After 120 Years How Are We Choosing To Change The World?

A message to all Chiropractors on the 120th birthday of our profession

Chiropractic embodies a truth and as that is shared through words and actions the more the awareness of that truth will spread. When that awareness reaches critical mass, action, actual system wide change will automatically come forth. I know we all want action now but I feel that the best action right now is to continue to tell the story. Right now there are too many people and groups that will try to squash any real action steps, and they will most likely succeed. It will only be when critical mass has been reached that the core paradigm will shift and those same people and groups will not be able to stop the actions that will spring forth. Perhaps our charge is to continually strengthen the wave of change that is already rising and then ride that wave on to the beach of a brighter future.

P.S. As BJ Palmer once said, "You never know how far reaching something you may think, say or do today, could affect the lives of millions tomorrow!" Who knows how many souls have read or been told something today, right now this very minute, that has changed how they view the world for the better. People that, had others not been willing to tell the story again and again and again and again, might not have heard it. Getting frustrated with the world and people today is normal, but change will happen faster if we are willing to keep telling the story.

"It is not the final chop that brings the tree down but all the ones that came before."

Keep chopping away.

Happy Birthday to a great profession and principle!

The Medullary Lock: The Basis Of Upper Cervical Care

Editor's note: This is a little on the technical side so some readers may get lost with some of the terminology. For some people who are more skeptical and analytical minded this will serve to explain upper cervical care in a more detailed way.

Medullary Lock

by KCUCS.com

The Brain Stem, from a Neuro-Physiological standpoint is the center of life in the body. It is one of the first organized structures formed in embryo (1) and the last place life is evident before a person passes. The lower portion of the Brain Stem lies in the cradle where the head sits on the spine. Therefore, a Head/Neck Misalignment can potentially manifest in a wide variety of symptoms and diseases.

The Medullary Lock is an elaborate network of hard and soft tissue that acts as a stabilizing support for the medulla and upper spinal cord. It secures the medulla and upper spinal cord in the center of the spinal canal and foramen magnum in cases of trauma. Otherwise, even minor slips and falls could be devastating to the body.

With atlas and/or axis misalignment, the very safeguards the medulla and upper spinal cord are afforded through the Medullary Lock become the very mechanism creating cord distortion.

The development of the Medullary Lock was built upon the foundation of Dr. John D Grostic's Dentate Ligament theory (2).

To introduce the Medullary Lock we need to consider 4 basic components.

1. Upper Cervical muscles and their roles
2. Supportive ligaments and membranes and their roles
3. 4 known structures with external attachments to the Dura Mater
4. One structure internally attached to the Dura Mater and intimately connected with the cord.

Each of these components not only work together but are synergistic one with another. There are 4 pairs of muscles called suboccipital muscles (3-5) that act to extend, rotate and laterally bend the Upper Cervical Spine and head. They as well are called proprioceptive muscles because they are chalked full of proprioceptive nerve fibers and carry the responsibility of relaying info to the brain stem as to head position at any given time.

There is an elaborate ligament system that secures the Upper Cervical spine (6-10). The Alar ligament attaches to the lateral margin of the dens about half way up from its base and connects to the medial aspect of the ipsilateral condyle. In the neutral head position these ligaments are in their most relaxed position. The purpose of the Alar ligaments is to check lateral bending and head rotation on the contralateral side. The Alar ligaments do afford some protection for the medulla in checking extreme head rotation. When Alar ligaments are compromised the atlas slides lateral ipsilateral upon lateral bending.

The tectorial membrane works together with the alar ligaments providing stability for the upper cervical region in flexion. The atlanto occipital membrane provides stability in extension. The anterior longitudinal ligament and posterior longitudinal ligament as well provide craniovertebral stability.

The muscles, ligaments, capsules and membranes all provide support for the cranio vertebral region working synergistically. They provide stability and positional awareness for the upper cervical region.

Some of these structures; ligaments, muscles and membranes have direct connection with the dura mater at the cranio vertebral junction. There are four known structures external to the cord that attach to the dura mater.

1. Attachment of the dura mater to the foramen magnum (11)
2. Attachment of the dura mater to the posterior arch of C1 & C2 (11)
3. Connective tissue bridge between the rectus capitus posterior minor muscle and the dura mater (12)
4. Connective tissue attachments between the ligamentum nuchae and flavum to the dura (13,14)

There is one internal structure to the dura mater, the dentate ligament, which stabilizes the medulla and upper spinal cord within the spinal canal space in the upper cervical spine. Dr. Grostic outlined its detrimental effects (2).

The Medullary Lock is a stabilizing factor for the medulla and upper spinal cord (15). The 4 known structures described above external to the dura and the one internal, the dentate ligament, all work together as a network of support. Regardless in what position the head moves, whether rotation right or left, flexion or extension, lateral bending left or right, or any combination, it is important for the medulla and upper spinal cord to remain fixed within their position relative to the spinal canal and foramen magnum. This becomes even more crucial in the cases of trauma. Movement beyond a small amount in the vertical superior or inferior, anterior upon flexion, posterior upon extension or any combination can prove to be fatal. In fact, it is reported that most fatal car crashes are the result of a fractured atlas. In these cases, it is easy to see how the Medullary Lock could lose its integrity.

The Medullary Lock is a mechanism that provides security and stability for the medulla and upper spinal cord. However, because of its mechanism of support, when the upper cervical vertebrae are in a 3 directional torque misalignment, stretch and tension are exerted through the dentate ligaments exerting forces on the cord as described by Dr. Grostic.

Dr. Grostic's dentate ligament cord distortion hypothesis was consistent with what BJ Palmer described (16) in Volume XVIII, regarding cord pressure.

BJ Palmer expounded upon the original 4 elements of a subluxation:

1. Misalignment
2. Occlusion of a foramen
3. Pressure upon nerves
4. Interference to the mental impulse.

BJ explained the necessity of a 5th element (17) describing the subluxation as a 3 directional torque, misaligning on three planes simultaneous. In this manner, the misalignment becomes permanent more or less. It is the permanency of the upper cervical subluxation that leads to the weakened ability of the body to adapt to the environment and grow in dis-ease.

The longer a person is able to stay balanced in the upper cervical area, remaining relatively clear from nerve interference, the stronger the Medullary Lock becomes. The stronger the Medullary Lock becomes the more difficult it is for a person to subluxate and the higher the potential is for that person to recover from long term illness or simply achieve their highest potential health. The reverse is true, the more unstable the Medullary Lock, the more easily it will be for that person to subluxate and the more susceptible the person will be in 'growing dis-ease'.

It is our opinion that over adjusting or adjusting too often, especially with upper cervical procedures, can weaken the Medullary Lock.

KCUCS practitioners view their purpose as Upper Cervical doctors to be guardians of the Medullary Lock, to facilitate more stability of the Medullary Lock over a long period of time. Putting particular emphasis on substantial long-term growth in health and life. This is consistent with what BJ Palmer referred to Accumulative Constructive Survival Value (ACSV) (18). The greater the ACSV, the greater the ability to grow in health, adapt to the environment and overcome disease.

REFERENCES:

1. Sanes DH, Reh TA, Harris WA: Development of the nervous system, 2nd edit. 2006, Elsevier Inc. Burlington, MA ISBN: 978-0-12-618621-5.
2. Grostic JD: Dentate ligament - cord distortion hypothesis. CRJ Vol 1(1): Spring, pp 47-55
3. Gray H, Pick TP, Houdin R: Gray's Anatomy: The unabridged running press edition of the American classic. ISBN: 0-914294-08-3.
4. Hallgren RC, Fernandez C: Suboccipital muscle contribution to tension-type headache chapter 7 in diagnosis and management of tension-type and cervico-genic headache. Jones and Bartlett, Sudbury, Massachusetts, 2008.
5. Hallegren RC, Andary, MT, 2008. Under-shooting of a neutral reference position following cervical motion in the sagittal plane. J Manipulative and Physiol Ther, 31(7):547-552.
6. Bogduk N, Mercer S: Biomechanics of the cervical spine, I: normal kinematics. Clin Biomech (Bristol, Avon). 2000; 15:633-648.
7. Dvorak J, Panjabi M, Gerber M, Wichmann W: CT-functional diagnostics of the rotatory instability of upper cervical spine, 1: an experimental study of cadavers. Spine, 1987; 12:197-205
8. Penning L: Kinematics of cervical spine injury: a functional radiological hypothesis. Eur Spine J. 1995; 4:126-132.
9. Swartz EE, Floyd RT, Cendoma M: Cervical spine functional anatomy and the biomechanics of injury due to compressive loading. J Athl Train. 2005 Jul-Sep; 40(3): 155-161.
10. Singh AP: Biomechanics of upper cervical spine. Bone & Joint. Feb 10, 2010, http://boneandspine.corn/spine/cervical-spine/biomechanics-of-upper-cervical-spine/
11. Hinson R, Zeng ZB: Epidural attachments in the Upper Cervical Spine. Abstracts from the 15th Annual Upper Cervical Spine Conference, November 20-21, 1998, CRJ, 1999;6(1):31-32.
12. Hack G: Anatomical relation between the rectus capitus posterior minor and the dura mater. Spine, 20(23): 2484-2486
13. Shinomiya K, Dawson, J, Spengler DM, Konrad P, Blumenkopf B: An analysis of the posterior epidural ligament role on the cervical spinal cord. Spine, 1996; 21(18):2081-2088
14. Dean N, Mitchell B: Anatomic Relation between the nuchal ligament (ligamentum nuchae) and the spinal dura mater in the craniocervical region. 2002 Clin. Anat. 15:182-185.
15. Kessinger, R: KCUCS instrumentation module notes. 2009, Cape Girardeau, MO, pp 20-23.
16. Palmer BJ: The subluxation specific the adjustment specific, Vol. XVIII. 1934, Palmer School of Chiropractic, Davenport, IA. pp 322-323.
17. Palmer BJ: The subluxation specific the adjustment specific, Vol. XVIII. 1934, Palmer School of Chiropractic, Davenport, IA. pp 248-251
18. Palmer BJ: History repeats, Vol. XXVII. 1951, Palmer School of Chiropractic, Davenport, IA. pp 707-708.

Multiple Sclerosis, BJ Palmer and Upper Cervical Care

Editor's Note: This is the first of a seven post series where I will be sharing five case reports on patients with MS that received upper cervical care and the results that occurred. The full article with all the reports can be read at length here.

B.J. Palmer, D.C., reported management of Multiple Sclerosis patients with upper cervical chiropractic care as early as 1934. In his writings, Palmer listed improvement or correction of symptoms such as "spasticity, muscle cramps, muscle contracture, joint stiffness, fatigue, neuralgia, neuritis, loss of bladder control, paralysis, incoordination, trouble walking, numbness, pain, foot drop, inability to walk, and muscle weakness." His chiropractic care included paraspinal thermal scanning using a neurocalometer (NCM), a cervical radiographic series to analyze injury to the upper cervical spine, and a specific upper cervical adjustment performed by hand.

While few of Palmer's Research Clinic cases were published, Palmer described one case of Multiple Sclerosis in detail. The patient, a 38-year-old male, went to the Palmer Research Clinic in Davenport, Iowa, in 1943, after a diagnosis of MS by the Mayo Clinic. At the time of admission into the Palmer Clinic, this subject was "…helpless; he could not feed nor take care of himself." His medical history included a head/neck trauma at age 16 in which "…he fell ten feet off a building, landing on his head." The fall rendered him unconscious for thirty minutes and he reported having a sore neck for several days. At the Palmer Clinic, upper cervical radiographs showed a misalignment of the atlas to the right. After upper cervical chiropractic care, the patient remarked, "I am happy to say that through (upper cervical) chiropractic, I have been made almost well. Today, I have just a little numbness left in my hands. I have the full use of my hands, feet, and my whole body."

Upper Cervical Care and Kids

Upper Cervical Care and the Pediatric Patient
by Dr. Claudia Anrig
from: Dynamic Chiropractic - April 10, 2006, Volume 24, Issue 08

Upper cervical technique is not new to the chiropractic profession. It started with the toggle (HIO) technique, developed by Dr. B.J. Palmer, followed by other upper cervical techniques, such as Grostic, NUCCA, orthospinology and atlas orthongal. In preparing this article, I interviewed Dr. Julie Mayer Hunt, a second-generation upper cervical chiropractor who is board certified in orthospinology and has earned diplomate status in chiropractic pediatrics. She is currently a board member of the Society of Chiropractic Orthospinology and the Academy of Upper Cervical Chiropractic Organizations (AUCCO).

According to Dr. Mayer Hunt, "The upper cervical spine is one of the most vulnerable areas of the spine and is a critical area to keep free from nerve interference." She cites a study published in the Journal of Clinical Chiropractic Pediatrics that identified approximately 58 articles regarding chiropractic care of the pediatric patient.1 All of the literature reviewed involved upper cervical adjustments (UCA) and reported the overall level of improvement as a result of rendering specific chiropractic care. Many of the studies involved cases in which any of a myriad of conditions frequently affecting children was resolved completely. Moreover, the response time of a UCA often was seen within one to three treatments. The conditions cited included infantile colic, glaucoma, irritability, head trauma, hemiparesis, projectile vomiting, tonsillitis, sinusitis, bronchitis, nocturnal enuresis, allergies, sleep disorders curvature of the spine, fever, otitis media, asthma, ADHD, headaches, torticollis and seizures. The JCCP study summarized studies involving more than 1,000 children under chiropractic care; the findings suggested the focal area of care involved the upper cervical spine.

Dr. Kirk Eriksen best describes the upper cervical biomechanics as not moving in only one plane of motion. During normal cervical movement, coupled motion occurs. Coupling is defined as motion in which rotation or translation of a rigid body about or along one axis is consistently associated with simultaneous rotation or translation about or along another axis. During normal range of movement, coupled motion helps reduce tension on the nervous system. This is accomplished by offsetting pure lateral flexion or rotation, with small amounts of movements in the X, Y or Z axes.2

One feature of an upper cervical subluxation is that the occipito-atlanto-axial articulations have misaligned in an uncoupled fashion. This condition is measured radiographically in a neutral posture, with the spine at rest. The body must continually adapt, from a biomechanical and neurological standpoint, to this type of subluxation.2

The birth process alone can contribute to upper cervical trauma and instability. Abraham Towbin, MD, reported the results of a study on newborn spinal cord/brainstem injuries that he conducted at the Harvard Department of Neuropathology.3 He performed autopsies on more than 2,000 newborns that died shortly after birth. In his report, Latent Spinal Cord and Brain Stem Injuries in Newborn Infants, Dr. Towbin stated: "Spinal cord and brain stem injuries often occur during the process of birth, but frequently escape diagnosis. Respiratory distress is a cardinal sign of such injury."3

A study by H. Biedermann, published in the Journal of Manual Medicine, high lights the importance of checking the newborn following delivery. In his evaluation of 1,000 newborns, he discovered that 119 cases revealed kinematic imbalances of the suboccipital spine. The finding of suboccipital strain equated to approximately 12 percent of the population group.4

Upper cervical techniques traditionally use the supine leg-length evaluation to determine necessity for adjusting the atlas. When evaluating the pediatric patient with the supine leg check, a leg-length difference is often readily apparent, usually half an inch or greater. Dr. K. Eriksen notes the following hypothesis regarding the short leg findings:

"The spinocerebellar tracts are located along the lateral edge of the spinal cord and are located at the most probable site of maximal mechanical irritation via the dentate ligaments. These proprioceptive tracts are primary pathways for regulating muscle tone and joint position sense. The spinocerebellar tracts are arranged in a laminar fashion (although somewhat angulated) with the most lateral fibers innervating the most caudal structures (i.e., legssacrallumbarthoracic cervical [very limited]). Irritation of these tracts could lead to muscle tone imbalance of the pelvic girdle resulting in a functional short leg."5

Upper cervical chiropractors also note postural corrections as a byproduct of specific upper cervical adjustments. These doctors advocate that one of the benefits of chiropractic care for the pediatric population is eliminating spinal stress (weight of the head centered and structurally/neurologically balanced) on the child's developing spine.

A resource regarding upper cervical techniques for both pediatric and general practice is Dr. Erikson's book, Upper Cervical Subluxation Complex: A Review of the Chiropractic and Medical Literature. The book reviews the anatomy and kinematics of the upper cervical spine, and explains how impaired biomechanics causes neurological dysfunction and physiological concomitants.5 This textbook is not intended to be about chiropractic technique; rather, the text provides the "why" as opposed to the "how" of upper cervical chiropractic care. A follow-up book providing specifics on upper cervical techniques including pediatric care is scheduled to be released in spring 2007.

Claudia Anrig, DC, practices in Fresno, Calif. She is on the board of directors of the International Chiropractic Pediatric Association. For more information, including a brief biography, a printable version of this article and a link to previous articles, please visit Dr. Anrig's columnist page online: www.chiroweb.com/columnist/anrig.

To learn more regarding specific upper cervical techniques for pediatrics, access the following resources:

orthospinology: www.orthospinology.org
atlas orthogonal: www.atlasorthogonality.com
NUCCA: www.nucca.org
It should be noted that Dr. Mayer Hunt has published several pediatric case studies on irregular bowel function, cystic hygroma and asthma,6-8 which illustrate functional improvement of these nonmuscular disorders when the subluxation was corrected by specific upper cervical adjustments.

References

1. Prax C. Upper cervical care of the pediatric patient: a review of the literature. Journal of Clinical Chiropractic Pediatrics 1999;4(1):257-263.
2. Eriksen K. The upper cervical subluxation complex. Today's Chiropractic, March/April 2004.
3. Towbin A. Latent spinal cord and brain stem injuries in newborn infants. Develop Med Child Neurol 1969;(11):54-68.
4. Biedermann H. Sub-occipital strain in newborn infants. Journal of Manual Medicine 1992;(6):151-156.
5. Eriksen K. Upper Cervical Subluxation Complex: A Review of the Chiropractic and Medical Literature. Baltimore, MD: Lippincott Williams & Wilkins, 2003.
6. Hunt JM. Upper cervical chiropractic care of an infant with irregular bowel function: a case report. Journal of Clinical Chiropractic Pediatrics, Spring/Summer 2000:221-312.
7. Upper cervical chiropractic care and resolution of cystic hygroma in a twelve-year-old female: a case study. Journal of Clinical Chiropractic Pediatrics, Spring/Summer 2000:221-312.
8. Upper cervical care of a pediatric patient with asthma: a case study. Journal of Clinical Chiropractic Pediatrics, Spring/Summer 2000:221-312.

How to Change the World

I realize that many of us want to change the world especially those that know the truth about Upper Cervical Care. The fact remains however that the more we are willing to share that knowledge the more the awareness will spread. When that awareness reaches critical mass, action, actual system wide action, will automatically come to pass.

I know that many of the doctors, patients and advocates of Upper Cervical Care want action now but I feel that the best action right now is to continue to tell the story, shout it from the rooftops and the mountain tops, here, there and everywhere. Right now there are too many people and groups that will try to squash any real action steps, and will most likely succeed. It will only be when critical mass has been reached that the core paradigm will shift and those same people and groups will not be able to stop the actions that will spring forth.

That should be our charge: to continually, and as quickly as possible, strengthen this rising wave of change and then ride that wave on to the beach of a brighter future.

P.S. As Dr. BJ Palmer once said, "You never know how far reaching something you may think, say or do could affect the live of millions tomorrow!" Who knows how many souls have read or been told the truth today, right now this very minute, that has changed how they view their health. People that, had others not been willing to tell the story again and again and again and again, might not have heard it. Getting frustrated with the world and people today is normal, but change will happen faster only if we are willing to keep telling the story. There is an old saying that says, "It is no measure of health to be well adjusted to a profoundly sick society." So don't be well adjusted to society be radical, be different, be abnormal, be crazy, share the truth.

"It is not the final chop that brings the tree down but all the ones that came before."

Keep chopping away.

Trigeminal Neuralgia and Upper Cervical

Yet another example of Upper Cervical Care and the results possible.

Chiropractic management of trigeminal neuralgia: A preliminary study

Roger Hinson, DC and Susan Brown, PhD, DC.

Trigeminal Neuralgia (TN), the most common pain disorder of the face and one of the most painful afflictions known,1 affects one or more branches of the fifth cranial nerve and has a reported annual incidence of 4.3 per 100,000.2 Once known as the suicide disease, TN effects women more often than men and the annual incidence rate increases significantly with age. The pain, abrupt in onset and typically lasting no more than a few seconds, can be triggered by both mechanical and thermal stimuli from inside or outside the area of pain. TN may undergo spontaneous remissions and recurrences, but the frequency of pain commonly increases with chronicity. 3

Medical management starts with a course of anticonvulsants (carbamazepine, gabapentin, phenytoin) gradually increasing in dosage as symptoms warrant. Surgery is performed if symptoms are initially, or become, refractory to medication. Percutaneous ablation of the Gasserian ganglion is the most commonly practiced approach but carries a relatively high risk of numbness and dysesthesia. Microvascular decompression (MVD) of the trigeminal root, involving open surgery through the posterior fossa, has the best results with long term pain relief and the lowest chance of numbness and dysesthesia but greater incidence of serious complications. All currently practiced neurosurgical procedures are associated with significant morbidity and recurrence rates.

There is no reference in the indexed literature to the efficacy of chiropractic procedures for TN. We report outcomes of an 8 week trial of chiropractic care on 8 subjects suffering from TN.

Patient Background

Eight subjects were recruited for this study through a support organization for facial pain sufferers. All reported with a previous diagnosis made by a neurologist of trigeminal neuralgia. Seven subjects met diagnostic criteria for trigeminal neuralgia set forth by the International Headache Society (IHS), while one subject (5) described pain more characteristic of atypical trigeminal neuralgia (ATN) as there were no pain free periods and Aslow@ pain, i.e. aching, burning sensations, was more bothersome than brief, lancinating pain. One subject (7) suffered from trigeminal neuralgia and contralateral anesthesia dolorosa (AD), an iatrogenic disorder caused by surgical deafferentation and characterized by a constant sensation of numbness and burning pain. She had suffered from bilateral TN prior to unilateral radio frequency ablation two years previous.

All subjects were under medical therapy at the time of enrollment and five had undergone unsuccessful surgical treatment, four subjects had undergone two procedures and one had undergone a single procedure. All were female and the ages ranged from 47 to 79 (mean, 62; SD 11.6) years. Chronicity of TN symptoms ranged from 1 15 (mean, 7.4; SD 5.3) years.

Methods

Informed consent was obtained from all subjects prior to enrollment. (Upper Cervical)Chiropractic management was per Grostic technique protocol, which utilizes three mutually orthogonal x ray views for measuring upper cervical displacement from a theoretical norm. Adjustments were administered by one clinician as indicated by supine leg length estimation and dual probe thermocouple analysis. The adjustments consisted of a low force, precisely vectored impulse delivered to the transverse process of C1 with an instrument. Patients were seen three times per week for the first 2 weeks of care, then twice a week for weeks 3 and 4. Visits were scheduled for weeks 5 through 8 as needed, typically once a week.

Pain was assessed via short form McGill Pain Questionnaire (SF MPQ), VAS and pain drawing. Depression was evaluated with the Modified Zung Depression Index. The Rand SF 36 was used to evaluate quality of life. Questionnaires were administered at two weeks prior to (Upper Cervical) chiropractic care, on the first day of care, and after 4 and 8 weeks of care. Subjects maintained a diary in which number, intensity and duration of paroxysms and analgesic usage were recorded.

Results

Reduction in pain was reported by all subjects during the experimental phase. Mean values after eight weeks of intervention were reduced by 69% for MPQ and 78% for VAS. Depression as measured by Zung was reduced by 43%. Pain drawings demonstrated reductions in distribution of pain for all patients. Antiseizure medication usage was discontinued by two, decreased by 33% by one and by 66% by one, and unchanged by four subjects during the eight week period of intervention. Two subjects reported complete absence of paroxysmal pain within four days of first adjustment and no return of paroxysms during eight weeks of intervention. One subject suffering from otalgia had no recurrence of such pain subsequent to first adjustment.

Discussion

The spinal tract and nucleus of the trigeminus descend from the caudal brainstem down to the level of the second cervical vertebra. That area of the nucleus located in the cervical spine, the subnucleus caudalis (Vc), contains second order neurons receiving pain and temperature stimuli not only of trigeminal origin, but also from the facial (n intermedius), glossopharyngeal and vagus nerves, and converges with neurons in the upper cervical dorsal horn which convey equivalent stimuli from upper cervical dorsal rami.

Trigeminal, geniculate, glossopharyngeal, vagal and occipital neuralgias have been described as hyperactive dysfunction syndromes. The efficacy of antiseizure compounds in the treatment of these primary neuralgias results from the depression of exitatory mechanisms of Vc neurons.4 The venules which drain the lateral columns proximal to the dorsal horn where Vc is located operate at low pressure and have little redundancy 5. If adverse mechanical tension were transmitted to the cord via upper cervical dentate ligaments, this area would be among those earliest effected. Such tension could lead to direct mechanical compression of the descending tract of the trigeminus, which lies on the periphery of the cord adjacent to the dorsal spinocerebellar tract, or of Vc. Compression might also lead to venous stasis with resulting hypoxia and hyperexcitability of Vc. We speculate that such tension may result from displacement of the atlanto occipital and atlanto axial joints, and that correction of such displacements may result in attenuation of Vc hyperactivity.

Conclusions

Results from this study suggest that upper cervical chiropractic procedures may be of benefit to TN sufferers. Further study is needed to better qualify the efficacy of chiropractic procedures for TN and other primary neuralgias. A controlled trial is planed to improve the evidence base on which clinicians and patients can make decisions.

References

1. Goodman J. chap 14. In: Biller J, Ed. Practical Neurology. Lippencott Raven, 1997: 142 3

2. Katusic S, Williams DB, Beard CM, Bergstralh EJ, Kurland LT. Epidemiology and clinical features of idiopathic trigeminal neuralgia and glossopharyngeal neuralgia: similarities and differences, Rochester, Minnesota, 1945 1984. Neuroepidemiology 1991;10(5 6):276 81

3. Adams R, Victor M, Ropper A. Principles of Neurology, Sixth Ed. McGraw Hill 1997

4. Kondo T, Fromm GH, Sxhmidt B. Comparison of gabapentin with other antiepileptic and GABAergic drugs. Epilepsy Res 1991 Apr;8(3):226 31

5.Gillilan LA. Veins of the spinal cord. Anatomic details; suggested clinical applications. Neurology 1970 Sep;20(9):860 8

Changing the World

A message to all Upper Cervical Doctors of Chiropractic on the 114th birthday of our profession

The more people are exposed to the thoughts of those that know the truth about Upper Cervical Care the more the awareness will spread. When that awareness reaches critical mass, action, actual system wide change will automatically come forth. I know we all want action now but I feel that the best action right now is to continue to tell the story, shout it from the rooftops and the mountain tops, here, there and everywhere. Right now there are too many people and groups that will try to squash any real action steps, and they will most likely succeed. It will only be when critical mass has been reached that the core paradigm will shift and those same people and groups will not be able to stop the actions that will spring forth. That should be our charge: To continually, and as quickly as possible, strengthen this rising wave of change and then ride that wave on to the beach of a brighter future.

P.S. As BJ Palmer once said, "You never know how far reaching something you may think, say or do could affect the live of millions tomorrow!" Who knows how many souls have read or been told something today, right now this very minute, that has changed how they view the world for the better. People that, had others not been willing to tell the story again and again and again and again, might not have heard it. Getting frustrated with the world and people today is normal, but change will happen faster ONLY if we are willing to keep telling the story.

"It is not the final chop that brings the tree down but all the ones that came before."

Keep chopping away.

Happy Birthday to a great profession and principle!

The Beginnings of Upper Cervical Research

From www.neurologicalfitness.com

NEUROLOGICAL FITNESS INTERVIEW:
LISA ZAYNAB KILLINGER, D.C.

Interview:

1. What surprised you the most when you actually began to work with the B.J. Palmer Clinic (BJPC) files?

As a Palmer student in the 1980's, I had never been given any information regarding B.J. Palmer's research. My perception of B.J. Palmer was more of a showman than researcher. When I began to read through the patient files of the B.J. Palmer Clinic, I was very surprised at how detailed they were, and how well the patient care was documented. I then began to realize what dedication B.J. Palmer had to chiropractic research. He utilized every state of the art tool available in his time, to assess the Palmer Clinic patients before and after their adjustments. Another surprise to me was how infrequently patients were adjusted. Many patient files showed one or two adjustments over months of observation and evaluation. This careful monitoring and follow-up impressed me greatly.

2. How has your work with the BJPC files affected you as a clinician?

I am humbled as a clinician at how carefully the B.J. Palmer Clinics documented chiropractic care. Clinicians often fall into the trap of just writing a bare minimum in the patient file due to time constraints of a busy practice. The message I get from working with the BJPC files is, "document, document, document!" I think most clinicians know the importance of documentation, but if our predecessors could do such a fantastic job of it half a century ago, we should certainly document our patient care perfectly today. Documentation is the key to research, and subsequent dissemination of information about chiropractic care.

3. Do all the cases you're reviewing and working with involve strictly HIO? If not, what types of techniques were used?

In all of the files I have reviewed, including the 1930's-1960's, an atlas or axis adjustment is the only treatment recorded in the files. I have conducted semi-structured interviews with several of the DCs who worked in the BJPC regarding the exact chiropractic procedures used. Each clinician has indicated to me that the adjustments were exclusively Toggle-Recoil (former Upper Cervical Specific) adjustments, usually performed on a side posture table. The knee-chest table was also used, but sporadically. One clinician who worked in the clinic in the mid-late 1950's stated that "when a side posture table wasn't available, or the room was too small for a side posture table, a knee-chest table was used." He also stated that the type of table used was a matter of personal preference, but that it was not a big issue.

4. What have you learned from working with the BJPC files that would make you a better patient educator? Please share that with us!

As a researcher, I want to be very careful about making statements that are not supported by the scientific literature. Working with the BJPC files has opened my eyes to a level of care-giving and patient monitoring that most of us may never live up to in our own practices. Patients came to the Palmer Clinics by ambulance, in wheelchairs, on crutches, and came to be treated at the best, or at least one of the best facilities that chiropractic had to offer at the time. It was a sort of chiropractic ICU. The patients didn't just come for back and neck pain. Around half of the patients, from my preliminary review of the files, came in with viscerosomatic or neuromuscular disease. These people saw the big picture, and came to understand the nervous system's relationship to all body systems. Seeing this in the files has really sparked my enthusiasm for chiropractic and in never underestimating the body's power to heal itself. This renewed spark will carry over into my enthusiasm for patient education.

5. What do you find different about a scientific endeavor guided by a specific set of principles and a specific philosophy?

Pure research or scientific endeavor is simply curiosity, and through that curiosity asking research questions. In scientific research you have to ask those questions, and then report the answers you find regardless of whether your results match your philosophies. Although B.J. Palmer was definitely outspoken on matters of philosophy, I really think he went about reporting what happened in his clinic, and in his studies of field doctors' practices, in a very 'research-minded' way. I will always admire Dr. Palmer for his contribution to our profession, and for working so hard to be a researcher (not an area in which he had training). I hope that all chiropractors will respect the very respect-worthy research that is currently being done in chiropractic. I also hope they will strive to be effective research consumers, keen to the methods of evaluating the quality of the research, and recognizing its strengths and its limitations.

Hodgkins Case

By: B.J. Palmer , Case Study
Entered Clinic April 5, 1955. Male – age 16.

Upon entry to the Clinic, it was reported that the patient’s condition had been medically diagnosed as Hodgkin’s Disease.

Two weeks prior to entry into the Clinic, surgery had been performed over the upper cervical region to remove a cyst. The condition was first noticed at Christmas time of 1953. It was freely movable – appeared hard to the touch.

It was related that analysis made at one of the leading medical sources indicated an involvement of the lymphatic system. The patient was told that the blood picture was no unusual. General health seemed to be good. He was very active. Recommendations were made for a series of radiation treatments, but none were taken.

Previous examinations indicated everything in normal range, including the blood picture, with the exception of a high blood pressure. Also, a trace of sugar was showing in the urine.

Laboratory examinations indicated everything in normal range, including the blood picture, with the exception of a high blood pressure. Also, a trace of sugar was showing in the urine.

The spinographic analysis indicated an Axis Left Lamina listing.
The patient was adjusted on April 6th, with a favorable change showing on the post check. There was a tendency for the pressure reading to return on the 2 days following the adjustment.

However the reading began to settle down by the third day following the adjustment and, with the exception of 3 rough readings, it settled down to a comparatively good reading for the time the patient was in the Clinic.

Daily Case Reports:

Following the adjustment on April 6th, the patient noticed that the right hip, which had been involved to some extent, was feeling a little better.

There was evidence of constructive changes taking place through the cervical area.
April 8th – “Just a little pain on the left side. Sleeping like a log. Eating good.”
April 9th – “Sleeping and eating good. No pain whatever.”
April 10th – “ Just a little stiffness through the neck.”
April 12th – “Feeling good. Eating good. Sleeping good.”
April 13th – “Feeling good. No more difficulty with the pain on the left side.”

From April 13th through April 17th, there was no particular change, but “feeling good”.

After returning home, the parents wrote on July 11, 1954, that their son was continuing to feel good and did not have the side-aces anymore.

On November 3, 1954, the Field Chiropractor wrote that the boy’s condition seemed to be about the same. He stated that there had been no noticeable enlargement of any lymph glands and the pain in his side had not returned.