Dear Colleague:
The SOT Quarterly Research Update:
Supplement is a service offered by SOTO-USA to keep doctors who may be
familiar with sacro occipital technique (SOT) aware of the latest
research related events, papers, and concepts affecting our practices.
Please contact me directly at drcblum@aol.com
if you are aware of others who might be interested in receiving this
quarterly newsletter.
The Research Agenda for Chiropractic
(RAC) / Association of Chiropractic Colleges (ACC) Conferences offer an
amazing opportunity to meet with the foremost chiropractic researchers,
college instructors and administration where the pulse of
chiropractic's future research can be palpated.
The purpose of this update is to
share some of the latest research presented at this conference and
offer some commentary about how this might relate to SOT practitioners.
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Clinical Practice in an
Integrative Environment
Presentations by Ian
Coulter, PhD, William Morgan, DC, Arlan Fuhr, DC.
Each of these doctors have had extensive experiences working
in an integrative environment and shared their wisdom at the
conference. Dr. Coulter illustrated how when forming an integrative
health center a review process is needed to assure a center's financial
success as well as creating a comfort level for the allopath to ensure
referrals and collaboration with chiropractors.
Dr. Morgan discussed his relationship working in military
hospitals/clinics and particularly emphasized a type of care called,
"synchronized care" which involves mutual trust between healthcare
professions working towards delivering the most appropriate care for
patients while minimizing procedures causing patients increased risk.
Dr. Fuhr discussed how to integrate chiropractic care into a
clinic for an underprivleged/underserved community as well as starting
a relationship with the Veterans Administration and developing
relationships with associated allopaths and related health
practitioners.
Gary Globe, MBA,DC, PhD (Cleveland Chiropractic College) has
developed some opportunities for chiropractic interns to participate in
multidisciplinary clinics in the Los Angeles area. From the current
complementary centers and his past experience he has found that, in
general, the medical profession is not as opposed to utilizing
chiropractic care as one might readily imagine. The key is
understanding that chiropractic assessment and care must fit into the
medical paradigm and that understandable biomechanic rational treatment
must be communicated. Once medical providers can be assured that
chiropractors will not be treating inappropriately and understand how
to perform as a multidisciplinary team member as well as focus on
demonstrating functional improvement in their patient's musculoskeletal
condition, then the foundation for trust and collaboration can be
achieved.
Dr. Globe has found that while initially this might seem
restrictive, the first step might be to show our success in
non-complicated neck and low back conditions. Then once clinical
success can be shown with these patients, the doors for trust and
communication can be opened into other areas where chiropractors are
successful as well.
Sacro Occipital Technique (SOT) is attempting to take steps
towards developing an integrative approach for healthcare interventions
not commonly considered. Some studies incorporating SOT care into
co-treatment with cardiologists,
oncologists,
and dental
practitioners have begun the process to build bridges towards
mutual trust and understandings between our varied professions.
SOTO-USA’s relationship with The
Alliance of TMD Organizations (an alliance of dental organizations
specializing in treatment of temporomandibular disorders) has led to
future possible research relationships with Tufts University College of
Dentistry. NYCC's
“The Art of Chiropractic: A Symposium on Chiropractic Technique” this
April 21-22, 2007 will feature a presentation discussing SOT and
the ability to function in a Complementary Alternative Medicine (CAM)
setting working together with a team of allied health practitioners.
RAC
/ACC Conferences March 2007 • Click Here
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Metastatic Disease
Can Chiropractic Play a
Role in Diagnosis?
Lisi AJ, Mara G, Undiagnosed metastatic disease presenting
as mechanical spinal pain. J Chirop Edu. Spr 2007;21(1):68.
Three cases of undiagnosed metastic diseases were referred
to a chiropractic clinic for treatment of mechanical spinal pain. Two
patients presented with lower back pain and one complained of thoracic
spine pain, all were over 50 years old and two had a history of cancer.
Interestingly all were seen by at least two medical physicians and had
radiographs with negative x-ray findings. Due to the red flags (over
50, history of cancer) and a clinical "feeling" that the patient's
presentation, pain levels, and history did not make the clinician feel
comfortable with the presenting diagnosis, referral was made for more
studies.
Other related articles discussed this phenomena, where a
patient's presenting symptoms did not seem typical and also led to an
early referral for more extensive studies.
Pringle
RK, Wyatt LH, Two Patients With Mechanical Back Pain Or Cancer? A Case
Report J Chiropr Educ: Spr 2004
(18:1): 81-82.
Blum
CL, Incongruent Sacro-Occipital Technique Examination Findings: Two
Unusual Case Histories. J Chirop Edu: Spr 2002(16:1):67.
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Patients Under Oncological
Care
Can Chiropractic Offer an
Opportunity for Cotreatment?
Osterbauer PJ, Management of mechanical back pain in a
patient with carcinoma of the bladder. J Chirop Edu. Spr
2007;21(1):115.
This case study illustrated how chiropractic care may assist
patients with multimorbidity. A 71-year-old female presented with
chronic lower back and leg pain which limited her ability to walk and
relied on two to three Tylenol #3 per day to manage her pain. Her
presenting health problems included: active bladder carcinoma,
diabetes, hypertension, fecal/
urinary incontinence, left knee replacement (twice), cervical
radiculopathy, hypothyroidism, emotional abuse, and hearing/vision
loss. Following two weeks of instrument assisted adjusting in a seated
posture her lower and mid back pain reduced significantly for her to
discontinue pain medication.
Holbeck M, Tomson A, Blum,
CL, Monk R, Effects of the
sacro-occipital technique on the quality of life in a lung cancer
patient undergoing chemotherapy and radiation treatment. J Chirop Edu.
Spr 2007;21(1):108.
A 57-year-old female patient undergoing chemotherapy and
radiation therapy for lung cancer was seen for chiropractic treatment
for gastrointestinal discomfort secondary for the oncological care she
was receiving. Sacro occipital technique (SOT) chiropractic
manipulative reflex technique (CMRT) was used to balance
viscerosomatic/somatovisceral reflexes associated with the stomach,
lungs and diaphragm along with some nutritional supplementation. The
patient noted that while receiving CMRT care, her digestive
disturbances were significantly lessened and occasionally completely
alleviated while receiving chemotherapy and radiation therapy.
Of significance is that co-treatment of patients presenting
with various comorbidities such as cancer may be viable options for
allopathic and chiropractic collaborative efforts. Commonly patients
are reaching their pharmaceutical limits and allopathic physicians are
looking for options to help patients so that if they cannot be helped
at least they might be made more comfortable. It may be that
chiropractic can offer options for improving patient's quality of life
in cases of patients undergoing care for cancer assuming the oncologist
is clear that the chiropractic care will not make the patient's
condition worse.
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The Meric System - Myth or
Mechanism?
 The Meric System of analysis, relating muscles (myomeres) and
organs (viscemeres), was reviewed and its rational analyzed through a
search of published studies in the scientific literature. Two criteria
were used for study inclusion: (1) Spinal manipulation was applied to
specific spinal levels that corresponded to the autonomic innervation
of a particular visceral organ, and (2) Outcome measures correlated to
expected functional changes of same visceral organ. Thirteen clinical
trials were identified, (6 = blood pressure or heart, 4 = asthma or
respiration, and 3 = dysmenorrheal) four studies fit both criteria,
with three of those reporting significant effects of spinal
manipulation. They concluded that "The Meric System is a reasonable
hypothesis to explain some effects of subluxation on visceral organs 1."
While the Meric System has been widely taught in chiropractic
for the past century, its minimal support in the research makes further
study into the validity of this theory worthwhile. Nansel and Szlazak
in their 1995 article discussing visceral mimicry syndrome went to
great lengths to discredit the Meric System's premise 2.
Also the diffuse nature of referred visceral pain along with varied
referred pain patterns from the parietal peritoneum or sympathetic
visceral pain fibers from the organ can lead to great difficulty making
discrete neural pathways for visceral dysfunction.
SOT uses a method of care for treatment of
viscerosomatic/somatovisceral reflex and referred pain patterns
associated with purported vertebral – visceral relationships.
DeJarnette used a modified Meric System within the system of CMRT
incorporated referred pain pathways and relationships between pain
along specific points along the suboccipital muscle and related
vertebra. If the Meric System is going to be used in the field of
chiropractic as a way of understanding viscerosomatic influences,
greater "controlled clinical trials should be designed and conducted to
test this hypothesis 1."
1. Tobias GS, Sikorski D, Kizhakkeveettil A, The Meric System
- Myth or Mechanism? J Chiro Ed. Spr 2007; 21(1): 125.
2. Nansel
D, Szlazak M.] Somatic dysfunction and the phenomenon of visceral
disease simulation: A probable explanation for the apparent
effectiveness of somatic therapy in patients presumed to be suffering
from true visceral disease. J Manipulative Physiol Ther. 1995
Jul-Aug;18(6):379-97.
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Dermatomes: Does Pain
Follow Radicular Patterns
Murphy DR Hurwitz EL,Gerard JK, Clary R, Pain patterns and
descriptions in patients with radicular pain: Does the pain necessarily
follow a specific dermatome? J Chiro Ed. Spr 2007; 21(1): 74.
Two hundred twenty-two nerve roots in 222 patients were
assessed in patients presenting with "objective" signs of radiculopathy
(e.g., MRI showing specific level nerve root entrapment or nerve
conduction studies). Pain related to cervical radiculopathy was
nondermatomal in 69.7% of cases and pain related to lumbar
radiculopathy was nondermatomal in 64.1% of the cases. Of significance
was that with a S1 radiculopathy, dermatomal patterns of pain was
relatively sensitive and specific. Further studies would need to
evaluate muscle strength, deep tendon reflexes, numbness and whether
normal variants affect pain radiculopathy. Also current research is
questioning whether discopathy is an indicator of pain generation or if
radiculopathies are even necessarily related to discopathies.
If common somatic pain generators are now being found to be
either less than discrete or not following clear pathways, it is no
wonder that mapping of more diffuse nerve pathways, such as with
viscerosomatic/somatovisceral referred pain, would likewise be
difficult to clearly ascertain in a reproducible reliable manner. With
all that being said practitioners need some starting point to help
develop plausible diagnostic procedures and at this time with
understandable limitations for many doctors the "Meric System" and
commonly understood dermatome patterns in the cervical or lumbar region
offer some a beginning focus of analysis.
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Sacro Occipital Technique
Organization - USA is a non-profit, professional organization formed to
promote the awareness, understanding and utilization of the Sacro
Occipital Technique method of chiropractic as founded and developed by
Dr. Major Bertrand DeJarnette.
While all research conferences offer
great opportunities to learn and share the RAC/ACC is one that tends to
reach a broad spectrum of researchers, faculty, administrators and
private practitioners. Since Dr. DeJarnette emphasized the need for
research it is important for all SOT chiropractors to be open to
inquiry and coming to research conferences is a way to challenge our
boundaries.
If you ever have a desire to submit a
paper relating to SOT to a research conference please do not hesitate
to contact me for any assistance that I might offer.
Thank you for your dedication and interest
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