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Law A. JCCA J Can Chiropr Assoc. 2001 December; 45(4): 232–240.

Abstract

Objective:

To evaluate the effectiveness of a conservative protocol for the relief of pain and dysfunction in a patient with knee osteoarthritis (OA).

Design:

Prospective interventional case report.

Patient:

A 54-year-old female presented with a complaint of moderate knee pain in both knees with an onset of approximately 3 years. The diagnosis was symptomatic OA of the knees.

Intervention and Outcome:

The patient was treated conservatively with active, passive, and nutritional therapy. The progress of the patient was scored by knee ranges of motion, the Lequesne index, and the WOMAC index at baseline and every four weeks there after. The total follow-up time was five months.

Results:

Positive trends were seen in the knee flexion ROM, the Lequesne index, and the WOMAC index.

Conclusion:

The treatment protocol in this study was effective for the treatment of knee OA. Conservative chiropractic treatment of knee OA has not been well documented in the literature. There is a need to document the effect of chiropractic care on the progression of OA. This case report may serve as a stepping-stone for prospective controlled trials concerning chiropractic management of knee osteoarthritis.

This case report demonstrates how Chiropractic care relieved symptoms of arthritis in a 54 year old female’s knee

Gregory D. Cramer, Jaeson T. Fournier, Christopher C. Wolcott, and Charles N. R. Henderson. J Manipulative Physiol Ther 2004 (Mar); 27 (3): 141–154

Objective:

The objective of this study was to evaluate changes of the lumbar vertebral column following fixation.

Design:

Using an established small animal (rat) model of spinal fixation (hypomobility), 3 contiguous lumbar segments (L4, L5, L6) were fixed with a specially engineered vertebral fixation device. Spinal segments of control rats were compared with those of animals with 1, 4, or 8 weeks of fixation. Subgroups of these fixation animals subsequently had the fixation device removed for 1, 2, 4, 8, or 12 weeks to evaluate the effects of attempting to reestablish normal forces to the vertebral segments following hypomobility.

Setting:

This Institutional Animal Care and Use Committee (IACUC) approved study was conducted in a university animal facility.

Animals:

Eighty-seven animals (23 controls animals and 64 fixation animals) were used in this study.

Main Results:

Very few degenerative changes were identified on the VBs and IVDs. Z joint changes were significant, both for osteophyte formation (analysis of variance [ANOVA], P <.0001) and ASD (ANOVA, P <.0001). Fixed segments had more degenerative changes than nonfixed segments for all Z joint parameters (ANOVA, P <.0001). Osteophyte formation and ASD were directly dependent on duration of fixation.

Conclusions:

These findings indicate that fixation (hypomobility) results in time-dependent degenerative changes of the Z joints. (Commonly known as arthritis)

Results of this study suggest restricted joint movement has the potential to accelerate arthritic changes. By undergoing Chiropractic care, adjustments get your joints moving, preventing such degeneration for taking place.

Atlas Vertebra Realignment and Achievement of Arterial Pressure Goal in Hypertensive Patients: A Pilot Study
Journal of Human Hypertension 2007 (May); 21 (5): 347–352

Anatomical abnormalities of the cervical spine at the level of the Atlas vertebra are associated with relative ischaemia of the brainstem circulation and increased blood pressure (BP). Manual correction of this mal-alignment has been associated with reduced arterial pressure. Using a double blind, placebo-controlled design at a single center, 50 drug naive (n=26) or washed out (n=24) patients with Stage 1 hypertension were randomized to receive a National Upper Cervical Chiropractic (NUCCA) procedure or a sham procedure. Patients received no antihypertensive meds during the 8-week study duration. The primary end point was changed in systolic and diastolic BP comparing baseline and week 8, with a 90% power to detect an 8/5 mm Hg difference at week 8 over the placebo group. The study cohort had a mean age 52.7+/-9.6 years, consisted of 70% males. At week 8, there were differences in systolic BP (-17+/-9 mm Hg, NUCCA versus -3+/-11 mm Hg, placebo; P<0.0001) and diastolic BP (-10+/-11 mm Hg, NUCCA versus -2+/-7 mm Hg; P=0.002). No adverse effects were recorded.

We conclude that restoration of Atlas alignment is associated with marked and sustained reductions in BP similar to the use of two-drug combination therapy.

You may also enjoy this WebMD review titled Chiropractic Cuts Blood Pressure and an ABC News article, titled: Could a Neck Adjustment Lower Your Blood Pressure?

If getting adjusted regularly can help lower your blood pressure without side effects then this is more evidence that chiropractic should be part of your first line of defense when managing hypertension (high blood pressure)

Treatment of lumbar intervertebral disc protrusions by manipulation.

Kuo, P P : Loh, Z C. Clin-Orthop. 1987 Feb; (215): 47-55

Abstract:

From 1975 through 1983, a total of 517 patients with protruded lumbar discs were admitted for manipulative treatment. Of these, 76.8% had satisfactory results. There were 73 recurrences (14.1%) at intervals ranging from two months to 12 years. Forty-seven cases did not respond to manipulation. These results indicate that manipulation of the spine can be effective treatment for lumbar disc protrusions. In general, the manipulation consists of eight maneuvers in three positions. The selection of the appropriate maneuvers depends on the patient's symptoms and signs and on the judgment and expertise of the operator. Practice is necessary to become proficient in spinal manipulation techniques. Several mechanisms of regression lumbar disc protrusions are possible.

Chiropractic adjustments are a very specific form of manipulation, targeting the joints which are restricted. This research strongly suggests that Chiropractic adjustments are an effective form of treatment in relieving the symptoms associated with invertebral disc protrusions.

Enhanced Phagocytic Cell respiratory Burst Induced by Spinal Manipulation

Brennan PC, Kokjohn K, Kaltinger CJ, Lohr GE, Glendening C, Hondras MA, McGregor M, Triano JJ. JMPT 1991:14:399-408

The effect of spinal manipulation on the respiratory burst of polymorphonuclear neutrophils (PMN) and monocytes from treated adults was measured by zymosan-stimulated chemiluminescence (CL). Peripheral blood was collected 15 min before and 15 min after treatment (sham manipulation, thoracic spine manipulation, or soft tissue manipulation), the cells were isolated, challenged with a standardized, opsonized luminol-containing suspension of zymosan, and monitored for CL. Plasma from two subsets of subjects was radioimmunoassayed for Substance P (SP). PMN were also preincubated with SP in vitro over the dose range 5 x 10(-12) M to 5 x 10(-8) M and the CL response monitored. The CL responses of both PMN and monocytes from subjects who received spinal manipulation were significantly higher after than before treatment, and significantly higher than the response in sham or soft-tissue treated subjects. Measurement of the force applied by sham and spinal manipulation suggested a force threshold for the enhancement of the CL response. Plasma levels of SP before and after treatment in sham treated subjects did not differ significantly; however, elevated plasma SP was observed in subjects after spinal manipulation. Preincubation of PMN with 1 x 10(-11) M, 5 x 10(-11) M or 1 x 10(-10) M SP in vitro primed PMN for an enhanced respiratory burst when the cells were subsequently challenged.

This studied analysed the effect that a Chiropractic adjustment has on the immune system. Blood was taken from each of the patients 15 minutes before and 15 minutes after the adjustment. It was demonstrated that in those who received a Chiropractic adjustive, the immune response had significantly increased. Chiropractic care is not limited to your body’s aches and pains – it can be part of your greater health care plan!

Olav Frode Aure, PT ; Jens Hoel Nilsen, PT ; Ottar Vasseljen, PhD. SPINE Journal 2003 (Mar 15); 28 (6): 525–531

Study Design:

A multicenter, randomized, controlled trial with 1-year follow-up.

Objectives:

To compare the effect of manual therapy to exercise therapy in sick-listed patients with chronic low back pain (>8 wks).

Summary and Background Data:

The effect of exercise therapy and manual therapy on chronic low back pain with respect to pain, function, and sick leave have been investigated in a number of studies. The results are, however, conflicting.

Methods:

Patients with chronic low back pain or radicular pain sick-listed for more than 8 weeks and less than 6 months were included. A total of 49 patients were randomized to either manual therapy (n = 27) or to exercise therapy (n = 22). Sixteen treatments were given over the course of 2 months. Pain intensity, functional disability (Oswestry disability index), general health (Dartmouth COOP function charts), and return to work were recorded before, immediately after, at 4 weeks, 6 months, and 12 months after the treatment period. Spinal range of motion (Schober test) was measured before and immediately after the treatment period only.

Results:

Although significant improvements were observed in both groups, the manual therapy group showed significantly larger improvements than the exercise therapy group on all outcome variables throughout the entire experimental period. Immediately after the 2-month treatment period, 67% in the manual therapy and 27% in the exercise therapy group had returned to work (P < 0.01), a relative difference that was maintained throughout the follow-up period.

Conclusions:

Improvements were found in both intervention groups, but manual therapy showed significantly greater improvement than exercise therapy in patients with chronic low back pain. The effects were reflected on all outcome measures, both on short and long-term follow-up.

Evidence that Manual Chiropractic Manipulation is more effective at managing Lower Back Pain than exercise therapy.

Cassidy JD, Lopes AA, Yong-Hing K. J Manipulative Physiol Ther. 1993 May;16(4):279-80.

Abstract

Objective:

The main objective of this study is to compare the immediate results of manipulation to mobilization in neck pain patients.

Design:

The patients were compared in a randomized controlled trial without long-term follow-up.

Setting:

The study was conducted at an outpatient teaching clinic on primary and referred patients.

Patients:

One hundred consecutive outpatients suffering from unilateral neck pain with referral into the trapezius muscle were studied. Fifty-two subjects were manipulated and 48 subjects were mobilized. The mean (SD) age was 34.5 (13.0) yr for the manipulated group and 37.7 (12.5) yr for the mobilized group. Sixteen subjects had neck pain for less than 1 wk, 34 subjects had pain for between 1 wk and 6 mo and 50 subjects had pain for more than 6 mo. Seventy-eight subjects had a past history of neck pain. Thirty-one subjects had been involved in an injurious motor vehicle accident and 28 subjects had other types of minor trauma to the neck. There were no significant differences between the two treatment groups with respect to history of neck pain or level of disability as measured by the Pain Disability Index.

Intervention:

The patients received either a single rotational manipulation (high-velocity, low-amplitude thrust) or mobilization in the form of muscle energy technique.

Main Outcome Measures:

Prior to and immediately after the treatments, cervical spine range of motion was recorded in three planes, and pain intensity was rated on the 101-point numerical rating scale (NRS-101). Both pre- and post-test measurements were conducted in a blinded fashion.

Results:

The results show that both treatments increase range of motion, but manipulation has a significantly greater effect on pain intensity. Eighty-five percent of the manipulated patients and 69% of the mobilized patients reported pain improvement immediately after treatment. However, the decrease in pain intensity was more than 1.5 times greater in the manipulated group (p = .05).

Conclusion:

This study demonstrates that a single manipulation is more effective than mobilization in decreasing pain in patients with mechanical neck pain. Both treatments increase range of motion in the neck to a similar degree. Further studies are required to determine any long-term benefits of manipulation for mechanical neck pain.

This study demonstrates that a single manipulation is more effective than mobilization in decreasing pain in patients with mechanical neck pain

Froehle RM. J Manipulative Physiol Ther 1996: 19:169-77

Objective:

The aims of this study were to determine (a) if the patients improved while under chiropractic care: (b) how many treatments were needed to reach improvement; and (c) which factors were associated with early improvement.

Design:

Cohort, nonrandomized retrospective study.

Setting:

Private chiropractic practice in a Minneapolis suburb.

Participants:

Forty-six children aged 5 yr and under.

Intervention:

All treatments were done by a single chiropractor, who adjusted the subluxations found and paid particular attention to the cervical vertebrae and occiput. Sacral Occipital Technique-style pelvic blocking and the doctor's own modified applied kinesiology were also used. Typical treatment regimen was three treatments per week for 1 wk, then two treatments per week for 1 wk, then one treatment per week. However, treatment regimen was terminated when there was improvement.

Outcome Measure:

Improvement was based on parental decision (they stated that the child had no fever, no signs of ear pain, and was totally asymptomatic), and/or the child seemed to be asymptomatic to the treating DC and/or the parent stated that the child's MD judged the child to be improved. A data abstraction form was used to determine number of treatments used and presence of factors possibly associated with early improvement.

Results:

93% of all episodes improved, 75% in 10 days or fewer and 43% with only one or two treatments. Young age, no history of antibiotic use, initial episode (vs. recurrent) and designation of an episode as discomfort rather than ear infection were factors associated with improvement with the fewest treatments.

Conclusion:

Although there were several limitations to this study (mostly because of its retrospection but also, significantly, because very little data was found regarding the natural course of ear infections), this study's data indicate that limitation of medical intervention and the addition of chiropractic care may decrease the symptoms of ear infection in young children.

As demonstrated by the above research, 93% of all episodes of Ear Infection (Otitis Media) improved after Chiropractic care.

Maxwell Walsh and Barbara I. Polus. J Manipulative Physiol Ther 1999;22:582-5

Abstract

Objective:

To evaluate the efficacy of chiropractic therapy on the treatment of symptoms associated with premenstrual syndrome.

Design:

A prospective, randomized, placebo-controlled, crossover clinical trial.

Setting:

Multicenter private clinics.

Subjects:

Twenty-five subjects with diagnosed premenstrual syndrome (with a Moos premenstrual syndrome questionnaire plus daily symptom monitoring).

Intervention:

After randomization, 16 of the subjects received high-velocity, low-amplitude spinal manipulation plus soft tissue therapy 2 to 3 times in the week before menses for at least 3 cycles. The remaining 9 subjects received a placebo treatment with a spring-loaded adjusting instrument wound down for minimum force. After a 1-cycle washout, the 2 groups changed over.

Outcome Measure:

Daily rating of symptom level, comparing total scores for premenstrual week with baseline for treatment and placebo phases.

Data Analysis:

The data were analyzed with paired Student t tests and Wilcoxon signed rank tests, with the statistical significance set at P < .05.

Results:

There was a significant decrease in scores after treatment compared with baseline scores (P = .00001) and a statistically significant decrease in scores for the treatment phase compared with the placebo (P = .006). For group 1 (n = 16), there was a significant decrease in scores after treatment compared with baseline scores (P = .0001) and a statistically significant decrease in scores for the treatment phase compared with the placebo (P = .041). For group 2 (n=9), there was a significant decrease in scores during treatment compared with the baseline (P = .01); however, there was no difference at the P = .05 level between treatment and placebo scores.

Conclusions:

Within the limitations of the study, the results support the hypothesis that the symptoms associated with PMS can generally be reduced by chiropractic treatment consisting of adjustments and soft-tissue therapy. However, the role of a placebo effect needs further elucidation, given that the group receiving the placebo first, although improving over the baseline, showed no further improvement when they had actual treatment.

This evidence suggests that Chiropractic care comprised of adjustments and soft tissue therapy can reduce the symptoms association with Premenstrual Stress.

Wenban AB, Nielsen Mk. J Manipulative Physiol Ther 2005 (Feb); 28 (2): 136–142

Objective:

To report on a 26-year-old female patient presenting with uncomplicated chronic low back pain who received chiropractic maintenance care using 2 quality of life outcome assessment instruments.

Outcome Measures:

Short-form (SF-36) subscales, Quality of Well-Being Scale, Visual Analog Scale, and number of tender vetebral [sic] spinous processes.

Results:

After 9 months of care the SF-36 subscale scores showed improvement. The SF-36, although low before care, approached normal on 3 subscales and exceeded normal population values on 5 subscales after 9 months. The SF-36 physical and mental composite scores improved from mean baseline scores of 23.4 and 25.3 to 43.7 and 62.8, respectively, after 9 months of care. The Quality of Well-Being Scale scores improved from a mean pre-intervention score of 1.1 to a post-intervention score of 8.2. The Visual Analog Scale scores improved from a mean pre-intervention score of 8 to a post-intervention score of 1.5. The mean number of chiropractic vertebral subluxations, detected via palpation of spinous process tenderness, went from a pre-care mean of 6.5 to a post-care mean of 4.

Conclusions:

The patient appeared to experience improvement in quality of life while showing signs suggestive of improved spinal function. The relationship between indicators of vertebral subluxation and quality of life deserves further investigation using a research design that allows for exploration of possible causal relationships.

Chiropractic care helping a 26 year old recover from chronic lower back pain and improving their quality of life.

Dabbs V, Lauretti WJ. J Manipulative Physiol Ther 1995 (Oct); 18 (8): 530–536

Objective:

We reviewed the literature to evaluate the risk of serious injury or death resulting from cervical manipulation and to assess the evidence that cervical manipulation is an effective treatment for mechanical neck pain. We also reviewed the literature to assess the risks and effectiveness of nonsteroidal anti-inflammatory drugs (NSAIDs), which are often used as the "conventional" first-line treatment for similar musculoskeletal conditions.

Data Sources:

A series of Medicine literature searches were performed, and materials were reviewed from 1966-1994. Key words included: Chiropractic or Orthopedic Manipulation; Non-Steroidal Anti-Inflammatory Agents; Neck or Back Pain; Randomized Controlled Trials; Adverse Effects.

Study Selection:

Studies and literature reviews that provided a numerical estimate of the risk of serious adverse effects or death from cervical manipulation or NSAID use were selected. Also, randomized, controlled studies that evaluated the effectiveness of manipulation or NSAID use for neck pain were included.

Data Synthesis:

Although there are a small number of well-performed trials of cervical manipulation for neck pain, we were unable to locate even a single randomized, controlled trial examining NSAID use specifically for neck pain. As for comparative safety, the best available evidence indicates that NSAID use poses a significantly greater risk of serious complications and death than the use of cervical manipulation for comparable conditions.

Conclusion:

The best evidence indicates that cervical manipulation for neck pain is much safer than the use of NSAIDs, by as much as a factor of several hundred times. There is no evidence that indicates NSAID use is any more effective than cervical manipulation for neck pain.

Chiropractic care has been found to be safer than the use of non-steroidal anti-inflammatory drugs by as much as a factor of several hundred times.

Tarola GA. J Manipulative Physiol Ther 1994 (May); 17 (4): 253–257

Objective:

This report of two cases illustrates the potential effect of chiropractic manipulative therapy on back pain and curve progression in the at-risk, skeletally mature patient with adolescent idiopathic scoliosis.

Clinical Feature:

Two patients suffering from lumbar scoliosis and chronic back pain. Both had scoliosis that had progressed after skeletal maturity.

Intervention and Outcome:

Diversified type chiropractic manipulative therapy was used palliatively for back pain relief in one case, and routinely 1-2 times per month in the other case. The manipulation was applied manually, with the patients in the prone and side-posture positions. Vertebral levels manipulated were identified as fixated/dysfunctional segments based on static and/or motion palpation. They were generally applied to areas above and/or below the curve apex. When applied at the apex, cavitation was more easily achieved when the direction of thrust was into the concave side. This was also tolerated better by the patient. No attempt was made to "straighten the curve" by thrusting into the convex side. Gentle manual intersegmental mobilization, stretching and muscle massage techniques were also applied. The case treated palliatively had curve progression consistent with the literature over an 8-yr period. The case treated routinely did not. The procedure was effective in both cases for subjective relief of back pain.

When Chiropractic Adjustments are used only to reduce pain in scoliosis the condition will continue to progress however maintenance care is effective to stop the progression of the condition.