Reduction of Cervical Dystonia
After an Extended Course
of Chiropractic Manipulation:
A Case Report

This section is compiled by Frank M. Painter, D.C.
Send all comments or additions to:    Frankp@chiro.org

FROM:   J Manipulative Physiol Ther 2004 (Jul); 27 (6): 421–426 ~ FULL TEXT

George W. Kukurin, DC

2415 Sarah St,
Pittsburgh, PA 15203;
DACAN@alt-compmed.com

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OBJECTIVE:   The diminution of the signs and symptoms of cervical dystonia following an extended course of specific chiropractic manipulation is described.

CLINICAL FEATURES:   A 38-year-old man had gross anterior-lateral torticollis, focal dystonia of the head and neck, and radicularlike pains which failed to respond to physical therapy, medication, and injection.

INTERVENTION AND OUTCOME:   Two specific spinal manipulative technique systems unique to the chiropractic profession (Applied Biostructural Therapy [ABT] and Atlas Coccygeal Technique [ACT]) were applied to the patient. The patient's grading on a modified cervical dystonia scale dropped from a grade 16 to a grade 5 after an extended course of these specific chiropractic manipulative techniques.

CONCLUSION:   The application of Advanced Biostructural Therapy and Atlas Coccygeal chiropractic techniques for management of cervical dystonia is presented. Substantial reduction in the cervical dystonia rating scale was observed with this approach, even after standard medical interventions had failed.

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From the Full-Text Article:

Discussion

As with all single case studies, there are numerous limitations. Two obvious explanations for the substantial improvement seen in this patient include spontaneous recovery or a therapeutic response to the chiropractic manipulation described above. Spontaneous recovery in CD is unlikely, since it occurs in as little as 12% of the cases studied objectively. The fact that CD is resistant to most forms of intervention suggest that the treatment rendered influenced the clinical course seen in this case. This leaves open the possibility that CD in at least some cases may respond to CMT. As stated above, CD patients have abnormalities in vestibular, sensory-motor integrations, central motor activations, and/or extrapyramidal system function. Some studies suggest that CMT can have a positive clinical effect in vestibular dysfunction. [32, 33] While vestibular dysfunction has been reported in some patients with CD, this case had no objective testing prior to manipulative intervention. So, it is impossible to know if vestibular dysfunction and its modification through CMT played a role in the reduction of dystonia seen in this case. Another study suggests that CMT can restore proprioceptive function in cervical spine. [34] This would seemingly be beneficial in patients suffering from movement disorders and involuntary abnormal cervical postures. Motor-evoked potential (MEP) studies have been used to demonstrate abnormal central motor function in CD patients. Recently, a motor-evoked potential study has demonstrated that CMT can alter central motor drive. [35] However, this study demonstrated facilitation rather than inhibition of central motor activity in normal subjects. [35] One would expect that facilitation of central motor function would exacerbate the central motor hyperactivity measured in CD patients.

A study investigating the affects of CMT on MEPs in CD patients might determine if CMT inhibits rather than facilitates central motor activity in these patients. The extrapyramidal system may be implicated in cervical dystonia. Parkinson disease is a common condition associated with dysfunction in the extrapyramidal system. Elster [36] recently published a case report of Parkinson disease that improved following a course of upper cervical chiropractic manipulation. The techniques used in the present case were very similar to the chiropractic techniques employed by Elster. [36] The mechanism for the observed improvement in her study is likewise unknown, suggesting the need for much more research in this area. Given the lack of an adequate treatment for CD, its profound affect on quality of life, and the substantial improvement seen in this case, collaborative research in a more controlled environment seems warranted. What cannot be appreciated in static radiographs are the waves of involuntary muscle contractions and the uncontrollable oscillations in the head and neck musculature. Technology that time-locks EMG activity to video recordings of the patient's dystonia has been developed, but it is not readily available outside specialized movement disorder centers. [17, 18]

Does chiropractic manipulative therapy alter the abnormal muscle patterns in CD patients? This question can only be answered by conducting controlled trials and utilizing technology that is available to document not only the static postural changes seen in this case but also the dynamic and physiological video-link EMG data that documents the true physiopathology of CD. It is also unclear if the improvement seen in this patient was due to the specific type of chiropractic manipulation employed or if similar results could have been obtained using more traditional manipulative techniques.

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Conclusion

A case is presented that exhibited substantial improvement of cervical dystonia following specific chiropractic manipulation. Possible explanations for this observed therapeutic response are offered, and the need for future research of less traditional chiropractic techniques in general and in cases of cervical dystonia is suggested.

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