Evidence Based Care Is Medical?

by Matthew McCoy DC, MPH

Because of the kind of work I do I attend a lot of chiropractic seminars, conventions etc. And since I run with the subluxation centered crowd these are usually the types of seminars and conventions I attend. I also grew up around this faction of the profession from an early age and have heard and seen countless presentations by subluxation centered chiropractors.

One thing I have been hearing quite a bit of from the stage and on social media is this notion that "Evidence Based Health Care" is "medical."

This makes no sense.

I understand chiropractors’ concerns in regards to the inappropriate interpretation and use of the concept of evidence based practice – that isn’t the issue. The issue is that requesting or requiring evidence regarding our care or our claims is considered "medical" or that research in and of itself is "medical" and therefore bad.

If a chiropractor tells me or shouts from the stage that they "don’t need no evidence" then I have a couple of questions for them:
1.  How do you determine that the practice member lying on your table is in need of an adjustment?
2.  How do you determine whether or not the subluxation was reduced or corrected?
Because unless you are just walking into your adjusting rooms and pushing haphazardly on the spine in no particular direction and for no particular reason then – you need evidence.

You need evidence that a subluxation is present.

You need evidence of its characteristics.

If you don’t have those then you have nothing.

So, now extrapolate your individual experience with this patient to the population level. We need evidence regarding the population level characteristics of subluxation as it manifests in the masses.

In research this is called epidemiology.

Evidence based practice is simply helping patients make decisions about their health care based upon:
1.  What does the scientific evidence say?
2.  Does the scientific evidence fit the clinical state and circumstance of my practice member?
3.  What does the patient want to do?
All three of these are overseen by the doctor who helps the patient make decisions about their health care.

It’s important to note that the absence of evidence does not mean that chiropractic (or any other care) is not warranted for the practice member. It just means there is no scientific evidence. Absent such evidence the decision to undergo care is based on the remaining factors.

It is also important to point out that there is an evidence hierarchy and that there are higher and lower levels of research. So even in a case where there is not a single case study, never mind a randomized controlled clinical trial, that does not mean there is no evidence. In situations like that one may need to rely on basic science research to bridge the evidence gap in order to make an informed decision.

So next time you hear a chiropractor say "we don’t need no evidence", do us all a favor and educate them on what evidence based practice really means.

As always, I look forward to comments, feedback and suggestions.

Matthew McCoy DC, MPH
Chair – Research Committee
International Federation of Chiropractors & Organizations
matthewmccoy@comcast.net

What do you think? Is Evidence-Based Practice Only Medical? #EBP #Medical #Chiropractic #Research
Posted by Travis Robertson on Thursday, March 31, 2016

What do you think? Is Evidence-Based Practice Only Medical? #EBP #Medical #Chiropractic #Research https://t.co/B3oeDPU1gM

— Travis Robertson (@theuppercblog) March 31, 2016

Upper Cervical Care and You Vs. Depression and Anxiety

A case study published in the Journal of Upper Cervical Chiropractic Research on June 20, 2013, reports on the results of a case series showing chiropractic helping patients with depression and anxiety. This case series was looking for follow up on previous surveys showing that chiropractic patients felt chiropractic care helped with their mental and emotional states.

The authors begin by reporting that a previous study showed that in a survey of 2818 patients who completed chiropractic care, 76% of those patients reported a mental/emotional improvement, as well as positive changes in stress and life enjoyment over a period of several months following the chiropractic care. Additional prior studies also showed chiropractic care assisting patients with these types of mental health disorders.

This case series study involved six patients who responded to an Internet posting looking for people suffering from mild to moderate depression or anxiety who wished to be a part of a study involving chiropractic. The patients were not under any psychotherapy at the time and were given tests using standard scales of psychological testing to determine and measure their mental state prior to and after the chiropractic care.

All six of the participants also suffered from a variety of problems including musculoskeletal pains, asthma, hypertension, gastrointestinal issues, and sleep disorders. Those who were taking medications made no changes to their medications during the study to rule out any improvement due to medication.

For the purposes of this study, care was limited to only 12 chiropractic visits over a six week period. A specific analysis and form of chiropractic adjusting was used to correct nerve system interference from subluxations. To measure patient progress, a number of protocols were used both to monitor the chiropractic correction of subluxations as well as to see any improvement in depression or anxiety.

The results of the study were recorded for five of the six participants as one participant left the program due to a family emergency. The remaining five participants all showed positive results in most of the areas that the researchers measured. All five also showed positive test results for a decrease in nerve interference from subluxation. All five participants showed a "...significant decrease in depressive symptom ratings." All five measured a "...significant decrease in anxiety."

Additionally, four of the five participants who completed the study also reported a self feeling of improvement with their depression, enough to state that they would recommend this type of care to others with depression. Four of the five participants also reported significant improvements in the other health issues and problems they were suffering from at the beginning of the study.

In their conclusion the authors wrote, "The results provide tentative support for the effectiveness of upper cervical (neck) chiropractic care for anxiety and depression symptoms." They also stated, "The present study found reduction in anxiety and depression symptoms and reduction in overall psychological distress among individuals with mild to severe depression, anxiety or both."

(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.)

Car Crashes, Vertigo, Migraines and Upper Cervical Care

More Research Linking Migraine Headaches, Vertigo and Car Crashes

A recent case study from the Blair upper cervical chiropractic group reveals additional evidence linking head and neck trauma to migraine headaches and vertigo.  This case study is another example of what the upright MRI research is revealing. 

Here’s a quote from Dr. Lenarz’s case report: 

A 54 year-old female patient entered the office with complaints of migraines 1-2 times per week and extreme chronic neck pain and vertigo for the past 10 years. She was injured in a motor vehicle accident ten years prior to her first visit in our office.  The patient was seen 19 times over a period of 12 weeks. She received 3 upper cervical corrections during this time. The patient reported having 1 migraine 2 weeks after the first correction. Since that time, she has reported no migraine episodes, neck pain or vertigo.

Dr. Scott Rosa, upper cervical chiropractor from New York has been doing some amazing research with upright MRIs.  He’s been able to show that when someone has a misalignment in the upper neck it is actually changing the flow of cerebral spinal fluid (CSF) to, from and through the brain.  CSF is the fluid that lubricates the brain and spinal cord.  This research is helping scientists to explain the results upper cervical chiropractors are seeing in their offices every day.

The upright MRI technology can show the obstruction at the first few bones in the neck and how this misalignment causes a backup of CSF and increased intracranial pressure. When the misalignment is corrected by an upper cervical procedure such as NUCCA, the studies show that the pressure decreases by 28.6%!  And the CSF flow becomes normal.

These changes in CSF, blood flow and intracranial pressure are likely linked to the results upper cervical chiropractors see with migraine patients and several other conditions, especially after a history of head or neck trauma.

(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.)

Christmas Wishes of the Upper Cervical Variety

Adapted from "12 days of Christmas, but only 3 Christmas Wishes"

Dr. Zachary Ward

There are 12 days of Christmas, but if I were to drop a letter in the mail to old Kris Kringle I would only have 3 items on my list.

Christmas Wish #1:  More doctors like Dr. Bruce Bell.

A couple of decades ago, upper cervical care certainly wasn’t on the radar of Dr. Bruce Bell MD, a family practice physician in the suburbs of Chicago.

Being a guy who loved his patients and science, he began to notice a trend among his patient population: some of them saw improvements in health status after receiving upper cervical care (UCC). He investigated it and discovered the NUCCA upper cervical approach to spinal balance.

That began a personal investigation into upper cervical care (UCC). And over several years, Dr. Bell sent thousands of referrals to an upper cervical doctor, Dr. Marshall Dickholtz, Sr. of Chicago, Illinois. The fruits of the Bell and Dickholtz working relationship weren’t just limited to happier patients. Dr. Bell insisted on trying to document some of the changes that he saw in his patients, and began the long task of trying to form a research investigation into NUCCA.

In a story to long to tell here, that investigation ended in the very groundbreaking pilot study on UCC and hypertension featured in the Journal of Human Hypertension. In that pilot study it was shown there was a strong association between NUCCA UCC and the reduction of blood pressure in high blood pressure patients.

Now the National Institutes of Health is funding another study to see if these findings can be reproduced among a larger patient population. And thousands of patients are discovering UCC who wouldn’t have found it otherwise!

All of this wouldn’t have been possible if it wasn’t for Dr. Bruce Bell, who stepped outside his experience, and found good things were happening for his patients under UCC.

Christmas Wish #2: More money for UCC research

Right now the Upper Cervical Research Foundation is researching the relationship between the upper cervical spine, and a number of conditions which cause human suffering. And they aren’t the only ones. A number of chiropractic colleges have strong, award winning research departments, whose studies have been instrumental in expanding our understanding about the human body. And the relationship between our health and health of the spine.

But it wasn’t until as recently as 1998, that chiropractic institutions began to get significant funding from the National Institutes of Health. Right now, those funding dollars add up to several millions of dollars a year, often spread out over many projects.

Compared to several decades ago, it’s better than nothing. But compared to the tens of billions of dollars the federal government gives medical institutions for research, per year, the amount is almost insignificant.

There are now hundreds of studies which support the benefits of care. Far more than there were even a few years ago. But for the public and the health care system to benefit from care, we need to be able to show how and why we help.

We can’t do that without more research money.

Christmas Wish #3: More children under upper cervical care

“I wish I would have tried this 30 years ago,” is a common phrase heard in my office, and the office of other chiropractors. Of course, sometimes it’s 10 years ago, or 2 years ago, but you get the idea.

My response, though I don’t always say it, is:  ” No, someone should have checked you right after birth.”

Now, not every baby has a difficult birth. And many of our modern birthing methods can save the lives of seriously threatened infants. Yet, they can also place a lot of stress on the upper cervical spine of infants as they move through the birth canal. A process that already places stress on the child’s head and neck.

As a result of this stress, many children come into the world with their bodies out of balance, and they show evidence of it as they grow. For many this shows up as inability or refusal to nurse on one side, a distorted sleep posture (c-shaped bent to the side), stronger motor development on one side of the body than the other, and colicky symptoms.

I can tell you from personal experience, that each of my children has only received a handful of adjustments, they tend to maintain their alignment for a long time, and don’t experience the health problems that plague their playmates, like colic, headaches, and ear infections.

Perhaps if more parents were willing to actually see if their child’s “head was on straight” we might be able to avoid some of the more serious problems that bring people to the doctor later on in life.

Thank you for reading my Christmas wish list! Here’s how you can make each of these wishes come true:

1.If you’re a person who’s seen major improvements in health since starting upper cervical care, share those changes with your primary care physician. They deserve to know what you’re doing.

2.If you’d like to have more groundbreaking research, consider become a donating sponsor of the Upper Cervical Research Foundation.

3.If you’re a parent with a child who has health challenges, consider the possibility that your child’s spinal alignment has a role to play in their health maintenance and healthy development. And get your child to an upper cervical doctor.

Have a blessed Holiday!

A Journal Of Upper Cervical Care Research...About Time

By Matthew McCoy, DC, MPH

Perhaps because of my long term affiliation with Life University I have always had a deep interest in upper cervical work. I’ve often thought that if we are going to get to the bottom of the nature of vertebral subluxation, why not start with the area of the spine considered to be the most crucial? A research journal devoted to the upper cervical spine has been needed in this profession since its inception. Just as occurred with children, the largest chiropractic managed care provider in the United States considers the use of specific upper cervical care to be experimental and investigational. The most dedicated, analytical and scientifically minded chiropractors I have ever known were upper cervical practitioners. A couple of the greatest textbooks in chiropractic are focused on upper cervical work. Through the publication of the Journal of Upper Cervical Chiropractic Research - JUCCR I hope to provide a venue and a forum to those doctors who are passionate about upper cervical work.

Seizures And Upper Cervical Care

A case study documenting the improvement of a 25 year old woman suffering from seizures who was helped by [upper cervical care] was published in June 2010. In this case the woman was diagnosed at age 14 with juvenile myoclonic epilepsy (JME), and had suffered with the problem for more than 10 years.

The woman's history showed that the seizures started at age 14 shortly after a neck injury and just after her first menstrual cycle. She had been diagnosed with JME by the Michigan Institute for Neurological Disorders in 1998, 11 years before starting [upper cervical] care. She reported that at age 14 she fell out of bed and hit her head on a desk 2 to 3 months before the seizures began. At the time of her initial visit she was taking 200 mg of lamotrigine per day to control the seizure activity. Over the previous 11 years, she reported that she experienced 1 to 2 seizures per month. She also noted that her menstrual cycles were severely abnormal lasting approximately 10 days, with 10 to 15 days between cycles.

Examination was specifically focused on the upper cervical spine and care was initiated to correct a [misalignment of the] first cervical vertebrae (atlas) using specific [correction] procedures. The study reported that the woman received this care over a 12 week period.

The results showed that the woman did report one seizure a few days after the beginning of [upper cervical] care. After that point she reported having 6 episodes of minor twitching that did not progress into seizure. According to the study the woman did not experience any additional seizures from this point forward. In addition to the seizure benefits she also reported that her last 2 menstrual cycles lasted less than 7 days and were 28 days apart.

In their conclusion the authors wrote, "This case study demonstrated improvement in a young woman with a seizure disorder after she received upper cervical [care]. This case suggests the need for more rigorous research to examine how upper cervical [care] may provide benefit to patients with seizure disorders."

But remember upper cervical care is not a treatment for seizures but people with seizures can improve with upper cervical care because it frees up the body to function more correctly and efficiently once again.

Upper Cervical Care and High Blood Pressure: The Palmer Study

Below is part of an article about the research that Palmer College will be doing regarding Upper Cervical Care and Hypertension/High Blood Pressure.

Click here for the full article

Researchers at the Palmer Center for Chiropractic Research (PCCR) clinic facility, 741 Brady St., Davenport, on the campus of Palmer College of Chiropractic, are looking for 165 people in the Quad Cities with hypertension, or high blood pressure, to participate in a clinical research study with the potential for significant impact on the treatment of hypertension. Patient recruitment began in late November. Participants must have high blood pressure and be between 21 and 75 years of age.

“More than 50 million Americans suffer from high blood pressure, making it the most commonly diagnosed disease in the United States,” said Dr. Goertz. “Although many medical treatments for diagnosed hypertension are available, only about 30% of patients achieve blood pressure goals. Many patients report that they are unable to tolerate medication side effects and find it difficult to sustain significant lifestyle changes. Thus, a non-pharmacological therapy that lowers blood pressure could become an attractive option to many patients and their physicians.”

“The concept that manipulation of the upper cervical spine could reduce blood pressure is both novel and appealing at the same time” said Dr. Lamas. “It is novel because of its originality of thought, and because it is backed up by preliminary data. It is appealing because any treatment for high blood pressure that does not expose patients to drugs and their side effects should be investigated. I really look forward to assisting with the study and seeing the results.”

“This should be an interesting trial,” added Dr. Giudici. “Work to date has shown that blood pressure responds to other non-pharmacologic interventions such as diet, weight loss, exercise, stress reduction and yoga. There is also some interesting early data on blood pressure response to slowing respiratory rate. Palmer has put together an impressive team of researchers and the infrastructure needed to perform this and other studies.”

Potential participants in the study will be examined at the PCCR clinic and Trinity Terrace Park Family Practice Clinic to determine whether they qualify for the study. If so, they will be randomly assigned to one of three different upper cervical treatment groups, all of which will receive chiropractic care at the Palmer Research Clinic for eight weeks. Patients will have their blood pressure monitored on a regular basis while participating in the study. All examinations and treatment are provided at no charge to the patient.