Biomedical subjects
Publications and source records attributed to D Nansel.
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The biomechanical and physiological effects of a single, unilateral lower cervical spinal adjustment delivered to the most restricted side of cervical lateral-flexion passive end-range were examined. Only healthy, asymptomatic male subjects who exhibited goniometrically verified lateral-flexion passive range of motion asymmetries of 10 degrees or greater on the morning of the experiment were chosen for the study. Posttreatment goniometric measurements revealed that in sham-adjusted controls, mean lateral-flexion asymmetries had not changed significantly during the 4-hr time period examined. However, in subjects who received lower cervical adjustments, dramatic ameliorations of asymmetry magnitude were observed which persisted throughout the entire 4-hr posttreatment time period. On the other hand, in the face of this rather robust biomechanical effect, heart rate and blood pressure measurements obtained at -60 and -15 min prior to treatments, and at 5, 30, 60, 120 and 240 min following treatments, revealed no significant differences between adjusted and sham-adjusted subjects at any of the time periods examined. Consistent with this, analysis of the plasma concentrations of norepinephrine, epinephrine and dopamine in serial blood samples collected at these same times also failed to reveal significant differences between treatment groups at any of the time periods examined. The results of this investigation indicate that lower cervical adjustments are capable, at least in asymptomatic subjects, of inducing relatively robust biomechanical effects related to passive cervical end-range capability without simultaneously inducing significant alterations in the overall activity of the sympathetic nervous system.
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The initial effectiveness as well as the temporal stability of the effect of cervical spinal manipulation with respect to the amelioration of goniometrically verified cervical lateral-flexion passive end-range asymmetry was examined. Responses of two groups of pain-free subjects were compared: a) those exhibiting end-range asymmetries of greater than 10 degrees who, in addition, had suffered previous neck trauma, and; b) those who happened to exhibit end-range asymmetries of greater than 10 degrees but who had no history of prior neck trauma. All subjects received a single lower cervical adjustment delivered to the side of most-restricted end-range, and goniometric reassessments were performed 30 min, 4 hr, and 48 hr following the adjustment. A dramatic amelioration of asymmetry was observed in both groups at 30 min and 4 hr postmanipulation. Furthermore, the magnitudes of these short-term effects were similar for the two groups. However, by 24 hours, a difference in the temporal responses of the groups had become readily apparent. By 48 hours, the difference was even more striking; whereas 14 of 16 of the subjects with no previous neck trauma continued to exhibit asymmetries of less than 10 degrees (mean +/- SEM = 3.8 +/- 1.0 degrees), 12 of the 16 subjects with previous neck trauma had regained asymmetries of greater than 10 degrees (mean +/- SEM = 11.4 +/- 1.7 degrees). These results indicate that among asymptomatic (pain-free) individuals, the mere presence of passive end-range asymmetry as well as the magnitude of the short-term ameliorative effect of cervical manipulation do not distinguish these two categories of subjects.(ABSTRACT TRUNCATED AT 250 WORDS)
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BACKGROUND AND OBJECTIVES: Several theories have been put forth in attempts to explain the possible mechanisms by which patients presumed to be suffering from any of a variety of internal organ diseases are occasionally found to respond quickly and dramatically to therapies delivered to purely somatic structures (e.g., spinal manipulation). The purpose of this review is to examine the scientific bases upon which these sorts of clinical phenomenaight be interpreted. DATA SOURCES: A review was conducted of over 350 articles that have appeared in the scientific literature over the last 75 years. Initially, a MEDLINE search was performed; however, because of the variability of indexing terms employed by investigators within a wide variety of biomedical disciplines, most of this literature had to be located article by article. DATA SYNTHESIS: At present, there have been no appropriately controlled studies that establish that spinal manipulation or any other form of somatic therapy represents a valid curative strategy for the treatment of any internal organ disease. Furthermore, current scientific knowledge also fails to support the existence of a plausible biological mechanism that could account for a causal segmentally or regionally related "somato-visceral disease" relationship. On the other hand, it has now been firmly established that somatic dysfunction is notorious in its ability to create overt signs and symptoms that can mimic, or simulate (rather than cause), internal organ disease. CONCLUSIONS: The proper differential diagnosis of somatic vs. visceral dysfunction represents a challenge for both the medical and chiropractic physician. The afferent convergence mechanisms, which can create signs and symptoms that are virtually indistinguishable with respect to their somatic vs. visceral etiologies, need to be appreciated by all portal-of-entry health care providers, to insure timely referral of patients to the health specialist appropriate to their condition. Furthermore, it is not unreasonable that this somatic visceral-disease mimicry could very well account for the "cures" of presumed organ disease that have been observed over the years in response to various somatic therapies (e.g., spinal manipulation, acupuncture, Rolfing, Qi Gong, etc.) and may represent a common phenomenon that has led to "holistic" health care claims on the part of such clinical disciplines.