Journal of Chiropractic Education | 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.