93% of Whiplash Patients Improve With Chiropractic

This article’s introduction sums up the state of whiplash treatment very well:

“The ‘whiplash’ syndrome is a collection of symptoms produced as a result of soft-tissue injury of the cervical spine. The accumulated literature suggests that 43 percent of patients will suffer long-term symptoms following ‘whiplash’ injury. If patients are still symptomatic after three months then there is almost a 90 per cent chance that they will remain so. No conventional treatment has proven to be effective in these established chronic cases.”

The authors of this study examined the effectiveness of chiropractic in 28 patients with chronic whiplash pain. The patients were referred to the chiropractic physician an average of 15.5 (range, 3-44) months after the accident, and were interviewed before treatment by both an independent chiropractic and orthopedic physician. The patients were assigned to one of four classification groups: A – No symptoms; B – Symptoms are a nuisance; C – Symptoms are intrusive; and, D – Symptoms are disabling. The initial evaluation placed 27 of the 28 patients in groups C or D.

“Following treatment, 26 (93 per cent) of the patients had improved: 16 by one symptom group and 10 by two symptom groups. This improvement was independent of whether it was assessed by an orthopaedic surgeon or a chiropractor. In the group that had improved, 17 had stopped their treatment at the time of assessment; symptoms had recurred to a minor degree in four (24 per cent) of these patients and they were considering further treatment.”

The authors conclude that these are exciting findings, and that they merit further investigations with randomized, controlled studies.

Woodward MN, Cook JCH, Gargan MF, Bannister GC. Chiropractic treatment of chronic ‘whiplash’ injuries. Injury: International Journal of the Care of the Injured 1996;27(9):643-645.

Musculoskeletal Problems and Chiropractic Care

This study evaluated chiropractic treatment and its cost effectiveness in caring for manual labor workers who complained of musculoskeletal problems. Of the 34 patients involved in the study, 13 complained of neck/arm pain and 19 of back/leg pain. 57% of the patients complained of symptoms lasting over 3 months. The subjects averaged 3.23 chiropractic treatments a month if they suffered from neck/arm symptoms, and 5.32 treatments a month if they reported back/leg symptoms. The course of treatment lasted six months. The researchers assessed the patient’s pain, functional outcomes, quality of life, perceived improvement, and employee satisfaction over 6 months. As well, they monitored the cost to the employer prior, during, and after the study period.

Throughout the study and its evaluations, back/leg patients displayed larger treatment benefits.

The Functional Outcome category, which is the patients’ ability to perform normal daily tasks, included the areas of mobility, body care, ambulation, house management, and work. Chiropractic modestly improved the subjects’ lives in body care, house management, and ambulation. The category Quality of Life, on the other hand, included social functioning, emotional disposition, general health, vitality, and body pain. The patient’s level of body pain, vitality, and emotional well being also improved with the treatments.

Patient satisfaction reports were very high. In both groups, those who did not feel “cured” at one month definitely did by six months. 84% of the back/leg patients found the treatment beneficial, and 77% of the neck/arm patients were pleased with their treatment outcomes.

In appraising the overall costs of treatments and sickness, the researchers reported that the employer’s overall costs fell by 30% in the first year of the arrangement and by a further 20% the following year. The extensive treatment costs, however, absorbed 40% and 82% of these savings.

Jay TC, Jones SL, Coe N, Breen AC. A chiropractic service arrangement for musculoskeletal complaints in industry: a pilot study. Occupational Medicine 1998;48:389-395.

Neck Pain, Proprioception and Chiropractic

In the last few months there have been a number of studies examining the relationship between whiplash and proprioceptive dysfunction. A new study adds to our knowledge, by examining the effectiveness of chiropractic in patients with chronic neck pain.

In this study, 20 patients with chronic neck pain were evaluated at the beginning of the study for pain levels and proprioceptive functioning. The patients were then divided into two groups: Group A, who received six sessions of spinal manipulation; Group B, who were instructed to perform stretching exercises twice daily for 3-4 weeks.

After the study period, the spinal manipulation patients showed a 44% improvement in pain symptoms on average, while the stretching patients showed just a 9% improvement. In regard to proprioceptive functioning, similar results were found: a 41% improvement in the manipulation group, but only an 11% improvement in the stretching group.

How spinal manipulation effects proprioception is not yet known, but the authors speculate that chiropractic treatment somehow stimulates the deep articular mechanoreceptors in the spine, in turn leading to improved functioning.

Rogers RG. The effects of spinal manipulation on cervical kinesthesia in patients with chronic neck pain: a pilot study. Journal of Manipulative and Physiological Therapeutics 1997;20(2):80-85.

National Usage of Chiropractic Services

A recent survey conducted by the Robert Wood Johnson Foundation questioned 3,450 U.S. residents about their usage of alternative therapies. These therapies were: chiropractic, therapeutic massage, relaxation techniques, and acupuncture.

The most commonly used treatment was chiropractic; the study estimated that 6.8% of the U.S. population, 17.6 million people, visited a chiropractor in 1994. Eight million people visited a massage professional, and1 million an acupuncturist.

The study also reported that HMO members were less likely to use chiropractic services than members of PPOs or other fee-for-service insurance plans. Of the patients who visited a chiropractor, 76.4% did so for a specific health condition.

Paramore LC. Use of alternative therapies: estimates from The 1994 Robert Wood Johnson Foundation National Access to Care Survey. Journal of Pain and Symptom Management 1997;13(2):83-89.

Chiropractic “Only Proven Effective Treatment” for Chronic Whiplash

A recent survey conducted by the Robert Wood Johnson Foundation questioned 3,450 U.S. residents about their usage of alternative therapies. These therapies were: chiropractic, therapeutic massage, relaxation techniques, and acupuncture.

The most commonly used treatment was chiropractic; the study estimated that 6.8% of the U.S. population, 17.6 million people, visited a chiropractor in 1994. Eight million people visited a massage professional, and1 million an acupuncturist.

The study also reported that HMO members were less likely to use chiropractic services than members of PPOs or other fee-for-service insurance plans. Of the patients who visited a chiropractor, 76.4% did so for a specific health condition.

Paramore LC. Use of alternative therapies: estimates from The 1994 Robert Wood Johnson Foundation National Access to Care Survey. Journal of Pain and Symptom Management 1997;13(2):83-89.

Chiropractic Treatment for Migraine

Migraine headaches are estimated to cost the U.S. over $17 billion each year. While it is clinically recognized that migraines can be related to cervicogenic conditions, the exact nature of this relationship is unknown. This study set out to test the effectiveness of chiropractic treatment for migraines.

123 participants diagnosed with migraines according to the International Headache Society standard completed the study. Each participant experienced a minimum of 1 migraine per month, and had at least 5 of the following indicators: inability to maintain normal activities/need to seek dark and quiet, pain located around the temples, “throbbing” pain, symptoms of nausea, vomiting, aura, photophobia or phonophobia, migraine triggered by weather changes, migraine worsened by head or neck movement, diagnosis of migraine by a specialist, and a family history of migraine.

The study consisted of three stages. In the pretreatment stage, researchers collected data on migraine incidence, intensity, duration, disability and use of medications, this data was used as a baseline to compare with study results and data collection continued throughout the trial. For the second stage of research participants were split into a control group (40) that received a placebo treatment using electrodes and an experimental group (83) that received a maximum of 16 treatments of chiropractic spinal manipulative therapy (CSMT). The last 2 months of the study involved data collection for comparison purposes.

Results showed that those that received chiropractic treatment had significant improvement in migraine frequency, duration, disability and lowered medication use in comparison to the control group. Improvements in migraine frequency and duration for the chiropractic group are illustrated below. The area of greatest improvement was medication use, with a significant number of participants reporting that their medication use was down to zero by the end of the trial. Five participants reported that migraine symptoms were worse after 2 months of CSMT, but they did not report intensified symptoms at the post treatment stage.

The authors report that their study with a 6-month duration is more valid than some previous studies because studies with shorter durations are too short to allow for the cyclical nature of migraines. Limited sample size and lack of consideration for what aspect of CSMT caused the improvements are some limitations of this study. Researchers also suggest that an improved study method might be to treat the control group with a sham form of CSMT rather than a treatment that does not mimic chiropractic. Despite some limitations this research adds to the body of evidence that suggests chiropractic manipulative therapy can be an effective treatment for migraine and headaches. The authors conclude:

“A high percentage (83%) of participants in this study reported stress as a major factor for their migraines. It appears probable that chiropractic care has an effect on the physical conditions related to stress and that in these people the effects of the migraine are reduced. However, further studies are required to assess how chiropractic SMT may have an effect on migraine morbidity.”

Tuchin PJ, Pollard H, Bonello R. A randomized controlled trial of chiropractic spinal manipulative therapy for migraine. Journal of Manipulative and Physiological Therapeutics 2000;23(2):91-95.

Chiropractic Treatment of Disc Herniations

This study examined 27 patients in a private chiropractic practice who presented with neck or back pain and who had MRI-documented cervical or lumbar disc herniations that corresponded with clinical findings.

“Patients were treated with a course of chiropractic care consisting of traction for the cervical spine or flexion distraction in the lumbar spine in the acute phase of care, in addition to interferential/ultrasound combination and cryotherapy. In the subacute phase, rotational manipulation was judiciously added, as were isometric and flexibility exercises. In the chronic stage of care, distraction manipulation and rehabilitative exercises were continually employed. Rehabilitative exercise included extension exercises in addition to pelvic tilts, lifts and knee flexion stretching.”

“Treatment frequency was typically four to five times/wk for weeks 1 and 2, then three times/wk with decreasing frequency as the patient progressed. Duration of active care varied from 6 wk to 6 months.”

“When patients reached the point at which their VAS [visual analog scale] score was [2, their exam findings reversed and their extremity pain resolved, a repeat MRI was obtained. This scenario occurred as early as 6 wk after initiation of care.”

 

If the patients did not reach these milestones, follow-up MRI was performed 1 year after the initiation of care.

The study found that 22 of 27 (80%) had good clinical outcomes; 17 of the 22 (77%) “had not only good clinical outcome but also evidence of reduced or resolved disc herniation upon repeat MRI scanning. ”

Five patients (18.5%) had a marginal or poor outcome, but none had worse clinical signs or pain ratings at the end of the study.

At the beginning of the study, all 27 patients had left work because of the severity of the pain; at follow-up, 21 (78%) were back to work in their former occupations.

VAS scores decreased from an average of 6.9 before treatment to 1.9 following treatment.

One important issue that the author addresses is the controversy of whether manipulation is contraindicated for disc herniation. After reviewing the literature, and from his clinical findings, he concludes that manipulation is indeed safe for disc herniation: “…in the cervical and lumbar spine, rotational manipulation most likely cannot be implicated in disc failure or exacerbation of a disc herniation, and for rotational forces from a manipulation to be involved in disc failure, facet fracture must occur first.” No complications occurred in this study.

BenEliyahu DJ. Magnetic resonance imaging and clinical follow-up: study of 27 patients receiving chiropractic care for cervical and lumbar disc herniations. Journal of Manipulative and Physiological Therapeutics 1996;19(9):597-606.

Chiropractic Can Reduce High Blood Pressure

The US Food and Drug Administration has a standard for determining the efficacy of new hypertension drugs: it requires “a blinded design with a placebo-subtracted reduction in diastolic BP of 5 mm Hg or more and be free of serious side effects to be approvable.”

With that guideline as their standard, a group of researchers from the University of Chicago set out to determine if chiropractic adjustment of the atlas could reduce blood pressure in patients with hypertension. The authors summarize the relationship between the first cervical vertebra (C1) and hypertension:

“Unlike other vertebrae, which interlock one to the next, the Atlas relies solely upon soft-tissue (muscles and ligaments) to maintain alignment; therefore, the placement of C-1 is pain free and thus, remains undiagnosed and untreated, whereas health-related consequences are attributed to other aetiologies.”

The position of the atlas can have an affect on the functioning of the brainstem, and, as shown in this study, can affect blood pressure. Chiropractic manipulation can adjust the position of the spine, relieving the pressure on the spinal cord.

“Minor misalignment of the Atlas vertebra can potentially injure, impair, compress and/or compromise brainstem neural pathways. The relationship between hypertension and presence of circulatory abnormalities in the area around the Atlas vertebra and posterior fossa of the brain has been known for more than 40 years.”

In this study, the researchers took 50 patients with Stage 1 hypertension who had either never been on hypertensive drugs or who had stopped taking hypertensive drugs for at least two weeks.

All of the patients were evaluated by a chiropractor for misalignment of C1 using radiographs and leg-length checks. Half of the patients received spinal manipulation of the C1; the other half received a sham treatment that was indistinguishable from a real treatment by the patient.

The diagnostic procedure was conducted at intake, after the treatment and at eight weeks.

The authors found that the patients who received the chiropractic treatment experienced a dramatic drop in average blood pressure compared to the control subjects:

The drop in blood pressure was so impressive the authors state that it “is similar to that seen by giving two different antihypertensive agents simultaneously.”

Furthermore, 85% of the patients needed only one treatment to realize the improvement in blood pressure.

In addition, the study also documented the degree of pelvic misalignment and the position of the C7 vertebra; these measurements are used with this particular method of chiropractic to diagnose dysfunction of the C1 vertebra. Just as they found with the results for blood pressure, the degree of misalignment was reduced dramatically in the treatment group, but not the control group.

“As discussed in the Methods section of this paper, techniques are now available to screen for atlas misalignment. This type of screening should be the responsibility of the primary care physician and should be performed on patients who have a history of head and neck trauma even if it is deemed insignificant. Those patients who present with pain related to head and neck trauma should not be screened. At a time when the prevalence of hypertension is increasing and its control more difficult due to a variety of factors, linking the correction of C1 misalignment to the subsequent lowering of BP may represent an important advancement in the screening of such patients.”

Bakris G, Dickholtz M, Meyer PM, Kravitz G, et al. Atlas vertebra realignment and achievement of arterial pressure goal in hypertensive patients: a pilot study. Journal of Human Hypertension 2007;21:347-352.