FROM: Journal of Vertebral Subluxation Research 2004 (Aug): 1-9
Erin L. Elster, D.C.
Objective: The objective of this article is threefold:
to examine the role of head and neck trauma as a contributing factor to
the onset of Multiple Sclerosis (MS) and Parkinson’s disease (PD); to
explore the diagnosis and treatment of trauma-induced injury to the
upper cervical spine through the use of protocol developed by the
International Upper Cervical Chiropractic Association (IUCCA); and to
investigate the potential for improving and arresting MS and PD through
the correction of traumainduced upper cervical injury. Data from 81 MS
and PD patients who recalled prior trauma, presented with upper cervical
injuries, and received care according to the above protocol are
reviewed.
Clinical Features: Each patient was examined and cared
for in the author’s private practice in an uncontrolled, non-randomized
environment over a five-year period. Of the 81 MS and PD patients, 78
recalled that they had experienced at least one head or neck trauma
prior to the onset of the disease. In order of frequency, patients
reported that they were involved in auto accidents (39 patients);
sporting accidents, such as skiing, horseback riding, cycling, and
football (29 patients); or falls on icy sidewalks or down stairs (16
patients). The duration between the traumatic event and disease onset
varied from two months to 30 years.
Intervention and Outcome: Two diagnostic tests,
paraspinal digital infrared imaging and laser-aligned radiography, were
performed according to IUCCA protocol. These tests objectively identify
trauma-induced upper cervical subluxations (misalignment of the upper
cervical spine from the neural canal) and resulting
neuropathophysiology. Upper cervical subluxations were found in all 81
cases. After administering treatment to correct their upper cervical
injuries, 40 of 44 (91%) MS cases and 34 of 37 (92%) PD cases showed
symptomatic improvement and no further disease progression during the
care period.
Conclusion: A causal link between trauma-induced upper
cervical injury and disease onset for both MS and PD appears to exist.
Correcting the injury to the upper cervical spine through the use of
IUCCA protocol may arrest and reverse the progression of both MS and PD.
Further study in a controlled, experimental environment with a larger
sample size is recommended.
From the Full-Text Article:
Introduction:
While the link between head trauma and the later development of
Parkinson’s disease (PD) or Multiple Sclerosis (MS) remains
controversial, many PD and MS researchers have confirmed the connection.
[
1-12] Several researchers have
reported a strong association between head trauma and the subsequent
development of PD in retrospective case-controlled studies and have
found this association to be stronger than that of other environmental
agents long suspected as risk factors for PD. [
1-5] On average, these studies found that head trauma occurred two to three decades prior to PD onset. [
1, 2, 5]
One recently published study, performed at the Mayo Clinic and headed
by Dr. J.H. Bower, investigated the association between head trauma and
PD in more detail. [
1] By
reviewing the complete medical records of both cases and controls, the
study team was able to objectively determine prior occurrence of head
trauma without introducing recall bias. Study results suggest that head
trauma is associated with the later development of PD, even when study
limitations were taken into consideration.
In a discussion regarding the possible role of trauma in the development of MS, Dr. Charles Poser [
9-11]
notes that “in some patients with MS, certain kinds of trauma (to the
brain and/or spinal cord, including whiplash injuries) may act as a
trigger at some time for the appearance of new or recurrent symptoms.”
Poser goes on to suggest that trauma to the central nervous system may
alter the blood-brain-barrier (BBB), which many researchers consider to
be a critical step in the formation of MS lesions. He cites research
conducted on monkeys demonstrating that mild trauma inflicted on the
central nervous system, including whiplash injury, results in a
breakdown of the BBB. He also cites several researchers who observed the
correlation between trauma and the formation or exacerbation of MS
lesions. He further notes that the “relationship (between cervical
spondylosis and MS) has been well documented by MRI in many patients
with MS, revealing a close anatomical correspondence between compression
of the cervical spinal cord by spondylosis or herniated discs … and
intraspinal plaques at the same level.”
In 1996, a British court awarded damages to a plaintiff based on the rapid onset of MS closely following a motor vehicle
accident. [
12] The presiding judge
stated that he was “satisfied that (the plaintiff) did sustain a
whiplash injury... and that the symptoms he later displayed indicated
that MS had developed in the very area which had been affected by the
trauma.” Experts testified that hundreds of MS cases diagnosed
subsequent to auto accidents existed; too many, they claimed, to be
caused by chance.
While links between trauma and the later development of MS and PD have
been established, researchers have yet to define
an exact mechanism to explain the onset of MS and PD following trauma,
nor have they isolated an objective method
for measuring and/or diagnosing the kind of trauma-induced injuries that
appear to precipitate MS and PD. This paper serves
to address the above issues through the summary of case histories,
diagnostic test results, and treatment responses of 81 MS and PD
patients, 78 of whom recalled head or neck trauma prior to disease
onset. These patients were examined and cared for in the author’s
private practice over a five-year period in a nonexperimental
environment without control subjects. This paper does not purport to be a
controlled research study, but rather serves to provide a foundation
for future research. Case reports of two of the 81 cases (1 MS case and 1
PD case) were published in indexed, peer-reviewed journals. [
13-14]
Other reports documenting successful treatment of patients with similar
diagnoses using upper cervical chiropractic care are limited primarily
to Palmer’s upper cervical research conducted seventy years ago, which
was never published in a peer-reviewed, indexed fashion. [
15-16]
Patients with other neurological conditions such as Migraine headaches
and Tourette Syndrome also responded favorably to IUCCA upper cervical
chiropractic intervention. [
17-18] In both cases, patients reported substantial traumas to the head or neck prior to the onset of symptoms and diagnoses.
Clinical Features
Of 81 total cases of Multiple Sclerosis (MS) and Parkinson’s
disease (PD), 44 individuals with MS and 37 with PD consented
to examination and treatment in the author’s private practice.
Patients began treatment at various intervals over a five-year
period. Treatment duration varied from one to five years depending
on the individual. Patient data for the 44 MS patients
and for the 37 PD patients were compiled and listed in Tables 1
and 2 respectively.
MS patients ranged in age from 21 to 66 years old and presented
with a one to thirty year history of MS, as diagnosed by
their neurologists. PD patients ranged in age between 34 and
77 years and presented with a one to twenty year history of PD,
as diagnosed by their neurologists. Most patients reported that
they “had tried everything” to relieve their symptoms including
prescription medications, chiropractic adjustments, osteopathic
manipulation, physical therapy, massage therapy, rolfing,
acupuncture, herbs, Chinese medicine, chelation, special diets,
supplements, and removal of dental amalgams.
Patients were questioned as to whether they recalled a history
of trauma (blow to the head, concussion, whiplash, accident,
fall, etc.) prior to the onset of MS or PD. Of the 44 MS
patients,
43 (98 %) recalled a history of trauma. (Table 1) Of
the 37 PD patients,
35 (95%) recalled a history of trauma. (Table
2) Of the 78 patients who recalled traumas (many recalled more
than one), 39 (21 PD patients and 18 MS patients) reported
experiencing one or more auto accidents (many were minor rearend
collisions); 29 reported multiple blows to the head and/or
neck during sporting activities including skiing, cycling, horse
back riding, football, gymnastics, etc.; and 16 reported falls on
icy sidewalks or down stairs. In other lesser-reported incidences,
one man reported being kicked in the head by a cow; another
man reported blows to the head as a result of heavy machinery
accidents; and two female patients reported concussions from
domestic abuse. The duration between the traumatic event and
disease onset varied from two months to 30 years.
It should be noted that sixteen additional MS patients and
seven additional PD patients were examined and accepted for
care during the same period but chose to discontinue care during
the early treatment weeks. Data from these patients were
not included in this report.
Intervention
Each patient was examined and cared for utilizing protocol
developed by the International Upper Cervical Chiropractic Association
(IUCCA), including the use of paraspinal digital infrared
imaging, laser-aligned upper cervical radiography, kneechest
adjusting posture, and post-adjustment recuperation. [
19] The
care, described in detail in previous publications, [
13-18] is based
on the original upper cervical chiropractic research performed
by Palmer seventy years ago. [
15, 16]
To diagnose spinal injury, a paraspinal thermal analysis was
performed using the Tytron C-3000 (Titronics Research and
Development) according to thermographic protocols. [
20-23] (Figure
1) In all 81 cases, paraspinal scans contained static thermal
asymmetry of 0.5ºC or higher, which indicates
neuropathophysiology originating from the upper cervical
spine. [
24-27] (Figure 2) (Table 1)
Based on the results of the thermal scans, a cervical x-ray
series (lateral, anterior-to-posterior, open mouth, and base posterior)
was taken utilizing a specially designed machine (American
X-ray Corp.) that incorporates a laser-aligned frame, a laser
mounted to the x-ray tube (Titronics Research and Development),
a positioning chair, and head clamps. [
28] (Figure 3) This
configuration is designed to ensure accuracy when measuring the deviation of the upper cervical spine from the neural canal.
Analysis of the upper cervical radiographs revealed deviation
of the upper cervical spine from the neural canal, or upper cervical
subluxations, in all 81 cases. On average, each patient’s
atlas and axis deviated from the foramen magnum (occiput)
laterally (to the left or right) five millimeters or less and
rotationally (anterior or posterior) five degrees or less. In Tables
1 and 2, atlas listings are depicted with laterality of left (L) or
right (R) and rotation of anterior (A) or posterior (P). The lateral
movement of axis is listed to the left (ESL) or right (ESR).
Because upper cervical subluxations were discovered in all
81 cases, it was recommended that these patients receive care
to correct their cervical injuries. Before initiating care, patients
were cautioned to continue medical treatment including medications
unless otherwise advised by their physicians. After consent
was obtained, care was administered according to IUCCA
protocol to correct the lateral and rotational deviation of each
patient’s upper cervical spine. To administer the adjustment,
each patient was placed on a knee-chest table with his or her
head turned to the side of laterality (either left or right). (Figure
4) Using the posterior arch of atlas or lamina of axis as the
contact point, an adjusting force was introduced by hand. [
29]
Following the adjustment, the patient was placed in a postadjustment
recuperation room for fifteen minutes as per thermographic
protocol. [
20-23] After the recuperation period, a postadjustment
thermal scan was performed to ensure restoration
of normal neurophysiology. (Figure 5)
All subsequent office visits 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 recuperation period to determine
whether restoration of normal thermal symmetry had
occurred. On average, patients were seen two times per week during the first two weeks of care, one time per week during
the following four weeks, two times per month during the following
month, one time per month for the following three
months, and once per quarter thereafter.
Outcome
Outcomes of the 44 Multiple Sclerosis (MS) patients and 37
Parkinson’s disease (PD) patients are illustrated in Tables 3 and
4 respectively. The tables list gender, age, years since diagnosis,
initial symptoms, improved symptoms, and category of improvement
(minor, moderate, substantial or no change). If the
patient’s condition remained the same during the care period,
“no change” was listed. Patients reporting improvement with,
or absence of, less than half of their symptoms were indicated as showing “minor” improvement. Patients reported reporting
improvement with, or absence of, half of their symptoms were
identified as having “moderate” improvement. If patients
showed improvement or with, or absence of, the majority of
their symptoms, they were categorized as having “substantial”
improvement.
Of the 44 MS cases, 40 (91%) reported improvement. Of
these, 28 showed “substantial” improvement; 8 showed “moderate”
improvement; and 5 showed “minor” improvement. No
further progression of MS was noted in the improved cases
during the care period, which ranged from one to five years
depending on the patient. Four cases reported “no change” in
their condition.
Of the 37 PD cases, 34 (92%) reported improvement. Of
these, 16 showed “substantial” improvement; 8 showed “moderate”
improvement; and 11 showed “minor” improvement.
No further progression of PD was noted in the improved cases
during the care period, which ranged from one to five years
depending on the patient. Three cases reported “no change” in
their condition.
Hypotheses
Seventy-eight of the 81 Multiple Sclerosis (MS) and
Parkinson’s disease (PD) patients recalled head or neck trauma
prior to the onset of the disease, including blows to the head,
whiplash, or concussion sustained as a result of motor vehicle,
sporting, or other accidents. These findings are consistent with published retrospective studies conducted with MS and PD
patients regarding head trauma sustained prior to disease onset.
In this case, patients were examined to confirm trauma-induced
spinal injuries. Two diagnostic tests - paraspinal digital
infrared imaging and laser-aligned upper cervical radiography
- were administered according to the protocol of the International
Upper Cervical Chiropractic Association (IUCCA). In
all 81 cases, trauma-induced upper cervical subluxations were
discovered.
After administering IUCCA upper cervical chiropractic care,
91% of the MS patients and 92% of the PD patients improved,
and no further progression of MS or PD was noted in the improved
patients during the care period. Seventy percent of the
improved MS patients and 47% of the improved PD patients
showed “substantial” improvement, reporting the absence or
significant improvement with the majority of symptoms.
Bower JH, Maraganore DM, Peterson BJ.
Head trauma preceding PD.
Neurology 2003 May; 60: 1610-1615.
Taylor CA, Saint-Hilaire MH, Cupples LA.
Environmental, medical, and
family history risk factors for Parkinson’s disease: a New England-based
case control study.
Am J Med Genet 1999 Dec 15; 88(6):
742-9.
Semchuk KM, Love EJ, Lee RG.
Parkinson’s disease: a test of the
multifactorial etiologic hypothesis.
Neurology. 1993 Jun; 43(6):
1173-80.
Stern M, Dulaney E, Gruber SB.
The epidemiology of Parkinson’s disease.
A case-control study of young-onset and old-onset patients.
Arch Neurol
1991 Sep; 48(9):903-7.
Factor SA, Weiner WJ.
Prior history of head trauma in parkinson’s disease.
Mov Disord (NIA) 1991; 6(3): 225-9.
Lees AJ.
Trauma and Parkinson disease.
Rev Neurol 1997 Oct; 153(10):
541-6.
Chaudhuri A, Behan PO.
Acute cervical hyperextension-hyperflexion
injury may precipitate and/or exacerbate symptomatic multiple sclerosis.
Eur J Neurol. 2001 Nov; 8(6):109-10.
Rudez J, Antonelli L, Materljan E.
Injuries in the etiopathogenesis of
multiple sclerosis.
Lijec Vjesn 1998 Jan-Feb; 120(1-2): 24-7.
Poser CM.
Trauma to the central nervous system may result in formation
or enlargement of multiple sclerosis plaques.
Arch Neurol 2000 Jul; 57(5):
1074-7.
Poser CM.
The role of trauma in the pathogenesis of multiple sclerosis: a
review.
Clin Neurol Neurosurg 1994 May; 96(2): 103-10.
Poser CM.
The pathogenesis of multiple sclerosis. Additional
considerations.
J Neurol Sci 1993 Apr; 115 Suppl: S3-15.
Christie B.
Multiple sclerosis linked with trauma in court case.
BMJ (BMJ)
1996 Nov 16; 313 (7067): 1228.
Elster E.
Upper cervical chiropractic management of a patient with
Parkinson’s disease: a case report.
J Manipulative Physiol Ther 2000 Oct;
23(8) 573-7.
Elster E.
Upper cervical chiropractic management of a patient with Multiple
Sclerosis: a case report.
Journal of Vertebral Subluxation Research 2001
May; 4(2).
Palmer BJ.
The Subluxation Specific The Adjustment Specific. Davenport,
Iowa:
Palmer School of Chiropractic, 1934: 862-70.
Palmer, BJ.
Chiropractic Clinical Controlled Research. Davenport, Iowa:
Palmer School of Chiropractic, 1951.
Elster E.
Upper cervical chiropractic care for a patient with chronic
migraine headaches with an appendix summarizing an additional 100
headaches cases.
Journal of Vertebral Subluxation Research 2003 Aug.
Elster E.
Upper cervical chiropractic care for a nine-year-old male with
tourette syndrome, attention deficit hyperactivity disorder, depression,
asthma, insomnia, and headaches: a case report.
Journal of Vertebral
Subluxation Research 2003 July.
Applied Upper Cervical Biomechanics program.
www.pacificchiro.com. Redwood City, California:
International Upper
Cervical Chiropractic Association, 1993.
International Thermographic Society. Thermography protocols.
In: Amalu
W, Tiscareno L. Clinical neurophysiology and paraspinal thermography:
module 2—applied upper cervical biomechanics course.
Redwood City,
Calif: International Upper Cervical Chiropractic Association; 1993. p.67-
70.
American Academy of Thermology. Thermography Protocols.
In: Amalu
W, Tiscareno L. Clinical neurophysiology and paraspinal thermography:
module 2—applied upper cervical biomechanics course.
Redwood City,
Calif: International Upper Cervical Chiropractic Association; 1993. p.67-
70.
American Academy of Medical Infrared Imaging. Thermography
Protocols.
In: Amalu W, Tiscareno L. Clinical neurophysiology and
paraspinal thermography: module 2—applied upper cervical biomechanics
course.
Redwood City, Calif: International Upper Cervical Chiropractic
Association; 1993. p.67-70.
Amalu W, Tiscareno L, et al.
Clinical neurophysiology and paraspinal
thermography: module 2- Applied Upper Cervical Biomechanics Course.
Redwood City, Calif: International Upper Cervical Chiropractic
Association, 1993. p.62-70.
Uematsu, E, et al.
Quantification of thermal asymmetry, part 1: normal
values and reproducibility.
J Neurosurg 1988; 69: 552-555.
Feldman F, Nicoloff E.
Normal thermographic standards in the cervical
spine and upper extremities.
Skeletal Radiol 1984;
12: 235-249.
Clark RP.
Human skin temperatures and its relevance in physiology and
clinical assessment.
In: Francis E, Ring J, Phillips B, et al. Recent advances
in medical thermology. New York: Plenum Press, 1984,
5-15.
Uematsu S.
Symmetry of skin temperature comparing one side of the body
to the other.
Thermology 1985; 1:4-7.
Amalu W, Tiscareno L, et al.
Precision Radiology: Module 1 and 5-
Applied Upper Cervical Biomechanics Course.
Redwood City, Calif:
International Upper Cervical Chiropractic Association, 1993. p.65-84.
Amalu W, Tiscareno L, et al.
Precision Multivector Adjusting: Modules 3
and 7- Applied Upper Cervical Biomechanics Course.
Redwood City, Calif:
International Upper Cervical Chiropractic Association, 1993. p. 64-73
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