Dural Connection Internet Edition    Volume 5 Number 1

This year’s RAC/ACC – 2005 conference was another great event for chiropractic and chiropractic research. While the list of amazing, important and interesting topics presented are too long for any report the following are some things I feel from my perspective are particularly valuable.

First as a technique representative, for sacro occipital technique (SOT), I do have a bias towards wanting to share and see future research in chiropractic methods and techniques that investigate SOT. The general trend in the chiropractic research community is to have all practitioners perform the same method of treatment; currently what seems acceptable is diversified technique and muscle release technique. While there may seem to be a general distain for chiropractic techniques by the research community conversely there is a significant welcoming to any technique that submits research and takes the effort to share in the RAC/ACC arena.

The ultimate irony is that there is little “evidence” of diagnostic and treatment protocols relating to diversified or muscle release techniques. The dilemma for the research community to me is two fold: (1) How can we adequately study chiropractic if chiropractors and their techniques are so varied? Even with a specific technique each practitioner still sometimes treat completely differently. (2) Is it possible to evaluate subsets of patients who might be more likely to favorably respond to chiropractic care? For instance, instead of putting every female patient suffering with premenstrual syndrome (PMS) into a study, what if the study was only limited to only female patients suffering from PMS whose symptoms began or were worsened by physical trauma? Presently with regard to the dilemma as I perceive it, we are left with more questions than answers.

Two different presentations discussed ways of evalutating which patients might be more responsive to chiropractic care for low back pain or disability. Ron Donelson, MD discussed the centralization phenomena in treating low back pain. [1] He found that when pain centralized with mechanical end-range test movements or positions of the lumbar spine or pelvis that this pattern predicted (early) excellent/good outcomes with mechanical treatment interventions. This means that a patient might have radiating paint from the low back to the leg, and a positive indicator might be that during evaluation a certain posture could be found to relieve the pain in the leg even though it might cause increased pain in the lumbar spine.

Julie Fritz PhD, PT shared a study she and others performed attempting to find a predictor for patients that would best respond to spinal manipulation. [2] Five criteria appeared to fit the best outcomes for patients receiving spinal manipulation and a positive outcome was determined if the 4 out of the 5 criteria were met. These criteria were: (1) Low back pain less than 16 days, (2) That symptoms did not extend distal to the knee, (3) A Fear Avoidance Beliefs Questionnaire (FSBQ) would score less than 19 points, (4) At least one hypomobile segment would be found in the lumbar spine, and (5) At least one hip would have more than 35 degrees of internal rotation.
Specifically pertaining to SOT, there were two studies that discussed SOT block placement. One by Blum and Globe [3] evaluated 38 patients in an in-office setting, 26 treated and 12 controls. R+C factors or cervical indicators were evaluated pre and post orthopedic block placement and tested with a visual analogue scale (VAS). A VAS is a line on a piece of paper with one end saying “very painful” and the other end saying “no pain whatsoever.” The patient would just draw a vertical line through the horizontal VAS line to indicate their pain level. In this study there was a statistically significant difference between the controls and treated group.

A study by Hossu, Rupert and Harrison [4] evaluated three different chiropractic techniques, one of them SOT, and their affect on three asymptomatic males in regard to their biophoton emissions (BPE). BPEs are interestingly found as light emissions from the human body in a completely dark environment. The results showed that each technique elicited a statistically significant and purportedly positive change in BPE, however each pattern of change was different depending upon the technique used.

A study that seemd to have a tangential SOT relationship was discussed by Dr. Ducar who found that groin pain was a common finding in pregnant women she treated and evaluated. [5] It is interesting that inguinal ligament pain which SOT practitioners find related to category two (SI joint hypermobility) and is commonly found with pregnant patients was discussed without any SOT related connection. This omission is primarily because SOT has not published in the literature what has been commonly found in practices that treat pregnant patients. There was some discussion with Dr. Ducar after her presentation and we are hoping to collaborative on a project using SOT treatment for pregnant patients with groin or inguinal pain. Drs. Alcantara and Anderson presented a study of treatment of a patient for gastroesophageal reflux. [6] Of significance is that this is the FIRST study ever presented or published in chiropractic on the treatment of gastroesophageal reflux disease.

Lastly there were three related studies on treatment of TMD. One by Vinjamury etal [7] successfully treated 7 patients presenting with TMD fitting their criteria for their study. Their treatment consisted of chiropractic procedures and muscle stretching. Drs. Skaggs, Gray, and McGill studied muscle activation patterns attempting to determine which supportive muscles were activated in the TMJ and neck during an endurance task (with patient supine they lift their head and hold it in flexion with chin tucked for 15 seconds). [8] While some activation was found of the sternocleidomastoid (SCM) muscles there was significant activity of the suprahyoid muscles which far out weighed any activity of the SCM or any other related muscle which were studied in this small group of 6 subjects.

The rational behind producing an assessment form for dental chiropractic cotreatment was presented to researchers at the RAC. [9] Discussed at the presentation was how dental occlusion can be affected by body posture and dynamics and that posture can affect occlusion and condylar position. The challenges of asking the right questions of patients in order to help dentists determine which patients receiving care would benefit from chiropractic co-treatment, was explored. Gary Globe, DC, PhD brought his expertise and knowledge of assessment instruments to the process of developing a useful tool and we hope to finish this study for publication. This presentation was a great opportunity to inform the chiropractic profession of the need of dental and chiropractic cotreatment and sow the seeds for further dentochiropractic research and examination.

While this year’s RAC/ACC was an informative and exciting event, nothing would make the next one in Washington DC more exciting then if SOT had a significant number of submissions to the conference. The bigger the presence we have at the conference the more we let the colleges, research community and those who make chiropractic policy that SOT is interested in supporting its methods and is responsible to do the work needed to evaluate its premises. If you have any interest in presenting or performing research for submission please let me know if I might be of assistance, the deadline for a March 2006 submission is the end of August 2005.