Dural Connection Internet Edition Volume 2, Number 1

This is the fifth of a series of abstracts of published articles relating to
Sacro Occipital Technique and Cranial Manipulation. Please use these for
educating insurance companies, the judiciary, the legislature, the colleges
and the interested public.

There is a prevailing theory that research is completely objective. Ideally,
in the best case scenario, that is so. Regretfully, to complicate things,
research is always relative to who is doing the research, the motives of the
researchers, who is funding the research, etc. As Einstein pointed out in
his theory of relativity, everything is relative. As we, alternative
healthcare providers, stand on the train tracks and see the train (entrenched
traditional medical self interests) approach, we appear to wonder, "are we
approaching the train or is the train approaching us". This bit of
enlightenment would occur just before we were run over.

In the front page of most major newspapers an article about chiropractic's
ineffectiveness was displayed. My October 8, 1998 Los Angeles Times had an
article entitled "Chiropractic Success on Back Pain Disputed in Study.
Health: Treatment is called no more effective than benign neglect." As
chiropractic treatment of musculoskeletal pain is questioned also pointed out
is research questioning the value of chiropractic treatment for asthma. In
the Los Angeles Times article quoted is a Dr. Paul Shekelle, a West Los
Angeles internist and a Rand corp. analyst, co-author of several
dispassionate studies of chiropractic. The internist states that hopefully
these two articles will "temper some of the irrational exuberance on the part
of the chiropractic community and their patients for spinal manipulation".

The focus of this article is on chiropractic's treatment of asthma. It is
obvious that the "medical approach", or those who benefit from "debunking"
chiropractic care, is to view chiropractic treatment of asthma without open
minded scientific interest. Their focus is, "How can we prove that
chiropractic is of no help to the asthma patient?". Most chiropractors on
the other hand perform research based primarily on, "How can we prove that
the patients with asthma, that we are helping, have benefited from
chiropractic care?". "What methods improve outcomes and how can we improve
our chiropractic techniques so that they are more effective in caring for the
asthma patient?" As you might imagine these points of reference usually lead
to different conclusions, often diametrically opposed.

At least now chiropractic is beginning to have some research to combat those
who automatically assume that visceral conditions are not the terrain of the
chiropractic profession. However, with our advancement in the research
community we must also welcome all results of studies questioning
chiropractic care and respond to them open-mindedly. Research related
roadblocks or obstacles to chiropractic's advancement must be looked on as
opportunities for growth.

There have been some studies that are being used to question the care of
chiropractic for asthma:
In a study by, Balon, J, et.al, "A comparison of Active and Simulated
Chiropractic Manipulations as Adjunctive Treatment for Childhood Asthma", New
England Journal of Medicine , 1998 Oct. 8 ; 339(15):1013-20 The authors
concluded that, "In children with mild or moderate asthma, the addition of
chiropractic spinal manipulations to usual medical care provided no benefit".
91 children were used in this study and 11 chiropractors were chosen to
participate. No mention was made as to the type of chiropractic techniques
that were used or how the participating chiropractors were chosen.
Another study was performed by, Nielsen, NH, et.al, "Chronic asthma and
chiropractic spinal manipulations: a randomized clinical trial", Clin Exp
Allergy , 1995 Jan; 25(1):80-8. In this study it was concluded that, "Using
the cross-over analysis, no clinically important statistically significant
differences were found between the active and sham chiropractic interventions
on any of the main or secondary outcome measures. Objective lung function
did not change during the study, but over the course of the study,
non-specific bronchial hyper-reactivity improved by 36% and patient-rated
asthma severity decreased by 34% compared with the baseline values."

A survey of chiropractors in Australia was documented by, Jamison, JR, et.al,
"Chiropractic adjustment in the management of visceral conditions: a critical
appraisal" Journal of Manipulative and Physiological Therapeutics , 1992
Mar-Apr; 15(3): 171-80. Their objective was "to establish whether Australian
chiropractors regard spinal adjustment as an intervention option for patients
presenting with visceral conditions and to ascertain the preferred level of
adjustment for patients presenting with migraine, asthma, hypertension or
dysmenorhea." They concluded that "chiropractors continue to use spinal
adjustment in the management of visceral conditions despite this intervention
being regarded as an obstacle to the recommendation of public finding for
chiropractic services in Australia."

Another study was performed by, Vallone, S, Fallon, JM, Treatment Protocols
for the Chiropractic Care of Common Pediatric Conditions: Otitis Media and
Asthma, Journal of Clinical Chiropractic Pediatrics , 1997 ; 2(1): 113-5.
In this survey, of 33 chiropractors enrolled in the first year of a three
year postgraduate course in chiropractic pediatrics, several interesting
patterns emerged. "The first was that of the primary therapeutic modalities
employed by the chiropractors, spinal adjusting was the most common modality
used for both asthma and otitis media, The second was that a pattern emerged
identifying certain areas of the spine to which adjustments were most
frequently applied for each of these two conditions. The third was a
significant number of non-spinal adjustment modalities were employed by the
survey group and that these modalities are used with a high frequency."


Questioned in another study was whether those patients that sought
alternative health care for asthma did so because they were unhappy with
"orthodox" medicine. Donnelly, WJ, et.al, "Are patients who use alternative
medicine dissatisfied with orthodox medicine?" Medical Journal of Australia
, 1985 May 13;142(10): 539-41. Donnelly noted that "approximately 45% of
asthmatic families and 47% of non-asthmatic families had consulted an
alternative-medicine practitioner at some time. The most popular form of
alternative medicine was chiropractic ......" The findings of the study did
not "support the view that patients who use alternative medicine are those
who are disgruntled with orthodox medicine."

There have been some studies supportive of chiropractic therapies and/or
manipulative treatment for asthma which were published in peer reviewed
journals:
Vange, B, "Contact between preschool children with chronic diseases and
the authorized health services and forms of alternative therapy" [Article in
Danish], Ugeskr Laeger , 1989 Jul 10;151(28): 1815-8. In this study a survey
was performed and it was determined that one third of the sick children had
received alternative care as opposed to medical treatment. "The majority had
consulted chiropractors. 73% of the parents reported that the treatment had
been of benefit to their child. Among parents of asthmatic children who had
received chiropractic treatment, 92% considered this treatment beneficial." "
A tendency was observed towards less satisfaction with medical treatment,
information and general guidance concerning the illness among families who
sought alternative treatment."
Gillespie, BR, Barnes JF, "Diagnosis and treatment of TMJ, head and
asthmatic symptoms in children" Cranio , 1990 Oct;8(4): 342-9. The authors
suggest that, "the normal physiologic tension of the TMJ muscles, fascia,
ligament and associated structures is critical for the health of children.
Pathologic strain patterns in the soft tissues can be a primary cause of
headaches, neck aches, throat infections, ear infections, sinus congestion,
and asthma." Treatment modalities are presented from both dental and
physical therapy viewpoints to relieve and restore structural balance to the
TMJ muscles, fascia, ligaments, and associated structures which is believed
to aid the prior mentioned visceral conditions.
Paul, FA, Buser, BR, "Osteopathic manipulative treatment applications
for the emergency department patient", Journal of the American Osteopathic
Association , 1996 Jul;96(7): 403-9. "The emergency department setting
offers osteopathic physicians multiple opportunities to provide osteopathic
manipulative treatment as either the primary therapy or as an adjunct to the
intervention." The authors determined that asthma was among some "of the
illnesses in which osteopathic manipulative therapy should be implemented as
part of the management plan".
Bronfort, G, "Asthma and Chiropractic", European Journal of Chiropractic
, 1996 Apr; 44(1): 1-7. "The paper provides a brief overview of the current
understanding of chronic asthma and its treatment in adults and children, and
discusses the potential role of chiropractic in the management of this
condition. A summary of the results of a recently published randomized trial
on the efficacy of chiropractic spinal manipulation in adult asthmatics is
presented as well as information on two ongoing clinical studies of the
effect of chiropractic co-management of chronic childhood asthma."
Gioia, A, Chiropractic Treatment of Childhood Asthma, Journal of the
American Chiropractic Association , 1996 Oct; 33(10): 35-6.

Killinger, L, "Chiropractic Care in the Treatment of Asthma", Palmer
Journal of Research , 1995 Sep;2(3): 74-7. This paper presents a case study
of an eighteen year old subject with a two year history of bronchial asthma.
The patient received chiropractic care during a five year period and the
greatest improvement in health status was reported in the weeks immediately
following the chiropractic adjustments. "This case is interesting in that
trauma to the cervical vertebra coincided with the onset of asthma and the
chiropractic care focused on those regions coincided with improvement in that
condition."
Lines, D, "A Wholistic Approach to the Treatment of Bronchial Asthma in
Chiropractic Practice", Chiropractic Journal of Australia , 1993 Mar; 23(1):
4-8. "Three case studies involving two children and a mature adult with
established diagnoses of bronchial asthma are presented." This paper suggest
that a "broad-based management approach may lead to higher rates of response
to chiropractic treatment of asthma, as well as providing greater long-term
relief for its victims."
Nilsson, N, Christiansen, B, Prognostic factors in bronchial asthma in
chiropractic practice, Journal of the Australian Chiropractic Association ,
1988 Sep; 18(3): 85-7. "A retrospective case record based study of asthmatic
sufferers treated by chiropractic was carried out to determine the
characteristics which correlate with a beneficial outcome following treatment
of asthmatic sufferers by a chiropractor. There was evidence that some
asthmatic sufferers obtain perceived (subjective) benefit following spinal
adjustment (manipulations). Those most likely to report a benefit had less
severe asthma, young ages of asthmatic onset and had an average of 5
treatments over an average period of 1 month."
Lines, D, et al, Effects of soft tissue technique and Chapman's
neurolymphatic reflex stimulation on respiratory function, Journal of the
Australian Chiropractic Association , 1990 Mar; 20(1): 17-22. This study
evaluated "thirty asymptomatic subjects treated on four separate occasions
with soft tissue technique and Chapman's neurolymphatic reflex stimulation
for the diaphragm. Spirometric assessment of respiratory function before and
after each treatment was performed." "Five of these subjects reported a past
history of asthma or bronchitis." The results of the study indicated "that tr
aditional chiropractic soft tissue and reflex techniques may have therapeutic
value in the treatment of patients who exhibit below average respiratory
function".

It is high time that alternative health care providers and SOT practitioners
gets off the tracks of approaching trains. We are building a train but we
need more material and fuel to have it move at any speed. Instead of
standing still as a train runs us over, we need to take charge of our
situation. No matter what it takes, we need to do or fund the research that
is needed to maintain and advance our position in health care. This is not
for our self aggrandizement or financial benefit, but because the
conservative care we offer can give the greatest help without the side
affects of drugs or surgery. We must however make careful diagnoses, refer
for medical care when necessary, co-treat, and use "negative" research
findings concerning chiropractic to help us grow and improve. After all, the
article in the Los Angeles Times gave me the impetus to sit down and write
this "article of interest".

Please see:

Blum CL, Role of chiropractic and sacro occipital technique in asthma
Chiropractic Technique , Nov 1999; 11(4) 174-80.

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