The Journal of Chiropractic Education 2000 Spr; 14(1): 55
ABSTRACT: Multiple sclerosis (MS) is a demyelinating disease of the central nervous system afflicting over 250,000 persons in the United States alone. While the etiology of MS is currently unknown, much clinical evidence points to an infectious process involving an unknown agent, causing an immune response against one’s own nervous system in genetically susceptible persons. The resulting inflammation of the central nervous system tissues produces a wide variability in the clinical sense, with subtypes of MS ranging from remitting-relapsing varieties to a chronic progressive expression of MS. No cure exists for MS, and as a result most therapies are directed toward the alleviation of MS-related symptomatology while promoting self-sufficiency. The medical approach toward MS symptom relief generally includes a vast array of pharmaceutical agents, diet modification, physical therapy, and addressing associated psychological issues. Alternatives to these treatment modalities have increasingly become available, most with little more than anecdotal support. Described is a prospective case series involving chiropractic care with four MS patients, each diagnosed with the chronic progressive form of the disease. The purpose of this series was to investigate any significant relationship between chiropractic care delivery and MS-related symptomatology.
METHODS: Four patients were selected from a local MS support group, each with a diagnosis of chronic progressive MS (confirmed by imaging). A clinical trial of 6 months duration was undertaken, utilizing two separate and distinct methods of chiropractic care: Three of the patients were treated over the course of 6 months utilizing full-spine chiropractic manipulative therapy, while the fourth was treated using only Toggle recoil upper cervical technique. Subjective and objective parameters were measured initially, and every 4 weeks until the completion of the 6 month trial. These outcome measures included the SF-36 Health Survey, as well as the MS-ADL Scale (Gulick); strict physical examination criteria were also followed at these intervals. Lastly, each patient was encouraged to keep a daily diary in which to record pertinent subjective data.
RESULTS: Data collected over the course of the clinical trial illustreates measurable change in various “quality of life” issues. Data retrieved from SF-36 surveys measured the following: General Health, Physical Functioning, Limitations Due to Physical Health, Limitations Due to Emotional Health, Pain, Energy/Fatigue, and Emotional Well-Being. The MS-ADL Scale (Gulick) measures were considerably more specific, including: Eating, Dressing, Walking, Transfer, Travel, Bathing, Toileting, Recreation/Socializing, Sensory/Communication, and Intimacy. Data collected indicated that change was primarily seen in categories involving physical ability, energy level, and bodily pain; these areas are discussed fully, with a comparison being made between the two treatment groups.
DISCUSSION: Presentations of multiple sclerosis vary greatly, in the clinical sense. Many patients are affected with change in physical ability or general musculoskeletal function as a direct manifestation of the disease. compensation for these deficits is certain. These compensatory efforts may in fact create still more symptoms, negatively influencing the patient’s perception of well-being. When normal spinal motion patterns have been altered, either directly or indirectly, chiropractic manipulative therapy may be indicated. Correction of these spinal aberrations may positively impact the MS patient’s quality of life.
CONCLUSION: This case series has suggested that chiropractic care is a viable, noninvasive form of treatment for musculoskeletal symptoms associated with multiple sclerosis. While promising, the results of this study indicate the need for further research in this area.