Non-Musculoskeletal Benefits of Chiropractic

Most Patients, over 95% according to recent surveys in North America and Europe, first consult chiropractic physicians for musculoskeletal pain, the majority for back pain or neck pain/headache.

This is the core of chiropractic practice, which is now well-supported by evidence and well-accepted by the medical profession. Articles in journals such as the Journal of Family Practice, and the Annals of Internal Medicine, the official publication of the American College of Physicians, now encourage physicians to refer patients to chiropractors who treat "mainly musculoskeletal disorders with manual manipulative techniques."

However many of these patients experience secondary health benefits in systems apparently remote from the spine and musculoskeletal system, for example, improved breathing and digestion, or resolution of pelvic or visual or circulatory problems. This is not so strange to chiropractors, neurologists, osteopaths and others who understand the intimite relationship between the spine and the central nervous system. However, it seems very strange to the average family physician and member of the public.

A weakness for the chiropractic profession has been little research documenting the nature and frequency of these non-musculoskeletal benefits following chiropractic treatment. Up until this point there have been numerous case studies and much anecdotal evidence. We now offer the following recent research.

The first such study has been published in the Journal of Manipulative and Physiological Therapeutics, with most interesting results. This is a national survey of 1504 patients of 87 members of the Swedish Chiropractors' Association, and it reports the following:

  • About 1 in 4 (23%) of adult patients consulting for neuromusculoskeletal (NMS) conditions experienced positive Non-NMS benefits after chiropractic adjustment/manipulation.
  • Positive reactions were most commonly grouped under the respiratory system (26%), the digestive system (25%), the circulation/heart (14%), and eyes/vision (14%)

 

By itself, this research proves little. And because of medical skepticism and the present lack of a strong body of scientific evidence in this area of the wider potential health benefits for chiropractic care, this important study could prove harmful if used irresponsibly. Recommendations are:

  • This form of research should be repeated in other countries to see if these results are repeatable.
  • The study should be used to generate interdisciplinary clinical research. Medical specialists in those fields should be encouraged to arrange for a series of suitable patients to be provided with a chiropractic spinal evaluation and, where necessary, trials of separate ad concurrent chiropractic management.

This is what happened 20 years ago for back pain. This study, when combined with other published work, now provides a credible basis for medical collaboration in other non-musculoskeletal areas.

Source: The Chiropratic Report, Editor: David Chapman-Smith LL.B. (Hons.), March 2000, Vol. 14, No. 2.


Medline Articles On Non-musculoskeletal Benefits of Chiropractic

·        Atlas vertebra realignment and achievement of arterial pressure goal in hypertensive patients: a pilot study.

Bakris G, Dickholtz M Sr, Meyer PM, Kravitz G, Avery E, Miller M, Brown J, Woodfield C, Bell B. Department of Preventive Medicine, Rush University Hypertension Center, Chicago, IL, USA

            Journal of Human Hypertension 2007 May;21(5):347-52. Epub 2007 Mar 2.

Anatomical abnormalities of the cervical spine at the level of the Atlas vertebra are associated with relative ischaemia of the brainstem circulation and increased blood pressure (BP). Manual correction of this mal-alignment has been associated with reduced arterial pressure. This pilot study tests the hypothesis that correcting mal-alignment of the Atlas vertebra reduces and maintains a lower BP. Using a double blind, placebo-controlled design at a single center, 50 drug naïve (n=26) or washed out (n=24) patients with Stage 1 hypertension were randomized to receive a National Upper Cervical Chiropractic (NUCCA) procedure or a sham procedure. Patients received no antihypertensive meds during the 8-week study duration. The primary end point was changed in systolic and diastolic BP comparing baseline and week 8, with a 90% power to detect an 8/5 mm Hg difference at week 8 over the placebo group. The study cohort had a mean age 52.7+/-9.6 years, consisted of 70% males. At week 8, there were differences in systolic BP (-17+/-9 mm Hg, NUCCA versus -3+/-11 mm Hg, placebo; P<0.0001) and diastolic BP (-10+/-11 mm Hg, NUCCA versus -2+/-7 mm Hg; P=0.002). Lateral displacement of Atlas vertebra (1.0, baseline versus 0.04 degrees week 8, NUCCA versus 0.6, baseline versus 0.5 degrees , placebo; P=0.002). Heart rate was not reduced in the NUCCA group (-0.3 beats per minute, NUCCA, versus 0.5 beats per minute, placebo). No adverse effects were recorded. We conclude that restoration of Atlas alignment is associated with marked and sustained reductions in BP similar to the use of two-drug combination therapy.

  • The types and frequencies of improved nonmusculoskeletal symptoms reported after chiropractic spinal manipulative therapy.
    Leboeuf-Yde C, Axen I, Ahlefeldt G, Lidefelt P, Rosenbaum A, Thurnherr T. Medical Research Unit, Amtsradhuset, Torvet, Denmark.
    J Manipulative Physiol Ther 1999 Nov-Dec;22(9):559-64

    OBJECTIVE: To investigate the frequency and types of improved nonmusculoskeletal symptoms reported after chiropractic spinal manipulative therapy. DESIGN: Retrospective information obtained by chiropractors through standardized interview of patients on return visit within 2 weeks of previous treatment. SETTING: The private practice of 87 Swedish chiropractors (response rate 81%). SUBJECTS: Twenty consecutive (presumably naive) patients per chiropractor (1504 valid questionnaires returned, 86% of optimal number of replies). INTERVENTION: Spinal manipulation with or without additional therapy provided by chiropractors. MAIN OUTCOME MEASURES: Self-reported improved nonmusculoskeletal symptoms (reactions). RESULTS: At least I reaction was reported after the previous treatment in 21% to 25% of cases. Of these responses, 26% were related to the airway passages (usually reported as "easier to breathe"), 25% were related to the digestive system (mostly reported as "improved function"), 14% were classified under eyes/vision (usually reported as "improved vision"), and 14% under heart/ circulation (about half of these reported as "improved circulation"). The number of spinal areas treated was positively associated with the number of reactions. CONCLUSION: A minority of chiropractic patients report having positive nonmusculoskeletal reactions after spinal manipulative therapy but such reports cluster predominantly around specific symptoms. It would be interesting to find out if these can be verified objectively and, if so, to investigate if they are caused by the treatment or if they are signs of natural variations in human physiology.
  • Indigestion and heartburn: a descriptive study of prevalence in persons seeking care from chiropractors.
    Bryner P, Staerker PG
    J Manipulative Physiol Ther 1996 Jun;19(5):317-23

    OBJECTIVE: To determine the prevalence of indigestion and mid-back pain in persons seeking chiropractic care. DESIGN: A cross-sectional survey using a self-report questionnaire. SETTING: Three primary care private chiropractic practices in metropolitan Perth, Australia. SUBJECTS: Persons seeking chiropractic care during a 1-month period. INTERVENTION: None. OUTCOME MEASURES: Six-month prevalence of indigestion and mid-back pain, rate of association between indigestion and mid-back pain, and distribution of thoracic dysfunction and manipulation. Proportion who report relief from manipulation. OBSERVATIONS: Of 1567 persons who consulted 8 chiropractors on 2974 occasions during November 1994, 1494 responses were obtained. There were 119 first-time consultations. The mean age of respondents was 41 yr (range 10-94); 57% were women. Fifty-seven percent reported indigestion infrequently or more and 71% reported mid-back pain during the previous 6 months. Forty-six percent experienced both symptoms during this time. Of these, 36% reported the symptoms together at some time. Twenty-two percent of those with indigestion reported some relief after chiropractic care. Compared with those reporting no relief, mid-back pain was more common among those reporting indigestion. The level at which the manipulation was given was unrelated to relief. No major differences were noted between the three clinics in patient demographics or the main outcome measures.
    CONCLUSIONS: Indigestion and mid-back pain are commonly experienced in this population. A person with indigestion is more likely to report mid-back pain. Relief of indigestion by manipulation is more common among those who report mid-back pain. Further research is needed to understand differences between subgroups and differences compared with other studies.
  • Somatic dysfunction and the phenomenon of visceral disease simulation: a probable explanation for the apparent effectiveness of somatic therapy in patients presumed to be suffering from true visceral disease.
    Nansel D, Szlazak M. Department of Life Sciences and Clinical Diagnosis, Palmer College of Chiropractic-West San Jose, CA 95134, USA.
    J Manipulative Physiol Ther 1995 Jul-Aug;18(6):379-97

    BACKGROUND AND OBJECTIVES: Several theories have been put forth in attempts to explain the possible mechanisms by which patients presumed to be suffering from any of a variety of internal organ diseases are occasionally found to respond quickly and dramatically to therapies delivered to purely somatic structures (e.g., spinal manipulation). The purpose of this review is to examine the scientific bases upon which these sorts of clinical phenomenaight be interpreted. DATA SOURCES: A review was conducted of over 350 articles that have appeared in the scientific literature over the last 75 years. Initially, a MEDLINE search was performed; however, because of the variability of indexing terms employed by investigators within a wide variety of biomedical disciplines, most of this literature had to be located article by article. DATA SYNTHESIS: At present, there have been no appropriately controlled studies that establish that spinal manipulation or any other form of somatic therapy represents a valid curative strategy for the treatment of any internal organ disease. Furthermore, current scientific knowledge also fails to support the existence of a plausible biological mechanism that could account for a causal segmentally or regionally related "somato-visceral disease" relationship. On the other hand, it has now been firmly established that somatic dysfunction is notorious in its ability to create overt signs and symptoms that can mimic, or simulate (rather than cause), internal organ disease. CONCLUSIONS: The proper differential diagnosis of somatic vs. visceral dysfunction represents a challenge for both the medical and chiropractic physician. The afferent convergence mechanisms, which can create signs and symptoms that are virtually indistinguishable with respect to their somatic vs. visceral etiologies, need to be appreciated by all portal-of-entry health care providers, to insure timely referral of patients to the health specialist appropriate to their condition. Furthermore, it is not unreasonable that this somatic visceral-disease mimicry could very well account for the "cures" of presumed organ disease that have been observed over the years in response to various somatic therapies (e.g., spinal manipulation, acupuncture, Rolfing, Qi Gong, etc.) and may represent a common phenomenon that has led to "holistic" health care claims on the part of such clinical disciplines.
  • Bilateral simultaneous optic nerve dysfunction after periorbital trauma: recovery of vision in association with chiropractic spinal manipulation therapy.
    Stephens D, Pollard H, Bilton D, Thomson P, Gorman F. Macquarie University School of Chiropractic, Sydney, Australia.
    J Manipulative Physiol Ther 1999 Nov-Dec;22(9):615-21

    OBJECTIVE: To discuss the recovery of optic nerve function after chiropractic spinal manipulation in a patient with loss of vision as a result of facial fracture from a fall. CLINICAL FEATURES: In a fall down a stairwell, a 53-year-old woman with migraines fractured her right zygomatic arch, which was later treated surgically. Approximately 3 weeks after the accident, vision in her contralateral eye became reduced to light perception. Electrophysiologic studies revealed that the function of both optic nerves was diminished, the right significantly more than the left. Single photon emission tomography showed pancerebral ischemic foci. INTERVENTION AND OUTCOME: Chiropractic spinal manipulation was used to aid recovery of vision to normal over a course of 20 treatment sessions. At times, significant improvement in vision occurred immediately after spinal manipulation. Progressive recovery of vision was monitored by serial visual field tests and by electrophysiologic studies. Unfortunately, the patient refused a further single photon emission tomographic study when visual recovery was complete. CONCLUSION: This case report adds to previous accounts of progressive and expeditious recovery of optic nerve function in association with spinal manipulation therapy.
  • The step phenomenon in the recovery of vision with spinal manipulation: a report on two 13-yr-olds treated together.
    Stephens D, Gorman F, Bilton D
    J Manipulative Physiol Ther 1997 Nov-Dec;20(9):628-33

    OBJECTIVE: To discuss the immediate increment of improvement in vision that occurs when the spine is manipulated. CLINICAL FEATURES: Two juvenile patients (13-yr-old female cousins) were found to have constricted visual fields and diminished visual acuities. INTERVENTION AND OUTCOME: Spinal manipulation was associated with recovery of normal vision over seven treatment sessions. It was noted that significant improvement in vision occurred immediately after the spinal manipulation treatments. Full recovery of vision was attained by series of these steps. In addition, both patients reported significant constitutional benefits after the treatment in addition to the improved vision. CONCLUSION: The change in visual function immediately related to spinal manipulation has been described as the "step phenomenon." The step phenomenon raises questions about the nature of the condition that may be treated by spinal manipulation and the method of action of the treatment. A vascular hypothesis is mentioned that could explain these events. The consistent occurrence of the step phenomenon indicates that spinal manipulation may have an effect on brain function.
  • Monocular visual loss after closed head trauma: immediate resolution associated with spinal manipulation.
    Gorman RF
    J Manipulative Physiol Ther 1995 Jun;18(5):308-14

    OBJECTIVE: To discuss the case of a patient who demonstrated that spinal injuries may cause both cortical and ocular visual loss that was ameliorated by manipulative care. CLINICAL FEATURES: The patient suffered separate incidents of binocular and monocular loss of vision. A female child, aged 9 yr, presented with bilateral concentric narrowing of the visual fields that returned to normal immediately after spinal treatment. Approximately 1 yr later, she returned with monocular loss of vision after she was struck on the head by a ball. INTERVENTION AND OUTCOME: The child was treated by spinal manipulation under anesthesia; the vision was found to be normal on awakening from the anesthesia. Both visual recoveries were authenticated by an independent ophthalmic specialist. CONCLUSIONS: This case history adds to the other recorded occasions in which vision is noted to improve when the spine is manipulated. Discussion is directed to the basic pathogenesis: is her condition a form of psychoneurosis, is it a variant of migraine, or could it be a combination of both conditions?
  • Cervicogenic hearing loss.
    [Article in German] Hulse M. Abteilung fur Phoniatrie, Padaudiologie und Neurootologie, Fakultat fur Klinische Medizin Mannheim, Universitat Heidelberg.
    HNO 1994 Oct;42(10):604-13

    Existing investigations of cervical hearing disorders have been carried out predominantly in patients in whom those with vertebrobasilar insufficiencies (VBI) could not be distinguished from patients suffering from functional deficit of the upper cervical spine. Since two different syndromes exist, no statement can be made about cervical hearing disorders. That deafness can occur in VBI is uncontested. In contrast, there remains a dispute whether a "vertebragenic hearing disorder" exists. This latter disorder is believed accompanied by tinnitus, a feeling of ear pressure, otalgia and deafness as symptoms of a functional deficit of the upper cervical spine. In reviewing the medical findings of 259 patients with well-defined functional deficits of the upper cervical spine and symptoms of cervical vertigo, subjective hearing disorders occurred in 15%. Audiometric threshold shifts of 5-25 dB, most often in lower frequencies, were observed in 40%. Additionally, results of click-evoked otoacoustic emissions (OAE) were negative in spite of approximately normal hearing. Findings in 62 patients suffering from vertebragenic hearing disorders are reported before and after chiropractic management. Results indicate that these hearing disorders are reversible, as demonstrated by audiometry and OAE. The therapy of choice is chiropractic manipulation of the upper cervical spine. The commoness of vertebragenic hearing disorders emphasizes their clinical and forensic importance.
  • Chronic tonsillitis and the upper cervical spine.
    [Article in Czech] Lewit K, Abrahamovic M
    Sb Lek 1975 Jan;77(1):30-2

    The authors investigated 46 patients with chronic tonsillitis. Only in 5 (11% blockage in the craniocervical junction were absent. The most frequently affected segment was between the occipital bone and the atlas (in 36 patients), between the atlas and axis in two and between the axis and C3 in three patients. In 28 treatment was only surgical. There blockage disappeared only in four, in two blockage developed operation. Five patients were treated before operation also by manipulation. There the blockage relapsed only once. In 10 treatment was by manipulation only. During the observation period (from 3-9 months) not a single relapse of blockage or tonsillitis was observed during the winter period.
  • Functional nocturnal enuresis [Bedwetting].
    Blomerth PR
    J Manipulative Physiol Ther 1994 Jun;17(5):335-8

    OBJECTIVE: To discuss a patient with primary nocturnal enuresis whose symptoms resolved following manipulation. CLINICAL FEATURES: An 8-yr-old boy with a history of primary functional nocturnal enuresis was under care at this office. The patient's clinical examination was benign. He had several areas of lumbar segmental dysfunction. The patient's medical history was unremarkable except for childhood asthma. INTERVENTION AND OUTCOME: The patient's lumbar spine was manipulated once, and at a 1 month follow-up there was complete resolution of enuresis. The patient had several recurrences of bed-wetting, all of which were associated with minor injury to the lower back. The patient responded positively to subsequent manipulation. CONCLUSION: This patient's enuresis resolved with the use of manipulation. This happened in a manner that could not be attributed to time or placebo effect.
  • Use of spinal manipulative therapy in the treatment of duodenal ulcer: a pilot study.
    Pikalov AA, Kharin VV. Division of Research,     Cleveland Chiropractic College, Kansas City, MO 64131.
    J Manipulative Physiol Ther 1994 Jun;17(5):310-3

    OBJECTIVE: To evaluate the effectiveness of spinal manipulative therapy (SMT) in the treatment of an internal organ disorder. DESIGN: Clinical trial. SETTING: Medical hospital. PATIENTS: Eleven adult men and women ranging in age from 18-44 yr with endoscopically confirmed diagnosis of ulcer disease took part in the study as an experimental group. The outcome of 24 cases of uncomplicated ulcerous disease treated by usual medical methods was analyzed as a control. INTERVENTIONS: The experimental group received spinal manipulative therapy (SMT) treatment from 5-22 days with a range of 3-14 procedures. The control group received traditional medical treatment (drug therapy and diet). The dietary regimen was standard for both groups. MEASUREMENTS: The effectiveness of the treatment was evaluated using clinical parameters and endoscopic examination performed weekly. MAIN RESULTS: The use of SMT resulted in pain relief after 1-9 (avg. 3.8) days and clinical remission an average of 10 days earlier than traditional care. CONCLUSIONS: Chiropractic practice often includes patients with gastrointestinal problems who report some relief of their symptoms after treatment; however, the physiological basis for these results has yet to be established. The normalization in segmental trophic innervation of the mucosal layer of the intestine, and positive reaction of the whole body, are under discussion as a possible mechanism for the treatment effect.