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Chiropractic Journal of Australia : CJA September 2013
116 Chiropractic Journal of Australia Volume 43 Number 3 September 2013 physical area of visceral referred pain goes from the surface downwards; the skin is the frst to normalize, but the muscle maintains some residual hyperalgesia for a long period of time.42 It is for this reason that, in chiropractic, it is recognised that viscerosomatic refex activity occurring in a patient's musculoskeletal system may be detected before (and after) symptoms of visceral change are evident, and that this phenomenon (the muscle inhibitions resulting from viscerosomatic refexes) has potential prognostic and diagnostic value.14-20, 49 The claim that spinal disorders have no effect upon visceral function appears to be weakening, with evidence emerging from neuroscience research involving both human33-39 and animal studies.50-54 This research confrms and partially validates what has been suspected clinically among chiropractic, osteopathic, manual medical, naturopathic, homeopathic, acupuncture and applied kinesiology clinicians for decades.14-25, 50-57 The neurosciences are adding evidence of manual therapies having distinct and clinically meaningful effects on visceral functions through somato-visceral refexes. A more extensive review of this research has been provided elsewhere.21-23, 50, 51 Emerging evidence supports the long-term clinical observations of the chiropractic and osteopathic professions that aberrant spinal mechanics can have an adverse effect on autonomic and visceral function, and that chiropractic treatment has a modulating effect upon autonomic and visceral function. This phenomenon appears to have a neurophysiological basis.54,55 According to Rome50, 51 "There appears to be extensive if not overwhelming evidence as to the potential for a manual model for positively infuencing the autonomic nervous system and through that, internal pathophysiology and symptoms". The vasomotor manifestation known as “hot fashes” is a commonly recognised and very disturbing symptom associated with autonomic imbalance and menopause, and it afficted each of the women in this study. One does not have to look far to see the prevalence of menopausal discomforts in the population, as an estimated 10-60% of American women suffer night sweats alone.58 Concurrent validity research: AK MMT examinations and Laboratory Tests Members of the International College of Applied Kinesiology have published outcomes research on adrenal gland dysfunctions since Goodheart published an article in Chiropractic Economics titled "Urinary Testing Methods" in 1964.14, 15, 59 In 1998, Schmitt and Leisman60 conducted a controlled clinical trial in an attempt to determine whether subjective muscle testing employed by AK practitioners could identify those individuals with specifc hyperallergenic responses. Seventeen subjects were found positive on AK muscle testing screening procedures indicating food hypersensitivity (allergy) reactions. Each subject showed muscle weakening (inhibition) reactions to oral provocative testing of one or two foods for a total of 21 positive food reactions. The lab tests performed were both a radio-allergosorbent test (RAST) and immune complex test for IgE and IgG against all 21 MENOPAUSE AND CHIROPRACTIC CUTHBERT • ROSNER between the muscle-organ inhibition patterns described in AK when the viscerosomatic refexes for these organs were simultaneously therapy localised. Importantly, the salivary hormone test results for abnormalities in the reproductive system hormones showed a 10 out of 10 patient correlation with inhibited muscles related to the reproductive system in AK. It should be pointed out that every patient in this cohort of symptomatic menopausal women had abnormal progesterone and/or estrogen values as well as adrenal hormone values. Based on the self-report of the patients and the changes in MRS fndings, 7 of the 10 patients had complete resolution of their menopausal symptomatology. Two patients showed significant improvements, and one showed moderate improvement. DISCUSSION Muscle dysfunction and viscerosomatic phenomena 14,15 A visceral problem can display itself in a specific dermatomal segment via a cutaneovisceral reflex,39 and stimulation of the skin can have a distinct effect on a related visceral area via the same cutaneous refex. This can best be understood by means of Head's Law.40-42 Head's Law states that when a painful stimulus is applied to a body part of low sensitivity such as an organ that is in close central connection (the same segmental supply) with an area of higher sensitivity (such as a muscle), pain will be felt at the point of higher sensitivity rather than where the stimulus was applied. This means that input from low-threshold nociceptors in an organ can modulate ongoing activity in muscles. Based upon this law and supporting EMG studies, we can assume that dermatomes are neurologically integrated with myotomes and sclerotomes producing associated sensory and motor dysfunction. Should there be an organic or biomechanical encroachment or compression affecting the ventral nerve root, for instance, we can anticipate autonomic impairment in the associated viscerotomes and dermatomes. This is demonstrated in chiropractic and applied kinesiology examination every day. When afferent pain fbers innervating a visceral organ and those innervating a muscle enter the spinal cord at the same segmental level, they converge on the same dorsal horn neurons.43,44 Gillette et al45 show how commonly inputs from many associated tissues (facet joints, periosteum, ligaments, intervertebral disc, spinal dura, low back, hip, proximal leg muscles, tendons and skin) converge into one sensory lumbar spinal neuron. The overwhelming majority of dorsal horn cells that receive visceral input also have a somatic input that is nociceptive.46 The brain-- which has no way of distinguishing from which of these two sites the pain stimulus has arisen and because the transmission neurons are more frequently activated by muscular afferents than by visceral ones -- tends to misjudge the location and source of pain of visceral origin and erroneously perceives it as coming from muscle. This convergence of visceral and somatic afferent fbers has been described in the low back47 and thoracic regions.48 The convergence of nociceptive input from internal organs appears to augment the neurons primarily concerned with receiving inputs from muscle nociceptors. In the process of healing from a disturbing organic and/or neurohormonal condition, the improvement in the
CJA June 2013
CJA December 2013