Cardiovascular (Heart)

“Shortly after this relief from deafness, I had a patient complaining of heart trouble which was not which was not improving. I examined the spine and found a displaced vertebrae pressing against the nerves which innervate the heart. I adjusted the vertebra and gave immediate relief -- nothing ‘accidental’ or ‘crude’ about this. Then I began to reason that if two diseases, so dissimilar as deafness and heart trouble, came from impingement, a pressure on nerves, were not other diseases due to a similar cause?”

D.D. Palmer, (Discoverer of Chiropractic) in The Chiropractors Adjuster. Portland Printing House, Portland, Oregon, 1910

Spine and heart, vertebrogenous cardiac syndromes. Egli, AB Ann Swiss Chiro Assoc 4:95-105, 1969.

The “flat thoracic spine” or “straight back syndrome” is described as accompanying heart murmurs, pulmonary problems, and other forms of cardiopulmonary disease.

A somatic component to heart disease. Koch RS: Journal of the American Osteopathic Association 60:735-739, 1961.

Numerous observations reveal that upper thoracic subluxations are common in heart patients; the subluxations appeared months or years before the cardiac symptoms. Koch reports that many heart patients reported heart disease following thoracic trauma with marked subjective and objective improvement following spinal care.

Out of 150 cases, no cardiac deaths occurred during the spinal corrective program.

The straight thoracic spine in cardiac diagnosis. Gooch AS, Maranhao, Goldberg H, Am Heart J 74:595-602, 1967.

Compression of the heart and great vessels by a chest deformity (with absence of normal thoracic kyphosis) is called the “straight back syndrome.” This deformity simulates organic heart disease by causing systolic murmurs, alterations of heart sounds, and an apparent enlargement of the cardiac silhouette.

The straight back syndrome: clinical cardiovascular manifestations. DeLeon AC, Perloff JK, Twigg H. Circulation 32:193-203. 1965

Abnormalities of thoracic configuration can alter the information derived from clinical assessment of the heart. Although these alterations may be subtle, occasionally they may be sufficiently overt to produce signs that closely mimic organic heart disease.

Straight back syndrome: a new heart disease. Rawlings ME, Dis Chest 39:435-443, 1961.

The “straight back” syndrome is a heretofore unrecognized deformity of the chest causing pseudo-heart disease.”

Reflex and vertebrogenic disorders in ischemic heart disease, their importance in therapy. Rvchlikova E, Rehabilitacia 8:109-114. 1975.

This is a study of 260 patients that explored the relationship between midthoracic subluxation (specifically T4-6) and angina pain. It was found that patients having myocardial infarction without prominent angina pain had subluxation patterns similar to healthy controls; however, those with significant cardiac pain appeared to have a high prevalence of T4-6 subluxation.

Osteopathic manipulative therapy in organic heart disease. Roebuck SV, Yearbook of the American Academy of Osteopathy 1965.

“During the period of emergency and many times after the period of emergency, the difference in success and failure may be determined by a timely and efficiently applied osteopathic manipulative therapy.”

Respiratory manifestations of dorsal spine radiculitis simulating cardiac asthma. Davis D. Annals of Internal Medicine 1950 22: (5) 954-959.

Dorsal spine radiculitis causes substernal and precordial pain which simulates coronary occlusion. Included in the symptoms is the inability to take a deep breath. Three cases are discussed. One patient felt that her chest felt “fixed.” The patients were placed on traction and showed some improvement.

The role of palpatory diagnosis and manipulation therapy in heart disease. Tilley RM Osteopathic Ann 4:272-277, 1976.

The author stresses that all patients with heart disease: acute, chronic and emergency should receive spinal care.

Palpatory testing for somatic dysfunction in patients for cardiovascular disease. Beal M, Journal of the American Osteopathic Association 82:822-831, 1983

The author found 108 patients with upper thoracic subluxations commonly associated with heart disease. Spinal palpation alone was 76% accurate in “indicating the presence of cardiac disease.” Data from 21 studies demonstrated the presence of T1-4 subluxations in cases of heart disease.

Short-term power spectrum analysis of heart rate variability of chiropractic students in college. Zhang, J. Chiropractic Research Journal, Vol. Vll, No. 2, Fall 2000

Heart rate variability (HRV) is a new way of measuring the relative health of the autonomic nervous system (ANS). The ANS regulates the function of internal organs.

In this study 27 students, aged 22 to 49 years old had their HRV measured 4 times in a 12 month period. After one year of chiropractic care a significant decrease in heart rate and increase in sympathetic system activity was noted.

Improvements of cardiac autonomic regulation following spinal manipulative therapy. Jarmel ME, Zatkin JL, Charuvastra E, Shell WE. Presented at the July 1995 Chiropractic Centennial event in Washington, DC.

Sudden cardiac death may arise from abnormal nerve firings. The author proposes that mechanical irritation of upper thoracic vertebral joints may cause abnormal heart nerve firings.

In this study, eleven patients without a prior history of myocardial infarction who had signs of heart rhythm abnormalities received “spinal manipulative therapy.” After one month, heart rhythm and function improved. The author writes “Spinal manipulative therapy significantly enhance(s) cardiac autonomic balance.”

Effects of spinal manipulative therapy on autonomic activity and the cardiovascular system: a case study using the electrocardiogram and arterial tonometry. Driscoll MD, and Hall MJ.J Manipulative Physiol Ther October 2000, Vol. 23 No. 8. (545-50)

ECG (electrocardiogram) and AT (arterial tonometry) data was used to study the effects of chiropractic care on the autonomic and cardiovascular systems. The patient was seen twice a week for six weeks. Changes in the relationship between the sympathetic and parasympathetic nervous systems were observed.

Systemic effects of spinal lesions. Dhami MSI, DeBoer KF In Principles and Practice of Chiropractic, 2nd edition, Appleton and Lange, East Norwalk, CT 1992.

The authors list “organic disorders reported to be related to spinal lesions or affected by chiropractic manipulation.” These include: abdominal discomfort, asthma, Barre-Lieou syndrome, cardiac arrhythmia, colic, constipation, dysmenorrhea, high blood pressure, low-blood sugar and hyperinsulinism, migraine, pulmonary diseases, ulcers, vertebral autonomic dysfunction.

ECG improvements following the treatment combination of chiropractic adjustments, diet, and exercise therapy. Lott GS, Sauer AD, Wahl DR, Kessinger J. Chiropractic: The Journal of Chiropractic Research and Clinical Investigation Vol. 6 No. 2, July 1990.

This paper presents the effects of chiropractic adjustments on the cardiac dysfunctions of four people as monitored by ECG. Patients with varying symptoms had a baseline ECG taken and received chiropractic adjustments. A follow-up ECG showed three of the four patients improved. They also reported lowered blood pressure, decreased ischemia of the myocardium, and better sleep habits accompanying the improved ECG readings.

Cervical angina. Jacobs B. Spinal Manipulation October 1990;90:8-11.

Cervical angina (also known as pseudo angina) resembles true angina pectoris but is the result of cervical spondylosis and nerve root compression. This is the report of 164 patients (103 men and 61 women) 45 to 68 years of age and cared for over a 22-year period. Most had been seen by at least two cardiologists prior to diagnosis. Symptoms common to all patients but in varying severity, included neck pain and stiffness, occipital headache and arm pain with sensory symptoms. The majority of patients responded satisfactorily to a standard nonsurgical regimen such as use of a hard collar, intermittent traction, isometric exercise and a combination of anti-inflammatory and muscle relaxant medications.

Relation of dorso-cervical posture deficiencies to cardiac disease, especially from middle life onwards. Cyriax E. Research Quarterly 7:74-77 Dec. 1936

In this paper the author discusses associations between dorso-cervical posture and cardiac disease.

Cardiovascular functional disorder and distress among patients with thoracic outlet syndrome. Gockel M, Lindholm H, Vastasmaki M et al. Journal of Hand Surgery (British and European Volume, 1995 20B: 29-33.

Cardiovascular function of 11 women with thoracic outlet syndrome (TOS)...was studied. It was found that TOS patients’ symptoms included higher sympathetic tone. “The pathology of TOS is pain at rest, effort pain; weakness and paraesthesia of the upper limb are unknown.” Often a broader pathology than irritation or compression of the brachial plexus or subclavian artery or vein in the region of thoracic outlet is involved....”

Comments by Dr. Koren: In reviewing this article from a chiropractic perspective, the phrase “So near and yet so far” comes to mind. I am constantly amazed that at this date the relationship of the structural system to functional health is often entirely overlooked. In this paper, the authors return to the medical bias, that if they cannot treat it medically then it must be, at least in part, a psychological problem

Influence of a cervical mobilization technique on respiratory and cardiovascular function. McGuiness J, Vicenzino B, Wright A. Manual Therapy, Nov. 1997; 2(4), pp.216-20.
This study involved a non-chiropractic manipulation to pain-free volunteers to see if the sympathetic nervous system would be affected.

The researchers found a significant increase in respiratory rate, heart rate, systolic and diastolic blood pressure occurred during application of the technique to C5/6, when compared to control and placebo conditions.

Comments by Dr. Koren: the presence of a subluxation was not determined nor was the correction of a subluxation determined. This research showed that there was a relationship between autonomic function and spinal integrity.

Functional Disorders of Internal Organs Due to Vertebral Lesions, Kunert W (1965) CIBA Symposium 13(3): 85-96.

Kunert, a German cardiologist has written that spinal examination should be performed for individuals with presumed cardiac pain. He writes: “…lesions of the spinal column…are perfectly capable of simulating, accentuating or making a major contribution to organic diseases. There can…be no doubt that the state of the spinal column does have a bearing on the functional status of the internal organs.”

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. Nansel D, Szlazak M, Journal of Manipulative and Physiological Therapeutics 1995;18:379-397.

This is a review of over 350 papers over 75 years on “vertebral lesions” and their relationship to visceral disease.

The authors feel that patients do not experience true “organic” disease healing after spinal care, rather the authors believe that “vertebral lesions” were mimicking organic disease. This is an assumption on their part which has not been proved. Indeed, over 100 years of chiropractic clinical successes for many organic diseases, plus many centuries of spinal care success for preventing organic disease undermine their hypothesis.

Spondylotic change of the cervical spine and coronary infarction. Bruckman W. Deutsche Medizinische Wochenschrift 1956; 44:1740

The relationship between cervical spondylosis and coronary infarction is discussed.

Segmental thoracic pain in patients admitted to a medical department and a coronary unit. Bechgaard P. Acta Med Scand Suppl, 1981:644:87-89.

The author estimates that 10% of the patients at his coronary unit have somatic mimicry rather than true angina.

Back problems and atherosclerosis. The study of osteoporotic fractures. Vogt MT, Nevitt MC, Cauley JA. Spine, Dec. 1997; 22(23), pp.2741-7.

In this study of 1,492 elderly women, those with cardiovascular disease were more likely to have back pain and disability as a result of the back pain than those women free of cardiovascular disease.

Back-related disability was more than twice as likely to have worsened in the cardiovascular disease group. Back problems in elderly women are associated with self-reported cardiovascular disease, but not with objectively assessed lower-extremity arterial disease.

Cervical Angina. Wells P. American Family Physician, 1997;55:2262-2264

Cervical angina is chest pain that resembles true cardiac angina but originates from a cervical discopathy with nerve root compression. This condition is also called pseudo angina and often is caused by compression of the C7 nerve root.

This is the case of a 48 year old woman who suffered from chest pain, nausea and shortness of breath of two weeks duration. An MRI showed a disc herniation. After being treated with physical therapy, a cervical collar and drugs, her symptoms reduced by 70-80%. (Imagine if she got an adjustment).

The impact of chiropractic care on established cardiac risk factors: a case study. Childs, N., Freerksen S and Plourde A. Chiropractic: the J of Chiropractic Research and Clinical Investigation. Vol. 8 No. 2, July 1992.

The purpose of this study was to relate the possible effects of regular chiropractic care to changes in lipid metabolism in a group of subjects exposed to a stressful environment. Ten chiropractic students (five males and five females, ages 22-38) were monitored for total cholesterol, high density lipoprotein (HDL), and cholesterol/HDL ratio or cardiac risk factor (CRF) over a period of one to three years. All of the ten students studied obtained marked reductions in the CRF during the duration of the study.

Palpatory musculoskeletal findings in coronary artery disease: results of a double-blind study. Cox JM, Rogers FJ, Gorbis, SL et al. Journal of the American Osteopathic Association. July 1981 Vol. 80.

Eighty eight patients underwent cardiac catheterization and within one week of angiography they underwent a standardized musculoskeletal examination. A high correlation was found between coronary atherosclerosis and abnormalities of range of motion and soft tissue texture in the 4th and 5th thoracic vertebrae and the 3rd cervical vertebrae alone. The authors view this as a “viscerosomatic reflex” that may be useful in cardiac diagnosis.

Copyright 2004 Koren Publications, Inc. & Tedd Koren, D.C.

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