In recent years, chiropractors have once more turned their attention to the neurological component of the subluxation. After decades of concentrating on musculoskeletal aspects, it’s a move that is as timely as it is important. In the years to come, our understanding of how we impact the brain will be the key to becoming the leader in the wellness revolution.
It’s a trend we’re seeing in other non-medical fields as well. In fact, a British research study published earlier this year in the journal Brain Research revealed that acupuncture has a significant effect on specific neural structures.
The researchers explained that when a patient receives acupuncture, it triggers a sensation called deqi (literally, the arrival of chi, pronounced duh-chi). Scientific analysis shows that this energy impulse deactivates areas within the brain that are associated with the processing of pain.
Dr. Hugh MacPherson, of the Complementary Medicine Research Group in the University of York’s Department of Health Sciences, noted: “These results provide objective scientific evidence that acupuncture has specific effects within the brain which hopefully will lead to a better understanding of how acupuncture works.”
Neuroscientist Dr. Aziz Asghar, of the York Neuroimaging Centre and the Hull York Medical School, added: “The results are fascinating. Whether such brain deactivations constitute a mechanism which underlies or contributes to the therapeutic effect of acupuncture is an intriguing possibility which requires further research.”
Last summer, following research conducted in York, acupuncture was recommended for the first time by the National Institute for Health and Clinical Excellence (NICE) as a treatment option for NHS patients with lower back pain. NICE guidelines now state that GPs should “consider offering a course of acupuncture comprising a maximum of 10 sessions over a period of up to 12 weeks” for patients with this common condition.
Current clinical trials at the University of York are investigating the effectiveness and cost-effectiveness of acupuncture for Irritable Bowel Syndrome (IBS) and for depression. Recent studies in the US have also shown that acupuncture can be an effective treatment for migraines and osteoarthritis of the knee.
The York team believes that the new research could help to clear the way for acupuncture to be more broadly accepted as a treatment option on the NHS for a number of medical conditions. “Our results show the importance of collecting and accounting for needle sensation data in neuroimaging studies of acupuncture,” researchers concluded.
There’s an equally important need to collect information on the neurological impact of chiropractic adjustments, such as that being collected by doctors who use the NeuroInfiniti equipment.
ABSTRACT: “Acupuncture needling sensation: The neural correlates of deqi using fMRI.” Brain Research, Vol. 1315, 22 February 2010, Pages 111-118.
AUDIO: Dr. Hugh Macpherson, from the University of York, discusses new research into the effects of acupuncture on the brain published in Brain Research.
Based on my previous articles on the subject, it’s clear there is a lot of interest about chiropractic neurology. What’s it all about? I’m posting this blog in frequently asked question (FAQ) format to ensure you can quickly find the answers you need.
Q. What’s chiropractic neurology?
A. According to the American Chiropractic Neurology Board (ACNB), chiropractic neurology is defined as “the field of functional neurology that engages the internal and external environment of the individual in a structured and targeted approach to affect positive changes in the neuraxis and consequent physiology and behavior.”
Q. So what does that mean in plain English?
A. It means that a chiropractic neurologist examines how the nervous system is functioning (or malfunctioning). If the system is out of balance, chiropractic treatment focuses on repairing the imbalance, such as vertigo, Autism, attention deficit disorder (ADD), to restore the patient to health.
Q. What others types of disorders can chiropractic neurology address?
A. Chiropractic neurologists may treat the above conditions, as well as dizziness, disequilibrium and imbalance, dystonia, tremors, chronic pain syndromes, back pain and movement disorders. They may also treat behavioral disorders such as Tourette’s Syndrome, as well as changes in personality or motor, sensory or cognitive impairments resulting from head traumas, accident injuries, traumatic brain injury (TBI) and mild TBI.
Q. So what’s the difference between a chiropractic neurologist and a medical neurologist?
A. According to the ACNB, the chiropractic neurologist provides the same manner of consultation as a medical neurologist, with the major difference being that the therapies and applications are performed without the use of drugs or surgery. So, a medical neurologist or neurosurgeon will prescribe medications, injections or brain surgery to correct a disorder or condition. On the other hand, the chiropractic approach is to therapeutically change brain and nervous-system function.
Q. How is a chiropractic neurologist different than a “traditional” chiropractor?
A. Most chiropractors are trained in the detection and correction of spinal dysfunction. But spinal function is just one of many influences on the nervous system. A neurologist not only has completed the doctor of chiropractic program, but must receive three years of additional training and testing to become a board-certified neurologist in the chiropractic profession. The extra training is specific to the field of neurology and includes the study of neurophysiology and clinical and diagnostic techniques.
Q. What are the benefits of chiropractic neurology?
A. Simply put, many conditions of the brain and nervous system do not respond well to aggressive interventions such as drug therapy or surgery. Both drugs and surgery are often associated with increased risks for serious complications or dangerous side effects. Thus, the approach taken by chiropractic neurologists can be highly beneficial in treating brain and nervous system disorders using safe and effective methods with lasting health benefits.
Previously, researchers determined a patient’s level of health by measuring vital signs, recording frequency of symptoms, examining X‑Rays, and observing character. Rarely did they ask the patient how he or she felt. They took pride in judging the patient’s quality of life based just on objective measurements.
Recently, a new instrument allows researchers a more accurate picture into the patient’s state of well-being ‑‑ the health related quality of life survey.
According to a paper published in the British Medical Journal (BMJ 1998;316:542‑545), “It is now widely acknowledged that the personal burden of illness cannot be described fully by measures of disease status such as size of infarction, tumor load, and forced expiratory volume. Psychosocial factors such as pain, apprehension, restricted mobility and other functional impairments, difficulty fulfilling personal and family responsibilities, financial burden, and diminished cognition must also be encompassed. The area of research that has resulted from this recognition is termed ‘health related quality of life’ [HRQL]. It moves beyond direct manifestations of illness to study the patient’s personal morbidity. That is, the various effects that illnesses and treatments have on daily life and life satisfaction. Although quality of life assessment was almost unknown a few years ago, it has rapidly become an integral variable of outcome in clinical research.”
The Internet has made these surveys more prominent and meritorious for scientists. The surveys are also more convenient for the researcher and the patient. “Instruments administered via the Internet appear to be reliable, and to be answered similarly to the way they are answered when they are administered via traditional mailed paper questionnaires,” reported Stanford University researchers in the Journal of Medical Internet Research (J Med Internet Res 2004;6(3):e29).
Measuring the impact of health care on the patient’s well-being has become so crucial that many medical experts say research that disregards such an element, may not be worthwhile for practitioners.
One research paper, published by Canada ‘s Centre for Health Evidence, reports, “When the goal of treatment is to improve how people are feeling (rather than to prolong their lives) and physiological correlates of patients’ experience are lacking, HRQL measurement is imperative. For example, we would pay little attention to studies of antidepressants that failed to measure patients’ mood, or trials of anti‑migraine medication that failed to measure pain.” (“How to Use Articles about Health‑Related Quality of Life Measurements,” by Gordon H. Guyatt, et.al, for the Evidence Based Medicine Working Group).
Chiropractic care is no different.
If research fails to measure how patients view their own health, the results will be inaccurate and will fail to establish the relationship between subluxation correction and quality of life. Objective tests may show some stress reduction on the nervous system, but we must step out-of-bounds to clarify the effect of that reduction on the way people behave and feel.
We should not rely solely on health questionnaires, but combine the results with standardized clinical exams and observations. This will enable us to answer many questions about chiropractic.
Prior to the Self‑Reported Quality of Life (SRQL) study, no specific outcome measurement existed for chiropractic care and very few non‑chiropractic quality of life surveys directed to chiropractic existed. With more than 7,000 records regarding the development and testing of patient‑reported health instruments indexed by the National Centre for Health Outcomes Development in Britain, only 17 engaged chiropractic. Of those 17, nine were specifically focused on back and neck pain, two on the symptom duration of myofascial pain, one on migraines, and two on general pain. One record was published in a non‑scientific trade newspaper when it should have appeared in a medical journal with comments and reviews from team experts.
Only one case out of 7,000 contained a broader application of chiropractic to quality of life issues – “A retrospective assessment of chiropractic care using a survey of self‑rated health, wellness and quality of life,” by Robert Blanks PhD, and colleagues, published in the Journal of Subluxation Research (JSR1997, 1:15‑31).
The quality of life questionnaire was created to specifically assess wellness via the patient’s self‑rating of the following: physical state, mental/emotional state, stress evaluation, life enjoyment, and general quality of life at two intervals: before and after they began chiropractic care.
I won’t regurgitate the technicalities involving the creation of this survey instrument. The study revealed that patients reported significant change in all areas, including quality of life. They felt better physically and emotionally, experienced less stress and enjoyed themselves more simply thanks to chiropractic.
According to the results, improvements took effect about one month after care began. As long as they continued chiropractic care, they continued to make progress. If this study had generated the international attention it deserved, thousands of people would have become better educated on how chiropractic could improve their well-being. News flashes would have lit up the television screen while major newspapers would have posted such revolutionary news on the front-page. Patients would have begun undergoing weekly adjustments and put aside their daily dose of aspirin.
There several reasons this did not occur. The most obvious involves the domination of the pharmaceutical industry that pays advertisers a tremendous amount of money.
One research study out of 7,000 will not persuade the research community, the media and the general population. Data is necessary from thousands of patients along with dozens of well-conducted research papers published in major medical journals.
For every human being, we have composed a study to assess chiropractic’s influence on quality of life. Mainstream media and the general public will not ignore this kind of evidence. It can transform health care to a higher level.
Millions of people around the globe have received chiropractic care and know its value. But the rest of the population dismisses the profession’s growth and patient testimonials as shoddy evidence.
Regrettably, scientists have only a few studies showing correlations between the quality-of-life changes and chiropractic care. Most scientific clinical studies suggest chiropractic as a treatment for adult low-back pain, thus limiting chiropractic care.
The public only hears: “…there is no evidence that any chiropractic treatment works for infants and/or kids.” (Healthwatcher.net) – or – “I am not aware of any chiropractic research that has led to any significant improvement in patient care.” (Stephen Barrett, MD)
Supporters of chiropractic care are aware of this false perception and its negative affects on the general public.
“The dearth of defensible information about chiropractic and chiropractors is still hampering our external ability to integrate successfully with the rest of the so-called health industry…. Let’s face it. We have a massive fact deficit in chiropractic.” (William Meeker, DC, MPH, FICC, director of the Palmer Center for Chiropractic Research)
“Whether the practice of chiropractic is of any value to the patient cannot be known with certainty until a scientific base has been established. …It is clearly apparent that it would be beneficial to the public for the profession to systematically study the subluxation as it relates to the health of the patient. Chiropractic can be observed and measured.” (The National Upper Cervical Chiropractic Research Association)
“The Committee believes additional research is necessary to further quantify the already‑known benefits of chiropractic care.” (US Senate Appropriations Committee hearings on ‘Health Care Access and Cost Containment Strategies’)
“Evidence of the value of spinal manipulation for problems other than low-back pain is less extensive, and the role that subluxation (of other forms of joint dysfunction) may play in causing and/or providing relief through adjusting is uncertain.” (“In the Quest for Cultural Authority,” Joseph Keating, DC, et. a., Dynamic Chiropractic, December 16, 2004.)
“The claim that loss of neural integrity influences ‘organ system function and general health’ is also unsubstantiated by currently available experimental data. … assertions may be appropriate as hypotheses (tentative assertions) and proto-theories (from which testable propositions may be derived), and deserve our critical attention by means of research. However, to assert their validity in the absence of hard scientific data is to engage in dogmatism.” (Joseph Keating, Dynamic Chiropractic, Dec. 16, 2004)
The answer lies in thoroughly conducted scientific research and observing the mechanisms surrounding chiropractic care such as stress reduction on the autonomic nervous system and wellness. The results must then be reviewed by chiropractic experts and other professionals with the appropriate credentials to write and review research reports. At that time, reports should be submitted to major health journals for publication.
It’s insufficient to research solely manual manipulation’s effectiveness as a resolution for musculoskeletal conditions such as low-back pain. Such technicalities only reemphasize the false belief that chiropractic is just physical therapy that can be provided by regular physician and physical therapists. Should this remain to be the only field of chiropractic research, it will be utilized as evidence to limit chiropractic care.
The chiropractic theory claims that stress on the nervous system negatively impacts overall wellness. Such health-like components like immunity, vitality, and well-being must be measured. It is essential to conduct research to confirm this supposal.
Research must compare and contrast the individual’s state of health before and after receiving chiropractic care. Our goal is to develop a standard rating system measuring the severity of stress on the nervous system and integrating it to measure the noteworthy result of chiropractic care. With this rating system, the next step is to create a formula connecting outcome results and the impact on a patient’s level of stress.
This method has gained popularity in epidemiology. It is also used for studying sleep apnea severities. (Journal of Subluxation Research, 3:24-30, 1999.) Upon completion, this formula will function as a universal standard for chiropractic care and wellness.
A detailed analysis of database findings of millions of chiropractic patients can disclose direct links between stress and wellness. The findings could lead to ground-breaking information regarding the impact of chiropractic on the human nervous system and overall health.
About the Author Terry A. Rondberg, DC, is a leading proponent of research to demonstrate the benefits of chiropractic care on patients, not only for back pain but also for the brain, the heart, the nervous system and total body wellness. He is a sought-after public speaker, author and advocate for millions of chiropractic patients and practitioners.
We’re getting a lot of interest in our articles on the brain and neurofeedback, and how it relates to chiropractic. Thanks to everyone for the great questions. We are posting the most frequently asked questions (FAQs) here for everyone to read and to learn. Please keep the feedback coming!
-Dr. Terry Rondberg
How are Neurofeedback and Chiropractic successful?
Chiropractors are especially concerned with childhood brain-based problems whose needs are not addressed, including:
Seizures and sub-clinical seizure activity
Severely disruptive behavior disorders such as Conduct Disorder and Bipolar Disorder
Autistic spectrum and pervasive developmental delay
Acquired brain injury
Many children have sleep problems that can be helped:
Sleep walking, sleep talking
We can also help with several adolescent issues:
Anxiety and depression
We can help maintain good brain function as people age. The good news is that almost any brain, regardless of its function level, can be trained to function more efficiently.
Are the effects of Neurofeedback and Chiropractic long-term?
If brain disregulation is addressed, the answer is yes. Neurofeedback is about the brain learning and if that brings order out of disorder, the brain will continue to use its new capabilities, while reinforcing them.
Conditions are different with degenerative conditions like Parkinson’s, the dementias, or when we are working against continuing insults to the system, as may be for autism spectrum. In such cases, the training needs to continue over time. Allergic susceptibilities and food intolerances make it more difficult to hold the gains. Poor nutrition, digestive function and a poor nerve supply are problematic. A child living in a toxic environment (physically or psychologically) will have more difficulty retaining good function.
What is the success rate of Neurofeedback and Chiropractic?
In the past twenty years of experience with Neurofeedback, practitioners have reached high expectations for success in training. When such success is not forthcoming, or if the gains cannot hold, then there is a reason which needs to be pursued. In the normal course of events, Neurofeedback ought to be effective with everybody. Nearly everyone should make gains they themselves would judge as worthwhile. Our brains are made for learning and skill-acquisition. On the other hand, we are working with many families whose expectations have been lowered by their past experience. They must see progress before they agree. With chiropractic care, who would not perform better with a healthier autonomic nervous system?
Among the vast majority of clients (>100% in most clinician’s experiences) the outcome exceeds the prior expectations. Against such low expectations, the changes that can be produced with Neurofeedback and Chiropractic may appear miraculous. One chiropractic office using neurofeedback has a sign on its front desk: “We expect miracles.” What appears miraculous in all of this is nothing more than the incredible capacity of our brains to recover function when given a chance and the body’s miraculous ability to heal itself.
What happens if Neurofeedback and Chiropractic patients are taking medications?
With successful Neurofeedback training and regular chiropractic care, the medications targeting brain function may not be needed, or needed at a lower dosage, as the brain and nervous system dominate the role of regulating itself. This decrease in medications is striking when the medications play a supportive role in any event, which is often the case for the more severe disorders we treat. It is important for patients to communicate with their prescribing physician regarding Chiropractic care, Neurofeedback and medications.