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NUCCA Technique/Hypertension Pilot Study: A brief history


June 17, 2008
By Marshall Dickholtz Sr. DC

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THE IDEA
The beginnings of the hypertension study can be traced back to 1968
when Bruce Bell, a medical doctor in Barrington, Illinois, first
discovered the effectiveness of adjustments on several of his patients
by my use of the National Upper Cervical Chiropractic Association
protocol (NUCCA technique). Over the next 25 years, Dr. Bell referred
more than six thousand patients to my Chicago office. In time, Dr. Bell
realized that 32 of the problems seen in his referred patients that
were successfully addressed by the upper cervical procedure, were
autonomic in nature. One of these problems was hypertension.

THE IDEA
The beginnings of the hypertension study can be traced back to 1968 when Bruce Bell, a medical doctor in Barrington, Illinois, first discovered the effectiveness of adjustments on several of his patients by my use of the National Upper Cervical Chiropractic Association protocol (NUCCA technique). Over the next 25 years, Dr. Bell referred more than six thousand patients to my Chicago office. In time, Dr. Bell realized that 32 of the problems seen in his referred patients that were successfully addressed by the upper cervical procedure, were autonomic in nature. One of these problems was hypertension.

Dr. Bell contacted Dr. George Bakris, an MD who, at the time, was at Rush Presbyterian St. Lukes, one of Chicago’s largest teaching hospitals. (Today Dr. George Bakris is director of the hypertension clinic at the University of Chicago’s Pritzker School of Medicine.)  Dr. Bell was able to get Dr. Bakris to head a pilot study, the protocol of which was subsequently submitted to and approved by the Western Internal Review Board. To fund the pilot study, Dr. Bell spearheaded the formation of the Barrington Atlas Research Corporation – now known as the Atlas Research Foundation – and enlisted business professionals such as George Schueppert, Norval Stephens, and Keith Hanson as directors.  

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THE VISION
Dr. Charles Woodfield, who is now in the research department of Parker College of Chiropractic realized that the study had to be exceptionally well done to appear in The Journal of Human Hypertension, the third most prestigious medical journal focusing on hypertension. To that end, only patients who had Level I hypertension, a short or contractured leg, and had no pain were recruited into the study. The criterion of “no pain” was critical because, if there was pain, then potential critics could argue that blood pressure dropped because pain was alleviated. In addition, that criterion of “no pain” also concurrently placed these patients out of the mainstream chiropractic paradigm that focuses on spinal manipulation, range of motion, and site of pain. If there is no site of pain, then where would mainstream chiropractic adjust? (What percentage of your new patients have no pain?)

The short or contractured leg is a necessary criterion in diagnosing the existence of a C-1 misalignment. NUCCA protocol only requires postural distortion for a person to qualify as a new patient; pain is not a necessary symptom. Using Level I hypertension patients ensured that patients were not that far removed from the blood pressure of the normal “healthy” population and provided an additional level of safety when removed from medication. All of the subjects in the study came from the practice of Dr. Bell. 

THE STUDY
The original 50 subjects, in the study, were randomly divided into two groups of 25 each. The control group received a placebo “adjustment.”  This was possible for two basic reasons: 1) because the “adjustment” is so light and 2) because the head could be braced and the adjusted vector controlled so well that no measurable change would take place in the misalignment.

The treatment or experimental group received an equally light adjustment but the vector used and the head placement were specific for each subject based on NUCCA’s “understanding” of the presenting biomechanics as interpreted from X-rays for that particular patient.  Patients were blinded as to whether or not they had received the sham “adjustment” or had received the real adjustment. The nurse taking the blood pressure readings was not aware of which subjects had been given the real adjustment. Hence, in this sense only, the pilot study was a double-blind study. With regard to posture measurements, X-rays, and adjustments the chiropractor was, of course, not blinded. 

Posture measurements in this study included both supine leg check (non-load bearing) and standing (load-bearing) pelvic inclination (frontal plane) as measured on the anatometer as well as bilateral weight distribution, pelvic distortion in the transverse plane (“rotation”) and lateral displacement of C-7 off a vertical axis. A laser light system was used to make measurements more readable. All patients were blindfolded for anatometer measurements and a digital camera recorded the posture of all 50 participants.

A standard cervical X-ray series was used and this consisted of lateral, nasium, and vertex views. Lead filters helped to minimized exposure to individuals. Atlas laterality and atlas rotation were measured and used in the calculus for determining the adjustic vector.

Three time events were of critical importance in measurement. Just before actual adjustment, just after adjustment, and eight weeks after adjustment; this sequence was identical for the placebo group. All patients had been off their medications two weeks prior to adjustments and randomization. All patients had all measurements taken at each of these three time events. In addition, all patients had blood pressure measurements taken weekly for eight weeks.

THE RESULTS
Of the 25 subjects in the treatment group, 15 had an average systolic blood pressure drop of 28 mm of Hg relative to the placebo group while the other 10 did not basically change. The treatment group (n=25) therefore had an average of 17 mm of Hg drop. Twenty-one patients had only one adjustment during the study. Future research will take a close look at why one portion of the treatment group (n=15) responded and the other portion of the treatment group (n=10) did not respond in a lowering of systolic blood pressure.

Papers are being written for publication by Dr. Woodfield, with partial financial support from the Upper Cervical Research Foundation (www.ucrf.org), showing that the VAS scores were basically “zero” for both the control and the treatment groups throughout the study, and that for the treatment group the SF-36 scores improved in all eight categories of well-being.

The NUCCA Technique is taught at Palmer College as an elective and is in the curriculum at Life Chiropractic College West. Canada has about three dozen NUCCA doctors. The hypertension article appeared in the Journal of Human Hypertension (May 2007) under the title: Atlas vertebrae realignment and achievement of arterial pressure goal in hypertensive patients: a pilot study.1 Additional information in supporting future research can be found by going to www.ucrf.org.

Many thanks to Professor James Palmer for editing this article. 


References:

1)  Bakris, G., Dickholtz M. Sr, et al.  Atlas vertebrae realignment and achievement of arterial pressure goal in hypertensive patients: a pilot study.  J. of Human Hypertension, May 2007, 21(5): 347-52.

Currently practising
in Chicago, Illinois, Dr. Dickholtz Sr. has been in practice for 51
years. He is a former president of the National Upper Cervical
Chiropractic Association (NUCCA) and the lead researcher for NUCCA. Dr.
Dickholtz is a recipient of the Daniel David Palmer Scientific Award,
the R.R. Gregory Award and chiropractor of the year of the Illinois
Prairie State Chiropractic Association in 2007. For additional
information regarding this research project, you may contact Dr.
Dickholtz at 773-267-0020 or 847-677-7253, or visit the website
www.nuccadickholtzsr.com.



 
OF NOTE: ATLAS ALIGNMENT AND THE NEED FOR X-RAYS

One of the significant observations in the study was that when
placebo-group subjects were carefully placed in position for X-rays at
all three time events, atlas laterality and atlas rotation measurements
were constant; in the treatment group the atlas laterality and atlas
rotation measurements were constant in the post adjustment phase. In
conclusion, if the patient placement is the same, then the measured
misalignment on X-rays is constant over time; if the correction holds,
then the X-ray listing – set of measurements – is constant over time.
(125 sets of X-rays are involved in these constant-over-time
measurements.)

This is not necessarily saying that the atlas is locked in position; it
is certainly not locked in flexion or extension. When coupled with
other research, these observations are consistent with the hypothesis
which suggests an abnormal set of “ locked-in” paths for a misaligned
atlas and a normal set of  “locked-in”paths for an aligned atlas for a
subject moving their head and neck. (One can see on X-rays other parts
of a given path for both cases of aligned and misaligned upper
cervicals, if the patient placement is not consistent!)  What this does
support is the validity of using X-rays for determining a vector for
adjustment if, and only if, the practice protocol requires consistent
patient placement for X-rays. If the misalignment were different on
every day of the week, even when the same patient was consistently
positioned, then one could relatively easily argue for a random vector,
or for no “known vector,” to be used in a spinal manipulation. Thus
X-rays for determining a vector would not be necessary – unless only
the vectored alignment process consistently resulted in a correction
that held over a reasonable time period.

Of even more importance is that an aligned set of upper cervicals is
found to be in alignment over time. If the time frame for maintaining
alignment were only on the order of a day or two, then the chiropractor
would have to be doing spinal manipulations several times a week.
Certainly it would be prohibitive to the health of the patient to X-ray
each visit. (In-house research has shown that any re-misalignment tends
to be in the same pattern – basic type – over time.)

It is important to understand that there is only a very small range of
neurological alignments possible – one necessary requirement is that
atlas laterality be less than 0.75 degrees –  whereas there is a very
large range (orders of magnitude larger in number) of neurological (and
biomechanical) misalignments possible.

   
   


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