Improved Health Outcomes in Parkinson’s Disease Utilizing Specific Upper Cervical Chiropractic Protocol: A Case Series
Tron Malachowski, DC Bio & Ruvayn Rubinstein, DC
Journal of Upper Cervical Chiropractic Research ~ May 15, 2014 ~ Pages 23-33
Abstract:
Objective: To report reductions in the Unified Parkinson’s Disease Rating Scale (UPDRS) in three patients diagnosed with Parkinson’s disease (PD) utilizing Kale Upper Cervical Specific Chiropractic protocol over 3 years.
Objective: To analyze a case which appears to support chiropractic success in treating neurovascular symptoms through adjustment of the first cervical vertebrae.
Clinical Features: The patient was a 75 year old female presenting with gait ataxia, strabismus, fatigue, blood pressure fluctuations, seizures of two weeks duration, and history of concussion with similar symptoms. Previous medical diagnosis and care had been unrewarding.
Intervention and Outcomes: The patient presented to an Atlas Orthogonal chiropractic clinic where she was examined and her atlas vertebra adjusted per the SCALE method. The patient’s symptoms were quickly and painlessly reduced and/or resolved.
Conclusion: Results suggest that Atlas Orthogonal care may be responsible for the reduction and elimination of neurological symptoms in this patient. Removal of intracranial insufficiency due to chronic compression of the vertebral artery by misalignment of the first cervical vertebra is a possible explanation for the mechanism of management success. These results suggest that chiropractic care, specifically adjustment of the atlas vertebrae, may be a useful treatment for conditions with neurovascular symptomatology.
Objective: To outline clinical changes after chiropractic care in a patient with vertigo, headaches and post concussion syndrome.
Clinical Features: A 23-year-old female presented for chiropractic care five months after a slip and fall that resulted in a concussion. The patient presented with symptoms of vertigo and headaches consistent with post concussion syndrome. The patient had a longstanding history of headaches that were exacerbated by the concussion and a new complaint of positional vertigo that occurred immediately following the trauma. Radiographs ruled out fracture but were remarkable for upper cervical subluxation.
Intervention and Outcomes: The patient received upper cervical specific chiropractic care through the technique of Atlas Orthogonal Chiropractic. Atlas Orthogonal protocol of upper cervical palpatory scanning and supine leg length analysis were used to indicate when an upper cervical adjustment was to be administered. Radiographic analysis was used to determine the misalignment and the exact vectors of the upper cervical adjustment.
Conclusions: Clinical findings suggest that upper cervical vectored manipulation was beneficial in this patient with vertigo, headaches and post concussion syndrome.
Anatomical abnormalities of the cervical spine at the level of the Atlas vertebra are associated with relative ischaemia of the brainstem circulation and increased blood pressure (BP). Manual correction of this malalignment has been associated with reduced arterial pressure. This pilot study tests the hypothesis that correcting mal-alignment of the Atlas vertebra reduces and maintains a lower BP. Using a double blind, placebocontrolled design at a single center, 50 drug naı¨ve (n¼26) or washed out (n¼24) patients with Stage 1 hypertension were randomized to receive a National Upper Cervical Chiropractic (NUCCA) procedure or a sham procedure. Patients received no antihypertensive meds during the 8-week study duration.
The primary end point was changed in systolic and diastolic BP comparing baseline and week 8, with a 90% power to detect an 8/5mm Hg difference at week 8 over the placebo group. The study cohort had a mean age 52.779.6 years, consisted of 70% males. At week 8, there were differences in systolic BP (“1779mm Hg, NUCCA versus “3711mm Hg, placebo; Po0.0001) and diastolic BP (“10711mm Hg, NUCCA versus “277mm Hg; P¼0.002). Lateral displacement of Atlas vertebra (1.0, baseline versus 0.041 week 8, NUCCA versus 0.6, baseline versus 0.51, placebo; P¼0.002). Heart rate was not reduced in the NUCCA group (“0.3 beats per minute, NUCCA, versus 0.5 beats per minute, placebo). No adverse effects were recorded.We conclude that restoration of Atlas alignment is associated withmarked and sustained reductions in BP similar to the use of two-drug combination therapy.
Objective.—To determine the incidence and types of head or neck trauma and headache characteristics among US Army soldiers evaluated for chronic headaches at a military neurology clinic following a combat tour in Iraq.
Background.—Head or neck trauma and headaches are common in US soldiers deployed to Iraq.The temporal association between mild head trauma and headaches, as well as the clinical characteristics of headaches associated with mild head trauma, has not been systematically studied in US soldiers returning from Iraq.
Methods.—A retrospective cohort study was conducted with 81 US Army soldiers from the same brigade who were evaluated at a single military neurology clinic for recurrent headaches after a 1-year combat tour in Iraq. All subjects underwent a standardized interview and evaluation to determine the occurrence of head or neck trauma during deployment, mechanism and type of trauma, headache type, and headache characteristics.
Results.—In total, 33 of 81 (41%) soldiers evaluated for headaches reported a history of head or neck trauma while deployed to Iraq.A total of 18 (22%) subjects had concussion without loss of consciousness and 15 (19%) had concussion with loss of consciousness. Ten subjects also had an accompanying traumatic neck injury. No subjects had moderate or severe traumatic brain injury. Exposure to blasts was the most common cause of trauma, accounting for 67% of head and neck injuries. Headaches began within one week after trauma in 12 of 33 (36%) soldiers with head or neck injury. Another 12 (36%) reported worsening of pre-existing headaches after trauma. Headaches were classified as migraine type in 78% of soldiers with head or neck trauma. Headache types, frequency, severity, duration, and disability were similar for soldiers with and without a history of head or neck trauma.
Conclusion.—A history of mild head trauma, usually caused by exposure to blasts, is found in almost half of returning US combat troops who receive specialized care for headaches. In many cases, head trauma was temporally associated with either the onset of headaches or the worsening of pre-existing headaches, implicating trauma as a precipitating or exacerbating factor, respectively. Headaches in head trauma-exposed soldiers are usually migraine type and are similar to nontraumatic headaches encountered at a military specialty clinic.
Objective: The objective of this article is to explore the diagnosis and treatment of trauma-induced injury to the upper cervical spine through the use of protocol developed by the International Upper Cervical Chiropractic Association (IUCCA) and to investigate the potential for improving and eliminating colic and acid reflux through the correction of upper cervical injury. Data from 16 infants who presented with upper cervical injuries and received care according to the above protocol are reviewed.
Clinical Features: Each patient was examined and cared for in my private practice in a non-experimental environment without control subjects. The 16 infants were diagnosed by their physicians with acid reflux (9 infants) or colic (7 infants). Ten of the 16 mothers reported difficulty in their child
Intervention and Outcome: Two diagnostic tests, paraspinal digital infrared imaging and laser-aligned cervical radiography, were performed according to IUCCA protocol. These tests objectively identify trauma-induced upper cervical subluxations (misalignments of the upper cervical spine from the neural canal) and resulting neuropathophysiology. Upper cervical subluxations were found in all 16 infants and all 16 cases were resolved with IUCCA upper cervical care.
Conclusion: A causal link between birth trauma-induced upper cervical injury and the onset of acid reflux and colic appears to exist. Correcting the injury to the upper cervical spine through the use of IUCCA protocol appears to reverse infantile colic and acid reflux. Further study in a controlled, experimental environment with a larger sample size is recommended.
Background: Observational studies have previously shown that adverse events following manipulation to the neck and/or back are relatively common, although these reactions tend to be mild in intensity and self-limiting. However, no prospective study has examined the incidence of adverse reactions following spinal adjustments using upper cervical techniques, and the impact of this care on clinical outcomes.
Methods: Consecutive new patients from the offices of 83 chiropractors were recruited for this practice-based study. Clinical outcome measures included 1) Neck pain disability index (100-point scale), 2) Oswestry back pain index (100-point scale), 3) 11-point numerical rating scale (NRS) for neck, headache, midback, and low back pain, 4) treatment satisfaction, and 5) Symptomatic Reactions (SR). Data were collected at baseline, and after approximately 2 weeks of care. A patient reaching sub-clinical status for pain and disability was defined as a follow-up score <3 NRS and <10%, respectively. A SR is defined as a new complaint not present at baseline or a worsening of the presenting complaint by >30% based on an 11-point numeric rating scale occurring <24 hours after any upper cervical procedure.
Results: A total of 1,090 patients completed the study having 4,920 (4.5 per patient) office visits requiring 2,653 (2.4 per patient) upper cervical adjustments over 17 days. Three hundred thirty- eight (31.0%) patients had SRs meeting the accepted definition. Intense SR (NRS ≥8) occurred in 56 patients (5.1%). Outcome assessments were significantly improved for neck pain and disability, headache, mid-back pain, as well as lower back pain and disability (p <0.001) following care with a high level (mean = 9.1/10) of patient satisfaction. The 83 chiropractors administered >5 million career upper cervical adjustments without a reported incidence of serious adverse event.
Conclusions: Upper cervical chiropractic care may have a fairly common occurrence of mild intensity SRs short in duration (<24 hours), and rarely severe in intensity; however, outcome assessments were significantly improved with less than 3 weeks of care with a high level of patient satisfaction. Although our findings need to be confirmed in subsequent randomized studies for definitive risk-benefit assessment, the preliminary data shows that the benefits of upper cervical chiropractic care may outweigh the potential risks.
Objective: The Upper Cervical Specific Chiropractic management of a patient diagnosed with Parkinson’s disease.
Clinical Features: A 77 year old man diagnosed with Parkinson’s disease in 2003 with progressive hand tremors, festinating gait, akinesia, and incoordination.
Intervention and Outcome: Using Kale Upper Cervical Specific Protocol, x-ray, bilateral NeuroCaloGraph readings and neurological testing the patient was monitored and evaluated over a three and a half month period. The patient demonstrated significantly reduced trembling of his extremities and improved speed of ambulation with less exertion. Neurological findings and NeuroCaloGraph readings also improved significantly subsequent to adjusting the patient’s second cervical vertebra.
Conclusion: Upper Cervical Specific chiropractic care of a patient diagnosed with Parkinson’s disease over the course of three and a half months is presented. Marked resolution of the patient’s neurological signs and symptoms associated with Parkinson’s as well as a reduction in the presentation of upper cervical subluxation was obtained.
Parkinson’s disease (PD) is a progressive neurodegenerative disease characterized by resting tremor, bradykinesia, rigidity, and postural instability. An estimated one million Americans live with Parkinson’s with approximately sixty thousand new cases diagnosed each year. Currently there is no cure for Parkinson’s disease.
PD is a result of destruction to the substantia nigra which is responsible for signaling the basal ganglia to secrete dopamine and filter sensory signals to the motor cortex. The inability to inhibit neural impulses to the cortex results in overactivation presenting as the essential tremor and muscular rigidity.
Conventional medical treatments include Levodopa and Carbidopa in order to increase dopamine action on the central nervous system. Though these drugs have displayed effectiveness in managing Parkinson’s symptoms, the effect of the drug decreases over time requiring higher dosages. It has been shown recently that Levodopa is associated with severe involuntary dyskinesias. Deep brain stimulation has shown promise in improving motor symptoms and quality of life, but come with a high risk of serious adverse effects.
Research in the chiropractic management of patients with Parkinson’s disease is limited. Elster documented improvements in Parkinson’s patients undergoing upper cervical chiropractic care in two studies. The current paper will describe the reduction of vertebral subluxation findings and its relationship to a patient’s self-reported symptomatology.
The following case report describes a 35-year-old professional ice skater’s fall on her head at age 23; the onset of headaches following the blow to the head; the intervention of chiropractic care utilizing an upper cervical technique; and her symptomatic response. An appendix details the examination findings and results utilizing the same upper cervical chiropractic procedure in 100 additional chronic headache cases.
Reports documenting successful treatment of patients with headaches using chiropractic care are limited primarily to Palmer’s research conducted seventy years ago (using a similar upper cervical technique), which was never published in a peerreviewed, indexed fashion.1-2 Palmer’s chiropractic care included paraspinal thermal scanning using a neurocalometer (NCM), a cervical radiographic series to analyze upper cervical misalignment, and a specific upper cervical adjustment performed by hand. Positive results (symptoms were dramatically improved and/or eliminated) were achieved in approximately 1000 headache cases (from 5000 Palmer Research Clinic cases) whose upper cervical subluxations were corrected.
The rationale for the use of chiropractic care in this case was to correct the patient’s upper cervical subluxation that was discovered during her initial evaluation. Patients with other neurological conditions such as Parkinson’s disease and Multiple Sclerosis, who presented with similar upper cervical subluxations, also responded favorably to chiropractic intervention. 3-4 It should be noted that, in such cases, patients reported a substantial blow to the head or whiplash injury prior to the onset of symptoms and diagnoses. This case suggests a correlation between a blow to the head, upper cervical subluxation, and neurological disease, and serves to establish a foundation for future research.