Thoracic Spinal Manipulation and Pulmonary Function in Stroke Patients

Not so long ago, the rumour mill was alive with talk that chiropractic care was bad news for stroke potential. A few short years on and not only has that rumour been put to rest, but we are beginning to see evidence that chiropractic care may even be good for stroke recovery! Not only have researchers found that there is no evidence that chiropractic care causes cervical artery dissection, but there is now evidence that chiropractic care may increase muscle strength, spinal excitability and even pulmonary function post-stroke [1-3]. 

These findings are significant, as stroke is a “major cause of disability worldwide [3].” Research has revealed that “About 50% to 70% of affected patients show recovery of functional independence and about 50% of these have hemiparesis” or paralysis on one side of the body [3]. Among the common side effects of stroke are things like:

• Cardiopulmonary issues (heart and lungs)
• Balance and coordination problems
• Difficulty with speaking, swallowing and chewing
• Changes in vision

Pulmonary function is particularly important post-stroke as “Abnormal pulmonary function in stroke patients is an independent risk factor for cardiovascular disease and may lead to an increased risk of recurrent stroke [3].” Hence, rehabilitation is paramount. 

A recent study, which slipped in under the radar, was released in 2018 and examined the important issue of pulmonary function post-stroke. Researchers took 36 volunteers who had suffered strokes and randomised them into either a thoracic spinal manipulation group or a sham group. There were 18 people in either group, and all underwent a pulmonary function test and then rested for ten minutes before the intervention. They were then tested again immediately after either the sham intervention or the thoracic spinal manipulation.

The test was thorough, measuring forced vital capacity, forced expiratory volume, maximum voluntary ventilation and residual volume, all of which was measured by spirometer.

Of the 36 participants, 34 completed the post-intervention test, and a certified respiratory therapist ran the pre and post-intervention tests in order to ensure data quality. While the full study, referenced below, includes details of the specific thoracic spinal manipulation used and statistical analysis of the results, key takeaways from the study include the following:

• There was no significant baseline data difference between the sham group and the intervention group.
• There were statistically significant improvements post-intervention for the thoracic spinal manipulation group when it came to forced vital capacity and forced expiratory volume.
• Maximum voluntary ventilation and residual volume remained unchanged.
• No significant changes were noted in the sham group.

The researchers noted previous evidence indicating that spinal manipulation could be helpful for increasing joint mobility and decreasing muscle hypertonicity (stiff muscles post-stroke), and suggested that thoracic spinal manipulation may alter chest wall mobility which may in turn “lessen asymmetry between the paretic and healthy sides.” This would potentially increase inspiratory (breathing in) muscle length, muscle efficiency and reduce muscle fatigue.

There are many other variables to examine and much further research to do on this topic, but it is encouraging to see more research showing that chiropractic care may be useful in the recovery phase after a stroke. When this all-important post-stroke rehabilitation may, in turn, mean a decrease in cardiovascular risk for the patient under care, it is a cause well-worth investigating.

REFERENCES:

1. Church E, Sieg E, Zalatimo O, Hussain N, Glantz M, Harbaugh R (2016) “Chiropractic Care and Cervical Artery Dissection: No Evidence for Causation,” Penn State Neurosurgery Channel, http://www.cureus.com/articles/4155-systematic-review-and-meta-analysis-of-chiropractic-care-and-cervical-artery-dissection-no-evidence-for-causationretrieved 29 March 2017
2. Holt K, Niazi IK, Nedergaar RW, Duehr J, Amjad I, Shafique M, Anwar MN, Ndetan H, Turker KS and Haavik H (2019), “The effects of a single session of chiropractic care on strength, cortical drive, and spinal excitability in stroke patients,” Scientific Reports, 9, Article Numbers: 2673(2019), https://www.nature.com/articles/s41598-019-39577-5retrieved 26 February 2019
3. Joo S, Lee Y, and Song C, (2018), “Immediate Effects of Thoracic Spinal Manipulation on Pulmonary Function in Stroke Patients: A Preliminary Study,” Journal of Manipulative and Physiological Therapeutics, https://doi.org/10.1016/j.jmpt.2017.12.005