Dear Colleague:
The SOT Quarterly Research Update: Supplement is
a service
offered by
SOTO-USA to keep doctors who may be familiar with
sacro
occipital technique (SOT) aware of the latest
research
related events, papers, and concepts affecting our
practices.
Please contact me directly at drcblum@aol.com if you
are
aware of others who might be interested in receiving
this
quarterly newsletter.
The Research Agenda for Chiropractic (RAC) /
Association of Chiropractic Colleges (ACC)
Conferences offer an amazing opportunity to meet with
the foremost chiropractic researchers, college
instructors and administration where the pulse of
chiropractic's future research can be palpated.
The purpose of this update is to share some of the latest
research presented at this conference and offer some
commentary about how this might relate to SOT
practitioners.
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Clinical Practice in an Integrative Environment
Presentations by Ian Coulter, PhD, William Morgan, DC, Arlan Fuhr, DC.
Each of these doctors have had extensive
experiences working in an integrative environment
and shared their wisdom at the conference. Dr.
Coulter illustrated how when forming an integrative
health center a review process is needed to assure a
center's financial success as well as creating a
comfort level for the allopath to ensure referrals and
collaboration with chiropractors.
Dr. Morgan discussed his relationship working in
military hospitals/clinics and particularly emphasized a
type of care called, “synchronized care” which involves
mutual trust between healthcare professions working
towards delivering the most appropriate care for
patients while minimizing procedures causing patients
increased risk..
Dr. Fuhr discussed how to integrate chiropractic care
into a clinic for an underprivleged/underserved
community as well as starting a relationship with the
Veterans Administration and developing relationships
with associated allopaths and related health
practitioners.
Gary Globe, MBA,DC, PhD (Cleveland Chiropractic
College) has developed some opportunities for
chiropractic interns to participate in multidisciplinary
clinics in the Los Angeles area. From the current
complementary centers and his past experience he
has found that, in general, the medical profession is
not as opposed to utilizing chiropractic care as one
might readily imagine. The key is understanding that
chiropractic assessment and care must fit into the
medical paradigm and that understandable
biomechanic rational treatment must be
communicated. Once medical providers can be
assured that chiropractors will not be treating
inappropriately and understand how to perform as a
multidisciplinary team member as well as focus on
demonstrating functional improvement in their
patient's musculoskeletal condition, then the
foundation for trust and collaboration can be
achieved.
Dr. Globe has found that while initially this might seem
restrictive, the first step might be to show our success in
non-complicated neck and low back conditions. Then
once clinical success can be shown with these patients,
the doors for trust and communication can be opened
into other areas where chiropractors are successful as
well.
Sacro Occipital Technique (SOT) is attempting to take
steps towards developing
an integrative approach for healthcare interventions
not commonly considered. Some studies
incorporating SOT care into co-treatment with cardiologists, oncologists,
and dental practitioners have
begun the process to build bridges towards mutual
trust and understandings between our varied
professions. SOTO-USA’s relationship with The Alliance of TMD
Organizations (an alliance of dental
organizations specializing in treatment of
temporomandibular disorders) has led to future
possible research relationships with Tufts University
College of Dentistry. NYCC's
“The Art of Chiropractic: A Symposium
on Chiropractic Technique” this April 21-22, 2007 will feature a presentation discussing SOT and the
ability to function in a Complementary Alternative
Medicine (CAM) setting working together with a
team of allied health practitioners.
RAC /ACC Conferences March 2007 • Click Here
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Metastatic Disease
Can Chiropractic Play a Role in Diagnosis?
Lisi AJ, Mara G, Undiagnosed metastatic disease
presenting as mechanical spinal pain. J Chirop Edu.
Spr 2007;21(1):68.
Three cases of undiagnosed metastic diseases were
referred to a chiropractic clinic for treatment of
mechanical spinal pain. Two patients presented with
lower back pain and one complained of thoracic
spine pain, all were over 50 years old and two had a
history of cancer. Interestingly all were seen by at
least two medical physicians and had radiographs
with negative x-ray
findings. Due to the red flags (over 50, history of
cancer) and a clinical “feeling” that the patient’s
presentation, pain levels, and history did not make
the
clinician feel comfortable with the presenting
diagnosis, referral was made for more studies.
Other related articles discussed this phenomena, where
a patient's presenting symptoms did not seem typical
and also led to an early referral for more extensive
studies.
Pringle RK, Wyatt
LH, Two Patients With Mechanical Back Pain Or
Cancer? A Case Report J Chiropr Educ: Spr 2004
(18:1): 81-82.
Blum CL,
Incongruent Sacro-Occipital Technique Examination
Findings: Two Unusual Case Histories. J Chirop Edu:
Spr 2002(16:1):67.
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Patients Under Oncological Care
Can Chiropractic Offer an Opportunity for Cotreatment?
Osterbauer PJ, Management of mechanical back pain in
a patient with carcinoma of the bladder. J Chirop Edu.
Spr 2007;21(1):115.
This case study illustrated how chiropractic care may
assist patients with multimorbidity. A 71-year-old
female presented with chronic lower back and leg
pain which limited her ability to walk and relied on
two to three Tylenol #3 per day to manage her pain.
Her presenting health problems included: active
bladder carcinoma, diabetes, hypertension, fecal/
urinary incontinence, left knee replacement (twice),
cervical radiculopathy, hypothyroidism, emotional
abuse, and hearing/vision loss. Following two weeks
of instrument assisted adjusting in a seated posture
her lower and mid back pain reduced significantly for
her to discontinue pain medication.
Holbeck M, Tomson A, Blum, CL, Monk R, Effects of the
sacro-occipital technique on the quality of life in a lung
cancer patient undergoing chemotherapy and radiation
treatment. J Chirop Edu. Spr 2007;21(1):108.
A 57-year-old female patient undergoing
chemotherapy and radiation therapy for lung cancer
was seen for chiropractic treatment for
gastrointestinal discomfort secondary for the
oncological care she was receiving. Sacro occipital
technique (SOT) chiropractic manipulative reflex
technique (CMRT) was used to balance
viscerosomatic/somatovisceral reflexes associated
with the stomach, lungs and diaphragm along with
some nutritional supplementation. The patient noted
that while receiving CMRT care, her digestive
disturbances were significantly lessened and
occasionally completely alleviated while receiving
chemotherapy and radiation therapy.
Of significance is that co-treatment of patients
presenting with various comorbidities such as cancer
may be viable options for allopathic and chiropractic
collaborative efforts. Commonly patients are
reaching their pharmaceutical limits and allopathic
physicians are looking for options to help patients so
that if they cannot be helped at least they might be
made more comfortable. It may be that chiropractic
can offer options for improving patient’s quality of life
in cases of patients undergoing care for cancer
assuming the oncologist is clear that the chiropractic
care will not make the patient’s condition worse.
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The Meric System – Myth or Mechanism
The Meric System of analysis, relating muscles
(myomeres) and organs (viscemeres), was reviewed
and its rational analyzed through a search of
published studies in the scientific literature. Two
criteria were used for study inclusion: (1) Spinal
manipulation was applied to specific spinal levels
that corresponded to the autonomic innervation of a
particular visceral organ, and (2) Outcome measures
correlated to expected functional changes of same
visceral organ. Thirteen clinical trials were identified,
(6 = blood pressure or heart, 4 = asthma or
respiration, and 3 = dysmenorrheal) four studies fit
both criteria, with three of those reporting significant
effects of spinal manipulation. They concluded that
“The Meric System is a reasonable hypothesis to
explain some effects of subluxation on visceral
organs 1.”
While the Meric System has been widely taught in
chiropractic for the past century, its minimal support
in the research makes further study into the validity of
this theory worthwhile. Nansel and Szlazak in their
1995 article discussing visceral mimicry syndrome
went to great lengths to discredit the Meric System’s
premise 2. Also the diffuse
nature of referred
visceral pain along with varied referred pain patterns
from the parietal peritoneum or sympathetic visceral
pain fibers from the organ can lead to great difficulty
making discrete neural pathways for visceral
dysfunction.
SOT uses a method of care for treatment of
viscerosomatic/somatovisceral reflex and referred
pain patterns associated with purported vertebral –
visceral relationships. DeJarnette used a modified
Meric System within the system of CMRT
incorporated referred pain pathways and
relationships between pain along specific points
along the suboccipital muscle and related vertebra. If
the Meric System is going to be used in the field of
chiropractic as a way of understanding
viscerosomatic influences, greater “controlled clinical
trials should be designed and conducted to test this
hypothesis 1.”
1. Tobias GS, Sikorski D, Kizhakkeveettil A, The
Meric System – Myth or Mechanism? J Chiro Ed. Spr
2007; 21(1): 125.
2. Nansel D, Szlazak M.] Somatic
dysfunction and
the phenomenon of visceral disease simulation: A
probable explanation for the apparent effectiveness
of somatic therapy in patients presumed to be
suffering from true visceral disease. J Manipulative
Physiol Ther. 1995 Jul-Aug;18(6):379-97.
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Dermatomes: Does Pain Follow Radicular Patterns
Murphy DR Hurwitz EL,Gerard JK, Clary R, Pain
patterns and descriptions in patients with radicular pain:
Does the pain necessarily follow a specific dermatome?
J Chiro Ed. Spr 2007; 21(1): 74.
Two hundred twenty-two nerve roots in 222 patients
were assessed in patients presenting with “objective”
signs of radiculopathy (e.g., MRI showing specific
level nerve root entrapment or nerve conduction
studies). Pain related to cervical radiculopathy was
nondermatomal in 69.7% of cases and pain related
to lumbar radiculopathy was nondermatomal in
64.1% of the cases. Of significance was that with a
S1 radiculopathy, dermatomal patterns of pain was
relatively sensitive and specific. Further studies
would need to evaluate muscle strength, deep
tendon reflexes, numbness and whether normal
variants affect pain radiculopathy. Also current
research is questioning whether discopathy is an
indicator of pain generation or if radiculopathies are
even necessarily related to discopathies.
If common somatic pain generators are now being
found to be either less than discrete or not following
clear pathways, it is no wonder that mapping of more
diffuse nerve pathways, such as with
viscerosomatic/somatovisceral referred pain, would
likewise be difficult to clearly ascertain in a
reproducible
reliable manner. With all that being said
practitioners need some starting point to help
develop plausible diagnostic procedures and at this
time with understandable limitations for many doctors
the “Meric System” and commonly understood
dermatome patterns in the cervical or lumbar region
offer some a beginning focus of analysis.
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Sacro Occipital Technique Organization - USA is a
non-profit,
professional organization formed to promote the
awareness,
understanding and utilization of the Sacro Occipital
Technique
method of chiropractic as founded and developed by
Dr.
Major Bertrand DeJarnette.
While all research conferences offer great
opportunities to learn and share the RAC/ACC is one
that tends to reach a broad spectrum of researchers,
faculty, administrators and private practitioners.
Since Dr. DeJarnette emphasized the need for
research it is important for all SOT chiropractors to be
open to inquiry and coming to research conferences
is
a way to challenge our boundaries.
If you ever have a desire to submit a paper relating to
SOT to a research conference please do
not hesitate to contact me for any assistance that I might
offer.
Thank you for your dedication and interest
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