Chiropractors will want to read us anywhere, anytime
The cranial connection and the neuropathic process
Narrative: This paper presents meticulous clinical instruction on the advanced-level diagnosis and treatment of presentations involving the cranial ventricles through highly targeted cranial adjusting.
The importance and clinical relevance of the Shimizu reflex is demonstrated along with impeccable approaches to relevant head and neck musculature.
The technique of choice is the NeuroImpulse Protocol,™ a low force and gentle technique which is specific in its application. Throughout the text, important clinical points are highlighted.
This paper is taken from Module 9 of the NeuroImpulse learning materials© and manual and provides the busy practitioner with a clean and tidy clinical approach to cranial adjusting in the young.
Indexing Terms: Chiropractic, Clinical management; Cranial; NeuroImpulse Protocol; Shimizu reflex.
Cite: Davies NJ. The cranial connection and the neuropathic process. Asia-Pac Chiropr J. 2024;5.1. apcj.net/papers-issue-5-2/#DaviesCranialConnecion
Temporomandibular Joint Disorder: Differing professional treatment options reviewed in two case reports. A speculative Case Series
Narrative: The comprehensive chiropractic TMJ examination must include the mandible’s motion by the muscles of mastication, the dental occlusion, the joints including its articulating disc, and their effects upon the motor nerves of the body. TMJ dysfunction can be caused or perpetuated by disturbance in any of the links in the closed kinematic chain of the ‘stomatognathic system’.
The muscle organisation within the chain is examined in chiropractic applied kinesiology by having jaw motion evaluated in opening, closing, lateral sway and teeth clenching during manual muscle testing of related muscles. It may also be evaluated with swallowing, talking, and with the head in different positions.
Three differing chiropractic and dental treatments in two cases of TMD (temporomandibular disorders) are compared in this case series review.
Indexing Terms: Chiropractic; AK; Applied Kinesiology; Temporomandibular Joint Disorder; TMJ.
Cite: Cuthbert S. Temporomandibular Joint Disorder: Differing professional treatment options reviewed in two case reports. A speculative Case Series. Asia-Pac Chiropr J. 2024;5.2. apcj.net/papers-issue-5-2/#CuthbertTMJOpinions
Applied Kinesiology Chiropractic: Clinical Algorithms for Comprehensive Management of Temporomandibular Joint Disorders
Narrative: Since temporomandibular joint function is interrelated with so many remote problems and is so frequently involved on a functional basis, it is realistic to at least do a screening examination of this mechanism on every new patient.
This type of examination requires little time and can be very effective in finding a majority of problems in this area. A considerable amount of evidence indicating the need for a more thorough evaluation becomes available during history-taking and consultation. This information comes from what the patient tells the physician and from body language observed during the discussion.
Indexing Terms: Chiropractic; AK; Applied Kinesiology; Temporomandibular Joint Disorder; TMJ; management algorithms; clinical flowcharts.
Cite: Cuthbert S. Applied Kinesiology Chiropractic: Clinical Algorithms for Comprehensive Management of Temporomandibular Joint Disorders. Asia-Pac Chiropr J. 2024;5.2. apcj.net/papers-issue-5-2/#CuthbertTMJAlgorithm
Atlas Orthogonal Chiropractic practitioner presentations of Craniocervical Junction and Brainstem disorders: A case series and review of 15 patients
Narrative: Chiari malformations, or cerebellar tonsillar ectopia (CTE), along with cranio-cervical syndromes (CCS) and cranio-cervical instability (CCI) may contribute to brainstem compression presenting as a complex clinical conundrum for physicians that treat the cranio-cervical junction (CCJ) as part of their clinical practice.
Patho-anatomical features causing the constellation of symptoms that confound efforts at diagnosis by mimicking other disorders are discussed. The lack of knowledge creating misdiagnoses, misunderstanding of how to treat, and possible dangerous treatment outcomes, in surgical and non-surgical care, is addressed as it permeates through medical and musculoskeletal physicians such as chiropractors and physiotherapists.
Discussion on where the limitations of surgery and contraindications to manual therapy fall in comparison and contrast to the oft sought out Atlas Orthogonal (AO) chiropractic approach is also given. Scores of patients accessing online information increasingly to ascertain treatments for symptoms their practitioners can neither explain nor alleviate presents a very uncertain and possibly dangerous picture for sufferers.
This report provides a structured approach to the assessment of such patients with recommendations for safe and effective clinical intervention and care. The lessons are taken from a series of 15 cases purposively selected from the clinics of 2 AO practitioners known to each other, one in Australia and the other, USA.
Indexing Terms: Chiropractic; Brainstem’ Chiari malformation; upper cervical; craniocervical junction; cerebellar tonsillar ectopia; cranio-cervical instability; Atlas Orthogonal; case series
Cite: Ierano J. Atlas Orthogonal Chiropractic practitioner presentations of Craniocervical Junction and Brainstem disorders: A case series and review of 15 patients. Asia-Pac Chiropr J. 2024;5.2. apcj.net/papers-issue-5-2/#IeranoAOCaseSeries
Dr. Robert Coté’s Clinical Research
Narrative: The late Dr Robert Coté was one of the top instructors working under Dr. DeJarnette. He has bequeathed his lifelong clinical research to assist us in our endeavour of bettering our clinical skills.
After all his years of clinical experience, he never stopped being amazed at how the basic SOT principles were proven to be correct and consistent with the new research in the field of neurophysiology.
He consistently studied the patients that were not responding positively to treatment and dedicated his life to understanding the underlying causal mechanisms.
His extensive clinical experience has led him to further his understanding of the body’s compensatory mechanisms involving mechanical patterns, neurophysiology and bio- energy, all within the SOT model of indicators. Understanding, recognising and correcting these compensatory mechanisms can facilitate the resolution of some of our most difficult cases.
The objective of this paper is to discuss these compensatory mechanisms and their respective indicators.
Indexing Terms: Chiropractic; SOT; Robert Coté
Cite: Vitez C. Dr. Robert Coté's Clinical Research. Asia-Pac Chiropr J. 2024;5.2. apcj.net/papers-issue-5-2/#VitezCoteResearch
Click through Dr Vitez's slides from her platform presentation and get the PDF
A tale of two paths. [WCCS]
Narrative: The first path for a chiropractic student is to become qualified and build the foundation for all that will be done in practice. There is a secondary path, one where the students find their passion. If this first path is everything you need to be qualified, the second path would be considered anything that you do while you’re in school that helps you to become competent.
This secondary path is the path that will help the student to one day stand in front of people with unconscious competence because they preemptively spent the time and energy to develop themself into the doctor they dreamt of becoming.
Taking time to care for one’s well-being while walking these paths is not optional, it is mandatory.
Indexing terms: Chiropractic; World Congress of Chiropractic Students, WCCS; self-care, well-being.
Cite: Boudar JW. A tale of two paths. [WCCS]. Asia-Pac Chiropr J. 2024;5.2. apcj.net/papers-issue-5-2/#BoudarTwoPaths
Evidence based chiropractic education: A student’s perspective
Narrative: Students, particularly those with an intimate experience of the power of Chiropractic in their own lives, find an educational environment challenging when it is built on denial of the subluxation.
Rather than attempting to fain political favour by teaching a poor version of Chiropractic as ‘chiropractic medicine’ institutions must start acting responsibly with rigorous research into why it is that conventional Chiropractors consistently achieve positive patient outcomes through subluxation-focussed patient care.
Indexing Terms: Chiropractic; education; curriculum; evidence based practice.
Cite: Nichols JG.Evidence based chiropractic education: A student’s perspective. Asia-Pac Chiropr J. 2024;5.2. apcj.net/papers-issue-5-2/#NicholsStudentPerspective
Point of view: Chiropractic philosophy [Column]
… Chiropractic philosophy is about your lifetime, it is not about what happens after your death …’
Indexing Terms: Chiropractic; establishment; subluxation; innate; philosophy
Cite: McKibben M. Chiropractic philosophy [Column]. Asia-Pac Chiropr J. 2024;5.2: apcj.net/papers-issue-5-2/#McKibbenColumn
Five unrelated abstracts of Chiropractic care showing diversity of clinical presentation
Narrative: This small collection of abstracts presents five disparate aspects of Chiropractic care to demonstrate the diversity of patients seen in the general practice of conventional Chiropractic.
There is a mix of cases and presentations and of course, clinical approaches. It is challenging to find any relationships or theme among these reports.
The conclusion is that all practitioners are encouraged to reflect on their practice and commence a habit of documenting the variety of patients to whom care is provided. It is clear there is no ‘recipe-book’ and that a well-trained Chiropractor must demonstrate a broad skills base to ensure high levels of patient management, regardless of their individual paradigm of care.
Indexing Terms: Chiropractic; Conventional Chiropractic; case-mix.
Cite: Blum CL. Five unrelated abstracts of Chiropractic care showing diversity of clinical presentations. Asia-Pac Chiropr J. 2024;5.2 apcj.net/papers-issue-5-2/#Blum5cases
Sacro Occipital Technique (SOT):
Documentation and recording system
Narrative: Sacro Occipital Technique (SOT) is a systems method of Chiropractic, assessment oriented and reasoning based, therefore a suitable recording system becomes a necessity.
Reasoning in this regard is defined as ‘the process of forming conclusions, judgements, or inferences from facts or premises’.
It has been my experience that the recording system outlined in this paper addresses these qualities while allowing for an ongoing method of reference and guidance.
Indexing Terms: Sacro Occipital Technique (SOT); Chiropractic; ;SOT Categories; SOT Indicators; Documentation.
Cite: Getzoff H. Sacro Occipital Technique (SOT): Documentation and recording system. Asia-Pac Chiropr J. 2024;5.2. apcj.net/Papers-Issue-5-2/#GetzoffSOTDocumentation
Infant Vertical Suspension testing
Narrative: In 2018 a Melbourne Chiropractor placed on social media a video of him safely and professionally performing an infant vertical suspension test. Leaving aside the stupidity of any Chiropractor using social media to show videos of their professional activities which are private interactions with a patient, the video of the test was used by Deep Medicine to hysterically and politically attack Chiropractors for inappropriate treatment of children.
In turn this led to the Government of the State of Victoria, Australia, in 2019 commissioning an agency of its Department of Health and Human Services, Safer Care Victoria (SCV), to undertake a review of chiropractic manipulative care for children under 12 years of age. This review found Chiropractic care to be safe.
However as of September 2024 the care of children in Australia by Chiropractors remains in question given the Federal Minister for Health, again under medical pressure, required the Chiropractic Board of Australia to restore its warning against Chiropractors providing spinal manipulation to children under 2.
The actual test in question sits within the standard protocols of safe care of infants in both medicine and chiropractic, a reality obfuscated by the medical enemies of Chiropractic in their eagerness to advance the Iowa Plan for containment of the profession.
This paper by a world-renown paediatric Chiropractor and educator examines the ‘infant vertical suspension test’ and gives clinical meaning to the observations provided by this safe and effective, gentle clinical test.
Indexing Terms: Chiropractic; evidence based practice; paediatrics; Safer Care Victoria; infant vertical suspension test; hanging baby
Cite: Rosen MG. Infant Vertical Suspension testing. Asia-Pac Chiropr J. 2024;5.2. apcj.net/papers-issue-5-2/#RosenInvertedSwingTest
Cauda Equina Syndrome: Are final-year clinical student chiropractors and their supervisors recognising and implementing the correct referral pathways in the UK? Two case reports
Background: Low back pain is a condition that is treated by chiropractors, osteopaths, and physiotherapists who use manipulation as one of their therapies. One presentation of low back pain is a disc extrusion or sequestration. Here the disc material has ruptured through the annular fibres and because of its acidic nature starts to damage the nerve root and can lead to cauda equina syndrome (CES). This paper explores this documented cause of CES with final year chiropractic students who are in a primary contact position. It describes whether they screen for signs and symptoms of CES and ask the appropriate questions leading to correct referral pathway. We review iatrogenic causes of CES by professionals who use manipulation, and ask does the literature support this effect? If signs and symptoms are not diagnosed, it can lead to a life-changing future for the patient and result in a legal process and an insurance claim. Professions treating low back pain must be vigilant and constantly screen for CES.
Intervention: Two cases presented to the AECC University college Chiropractic (AECC UC) Teaching Clinic are reviewed. Final-year students see patients in their placement year as part of their training. They take a detailed history and physically examine the presenting complaint. Low back pain is a common complaint presented by patients at the AECC UC Chiropractic teaching Clinic. Are Cauda Equina Syndrome (CES) questions asked during the initial consultation and treatment? The required routinely asked questions are as follows: Has the patient experienced any of or a combination of the following signs and symptoms: saddle anaesthesia, nerve root pain, sexual dysfunction, bowel disturbance, bladder disturbance and relevant medical history relating to a previously diagnosed CES?
Outcomes: The findings from the case reports suggest that chiropractic students supervised by registered chiropractors are good at recognising CES signs and symptoms either initially or ongoing, through a course of treatment and are following the modified NHS guidelines for referral with the AECC UC CES pathway. The literature refers to a mechanical cause of CES due to lumbar spinal manipulation. According to the current literature lumbar spinal manipulation delivered by a registered professional for low back pain is not a risk factor for CES.
Conclusion: Patients with low back pain may have an elevated risk of cauda equina syndrome independent of manipulative treatment which is not considered a risk factor. Therefore, students and clinicians treating lower back pain patients are ideally placed in clinical settings to identify cauda equina syndrome signs and symptoms and should always be aware of any deterioration in presentation and review CES signs and symptoms and use the appropriate clinical pathway.
Indexing terms: Chiropractic; Cauda equina syndrome; chiropractic adjustment; manipulation; care pathway.
Cite: Nunn N, Gregory C, Battiston A, Breeze S. Cauda Equina Syndrome: Are final-year clinical student chiropractors and their supervisors recognising and implementing the correct referral pathways in the UK? Two case reports. Asia-Pac Chiropr J. 2024;5.2 apcj.net/papers-issue-5-2/#BNunnCaudaEquina
The Managerialist Revolution in Medicine
Narrative: Medicine has always been hierarchical; but never has it been so conformist, with uncritical, thoughtless physicians marching in lockstep to hit metrics dictated by vested interests that show little concern for sick patients.
Confidence in medicine is falling and I argue that real patients cannot be adequately managed by a diagnostic-based algorithm or treated by an iPad. Medicine is constituted by a particular kind of relationship, a relationship based upon trust between a patient made vulnerable by illness and a doctor who professes to use his knowledge and skills always and only for the purposes of health and healing. No technological advance, no societal development, will ever alter this.
Indexing Terms: Medicine; EBM; managerialism; Technocratic Scientism; Utopian Progressivism; Liberationism.
Cite: Kheriaty A. The Managerialist Revolution in Medicine. Asia-Pac Chiropr J. 2024;5.2. apcj.net/papers-issue-5-2/#KheriatyManagerialistMedicine
Muscle clamps and patterns as an emotional disturbances reflection: Wilhelm Reich’s armour concept
Abstract: Wilhelm Reich’s theory of ‘muscle defense’ remains an important chapter in the history of psychology, psychotherapy and psychoanalysis. His exploration of the mind-body interaction and the role of emotional experience in physical health challenged conventional wisdom. Although his life was marred by controversies, his ideas continue to resonate with those seeking a holistic approach to healing and well-being.
Application of his ideas is seen in the work of George Goodheart who proposed a method of functional muscle testing which made it possible to obtain biological feedback from the body due to which the emotional disorders more accurately diagnosed.
Indexing Terms: Chiropractic; Wilhelm Reich; George Goodheart; psycho-emotional disorders; muscle patterns.
Cite: Kirdoglo GK. Muscle clamps and patterns as an emotional disturbances reflection: Wilhelm Reich’s armour concept. Asia-Pac Chiropr J. 2024;5.2. apcj.net/Papers-Issue-5-2/#KirdogloArmour
Channeling healing energy: Encouraging active patient participation in their care, Part seven
Narrative abstract: Medicine, oncology, and nursing all are exploring the concept of stimulating active patient participation in their health care. A doctor’s involvement will need to be flexible and accommodating to the patient’s individual preferences in order to maximise the benefits of their participation on health outcomes.
While Chiropractors are not psychotherapists they can help guide a patient to consider psychotherapeutic care when it appears that there is a relationship between a patient’s physical presentation and their emotional stressors. Before we can attempt to influence our patients we need to gain their trust as well as lead by example. If we personally don’t have healthy lifestyle choices and behave in emotionally balanced ways it can adversely affect the advice we might share with our patients.
As healthcare providers we need to see ourselves as partners in our patient’s health. We need to meet our patients on their path and walk with them side by side.
Indexing terms: Chiropractic; chiropractor; active patient participation; healing energy.
Cite: Blum CL. Channeling healing energy: Encouraging active patient participation in their care, Part seven. URL Asia-Pac Chiropr J. 2024;5.2 apcj.net/Papers-Issue-5-2/#BlumHealingEnergy7
‘Off-Label’ Valsalva Manœuvre
Narrative abstract: The Valsalva manoeuvre is a forced expiratory effort against a closed airway as one of several simple physical actions called vagal manoeuvres that act on the vagus nerve to slow heart rate.
This manoeuvre increases intrathecal pressure and may point to a space occupying lesion if pain about a spinal region is reported. There may also be dermatomal radiations indicative of neurological involvement.
Here I present several ‘off label’ clinical uses of the Valsalva manoeuvre and give an integration with manual muscle testing to increase the clinical tools available to the Chiropractor.
Indexing terms: Chiropractic; Valsalva manoeuvre; clinical assessment; subluxation; therapy localisation.
Cite: Masarsky CS. ‘Off-Label’ Valsalva manœuvre. [The wide-angle lens]. Asia-Pac Chiropr J. 2024;4.3. apcj.net/papers-issue-5-2/#MasarskyValsalva
Down the sacrum rabbit hole: Part 2
Narrative: Here I continue my presentation of an overview of sacral listings conceptualised by Gonstead. I provide the clinical rationale for listings of the sacral base which have clinical utility for sacral adjusting.
In particular I address the ‘base anterior’ listing.
These additional concepts take into account developmental anomalies such as lumbarisation and sacralisation.
Indexing terms: Chiropractic; Gonstead; technique; sacrum; sacral listings; anomalies; base anterior.
Cite: Johnson RC. Down the sacrum rabbit hole: Part 2 Asia-Pac Chiropr J. 2024;5.2. apcj.net/papers-issue-5-2/#JohnsonSacrum2
In memoriam: Paul Daniel Pringle
A tribute to the ‘flying chiropractor'
Cite: Editorial staff. Paul D Pringle [In Memoriam]. Asia-Pac Chiropr J. 2024;5.2 apcj.net/papers-issue-5-2/#IMPringle
In memoriam: Dean Lines
Cite: Gilberd C, Cahill D, Editorial staff. Dean H Lines [In Memoriam]. Asia-Pac Chiropr J. 2024;5.2 apcj.net/papers-issue-5-2/#IMDeanLines
An ASRF Research Project
Improvement in low tone and retained primitive reflexes in a 15-week-old female concomitant with Chiropractic care: A case report
Background: A fifteen-week-old infant was presented for chiropractic care with the mother listing concerns that the infant could not participate in life the way she should. The infant was behind on all her milestones, was showing head asymmetry, and inability to to lift her head or respond to caregivers the way she should.
Intervention: The infant commenced a course of chiropractic care, during which the patient was adjusted using the Diversified technique, with assistance from the baby drop piece, vibrations, hands-on adjusting, Sacro-occipital technique basics and cranial adjusting. Dural support was used, along with Activator methods and logan, all of which were modified for age-appropriateness.
Outcomes: In addition to significant improvements in her subluxations, the infant was able to make strong leaps forward in tone, responses and reflex integration. She was able to fully regain age-appropriate developmental milestones and undertake strength and skill-based tests appropriate to her age. Parents remarked that she was like a completely different child.
Conclusion: This case report illustrates an instance in which a child’s developmental trajectory was significantly changed by chiropractic care. Given the outcomes of this case, the impact of chiropractic care on infant development is warranted.
Indexing Terms: Chiropractic; Subluxation; adaptation; developmental signposts; infant care.
Cite: Pryjma J, Postlethwaite R, McIvor C. Improvement in low tone and retained primitive reflexes in a 15-week-old female concomitant with Chiropractic care: A case report. Asia-Pac Chiropr J. 2024;5.1. apcj.net/papers-issue-5-1/#PryjmaImprovedTone
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