Improvement in Quality of Life in a Patient with Depression Undergoing Chiropractic Care

Improvement in Quality of Life in a Patient with Depression
Undergoing Chiropractic Care Using Torque Release
Technique: A Case Study
Theo Mahanidis BA (Sports Ed),1 B(Chiro) & David Russell BSc (Psych), B(Chiro)2
__________________________________________________________________________________________
ABSTRACT
Objective: To report on a female patient who presented for chiropractic care with depression.
Clinical Features: 49 year old female who presented with a history of depression, asthma, high stress, mood and gastrointestinal changes.

Intervention and Outcome: Over a period of 7 months, a specific, conservative chiropractic adjustment regimen for the correction of vertebral subluxation was administered to the patient. The care plan was altered in accordance to outcome
measures and over this time period the patient exhibited a considerable decrease in presenting symptomology alongside a substantial increase in self rated quality of life. Self-rated health/wellness (SRHW) surveys were taken prior to care and at
subsequent progress visits assessing four domains of health(Physical state, Emotional/Mental state, Stress and Life Enjoyment) as well as Overall Quality of Life. Static and Thermal EMG were performed using the Chiropractic
Leadership Alliance (CLA) Insight􀂌 surface EMG and thermal scanning technology. Improvements were noted in SRHW and surface EMG and thermal scanning over the 7 months of care.

Conclusions: While under chiropractic care subjective and
objective improvements in physical, mental and social wellbeing were documented in a patient with a history of depression,asthma, high stress, mood and gastrointestinal changes
Keywords: Chiropractic, subluxation, depression, quality
of life, Stress, Torque Release Technique (TRT), Insight􀂌
surface EMG and thermal scanning
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Introduction
Mood disorders affect approximately 1 in 7 New Zealanders
within their lifetime with 1 in 5 experiencing some kind of
serious mood disorder by the age of 25 with females reporting
a higher incidence of depression than males.1 The most
common types of mood disorders include Major Depression,
Dysthymia and Bipolar Disorder. Some of the more common
symptoms of these disorders are loss of interest or pleasure in
hobbies and activities, decreased energy (fatigue), feelings of
worthlessness, anxious or 􀂳empty􀂴 mood, difficulty
concentrating, insomnia, thoughts of death and or suicide.1
The common pathway of depression involves biochemical
changes in the brain. This is believed to be due to the roles of
serotonin, GABA, dopamine and opioid peptides which when
imbalanced or deficient can cause mood disorders.2 There is
also evidence suggesting a correlation between cervical
trauma and the onset of social disorders although there is still
debate about the true cause of social and mood disorders.3
Chiropractic care aims to optimize health and wellbeing
through removing interference from the nerve system.
Chiropractic follows the notion that the correction of any
interference in the nerve system is an essential component of
personal enhancement and health maintenance. This
professional objective is achieved through the correction of
vertebral subluxations.4 The Association of Chiropractic
Colleges defines subluxation as follows: 􀂳A subluxation is a
complex of functional and/or structural and/or pathological
CASE STUDY
1. Private Practice, Wollongong, NSW Australia
2. Centre Director, New Zealand College of Chiropractic
J. Vertebral Subluxation Res. January 31, 2010 1
Depression & Chiropractic
articular changes that compromise neural integrity and may
influence organ system function and general health.􀂴4 Thus,
reduction of vertebral subluxation is thought to promote
overall health by contributing to the proper function of the
body􀂶s inherent adaptive abilities, many of which appear
linked to neurological function.5
Case Report
A 49-year-old caucasian female presented for chiropractic care
at a private practice in Auckland, New Zealand in January
2006. Initial examination revealed a history of depression,
asthma, high stress, mood and gastrointestinal changes
(flatulence) and a generalised loss of lust for life. It was also
noted that she had been prescribed Aropax by her General
Practitioner 14 months prior for her depression. Over a period
of seven months from the date of presentation a specific
conservative chiropractic adjustment regimen for the
correction of vertebral subluxations was delivered to the
patient.
This consisted of a series of adjustments using the Torque
Release Technique (TRT), developed by Jay Holder, D.C.
TRT uses various indicators of vertebral subluxations and also
prioritizes their correction into a system called Non/Linear
Testing Priorities. The main focus of TRT is detecting areas of
subluxation at locations of dural attachment being the upper
and lower cervical spine (C1, C2 and C5), sacrum, coccyx and
the pelvis. The use of an adjusting device called an Integrator
is used for the correction of vertebral subluxations. It features
a pre-cocking, pressure sensitive tip with an automatic release
mechanism that includes a torque and recoil component.6
The care plan was altered in accordance to outcome measures.
Self-rated health/wellness (SRHW) surveys were taken prior
to care and at subsequent progress visits assessing four
domains of health (Physical state, Emotional/Mental state,
Stress and Life Enjoyment) as well as Overall Quality of Life.7
Over this time period the patient exhibited a substantial
increase in quality of life ratings alongside a considerable
decrease in presenting symptomology.
The survey instrument used has been specifically developed
by Blanks et al. to analyze wellness. Aptly named 􀂳Survey of
Self-Rated Health, Wellness and Quality of Life􀂴 (HWQL) the
questionnaire aims to record health, wellness and quality of
life levels by having the subject self-rate (fill out personally)
fifty-five items within five domains.7 Self assessment using
the 􀂳HWQL Survey􀂴 was used at the initial consultation prior
to commencing the chiropractic care to gain a baseline of the
patient􀂶s perceptions and again at intervals thereafter as
indicated for the duration of the study (7 months).
Spinal thermal and surface electromyography (sEMG) scans
were completed at the initial consultation. These initial sEMG
and thermography scans revealed areas of asymmetrical motor
and autonomic function respectively throughout the entire
spine. See figure 1. The scans were performed using the
Chiropractic Leadership Alliance (CLA) Insight􀂌 7000
sEMG and thermal scanning technology.
The intervals for progress exams (periodical re-examination)
were set specifically for the patient in relation to presentation
and were taken at week 4 and 11 within the care plan. The
frequency of care was reassessed at each progress exam with
an initial frequency of 3 visits per week for the first 8 weeks.
At the 4 week progress exam the plan was altered to twice a
week for 14 weeks with a subsequent progress scheduled for
14 weeks.
Comparable thermal and sEMG scans were taken at progress
exams 1 and 2 following the onset of care. Increased balance
and symmetry were noted on the 1st progress in both motor
and autonomic function. This further improved on the 2nd
progress scans. Figures 2 and 3.
Table 1 shows the calculated results as recorded from the
initial examination and two subsequent progress exams as well
as their correlating percentage improvements. Figure 4, 5 and
6 further illustrate these improvements. It can be seen that at
initial progress examination there were positive changes (from
9-28% improvement) in all aspects of the survey calculated
except for the section in regards to the ability to handle stress
which presented a negative result. It was stated by the patient
that after 6 weeks of care she had stopped taking the antidepressants.
This may correlate to the improvements seen in
subsequent progress exams. According to the patient: 􀂳After 6
weeks I have been able to come off the anti-depressants
already.􀂴
At progress exam two, the results varied from that of progress
one ranging from 0-46% improvement. Most significant
improvement was seen in Physical Score with 46% and the
most significant percentile change was in the Quality of Life
Score.
Overall there was an increase on average of 23.2% with the
most change noted on Wellness Scores (44%) and least with
Quality of Life Score (8%).
Figure 6 and Table 2 illustrate the change over time between
categories within the survey. This clearly displays that each
area of the survey improved yet at very differing values and
times within care.
Discussion
The purpose of this case study was to document the changes
that occurred while under chiropractic care and the positive
affect on the patient􀂶s quality of life in relation to a patient􀂶s
self-rated health perceptions as measured by the Health,
Wellness and Quality of Life survey.
All domains of the completed survey have showed notable
increases in ratings between initial and follow-up with the
most significant being the physical domain.
As this study is of the patient􀂶s perception of their health, all
answers are relevant to the way they interpret the question.
The patient may have adapted her answers according to
expected benefit, social willingness and their current mood. It
was suggested that the patient be completely honest when
filling in the survey.
J. Vertebral Subluxation Res. January 31, 2010 2
Depression & Chiropractic
Increasingly, health care providers are being encouraged to
adopt an evidence-based approach to delivering the services
they provide.8 The approach of wellness oriented outcome
assessments are not yet widely adopted in the area of health
care where it would be most applicable, i.e., non-medical
practices that have as their primary clinical goal the
enhancement of over-all health. This is perhaps due to the
disease-specific orientation found in most recently developed
surveys.
Historically there is not adequate scientific evidence into the
effects of the vertebral subluxation in relation to its ability to
interfere with well-being. More recent studies however
describe the correction of vertebral subluxation as having an
impact on the improvement of general health, brain function,
quality of life and well being.7,9,10
Blanks et al described the profound effects chiropractic has
had on patients well being in the self􀂱reported retrospective
study of 2818 people. After 3 years of chiropractic care
patients found their quality of life was maintained and did not
plateau.7
Although depression is associated with biochemical changes it
is impossible to say whether improvements in quality of life
observed in this case are related to changes in biochemistry
caused by antidepressant use or due to the correction of
vertebral subluxations or another mechanism altogether. It is
fair to say that by providing care to this patient the interaction
with the chiropractor may also have been a positive influence.
Conclusion
This report outlines the history and symptomology of a 49
year old women suffering from a history of depression,
asthma, high stress, mood and gastrointestinal changes. The 7
months of chiropractic care and the women􀂶s physical, social
and mental response to the correction of vertebral subluxations
were discussed. This report supports previous literature
regarding chiropractic care and its positive effect on physical,
mental and social well-being.
References
1. Strock M. Depression: NIH, 2000.
2. Nemeroff CB. The neurobiology of depression.
Scientific American. 1998 Jun;278(6):42-9.
3. Jelinski SE, Magnusson JE, Becker WJ. Factors
associated with depression in patients referred to
headache specialists. Neurology. 2007 Feb
13;68(7):489-95.
4. Association of Chiropractic Colleges. The
Association of Chiropractic Colleges Position Paper
# 1. July 1996. . ICA Rev.
1996;November/December.
5. Leach RA. The chiropractic theories: a textbook of
scientific research. 4th ed. Baltimore: Lippincott
Williams and Wilkins; 2004. 18-20, 137, 251, 359 p.
6. Nadler A, Holder JM, Talsky MA. Torque Release
Technique (TRT): A technique model for
chiropractic's second century. Canadian Chiropractor.
1998;3(1).
7. Blanks RHI, Schuster TL. A retrospective assessment
of network care using a survey of self-rated health,
wellness and quality of life. Journal of Vertebral
Subluxation Research. 1997;1(4):1.
8. Sackett DL. Evidence-based medicine. Seminars in
perinatology. 1997 Feb;21(1):3-5.
9. Boone WR, Oswald P, Holt K, Beck R, Singh K,
Ashton A. Physical, physiological, and immune
status changes, coupled with self-perceptions of
health and quality of life, in subjects receiving
chiropractic care: A pilot study. Journal of Vertebral
Subluxation Research. 2006;July 5:1-6.
10. Taylor HH, Murphy B. Altered sensorimotor
integration with cervical spine manipulation. J
Manipulative Physiol Ther. 2008 Feb;31(2):115-26.
J. Vertebral Subluxation Res. January 31, 2010 3
Depression & Chiropractic
Initial SEMG Scan 2nd SEMG Scan
Final SEMG Scan
Initial Thermal Scan 2nd Thermal Scan
Final Thermal Scan
Depression & Chiropractic
J. Vertebral Subluxation Res. January 31, 2010 4
Table 1
Initial Progress 1 Progress 2
Score Score Difference Improvement Score Difference Improvement Overall
Improvement
Combined wellness 0.48 0.56 0.08 14% 0.74 0.18 24% 35%
1. Physical state 0.25 0.35 0.10 28% 0.65 0.30 46% 61%
2. Mental/Emotional
state
0.38 0.55 0.17 30% 0.75 0.20 26% 49%
3. Stress Evaluation 0.63 0.60 -0.03 - 0.78 0.18 23% 19%
4. Life Enjoyment 0.68 0.75 0.07 9% 0.77 0.02 3% 12%
Overall quality of
life
0.64 0.83 0.19 23% 0.83 0 0 23%
Table 2
Date Physical (P) Mental/Emotional (M/E) Stress Evaluation (S)
1 2 3 4 5 6 7 8 9 10 1 2 3 4 5 6 7 8 9 10 1 2 3 4 5 6 7 8 9 10
31.01.2006 5 5 5 2 5 2 5 4 4 3 4 2 3 4 5 5 2 5 4 1 1 4 3 4 3 3 3 2 1
28.03.2006 5 4 5 2 4 2 5 4 3 2 4 2 2 1 3 4 2 2 5 3 2 1 4 3 4 3 2 3 2 2
10.05.2006 4 3 3 1 2 2 4 3 1 1 3 1 2 3 1 3 1 1 4 1 2 1 2 2 3 3 3 1 1 1
Life Enjoyment (LE) Overall Quality of Life (QoL)
1 2 3 4 5 6 7 8 9 10 11 1 2 3 4 5 6 7 8 9 10 11 12 13 14
31.01.2006 3 3 4 4 5 5 5 2 5 2 3 7 5 3 5 3 6 4 5 7 7 7 7
28.03.2006 4 3 4 4 5 5 5 3 4 4 3 7 7 6 4 6 3 6 6 5 6 7 7 7 7
10.05.2006 4 4 4 4 5 5 5 3 5 3 3 7 7 6 4 5 3 7 7 4 6 7 7 7 7
Figure 4
Results from SRWH Survey after Initial Progress Exam (31/01/06)
4
3.5
2.5
3.727272727
4.857142857
0 1 2 3 4 5 6
Physical
Mental/Emotional
Stress Evaluation
Life Enjoyment
Quality of Life
Figure 5
Results from SRWH Survey after second Progress Exam (28/02/06)
3.6
2.8
2.6
4
6
0 1 2 3 4 5 6 7
Physical
Mental/Emotional
Stress Evaluation
Life Enjoyment
Quality of Life
Depression & Chiropractic
J. Vertebral Subluxation Res. January 31, 2010 5
Figure 6
Wellness Scores
0.00
0.10
0.20
0.30
0.40
0.50
0.60
0.70
0.80
0.90
1.00
Health Domains
Scores
(1) 31.01.2006 0.25 0.31 0.63 0.68 0.75 0.47
(2) 28.03.2006 0.35 0.55 0.60 0.75 0.83 0.56
(3) 10.05.2006 0.65 0.75 0.78 0.77 0.83 0.74
P M/E S LE QoL W
Key:
P - Physical Score
M/E - Mental / Emotional Score
S - Ability to Handle Stress
LE - Life Enjoyment Score
QoL - Quality of Life Score
W - Combined Wellness Score
Depression & Chiropractic
J. Vertebral Subluxation Res. January 31, 2010 6