Check this out!!! HVLA and blood pressure

[Bleurberry]

http://www.webmd.com/hypertension-high-blood-pressure/news/20070316/chiropractic-cuts-blood-pressure

This is landmark guys! A chiropractic study sponsored by an allopathic physician at university of Chicago. I am shocked webmd posted this on their site and I will be even more shocked if pressure from the drug companies dont push this article right off the website. Even though this is a pilot study, there is a larger clinical trial that is beginning.

It's really funny you posted this, I'm glad for it.
I've been emailing an esteemed Infectious Disease doctor who
thinks chiropractic is a load of crap, and was able to pass it along.
Its not going to change his mind one bit but I found the timing
of your post really right-on!

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[Idiopathic]

Oh, dear. What have we here.

This is the only problem I have with this study, in that it is most likely not a "study" at all, but rather an anecodtal case report, which can have its own merit, mind you.

"Yet after seeing the chiropractor, the patients' blood pressure had normalized -- and a few of them were able to stop taking their blood pressure medications."

Obviously this needs to be controlled for medications. Either you study only those pre-hypertensives where lifestyle change is still indicated, put everyone on a strict diet and exercise regimen and add NUCCA or dont. That would be a fine study.

Or you have to make sure everyone is treated with medication according to JNC guidelines and treat lots of people and then do subset analysis. I think it could be an excellent study, but you would pretty much have to have a couple of thousand people to meet power requirements for individual subsets.

Its easy to say "Old Roy had high blood pressure, so I fixed his OA and the next time he came in, instead of being 160/90, it was 145/83" Hmm......fixed?

 

[McDoctor]

Just to clarify most post above about using OMT over medication. I'm mostly referring to using OMT for painful conditions instead of analgesics. I'm definitely not advocating it for hypertension. This study is hardly "landmark". Its a pilot study. Besides, the majority of antihypertensives in common use provide benefits beyond just reduction of blood pressure.

This study is surprising. But even if it held up with larger trials, which I doubt it would, I just don't see any practical applications. Unlike nonpharmacologic lifestyle modifications which confer similar benefits, this type of procedure requires a skilled provider, cannot be carried out by the layperson, and who knows how many "alignments" are needed over a lifetime?

HCTZ literally costs pennies a tablet. The DASH diet can be followed by anyone. Moderate exercise confers similar benefits. These are all more practical approaches to hypertension.

I encouraged students or other residents to do research on this in an earlier post, but that was mostly just for the sake of encouraging research. I'm skeptical that these results would be replicated. If they were, I still don't see any practical applications.

 

[McDoctor]

Oh, dear. What have we here.

This is the only problem I have with this study, in that it is most likely not a "study" at all, but rather an anecodtal case report, which can have its own merit, mind you.

"Yet after seeing the chiropractor, the patients' blood pressure had normalized -- and a few of them were able to stop taking their blood pressure medications."

Obviously this needs to be controlled for medications. Either you study only those pre-hypertensives where lifestyle change is still indicated, put everyone on a strict diet and exercise regimen and add NUCCA or dont. That would be a fine study.

Or you have to make sure everyone is treated with medication according to JNC guidelines and treat lots of people and then do subset analysis. I think it could be an excellent study, but you would pretty much have to have a couple of thousand people to meet power requirements for individual subsets.

Its easy to say "Old Roy had high blood pressure, so I fixed his OA and the next time he came in, instead of being 160/90, it was 145/83" Hmm......fixed?

I looked it up on pubmed. It was a double blinded prospective RCT. 50 subjects were enrolled, and all were medication naive. Medications were not administered during the 8 week study. The results showed average systolic reduction -17 +/- 9 (placebo -3 +/-11) and diastolic -10 +/-11 (placebo -2 +/- 7) in the treatment group. The p values were P<0.0001 and P=0.002 respectively. The study had 90% power to detect 8/5 mm Hg difference.

It appears well designed. I'm surprised by the results, small number enrolled notwithstanding.

 

[beastmaster]

Full text for those with access. Abstract posted below.
http://www.nature.com/jhh/journal/v21/n5/abs/1002133a.html

J Hum Hypertens. 2007 May;21(5):347-52. Epub 2007 Mar 2.
Atlas vertebra realignment and achievement of arterial pressure goal in hypertensive patients: a pilot study.

Bakris G, Dickholtz M Sr, Meyer PM, Kravitz G, Avery E, Miller M, Brown J, Woodfield C, Bell B.
Department of Preventive Medicine, Rush University Hypertension Center, Chicago, IL, USA.

Anatomical abnormalities of the cervical spine at the level of the Atlas vertebra are associated with relative ischaemia of the brainstem circulation and increased blood pressure (BP). Manual correction of this mal-alignment has been associated with reduced arterial pressure. This pilot study tests the hypothesis that correcting mal-alignment of the Atlas vertebra reduces and maintains a lower BP. Using a double blind, placebo-controlled design at a single center, 50 drug naive (n=26) or washed out (n=24) patients with Stage 1 hypertension were randomized to receive a National Upper Cervical Chiropractic (NUCCA) procedure or a sham procedure. Patients received no antihypertensive meds during the 8-week study duration. The primary end point was changed in systolic and diastolic BP comparing baseline and week 8, with a 90% power to detect an 8/5 mm Hg difference at week 8 over the placebo group. The study cohort had a mean age 52.7+/-9.6 years, consisted of 70% males. At week 8, there were differences in systolic BP (-17+/-9 mm Hg, NUCCA versus -3+/-11 mm Hg, placebo; P<0.0001) and diastolic BP (-10+/-11 mm Hg, NUCCA versus -2+/-7 mm Hg; P=0.002). Lateral displacement of Atlas vertebra (1.0, baseline versus 0.04 degrees week 8, NUCCA versus 0.6, baseline versus 0.5 degrees , placebo; P=0.002). Heart rate was not reduced in the NUCCA group (-0.3 beats per minute, NUCCA, versus 0.5 beats per minute, placebo). No adverse effects were recorded. We conclude that restoration of Atlas alignment is associated with marked and sustained reductions in BP similar to the use of two-drug combination therapy

 

[Xoynx]

it (OA HVLA) was in my curriculum, too. and now that I'm done with second year, I can say without a doubt: NO ONE (DO or otherwise) will be using HVLA on my c-spine again.

although, i must confess - other than the c-spine, i love it.

For cervical adjustments, the Activator is the way to go. Eliminates all that risky head-twisting.

 

[Xoynx]

...On the whole, I would say that there are probably far fewer DO's who are that aggressive to try to get a joint to go. We have lots of great techniques to fall back on if we can't get that articulation that so many people think is necessary for a correction. I have, however, heard from friends in chiropractic school that HVLA is their absolute bread & butter & are more likely to "go after" something that just won't pop....

When I decided to explore osteopathy, I booked an appt with a DO who is a professor of OMM at my local DO school. I've been to a lot of chiros, but this experience was sheer hell. The soft tissue kept ripping as she muttered--I am not making this up--that she had to "get out the evil." My neck hurt for weeks.

But I decided to become a DO anyway--just not at that school.