Editor's note: Part I of this article appeared in the March 11 issue.
by David Seaman, DC, MS, DABCN
Research Efforts Into Nerve Interference?
Doctors William Meeker, Robert Mootz and Scott Haldeman recently reviewed the literature and listed all of the research trials on spinal manipulation.1 In the studies, adjustments had been applied to patients with various conditions, nearly all of which are related to increased nociceptive activity and not due to nerve interference:
- back and neck pain, which are caused by increased activity in group III and group IV afferents;
- headaches, which are caused by increased activity in group III and group IV afferents;
- PMS, which is caused by increased activity in group III and group IV afferents;
- dysmenorrhea, which is caused by increased activity in group III and group IV afferents;
- infantile colic, which is caused by increased activity in group III and group IV afferents;
- asthma, which is caused by increased immune activity and perhaps increased nervous activity;
- hypertension, which involves increased sympathetic activity.
Where is the nerve interference, much less the interference with the immeasurable mental impulse? Clearly, we need to rethink our use of the term "nerve interference." Nociceptive excitation seems to be the neuropathophysiological effect of the subluxation complex; this is not surprising, considering that up to 95 percent of joint afferents
2 and 75 percent of muscle afferents are nociceptive.
3 Health Interference?
In the past, when I have applied these arguments against so-called "straight" colleagues, they have immediately resorted to personal attacks, or changed the subject and claimed that subluxations interfere with health. Regarding the latter tactic, I think we can all agree that "nerve interference" and "health interference" are two totally different concepts.
While nerve interference appears not to exist, every known and unknown condition, malady or disease will interfere with the expression of complete physical, mental and social well-being, i.e., health. We can all agree that a partial dislocation, i.e., subluxation, back pain, or pathological changes in spinal tissues that we call the subluxation complex, represent conditions that detract from the expression of complete well-being or health. However, "health interference" is not the issue at hand - our subject is nerve interference, and it should be fairly obvious that little evidence supports its interference.
I am not saying that nerve interference absolutely does not exist, but that we have no data to support that we encounter it commonly - or even remotely - in clinical practice. And just because patients have a positive outcome after an adjustment does not demonstrate that the nerve interference theory is true. Positive outcomes don't justify theories that go untested.
Can We Live Without Nerve Interference?
We are actually much better off without nerve interference as one of our subluxation descriptors. Consider that most of the conditions we encounter involve inflammation and increased nociceptive activity, including pain, headaches, and visceral symptoms.4,5 In short, patients suffer from increased nociceptive activity, not nerve interference. And we should expect this, because as stated earlier, up to 95 percent of joint afferents2 and 75 percent of muscle afferents are noc-iceptive.3
Fortunately for us, the forms of care we chiropractors utilize, such as the adjustment, spinal stabilization exercises, and nutrition, can decrease inflammation and nociception. Pickar recently reviewed the literature on spinal manipulation and explained how the adjustment can reduce nociception.6 Spinal stabilization exercises, which are used by numerous chiropractors, can reduce nociception and back pain.7,8 Nutrition is a powerful tool for reducing nociception and inflammation.9
All of the treatment approaches we are licensed to use are able to get at the problem of inflammation and increased nociception, both of which are associated with the subluxation complex, and which cause patients to seek the help of chiropractors. Clearly, the subluxation complex will exist quite well without the "nerve interference."
References
- Meeker WC, Mootz RD, Haldeman S. The state of chiropractic research. Top Clin Chiro 2002;9:1-13.
- Leach RA, Pickar JG. Segmental dysfunction hypothesis: joint and muscle pathology and facilitation. In Leach RA. Ed. The Chiropractic Theories: A Textbook of Scientific Research. Baltimore: Lippincott Williams & Wilkins; 2004:137-205.
- Mense S, Simmons DG. Muscle Pain: Understanding its Nature, Diagnosis and Treatment. Philadelphia: Lippincott, Williams & Wilkins; 2001:26-30
- Seaman DR, Cleveland C. Spinal pain syndromes: nociceptive, neuropathic, and psychologic mechanisms. J Manip Physio Ther 1999; 22:458-72
- Seaman DR, Winterstein JF. Dysafferentation, a novel term to describe the neuropathophysiological effects of joint complex dysfunction: A look at likely mechanisms of symptom generation. J Manip Physiol Ther 1998; 21:267-80
- Pickar JG. Neurophysiological effects of spinal manipulation. Spine J. 2002; 2:357-71
- Murphy DR. Conservative Management of Cervical Spine Syndromes. New York: McGraw-Hill; 2000
- McGill SM. Low Back Disorders: Evidence-Based Prevention and Rehabilitation. Human Kinetics 2002, Champaign, Illinois.
- Seaman DR. Clinical Nutrition for Pain, Inflammation, and Tissue Healing. NutrAnalysis 1998, Hendersonville, North Carolina.
David Seaman, DC, MS, DABCN
Port Orange, Florida
