An example of a potential future direction for joint medical-chiropractic research is found in the book Chiropractic: Interprofessional Research, a summary of research presented at the World Chiropractic Conference, held in Venice, Italy in 1982. A series of studies by chiropractors, working in concert with Italian medical doctors, demonstrated promising effects of chiropractic treatment in cases of vertigo, tinnitus (ringing of the ears), headaches, and visual disorders.
There is far less research available concerning chiropracticâs effects on visceral (internal organ) disorders than exists in relation to lower back pain and other musculoskeletal problems. This is because the chiropractic profession has had to prioritize the research it could afford to pursue in the absence of significant government funding. Proving the validity of chiropractic manipulation for those conditions most commonly treated by chiropractors (low back pain, neck pain, and headaches) has been the highest priority.
There is, nevertheless, a growing body of literature, some of it published in peer-reviewed scientific journals, on the effects of manipulation for problems related to internal organ dysfunction. Some of these are controlled clinical trials, while others are thought-provoking case studies which point to the need for more extensive future research:
A randomized, controlled clinical study demonstrated that diastolic and systolic blood pressure decreased significantly in response to chiropractic adjustments of the thoracic spine (T1-T5), while placebo and control groups showed no such change. This study demonstrated short-term effects of manipulation on blood pressure, and indicates a need for studies on long-term effects.
As noted earlier in this book, there have been two controlled clinical trials which studied the effects of spinal manipulation on dysmenorrhea. The results were quite promising, and further research is in progress.[6,7]
A study at the National College of Chiropractic showed a marked increase in the activity levels of certain immune-system cells (PMNs and monocytes) after thoracic spine manipulation. These increases were significantly higher than in control groups, who were given either sham manipulation or soft-tissue manipulation.
A study involving 73 Danish chiropractors in 50 clinics showed satisfactory results in 94 percent of cases of chiropractic research:infant colicinfant colic. The results occurred within two weeks, and involved an average of three treatments.
Several case studies have indicated that bladder dysfunction can be responsive to lower back manipulation.[10,11]
Lung volume and forced vital capacity (a measure of lung strength), were shown in a series of cases to increase after chiropractic adjustments.[12,13]
A 7-month-old infant suffering from chronic constipation since birth (with a history of hard, pellet-like stools following hours of painful straining) was restored to normal bowel function by full-spine and cranial adjustments.
A two-year-old child medically diagnosed with asthma and enuresis (bedwetting) improved dramatically as a result of spinal adjustments, after medication had proved inadequate.
Pelvic pain and pelvic organ dysfunction, in which there was no accompanying lower back pain, was shown in a case study to resolve fully with chiropractic manipulation of the lumbar spine, after numerous failed attempts at treating the symptoms medically.
A 5-year-old girl, who was experiencing up to 70 seizures a day, was treated with upper neck adjustments and became virtually seizure-free.
Further exploration of chiropracticâs effects on internal organ problems holds great promise. Studies are underway as this book goes to press, and many more are expected. This may turn out to be the most fertile area for chiropractic research in the Twenty-First Century.
The Chiropractic Perspective
Looking back over the material weâve covered, how would we best summarize the differences between the chiropractic approach and the standard medical model?
First and foremost, the chiropractic model views symptoms in a broad context of health and body balance, not as isolated aberrations to be suppressed and then forgotten. Chiropractors recognize the need for thorough evaluation of symptoms, but do not assume that the elimination of symptoms is the ultimate goal of treatment. Just as peace is not the absence of war, health is not the absence of disease symptoms. The true goal is sustainable balance. This is recognized by chiropractors and by holistic medical physicians as well.
While chiropractors are trained in state-of-the-art diagnostic techniques, and while chiropractic examination procedures overlap significantly with those used by conventional medical physicians, chiropractors evaluate the information gleaned from these methods from a perspective that recognizes the intricate structural and functional interplay between different parts of the body.
The contrasting medical and chiropractic diagnostic approaches to pain provide a case in point. In my experience, conventional medical physicians far more frequently than chiropractors make the assumption that the location of a pain is the location of its cause. Thus, knee pain is generally assumed to be a knee problem, shoulder pain is assumed to be a shoulder problem, etc. This pain-centered diagnostic logic frequently leads to increasingly sophisticated and invasive diagnostic and therapeutic procedures. (If physical examination of the knee fails to clearly define the problem, then the knee is x-rayed. If the x-ray fails to offer adequate clarification, then an MRI of the knee is performed, etc.)
Chiropractors also utilize these diagnostic tools. I refer some patients for x-rays and MRI studies. My point is not to criticize these machines, but to present an alternative diagnostic model. I have seen more than a few cases of knee trouble where this entire high-tech diagnostic scenario was played out, and the cause of the problem turned out to be in the lower back.
If the lower back is mechanically dysfunctional, and in need of spinal manipulation, this can often place unusual stress on the knees. In cases of this sort, one can spend months or years medicating the knee symptoms with painkiller pills and/or steroid injections, or performing knee surgery, without ever addressing the real problem. This is not an isolated hypothetical instance. It happens far too often.
The chiropractic approach to musculoskeletal pain involves evaluating the site of pain in a whole-body context. Shoulder, elbow and wrist problems can of course be caused by problems in the shoulder, elbow and wrist but pain in all of these joints frequently has its source in the neck. Similarly, pain in the hip, knee, and ankle can also have its source at the site of the pain but in many cases the source lies in the lower back. The need to consider this chain of causation is built into the core of chiropractic training.
Chiropractors from D.D. Palmer onward have purposely refrained from assuming that the site of a symptom is the site of its cause. They have assumed instead that the source of the pain should be sought somewhere along the path of the nerves leading to and from the site of the symptoms.
Thus, a pain in the knee might come from the knee itself, but if we trace the nerve pathways between the knee and the spine, we find along the way possible areas of causation in or around the hip, in the deep muscles of the buttocks or pelvis, in the sacroiliac joints, or in the lower spine.
Furthermore, if an imbalance does exist in the lower spine (at the fourth lumbar level, for example), it might have its source right there at L4, or might in turn be a compensation for another joint dysfunction elsewhere in the spine, perhaps in the middle or upper back. Thus, an integrated, whole-body approach to structure and function is of great value.
For a patient with an internal organ problem, chiropractic diagnostic logic would include evaluation of those spinal levels which are the source of the nerve supply to the involved area, as well as consideration of possible nutritional, environmental and psychological causes. Chiropractic practice standards also mandate timely referral to a medical physician for diagnosis and/or treatment, for any condition that is acute and dangerous, or when a reasonable trial of chiropractic treatment (current standards in most cases limit this to about one month) fails to bring satisfactory results.
Wellness and the Chiropractic Model
The chiropractic model pays heed to patientsâ nutritional needs, exercise habits, work conditions, and psychological health. In many cases, particularly with regard to nutrition and exercise, the chiropractor will act as a teacher, directly counseling patients on proper diet or exercise methods. In other instances, chiropractors will make referrals to other health practitioners, or to appropriate classes in the community.
The traditional chiropractic philosophy I learned during my training anticipated in many respects the concepts that comprise the modern wellness paradigm. Aside from being taught the importance of good diet, exercise, and emotional health, we also learned that it is far better to practice prevention than to engage in crisis-care, and that health is far more than the absence of symptoms. These ideas together form a respectable foundation for a profession that seeks to practice holism.
1. Copland-Griffiths, Dynamic Chiropractic Today, p. 159
2. Bourdillion, J.F. Spinal Manipulation. pp. 205-206
3. Copland-Griffiths, op. cit. p. 162
4. Mazzarelli, Joseph, D.C. (editor). Chiropractic: Interprofessional Research. pp. 69-76.
5. Yates RG, Lamping DL, Abram NL, Wright C. "Effects of Chiropractic Treatment on Blood Pressure and Anxiety: A Randomized, Controlled Trial." Journal of Manipulative and Physiological Therapeutics, 1988; 11: 484-488.
6. Kokjohn K, Schmid DM, Triano JJ, Brennan PC. "The Effect of Spinal Manpulation on Pain and Prostaglandin Levels in Women with Primary Dysmenorrhea." Journal of Manipulative and Physiological Therapeutics, 1992; 15: 279-285.
7. Thomason, PR, Fisher BL, Carpenter PA, Fike GL. "Effectiveness of Spinal Manipulative Therapy in Treatment of Primary Dysmenorrhea: A Pilot Study." Journal of Manipulative and Physiological Therapeutics. 1979; 2: 140-145.
8. Brennan PC, Kokjohn K, Katlinger CJ, Lohr GE, Glendening C, Hondras MA, McGregor M, Triano JJ. "Enhanced Phagocytic Cell Respiratory Burst Induced by Spinal Manipulation: Potential Role of Substance P." Journal of Manipulative and Physiological Therapeutics, 1991; 14: 399-408.
9. Klougart N, Nillson N, Jacobsen J. "Infantile Colic Treated by Chiropractors: A Prospective Study of 316 Cases." Journal of Manipulative and Physiological Therapeutics, 1989; 12: 281-288.
10. Falk, JW. "Bowel and Bladder Dysfunction Secondary to Lumbar Dysfunctional Syndrome." Chiropractic Technique, 1990; 2: 45-48.
11. Borregard, PE. "Neurogenic Bladder and Spina Bifida Occulta: A Case Report." Journal of Manipulative and Physiological Therapeutics, 1987; 10: 122-123.
12. Masarsky, CS and Weber M. "Screening Spirometry in the Chiropractic Examination." ACA Journal of Chiropractic, February 1989; 23: 67-68.
13. Masarsky, CS and Weber M. Chiropractic and Lung Volumes A Retrospective Study. ACA Journal of Chiropractic, September 1986; 20: 65-68.
14. Hewitt, EG. "Chiropractic Treatment of a 7-Month-Old With Chronic Constipation: A Case Report. Proceedings of the National Conference on Chiropractic and Pediatrics (International Chiropractors Association), 1992; 16-23.