effects on postural control with a sacroiliac belt and 10 chirorpactic treatments on 11 random fibromyalgia subjects: A pilot study. J Chirop Edu. 2010 24(1):138.
Background and Objectives: The sacroiliac belt, also known as a pelvic belt helps to reduce hypermobility and limit laxity. Compression has been found to stabilize the sacroiliac (SI) joint. The fibromyalgia syndrome (FMS) patient has been reported to have generalized joint hypermobility. The purpose of this study was to determine the effects of a Serola sacroiliac belt in 11 random fibromyalgia subjects on postural control as measured by a MIDOT unit.
Methods: Eleven FMS subjects, between the ages of 22 and 55 were randomly chosen from the population. An inclusion and exclusion questionnaire was filled out. Subjects were measured on the MIDOT balance scale with and without SI belt with eyes open and closed before and after 10 chiropractic treatments using sacro occipital technique.
Results: The MIDOT unit measured the proprioceptive balance input of the body via lateral and anterioposterior (AP) sway velocity, offset, and stability pre- and post- SI belt. The sacroiliac belt improves significantly (p< 0.5) lateral (by 13 points) and AP (by 18 points) stability and lateral sway velocity (by 5 points) with eyes closed compared to treatments alone. The belt and treatments improved significantly the lateral and AP stability and lateral sway, but none was found to be significantly better than the other during the eyes-opened testing.
Conclusions: The Serola sacroiliac belt improved the postural control during eyes-closed testing compared to control but did not make significant postural changes compared to the control with eyes-opened testing. The current pilot study, while giving interesting information, indicates that further studies are needed with a larger sample of subjects.
Blum CL. Temporomandibular joint disorders and forward head posture secondary to airway compromise: A case report. J Chirop Edu. 2010 24(1):121.
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.
Case Report – The Assessment: 58 year old female was referred for chiropractic care for severe chronic migraines headaches, low back pain, and associated disabilities. She had a history of chronic obstructive sleep apnea, FHP, TMJ dysfunction with decades of dental treatment including two full mouth reconstructions.
Treatment/Intervention: Treatment involved SOT management of the patient’s primary TMJ dysfunction while stabilizing whole body dynamics and function. Also a referral for Alexander Technique, home traction, and rehabilitative exercises were implemented.
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. Within 3 months she had eliminated all medications except for occasional flare-ups occurring 4-5 times per year.
Discussion: Patients with mixed presentations (ascending or descending postural influences) can be best treated utilizing chiropractic and dentistry co-management to improve patient outcomes. Typically patients that 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: 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.
The following are the Abstracts from the 2009 ACC Conference, Las Vegas, Nevada.
Giggey K, Tepe R. Sacroiliac Orthopedic Blocking Improves Cervical Spine Extensor Isometric Strength. J Chirop Ed. 2009;21(1): 68.
Purpose: Reviews of the effects of chiropractic manipulative therapy on head and neck conditions are equivocal. The spine is a kinematic chain subject to reflexive muscle responses induced by the stimulation of muscle and joint afferents. The purpose is to determine if an orthopedic blocking procedure may be a useful adjunctive treatment for cervical spine dysfunction.
Methods: Following written informed consent, 22 participants with a measured leg length inequality of 5 mm or more were sequentially assigned into treatment and control groups. Treatment consisted of a 2-minute procedure using orthopedic blocks (padded wedges with a 45 degree incline), which were placed bilaterally under the ilia as determined by leg length assessment. Isometric strength measurements took place in two sessions with a day of rest between. The treatment group received therapy at the second session immediate to post isometric measures.
Results: Outcome measures were the pre and post measurements of cervical isometric extension strength in pounds. T-tests showed no statistically significant difference between groups in isometric extension strength prior to treatment. One-way ANOVA demonstrated a significant difference between groups following treatment. F (1, 21) = 7.174; p = .014. The treatment group demonstrated an average increase of 6.35 (818) lbs in extensor strength.
Conclusions: The current study showed a statistically significant change in cervical isometric extensor strength following SIJ manipulation. Orthopedic blocking may be a useful adjunctive treatment for cervical spine dysfunction. (This is an abstract from a conference presentation only and does not represent a full work that has been peer-reviewed and accepted for publication.)
Mykietiuk C, Wambolt M, Pillipow T, Mallay C, Gleberzon B. Technique Systems used by post-1980 graduates of the Canadian Memorial Chiropractic College practicing in five Canadian provinces: A preliminary study. J Chirop Ed. 2009;21(1): 84.
Introduction: The purpose of this study was to determine which, if any, techniques systems our graduates sought out instruction in and/or were utilizing either primarily or secondarily for patient care, in addition to Diversified technique.
Methods: We surveyed 200 randomly selected post 1980 graduates of our college practicing in five Canadian provinces.
Results: Eight-three eligible data sets were received. Respondents reported to have sought out instruction in a total of 187 technique systems other than Diversified technique. In addition, although 86% of respondents stated they primarily used Diversified technique in practice, they reportedly used 134 different technique systems secondarily for patient care. This calculates to an average of 2.27 different techniques used per respondent. The technique systems most commonly used in addition to Diversified technique by the respondents in this study were Activator Methods Chiropractic Technique, Active Release Therapy, Thompson Terminal Point, and Sacro-Occipital Technique.
Conclusion: These findings are consistent with previous data collected on this topic. Future studies should survey a larger percentage of practitioners to better assess the validity of these findings.. (This is an abstract from a conference presentation only and does not represent a full work that has been peer-reviewed and accepted for publication.)
Blum CL, Panahpour A. TMD – Chiropractic and Dentistry: Two Case Reports. J Chirop Ed. 2009;21(1): 104.
Introduction: Symptoms of temporomandibular/craniomandibular disorders (TMD/CMDs) vary but often involve severe pain in the jaw musculature, severe pain or difficulty when opening the mouth and chewing, headaches, and ear pain. In conditions where a chiropractor or dentist has reached a therapeutic impasse with a patient’s TMD/CMD, cotreatment may be indicated. This article presents two case reports demonstrating how cotreatment may proceed initiated by a dental and/or a chiropractic referral.
Intervention: The treatment involved SOT management of the patient’s presentation, while relating to TMJ dysfunction, was focused on whole body dynamics and function. The treatment with these two patients had similar aspects in that they both presented with sacroiliac joint hypermobility syndrome (category two), cervical intersegmental restricted motion, and needed craniomandibular balancing therapeutic interventions.
Results: The essential findings in both cases showed reduced pain in TMJ function and/or symmetrical joint translation without crepitus. General relaxation in cervicocranial and craniomandibular musculature was noted by the patient, chiropractor and dentist. The focus was having the patient gain independence from chiropractic/dental care with reduced discomfort and increased function.
Discussion: With a subset of patients body distortions ascend from the feet, pelvis, spine, and neck to affect TMJ dynamics affecting dental occlusion, condylar position, and airway space. With another subset of patients patterns of body distortions descend from TMJ dynamics affecting dental occlusion, condylar position, and airway space. A main obstacle for chiropractic/dental cotreatment is the lack of awareness and knowledge of each other’s professional treatment and diagnostic focus as well terminology. Research studies have noted a relationship between ascending and descending relationships associated with CMD/TMD and postural dysfunctions.
Conclusion: While these two cases illustrate how the chiropractic and dental fields can work together for successful treatment outcomes, there is a need to determine what subsets of patients may fit this model. (This is an abstract from a conference presentation only and does not represent a full work that has been peer-reviewed and accepted for publication.)
Zablotney J, Blum CL. Chiropractic care and the Situs Inversus patient: Modifying technique to match anatomy. J Chirop Ed. 2009;21(1): 119.
Introduction: In situs inversus totalis the heart chambers, lung lobes, abdominal organs and colon are all found in a mirror image arrangement of normal. The purpose of this paper is to present a novel case report of a patient with situs inversus treated by chiropractic care involving chiropractic manipulative reflex techniques (CMRT) modified to the patient’s condition.
Case Report: This patient was a 60 year old mother of 4 who has been a chiropractic patient for over 20 years receiving spine-only chiropractic care. The patient began care in this office in and was seen for 16 office visits utilizing Blair Upper Cervical (BUC) x-ray spinography protocols, Sacro Occipital Technique (SOT) categorization, and CMRT procedures.
Treatment/Intervention: Her response to Blair and SOT protocols was good and as expected however CMRT protocols needed to be modified in novel ways to compensate for her situs inversus presentation. Occipital fiber analysis found an active visceral reflex on 13 out of her 16 visits. On visits that necessitated treatment to the ileocecal or pancreas reflex arc the reflex patterns were opposite to normal.
Results: The outcome to treatment involved reduction in pain and increased function in various areas of the spine, pelvis, and right shoulder as well as reduction of prior sleep disturbances and constipation.
Discussion: While the response to BUC and SOT Category Two protocols were as anticipated, the CMRT evaluation and treatment was unusual based on the patient’s situs inversus presentation. The patient’s immediate response to treatment suggests that further investigations may be indicated.
Conclusion: Future studies could compare a blinded evaluation of patients with situs inversus and normal organ anatomy to determine if side of CMRT reflex and referred pain patterns is consistent. Greater research is needed to investigate what subset of patients may respond to viscerosomatic/somatovisceral chiropractic reflex treatment. (This is an abstract from a conference presentation only and does not represent a full work that has been peer-reviewed and accepted for publication.)
Hochman J. Chiropractic Intervention for Pruritis: A Case Report. J Chirop Ed. 2009;21(1): 109-10.
Background: Little research exists regarding the primary complaint of itching and its alleviation with chiropractic care. Patients seeking chiropractic care seldom present with itching as their primary complaint.
Objective: To discuss the case of a patient with 2 years of daily itching whose symptoms were relieved with spinal adjustments.
Clinical Features: A 34-year-old female patient presented with chronic itching of unknown etiology in the upper and lower extremities, worse at night. No visible skin lesions were apparent and this case was never determined to be eczema. All orthopedic and neurological signs were negative on examination.
Intervention and Outcome: Standard diversified adjustments were administered to the mid-dorsal region. Analysis according to Sacro Occipital Technique (SOT) was used to guide the clinician’s treatment. Manual pressure was also applied to specific reflex areas associated with possible visceral dysfunction related to the spinal levels treated. The symptom resolved within 4 visits.
Conclusion: Chiropractic intervention seems to have been responsible for the elimination of itching in this case. Other case studies may reveal further evidence that chiropractic care is a feasible approach in cases of itching. This case illustrates that chiropractic care may help other patients with non-musculoskeletal complaints. (This is an abstract from a conference presentation only and does not represent a full work that has been peer-reviewed and accepted for publication.)
The following are the Abstracts from the 2008 ACC Conference, Washington DC.
Williams S, Blum CL, Billings S. Plagiocephaly: The Oblique Skull A Method Of Chiropractic Correction. J Chiro Ed. 2008; 22(2).
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.
Case Report: 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.
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 development.
Conclusion: The purpose of this paper was to offer an alternative view of how DP 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. (This is an abstract from a conference presentation only and does not represent a full work that has been peer-reviewed and accepted for publication.)
Giggey K, Tepe R. Poor Postural Control May Signal Autonomic Imbalance: A Cross-Sectional Pilot Study. J Chiro Ed. 2008; 22(1):87.
Background: Autonomic balance is often assessed using heart rate variability (HRV). Autonomic imbalance (low HRV state) is associated with multiple pathological conditions but has not been examined in relation to postural control. Postural control is the body’s ability to re?exively sway within normal sway limits. Slower sway is thought to indicate greater stability, whereas faster sway suggests instability. This study seeks to determine if a relationship exists between autonomic balance and postural control.
Methods: A convenience sample was made up of 38 consenting, young adults. Persons with any condition that could affect postural control were excluded. Participants received a 5-minute HRV recording followed by a postural control assessment using a balance plate. The HRV median root mean successive squares difference was used to split participants into low- and high-HRV groups for postural control comparisons. Postural control was quanti?ed as sway velocity. Sway velocity in excess of 1.9? per second was considered abnormal. Chi-square goodness-of-?t test was performed to compare the observed versus expected occurrences of abnormal postural control in the groups.
Results: Signi?cantly fewer high-HRV participants had abnormal postural control than could be expected by chance alone. The incidence of abnormal postural control in the low-HRV group was higher than that observed in the high-HRV group but was no different than could be expected by chance.
Conclusion: The high-HRV group exhibited greater postural control than the low-HRV group. A postural exam may serve as a screening test to identify persons with autonomic imbalance, an indicator for manipulative therapy. (This is an abstract from a conference presentation only and does not represent a full work that has been peer-reviewed and accepted for publication.)
Blum CL, Cuthbert S. Developmental Delay Syndromes and Chiropractic. J Chiro Ed. 2008; 22(1):84.
Introduction: Issues regarding chiropractic treatment for various types of conditions such as developmental delay syndromes, while controversial to some, have some support in the literature. At this time, developmental delay syndromes such as attention-defiit/hyperactivity disorder (ADHD) have inconclusive etiologies. Although many consider that developmental delay disorders are solely genetic in origin, others have supported the concept that a subset of patients may have a trauma or other physical-related imbalances that could be contributory to the patient’s dysfunction.
Case Report: A case of fraternal twins is presented in which one twin’s developmental and emotional growth was notably delayed compared with her other twin. Chiropractic cranial care was rendered, which appeared to assist a positive outcome for the treated child.
Discussion: Perhaps a better way of interpreting chiropractic’s ability to help patients with learning disabilities, dyslexia, dyspraxia, and ADHD is viewing a specific subset of patients as having their conditions secondary to trauma. With developmental delay syndromes, there are various related possible chiropractic interventions, such as cranial related therapies and upper cervical, cervical, and even treat- ment for pelvic-related dysfunction.
Conclusion: Since there is some question as to the causation of the various developmental delay syndromes, this ultimately leads to some lack of clarity on treatment options, particularly for children sensitive to medication or who do not chose medication as an option. Patients are seeking alternative care, and particularly care that offers low risk and some bene?t should be brought to their attention. Although the studies are inconclusive, there is an emerging evidence base that does show chiropractic care can be involved in the treatment and care of patients with developmental delay syndromes. Greater study is needed to understand which patients might best benefit from chiropractic care and where co-treatment is indicated and to determine consistent outcome assessment tools to measure changes so mechanisms of care can be evaluated. (This is an abstract from a conference presentation only and does not represent a full work that has been peer-reviewed and accepted for publication.)
The following are the Abstracts from the 2007 ACC Conference, Phoenix, Arizona.
Holbeck M, Tomson A, Blum, CL, Monk R, Effects of the sacro-occipital technique on the quality of life in a lung cancer patient undergoing chemotherapy and radiation treatment. J Chirop Edu. Spr 2007;21(1):108.
Introduction: A 57-year-old female patient undergoing chemotherapy and radiation therapy for lung cancer was seen for chiropractic treatment for gastrointestinal discomfort secondary for the oncological care she was receiving.
Intervention/Methods: Sacro occipital technique (SOT) chiropractic manipulative reflex technique (CMRT) was used to balance iscerosomatic/somatovisceral reflexes associated with the stomach, lungs and diaphragm along with some nutritional supplementation.
Results: The patient noted that while receiving CMRT care, her digestive disturbances were significantly lessened and occasionally completely alleviated while receiving chemotherapy and radiation therapy.
Discussion: Of significance is that co-treatment of patients presenting with various comorbidities such as cancer may be viable options for allopathic and chiropractic collaborative efforts. Commonly patients are reaching their pharmaceutical limits and allopathic physicians are looking for options to help patients so that if they cannot be helped at least they might be made more comfortable.
Conclusion: It may be that chiropractic can offer options for improving patient’s quality of life in cases of patients undergoing care for cancer assuming the oncologist is clear that the chiropractic care will not make the patient’s condition worse.
The following are the Abstracts from the 2006 ACC Conference, Washington DC.
Blum CL, Globe G. Angina visceral mimicry syndrome: A proposed collaborative integrative treatment model. J Chiro Ed. Spr 2006;20(1): 51-2.
Introduction: Visceral mimicry syndrome, first referenced in the mid-1990s, refers to the presence of somatic dysfunction creating pain patterns that appear to resemble (mimic) visceral-related dysfunction. The purpose of this paper is to propose a parsimonious model treatment pathway for mimicry syndromes, related to angina-like pain patterns, that could potentially improve interdisciplinary collaboration between allopathic and chiropractic practitioners.
Background: Literature describing visceral mimicry dysfunctions has primarily been limited to referred pain patterns that are commonly related to viscera, such as left shoulder pain arising from somatic versus cardiac etiology, right shoulder pain arising from somatic versus gallbladder etiology, and low back pain arising from somatic versus uterine/menstrual cycle etiology. Typical angina manifests as chest pain or discomfort and is believed to occur when heart muscle receives an inadequate supply of blood. Angina may present subjectively as a pressure-like or a squeezing pain in the chest. This pain may also occur in the shoulders, arms, neck, jaw, or back and occasionally resemble symptoms related to indigestion.
Collaborative Model: The issue of visceral mimicry syndrome represents opportunities for collaborative treatment options with chiropractors and allopathic physicians. Considering the reported prevalence of angina of somatic etiology, in the case of a patient presenting with myofascial indications of angina, in the presence of a negative history for cardiac red ?ags, normal vital signs, and other normal screening tests, it would be reasonable to have the chiropractor evaluate possible musculoskeletal involvement. A trial of chiropractic treatment could serve as a diagnostic test to help differentially diagnose this type of mimicry syndrome. Even while the patient is receiving the battery of cardiac tests, one method of assess- ment could be a brief chiropractic assessment and trial of therapy of 1 week. The patient would follow up with the cardiologist to assess any changes in pain or dysfunction. Very close collaboration between a cardiologist and a chiropractor, even possibly offering chiropractic treatment within the cardiologist’s office, would ensure the avoidance of unnecessary repeat testing as well as avoidance in delay of appropriate referral in both directions.
Discussion: In chiropractic there are various methods that have attempted to incorporate viscerosomatic and somatovisceral interrelationships. Sacro-occipital technique is one such “technique system” which includes both reflex and direct somatic treatment components. The sacro-occipital technique system includes a model that addresses the relationships between myofascial dysfunction and mimicry visceral dysfunction syndromes called chiropractic manipulative re?ex technique. Chiropractic manipulative reflex technique aims to diagnose visceral referred pain patterns and to suggest possible spinal manipulative and re?ex treatments to aid a patient suffering from visceral mimicry or somatovisceral syndromes.
Conclusion: This paper has highlighted the potential gap in delivering more effective patient care for mimicry syndromes, specifically those that produce angina-like symptoms, and offer to a model of collaborative care based on both practical, conceptual, and patient-centered concepts. Bridging communication and collaboration between conventional and alternative practitioners will only serve to improve patient outcomes and perhaps reduce the need for repeat extensive diagnostic testing. Other opportunities to demonstrate further effects of chiropractic care on the organic component of cardiac disease might potentially grow from these interdisciplinary collaborations. In the presence of a fractious delivery system, that does not foster integration between conventional and alternative care providers, it is very likely that the majority of these types of mimicry syndromes, which could potentially respond to somatically directed care, will continue to be go unrecognized and untreated.
Blum CL, Globe G, Mirtz TA, Greene L. Patient preference for wellness care: Is it on the menu? J Chiro Ed. Spr 2006;20(1): 53-4.
Introduction: Wellness care is a relatively popular topic in the emerging health care arena. Consumers are seeking better ways to prevent the onset of chronic diseases and even the common affects of aging by increasing their use of alternative approaches to getting and staying well including preventing illness. Currently, patient preferences for wellness care are relatively low within the profession, ranging near the 10% level depending on the study. The World Federation of Chiropractic’s “Consultation on Identity” found that only 6% of patients seek wellness care.
One question posed is, will patients seek out chiropractors more if they increase their level of orthodox preventive health screenings and recommendations? Will a patient seek out a chiropractor for wellness any more than they would an allopathic health care provider? Clearly, in light of the inconclusive research evidence base on chiropractic alternative techniques, a balanced approach to wellness, inclusive of both normative public health promotion objectives as well as a reasonable approach to offering chiropractic alternative methods, should remain within the realm of discussion.
The study’s specific goal was to find out what proportion of chiropractic patients seek wellness care when the practitioner incorporates an alternative model of accomplishing wellness beyond moving joints. An attempt to determine whether a specific cohort of sacro occipital technique (SOT) practitioners that utilize a broad palate of methods would have a similar or dissimilar proportion of patients operating under health beliefs that proactively sought care prior to focused complaint manifestation.
Methods: A convenience sample of chiropractors, interested in participating in research, was asked to add a question regarding patient health preferences to their standard patient intake forms. This convenience sample was comprised of SOT practitioners from three geographic locations, United States, Australia, and Europe, who agreed to participate in this pilot study.
Results: The most interesting finding is the variable of Health Behavior where 42.1% percent of patients presented to these chiropractor’s offices without a specific focused complaint. These patients either presented for wellness, prevention of illness or perceived they were at risk for injury.
Discussion: Definitions of wellness argue for a more comprehensive paradigm for patient illness such as that described by the biopsychosocial model, which incorporates psychological and social components to health in addition to the biologic domain. When the patient has not been unduly coerced or pressured to accept prophylactic chiropractic care but elects freely to utilize this type of care secondary to direct experience, then who is to say that this should not be allowed? How will patients even have this choice if one takes a hard line on an evidence-demand approach to this and all other alternative treatments available today, including medical treatments that have no efficacy data?
Conclusion: This pilot study evaluated patient health preferences as part of the normal patient self-reported history. An increased proportion of patients, relative to other studies, were identified as presenting for a category of wellness care. Although great care must be exercised in making generalizations from this set of data, clearly, increases in patient’s preferences for wellness care could be related, quite simply to whether the chiropractor is perceived by the patient to offer a mode of wellness care other than counseling for obesity or smoking cessation. Hopefully greater study into the field of health behavior preferences and chiropractic will continue and greater insight will be garnered that will help chiropractors serve their patient’s needs.
Hochman JI, The Effect of Sacro Occipital Technique Category II Blocking on Spinal Ranges of Motion: A Case Series. J Chiro Ed. Spr 2006;20(1): 69.
Objective: To describe changes in lumbar and cervical range of motion measurements after supine pelvic blocking as used in Sacro Occipital Technique (SOT).
Methods: Five subjects with sacroiliac distortion and instability were recruited and selected for SOT. Cervical and lumbar ranges of motion were measured before and after category II blocking procedures used to change pelvic mechanics. Pre- and post-measurements were taken by a blinded assessor using a Zebris ultrasonic motion detector.
Results: Changes were found in the lumbar spine only. Increased ranges of lumbar motion occurred in all planes except extension (21%-57%).
Conclusion: Supine pelvic blocking as used in SOT affected lumbar ranges of motion in these 5 cases. This may indicate that functional change in the pelvis results in changes in lumbar motion, especially lumbar flexion. Larger data sets are needed for further study.
The following are the Abstracts from the 2005 ACC Conference, Las Vegas, Nevada.
Blum CL, Globe G. Assessing the Need for Dental – Chiropractic TMJ Co-Management: The Development of a Prediction Instrument. J Chiro Ed. Sum 2005;19(2).
Introduction: Historically the evolution of interdisciplinary care of temporomandibular joint (TMJ) began in the last 20th century. It may be that for some proportion of patients who eventually develop a full-blown TMJ disorder, there is an adaptive stage whereby the related musculature in the cervical spine and other posturally related muscles may be able to accommodate so as to mitigate TMJ restriction or crepitus. The challenge for dentists, planning to treat a patient with TMD, remains a guessing game as they continue unaided in attempting to determine whether or not a patient would prophylactically benefit from chiropractic co-treatment in order to prevent the onset or minimize the effect of musculoskeletal symptoms secondary to dental TMD intervention. The purpose of this paper is to help begin the process of developing an assessment tool for dentists to assist them in determining when a patient might not be able to easily adapt to related postural changes that may occur secondary to dental modifications of occlusion or TMJ balancing.
Methods: Qualitative Assessment of Risk Factors: In-depth interviews were conducted with groups of dentists specializing in the treatment and the consistent request from the vast majority was the need for a tool to guide them in determining which patient’s would best benefit from chiropractic co-treatment. Development Of A Predictive Tool: Based on the preliminary interviews and a review of existing, valid and reliable measures, a preliminary assessment tool that measures the following five domains was developed; (1) musculoskeletal manifestations (2) the patient’s perception of pain, (3) somaticization of psychological stress, (4) physiological reserves to deal with stress and (5) the patient’s self-reported quality of life. Preliminarily Selected Instruments: The preliminary assessment tool will be composed of three instruments:. (1) A general questionnaire which will address the patient’s physiological reserve, level of pain tolerance, level of psychological health and their fear avoidance behavior. (2) The general symptom survey for musculoskeletal dysfunction determines if the patient has had a history or is currently suffering from cervical (headaches, neck, shoulder, and hand pain) or locomtive or balance (lower back, knee, or foot pain) dysfunction(s). (3) The functional evaluation form tests proprioceptive abilities, static and dynamic postural balance tests and cervical ranges of motion.
Discussion: The interviewed dental professionals observed that posture can be a determinant of occlusion functionality outcomes in some of their patients. They have identified a need for an assessment instrument that would help them to identify patients who may be at risk so that referral could be made before the initiation of occlusion modification. The goal of the assessment form, which includes functional analysis tests, is to help determine which “appropriate situations” or conditions are best for referral for chiropractic care.
Conclusion: While the selected assessment instruments were not originally developed or validated for their predictive capabilities, they are posited to measure health domains that may have some transferability to measuring predictive factors associated with the development of musculoskeletal reactions secondary to dental TMJ treatment. As new data becomes available, this instrument will be modified to reflect improved understanding of predictive elements. Concomitant with the development of a predictive assessment tool is the process goal of expanding interdisciplinary dialogue, which may help lead to standardization of TMJ dysfunction terminology and a “common language.” A starting point is needed and a reasonable attempt has been made to begin the daunting process of developing an instrument that would help inform dentists as to which patients may be likely to become symptomatic to peripheral musculoskeletal regions secondary to occlusion modification.
Hossu M, Rupert R, Harrison N. Changes in biophoton emission associated with chiropractic treatments: A descriptive pilot study. J Chiro Ed. Spr 2005;19(1): 60.
([http://www.soto-usa.org/SOTLiterature/PeerReviewed/HossuRAC2005.pdf ][What is the significance of biophoton emission in chiropractic? ([http://www.soto-usa.org/SOTLiterature/PeerReviewed/HossuRAC2003Biophotons.pdf]
Blum CL, Globe G. R + C Factors and Sacro Occipital Technique Orthopedic Blocking: A Pilot Study Using Pre and Post VAS Assessment. J Chiro Ed. Spr 2005;19(1): 45.
Introduction: Since the early 20th century, some within the chiropractic profession have posited that there is a functional relationship between the lumbar and cervical vertebra and have incorporated this concept into methods of evaluating and treatment. This concept of a systematic or predictive relationship between distant vertebral levels distinct from accumulative functional compensatory mechanisms, such as in scoliosis, is perpetuated based on observation and clinical experience without published report of any systematic study. This study seeks to investigate this relationship between the cervical and lumbar vertebra.
Methods: Patients were selected from the patient base of one office, and were limited to patients that had sensitivity at specific cervical reflex points. Using an outcome measurement, the Visual Analogue Scale (VAS) sensitivity was noted at specific points of the cervical vertebra. Then according to sacro occipital technique R + C protocol the related lumbar vertebra was adjusted opposite to the direction indicated by the cervical vertebral sensitivity. VAS measurements were recorded before lumbar vertebra manipulation and afterwards.
Results: At total of 38 patients were enrolled into this pilot study; 26 into the experimental group an 12 into the control group. Raw data from the VAS recordings were entered into SPSS, version 12.0 with a 10% check for accuracy performed. Mean change in report sensitivity as measured by VAS was notably larger for the experimental group (Table 2.0) The data was checked for normality to determine whether parametric testing would be appropriate. Both the Kolmogorov-Smirnov and Shapiro-Wilk tests indicated that the data was normally distributed. First we tested whether there was a statistically significant difference between mean VAS upon study entry. A t-test demonstrated that there was not a statistically significant difference (p=.189). This was important as we would not want a statistically significant difference between the two groups pre-test VAS measurement to be present at the outset or this might bias any interpretation of the study post-test findings. Finally we tested whether there was a statistically significant difference between pre- and post-VAS measurements and we found, using a t-test, that the notable difference in mean change in VAS scores (the experimental group mean decrease in sensitivity to palpation as reported by VAS being much greater) were statistically significantly different between the experimental and control groups (p < .001).
Treatment: R + C Factors are reflex indicators at the cervical vertebra used to identify vertebral rotation and lateral flexion inferiorities of the lumbar spine. Each lumbar vertebra is purported to have a corresponding “Lovett Brother” indicator in the cervical spine. Any manipulative form that accomplishes the “normalization” of position of the vertebra will usually cause the cervical indicator to lessen in sensitivity, which is the desired response. Sacro occipital technique has a low velocity high amplitude method of treating lumbar rotations and inferiorities using pelvic blocks for leverage while sustained pressure is applied at the lumbar vertebra.
Discussion: In an attempt to develop a biological plausibility to the R + C Factor and orthopedic block treatment phenomena found clinically some theories have been proposed. They vary from fascial and myological interrelationships, referred pain patterns facilitating tonic neck reflexes involving intersegmental spinal pathways, and visual, vestibular, proprioceptive and plantar mechanoreceptors affecting righting mechanisms for posture particularly to the cervical region.
Conclusion: Greater studies are needed to determine the relationship between the decreased sensitivity at the cervical indicators following lumbar manipulation. The findings of this study suggest further research into to cervical and lumbar vertebra interrelationships as well as orthopedic block placement and treatment may be warranted.
The following are the Abstracts from the 2004 ACC Conference, Las Vegas, Nevada.
Cooperstein R, Crum E, Morschhauser E, Lisi A. Sitting PSIS Positions and Prone Blocking Preferences. J Chiro Ed. Spr 2004; 18(1): 44-5.
Introduction: Blocking the pelvis with padded wedges, a technique procedure most closely identified with Sacro-occipital Technique, is believed to correct pelvic torsion, in which the innominate bones have rotated in opposed directions. The direction of pelvic torsion (e.g., left posterior-inferior ilium, or left PI) is identified by a prone leg check, where the short leg is thought to identify relatively posterior ilium rotation. This study used the direct approach of sitting PSIS palpation to identify pelvic torsion, rather than the more typically used and indirect approach of leg checking. This study also tested the assumption that blocking preferences are related to pelvic torsional patterns as assessed by PSIS palpation.
Methods: In a 28-subject study, investigator 1 palpated each of these asymptomatic participants in the seated position for evidence of PSIS positional asymmetry. Immediately following, investigator 2 examined each of the participants for blocking preferences. One block was inserted under the left ASIS and the other under the right greater trochanteric area, after which the blocks were removed and reinserted in the opposite pattern.
Results: Of the 26 study participants whose PSISs were palpable, 21 exhibited preferences for one of the blocking patterns, and three did not: 16 preferred a pattern corrective of a right PI, and five preferred a pattern for a left PI. Twelve had a lower PSIS on the right (thought to identify right PI), four had a low PSIS on the left (thought to identify left PI), and eight were judged symmetric. A subset of 14 participants had both PSIS asymmetry and a clear blocking preference. Of these, nine showed concordant right-sided PSIS calls and blocking preferences, three showed left-sided concordance and two were not concordant. Thus, 12 of the 14 study participants showed a concordant pattern of PSIS asymmetry and blocking preferences.
Discussion: Since the incidence of anatomic leg-length inequality (LLI) of _ inch or more is a much as 50% in asymptomatic subjects, leg checking procedures may not be able to distinguish the functional short leg thought to be associated with posterior innominate rotation from anatomic LLI. Moreover, an anatomic short leg has been found associated with anterior innominate rotation, and anatomic long leg with posterior innominate rotation. Therefore, we decided against using leg checking to identify pelvic torsion, and used instead static palpation of the pelvis in the seated position. Given the evidence that congenital asymmetry of the innominate bones is minimal, it is likely that PSIS asymmetry reflects pelvic subluxation rather that innominate dysplasia. The high degree of concordance (Kappa = .65, CI = 0.5) found in this study between inferred pelvic torsion and corrective blocking preferences suggests that blocking subjects might predict positive clinical outcomes in a program of chiropractic care. The relatively wide confidence interval for the Kappa statistic suggests the need for a larger data set.
Conclusion: The results of provocation prone pelvic blocking and seated PSIS palpation were strongly concordant in this preliminary study. If the current findings are substantiated. Sacro-occipital Technique and other practitioners may consider the manner in which they obtain their indications for pelvic blocking.
Blum C, Sacro Occipital Technique Pelvic Block Treatment for Severe Herniated Discs: A Case Study. J Chiro Ed. Spr 2004;18(1): 38-9.
Introduction: The chiropractic profession is beginning to gather sufficient evidence that its conservative method of care is a viable option for patients suffering from lumbar disc herniation. Recently two papers were presented which discussed the positive outcome of Sacro Occipital Technique (SOT) pelvic block placement on the treatment of lumbar disc herniation. A 37-year-old patient presented at this office September 2002 due to an aggravation, a week earlier, of a prior work related injury, which occurred in 1997. He presented with a 1.3 cm concentric disc bulge at L5-S1 and an extruded disc at the L3-L4 level, extending 8-9 mm posteriorly and to the right per the radiologist’s report.
Methods: Using various SOT diagnostic and treatment protocol for the treatment of lumbosacral discopathy, Category Three, the patient was treated with pelvic blocks or wedges. The majority of the treatment was performed with the patient prone and pelvic blocks placed under the pelvis according to leg length, cervical indicators, and determined by reduction of pain. Gentle distraction was placed to the herniated disc by leg traction and/or sacral traction and stabilization of the lumbar vertebral segment superior to the herniation. Psoas tension on the anterior aspect of the discs was “released” with the patient resting prone, on pelvic blocks, and with doctor’s hand placed under the patient with finger pressure directed anterior/posterior gently relaxing the muscle.
Discussion: Following three weeks of treatment at intervals of 1-2 times per week the patient noted that he felt markedly improved and had no limitations in his activities or ranges of motion to a large degree. The patient received infrequent treatment following the initial 2 months and months following his initial MRI a follow-up MRI was performed (7 months later due to awaiting approval from his workers compensation carrier) which found a 3 mm diffuse disc bulge at L3-L4 and L4-L5 per radiologist’s report.
Conclusion: Many practitioners from a variety of technique disciplines utilize pelvic wedges or blocks as a chiropractic adjustment tool. DeJarnette introduced the pelvic blocks or wedges in the development of the Sacro Occipital Technique and their use is indicated by identifying specific criteria, with the positional placement under the pelvis is directed by identifying the short leg and pain reduction. Future studies are needed to determine whether the findings in this case history can be generalized to patients presenting with herniated discs of the magnitude found with this patient. Pre and post MRIs seem to be an important part of the process of determining a relationship between clinical findings and objective measurements of disc herniation. While it must be noted that sometimes disc herniations will resolve over time independent of treatment, this patient’s concurrent clinical findings during the course of care make further investigation into SOT pelvic block placement for similar conditions warranted.
Blum C. A Chiropractic Perspective of Dental Occlusion’s Affect on Posture. J Chiro Ed. Spr 2004;18(1): 38.
Introduction: For years, chiropractors have used the term “Lovett Brothers” to describe the relationship between specific vertebra in the lumbar and cervical spine. Chiropractic procedures have also been proposed to be effective in treating conditions affecting the pelvis and temporomandibular joint (TMJ). In fact, the whole nature of the chiropractic technique, Sacro Occipital Technique (SOT) was that its developer, Major B. DeJarnette, found relationships between the sacrum and occiput, which he used in diagnosis and treatment. Chiropractic techniques need to be able to identify and treat conditions secondary to TMJ and dental occlusion dysfunction as well as develop understanding of the dental profession’s perspective for proper referral and co-treatment.
Methods: SOT methods of treatment have been found effective for treatment of cranial and TMJ related conditions. Various rationales for the relationship between the spine or pelvis and TMJ or Lovett Brothers have been found. These theories include fascial, myological interrelationships, referred pain patterns and facilitating tonic neck reflexes involving intersegmental spinal pathways. A review of the literature has found a relationship between dental occlusion and orthodontic procedures and their affect on posture and the spine.
Discussion: If chiropractors and dentists are going to be working together to treat conditions affecting the spine and posture as well as dentofacial orthopedics and/or temporomandibular dysfunction (TMD) a common language will need to be developed. SOT has methods of TMJ, cranial bone and whole body evaluation and therapy that facilitate the treatment of TMD, which are primary to occlusion (ascending disorder). In addition, SOT has methods of diagnosis, which can evaluate when the TMD is primary to conditions affecting the spine and posture (descending disorder), which necessitate referral to the dental practitioner skilled in TMD treatment.
Conclusions:: Chiropractic and dental co-treatment of TMD, occlusion and dentofacial orthopedics with its relationship to the spine, pelvis, and posture offer a valuable opportunity for multidisciplinary growth. This growth and intercommunication will enable patients suffering from long-term disorders to be offered the possibility of relief that alone, chiropractic or dentistry, cannot offer. Future studies are needed to evaluate this complementary relationship between dentistry and chiropractic to determine the effectiveness of this care and its benefit for patients with prior intractable chronic conditions.
Thompson DM, Unger J, Johnson K. Influence of Sacroiliac Joint Belt on Pain Threshold Along the Inguinal Ligaments. J Chiro Ed. Spr 2004; 18(1): 88-9.
Introduction: The sacroiliac joint (SIJ) has been credited as a source of low back pain partially because of the role of the joint in providing stability for the passage of forces from the upper body to the legs. The external oblique muscles are thought to aid in the stability of the sacroiliac joint and the aponeurosis forms the inguinal ligaments. Sacro-occipital technique challenges the inguinal ligament area by using the arm fossa test as an indicator of pelvic instability. Pelvic belts have been examined in the role of reducing pelvic instability. This study utilized these concepts by challenging the inguinal ligaments to the point of pain by using a pressure algometer before and after the application of a SIJ belt. The hypothesis is that the pain pressure threshold along the inguinal ligament will be increased and become more symmetrical along portions of the ligament after the application of a pelvic belt as compared to those who do not wear a pelvic belt.
Methods: A total of 21 individuals agreed to participate in the study. 10 in the belted group and 11 controls. The pressure algometer was used on four areas of inguinal ligament. Immediately after testing the inguinal ligaments, the SIJ belt was placed on alternating subjects. All subjects were instructed to either walk or stand for 15-20 minutes and immediately return to the testing area. Each subject was then placed supine and the belted was removed. If being worn, and each subject was retested with the pressure algometer.
Results: Significant differences for pain threshold along the inguinal ligament were found in the belted group for the left upper and lower portion and the right lower portion. The right upper portion was not significant for the belted group and there were no areas significantly different for the control group. The mean differences between pre- and post-testing show that the significant changes occurred in the belt group as a result of an increase in pain threshold. The lower inguinal areas, after adjusting for the change of the control group, both increased by 5.0 psi. When comparing inguinal areas, neither group had a significant difference between pre- and post measurements.
Discussion: When artificially inducing a force into the pelvic ring, such as the wearing of a SIJ belt, alteration in the balance of forces may take place. This study suggests that the SIJ belt produced a greater change in the status of the structures in the lower ligament areas as seen by an increase in the pressure required to induce pain. However, a comparison between ligament areas does not seem to give any insight into any changes that may have occurred from wearing the SIJ belt.
Conclusion: There was a change in pain pressure threshold within, but not between, most inguinal ligaments areas after the wearing of a sacroiliac joint belt with the greatest change seen in the lower portions of the ligaments. Further studies are needed to determine if these findings hold true in a blinded subject base as well as with those with confirmed SIJ dysfunction. Such findings may aid in the validation of using the inguinal ligaments as a diagnostic structure when addressing SIJ dysfunction.
The following are the Abstracts from the 2003 ACC Conference, New Orleans, Louisiana.
Thompson DM, Vrugtman RP, Johnson KM, Dicks SK, Unger-Boyd M. Correlation of Lateral Pelvic Sway to Variances of Pain along the Inguinal Ligaments: A Pilot Study. J Chiro Ed. Spr 2003; 17(1): 76.
Introduction: Sacro-occipital technique utilizes several clinical tests within its protocols to determine the physical status of a patient. Two of the indicators to identify a category II subject are increased lateral pelvic sway with eyes closed and held inspiration, and the arm fossa test, which challenges the inguinal ligaments. As a result of issues relating to intra– and interexaminaer reliability of the arm fossa test, this research project tested a modification of the arm fossa test. To provide specific measurement data, the authors chose to challenge the inguinal ligaments with a pressure algometer to the point of pain. The purpose of the study was to determine if there is a correlation between increased lateral pelvic sway greater than 1.2 cm (0.5 inch) and the asymmetry of pressure needed to induce pain along areas of the paired inguinal ligaments.
Methods: Subjects consisted of a single cohort of male and female chiropractic students between the ages of 20 and 40. Observation for increased lateral sway greater then 1.2 cm with eyes open and then with eyes closed, both with held inspiration, was determined with a postural analyzer (Foot Levelers). The subjects were then tested, to a maximum of 40 psi with a pressure algometer, to the point of pain along the inguinal ligaments. The inguinal ligament was divided into upper and lower fossae.
Results: Forty-seven subjects were tested. Five subjects were excluded due to the inability to produce pain below 40 psi in at least one of the fossae areas. Group 1 (n=23) had increased lateral pelvic sway with eyes open and eyes closed. Group 2 (n=11) had increased lateral pelvic sway with eyes closed but not with eyes open. Group 3 (n=6) did not have increased lateral pelvic sway with eyes open or with eyes closed. Group 4 (n=2) had increased lateral pelvic sway with eyes open but not with eyes closed. There were no significant differences of the pressure needed to induce pain within or between groups.
Conclusion: We did not find significant and meaningful differentiation among the required pressure to produce pain in the inguinal ligaments. As a result, we could not establish a relationship between increased lateral pelvic sway and the asymmetry of pressure needed to produce pain along the inguinal ligaments. However, the authors believe that there are some important findings from this pilot study. For example, since the sample sizes within some of the sway groups were to small of proper analysis, these data provide a baseline group percentage to calculate sample size with the power needed for similar studies. Also, since there was not an inclusion criteria for back pain within our subjects, the findings of the inguinal ligament mean pressures can begin to provide a baseline comparison for any further testing with known symptomatic low back or pelvic pain subjects.
Blum CL, Esposito V, Esposito C. Orthopedic Block Placement and its Affect on the Lumbosacral Spine and Discs: Three Case Studies with Pre and Post MRIs. J Chiro Ed. Spr 2003; 17(1): 48.
Objective: Research substantiating the chiropractic treatment of lumbar herniated discs is relatively new, particularly within the past two decades. With the advent of the new radiographic diagnostic tools, computerized tomographic (CT) scans and magnetic resonance imaging (MRI), pre- and post- studies can now be used to determine the effectiveness of conservative management of disc herniations. Three lumbar herniated disc cases where chosen to evaluated the effectiveness of chiropractic, Sacro Occipital Technique (SOT), and specifically SOT pelvic block placement in the treatment of lumbar herniated discs.
Features: Three separate case histories are evaluated of subjects who sustained trauma, which appeared to be directly related to the creation of a lumbar disc herniation(s). In each case, SOT block placement was used in treatment to help reduce the herniation(s). Pre- and post- MRI studies were used to determine the effectiveness of the SOT pelvic blocks: Case Study #1 had pre- and post- MRIs, with the post taken while SOT pelvic blocks were in place, Case Study #2 had pre- and post- MRIs, with post taken shortly following SOT pelvic block removal, and Case Study #3 had pre- and post- MRIs, with post following approximately six months of treatment.
Intervention and Outcome: The rationale of the use of SOT pelvic blocks is presented. Pelvic blocks or wedges have been shown to create changes radiographically , affect pain patterns , muscle strength , and proposed for orthopedic examinations . Cranial manipulation, cervical and thoracolumbar adjustments were also used when indicated to aid the reduction of the subject’s disc herniation. In each case significant reduction of symptomatology, neurologic, orthopedic, and chiropractic findings were found along with a reduction of the lumbar disc herniation as visualized on the post-MRI, as compared to the initial pre-treatment MRI.
Conclusion: Conservative methods have been shown to help reduce disc herniation. However, the significance of the three studies presented in this paper show that there was an immediate response by the herniated lumbar disc to the SOT pelvic blocks , and this sustained itself while on and off the blocks. Later, six months of treatment still evidenced a successful indication that most likely SOT pelvic block treatment was helping to reduce the herniated lumbar disc. SOT treatment uses SOT pelvic blocks and cranial manipulation as a major portion of its method of care. While it is clear that positive changes occurred during pelvic block placement and sustained itself shortly after, the 3rd case history could also have been attributed to a natural progression. Further investigation into chiropractic treatments, and specifically SOT pelvic block techniques are indicated, due to their effectiveness and the low level of contraindications for this conservative chiropractic therapy. References 1. Klingensmith RD, Blum CL The relationship between pelvic block placement and radiographic pelvic analysis. Proceedings of the 10th Annual Vertebral Subluxation Research Conference: Hayward, CA, Dec 8, 2002. 2. Lisi AJ, Coopertein R, A pilot study of provocation testing with pelvic wedges: Can prone blocking demonstrate a directional preference? Proceedings of the ACC Conference IX, Journal of Chiropractic Education Spr 2002; 16(1): 30-1. 3. Unger JF, Jr, The Effects of a Pelvic Blocking Procedure upon Muscle Strength: a Pilot Study Chiropractic Technique Nov 1998; 10(4): 50-5. 4. Coopertein R, “Padded Wedges for Lumbopelvic Mechanical Analysis” Journal of the American Chiropractic Association, Oct 2000: 24-6.
Pfefer, MT, Rasmussen S, Uhl NS, Cooper S, Treatment of a lumbar disc herniation utilizing sacro occipital chiropractic technique. J Chiro Ed. Spr 2003; 17(1): 72.
Introduction: The purpose of the paper is to describe a case of symptomatic lumbar disc herniation, successfully treated using sacro-occipital chiropractic technique procedures. Clinical Features and Outcome: A 53-year-old male with significant low back and radicular pain presented for chiropractic evaluation following mild injury. MRI findings included large uncontained central disc herniation at the L4-L5 level. Chiropractic intervention consisted of sacro-occipital category 3 procedures. Patient responded well to a 6-week intervention. Follow-up MRI at 5 months demonstrated significant reduction in the size of the herniation.
Conclusion: This report suggests that chiropractic treatment of symptomatic lumbar disc disorders may, in certain cases, be effectively treated via use of sacro-occipital procedures. The procedures utilized in this technique are low force and do not involve placing torsional stress on the low back, and potentially may be well tolerated and safe for patients in high-level acute paint that is often associated with symptomatic lumbar disc herniation. Further study is needed to determine the most effective and best tolerated strategies to be used in the chiropractic setting for the treatment of symptomatic lumbar disc herniation.
Cooperstein R, Lisi A. Correlation of Ankle Joint Complex Range of Motion, Leg Checks, PSIS Measurements, and Radiological Findings. J Chiro Ed. Spr 2003; 17(1): 51.
Introduction: The chiropractic, physical therapy, and osteopathic professions all use let-checking methods, and each has some concept of distinguishing a functional short leg from an anatomical short leg. Although finding accurate ways of measuring the anatomic length of the legs has not been without difficulties, identifying (i.e., validating) and reliably measuring the functional short leg has been far more difficult. The authors conducted a series of small studies to devise reliable leg checks and determine if their findings correlated with either the sitting or standing PSISs, or the radiological parameters of femur heads or inferior SI joints.
Methods: A triaxial foot posturometer was constructed, consisting of two orthogonally placed inclinometers and a compass mounted on a surgical boot, screwed to a wood “footprint.” This allowed measurement of the six end ranges, two for each direction of rotation around each of three axes for the foot-ankle joint complex. The first study looked for covariance in the end range rotations, the second study investigated the interexaminaer reliability of two novel methods on leg checking (compressive and triaxial), the third evaluated possible correlation of the leg checks with both each other and pelvic landmarks, and the fourth the possible correlation of the leg checks with radiological parameters.
Results: Plantarflexion, abduction and inversion of the foot-ankle joint complex tend to covary; this triad of findings was termed the “triaxial foot.” The values were: inversion-abduction r=.96, p=.0`1; inversion -plantarflexion r=.87, p=.0530; and plantarflexion-abduction r=.98, p=.004. Noninstrumented (subjective) ratings of two examiners for degree of triaxial foot were highly correlated (kappa=.85) as were their ratings for compressive leg checking (kappa=.67). The triaxial foot correlated with posterior innominate rotation in the group with a relatively small amount of torsion (r=.58, p=.17). The compressive leg cheek covaried with the difference between sitting and standing PSIS discrepancies, r=.44, p=.07 (a surrogate value for anatomical leg length inequality (LLI). The compressive leg check covaried with the radiological inferior SI joints, r=.87, p=.003, a surrogate for anatomic LLI. Looking at subjects in whom delta PSIS sitting was >3mm, a high torsion group, the triaxial and compressive leg checks were more highly correlated, r=.85, p<.001 and were unrelated in the low torsion group.
Discussion: Using the difference between the sitting and standing delta PSIS as a surrogate measure for anatomic LLI compressive leg checking tends to correlate with the “delta of the deltas,” suggesting it detects primarily anatomic LLI. This impression is further supported by the correlation between compressive leg checking and radiographic inferior sacroiliac joints. It was more difficult to determine the significance of the triaxial foot , except to see that in a low torsion group it predicted standing PSIS deltas, occurring on the side of the weightbearing low hip.
Conclusion: Since the results of compressive and triaxial leg checking covaried among the 17 subjects, it is reasonable to assume that the triaxial pattern serves as an easily identified surrogate for the more traditional identification of the short leg. We believe the triaxial foot to correspond under some circumstances to what clinicians generally call the function short leg and the compressive short leg more to an anatomic short leg. Having reliable leg checks facilitates the conduct of validity studies, which might determine what pathological significance (if any) leg length asymmetry may denote. Ultimately, we hope to validated or refute the suggestion that leg checks provide clinically useful information about pelvic function.
The following is an Abstract from the 2002 ACC Conference, New Orleans, Louisiana.
Blum CL. Incongruent sacro-occipital technique examination findings: Two unusual case histories. J Chiro Ed. Spr 2002; 16(1): 67.
Introduction: Background: Two highly unusual patients who were seen at my office for what they considered trauma induce severe low back pain stimulated the following paper. Objectives: Chiropractors who are or are becoming primary portals of entry into the healthcare field for many patients need to be cognizant of various however, unlikely sequelae. Purpose: The purpose of these two case studies are to alert the doctor to possible clinical findings that a specific chiropractic methodology, sacro occipital technique helped to uncover.
Methods: The severity of the patients’ pain made the typical neurological and orthopedic examination procedures virtually impossible. Emergency treatment was performed using specific Sacro Occipital Technique (SOT) examination and evaluation procedures.
Results: Incongruities between SOT anticipated examination and evaluation procedures were discovered. The location of the patients’ severe pain, the exquisite pain and intense sensitivity associated with negative SOT findings “demanded” an MRI of the area in question. Both radiology reports initially interpreted musculoskeletal related findings. However, due to the lack of positive SOT findings (R+C Factors, Trapezius Fiber Analysis and Category Diagnoses) a consultation with the radiologist encouraged further investigation for pathology. The results of the further investigation revealed with one case a metastasis to the mid lumbar spine believed associated from a malignant “skin cancer” found a month prior located on the patient’s scalp. With the other case an MRI of the lumbar spine revealed what was later to be determined a Staph infection spreading from the body of L2 to the body of L3, across the L2/3 disc space.
Discussion: In both cases each patient presented with, according to their history, trauma induced lumbosacral related pain. The patient with the metastasis described noting the pain upon falling from a chair, and reported having injured his “back” over the years in the same area, with chiropractic care reducing the pain in 5-10 treatments. SOT chiropractic treatment had initially been employed however, due marked sensitivity at the vertebra no thrusting or pressure to the spine were used. The other patient with the infection reported falling when playing soccer with his friends, and presented with sciatica along with specific L2/L3 lumbar spine pain. Similar with the other case SOT chiropractic treatment had initially been employed however, due to marked sensitivity at the vertebra no thrusting or pressure to the spine were used. With this case of significance was the elimination of sciatic radiating pain while the L2/L3 pain persisted.
Conclusion: With both cases the lack of congruent SOT examination findings associating with the patient’s presenting symptoms caused the practitioner to exercise extreme caution and by the second or third office visit both were referred for an MRI of the region in question. Regretfully the patient whose condition, which metastised to the spine, was so pervasive that surgery was not an option and he did not survive. The patient with Staph infection received bed rest and a course of antibiotics. He received chiropractic treatment at home and recovered full function of his lumbar spine and lower extremities. SOT examination procedures can be a valuable tool for the chiropractic practitioner for early detection of unusual pathology and help guide cautious management of the patient’s care until further in-depth diagnostic procedures can be performed or referrals to specialists made. It is suggested that greater research is needed into the SOT evaluation procedures and their ability to help the chiropractic diagnostic process.
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