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A Patient's Perspective

Up C Spine - Is your Head on Straight?

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Category: Case Studies

Date	12-may-2003
Case Title	Parkinson's Disease,Meniere's Syndrome,Trigeminal Neuralgia & Bell's Palsy:One Cause,One Correction
Author	Michael T. Burcon, D.C.
Main Condition/ Disease	Parkinson's Disease,Meniere's Syndrome,Trigeminal Neuralgia & Bell's Palsy
Source	Dynamic Chiropractic May 19, 2003;www.chiroweb.com/archives/21/11/05.html
Abstract	As quoted:I currently have 16 Meniere's syndrome, two Parkinson's disease, two Trigeminal neuralgia and two Bell's palsy patients under my care. They all have one thing in common: The atlas vertebra is subluxated posteriorly, which has caused the head to project forward, taking away the healthy curve of the neck. In each patient, the pelvis has twisted to take pressure off the important nerves in the upper neck and brainstem, causing one leg to appear shorter than the other; normal lumbar curvature is compromised; and finally, if not specifically adjusted, the patient compensates by developing an exaggerated curve in the thoracic spine. I hypothesize that in each patient, kink(s) in the neck inhibited the normal flow of cerebrospinal fluid out of the skull and down the spine; this created excess pressure in the fourth ventricle, causing abnormal function of some of the structures in the midbrain. It also inhibited the flow of blood into the occipital area of the brain by kinking one of the vertebral arteries. Additionally, I suggest that the posterior atlas irritated the anterolateral aspect of the brainstem, irritating any combination of the bottom seven cranial nerves. All 22 patients improved dramatically after one or two adjustments under cervical-specific chiropractic care. When the atlas returns to juxtaposition, the spinal cord relaxes and actually positions itself lower within the spinal column.
Summary	INTRODUCTION Parkinson’s Disease (PD, Paralysis Agitans, Shaking Palsy) is an idiopathic, slowly progressive, degenerative CNS disorder with 4 characteristic features: slowness and poverty of movement, muscular rigidity, resting tremor and postural instability. Parkinson’s disease is the fourth most common neurodegenerative disease of the elderly. It affects about 1% of the population over 65 years old and 0.4% of the population under 40 years old. The mean age of onset is about 57 years old. Onset in childhood or adolescence (juvenile parkinsonism) also occurs. (1) The etiology and pathophysiology of primary parkinsonism is loss of the pigmented neurons of the substantia nigra, locus ceruleus and other brainstem dopaminergic cell groups. The loss of substantia nigra neurons, which project to the caudate nucleus and putamen, results in depletion of the neurotransmitter dopamine in these areas. (1) The signs and symptoms in 50 to 80% of patients with PD, the disease begins insidiously with a resting 4- to 8-Hz “pill-rolling” tremor of one hand. The tremor is maximal at rest, diminishes during movement and is absent during sleep; it is enhanced by emotional tension or fatigue. The hands, arms and legs usually are most affected, in that order. Jaw, tongue, forehead and eyelids may be involved as well, although the voice is not. Many patients display only rigidity and never manifest tremor. Progressive rigidity, slowness and poverty of movement (bradykinesia) and difficulty in initiating movement (akinesia) follow. (1) The face becomes masklike and open-mouthed, with diminished blinking. The posture becomes stooped. Patients find it difficult to start walking; the gait becomes shuffling with short steps and the arms are held flexed to the waist and fail to wing with stride. The steps may inadvertently quicken and the patient may break into a run to keep from falling (festination). On examination, passive movement of the limbs is met with plastic, unvarying lead-pipe rigidity; superimposed tremor bursts may give ratchet-like cogwheel quality. (1) The sensory examination usually is normal. Signs of autonomic nervous system function may be seen. Muscle strength is usually normal. Dementia occurs in about 50% of patients; depression also is common. (1) The standard medical treatment for PD has been the administration of the drug Sinemet, which combines Levodopa (a short acting drug that enters the brain and is converted into dopamine) and Carbidopa (enhances levodopa’s action in the brain). Several neurosurgical techniques also exist, including thalamotomy (destruction of ventral thalamus to control tremor), pallidotomy (destruction of posterior ventral globus pallidus to control hyperkinetic symptoms) and deep brain stimulation (electrode implantation for patient-controlled stimulation of thalamus to control tremor). While the medications and surgeries may temporarily control symptoms, neither stops nor reverses the progressive degeneration of the substantia nigra. (2) BJ Palmer reported the use of upper cervical chiropractic care with PD patients as early as 1934. In his writings, he referred to patients with shaking palsy and listed improvement of correction of symptoms such as tremor, shaking, muscle cramps, muscle contracture, joint stiffness, fatigue, incoordination, trouble walking, numbness, pain, inability to walk and muscle weakness. His chiropractic care included Paraspinal thermal scanning using neurocalometer (NCM), a cervical radiographic series to analyze the upper cervical spine and a specific upper cervical adjustment performed by hand. Erin L. Elster D.C., found no other references for the chiropractic management of PD patients, prior to her study on ten PD patients in the year 2000, utilizing modern upper cervical chiropractic care. (2) Three-month reevaluations revealed a substantial improvement in subjective and objective findings in six out of the total ten patients, and a mild improvement in two patients. The findings of the other two patients, both over age 65, remained unchanged. According to the UPDRS, six out of ten patients showed overall improvement ranging from 21 to 43 percent after three months of upper cervical chiropractic care. (2) Meniere’s disease (syndrome) is characterized by vertigo or dizziness, and some combination of four associated symptoms: nausea, inner ear pressure, low-frequency hearing loss and tinnitus. The cause of Meniere’s disease is unknown, and the pathology is poorly understood. (1) The attacks of vertigo appear suddenly, last from a few to 24 hours, and subside gradually. The attacks are associated with nausea and vomiting. The patients may feel a recurrent feeling of fullness in the affected ear, and the hearing in that ear tends to fluctuate, but worsens over the years. Tinnitus may be constant or intermittent. Trigeminal neuralgia (Tic Douloureux) is a disorder of the Trigeminal nerve producing bouts of severe, lancinating pain lasting seconds to minutes in the distribution of one or more of its sensory divisions, most often the mandibular and/or maxillary. The cause is uncertain. Recently, surgery at autopsy suggests that tic is essentially a compressive neuropathy of the brainstem. (1) Bell’s palsy is a unilateral facial paralysis of sudden onset and unknown cause. Pain behind the ear may precede the facial weakness that develops within hours, sometimes to complete paralysis. The mechanism is presumed to involve swelling and compression of the facial nerve. (1) In addition to the upper cervical chiropractic care based on the research of BJ Palmer, D.C., with the assistance of Lyle Sherman, D.C., later refined by William G. Blair, D.C., I have added the lower cervical research and adjustment utilized by Walter Vern Pierce, D.C., into a technique that I refer to as cervical specific chiropractic. (3) In my previous research with cases involving brainstem irritation (Meniere’s disease, Trigeminal neuralgia and Bell’s palsy), I have discovered that the main cause was cervical trauma. The trauma forced the top cervical vertebra (atlas) to subluxate posteriorly, with laterality on the opposite side of the patient’s problem, i.e., if the patient had fullness and gradual loss of hearing in the right ear, the atlas listing would be posterior and inferior on the left (PIL). These same findings are substantiated by my Parkinson’s research. (4) METHODS My technique is based on the work of BJ Palmer, DC, as developed at his research clinic at Palmer Chiropractic College in Davenport, IA, from the early nineteen thirties until his death in 1961. (5, 6, 7) I have also studied the vertebral subluxation pattern work of BJ’s clinic director, Lyle Sherman, DC, for whom Sherman College of Straight Chiropractic, Spartanburg, SC, is named. (8,) A detailed case history was taken on the first visit, followed by a spinal examination. First, a NervoScope was used to graph the patient’s cervical spine. The NervoScope is an advancement of the dual probed NCM first used by BJ Palmer, DC. (9) Next, cervical motion palpation was performed, noting any aberrant motion of the vertebrae. Detailed leg checks were performed on each patient visit, utilizing the work of J Clay Thompson, DC and Clarence Prill, DC. (10) With the patient prone, an apparent short leg was notated. The patient was instructed to turn their head to the right. If the short leg became more balanced, a right cervical syndrome was listed. The patient was then instructed to turn their head left. If the short leg became more balanced, a left cervical syndrome was listed. If both movements lengthened the short leg, a bilateral cervical syndrome was listed. Modified Prill leg checks were used to determine the major cervical subluxation. The top four cervical vertebrae were tested as instructed by the Blair Chiropractic Society. They are referred to as modified because Dr. Prill uses the arms to detect imbalances, whereas Blair chiropractors use the legs. Patrick J Sweeney, DC and I refined the tests for the bottom three cervical vertebrae. Atlas (C1) was tested by instructing the patient to “gently and steadily raise both feet.” The doctor resists by holding the heels of the feet with his open hands. If the short leg stays short or becomes shorter, it is listed as a positive test for nerve interference at the level of C1. It is postulated that the flexion and extension of the leg correlates to the flexion and extension of the head, 50% of which occurs at atlas.. Axis (C2) was tested by instructing the patient to “gently and steadily pull your feet together,” while the doctor resists foot rotation. The rotation of the feet correlates to the rotation of the head, 50% of which occurs at axis. The third cervical vertebra is tested by having the patient pull his legs together and C4 by having the patient pull their legs apart. The fifth cervical is tested by having the patient raise his arms while the doctor holds the biceps. Patient raises his arms while doctor holds brachioradialis muscles to test C6, and patient pushes arms down while doctor holds the triceps to test C7. Three cervical x-rays are then taken to get listings for the segments that tested positive and to check for contraindications to adjusting, a lateral, an A-P open mouth and a nasium. The lateral is used to check for a posterior kink in the lower cervicals. The A-P is used to check for translation, usually the result of a “T-bone” automobile accident. The nasium is used to determine the atlas listing utilizing the Blair theory of upper cervical subluxation. There are only four atlas listings in Blair work. Dr. Blair’s research demonstrated that there is no pure lateral movement at C1. Atlas will tend to articulate properly on one condyle, while partially slipping off from the other. (11) If the atlas subluxates anteriorly, it must move superiorly, due to the “rocker” shape of the articulation. If it tracks on the left, atlas will show an overlap on the right articulation on the nasium. This is listed as an ASR (anterior and superior on the left). If it tracks on the right, it will overlap on the left (ASL). Anterior listings are more common and tend to be less symptomatic than posterior listings. A posterior atlas subluxation is typically the result of trauma to the head, neck or upper back. If atlas subluxates posteriorly, it must also move inferiorly. If it tracks on the right, it will underlap on the left. This listing is PIR (posterior and inferior on the right). If it tracks on the left, it underlaps on the right, and is listed as a PIL. I postulate that one of the reasons that patients have a problem on the opposite side of their posterior listing is that this is the side where atlas is not articulating properly with the occiput. Over time, this can cause irritation in that area leading to inflammation and eventually even the creation of scar tissue. I feel that the vertebral artery is often kinked on that side, adding to the problem. One thing I’ll never forget from cadaver dissection is how every structure seemed to be fighting for its space within the human body. This was especially true at what I found to be the surprisingly small junctions between the skull and the upper cervicals, and the junction between the base of the neck and the thorax. No adjustment was given on the first visit. A pattern of subluxation had to be established on the second visit. Patients were checked on subsequent visits. If the pattern had not returned, no adjustment was give. Atlas was always the first segment adjusted. The technique used varied with the radiographic analysis. If the major misalignment was translation, a side posture toggle recoil technique was used (hole in one). If the major component of the subluxation was posteriority, a prone position was used. A drop mechanism was used on all adjustments. If after atlas was holding, positive tests persisted in other cervical segments, those vertebrae were adjusted. Again, both side posture and prone patient positions were used on the lower cervicals. Patients were rested for fifteen minutes after every adjustment, and then post checked. Patients were released only after their legs presented balanced. The Unified Parkinson’s Disease Rating Scale (UPDRS) was used on every visit to graph any improvement in the patient’s symptoms. Thirty-one separate areas are graded covering mentation, behavior and mood, activities of daily living and motor examination. Each is graded 0 for no problem, 1 for mild problem, 2 for moderate problem, 3 for severe problem or 4 for persistent problem. CASE REPORTS CASE 1 HISTORY: Seventy four year old male retired truck driver. Diagnosed with Parkinson’s in 1994. He broke his right collarbone and left wrist falling off from a ladder (about 8’) onto the right side of his head in 1991. Diagnosed with Meniere’s in 1985, Bell’s palsy in 1983. Low speed auto accident in 1974. Medications included Permax and Singmet. He still plays golf occasionally and bowls regularly. EXAMINATION: Patient presented with tremor of left hand and jaw. Reported restlessness and inability to sleep. Disappointed because he and his wife could not go to Florida this winter, which they had been doing for several years. UPDRS points totaled 44. Inability to rise out of a chair was highest score (3). Thermograph was 3 degrees cold at the bottom of the cervicals, increasing to 5 degrees at the top. Patient had a ¾” short left leg, ½” right cervical syndrome (RCS), and positive modified Prill tests on C1, C2 and C5. Lateral x-ray revealed a severe kink at C4/5, AP showed axis to be body left, and nasium determined atlas to be PIR. INTERVENTION AND OUTCOME: Patient was in pattern of subluxation on second visit. Atlas was adjusted with patient in prone position, chin tucked towards chest. Knife-edge contact was made lateral to spinous process of axis, doctor standing on right side of table. Line of drive was mostly posterior to anterior (P-A), somewhat inferior to superior I-S). Patient’s hand tremor ceased immediately upon adjustment. After his rest, there still was no evidence of tremor, which was noted as constant on his first visit. I had the patient attempt to get out of a chair without assistance. He could not get up. I repeated the leg checks. The only positive test was for C5. I challenged the segment on the right and the short leg went shorter. The challenge while standing on the left balanced the legs. I did a Pierce technique adjustment on C5, standing on the left side of the table, using a knife-edge contact below the spinous process. Adjustment is mostly P-A, some I-S, using the drop mechanism. Again, the patient was rested for fifteen minutes. There still was no tremor, and this time, he was able to lift himself out of a chair without help. CASE 2 HISTORY: Twenty one-year-old single female college student working as a receptionist in a medical office. She had been taking Tegretol and Neurotin for the past year, after being diagnosed with Trigeminal neuralgia. She was doing poorly in school, which she attributed to her meds. She was diagnosed with a scoliosis at age nine. Her mother reported that her delivery was difficult. She denied being in any auto accidents, but she did play contact sports in high school. EXAMINATION: Leg checks showed a ¾” Right Pelvic Negative (RPN), 1” Bilateral Cervical Syndrome, positive C1 and C5 Prill tests. She had limited range of motion upon bilateral cervical rotation and left lateral cervical flexion. Her left ear was noticeably higher than her right. X-ray showed a PIL atlas, body left axis and posterior C5. INTERVENTION AND OUTCOME: Subjective findings included light-headedness from medications, stabbing, burning and throbbing right maxillary pain and low back pain. I adjusted her atlas PIL using side posture toggle recoil technique. She reported dizziness on her next visit. I adjusted her C5 after it tested positive for nerve interference. On her third visit, I adjusted her sacrum. On her fourth visit she presented balanced and pain free and was not adjusted. She discontinued her medications and held her atlas adjustment for eight months. She lost her adjustment when she received a neck massage. Her second atlas adjustment has held for sixteen months. CASE 3 CASE HISTORY: Forty six-year-old married Caucasian female diagnosed with Trigeminal neuralgia (left mandibular), Sjogren’s syndrome, irritable bowel syndrome, erythema multiforme, allergies and Raynaud’s phenomon. She reported whiplash from her auto being rear ended in 1998. EXAMINATION: One half inch Right Pelvic Positive and positive Prill tests for C1 and C5. Limited range of motion left lateral cervical flexion. X-rays showed evidence of atlas PIR and C5 posterior subluxations. She was hoarse, which was later diagnosed as a staff infection of her lungs. INTERVENTION AND OUTCOME: Atlas and C5 were adjusted on the first visit. The fifth cervical and fifth lumbar were adjusted on the second visit. Axis and sacrum were adjusted on the third visit, C5 and sacrum on the forth. She presented balanced and pain free on the fifth visit, after two months of specific care. She is still holding her balance after two months. CASE 4 CASE HISTORY: Seventy eight year old male woke up with right facial paralysis. He was an existing patient being treated for cervicalgia and severe motion restriction of the cervicals. His chief complaint was that he could no longer look over his shoulder to back out of his driveway. He was also experiencing low back pain and some problems with his right shoulder and right hip. Additionally, he was being medicated for high blood pressure, and had a history of a minor stroke. EXAMINATION: 1” LPP with positive Prill C5 and C1 tests. X-rays showed a PIL atlas and posterior fifth and sixth cervicals. Apparent stenosis of the entire spine was noted. INTERVENTION AND OUTCOME: I adjusted his C5 P-A and his atlas PIL using an Integrator adjusting instrument. He said he was feeling only somewhat better after his rest, but called the next morning to report that the paralysis was mostly gone. It was completely gone after three days. It has not returned in the last two years. CASE 5 CASE HISTORY: This 88 year old female suffered frequent episodes of vertigo, tinnitus and nausea for 45 years. She was in a moderate car accident a few years before onset. She was a passenger and she was not wearing a seat belt. During episodes she walked around her home holding onto the walls, trying to keep her head level at all times. She reported numerous falls over the years, some resulting in broken bones. She was diagnosed with Meniere’s disease at University of Michigan Hospital in Ann Arbor and Memorial Hospital in Chicago. She tried a variety of medications which would help her sleep, but did not negate her symptoms. Surgical history of colostomy and right radical mastectomy noted. EXAMINATION: Subject reported severe dizziness, blindness in the left eye, fullness in the right ear, pain and stiffness of the neck and numbness in the left thumb. She was unable to lift her left arm above her shoulder. She exhibited limited range of motion with left lateral flexion and left rotation of the head. Edema was noted below the posterior base of occiput. Leg checks showed a 1” RPP and 1” left cervical syndrome. Modified Prill check elicited positive test for C1 subluxation. Cervical x-rays revealed narrowed disc spaces at multiple levels, particularly evident at C6/7. Minimal marginal spurring and bony overgrowth of facet margins. Atlas was subluxated posterior and inferior on the left articulation, underlapped on the right. Fifth cervical was inferior and posterior. INTERVENTION AND OUTCOME: Immediately following specific toggle recoil adjustment of atlas, patient reported complete alleviation of vertigo and dizziness. When she awoke the following morning, the tinnitus was also gone. She held this adjustment and was symptom free for two years. After suffering a minor stroke, closely followed by three compression fractures caused by osteoporosis, the subluxation returned and a second adjustment was given. This adjustment has held for the past year. DISCUSSION All of my patients with Parkinson’s, Meniere’s, Trigeminal neuralgia and Bell’s palsy have had trauma to the upper back, neck and/or head, and they all have posterior atlas subluxations with laterality on the opposite side of their problem. It is my theory that the pressure exerted by the subluxated atlas causes a combination of problems including, but not limited to, degenerative posture changes caused by carrying the skull too far anterior, decreased blood supply to the occipital portion of the brain, pressure on the nuclei of Cranial Nerves V (Trigeminal) and VIII (Vestibulocochlear), nerve root irritation of Cranial Nerve VIII (4), paralysis of the branches to the M. tensor veli palatini, which opens the Eustachian tubes (12) and/or compression preventing normal cerebral spinal fluid flow downward from the fourth ventricle into the spinal subarachnoid space, resulting in hydrocephalus. CONCLUSION Anyone who has had trauma to the upper body, neck and/or head, or diagnosed with any disease related to a problem with the brainstem, should be evaluated by an upper cervical specific chiropractor.
References	1.The Merck Manual, 16th edition. Berkow RR. N.J.: Merck Research Laboratories, Merck & Co. Inc., 1999. 2.Elster EL. Parkinson's disease: upper cervical chiropractic management of Parkinson's disease patients, Today's Chiropractic, July-August 2000. 3.Pierce WV. Results, CHIRP, Inc., Dravosburg, Penn., 1981. 4.Burcon MT. Upper cervical protocol for ten Meniere's patients, Journal of Vertebral Subluxation Research; passed peer review and waiting publication. 5.Palmer BJ. The Subluxation Specific, The Adjustment Specific. Davenport, Iowa: Palmer School of Chiropractic, 1934. 6.Palmer BJ. Chiropractic Clinical Controlled Research. Volume XXV. Davenport, IA: The B.J. Palmer Chiropractic Clinic, 1951. 7.Palmer BJ. History in the Making. Volume XXXV. Davenport, IA: Palmer School of Chiropractic, 1957. 8.Sherman L. Neurocalometer-neurocalograph-neurotempometer research. Eight BJ Palmer Chiropractic Clinic Cases. Davenport, IA: Palmer School of Chiropractic' 1951. 9.Burcon MT. BJ's $50,000 timpograph, Chiropractic Economics, Nov/Dec 1995. 10.Prill CE. The Prill Chiropractic Spinal Analysis Technique, 2001. 11.Addington EA. Overview of Blair Cervical Technique, Council on Chiropractic Practice, Chandler, AZ, October 2-3, 1995. 12.Hamersma H. A New Look at Meniere's Syndrome. The Ear, Nose and Throat Institute of Johannesburg, Florida Park, Gauteng, South Africa.
Keywords	Parkinson's disease;Meniere's syndrome;Trigeminal neuralgia;Bell's palsy,posterior atlas subluxation

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