FROM: ICA International Review of Chiropractic 1992 (Oct): 45-47
Joseph M. Flesia, Jr., D.C.
Author's Note: The pediatric and prevention aspects of chiropractic care for the Vertebral Subluxation Complex have matured into major clinical issues and challenges for the chiropractic clinician. This article is a two-part review of the pathogenesis of the Vertebral Subluxation Complex. It will act as a springboard into further clinical and scientific inquiry concerning these two timely issues. The American public is seriously concerned with these two important aspects of health care. This increasing concern on the part of the health care consumer is not being satisfied under the traditional medical model of health services. As a consequence people are now deciding to actively participate in "alternate" methods of health care. A recent Time/ CNN poll reveals that 62% of Americans who have never sought alternative therapy said that they would do so if conventional treatment failed, and 84% of those who had already visited an alternate therapist said they would go back.
Chiropractic pediatric care and prevention have much to offer the dissatisfied medical model health care consumer, however, few are finding their way to chiropractic as the face of the chiropractic profession tries on the new look of "musculoskeletal disorders" as its identity in the health care community.
The first installment of these articles reviewed the basis of the component model of the Vertebral Subluxation Complex from an integrative standpoint. This installment will begin an exploration of the references presented in that article concerning pathogenesis. The point of this article is that the Vertebral Subluxation Complex can be caused by the birth process or early in life. The point is not made that all children are involved in the Vertebral Subluxation Complex trauma at birth. This is not borne out in the literature. As chiropractic clinicians, confronted by a traumatic condition that is degenerative if left uncorrected, the question becomes, when does care begin? Especially since subtle VSC episodes are not detectable by parents and since most medical physicians refuse to recognize its existence.
Our clinical strategy is simple. Examine and screen all newborns for the Vertebral Subluxation Complex (VSC). If evidence of VSC is detected, correct it and set up an appropriate preventive screening program thereafter. If no evidence of VSC is detected, simply set up an appropriate preventive program thereafter, with parental consent, of course. This consent will be more available if the parents are educated as to the nature of the Vertebral Subluxation Complex and are under appropriate care themselves.
Pathogenesis: A Literature Review References #307-348
This is a literature search funded by Renaissance International in 1982. lt contains 496 references that support the various components and subcomponents of the Vertebral Subluxation Complex. Most of these references are mainstream medical references, some are marginal and some are from the chiropractic literature. The reason why such a broad sweep of references are included in this report, is to show that the mainstream medical, marginal, and chiropractic literature all support the component basis of the Vertebral Subluxation Complex. 'During Renaissance presentations, mainstream medical references are highlighted simply because, the health care marketplace and the scientific research arena rely on major mainstream medical research when judging anything new in the health care sciences..." Chiropractic." Note that when reading most of the medical references referenced in the Renaissance seminar and literature, expect to find the reference directly related to the Vertebral Subluxation Complex component terminology targeted by Renaissance and do not expect to find a glowing report about chiropractic, "the Vertebral Subluxation," "Subluxation" (the way we mean it), or the Vertebral Subluxation Complex. The references will be very specific concerning component terminology. Remember, no matter what umbrella terminology you apply to the components of the Vertebral Subluxation Complex, they still remain the Vertebral Subluxation Complex.
The above literature review references #307-348, substantiate the observation that spinal injury with nerve damage (the Vertebral Subluxation Complex) can happen during the birth process or shortly thereafter. Keep in mind when reading the literature, that the phrase, spinal injury with nerve damage describes the Vertebral Subluxation Complex.
Sudden Infant Death Syndrome:
A Literature Review with Chiropractic Implications
Journal of Manipulative and Physiological Therapeutics 1987 (Oct); 10 (5)
This article substantiates the observation that spinal injury with nerve damage can be caused during the birth process or shortly thereafter. The article has with 79 references. Some of these references overlap the above references, however, we now have over 100 references indicating that the Vertebral Subluxation Complex can happen at the birth process or early in life.
Spinal Injury Related to the Syndrome of Sudden Death (Crib Death) in Infants
Abraham Towbin, M.D., Department of Pathology, Boston University School Medicine, Mallory Institute of Pathology, Boston, Massachusetts, The American Journal of Clinical Pathology, Vol. 49, No. 4,1968, Williams & Wilkins Company.
In this article, Dr. Towbin relates spinal injury at birth to spinal cord damage resulting in sudden infant crib death. This article is very specific in its terminology.
Latent Spinal Cord and Brain Stem Injury in New Born Infants
Abraham Towbin, MD. Neuropathologist, Harvard Medical School, Develop, Med., Child Neurol, 1969, II, 54-78
In this article about a year later, Dr. Towbin points out that seven of the eight of the SIDS infant cadavers he performed autopsy on, died from spinal injury with neurovascular damage. Dr. Towbin describes various clinical neonatal spinal cord and brain stem injury groups. In the first group, death of the neonate occurs during the course of labor or soon after birth. The second group, is composed of newborns with cord or brainstem damage who survive for days. The third group are infants who survive for long periods, often for years. Under this group, Dr. Towbin describes a subgroup, or the fourth group. "...there must exist a large number of instances with mild injury, with minimal neurologic symptoms, going unnoticed clinically, or being relegated to the category of cerebral palsy."
Can the Vertebral Subluxation Complex be caused at birth? Yes. Can the Vertebral Subluxation Complex cause an early death in some of these cases? Yes.
Laboratory Notes on the Tensile Strength of The Fresh Adult Foetus
Brit. Med. J. II, 763, J. M. Duncan (1874)
This is found as a reference to the Towbin article listed above, and is mentioned in the article. During the above research in 1969, Dr. Towbin delved into the medical literature for observations concerning axial pull on the baby's head during delivery. That he had to go as far back as 1874, only indicates to me that the research necessary to prove that a child's neck can be traumatized severely at birth could not be tolerated in today's scientific community. And so, without apology for the year in which this research was performed, let us review Dr. Towbin's comments. Simply stated, Dr. J .M. Duncan tested the tensile strength of the spinal columns in fresh adult (term) infant cadavers. He found that an average of 120 pounds of force caused decapitation. And 90 pounds of force caused decerebration causing disseverance of the brain and spinal cord. Of course, both caused instant death. Dr. Duncan commented, "this is probably far from being what most obstetricians would regard as a great force. "
Can the Vertebral Subluxation Complex be caused at birth ? Yes. Can the Vertebral Subluxation Complex cause an early death? Yes. Remember, decapitation and decerebration have all the components of the Vertebral Subluxation Complex at work. This article does not claim that chiropractic care can correct diagnosed cases of SIDS (most SIDS cases are diagnosed after death has occurred). For the purposes of this article, it is noted that SIDS research does contain references concerning spinal injury and nerve damage at birth.
Spinal Injury 2nd Ed., David Yashon, MD., FACS, FRCS(C),
Professor of Neurosurgery, Ohio State University, 18, 347-352, AppletonCentury-Crofts.
In this textbook, Dr. Yashon, in Chapter 18, "Birth Injury," comments that it is possible that spinal cord injury at birth is more common than has been thought. Dr. Yashon specifically delineates excessive longitudinal traction, especially when combined with flexion and torsion of the spinal axis as a cause of spinal injury at birth.
He also reports that spinal injury should be considered in the presence of neonatal distress, apnea, and flaccidity.
Blocked Atlantal Nerve Syndrome in Babies and Infants
G. Gutmann, Manuelle Medizin, 25:5-10,1987
In "The Chiropractic Report," January 1989, attorney David Chapman Smith, publisher, reviews the abstract to Gutmann's paper. We urge you to read this entire abstract. In essence, Gutmann, reports that blocked nerve impulses develop a clinical picture that ranges from central motor impairment and development, as well as, lowered resistance to infections, especially to ear, nose, and throat infections. Gutmann reports the examination and adjustment of more than 1000 infants with Atlas blockage. The results are amazing and generally swift. From his and other German medical studies, Gutmann concludes that approximately 80% of all children are not in autonomic balance and that many have Atlas blockage. It seems that Dr. Gutmann perceives component #2 of the Vertebral Subluxation Complex, neuropathophysiology /neuropathology, as the preeminent factor in spinal related neuropathology.
Subluxation at Birth and Early Childhood
Larry L. Webster, D.C., International Chiropractic Pediatric Association, March 1989.
5231 East Memorial Drive, Suite 210, Stone Mountain, GA 30083
Dr. Larry Webster states that, "New studies are now indicating that the birth process may be one of the foremost causes of Vertebral Subluxation." "With the new studies of the Vertebral Subluxation Complex coming to the forefront - in that it takes less trauma than ever suspected before to produce the Vertebral Subluxation Complex, and that pathology starts faster after the Vertebral Subluxation Complex than ever suspected, it behooves a chiropractor to emphasize the correction of the Vertebral Subluxation Complex in .the child to the parent more than ever before." In a discussion with Dr. Webster in 1991, he stated that, "An uncomplicated delivery takes about 90140 lbs. of pull. And during this time, the spinal cord has been reported to stretch up to 2¼ inches." Dr. Webster also confirmed, "that the new vacuum device utilized in the delivery of children exerts this same amount of pull."
Experimental Models of Osteoarthritis: The Role of Immobilization
T. Videman, Clinical Biomechanics, 2:223-229, 1987, and the various papers by Videman there referenced.
The reason this paper is highlighted in the Pathogenesis of the Vertebral Subluxation Complex, is simply to call into question two major factors in the clinical practice of chiropractic... 1) The complete reversibility of all residual damage of ongoing, uncorrected Vertebral Subluxation Complex with just a few adjustments no matter the age of the patient, and 2) The once-a-month adjustment as a preventive measure for the Vertebral Subluxation Complex. This article is also reviewed in "The Chiropractic Report," January 1989, attorney David Chapman Smith, publisher. For the past 17 years, Dr. Videman has been conducting experiments in understanding what role immobilization of a joint has in the pathogenesis of osteoarthritis. His conclusions indicate that after two weeks of the slightest nontraumatic hypomobility, the first signs of eburnation in the subchondral bone occur-that is exposure, wearing and hardening of bone because of extended fragmentation of the protective layer of cartilage in the joint occur. Such changes are not reversible, however release of the hypomobility and with the resumption of normal joint activity there was no radiographic increase in the level of osteoarthritis.
The question is, if freely movable joints can become permanently degenerated after only a few weeks of the slightest hypomobility, what positive effect does a once-a-month checkup provide for articular pathomechanics? Another question is, what is an adequate Vertebral Subluxation Complex screening frequency? Reader comments are invited on this issue.
Chiropractic and Children
The Journal of the CCA, Vol. 23, No.3, September 1979, editorial containing a quote by Dr. Joseph Janse.
The editor writes "In this, the International Year of the Child, let us take a moment to re-examine the role of chiropractic care of children. Child care has been a prominent feature of chiropractic since the inception of our profession. "
He ends with a quote from Dr. Joseph Janse, "When the teaching of good body mechanics becomes a more generally recognized public health measure, when there is greater cooperation by the home and the school in this problem with persistence and unity of aim, then we shall see a great improvement in the physical well-being of the next generation."
Can the Vertebral Subluxation Complex be caused by the birth process? According to the above papers and opinions ... yes. When should appropriate chiropractic care begin on a pediatric and prevention basis? The current working conclusion is, as soon as the Vertebral Subluxation Complex can be detected ... at birth or early in life.
Joseph M. Flesia, DC graduated from Palmer College of Chiropractic in 1957. A very successful private practitioner for more than 12 years, he limited his practice to the Vertebral Subluxation' Complex based on an in-depth Well Patient Care patient education program, averaging over 360 patients a day. Currently President of Renaissance International, he presents over 48 complete seminars a year and has more than 40 speaking engagements a year. Dr. Flesia's quest for the global acceptance of chiropractic is legendary and provides the basis for his unbounded energy and enthusiasm.