Chiroblog

A study in 2015 discussed the link of trigeminal neuralgia (TN) with dysfunction of the autonomic nervous system. ¹
Method: 12 patients with classical TN and 12 healthy control patients. Patients are asked to submerge right arm for 5 into 10*C water to trigger pain. Patients rated their pain every 30 seconds on a 0-100 scale. Electrocardiograms were taken before and during experimental pain test. Heart rate was also analyzed in frequency domain, differentiating low frequency components ( HR fluctuations in the LF range reflect baroreflex-mediated sympathetic activity associated with Mayer waves of blood pressure) and high frequency components (HRV in the HF range is generated by respiratory sinus arrhythmia and
constitutes a sensitive measure of cardiac vagal parasympathetic activity).

Result: No difference in pain perception or heart rate between TN group and control group. No one in TN group experienced facial pain. All patients experienced an increase in low frequency oscillations (increased sympathetic activity) and decrease in high frequency (decrease in parasympathetic activity), but the changes were more pronounced in the TN group.

Conclusions: “Results indicate that TN patients and healthy controls have comparable
autonomic cardiac responses at rest, but that in response to a tonic experimental pain challenge, TN patients show greater sympathetic arousal and parasympathetic withdrawal than healthy controls.” “The exact reason for the negative association between sympathetic reactivity and the number of pain paroxysms experienced by TN patients remains unclear and surely merits future attention.”

The Vagus nerve has clear parasympathetic connections, but the jury is still out on the trigeminal nerve. However, one thing noticed frequently in chiropractic practices is how the temporomandibular joint (TMJ), when not functioning, will usually be associated with increased tension in that person, whether they are a child or an adult ².  Reducing the alignment issues in the TMJ often reduces that person’s stress as well.

References 

1. Léonard, G., Chalaye, P., Goffaux, P., Mathieu, D., Gaumond, I., & Marchand, S. (2015). Altered
Autonomic Nervous System Reactivity to Pain in Trigeminal Neuralgia. Canadian Journal of
Neurological Sciences / Journal Canadien Des Sciences Neurologiques, 42(2), 125-131.
doi:10.1017/cjn.2015.10

2. Santos, E. et al.  (2022). Association between temporomandibular disorders and anxiety: A systematic review. Frontiers in Psychiatry.  https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2022.990430/full 

Diagnosis and referral for surgical treatment of ankyloglossia, commonly referred to as a tongue-tie, has been on the rise over the past 25 years.^1-5 Breastfeeding difficulties such as poor latch, painful latch, poor infant weight gain, and long duration of feeding are most often attributed to tongue-ties. Interestingly, the highest rate of surgical intervention referrals occurs in male infants with private insurance from affluent regions of the United States.¹ However, there is a paucity of data to support that surgical interventions provide meaningful changes in breastfeeding outcomes. There is moderate data to support that mothers report decreased nipple pain but limited overall data to support immediate or long-term breastfeeding success after surgery.^1-5 Unfortunately, this has resulted in a lack of substantiated universal diagnostic and treatment criteria for tongue-ties.^1-5

The apparent lack of clinical consensus leads to confusion among parents regarding the correct course of treatment for their infant. The good news is that healthcare practitioners are starting to investigate surgical alternatives. There is some positive data to support osteopathic, myofunctional, speech language pathology and/or chiropractic therapy for improving sub-optimal infant feeding with or without a tongue-tie.^7-11 In general, the results appear to be amplified when any of the aforementioned therapies are combined with breastfeeding training with Certified Lactation Consultants.^8-10 In short, approximately 60% of patients who take a multi-modal conservative approach to a suspected tongue-tie can avoid surgical intervention.⁴ Results from these interventions can be seen in as little as two weeks.¹⁰ Some severe tongue ties may still require surgery if the degree of restriction could eventually interfere with speaking and/or swallowing solid foods.⁵ It is always recommended to speak to your pediatrician about your infant’s feeding difficulties and determine a care plan, but equally important to realize that not all tongue ties require surgical intervention and might be amenable to alternative care. 

References

1. Walsh J, Links A, Boss E, Tunkel D. Ankyloglossia and lingual frenotomy: National trends in inpatient diagnosis and management in the United States, 1997‐2012. Otolaryngology–Head and Neck Surgery. 2017;156(4):735-740. doi:10.1177/0194599817690135
2. Rosi-Schumacher M, Ma AC, Reese A, et al. Feeding issues in infants referred for frenotomy. Cureus. Published online May 2, 2024. doi:10.7759/cureus.59539
3. O’Shea JE, Foster JP, O’Donnell CP, et al. Frenotomy for tongue-tie in newborn infants. Cochrane Database of Systematic Reviews. 2017;2021(6). doi:10.1002/14651858.cd011065.pub2
4. Caloway C, Hersh CJ, Baars R, Sally S, Diercks G, Hartnick CJ. Association of feeding evaluation with frenotomy rates in infants with breastfeeding difficulties. JAMA Otolaryngology–Head & Neck Surgery. 2019;145(9):817. doi:10.1001/jamaoto.2019.1696
5. Frezza A, Ezeddine F, Zuccon A, Gracco A, Bruno G, De Stefani A. Treatment of ankyloglossia: A Review. Children. 2023;10(11):1808. doi:10.3390/children10111808
6. Tomara E, Dagla M, Antoniou E, Iatrakis G. Ankyloglossia as a barrier to breastfeeding: A literature review. Children. 2023;10(12):1902. doi:10.3390/children10121902
7. Chowdhury R, Khoury S, Leroux J, Alsayegh R, Lawlor CM, Graham ME. Alternative therapies for ankyloglossia-associated breastfeeding challenges: A systematic review. Breastfeeding Medicine. 2024;19(7):497-504. doi:10.1089/bfm.2024.0072
8. Herzhaft-Le Roy J, Xhignesse M, Gaboury I. Efficacy of an osteopathic treatment coupled with lactation consultations for infants’ biomechanical sucking difficulties. Journal of Human Lactation. 2016;33(1):165-172. doi:10.1177/0890334416679620
9. Miller JE, Miller L, Sulesund A-K, Yevtushenko A. Contribution of chiropractic therapy to resolving suboptimal breastfeeding: A case series of 114 infants. Journal of Manipulative and Physiological Therapeutics. 2009;32(8):670-674. doi:10.1016/j.jmpt.2009.08.023
10. Vallone, Sharon. Evaluation and treatment of breastfeeding difficulties associated with cervicocranial dysfunction: a chiropractic perspective. Journal of Chiropractic Pediatrics. 2006; 15.
11. González Garrido M del, Garcia-Munoz C, Rodríguez-Huguet M, Martin-Vega FJ, Gonzalez-Medina G, Vinolo-Gil MJ. Effectiveness of myofunctional therapy in ANKYLOGLOSSIA: A systematic review. International Journal of Environmental Research and Public Health. 2022;19(19):12347. doi:10.3390/ijerph191912347

There are many healthcare providers that can diagnose a concussion; however chiropractors are the only healthcare providers trained to address the cervicogenic changes that may be driving a number of your child’s symptoms.⁴ Research is still limited on pediatric concussions in general, but in case studies and case series chiropractic care has demonstrated to assist in a full resolution of the symptoms in 2-8 visits over 2-5 weeks after initial injury.^5-6 It is also important to note that a resolution of symptoms at rest does not mean that your child has completely recovered and full stepwise return-to-play protocol over a minimum of five days is considered the gold standard for safe reintroduction of activity.^2-3 There is always a risk of development of delayed symptoms, particularly in females.⁷ Cognitive rest in the initial period after injury should always be encouraged. You should always work with an experienced healthcare provider in order to determine a safe care plan for your child and sport-certified pediatric chiropractors have the education and experience to help you.⁸

Pediatric and sports chiropractors have been trained to examine children and adults with concussion and often are able to help those people with post-concussion syndrome that we not helped by traditional health care providers.  

References

4. Shannon N, Patricios J. Sports-related concussion: assessing the comprehension, collaboration, and contribution of chiropractors. Chiropractic & Manual Therapies. 2022;30(1):NA–NA. doi:https://doi.org/10.1186/s12998-022-00471-z

5. Journal of Clinical Chiropractic Pediatrics : Editorial. jccponline.com. Accessed March 26, 2023. https://jccponline.com/Concussion-Vol17-01.html

6. Chiropractic management of three young athletes with concussion. Chiropractic Journal of Australia (Online), 46(1), 29–47. https://search.informit.org/doi/10.3316/informit.903767969878389

7. Onicas AI, Deighton S, Keith Owen Yeates, et al. Longitudinal Functional Connectome in Pediatric Concussion: An Advancing Concussion Assessment in Pediatrics Study. Journal of Neurotrauma. Published online August 23, 2023. doi:https://doi.org/10.1089/neu.2023.0183

8.  Moreau WJ, Nabhan DC, Walden T. Sport Concussion Knowledge and Clinical Practices: A Survey of Doctors of Chiropractic With Sports Certification. Journal of Chiropractic Medicine. 2015;14(3):169-175. doi:https://doi.org/10.1016/j.jcm.2015.08.003

Participating in sports has a significant number of physical, mental, educational, and eventual career benefits.¹  However, there is always a risk of injury with participation. Head injuries leading to concussions is a growing area of concern due to the potential long-term effects. Young children may not have the vocabulary to describe their symptoms to you and therefore, diagnosis relies on a combination of child interview by an experienced practitioner, parent interview, and child evaluation. Current diagnostic criteria for children under the age of 12 has been identified for healthcare providers in the Child Sport Concussion Assessment Tool 5 (Child SCAT-5).² Parents can also access the free Concussion Recognition Tool 5 for a quick reference guide to not only identifying a concussion but identifying an emergency.³

There are a few symptoms that you might want to notice or ask about after a head injury: complaints of headaches, dizziness, feeling like the room is spinning, altered or double vision, and/or nausea. You may also notice other changes like a change in your child’s mood such as unexplained sadness or irritability, trouble falling asleep or staying asleep, excessive tiredness or rapid fatigue, as well as trouble concentrating, following instructions, or completing tasks. While this is not an exhaustive list of symptoms, these are some of the most common. It is important to understand that “just do not feel right” is considered a symptom and is enough to warrant investigation into your child’s condition.^2-3

Dr Rubin is both pediatric and sports certified, so has a unique skill set to help kids with post-concussion syndrome.  Let us know how we can help you and your child get back to school and sports the right way. 

References

1. PCSFN Science Board. Benefits of Youth Sports.; 2020. https://health.gov/sites/default/files/2020-09/YSS_Report_OnePager_2020-08-31_web.pdf

2. Davis GA, Purcell L, Schneider KJ, et al. The Child Sport Concussion Assessment Tool 5th Edition (Child SCAT5). British Journal of Sports Medicine. Published online April 26, 2017:bjsports-2017-097492. doi:https://doi.org/10.1136/bjsports-2017-097492

3. Concussion recognition tool 5©. British Journal of Sports Medicine. Published online April 26, 2017:bjsports-2017-097508CRT5. doi:https://doi.org/10.1136/bjsports-2017-097508crt5

Down syndrome is a genetic condition resulting from an extra copy of chromosome 21.  The disorder often includes developmental delays, cognitive challenges, and various health concerns, including those affecting the musculoskeletal system¹. While conventional treatments like physical therapy and medical management are well-established, recent studies suggest that chiropractic care might offer additional benefits for children with Down syndrome. Multiple case studies conclude that chiropractic care is a safe and effective treatment option, reporting no adverse side effects but many positive effects². A case report of a 4-year-old patient with Down syndrome concluded that the correction of the first cervical vertebra (atlas) using gentle chiropractic adjustments was responsible for the correction of convergent strabismus³. Another study reported improved breastfeeding patterns, resolution of a chronically blocked nose, and improved sleep and concentration following regular chiropractic care in a 9-year-old Down syndrome patient².

Children with Down syndrome also show distinct physical issues such as hypotonia (decreased muscle tone) and joint laxity. Spinal misalignments such as scoliosis and hip instability are frequently observed due to their unique musculoskeletal structure⁵. Chiropractic care aims to remove subluxations and enhance the body’s physical function by addressing postural imbalances and reducing discomfort associated with spinal misalignments⁷. This could enhance quality of life in patients with Down syndrome, who commonly experience musculoskeletal pain from joint instability and misalignments².

Chiropractic care might also indirectly boost immune function. A review published in the journal Medicina concluded that spinal adjustments may support a healthy immune response by affecting immune mediators in the body⁴.  Given that children with Down syndrome are more susceptible to infections², maintaining a well-functioning immune system could be beneficial. 

Chiropractic care should complement a comprehensive treatment plan tailored to the child’s specific needs. Some Down syndrome patients also fail to develop the transverse ligament, which stabilizes the two first vertebrae of the spine by binding the dens of C2 (Axis)  to the anterior arch of C1 (Atlas). This causes atlanto-axial instability in the upper cervical spine². Choosing a chiropractor experienced in working with children and individuals with developmental disorders is essential. Use of the Activator instrument offers a very gentle adjustment that is both safe and effective for a wide variety of conditions⁸, including Down syndrome⁶.

References:

1. “Down Syndrome: Symptoms & Causes.” Cleveland Clinic, 1 May 2024, my.clevelandclinic.org/health/diseases/17818-down-syndrome. 
2.  Daruwalla, Delsey. “Down Syndrome and Chronic Ear, Nose and Throat Infections: A Case Report.” Journal of CliniCal ChiropraCtiC pediatriCs, vol. 14, no. 1, June 2013, pp. 1088–1092, https://doi.org/https://jccponline.com/jccp_v14_n1.pdf#page=35. 
3. “Chiropractic Care of a Down’s Syndrome Patient with Vertebral Subluxation and Strabismus.” Vertebral Subluxation Research, vertebralsubluxationresearch.com/2017/09/10/chiropractic-care-of-a-downs-syndrome-patient-with-vertebral-subluxation-and-strabismus/. Accessed 18 Sept. 2024. 
4. 4) Haavik, Heidi, et al. “The Potential Mechanisms of High-Velocity, Low-Amplitude, Controlled Vertebral Thrusts on Neuroimmune Function: A Narrative Review.” MDPI, Multidisciplinary Digital Publishing Institute, 27 May 2021, www.mdpi.com/1648-9144/57/6/536. 
5. 5) Foley, Charlene, and Orla G Killeen. “Musculoskeletal Anomalies in Children with Down Syndrome: An Observational Study.” Archives of Disease in Childhood, U.S. National Library of Medicine, May 2019, www.ncbi.nlm.nih.gov/pmc/articles/PMC6557226/. 
6. 6) Dyck, V. Gary. “ Upper cervical instability in Down’s syndrome: A Case Report.” Journal of the Canadian Chiropractic Association, vol. 25, no. 2, June 1981. 
7. 7) professional, Cleveland Clinic medical. “Chiropractic Adjustment Care, Treatment & Benefits.” Cleveland Clinic, 27 June 2024, my.clevelandclinic.org/health/treatments/21033-chiropractic-adjustment. 
8. Taylor, Shane H, et al. “A Review of the Literature Pertaining to the Efficacy, Safety, Educational Requirements, Uses and Usage of Mechanical Adjusting Devices: Part 2 of 2.” The Journal of the Canadian Chiropractic Association, U.S. National Library of Medicine, June 2004, www.ncbi.nlm.nih.gov/pmc/articles/PMC1840040/#:~:text=Of%20the%2016%20studies%20that,than%20do%20manual%20HVLA%20procedures.

Adult ADHD & Chiropractic care, continued:

Once diagnosed, those seeking an alternative or holistic healthcare approach do have options. There is a paucity of research on non-pharmacological and/or holistic healthcare interventions for ADHD in any age-group, but small studies have demonstrated positive results from Cognitive Behavioral Therapy, transitioning to a diet higher in vegetable protein and lower in fat, supplementation of magnesium, zinc, and iron, Lactobacillus rhamnosus probiotic supplementation, yoga, mindfulness activities, and finally, chiropractic care.^5-8 In fact, chiropractic care demonstrated statistically significant effects on hyperactivity and inattentiveness as compared to standard care options.^9-10   When coping with ADHD symptoms, it is important to take a multimodal approach with a care team supportive of your individual needs and goals for treatment.

5.  https://doi.org/10.1017/s0033291720000069

6.  https://doi.org/10.1007/s13668-023-00487-8

7.  https://doi.org/10.7759/cureus.63576

8.  https://doi.org/10.3389/fpsyg.2024.1323397

9. https://jccponline.com/ADHD.html

10. https://www.frontiersin.org/journals/psychology/articles/10.3389/fpsyg.2024.1323397/full

Adult diagnoses of Attention Deficit Hyperactivity Disorder (ADHD) are on the rise and represent a growing challenge for both patients and their care team. Up to 65% of children diagnosed with ADHD have on-going symptoms as adults, about 3% of all adults have new symptoms. Additionally, up to 80% of adults with ADHD also report at least one psychiatric comorbidity.¹ While most of the same symptoms are present in both childhood ADHD and the adult presentation, adults also report additional symptoms and challenges related to their condition. For example, executive dysfunction is extremely common in adult presentations of ADHD and results in an inability to organize tasks, inability complete complex or difficult tasks, inability to identify mistakes, frequent procrastination, forgetfulness, and inability to establish proper boundaries. Additionally, adult ADHD patients report emotional dysregulation resulting in decreased satisfaction in romantic partnerships, difficulty maintaining friendship, and parenting concerns. These disease traits and associated behaviors can lead to feelings of isolation and loneliness, struggles in career and education, negative emotional responses in parenting, higher divorce rates, increased risk of injuries and accidents, and decreased overall mortality as compared to the rest of the population.^1-4

Chiropractic care has the potential to help both children and adults with ADHD, by allowing the nerve system and brain to work in a more relaxed and focused manner through gentle adjustments, neurological exercises, and dietary modification. ^10-11

References:

1.  https://doi.org/10.1371/journal.pone.0277175  

2. https://doi.org/10.4088/pcc.16r02000

3.  https://doi.org/10.1002/mpr.1555

4.  https://doi.org/10.1177/10870547231158572

10. https://www.frontiersin.org/journals/psychology/articles/10.3389/fpsyg.2024.1323397/full

11. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7706103/

For new parents, the first few weeks after birth can bring on a lot of challenges. Adjusting to the changes can be even more difficult if the newborn is suffering from infantile colic. This common condition is characterized by abdominal discomfort, resulting in the infant crying excessively which the parents are unable to console. Research suggests that almost 20% of newborns and infants may be affected by colic, with symptoms starting around week 2 or 3 and typically resolving before the child reaches 6 months of age. However, the cause of infantile colic is not fully understood. Factors that are proposed to contribute to this condition are sensitivity to certain foods (especially dairy), feeding techniques, overfeeding, underfeeding, insufficient burping and even maternal diet, with the mom’s consumption of dairy being a supposed culprit (1).

The result is an uncomfortable baby and parents that are stressed and unable to get the rest they need. Several studies have examined the safety and efficacy of chiropractic care in the treatment of colic. One of them, a single-blinded, randomized controlled trial conducted in Denmark, recruited infants age 2-14 weeks presenting with symptoms of infantile colic. These children were divided into a treatment and a control group. The infants in the treatment group were adjusted twice a week for 2 weeks using very light, fingertip pressure and gentle massage of any potential tight muscles. Their parents were asked to keep a diary of how many hours their children were crying, and how many hours they were awake and happy. Once the study was completed, the treatment group demonstrated a reduction of excessive crying by half an hour, without adverse side effects. Over 90% of the parents were content that they joined the study (2).  Chiropractic therefore can be of possible benefit to colicky infants and should be considered a safe and effective alternative to other more traditional treatments. 

1) https://www.ncbi.nlm.nih.gov/books/NBK518962/

2) https://chiromt.biomedcentral.com/articles/10.1186/s12998-021-00371-8

Chiropractic care can offer valuable support for adults with autism by utilizing a gentle approach that helps to balance and optimize the nervous system. For many individuals on the autism spectrum, sensory processing challenges and heightened sensitivity can be significant concerns. Chiropractic adjustments aim to improve spinal alignment and nervous system function, which can, in turn, influence the body’s ability to manage sensory input more effectively. By focusing on gentle, targeted adjustments, chiropractors work to reduce stress on the nervous system, which may help individuals experience a greater sense of calm and improved overall well-being.

Chiropractic care often includes techniques that are tailored to be non-invasive and sensitive to individual needs. Dr. Rubin’s method stands out in this regard. He employs gentle pressure adjustments and a specialized tool known as the “Activator” to deliver precise and comfortable adjustments. This customized approach helps reduce discomfort while enhancing the nervous system’s capacity for self-regulation. For adults with autism, this can lead to better stress management, improved sleep, and more stable emotional regulation, ultimately enhancing overall quality of life.

Numerous articles have demonstrated the effectiveness of chiropractic care for adults with autism. One notable case study involved two patients: a 20-year-old and a 17-year-old. Both individuals exhibited aggressive behavior towards others and engaged in self-harm. After undergoing weekly chiropractic adjustments for five months, both patients showed significant improvements. The chiropractic care led to reductions in aggressive behavior and self-abuse, as well as enhanced social interaction.

https://vertebralsubluxationresearch.com/2017/09/10/improvement-in-autistic-behaviors-following-chiropractic-care-a-case-series/

Chiropractic care can offer significant benefits for babies and young children suffering from constipation by helping to relieve pressure on the nervous system to improve gastrointestinal function. Misalignments in the spine, particularly in the lower back, can interfere with the nerves that control the muscles of the digestive tract, potentially leading to sluggish bowel movements and constipation. Gentle chiropractic adjustments tailored for infants and toddlers can help realign the spine, reduce nerve interference, and restore normal bowel function. This natural approach can reduce the need for medications, which may have unwanted side effects in youngsters. Additionally, chiropractic care can promote overall well-being by enhancing the child’s comfort, improving sleep, and boosting the immune system.

The Logan Basic Technique is a gentle chiropractic method often used for treating babies with constipation. Developed by Dr. Hugh B. Logan in 1931, this technique involves applying light, sustained pressure to the sacrum, (a triangular bone at the base of the spine), and specific ligaments connected to it. By balancing the muscles around the sacrum and pelvis, the Logan Basic Technique helps to release tension and promote proper nerve function, which can positively impact the baby’s digestive system. The method is particularly suitable for infants because of its soft, non-invasive nature, making it a safe and effective option for relieving constipation and improving overall health in babies.

https://dynamicchiropractic.com/article/56272-treating-the-pediatric-patient-part-1-logan-basic-technique