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Chiropractic for high blood pressure?

shuttlt

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I came across the following research in a debate about chiropractic. The claim is from a study by George Bakris that their back cracking can reduce high blood pressure.

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

Now this isn't exactly the far out end of chiropractic like treating ADHD, autism and cancer, but I wondered whether anybody knew anything about it and whether it in any way stood up.

My guess is "...promising results, too early to say, needs to be replicated in a large study...", but I'd greatly appreciate any insight the forum may be able to provide.
 
shuttlt said:
I came across the following research in a debate about chiropractic. The claim is from a study by George Bakris that their back cracking can reduce high blood pressure.

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

Now this isn't exactly the far out end of chiropractic like treating ADHD, autism and cancer, but I wondered whether anybody knew anything about it and whether it in any way stood up.
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You might be interested in this news report on the study: http://abclocal.go.com/wls/story?section=news/health&id=6033564

It’s accompanied by a 3.5 minute video segment (takes about a minute to load), from which the following is lifted:
Doctor George Bakris, a hypertension expert at the University of Chicago Medical Center, decided to find out if there really was some kind of connection.

-snip-

There are still a lot of unanswered questions, including who will benefit from this and what actually happens physically when this part of the vertebra is realigned.

Doctor Bakris cautions patients to stick with their proven treatments for now.
“This is not available now for everybody, so everybody is going to rush out, no, it’s still investigational,” he said.

Dr. Bakris says there still needs to be a lot of research done on this before mainstream doctors will even consider this a possibility.
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Another video report here (4min 40secs):
http://www.youtube.com/watch?v=5TTzKwvNbP0


And this is what a couple of academics on another skeptical list had to say about the study:
There is more here than I can swallow.

I just don't believe that very minor claimed displacements of the atlas could have the effects described, and certainly not without having additional neurological effects. There is stacks of room within the spinal column for the spinal cord at this level. In any case you would think that if there is significant pressure on the medulla or its blood supply in a rest position, just about any further angulation of skull on the atlas would have quite drastic effects. It seems, frankly, ridiculous.

I also suspect a 1 degree alteration in the radiological alignment of the
atlas is less than the range of error of any technique used to measure it. I'll bet these chiropractors have not tested themselves out for consistency of measurement and any effects of adjustment.
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…this is a study frequently cited by the general run of chiropractors to justify their routine upper cervical neck-cracking.

What they don’t mention is that “The subtle adjustment is practiced by the very small subgroup of chiropractors certified in National Upper Cervical Chiropractic (NUCCA) techniques. The procedure employs precise measurements to determine a patient’s Atlas vertebra alignment.”

Taking all that with many large grains of salt, what it boils down to is a specialized procedure performed by few chiros, which in this instance is cited as having a small effect on blood pressure in a small group of test subjects over a short study period.

The odds of there ever being a large-scale trial of this proving to be a cost-effective, safe procedure that works long-term are not very high.

Much easier for chiros just to cite this study without appropriate context and rely on testimonials for the remainder of their “evidence”.
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Hope that's of some help to you.
 
I found the study:http://www.nuccra.org/themes/nuccra/images_new/pdf/Hypertension2007.pdf

The familiar phrase 'pilot study' jumps out. Aside from that I can't see anything obviously wrong with it. It's nice that the misalignment that they are supposedly treating here does seem to be unambiguously detectable.

ABSTRACT:
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 naïve (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.
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First, one cannot manually re-align a single vertebra (or, even, multiple vertebrae short of breaking the customers back). Second, as suggested above, one cannot measure such a tiny correction. Third, one does not measure lateral displacements (as claimed in the original paper) in terms of "degrees." Finally, Bakriss is an idiot (formerly a scientist) for associating himself with such a crappy paper in a bottom-feeding magazine.

Aside from that, it is important news.
 
Thanks JJM. What you say certainly sounds to me like bunk beginning to be knocked out of this. It does seem odd, as you say to measure a lateral displacement in terms of degrees. I think the claim was that this vertebra is 'special' and held in place by soft tissue. At any rate, I wonder if you could direct me in the direction of something quotable indicating that these kinds of tiny changes haven't been/can't be measured?
 
sanguine said:
The bleeding out following carotid aneurysm will certainly reduce blood pressure.
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Where can I get this procedure done, and who should I make the cheque out to? I take it multiple sessions shouldn't be necessary?
 
JJM said:
First, one cannot manually re-align a single vertebra (or, even, multiple vertebrae short of breaking the customers back). Second, as suggested above, one cannot measure such a tiny correction. Third, one does not measure lateral displacements (as claimed in the original paper) in terms of "degrees." Finally, Bakriss is an idiot (formerly a scientist) for associating himself with such a crappy paper in a bottom-feeding magazine.

Aside from that, it is important news.
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Do vertebral subluxations actually exist?
 
Delscottio said:
Do vertebral subluxations actually exist?
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Not really.

A degenerate disk can misalign the spine, as can developmental defects.

As I understand it, neither are things you can correct with manipulation.

Nor, I am lead to think, do these "VAX-D" and similar traction machines "real" doctors use have any effect other than to increase damage.
 
I think this was a specific claim about the Atlas vertebra only. Apparantly this is the specialty of a sub-disipline within chiropractic. They are claiming an actual, conventional, appears on x-rays, you can measure it type misalignment. Normally it is left ambiguous whether, by subluxations, chiropractic is talking about an actual, but undetectable, misalignment or a metaphysical concept.

The study claims to be measuring the misalignment. Of course if they can't actually measure any such thing then that's the study debunked.
 
shuttlt said:
{snip} At any rate, I wonder if you could direct me in the direction of something quotable indicating that these kinds of tiny changes haven't been/can't be measured?
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No, sorry. I doubt it is the subject of serious study.

Delscottio said:
Do vertebral subluxations actually exist?
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No, in the chiropractic sense "subluxations" are imaginary.

shuttlt said:
I think this was a specific claim about the Atlas vertebra only. ...
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Yeah, this is about a sub-group (NUCCA nuts) of chiros. Imagine how bad a group must be to be considered quacks by fellow quacks, as they are.
 
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BenBurch said:
Murder by Chiropractic. That is what it is.
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So, when a U. of Chicago study shows that, eight weeks after undergoing a chiropractic procedure, 25 patients with early-stage high blood pressure had significantly lower blood pressure than 25 similar patients who underwent a sham chiropractic adjustment, that's murder by chiropractic?
 
JJM said:
No, in the chiropractic sense "subluxations" are imaginary.
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Worse than that, they're the imaginings of an Iowa grocer and fish peddler who dabbled in phrenology, the occult, animal magnetism and the like.
 
I'm currently suffering from a degenerative neck. The Physical Therapist gave me a couple little exercise to do, to relax some muscles and strengthen others. Not exactly pumping iron. Just a kind of wiggling my head, using the necks own muscles. No massage involved.

Anyhow, I have hypertension too. I can't lower it as much as the docs want me to, because I get a vision problem when it get down to 145 or so. That prob is usually about noon, I figure the morning pills kick in about then. Patches of vision looks like the fuzzed-out scrambling on those "true" cop shows. Somewhat reminiscent of a migraine, which I get too.

Anyways, doing my neck exercises bring on the hypo-perfusion problem at about 9:00 AM, even though I haven't had the noon prob for several weeks. I skipped the exercises today, no 'scrambling'. I'll skip them again tomorrow as I have to drive someplace.

Seems to me the body has two blood pressure sensors. One in the aorta, the out put from the heart. The other is in a brain artery. So I am thinking the relax of a muscle, or the exercising of the other, is doing something to blood flow. Probably a positive effect, once by body gets accustomed to it. AND, neck 'work' can have an effect on HT.
 
Rodney said:
So, when a U. of Chicago study shows that, eight weeks after undergoing a chiropractic procedure, 25 patients with early-stage high blood pressure had significantly lower blood pressure than 25 similar patients who underwent a sham chiropractic adjustment, that's murder by chiropractic?
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Do you understand what a "Pilot Study" is and how those are very often showing nothing but selection bias?

I didn't think so.

But that is all it was; http://www.nuccra.org/themes/nuccra/images_new/pdf/Hypertension2007.pdf

But all over the place you can find Chiros prescribing this to patients as though the matter were proven.

I can find you studies of similar magnitude that show you that sugar pills can have similar results.

Many drugs tested in as few patients seemed wonderful until the study was expanded and the effect disappeared.

Sad thing is, this is the best evidence they have for ANY of their claims.
 
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There is this paper, in which the neck was visualized during manipulation:

Lee, RY et al Clin Biomech (Bristol, Avon). 2005 Feb;20(2):228-31. "Dynamic response of the cervical spine to posteroanterior mobilisation."
INTERPRETATION: The magnitude of intervertebral movement produced by mobilisation is small. Forces applied at one spinous process produced not only movements at the target vertebra but also movements of the entire cervical spine resulting in an increase in lordosis. Mobilisation should be interpreted as three-point bending of the entire cervical spine, rather than simple gliding of one vertebra upon another.
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Kulig, K et al J Orthop Sports Phys Ther. 2004 Feb;34(2):57-64. Came to a similar conclusion regarding the lumbar spine.

In addition, there is this classic article in which an anatomist shows that actually changing the spinal joints (as opposed to just flexing them) requires enough force to break a person's back http://www.chirobase.org/02Research/crelin.html

To read more about the subject, see www.quackwatch.org and the chirobase subsite.

ETA: The two journal names are hot-links that do not work.
 
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JJM said:
In addition, there is this classic article in which an anatomist shows that actually changing the spinal joints (as opposed to just flexing them) requires enough force to break a person's back
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When I was a little kid several of us in the neighborhood used to pin towels on our necks and play "Superman". One kid in the neighborhood insisted that he could lift a car like Superman. When he finally agreed to give us a demonstration, he'd grab a car's bumper and raise it slightly on its shocks or springs.

That's what this makes me think of. Flexing the neck and claiming to change someone's anatomy is just as silly as a kid claiming he can lift up a car.

ETA: And it's a good thing Palmer's silly ideas are wrong. Otherwise, every time you flexed your neck or back, there would be all sorts of changes in bodily functions. Kidney failure because you bend a certain way, ear infections when you reach for something, etc.
 
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