Palpatory Musculoskeletal Findings as Early Indicators of Visceral Disease Somatic Vertebral Dysfunction and Spinal Manipulative Therapy A Review of the Literature

History of Somatic Dysfunction and Spinal Manipulation

Historian Elizabeth Lomax1, presented her 250 Review Summary of the Literature in The 1975 Conference

presentation, Research Status of Spinal Manipulative therapy, and stated: "the physician could clinch the diagnosis

by finding tenderness in the appropriate vertebra".

The use of Palpatory Musculoskeletal Spinal Exams as a tool for diagnosing disease were discussed by Avicenna,

the father of Modern Medicine, in The Canon of Medicine2, and the strongest, M.D. proponent of Spinal

Manipulation was John McMennel3,4 who wrote an article in JMPT "Understanding Manipulative Medicine in

General Practice published in JMPT in 1989. This article states "Then suddenly we find ourselves in practice

where 80% of our patients complain to us of some sort of musculo-skeletal pain, 80% may sound high, yet

remember that visceral and systemic diseases very frequently manifest themselves initially as musculoskeletal pain.

Again John McMennel concludes his article as follows: "Joint dysfunction is not only a diagnosis but an early sign

of visceral and systemic diseases".

Manipulative therapy has known a parallel development throughout many parts of the world. Three professions,

Osteopathy, Chiropractic and Physiotherapy, have incorporated their own variations of Spinal Manipulative Therapy

in their practice. Physiotherapist Erland Pettman5 states:

The earliest historical reference to the practice of manipulative therapy in Europe dates back to 400 BCE.

Over the centuries, manipulative interventions have fallen in and out of favor with the medical profession.

Manipulative therapy also was initially the mainstay of the two leading alternative health care systems,

osteopathy and chiropractic, both founded in the latter part of the 19th century in response to shortcomings

in allopathic medicine. With medical and osteopathic physicians initially instrumental in introducing

manipulative therapy to the profession of physical therapy, physical therapists have since then provided

strong contributions to the field, thereby solidifying the profession's claim to have manipulative therapy

within in its legally regulated scope of practice.

While Chiropractic Literature lacks the presentation of evidence based studies of the caliber Burns6, Cervero

7,

Bonica8, Beal

9, Korr

10 have presented, Osteopathy, Medicine and Physiotherapists themselves have contributed

greatly to the scientific validation of the role Spinal Manipulation plays in both early detection, diagnosis and

Clinical Management of Visceral Diseases.

1 Lomaz, Elizabeth in Goldstein, Murray, "Manipulative therapy: a historical perspective from ancient times to the

modern era," which appeared in The Research Status of Spinal Manipulative Therapy, published by the United

States Government Printing Office (1975), pp. 11-17. 2 Ibn Sina, Abu Ali al-Hussain Ibn Abdallah, (Avicenna) Qanun Al Tib (Canon of Medicine)

3 Mennell JM. The Science and Art of Joint Manipulation. Volume 2 The Spinal Column. New York, NY: Blakiston,

1952. 4 Mennell JM. Understanding Manipulative Medicine in General Practice J Manipulative Physiol Ther. 1989

Jun;12(3):231-5. 5 Erland Pettman, A History of Manipulative Therapy The Journal of Manual & Manipulative Therapy Vol. 15 No. 3

(2007), 165174 6 Burns, Louisa, Viscero-Somatic and Somato Visceral Reflexes - JAOA Vol 100 No 4 April 2000 249-257

7 Cervero, Fernando Sensory Innervation of the Viscera: Peripheral Basis of Visceral Pain Physiol Rev 1994; 74: 9 5 1 3

8 Bonica JJ: The Management of Pain. Lea & Feibger Philadelphia. 1990; Vol. 1: p 229

9 Beal, Myron, Viscerosomatic Reflexes, A Review. JAOA Vol 85 No 12 December 1985 786-801

10 IM Korr The spinal cord as organizer of disease processes: some preliminary perspectives J Am Osteopath

Assoc, Sep 1976; 76: 35.

Beal11

states that the concept of viscerosomatic which he has presented, are based on a review of 143 articles which

hypothesize the role of palpatory musucluskeletal findings as early indicators of visceral disease, as well as Spinal

Manipulative therapy as the non medicinal care of the reversal of those visceral diseases. He sites Burns12

and

Korr13

, who wrote milestone articles in the Journal of the American Osteopathic Association, to support the

Viscerosomatic Reflex he hypothesizes.

His review and supporting documentation include both the basic and clinical sciences. Beal describes both the

somatic manifestations of visceral disease, as well as their vertebra by vertebra, organ by organ autonomic

segmental reference sites, as presented in tables. Beal emphatically argues in favor of palpatory vertbral

subluxations, that are consistent with diagnosis of a viscerosomatic reflex, as well as their predictive value in

pinpointing symptoms of visceral disease. In addition, he also documents numerous studies, the principles and

results of spinal manipulation as a treatment for visceral disease, and also presents the findings, from his review of

the effects of surgery on viscerosomatic diseases.

At the end, my conclusion about the evidence based scientific validation of motion palpation and manual adjusting,

is a along the same line of thinking as Wadie I Najms14

Content validity of manual spinal palpatory exams - A

systematic review.

Conclusion

Despite the use of manual spinal palpation by chiropractors, very few studies have investigated their ability to

measure the accuracy of spinal palpation as an objective tool to detect the link between the subluxation and visceral

disease, as well as any documentation, that the Chiropractic Adjustment has reversed a visceral disease. Many

authors have presented Proposals for a Randomized Clinical trial, and what they intend to measure (content

validity). Given the high frequency of spinal pathology and the use of these diagnostic methods to investigate them,

well-designed studies are needed. For the practice of evidence-based medicine, it is important to assess the efficacy

and effectiveness of procedures usually and customarily used in clinical practice. To this end, established

benchmarks for the validity and reliability of procedures are essential.

While earlier reviews were not comprehensive systematic reviews, recent masters thesis and doctoral dissertations

by Tuchin, Rampersad, Hoogendorn15

,16

,17

,18

, have attempted to highlight what would have previously been

considered serious gaps in the knowledge about the accuracy of spinal palpatory procedures. Instrument Adjusting

offers an excellent solution to those problems by providing practitioners of spinal manipulation the ability to

measure joint stiffness, as well as to apply measured and specific force. In Collocas animal studies19

, the findings

have implications for human RCTs, literature reviews and collaborative research, and the development of evidence

based clinical practice and policy. From the research perspective, chiropractic researchers need to incorporate more

rigor towards the definition of the study questions, methods and measures, implementation procedures, and

reporting, as are addressed in the dissertations and theses by Tuchin, Rampersad, Hoogendorn. These dissertations

now identify previously absent reference standards, and instrument adjusting can add objectivity both in the

detection of stiffness and the correction, compared to their absence with manual adjusting.

11

Beal, Myron, Viscerosomatic Reflexes, A Review. JAOA Vol 85 No 12 December 1985 786-801 12

Burns, Louisa, Viscero-Somatic and Somato Visceral Reflexes - JAOA Vol 100 No 4 April 2000 249-257 13

IM Korr The spinal cord as organizer of disease processes: some preliminary perspectives J Am Osteopath Assoc, Sep 1976; 76: 35. 14

Najm, Wadid, BMC Complementary and Alternative Medicine 2003, 3:1doi:10.1186/1472-6882-3-1

Published: 7 May 2003 15

Rampersad, Rekha Chiropractic Effectiveness in the management of Primary Dysmenorrhe, Masters

Thesis, September 13, 2002 16

Tuchin, Peter A Randomized Controlled Trial of Chiropractic Spinal Manipulative Therapy for Migraine 17

Edmunds, Brett Lower respiratory tract disorders and thoracic spine pain and dysfunction in subjects presenting

to the Durban Institute of Technology Chiropractic Day Clinic; a retrospective clinical survey. 18

Hoogendoorn , Roelof Jan Willem Studies on the degeneration and regeneration of the intervertebral

discDoctoral Dissertation, Spine 2007 Aug 15; 32(17):1816-1825 19

Colloca, Chris, Validation of a Noninvasive Dynamic Spinal Stiffness Assessment Methodology in an Animal

Model of Intervertebral Disc Degeneration

Collocas animal study finally offers some rich rather than the poor sensitivity of the range of motion normally

presented in the literature. From the clinical perspective, Collocas findings add objectivity to what in the past was

based only on motion palpation, except for a few studies by Fuhr20

,21

,22

on the Activator instrument. The author

suggests development of algorithms and protocols as well as diagnostic tests in the evaluation of spinal dysfunction.

From a policy perspective, the chiropractic as well as medical manual medicine institutions need to enact continuing

medical education and research guidelines to address the efficacy of spinal palpatory versus instrument joint

stiffness measurement and instrument adjusting procedures. Faridi proposes a dialogue amongst the research

departments at chiropractic colleges for the development of onsite Instrument Adjusting clinics. This will move the

chiropractic profession from non evidence-based palpatory findings and manual adjusting, to objective Instrument

Adjusting. This provides Objective Data for both the presence of the problems chiropractors claim they determine

with palpation, as well as the removal of symptoms they claim have been removed due to manual adjusting. It is

time the chiropractic profession move into evidence based care, and utilize objective facts, and not anecdotal

subjective findings, and position the profession to be accepted by and integrated in mainstream medicine.

Faridi, Tariq J, B. Sc., M. Ed.

Tariq Faridi is the codevelepor of the VisceroPatholator module addition to the Neuropatholator, a Patient Education

Software. He speaks at Chiropractic Colleges and Seminars worldwide. He can be reached at visualodsy@aol.com

20

Fuhr AW, Menken, MY. Activator Methods Chiropractic Technique. Activator Methods Chiropractic Technique.

Topics in Clinical Chiropractic 2002: 30-43 21

Fuhr AW, Smith DB. Accuracy of piezoelectric accelerometers measuring displacement of a spinal adjusting

instrument. J Manipulative & Physiol Ther 1986; 9(1):15-21. 22

Fuhr AW, Colloca CJ. Evaluation and management of common clinical syndromes utilizing Activator Methods

Chiropractic Technique. D.C. Tracts 1998; 10(2):3-8