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The Effect of Combining Manual Therapy with Exercise on the Respiratory Function of Normal Individuals:

A Randomized Control Trial

Objective: The objective of this study was to explore the effect of combining manual therapy with exercise on respiratory function in normal individuals.

Methods: The study design was a randomized control trial. Forced vital capacity (FVC) and forced expiratory volume in the first second (FEV1) were measured in
20 healthy, nonsmoking individuals before and after 3 interventions: exercise only, chiropractic manual therapy only, and manual therapy followed by exercise. The participants, 18 to 28 years of age, were randomly allocated to a control and 3 intervention groups. Each participant underwent 6 sessions of interventions over
a 4-week period.

Results: The exercise only group showed a significant decrease in FVC (P = .002, generalized linear model [GLM]) and FEV1 readings (P = .0002, GLM). The manual therapy only group showed a significant increase in FVC (P = .000, GLM) and FEV1 (P = .001, GLM). The group that received both manual therapy and exercise showed increases in FVC and FEV1 immediately after manual therapy followed by
an additional increase after exercise. The overall increase in this group was not statistically significant. Participants in the control group showed no change in
FVC or FEV1.

Conclusions: Manual therapy appears to increase the respiratory function of normal individuals. The potential for this intervention administered before exercise to permit additional tolerance within the respiratory system that could allow an extended exercise program than was previously possible is discussed.

Source: Engel RM, Vemulpad S. Journal of Manipulative and Physiological Therapeutics. September 2007; Vol. 30, Iss. 7

A study published in the November / December 2000 issue of Today's
gives some insight into the use of chiropractic in combating
asthma. Forty seven patients were observed for a two year period. They
had been medically diagnosed with persistent asthma ranging from mild
persistent in 11 cases, moderate persistent in 28 cases, to severe
persistent in 8 cases. The care rendered consisted of specific chiropractic adjustments. The range of visits was from 14 to 44, with the average
being 26 during the study period.

All 47 of the study patients showed "a marked improvement ranging from 87
to 100 percent." Their symptoms improved as well as a decrease in their
usage of acute asthma attack medication. Even more impressive was the
fact that all of the patients in the study reported maintaining their
improvement after a two-year follow up.

Childhood Asthma and Chiropractic

It is estimated that up to 15 million people suffer from asthma. Of those,
14.8 million are children under the age of 18. In 1993 alone, there were
198,000 hospitalizations for asthma. In that same sample year, 342
people under the age of 25 died due to this problem. In money terms,
the direct cost of managing a patient with severe asthma has been
estimated at more than $18,000 per year.


"The traditional medical treatment for asthma is anti-inflammatory and bronchodilator drugs. In some cases, treatment included syrups such as
Preventils, which is usually prescribed on a "taken as needed" basis.

The combination of the drugs above promotes drowsiness and may be habit forming. A patient denied of medication feels they can not breathe properly
without it, thus becoming irritable. In some cases they become so irritable
that they bring on an asthma attack."


From the abstract Case review of a 6-year-old boy who has had asthma
since 1991 and his condition since chiropractic intervention. Child was
prescribed aerosol inhalers (Beclovert and Vertolin) using them every day,
up to three times a day. Adjustments were delivered to the cervical,
thoracic and lumbar areas. Significant progress. Could run during soccer
games and almost never used his inhaler. Slept more soundly. Hardly ever
had bouts with mucous clogged nasal passages. Nasal inhalant use stopped.

Source: Asthma and chiropractic. Garde R. Chiropractic Pediatrics.
Vol 1 No.3 Dec, 1994.


Allergy shots used as treatment of asthma in children appears to be
ineffective. Studies have proven there were no significant benefits with
the shots given to children with moderate to severe asthma.
Dr. N. Franklin Adkinson Jr., John Hopkins University

Nearly 40 million Americans -- 25% of the total population -- suffer from
asthma and other allergy diseases

Source: The New England Journal of Medicine in February of 1992

FROM: Foundation for Chiropractic Education and Research (FCER)

October 24, 2002 Des Moines, Iowa— Patients afflicted with asthma may
benefit from spinal manipulation in terms of symptoms, immunological
capacity, and endocrine effects, an audience was told on October 5 at
the 9th International Conference on Spinal Manipulation in Toronto. The investigative team, headed by Ray Hayek, Ph.D., has been conducting
a trial at 16 treatment centers in Australia involving 420 patients with an
average age of 46 in an effort to find out what effects spinal manipulation
has on symptoms, depression and anxiety, general health status,
and the levels of immunity as reflected by the concentrations of both an
immunoglobulin (IgA) and an immunosuppressant (cortisol). This investigation
draws from several references in the scientific literature which suggest that
different forms of manual therapy (including massage) improve the
symptomatology and lower cortisol levels in asthma patients.

Dr. Hayek reported that only the patient group which underwent spinal
manipulation (by any of four commonly used manipulative treatment
protocols) displayed significant improvement in asthma symptoms and
depression and anxiety scores.

Simply experiencing structured interviews at the treatment centers or being
monitored at home did not yield these improvements. In addition, patients
actually undergoing spinal manipulation displayed dramatic increases of IgA
and decreases of cortisol through the posttreatment period, suggesting
that there were physiological consequences to their manipulative treatments reflecting increased immunological capacities which would be expected to
ward off subsequent asthmatic attacks.

These biochemical changes not only suggest that the effects of spinal
manipulation are more far-reaching than commonly believed, but that they
may be more long-term as well. The gain in immunological capacity achieved
with the simultaneous loss of the immunosuppressant cortisol and the
increase of the immunoglobulin IgA following spinal manipulation would be
expected to reduce the incidence and severity of pathogenic invasion of the airways. There would be less of a risk under these circumstances of
compounding the symptoms of asthma.

The immunosuppressing mechanism of glucocorticoids is believed to occur by
their reducing the permeability of capillaries, decreasing the migration of white
blood cells in inflamed areas, suppressing the release of interleukins, and
inhibiting the production of proteolytic enzymes by stabilizing the lysosomal
membranes which release them.

This followed contacts that the Director of Research at FCER was able to
make with the Australian research community in 1995, taking into
consideration the expertise of the investigative team as well as the fact
that Australia's 2 million asthma sufferers have given the Island Continent
the dubious distinction of being the asthma capital of the world.

It has been carried out with the support of research grants exceeding a
quarter of a million dollars from both the Foundation for Chiropractic
Education and Research (FCER) and the National Chiropractic Mutual
Insurance Company (NCMIC). This research, which may be highly
influential on the future of the chiropractic profession, is still in need of
funding. To contribute to this important project, please call FCER at
800-637-6244,or donate via the Foundation's secure website at:

This research represents one of approximately 50 projects administered by
FCER since 1990 in the effort to document both the theory and practice of
chiropractic to increase its effective integration into healthcare systems
worldwide. The conference at which these results were presented is an
international forum which FCER has sponsored at different locations worldwide
for the past 14 years.

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