Chronic Shoulder Problems and Upper Cervical Care: A Case Series

A case series published on July 31, 2014, in the Journal of Upper Cervical Chiropractic Research documented chiropractic care helping patients with chronic shoulder problems. The authors note how common shoulder problems are accounting for 16% of all musculoskeletal complaints with a yearly incidence of 15 new episodes per 1,000 patients seeking primary care.

This case series documented the care of two male patients with chronic shoulder problems. The first patient was a 55-year-old man who went to an upper cervical chiropractor with a chief complaint of right shoulder pain. Seven months earlier, the man had fallen off a 10-foot ladder and landed on his left shoulder, which was not the one he was suffering with at the time of his visit to the upper cervical chiropractor. His examination showed restricted range of motion for his right shoulder. A chiropractic examination showed areas of sensitivity in the man's neck along with postural imbalances of the spine. From the findings, it was determined that subluxations in the neck were present.

The second patient was a 60-year-old man who had pain in both shoulders for one year before coming to the upper cervical chiropractor. He did not have a history of an accident or trauma before his problem started. His examination showed range of motion reductions in his shoulders and his neck. It was also determined that this patient had a subluxation of his neck.

Specific upper cervical chiropractic adjustments were given to both patients according to their chiropractic analysis. The study reported that the results of the chiropractic care for both men were very positive. The 55-year-old man with pain in his right shoulder showed a complete return to normal shoulder movement within a few visits. The recovery was such that the man went on vacation shortly after his upper cervical chiropractic care.

The second man with pain in both his shoulders had a complete return to normal motion in both his shoulders after his first upper cervical chiropractic adjustment. Additionally, his pain was reduced to minimal after the first visit.

The authors noted that although both patients had issues with their shoulders, the chiropractic care given was exclusively to the upper neck, (upper cervical chiropractic care). Both patients were mainly concerned with their ability to move their shoulders, and both regained total range of motion as a result of their chiropractic care. In their conclusion, the authors wrote, "This case series provides support on the use chiropractic adjustments directed to the upper cervical spine in patients with subluxation, shoulder pain and dysfunction."

(Editor's note: Remember the objective of upper cervical care is to correct head neck misalignment that is interfering with proper brain to body communication. When this is corrected the body functions at a higher level and can often correct other problems more efficiently on its own. Please do not confuse upper cervical care as a treatment for any condition, disease or symptom.)

Baby's Low Apgar Improves With Upper Cervical Care

Apgar Score, Respiratory Rate, Distress and  Inability to Cry Helped with (Upper Cervical) Chiropractic

The Journal of Pediatric, Maternal and Family Health published a case study on November 5, 2012, documenting the improvement of an infant who was born suffering from Transient Tachypnea of Newborns (TTN), causing a high respiratory rate, and a lowered Apgar score.

According to the study authors, "Transient tachypnea of newborns (TTN) is a benign, self-limiting respiratory disorder presenting in the first 1-2 hours after delivery and usually resolving within 2 to 5 days of age." TTN is defined by the authors as including an infant with a respiratory rate exceeding 60 breaths/min, nasal flaring, grunting, retractions, cyanosis, poor feeding, and a lowered Apgar score.

In this case, the baby was born weighing 8.1 lbs. and measuring 21 3/8 inches. The labor and delivery were at home with a Certified Practicing Midwife (CPM) present. The birth occurred at  39 weeks 2 days of pregnancy, and the child was born vaginally with no medical interventions or surgical procedures. The delivery was natural without any complications.

At one minute after birth, the respiratory rate was 93 breaths per minute, with normal for a newborn being between 40 and 60.  The study records that at two and a half minutes after birth, the baby was showing obvious signs of distress and was grunting, flaring nostrils, and making gurgling sounds. The baby's Apgar score at 1 minute after birth was recorded at a 6 due to weak respiratory effort, bluish color, and grimacing reflex stimulation. Apgar scores are rated between 1 and 10 with 10 being optimal. It is considered a good normal to have an Apgar score between 8 and 9.

An upper cervical doctor who was on site was asked to examine the infant for head/neck misalignment. Based on a pediatric chiropractic evaluation performed, the doctor determined that a misalignment was present at the upper cervical (neck) area and, with the consent of the mother, a specific form of chiropractic adjustment for an infant was performed.

At 10 minutes after the birth, and following the (upper cervical) chiropractic adjustment, another examination was performed that showed the Apgar score had returned to a normal score of 9. Additionally, the respiratory rate had also lowered to 80 breaths per minute, and within one hour had lowered further to 74 breaths per minute. The report notes that at 12 hours after birth, the respiratory rate was at 60 breaths per minute and all other findings were within normal range.

The authors of the study summed up the success of upper cervical care in helping this infant by saying, "The case of a newborn diagnosed with Transient Tachypnea of Newborn is presented. Respiratory rate, Apgar score, and other signs of TTN improved dramatically following an upper cervical adjustment to reduce vertebral subluxation."

(Editor's note: Remember the objective of upper cervical care is to correct head neck misalignment that is interfering with proper brain to body communication. When this is corrected the body functions at a higher level and can often correct other problems more efficiently on its own. Please do not confuse upper cervical care as a treatment for any condition, disease or symptom.)

Multiple Sclerosis and Upper Cervical Care: Case 5

Editor's Note: This is the sixth 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.

CASE 5

History: This 43-year-old female first experienced symptoms of MS seven years ago. The symptoms included numbness in her legs, hands, and face, and lasted for two weeks. No further symptoms occurred until six years later with the onset of L'hermitte's Sign. Soon after L'hermitte's Sign began, this patient noticed loss of grip strength and a spasmodic curling of her left hand. After an MRI, she was diagnosed with MS. Because Lhermitte's Sign was present every time she nodded her head causing her pain, she began daily pain medications (neurontin). After the symptoms were constantly present for six months, she began upper cervical care.

Exam: During her initial (upper cervical) chiropractic exam, cervical flexion produced L'hermitte's Sign. Cervical extension and left rotation were reduced and painful. She reported constant tingling in her left arm, grip strength loss in her left hand, and weakness and pain in both forearms. She experienced aggravation of forearm pain while taking notes in class. As an avid martial arts participant, she expressed concern over her inability to perform push-ups in class due to exacerbation of L'hermitte's Sign. She also reported experiencing dizzy spells several times per day for many years. Cervical radiographs depicted right laterality of atlas. Computerized thermal imaging revealed thermal asymmetries of 0.5ºC.

Outcome: After the first upper cervical adjustment, this patient noted reduction in intensity of L'hermitte's Sign. By the end of two weeks of care, L'hermitte's Sign was noticeable only occasionally and no dizzy spells had occurred. After four weeks of care, this patient no longer reported experiencing any dizzy spells, arm pain, tingling, forearm weakness, or L'hermitte's Sign. Consequently, she reduced her pain medication dosage. In addition, she resumed taking notes in class and performing pushups in her martial arts class without pain or tingling.

Summary: This subject's symptoms were present constantly for six months prior to upper cervical care. With the intervention of (upper cervical) chiropractic care, symptoms were reversed either immediately or over one month's time.

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.

Can Mental Function Improve with Upper Cervical Care?

J Manual Medicine (1992) 6:215-216
(c) Springer-Verlag
Clinical Note

Upper Cervical Adjustments May Improve Mental Function
M.D. Thomas and J. Wood

Palmer College of Chiropractic Clinic, 1000 Brady Street, Davenport, Iowa 52803, USA

Summary

This report describes abrupt improvement in mental and motor deficits in a 14-year-old girl after the initiation of specific upper cervical chiropractic care. Cessation of this care for several months was associated with a return to the patient's previous condition. Repeat manipulation was followed by recovery of the patient to the level of her previous improvement. This cycle of regression to pretreatment condition in the absence of care followed by recovery after specific upper cervical care has occurred three times to date.

Periodic evaluations of a 14-year-old girl by her school psychologist were conducted between March 1984 and October 1989. The Leiter Performance Scale indicated severe mental, deficits, and the Vineland Adaptive Behavioral Scale indicated social adaptation within the trainable mentally handicapped range. Evaluations were most recently performed prior to initial chiropractic care in 1989. Informally, her teachers reported occasional moments of increased alertness and performance of tasks she normally did not perform.

Medical history

The birth of this patient followed an uncomplicated pregnancy. Apgar scores were seven after 1 min and nine after 5 min., well within normal ranges. Speech problems were first noted at 30 months of age. In November 1978, the patient was admitted into an Early Childhood Education Program because of her deficiencies in speech and social development. She had developed behavioral problems by November 1979. She was evaluated by a neurologist who told the parents she would outgrow these problems by the age of 6 years. An electroencephalogram (EEG) performed in September 1980 was reported as normal.

The patient was enrolled in kindergarten in September 1981. She was transferred to a behavioral disability class in the next semester because of inattention in class and poor test scores. Initially, it was hoped the smaller class and more intense instruction would correct the inattention and test scores would improve. In September 1982, the patient's teacher reported she was having "staring spells". In January 1983 "slight abnormalities” were noted in a sleeping EEG.

In February 1983 the diagnosis of psychomotor seizures was presented to the family. Tegretol and Dilantin were prescribed without positive results. By August 1983, the patient had been weaned off both medications. At this time the patient's neurologist felt that there was a “degenerative neurological disorder," and she was subsequently referred to the Mayo Clinic in Rochester, Minnesota. By January 1984, she had twice been examined at the Mayo Clinic without further definition except for acknowledgment that the sleeping EEG continued to be slightly abnormal. In May 1984, the patient was transferred from a behavioral disability class to a trainable mentally handicapped class.

In August 1985, she underwent a week-long evaluation at the National Institute of Health in Bethesda, Md. Again, all was normal (including MRI and various serum studies) except for slightly abnormal EEG. By July 1987, her EEG had improved and a degenerative neurological process was ruled out. In October 1988 and August 1989, this patient was examined at the Children's Hospital in Milwaukee. All findings were negative.

Chiropractic care

At the Palmer Public Clinic, interviews conducted in October 1989 with the parents and examination of available written records revealed a 13 -year-old female with a tested verbal ability at approximately 3 years of age. The patient reportedly spent most of every day sitting and staring into space while listening to the radio. She never made contact with others. The patient tended to stay near her family and followed behind them when they went walking. She spoke very rarely, using single words, always nouns, which were occasionally appropriate and often echolalic. She often mumbled incoherently to herself. Given several choices, she always took the last choice offered.

The patient did not use her left arm or hand in situations where normal children would. In retrieving objects or grasping a swing while swinging she used only her right arm. The left arm did not swing appropriately as she walked, hanging flaccidly at her side while her right arm swung appropriately. We found adequate grip strength in both hands, with the right hand stronger than the left.

Orthopedic and neurologic evaluation was difficult due to patient noncompliance. The supine leg check showed leg length inequality, with the right leg 2 cm shorter. X-rays revealed osseous misalignment at the craniovertebral junction, with left atlas laterality and posterior rotation. This was accompanied by coupled motion of the inferior cervical vertebrae into the left frontal plane. Skull rotation was into the right frontal plane. Postural distortion was consistent with unilateral right extensor muscle hypertonicity. Specific upper cervical adjustments using National Upper Cervical Chiropractic Association (NUCCA) procedures were given on 16, 17, and 19 October 1989. Leg length inequality and postural distortion were corrected after the third adjustment. Post manipulation X-rays on 19 October 1989 revealed a proportional 90% correction of the previous cranio-vertebral misalignment.

The patient began to make eye contact. On 19 October 1989 she returned with her parents to her home in Wisconsin. Within 2 weeks, the patient was forming sentences with personal pronouns, verbs, adjectives and nouns. The patient began standing straighter. She used her left arm in activities and swung her left arm normally during walking. These changes persisted for about 6 weeks, when her condition again began to deteriorate.

The patient was adjusted by a succession of three chiropractors near her home utilizing three techniques, different from the technique we employed. None of their interventions was effective. By June 1990, the patient's condition was back to its
previous baseline. On 6 August 1990, the patient was again brought to our clinic. Upper cervical radiographs were again taken and specific upper cervical adjustment delivered. Radiographs obtained immediately after the adjustment revealed a proportional 95% correction. Immediately, the patient responded with eye contact, full sentences, and appropriate speech which she initiated. Left arm use was again regained. She stood straighter and walked more symmetrically. For the first time, she engaged in family conversation and activities. When offered a choice, her decision was truly a decision and not agreement or a repeat of the last choice given.

The family returned home and these changes persisted for about 6 weeks before the patient began to return to her former condition. By the time the patient was next adjusted by a chiropractor using NUCCA procedures, in late June of 1991, she had lost much of the use of her left arm and was no longer speaking in sentences. Specific upper cervical adjustment again restored use of the left arm and ability to speak in complete sentences. As of 28 August 1991, the patient had not been again
adjusted and no longer spoke in complete sentences, although active left arm use persisted.

Discussion

Interpretation of these results is difficult, because there is a correlation between upper cervical adjustments and apparent improvement in mental function. High correlation does not necessarily indicate a causative relationship. Perhaps the mechanism that might most assist in explaining neural dysfunction accompanying upper cervical misalignments is altered input to the central nervous system from neck joint capsule receptors [1]. Some chiropractors who treat the upper cervical spine believe that upper cervical misalignments may alter neural function by causing longitudinal and transverse traction on the upper cervical spine and brain stem or on the upper cervical spine alone. Even in cases where stretching is not pathological, stretching of axons decreases their diameter. Conduction velocity decreases as fiber diameter is decreased [2]. Sufficient reduction of axon diameter completely blocks the transmission of nerve impulses.

References

1. Schwartz IL, Siegel GJ (1985) Excitation, conduction, and transmission of the nerve impulse. In: West JB (ed) Best and Taylor's physiological basis of medical practice, 11 th edn, chapter 3. Williams & Wilkins, Baltimore, pp 28-57

2. Wyke B (1979) Neurology of the cervical spinal joints. Physiotherapy 65:72-76

Lung Function and Upper Cervical

The study below suggests that with correction of the upper neck via Upper Cervical Care the function of the lungs can be improved.

Changes in Pulmonary Function Associated with Upper Cervical Specific Chiropractic Care
Robert Kessinger, D.C.
[Vol 1, No. 3. p 1-7]

A study was conducted on 55 patients in the private office setting to assess the influence of upper cervical adjustments on pulmonary function. Subjects were monitored before and after chiropractic care by spirometric indices which measured forced vital capacity (FVC) and forced expiratory volume in one second (FEV-1). Of the 55 subjects, 33 (60%) presented with lung function outside of the normal range.The 33 subjects outside of the normal range showed the greatest increases in FVC and FEV-1 over the two week course of the study, although subjects within normal range also showed improvement in the spirometric tests.Additionally, significant positive changes were observed in subjects of both sexes representing the age range of 48-80 years, when compared to the younger age range of 18-47 years. The magnitude of these finding resulted in both a statistically significant functional effect, as well as a moderate clinical effect determined by effect size measurements for FVC and small clinical effect for FEV-1. This study indicates that subjects show improved pulmonary function in FVC and FEV-1 after receiving chiropractic care for the correction of upper cervical vertebral subluxation.