What is the healthcare professional looking for?

Research is the language the healthcare world speaks. It is like the saying, “pics or it didn’t happen.” Without it, making a claim about the efficacy of a particular technique for a given malady will not be taking very seriously. There are varying levels of research about, and on topics within, chiropractic.

Jonathan Hooker

As a specific example, let us explore hypertension. An early study by Yates et al. using the activator method showed a statistically significant reduction in both systolic and diastolic blood pressure (1). Yates et al. focused on adjusting the upper thoracic spine (T1-5) and observed the effect on blood pressure and “state anxiety.” Another study was conducted by Bakris et al. on the effect of NUCCA care on hypertensive patients, which reduced the systolic and diastolic blood pressures aby 17.2 and 10.3 mm Hg respectively (2). Another study by Goertz et al. examined those under a diet change as administered by a dietitian, along with those with both chiropractic care and a diet change as administered by a chiropractor. That study did not find a statistically significant difference between the two groups. A final study I found by Plaugher et al. examined a small group of patients under Gonstead care, and compared them to a “brief massage” group and a control group (3). Plaugher et al. also did not find a meaningful change in blood pressure for the treatment group.

My literature search on this topic was far from exhaustive, but these are four studies I was able to find as a cursory “literature review.” Based on the findings of these four papers, only NUCCA and activator had a meaningful effect on hypertension and blood pressure. Continuing the work these papers have started will give a clearer picture on the effects chiropractic may have on blood pressure. Many remaining questions are brought up by Grassi in a commentary piece submitted to the Journal of Human Hypertension in response to Bakris et al. (4), including the long term effect of chiropractic on blood pressure.

Another example would be on the efficacy of a given technique as whole. There is a body of work published about the activator technique, ranging from case studies to no less than 23 clinical trials (5). The research covers a broad collection of topics, ranging from addressing TMJ disorders, treatment of cervical spine dysfunction, to emotional effects in phobic individuals.
For NUCCA, I found four peer-reviewed articles and seven abstracts, with another 13 “non-indexed” publications and six more abstracts (6). Most of these papers are on effects of care on individual ailments, but also have the above-mentioned hypertension study along with a study on migraines. Chiropractic Biophysics has 160 articles published (7), which also range from case studies to clinical trials. Many of these papers focus on spinal curve correction and observing the effects of these corrections.

Based on the data these papers provide thus far, is this sufficient to give the “all clear” for a health professional to look at and say, “I feel safe and confident my referral to Dr. Chiropractic will help you with Y condition”? Some may think so, others may not. Much of this willingness may depend on what it is the referring doctor is referring for. For more general referrals, I believe we have a long way to go. But for some specific things, such as hypertension, spinal curve correction and headaches, there is a body of evidence that show that there is the potential for chiropractic to help. This is just an example of three techniques with publications within Chiropractic, illustrating how much opportunity we have in furthering the profession through research by looking what these, and other researchers have done and building on their findings.

Healthcare professionals want to see outcomes, and proof of these outcomes. Without publishing quality research showing these outcomes, wider acceptance will be met with great resistance. There is a good foundation in some topics, such as the hypertension example, but if a medical professional wants to reliably refer a patient to a Chiropractor for care for a given ailment or malady, more will have to be done.

References:

1. 1. Yates RG, Lamping DL, Abram NL, Wright C. Effects of chiropractic treatment on blood pressure and anxiety: a randomized, controlled trial. J Manipulative Physiol Ther [Internet]. 1988 Dec [cited 2019 Jul 24];11(6):484–8. Available from: ncbi.nlm.nih.gov/pubmed/3075649
   2. Bakris G, Dickholtz M, Meyer PM, Kravitz G, Avery E, Miller M, et al. Atlas vertebra realignment and achievement of arterial pressure goal in hypertensive patients: a pilot study. J Hum Hypertens [Internet]. 2007 May 2 [cited 2019 Mar 17];21(5):347–52. Available from: ncbi.nlm.nih.gov/pubmed/17252032
   3. Plaugher G, Long CR, Alcantara J, Silveus AD, Wood H, Lotun K, et al. Practice-based randomized controlled-comparison clinical trial of chiropractic adjustments and brief massage treatment at sites of subluxation in subjects with essential hypertension: Pilot study. J Manipulative Physiol Ther. 2002;25(4):221–39.
   4. Grassi G. Blood pressure lowering effects of non-surgical procedures for vascular decompression: good news to be taken with caution. J Hum Hypertens [Internet]. 2007 [cited 2019 Jul 24];21:341–2. Available from: nature.com/jhh
   5. Research | Clinical Trials | Activator Methods International [Internet]. [cited 2019 Jul 24]. Available from: activator.com/research/
   6. Publications – NUCCA Upper Cervical Monograph [Internet]. [cited 2019 Jul 24]. Available from: ucmonograph.org/publications/
   7. Chiropractic BioPhysics NonProfit [Internet]. [cited 2019 Jul 24]. Available from: cbpnonprofit.com/Publications/

This article first appeared in the August 2019 issue of Lifelines, the Life West student magazine.