B.J. Palmer, D.C., reported management of Multiple Sclerosis patients
with upper cervical chiropractic care as early as 1934. (7-8) In his
writings, Palmer listed improvement or correction of symptoms such as
"spasticity, muscle cramps, muscle contracture, joint stiffness,
fatigue, neuralgia, neuritis, loss of bladder control, paralysis,
incoordination, trouble walking, numbness, pain, foot drop, inability to
walk, and muscle weakness." His chiropractic care included paraspinal
thermal scanning using a neurocalometer (NCM), a cervical
radiographic series to analyze injury to the upper cervical spine, and
a specific upper cervical adjustment performed by hand.
While few of Palmer's Research Clinic cases were published, Palmer
described one case of Multiple Sclerosis in detail. (8) The patient, a
38-year-old male, went to the Palmer Research Clinic in Davenport,
Iowa, in 1943, after a diagnosis of MS by the Mayo Clinic. At the time
of admission into the Palmer Clinic, this subject was "…helpless; he
could not feed nor take care of himself." His medical history included a
head/neck trauma at age 16 in which "…he fell ten feet off a
building, landing on his head." The fall rendered him unconscious for
thirty minutes and he reported having a sore neck for several days. At
the Palmer Clinic, upper cervical radiographs showed a misalignment
of the atlas to the right. After upper cervical chiropractic care, the
patient remarked, "I am happy to say that through chiropractic, I
have been made almost well. Today, I have just a little numbness left
in my hands. I have the full use of my hands, feet, and my whole
body."
During the past several decades, research linking chiropractic and MS
has been virtually nonexistent. A literature search produced only two
single case reports. One patient was adjusted with an instrument, while
the other was managed with thoracolumbar manual chiropractic
adjusting procedures. (9-10) No other references for the chiropractic
management of MS patients were found. To the author's knowledge, the
MS cases discussed in this report are the first documented using
specific upper cervical care (cervical radiographs, thermal imaging,
and knee-chest adjustments) since Palmer's research seventy years ago.
The following five individuals suffered from Multiple Sclerosis for one
to ten years, ranged from 33 to 55 years of age, and had symptoms
varying from mild to severe. All patients showed lesions on MRI (MS
plaques) and were diagnosed with MS by their neurologist. Some
concurrently were undergoing treatment with medications. The following
report discusses the upper cervical chiropractic intervention in
detail and summarizes the five cases' results.
IUCCA UPPER CERVICAL CHIROPRACTIC INTERVENTION
At
each subject's first upper cervical chiropractic office visit,
her/his medical history was discussed. In Case 1, a nine-year history
of the typical relapsing-remitting pattern of MS symptoms was
established. In Cases 2 through 5, MS symptoms were constant and
progressively worsening without remission
Paraspinal digital infrared imaging, which measures cutaneous infrared
heat emission, was chosen as the diagnostic test for neurophysiology.
Thermography has been proven valid as a neurophysiological diagnostic
imaging procedure with over 6000 peer-reviewed and indexed papers in
the past 20 years. In blind studies comparing thermographic results to
that of CAT scans, MRI, EMG, myelography, and surgery, thermography
was shown to have a high degree of sensitivity (99.2%), specificity
(up to 98%), predictive value, and reliability. (11-13) Thermal
imaging has been effective as a diagnostic tool for breast cancer,
repetitive strain injuries, headaches, spinal problems, TMJ
conditions, pain syndromes, arthritis, and vascular disorders, to name
a few. (14-23)
At each patient's first upper cervical chiropractic office visit, a
paraspinal thermal analysis was performed from the level of C7 to the
occiput according to thermographic protocol. (24-26) Compared to
established normal values for the cervical spine, each of the five
subject's paraspinal scans contained thermal asymmetries higher than
0.5 ºC. According to cervical thermographic guidelines, thermal
asymmetries of 0.5ºC or higher indicate abnormal autonomic regulation
or neuropathophysiology. (27-30) Because upper cervical misalignments
were suspected in all five patients, a precision upp
er cervical radiographic series, including Lateral, A-P, A-P Open
Mouth, and Base Posterior views, was performed at each patient's
initial chiropractic office visit. (31) These four views enabled
examination of the upper cervical spine in three dimensions: sagittal,
coronal, and transverse. To maintain postural integrity, each subject
was placed in a positioning chair using head clamps. Analysis of the
four views was directed towards the osseous structures (foramen magnum,
occipital condyles, atlas, and axis) that are intimately associated
with the neural axis. Laterality and rotation of atlas and axis were
measured according to each vertebra's deviation from the neural axis.
(31) All five patients showed upper cervical misalignments.
Because the two criteria determining subluxation (thermal asymmetry and
vertebral misalignment) were met in each case, a treatment plan was
discussed with each patient. After each subject consented, chiropractic
care began with an adjustment to correct the atlas/axis misalignment.
To administer the adjustment, the patient was placed on a knee-chest
table with his/her head turned to the direction of misalignment (left
for left misalignments and right for right misalignments). The
knee-chest posture was chosen because of the accessibility of the
anatomy to be corrected. In addition, this posture retained spinal
curvatures, thus preventing compression of the spine. Using the
posterior arch of atlas as the contact point, an adjusting force was
introduced by hand. (32) The adjustment's force (force = mass X
acceleration) was generated using body drop (mass) and a toggle thrust
(acceleration).
Then, each patient was placed in a post-adjustment recuperation suite
for fifteen minutes as per thermographic protocol. (24-26) The
adjustment's success was determined by reviewing the post-adjustment
thermal scan. The first post-adjustment scans of all five patients
revealed thermal differences of 0.1 ºC to 0.2ºC, which were considered
normal according to established cervical thermographic guidelines
(compared to the pre-adjustment differential of 0.5 ºC or greater).
Therefore, resolution of each patient's presenting thermal asymmetry
was achieved.
All subsequent office visits for each patient began with a thermal
scan. An adjustment was administered only when the patient's presenting
thermal asymmetry returned. If an adjustment was given, a second scan
was performed after a fifteen-minute recuperation period to determine
whether restoration of normal thermal symmetry had occurred. On
average, each subject's office visits occurred three times per week for
the first two weeks of care, two times per week for the following two
weeks, and once per week for the subsequent month. After spinal
stability was achieved (thermal asymmetry was rarely present), visits
were reduced to once per month.
CASE 1
History: This 54-year-old
female was diagnosed with Multiple Sclerosis at age 44 after a bout of
optic neuritis, which prompted an MRI (MS plaques were visible). Over
the next nine years, she experienced a minimum of one exacerbation per
year lasting an average of one month. She recovered completely each
time except for partial vision loss resulting from optic neuritis. The
most recent flare-up occurred at age 53 when she experienced numbness
that switched from side-to-side in her body. With this exacerbation,
no remission occurred. Symptoms included tingling in her arms, hands,
legs, and feet as well as a positive L'hermitte's Sign (pain,
numbness, tingling down extremities upon cervical flexion). After
these symptoms were present for three months, this subject's
neurologist surmised her condition was worsening and recommended drug
therapy. Due to her concerns over long-term drug use, this patient
chose to undergo upper cervical chiropractic care first.
Exam: During her initial chiropractic examination, this subject showed
reduced sensitivity bilaterally in her arms, hands, legs, and feet.
L'hermitte's Sign was present during cervical flexion and right lateral
flexion compression was positive. The subject reported experiencing
these symptoms constantly for the three months prior to her
chiropractic exam. Cervical ranges of motion were reduced during left
lateral bending and left rotation. She reported visual loss from
previous optic neuritis episodes. Computerized thermal imaging showed
thermal asymmetries as high as 1.0 ºC. Analysis of cervical radiographs
revealed left laterality and left anterior rotation of atlas.
Outcome: Immediately following this subject's first upper cervical
adjustment, Lhermitte's Sign was no longer present. During the
following week, normal sensation returned to her extremities. After two
weeks of upper cervical care, cervical ranges of motion no longer
produced pain and cervical compression tests were negative. At the end
of week four, this patient reported improved vision in her left eye
(which had been damaged by the episode of optic neuritis ten years
earlier). After four weeks of upper cervical care, this subject's
neurologist reexamined her and no longer recommended drug therapy. Two
years after beginning upper cervical care, this subject remained
symptom-free.
Summary: This patient experienced a minimum of one relapse per year for
the ten years prior to upper cervical care. After upper cervical
intervention, two years passed without reoccurrence of symptoms.
CASE 2
History: After this 33-year-old
male noticed visual changes at age 30, he was examined by a
neuro-opthalmologist and showed 20/30 vision in the right eye
(according to the Snellen eye chart examination). After an MRI showed
three brain lesions (MS plaques), he was diagnosed with MS. The year
following his diagnosis, this subject showed minimal deterioration in
his condition. However, during the subsequent two years, he experienced
chronic progression of MS symptoms. In addition to vision loss, he
suffered from loss of bladder control, constipation, loss of balance,
sensory deficits in his extremities, and L'hermitte's sign. Three years
after the MS diagnosis, he was reexamined by his neuro-opthalmologist
who noted his optic nerves appeared pale and his vision had
deteriorated to 20/400 in the right eye and 20/200 in the left eye. He
was declared legally blind. A follow-up MRI showed ten lesions, one
active. This subject began upper cervical care soon after the second
MRI.
Exam: During this patient's initial examination, he reported wearing
sunglasses at all times, even indoors, due to light sensitivity.
L'hermitte's Sign was present. Sensitivity was reduced in his hands and
feet. Heat aggravated his symptoms. He showed inability to balance on
one foot bilaterally and to walk heel-to-toe in a straight line. As a
result, he reported frequent falls on hiking trails. He reported
difficulty with bladder control (he urinated six times per night) and
constipation (averaging four to five days without a bowel movement). He
also suffered with memory loss (he carried a tape recorder to remind
himself of errands, etc.), insomnia, and fatigue. Most of his MS
symptoms had progressively worsened during the second and third years
following his diagnosis and had been constant for at least one year.
Analysis of cervical radiographs revealed left laterality of atlas.
Computerized thermal imaging showed thermal asymmetries as high as
0.8ºC.
Outcome: After the first upper cervical adjustment, L'hermitte's Sign
was absent and balancing on his left leg improved (both symptoms had
been present for one year or greater). One week later, he reported that
due to less light sensitivity, he was able to leave his sunglasses
off, even outdoors. Upon visual reexamination one month later, he
tested 20/160 bilaterally. Six months later, balancing on both left and
right legs improved, so he was able to resume hiking while carrying a
heavy backpack. He also was able to take hot showers and sit in
jacuzzis because heat no longer aggravated his symptoms. In addition,
normal sensation returned to his extremities, bladder control improved
(urination occurred once per night), and constipation improved (one
bowel movement per day).
Summary: During the two years prior to chiropractic care, this patient
experienced a progressive worsening of MS symptoms. Most symptoms had
been present constantly for at least one year prior to the start of
upper cervical care. After the intervention of chiropractic care, this
subject reported immediate correction of some symptoms as well as
gradual improvement of other symptoms over several months. One year
after beginning care, this patient reported an overall correction
and/or improvement in MS symptoms.
CASE 3
History: This 46-year-old
female first experienced symptoms of MS at age 44, when she noticed
memory and cognitive problems (inability to formulate thoughts or
words), frequent urination and loss of bladder control (loss of
muscular control to begin and end urination). She was diagnosed with MS
after an MRI showed active brain lesions. Her symptoms remained
constant without worsening until the addition of sensory deficits
(painful tingling) in her arms and legs, two years after her diagnosis.
Exam: At her initial chiropractic examination, this subject reported
feeling continuous, painful tingling and loss of sensation in both arms
and legs during the previous month. She complained of a weakness in
her legs that she described as "a rubbery feeling." She also had
difficulty with cognition and bladder control for the previous two
years. She complained of generalized stiffness and aching in her neck.
Cervical extension was reduced and painful. Analysis of cervical
radiographs revealed right laterality and right posterior rotation of
atlas. Computerized thermal imaging showed 0.5ºC thermal asymmetries.
Outcome: Within the first week of upper cervical care, this subject
reported improved bladder control (resumption of muscular control
during urination) and a decrease in numbing, tingling, and pain in her
left leg and right hand. One month later, her leg strength returned
and numbness was noted only in her left hand. In addition, memory and
cognitive ability returned to normal. After two months of care,
bladder control, sensitivity, and strength in her extremities returned
to normal. After four months of upper cervical care, this subject
reported the absence of all MS symptoms. A follow-up MRI showed no new
lesions as well as a reduction in intensity of the original lesions.
During the subsequent six months, this patient was examined once per
month with digital infrared imaging. An adjustment was necessary on
three visits. At each of those three occasions, a minor reoccurrence
of symptoms also existed, which was corrected following each
adjustment. No other flare-ups occurred.
Summary: Most of this patient's MS symptoms (except one month of
sensory deficits) had been present for two years prior to the start of
upper cervical care. After the intervention of upper cervical
chiropractic care, the patient's MS symptoms gradually improved over
several months. After one year of care, this individual primarily
remained asymptomatic.
CASE 4
History: This 55-year-old
female was diagnosed with MS nine years ago at age 46 after an MRI
confirmed active brain lesions. Her symptoms included painful
paresthesia of her left arm, fatigue, mental confusion, insomnia, and
lack of coordination of her right arm and leg. All symptoms
progressively worsened over the nine-year period. Seven years after her
diagnosis, a follow-up MRI confirmed the addition of new active
lesions. Due to the fatigue, confusion, and pain, she had been on
disability leave from work for several years.
Exam: During this patient's initial exam, she complained of extreme
pain in her left arm, requiring multiple doses per day of pain
medication (neurontin). She also took daily medication for sleeping
(klonopin) and energy level (amantadine) due to her insomnia and
fatigue. Her handwriting coordination (right-handed) was poor so she
preferred using a computer. Cervical radiographs depicted a
misalignment of her atlas to the right and posterior. Computerized
thermal imaging revealed thermal asymmetries of 0.5ºC.
Outcome: During the first week of upper cervical care, this subject
noticed an increase in energy level. One month later, she no longer
noticed arm pain. Consequently, she consulted with her neurologist to
reduce her pain medication. Her pain medication was reduced by
two-thirds and she had no occurrences of arm pain. This patient also
reported a continued increase in energy level and a renewed sense of
mental clarity, so she considered looking for a part-time job. She felt
"more alert and energized" and her "mind was clear." Four months
after the start of upper cervical care her condition continued to
improve without any relapses.
Summary: For the nine years prior to upper cervical care, this patient
suffered from a chronic, progressive worsening of MS symptoms. Since
the intervention of upper cervical care, this individual experienced
improvements in MS symptoms and required less medication.
CASE 5
History: This 43-year-old
female first experienced symptoms of MS seven years ago. The symptoms
included numbness in her legs, hands, and face, and lasted for two
weeks. No further symptoms occurred until six years later with the
onset of L'hermitte's Sign. Soon after L'hermitte's Sign began, this
patient noticed loss of grip strength and a spasmodic curling of her
left hand. After an MRI, she was diagnosed with MS. Because Lhermitte's
Sign was present every time she nodded her head causing her pain, she
began daily pain medications (neurontin). After the symptoms were
constantly present for six months, she began upper cervical care.
Exam: During her initial chiropractic exam, cervical flexion produced
L'hermitte's Sign. Cervical extension and left rotation were reduced
and painful. She reported constant tingling in her left arm, grip
strength loss in her left hand, and weakness and pain in both forearms.
She experienced aggravation of forearm pain while taking notes in
class. As an avid martial arts participant, she expressed concern over
her inability to perform push-ups in class due to exacerbation of
L'hermitte's Sign. She also reported experiencing dizzy spells several
times per day for many years. Cervical radiographs depicted right
laterality of atlas. Computerized thermal imaging revealed thermal
asymmetries of 0.5ºC.
Outcome: After the first upper cervical adjustment, this patient noted
reduction in intensity of L'hermitte's Sign. By the end of two weeks
of care, L'hermitte's Sign was noticeable only occasionally and no
dizzy spells had occurred. After four weeks of care, this patient no
longer reported experiencing any dizzy spells, arm pain, tingling,
forearm weakness, or L'hermitte's Sign. Consequently, she reduced her
pain medication dosage. In addition, she resumed taking notes in class
and performing pushups in her martial arts class without pain or
tingling.
Summary: This subject's symptoms were present constantly for six months
prior to upper cervical care. With the intervention of chiropractic
care, symptoms were reversed either immediately or over one month's
time.
RESULTS
At their first upper cervical
chiropractic office visits, computerized thermal scans showed thermal
asymmetries and cervical radiographs showed upper cervical
misalignments in all five subjects. Because these exam findings
indicated upper cervical injuries, all five patients consented to upper
cervical chiropractic care. The five subjects underwent upper
cervical care for a minimum of four months and a maximum of two years
at the time of this paper's submission for publication. Before the
intervention of upper cervical chiropractic care, four out of the five
patients (Cases 2 through 5) showed patterns of constant, progressive
MS symptoms for a minimum of six months. After upper cervical care, MS
symptoms were improved or corrected, including L'hermitte's Sign,
paresthesias, pain, balance, muscle weakness, bladder control, bowel
control, cognitive ability, vision loss, insomnia, dizziness, and
fatigue. The only case that followed the typical MS relapse-remit
pattern, Case 1, had a history of MS relapses once per year for nine
years. After the intervention of upper cervical care, this subject had
no further relapses and remained symptom-free for two years. Therefore,
results of the five cases indicated that upper cervical chiropractic
care prevented the progression of MS, stopped the MS relapse pattern,
and improved and/or reversed symptoms of
DISCUSSION
An important parallel in
the MS patients' medical histories was their recollection of head
and/or neck trauma(s) prior to the onset of MS (also mentioned in the
Palmer case described in the Introduction). All five patients
remembered specific incidences of trauma preceding the onset of MS
symptoms such as a fall on an icy sidewalk, an auto accident, and a ski
accident. In addition, all five individuals showed evidence of upper
cervical injury during exams (digital infrared imaging and cervical
radiographs). The body of medical literature detailing a possible
trauma-induced etiology for MS, or at least a contribution, is
substantial. (33-35) In fact, medical research has established a
connection between spinal trauma and numerous neurological conditions
besides Multiple Sclerosis, including Parkinson's Disease, Amyotrophic
Lateral Sclerosis (ALS), epilepsy, migraine headaches, Attention
Deficit Hyperactivity Disorder (ADHD), vertigo, and bipolar disorder,
to name a few. (36-43)
While medical research has shown that trauma may lead to MS and the
other neurological conditions mentioned above, no mechanism has been
defined. It is the author's hypothesis that the missing link may be the
injury to the upper cervical spine. While various theories have been
proposed to explain the effects of chiropractic adjustments, a
combination of several theories seems most likely to explain the
profound changes seen in these MS patients due to upper cervical
chiropractic care. After a spinal injury, central nervous system (CNS)
facilitation can occur from an increase in afferent signals to the
spinal cord and/or brain coming from articular mechanoreceptors.
(44-48) The upper cervical spine is uniquely suited to this condition
because it possesses inherently poor biomechanical stability along with
the greatest concentration of spinal mechanoreceptors.
Hyperafferent activation (through CNS facilitation) of the sympathetic
vasomotor center in the brainstem and/or the superior cervical
ganglion may lead to changes in cerebral blood flow, including
ischemia. (49-55) Because of the close association between the nervous
and immune systems (the immune system recently has been reclassified
as the neuroimmune system), upper cervical injuries affecting
sympathetic function consequently may cause a cascade of non-favorable
immune responses. (56-58) Among these are uncoordinated immune tissue
responses (auto-immune responses) and the release of cortisol, which
ultimately can result in decreased immune function.
It is likely that the five MS patients sustained injuries to their
upper cervical spines (visualized on cervical radiographs) during
spinal traumas they experienced. It is also likely that due to the
injuries, through the mechanisms described previously, sympathetic
malfunction occurred (measured by paraspinal digital infrared imaging),
possibly causing decreases in cerebral blood flow. Consequently,
because the nervous and immune systems are so closely intertwined, it
is possible that CNS facilitation and cerebral ischemia could have
stimulated an auto-immune response such as myelin destruction.
According to the results of each of the five patients discussed in this
report, it seems correction of the upper cervical injury not only
stopped but also reversed the pathological processes involved in MS.
However, few conclusions can be drawn from a small number of cases.
Therefore, further research is recommended to study the link between
trauma, the upper cervical spine, and neurological disease.
CONCLUSION
All five patients
discussed in this report recalled experiencing head or neck trauma(s)
prior to the onset of Multiple Sclerosis symptoms. In all five cases,
evidence of upper cervical injury was found using paraspinal digital
infrared imaging and upper cervical radiographs. After IUCCA upper
cervical chiropractic care, all five cases reviewed revealed
improvements in Multiple Sclerosis symptoms. In fact, correction of the
five patients' upper cervical injuries appeared to stimulate a
reversal in the progression of MS symptoms. To the author's knowledge,
these are the first cases reported on this topic using thermal imaging
and knee-chest adjustments since Palmer's research seventy years ago.
Further investigation into upper cervical injury and resulting
neuropathophysiology as a possible etiology or contributing factor to
Multiple Sclerosis should be pursued.
Hilary Kingston, (
