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Chiropractic Journal of Australia : CJA September 2013
Chiropractic Journal of Australia Volume 43 Number 3 September 2013 109 MENOPAUSE AND CHIROPRACTIC CUTHBERT • ROSNER 89% of the women reported that they found the treatment "somewhat or very" helpful. The authors concluded that "the use of alternative therapies for menopause symptoms is common, and women who use them generally fnd them to be benefcial.” 8 In today's environment of evidence-based medicine, it is appropriate that chiropractors provide meaningful clinical evidence to support the profession's treatment of Type-O disorders. This would specifcally apply to peri- and post- menopause, giving scientific strength to what has been suspected clinically for decades. Accordingly, we evaluated the correlation between chiropractic physical fndings and salivary hormone findings in patients with menopausal symptoms, recording whether treatments based upon the chiropractic fndings were successful for these women, using the validated Menopause Rating Scale.9 Menopause Rating Scale for assessment of severity of menopausal symptoms and responsiveness to AK treatment The Menopause Rating Scale (MRS) is a Quality of Life scale developed in the early 1990s. (Figure 1) The scale was created so that women could easily complete it rather than their physician.9 It has been investigated and validated since that time as an outcomes measure for hormone therapy for women with menopausal symptoms.10 The MRS has the capacity to measure treatment effects on quality of life across the full range of severity of complaints before and after treatment. Because it is a standardised test, it allows the comparison of treatments across the healing professions. Like the Visual Analog Scale (VAS), the MRS does not require any interpretation by the investigator, because patients assess the severity of their menopause symptoms in terms of their own personal judgment. These types of tools are held to possess sensitivity (correct prediction of the positive assessment) and specifcity (correct prediction of a negative assessment) and are thus useful in both clinical practice and research studies.11 The MRS lists 11 symptoms to be evaluated by the patient. For each, the respondent has a choice among 5 categories: no symptom, mild, moderate, severe, and very severe, employing a range from 0 (no symptom) up to 4 (severe symptom). The total score of the MRS therefore ranges from 0 (asymptomatic) and 44 (highest degree of complaints). Salivary Hormone Testing for assessment of biochemical causes of menopausal symptoms We found that testing hormones in saliva was convenient, painless, less expensive than blood tests, and (apparently) accurate. More importantly, saliva contains the free, "bioavailable" fraction of steroid hormones that have moved out of the bloodstream and into the tissues. (Blood and urine measure total levels instead. In cases of hypothyroidism -- not uncommon -- the urinary excretion of several adrenal hormones is decreased). Furthermore, the stress caused by a conventional blood draw can alter test results. For salivary hormone determinations, the home collection kit routinely given to patients allows for optimal collection times. It is worth noting that the World Health Organization uses saliva testing to study human hormone levels around the world. The steroid hormones most readily measured in saliva are: estrogens (estradiol, estrone, and estriol), progesterone, androgens (DHEA, testosterone), and cortisol.5, 12 Our approach in this case-series has been to determine the concurrent validity of the AK MMT diagnostic method compared to an established, "gold-standard" biochemical testing method, the salivary hormone test. Were the AK sensorimotor tests of the biochemical component of menopausal disorders consistent with the fndings of this "gold-standard" laboratory test? The association between the muscles and organs or glands has become well-defned in applied kinesiology. As more knowledge has been gained, there have been few modifcations necessary to Goodheart’s original observations. An early AK study was performed at the Anglo-European College of Chiropractic13 to evaluate the muscle-organ-gland association. An organ was irritated, and the muscle associated with that organ was tested with a spring scale. Then a control muscle was tested. Four muscle-organ-gland associations were evaluated: the eye, ear, stomach, and lung. The stomach was irritated by placing cold water into it; the eye was bathed with chlorinated water; the ear with sound of a controlled frequency and decibel rate; and the lung with cigarette smoke. In all cases, the associated muscle weakened signifcantly after the irritation. The control muscle also weakened, but to a much lesser degree. The control muscle weakening parallels the applied kinesiology fnding that general muscles of the body weaken when an irritation ("sensorimotor challenge") is placed into the nervous system or other controlling factory of the body as well. Viscero-somatic reflex phenomena of this type have been extensively explored in AK and chiropractic research generally.14-25 It has long been established that visceral disturbances can be referred not only to skeletal muscles but also to the skin, ligaments, and bone.26 Travell & Rinzler27 have shown that pain in the pectoralis muscle can accompany coronary infarction, and this fnding has been confrmed.28 This fnding is further supported by research that has shown stress to an internal organ can result in a viscero-somatic reflex inhibiting both motor and sensory nerves in AK practice.29-34 Visceral infammation has also been shown to produce refex cutaneous leukocyte extravasation.35 Korr presciently observes that viscerosomatic refex activity may be observed before any symptoms of visceral change are evident and that this phenomenon therefore is of important diagnostic value.36 Finally Beal37 elegantly summarises the research about the "body language" of visceral disease by stating that "somatic manifestation is an integral part of visceral disease." Neural control of visceral and neurohormonal function is a unique coordination of somatic and autonomic motor nervous systems; sensory information and motor control are supplied by both visceral and somatic sensory and motor fber systems.38 This mechanism may account for the clinical observation that muscle weakness, tenderness and pain often develop in association with visceral disorders. A broader review of the basic science and outcomes research published over the past 50 years in chiropractic and AK relating to viscerosomatic disorders is available elsewhere.14-16
CJA June 2013
CJA December 2013