Research Article| Volume 24, ISSUE 2, P101-109, February 2001

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Significant changes in systolic blood pressure post vectored upper cervical adjustment vs resting control groups: A possible effect of the cervicosympathetic and/or pressor reflex


      Objective: To determine whether a vectored adjustment of the atlas in patients identified as demonstrating signs of upper cervical joint dysfunction would cause lowering of blood pressure in comparison with resting controls. Design: Test 1: controlled clinical trial with a treatment (adjustment) group and a control (resting) group. Test 2: controlled clinical trial with subjects serving as their own controls. Setting: Private chiropractic practice. Participants: Test 1: Forty established patients demonstrating signs of upper cervical subluxation/joint dysfunction and 40 established patients without such signs. Test 2: Thirty established patients demonstrating signs of upper cervical subluxation/joint dysfunction. Intervention: Specific, vectored upper cervical (atlas) adjustment or similarly positioned resting. Main Outcome Measures: Prerest, postrest, and postadjustment systolic, diastolic, and pulse rates as recorded through use of a digital oscillometric sphygmomanometer. Results: In test 1, subjects receiving adjustment had a significant (P <.001) decrease in systolic blood pressure whereas resting subjects did not. Intergroup comparison of the treatment (adjustment) and control (resting) groups demonstrated a significant difference (P <.001). A greater pre/post drop in systolic pressure was associated with greater age and higher initial systolic pressure. In test 2, the pre/postrest change in systolic blood pressure was not significant. The systolic blood pressure changed significantly (P <.001) from postrest readings to postadjustment readings. Conclusion: The results indicate that palpation and vectored atlas adjustment causes a significant decrease in systolic blood pressure in patients with putative upper cervical subluxation/joint dysfunction in comparison with resting controls. Similar results were also demonstrated when subjects acted as their own controls. The lack of randomization, blinding, and a manipulated control group are factors that weaken these findings. The sudden drop in systolic pressure is proposed to be due to stimulation of the cervicosympathetic reflex or moderation of muscle tone and elimination of the effects of the pressor reflex. (J Manipulative Physiol Ther 2001;24:101-9)


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        • Plaugher G
        • Bachman TR
        Chiropractic management of a hypertensive patient.
        J Manipulative Physiol Ther. 1993; 16: 544-549
        • Yates RG
        • Lamping DL
        • Abram NL
        • Wright C
        Effects of chiropractic treatment on blood pressure and anxiety: a randomized, controlled trial.
        J Manipulative Physiol Ther. 1988; 11: 484-488
        • McKnight ME
        • DeBoer KF
        Preliminary study of blood pressure changes in normotensive subjects undergoing chiropractic care.
        J Manipulative Physiol Ther. 1988; 11: 261-266
        • Nansel D
        • Jansen R
        • Cremata E
        • Dhami MS
        • Holley D
        Effects of cervical adjustments on lateral-flexion passive end-range asymmetry and on blood pressure, heart rate and plasma catecholamine levels.
        J Manipulative Physiol Ther. 1991; 14: 450-456
        • Goodman R
        Hypertension and the atlas subluxation complex.
        Chiropractic. 1992; 8: 30-32
        • Morgan JP
        • Dickey JL
        • Hunt HH
        • Hudgins PM
        A controlled trial of spinal manipulation in the management of hypertension.
        J Am Osteopath Assoc. 1985; 85: 308-318
        • Crawford JP
        • Hickson GS
        • Wiles MR
        The management of hypertensive disease: a review of spinal manipulation and the efficacy of conservative therapeusis.
        J Manipulative Physiol Ther. 1986; 9: 27-32
        • Gerber S
        Workup and office management of the hypertensive patient.
        Osteopath Ann. 1976; 4: 234-244
        • Mannino JR
        The application of neurologic reflexes to the treatment of hypertension.
        J Am Osteopath Assoc. 1979; 79: 47-53
        • Tran TA
        • Kirby JD
        The effects of upper cervical adjustment on the normal physiology of the heart.
        J Am Chiropr Assoc. 1977; 14: s59-s62
        • Bolton PS
        • Kerman IA
        • Woodring SF
        • Yates BJ
        Influences of neck afferents on sympathetic and respiratory nerve activity.
        Brain Res Bull. 1998; 47: 413-419
        • Murphy BA
        • Dawson NJ
        • Slack JR
        Sacroiliac joint manipulation decreases the H-reflex.
        Electromyogr Clin Neurophysiol. 1995; 35: 87-94
        • Thabe H
        Electromyography as tool to document diagnostic findings and therapeutic results associated with somatic dysfunctions in the upper cervical spinal joints and sacroiliac joints.
        Man Med. 1986; 2: 53-58
        • England RW
        • Deibert PW
        Electromyographic studies, part I: consideration in the evaluation of osteopathic therapy.
        J Am Osteopath Assoc. 1972; 72: 221-223
        • Shambaugh P
        Changes in electrical activity in muscles resulting from chiropractic adjustment: a pilot study.
        J Manipulative Physiol Ther. 1987; 10: 300-304
        • Richmond FJR
        • Bakker DA
        • Stacey MJ
        The sensorium: receptors of neck muscles and joints.
        in: Control of head movement. Oxford University Press, New York1988: 49-62
        • Cooperstein R
        • Bricker DS
        • Jansen R
        Detection of absolute and relative left and right leg displacements as a function of head rotation: the advantages of a friction-reduction segmented table.
        Chiropractic Centennial Foundation, Washington DC1995
        • Karlberg M
        • Persson L
        • Magnusson M
        Reduced postural control in patients with chronic cervicobrachial pain syndrome.
        Gait Posture. 1995; 3: 241-249
        • Richmond FJR
        • Bakker DA
        Anatomical organization and sensory receptor content of soft tissues surrounding upper cervical vertebrae in the cat.
        J Neurophysiol. 1982; 48: 49-61
        • Bakker DA
        • Richmond FJR
        Muscle spindle complexes in muscles around upper cervical vertebrae in the cat.
        J Neurophysiol. 1982; 48: 62-74
        • Grostic JD
        Dentate ligament-cord distortion hypothesis.
        Chiropr Res J. 1988; 1: 47-55
        • Crowe H
        • Kleinman T
        Upper cervical influence on the reticular system.
        Upper Cervical Monograph. 1991; 5: 12-14
        • Knutson GA
        Tonic neck reflexes, leg length inequality atlanto-occipital fat pad impingement: an atlas subluxation hypothesis.
        Chiropr Res J. 1997; IV: 64-76
        • Knutson G
        Thermal asymmetry of the upper extremity in scalenus anticus syndrome, leg-length inequality and response to chiropractic adjustment.
        J Manipulative Physiol Ther. 1997; 20: 476-481
        • Knutson G
        Moderation of postural distortion following upper cervical facet joint block injection: a case study.
        Chiropr Res J. 1998; V: 28-34
        • Seemann DC
        Bilateral weight differential and functional short leg: an analysis of pre and post data after reduction of atlas subluxation.
        Chiropr Res J. 1993; 2: 33-38
        • Seemann DC
        Anatometer measurements: A field study intra- and inter-examiner reliability and pre to post changes following an atlas adjustment.
        Chiropr Res J. 1999; VI: 7-9
        • Nansel DD
        • Waldorf T
        • Cooperstein R
        Effect of cervical adjustments on lumbar paraspinal muscle tone: evidence for facilitation of intersegmental tonic neck reflexes.
        J Manipulative Physiol Ther. 1993; 16: 91-95
        • Pollard H
        • Ward G
        The effect of upper cervical or sacroiliac manipulation on hip flexion range of motion.
        J Manipulative Physiol Ther. 1998; 21: 611-616
        • Hinson R
        • Brown SH
        Supine leg length differential estimation: an inter- and intra-examiner reliability study.
        Chiropr Res J. 1998; V: 17-22
        • Fagard R
        • Lijnen P
        • Staessen J
        • Thijs L
        • Amery A
        Effect of age on the hemodynamic response to posture in nonelderly hypertensive patients.
        Am J Hypertens. 1994; 7: 30-35
        • Frey MA
        • Tomaselli CM
        • Hoffler WG
        Cardiovascular responses to postural changes: differences with age for women and men.
        J Clin Pharmacol. 1994; 34: 394-402
        • Wietlisbach V
        • Rickenbach M
        • Burnand B
        • Hausser D
        • Gutzwiller F
        Combining repeated blood pressure measurements to obtain prevalences of high blood pressure.
        Acta Med Scand Suppl. 1988; 728: 165-168
        • Jamieson MJ
        • Webster J
        • Philips S
        • Jeffers TA
        • Scott AK
        • Robb OJ
        • et al.
        The measurement of blood pressure: sitting or supine, once or twice?.
        J Hypertens. 1990; 8: 635-640
        • White MJ
        • Carrington CA
        The pressor response to involuntary isometric exercise of young and elderly human muscle with reference to muscle contractile characteristics.
        Eur J Appl Physiol. 1993; 66: 338-342
        • Duke PC
        • Wade JG
        • Hickey RF
        • Larson CP
        The effects of age on baroreceptor reflex function in man.
        Can Anaesth Soc J. 1976; 23: 111-123
        • Purdy WR
        • Frank JJ
        • Oliver B
        Suboccipital dermatomyotomic stimulation and digital blood flow.
        J Am Osteopath Assoc. 1996; 96: 285-289
        • Simons DG
        • Mense S
        Understanding and measurement of muscle tone as related to clinical muscle pain.
        Pain. 1998; 75: 1-17
        • Bonde-Petersen F
        • Mork AL
        • Nielsen E
        Local muscle blood flow and sustained contractions of human arm and back muscles.
        Eur J Appl Physiol. 1975; 34: 43-50
        • Rowell LB
        • Freund PR
        • Hobbs SF
        Cardiovascular responses to muscle ischemia in humans.
        Circ Res. 1981; 48: 37-47
        • Piepoli M
        • Clark AL
        • Coats AJS
        Muscle metaboreceptors in hemodynamic, autonomic, and ventilatory responses to exercise in men.
        Am J Physiol. 1995; 269: H1428-H1436
        • Mitchell JH
        • Kaufman MP
        • Iwamoto GA
        The exercise pressor reflex: its cardiovascular effects, afferent mechanisms, and central pathways.
        Ann Rev Physiol. 1983; 45: 229-242
        • Matsukawa K
        • Wall PT
        • Wilson LB
        • Mitchell JH
        Reflex stimulation of cardiac sympathetic nerve activity during static muscle contraction in cats.
        Heart Circ Physiol. 1994; 267: H821-H827
        • Solomon IC
        • Adamson TP
        Static muscular contraction elicits a pressor reflex in the chicken.
        Am J Physiol. 1997; 272: R759-R765
        • Crandall CG
        • Stephens DP
        • Johnson JM
        Muscle metaboreceptor modulation of cutaneous active vasodilation.
        Med Sci Sports Exerc. 1998; 30: 490-496
        • Matsukawa K
        • Wall PT
        • Wilson LB
        • Mitchell JH
        Reflex responses of renal nerve activity during isometric muscle contraction in cats.
        Am J Physiol. 1990; 259: H1380-H1388
        • Hollman JE
        • Morgan BJ
        Effect of transcutaneous electrical nerve stimulation on the pressor response to static handgrip exercise.
        Phys Ther. 1997; 77: 28-36
        • Vissing J
        • Iwamoto GA
        • Fuchs IE
        • Galbo H
        • Mitchell JH
        Reflex control of glucoregulatory exercise responses by group III and IV muscle afferents.
        Am J Physiol. 1994; 35: R824-R830
        • Alam M
        • Smirk FH
        Observations in man upon a blood pressure raising reflex arising from the voluntary muscles.
        J Physiol. 1937; 89: 372-383
        • Fallentin N
        • Jorgensen K
        Blood pressure response to low level static contractions.
        Eur J Appl Physiol. 1992; 64: 455-459
        • Seals DR
        Influence of active muscle size on sympathetic nerve discharge during isometric contractions in humans.
        J Appl Physiol. 1993; 75: 1426-1431
        • Vissing SF
        • Scherrer U
        • Victor RG
        Stimulation of skin sympathetic nerve discharge by central command: differential control of sympathetic outflow to skin and skeletal muscle during static exercise.
        Circ Res. 1991; 69: 228-238
        • Vissing SF
        • Hjortso EM
        Central motor command activates sympathetic outflow to the cutaneous circulation in humans.
        J Physiol. 1996; 492-3: 931-939
        • Saito M
        • Naito M
        • Mano T
        Different responses in skin and muscle sympathetic nerve activity to static muscle contraction.
        J Appl Physiol. 1990; 69: 2085-2090
        • Plaugher G
        Skin temperature assessment for neuromusculoskeletal abnormalities of the spinal column.
        J Manipulative Physiol Ther. 1992; 15: 365-381
        • Wallace H
        • Wallace J
        • Resh R
        Advances in paraspinal thermographic analysis.
        Chiropr Res J. 1993; 2: 39-54
        • Stillwagon G
        • Stillwagon KL
        Vertebral subluxation correction and its affect on thermographic readings: a description of the advent of the Visi-therm as applied to chiropractic patient assessment.
        J Vertebral Subluxation Res. 1998; 2: 137-140
        • Nansel D
        • Szlazak M
        Somatic dysfunction and the phenomenon of visceral disease simulation: a probable explanation for the apparent effectiveness of somatic therapy in patients presumed to be suffering from true visceral disease.
        J Manipulative Physiol Ther. 1995; 18: 379-397