Supporting a Complex Position

by: Lisa K. Bloom, DC, DACS, DIBCN

More than a century ago Daniel David Palmer set his hands to the spine of Harvey Lillard and, in Palmer’s own words, “racked (vertebrae) into position by using the spinous process as a lever.” (1) At the time, Palmer had no philosophy, no science, and no semblance of what was to be the art of chiropractic – yet a deaf Harvey Lillard reportedly found his hearing restored shortly after this first chiropractic adjustment. It appears that Lillard was selected as a subject for Palmer’s experiment because of his deafness. Palmer in the truest sense practiced medicine without a license when he used his manual treatment for the purpose of affecting a specific condition, and he was successful.

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As history tells us, Palmer’s systematic investigation for the cause of all disease revealed that various health problems frequently resolved or abated while undergoing chiropractic care. It was this success, combined with his knowledge of neurology, that led Palmer to the premise that the presence of subluxation, and therefore the chiropractic adjustment, could affect all systems of the body. Definitions of the vertebral subluxation and the statement of purpose of chiropractic care – as established by the Association of Chiropractic Colleges, the American Chiropractic Association, and the International Chiropractic Association – all contain a phrase which infers that we intend to affect all body systems and impact general health. In spite of history and the standards we set by our own definitions, the current political climate within the chiropractic profession can be summed up by the following statement:

“The issue of whether chiropractors have a role in the management of patients with visceral disorders is so sensitive politically, and open to exploitation by others saying this is evidence of unscientific practice, that some have questioned whether or not it might be better for the general advancement of the profession to jettison all claims in this area.” (2)

This statement underscores the sacrifices a portion of the chiropractic profession is willing to make for the sake of acceptance into a medical model of healthcare that medicine itself is changing. It is also curious that medical specialists who practice spinal manipulation have noted the ability to influence conditions other than back pain. (3,4)

The other side of the story is equally interesting. Investigations by medical doctors in the 1930s revealed a “viscerospinal syndrome” which involved the symptoms of asthma, angina, dysuria, pyloric and esophageal spasm. The physicians noted x-ray and physical examination evidence of scoliotic changes, changes in lordotic and kyphotic curves of the spine and evidence of leg length inequality. When the musculoskeletal abnormalities were addressed and treated, a relief or resolution of the apparent visceral symptomatology resulted. (5-7) A 1954 study demonstrated that irritation to spinal structures resulted in pallor, diaphoresis, nausea, bradycardia, and syncope. Of note is that these symptoms were most prevalent in subjects who concurrently complained little of the pain. (8) It has since been demonstrated in animal and human models that irritation (noxious stimulation) to spinal structures produces changes in sympathetic nervous system activity, resulting in measurable changes in the function of the target tissue. (9-17)

A myth often generated about the chiropractic profession is that there is no scientific research to substantiate chiropractic treatment. When the profession is without an evidenced-based knowledge base, we have no choice but to concede. The purpose of my lecture is to provide an accessible, evidence-based presentation that demonstrates and supports the biomechanical and neurological effects of the vertebral subluxation complex and provides a focused source containing the current research available.

David Chapman-Smith stated, “at one end of the spectrum some chiropractors continue to make outrageous claims, at the other end some avow that chiropractors should only treat patients for musculoskeletal pain.” (18) In order to appropriately respond to this statement, we need an evidence-based, contemporary understanding of the vertebral subluxation. In addition, we need to bring the profession up-to-date, facilitate inter-professional communication, and provide the information necessary to document the need for and the basis of chiropractic care.

Dr. Lisa Bloom is a Diplomate of the International Board of Chiropractic Neurology and holds a Diplomate in Applied Chiropractic Sciences. She has lectured nationally on various topics in neurology and has been the recipient of numerous awards. Dr. Bloom is an Associate Professor in the Department of Diagnosis and Clinical Sciences at New York Chiropractic College.

References

1. Palmer DD. The Science, Art, and Philosophy of Chiropractic. Davenport, IA: Palmer College of Chiropractic, 1910:18.
2. Jamison JR. Chiropractic referral: In search of criteria upon which medical practitioners agree to refer for chiropractic care. Chiropractic Journal of Australia 1991; 15:13-18.
3. Lewitt K. Manipulative Therapy in Rehabilitation of the Locomotor System. London: Butterworth and Co., 1985:336-342.
4. Kunert W. Functional disorders of internal organs due to vertebral lesions. CIBA Symposium 1965; 13(3):85-96.
5. Ussher NT. Spinal curvatures: Visceral disturbances in relation thereto. California West Medicine 1933; 38:423-428.
6. Ussher NT. The viscerospinal syndrome: A new concept of visceromotor and sensory changes in relation to deranged spinal structures. Annals of Internal Medicine 1940; 54:2057-2090.
7. Will I, Atsatt RE. The viscerospinal syndrome: A confusing factor in surgical diagnosis. Archives of Surgery 1934; 29:661-668.
8. Feinstein B. Experiments on pain referred from deep somatic tissues. Journal of Bone and Joint Surgery 1954; 36A(5):981-997.
9. Budgell B et al. Spinovisceral reflexes evoked by noxious and innocuous stimulation of the lumbar spine. Journal of the Neuromusculoskeletal System 1995; 3:122-131.
10. Ibid.
11. Kametani H et al. Neural mechanisms of reflex facilitation and inhibition of gastric motility to various skin areas in rate. Journal of Physiology 1979; 294:407-418.
12. Kimura A et al. Somatocardiovascular reflexes in anesthetized rats with the central nervous system intact of acutely spinalized at the cervical level. Neurosciences Research 1995; 22:297-305.
13. Adachi T et al. Cutaneous stimulation regulates blood flow in the cerebral cortex in anesthetized rats. Neuroreport 1990; 1:41-44.
14. Budgell B, Sato A. Somatoautonomic reflex regulation of sciatic nerve blood flow. Journal of the Neuromusculoskeletal System 1994; 4(2):171-177.
15. Sato A, Swenson RS. Sympathetic nervous system response to mechanical stress of the spinal column in rats. Journal of Manipulative Physiological Therapeutics 1984;7(3):141-147.
16. Kimura A et al. Somatic afferent regulation of cytotoxic activity of splenic natural killer cells in anesthetized rats. Japan Journal of Physiology 1994; 44:651-654.
17. Harris W, Wagner R. The effects of chiropractic adjustments on distal skin temperature. Journal of Manipulative Physiological Therapeutics 1987; 10(2):57-60.
18. Chapman-Smith D. The Chiropractic Report 1997; 11(3).