Attention Deficit Hyperactivity Disorder (ADD/ADHD)

A Patient’s Perspective – April 2005 (ADD/ADHD)

Welcome to my latest newsletter which looks at Attention Deficit Disorder/Attention Deficit Hyperactivity Disorder (ADD/ADHD). As there is an increasing tendency for drugs to be prescribed to our children and lately adults for the treatment of this condition I felt that it is timely to provide some information with regards to the potential treatment of this disorder using an upper cervical chiropractic approach.

I hope you enjoy this edition and as always feel free to provide me with any feedback and suggestions to info@upcspine.com. The purpose of my newsletters is to challenge the mainstream thinking on what may be the cause of some conditions and to encourage researchers to think outside the ‘normal’ boundaries when looking for solutions. I am a patient and not a medical practitioner; however I am entitled to my own opinions. People are free to disagree with me. My newsletters are provided as an informational source only, and are not a medical opinion. Therefore you should do further research for yourself and make your own decisions.

Condition Report

Attention Deficit Hyperactivity Disorder (ADD/ADHD)

I recently watched a TV news show in which a doctor was being interviewed about Attention Deficit Disorder/Attention Deficit Hyperactivity Disorder (ADD/ADHD). Apart from the increasing numbers of children being diagnosed with these disorders the doctor claimed that around 4% of the US adult population was also suffering from the disorder. Ah! I thought here we go, yet another market opportunity opens up for pharmaceutical companies. It made me think about the current drug advertising. Some of the current drug advertisements make you feel like you are missing out on something and that you should run straight to your doctor to get a prescription! Isn’t it amazing to think that a product which is supposed to help sufferers of diseases is peddled as if it was the latest consumer ‘got-to-have’! Such are the dynamics of a global multi-billion dollar drug industry.

Mercola and Droege[1] reported (2004) that “well over 1 million American children are on drugs for ADHD” and “that drugs for attention disorders bring in $2.2 billion a year” despite evidence that “the effect of treatment beyond four weeks has not been demonstrated. In other words, no one knows what the long-term effects will be.” Mercola and Droege further state that “Although it is estimated that more than 8 million adults in the United States have ADHD, the disorder is typically thought of as something that is outgrown during adolescence. Why, then, would adults need these drugs? Perhaps it has something to do with one pharmaceutical executive’s statement in a Reuters interview, “The adult market is three times the size of the children’s market. The market is ripe and is moving in the right direction.”

A newspaper article[2] recently reported a case of a woman who was incorrectly diagnosed with bipolar disorder and ADHD and subsequently prescribed medications. According to the article she “suffered a drug induced psychosis from the range of medications which included Prozac and dexamphetamine.” Additionally she was told that her 7 year old son had ADHD which turned out to be yet another misdiagnosis. The article goes on to say that doctors are increasingly prescribing drugs to treat an array of conditions including ADHD” and “despite ongoing education campaigns and research into ADHD, debate about the prevalence and treatment of the condition continues.” Further a report in the lower house of the West Australian parliament “estimated 11,500 children in that state – some as young as two were prescribed psychostimulant drugs, mainly dexamphetamine, for ADHD.” Perhaps even more disturbing is that a survey of parents “found 11 per cent thought their child was suffering from the symptoms of ADHD.” The article concludes with figures showing that prescriptions for dexamphetamine (the top-selling ADHD drug) rose from 46,000 in 1994 to 246,000 in 2004 in Australia. Sadly this trend is increasing.

For those of you who read my Parkinson’s disease blog you will note that I covered off on Dr Fernandez-Noda’s[3][4][5][6] assertion and findings that Parkinson’s and other diseases (Alzheimer’s, multiple sclerosis & epilepsy) may well be a consequence of a reduction of oxygenated blood flow to the dopamine producing cells of the brain and compression of the brachial plexus of nerves, the assumption being that the restoration of correct blood flow and nerve impulse amplitude may well have a positive effect on peoples’ health and go some way towards reversing this condition.

Why do I mention Parkinson’s disease in an ADHD newsletter you ask? Well as I started to research various treatments I found that the dopamine link could also be found in pharmaceutical approaches to treating ADHD. Many imaging studies of children with this ADHD have found an imbalance of the neurochemical dopamine. Methylphenidate, (Ritalin) a dopamine reuptake inhibitor, is the most common pharmaceutical treatment for attention-deficit hyperactivity disorder despite there being little evidence of any long-term benefit, nor knowledge of potential chronic side-effects. However, according to Gottlieb[7] reporting on an article in the Journal of Neuroscience, “Methylphenidate works in the treatment of attention deficit hyperactivity disorder by increasing levels of dopamine in children’s brains”. Apparently “the drug seems to raise levels of the hormone by blocking the activity of dopamine transporters, which remove dopamine once it has been released.”

If Parkinson’s, Alzheimer’s, multiple sclerosis, epilepsy and now ADHD drug treatment targets dopamine depletion, could there be a common causal link in all of these diseases? If the end result is dopamine depletion then I assume the causal link could be something which reduces the production of dopamine? Could Fernandez-Noda et al be correct in their conclusions that it is muscular compression of structures (arterial and neurological) which is the causal factor in the lack of dopamine production? Seems quite plausible I would think and certainly worthy of at least some amount of focus from research organizations. Given that all of these conditions reportedly respond positively to upper cervical chiropractic treatment to realign the relationship between the skull and cervical vertebrae could the causal link be upper cervical subluxations causing compression of neurovascular structures at the base of the skull and/or further down at the base of the neck, where it meets the shoulders?

The phenomenon of upper cervical subluxations causing various health issues needs to be researched vigorously now, and I call on all Governments to pour funds into upper cervical chiropractic research. I have found it no use whatsoever approaching various research organizations to get them to put some of their funds towards chiropractic research. They are usually polite but dismissive that chiropractic would produce any positive results. Surely scientists need to keep an open mind when it comes to research and investigate all avenues and claims?

Conservative treatment for ADHD is becoming a viable alternative as my research shows. In particular the application of manual therapy (chiropractic) appears to result in both reversal of the condition and the elimination of the need for administration of pharmaceuticals.

I came across a really wonderful book “Manual Therapy in Children”[8] edited by Heiner Biedermann which communicates the benefit of manual therapy in the treatment of children for various disorders including ADHD. When one reads this book one could be forgiven for thinking one was reading a chiropractic textbook because it discusses and advocates the manipulation of the skeleton including the upper cervical spine using many of the approaches developed by chiropractors over decades. The book is a great reference for any practitioner.

In fact, this book has contributions from various medical doctors (MD) including surgeons! In the ‘Introduction’ (p5) Biedermann says “the problems associated with and labeled ADHD have a close connection with problems originating in functional spinal disorders”. At the end of the book, in the ‘Epilogue’ (p321), as if out of frustration he says “From the inside out it (manual therapy) is a wonderfully all-encompassing variant of the healing professions” and it is “this very ability which turns manual therapy into an unwelcome guest of one’s own field of work.” He cites comments from his peers like “How dare these people claim to solve problems which have been hounding us for many years … branding those intruders as confidence tricksters.” Sound familiar? If you have been following the chiropractic scene you would immediately see the parallels between what Biedermann and his associates are now facing from their own peers and the systematic denigration of chiropractic over the past century. The fact is that Biedermann et al are right on the money and history will eventually show that they and chiropractors have been right all along.

Chapter 12[8], “Attention deficit disorder and the upper cervical spine”, 133-42; Theiler R. DrMed FMH is of particular significance for this newsletter. Theiler discusses findings relating upper cervical spine (sub-occipital) subluxations or what they call KISS (kinematic sub-occipital strain syndrome) to ADD/ADHD. In particular he notices that children with ADHD exhibit postural distortions and associated movement deficits of the upper cervical spine. He finds that following manual therapy applied to the cervical spine not only do postural deficits resolve in the children but so do concentration and cognitive abilities. As such visual concentration span and thus reading difficulties were improved immediately following manual manipulation. “Ten children achieved an oral reading fluency appropriate for their age usually in the days following therapy.” Interestingly there is a discussion about one of the main findings being “reduced capacity for processing information” which is “an expression of deficiencies in executive functions, which are carried out in the dopamine-dependent structures of the frontal lobe and corpus striatum.”

The chapter finishes with the discussion of three case studies of ADHD, the first one (p139) of a female 7.2 years who apart from a “fall from a swing” had no other trauma. She showed “persistent postural asymmetry and insufficient gross motor functions” and “her attention span was short and she was impulsive when assigned tasks.” Examination revealed head tilted to the right and rotated to the left with a C1/C2 blockage. She was treated with manual therapy left C1/C2. Apart from initial giddiness, her posture straightened and motor coordination improved and her verbal capacities and visual component became better than an 8 year old. A later reoccurrence of the subluxation was subsequently corrected following a relapse, and after the correction things returned to normal again.

The second case study (p140) is of 6.5 years female who was born with a fractured clavicle. It was noticed that as she developed, her clumsiness was remarked and drawing and scribbling skills lagged her age group. At age 6 she could not use scissors nor fasten her shoes and jumping on one leg was impossible for her. Fine motor tasks were also below par and her memory capacity and processing capacity were 1.5 years below average. An examination revealed impaired side bending of the head and reduced left sided rotation, as well she had “excessive thoracic kyphosis.” X-rays showed “a lateral displacement of C1/C2 to the right”, in other words upper cervical subluxation. The treatment administered was “a sagittal impulse on C1 and a HIO C1/C2 from the right side (impulse manipulation).” I take the HIO reference to mean “Hole-in-One” as developed by B.J. Palmer http://www.upcspine.com/tech8.htm. Two months post the manipulation and even though the mother reported no change, the doctors found she now had unhindered head movements, could “jump a bit on one leg now”, was more considered and less impulsive when working, was able to concentrate longer and her verbal memory was now +2 years her age. Her mother conceded an improvement when showed comparisons of test results.

The third case study (p141) is of a 11.5 years female with concentration and long term attention span problems, fine motor coordination difficulties with increasing speed, problems with writing and becoming impulsive when tackling difficult tasks. “In copying of dots and in repeating nonsense syllables, her performance was at the level of an 8 – 8 1/2 year old.” Examination revealed scoliosis with associated postural deviations, a blockage at the SI joint, right head tilt, C1/C2 blocked on the right and x-rays revealed “an offset of the atlas to the right”. Hmmm … sounds like upper cervical subluxation to me. The family decided upon Ritalin therapy and the girl improved immediately. After a time manual therapy was finally applied and simultaneously the medication was stopped. She was able to function normally without medication but the parents requested resumption of the Ritalin to see if they could get further improvement. When it was determined there were no more “perceptible gains” the medication was stopped. The improvements have lasted well into the next school year. The authors conclude “we are in favour of examining and treating functional problem of the cervical spine …. even if a pharmacotherapy seemed top have already resolved the problem at hand.”

Erin Elster[9] reports in a case study about a 9 y.o. boy suffering from Tourette syndrome, Attention Deficit Hyperactivity Disorder (ADHD), depression, asthma, insomnia and headaches that he was born via forceps delivery and was taking various medications for his conditions. Chiropractic examination revealed evidence of an upper cervical subluxation and he was treated with an upper cervical chiropractic technique (IUCCA) http://www.upcspine.com/tech12.htm. After 6 weeks of care all six (6) conditions were absent and all medications except a small amount of one were discontinued. Five months post all symptoms remained absent. Elster suggests a link between the patient’s traumatic birth, the upper cervical subluxation, and his neurological condition. Further research is suggested.

In another case Giesen, Center and Leach[10] discuss 4 of 7 children who showed statistically significant improvement in their ADHD condition following specific chiropractic care and although not conclusive the authors suggest that chiropractic manipulation has the potential to become and important non-drug intervention for children with hyperactivity.

Interestingly a newspaper article[11] suggests “Head injuries could be responsible for some behaviour disorders in children and adolescents, a study has found. As many as 20 per cent of children who have suffered mild head injuries through sport or playground falls may develop symptoms years later. These symptoms, according to Uni of New England lecturer Dr James Donnelly, may be misdiagnosed as ADD or attitude or motivational problems. “Blows to the head that cause changes in the child’s ability to think clearly, especially those that cause a loss of consciousness, may have jarred the brain in the skull,” Dr Donnelly said.” A well known Sydney neurosurgeon once told me that the results of brain injuries are usually evident immediately and do not become evident years later. I think that this is just another piece of evidence that the contributing event to many conditions is head and/or neck trauma, and I think one could rightfully conclude that this leads to an upper cervical subluxation. I’ve also heard that Daniel G. Amen the author of “Healing ADD: The Breakthrough Program That Allows You to See and Heal the 6 Types of ADD” runs a clinic for treating ADD/ADHD in California and apparently when someone goes to his clinic they will be asked no less than 5 times whether or not they have sustained a head injury. I also find many people on discussion forums questioning whether or not a head injury was the initial event in their disease or condition. It seems many people do recall a head injury prior to the onset of symptoms. I know I did!
In a case study Bastecki et al[12] report that a 5 year-old patient diagnosed by a medical practitioner with ADHD and for which Ritalin treatment for 3 years was not effective, and who exhibited cervical kyphosis (reversed neck curve), underwent multiple chiropractic treatments. During chiropractic care the child’s facial tics and behaviour vastly improved and the child’s paediatrician stated that the child no longer exhibited the signs of ADHD. The reduction in symptoms was significant enough to discontinue medication. The authors suggest a possible correlation between cervical kyphosis and ADHD.

In 1995 Lahat et al[13] in a study of 114 children with ADD concluded that they have brainstem dysfunction as measured using BAEP (brainstem auditory evoked potentials) and that BAEP, may contribute to the diagnosis of ADD. Wehrenberg and Mulhall-Wehrenberg[14]in their SIDS book discuss how an upper cervical (atlas) subluxation can affect the brainstem area in SIDS kids.

Hospers[15] presents case studies of 5 children, two with petit mal (absent seizures), two with hyperactivity and attention deficit disorder and one rendered hemiplegic (one-sided paralysis) following a car accident. Following upper cervical  adjustment in the seizure cases a reduction in the frequency of seizures resulted, for the ADHD cases, increased attention span and improvement of social behaviour were reported and in the hemiplegia case the child was able to utilize his arm and leg without assistance.

McPhillips et al as discussed in Kirk Eriksen’s book[16] studied 60 children with “persistent primary reflexes (relating to the balance system) and reading difficulties”. In a number of studies there has seen to be a correlation between movement disorders or problems and reading difficulties. This study also found such a link and the authors suggest a “new approach to the treatment of reading difficulties involving assessment and remediation of the underlying neurological functioning.”

Robert Goodman presents a case history of a 9 y.o. female diagnosed with ADD “with signs of hyperactivity, short attention span and poor impulse control”. Examination revealed postural distortions consistent with upper cervical insult and X-rays revealed atlas subluxation complex and hypolordotic cervical curve. A NUCCA www.nucca.org upper cervical adjustment was delivered and follow-up results indicated a complete remission of the symptoms associated with ADD.

There are two further references in Kirk Eriksen’s book p404[16] one being a Peet[17] case of a 4 y.o. child whose ADHD and asthmatic symptoms improved following upper cervical adjustment and Hospers et al[18] a case of a 15 y.o. with a history of head injury and concussion. His EEG showed “lack of synchronization of alpha and beta frequencies between left and right hemispheres” and he exhibited restlessness and “compulsively handled objects around him”. Following upper cervical adjustment the restlessness and compulsiveness resolved and his social communication improved. A follow-up EEG revealed synchronisation between alpha and beta frequencies.

Summary

To me it seems quite plausible that sub-occipital strain caused by upper cervical subluxations can cause problems for young children. When your head is not on straight you experience all kinds of symptoms. It also makes complete sense that following a well administered precision upper cervical adjustment that these kids’ symptoms improve or disappear. The explanation can only be that these skull base subluxations do occur and do interfere with the body’s normal control mechanisms and blood flow to and from the brain. Let’s get serious and put at least a fairer portion of available research funds toward ‘disease analysis and correction utilising upper cervical chiropractic methodologies and techniques’. We owe it to our kids to open up every avenue and analyse every possible option for the eradication of the symptoms associated with Attention Deficit Hyperactivity Disorder.

Suggested Further Reading

1. International Chiropractic Pediatric Association (I.C.P.A.); http://www.icpa4kids.org/research/chiropractic/adhd.htm

2. Phillips C: “Case study: the effect of using spinal manipulation and craniosacral therapy as the treatment approach for attention deficit-hyperactivity disorder.” Proceedings of the National Conference on Chiropractic and Pediatrics 1991, P. 57.

3. Anderson C, Partridge J: “Seizures plus attention deficit hyperactivity disorder.” International Review of Chiropractic Jun 1993; P. 35.

4. Barnes T: “A multi-faceted approach to attention deficit hyperactivity disorder: a case report.” International Review of Chiropractic Jan/Feb 1995; P. 41.

5. Barnes T: “Attention deficit hyperactivity disorder and the triad of health.” Journal of Clinical Chiropractic Pediatrics 1996;1(2):59.

6. Thomas M, Wood J: “Upper cervical adjustments may improve mental function.” Manual Medicine 1992;6(6):215.

7. Walton EV: “The effects of chiropractic treatment on students with learning and behavioral impairments due to neurological dysfunction.” International Review of Chiropractic 1975;29(4-5):24

8. Jacinda’s Story – Tourette Syndrome and ADHD – http://www.kentuckiana.org/jacinda.html

9. Stephen’s Story – ADHD – http://www.kentuckiana.org/stephen.html

10. Tucker’s Story – ADHD, Autism, Depression – http://www.kentuckiana.org/tucker.html

11. Erin Elster Case Studies – http://www.erinelster.com/Case%20Studies/pediatric_case_studies.html

12. The Chiropractic Resource Organization – http://www.chiro.org/pediatrics/ADD.shtml#Articles

13. Chiropractic First site

References


[1] Mercola, J and Droege R; Adults With ADHD: Don’t Become the Next Drug Target … Here’s How to Treat it Naturally; 2004, June 26th

[2] Clara Pirani, Unhappy Pills; The Weekend Australian, January 29-30, 2005, 19-20

[3] Fernandez Noda EI, Lopez S; Thoracic outlet syndrome: Diagnosis and management with a new surgical technique. Herz 9 (1984), 52-56 (Nr.1)

[4] Fernandez Noda EI, Lugo A, Berrios E, Rodriguez de Valle J, Alvardo F, Buch MS, Perez Fernandez J; A new concept of Parkinson’s disease as a complication of the Cerebellar Thoracic Outlet Syndrome. Japanese Annals of Thoracic Surgery 1987;7(3):271-5

[5] Fernandez Noda EI, Nunez-Arguelles J, Perez Fernandez J, Castillo J, Perez Izquierdo M, Rivera Luna H; Neck and transitory vascular compression causing neurological complications-Results of surgical treatment on 1,300 patients. J cardiovasc surg 1996;37(Suppl. 1 to No. 6):155-66

[6] Fernandez Noda EI, Rivera Luna H, Perez Fernandez J, Castillo J, Perez Izquierdo M, Estrada C; New concept regarding chest pain due to hypoxia of the internal mammary arteries in more than 1,600 operated patients with cerebral thoracic neurovascular syndrome (CTNVS). Panminerva Med 2002;44:47-59

[7] Gottlieb, S New York ; Methylphenidate works by increasing dopamine levels. BMJ 2001;322:259 (3 February) http://bmj.bmjjournals.com/cgi/content/full/322/7281/259/b

[8] Beidermann, H (MD) edited by; Manual Therapy in Children; Elsevier Limited 2004, Churchill Livingston http://www.elsevier.com/wps/find/bookdescription.cws_home/695526/description#description

[9] Elster, E, D.C.; Upper Cervical Chiropractic Care For A Nine-Year-Old Male with Tourette Syndrome, Attention Deficit Hyperactivity Disorder, Depression, Asthma, Insomnia, and Headaches: A Case Report; Journal of Subluxation Research (JVSR); July 12, 2003 www.jvsr.com

[10] Giesen JM, Center DB, Leach RA; An evaluation of chiropractic manipulation as a treatment of hyperactivity in children; Journal of Manipulative and Physiological Therapeutics (JMPT); 12(5):353-63; (Oct 1989)

[11] The Sunday Telegraph, Sydney, Australia ;Head Injury Warning; Sunday Telegraph (July 1st, 2001) pg 27

[12] Bastecki AV, Harrison DE, Haas JW; Cervical kyphosis is a possible link to attention-deficit/hyperactivity disorder; Journal of Manipulative and Physiological Therapeutics (JMPT); 2004 Oct;27(8):e14

[13] R. Frank Gorman, M.B.B.S., D.O. Monocular Scotomata and Spinal Manipulation: the Step Phenomenon; Journal of Manipulative and Physiological Therapeutics (JMPT); Volume 19, No5, 344-49; (June 1996)

[14] Wehrenberg C, Mulhall-Wehrenberg T; The Best-Kept Secret to Raising a Healthy Child .. and the Possible Prevention of Sudden Infant Death Syndrome (SIDS), Publisher: Specific Chiropractic 2000

[15] Hospers LA: EEG and CEEG studies before and after upper cervical or SOT Category II adjustment and children after head trauma, in epilepsy, and in ‘hyperactivity; Proceedings of the National Conference on Chiropractic and Pediatrics 1992:84

[16] Eriksen, Kirk; Upper Cervical Subluxation Complex: A Review of the Chiropractic and Medical Literature. , pp150-55. Publisher: Lippincott Williams & Wilkins 2004; www.lww.com

[17] Peet JB; Hyperactivity and Attention Deficit:A Chirpractic Perspective; AM J Clin Chiopr, 1993: 3(3):5

[18] Hospers LA, Zezula L, Sweat M;Life Upper cervical Adjustment in a Hyperactive Teenager; Today’s Chiropractic, 1987, 15(16):73-75

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Visual Disturbances

A Patient’s Perspective – August 2004 (Visual Disturbances)

For this newsletter I have chosen visual disturbances as the subject. I have found that it is extremely common for people to report improvements in vision immediately following a chiropractic adjustment, and there have also been some remarkable recoveries of loss of vision. I personally had visual disturbances which recovered following chiropractic intervention and even today if I have an upper cervical adjustment I can discern even the smallest improvements in visual acuity.

Some of the research papers I refer to in this newsletter are not specifically related to chiropractic; however what you will see again is the common thread of ‘cervical’ involvement in visual dysfunction.

The theories put forward by the various authors include irritation of the cervical sympathetic chain in the neck, incorrect proprioceptive feedback to the brain, irritation of the nerves affecting the vertebral and carotid arteries resulting in a reduced blood flow to the brain, referred to as hypoperfusion. One thing is certain, when you head is not on straight, interference could result to the various structures neurological and vasculature in the neck which could have the affect of diminishing visual functions.

Researcher Dr. Allan Terrett[1] has observed in reference to chiropractic that “Many of the anecdotal claims that at first appear fanciful are being validated.”[2] The claims are no longer just anecdotal and certainly in my view have never been fanciful. These claims and positive results are appearing in chiropractic offices daily, in well constructed case studies and in scientific studies. The powerful healing powers of a well delivered upper cervical adjustment can no longer be ignored and can no longer remain hidden from us patients.

I hope you enjoy my newsletters and as always feel free to provide me with any feedback and suggestions to info@upcspine.com. Remember I am a patient and not a medical practitioner; however I am entitled to my own opinion. People are free to disagree with me. My newsletters are provided as an informational source only, and are not a medical opinion. Therefore you should do further research for yourself and make your own decisions.

Condition Report

n a hunt for papers which discuss the correlation of changes in vision following chiropractic or spinal manipulative therapy you will find articles written by chiropractors, osteopaths, ophthalmologists and medical specialists. You will find papers in various chiropractic journals, the journal of Manipulative and Physiological Therapeutics, the journal of Chinese Medicine, optometry journals an so on. The point is that there are a diverse range of people who are smart enough to have recognized the obvious link between vision problems and the cervical spine.

Stephens and Gorman[3] discuss the case study of two girls aged 13, one with “headaches, blurred vision, motion sickness and peripheral pains and aches”. She had “concentric narrowing of the visual fields” and her “suboccipital joints were tender to palpation.” The other patient “complained of headaches, dizziness, blurred vision and peripheral pains and aches but no motion sickness”. She also had sub-occipital pain and decreased range of motion of the cervical spine. The authors indicate that treatment was by chiropractic manipulation of the cervical, thoracic and lumbar spines, so it wouldn’t be classed as ‘specific’ chiropractic, however, improvements in vision were immediate after spinal manipulation.

A further case by Gorman et al[4] is a single case of a patient with reduced visual field and retinal damage due to congenital glaucoma. The patient had her left eye removed at age 3 and glaucoma progression resulted in marked loss of vision in her remaining eye such that at age 16 she was “declared legally blind”. The patient apparently sought chiropractic care because of “long-term back pain, neck pain, headache, and frequent classic migraine.” I find in my research that in many cases people seek out chiropractic care for those conditions for which chiropractic treatment is pigeon-holed e.g. back pain. They are amazed to discover that when they are treated other symptoms and deficits seem to improve. This frequently occurs when upper cervical spine dysfunction is addressed. Previous chiropractic intervention to the lumbar and thoracic spine had not resulted in any visual field change. Confirmation of the patient’s visual field deficit was confirmed by ophthalmic examination. “Total area of vision …. was assessed as 2% of a normal field.” She indicated that her perception of vision was “shadows only.” Chiropractic manipulation using diversified technique was applied (low amplitude, high velocity) with “joint cavitation sound.” Immediately after the first chiropractic treatment the patient reported that she “can now see a hand, not just a shadow”. Ophthalmic examination revealed visual field increase from 2% to 11%. Following the 2nd chiropractic session the field increased further. Many months after her treatment he visual field has increased to 20% and been maintained. Her headaches, migraines, neck and back pain responded well with migraines ceasing completely. In the discussion session of the paper there is a familiar theme, that is, “cervical pathology may irritate the sympathetic nerve fibres (vertebral nerve), which accompany the vertebral arteries which may lead to constriction of the vertebral-basilar arterial system.” The paper mentions a study by Bogduk [5] et al stimulating the cervical sympathetics resulting “in pronounced decrease in carotid artery flow (30% of control group)” and further said stimulation has been shown to “reduce blood supply to the retina in human subjects.” The treatment in this case was a good outcome for this patient, but one has to wonder if she could have achieved normal eyesight and not lost her left eye had she had the benefit of chiropractic evaluation and treatment very early on in her life.

Charlotte Leboeuf-Yde at al [6] initiated a study to investigate the frequency of different non-musculoskeletal symptoms reported by patients who had sought chiropractic care for musculoskeletal conditions e.g. back pain, sciatica etc. There have been reports throughout the literature and anecdotally that according to the authors “spectacular ‘cures’ have been reported, based solely on clinical observations.” 462 separate reactions were recorded by about 23% of the patients and these fell into the following categories; respiratory system “easier to breathe”; digestive system “improved function” and eyes/vision “clearer, sharper, better vision”, followed by circulatory system “improved circulation”; Urinary tract “easier to urinate”; hearing “less tinnitus, better hearing”; followed by other improvements. It is not clear from the paper what vertebrae were adjusted/manipulated or how the manipulation was achieved (what technique). In the 8 cases who reported improvements in hearing it is stated that the thoracic spine, in combination with some other spinal region was adjusted. The authors cite the Harvey Lillard experience and indicate that D.D. Palmer had adjusted the 4th thoracic vertebra or Lillard resulting in resumption of hearing. In fact my research shows this, adjustment to T4, to be incorrect, as according to the Chiropractic Green Books, Palmer actually adjusted axis (C2)

In yet another paper involving Gorman [7] a woman reported loss of vision in her left eye following a fracture of the left zygomatic arch. The left eye had reduced light perception and both optic nerves were diminished. Following chiropractic treatment over several sessions a significant improvement occurred in vision immediately following spinal manipulations.

Stephens and Gorman [8] in a paper discuss a patient who presented with neck pain, and a history of incidents of acute spastic torticollis. Examination revealed limited flexion, extension and rotation of the cervical spine and a slight scoliosis. The c-spine was adjusted by hand with a lateral thrust; each thoracic segment was adjusted and some “torsional lumbar manipulations” were performed. The graphs in this case study indicate “immediate improvement in visual field sensitivities and a decrease in defect levels measured after spinal adjustment.” The authors call for more research into how spinal manipulation can improve vision in so called ‘normal’ vision patients presenting with back pain. Bring on the research!

Stephens and Gorman in yet another paper [9] focus on visual deficit concerned with the narrowing of visual fields. They cite numerous studies which suggest a link between recoveries of vision following spinal manipulation. One of the hypotheses as to the cause of the vision loss they suggest is cerebral hypoperfusion (deficient or reduced blood flow) which “has been confirmed to be part of upper spinal derangement”.  In this case the patient presented with ongoing minor headaches which resulted in a more severe headache. The visual field results following the spinal manipulative therapy (SMT) revealed immediate full visual fields. In other words, the patient’s vision improved significantly. According to the authors “the patient was able to read the last line of the visual acuity chart.” A telephone follow up with the patient some 3 months later showed she no longer had headaches and her mother remarked on improvements in learning, sport and attitude. The authors conclude that SMT should be considered in the treatment of symptoms as a result of head trauma and whiplash and suggest that chiropractors utilize the various ophthalmic tests and equipment available to check for visual field loss before and after the application of SMT.

Gorman [10] presents a case of a 62-year-old male with presumptive optic nerve ischemia, who presented with a one week history of monocular visual defect, headaches and neck strain. Vision improved dramatically following spinal manipulation as measured using static perimetry. The author’s conclusion is that cervical spine derangement produces microvascular spasm in the cerebral vasculature, including that of the eye.

Gorman [11] again discusses a case of a 9 year-old with demonstrated spinal injuries which may have caused cortical and ocular vision loss which was ameliorated following spinal a manipulation under anaesthesia. Two separate incidents of head trauma and vision loss are discussed which resolved following spinal manipulation. Gorman refers to studies which discuss ‘cervical syndrome’ and personal experience with 6,000 manipulations under anaesthetic to support his theories that “spinal manipulation, by repositioning vertebrae, defuses the irritative focus, leading to relaxation of the cerebral vasculature.” Because the carotid artery supplies microcirculation to the optic nerve, he believes manipulation can affect this circulation by freeing up irritation to the arteries and restoring ‘normal’ flow.

Two chiropractors Kessinger and Boneva [12] carried out a study involving 67 subjects, which investigated the relationship between upper cervical ‘specific’ chiropractic care and changes in visual acuity. Results indicated statistically significant improvement in visual acuity in both right and left eyes. They noted that “considerable evidence attests an association between visual disorders and head/cervical neck trauma” although the body of study is not great with reported cases being only case reports or small studies. According to the authors it is also “not unreasonable to assume that ischemic changes in vasculature associated with the sympathetic and parasympathetic innervation, or pressure to the eyes per se could elicit changes in vision.” Of the 67 subjects in this case, 59 had a demonstrated C1 listing (subluxation) and the other 8 had a C2 listing.

Gorman [13] published a case of a patient who developed a scotoma in vision in the right eye. The scotoma resolved after spinal manipulation. The author found significant recovery in vision occurring with each spinal manipulation treatment. This case reinforces SMT as the recovery event, as Gorman discusses the reoccurrence of the scotoma on three separate occasions and on each case following SMT, vision returned to normal. According to the author this case suggests “SMT can affect blood supply of localized brain tissue and microvascular abnormality of the brain is caused by spinal derangement.” Interestingly Gorman cites a study by Otte which found that 6 of 7 patients with non-traumatic cervical pain had “parieto-occipital hypoperfusion” and “in 24 patients confirmed by independent observers to be suffering from cognitive disturbances after whiplash ALL had parieto-occipital hypoperfusion compared to control subjects.” Parieto-occipital hypoperfusion basically means reduced flow of blood to the cerebral cortex in the brain. For us laypersons it means the blood flow to part of your brain was not normal.

There are some other interesting studies worth following up as follows. A summary of a few of these can be found in Kirk Eriksen’s book [14] .

Zhang et al [15] in this study provides information regarding improvement of visual disturbance in 83% of 111 cases treated over a period of seven years, including 9 cases out of 12 blind eyes which regained vision. The authors indicate a finding of a correlation between poor posture of the cervical spine and head and visual disturbances.

Briggs and Boone [16] show a relationship between upper cervical chiropractic adjustments and changes in nervous system response, sympathetic and parasympathetic.

Schutte et al [17] a study of 12 children with Esophoria, which is a muscle co-ordination problem in which an eye or eyes have a tendency to turn inward. The findings suggest that esophoria may respond to chiropractic cervical adjustment.

Terrett and Gorman [18] report a news article about a 4 year-old girl, blind since age 9 months who recovers sight after adjustment of the first cervical vertebra (C1-atlas) and discuss research with rabbits in which removal of superior cervical ganglion in the neck resulted in a disappearance of fluorescent fibers of the iris. In other words the sympathetic nerve fibers affecting the iris originate in the nerve ganglion in the neck! Thus visual disturbances may well be caused by irritation of the cervical sympathetic chain in the neck which may be corrected by cervical chiropractic adjustment to restore correct vertebral relationships.

Further information about the role of neck proprioception in visual competence can be gleaned from a study by Dichgans [19] et al in which they find that “compensatory eye movement is critically influenced by vestibular and neck afferents and is not initiated centrally” in the brain. The study discusses removal of labyrinth (labyrinthectomy) and neck input (rhizotomy) or both and finds a replacement compensatory mechanism between the two and not a central compensation. The authors state “these findings extend our previous conclusion that for the range of movements we tested, ocular stabilization is entirely achieved by afferents from the labyrinth and neck proprioceptors.” Following labyrinthectomy a recovery of ocular stabilization returned to 90% post 1-month and this is attributed to “an increase in gain of the neck-to-eye loop” and notably the tests were done in the dark so there was no visual feedback to the monkey during the test. This paper seems to lend weight to the argument that neck dysfunction can affect vision. The plasticity of the central nervous system is demonstrated in this case.

I also came across a study by Brown [20] in which it is suggested that accommodative disturbance has been cited as one of the causes of visual disturbance following whiplash injury. A whiplash group consisted of 19 subjects and the control group consisted of 43 subjects. The amplitude of accommodation of the right and left eyes of the whiplash and control group subjects was measured and the results of the two groups compared. The results indicate that whiplash was associated with defective visual accommodation in the present whiplash subjects.

Murphy [21] indicates that it is reasonable to conclude that the posture control system is affected in whiplash subjects due to misleading information from the cervical (neck) proprioceptors. This causes vertigo, disturbed eye movements and reading problems.

Ernst, Seidl and Todt [22] conclude “manual medicine should be an integrated part of modern clinical otolaryngology” and “joint disorders” in the c-spine are “characterized by a variety of symptoms” (e.g. headache, vertigo, dizziness, blurred vision)”.

Suggested Further Reading

  1. Abraham M, Sakhuja N, Sinha S, Rastogi S.; Unilateral visual loss after cervical spine surgery; J Neurosurg Anesthesiol. 2003 Oct;15(4):319-22
  2. Wong CW, Chen TY, Liao JJ, You DL; Serial regional blood flow and visual evoked responses in transient cortical blindness; Acta Neurochir (Wien). 1993;120(3-4):187-9
  3. Awan KJ; Association of ocular, cervical, and cardiac malformations; Ann Ophthalmol. 1977 Aug;9(8):1001-11
  4. Srinivasan K, Rajan N, Ramamurthi B; Craniovertebral anomaly with visual field defect; J Assoc Physicians India. 1970 Aug;18(8):697-8
  5. Rohmer F, Brini A, Mengus M; Regression of visual disorders after reduction of a cervical spine dislocation; Rev Otoneuroophtalmol. 1954;26(1):31-4

References

[1] Faculty of Biomedical & Health Sciences, Royal Melbourne Institute of Technology, Australia

[2] The eye, the cervical spine, and spinal manipulative therapy: a review of the literature; Allan G.J. Terrett and R. Frank Gorman; Chiropractic Technique, Vol. 7, No. 2, May 1995

[3] Stephens D; Gorman F; Bilton D; The Step Phenomenon in the Recovery of Vision with Spinal Manipulation: A Report on Two 13-Yr-Olds Treated Together. Journal of Manipulative and Physiological Therapeutics; Volume 20, No9, 628-33; (November/December 1997)

[4] Benjamin R. Wingfield, BAppSc(Chiro), R. Frank Gorman, MBBS. DO, FRACO; Treatment of Severe Glaucomatous Visual Field Deficit by Chiropractic Spinal Manipulative Therapy. A Prospective Case Study and Discussion. Journal of Manipulative and Physiological Therapeutics; Volume 23, No6, 428-34; (Jul/Aug 2000)

[5] Bogduk N, Lambert G, Duckworth JW; The Anatomy and Physiology of the Vertebral Nerve in Relation to Cervical Migraine; Cephaalgia 1981; 1:1-14

[6] Charlotte Leboeuf-Yde, DC, PhD,  Iben Axén, DC, Gregers Ahlefeldt, DC,  Per Lidefelt, DC, Annika Rosenbaum, BAppSc (Chiro),  and Thomas Thumherr, DC ; The Types and Frequencies of improved Nonmuskuloskeletal Symptoms Reported After Chiropractic Spinal Manipulative Therapy. Journal of Manipulative and Physiological Therapeutics (JMPT); Volume 22, No9, 559-64; (Nov/Dec 1999)

[7] Danny Stephens, DC, DO, Henry Pollard,  Don Bilton, DC, Peter Thomson, DC, DO and Frank Gorman, DO; Bilateral Simultaneous Optic Nerve Dysfunction After Pariorbital Trauma: Recovery of Vision in Association with Chiropractic Spinal Manipulation Therapy. Journal of Manipulative and Physiological Therapeutics (JMPT); Volume 22, No9, 615-21; (Nov/Dec 1999)

[8] Danny Stephens, D.C., M.Chiro.Sc., R. Frank Gorman, M.B.B.S., D.O. Does ‘Normal’ Vision Improve with Spinal Manipulation? Journal of Manipulative and Physiological Therapeutics (JMPT); Volume 19, No6, 415-18; (Jul/Aug 1996)

[9] Danny Stephens, D.C., R. Frank Gorman, M.B.B.S., D.O. The Association between Visual Incompetence and Spinal derangement: An Instructive Case Study; Journal of Manipulative and Physiological Therapeutics (JMPT); Volume 20, No5, 343-50; (June 1997)

[10] R. Frank Gorman, M.B.B.S., D.O. The Treatment of Presumptive Optic Nerve Ischemia by Spinal Manipulation; Journal of Manipulative and Physiological Therapeutics (JMPT); Volume 18, No3, 172-77; (Mar/Apr 1995)

[11] R. Frank Gorman, M.B.B.S., D.O. Monocular Vision Loss After Closed Head Trauma: Resolution Associated with Spinal Manipulation; Journal of Manipulative and Physiological Therapeutics (JMPT); Volume 18, No5, 308-14; (June 1995)

[12] Robert Kessinger, D.C.; Dessy Boneva, D.C. Changes in visual Acuity in Patients Receiving Upper Cervical Specific Chiropractic Care; Journal of Vertebral Subluxation Research (JVSR); 2(1), Jan 1998

[13] R. Frank Gorman, M.B.B.S., D.O. Monocular Scotomata and Spinal Manipulation: the Step Phenomenon; Journal of Manipulative and Physiological Therapeutics (JMPT); Volume 19, No5, 344-49; (June 1996)

[14] Eriksen, Kirk Upper Cervical Subluxation Complex: A Review of the Chiropractic and Medical Literature. , pp339-344. Publisher: Lippincott Williams & Wilkins 2004 http://www.LWW.com.

[15] Zhang CJ, Wang Y, Lu WQ, Li YM, Shen ZX, Li JX, Liu XC, Zhou SD, Gao JS; Study on Cervical Visual Disturbance and its Manipulative Treatment; Journal of Traditional Chinese Medicine, 1984 Sep; 4(3):205-10

[16] Briggs L, Boone WR; Effects of a chiropractic adjustment on changes in pupillary diameter: a model for evaluating somatovisceral Response; Journal Manipulative Physiol Ther. 1988 Jun;11(3):181-9

[17] Schutte BL, Teese HM, Jamison JR; Chiropractic adjustments and Esophoria: A Retrospective Study and Theoretical Discussion; Journal Australian Chiropractic Association, 1989;19(4):126-128

[18] Terrett AGJ, R. Frank Gorman;The Eye, the Cervical Spine, and Spinal Manipulative Therapy: A Review of the Literature.; Chiropractic Technique, 1995;7(2):43-54

[19] J. Dichgans, E. Bizzi, P. Morasso, V. Tagliasco;The Role of Vestibular and Neck Afferents During Eye-Head Coordination in the Monkey.; Brain Research, 71 (1974) 225-232

[20] Shayne Brown; Effect of whiplash injury on accommodation; Clinical & Experimental Ophthalmology 31(5) 424 – Oct 2003

[21] Murphy DJ; Whiplash and Vision; American Journal Clinical Chiropractic 1999 9(2) 16-17

[22] A. Ernst, R.O. Seidl, I Todt;Mode-of-action of manual medicine in the cervical spine; HNO 2003 51:759-770 July 2003

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Parkinson’s disease

A Patient’s Perspective – March 2004 (Parkinson’s disease)

I continue to be amazed at what I read in the research. The cervical spine, in particular the upper cervical spine is mentioned in most of the research (chiropractic and medical) I have located.  It is such a vital area which is the main communication pathway between your body and brain and yet apart from obvious injuries like fractures or other pathologies it is rarely analyzed in detail. Why do some medical researchers not see the importance of this area in the conditions they are investigating? Why are charitable foundations which are set up to support research into a particular medical condition or disease not interested including upper cervical chiropractic in the investigation and funding process? Why is research into pharmaceutical outcomes favored over alternative and complementary approaches? I would have thought that patients’ interests are what are most important and therefore any and all possible solutions to disease eradication should be researched?   Scientific researchers should be given freedom to investigate any and all options rather than having them focus on pharmaceutical or surgical solutions.

In this issue I have provided some research information on the condition Parkinson’s disease. I chose this one because I have a friend who is struggling with the disease at the moment. There is some interesting research and case studies which would seem to point once again to the cervical spine as being a culprit. I did once convince my friend to visit an upper cervical chiropractor. He had an amazing response to the treatment as you can see by his communication to me soon after his first atlas adjustment.

“DEAR GREG

WE SAW [the chiropractor] TODAY. HE TOOK 3 X RAYS AND ZAPPED US TWICE!.

ALREADY BOTH OF US CAN MOVE OUR HEADS TWICE AS FAR!! MY NECK WAS ABOUT 8 DEGREES OFF CENTRE.

WE ARE THRILLED AND GO BACK TOMORROW FOR MORE X RAYS AND ZAPS.

THANKS FOR YOUR SUGGESTION AND CARE I OWE YOU A FEW BEERS!!! LOOK FORWARD TO SEEING YOU ALL SOON”

To look at my friend you could see his head was very noticeably tilted to one side and his head was quite forward. His trapezius muscles are extremely tight, the sternocleidomastoid is under tension on one side, and the scalenes seem very tight and bulky (scar tissue?). Apart from the Parkinson’s symptoms he also has tinnitus, deafness, tingling & pins and needles and pain in the neck and shoulders. In other words he appears to have a massive atlas subluxation which, as you can see from the above communication was evident on x-rays. He would need ongoing treatment for a lengthy period.

Sadly he did not continue with this treatment (AO upper cervical chiropractic) as he was basically told by his doctors that neck problems could not be a cause of Parkinson’s disease. I could not persuade him or his wife to keep up the treatment and was told in no uncertain terms that Parkinson’s disease was a problem with the brain and there is no way the neck could be involved. I beg to differ and in this edition of my newsletter I will explain my opinions and conclusions. My friend is lost to the medical profession having now graduated firstly to a motorized scooter and more recently to a nursing home periodically! This is a tragedy and I feel for my dear friends; however I am no match for the medical system and the misleading information spread about chiropractors.

I hope you enjoy my newsletters and as always feel free to provide me with any feedback and suggestions to info@upcspine.com. Remember I am a patient and not a medical practitioner; however I am entitled to my own opinion. People are free to disagree with me. My newsletters are provided as an informational source only, and are not a medical opinion. Therefore you should do further research for yourself and make your own decisions.

What is Parkinson’s disease (PD) according to medical science? PD is a progressive neurological condition affecting movements such as walking, talking and writing. PD has three main symptoms which are tremor, muscle and limb rigidity & stiffness and slowness of movement. Other symptoms include loss of balance, constipation, tingling & prickling sensations in the limbs, tiredness and depression. However, the tiredness and depression I contend are as a result of contracting the disease and not a symptom of the disease. According to American Parkinson Disease Association Inc.[1] “Parkinson’s disease is caused by the degeneration of the pigmented neurons in the Substantia Nigra of the brain, resulting in decreased dopamine availability.” It is this decreased dopamine phenomena which is the focus of much of the current research and the target for therapeutic drug intervention. There would, however, appear to be other treatment alternatives which need to be investigated.

One particular doctor Fernandez Noda[2] has done some work which really interests me and I contend his work confirms that injury to the cervical spine as I describe on my website is a major contributor to the development of PD if not the main causal factor in the disease. If this is the conclusion then maybe upper cervical chiropractic can help people with Parkinson’s disease? The first paper I would like to refer to by Fernandez Noda and Lopez[3] in 1984 describes a surgical technique for a condition referred to as thoracic outlet syndrome (TOS) in later papers cerebellar thoracic outlet syndrome (CTOS) and more recently cerebral thoracic neurovascular syndrome (CTNVS). The doctors carried out surgery on 71 patients presenting with TOS which “the signs and symptoms are considered to be caused by neurovascular compression through boney, muscular or ligamental structures in the thoracic outlet.”Reported symptoms include paresthesia (tingling, prickling, burning-abnormal sensations), pain, weakness, dizziness, transient blindness, fainting and coldness in fingers/hands/face. The paper discusses complete (100%) removal of the signs and symptoms following division/section of the anterior scalene muscle compressing neurological and vascular structures in the region (thoracic outlet just above the clavicle), with no recurrence of symptoms.

In another paper Fernandez Noda et al[4] conclude that “Parkinson’s disease is a complication of CTOS, caused by insufficient irrigation of the dopamine producing cells and subsequent reduction of dopamine secretion.” Using a surgical technique to perform a division of the scalene muscles (scalenotomy) in order to remove neurovascular compression the authors achieved excellent results with 5% of patients reported completely cured of Parkinson’s symptoms and a further 80% showing significant improvement and able to reduce their dependence on medication. The authors state “After operation, these patients continue to take anti-Parkinson drugs etc. in progressively decreasing quantities until symptoms abate and further medication is unnecessary.” Further they conclude “compression is produced by the anterior scalene muscles and the cervical ribs at the level of C6-7. The faulty irrigation of the cerebellum and cerebral cells produces CTOS and its complications, notable among which are ipsilateral paralysis and Parkinson’s disease.”

A single case report by Sell et al[5] discusses a “tight anterior scalene muscle”resulting in “entrapment of the left vertebral artery”about 2cm from its origin when the patient turned her head to the left. If the patient turned her head “excessively to the left” she would present with, amongst other brain stem symptoms, “global binocular blindness” and her vision would “quickly return to normal when she turned her head to the right. The surgeons discovered that the scalene muscles (anterior and middle) were also compressing the lower cord of the brachial plexus. These muscular compressions of neurovascular structures are important in forming the conclusion that upper cervical chiropractic can and does assist in relief on CTOS symptoms and more than likely Parkinson’s disease symptoms.

Fernandez Noda et al[6] paper describes “the role of compression of the vertebral, subclavian arteries, internal mammary, internal carotid arteries, brachial plexus and coiling and kinking of the vertebral and basilar arteries, the faulty irrigation of blood supply and oxygen of the cerebellum and basal ganglia of the brain.” Basically their conclusion is that this compression which is caused by the “anterior scalene muscles and the cervical ribs at the level of the C6-7 vertebrae; by the sternocleidomastoid at the level of the cervical atlas; coiling and kinking of the vertebral, basilar and the internal carotid arteries” produces the symptoms of Parkinson’s because the effect of the compression of these vital structures is to “decrease secretion of dopamine at the level of the basial ganglia (putamen, caudate, thalamus)”. The authors discuss PET scanning which reveals that the illnesses “epilepsy, memory deficit, agnosia, dementia, Huntington’s disease, chronic schizophrenia and manic depression … demonstrate intermittent and patchy decreases in blood flow”. They report significant improvements in people with all these diseases and 88% healing results for Alzheimer’s disease. They also report having operated on 17 patients with multiple sclerosis and 12 having “shown great improvement” and their “colleagues in Spain have had excellent results with 40 multiple sclerosis operated patients.” They conclude with a view that the neurovascular compression mentioned earlier which, in their opinion results in reduced oxygenated blood to the dopamine producing cells, can be relieved by their surgical technique (scalenotomy) and the results are positive in “CTOS, symptomatic Parkinson’s disease, Alzheimer’s disease, psychological disturbances by hypoxia, epilepsy, multiple sclerosis, hemodynamic parkinsonism and impending gangrene of the upper extremities.”

Fernandez Noda et al[7] in this 2002 paper have renamed the syndrome to cerebral thoracic neurovascular syndrome (CTNVS) when they discovered that the internal carotid arteries were part of the syndrome (pg. 58) and in their abstract reiterate conclusions from the previous papers, “decreased blood supply to the cerebellum and basal ganglia is the cause of the CTNVS and its neurological complications, among which are ipsilateral paralysis, symptomatic Parkinson’s disease, functional Alzheimer’s disease, multiple sclerosis and others.” They further reinforce that the symptoms associated with these diseases are caused by compression of vital neurological (e.g. nerves and nerve plexuses) and vascular structures (arteries and veins) both at the C6-7 level and at the level of the cervical atlas (C1), by muscles such as the anterior and middle scalenes, the sternocleidomastoid and other neck muscles. The compression causes “sporadical insufficient blood supply and oxygen to the cerebellum, brain and the twelve cranial pair nerves”. They list great improvements in many patients with these diseases when they carry out their surgical procedure to remove the compression on the neurovascular structures. As mentioned before this surgery involves removing muscle which causes the compression. They state “all symptoms disappeared after surgery” in many cases involving the different diseases. They list the symptoms of CTNVS on page 56[8] of the paper under the heading “Symptomatology produced by CTNVS. This list includes all of the symptoms which have been demonstrated to be relieved with treatment by upper cervical chiropractors. If you also refer to my symptoms at http://www.upcspine.com/greg4.htm you will note how closely my symptoms at the time correlated with CTNVS. I wonder what Fernandez Noda and his colleagues would say to those doctors who told my friends that Parkinson’s disease was not related to the neck.

On my website you will also find that I frequently refer to compression of vital neurological and vascular structures by the muscles which have the job of holding the head atop the cervical spine. These structures include the jugular vein, vertebral and carotid arteries, phrenic nerve, brachial plexus, and the cranial nerves, vagus, glossopharyngeal, spinal accessory and hypoglossal. It makes complete sense that if one’s head has been shifted on the atlas due to trauma then muscle imbalance, spasm and compression or traction of vital structures will result. You will note I also discuss the need to address the dental mal-occlusion which can be a result of upper cervical subluxation. At this point I refer you to a very interesting paper well worth reading by Dr A.C. Fonder, “The Dental Distress Syndrome Quantified” http://www.icnr.com/DentalDistressSyndrome/DentalDistressSyndrome.htm. Fonder discusses the relationship between dental occlusion and posture and human ailments. Note references to successful treatment of Parkinson’s.

I think that Fernandez Noda et al have done a wonderful job of explaining exactly what the causal mechanisms of human disease are and I continue to wonder why their work is not more widely heralded by medical organizations. If you look closely at people with Parkinson’s or any other disease you will notice the signs of muscle imbalance, poor posture, muscles struggling and fighting to maintain balance.

  1. Could CTNVS be nothing more than a subluxation in the upper cervicals?
    1. My conclusion is most definitely yes!
  2. Can people with CTNVS, Parkinson’s or other disease be helped with upper cervical chiropractic?
    1. In my opinion – Yes!
  3. Should conservative treatment (a.k.a. upper cervical treatment) be tried before invasive procedures?
    1. Of course – Yes!

A video-tape of a dissection of the cervical spine[9] is also interesting because it demonstrates the anatomy of the cervical spine and the scalene muscles very well. About 36.5 minutes into the videotape, thoracic outlet syndrome (TOS) and tests are demonstrated and explained. The authors note the number of people they see in their clinic with forward head posture and suggest compression of the brachial plexus and other neurovascular structures (e.g. carotid sheath which contains the jugular vein, carotid artery and sympathetic chain) in and around the scalenes can occur. According to the authors “the close proximity of soft tissues and bony structures create the potential for compressive and tensile forces on the neurovascular structures in this area.” It is emphasized that proper position of the head and neck a vital to a healthy cervical spine. If you get to watch the tape, think about an off centre head and what might happen to the cervical spine muscles as they try to hold the head erect. In my opinion TOS, CTOS and CTNVS are the result of an upper cervical subluxation and it follows that correction by specific upper cervical chiropractors can relieve myriad symptoms associated with these syndromes without the need for invasive surgery.

A paper by Herrera-Marschitz, Utsumi and Ungerstedt[10] is very interesting and it has nothing to do with humans. Experiments were done on rats which when subjected to decreases in dopamine; scoliosis of the spine was a direct result. In fact, “rats with the strongest dopamine depletion (greater than 95%) and the strongest rotational responses showed the sharpest spinal deviation and skeletal deformity. These findings agree with the clinical observations that scoliosis occurs in patients with Parkinson’s disease and its direction is correlated with the side of the major signs and symptoms of parkinsonism.” This could further reinforce that Parkinson’s and other diseases are a result of an upper cervical subluxation as it is well known and well recorded that upper cervical subluxations result in scoliosis (see my February 2004 newsletter about fibromyalgia).

Chiropractic and Parkinson’s disease

A search for Parkinson’s research and chiropractic does not turn up voluminous studies. I believe this to be a function of research funding which usually is channelled toward pharmaceutical outcomes. It would be a brave doctor who recommended to a research organization or government body that funding is directed towards chiropractic research! There are however a couple of studies worthy of mention. The first is a case report by Elster[11] an upper cervical chiropractor from Colorado, USA. This is the case report of a 60 year old man who was diagnosed with PD at age 53. Elster used “paraspinal digital infrared imaging” and “precision upper cervical radiographic series” of x-rays and cites “6,000 peer-reviewed and indexed articles” as well as “blind studies comparing thermographic results to CT-scan, MRI, EMG, myelography and surgery, thermography was shown to have a high degree of sensitivity (99.2%), specificity (up to 98%), predictive value and reliability”.

The author discovered through her upper cervical methodology that the patient had “right laterality of the atlas.” In other words, the patient had an upper cervical subluxation of atlas. After receiving consent, “treatment began with an adjustment to correct the right laterality of atlas.” The adjustment was performed using the knee-chest adjustment technique which is described on my site at http://www.upcspine.com/tech12.htm and the usual protocols associated with that technique were followed.

Following further treatment by the end of the 2nd week of care the patient “reported greater range of motion in his neck, improved sleep, better energy, and decreased stiffness in his overall body.” Utilizing the United Parkinson’s Disease Rating Scale (UPDRS) a “re-evaluation revealed a reduction in symptoms” accompanied with an overall “43% improvement”. Other improvements not listed in the UPDRS understated the improvement as “it did not take into consideration other associated symptoms, such as spinal pain, insomnia and fatigue”. The patient continues under the care of Elster and maintains the improvement as well as exhibiting no deterioration in condition. He has also started a regular exercise and training program.

The patient reported a history of trauma “6 specific incidents” prior to the onset of symptoms including significant trauma to the head. Elster concludes with some theories as to the connection between the head injuries, the upper cervical subluxation and the onset of PD. One theory suggests that “sympathetic malfunction occurred, possibly causing a decrease in cerebral blood flow compromising a patient’s substantia nigra”. She rightly states that this one case does not confirm a link between an upper cervical subluxation and PD, however combined with the CTNVS studies and other known facts about the consequences of upper cervical subluxations it is not hard to make the connection. It only needs to be researched.

A second article by Elster[12] a copy of which can be found at http://www.erinelster.com/Articles/parkinsons_article%20_07_00.html discusses 10 cases of PD and the “results revealed a substantial improvement in subjective and objective findings in 6 out of 10 patients and mild improvement in 2 patients. The final 2 patients remain unchanged.” All patients had atlas subluxations which were visible on precision upper cervical x-rays.

In another paper by Burcon[13] finds remarkably consistent findings in a number of patient’s with a variety of conditions. All exhibit upper cervical subluxations and all improved following upper cervical chiropractic intervention. Burcon concludes with the theory amongst others “ pressure exerted by the subluxated atlas causes a combination of problems including, decreased blood supply to the occipital portion of the brain; pressure on the nuclei of cranial nerves V (trigeminal) and VIII (vestibulocochlear); nerve-root irritation of cranial nerve VIII.” These would seem to be in agreement with Fernandez Noda with respect to decreased blood flow and cranial nerve impairment. Reduced blood flow to cranial nerve VIII for example most likely would result in hearing disorders like tinnitus and deafness. Interestingly in some Doppler sonography studies[14],[15] of people with tinnitus, blood flow is significantly reduced in the vertebral artery on the side of the tinnitus.

Someone Please Save the Pope!

There are a number of celebrities who have been diagnosed with PD most notably Mohammed Ali, Michael J. Fox and of course the Pope. In just about every photo that I have seen of Michael J Fox he favors having his head forward and to the right and side-on photos would “seem” to indicate loss of cervical curve. The photo on this page is an example http://mjftribute.tripod.com/mikephoto3.htm. Now I’m not saying that this is definitive, however a quick check by Michael himself may reveal that he does have right head tilt and has had it for some length of time. A tilted head is often a result of atlas subluxation. Has he had a head injury? Probably. Has Mohammed Ali had a head injury? Yes!

Upon observing the posture of Pope John Paul II on many occasions and looking at some photos at http://przewodnik.iq.pl/fatima/page_02.htm, I have to conclude that he exhibits the ‘classic’ upper cervical (atlas) subluxation, exaggerated thoracic kyphosis and lower spine compensatory subluxation. His head is so far forward that compression of neurovascular structures in his neck and of the brachial plexuses as suggested by Fernandez Noda et al is highly likely. The forward head carriage of the Pope is NOT a normal part of the aging process which some people would have us believe. It is due to cumulative trauma throughout one’s life, subluxating atlas, which never gets corrected. I would further suggest that because of the ‘link’ between upper cervical subluxations and hearing disorders, the Pope is more than likely exhibiting both tinnitus and deafness. Why don’t his doctors address the Pope’s obvious postural anomalies?

Parkinson’s Danger

People who suffer head injury are four times more likely to develop Parkinson’s disease.  The study also found that this risk increases eightfold for people with a head trauma requiring hospitalization and 11-fold for those with a severe head injury, characterized by long loss of consciousness and brain bruising.  Lead author Dr James Bower, a Mayo Clinic neurologist, says:  “I was surprised by the strength of the association and was also surprised that the average head trauma was about 20 years before the start of the disease.” Details of the study are published in Neurology.

Compiled by Kym Nicoll – Sydney Morning Herald (Sydney, Australia) Thursday 22 May 2003 Health & Science section P.1

Chiropractic Testimonials

As mentioned earlier Erin Elster www.erinelster.com is achieving wonderful results with a range of conditions. See her testimonial site http://www.erinelster.com/Case%20Studies/parkinsons_case_studies.html for some great Parkinson’s success stories.

Anecdotal Cases

A patient developed Parkinson’s like symptoms such as tremors with facial twitches one hour after taking a prescribed medication. When the patient was told to discontinue the prescription, the symptoms worsened. After being under upper cervical care for one month her symptoms have decreased by 50% and are progressively getting better.

A Parkinson’s patient with pill rolling hand tremors, slurred speech, vacant look, extreme head posture with the head in extreme chin to chest position. Two days after an atlas adjustment the patient waltzes into the office with her head in a normal position speaking normally and without tremors.

A Parkinson’s patient who fell off the rings in gymnastics as a youth and would have similar spasms, arm extension seizures,…Despite a 3 hour round trip needed to get UC care, the man claims to already  be 60% better after only two weeks of care!!!

Parkinson’s case with persistent tremors in both her arms and legs. Within one week, the tremors have dramatically dropped and the strength is coming back into her arms!

I have a Parkinson patient, who has only received one adjustment. She was my first patient adjusted.  Her neurologist is shocked by the changes, and she called and scheduled next week.

Had a fellow in his eighties with severe Parkinson like head tremors who was one of my first people last November.  Adjusted him 11/30 and checked him weekly for 2 months and now monthly.  He held his first correction till April and the tremors where gone by January!

A middle aged woman with Parkinson’s. She was continually rolling and jerking her head every three seconds and the right arm kept contracting towards her chest. After being scanned and precisely adjusted, right on the table the head tremors stopped and as she sat up, the arm contractures reduced by 2/3rds.

I have one lady that had Parkinson’s, daily seizures, and is confined to a wheelchair.  The symptoms started after she received a TB medication for a sore throat.  She hasn’t had a seizure in 3 weeks, her arms are less rigid, and she jumped out of bed one night and tried to make a run for it (falling after a few meters, but she was holding strong when I checked her the day after).  She has started talking more, the first two weeks she said nothing. She has the mask face typical of  some Parkinson’s patients, one day she came in on a cloudy morning and smiled for the first time in a while, and miraculously the sun came out from behind the clouds beaming in on her face.  It was a very emotional moment for me because you realize who is really doing the healing. Her family has also reduced all the meds she was taking, (probably why she is healing so fast)  I have been refining my technique every morning before I start seeing patients.  I just went through the travel cards and I have 9 patients who have only ever had one correction over a period of many months.

A Parkinson’s patient is now able to walk without his walker and his BP is normalized.  (He’s off the meds)  His wife continues to comment that he is more trouble now than before his correction because he’s into everything!  He is driving again, shooting his shotgun at matches and he says, “I feel like me again.

A Parkinson’s patient. The woman had persistent head tremors and left her arm would jerk upward involuntarily. The UC doctor’s assistant had to hold the patient’s arm and head, the husband held her lower torso while the doctor adjusted the atlas. When they sat her up, her rigid arm was relaxed as she was fanning herself due to the warmth she was feeling. (We’ve all had the patient who describes that hot water flowing down the back feeling…and you know you cleared them.) Anyway, the head tremors STOPPED post adjustment.

The two key features of a Parkinson’s Disease (PD) case I am currently looking after for, this particular blog post are:

  1. To differentiate resting tremor (a feature of PD) from essential tremor (not a feature of PD); and
  2. To illustrate an almost complete reversal of micrographia (small handwriting) through upper cervical specific chiropractic care.

http://spinewave.co.nz/parkinsons-disease/

The Chiropractic Green Books[16]

Copyright with permission – Chiropractic Books www.chiropracticbooks.com

There are only a few references to PD by B.J. Palmer who reported the use of upper cervical chiropractic care for PD patients. In the Greenbooks, he referred to patients having “shaking palsy” also referred to by Firth[17] as Paralysis Agitans (see below). Palmer listed improvement or correction of symptoms such as “tremor, shaking, muscle cramps, muscle contracture, joint stiffness, fatigue, incoordination, trouble walking, numbness, pain, inability to walk, and muscle weakness.” His upper cervical chiropractic care included use of the neurocalometer (NCM) thermal scanning device as discussed in last month’s newsletter. Note he recommends adjustment to atlas (C1) or axis (C2).

Paralysis Agitans

Definition.—This is also called Parkinson’s disease or shaking palsy, and is a chronic incoordination of the muscles, characterized by muscular weakness, tremor and flexor rigidity.

Adjustment.—Atlas or axis.

There is no known pathology and no definite nerve-tracing in shaking palsy. Most cases begin after the fortieth year of life.

Symptoms.—This usually begins with slight aching pains in the thumb and first two fingers of one hand, and a slight unsteadiness of the thumb of the affected hand, which soon develops into a tremor. Later the tremor starts in the fingers, and the characteristic “bread crumbling, or pill rolling” movement is noticed. The extent of the tremor increases so that the entire forearm trembles, and the tremor begins to be noticed on the hand of the opposite side. The legs, face, and neck muscles may become affected. There is a marked flexor rigidity affecting all of the muscles of the body so that the patient always assumes a stooped position, the knees are bent, the forearms are flexed upon the arms, and the trunk leans forward.

The festination or propulsive gait is characteristic of this disease; in it the patient leans far forward, and it appears that he is on the point of running or that his gait is increasing in speed and his steps are shuffling. It is difficult for him to stop quickly or to turn a corner, the voice becomes weak and high-pitched, the saliva is secreted in excess, and often dribbles from the mouth, and the patient is usually emotional. The movement temporarily stops upon voluntary movement and during sleep. The patient is usually restless, and sleeps poorly. The general health may be fairly good, and life is not greatly shortened by the paralysis, but the patient may become entirely helpless.”

In the Greenbooks Palmer discusses one PD case[18] as follows:-

“We recall a case of paralysis agitans. We mentioned, one day, that we thot shaking of right hand was less. She denied it. We said nothing more, but watched right leg. Every day that case came, we watched right leg. After two weeks, satisfying ourself that right leg did not shake AT ALL, we asked her how her right leg was, and she affirmed that “it is the same, no better.” We told her. She was surprised and had to remember back that there was a time when it did shake ALL THE TIME and now it did not shake AT ALL. Then she admitted she was better.”

Palmer also provides a table/(list of conditions)[19] in which he lists the number of cases by condition. This list shows “5 Cases of Shaking Palsy” – p869 and “2 cases of paralysis agitans” – p868. Palmer further demonstrates that in the majority of cases it was the upper cervical spine which was adjusted. In 94% of cases the adjustment was either to the atlas or the axis ONLY. Notably 97.4% of patients either got well or improved.

This report shows that out of 5,000 cases, 3,856 got WELL and 1,013 IMPROVED, by adjusting ONE place only in 4,904 cases and TWO or more places in 96 cases, with an average of 8.9 adjustments per case, with an average adjustment given 1 in 6.9 days; where ATLAS ONLY was adjusted in 1,829 cases; AXIS ONLY in 2,872 cases; 3rd CERVICAL ONLY in 157 cases; 96 other places in other cases; Spinograph being used in 2,564 cases and palpation in 1,912 cases. The report further proves that the NCM was 100% exclusively used, as the efficient, competent, accurate, and honest means used on 5,000 cases to locate the interference and determine the mace of and for adjustment.

Summary

The phenomena of atlas subluxations which manifest as poor posture would seem to be evident in PD as well as many other serious human diseases. I think these postural anomalies most definitely caused by upper cervical subluxations should be addressed before any other medical intervention. Let’s see what happens when these postural distortions are corrected. Research organizations serious about finding cures for a range of human diseases should work with the best minds in upper cervical chiropractic. The day that happens will truly be a wonderful day for us patients.

References

[1]http://www.apdaparkinson.org/publications-information/basic-info-about-pd/

[2] Esteban I. Fernandez Noda, M.D. – Mimiya and Auxilio Mutuo Hospitals-San Juan, Puerto Rico.

[3] Fernandez Noda EI, Lopez S; Thoracic outlet syndrome: Diagnosis and management with a new surgical technique. Herz 9 (1984), 52-56 (Nr.1)

[4] Fernandez Noda EI, Lugo A, Berrios E, Rodriguez de Valle J, Alvardo F, Buch MS, Perez Fernandez J; A new concept of Parkinson’s disease as a complication of the Cerebellar Thoracic Outlet Syndrome. Japanese Annals of Thoracic Surgery 1987;7(3):271-5

[5] Sell JJ, Rael Jr, Orrison WW; Rotational vertebrobasilar insufficiency as a component of thoracic outlet syndrome resulting in transient blindness. J Neurosurg 81:617-619, 1994

[6] Fernandez Noda EI, Nuňez-Arguelles J, Perez Fernandez J, Castillo J, Perez Izquierdo M, Rivera Luna H; Neck and transitory vascular compression causing neurological complications-Results of surgical treatment on 1,300 patients. J cardiovasc surg 1996;37(Suppl. 1 to No. 6):155-66

[7] Fernandez Noda EI, Rivera Luna H, Perez Fernandez J, Castillo J, Perez Izquierdo M, Estrada C; New concept regarding chest pain due to hypoxia of the internal mammary arteries in more than 1,600 operated patients with cerebral thoracic neurovascular syndrome (CTNVS). Panminerva Med 2002;44:47-59

[8] Symptoms of CTNVS (pg 56)-headaches (migraine), neck and thorax pain, chest pain and arm numbness, shortness of breath, sleep apnea, diurnal apnea, memory deficit, absences, disorientation, dysphagia, dizziness, tinnitus, urinary incontinence, speech difficulty, loss of consciousness, ipsilateral palsy, severe stress, temporomaxillar joint pain, amaurosis fugax, tachycardia, dysmenorrhea, profuse menstrual bleeding, severe constipation, paresia, snoring, facial paralysis, pseudocarpal tunnel syndrome, coldness of the hands and feet, profuse perspiration, thenar, hypothenar atrophy, Raynaud disease and others.

[9] Porterfield JA, DeRosa C; Cadaver Dissection Videotapes-Cervical Spine”: Educational Videotapes ©1996 Rehabilitation & Health center, Inc., 3975 Embassy Parkway, #103, Akron, OH Ph:1-800-662-4043

[10] Herrera-Marschitz M, Utsumi H, Ungerstedt U. Scoliosis in rats with experimentally-induced hemiparkinsonism: dependence upon striatal dopamine denervation. J Neurol Neurosurg Psychiatry. 1990 Jan;53(1):39-43.

[11] Elster, Erin D.C.; “Upper cervical chiropractic management of a patient with Parkinson’s disease; A Case report” J Manip Physio Therap 2000 Oct;23(8):573-7

[12] Elster, Erin D.C.; “Parkinson’s disease:IUCCA Upper cervical Chiropractic Management of 10 Parkinson’s disease patienst ” Today’s Chiropractic, July-August 2000

[13] Burcon, Michael T. D.C., “Parkinson’s Disease, Meniere’s Syndrome, Trigeminal Neuralgia and Bell’s Palsy: One Cause, One Correction”; Source: http://www.chiroweb.com/archives/21/11/05.html

[14] Damir Gortan MD, PhD; Division of Audiology; Dept. ENT, Zagreb University, Croatia: Transcranial Doppler sonography in patients with Meniere’s disease; Acta Media Croatia, 53 (1999) 11-14

[15] Mehmet Koyuncu, MD; Onur Çelik, MD; Cemal Lűceli, MD; Erol İnan, MD and Ahmet Öztürk: Doppler Sonography of Vertebral Arteries in Patients with Tinnitus ; Auris . Nasus . Larynx (Tokyo) 22, 24-28 (1995)

[16] Sinnott, R; The Green Books-A collection of timeless Chiropractic works-by those who lived it! www.chiropracticbooks.com

[17] Firth, James H. Professor of Symptomatology in the Palmer School of Chiropractic; Chiropractic Symptomatology – or the Manifestations of Incoordination Considered from a Chiropractic Standpoint; Chiropractic Greenbooks; Volume 7;1925:p301

[18] Palmer B.J.; “Fight to Climb” : Chiropractic Greenbooks; Volume 24;1950:p654

[19] Palmer B.J.; “The Subluxation Specific The Adjustment Specific” Chiropractic Greenbooks; Volume 18;1934:862-70

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FMS

A Patient’s Perspective – February 2004 (FMS)

I have had some great feedback regarding my website and newsletters and continue to get emails from people all over the world. It seems there are a lot of sufferers out there who have tried everything but haven’t yet experienced upper cervical chiropractic.

Many patients have had great responses from their first experience with upper cervical chiropractic; therefore I would encourage them and their chiropractors to consider placing their testimonials on my site via this link http://www.upcspine.com/subtest1.asp, via the link on my home page or under the menu listing ‘contact us’.  The more people who have benefited from upper cervical chiropractic who provide their stories the sooner it will be realized just how powerful this approach is. Other people around the world must be told about this now!

The biggest issue for patients appears to be finding an upper cervical practitioner within a close proximity. I know that in Australia, we have only a handful of practising specialist upper cervical chiropractors. It would be nice some day to have all chiropractors trained in precision upper cervical. Patients will be the beneficiaries.

In this issue I have provided some research information on the condition known as fibromyalgia. It would seem that it is becoming quite common for people, especially women to be diagnosed with this condition.

I hope you enjoy my newsletters and as always feel free to provide me with any feedback and suggestions to info@upcspine.com. They will evolve with time and with your input. I did get some feedback on my last newsletter that some of it was quite technical. Sorry, I’ve been researching this for so long that I have tended to use medical terminology, because when searching the internet and other resources it is necessary to be familiar with such terminology. I will try to and tone it down a little for the patients reading my newsletters whilst still keeping it at a level practitioners would be comfortable with.

Remember I am a patient and not a medical practitioner. My newsletters are provided as an informational source only, and are not a medical opinion. Therefore you should do further research for yourself.

Condition Report

Fibromyalgia Syndrome (FMS)

What is FMS according to medical science? FMS is a chronic (i.e. long standing) condition. The patient has muscular pain and tenderness throughout the body and frequently other symptoms like sleep disturbances, fatigue, hearing disturbances, muscle twitches, cold extremities, headaches & migraines, TMJ syndrome and blurred vision. For a diagnosis of fibromyalgia to be concluded, although fibromyalgia can be over diagnosed[1], the patient must exhibit tenderness in a minimum of 11 of 18 pre-defined points on the body (see figures). Have a good look at the location of these points, as I think that along with other evidence they provide a pointer to a possible cause of FMS.

Although the exact cause of FMS has apparently not been discovered and there are various research theories including poor nutrition, stress factors, alterations in the pattern of sleep and changes in neuroendocrine transmitters (serotonin, substance P, growth hormone and cortisol) a common theme which appears to emerge throughout the research is that of poor posture, cervical spine dysfunction and degeneration in the spinal joints.

Hiemeyer et al[2] for example, examined 40 patients with FMS and noted the relationship between posture and tender points. They discuss disappearance of tenderness at a number of the tender point sites following correction of posture and conclude; “flexed posture could be an important factor in generalized muscular pain, and posture therefore should be an essential part of the clinical examination of patients with FMS.”

Muller et al[3] state “In fibromyalgia as well as in low back pain we frequently find disturbances of the posture of vertebral column clinically and radiologically.” Further Buskila et al[4] examined two groups of patients, a control group (59) consisting of patients with leg fractures and a study group (102) with a neck injuries. “FMS was diagnosed in 21.6% of people with neck injuries versus 1.7% of those in the control group” and further “FMS was 13 times more frequent following a neck injury than following a lower extremity injury” and “almost all symptoms were more common and severe in the group with the neck injury”.

Schnur[5] conducted a review of the record of 61 patients with primary fibromaylgia syndrome (PFS) and found “in over 50% of examined patients diagnostic details referred to chronic lumbar and cervical spine syndromes” and chronic lumbar and cervical spine syndromes pre-dispose the person to development of PFS.

A study by Ambrogio et al[6] is interesting if only for the finding that “from a patient’s perspective, neck support is an important part of a comprehensive physiotherapy program.” Thus FMS patients, in a small study, indicate that to have some support for their necks was important to them. This is another pointer, I assert, to the cervical spine being heavily involved in the origin of FMS. In fact, I believe, like others before me, that it is highly likely that a subluxation at the level of the atlas is the causal factor in the generation of FMS, and patients should be checked by professional precision upper cervical chiropractors. Such subluxations not only initiate pain in the neck, head, and shoulders, but also have been shown to directly cause postural distortions[7].

A study by Larsson R, Oberg PA, Larsson SE[8] is interesting because the authors propose “chronic neck pain may increase the transmitter activity of neuropeptides in the upper cervical medulla causing impairment of blood flow in the local muscle” and conclude “an impaired regulation of the microcirculation in the local muscle is of central importance in chronic trapezius myalgia, causing nioceptive pain.” This study, these two studies[9],[10] and many other studies by Larsson et al, show patients with neck and shoulder pain as having reduced blood flow through these painful muscles, further exacerbating the pain. I assert that if your “head is not on straight”, your cervical and shoulder muscles fight to maintain your head erect. These spasms I believe cause the neck, back and shoulder pain associated with FMS. Further atrophy (wasting) of these muscles due most probably to reduced blood flow just compounds the painful problem.

Could it be that an upper cervical subluxation uncorrected over a long period directly causes FMS? Let’s look at Dr Daniel Clark’s (www.uppercervicalillustrations.com) graphic opposite. (Reprinted with permission from Daniel O. Clark, D.C.)

This is what is known in upper cervical chiropractic circles to occur to the body/skeleton when one sustains an atlas subluxation. Now look at the location of the tender points in the previous diagrams. I contend that if you overlay those tender points over this diagram, the tender points will correlate highly to muscle tension caused by the misaligned skeleton. The neck, shoulder, pelvis and knees are all affected by the upper cervical subluxation. The 10 tender points to the top of the body (front and rear) could be caused by the muscles straining to hold the head perpendicular. The others may be due to the unlevel pelvis and corresponding functional short leg. Now think about the earlier references to poor posture and cervical spine disorders in those people with FMS. Is there a connection? I think so.

Not many therapies appear to be successful at alleviating FMS symptoms. One study by Freidman and Nelson[11] does discuss some success with some individuals using “ice water circulating through hollow metal tubes” which was delivered “intraorally for 15 minutes in the posterior maxillary area”. According to the authors, 9 out of 12 patients had “reduced cervical pain perception” and electromyography revealed less upper trapezius signal, or lessening of pain in the trapezius muscles. The authors suggest a “strong trigemino-cervical relationship to neck pain and headache.” There’s that reference to neck (cervical) pain again!

If an upper cervical subluxation is responsible for postural changes, neck pain and the development of FMS as I suggest then upper cervical chiropractic may have a role to play in the treatment of FMS patients.

Like conventional treatment studies however, there haven’t been a lot of studies which demonstrate the efficacy of a chiropractic treatment for FMS, but if you read the chiropractic studies the results appear to be quite favourable.

A study by Blunt, Rajwani and Guerriero[12] of 21 patients consisted of a utilizing “chiropractic spinal manipulation, soft tissue therapy and passive stretching” and the results indicated that “chiropractic management improved patients’ cervical and lumbar ranges of motion .. and reported pain levels” and a study by Hains[13] combining spinal manipulation and ischemic compression resulted in a “statistically significant lessening of pain intensity and corresponding improvement in quality of sleep and fatigue level.” Hains and Hains conclude that the “study suggests a potential role for chiropractic care in the management of fibromyalgia”.

In a study of 23 patients with fibromyalgia by Amalu[14] he states “The most common medical treatments for FMS and CFS can include one or more of the following: tricyclic antidepressants, nonsteroidal anti-inflammatories, physical therapy, gentle stretching, low impact exercises, stress reduction, counseling, and lidocaine injections with or without hydrocortisone”. It is not uncommon for FMS or CFS patients themselves to try many treatments including but not limited to physical therapy, massage, acupuncture, mainstream chiropractic, osteopathy, medications and exercise with little to no improvement. As a result of pursuit of these multiple therapies it is also a common for patients to doubt the efficacy of yet another treatment like upper cervical chiropractic.

However, you will note that Amalu’s “treatment consisted solely of corrections to aberrant arthrokinematic function of the occipito-atlanto-axial complex.” In other words treatment to correct dysfunction of the upper cervical spine [C0(skull)-C1(atlas)-C2(axis)]. He uses an upper cervical chiropractic method of adjusting known as Applied Upper Cervical Biomechanics (International Upper Cervical Chiropractic Association-IUCCA) in combination with paraspinal infrared scans to measure the stabilization of the upper cervical joint complex and hence effectiveness of the adjustment.

See my site http://www.upcspine.com/tech12.htm for a description of this upper cervical approach and for Dr Amalu’s paper see my research section.

Amalu found “Upon stabilizing the upper cervical spine ..  improvement in the symptomatic profile of both FMS and CFS was 92-100% (VAS[15]) for all 23 patients. Chronic fatigue syndrome (CFS) is mentioned because invariably FMS patients are also diagnosed with CFS. Read the entire case for the patient outcomes.

In conclusion Amalu states “The body of literature detailing the upper cervical spine’s role in affecting global physiology is substantial. Further research into this area of the spine, combined with objective monitoring of neurophysiology, may reveal that chiropractic does indeed offer a consistent conservative solution for patients with fibromyalgia and chronic fatigue syndrome.”

Chiropractic Testimonials

Some further reading in the form of testimonials can be found at the following sites. In my testimonial section are some fibromyalgia testimonials from patients of the Brooks Spinal Care clinic http://www.brooksspinalcare.com/. Dr Brooks is the current President of the National Upper Cervical Chiropractic Association (NUCCA), www.nucca.org. Dr Brooks and his staff are achieving amazing results with the treatment of FMS and CFS patients.

Dr Erin Elster www.erinelster.com is also achieving wonderful results with a range of conditions. See her fibromyalgia and chronic fatigue testimonial section

http://www.erinelster.com/Case%20Studies/fibromyalgia_case_studies.html for some great success stories.

Read also this testimonial from Sonya Porter of the Fibromaylgia Support Group after following upper cervical chiropractic treatment. “Upper cervical chiropractic care should be considered one of the possible treatment paths available for the improvement of fibromyalgia symptoms as well as improved general health.”

Isn’t it time to allocate research funds towards researching upper cervical chiropractic treatment for FMS and a range of other conditions?

The Chiropractic Green Books

Picture and copyright with permission – Chiropractic Books www.chiropracticbooks.com

For this month I have selected an interesting case from the Green Books which demonstrates correction of a scoliotic curve by manipulation of the upper cervical spine in a patient suffering from low back pain and sciactic trouble. In this Case #1131[16] B.J. Palmer uses spinographs (X-rays) and the neurocalograph (NC), an instrument for the measure of nerve interference, to manage the patient.

The re-drawing of the X-ray and NC output are shown in this diagram opposite. The NC shows nerve interference to be in the lower back, which corresponds with the patient’s pain. Further the upper cervical NC shows nerve interference in the upper cervical region. Palmer focussed on the upper cervical spine as the area of adjustment. Specific cervical pictures revealed axis (C2) subluxated posterior and right.

“The Neurocalograph reveals the causative factor in this case to be quite remote from the area of pain or from the area of spinal distortion as shown by the spinograph. The average uninformed mind usually thinks in terms of direct manipulation of the affected areas when the spine is concerned, rather than with the correction of the cause which is usually in the atlas axis region of the spine.” B.J. Palmer.

Throughout this case Palmer gathers feedback from the patient and with the spinographs and NC is able to show marked improvement in both scoliotic curve and nerve interference.

“Patient was adjusted Axis PR. (Posterior and right.) Patient allowed to rest for a few minutes and then re-read revealing the break reading gone. Neurocalograph Reading: Next day reveals break reading gone. Pattern changing in middle cervical region. Patient Report: “Head felt clearer as though load had been lifted. Felt glow over body, especially in hands and feet.”

The glow feelings are common amongst patients I have been involved with. Both my wife and I experienced a warm feeling down to our feet immediately following our very first upper cervical adjustment. Following are some of the chronological events described by the patient and Palmer during the treatment process. The point of this is that changes to the body, especially one which has been racked with pain for years takes time. However, the body is a wonderful piece of engineering and if in the right state can keep itself well maintained.

Neurocalograph Reading: Increase in pattern in middle and lower cervicals. Atlas-axis region clear.

Patient Report: “Seem to be much more straight this p. m. Gnawing sensation continued again last night in right leg but managed to sleep about 7 hours in spells. Hip is sore today but ankle a little warmer. Feel definite improvement.”

Neurocalograph Reading: Pattern very rough in middle cervicals. Please note no return of reading at base of skull. Patient Report: “Leg and knee gaining strength; no tendency to cave in on stairs. Itchy sensation in leg deep as though healing was in progress. Resting better all the time. Vitality picking up. Walked too far on crutches last night which gave little stiffness in leg this morning.”

Neurocalograph Reading: Reveals some disturbance in atlas-axis region.

Patient Report: “After a very restless night with drawing pains in legs, hips, and thighs woke with feeling of stiffness in both hips. Feels like a large wound just healing over. Soreness seems to be working back up into lumbars. Feel straighter. Think it is all progress. Feet seem to be getting more life.”

Neurocalograph Reading: Good.

Patient Report: “Went without crutches all day yesterday. Felt strain on neck and soreness in hip and leg as result of lack of support. It seems to have made an improvement as of today. Pelvis will come more nearly straight. Exercised 1 mile on bike last two days.”

Neurocalograph Reading: Final reading by Neuro-calograph of full spine shows entire spine quite clear of any evidence of nerve pressure. This comparative picture between the full spine Neurocalograph reading when the patient entered the Clinic before being adjusted as compared to the reading of the full spine after approximately one month service is quite typical of other cases when the subluxation has been corrected. The service rendered this case consisted of one adjustment given at axis on 6-2-42. He received no adjustment at any place between these two readings.

The patient continued to improve with Palmer using the NC to monitor changes in both the upper cervical spine and lower spine. The final spinographs (right diagram) reveal improved scoliotic curve and the final NC (above) reveals complete reduction in signal and nerve interference. Remember the only chiropractic adjustment being done by Palmer was the upper cervical adjustment to axis (C2).  Please note that X-rays of FMS patients do usually reveal scoliosis. Upper cervical subluxations can and do cause scoliosis. Toftness has one of the largest collections of pre and post scoliosis correction X-rays available today. I refer you to the book “Chiropractic Spinal Correction”, I.N. Toftness, D.C.. Also I refer you to Appendix D of Kirk Eriksen’s recently published book[17] “Upper Cervical Subluxation Complex: A Review of the Chiropractic and Medical Literature” for some excellent pre and post adjustment X-rays of scoliosis.

Further Reading – related to Newsletter Research Topic

  1. Cimino R, Michelotti A, Stradi R, Farinaro C.: Comparison of clinical and psychologic features of fibromyalgia and masticatory myofascial pain.; J Orofac Pain. 1998 Winter;12(1):35-41.
  2. Wachter KC, Kaeser HE, Guhring H, Ettlin TM, Mennet P, Muller W.: Muscle damping measured with a modified pendulum test in patients with fibromyalgia, lumbago, and cervical syndrome.; Spine. 1996 Sep 15;21(18):2137-42.
  3. Turk DC, Okifuji A, Sinclair JD, Starz TW.; Pain, disability, and physical functioning in subgroups of patients with fibromyalgia.: J Rheumatol. 1996 Jul;23(7):1255-62.
  4. Smythe H.: Referred pain and tender points.; Am J Med. 1986 Sep 29;81(3A):90-2.
  5. Gerow G, Poierier MB, Alt R.: Chronic fatigue syndrome.; J Manipulative Physiol Ther. 1992 Oct;15(8):529-35. “Chiropractic manipulation afforded relief of some symptoms for this patient.”
  6. Woodfield C, Dickholtz M.: The effect of upper cervical chiropractic corrections on patients with chronic fatigue syndrome;15th Annual Upper Cervical Conference, November 21-22, 1998. Abstract and editorial comment on this study can be found in the book by Kirk Eriksen: Upper Cervical Subluxation Complex: A Review of the Chiropractic and Medical Literature. Lippincott Williams & Wilkins 2004 http://www.LWW.com, pp335-37.

Upcspine.com Updates and Additions

I have quite a few website updates coming over the next few months, including a page on the Zimmerman Adjusting Machine, Toftness technique and a page on the CBP technique.

The latest update however, is an additional page at which I hope to provide links to upper cervical chiropractic testimonial pages, see ‘testimonials’ under the ‘evidence’ menu or click here http://www.upcspine.com/tmlinks.asp.  I have also added further papers to my research section. The only thing holding me back here is the time to read and summarize them all before placing them up on my site. I have literally hundreds of references to be added.

If any patients or chiropractors have information in regards to good research references or testimonial websites, please let me know.  Contact me at info@upcspine.com.

References


[1] Fitzcharles MS, Boulos P. Inaccuracy in the diagnosis of fibromyalgia syndrome: Analysis of referrals. J. Rheumatology 2003:42(2), pp. 263-67

[2] Hiemeyer K, Lutz R, Menninger H. Dependence of tender points upon posture – A key to the understanding of Fibromyalgia syndrome. . J Manipulative Medicine, 1990; 5:169-174

[3] Muller W, Keleman J, Stratz T. Spinal factors in the generation of fibromyalgia syndrome. Z Rheumatol. 1998;57 Suppl 2:36-42.

[4] Buskila D, Neumann L, Waisberg G, Alkalay D, Wolfe F. Increased rates of fibromyalgia following cervical spine injury. A controlled study of 161 cases of traumatic injury. Arthritis Rheum. 1997 Mar;40(3):446-52.

[5] Schnur S. Primary fibromyalgia syndrome-diagnostic statistics from primary care. J. Rheumatol. 1992 May-Jun;51(3):115-20.

[6] Ambrogio N, Cuttiford J, Linekar S, Li L. A comparison of three types of neck support in fibromyaglia patients. Arthritis Care Res. 1998 Oct;11(5):405-10.

[7] Eriksen, Kirk Upper Cervical Subluxation Complex: A Review of the Chiropractic and Medical Literature. , pp150-55. Publisher: Lippincott Williams & Wilkins 2004 http://www.LWW.com.

[8] Larsson R, Oberg PA, Larsson SE.: Changes of trapezius muscle blood flow and electromyography in chronic neck pain due to trapezius myalgia.; Pain. 1999 Jan;79(1):45-50.

[9] Larsson R, Cai H, Zhang Q, Oberg PA, Larsson SE.: Visualization of chronic neck-shoulder pain: impaired microcirculation in the upper trapezius muscle in chronic cervico-brachial pain.; Occup Med (Lond). 1998 Apr;48(3):189-94.

[10] Larsson SE, Alund M, Cai H, Oberg PA.: Chronic pain after soft-tissue injury of the cervical spine: trapezius muscle blood flow and electromyography at static loads and fatigue.; Pain. 1994 May;57(2):173-80.

[11] Freidman MH, Nelson AJ Jr.: Head and neck pain review: traditional and new perspectives. J Orthop Sports Phys Ther. 1996 Oct;24(4):268-78

[12] Blunt Kl, Rajwani MH, Guerriero: The effectiveness of chiropractic management of fibromyalgia patients: a pilot study. J Manipulative Physiol Ther. 1997 Jul-Aug;20(6):389-99

[13] Hains G, Hains F: A combined ischemic compression and spinal manipulation in the treatment of fibromyalgia: a preliminary estimate of dose and efficacy. J Manipulative Physiol Ther. 2000 May;23(4):225-30.

[14] Amalu WC: Primary Fibromyalgia and Chronic Fatigue Syndrome: Upper Cervical Management of 23 Successive Cases. Todays Chiropr, 2000;29(3):76-86

[15] VAS= pain visual analog scale

[16] The Green Books; Compiled Rob Sinnott, D.C.; Chiropractic Books 1997. Volume 25, (1951), “Chiropractic Clinical Controlled Research”, Chapter 1: Researching the Unknown Man – Pages 384-402. Copyright permission granted by Chiropractic Books

[17] Eriksen, Kirk Upper Cervical Subluxation Complex: A Review of the Chiropractic and Medical Literature. pp335-37 Publisher: Lippincott Williams & Wilkins 2004 http://www.LWW.com.

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Cervicogenic Hearing Loss

A Patient’s Perspective – April 2004 (Cervicogenic Hearing Loss[1])

“Findings in 62 patients suffering from vertebragenic hearing disorders are reported before and after chiropractic management. Results indicate that hearing disorders are reversible… the therapy of choice is chiropractic manipulation of the upper cervical spine.” M. Hülse, Professor of ENT, Heidelberg University.

This paper by Hülse cannot be underestimated for its importance to chiropractic. Early in my research I came across it but I only had the abstract. I purchased the paper, which was in German. It’s taken me some time to receive the translation into English and following is my summation of the paper. When you put the results of this study and a multitude of others together with the Harvey Lillard adjustment of 1895 (see Green Books this newsletter), you will soon come to appreciate that despite some medical opinions to the contrary, dysfunction of the upper cervical spine may well be one cause of an abundance of hearing disorders like tinnitus, vertigo, otalgia (ear pain), fullness, deafness, otitis media and Meniere’s disease. To dismiss the link just because it is difficult to find an anatomical link is poor investigative research. The evidence is there in one form or another. You just have to open your mind, and investigate it for yourself and you don’t have to be a medical professional to read and understand medical papers. You’ll probably need help with the medical terms used, but over time you can gain that knowledge also.

If upper cervical chiropractic, as mounting evidence would suggest, has a positive impact for people suffering from these conditions, then research funds should be directed towards implementing well constructed studies using upper cervical chiropractic as a treatment.

In his paper, Hülse starts by listing three points of view as to the classification of hearing disorders known as ‘cervical syndrome’. These classifications being a vascular syndrome, resulting from a narrowing of the vertebral artery(s), a neural syndrome with irritation of the sympathetic nervous system, and in the Bartschi-Rochaix syndrome, being a disturbance in the functionality of the arteries and nerves, caused by ‘myogenic or articular dysfunction’.” I think that it is very possible that all three ‘syndromes’ could be as a direct result of a vertebral subluxation C0-C1-C2 including VBI.

According to Hülse, “scientific proof does not exist for ‘neurologic cervical syndrome’”, and thus treatment protocols are non-existent, although there are cases[2] where chiropractic adjustments have improved VBI. Jensen’s article describes two such cases, where the authors examined cerebral artery flow in the two patients, both of whom exhibited signs of vertebrobasilar ischemia prior to chiropractic treatment. The adjustments entailed non-rotary cervical adjustments and a ‘diversified’ adjustment technique to the thoracic spine. The authors postulate the adjustments had the effect of normalizing the sympathetic nervous system, allowing for change in the vasospastic cerebral vascular arteries. Improvements were measured using Doppler sonography some months post adjustments. Improvements included tremor reduction and improved peak systolic flows in common carotid and vertebral arteries.

Hülse lists symptoms as a result of cervical syndrome as being “headaches, dizziness, vision disturbances, hearing disturbances and subjective ear droning.” Anyone who has studied it knows that these symptoms are consistent with people who have suffered whiplash injury. The author goes on to discuss there being quite a deal of research which links ‘vertebrobasilic’ insufficiency (VBI) or reduced blood flow through the vertebral and basilar artery system, to cochlear (inner ear) related symptoms and he goes on to state that “a forced posture with rotated head leads to dramatic decline in hearing ability”. He cites Boenninghaus (1959), Brusis[3] as explaining this hearing decline as a result of “a reduction of blood flow to the inner ear is caused by the awkward/wrong posture of the cervical spine region” and that “complete deafness has also been described.” Very interesting! Awkward or poor posture leads to a reduction in blood flow to the inner ear and as a consequence hearing disorders. (Note: regarding reduced blood flow to the inner ear, see papers[4],[5] in the www.upcspine.com research section).

According to the author “hearing disturbance can reach a mid to high level of severity” and “complete deafness has also been described”. It would seem that success via manual (chiropractic therapy) has been achieved and that “within minutes or hours of manual therapy, a significant improvement of blood flow can be achieved in the vertebral artery. This leads Hülse to postulate that because these conditions appear to reverse after chiropractic intervention, something other than VBI is the cause of the symptoms. I think he concludes this because VBI may cause irreversible cochlear damage.

He suggests a proprioceptive influence through irritation of proprioceptors and nociceptors at the head to neck joint [cranio-cervical junction], and cites the movement segments C0/C1, C1/C2 and C2/C3 as being involved. That is the joint receptors in the upper cervical spine. A functional disturbance in these joints can lead “to a change in sensory and motor nerves and their regulatory capabilities”. He further states there are “proven connections from the neck to the core areas of the trigeminal, vestibular cochlear and vagus nerves”. Thus joint dysfunction can result in disturbance to the signals of these areas. He says that “lasting complaints” can follow “cervical trauma and “can be explained as a functional deficiency in the cervical region. The therapy of choice with this type of neck trouble is chiropractic therapy”.  Further Feldman[6], he notes, writes, “Hearing disturbance is one of more often observed cochlear vestibular damage post whiplash trauma.”

Of the 62 patients Hülse studied 24 had low frequency (up to 1000Hz) deafness, 33 had deafness at 5-10dB, and 5 had feeling of ear pressure, and subjective deafness without verification from audiometry. Audiometric tests indicated that the non-subjective hearing loss was no longer evident following chiropractic therapy.

“Proof that a functional deficit of the upper cervical spine causes the deafness, is because of successful manual therapy/chiropractic management. Not only do the subjective cochlear complaints disappear, but also low frequency deafness is no longer evident.” M. Hülse, Professor of ENT, Heidelberg University.

For example, one 43-year-old patient who was 13 weeks post whiplash from an automobile accident had “distinct proprioceptive cervical nystagmus of the left ear. After successful chiropractic treatment, not only did she not have vestibular symptoms, but her entire cochlear related symptoms had disappeared.”

Hülse also carried out retrospective examinations on 259 patients over a 5-year period. These patients had a functional deficit of the upper cervical spine, but had no primary deafness. With a battery of ENT and neuro-otological tests having been performed, and after ruling out other disturbances like VBI and more central nervous system related conditions, Hülse says, “it can be said that cochlear symptoms are linked to functional deficits in the upper cervical spine region.” Thus symptoms like deafness, tinnitus, a feeling of pressure in the ears, ear droning and otalgia are not unusual symptoms of functional deficits of the upper cervical spine.

In summary, Hülse concludes that deafness at low frequencies can be as a result of functional deficits of the upper cervical spine and …

“Cochlear symptoms are full reversible and curable if the functional deficit of the upper cervical spine is successfully approached with chiropractic treatment.” M. Hülse, Professor of ENT, Heidelberg University.

One thing that these studies do not mention however, is exactly what chiropractic manipulative technique was used. It would seem that it would make sense to mention this and to determine if there are any correlations between a particular technique and more or less successful reversal of the condition.  Either way this is a powerful paper and adds weight to what is already known throughout many chiropractic offices throughout the World, that is, some hearing disorders can be helped with well-delivered and precision upper cervical chiropractic therapy.

The Chiropractic Green Books

www.chiropracticbooks.com

Picture with permission – Chiropractic Books

In my readings about chiropractic I obviously came across references to the Harvey Lillard adjustment by D.D. Palmer. For those people who are not aware of this little piece of history I will summarise briefly that in 1895 D.D. Palmer discovered a bump in the ‘back’ (I’ll get to this shortly) of Harvey Lillard, his janitor who was deaf and had been so for 17 years or more, and proceeded to adjust ‘a displaced 4th dorsal vertebra’ back into position at which point Mr. Lillard’s hearing was reportedly restored. You will come across many references to this adjustment and quite rightly the exact causal mechanisms are being debated, for example, there are suggestions by Marsarsky[7] that a subluxation at T4 could be “responsible for preganglionic outflow to the stellate and superior cervical ganglion… and “our current understanding of the sympathetic innervation of the cochlear vasculature… seems to suggest that a probable explanation exists”. As a past sufferer of tinnitus I can tell you that on occasions when my tinnitus, fullness etc. were at their worst, both my neck and back pain were most noticeable. For me, even a bite splint provided by a dentist halted the tinnitus and ear problems in their tracks. Utilization of the jaw caused problems to start again, including back and neck pain. There are numerous muscular connections between the cervical spine, shoulder and jaw musculature. Thus any usage (eating, talking, yawning) can and does, cause spasms in the cervical and shoulder muscles to occur. Therefore I put to you that there is a connection between back problems and hearing disorders, however I also know that upper cervical adjustments correct scoliosis resulting from atlas subluxations, and therefore it stands to reason that a correction of an upper cervical subluxation can correct ‘misalignments’ below C1 and even at T4. Which vertebra was actually adjusted in Mr. Lillard’s back in 1895? If you read the Chiropractic Green Books you will note the following references to the Harvey Lillard[8] adjustment.

On page 137 of D. D. Palmer’s book, THE SCIENCE, ART, AND PHILOSOPHY OF CHIROPRACTIC (1911), is a picture of Harvey Lillard. Underneath, is this statement: “The above is a likeness of Harvey Lillard, the first person who received a Chiropractic adjustment from the hands of D. D. Palmer.”

“On Sept. 18, 1895, Harvey Lillard called upon me. He was so deaf for seventeen years that he could not hear the noises on the street. Mr. Lillard informed me that he was in a cramped position and felt something give IN HIS BACK. I replaced the displaced 4TH DORSAL VERTEBRA by one move, which restored his hearing.” D.D. Palmer

Comments from B.J. Palmer:

“My father was at all times and in all ways an honest man, not given to misrepresentations, evasions, or deceit in anything he said, wrote, or printed. He was factual in all professional statements but one – which we here now correct.

We consistently and repeatedly have said it was NOT “4th dorsal vertebra” but was AXIS that was adjusted in Harvey Lillard. Why this discrepancy, this disagreement?

In those early days, there was no mention of “vertebral subluxation” in ANY book on anatomy or orthopedic surgery. It was something NEW, even to my father. All medical books WERE FULL OF DISLOCATIONS. All medical books said that if anything happened in the backbone IT WAS A DISLOCATION, and all strenuously warned and advised against any fooling with the bones OF THE NECK particularly, because TO DO SO WOULD PRODUCE A DISLOCATION AND PRODUCE COMPLETE PARALYSIS OF THE BODY BELOW.

What had father done? Had he set a DISLOCATION? If so, it was a dangerous thing to do.

In those early days, father’s idea was in stage of growing pains. He did not want ANYBODY to do ANYTHING to NECKS, for fear of consequences. He taught his earliest students, “Stay away from THE NECK because you MIGHT produce paralysis and thus destroy my new work which is just beginning to take shape. If some of you boys should fool around with necks and paralyze people, you easily could kill my new work before we get it established.”

For this reason only, my father covered up WHAT he did, WHERE he did it, to avoid dangers that COULD occur. For THIS reason ONLY, he said WHAT he did and WHERE he did it was “4th dorsal vertebra.”

Why do I say it was “the axis”? Because I was there and SAW WHAT HE DID, WHERE he did it—and it WAS the axis.

We since have learned much about cervical vertebral subluxations which are common in almost every person, which are NOT dislocations; and ADJUSTING THEM BY HAND ONLY is easy and is NOT fraught with danger when done correctly and efficiently.”

So you see according to B.J. Palmer, the adjustment given that day back in 1895 was to Harvey Lillard’s axis (C2) vertebra and not to T4 (thoracic). But does it mean that a T4 subluxation does not affect hearing? Not sure, however as most upper cervical chiropractors will know subluxations in the upper cervical spine (C1 and C2) do in fact affect the spinal column throughout, causing secondary misalignment as the skeleton realigns underneath the skull. As a result of scoliosis there could be the potential for muscular interference to structures within the vicinity of the T4 vertebra. Whilst I’m certain that the debate will continue, the important thing is to get more studies started which investigate upper cervical chiropractic so that we patients can benefit.

Further Reading – related to Newsletter Research Topic

  1. Bjorne A, Agerberg C: Symptom relief after treatment of temporomandibular and cervical spine disorders in patients with Meniere’s disease: a three year follow-up; Cranio. 2003 Jan;21(1):50-60
  2. Franz B, Atildis P, Atildis B, Collis-Brown G: The cervicogenic otocular syndrome: a suspected forerunner or Meniere’s disease; Int Tinnitus J. 1999;5(2):125-130
  3. Kessinger RC, Boneva DV; Vertigo, tinnitus, and hearing loss in the geriatric patient: J Manipulative Physiol Ther. 2000 Jun;23(5):352-62
  4. Bjorne A, Berven A., Agerberg C:Cervical signs and symptoms in patients with Meniere’s disease: a controlled study; Cranio. 1998Jul;16(3):194-202
  5. Strek P, Peron E, Olszewski E, Maga A, Modrzejewski M, Szybist N:Correlation of Doppler’s blood flow distempers in vertebral arteries with degenerative cervical spine changes of patients undergoing treatment for tinnitus;Otolaryngol Pol. 1998;52(4):425-9
  6. Decher H: Hearing alterations in vertebro-basilar insufficiency:Laryngol Rhinol Otol (Stuggt). 1975 Sep;54(9):728-34
  7. Bonnal J, Legre J:Left mastoid humming caused by probable compression of the vertebral artery at the level of an abnormality of the cervical spine complicated by arthrosis:Rev Otoneuroophtalmol. 1960;32:125
  8. Cowin R,Bryner P;Hearing loss, Otalgia and Neck Pain:A case report on long-term chiropractic Care;J Chiro Research (Australia) Vol.32;No.4;Dec.2002
  9. Galm R; Rittmeister M;Schmitt E:Vertigo in patients with cervical spine dysfunction;Eur Spine J 1998;7(1):55-8
  10. Mahlstedt K, Westhofen J, Konig K:Therapy of functional disorders on the craniovertebral joints in vestibular diseases;Laryn J (Germany):1992 May;71(5):246-50
  11. Weh L, Hormann K, Frohlke O:Sudden deafness and biometric function analysis of the cervical spine:Z. Orthop 1988 Sep-Oct;126(5);539-46. Erratum in Z. Orthop 1989 Mar-Apr;127(2):268
  12. Biesinger E:Diagnosis and therapy of vertebrogenic vertigo:Laryngol Rhinol Otol (Stuttg) 1987 Jan;66(1):32-6
  13. IUCCA Upper Cervical Chiropractor Dr. Erin Elster, D.C. – http://www.erinelster.com/vertigo.html (Dizziness, vertigo Disorders)
  14. Blair chiropractor Dr. Michael T. Burcon, D.C. – http://www.burconchiropractic.com – (Upper Cervical Protocol for Three Meniere’s Syndrome Patients); ‘Parkinson’s disease, Meniere’s Syndrome, Trigeminal Neuralgia and Bell’s Palsy: One cause, one correction’
  15. Update: July 2013 – Michael Burcon, D.C. has submitted for peer review a 300 person case study demonstrating the benefits of Upper Cervical chiropractic care in the treatment of Meniere’s disease.

References


[1] M. Hülse – Professor of ENT, Faculty of Clinical Medicine Mannheim of the University of Heidelberg. HNO (1994) 42:604-613. ‘The Cervical vertebra as a cause of hearing disorders.” Article in German. This paper was presented in part at the German HNO Conference in Muenster 1993.

[2] Jensen TW. Vertebrobasilar ischemia and spinal manipulation. J. Manipulative Physiol Therap 2003;26:443-7.

[3] Brusis T (1978), Sound deafness and its meaning. Demeter, Graefelfing. (see paper for more detail on this reference)

[4] Mehmet Koyuncu, MD; Onur Çelik, MD; Cemal Lűceli, MD; Erol İnan, MD and Ahmet Öztürk: Doppler Sonography of Vertebral Arteries in Patients with Tinnitus ; Auris . Nasus . Larynx (Tokyo) 22, 24-28 (1995)

[5] Damir Gortan MD, PhD; Division of Audiology; Dept. ENT, Zagreb University, Croatia: Transcranial Doppler sonography in patients with Meniere’s disease; Acta Media Croatia, 53 (1999) 11-14

[6] Feldmann H (1984); “The opinion of the ENT specialist”

[7] Masarsky CS, Todres-Masarsky M: Subluxation and the Special Senses, Chap 13, pp184, ‘Somatovisceral Aspects of Chiropractic’-An Evidence Based Approach. Pennsylvania, 2001, Churchill Livingston.

[8] The Green Books; Compiled Rob Sinnott, D.C.; Chiropractic Books 1997. Chapter 7 – Pages 117-118. Copyright permission granted by Chiropractic Books.

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About UpCspine.com

My name is Greg Buchanan. Welcome to my blog. My views expressed at this blog are the culmination of many years (since 1997) of my own personal experiences, researching every day, reading medical papers & books and discussion with hundreds of medical professionals, patients and others. You can read my full story at http://www.upcpsine.com

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