Improvement in Cervical Curvature and Health Outcomes in a Patient with Rheumatoid Arthritis Undergoing Chiropractic Care to Reduce Vertebral Subluxation

CASE STUDY

 Jason Pero, DC Bio & David Jockers, DC Bio

Annals of Vertebral Subluxation Research ~ July 26, 2012 ~ Pages 77-81

 

Abstract


 
Objective:  To report a case of corrective chiropractic management of a woman diagnosed with rheumatoid arthritis.

 

Clinical Features:  A 54 year-old woman presented having previously been diagnosed seven years prior with rheumatoid arthritis.  Her chief complaint was severe bilateral polyarthralgia, especially in the hands and fingers.  Marked swelling was noted in her hands, fingers, knees, feet and toes.  The patient experienced difficulty executing and sustaining weight-bearing activities due to the severity of pain.  Methotrexate and Prednisone slightly reduced the pain and inflammation.

 

Interventions and Outcomes:  The patient was evaluated using various assessment tools by the chiropractor including inspection, palpation, surface electromyography and x-ray imaging.  The patient underwent chiropractic care that improved an 11-degree hypolordotic cervical curve to 21 degrees and an anterior head translation (AHT) of 33 mm to 29mm.  The SEMG scan improved from severe hypertonicities at C1, C3, C5 and C7 to moderate hypertonicities at C1 and C5 only.  Also, the patient’s pain scale was reduced from 9/10 to 1/10.  The patient also experienced improved ambulatory gains and is now able to walk up-and-down stairs, dance and exercise without pain.

 

Conclusion:  Chiropractic management was successful in this case report of a middle-aged female with rheumatoid arthritis.

 

Keywords:  Rheumatoid arthritis, RA, chiropractic, subluxation, arthritis, inflammatory arthritis, chiropractic adjustment, CAM

 

Resolution of Breech Presentation Confirmed by Ultrasound Following Webster’s Technique

This  technique I learned for the inventor, Dr. Larry Webster.
 
CASE STUDY
 
 
Miranda Abbott, DC Bio   
 
Journal of Pediatric, Maternal & Family Health – Chiropractic ~ Volume 2012 ~ Issue 3 ~ Pages 66-68 
 
Abstract

Objective:  To describe the results from chiropractic care of a patient presenting with a breech pregnancy using the Webster Technique analysis with Activator Adjusting Instrument thrust.

Clinical Features:  A 30 year old woman in her 34th week of pregnancy with her second child presented for a regular chiropractic visit after having an ultrasound that determined the baby was in a breech position.  She had a previous cesarean section and was continuing chiropractic care with hopes of avoiding another cesarean section.   

Intervention and Outcome:  Webster Technique was used to analyze the patient and a light force adjusting instrument (Activator Adjusting Instrument) was used to administer an adjustment.  Trigger point therapy was also performed according to Webster protocol.   After three adjustments, the fetus moved from a breech position to a normal vertex or head down position.

Conclusion:  Webster Technique protocol while using the Activator Adjusting Instrument along with trigger point therapy was successful in decreasing sacral subluxation and the fetus assumed a normal vertex position according to a follow-up ultrasound. 

Key Words: Subluxation, Webster’s Technique, Activator Adjusting Instrument, Pregnancy, Breech Presentation, Intrauterine Constraint, Chiropractic, External Cephalic Version

Correction of Subluxation and Alleviation of Asthma Symptoms in a Pediatric Patient: A Case Study

 

Heather Davis, D.C.Bio & Amy Byrley, D.C. Bio   

  

 
Journal of Pediatric, Maternal & Family Health – Chiropractic ~ Volume 2012 ~ Issue 3 ~ Pages 69-73 
 
Abstract

 


Objective: To report on the outcomes of a child suffering with asthma, chronic colds and respiratory issues undergoing subluxation based chiropractic care.

 

Clinical Features: A two-year-old male suffering from asthma, chronic colds, and respiratory issues since birth was presented by his mother for chiropractic evaluation and possible care. At the time of initial examination the patient was taking two medications, Flovent and Singulair, daily.

 

Interventions and Outcomes: The patient was cared for using specific, low-force adjustments with the Activator adjusting instrument to address areas of vertebral subluxation in the cervical, thoracic and lumbosacral spine. Within approximately two weeks (4 adjustments) the patient’s mother reported improvement in the boy’s condition.

 

Conclusion: This case report reviews the benefit a young boy suffering from asthma experienced while undergoing chiropractic care. It is recommended that further investigation be conducted on this subject with large clinical trials.

 

Key Words: Chiropractic, asthma, vertebral subluxation, pediatric, children, thermography

Upper Cervical Chiropractic Management of a Patient with Idiopathic Parkinson’s Disease:

CASE STUDY

 Steve Landry TRP, DC Bio    

 Journal of Upper Cervical Chiropractic Research ~ Issue 3 ~ July 30, 2012 ~ Pages 63-70

 Abstract


Objective: To demonstrate the effectiveness of upper cervical chiropractic care in managing a single patient with idiopathic Parkinson’s disease and to describe the clinical findings.

 

Clinical Features: A 63-year-old man was diagnosed with Idiopathic Parkinson’s disease after a twitch developed in his right hand at rest. Other findings included loss of energy, anxiety and localized middle back pain.

 

Intervention and Outcomes: Hole-In-One (HIO) Knee Chest protocol was used over a 4 week period using x-ray procedures, and analysis, skin temperature differential (pattern) analysis and Knee Chest adjusting technique. Contact-specific, low amplitude, high-velocity, moderate-force adjustments were delivered to the Atlas vertebra.  The patient experienced significant improvements in his quality of life using SF-36, PDQ-39 and subjective intake during upper cervical care. The patient also showed considerable improvements in the overall bodily pain, active and passive cervical range of motion, postural correction and better quality of sleep following the cessation of his restless leg syndrome.

 

Conclusions: We conclude that improvement of the Atlas alignment is associated with reduction of most of his Parkinson’s symptoms. Including decrease in frequency and intensity of his middle back pain, improvement in his quality of life and improvement in his motor functions. 

 

Keywords:idiopathic Parkinson’s disease, upper cervical care, middle back pain, Subluxation, chiropractic, Knee Chest, HIO

The Foods Cancer Loves

Many of your patients are pursuing cancer as a dietary goal – and don’t even know it.

By David Seaman, DC, MS, DABCN

Texts and papers that discuss cancer often illustrate how a normal cell is transformed into a cancerous cell.

 

Normal cells should die off; however, they instead go through metaplastic and dysplastic changes, which leads to the transformation of normal cells into cancerous cells that proliferate and do not die.1 One of the chemicals that pushes the transformation of normal cells into cancer cells is prostaglandin E2,1 which is derived from arachidonic acid. In fact, we eat an excess of arachidonic acid indirectly and directly. We eat an excess of linoleic acid from refined foods, fast foods, and packaged foods. Some of the worst culprits are French fries and the various chips that have been cooked in linoleic acid-rich oils (corn, sunflower, safflower, cottonseed).

 

Our bodies convert linoleic acid into arachidonic acid. We also eat arachidonic acid in excessively in excessively fatty meats and farm-raised fish, such as tilapia and catfish, which have subsisted almost exclusively on feed that contains linoleic acid. Arachidonic acid from the various sources is then converted into PGE2 by the COX1 and COX2 enzymes in the human body. (Interestingly, an image showing the conversion of arachidonic acid into PGE2 is provided in an article about fatty acids, PGE2 and other eicosanoids, and brain cancer.)2

fries A recent news piece on Medscape discussed why aspirin helps to prevent cancer: it blocks the conversion of arachidonic acid into PGE2.3 This is actually not new news; the cancer-modulating effects of NSAIDs has been known for years.4-7 Of course, nothing is ever mentioned in these articles about the fact that we get arachidonic acid in unhealthy foods and that we should stop eating these foods in excessive amounts.

Images in certain papers actually show us that PGE2 is involved in cancer promotion, such as esophageal and breast cancer.1,8 Bulun even provides an image of how PGE2 inhibits BRCA, which is a famous anti-cancer gene related to breast cancer expression.8 Another paper explains that patients with brain cancer have measured levels of linoleic acid and arachidonic acid that are excessive.2

The bottom line is that an excess consumption of linoleic acid and arachidonic acid represents the pursuit of cancer because cancer transformation, in part, requires PGE2. And it is well-known that modern man consumes excessive levels of omega-6 fatty acids. In fact over 20 percent of our calories come from omega-6-rich refined oils and obese meat,9 which means the modern diet is really the “PGE2/cancer diet.”

It is also well-known that modern man consumes excessive amounts of refined carbohydrates with high glycemic indexes/loads. Approximately 20 percent of our calories come from sugar and another 20 percent from refined flour.9 Research has demonstrated that cancer cells actually survive on sugar. In fact, “cancer cells are addicted to aerobic glycolysis.”10 The details of the chemistry related to this phenomenon are elegantly described in two excellent papers.10-11

The short story is that mitochondria are the key executors of normal cell turnover. Without normal functioning mitochondria, cell apoptosis is prevented. The cancerous process involves the “silencing” of mitochondria, such that they are unable to push apoptosis and so cancer cells become immortal.11 Cancer cells can only survive on glycolysis, so they require a constant supply of sugar, which is generously supplied by the modern diet. Interestingly, fasting and ketogenic diets appear to have cancer-preventing properties.10

Sixty percent of calories in the current modern diet come from refined omega-6 oils, sugar, and flour, all of which feed the cancerous process. This means that the average American is pursuing cancer as a dietary goal. If you, colleagues, or patients, find this to be a disagreeable concept, read the cited papers and you will see that it is true, which means that much suffering on the part of patients and family members can be prevented. We need to stop feeding cancer and other chronic diseases the food they love.

This type of information is no longer relegated to conspiracy theorists in health food stores, as made evident by the relevant citations in this paper. Additionally (and surprisingly), even the mainstream media is now reporting that sugar is a driver of cancer and stimulates the same “addiction pathways” in the brain as cocaine.12

References

  1. Buttar NS, Wang KK. Mechanisms of disease: carcinogenesis in Barrett’s esophagus. Nat Clin Pract Gastroenterol Hepatol, 2004;1(2):106-12.
  2. Nathoo N, Barnett GH, Golubic M. The eicosanoid cascade: possible role in gliomas and meningiomas. J Clin Pathol, 2004;57;6-13.
  3. Kerr DJ. “Can Aspirin Slow Cancer Progression?” Medscape Today, Feb. 12, 2012.
  4. Rosenberg L, Palmer JR, Zauber AG, Warshauer ME, Stolley PD, Shapiro S. A hypothesis: nonsteroidal anti-inflammatory drugs reduce the incidence of large-bowel cancer. J Natl Cancer Inst, 1991;83(5):355-8.
  5. Norrish AE, Jackson RT, McRae CU. Non-steroidal anti-inflammatory drugs and prostate cancer progression. Int J Cancer, 1998;77(4):511-5.
  6. Smalley W, Ray WA, Daugherty J, Griffin. MR. Use of nonsteroidal anti-inflammatory drugs and incidence of colorectal cancer: a population-based study. Arch Intern Med, 1999;25;159(2):161-6.
  7. Langman MJ, Cheng KK, Gilman EA, Lancashire RJ. Effect of anti-inflammatory drugs on overall risk of common cancer: case-control study in general practice research database. Brit Med J, 2000;320:1642-46.
  8. Bulun SE, et al. Regulation of aromatase expression in breast cancer tissue. Ann NY Acad Sci, 2009;115:121-31.
  9. Cordain L, et al. Origins and evolution of the Western diet: health implications for the 21st century. Am J Clin Nutr, 2005;81(2):341-54.
  10. Klement RJ, Kammerer U. Is there a role for carbohydrate restriction in the treatment and prevention of cancer? Nutr Metab, 2011;8:75.
  11. Seyfried TN, Shelton LM. Cancer as a metabolic disease. Nutr Metab, 2010;7:7.
  12. “60 Minutes.” Dr. Sanjay Gupta reporting the on the disease-driving nature of refined sugar. www.cbsnews.com/video/watch/?id=7403942n

A Nonsurgical Approach for Treating Meniscus Injury

By Warren Hammer, MS, DC, DABCO

Patients occasionally enter the office with a torn meniscus of the knee. In these cases, it is important to determine if they could respond to conservative care. Meniscal tears may be either traumatic or degenerative, and degenerative tears are closely associated with osteoarthritis.

 

Based on symptomatology, examination and age, one might consider a degenerative meniscal tear from a plain X-ray, but acute tears do not have any specific radiographic findings.1

 

While magnetic resonance imaging (MRI) is considered the best method for visualizing the knee meniscus, the tear appearing on MRI has no significant basis unless it is based first on the history and physical examination. Between 36-76 percent of asymptomatic patients show tears on MRI and the percentage greatly increases with age. Asymptomatic patients older than age 65 show meniscal tears at a 67 percent rate, and tears are prevalent in 86 percent of patients with symptomatic osteoarthritis.2 Since asymptomatic meniscal tears are common, it is essential that a practitioner be certain that the meniscal tear is the source of the patient’s pain.

knee pain One of the most important factors with conservative vs. surgical care is the location of the tear with regard to meniscal vascularity, since the areas of the meniscus with the most vascularity have the greatest ability to heal. The periphery of the menisci is where the blood supply originates (perimeniscal capillary plexus), which derives its supply from the outer medial and lateral geniculate arteries.

Only the peripheral 25-30 percent of the meniscus is vascularized,1 leading to a division of the meniscus with regard to its circulation. The outer third is called the red-red zone, the middle third is called the red-white zone and the remainder of the internal zone (adults) is called the white-white zone. In the red-red zone, bleeding can result in the formation of fibrovascular scar tissue and attract anabolic cells due to cytokines released during the inflammatory phase. The red-white zone has less vascularity and healing potential is therefore less. The white-white zone receives nutrition from synovial fluid by passive diffusion, which can be stimulated by knee joint motion, but since a healing response is not created, the prognosis is poor regarding surgical repair in this zone.

Healing is influenced by the pattern of the tear and the type of vascularity. Longitudinal tears heal better than radial tears. Simple tears heal better than complex tears. Traumatic tears have higher healing rates than degenerative tears, and acute tears heal better than chronic tears.3

Of the many tests used to diagnose a meniscal tear, tenderness at the medial joint line scores highest in terms of accuracy (76-86 percent), the Apley grinding test 46 percent, painful hyperextension 43 percent, Steinmann I sign 42 percent, and McMurray test 35 percent. Most meniscus tests attempt to trap abnormally mobile fragments of the menisci between the femur and the tibia, causing either pain or clicking; but the use of joint-line tenderness in patients with both a meniscus tear and an acute anterior cruciate ligament tear has been shown to be completely unreliable. Joint-line tenderness is most reliable when the tenderness is localized to the posteromedial or posterolateral corner of the knee, since anterior joint-line tenderness is usually present with patellofemoral disease.4

A simple “squat test,” whereby the patient raises and lowers themselves from a crouched position, is more indicative of a patellofemoral problem as long as the squat is less than 90 degrees flexion. In 90 degrees knee flexion, 85 percent of the joint load is transmitted through the menisci.4

A particular soft-tissue method I have found beneficial over the years for meniscal tears relates to the treatment of peripheral tears. Free nerve endings of the meniscus are only found on the peripheral one-third, and since palpation of the meniscus at the joint line seems to be the most acceptable test for determining a meniscal lesion, you might assume that the lesion may be more peripheral where the circulation is most prominent.

For the medial joint-line tender area, if it is the right knee, flex the patient’s knee 90 degrees and externally rotate the foot and tibia to open up the medial space. Externally rotating the foot also puts pressure on the medial meniscus tear from the medial femoral condyle. Internally rotate the foot and tibia for a lateral tear. Use friction massage with your finger or Graston Technique over the area until you feel a marked decrease in tissue density. (This might take up to 5 minutes.) Do not repeat this treatment for at least five days.

Pain during knee flexion implicates the posterior horns. Pain with extension implicates the anterior horns. Internal rotation tests the lateral meniscus while external rotation tests the medial meniscus.

Manipulation may be performed within the first 24 hours of acute locking (swelling may prevent manipulation) or in chronic locking. Mennell describes a manipulation for a medial-locked torn meniscus as follows.4 He states that in all his years of treating meniscal locking by manipulation, he has never had to treat a lateral lock.

  1. Standing on the supine patient’s left side, flex the patient’s left knee approximately 110 degrees.
  2. Put your left forearm over the patient’s lower tibia and medial malleolus, grasp the calcaneus with the hand and then externally rotate the foot (the entire procedure may also be attempted with the foot internally rotated).
  3. With the right hand, steady the knee with a minor valgus stress. It is important that the tibia remain in a sagittal neutral position (no varus or valgus) during the entire manipulation.
  4. Fully flex the knee, literally kicking the knee into the buttock.
  5. If locking is not immediately reduced, the patient should be referred to an orthopedist.

Estimation of the severity of the lesion, the age of the patient, the degree of knee instability, and the patient’s occupation all have significance in determining whether conservative treatment may be attempted. Prolonged loss of knee extension, chronic severe pain, locking, and swelling are definite indicators for possible surgery. An acute injury in young patients (usually in their 20s) should always make one suspect more than just the isolated meniscus lesion. Usually there is pain, swelling, giving way and locking. Often the meniscus tear is associated with an MCL or ACL lesion.

In an athlete, an acute meniscus lesion usually prevents the individual from walking off the field unaided. (This is not the case with an isolated ligamentous injury.) The patient usually complains of a giving way at the time of injury. The meniscus may displace, causing an immediate loss of extension. Patients with medial meniscal tears create a knee locking at 10-30 degrees of flexion, while laterally displaced meniscal tears lock in greater degrees of flexion, especially posterior tears at more than 70 degrees.

Pain at extreme knee extension is affecting the anterior horn, while pain at extreme knee flexion is affecting the posterior horn. The pain in a medial meniscus injury is more often in the posterior medial or medial joint line and is rarely localized anteromedially. Lateral meniscus joint line pain is more often midlateral than posterolateral.4

A degenerative tear of the meniscus in an older patient (40 years or older) is more likely to be an isolated lesion. Older individuals may develop a tear for no apparent reason or feel it as they arise from a chair. If they develop chronic symptoms, they may present with thigh atrophy and weakness associated with pain, effusion, and giving way.

An isolated meniscus lesion will develop mild effusion gradually over a few days, compared with the almost immediate swelling of an anterior cruciate lesion, although swelling can be rapid in a meniscus tear if it occurs in the peripheral vascular zone. If the swelling occurs a day or so later, the tear is probably in the nonvascular central meniscal area. Immediate locking (loss of knee extension) may occur, especially if a bucket-handle tear (longitudinal type) occurs.

Failure to extend the knee may be due to eventual effusion (hamstring spasm and pseudo-locking), so it is important to question the patient to find out whether it was possible to extend the knee fully immediately after the injury. Rarely, a posterior vertical tear of the lateral meniscus will cause a locking in full flexion.4 The majority of the time, knee locking occurs in extension. Of course, rehabilitation, stretching and strengthening should be included with a conservative approach.

References

  1. Mazak TG, Fabricant PD, Wickiewicz TL. Indications for meniscus repair. Clinics in Sports Med, 2012;31(1):1-14.
  2. Greis PE, Bardana DD, Holmstrom MC, et al. Meniscal injury: basic science and evaluation. J Am Acad Orthop Surg 2002;10(3):168-76.
  3. McCarty E, Marx RG. Meniscal tears in the athlete. Operative and nonoperative management. Phys Med and Rehab Clin North Amer, 2000;11(4):867-878.
  4. Hammer W. Functional Soft Tissue Examination and Treatment by Manual Methods, 3rd Edition. Jones & Bartlett: Sudbury, MA, 2007.

Laughter And Health: What Laughing Does For Our Bodies (INFOGRAPHIC)

When was the last time you had a true, honest-to-goodness laughing jag? The kind where your mouth and stomach hurt from the amazing pain of hilarity, even if you can’t quite remember what started it in the first place? Well, it might be time to get back to that place.

Many studies have linked a positive outlook on life with increased longevity, and a ‘sense of humour’ is one of the top attributes cited when looking for a mate. But what are all those chuckles actually doing for your body?

The folks at Greatist.com have put together an infographic spelling it all out — in anatomically correct detail. Take, for example, issues with the thyroid, which can be aggravated by stress. Start to laugh, stress starts to dissipate — and your immune system receives a much-needed boost.

But what about those who don’t have a strong sense of humour, or find it difficult to laugh? You could start with movies or TV as a test stage for what you find funny, as suggested by David Laing, a clinical hypnotic consultant based in the U.K. But we prefer his easier-to-implement suggestion of ‘faking it until you make it’: “Smile more often, and fake laughter; you’ll still achieve positive effects, and the fake merriment may lead to the real thing.”

Check out the ways in which laughter can lead to great benefits for your body — and find something to giggle about today: