CBP® NonProfit, Inc. Research Update

Paul A. Oakley, M.Sc., DC

CBP Research & Instructor

Private Practice New Market, Ontario, Canada

CBP Technique Case Report in JVSR 2011

In June, Drs. Curtis Fedorchuk and Andrew St. Bernard, had their case study published in the Annals of Vertebral Subluxation Research. This is one of many case reports that Dr. Fedorchuk has authored evidencing the utilization of CBP Technique procedures in the resolution of a variety of chronic diseases and conditions. Here's acknowledging a job well done to Drs. Fedorchuk and St. Bernard--keep up the good work.

This recent article is:

Curtis Fedorchuk DC and Andrew St. Bernard DC. Improvement in Gastro Esophageal Reflux Disease Following Chiropractic Care and the ALCAT Procedure. Annals of Vertebral Subluxation Research ~ June 23, 2011 ~ Pages 44-50

ABSTRACT
Objective: The chiropractic care of a patient with chronic back pain and gastro-esophageal reflux disease is described.

Clinical Features: A 42 year-old female with chronic gastro-esophageal reflux, chronic mid-back pain and vertebral subluxations.

Intervention and Outcomes: High velocity low amplitude spinal adjustments and Chiropractic Biophysics (CBP) technique were applied throughout patient care. Extension traction of the cervical spine was assigned to the patient to perform at home. In addition, the Antigen Leukocyte Cellular Antibody Test (ALCAT) procedure and dietary plan was introduced. The persistent complaints of GERD and mid-back pain were resolved and the patient also showed marked improvement in quality of life as demonstrated by SF-36 scores. 

Conclusion: A combination of chiropractic care focused on reduction of vertebral subluxations and dietary modification resulted in resolution of this patient’s chronic back pain and GERD.

Foot Orthotics and Muscle Activity

Stuart Currie DC,

Director of Research, Sole Supports.

www.solesupports.com

INTRODUCTION

A 2008 critical review of lower limb muscle activation examined the evidence for changes in muscle activation patterns while wearing a foot orthotic¹. This should be of great interest to clinicians treating lower extremity pathology with foot orthotics.

Questions to consider when considering the clinical implementation of a foot orthotic include:

· How does a device that is placed in the shoe affect muscular function?

· Which muscles are involved?

· In which patients, and when?

The kinematic (movement) and kinetic (force) effects of foot orthotics on the human body are often widely discussed and debated with broad conclusions being difficult to draw. In addition to the forces and motions involved, as chiropractors, we are interested in the resultant changes in muscle activity. The reaction of muscles (whether activated or inhibited) is a core component of treatment making it very important to know what a foot orthotic does (if anything) to the lower limb musculature.

DISCUSSION

Given the wide variety of foot orthotics, the variable construction, and the different biomechanical theories the literature on muscle activity and foot orthotics can be hard to generalize. A systematic review of the literature revealed that peroneus longus and tibialis anterior EMG amplitude and tibialis anterior duration is greater when wearing foot orthoses². The duration effects may suggest a greater fatigue reduction with a foot orthotic. This review also concluded there is evidence that foot orthotics affect lower back EMG muscle function. This information can be considered with EMG studies that reveal inverter muscles are increased and evertor muscles are decreased in amplitude with a pronated foot posture². Tibialis posterior, a stabilizer and supporter of the arch, was demonstrated to be selectively activated in adults with pes planus to a level equivalent to those with a normal arch index while wearing a foot orthotic.³

It is important to keep in mind that any increase or decrease in the measured EMG variables could be beneficial or detrimental, depending on patient specifics such as pathology, foot type, activity levels, and overall condition of the musculoskeletal system.

Do not overlook the role of sensory system in the control of muscles. Changes to muscle activation may be altered by sensory input on the plantar aspect of the foot. One investigation that altered only the texture of the shoe insert found alterations in lower limb muscle activity⁴. In other words, by changing the texture without changing the geometry of the orthotic, the gait pattern and muscle activity was altered by sensory feedback. This underscores the notion that a full-contact or isomorphic orthotic may be of benefit. Isomorphic contact refers to a custom device that is in contact with the bottom of the foot in a corrected posture during the entire gait cycle, in contrast to an extrapolated or low-arched device that only contacts the plantar surface of the foot after it has pronated significantly. The more contact, the more opportunity to affect change. If the rate or temporal firing patterns of populations of sensory afferents are to be influenced, it makes sense to do this as early in the gait cycle as possible. This also concurs with EMG findings that show a molded orthotic has different EMG findings than a posted orthotic alone⁵.

Shoe wear is another factor that needs to be considered when relating EMG findings to gait. The recent popularity of various minimalist running techniques leads to a discussion of whether the foot orthotic is a brace. This concept is not new to chiropractors who generally do not prescribe back braces indefinitely with the assumption that it may inhibit the body’s own natural muscular bracing, but in the case of a foot orthotic is generally not supported by the EMG literature which shows an increase in muscle activation with foot orthotics in many cases. Masai Barefoot Technology (MBT) shoes are designed to strengthen the lower limb by providing an uneven surface challenging the muscles to be more active. One EMG analysis showed only tibialis anterior activity was increased during standing and no significant differences were seen walking when normalized to control shoes.⁶

Heel lifts are another orthotic modification that are prescribed regularly and warrant consideration for the muscular effects involved. Heel lifts have been shown to have an earlier onset of muscle activity in erector spinae during gait and a delay in on the onset of gluteus medius activity⁷.

We must also consider this research in light of the human body as a whole, with antagonist and agonist muscle groups working together to improve efficiency or decrease tissue stress. It is currently unclear to what degree changes in any one isolated muscle affects the system as a whole. In addition, not all orthotics are created equally. There are different theories and different manufacturing processes that result in different final products. Therefore the literature trends must be interpreted with caution considering differences in subjects (injured vs. healthy), the construction of the device (flexible vs. rigid) and the activity measured (walking vs. running).

SUMMARY

In summary, the following are considerations when evaluating both EMG research articles and your patients:

1) Different foot orthotics can affect the EMG activity in different ways.

2) The results may be specific to a specific patient population or foot type

3) The temporal nature of the EMG change must be considered.

4) The EMG results may be related to very different clinical outcomes depending on the pathology involved.

References

1. Hatton A. Physical Therapy Reviews 2011;13(4):280-93.

2. Murley GS. Gait Posture 2009 February;29(2):172-87.

3. Kulig K. Med Sci Sports Exerc 2005 January;37(1):24-9.

4. Nurse MA. J Electromyogr Kinesiol 2005 October;15(5):496-506.

5. Mundermann A. Gait Posture 2006 April;23(3):295-302.

6. Nigg B. Clin Biomech (Bristol , Avon ) 2006 January;21(1):82-8.

7. Bird AR. Gait Posture 2003 October;18(2):81-91.

The MMR Vaccine and Autism: An Interview with Dr. Andrew Wakefield

Dan Murphy, DC—

Private Practice of Chiropractic;
Diplomate American Board of Chiropractic Orthopedist;
Faculty Life Chiropractic College West;
Vice President ICA 2003-2009;

ICA Chiropractor of the Year 2009

INTRODUCTION

In 1998, Dr. Andrew Wakefield and 12 colleagues from the Inflammatory Bowel Disease Study Group, University Department of Medicine, Royal Free Hospital and School of Medicine, London, UK, published a study in the journal Lancet. Twelve children with a normal history developed behavioral symptoms including loss of acquired skills, including language, together with diarrhea and abdominal pain. In 8 of 12 cases, parents associated their child’s symptoms with receiving the measles, mumps, and rubella vaccination (MMR). These children (all twelve) then underwent gastroenterological, neurological, and developmental assessment and review of developmental records. Additionally, ileocolonoscopy and biopsy sampling, magnetic-resonance imaging (MRI), electroencephalography (EEG), and lumbar puncture was performed. All 12 children showed intestinal abnormalities of various types. Dr. Wakefield and colleagues interpreted their results as:

'Scientific' Persecution

Even with such an innocuous interpretation, a persecution against the authors, especially Dr. Wakefield began. The persecution was often driven by UK journalist, Brian Deer. The ultimate consequence was the retraction of Dr. Wakefield’s 1998 study by the editors of Lancet along with a public discrediting of Dr. Wakefield and his colleagues.

I went to the National Library of Medicine and typed “Wakefield AJ and Vaccine” into the PubMed search engine (www.pubmed.com). Sixteen publications were identified spanning 1995–2009. All 16 of these publications pertained to various problems associated with vaccinations.

In an effort to exonerate his reputation and that of his colleagues, and to protect the health of children worldwide, Dr. Wakefield wrote a book titled Callous Disregard; Autism and Vaccines—The Truth Behind a Tragedy, which was published last year 2010 (Skyhorse Publishing). This book tells a very different story as to the persecution of Dr. Wakefield and his colleagues by the pro-vaccination medical establishment, and exposes the official spinning of unpopular science and conclusions.

I believe that all parents should read this book prior to vaccinating their children.

MY INTERVIEW WITH DR. WAKEFIELD

On March 3, 2011, I interviewed Dr. Andrew Wakefield on the relationship between the MMR vaccination and autism. These are his responses to my queries.

· Is the MMR vaccine necessary?

No. The measles might be, but the MMR together is not. The mumps in particular is never necessary. This is not my opinion, it is also the position of the Centers for Disease Control (CDC) in the United States, and the Department of Health UK. The mumps vaccine pushes the age of susceptibility upwards, with greater adverse consequences in the adult population. The MMR vaccine has never been tested for safety. The MMR vaccine is dangerous.

· Do you believe the parents who claim that MMR vaccine caused their child’s autism?

Yes, I believe those parents.

· Is there any proof that MMR vaccine causes autism?

No, there is no proof. That issue requires further investigation.

· There are studies that claim that the MMR vaccine is not a cause of autism. Do you have any comment on those studies?

Yes, I am aware of those studies. Those studies were not performed well and those studies were not fairly reported. In fact there is evidence in studies that are reported as a negative association between MMR vaccine and autism that actually show that the younger the child at time of vaccination the greater the risk of autism.

· Why is there so much controversy pertaining to the MMR vaccine? Why would medical authorities and public health officials push so hard for all children to receive the MMR vaccine and so vigorously attempt to discredit opposite cautionary opinions such as yours?

This occurs primarily for three reasons:

1. Fear of accountability,

2. Blind faith,

3. Commercial imperative,

[We discussed how there is literally billions of dollars at stake on this issue].

· Please comment on the criticism of the ethics of your research:

I have been criticized for not securing proper ethical approval for the investigations I performed on the initial 12 children subjects. This is completely false in that what I did was a clinical trial, and ethical approval is not necessary for a clinical trial.

The biopsies I performed did require ethical approval, and I have parental signed ethical approvals on 100% of the children who were subjected to biopsy.

· Why does reporter Brian Deer claim that you did not have these ethical approvals?

Brian Deer knew I had the appropriate ethical approvals, he has copies of them. I believe he did not tell the truth about them because it would kill his story. Brian Deer withheld this information from the medical board [GMC = General Medical Council].

· Why would Brian Deer do such a thing?

I am unsure, other than understanding that Brian Deer has a close relationship with drug maker GlaxoSmithKline. [GlaxoSmithKline is a global pharmaceutical, biologics, vaccines and consumer healthcare company headquartered in London, United Kingdom. It is the world's third largest drug company].

NOTES FROM DAN MURPHY:

Autism officially afflicts 1/110 children in the United States.

Autism officially afflicts 1/64 children in the United Kingdom.

A recent (2011) interesting review article titled Theoretical Aspects of Autism: Causes—A Review was published January 2011 in the Journal of Immunotoxicology. The author notes a spike in autism worldwide following the release of the MMR II vaccine, and proposes a scary mechanism to explain the spike. I have posted my review of this article to my Article Review service.

On the top of the copyright page of Dr. Wakefield’s book, in a large font and in bold capitol letters is a box containing these words:

NOTE TO ALL CUSTOMERS:

NOT FOR SALE IN THE UNITED KINGDOM

In the United States, Dr. Wakefield’s book can be purchased from many sources, including from the bookstore at Life Chiropractic College West: (510) 780-4500, and ask for the bookstore, or dial the bookstore direct at (510) 780-4502.

References

1. Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children. Wakefield AJ, Murch SH, Anthony A, Linnell J, Casson DM, Malik M, Berelowitz M, Dhillon AP, Thomson MA, Harvey P, Valentine A, Davies SE, Walker-Smith JA. Lancet. 1998 Feb 28;351(9103):637-41.
2. Wakefield, A. Callous Disregard; Autism and Vaccines—The Truth Behind a Tragedy, Skyhorse Publishing, 2010.
3. Ratajczak HV. Theoretical aspects of autism: Causes—A review. J Immunotoxicol. 2011 Jan-Mar;8(1):68-79.