Chiropractic Research

Auckland, New Zealand

Resolution of Vertigo, Migraines and Neck Pain

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Resolution of Vertigo, Migraines and Neck Pain in a 12 Year Old Boy Receiving Chiropractic Care – A Case Study

Objective: This article describes and discusses changes in vertigo, migraine and neck pain symptoms in a 12 year old boy receiving chiropractic care. Clinical Features: A twelve year old boy with a long history of routine, recurrent dizziness, chronic neck pain and migraines presented for chiropractic care. These symptoms resulted in him being absent from school more than half of the time for the previous seven years.

Intervention and Outcome:The patient received high velocity low amplitude thrust chiropractic adjustments for the reduction of vertebral subluxations over a twelve month period. The C2 and C6 spinal segments were regularly adjusted over this timeframe, as well as mid-thoracic vertebrae and the sacrum. The initial frequency of care was three chiropractic visits per week for four weeks. Visit frequency was then gradually reduced over the next 12 months to one visit per month. Besides the chiropractic adjustments the patient was also advised to perform cervical stretches (lateral flexion, rotation and flexion/extension) twice daily. After the first week of chiropractic care the patient reported a cessation of his headaches and neck ache. His vertigo attacks decreased in frequency and became less severe, then ceased altogether. His attendance improved dramatically at school and dropped from 223 half days absent the previous year to 56 half days absent for the 12 months after beginning chiropractic care.

Conclusion: This case report describes a child who reported a cessation in symptoms of vertigo, neck pain and headaches after beginning chiropractic care. There are a growing number of case reports that suggest chiropractic care may be beneficial for patients suffering from vertigo. Further study is required to investigate the role chiropractors may play in caring for people with vertigo.

Altered central integration

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2008 ACC-RAC AWARD WINNING PAPER

Heidi Haavik · Bernadette Murphy . Kelly Holt

Altered central integration of dual somatosensory input after cervical spine manipulation

Objective: The aim of the current study was to investigate changes in the intrinsic inhibitory interactions within the somatosensory system subsequent to a session of spinal manipulation of dysfunctional cervical joints.

Method: Dual peripheral nerve stimulation somatosensory evoked potential (SEP) ratio technique was used in 13 subjects with a history of reoccurring neck stiffness and/or neck pain but no acute symptoms at the time of the study. Somatosensory evoked potentials were recorded after median and ulnar nerve stimulation at the wrist (1 millisecond square wave pulse, 2.47 Hz, 1 × motor threshold). The SEP ratios were calculated for the N9, N11, N13, P14-18, N20-P25, and P22-N30 peak complexes from SEP amplitudes obtained from simultaneous median and ulnar (MU) stimulation divided by the arithmetic sum of SEPs obtained from individual stimulation of the median (M) and ulnar (U) nerves.

Results: There was a significant decrease in the MU/M + U ratio for the cortical P22-N30 SEP component after chiropractic manipulation of the cervical spine. The P22-N30 cortical ratio change appears to be due to an increased ability to suppress the dual input as there was also a significant decrease in the amplitude of the MU recordings for the same cortical SEP peak (P22-N30) after the manipulations. No changes were observed after a control intervention.

Conclusion: This study suggests that cervical spine manipulation may alter cortical integration of dual somatosensory input. These findings may help to elucidate the mechanisms responsible for the effective relief of pain and restoration of functional ability documented after spinal manipulation treatment. (J Manipulative Physiol Ther 2010;33:178-188)

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Altered cortical integration

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Altered cortical integration of dual somatosensory input following the cessation of a 20 min period of repetitive muscle activity

Heidi Haavik · Bernadette Murphy

Received: 29 January 2006 / Accepted: 8 October 2006
Published online: 30 November 2006 © Springer-Verlag 2006

Abstract

The adult human central nervous system (CNS) retains its ability to reorganize itself in response to altered aVerent input. Intracortical inhibition is thought to play an important role in central motor reorganization. However, the mechanisms responsible for altered cortical sensory maps remain more elusive. The aim of the current study was to investigate changes in the intrinsic inhibitory interactions within the somatosensory system subsequent to a period of repetitive contractions. To achieve this, the dual peripheral nerve stimulation somatosensory evoked potential (SEP) ratio technique was utilized in 14 subjects. SEPs were recorded following median and ulnar nerve stimulation at the wrist (1 ms square wave pulse, 2.47 Hz, 1£ motor threshold). SEP ratios were calculated for the N9, N11, N13, P14–18, N20–P25 and P22–N30 peak complexes from SEP amplitudes obtained from simultaneous median and ulnar (MU) stimulation divided by the arithmetic sum of SEPs obtained from individual stimulation of the median (M) and ulnar (U) nerves.

There was a signiWcant increase in the MU/M + U ratio for both cortical SEP components following the 20 min repetitive contraction task, i.e. the N20–P25 complex, and the P22–N30 SEP complex. These cortical ratio changes appear to be due to a reduced ability to suppress the dual input, as there was also a signiWcant increase in the amplitude of the MU recordings for the same two cortical SEP peaks (N20–P25 and P22–N30) following the typing task. No changes were observed following a control intervention. The N20 (S1) changes may reXect the mechanism responsible for altering the boundaries of cortical sensory maps, changing the way the CNS perceives and processes information from adjacent body parts. The N30 changes may be related to the intracortical inhibitory changes shown previously with both single and paired pulse TMS. These Wndings may have implications for understanding the role of the cortex in the initiation of overuse injuries.

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Interexaminer reliability

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Interexaminer reliability of a leg length analysis procedure among novice and experienced practitioners

Kelly Holt, BSc (Chiro), PGCertHSc,a David G. Russell, BSc (Chiro),b Nicholas J. Hoffmann, BHlthSci, B Chiro, Benjamin Bruce, B Chiro,d Paul M. Bushell, B Chiro,e and Heidi Haavik, BSc (Chiro), PhDf

Objective: The purpose of this study was to evaluate the interexaminer reliability of a leg length analysis protocol between an experienced chiropractor and an inexperienced chiropractic student who has undergone an intensive training program.

Methods:Fifty participants, aged from 18 to 55 years, were recruited from the New Zealand College of Chiropractic teaching clinic. An experienced chiropractor and a final-year chiropractic student were the examiners. Participants were examined for leg length inequality in the prone straight leg and flexed knee positions by each of the examiners. The examiners were asked to record which leg appeared shorter in each position. Examiners were blinded to each other’s findings. κ statistics and percent agreement between examiners were used to assess interexaminer reliability.

Results: κ analysis revealed substantial interexaminer reliability in both leg positions and also substantial agreement when straight and flexed knee results were combined for each participant. κ scores ranged from 0.61, with 72% agreement, for the combined positions to 0.70, with 87% agreement, for the extended knee position. All of the κ statistics analyzed surpassed the minimal acceptable standard of 0.40 for a reliability trial such as this. Conclusion: This study revealed good interexaminer reliability of all aspects of the leg length analysis protocol used in this study. (J Manipulative Physiol Ther 2009;32:216-222)

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