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To determine if there is an association between a test commonly used by chiropractors as a sign of subluxation/joint dysfunction – supine leg length alignment (LLA) asymmetry – and health-related quality of life as measured by the SF-12 questionnaire, in a non-clinical population.
Volunteers answered the SF-12 and background questionnaires and were then examined for supine LLA by a chiropractor blinded to their answers.
Gatherings of people in the general population.
Fifty-five unscreened volunteers.
Chiropractor with approximately 20 years of clinical experience.
Main Outcome Measures:
The association of supine LLA asymmetry with general health based on the two summary scores – physical (PCS) and mental (MCS) – of the SF-12.
There were 27 volunteers with LLA asymmetry, they had a mean PCS of 49.6 and a mean MCS of 47.9. In the no – LLA asymmetry group (n=23) the mean PCS was 50.8, and mean MCS of 54.0. A multiple regression analysis found that of the variables gender, age, back pain (current/former) and LLA asymmetry, the only factor to approach significance with the SF-12 MCS/PCS was the presence of LLA asymmetry. A t-test found there was a significant difference (p=0.017) in the MCS between the supine LLA asymmetry and no-LLA asymmetry groups.
This pilot study suggests that in this group of volunteers (n=50) from the non-clinical general population, those who demonstrated a commonly used sign of subluxation/joint dysfunction – supine leg length alignment asymmetry – had a significantly (P=0.017) lower measure of general health as determined by the SF-12 survey than those volunteers without such asymmetry. Further investigation to clarify this relationship and to establish whether there is a connection between the putative entity of chiropractic subluxation and unloaded leg length alignment asymmetry is recommended.
Leg Length Inequality (Short/Long Leg)
The supine leg check as a determinant of physiological/postural leg length inequality: a case study and analysis leg length inequality (LLI) Knutson, Gary A., Chiropractic Research Journal, Vol. VII, No. 1, Spring 2000.
This paper presents a case study of imposed leg length inequality following total hip replacement surgery and compares and contrasts methods used to determine anatomic and physiologic or postural LLI.
It is proposed that, within certain parameters, nonweight-bearing postural leg checks are evidence of physiological or postural, and not anatomic, LLI.
Thermal asymmetry of the upper extremity in scalenus anticus syndrome, leg-length inequality and response to chiropractic adjustment. Knutson GA. Journal of Manipulative and Physiological Therapeutics 1997; 20(7):476-481.
Fourteen patients aged 8.8-20.8 years who had a history of wedge-shaped vertebral compression fracture at least one year prior were compared to 14 controls. The majority of the children who had the trauma had disc degeneration and endplate changes while only one of the 14 in the control group had degeneration with endplate damage.
Recurrent low back pain and early disc degeneration in the young. Salminen JJ, Erkintalo MO, Pentti J et al. Spine 1999; 24(3):1316-21.
Out of 1,503 14 year olds 7.8%, reported recurrent low back pain (LBP). The children had MRIs at 15 and 18 years of age and were questioned about their LBP at ages 15, 18 and 22. Those children who showed signs of disc degeneration at age 15 were 16 times more likely to report LBP at age 23.
The study concluded: “Individuals with disc degeneration soon after the phase of rapid physical growth not only have an increased risk of recurrent low back pain but also a long-term risk of recurrent pain up to early adulthood.”
Management of cervical disc herniation with upper cervical chiropractic care: a case study. Eriksen K. Journal of Manipulative and Physiological Therapeutics 1998 21(1):51-56.
A 34-year-old man with severe neck, lower back and radicular pain of 1 year duration had previously received care from multiple medical specialists with little or no results. An MRI of the cervical spine demonstrated a C6-C7 herniated nucleus pulposus. A needle electromyogram examination confirmed the presence of a C6-C7 radiculopathy with radiculopathic changes from C4-C7. X-ray analysis showed that the atlas and axis were misaligned. The patient was adjusted using Grostic procedures by hand. Within one month there were dramatic improvements in all subjective and objective findings At a one year follow-up it was concluded that surgery was not necessary.
Magnetic resonance imaging and clinical follow-up: study of 27 patients receiving chiropractic care for cervical and lumbar disc herniations Ben Eliyahu, DJ. Journal of Manipulative and Physiological Therapeutics Vol. 19 No. 19 Nov/Dec 1996.
Twenty-seven patients with MRI documented and symptomatic disc herniations of the cervical or lumbar spine were given chiropractic spinal care, flexion distraction, physiotherapy and rehabilitative exercises. Post-care MRIs revealed that 63% of the patients had a reduced or completely resorbed disc herniation. 78% of the patients were able to return to work in their pre-disability occupations.
L5 subluxation: a cause of interstitial cystitis. Hammer W. Dynamic Chiropractic, 1997 (April 7):14.
This is the case of a 28-year-old male who suffered from urinary frequency, perineal pain and mild low back and buttock pain. An MRI confirmed a lateral L5 disc bulge and a fixation at L5/S1. After two adjustments to the 5th lumbar vertebrae the patient’s pelvic and urological symptoms disappeared. The paper below discusses the same condition but because the authors are MDs they corrected the problems using surgery.
Lumbar nerve root compression and interstitial cystitis – response to decompressive surgery. Gillespie, L, Bray R, Levin R. British Journal of Urology, 1991;68;361-364.
This paper discusses ten patients with interstitial cystitis (nine females, one male). MRI revealed nerve compression at L5 and after surgery the symptoms in 9 of the 10 cleared up.
Reduction of a confirmed C5-C6 disc herniation following specific chiropractic spinal manipulation: a case study. Siciliano MA, Bernard TA, Bentley, NJ. Chiropractic: The Journal of Chiropractic Research and Clinical Investigation Vol. 8 No. 1 April 1992.
This is the case of a 39-year-old male cable technician who complained of right neck and arm pain. He had a football injury 20 years prior and had some similar, temporary pain at that time. He now had an aching, deep pain running from the base of his neck to the right elbow and sometimes running sharply down his arm. Magnetic resonance imaging (MRI), thermography and Kronamaz muscle testing apparatus documented a C5-C6 disc herniation. Under chiropractic care the patient became symptom free and a later MRI revealed a reduction in the herniation.
Low force chiropractic care of two patients with sciatic neuropathy and lumbar disc herniation. Richards GL et al. Am J Chiro Med Mar 1990;3(1):25-32.
Two patients with sciatic neuropathy and confirmed disc herniation received chiropractic care. A follow-up CAT scan in the first patient revealed complete absence of disc herniation. A follow up scan in the second case revealed the continued presence of a silent disc bulge at the L3-4 level and partial decrease in a herniation at the L4-5 level. The bulge appeared to have shifted away from the nerve root. Both patients’ pain levels decreased from severe to minimal as they regained the ability to stand, sit and walk for longer periods without discomfort and lifting also became easier. They were able to return to full time work capacity at three and nine months respectively.
Disc regeneration: reversibility is possible in spinal osteoarthritis. Ressel, OJ. ICA Review March April 1989 pp. 39-61.
Osteoarthritis has been regarded as a product of “wear and tear” of the spine. This paper reveals that chiropractic management of osteoarthritis can lead to its arrest and even reversal.
Low back pain and the lumbar intervertebral disc: clinical consideration for the doctor of chiropractic. Troyanovich SJ, Harrison DD, Harrison DE. Journal of Manipulative and Physiological Therapeutics, Feb. 1999; vol. 22, no. 2, pp 96-104.
This paper lists various causes of low back pain, noting what findings in patient histories, physical examinations, and diagnostic imaging represent “red flags” that indicate the need for referral to a specialist for surgical intervention.
After patients are screened for red flags, conservative treatment should be the first line of treatment for patients without absolute signs for surgical intervention. The authors concluded:
Chiropractic management has been shown through multiple studies to be safe, clinically effective, cost-effective, and to provide a high degree of patient satisfaction. As a result, in patients . . . for whom the surgical indications are not absolute, a minimum of 2 or 3 months of chiropractic management is indicated.
Reabsorption of a herniated cervical disc following chiropractic treatment utilizing the atlas orthogonal technique: a case report. Robinson, G. Kevin. Abstracts from the 14th annual upper cervical spine conference Nov 22-23, 1997 Life University, Marietta, Ga. Pub. In Chiropractic Research Journal, Vol. 5, No.1, spring 1998.
A 44 year old man with a herniated cervical disc as diagnosed by magnetic resonance imaging (MRI) and adjusted utilizing chiropractic care (atlas orthogonal technique) is discussed. His symptoms included severe neck pain, constant burning, left arm pain and left shoulder pain plus paresthesia in the index finger of the left hand. Patient also had diminished grip strength on left hand, a hyporeflexive biceps and triceps on the left as well as a C6 and C7 sensory deficit on the left. The MRI scan revealed a large left lateral herniated disc at the C6-7 level.
By the fifth week of care, the patient’s symptoms of severe neck, shoulder, and arm pain were completely resolved. The patient’s numbness and grip strength improved consistently during the following six months. Comparative MRI obtained 14 months following the initial exam revealed total resolution of the herniated cervical disc.
Treatment of multiple lumbar disc herniations in an adolescent athlete utilizing flexion distraction and rotational manipulation. Hession EF, Donald GD. J Manipulative Physiol Ther, 1993; 16:185-192.
This is the case of a 15-year-old high school athlete with acute low back pain that began after weightlifting in preparation for a football game. MRI demonstrated disc herniations of the lumbar area. Chiropractic care resulted in long-term resolution of the symptoms. Patient returned to playing football.
Correction of multiple herniated lumbar disc by chiropractic intervention. Sweat R. Journal of Chiropractic Case Reports. Vol. 1 No. 1 Jan 1993.
This is the case of a 39 year old patient presenting with severe pain in his lower back, radiating into the buttocks, the thigh and his left calf and foot. A herniated nucleus pulposus at L-4 L-5 and L-5 S-1 was confirmed by Magnetic Resonance Imaging (MRI) and surgical procedures were recommended. Chiropractic was begun utilizing the Atlas Orthogonal Percussion Instrument on the atlas vertebrae. After 4 weeks of care, he showed a 50% improvement and was not using medications. After six months of care a subsequent MRI radiologist’s report indicated that a herniation was not present.
Chiropractic adjustments, cervical traction and rehabilitation correct cervical spine herniated disc. Breakiron G. Journal of Chiropractic Case Reports. Vol. 1 No. 1 Jan 1993.
This is the case of a 43 year old female who suffered C5-6 and C6-7 nuclear herniations as a result of an automobile collision causing whiplash. She had a reversal of her cervical curve and extensive soft tissue damage and herniations as seen on magnetic resonance imaging (MRI). Specific spinal adjustments were administered and a therapeutic exercise program was prescribed along with cervical traction and soft tissue rehabilitation. After 6 months, a repeat MRI revealed that there was a mild posterior bulging of the C5-6 level in the mid line with no evidence for significant disc herniation. The C5-6 area appeared normal.
Lumbar intervertebral disc herniation: treatment by rotational manipulation. Quon, J.A., Cassidy, J.D., O’Connor, S.M., & Kirkaldy-Willis, W.H. Journal of Manipulative and Physiological Therapeutics 1989; 12: 220-227.
A 30 year old computer technician with an L4-L5 disc herniation had relief from back and leg pain after rotational adjustments. Interestingly, there was no change in the pre- and post-CT scans. Commenting on the type of adjustment performed, the authors write: “The treatment of lumbar intervertebral disc herniation by side posture manipulation is both safe and effective.”
Treatment of lumbar intervertebral disc protrusions by manipulation. Pang-Fu Kuo P, Loh Z. Clinical Orthopedics and Related Research, Feb. 1987; 215:47-55.
Out of 517 patients with protruded lumbar discs, 76.8% had satisfactory results. It was concluded that manipulation of the spine can be effective for lumbar disc protrusions.
Lumbosacral disc protrusion: a case report. Cox J.J Manipulative Physiol Ther, Dec. 1985; 8(4): 261-266.
Lumbar disc herniation: computed tomography scan changes after conservative treatment of nerve root compression. Delauche-Cavallier MC, Budet C, Laredo JD, et.al Spine, 1992; 17(8): 927-933.
This paper describes 21 patients with CT scan diagnosed lumbar disc herniation and nerve root pain. They began chiropractic care and a follow-up CT scan at least 6 months later showed the herniations reduced or disappeared in most patients.
Manipulative Therapy and Rehabilitation of the Locomotor System, second edition, Lewit, K. 1991. Butterworth-Heineman, Oxford, 272. Quoted in the Chiropractic Report July 1992. Vol. 6 No.5.
Spinal manipulation has been shown to successfully resolve disc problems without the need for surgery in most cases.
Chymopapain, chemonucleolysis and nucleus pulposis regeneration. A biochemical study. Bradford DS, Cooper KM, Oegema TR Jr. Spine, and Mar (2): 135-147, 1984.
This paper discusses the ability of the intervertebral disc to heal and regenerate itself.
Bourdillon JE, Day EA, Bookhout MR: Spinal Manipulation, 5th edition. Oxford, England, Butterworth-Heinemann Ltd, 1992.
“There is no doubt that surgery is occasionally the only satisfactory treatment for those with unequivocal signs of protrusion, and the more so with extrusion of disc material. There is also ample evidence in the experience of most manual practitioners to show that, even in the presence of such unequivocal evidence, relief may be obtained by conservative measures including manual intervention.”
Traction and manipulative reduction for the treatment of protrusion of lumbar intervertebral disc – an analysis of 1455 cases. Yefu L, Jixiang F, Zuliang L, Zhengian L. J Traditional Chinese Medicine. 1986; 6:31-3.
This paper documents 1455 cases of lumbar disc protrusion that were reduced by traction and manipulation.
Re-establishing the intervertebral disc by decompression. Neugebauer J. Med Welt 1976;27:19.
The author reports relief in 99% of 30,000 patients with disc protrusion over a 14-year period
Disc regeneration: reversibility is possible in spinal osteoarthritis. Ressel, OJ. ICA Review March April 1989 pp. 39 -61.
Osteoarthritis has been universally accepted as an integral consequence of aging. The condition is considered to be the product of various pathobiomechanical alterations in joint function, a “wear and tear” sequelae. Under chiropractic care this condition may be arrested and even reversed.
The author reports that usually two to three visits are required to solve bedwetting problems. He presents two case studies that are the extremes in number of adjustments.
1. Esta, a 4-year-old female, wet nearly every night. Subluxations were found at her sacrum, ileum, T3, T5 and cervical area. The next day her mother reported she was dry. She had no more problems with bedwetting from then on.
2. Aaron, a 5 year old male had pain in his feet in addition to nightly bedwetting. Subluxations were found in his sacrum, ileum, thoracic and cervical spine. In addition restrictions were found in the calcaneus vulgus of both feet.
Adjustments were performed. He no longer complained of foot pain and his mother reported that he was dry about half the nights since his previous visits. “Aaron required 10 more adjustments before his bedwetting totally resolved.”
Asthma and Enuresis. Zell, P. International Chiropractic Pediatric Assn. Newsletter May/June 1998
Case report #1374.
This is the case of a 7-year-old girl suffering from asthma and enuresis (bedwetting) brought to the chiropractor by her mother.
Since she was three years old she suffered from asthma along with many attacks of colds and flu. The asthma was so severe that she was hospitalized for 3 days at one time and had gone to the emergency room another time. The mother reports that her daughter would cough up a ball of phlegm following each attack.
Chiropractic examination revealed vertebral subluxation at C2, T5, T12 ileum and sacrum. She improved following her first adjustment. After the 5th adjustment the asthma and bedwetting ceased and did not return.
ADD, Enuresis, Toe Walking. International Chiropractic Pediatric Association Newsletter May/June 1997. From the records of Rejeana Crystal, D.C., Hendersonville, TN.
This is the case of a six-year-old boy suffering from nightly nocturnal enuresis (bedwetting), attention deficit disorder and toe walking. He walked with his heels 4 inches above the ground. The medical specialist recommended both Achilles’ tendons cut and both ankles broken to achieve normal posture and gait.
Chiropractic findings included subluxation of atlas, occiput, sacrum and pelvis.after 4 weeks of care both heels dropped 2 inches and the bedwetting frequency decreased to 2-3 times per week. His medical doctor was shocked at his recovery under chiropractic care.
Chiropractic management of primary nocturnal enuresis. Reed WR, Beavers S, Reddy SK, Kern G.J Manipulative Physiol Ther Vol. 17, No. 9 Nov/Dec 1994.
This was a controlled clinical trial of 46 enuretic (bedwetting) children that were placed under chiropractic care. The children were under care for a 10 week period preceded by and followed by a 2 week no treatment period.
The 46 children were divided into two groups: 31 received chiropractic care and 15 were in the control group.
At the end of the study, 25% of the treatment-group children had 50% or more reduction in the wet night frequency from baseline to post-treatment while none among the control group had such reduction.
Bed-wetting; two case studies. Marko, RB Chiropractic Pediatrics Vol 1 No 1 April 1994.
This is the case of a five-year-old female who had been wetting her bed for six months and was prescribed antibiotics for what MDs diagnosed as a bladder infection.
After the second chiropractic adjustment, she stopped wetting her bed for three weeks. She had a bad fall and began to wet her bed again. Following her next adjustment, she has remained dry.
This is the case of a nine-year-old male who wet his bed almost every day of his life. During his first six months of chiropractic care he would remain dry for one or two days after his adjustments. A change in adjustments to the sacrum resulted in greater improvement. He is now dry for one-half to two-thirds of the nights between the adjustments.
Functional nocturnal enuresis. Blomerth PR. Journal of Manipulative and Physiological Therapeutics 1994:17:335-338.
This is the case of an eight-year-old male bed-wetter. He was adjusted once in the lumbar spine. At a one month follow-up there was complete resolution of enuresis.
The child had two wet nights following a sports accident but was adjusted and the bed-wetting ceased. He had minor accidents one year and two years later, with enuresis starting again. In both instances the bedwetting ceased after adjustments.
The author remarks: “This happened in a manner that could not be attributed to time or placebo effect,” since the patient didn’t know that adjustments could affect that condition.”
Nocturnal enuresis: treatment implication for the chiropractor. Kreitz, BG, Aker PD. J Manipulative Physiol Ther 1994:17(7): 465-473.
A review of the literature of nocturnal enuresis is presented. The author states: “Spinal manipulative therapy has been shown to possess an efficacy comparable to the natural history.”
Epileptic seizures, nocturnal enuresis, ADD. Langley C. Chiropractic Pediatrics Vol 1 No. 1, April, 1994.
This is the case of an eight-year-old female with a history of epilepsy, heart murmur, hypoglycemia, nocturnal enuresis and attention deficit disorder.
The doctors told her mother that her daughter would never ride a bike or do things like normal children. She was wetting the bed every night, experiencing 10-12 seizures/day, with frequent mood swings, stomach pains and diarrhea. She was in special education classes for the learning disabled.
The child had been to five pediatricians, three neurologists and six psychiatrists. She had ten hospitalizations and had been on Depakote T, Depakene, T Tofranil T and Tegretol T.
Her birth was difficult (cesarean section under general anesthesia). Her mother was told the baby was allergic to breast milk and formulas and was on prescription feeding.
Chiropractic adjustments were to C1 and C2 three times/week. After two weeks of care, the bed-wetting began to resolve and was completely resolved after six months. During that period, her attention deficit disorder resolved and she left special education classes to enter regular fifth grade classes.
Her seizures diminished to 8-10 per week after one year of care. She was released from psychiatric care as “self managing.”
Her resistance to disease increased and she can now ride a bike, roller skate and ice skate like a normal child. She is expected to be off all medication within a month of this writing
Dear Abby. San Francisco Chronicle March 5th, 1992.
Although not a research study, this exchange of columnist “Dear Abby” addresses bed-wetting from a person-on-the-street perspective:
I took my 15-year-old twin sons (both daily bed-wetters) to a chiropractor, and within a month, both boys were completely cured. Regular medical doctors could not help them.” True Believer.
Dear True believer:
I believe you. I have several hundred letters bearing the same message concerning chiropractors
Chiropractic care of children with nocturnal enuresis: A prospective outcome study. LeBoeuf, C.; Brown, P; Herman, A; Leembruggen K; Walton D; Crisp TC. Journal of Manipulative and Physiological Therapeutics, 1991, 14 (2), pp. 110-115.
This is the study of 171 children with a history of persistent bed-wetting at night who received eight chiropractic adjustments each.
The average number of wet nights fell from 7 per week to 4 per week. At the end of the study, 25% of the children were classified as successes
Additionally 1% of patients were considered “dry” at the beginning of the study, while 15.5% were considered “dry” at the end of the study.
Management of pediatric asthma and enuresis with probable traumatic etiology. Bachman TR, Lantz CA Proceedings of the National Conference on Chiropractic and Pediatrics (ICA), 1991: 14-22.
This is the case of a 34-month-old boy with asthma and enuresis who had not responded to medical care.
He was brought to the hospital emergency room more than 20 times for his asthma attacks during a 12-month history.
The boy received three chiropractic adjustments over an 11 day period and the asthma symptoms and enuresis ceased for more than 8 weeks.
The asthma and enuresis recurred following a minor fall from a step ladder but disappeared after adjustments. After a two-year follow-up, the mother reports no recurrence of the asthma or the enuresis.
Enuresis, spasmodic dysmenorrhea and gastric discomfort: a vertebral subluxation complex entity. Regan KJ Dig Chiro Econ Mar/Apr 1990;32(5):110
This is a study of eight patients suffering from bed-wetting, menstrual cramps and ulcer pains/indigestion.
The patients had all been previously examined by MDs, had received pap tests, pelvic exams and upper GI studies and were negative for active pathology. One subject however did have a true peptic ulcer but wished to remain in the study.
The author writes: “A total of eight subjects in each category were selected and two in each category were not treated (to be used as control studies)..No one had any low back, dorsal or cervical spine pain prior to being a patient in this program.
Among those with menstrual problems, all cases of pelvic pain and severe cramping of the uterus had stopped. All women experienced three menstrual cycles through the duration of the study.
All the patients in the gastric category except one responded to chiropractic care; no one was taken off medication or put on special diet.”
Chiropractic management of enuresis: time series descriptive design. Gemmell HA, Jacobson, BH Journal of Manipulative and Physiological Therapeutics 1989; 12:386-389.
This is the case of a 14-year-old male with a long history of continuous bed-wetting. He never had a dry night in his life. The bell and pad method was tried but did not help.
Improvement began after the first adjustment. Over the next 21 days, he had 15 nights of dry bed and 6 damp nights, but not wet nights.
He continued to have dry, damp and wet nights. His condition was alleviated (not completely cured) by chiropractic adjustments.
Characteristics of 217 children attending a chiropractic college teaching clinic. Nyiendo J. Olsen E. Journal of Manipulative and Physiological Therapeutics, 1988; 11(2):78084.
The authors found that pediatric patients at Western States Chiropractic College public clinic commonly had complaints of ear-infection, sinus problems, allergy, bedwetting, respiratory problems, and gastro-intestinal problems.
Complete or substantial improvement of their chief complaint had been noted in 61.6% of pediatric patients, while 60.6% received “maximum” level of improvement. Only 56.7% of adult patients received “maximum” level of improvement.
Neurogenic Bladder and spinal bifida occulta: a case report. Borregard PE.J Manipulative Physiol Ther 1987; 10(3):122-3.
Examination found fixation in L3 and both SI joints, following the restoration of SI function the patient’s mother reported the patient was now aware of bladder distention approximately 30 minutes before it was necessary to void. A slight decrease of bladder sensitivity occurred 4 months after the release from treatment and responded immediately to manipulation.
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