Articles by JCS
JC Smith, DC
A few years ago collegiate basketball player Chris Daniels from the University of Dayton suddenly died on the court from an apparent cardiac arrest. Autopsy failed to reveal anything that would explain this sudden tragedy -- no drugs, blocked coronary arteries or myocardial infarction -- his heart just stopped without any plausible medical explanation. This unfortunate and unexplainable occurrence of this apparently healthy athlete reminds me of other past tragedies in sports, such as Hank Gathers from Loyola-Marymount in L.A., "Pistol Pete" Maravich, the former NBA All-Pro, and Reggie Lewis of the Boston Celtics.
These paradoxical deaths may not be explainable with any medical answers, but I cannot help but think that a chiropractic answer may be offered, although that, in itself, is treading on thin ice. Whenever chiropractors attempt to explain organic dysfunction or death as a result of vertebral subluxation, few people understand our logic and sometimes even our supporters cringe when they hear such explanations. The idea of sudden cardiac arrest from a vertebral subluxation is just too far outside the consciousness of most people, and has often gotten our profession into trouble when some DCs publicly had advertised this concept.
For example, during the Chiropractic Centennial Celebration in Washington DC, the ACA's general counsel, Mr. George McAndrews, and his brother, the ACA's vice president, Dr. Jerry McAndrews, gave a most interesting seminar on the background and development of the Wilk trial. It was fascinating to hear these two eloquent speakers detail various "insider" accounts of the dynamics of this important break-through case that brought chiropractic from the back seat of the medical bus, if you will. Mr. McAndrews not only recounted the positive aspects of this case, he also elaborated on the problem he encountered from embarrassing chiropractic advertisements that the AMA's attorneys used against chiropractors to portray all DCs as loose cannons making unsubstantiated claims.
Aside from the "Spines 'R Us" image that grace too many newspaper and telephone book ads, Mr. McAndrews singled out the infamous "Killer Subluxation" ad that warned prospective patients that if uncorrected, these life-threatening conditions may be fatal. Apparently after the AMA's attorneys embarrassed Mr. McAndrews by submitting this as evidence of the greedy, outlandish claims some DCs make, Mr. McAndrews actually telephoned the particular DC responsible for this ad to ask him if he had any proof of such "killer subluxations." Of course, he had none. It was simply his chiropractic "philosophy" that had him convinced, without any supportive research whatsoever.
Although outlandish ads, especially the "Free Spinal Exams" and "Free Chicken Dinners" gambits, do cast all DCs in a bad light, I must add that "killer subluxations" actually may not be that far from the truth. I realize few people understand this concept, but there is now some scientific basis for "killer subluxation" causing sudden heart attack. Before you think I too have gone over the deep end with pie-in-the-sky philosophy, let me explain.
As proof in point, in December 1989 an excellent article appeared in the Journal of Manipulative and Physiological Therapeutics by Mark E. Jarmel, DC, titled "Possible Role of Spinal Joint Dysfunction in the Genesis of Sudden Cardiac Death." He noted that sudden cardiac death causes about 15% of all natural fatalities in the industrially developed countries. In the United States alone, it claims over 400,000 lives each year. Anecdotal reports from the chiropractic and osteopathic professions have indicated the beneficial effects of manipulation in the management of arrhythmias, coronary arterial spasm, and premature ventricular contractions. Dr. Jarmel's study simply suggests that nerve irritation from the spine will cause heart problems:
"Numerous researchers have concluded that strategies for prevention of sudden death should be focused on controlling neurophysiologic factors which may enhance ventricular vulnerability. By removing a source of destabilizing neural input to the heart, correction of vertebral dysfunction may prove of value in reducing susceptibility to sudden cardiac arrest." 1
Explaining organ function, dysfunction or failure as a result of vertebral subluxation is too alien for most people. Few people ever think of heart disease in terms of dysfunction of their nerve system. Instead, they focus on other contributors such as smoking, lack of exercise, junk phoods and the "bad blood" nutritional concepts like cholesterol levels. Even being physically fit and eating correctly may not be assurance enough to avoid a sudden heart attack, as evident in the deaths of these basketball players.
Dr. Jarmel noted in his study of 79 cases of sudden cardiac death in people 18-35 years of age, three of them were competitive athletes. "This may suggest," according to Jarmel, "that so-called 'physical fitness' may provide little cardiovascular protection when asymptomatic coronary artery disease is combined with neurally induced vasomotor disturbance." In my mind, it's equivalent to a race car with a big engine that fails because of faulty electrical wiring although nothing is mechanically wrong with the engine itself.
Dr. Jarmel's main premise that nerve irritation may lead to a sudden heart attack and that spinal adjustments may help alleviate or prevent such problems should come as no surprise to any chiropractor or researcher with an understanding of neuro-anatomy and spinal mechanics. Understandably, Mr. McAndrews might prefer more RCT research to validate such an idea before anyone advertises this concept. Coincidentally at the Centennial in Washington, a myriad of scientific papers were presented and one in particular caught my eye on this very subject, titled "Improvement of Cardiac Autonomic Regulation Following Spinal Manipulative Therapy." Once again it was written by Mark Jarmel, DC along with Judith Zatkin, Ph.D., of Cleveland College of Chiropractic in L.A. Their paper mentioned a trial about heart conditions and chiropractic care, which may substantiate the claim of "killer subluxations" as a plausible explanation of sudden heart attacks. Maybe that chiropractor who McAndrews mentioned wasn't so far from the truth after all!
"Unbalanced activation of cardiac sympathetic nerves plays a crucial role in the pathogenesis of sudden cardiac death. It has been proposed that mechanical irritation of upper thoracic vertebral joints may create an ectopic source of unbalanced cardiac sympathetic nerve activation. Spinal manipulative therapy is hypothesized to modulate mechanically induced sympathetic activity by restoring proper mobility to dysfunctional vertebral joints. This study evaluated the possibility that spinal manipulative therapy may have value in treating a previously unrecognized source of unbalanced cardiac autonomic regulation.
"Eleven patients without a prior history of myocardial infarction who were found to have signs of dysrhythmic abnormalities on Holter monitoring, received a one month course of chiropractic manipulative treatment. After one month of spinal manipulative therapy, follow-up 24 hour ECG recordings were performed. A positive trend was noted in the number of ventricular beats, number of ischemic events, maximum time of ST segment depression, elimination of after-depolarizations, and enhanced heart rate variability. These preliminary results suggest that spinal manipulative therapy may significantly enhance cardiac autonomic balance.
"The results of this study suggest that upper thoracic spinal joint dysfunction may be a previously unrecognized source of cardiac sympathetic activation. The results of this study may have implications for developing a novel nonpharmacological treatment which may have value in reducing risk of sudden cardiac death."2
While the medical-drug cartel has long taught the public the bio-chemical concepts of disease -- the germ and genetic theories of disease -- the medics have purposely failed to mention the neurological cause of disease, except for the severe cases such as strokes and severe spinal column injuries that cause total paralysis or even death. In between these extreme conditions -- no nerve interference to the other end of severe nerve damage -- does there exist that huge "range of gray" nerve interference that most people may suffer from? Do these mild to moderate cases of nerve interference caused by vertebral subluxations exist, yet remain sorely misdiagnosed and virtually ignored by our medical counterparts? In other words, does chiropractic care possibly play a role in the treatment of sudden cardiac arrest?
No doubt it rankles the medical professionals when they have to compete with chiropractors for backache cases, but if they were to compete with doctors of chiropractic for heart cases too, that would really hit a nerve! While "killer subluxation" might seem preposterous to some, the concept may be more valid than anyone wants to admit. Chiropractic's potential to help any condition rests with the role of the nerve system, therein lies its great possibilities. In fact, the Big Idea of chiropractic is very big, albeit little understood.
A few cases in point illustrate how close the medics will come to avoid diagnosing vertebral subluxation as a cause of death. Aside from the recent death of Chris Daniels, in the last decade, at least three other athletes suddenly died from heart attacks while playing basketball. In each case, it can be assumed that they did not suffer from the many co-factors of heart disease, such as a weak heart, cholesterol problems, or drug reactions. In fact, one player, Pete Maravich, was a vegetarian, dispelling bad nutrition as a cause. According to the newspaper account of the death of the great collegiate player, Hank Gathers, the experts explained his heart attack as the result of "electrical conduction problems to his heart." At the time, I thought to myself this diagnosis is about as close as the medical profession will ever come to naming the cause of death as a vertebral subluxation.
Another athletic example of nerve interference causing heart dysfunction was the case of the Boston Celtic basketball player, Reggie Lewis, whose final diagnosis was "neuro-cardiogenic heart failure" -- which simply means nerve conduction problems to his heart caused it to stop. The neurologist who examined Lewis mentioned in a Sports Illustrated article about his condition that Vagus nerve irritation can cause many conditions such as hypertension, arrythmias, and, in extreme cases, cardiac arrest. But this MD also mentioned that he didn't know what caused the nerve interference because there was no evidence of tumors or vertebral fractures that could be the source of this problem. After reading about Reggie Lewis' predicament in Sports Illustrated, I wrote a letter to him suggesting that he seek chiropractic care. Unfortunately, he chose to remain on drugs instead, and shortly thereafter he died of his final cardiac arrest. To this day I wonder if he might still be alive if he had followed my advice and seen a chiropractor. Maybe, maybe not.
While others may not know, chiropractors have long known that upper cervical and thoracic subluxations could be the cause of nerve dysfunction to the heart muscle. In these athletic examples, it is conceivable that the many falls these athletes undoubtedly have sustained could have lead to spinal subluxations which, in turn, may have caused enhanced nociception and reduced mechanoreception leading to abnormal afferent input to the heart muscle.
Unfortunately, the medical world ignores this possibility and refuses to recommend a chiropractic analysis to locate any spinal subluxation as a source of neuro-genic heart problems. Any suggestion that patients should go to chiropractors for their back attacks is difficult enough, but to suggest that patients seek a chiropractic consultation for heart problems that may be caused by nerve dysfunction from the spinal subluxations is beyond the ethical conduct of most MDs. Indeed, the mere suggestion of vertebral subluxation as a cause of heart problems would be political suicide for any MD.
Although few medics are willing to relate any heart condition to vertebral subluxation, some scientific researchers recognize that Vagus nerve interference is a possible cause of sudden cardiac arrest. Remarkably, a few objective MDs have postulated the concept of nerve dysfunction as a source of heart problems. A 1985 research article, "Effective Prevention of Coronary Heart Attacks," by P. Sherwood, MD, from London, England presented the theory that many (40%) coronary attacks are caused by a spasm of the coronary artery, triggered by malfunction of the sympathetic stellate ganglion. This malfunction arises from a state of congestion brought about by upper thoracic spinal dysfunction which sensitizes the ganglion either to an increase of congestion around it or a sudden change in its activity. The basic aim of his treatment is to help repair damage to the facet joints in the upper cervical spine. "This requires two things - that the intense pressure of the muscle spasm is relaxed and that the muscle pump is evoked to gain the maximum tissue circulation, especially to the facet joints and the sympathetic chain." Dr. Sherwood principally uses spinal manipulation and massage of the thoracic spine to accomplish his aim.3
John Bourdillon, MD, author of Spinal Manipulation, also mentioned in his textbook of case a coronary vasospasm caused by spinal dysfunction:
"The idea that organic disease can precipitate musculoskeletal manifestation such as muscle spasm and autonomic reflex activity is well recognized. In contrast, the idea that musculoskeletal dysfunction may precipitate organic problems is usually considered as nothing less than quackery. It is difficult for a traditionally trained physician to accept such a possibility. The thought of treating vascular disease by manipulation seems outrageous, but it should not be rejected out of hand. If autonomic reflex activity is accepted as a vehicle of many of the manifestations of joint or somatic dysfunction, then one can postulate that coronary vasospasm might be a result of somatic dysfunction and, if so, that it might respond to manual management.
"One of the authors (JFB) has experience in a case which gives one pause to reflect. A cousin visiting from abroad remarked that since his previous visit he had developed angina. ECG changes were present and walking for some 180 meters up a slope of 1 in 7 made him need nitroglycerin. Inquiry revealed that he had a history of neck pain and stiffness, although at the time he had no neck symptoms. It was proposed that he should be examined and treated on the basis that any dysfunction found would be treated and the effect on cardiac function observed, if any. Examination did indeed reveal dysfunction in both neck and upper thoracic spine, and treatment of five visits over a 2 week period made a significant difference to the objective signs of joint dysfunction. The effect on cardiac function, or presumably on cardiac function, was remarkable. By the time he was due to return home, he was able to play a full set of tennis followed by a swim with no need of medication.
"This case does not signify anything other than that an explanation is necessary. The results may not have anything to do with manipulation, but similar observations have been recorded by other practitioners of manual medicine. The cardiac nerve is said to arise from the T1 to T4 segments. It has long been speculated that the visceral effects of manipulation are mediated through the autonomic system and vasospasm as a result of autonomic reflex changes is certainly possible. It seems that following up this anecdotal experience is likely to be worthwhile; only the fool demises what he does not understand!"4
Another interesting illustration is the tragic injury to the movie actor, Christopher Reeve, who portrayed Superman. As you may remember, he was thrown from his horse and fractured his top two vertebrae, the Atlas and Axis. At this time, his condition is common to anyone who breaks the neck - total paralysis and respiratory problems requiring ventilation to stay alive. When the news reporter on the Today Show on NBC interviewed a neurosurgeon about Reeve's condition, she asked the MD, "Just because he broke his vertebrae, why can't he breathe?" Of course, the neurosurgeon explained that nerves in the brain stem in his neck region controlled the function of breathing by the lungs, so any nerve damage in the neck would result in the inability to breathe properly. His explanation was simple neuro-physiology that is scientifically true, albeit too "high-tech" for many people to understand.
Upon hearing this explanation, I turned to my wife and said, "If a chiropractor were to offer a similar explanation about nerve pressure from vertebral subluxation causing breathing or any organ dysfunction, the medics would jump up and call it quackery. But when a neurosurgeon says virtually the same thing, it's considered "high-tech" science and draws admiration."
The idea that spinal dysfunction causes organ dysfunction via the nerve system is not solely a chiropractic notion. Neuro-physiology is a subject studied in every medical and osteopathic college as well as chiropractic. In fact, one of the most noted experts in this field is a neuro-physiologist, Irvin Korr, PhD, from Princeton University. Dr. Korr's research in the 1960-70s focused on a new concept in neuro-physiology called trophic functions of nerves. He and his associates produced exciting work revealing that nerves not only conduct electrical impulses to muscles, but also supply nourishment to organs through continuous transfer of proteins and other substances along the nerve fibers. This research demonstrated that nerve compression may interrupt or reduce the 'axoplasmic flow' of material from nerve to muscle, influencing muscle structure, excitability, contractile properties and metabolism. Korr postulated that one mechanism by which spinal manipulation achieves its affects may be by removing this obstruction to trophic function in compromised nerves.5
Research by H.T. Vernon, DC, and M.S. Dhami, PhD, perhaps best summarizes the impact of the effects of spinal adjustments upon the whole body:
"There is now good evidence that spinal adjustment decreases pain, increases range of movement, increases pain tolerance in the skin and deeper muscle structures, raises beta-endorphin levels in the blood plasma and... has potent impact on a variety of nerve pathways between the soma and viscera that regulate good health."6
I find it saddening that Americans have become so myopic about their health analysis, depending solely upon blood analysis as the guiding factor in their diagnosis. I mention to my patients to use their car problems as an analogy: If a car doesn't start, what's the first thing they would check? Would they first change their oil, their gas, the water in their engines or simply add STP to the crankcase? Probably not, because most people would check their battery and electrical system first if their car didn't start or suddenly died. But when it comes to our body's health, rarely do patients have their spines checked to see if nerve interference may be the reason why their organs don't work well or prematurely die. Although international research is replete with such neurological explanations, few people are told of this co-factor of organic disease. Indeed, if the electronics industry were controlled by political medicine, it would still be in the vacuum tube era. Ironically, while modern medicine utilizes many high-tech instruments, much of their basic philosophy remains in the last century.
Not only do organs require proper blood flow to function, but proper nerve energy also is required to sustain the organs. But few people understand that the essential blood flow is also controlled by the nerve system and, thus, any interference in these regulating nerves can cause blood circulation problems. Once again, let J.R. Verner, DC, explain this physiological fact:
"Every function in the human body, be it conscious or otherwise, depends upon nerve energy. This energy has its source in the cells of the brain and spinal cord. Even the calibre of the blood vessels throughout the entire body is under the control of the nervous system. The blood aspect of disease permits the use of an interesting illustration which applies to many other disease processes.
"For example, if the nerves supplying the blood vessels are disturbed, then normal generation, transmission, distribution, or expression of the nerve energy is interfered with, and the vessels become either contracted or dilated as the case may be. This contraction or dilation prevents normal blood circulation, and this insufficient or excessive blood supply, technically known as ischemia or hyperemia, may cause the organ which it supplies to become diseased.
"It should be understood that this is merely one of the many possibilities of nerve disturbance: What applies to this, likewise applies to all the nerves that regulate the ductless glands, the digestive and respiratory systems, and every other tissue, gland, organ, and system in the body. Interference with the nerve supply may cause disease in any of these tissues, glands, organs, and systems."7
The essence of the Big Idea has been understood by some MDs who have taken an objective view of chiropractic science. Dr. Albert Cramer, a Hamburg physician, has written in the Hippokrates Medical Journal:
"The great possibilities of chiropractic lie in the exactly purposeful removal of a blocking of the spinal dynamics. The working of the purposeful thrust is aimed at the purely mechanical component. It amounts to a regulating thrust into the nervous control centers, into the dynamic expression of the individual. Chiropractic does not belong, therefore, in the realm of a medical specialty - somewhat like neurology, internal medicine, or orthopedics - rather it does cut across all medical disciplines, not superseding them, restraining them, but broadening, uniting and enriching them." 8
Wow. Did he get the Big Idea or what?
Another excellent summary of chiropractic was given in 1958 by Dr. A.A. Hochfeld in his book, Moderne Kiropracktik. He stated:
"Chiropractic is thoroughly suited to be accorded an authorized place in our therapy chest...If one wishes to pursue the theories of chiropractic, it is to be realized that the modern neural pathology and pathological physiology (Pavlov's teaching) lead most quickly to the understanding of the successes of chiropractic treatment. In the chiropractic reposition, not only is the subluxation reduced and even replaced, but above all else the pathological reflex arcs are broken, and thus a success is obtained similar to that of a novacain blockade, except that the latter is of shorter duration. Experienced and critical observers of chiropractic see it in a substantial enrichment of our present methods of treatment."9
"Killer subluxation" may be a preposterous notion to the medically-minded public; it may be ridiculed by our medical counterparts as speculative and quackery; it may be embarrassing to those DCs who cannot properly explain the concept of "unbalanced activation of sympathetic nerves"; but the facts remain that "killer subluxation" may be a very real phenomenon in the role of cardiac arrest.
Although the Big Idea has been with us for over 100 years, apparently it still remains an idea ahead of its time. Unfortunately, most people today are unaware of the Big Idea of neuro-physiology -- how the nerve system controls body functions. Although most people acknowledge chiropractic's effectiveness with back pain, most remain uninformed about the greater impact of spinal adjustments. While many patients may experience improvements with their organic conditions as they are treated for their musculo-skeletal problems, the Big Idea of chiropractic remains relatively obscure to most people because many DCs are uncomfortable discussing it.
It's a sad realization that the public is being denied this valuable explanation and all the possible benefits of chiropractic spinal care. Not only can chiropractic care help to solve the costly epidemic of back attacks, our science and art may have an important contribution to make to the puzzle of heart attacks. How many more paradoxical diagnosis will have to occur before some ethical MD makes the link between sudden cardiac arrest and spinal subluxation? How many more people will die before they learn that chiropractic care is good for more than just back attacks? Although the Big Idea may remain too "high-tech" for many people, nonetheless it appears to be an idea whose time must come. Indeed, "killer subluxation" may be more plausible than we think!
1. Jarmel, Mark E., DC, a paper, "Possible Role of Spinal Joint Dysfunction in the Genesis of Sudden Cardiac Death," Journal of Manipulative and Physiological Therapeutics, vol. 12-6, Dec. 1989.
2. Jarmel M, DC, Zatkin J, PhD, et al., "Improvement of Cardiac Autonomic Regulation Following Spinal Manipulative Therapy," Cleveland College of Chiropractic, LA, a paper presented at the Conference Proceedings of the Chiropractic Centennial Foundation, July 6-8, 1995.
3. Sherwood, P , "Effective Prevention of Coronary Heart Attacks', Digest Chiro Econ, Nov-Dec, 1985, 54-57 and 122-123.
4. Bourdillon, JF and May, EA; (1987) Spinal Manipulation, William Heinemann Medical Books, London. Appleton and Lange, Norwalk CT/Los Altos, CA, 4th ed., 203.
5. Korr I M, 'The Collected Papers of Ivan M. Korr' (1979), American Academy of Osteopathy, Newark Ohio.
6. Vernon H T, Dhami M S et al (1986) 'Spinal Manipulation and Beta-Endorphin: A Controlled Study on the Effect of a Spinal Manipulation on Plasma Beta-Endorphin Levels in Normal Males', J. Manipulative Physio Ther 9(2): 115-123.
7. Vernon, ibid.
8. Cramer A, MD, Hippokrates Medical Journal
9. Hochfeld AA, MD, Moderne Kiropracktik, 1958