World Federation of Chiropractic’s Biennial Congress Proceeding’s Abstracts

The World Federation of Chiropractic’s (WFC) Biennial Congress

Held every two years, the Congress, comprises an Assembly (business meeting of members) and Conference (educational and scientific meeting). Invited papers and research abstracts for the Conference are available in written proceedings and on CD, and award-winning original research papers are published in the Journal of Manipulative and Physiological Therapeutics (JMPT).

Past Congresses have been in Toronto (1991); London (1993); Washington DC (1995); Tokyo (1997); Auckland (1999); Paris (2001); Orlando, Florida (2003); Sydney, Australia (2005); Vilamoura, Portugal (2007); Montreal, Canada (2009), Rio de Janeiro, Brazil (2011); and Durban, South Africa (2013).

The following are Abstracts from the 2013 Thirteenth WFC Biennial Congress, Durban, South Africa, April 10-13, 2013.
Dell C, Losco B, Losco D. The effects of diversified chiropractic manipulation versus sacro occipital technique (SOT) in chiropractic management of sacroiliac syndrome. World Federation of Chiropractic’s 12th Biennial Congress. Durban, South Africa. April 10-13, 2013.
Introduction/Background : The purpose of this pilot comparative study was to assess the effects of diversified manipulation (DM) versus sacro occipital technique (SOT) in the management and treatment of sacroiliac syndrome (SS). Since there are not many comparative studies in chiropractic regarding its techniques, SOT included [1,2], a randomized non-controlled study was performed with IRB approval granted through the University of Johannesburg.

Methods:: Patients were recruited by means of numerous advertisements in local newspapers and posters placed throughout the University of Johannesburg, Doornfontein Campus. Both male and female patients between 18-55 years of age with mechanical low-back pain or localized pain/tenderness over the PSIS with possible lower extremity referred pain. Orthopedic tests evaluated sacroiliac joint movement restriction, positive Straight-leg raise, Patrick Fabere test, Gaenslen’s test, Ericsen’s tests, and sacral compression test.

Potential candidates were examined and accepted based on the inclusion and exclusion criteria. This study consisted of two groups; a DM group and a SOT group each consisting of 15 subjects (18-55 years) with SS. Each successful candidate was treated six-times over a two-week period.

The objective measurement consisted of inclinometer range of motion readings [3] of the thoraco-lumbar and lumbo-sacral regions of the spine in all directions. DM group received Thigh-Ilio Deltoid manipulation [4) whereas the SOT group received category two blocking (supine pelvic blocking reducing pelvic torsion) [5]. The objective data collected over the six-treatment sessions was statistically analyzed to ascertain any differences in improvement between the two groups. Before the commencement of the treatment one, three and six, the candidate completed the Oswestry Back Pain and Disability Index questionnaire (OBPDIQ) [6] and the Numerical Pain Rating Scale (NPRS) [7].

Results: Digital inclinometer findings noted statistically significant improved lumbosacral ranges of motion in both groups, with particular increases in flexion/lateral-flexion in the SOT group and increases in extension/rotation in the DM group. Subjective outcome assessments showed statistically significant improvements with regards to OBPDIQ and NPRS for both groups.

Discussion:: Of importance is that apparently both the DM and SOT group both showed improved objective and subjective assessment changes following the 6-treatments in the 2-week period of time. In another study [n=5] that assessed lumbar range of motion utilizing SOT category two block placement, they noted increased lumbar ranges of motion but not in extension [8]. This suggests the findings of increased lumbar range of motion may not be isolated to this pilot study alone.

Conclusion: The results of the study indicate that both SOT and DM had a positive effect on patients suffering from SS, with SOT care appearing to have a greater overall benefit. It should be emphasized that the present study was a pilot study to determine the effects of DM versus SOT in the management of SS. Since both techniques appeared to have a positive effect, the SOT care could be appropriate for a patient and/or doctor if a preference is indicated for a low-force intervention. Further research into comparative studies of chiropractic technique is indicated ideally with a larger sample and a control group.



REFERENCES :

1. Maltezopoulos V, Armitage N. A comparison of four chiropractic systems in the diagnosis of sacroiliac malfunction. Europ J Chiropr. 1984;32:4-42.
2. Kinsinger FS. A Comparative Study of Activator Methods and Sacro Occipital Technique in Low Back Pain: Short Term Effects on Biomechanical Measures. Proceedings of the 1991 International Conference of Spinal Manipulation. 1991 Apr: 87-9.
3. States AZ. States manual of spinal, pelvic and extravertebral technic. Second Edition. Kirk C.R, Lawrence D.J, Valvo N. L. Eds: National College of Chiropractic. 1985:119.
4. Monk R. Sacro Occipital Technique Manual. Sacro Occipital Technique Organization – USA: Sparta, NC, USA. 2006: 15-87.
5. Saur PMM, Ensink FBM, Frese K, Seeger D and Hildebrandt J. Lumbar Spine Range of Motion: Reliability and Validity of the Inclinometer Technique in the Clinical Measurements of Trunk Flexibility. Spine. 1996; 21(11): 1332-1338.
6. Fairbank JC, Couper J, Davies JB, O’Brien JP. The Oswestry low back pain disability questionnaire. Physiotherapy. 1980 Aug;66(8):271-3.
7. Farrar JT, Young JP Jr, LaMoreaux L, Werth JL, Poole RM. Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale. Pain. 2001 Nov;94(2):149-58.
8. Hochman JI, The Effect of Sacro Occipital Technique Category II Blocking on Spinal Ranges of Motion: A Case Series Journal of Manipulative and Physiological Therapeutics, Nov 2005;28(9): 719-23.

Evans AC, Yelverton C. The validity and specificity of the arm fossa test. World Federation of Chiropractic’s 12th Biennial Congress. Durban, South Africa. April 10-13, 2013.

Introduction: Sacroiliac joint dysfunction (SJD) is a common problem in the general population and diagnosis is primarily made with the use of manual orthopedic tests [1,2]. Whether clusters of these tests can be used to accurately diagnose SJD is being studied [3]. This study is designed to assess the validity and specificity of the Arm Fossa Test (AFT), which is part of the Sacro Occipital Technique (SOT) evaluation protocols [4]. This may contribute to the research related to diagnostic tests that assess the specific joint dysfunction related to SJD. An ethics committee at Technikon Witwatersrand (TWR) (now Johannesburg University) approved the study in January 2005.

Methods: To perform the AFT, the examiner tests the responsiveness of the latissimus dorsi muscle on the supine patient, as the examiner successively makes light contact with the upper and lower portions of the left and right inguinal ligaments. The finding of a delayed or slow responding latissimus dorsi muscle is thought to be consistent with sacroiliac hypermobility; whereas a strong muscle points toward either a normal sacroiliac joint or one with sacroiliac hypomobility.

Eighty subjects were selected for the study, 35 females and 45 males. They were sourced from the TWR health clinic. Prior to testing subjects a case history was taken, and they underwent a full sacroiliac regional examination using generally accepted diagnostic techniques. The subjects were then taken to a different room where an assessor tested for SJD using the AFT. This was done by two different assessors, each without knowledge of the other’s results and was therefore double blinded.

Results: Of the 160 sacroiliac joints (right and left side for each of the 80 subjects) evaluated, the AFT correctly evaluated 166 (28 true positives and 88 true negatives). This gives a percentage correlation of 72.5%. The AFT incorrectly evaluated 44 (40 false positive and 4 false negatives) as shown by the misclassification rate of 27.5%. The Kappa Coeffiient, indicated as 0.40, is bordering on a moderate strength of agreement.

Discussion: Since the AFT’s main purpose is to assess the presence of a specific type of SJD hypermobility, it is possible that it is not as sensitive for assessing SJD associated with hypomobility. Yet in several separate studies of various SOT examination procedures including the AFT test, Leboeuf-Yde reported the following for the AFT:

- intraexaminer reliability: high in one study [5] and low in another [6]

- interexaminer reliability: low [6]

- validity: some value in correctly distinguishing a correctly treated from an incorrectly treated group of participants [7]

- validity: in relationship to lumbopelvic pain: sensitivity=54%, specificity=69% [8]

- validity: no relation between side of involved fossa and side of sacroiliac fixation [7].

Conclusion: The AFT clearly has some validity but should not be used on its own as a tool for the diagnosis of SJD but rather as part of a comprehensive diagnostic evaluation of the joint. Further research is needed to determine whether the AFT is better suited for evaluating the subset of patients with SJD that is related to hypermobility or SJD associated with hypomobility.

References: :

1. Arab AM, Abdollahi I, Joghataei MT, Golafshani Z, Kazemnejad A. Inter- and intra-examiner reliability of single and composites of selected motion palpation and pain provocation tests for sacroiliac joint. Man Ther. 2009;14(2):213-21.
2. Hestìk L, Leboeuf-Yde C, Are chiropractic tests for the lumbo-pelvic spine reliable and valid? A systematic critical literature review. J Manipulative Physiol Ther. 2000 (May);23:258–75.
3. Kokmeyer DJ, Van der Wurff P, Aufdemkampe G, Fickenscher TC. The reliability of multitest regimens with sacroiliac pain provocation tests. J Manipulative Physiol Ther. 2002;25(1):42-8.
4. Monk R. Sacro Occipital Technique Manual. Sacro Occipital Technique Organization – USA: Sparta, NC, USA. 2006: 15-87.
5. Leboeuf C, Jenkins DJ, Smyth Ra. Sacro-occipital technique: The so-called arm fossa test. Intraexaminer agreement and post-treatment changes. J Australian Chiropr Assoc. 1988;18(2):67-68.
6. Leboeuf C. The reliability of specific Sacro-occipital Technique diagnostic tests. J Manipulative Physiol Ther. 1991;14(9):512-517.
7. Leboeuf C, Jenkins DJ, Smyth Ra. Sacro-occipital technique: An investigaton i into the relationship between the arm fossa test and certain examination findings. J Australian Chiropr Assoc. 1988;18(3):97-99.
8. Leboeuf C. The sensitivity and specificity of seven lumbo-pelvic orthopedic tests and the arm fossa test. J Manipulative Physiol Ther. 1990;13(3):138-143. br>
Pretorius G, Yelverton C, Moodley M. A comparative study between the effects of side-lying sacroiliac adjustments and Sacro Occipital Technique on the muscle strength of the gastrocnemius muscle in asymptomatic adult males. World Federation of Chiropractic’s 12th Biennial Congress. Durban, South Africa. April 10-13, 2013.

Introduction: Comparative studies of the effectiveness of chiropractic techniques have not been readily performed in the chiropractic literature. One study did attempt to rate specific chiropractic technique procedures for common low back conditions [1]. Another two others studies compared the assessment and treatment of chiropractic techniques: One study evaluated Gonstead, Logan Basic, Sacro Occipital Technique (SOT) and Motion Palpation [2] while the other evaluated Activator Methods and SOT [3].

The purpose of this unblinded, randomised pilot comparative study was to determine if diversified chiropractic manipulation and/or SOT adjustments of the sacroiliac (SI) joint could increase the short-term strength of the gastrocnemius muscle. IRB approval for this study was granted by the Technikon of the Witwatersrand (TW).

Methods: Three groups of thirty adult male patients were used. The participating patients were randomly placed into these groups and received the diagnostic assessment and treatment intervention specific to that particular group.

Ninety asymptomatic male patients between the ages of 20 and 30 years participated in the investigation. These patients were recruited by the use of posters that were placed in strategic areas around the TW campus. The patients were randomly placed into one of three groups of thirty. Group FA (force adjustment) received force, side-lying, diversified [4] sacroiliac adjustments to the sacroiliac joint. Group NA (non-force adjustment) received non-force sacro occipital technique (SOT) [5] adjustments to the same area by means of SOT blocking technique. The third group. Group C (control) received detuned ultrasound over the SI joint. Each patient received only one treatment.

The inclusion criteria required that the patient had to be male, fall inside the above age range, and presented with asymptomatic sacroiliac joint dysfunction. This was determined either by diversified chiropractic motion palpation or SOT category analysis. Only category one patients (pelvic torsion affecting sacral nutation) were used in this study and treated for pelvic torsion with pelvic blocks in a prone position whereas the diversified group with a thigh ilio-deltoid technique. The objective data was collected using a plantar flexion isometric dynamometer [6]. The gastrocnemius muscle strength was measured with the dynamometer before and after the treatment.

Results: Inter group analysis was achieved using the analysis of variance (ANOVA) Technique which indicated the results noted trend were not merely random. The validity of the procedures was then carried out by using the T-test for paired observations (”Before” and “After” treatment). This test calculated the p-value,(P< 0.05) noting that the date was statistically significant. The clinical significance of the treatment interventions was determined by comparing the mean "Before" versus the mean "After" treatment. Ultimately the objective results indicated that there was a statistically significant increase in gastrocnemius muscle strength in both of the experimental groups.

Discussion: Previous studies have shown similar statistical evidence that active muscle strength is positively affected by a diversified adjustment [7]. Various studies have tested the effect of SMT (diversified adjustment) on muscles that were relatively proximal to the joints being adjusted. Thus it was not entirely conclusive whether a biomechanical change had occurred, leading to an alteration in the lever system of the muscle and promoting a more efficient contraction, or if there was an underlying neurological effect leading to the increased muscle strength. None of these studies tested the effect of a non-force adjustment. For these reasons, this study chose to select a relatively distal muscle to be tested (without close biomechanical links) and included a non-force SOT adjustment to the pelvis.

Since both the non-force and force adjustments in this and other studies [2,3] showed statistically significant increases in muscle strength a common factor in both treatments was the stress placed upon the joint capsule. Thus it was hypothesised that that the capsular reflex, and its effect on the alpha motor neuron via the mechanoreceptors of the joint capsule, may have played a role in the production of an increased muscle contraction post treatment [8].

Conclusion: The positive effect noted in the non-force adjustment group gives one cause to wonder if force is always required to produce the therapeutic effects spinal manipulative therapists aim to achieve. It is possible that safer and less invasive techniques may thus be indicated on a more regular basis protecting both practitioner and patient alike. This study contributes to information about possible underlying mechanisms of the chiropractic adjustments and may support the role of non-force techniques in treating patients.

REFERENCES:

1. Gatterman MI, Coopertein R, Lantz C, Perle SM, Schneider MJ. Rating Specific Chiropractic Technique Procedures for Common Low Back Conditions. J Manipulative Physiol Ther. Sep 2001;24(7):449-56.
2. Maltezopoulos V, Armitage N. A comparison of four chiropractic systems in the diagnosis of sacroiliac malfunction. Europ J Chiropr. 1984;32:4-42.
3. Kinsinger FS, A Comparative Study of Activator Methods and Sacro Occipital Technique in Low Back Pain: Short Term Effects on Biomechanical Measures Proceedings of the 1991 International Conference of Spinal Manipulation 1991 Apr: 87-9.
4. States A.Z. (1985) States manual of spinal, pelvic and extravertebral technic, second edition, Kirk C.R, Lawrence D.J, Valvo N. L. Eds. National College of Chiropractic: 119.
5. Monk R. Sacro Occipital Technique Manual. Sacro Occipital Technique Organization – USA: Sparta, NC, USA. 2006: 15-87.
6. Daity D, Mior S, Bereznick D. (1998) Validity and reliability of an isometric dynamometer as an evaluative tool in a rehabilitative clinic, Sports Chiropractic and Rehabilitation 12 (3): 109-116.
7. Herzog W, Scheale D, Conway P.J. (1999) Electromyographic responses of back and limb muscles associated with spinal manipulative therapy, Spine 24 (2): 146, 149, 151.
8. Indahl A, Kaigle A.M, Reikeras O, Holm S.H. (1997) Interaction between the porcine lumbar intervertebral disc, zygapophysial joints, and paraspinal muscles, Spine 22 (24): 2834-2840.

Bloink T, Blum CL. SOT Cranial and TMJ therapy for unresolved BPPV: A case report. World Federation of Chiropractic’s 12th Biennial Congress. Durban, South Africa. April 10-13, 2013.

Introduction: Vertigo, also called dizziness, accounts for about 6 million clinic visits in the U.S. every year, and 17–42% of these patients eventually are diagnosed with benign paroxysmal positional vertigo (BPPV). Two-treatments have been found helpful for BPPV: the canalith repositioning procedure (CRP) or Epley maneuver, and the liberatory or Semont maneuver [1]. The following is a case study that discusses another possible treatment for BPPV.

A 37-year-old female with acute benign vertigo was referred to this office by her allopathic physician to determine the need for interdisciplinary care. The patient had 2-3 months of constant vertigo, diagnosed as BPPV. She had been treated with the Epley Maneuver and various medications, but her symptoms were unresponsive. Her vertigo would last the whole day, with peaks and valleys related to intensity. This affected her ability to function at home, drive her car and even walk “out of the door” of her home.

Methods: Patient presented with a sacro occipital technique category two (sacroiliac joint hypermobility syndrome) [2], right temporal bone with external rotation, and significant malocclusion with clenching and anterior interferences. Her malocclusion was affected by the stress of the anterior interferences, particularly on the right side, and the repetitive stress on occlusion appeared to create right temporomandibular (TMJ) stress summating at the right temporal fossa. It was theorized this possibly contributed to the patient’s vertigo presentation [3].

Category two protocols for the pelvis were applied [2] and an intraoral cranial adjustment to the temporal bone, maxilla, sphenoid, and zygoma were performed [4]. Reduction of palpatory pain in and around the TMJ along with joint translation was used to help guide treatment. Cotreatment with a dentist was used to help stabilize and maintain the chiropractic cranial and TMJ corrections.

Results: By the 7th-office visit (3-4 weeks of care) the patient’s vertigo had resolved. In addition her TMJ translation and opening had improved significantly with right TMJ and related tissue pain eliminated. The anterior interferences were treated with a nighttime dental appliance that allowed the patient to have bilateral posterior teeth contact and reduced contact to the front teeth.

Discussion: Occlusion and condylar position is purported to be affected by or affect cranial bone distortion patterns [5]. When there is malocclusion affecting the cranial suture and local periosteal tissue, it is theorized that with some patients — possibly the internal periosteal dura, CSF circulation, and related cortical region might be affected [6-8]. On the other hand reliving the stressors of restricted cranial motion and malocclusion could lead to improved function just by reducing global stress to the CNS due to reduced pain and related myofascial tension [5].

Conclusion: In this case report the patient’s response to care was quite dramatic. She was unresponsive to prior care and her quality of life was profoundly affected. It is difficult to extrapolate from this one case and apply this to the general population however the patient’s rapid response to care suggests that further investigation into this method of care for patients presenting with vertigo be considered.

REFERENCES:

1. Bhattacharyya N, Baugh RF, Orvidas L, Barrs D, Bronston LJ, Cass S, Chalian AA, Desmond AL, Earll JM, Fife TD, Fuller DC, Judge JO, Mann NR, Rosenfeld RM, Schuring LT, Steiner RW, Whitney SL, Haidari J; American Academy of Otolaryngology-Head and Neck Surgery Foundation. Clinical practice guideline: benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg. 2008 Nov;139(5 Suppl 4):S47-81.
2. Monk R. Sacro Occipital Technique Manual. Sacro Occipital Technique Organization – USA: Sparta, NC, USA. 2006: 91-126.
3. Steigerwald DP, Verne SV, Young D. A retrospective evaluation of the impact of temporomandibular joint arthroscopy on the symptoms of headache, neck pain, shoulder pain, dizziness, and tinnitus. Cranio. 1996 Jan;14(1):46-54.
4. Monk R, Blum CL. SOT Cranial Level Two Manual: TMJ Technique. Sacro Occipital Technique Organization – USA: Sparta, NC, USA. 2004.
5. Chinappi AS, Getzoff H. The Dental-Chiropractic Cotreatment of Structural Disorders of the Jaw and Temporomandibular Joint Dysfunction. J Manip Physio Therap. Sep 1995; 18(7): 476-81.
6. Retzlaff EW, Mitchell FL jr, Upledger J, Biggert T Nerve fibers and endings in cranial sutures – research report. J Am Osteopath Assoc. 1978;77(6):474-5.
7. Pick, MG. A Preliminary Single CaseMagnetic Resonance Imaging Investigation into Maxillary Frontal-Parietal Manipulation and its Short-Term Effect upon the Intercranial Structures of an Adult Human Brain. J Manip Physio Therap, Mar-Apr 1994; 17(3): 168-73.
8. Jones L, Retzlaff E, Mitchell FL Jr., Upledger J, Walsh J. Significance of nerve fibers interconnecting cranial suture vasculature, the superior sagittal sinus, and the third ventricle. J Am Osteopath Assoc. 1982;82:113.

Bloink T, Rahimi M, Blum CL. Integration of SOT cranial therapy with an occlusal splint for the treatment of obstructive sleep apnea: A case report. World Federation of Chiropractic’s 12th Biennial Congress. Durban, South Africa. April 10-13, 2013.

Introduction: Obstructive sleep apnea (OSA) relates to an obstruction to the continuum of airway expressed as sleep-disordered breathing associated with multiple co-morbidities and societal implications [1,2]. With untreated sleep apnea patient the risk of automobile accidents are approximately 8-times more likely than that of a normal sleeper and in the work arena likewise productivity and safety suffer [1].

Common treatments for OSA usually start with a continuous positive airway pressure (CPAP) machine and can progress to surgery to facilitate airway expansion and/or increase function. Surgery is costly and invasive and patient compliance with CPAP machines is estimated at only 40% [2]. A 56-year-old female patient presented for chiropractic and dental care with persistent symptoms of sleep apnea, excessive daytime sleepiness, short-term memory loss, foggy-headedness, temporomandibular joint (TMJ) pain, chronic myofascial neck and shoulder pain, fatigue, and vertigo.

Methods: Cranial-dental exam revealed a dental class II, narrow arches and premature anterior contacts with evidence of clenching and bruxism. The sleep study revealed a Respiratory Disturbance Index (RDI) of 17.1 and Apnea Hypopnea Index (AHI) of 16.3, with the lowest oxyhemoglobin saturation (SaO2) of 89% during sleep. Six-treatments over a 3-4 week period of time consisted of sacro-occipital technique (SOT) care [3], cranial-dental treatments incorporating SOT intra-oral cranial adjustments [4], and spheno-maxillary cranial care. Dental care was provided in conjunction utilizing occlusal balancing by a mandibular flat plane dental splint.

Results: Following the 6-office visits the patient reported significant reduction of all symptoms. Follow-up polysomnogram was performed one-month following prior study and with the dental appliance in her mouth. RDI and AHI were both reduced to 2.9 and lowest Sa02 was 92% during sleep. The patient had significantly reduced TMJ pain and the chronic myofascial neck and shoulder pain had gradually resolved over the 3-4 weeks of care. Due to her increased ability to sleep and increased oxygenation, she had less daytime fatigue and greater function.

Discussion: The combination of SOT cranial therapy with a flat plane mandibular occlusal splint appeared to help resolve this patient’s apnea and accompanied symptoms. This intervention was minimally invasive, less costly than a CPAP, and only required a 3-4 week treatment program. Splint type therapy has been found to be helpful for OSA patients and one prospective randomized study found “that a dental appliance could be an alternative treatment for some patients with severe OSA [5].”

Ascending and descending kinematic postural influences have been found between posture and occlusion, condylar position, and airway space — suggesting that the treatment of TMJ disorders and sleep apnea may be an opportunity for dental and chiropractic collaboration [6-8]. Clinically, chiropractors and dentists are realizing a relationship between posture and the OSA, supporting the need for interdisciplinary efforts [8].

Conclusion: The persistent nature of the patient’s apnea, the pre and post-sleep study objective findings, and the patient’s significant reduction in pain and improved function are compelling features of this case. Greater study is needed to identify the subset of apnea patients that could benefit from this approach.

REFERENCES:

1. Al Lawati NM, Patel SR, Ayas NT. Epidemiology, risk factors, and consequences of obstructive sleep apnea and short sleep duration. Prog Cardiovasc Dis. 2009 Jan-Feb;51(4):285-93.
2. Kapur VK. Obstructive sleep apnea: diagnosis, epidemiology, and economics. Respir Care. 2010 Sep;55(9):1155-67.
3. Monk R. Sacro Occipital Technique Manual. Sacro Occipital Technique Organization – USA: Sparta, NC, USA. 2006: 91-126.
4. Monk R, Blum CL. SOT Cranial Level Two Manual: TMJ Technique. Sacro Occipital Technique Organization – USA: Sparta, NC, USA. 2004.
5. Walker-Engström ML, Ringqvist I, Vestling O, Wilhelmsson B, Tegelberg A. A prospective randomized study comparing two different degrees of mandibular advancement with a dental appliance in treatment of severe obstructive sleep apnea. Sleep Breath. 2003 Sep;7(3):119-30.
6. Sakaguchi K, Mehta NR, Abdallah EF, Forgione AG, Hirayama H, Kawasaki T, Yokoyama A. Examination of the relationship between mandibular position and body posture. Cranio. 2007 Oct;25(4):237-49.
7. Maeda N, Sakaguchi K, Mehta NR, Abdallah EF, Forgione AG, Yokoyama A. Effects of experimental leg length discrepancies on body posture and dental occlusion. Cranio. 2011 Jul;29(3):194-203.
8. Blum CL. TMD Functional Integrative Approach: Dental and Chiropractic Approach to Forward Head Posture. Journal of the American Academy of Craniofacial Pain. Fall 2009; 22(2):18,31,39.

The following are Abstracts from the 2011 Eleventh WFC Biennial Congress, Rio de Janeiro, Brazil, April 6-9, 2011.
Williamson WP, Blum CL. Exercises and Stretches to Facilitate SOT Blocking Treatments Category One and Category Two: A Case Series. 2011 WFC Biennial Congress, Rio de Janeiro, Brazil, April 6-9, 2011.

Introduction: The treatment of lower back conditions through the use of chiropractic manipulation can be facilitated by rehabilitative exercises and stretches, (E/S). A retrospective comparison study was performed of E/S applications to SOT category treatment from a 6-month period from May–December 2006 and June–December 2007 Cases were selected if: SOT category-1 or category-2 blocking was incorporated and if that patient completed care to the point where SOT blocking was no longer necessary.

Methods and Intervention: As a baseline testing muscle the hamstring muscle was used, because of its ease of access and its connection to the pelvic region. The patients tested were always in a prone position on the treatment table and were evaluated so that they could consistently respond to testing.

Results: The results of the four groups were generally standard across age and gender and the exercises appeared to facilitate a quicker recovery.

Conclusion: Muscle testing, like DeJarnette’s category system, provides a direction for further investigations by monitoring both a patient’s response to the muscle test and their ongoing outcome to the therapy rendered. When a patient’s response to typical SOT category one or two therapeutic intervention seems limited incorporating E/S specific maneuvers may be indicated.

Shelley JR, Blum CL. Pregnancy, sacroiliac joint laxity, and the SOT category two pelvic distortion: A case series. 2011 WFC Biennial Congress, Rio de Janeiro, Brazil, April 6-9, 2011.

Introduction: Sacro occipital technique (SOT) describes a category (category two) of pelvic girdle pain and/or low back pain (PLPP) associated with increased posterior SI joint ligamentous laxity. This retrospective case series study involved 103 pregnant women age range from 21-32 years old were seen at this clinic from 1979-83.

Methods: Patients were evaluated via SOT diagnostic protocol, which included the SOT arm fossa test (AFT), increased unilateral or bilateral iliopsoas tension, palpation for pelvic torsion, leg length differentials, and Moiré contour photography.

Results: Using SOT’s arm fossa test as a method to evaluate sacroiliac joint laxity, a large percentage of the patients (95%) had AFT positive (AFT+) findings, with 5 of the 103 patients having an AFT negative (AFT-). AFT- findings were associated with reduction or elimination of pelvic or inguinal pain, improvement of muscle strength and ability to rise from seated position as well as lift or carry objects, and improved sleeping and restfulness.

Conclusion: Further study would be of value to determine if the AFT can become part of a series of tests used to assess the need for care of PPLP as well as if there is successful patient response to treatment.

Dal Bello F. The alterations of the dyspeptic signs and symptoms in caring for patients of gastritis following chiropractic treatment. 2011 WFC Biennial Congress, Rio de Janeiro, Brazil, April 6-9, 2011.

Introduction: Knowledge on the incidence, prevalence and natural history of gastroesophageal reflux disease (GERD) is limited. The objective of this study was to investigate the alterations of dyspeptic signs and symptoms in patients presenting with GERD following chiropractic treatment.

Methods: This was a pilot study with a sample composed of 10 individuals sent for chiropractic treatment by a gastroenterologist surgeon. High digestive endoscopy exam was performed on all individuals before and after 8 sessions of SOT/CMRT chiropractic treatment. A gastroesophageal reflux disease symptom’s questionnaire and the results from high digestive endoscopy exams were used to evaluate dyspeptic signs and symptoms.

Results: At the end of chiropractic treatment a statistically significant global reduction of GERD symptoms was observed (p=0.0002) especially on the evaluation of pre and post treatment postprandial pyrosis data (p=0.000004). Through endoscopic examinations on the 10 patients the findings noted a 58% improvement of esophagitis caused by GERD.

Discussion: There is some research to suggest that stimulation of spinal structures may have a connection with reflex responses of the autonomic nervous system, which in turn may alter visceral functioning.

Conclusion: 10-cases treated with chiropractic treatment (CMRT) noted improved esophagitis signs secondary to GERD (high digestive endoscopy exam).

Dal Bello F. Effectiveness of the chiropractic treatment in caring for patients with Arterial Systemic Hypertension. 2011 WFC Biennial Congress, Rio de Janeiro, Brazil, April 6-9, 2011.

Unger-Boyd M, DeCamp N, Provencher S. A Clinical Trial to Investigate Whole Body Compensation Due to Sacroiliac Joint Dysfunction. WFC Congress: April 6-9, 2011 – Rio de Janeiro.
The following are the Abstracts from the 2009 Tenth WFC Biennial Congress. Montreal, Canada. Apr 30 – May 2, 2009.
Rosen M, Blum CL. Chiropractic Care of Pediatric Nonmusculoskeletal Conditions: A Case Series. WFC’S 10th Biennial Congress. International Conference of Chiropractic Research. Montreal, Canada. Apr 30 – May 2, 2009: 319-21.

Introduction: A call has been made for more rigorous scientific inquiry to examine the value of manipulative therapy in the treatment of pediatric conditions [1]. Simultaneously there have also been inquiries by our scientific community attempting to isolate what subset of patients with nonmusculoskeletal conditions might respond to chiropractic care [2]. Due to the scarcity of published literature relating to the chiropractic treatment of nonmusculoskeletal conditions [3], particularly of pediatric patients, this paper attempts to facilitate a glimpse into a clinical practitioner’s office where these conditions are routinely being treated. There are some specific difficulties with performing research with children, this is because: (1) Information is usually gathered second hand from their parents or via parent/doctor observation; and (2) randomized controlled studies have limitations since children by nature of their age are not considered competent to give consent to participate in experimental studies. While randomized controlled studies are the preferred option for investigative studies, observational studies may also offer valuable information [4]. Case reports (series) have a tendency to represent a positively biased presentation of selectively chosen patients by a doctor, yet still in some instances they may offer an important window into what is taking place in chiropractic clinical practice.

Methods: Cases were identified by reviewing the files of active patients under age 12 who presented for treatment of nonmusculoskeletal complaints. Data were abstracted from the identified charts and were entered into an SPSS (v. 14.0) database. All pediatric patients were treated by the same clinician. In all cases active chiropractic care consisted of sacro occipital technique and cranial pediatric treatments, with ancillary procedures to improve neurological function, when clinically indicated. These included cross patterning, biofeedback, early intervention, targeted exercise, nutritional support or homeopathic allergy desensitization.

Results: Of the 36 (16 male, 20 female) nonmusculoskeletal pediatric patients identified for this case series, 5 had presenting complaints of immune function, 7 for developmental delays/dysfunction, 9 for birth trauma, 1 for seizure activity, 3 for learning problems, 3 for endocrine problems, 3 for migraines, 2 gastrointestinal issues, 2 for fussiness/agitated/anxiety, and 1 for enuresis. Immune function presentations (n=5, 3_, 2_) consisted of children (1.2-6 years old) with allergies, asthma, ear infections, eczema, chronic congestion, and chronic recurring coughs, needing between 5-20 (average 11.4) office visits until significant improvement was noted. Developmental delays/dysfunction presentations (n=7, 4_, 3_) consisted of children (5 months-6 years old) with difficulties with verbal skills, motor skills/coordination, ambulation, visual dysfunction, and tics – vocal and physical, needing between 5-14 (average 10.1) office visits until significant improvement was noted. Birth trauma presentations (n=9, 5_, 4_) consisted of children (3 days-1.8 years old) with secondary birth difficulties due to c-section, vacuum delivery, premature birth, and nursing difficulties, needing between 1-12 (average 5.5) office visits until significant improvement was noted. Seizure activity presentations (n=1_) consisted of a child 3.8 years old until significant improvement was noted after one treatment. Learning problem presentations (n=3, 2_, 1_) consisted of children (2.4-13.4 years old) with ADD, ADHD, Asperger’s Syndrome, and verbal issues, needing between 1-9 (average 6) office visits until significant improvement was noted. Endocrine problem presentations (n=3_) consisted of children (8.6-14 years old) with low HGH/ stature, menarche symptoms, and thyroid dysfunction, needing between 3-18 (average 13) office visits until significant improvement was noted. Migraine headache presentations (n=3, 1_, 2_) consisted of children (8.3 – 14 years old) needing between 1-6 (average 3.3) office visits until significant improvement was noted. Gastrointestinal dysfunction presentations (n=2, 1_, 1_)) consisted of children (2 weeks and 1 year old) needing between 2-6 (average 4) office visits until significant improvement was noted. Patients (n=2_) seen for fussiness/agitated/anxiety were 2 and 3 months old needing between 1-5 (average 3) office visits until significant improvement was noted. One female patient (9.4 year old) presented with enuresis needing 14 office visits until significant improvement was noted.

Discussion: A challenge in evidence based healthcare is integrating historically successful clinical practice with current published research. Developing a pediatric chiropractic evidence base, particularly one for nonmusculoskeletal conditions, for practicing doctors [2,3] would likely start with expanding the doctor’s knowledge of pediatric diagnosis and treatment options. This process could involve a certification process such as one by the International Chiropractic Pediatric Association (ICPA) which has postgraduate 180 hour certification and 360 hour diplomate programs. Implementing chiropractic adjustive techniques on newborns, infants, and young children is completely different from dealing with the adult patient so learning appropriate chiropractic therapeutic interventions to mitigate any adverse response to treatment [5] may be important. Sacro occipital technique (SOT) has protocols that are indicator based and offers low force techniques may be better applied to a young child. Cranial techniques, which are part of SOT’s system of analysis and treatment maybe indicated to address some newborn and developmental conditions. The Sacro Occipital Technique Organization – USA (SOTO-USA) like the ICPA also has a certification program to ensure that practitioners treating pediatric patients have appropriate training. It seems reasonable that chiropractic pediatric practitioners who are using SOT and cranial procedures are adequately trained in pediatrics and SOT/cranial care, possibly through certification programs. Part of this training should be to know when it is appropriate to refer patients for both emergency care and allopathic cotreatment. It is anticipated that the success in treatment for nonmusculoskeletal pediatric patients in this case series was high since cases were identified among active patients currently participating in wellness/maintenance care.

Conclusion: Since it does appear from this case series that pediatric nonmusculoskeletal conditions may benefit from SOT and cranial pediatric adjustive techniques, there is a greater need to investigate whether these responses to care can be generalized. Studies incorporating comparison groups may be warranted. In order to build an evidence base that accurately reflects real-life practice, it is essential that successful chiropractic clinical practices treating pediatric patients with nonmusculoskeletal conditions collaborate with the chiropractic research community.

References:

1. Gotlib, A.; Rupert, R.; Chiropractic manipulation in pediatric health conditions – an updated systematic review. Chiropr Osteopat. 2008 Dec; Vol. 16(4): 11.

2. Hawk C, Khorsan R, Lisi AJ, Ferrance RJ, Evans MW. Chiropractic care for nonmusculoskeletal conditions: a systematic review with implications for whole systems research. J Altern Complement Med. 2007 Jun;13(5):491-512.

3. Hawk C, Long CR, Boulanger KT. Prevalence of Nonmusculoskeletal Complaints in Chiropractic Practice: Report from a Practice-based Research Program. J Manip Physio Therap. Mar-Apr 2001; 24(3):157-69.

4. Concato J, Shah N, Horwitz RI. Randomized, controlled trials, observational studies, and the hierarchy of research designs. N Engl J Med. 2000 Jun 22;342(25):1887-92.

5. Vohra S, Johnston BC, Cramer K, Humphreys K. Adverse events associated with pediatric spinal manipulation: a systematic review. Pediatrics. 2007 Jan;119(1):e275-83.

Bloink T, Blum CL. Autism and Language Delay, Integration of SOT Cranial Therapy and Tomatis Auditory Therapy to Stimulate the Auditory Cortex: A Case Report. WFC’S 10th Biennial Congress. International Conference of Chiropractic Research. Montreal, Canada. Apr 30 – May 2, 2009: 284-5.

Introduction: Autism is a brain development disorder that impairs social interaction and communication, and causes restricted and repetitive behavior, all starting before a child is three years old. Various sets of signs distinguish autism from milder autism spectrum disorders (ASD) such as Asperger’s syndrome. Most recent reviews estimate prevalence of one to two cases per 1,000 people for autism, and about six per 1,000 for ASD, with ASD averaging a 4.3:1 male-to-female ratio. The number of people known to have autism has increased dramatically since the 1980s, at least partly due to changes in diagnostic practice; the question of whether actual prevalence has increased is unresolved. Autism is highly heritable, although the genetics of autism are complex and it is generally unclear which genes are responsible. However there are also non-hereditary possible etiologies or triggers that affect ASD presentations. The female may carry the genetic profile for ASD, which in 25% of the cases they pass on to their children. However genetic research to date has not found any specific gene associated with ASD, but a cause for ASD has been implicated in 20 of the 23 pairs of chromosomes, which may involve up to a hundred genes in the human genome. Spontaneous structural events associated with ASD onset are also believed to be primarily deletions of a gene, leaving the individual with only one copy of a particular gene leading to disruption of that gene’s function and ASD. ASD has multifactorial presentations with one type involving language delay that obviously would affect social interaction and communication [1].

Case Report: Assessment: 19-year-old female diagnosed with autism spectrum disorder (ASD) characterized by pervasive language delay, presented for cranial treatment at Atlantis (Tomatis) Clinic, St Truiden, Belgium. The patient was unable to speak prior to 11 years of age at which time she had a series Tomatis Auditory Therapy (TAT) treatments [2]. By age 19 she could speak coherently when her head would be in flexion with her eyes looking downward. With her head and eyes directed forward she was unable to speak in a coherent manner.

Treatment/Intervention: Treatment consisted of sacro occipital techniques (SOT) and cranial care [3], specifically treatment for sacroiliac joint hypermobility syndrome (category two) [4] and for a significant craniomandibular dysfunction (CMD) [5]. Typical blocking treatment was used for the pelvic component and the CMD was treated with cranial therapies including SOT related intraoral temporal and sphenomaxillary procedures.

Results: Immediately following care the patient stood up, held her head up and looked straight in the eyes of the doctor and said clearly, “Thank you very much, goodbye.” The patient’s ability to speak with the head and eyes in an upright position maintained for approximately 7 days, however due to her significant CMD, it appeared she would need concurrent dental orthopedic/orthodontic cotreatment to maintain a lasting positive outcome.

Discussion: Along with chiropractic SOT and cranial care, two main therapeutic interventions for autism spectrum language delay could be TAT and specific vestibular training exercises. Autism spectrum children commonly have hypersensitivity to touch, sound, and visual input. TAT has been found to improve the life of many autistic people by attenuating ASD symptoms. By stimulating the auditory system, and ultimately the brain, TAT, commonly used with other integrative therapies, has been able to help reduce the ASD symptoms. In this case study both chiropractic care and TAT were needed together to facilitate the best outcome, however for lasting effects dental interventions appears to be also necessary. For ASD patients vestibular training is also essential and one vestibular type training exercise could involve using a “hula hoop” on one arm and while in motion moving the hoop from one arm to the other across the midline and back again, performing this 5-6 times per session, everyday. As the child integrates this behavior they then begin with one hand holding a soft ball while the other hand rotates the “hula hoop” on their other arm, then placing the hand with the ball through the moving hoop, holding the ball with both hands, and then as the hoop crosses the midline towards the other arm, the other hand pulls the ball through the hoop, performing this 5-6 times per session, everyday.

Conclusion: Current theory on ASD believes that it is unreasonable to assume a “cure” will take place for this condition at this time, but rather acknowledging there are therapeutic interventions that will aid and raise the patient’s thresholds to cope and function. Treatments for some children may both have a physical component involving chiropractic or even dental chiropractic cotreatment and a neurological processing component, which can be helped with interventions such as auditory or vestibular training. It is important for future research to determine what subset of children may best respond to chiropractic therapy and neurological type exercises. While the case presented was quite dramatic, it illustrates the need for greater research into the study of interdisciplinary care of ASD and if these types of results can be duplicated in case controlled studies.

References:

1. Newschaffer CJ, Croen LA, Daniels J, Giarelli E, Grether JK, Levy SE, Mandell DS, Miller LA, Pinto-Martin J, Reaven J, Reynolds AM, Rice CE, Schendel D, Windham GC. The epidemiology of autism spectrum disorders. Annu Rev Public Health. 2007;28:235-58.

2. Joan M. Neysmith-Roy. The Tomatis Method with severely autistic boys: Individual case studies of behavioral changes, S. Afr. J. Psychology, 2001, 31 (1).

3. Blum CL, LETTER TO THE EDITOR: Sacroiliac Dysfunction and SOT – Response to the Nov. JACA Online Focus article on sacroiliac joint dysfunction. Journal of the American Chiropractic Association. Dec 2006: 20-1.

4. Blum CL, Cuthbert S. Cranial Therapeutic Care: Is There any Evidence? Journal of Chiropractic and Osteopathy. 2006; 14(10).

5. Fink M, Wahling K, Stiesch-Scholz M, Tschernitschek H. The functional relationship between the craniomandibular system, cervical spine, and the sacroiliac joint: a preliminary investigation. Cranio. 2003 Jul;21(3):202-8.

dal Bello F, Borilli F. Pain Alterations on the Temporo Mandibular Joint in Individuals with Malocclusion after Chiropractic Treatment. WFC’S 10th Biennial Congress. International Conference of Chiropractic Research. Montreal, Canada. Apr 30 – May 2, 2009: 287-8.

Introduction: Temporo Mandibular Joint (TMJ) is considered the most complex joint in the human body [1]. Due to this joint, daily vital functions are possible such as: speaking, smiling and crying, kissing, yawning, and mainly eating which without it the human being would not be able to survive. When the harmony of the normal fit of the TMJ is not perfect it will provoke the individual’s adaptation, causing clinical discomfort and functional deficiencies to the system, leading to muscles spasms, clacking, neck pain, cephalgia, deficiencies on the opening and closing movements of the jaw and pain which interferes in the individuals daily activities and well-being, and also enables the normal development of vital functions [1,2]. Malocclusion is the second cause related to TMJ pain Complaints [3], due to the functional imbalance between the TMJ and the neuromuscular system of the jaw caused by unstable and not simultaneous dental contact. Orthodontics is the usual approach for these cases, although not always effective and it suggests the use of therapies that focus on the recovery of TMJ and muscles spasms in order to assist the orthodontic treatment4. The interrelation between joint, muscles and nerves lead us to believe that malocclusion has its effects on TMJ symptoms [2,5] and so on to the whole body, as the purpose of this study is to approach the individual as a whole.

Methods: The study is characterized as an almost experimental study because establishes comparisons between two non equivalent groups. The research had the participation of 6 individuals which had an orthodontics´ diagnosis of malocclusion, TMJ pain and were between 10 to 45 years old. The individuals were divided consecutively into two different groups of treatment. The first group was treated with Cervical Manual Adjustment and the second group with the basic protocol of the SOT Technique. After physical evaluation and patient’s historical being collected it was made in each visit: in the first group, the palpation of subluxations and then the manual adjustment of the cervical segment involved, in the second group, the categorization and treatment with the basic protocol of the SOT Technique. The treatment was made in 4 visits during a month. To evaluate the pain of the participant it was used an informative questionnaire, and to measure the pain it was used the Visual Analogical Scale (VAS). Both were used in the first and in the last visit to evaluate the treatment’s effects.

Results: The research showed that in 83,33% of the cases there were TMJ pain decrease in individuals with malocclusion, nevertheless in 16,66% of the cases the results of the chiropractic treatment for the pain were negative. The Manual Cervical Adjustment group obtained 100% of TMJ pain decrease, being asymptomatic after treatment. The SOT Technique group obtained a gradual improvement of TMJ pain in 66,66% of the cases, however 33,33% obtained a negative result presenting increase of TMJ pain. Both treatments had shown to be effective for the TMJ symptoms, not only for pain, but joint clacking, cephalgia, neck pain, muscles tension, enhance of the opening and closing movements of the jaw and the region’s sensitivity.

Conclusion: The results of this research showed the chiropractic treatment as being effective to the TMJ symptoms in individuals with malocclusion, and not only relating to pain, but also for cephalgia, neck pain, muscles tension, enhance of the opening and closing movements of the jaw and joint clacking, giving the individual a better life quality and well-being.

References:

1. Maciel R.N. Oclusão e ATM: procedimentos clínicos. 1ed. Editora Livraria Santos Comp. Imp. Ltda. 1998. São Paulo.

2. Howat J.M.P. Chiropractic: Anatomy and Physiology of Sacro Occipital Technique. Cranial Communication Systems. 1999. Oxford.

3. Tosa H., Imai T., Watannabe F., Sumori M., Tsuchida T., Matsuno I., Nakamura S. The clinical study on occurrence of TMJ dysfunction in orthodontic patients. Nippon Kyosei Shika Gakkai Zasshi. August, 1990 (Vol. 49, Issue 4, Pages 341-51).

4. Viazis A.D. Atlas de Orthodontia – Princípios e Aplicações Clínicas. 1ed. Livraria Santos Editora Com. Imp. Ltda. 1996. São Paulo.

5. Mongini F. ATM e Músculos Craniocervicofaciais – Fisiopatologia e Tratamento. 1ed. Livraria Santos Editora Com. Imp. Ltda. 1996. São Paulo.

Dal Bello F, Dal Bello V, Santos LN, Raupp JM. Alterations on Dyspeptic Signs and Symptoms on Patients Presenting with Gastroesophageal Reflux Disease Submitted to Chiropractic Treatment. WFC’S 10th Biennial Congress. International Conference of Chiropractic Research. Montreal, Canada. Apr 30 – May 2, 2009: 290.

Introduction: Knowledge on the incidence, prevalence and natural history of gastroesophageal reflux disease (GERD) is still little. It is estimated that 40% of the western population has already presented with signs and symptoms of GERD. The important fact regarding this disease is the compromising of the patient’s life quality of life, besides high treatment cost. GERD treatment is based on clinical, pharmacological or surgical treatment. Chiropractic treatment on the neuromusculoskeletal system influences the functioning of internal organs, through autonomic nervous system stimulation. The objective of this study was to verify the alterations of dyspeptic signs and symptoms in patients presenting with GERD after chiropractic treatment.

Methods: This was a pre-experimental study and the sample was composed of 10 individuals sent to chiropractic treatment by a gastroenterologist surgeon. High digestive endoscopy exam was performed on all individuals before and after 8 sessions of chiropractic treatment, based on Chiropractic Manipulative Reflex Technique (CMRT), specific for gastric syndrome. The gastroesophageal reflux disease symptom’s questionnaire and the results from high digestive endoscopy exams were used to evaluate dyspeptic signs and symptoms.

Results: At the end of chiropractic treatment a statistically significant global reduction of GERD symptoms was observed (p=0.0002) especially on the evaluation of pre and post treatment postprandial pyrosis data (p=0.000004). The chiropractic treatment can improve visceral conditions, causing response in many systems, including the digestive system. Through endoscopic exam results it was possible to verify an improvement of 58% of esophagitis degree caused by GERD. The stimulation of spinal structures may have a connection with reflex responses of the autonomic nervous system which in turn may alter visceral functioning.

Conclusion: At the end of the study it was possible to conclude that chiropractic treatment was efficient in improving symptoms caused by GERD, as well as improving esophagitis signs secondary to GERD, shown by high digestive endoscopy exam.

Rozeboom D, Blum CL. Sacral Block Technic: Balancing Sacrospinal Function: A Case Report. WFC’S 10th Biennial Congress. International Conference of Chiropractic Research. Montreal, Canada. Apr 30 – May 2, 2009: 222-3.

Introduction: This case report investigates the therapeutic benefits of utilizing the sacral block to balance sacrospinal and cranial dural tensions ultimately assisting to balance sacral nutation. A relationship between intrathecal tensions, Milgram’s sign, and sacral block technic is also explored. Sacral block technique was initially developed by M. B. DeJarnette in 1976 and was used to treat, when applicable, any related cranial dural imbalance, and was termed, “cranial vault balancing technique.” Since Milgram’s sign is related to intrathecal pressure imbalance, leg lift testing was incorporated to evaluate the effectiveness of the sacral block technic. While reduced sacral nutation is commonly associated with SI fixation (category one) [1], DeJarnette also found some restriction to sacral nutation with SI joint hypermobility (category two).

Methods: The arm fossa test is an evaluation tool developed by DeJarnette to differentiate between SI joint fixation or hypermobility [2]. He found that SI joint hypermobility, with altered sacral nutation, at the full inspiration or expiration phase of pulmonary respiration, would cause inhibited response during the arm fossa test. With the patient supine the sacral block or wedge would be placed under the sacral apex when there was an inhibited response on inhalation to the arm fossa test and under the sacral base when there was an inhibited response on exhalation. Clinically a relationship was found relating to the patient’s inability to lift their legs when supine, an inhibited arm fossa test with a specific phase of respiration, and improvement of these indicators with sacral block technic.

Case Report: Assessment: A 75 year old male patient who had received chiropractic care since 1989 noted that in mid 2006, his gait and balance started to deteriorate which was of concern since he had a history of diabetic neuropathy in the lower extremities. In early 2007 he was seen for treatment and physical examination findings noted the patient had a positive Milgram’s Test and was unable to lift his legs in a supine position.

Treatment/Intervention: During 2007 he was treated approximately 5 times using the sacral block technic and gradually responded to treatment, had improved gait/balance, and was able to lift his legs in a supine position. Three months later, July 2007, the patient returned with inability to lift his legs in the supine position along with some decreased gait/balance functioning. He was adjusted again with the sacral block technic, the gait/balance improved and he could lift his legs. Subsequently while he suffered from some dizziness and knee pain with over exertion, his gait and stability remain improved through the spring of 2008.

Discussion: Sacral nutation involves anterior and posterior cyclic rotation (rocking) of the sacrum focusing at the anterior sacroiliac (SI) joint [3]. Nutation occurs secondary to pulmonary respiration and during walking and is postulated to assist with cerebrospinal fluid mixing from the lumbopelvic cistern cephalward. SI joint fixation secondary to pelvic torsion [4] or any factor that alters sacral nutation would then purportedly adversely affect CSF circulation and leading to some degree of CSF stagnation and resultant catabolic build-up in the sacrospinal subarachnoid space. The cranial-sacral dural system continues from the periosteal/meningeal cranial dura to the spinal canal ending within the sacrum at the 2nd sacral segment. This dural system also has various myoligamentous connections (Trolard’s Ligament, Thoracolumbar Ligaments of Hoffman, and ligamentum flava), which maintain balanced intrathecal tensions. Any factors limiting sacral nutation would likely alter dural tensions creating ascending influences on the spinal dural space and adjacent spinal subarachnoid space where CSF circulates [5].

Conclusion: The sacral block technic may be an effective tool for treatment of conditions associated with CSF stagnation secondary to reduced sacral as well as patients with a positive Milgram’s sign. Further study is necessary to evaluate greater clinical correlations to determine the effectiveness of the sacral block technic. While this patient had a significant response to treatment further research is indicated to determine what subset of patients would best respond to this care. Since the treatment represents a low force, low risk intervention further study to evaluate its benefit would be warranted.

References:

1. Blum CL, Sacro-Occipital Technique’s “Category Two”: A Remedy for Fixated Thinking. Dynamic Chiropractic. Sep 1, 2006; 24(18).

2. Hestoek L, Leboeuf-Yde C, Are chiropractic tests for the lumbo-pelvic spine reliable and valid? A systematic critical literature review. Journal of Manipulative and Physiological Therapeutics. May 2000;23:258–75.

3. Vleeming A, Pool-Goudzwaard AL, Hammudoghlu D, Stoeckart R, Snijders CJ, Chris J, Mens JMA. The Function of the Long Dorsal Sacroiliac Ligament: Its Implication for Understanding Low Back Pain. Spine. Mar 1996;21(5):556-62.

4. Cooperstein R, Lisi A. Pelvic Torsion: Anatomic Considerations, Construct Validity, and Chiropractic Examination Procedures. Topics in Clinical Chiropractic. Sep 2000; 7(3): 38-49.

5. Farmer JA, Blum CL. Dural Port Therapy. Journal of Chiropractic Medicine. Spr 2002; 1(2):1-8.

Zablotney J, Blum CL. Chiropractic Care and the Situs Inversus Patient: Modifying Technique to Match Anatomy. WFC’S 10th Biennial Congress. International Conference of Chiropractic Research. Montreal, Canada. Apr 30 – May 2, 2009: 235-7.

Introduction: In situs inversus totalis the heart chambers, lung lobes, abdominal organs and colon are all found in a mirror image arrangement of normal. The purpose of this paper is to present a novel case report of a patient with situs inversus treated by chiropractic care involving chiropractic manipulative reflex techniques (CMRT) modified to the patient’s condition.

Case Report: This patient was a 60 year old mother of 4 who has been a chiropractic patient for over 20 years receiving spine-only chiropractic care. The patient began care in this office in and was seen for 16 office visits utilizing Blair Upper Cervical (BUC) x-ray spinography protocols, Sacro Occipital Technique (SOT) categorization, and CMRT procedures.

Treatment/Intervention: Her response to Blair and SOT protocols was good and as expected however CMRT protocols needed to be modified in novel ways to compensate for her situs inversus presentation. Occipital fiber analysis found an active visceral reflex on 13 out of her 16 visits. On visits that necessitated treatment to the ileocecal or pancreas reflex arc the reflex patterns were opposite to normal.

Results: The outcome to treatment involved reduction in pain and increased function in various areas of the spine, pelvis, and right shoulder as well as reduction of prior sleep disturbances and constipation.

Discussion: While the response to BUC and SOT Category Two protocols were as anticipated, the CMRT evaluation and treatment was unusual based on the patient’s situs inversus presentation. The patient’s immediate response to treatment suggests that further investigations may be indicated.

Conclusion: Future studies could compare a blinded evaluation of patients with situs inversus and normal organ anatomy to determine if side of CMRT reflex and referred pain patterns is consistent. Greater research is needed to investigate what subset of patients may respond to viscerosomatic/somatovisceral chiropractic reflex treatment. (This is an abstract from a conference presentation only and does not represent a full work that has been peer-reviewed and accepted for publication.)

Vallone SA, Tow J. Collaborative Assessment and Management of Breastfeeding Difficulties by Lactation. Consultant and Chiropractor: A Case Series. WFC’S 10th Biennial Congress. International Conference of Chiropractic Research. Montreal, Canada. Apr 30 – May 2, 2009: 230-1.

Introduction: Breastfeeding is a dynamic relationship designed to modulate the optimal development of the human infant. The environment in which the infant is uniquely designed to thrive is the body of the mother. The infant is born neurologically competent and aware, fully prepared to initiate appropriate responses from the mother, guiding her in the biological imperative of attachment and bonding. Today, lactation consultants and other health care practitioners are observing a greater number of babies than ever who are incapable of feeding at the breast. As birth has become more medicalized, as we as a culture have responded through embracing intervention as the norm, we are seeing the impact of trauma to the infant in broader and more intrinsically damaging ways. We are only beginning to grasp both the magnitude and implications of this trend and have not yet begun to address treatment in any significant way. For babies to feed effectively, one must address form and function within the context of the maternal-infant relationship, using normal competency as the compass. Collaboration between the lactation consultant and the chiropractor has evolved as a means of restoring normal form and function and with it the potential for both competency and optimal development.

Methods: The authors review a case series of 25 mother infant pairs who experienced breastfeeding problems related to a variety of musculoskeletal dysfunctions including cervicocranial subluxation, torticollis, mandibular retraction or asymmetry and myofascial constraint (including ankyloglossia) [1-9]. Ages of the infants ranged from 0-4 mos. Objective and subjective signs of breastfeeding dysfunction in the infant included, failure to elicit a milk ejection reflex, insufficient milk removal, poor weight gain, failure to thrive, infrequent voiding, spinal hyperextension (arching) at and away from the breast, hyperirritability, decreased peristalsis, reflux and jaundice. Maternal signs and symptoms included lack of a milk ejection reflex, hypolactation, plugged ducts, blebs and mastitis, hyperlactation and nipple pain, deformity and damage [9,10] Objective signs of biomechanical dysfunction included limited range of motion, visible structural asymmetry, muscle hypertonicity or hypotonicity [1-9]. After evaluation the infant for neuromusculoskeletal integrity including range of motion (craniocervical, spinal and mandibular), muscle tone, oral function (including lips and tongue), and manual techniques were employed including myofascial release and chiropractic adjustments consisting of low force techniques, vertebral and cranial adjustments. Most, but not all mothers, continued to be supported by participating in follow up visits with the lactation consultant and chiropractor and/or as active participants in a mother’s support group moderated by the lactation consultant.

Results: Co-management consisting of chiropractic adjustments and manual therapy techniques coupled with lactation counseling resulted in successful breastfeeding in the majority of cases. Transition from the relationship with the lactation consultant and chiropractor to peer support appear to contribute to overall success rate of the challenged mother-infant dyad.

Conclusion: From our perspective, there is no more normal human function than the ability of the infant to direct his own feeding at his mother’s breast. Further, no other activity is more integral to healthy neurological development. Bonding is dependent upon competency—the infant’s competency in turn leads to maternal competency and guides the mother in completing the circuit for which both have been hard-wired. Indeed, the inability to feed effectively at the breast should be the earliest possible indication that intervention is required for the mother-infant dyad. This case series demonstrates the potential for success when the lactation consultant and other health care providers are able to recognize neuromusculoskeletal dysfunction in breastfeeding difficulties. And also demonstrates the potential efficacy of early chiropractic intervention in facilitating successful breastfeeding.

References:

1. Vallone S, Chiropractic Evaluation and Treatment of Musculoskeletal Dysfunction in Infants Demonstrating Difficulty Breastfeeding. Journal of Clinical Chiropractic Pediatrics. 2004; 6(1):349-61.

2. Holtrop DP, Resolution of suckling intolerance in 6 month old chiropractic patient, J Manipulative Physiol Ther 2000 Nov-Dec;23 ( 9):615-618.

3. Hewitt, EG, Chiropractic care for infants with dysfunctional nursing: a case series. Journal of Clinical Chiropractic Pediatrics. 1999; 4(1).

4. Sheader, WE, Chiropractic management of an infant experiencing breastfeeding difficulties and colic: a case study. Journal of Clinical Chiropractic Pediatrics. 1999; 4(1).

5. Krauss, L, Case study: infant’s inability to breast-feed. Chiropractic Pediatrics 1994; 1(3).

6. Arcadi, VC, Birth induced TMJ dysfunction: the most common cause of breastfeeding problems Sherman Oaks, CA, Proceedings of the National Conference on Chiropractic and Pediatrics. Oct, 1993 Palm Springs, CA.

7. Esch, S, Newborn with atlas subluxation/absent rooting reflex from Case reports in chiropractic pediatrics (case #4). ACA J of Chiropractic December 1988.

8. Wall V, Glass R, Mandibular Assessment and Breastfeeding Problems: Experience from 11 Cases, J Hum Lact. 2006; 22(3).

9. Coryllos E, Congential Tongue Tie and It’s Effect on Breastfeeding, Breastfeeding: Best for Baby and Mother, a publication of the American Academy of Pediatrics, Section on Breastfeeding, Sum 2004.

10. Watson Genna C, Supporting Sucking Skills in Breastfeeding Infants, Jones and Bartlett Publishers, Sudbury, MA, USA 2008.

DeCamp ON, Provencher S, Unger-Boyd M. A Pilot Study: Investigating a Sacroiliac Syndrome. WFC’S 10th Biennial Congress. International Conference of Chiropractic Research. Montreal, Canada. Apr 30 – May 2, 2009: 242-3.

Introduction: Some authors have showed 60% unreliability toward SIJ testing [1]. The purpose of this investigation is to propose a relationship between the present regional sacroiliac syndrome (SIS) [2] and additional somatic areas of neuromuscular compensatory postural stresses relating to sacroiliac joint dysfunction (SIJD) [3]. Comparative bilateral areas of pain/spasm as utilized in Sacro Occipital Technique (SOT) [4], termed indicators, were analyzed for clinical and neurophysiological correlation.

Method: 12 subjects were chosen at random, from the student population of Logan College of Chiropractic (IRB approved through Logan College of Chiropractic). Subjects selected were tested with an Algometer for pain response, and recorded, at specific somatic areas utilized diagnostically in SOT related diagnostic procedures (medial knee, lateral thigh, upper and lower aspects of the inguinal ligament, posterior 1st costovertebral junctions, temporalis muscle, occipitomastoid, and occipitoparietal sutures). Subjects were then analyzed for placement of orthopedic pelvic wedges (blocks) and treated according to SOT related protocols. The control group was lying supine for 5 minutes on a chiropractic Zenith table without any intervention.

Results: The Algometer measured the pain threshold differences experienced by the subject’s proposed SIJ related somatic indicators. The mean pain threshold value for the control, which the subject was not orthopedically blocked, was an increase or decrease in pain by -3 to 2 lbs/cm2 for all somatic indicators. Pain thresholds were found to be significantly increased (p < 0.05) when the subjects were treated with orthopedic blocks most noted to the left upper inguinal ligament (9.4 lbs/cm2; p < 0.05), left lower inguinal ligament (6 lbs/cm2; p < 0.05) and left occipitomastoid suture (3.6 lbs/cm2; p < 0.05). The major difference was seen in the left upper inguinal ligament with an increase of 9.4 lbs/cm2 in pain threshold.

Discussion: Based on the taxonomy for SIS provided by The International Association for the Study of Pain, McGrath indicates that diagnostic examination of the SIJ by palpation “is confounded by anatomical and sensory variables. Illustrative of systematic and possibly insurmountable anatomical and sensory confounding [5]” therefore, “the continued use of non-standardized, manual diagnostic palpation as a basis for manipulative intervention is questionable. There is a need to develop a sophisticated, technologically based alternative that offers a reliable multimodal input, standardization of findings and comparative indexing of such findings to a reference data-base [5].” This study, involving analysis and treatment of SIJ torsion lesions, proposes a new definition of a sacroiliac syndrome based upon a novel interpretation of the neurophysiology and the current pilot clinical trial. Three of the 16 indicator’s pain thresholds increased significantly after orthopedic pelvic blocking as compared to the control group indicating a plausible relationship between the 3 indicators and sacroiliac dysfunction.

Conclusion: There is a clear need for diagnostic protocols that offer a reliable and valid method of evaluating sacroiliac joint dysfunction. It is possible that SOT related protocols may offer a viable alternative to what is used currently in orthopedic circles. The current pilot study while giving interesting information indicates that further studies are needed with a larger sample of subjects, with the full SOT protocols and delineating the possible SI osseous weightbearing versus nutation/counternutation (respiratory) dysfunctions.

References:

1. Laslett M, April CN, McDonald B, Young SB. Diagnosis of sacroiliac joint pain: validity of individual tests and composites of tests. Man Ther 2005, 10:207-18.

2. Cooperstein R. Sacro Occipital Technique. Chiropractic Technique. Aug 1996; 8(3): 125-31.

3. Sterenfeld EB, Chou LH, Herzog R, Vresilovic E. The predictive value of provocative sacroiliac joint stress maneuvers in the diagnosis of sacroiliac joint syndrome. Arch Phys Med Rehabil. 1998 Mar; 79(3):288-92.

4. Zelle BA, Gruen GS, Brown S, George S. Sacroiliac joint dysfunction: evaluation and management. Clin J Pain. 2005 Sep-Oct; 21(5):446-55.

5. McGrath MC. Clinical considerations of the anatomy of the sacroiliac joint (SIJ). A review of the characteristics of function, motion and pain. J Osteopath Med 2004; 7: 16-24.

dal Bello F, Borilli F. A Research on the Effects of the Chiropractic Treatment on Individuals with Malocclusion as an aid to the Orthodontic Treatment. WFC’S 10th Biennial Congress. International Conference of Chiropractic Research. Montreal, Canada. Apr 30 – May 2, 2009: 257-8.

Introduction: Malocclusion is the second cause related to TMJ pain complaints1 due to the non-stable contact among superior and inferior teeth leading to functional imbalance between the TMJ and the neuromuscular system of the jaw [1]. Not proper fit of the TMJ will provoke the individual’s adaptation leading to clinical discomfort and functional deficiencies in the system introducing to symptoms such as clicking, muscles spasms, bruxism, cervicalgia, cephalgia, deficiencies on the opening and closing movements of the jaw and pain which take from the individual its wellbeing and enable the normal development of daily activities [2,3]. Orthodontics is the conventional approach to treat this condition making use of induced movement of teeth and bones to correct malocclusion [4]. Although the benefits of correcting centric occlusion may enhance the individual’s well-being, the treatment can be long, expensive, not pleasant and many times not totally efficient mainly because of the dysfunctions developed due to the malocclusion. In order to reach satisfactory results the use of other therapies and methods to recuperate the TMJ and muscles are involved to assist the orthodontic treatment [5].

Methods: The patients of this study were headed to chiropractic treatment by their orthodontist before further orthodontic treatment. All patients had malocclusion diagnosis and TMJ pain. The patients were treated with chiropractic techniques for a period of a month, having 4 visits total. Each individual was evaluated by the orthodontist, focusing on occlusion and its effects in other structures, before and after chiropractic treatment. To be able to evaluate the orthodontic professional’s opinion about the effects of the chiropractic treatment it was used a satisfaction questionnaire after the orthodontist’s second and last evaluation.

Results: The research showed that in 50% of the cases the orthodontist was positive in relation to the occlusion condition. In 66.66% of the cases the orthodontist was positive relating to the chiropractic treatment to the patient with malocclusion. And in 83.33% of the cases the orthodontist was largely positive about the chiropractic treatment as a tool to the orthodontic treatment. In the majority of the cases the orthodontic professional pointed up the benefits of the chiropractic treatment to reduce the different symptoms related to malocclusion, giving the orthodontist better conditions to develop a specific treatment to correct the biomechanical occlusion of each patient satisfactorily.

Conclusion: The results of this study suggests the chiropractic treatment as a great allied to the orthodontic professional, facilitating its procedures due to the symptoms reduction, also supplementing its work to reach the individual’s global health, reducing time and costs of the treatment. It also suggests an interdisciplinary work between chiropractors and orthodontists to promote a greater life quality to the individual with occlusion disorders.

References:

1. Tosa H., Imai T., Watannabe F., Sumori M., Tsuchida T., Matsuno I., Nakamura S. The clinical study on occurrence of TMJ dysfunction in orthodontic patients. Nippon Kyosei Shika Gakkai Zasshi. August, 1990; 49(4):341-51.

2. Howat J.M.P. Chiropractic: Anatomy and Physiology of Sacro Occiptal Technique. Cranial Communication Systems: Oxford Press. 1999.

3. Maciel RN, Oclusão e ATM: procedimentos clínicos. 1ed. Editora Livraria Santos Comp. Imp. Ltda. São Paulo. 1998.

4. Brew MC, Pretto SM, Ritzel IF. Odontologia na Adolescência – Uma abordagem para pais,educadores e profissionais da saúde. Editora Mercado Aberto Ltda. Porto Alegre. 2000.

5. Viazis AD. Atlas de Ortodontia – Princípios e Aplicações Clínicas. 1st ed. Livraria Santos Editora Com. Imp. Ltda. São Paulo. 1996.

The following are the Abstracts from the 2007 Ninth WFC Biennial Congress, Vilamoura, Portugal – May 17-19, 2007.
Blum CL, Cuthbert S, Williams S, Developmental Delay Syndromes and Chiropractic: A Case Report. International Conference on Chiropractic Research. Vilamoura, Portugal – May 17-19, 2007: CM53.

Introduction: Chiropractic treatment for developmental delay syndromes (DDS), while controversial to some, has growing support in the research literature. Yet at this time there is no conclusive information on the causation of DDS. This ultimately leads to some lack of clarity about treatment options, particularly for children sensitive to medication or who do not choose medication as an option.

Discussion: Patients are actively seeking alternative care, and particularly care that offers low risk and measurable benefits should be brought to their attention. Since for many patients and their families the option of no treatment for DDS is not an “option,” we need to explore which patients might best respond to conservative therapies such as chiropractic.

Conclusion: The current evidence supports the premise that some DDS may be secondary to trauma and related to the sensory-motor impairment syndrome known as dyspraxia. While the studies are inconclusive, there is an emerging evidence base that does show chiropractic care may be successfully employed in the treatment of patients with DDS such as dyslexia, dyspraxia, learning disabilities, and ADHD.

Kalamir A, A Randomised Controlled Pilot Study of Chiropractic Craniomandibular Treatment for Chronic TMD. International Conference on Chiropractic Research. Vilamoura, Portugal – May 17-19, 2007: CM14.

Introduction: 30 blinded chronic TMD sufferers were randomized into 3 groups (control, Rx, and Rx plus self care/ education).

Methods and Intervention: Rx intervention involved osseous adjustments to the TMJs, along with intraoral craniomandibular soft tissue releases (involving ischemic pressure, and PIR). No spinal treatment was performed. Practitioner was blinded to outcomes and assessor was blinded to group assignment.

Results: Results showed statistically and clinically significant differences in resting pain, clenching pain, inter- incisal opening, maximum opening pain between both Rx groups and control over 6 weeks and 6months. No statistical difference between the 2 RX groups at this stage.

Conclusion: It is proposed that chiropractic treatment of the masticatory apparatus may be of benefit in cases of chronic TMD.

Kalamir A, Chiropractic Intraoral Craniomandibular Technique for Migraine.International Conference on Chiropractic Research. Vilamoura, Portugal – May 17-19, 2007: CM18.

Introduction: Two female patients suffering from (at least fortnightly) chronic classic migraine (migraine without aura classification 1.1), who were unresponsive to chiropractic (SMT), physiotherapy, acupuncture and allopathic medication were assessed and found to have ADDWR (anterior disc displacement with reduction) of their TMJs.

Intervention and Results: A 5 week protocol involving chiropractic soft tissue myofascial techniques (e.g. Ischemic pressure, PIR). Aside from improved TMJ biomechanics (ROM), both patients noted dramatic improvement in their migraine symptoms over the course of 6 weeks.

Conclusion: It is proposed that chiropractors are well positioned to address autonomic disturbances that are implicated in migraine, and that TMJ techniques that are widely taught should be utilized more often in practice.

Kalamir A, Pronation Associated with Temporomandibular Joint Sounds.International Conference on Chiropractic Research. Vilamoura, Portugal – May 17-19, 2007: SI10.

Introduction: Two male patients with spinal symptoms (and TMJ sounds with ADDWR) were assessed and found to have moderate pronation of their feet. Occasional chiropractic SMT alleviated their spinal symptoms but not the TMJ sounds and ROM.

Intervention and Results: Both patients were fitted with EVA prefabricated arch supports (orthotics) to address their pronation. Within 48 hours, both patients noted marked improvement in their TMJ sounds, TMJ range of movement normalization, and improvement in spinal symptoms. Both patients additionally commented that when they failed to wear the orthotics for more than a few days, the joint sounds gradually returned, only to disappear again with days upon reinsertion of orthotics.

Conclusion: It is proposed that orthotics, when indicated, may be of benefit in managing chronic cases of TMJ dysfunction.


The following are the Abstracts from the 2005 Eighth WFC Biennial Congress, Sydney, Australia – June 16-18, 2005.
Blum CL, Pick MG, Lovett L, Sitting disc technique: video myelogram fluoroscopy study. Proceedings of the 2005 WFC Biennial Congress: Sydney Australia. Jun 16-18, 2005: 272.

INTRODUCTION: Conservative management of lumbar herniated discs and their possible affects on the thecal sac and CSF circulation deserves consideration as a possible modality. Sacro occipital technique method of care called the sitting disc technique [1] and its treatment being rendered were visualized during a video myelogram fluoroscopy. The fluoroscopy study allowed for direct visualization of the CSF, thecal sac and the doctor’s thumb contact at the L4 spinous process.

The procedure was performed in Japan with the patient’s consent and was part of the treating medical doctor’s normal procedure for guiding and rendering treatment. The treatment was videotaped so that the practitioner could evaluate the results of therapy and that fluoroscopic studies would not be needed when future therapy was rendered. The treatment was rendered 15 years ago and at that time the videotape was not initially anticipated to be used for research purposes.

METHODS AND INTERVENTION: The sitting disc technique was performed on a 50-year-old man presenting with a left spinal inline, right sided sciatica, and decreased CSF circulation as visualized on video myelogram fluoroscopy. The sitting disc technique was applied approximately 3-5 intervals to L4 as the patient flexed and extended their lumbar spine under the direction of the doctor.

RESULTS: Following the procedure the patient reported less pain, and greater movement could be visualized of the vertebra as well as increased CSF circulation during application of the sitting disc technique during video fluoroscopy.

DISCUSSION: There are various theories as to why there would be this increased CSF circulation in the lumbosacral region following the application of the sitting disc technique. These might be associated with an actually mechanical increase in disc height through a form of distraction on the disc and local L4/L5 decompression [2], balancing tensions on the related meningeal or thecal structures [3], and affects of increased CSF fluctuations and circulation secondary to diaphragmatic or vascular influences. [4]

CONCLUSION: While the patient’s improved posture and decreased pain were successful outcomes of the sitting disc technique procedure, [5] of greater magnitude was the visualization of the increased circulation of the CSF following and during application. Greater investigation into this conservative method of care and determination of whether this single procedure might have a greater application beyond this single subject study is warranted.

REFERENCES:

1. Getzoff H. Disc Technique: An Adjusting Procedure for any Lumbar Discogenic Syndrome. The Journal of Chiropractic Medicine. Fall 2003; 2(4):142-4.

2. Gose EE, Naguszewski WK, Naguszewski RK. Vertebral axial decompression therapy for pain associated with herniated or degenerated discs or facet syndrome: An outcome study. Neurological Research. Apr 1998;20(3):186-990.

3. Bashline SD, Bilott JR, Ellis JP, Meningovertebral ligaments and their putative significance in low back pain. Journal of Manipulative and Physiological Therapeutics. Nov-Dec 1996;19(9):592-6.

4. Brisby H, Olmarker K, Larsson K, Nutu M, Rydevik B. Proinflammatory cytokines in cerebrospinal fluid and serum in patients with disc herniation and sciatica. Eur Spine J. 2002 Feb;11(1):62-6.

5. Hahne AJ, Keating JL, Wilson SC. Do within-session changes in pain intensity and range of motion predict between-session changes in patients with low back pain? Aust J Physiother. 2004;50(1):17-23.

The following are the Abstracts from the 2003 Seventh WFC Biennial Congress, Orlando, Florida, United States – May 1-3, 2003.
Edwards DM. Wood TG. A sacro-occipital technique (SOT) inter-examiner reliability study WFC’s 7th Biennial Congress Conference Proceedings, May 1-3, 2003; 7: 379-80.

Introduction: SOT is a popular low-force approach within chiropractic. It has its own theories of dysfunction, diagnostic procedures and specific treatment protocols. The basic diagnostic procedure involves a “five step analysis” leading to a classification into one of three categories. In addition to these 5 indicators, leg length inequality, and “heel tension” are also used to aid in category classification. Barring one or two indicators reliability studies show poor reproducibility. [1,2]

Methods: Four chiropractors experienced in Sot performed the appropriate 5 Step procedures (”Mind-language,” “Sway,” “Rib head motion,” Arm-fossa,” and “cervical compaction”) as well as “Leg length inequality” and “Heel-tension” on fifteen subjects during a single 75-minute session at the University of Surrey Chiropractic Clinic. Correlations were assessed using Cohen’s Kappa for interagreement by percentage-based calculation, enabling a comparison with predicted agreement by chance through a result/chance ratio. Discriminate function analysis was also performed. This technique has the advantage of identifying those tests that are most able to predict overall outcome. To permit the potential identification of individual indicator strength and aid identification of any variation between examiners, a “sureness of result” chart was used. This was completed as a numerical score on a 0-10 scale for each examination undertaken, as well as for the overall category outcome.

Results: Cohen’s Kappa as performed on categorical data showed poor reliability (K=0.02). In contrast the percentage inter-examiner agreement was generally found to be poor to moderate but results were seen to improve in comparison with predicted values calculated for chance alone. This trend became more marked with increase in examiner numbers. (Result: Chance ratios were 52%; 16.7 for 2 examiners; 33%: 7.2% for 3 examiners and 20%; 3.2% for 4 examiners). Thus it seems that the five-step analysis may operate as a system with reliability significantly improved above findings, which would be expected if examiners results were generated on a random basis. Both discriminate function analysis and percentage-based results identified the indicators “Sway” and “Arm-fossa” as being the most useful predictors of categorical outcome, although it must be noted that “Arm-fossa” discriminated only between the presences of absence of category II. In addition, evaluation of the criteria “leg length inequality” and “heel tension” gave poor interexaminer reliability using the percentage-based approach. Examiner confidence in test results was generally strong, these were overall slightly higher than confidence in categorical assessment.

Conclusion: Interexaminer reliability for the SOT 5 step analysis, in absolute terms, was found to be low. However, Kappa becomes unstable when applied to data of limited variation, [3] this may have been the case with this seemingly uniform sample. Result: Chance ratios increased with increasing examiners suggesting that there is some form of systematic process occurring within the mechanism of the 5 step analysis.

References:

1. Leboeuf C. The Reliability of Specific Sacro-Occipital Technique Diagnostic Tests. Journal of Manipulative and Physiological Therapeutics. 1991;14:3-4.

2. Hestoek L, Leboeuf-Yde C. Are chiropractic tests for the lumbo-pelvic spine reliable and valid? A systematic critical literature review. Journal of Manipulative and Physiological Therapeutics. May 2000;23:258-75.

3. Haas M. The reliability of reliability. Journal of Manipulative and Physiological Therapeutics. 1991;14(3):199-208.

The following are the Abstracts from the 1997 Fourth WFC Biennial Congress, Toyko, Japan – Jun 6-8, 1997.
Sanders GE, Unger JF. Cranial Distortion and Category II Pelvic Blocking – A Pilot Study: Poster Presentation. (Diagnostic Sciences) Proceedings of the Scientific Symposium – WFC’s 4th Biennial Congress Conference Proceedings: Tokyo, Japan. Jun 6-8, 1997: 252.

Many practitioners of SOT Craniopathy have observed visual changes in cranial and facial structures with respect to pelvic blocking procedures. To date there are no published studies describing or critically evaluating these potential changes. Potential implications in the treatment of conditions such as temporomandibular joint dysfunction warrant significant investigation. According to some theories, the cranium is a solid, immovable collection of bones by adulthood. According to other chiropractic theories, there is a direct relationship between the relative position of an ilium and a temporal bone on a given individual.

Unger JF. Temporomandibular Joint Dysfunction (TMJD): Work Shop [In English and Japanese]. Proceedings of the Scientific Symposium – WFC’s 4th Biennial Congress Conference Proceedings: Tokyo, Japan Jun 6-8, 1997: 274.

Temporomandibular joint dysfunction (TMJD) has become a relatively prevalent disease entity. The Sacro Occipital Technique of chiropractic (SOT) has proposed a theory of evaluation and treatment that has been used for many decades. The advantages of this system are multiplicity of perspective in the analysis and treatment procedures for TMJ dysfunction.

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This World Federation of Chiropractic’s Biennial Congress Proceeding Compendium of Abstracts and all its contents herein are published by SOTO-USA solely for the purpose of education and should not be used by patients or unlicensed persons to diagnose or treat any condition.

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