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What Are Blood Clots and When Are They Dangerous?

What Are Blood Clots and When Are They Dangerous?

Close-up of red blood cells and germs

The ability for blood to clot is a mechanism for keeping us from bleeding to death when we receive minor injuries. People with the genetic condition hemophilia lack the substance in their blood that spurs it to clot. This can lead to death at a young age due to hemorrhage. When we first receive a cut, platelets in our blood collect at the site to form a temporary barrier. Then these platelets send out chemical signals that cause the blood’s clotting factors to replace the platelets with fibrin, which is tougher and more durable than the platelet barrier. When the bleeding is sufficiently stopped, anti-clotting proteins are then released that stop the clot from growing larger and spreading.

However, sometimes blood clots develop in an abnormal fashion or break off and travel to other parts of the body where they can cause serious medical problems, such as a stroke or heart attack. More than one in every thousand people develops a venous thrombosis (blood clot in a vein), which may prove fatal. The aging population and increased immobility due to lack of exercise and obesity have served to contribute to ever increasing rates of venous thrombosis. A study reported in the American Journal of Hematology predicts rates of venous thrombosis to more than double by 2050.

Clots are most likely to form when the flow of blood through the veins is slowed, such as when sitting in a chair for long periods of time, or when confined to bed. Those at greater risk for developing blood clots are the elderly, smokers, those who have recently had surgery to the hips or knees, pregnant women, women who use oral contraceptives or HRT, and those who are immobile due to illness, travel or surgery. Long plane flights are a well-known contributor to episodes of deep vein thrombosis (DVT), due to the extended periods of immobility imposed on passengers.

Symptoms of a clot are relatively obvious. Because a clot in a limb blocks the drainage of blood, the limb becomes swollen and reddish or purple and the skin becomes tight and shiny in appearance. If the clot is not dealt with in a speedy fashion, part of it can break off and travel through the circulatory system, where it can block a blood vessel in the lungs, causing a pulmonary embolism (PE). Symptoms of a PE include chest pain and shortness of breath, although some people do not exhibit these symptoms.

In order to help prevent blood clots, there are a few precautions you can take. If you will be traveling or immobile for long periods of time, be sure to increase your intake of water. This has been shown to help keep blood flowing. Take frequent breaks for exercise, if possible. Even if confined to a chair, you can practice some simple leg exercises such as flexes and stretches. Finally, you can invest in specially-designed compression stockings that can help to support the flow of blood through the veins.

 

Bursitis Causes and Treatment Options

Bursitis Causes and Treatment Options

Bodily movement is assisted by over 150 fluid-filled sacs called bursae. Bursae help to cushion your bones, ligaments, and tendons as they move against each other. When in good health these bursae ensure that your joins have a full range of motion. However, these sacs can become swollen and irritated, creating a condition known as bursitis.

The most common cause of bursitis is overuse of the joint. Repetitive movements can irritate the bursae, leading to pain, swelling, and tenderness. Common movements that may lead to bursitis are extensive kneeling (scrubbing the floor or laying carpet, for example), lifting heavy objects (lifting a bag of groceries into the car), and athletic injuries (an aggressive tennis swing). These movements cause the sac to fill with fluids. The resulting swelling puts pressure on the tissue around the sac, causing pain and tenderness.

Other less-common causes of bursitis include gout and infection. Gout crystals can form in the elbow, causing pain and inflammation. Bursae in the knee and elbow lie just below the skin. This leaves them vulnerable to puncture injuries, which can lead to infection.

People become more susceptible to bursitis as they age. Because the shoulder is the most used joint in the body, it is the place where it is most likely to be felt. People over the age of 65 should be especially cautious when carrying out activities that put stress on the shoulder joint.

Treating bursitis begins with conservative measures. Because bursitis due to injury and repetitive movement often goes away on its own, these treatments focus on relieving pain and making the sufferer more comfortable. Treatments for this situation include ice packs, rest, and over the counter anti-inflammatory pain relievers (such as Aleve or Advil).

In more severe cases, a physician may inject a corticosteroid into the inflamed sac. He or she may also use a needle to draw fluid out of the bursae, relieving pressure and quickly reducing pain. In very rare cases of persistent bursitis, surgical intervention may be necessary to remove the problematic bursa.

Part of bursitis treatment is giving the body enough rest to heal the inflamed bursae. Patients should be careful not to overuse the affected area. Immobilization is best, as is getting plenty of rest. After the swelling and pain have receded, patients should be careful in how they treat the problematic area to reduce the chances of the problem recurring.

Bursitis can be painful, but for most people the discomfort will fade with time and rest. If the pain lasts for more than a week or two, or if it becomes so intense that you cannot carry out your daily activities, consult with your doctor.

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Spinal Health at the Gym—Form Matters!

Spinal Health at the Gym—Form Matters!

Whether you are an athlete training for competition or someone who visits the gym regularly just to keep fit, protecting your back and spine from injuries during workouts is important. A large-scale University of Arkansas study found that after injuries to the hand, injuries to areas ranging from the neck to the lower back were the most common type of gym-related injuries.

Back injuries at the gym are more common today due to the large amounts of time we spend sitting at a desk or hunched over a computer. According to personal trainer Justin Price, a specialist in functional fitness and corrective exercise, “If someone is rounded throughout the day in their upper back, and then they go to the gym and do an overhead shoulder lift standing, their upper back cannot extend properly. They straighten and arch upward from their lower back, which has a nervous breakdown because it’s getting all the stress.”

Price suggests that in order to avoid injury you consider getting a personal trainer who can show you the proper way of performing exercises and using equipment. The most important way to maintain good spinal health is to strengthen your core muscles. These are the muscles that lend strength and support to the spine, and which tend to become weakened with long periods of sitting. Following are a few tips on how to use proper form when exercising or lifting weights in the gym.

Tighten your gluteus muscles – When performing a squat, deadlift, or during pushups, be sure to squeeze your glutes. This ensures that the muscles connecting your lumbar and sacral areas are locked so your hips and lower back move as a single unit. Otherwise there is a tendency for the lower back to curve, with the vertebral discs being exposed to more stress than they are designed to handle.

Tighten your abs – So as to keep your spine from arching too much in either direction, tighten your abdominal muscles like you are preparing to be punched in the stomach. This will provide stability to the spine as you bend and lift.

Pull your shoulders down and back – A rounded upper back is one of the leading causes of back injury. It increases pressure on the front side of the vertebral disks, increasing the risk of disc herniation.

Keep hips and shoulders aligned – Back injuries happen more often when twisting and bending. Ensure that your hips and shoulders move as one unit. If you need to change direction, lead with the hips and the shoulders will follow. If you lead first with the shoulders, the hips tend to fall behind, too late to keep from overstraining the low back muscles.

 

How Do Chiropractors Know If Your Spine is Out of Alignment?

How Do Chiropractors Know If Your Spine is Out of Alignment?

Views of the spine
Human Spine

Having a misaligned spine (also called a spinal subluxation) can negatively affect your daily life in a number of ways.  It can not only cause pain in the back and neck, but can also cause pain in the rest of the body because of the pressure that the misaligned vertebrae place on nerves in the spinal column.  For example, many people suffer from sciatica (a condition in which pain can be felt shooting down the leg as far as the foot) due to a misaligned vertebral disc putting pressure on the spinal nerve roots.  A chiropractor can diagnose if your pain is due to your spine being misaligned and can perform a spinal adjustment to restore proper alignment and range of movement, relieving pain.

Spinal subluxations are very common.  They occur when one or more of your 24 bony vertebrae (most people actually have 33 vertebrae counting the nine that are fused to form the sacrum and coccyx) are pulled out of alignment with one another.  This can happen for a variety of reasons.  Among the most frequent contributors to spinal misalignment are an injury, a sudden jar, fall or trauma, bad posture, stress, inactivity, obesity, repetitive motions and lifting something improperly.  When your spine becomes misaligned, your range of motion can become more restricted, with or without accompanying pain.  Although spinal misalignments can happen quickly (usually in the case of an accident or acute injury), they can also occur over time due to weak postural muscles. This is often the case with those who sit at a desk for hours each day.

A chiropractor may use a variety of different diagnostic techniques to determine if your spine is out of alignment.  Most chiropractors can easily spot a subluxation, as body posture reflects any misalignment.  For example, when lying down, one leg will appear shorter than the other.  When standing up, the body may lean to one side, or the head may tilt to the left or right.  Also, one shoulder or hip may appear higher than the other, and the distribution of body weight may favor one foot or the other.

Other things that your chiropractor may do to determine if your spine is out of alignment are to check your range of motion (reduced range of motion usually indicates a misalignment), press along your spine (called palpation) to evaluate joint function, perform strength testing and look for changes in muscle tone.  He or she may also order x-rays of the spine to be taken, so as to have a visual confirmation of your spinal subluxation.

Once the misalignment has been pinpointed, your chiropractor will perform a spinal adjustment that will move your vertebrae back into alignment, restoring correct posture and alleviating pain that may have been caused by the misalignment.

The Opioid Crisis’ Latest Victims: Addicted Babies

The Opioid Crisis’ Latest Victims: Addicted Babies

(NU) – And now the nation’s opioid crisis is putting newborn babies at risk.
The use of prescription painkillers like OxyContin by women during pregnancy has resulted in what’s being called “an explosion” of infants as addicted to the drugs as their mothers. Newly published data in JAMA Pediatrics shows the number of cases of neonatal abstinence syndrome (NAS) has risen five-fold in the U.S. from 2000 to 2012 – that’s nearly 22,000 affected inf ants in that last year alone – and the reality behind those stats is heart-wrenching. “The babies, they really suffer,
just like adults do when they withdraw from narcotics,” Dr. Terrie Inder, chair of pediatric new born medicine at Boston’s Brigham and Women’s Hospital, told CBS News. “The babies are very irritable and sometimes have high heart rates, sweating, flushing, diarrhea. They cry a lot.”

Heightening experts’ concern: The crucial early “bonding” between mother and child is disrupted, given the babies’ average hospital stay of 24 days. The mothers, often unaware of the potential collateral damage from the painkillers they’ve been taking, experience what Inder calls “anxiety and guilt.”

Back and neck discomfort is especially common during pregnancy since women’s postural changes can result in spine and pelvic pain.

The open question is whether this latest development, combined with the Centers for Disease Control and Prevention’s call last year for physicians to dramatically curtail prescribing opioids will encourage more women to seek alternatives like drug-free chiropractic care. “All chiropractors are trained to work with women who are pregnant,”, The American Pregnancy Association says, lauding their expertise in “establishing pelvic balance and alignment.”

If you are expecting a baby or know someone who is, Dr. Oblander is well-trained in taking care of women during their pregnancies. Be sure to take good care of yourself and give our office a call if you experience back or hip pain during your pregnancy!

(Article shared from News USA)

I Trust Chiropractic Care

I Trust Chiropractic Care

Clinton Romesha

“When I first consulted a doctor of chiropractic for back pain, it was discovered that my pelvis was imbalanced – little surprise after many years of carrying military gear in all kinds of terrain. Aligning my hips and lower back, along with stretching and healthy living advice, made all the difference for me. Chiropractic is a natural alternative, and I am grateful for this car that has kept me away from having to mask my pain with addictive painkillers and their harmful side-effects. I encourage my brother and sister Veterans to consider chiropractic for healthier living.”   –  Clinton Romesha

 

In a 2013 ceremony, U.S.Army Staff sergeant Clinton Romesha received the Medal of Honor for acts of gallantry on 10/3/2009, during Operation Enduring Freedom in Afghanistan.

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Can You Really “Bank” Sleep?

Can You Really “Bank” Sleep?

striped-cat-sleeping-on-chair

Banking sleep to save energy for later? To most people, this idea probably sounds too good to be true. At the very least, it probably seems to defy common sense and or runs counter to the way we think our bodies work. However, it actually turns out that banking sleep is possible—within limits.

A great deal of research has been conducted on this subject.  In one particular study, American scientists invited a number of volunteers to adjust their sleep patterns so that researchers could observe the effects. For a week, half of the volunteers were permitted to sleep more than usual, and the remaining volunteers were made to sleep according to their usual pattern.

“After this week of either extended or habitual sleep per night, all the volunteers came to the lab and they were given three hours of sleep, per night, for a week,” says Tracy Rupp of the Walter Reed Army Institute of Research. The volunteers were then assigned tasks of varying difficulty, and those who had banked their sleep were more unaffected throughout the sleep restriction.

Rupp elaborates: “They showed less performance deterioration with regards to reaction time and alertness than the group that had been given the habitual prior sleep.”

The study also revealed that a week after the experiment, the banked sleepers were recuperating faster from deficiency of sleep than the others were. Rupp again: “What we’re basically saying is if you fill up your reserves and pay back your sleep debt ahead of time, you’re better equipped to deal with the sleep loss challenge.”

While these results may sound great, there are limits to what banking sleep can do for you. “It’s a strategy that’s only partially successful,” explains Michael J. Breus, Ph.D., in the November 2013 issue of Psychology Today. “New research indicates that although some of the negative effects of a week of insufficient sleep can be remedied with extra sleep on the weekend, others cannot. Researchers at Penn State University College of Medicine studied the effects of weekend recovery sleep after a week of mild sleep deprivation. They found that make-up sleep on the weekends erased only some of the deficits associated with not sleeping enough the previous week.”

Banking sleep isn’t limited to sleeping longer nights. Naps can be extremely effective as well—within limits, of course. According to Science Focus, “A 1991 study at Wright State University in Dayton, Ohio found that after an ordinary night’s sleep, subjects could take an extra nap in the afternoon and then work through the night with greater alertness that a control group who didn’t nap. The study also found that performance is proportional to the length of the nap—but the effect doesn’t last.

After a second consecutive night without sleep, all of the subjects performed equally badly, regardless of how much sleep they had initially. It may be that all of us are normally slightly sleep-deprived and one really good night’s sleep will bring us back up to 100%, but that the ‘tank’ isn’t big enough to buffer us against more than one all-nighter.”

The practical uses of banking sleep go beyond needing to pull an all-nighter before finals or a big presentation at work. Dr. Winter, a member of the American Academy of Sleep Medicine, puts it thusly: “If you knew you were going to give birth on a particular day, for example, you could sleep for 10 hours a day for multiple days before the event, and be fine.”

Lastly, it is important to consider the host of negative effects of sleep deprivation. Memory loss, obesity, and even early death comprise some of these consequences. The moral of the story here is that banking sleep in advance may actually be a reasonable short-term strategy for coping with an isolated event (like giving birth). However, the best long-term strategy for staying healthy and performing well is to get a good night’s sleep as consistently as possible.

 

Endurance Sports Provide a Boost to the Body’s Nervous System

Endurance Sports Provide a Boost to the Body’s Nervous System

woman-running-in-cold-arid-land

It’s well known that training in certain sports can improve a person’s endurance. If you’re a runner, for example, you know that as you continue to run every day or according to whatever training schedule you follow, you gradually develop the ability to run further, faster, and for longer periods of time. But did you know modern science doesn’t have a complete understanding of why or how this actually happens? Experts still have a lot of unanswered questions about the exact mechanisms at work when an endurance sport triggers these kinds of performance improvements.

When it comes to muscle strength, there’s certainly an element of adaptation at work—it’s clear that the phrase “use it and strengthen it” is every bit as true as “use it or lose it”. But muscle strength isn’t the whole story. Many long-distance runners would probably tell you that their coordination and ability to deal with rough surfaces and obstacles also seem to increase with practice. To them, it seems as if their muscle-brain communication has improved along with their muscle strength.

According to a study conducted at the Biozentrum of the University of Basel, not only may the runners’ perception be correct, but researchers may also have found one of the mechanisms that cause the improvements the runners are noticing. Their research suggests that endurance sports not only change the condition and fitness of your muscles, they also improve the neuronal connections to individual muscle fibers, based on a type of muscle-induced feedback, all accomplished through increased levels of a blood protein called PGC1α.

PGC1α seems to play a major role in muscle adaptation because it regulates the genes that cause muscle cells to change to keep up with the greater demands being placed on them. When your muscles are inactive (or diseased), they contain a low concentration of PGC1α. When the muscles are more challenged, however – for example when running for long distances – PGC1α levels increase. Professor Christoph Handschin and his colleagues in Basel have been able to show that this increase in PGC1α not only increases muscle size and strength, it also improves upstream synaptic nerve connections to and from the muscles.

The presence of more PGC1α improves the health of the synapses that link the muscles to the brain, allowing the muscles to change and develop new activation patterns, based on changing requirements placed upon them by the exercise. In effect, the more you train, the more PGC1α is in your muscles, and the more quickly they are able to “learn” how to become stronger and more adaptable to challenges.

However, the most surprising part of this study, published in the journal Nature Communication may be that Professor Handschin and his colleagues were able to induce this same improvement in synaptic communication by introducing higher concentrations of PGC1α into the muscles artificially. As the researchers increased PGC1α levels, the muscles became stronger and the neuronal connections became stronger, just as if the subjects had been performing endurance training.

These findings are seen as possibly having therapeutic applications in the treatment of diseases such as muscle wasting and amyotrophic lateral sclerosis (ALS or Lou Gehrig’s Disease). As Handschin explains, “In patients, whose muscles due to their illness are too weak to move on their own, an increase in PGC1α levels could strengthen muscles and nerves until the patients can move enough to finally do some physical therapy and to further improve their mobility.” Then after some improvement to their muscles as the result of pharmacological treatment, the patients could continue to improve their muscle strength through practicing endurance sports.

But for healthy people, there’s a much simpler message—certain types of sports normally associated with endurance-building also build muscle coordination and adaptability.  Not only is this type of exercise good for cardiovascular and musculoskeletal health, it also seems to pay big “fitness dividends” for your body’s nervous system.

 

Chiropractic Care and Professional Baseball: The Philadelphia Phillies and Dr. Michael Tancredi

Chiropractic Care and Professional Baseball: The Philadelphia Phillies and Dr. Michael Tancredi

When it comes to helping elite athletes prevent and recover from injuries—as well as achieve peak performance—chiropractic care can offer many advantages. That’s why large numbers of professional and college sports teams throughout the U.S. have turned to chiropractors over the past decade. The Philadelphia Phillies is one such team, and Dr. Michael Tancredi is one such chiropractor. As a Doctor of Chiropractic, a Certified Chiropractic Sports Physician, an Active Release Technique Instructor and Practitioner, and a certified athletic trainer, Dr. Tancredi clearly understands the valuable role that chiropractic care can play in keeping teams healthy and performing at their best.

By almost any measure, Dr. Tancredi has had a long and successful career in sports medicine. He has worked extensively with the Philadelphia Eagles, Philadelphia Phillies, and Villanova University. While Dr. Tancredi has accomplished a great deal in his professional life (and he continues to work with patients through his practice in Broomall, Pennsylvania), he is perhaps best known as the chiropractor who went all the way to the 2008 World Series as a consultant with the Philadelphia Phillies. From 2008 through 2010, he was a chiropractor and Active Release Technique provider for the team.

Cole Hamels, a member of the 2008 Phillies team, has been very vocal about the difference chiropractic care has made for him. “Being introduced to chiropractic care has definitely helped my game. When you add it with a lot of the physical therapy exercises and the in-game exercises, I think it just prevents a lot of injury. I went through a lot of injury in my career, and the first time I actually was introduced to chiropractic care, it pretty much kept me on the field. It’s something that helps me feel much better when I’m on the field and off the field.”

As a pitcher, Hamels is particularly aware of the complex biomechanics involved in throwing a baseball, and recognizes how the larger muscle groups—not just the shoulder and elbow—must work together to perform well. “Your body starts from the ground up, and in order to pitch, you have to use everything. You have to have a good back in order to get the good torque. Most of your power comes from your core.”

It’s a challenge staying healthy through a 162-game regular season, and players at the elite major-league level do what they can to avoid injuries. Hamels recalls how chiropractic care became popular among his teammates and coaches. “It’s another way to help us get out on the field… We’ve seen more and more players start to go in to get adjustments, to get the ART. And I think that’s good for our whole team because you want them to be able to go out on the field every day because we’re very good at what we do, but you’re not going to help the team out when you’re not playing.”

In a brief interview published in ACA Today, Dr. Tancredi described his own experience with the Phillies and explained why chiropractic care is such a good fit for professional baseball. “It was a dream job and a dream season. The whole sports medicine staff was phenomenal. They were all really open to the benefits of chiropractic care. Athletes at this level rarely have an acute injury. However, a little hamstring pull can turn into a major problem when they have no time off. Baseball’s schedule is grueling in that the players are on the field 28 out of 30 days a month, so we have to do what we can to help them heal while keeping in mind the long-term consequences. Chiropractic has cut the injury rate; the players love it, the athletic trainers see how effective it is and the orthopedic surgeon is totally open to my suggestions—it’s a win-win situation.”

Whether you’re playing professionally or at an amateur level, baseball puts unique demands on the body’s musculoskeletal system, from asymmetrical movements (throwing and hitting) and extreme acceleration and deceleration to sudden impacts. Take it from the Phillies and Dr. Michael Tancredi, chiropractic care can help players stay healthy and perform at their best.

If you need to make chiropractic a part of your success protocol, be sure to give our office a call at 406-652-3553 to schedule your appointment with Dr. Oblander!

 

The Positive Effects of Chiropractic Care!

The Positive Effects of Chiropractic Care!

We know that our patients who get adjusted regularly see the wonderful side effects! Their backs are not the only beneficiary of their adjustments! Here is a study that confirms that keeping the spine adjusted has more positive effects than just your back or neck feeling better!:

A retrospective study conducted in Sweden [1] has determined that about one in four chiropractic patients experiences some form of “positive nonmusculoskeletal side effect” after spinal manipulative therapy (SMT).

In addition, the percentage of patients who experience positive side effects increases with the number of spinal regions adjusted. The Swedish researchers asked all members of the Swedish Chiropractors Association (SCA) to participate in the study. Eighty-one percent of the SCA membership complied. Each doctor of chiropractic gathered data from 20 patients over a three-week period for a total of 1,504 valid patient questionnaires. Patients were included if they had been previously adjusted within the last two weeks for musculoskeletal complaints. The patients were asked if after their previous visit they ìexperienced any positive changes that do not seem to have anything to do with your back problem?

At least one positive side effect or reaction was reported by 23 percent of the respondents. The more spinal areas that were adjusted, the better their chances of experiencing at least one positive reaction:

The positive, nonmusculoskeletal reactions appear to cluster into a number of system/organ-related classifications. Of those patients who experienced them, here is the breakdown by percentage:

 

  • Respiratory System: 26%

  • Digestive System: 25%

  • Circulatory System/Heart: 14%

 

  • Eyes/Vision: 14%

The benefits experienced can also be broken down into subcategories:

 

  • Easier to Breathe: 21%

  • Improved Digestive Function: 20%

  • Clearer/Better/Sharper Vision: 11%

  • Better Circulation: 7%

  • Changes in Heart Rhythm/Blood Pressure: 5%

 

  • Less Ringing in the Ears/Improved Hearing: 4%


The authors, as is typical in research papers, are careful to point out the limitations of extrapolating the findings. They note that the study does not demonstrate whether the statistical link between treatment and reaction is causal. They assert that ìthe absence of an untreated control group makes it impossible to say whether these reactions are treatment-specific, or if they simply represent normal fluctuations of common symptoms of physiologic function. While these results are very exciting, it is clear that additional research is needed.

Reference:

The Types of Improved Nonmusculoskeletal Symptoms Reported After Chiropractic Spinal Manipulative Therapy
J Manipulative Physiol Ther 1999 (Nov);   22 (9):   559–564

The Abstract

OBJECTIVE:   To investigate the frequency and types of improved nonmusculoskeletal symptoms reported after chiropractic spinal manipulative therapy.

DESIGN:   Retrospective information obtained by chiropractors through standardized interview of patients on return visit within 2 weeks of previous treatment.

SETTING:   The private practice of 87 Swedish chiropractors (response rate 81%).

SUBJECTS:   Twenty consecutive (presumably naive) patients per chiropractor (1504 valid questionnaires returned, 86% of optimal number of replies).

INTERVENTION:   Spinal manipulation with or without additional therapy provided by chiropractors.

MAIN OUTCOME MEASURES:   Self-reported improved nonmusculoskeletal symptoms (reactions).

RESULTS:   At least I reaction was reported after the previous treatment in 21% to 25% of cases. Of these responses, 26% were related to the airway passages (usually reported as “easier to breathe”), 25% were related to the digestive system (mostly reported as “improved function”), 14% were classified under eyes/vision (usually reported as “improved vision”), and 14% under heart/ circulation (about half of these reported as “improved circulation”). The number of spinal areas treated was positively associated with the number of reactions.

CONCLUSION:   A minority of chiropractic patients report having positive nonmusculoskeletal reactions after spinal manipulative therapy but such reports cluster predominantly around specific symptoms. It would be interesting to find out if these can be verified objectively and, if so, to investigate if they are caused by the treatment or if they are signs of natural variations in human physiology.