Blair Society Upper Cervical Research Gems

  • Woodfield, H. C., 3rd, York, C., Rochester, R. P., Bales, S., Beebe, M., Salminen, B., & Scholten, J. N. (2015). Craniocervical chiropractic procedures – a précis of upper cervical chiropractic. The Journal of the Canadian Chiropractic Association, 59(2), 173–192.

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4486989/

    A narrative review of upper cervical procedures intended to facilitate understanding and to increase knowledge of upper cervical chiropractic care. Safety, efficacy, common misconceptions, and research are discussed, allowing practitioners, chiropractic students, and the general public to make informed decisions regarding utilization and referrals for this distinctive type of chiropractic care.

  • Eriksen, K., Rochester, R.P. & Hurwitz, E.L. Symptomatic reactions, clinical outcomes and patient satisfaction associated with upper cervical chiropractic care: A prospective, multicenter, cohort study. BMC Musculoskelet Disord 12, 219 (2011).

    https://doi.org/10.1186/1471-2474-12-219

    Study of 1090 patients having an average of 4.5 office visits requiring an average of 2.4 upper cervical adjustments over 17 days. Outcome assessments were significantly improved for neck pain and disability, headache, midback pain and lower back pain and disability. Symptomatic reactions are short lived < 24 hours and rarely severe. Findings indicate a high level of patient satisfaction.

  • J. David Cassidy, Eleanor Boyle, Pierre Côté, Yaohua He, Sheilah Hogg-Johnson, Frank L. Silver, Susan J. Bondy, Risk of Vertebrobasilar Stroke and Chiropractic Care: Results of a Population-Based Case-Control and Case-Crossover Study, Journal of Manipulative and Physiological Therapeutics, Volume 32, Issue 2, Supplement, 2009, S201-S208.

    https://doi.org/10.1016/j.jmpt.2008.11.020

    Vertebrobasilar Stroke (VBA) eligible incidents in Ontario hospitals between April 1 1993 and March 31 2002. 818 VBA strokes hospitalized in a population of more than 100 million person-years. VBA is a very rare event. No evidence of excess risk of VBA stroke is associated with Chiropractic Care compared to primary care. Association of stroke for both Chiropractic and Primary Care were similar and most likely attributed to the onset of headache and neck pain occurring at the same time as the vascular incident.

  • Todd A. Hubbard, Brett M. Vowles, Tom Forest, Inter- and intraexaminer reliability of the Blair protractoview method: examination of a chiropractic radiographic technique, Journal of Chiropractic Medicine, Volume 9, Issue 2, 2010, Pages 60-68, ISSN 1556-3707.

    https://doi.org/10.1016/j.jcm.2010.02.004

    Retrospective study evaluating 25 Blair Upper Cervical Clinicians with more than 11 years chiropractic experience. Participants evaluated 100 Blair Protractoview Radiographs (oblique Nasiums). Participants showed good inter- and intraexaminer reliability.

  • H. Charles Woodfield, B. Burt Gerstman, Renate Henry Olaisen, Dale F. Johnson, Interexaminer Reliability of Supine Leg Checks for Discriminating Leg-Length Inequality, Journal of Manipulative and Physiological Therapeutics, Volume 34, Issue 4, 2011, Pages 239-246, ISSN 0161-4754.

    https://doi.org/10.1016/j.jmpt.2011.04.009

    2 Doctors of Chiropractic examined 50 volunteers for leg-length inequality. The order of the exam was randomized and the side and magnitude of the leg length inequality was determined to the nearest 1/8th of an inch. Examiners showed moderate reliability in assessing leg-length inequality of 1/8 inch increments and good reliability in determining the presence of a leg-length inequality.

  • Knutson, G.A. Anatomic and functional leg-length inequality: A review and recommendation for clinical decision-making. Part I, anatomic leg-length inequality: prevalence, magnitude, effects and clinical significance . Chiropr Man Therap 13, 11 (2005).

    https://doi.org/10.1186/1746-1340-13-11

  • Knutson, G.A. Anatomic and functional leg-length inequality: A review and recommendation for clinical decision-making. Part II, the functional or unloaded leg-length asymmetry . Chiropr Man Therap 13, 12 (2005).

    https://doi.org/10.1186/1746-1340-13-12

    Leg length inequality is separated by two groups; anatomic and functional. Online data base and library searches from 1970-2005 were done using the term “leg-length inequality”. Part I analyzes data collected on anatomic leg length inequality relative to prevalence, magnitude, effects and clinical significance. Part II examines the functional “short leg” or unloaded leg length alignment asymmetry, including anatomic-functional relationships, and provides an outline for clinical decision making. In Part I anatomical leg lengths were determined by accurate and reliable x ray methods and prevalence was found to 90% with the average magnitude at 5.2 mm. Evidence suggests that anatomical inequality does not appear to be clinically significant until magnitude reaches approx. 20mm or ¾ inch. Part II notes that unloaded leg-length asymmetry is a different phenomenon than an anatomic leg-length inequality, and may be due to suprapelvic muscle hypertonicity.

  • Michael D. Freeman, Scott Rosa, David Harshfield, Francis Smith, Robert Bennett, Christopher J. Centeno, Ezriel Kornel, Ake Nystrom, Dan Heffez & Sean S. Kohles (2010) A case-control study of cerebellar tonsillar ectopia (Chiari) and head/neck trauma (whiplash), Brain Injury, 24:7-8, 988-994.

    https://doi.org/10.3109/02699052.2010.490512

    Cervical MRI scans for 1200 neck pain patients were reviewed; 600 trauma cases and 600 non-trauma cases. Half of each group were scanned in recumbent position and half scanned in the upright position. Two Radiologists interpreted the scans for the level of the cerebellar tonsils. The purpose of the study was to assess the frequency of cerebellar tonisillar ectopia (CTE) in traumatic vs non-traumatic populations. CTE prevalence was noted high those patients with trauma and significantly higher in those patients who were imaged in an upright position.

  • Marshall, C. M., Vernon, H., Leddy, J. J., & Baldwin, B. A. (2015). The role of the cervical spine in post-concussion syndrome. The Physician and sportsmedicine, 43(3), 274–284.

    The CCJ may be closely correlated to brain health with consideration to concussion and post-concussion syndrome. Linear acceleration measurements causing concussive forces have been measured with head impact telemetry systems in high school and college football players, with the highest predictive value at 96.1g (gravity). Biomechanical studies for whiplash associated disorders reveal as little as 4.5 g of neck accelerate can cause mild strain injury to the soft tissue of the cervical spine.

  • Heidi Haavik-Taylor, Bernadette Murphy, Cervical spine manipulation alters sensorimotor integration: A somatosensory evoked potential study, Clinical Neurophysiology, Volume 118, Issue 2, 2007, Pages 391-402, ISSN 1388-2457.

    https://doi.org/10.1016/j.clinph.2006.09.014

    Spinal manipulation of dysfunctional cervical joints can lead to transient cortical plastic changes, as demonstrated by attenuation of cortical somatosensory evoked responses. This study suggests that cervical spine manipulation may alter cortical somatosensory processing and sensorimotor integration. These findings may help to elucidate the mechanisms responsible for the effective relief of pain and restoration of functional ability documented following spinal manipulation treatment.

  • Zheng N, Yuan X-Y, Li Y-F, Chi Y-Y, Gao H-B, Zhao X, et al. (2014) Definition of the To Be Named Ligament and Vertebrodural Ligament and Their Possible Effects on the Circulation of CSF. PLoS ONE 9(8): e103451.

    https://doi.org/10.1371/journal.pone.0103451

    This study examined 30 adult specimens to understand the connection between then cervical dura mater and the posterior wall of the spinal canal at the level of C1-C2. In all 30 specimens a previous un-discovered ligament (to be named ligament TBNL) and the vertebrodural ligament (VDL) were identified. The TBNL and VDL firmly link the posterior aspects of the cervical dura mater to the rear of the atlas-axis and nuchal region. The authors speculate that movements of the head and neck are likely to affect the shape of the dural sleeve surrounding the spinal cord which may influence the CSF flow in the spinal canal.

  • Bakris, G., Dickholtz, M., Meyer, P. et al. Atlas vertebra realignment and achievement of arterial pressure goal in hypertensive patients: a pilot study. J Hum Hypertens 21, 347–352 (2007).

    https://doi.org/10.1038/sj.jhh.1002133

    50 drug naïve patients with Stage 1 hypertension underwent a double blind, placebo-controlled study at a single Upper Cervical Chiropractic center utilizing the NUCCA technique. The primary end point was a change is systolic and diastolic blood pressure comparing baseline to week 8. It was concluded that restoration fo the Atlas alignment is associated with marked and sustained reductions in BP similar to the use of two-drug combination therapy.

  • H. Charles Woodfield, D. Gordon Hasick, Werner J. Becker, Marianne S. Rose, James N. Scott, “Effect of Atlas Vertebrae Realignment in Subjects with Migraine: An Observational Pilot Study”, BioMed Research International, vol. 2015, Article ID 630472, 18 pages, 2015.

    https://doi.org/10.1155/2015/630472

    11 neurologist diagnosed migraine subjects were tested with MRI at baseline, 4 weeks, and 8 weeks. Presence of an atlas vertebrae misalignment with diagnosis of migraine was the inclusion criteria. The Primary outcome was the assessment of change in brain compliance via MRI, the secondary outcome was a migraine specific quality of life outcomes. There was no observable trend with respect to brain compliance via MRI however there was clinically significant improvement in symptoms with decrease in headache days. This study suggests that atlas realignment intervention may be associated with a reduction in migraine frequency and marked improvement in quality of life.

  • Curtis D. Westersund (DDS), Jeffrey Scholten (DC, DCCJP, BSc) & Raymond J. Turner (PhD) (2017) Relationship between craniocervical orientation and center of force of occlusion in adults, CRANIO®, 35:5, 283-289, DOI: 10.1080/08869634.2016.1235254

    Clinical observation and anecdotal reports suggest changes can occur to dental occlusion following intervention with the National Upper Cervical Chiropractic Association (NUCCA) procedure. A case controlled study discerned if occlusion changes are measurable using a dental force plate (T-Scan) following an adjustment to the craniocervical junction (CCJ). Findings suggest that changes in posture and occlusion can be observed after the NUCCA chiropractic procedure. Not all patients demonstrated a more balanced contact pattern following the adjustment, indicating the need for further investigation.

  • The Effects of Specific Upper Cervical Adjustments on the CD4 Counts of HIV Positive Patients Selano J, Hightower BC, Pflege Br, Collins KF, Grostic J. Chiropractic Research Journal. 1994, Vol 3, N1.

    The researchers of this project sought to demonstrate that upper cervical specific adjustments would have a profound effect on the physiology, serology and immunology of HIV positive individuals. The effect of specific upper cervical adjustments on the immune system CD4 cell counts of HIV positive individuals was measured by CD4/mm3 in the blood. These tests were performed by the patient’s independent medical center where they were under medical supervision for the condition. The measured CD4 counts in the regular group were dramatically increased over the counts of the control group. A 48% increase in CD4 cells was demonstrated over the six-month duration of the study for the adjusted group.

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