Abstract
BackgroundFew manual chiropractic high velocity, low amplitude (HVLA) type shams have been validated in research. The proposed project is a randomized controlled trial (RCT) designed to assess a novel, full-spine, manual sham chiropractic maneuver and its blinding success.
ObjectiveThis study aims to evaluate the blinding integrity of participants receiving a genuine or sham chiropractic maneuver. We will also be evaluating the effects of genuine chiropractic treatments relative to sham chiropractic treatments by measuring several neurophysiological mechanisms.
MethodsParticipants (N=60) will be recruited from in and around Marietta, Georgia, United States. They will undergo a chiropractic physical exam and health history review with a licensed chiropractor and be randomized to either a sham or genuine chiropractic group (1:1 ratio). Participants, outcome assessors, and data analysts will be blinded to group allocation. The genuine group will receive diversified HVLA chiropractic spinal manipulative therapy (SMT), while the sham group will receive a novel chiropractic HVLA-emulating therapy. Each participant will attend 2 sessions spaced 1 week apart. Assessments will consist of blinding surveys postsessions (both visits) and presession (second visit). Additionally, we will measure gait parameters. The primary outcome of interest is blinding measured via the Bang Blinding Index (Bang BI). Secondary aims include measuring blinding via the James Blinding Index (James BI) and exploring the potential differential effects of genuine versus sham SMT on gait parameters.
ResultsThis study is being supported and internally funded by the Dr. Sid E. Williams Center for Chiropractic Research at Life University in Marietta, Georgia, United States. Our study was prospectively registered on clinicaltrials.gov (NCT06931600) on March 28, 2025, and the first participant was enrolled on May 5, 2025. As of December 10, 2025, 18 participants have completed the trial. Projections for completing data collection, data analysis, and manuscript submission are Summer 2026, Fall 2026, and Winter 2027, respectively.
ConclusionsThe significance of the current RCT will be in its ability to inform whether our novel, full-spine, manual sham SMT protocol successfully blinds participants, suggesting feasibility for future clinical trials, as well as assessing for secondary outcome measures between groups.
Medicine, Computer applications to medicine. Medical informatics
This article examines the vitalistic (holistic) foundation of modern complementary and alternative medicine (CAM). It substantiates that, according to the principles of holistic medicine, health is associated with the harmonization of the elements and forces that constitute human nature on both the physical and spiritual levels of existence. Regarding the religious foundations of CAM practices of Eastern origin, the systems such as yoga, Daoism, and Ayurveda perceive energy as an impersonal force that an individual can accumulate, balance, and influence through physical and spiritual exercises to achieve health, longevity, and personal self-improvement. These systems are vitalistic, as they recognize impersonal energy as the fundamental basis of existence. In contrast, the conceptual foundation of CAM practices of Western origin differs fundamentally from Eastern approaches. These practices are not rooted in Christianity, despite having emerged in countries belonging to Christian civilization. This is because, in Christianity, the source of existence is God-Person, which significantly diminishes the ontological status of impersonal energy. As a result, Western CAM practices have developed an instrumental approach to vitalistic methods, adapting many Eastern techniques to the Western cultural and anthropological context. Additionally, they are based on various personal quasi-scientific systems, such as Mesmer’s magnetism, Hahnemann’s home-opathy, Palmer’s chiropractic methods, and others. To an external observer, these methods may appear impressive. However, whether a physician chooses to incorporate them into their practice depends entirely on their personal experience and convictions.
History (General) and history of Europe, Philosophy. Psychology. Religion
Vaughan Thompson, Caroline Hay, Christopher Yelverton
et al.
Background: One variation of the atlanto-occipital joint contains a groove or crest dividing the superior articulating facet of C1 and/or the corresponding occipital condyle. This study aimed to estimate the prevalence of bipartition of the facets associated with the atlanto-occipital joint and to determine the relationships between the corresponding joint surfaces, bilateral and unilateral facets as well as demographic factors in a South African sample. Materials and methods: Data about shape and bipartition found on the superior articular facets of the atlas and the occipital condyles were collected from 109 skulls and atlases from the Pretoria Bone Collection, South Africa. Shape data was categorically classified according to existing criteria from literature. Results: The results revealed the occasional occurrence of a double facet at both the superior articular facet of the atlas (15.6 %), and the occipital condyle (7.34 %). Shape and facet number of the superior articulating facet and corresponding occipital condyle were significantly correlated. The prevalence of bipartition of neither the superior articular facets nor the occipital condyles were statistically significantly different between the left and right sides. Sex and age did not statistically significantly contribute to prevalence of bipartition in this population. However, population group statistically significantly contributed to prevalence of bipartition (p = 0.019), with the White South African sample having a much higher prevalence (88.24 % superior articulating facet, 100 % occipital condyle) of bipartition compared to the Black South African sample (11.76 % superior articular facet, 0 % occipital condyle). Conclusion: Awareness of this joint variation and instances where it is more likely to occur may be valuable for neuro-vascular and orthopaedic surgeons when doing invasive treatments around the craniocervical junction, and chiropractors when assessing and treating patients.
BackgroundRadiculopathy can be a debilitating condition. Amniotic membrane/umbilical cord (AM/UC) particulate is a relatively new injectable treatment modality. Herein we report the outcomes of epidural injection of AM/UC particulate in managing lumbar radiculopathy.MethodsConsecutive patients with lumbar radiculopathy who received epidural injection of AM/UC particulate for lumbar radiculopathy were included. Primary outcome was change in pain as measured by the 11-point numerical rating scale. Safety was assessed by AM/UC- and procedure-related complications. Paired t-tests were used to determine statistical significance.ResultsA total of 12 patients with a mean age of 56.7 ± 21.0 years were included in the analysis. The patients were previously treated with physical therapy (91.7%), chiropractic corrective measures (16.7%), epidural steroid injection (83.3%), and radiofrequency ablation (8.3%). Two patients (16.7%) were taking opioids for chronic pain syndrome. After AM/UC injection, the average pain score decreased from 6.6 ± 1.5 to 5.2 ± 1.9 at 1–3 months, 2.0 ± 1.4 at 6 months, and 2.9 ± 1.4 at last mean follow-up of 21.3 ± 11.1 months (p < 0.001). No patients required subsequent treatment or surgery. There were also no complications.ConclusionThis case series supports the preliminary safety and shows potential benefit of epidural AM/UC particulate injection in this cohort of patients with lumbar radiculopathy pain.
Robert J. Trager, Timothy J. Williamson, Pratheek S. Makineni
et al.
ABSTRACT Background and Aims Butalbital is an acute headache medication commonly prescribed for tension‐type headache (TTH), although discouraged by guidelines due to a risk of medication overuse headache (MOH). Considering spinal manipulative therapy (SMT) may reduce TTH frequency and intensity, we hypothesized adults with TTH receiving chiropractic SMT would be less likely to receive a butalbital prescription over 2 years versus matched controls not receiving SMT. We secondarily compared likelihood of MOH between cohorts. Methods We searched a United States medical records database of patients attending academic medical centers for adults with TTH, from 2013 to 2024, excluding those diagnosed with other headaches and seen in inpatient/emergency settings. We divided patients into two cohorts: (1) SMT and (2) non‐SMT, using propensity matching to control for demographics and other variables associated with likelihood of butalbital prescription and MOH. Results Three thousand one hundred and sixteen patients remained per cohort after matching. The incidence of butalbital prescription was lower in the SMT cohort compared to the non‐SMT cohort (SMT: 1.7%; non‐SMT: 3.8%), yielding an RR (95% CI) of 0.46 (0.33–0.63; p < 0.001). The incidence of MOH was lower in the SMT cohort versus non‐SMT cohort (SMT: 0.5%; non‐SMT: 1.2%), yielding an RR (95% CI) of 0.44 (0.25–0.80; p < 0.001). Conclusion Adults receiving chiropractic SMT had a significantly lower likelihood of butalbital prescription and, tentatively, MOH compared to matched controls not receiving SMT. These findings support current guideline recommendations favoring SMT in TTH care, though future studies should replicate and compare these findings with other nonpharmacologic clinicians and interventions.
In this study, the effect of the combination of mat and equipment-based Pilates exercise method applied to sedentary female individuals on fatigue and physical self-perception was examined. 70 women between the ages of 18 and 45, defined as sedentary according to the International Physical Activity Questionnaire, were included in the study. Participants were randomized into combined Pilates exercise (PG=35) and control (CG=35) groups. Pilates exercises were given three days a week, 50 minutes each session, for 10 weeks. No intervention was made to CG. Fatigue Severity Scale and Physical Self Inventory evaluations were repeated for pre- and post-intervention (10th week). The initial data of the participants showed a homogeneous distribution. In the results, in intragroup comparison, a statistically significant improvement in fatigue severity (p=0.001; p
Abstract Background Trauma is an emotional response to distressing events where coping and subsequent recovery are absent. Adverse Childhood Experiences (ACEs) are traumas, occurring before the age of 18 years, such as child abuse or neglect, caregiver instability, and household dysfunction. Sixty-four percent of the U.S. population report experiencing at least one ACE, with over 1 billion children experiencing abuse and neglect annually worldwide. Chronic exposure to stressful circumstances or multiple traumatic events has negative physiologic impacts. Persons who experience 3 or more ACEs in childhood are at greater risk of poor mental health outcomes and may be more likely to engage in high-risk behaviors, predisposing them to long-term health impacts, such as metabolic diseases, anxiety, depression, substance use, and chronic pain. Trauma informed care (TIC) is a recommended approach to healthcare delivery across professions, especially when a trauma history is suspected. This commentary aims to increase awareness of the impact of ACEs on health outcomes and introduce TIC concepts as they may apply to chiropractic care for adults with a history of ACEs. Discussion This commentary reviews an introductory model (4R's: realize, recognize, respond, resist re-traumatization) as one TIC framework used by healthcare practitioners. Prior trauma can lessen trust, alter perceptions of physical touch, and hands-on examinations and chiropractic treatments may trigger stress responses. Using TIC after appropriate training, includes referrals to multidisciplinary providers to address trauma-related concerns outside the scope of chiropractic, and screening for ACEs if deemed appropriate. Creating safe spaces, communicating clearly, avoiding victimizing language, explaining procedures, asking for consent before physical contact, and giving patients choice and control in their own care may avoid triggering prior traumas. Conclusion Given the high worldwide prevalence of persons experiencing 3 or more ACEs, TIC principles are practical adaptations to chiropractic care for use with many patient populations. As TIC and ACEs are emerging concepts within chiropractic, students and practitioners are encouraged to undertake additional training to better understand these complex and sensitive topics. Exploratory research on the incidence, presentation, and impacts of various trauma types, including ACEs, to support adoption of TIC in chiropractic settings is essential.
Chiropractic, Diseases of the musculoskeletal system
This case report discusses the treatment of brachioradial pruritus (BRP) in a 57-year-old white male veteran with chiropractic and acupuncture. The patient presented with findings consistent with a diagnosis of BRP to include sharp pain, burning, and itching at the bilateral upper extremities over the C5 and C6 dermatomes with acquired excoriations over the affected regions. The only known palliative measure was applying icepacks. Plain film radiographs revealed mild degenerative change at the C4–C5 and C5–C6 levels and postural evaluation observed anterior head carriage with forward-rounded shoulders. He had pain upon palpation and motion restriction in the cervical spinal region. His trial of treatment consisted of manual cervical and thoracic spinal manipulation, manual cervical traction, prescription of a home exercise program, and acupuncture. At the conclusion of this trial, the patient’s symptoms resolved and his acquired excoriations began to show signs of healing. A proposed etiology of BRP is cervical spine disease. There are limited case reports and retrospective studies in the literature that examine conservative care options targeting cervical spinal disease for the treatment of BRP. This case study reviews a patient diagnosed with BRP and confounding cervical spine disease who was treated with chiropractic and acupuncture, experiencing relief from his symptoms.
Karthik V. Hariharan, Michael G. Timko, Christopher G. Bise
et al.
Abstract Objective The objective of this study was to establish the level of inter-examiner reliability for six common cervical manual and physical examination procedures used to assess the cervical spine. Materials: Reliability study that used a convenience sample of 51 patients between the ages of 16–70 years presenting with a chief complaint of neck pain. Two physical therapists independently performed the same series of cervical physical examination procedures on each of the participant. The clinicians were blinded to each other’s findings and the clinical status of the patient. Kappa coefficients (κ) were calculated for levels of agreement between the clinicians for each procedure. Results When assessing for asymmetrical motion, excellent levels of reliability (κ range: 0.88–0.96) were observed for the Bilateral Modified Lateral Shear (asymmetry criterion), Bilateral C2 Spinous Kick (asymmetry criterion) and Flexion-Rotation Tests. When pain provocation was used as the indicator of a positive test during palpation of the cervical facet joints, moderate to substantial levels of reliability (κ range: 0.53–0.76) were observed. When patients were instructed not to provide feedback to the clinicians about pain provocation during facet joint palpation and clinicians relied solely on their qualitative assessment of segmental mobility, the level of reliability was lower (κ range: 0.45–0.53). Due to 100 % prevalence of negative findings, Kappa values could not be calculated for the Sharp-Purser test or the Unilateral C2 Spinous Kick Test. Conclusions Most physical examination procedures examined in this study demonstrated moderate to excellent levels of inter-examiner reliability. Palpation for segmental mobility without pain provocation demonstrated a lower level of reliability compared to palpation for pain provocation. Correlation with clinical findings is necessary to establish validity and the applicability of these procedures in clinical practice.
Chiropractic, Diseases of the musculoskeletal system
Ernest R. Vina, Ada O. Youk, Cristian Quinones
et al.
Objective To evaluate race and gender variations in complementary and alternative medicine (CAM) use for knee osteoarthritis (OA) (unadjusted and adjusted for demographic and clinical factors). Methods A secondary analysis of cross‐sectional data was conducted. The sample included Veterans Affairs patients 50 years of age or older with symptomatic knee OA. Current use of various CAM therapies was assessed at baseline. Logistic regression models were used to compare race and gender differences in the use of specific CAMs. Results The sample included 517 participants (52.2% identified as African American [AA]; 27.1% identified as female). After adjusting for demographic and clinical factors, AA participants, compared with white participants, were less likely to use joint supplements (odds ratio [OR]: 0.53; 95% confidence interval [CI], 0.31‐0.90]); yoga, tai chi, or pilates (OR: 0.39; 95% CI: 0.19‐0.77); and chiropractic care (OR: 0.51; 95% CI: 0.26‐1.00). However, they were more likely to participate in spiritual activities (OR: 2.02; 95% CI: 1.39‐2.94). Women, compared with men, were more likely to use herbs (OR: 2.42; 95% CI: 1.41‐4.14); yoga, tai chi, or pilates (OR: 2.09; 95% CI: 1.04‐4.19); acupuncture, acupressure, or massage (OR: 2.45; 95% CI: 1.28‐4.67); and spiritual activities (OR: 1.68; 95% CI: 1.09‐2.60). The interactive effects of race and gender were significant in the use of herbs (P = 0.008); yoga, tai chi, or pilates (P = 0.011); acupuncture, acupressure or massage (P = 0.038); and spiritual activities (P < 0.001). Conclusion There are race and gender differences in the use of various CAMs for OA. As benefits and limitations of CAM therapies vary, clinicians must be aware of these differences.
Melissa Corso, Carol Cancelliere, Silvano Mior
et al.
Abstract Introduction The safety of spinal manipulative therapy (SMT) in children is controversial. We were mandated by the College of Chiropractors of British Columbia to review the evidence on this issue. Objectives We conducted a rapid review of the safety of SMT in children (< 10 years). We aimed to: 1) describe adverse events; 2) report the incidence of adverse events; and 3) determine whether SMT increases the risk of adverse events compared to other interventions. Evidence review We searched MEDLINE, CINAHL, and Index to Chiropractic Literature from January 1, 1990 to August 1, 2019. We used rapid review methodology recommended by the World Health Organization. Eligible studies (case reports/series, cohort studies and randomized controlled trials) were critically appraised. Studies of high and acceptable methodological quality were included. The lead author extracted data. Data extraction was independently validated by a second reviewer. We conducted a qualitative synthesis of the evidence. Findings Most adverse events are mild (e.g., increased crying, soreness). One case report describes a severe adverse event (rib fracture in a 21-day-old) and another an indirect harm in a 4-month-old. The incidence of mild adverse events ranges from 0.3% (95% CI: 0.06, 1.82) to 22.22% (95% CI: 6.32, 54.74). Whether SMT increases the risk of adverse events in children is unknown. Conclusion The risk of moderate and severe adverse events is unknown in children treated with SMT. It is unclear whether SMT increases the risk of adverse events in children < 10 years.
Chiropractic, Diseases of the musculoskeletal system
Mariana Tedeschi Benatto, Lidiane Lima Florencio, Marcela Mendes Bragatto
et al.
Abstract Background Migraine is a highly disabling condition and pharmacological treatment is the gold standard. However, several patients have also positive responses to the application of different manual techniques and therapeutic exercises in terms of reducing the intensity and frequency of migraine attacks. Nevertheless, the effects of a neck-specific exercise program have not yet been evaluated in these patients. Objective To determine the effectiveness of a neck-specific exercise program in reducing the intensity and frequency of migraine attacks as compared to a sham ultrasound group. Methods A two-armed, parallel-groups randomized controlled trial with 3 months of follow-up will be conducted. 42 individuals, both genders, aged between 18 and 55 years old with a medical diagnosis of migraine will be included. The intervention group will perform a protocol consisting of exercises for strengthening the muscles of the cervical spine. Participants within the sham ultrasound group will receive detuned ultrasound therapy in the upper trapezius muscle. Both groups will receive a weekly session for 8 weeks. The efficacy of each intervention will be measured by the frequency and intensity of migraine at a 3-months follow-up. Trial registration This study was registered under access code RBT-8gfv5j in the Registro Brasileiro de Ensaios Clínicos (ReBEC) in November 28, 2016. Conclusion This study will aim to determine the efficacy of a neck-specific exercise program in reducing the frequency and intensity of migraine attacks. If the results show that a neck-specific exercise program is effective in reducing the frequency and intensity of migraine attacks, therapists will have a low cost and easily applicable tool to treat migraine.
Chiropractic, Diseases of the musculoskeletal system
Louise Fleng Sandal, Cecilie K. Øverås, Anne Lovise Nordstoga
et al.
Abstract Background Very few of the publicly available apps directed towards self-management of low back pain (LBP) have been rigorously tested and their theoretical underpinnings seldom described. The selfBACK app was developed in collaboration with end-users and clinicians and its content is supported by best evidence on self-management of LBP. The objectives of this pilot study were to investigate the basis for recruitment and screening procedures for the subsequent randomized controlled trial (RCT), to test the inclusion process in relation to questionnaires and app installation, and finally to investigate the change in primary outcome over time. Methods This single-armed pilot study enrolled 51 participants who had sought help for LBP of any duration from primary care (physiotherapy, chiropractic, or general practice) within the past 8 weeks. Participants were screened for eligibility using the PROMIS-Physical-Function-4a questionnaire. Participants were asked to use the selfBACK app for 6 weeks. The app provided weekly tailored self-management plans targeting physical activity, strength and flexibility exercises, and education. The construction of the self-management plans was achieved using case-based reasoning (CBR) methodology to capture and reuse information from previous successful cases. Participants completed the primary outcome pain-related disability (Roland-Morris Disability Questionnaire [RMDQ]) at baseline and 6-week follow-up along with a range of secondary outcomes. Metrics of app use were collected throughout the intervention period. Results Follow-up data at 6 weeks was obtained for 43 participants. The recruitment procedures were feasible, and the number needed to screen was acceptable (i.e., 1.6:1). The screening questionnaire was altered during the pilot study. The inclusion process, answering questionnaires and app installation, were feasible. The primary outcome (RMDQ) improved from 8.6 (SD 5.1) at baseline to 5.9 (SD 4.0) at 6-week follow-up (change score 1.8, 95% CI 0.7 to 2.9). Participants spent on average 134 min (range 0–889 min) using the app during the 6-week period. Conclusion The recruitment, screening, and inclusion procedures were feasible for the subsequent RCT with a small adjustment. The improvement on the RMDQ from baseline to follow-up was small. Time pattern of app usage varied considerably between the participants. Trial registration NCT03697759. Registered on August 10, 2018. https://clinicaltrials.gov/ct2/show/NCT03697759
Jordan A. Gliedt, Patrick J. Battaglia, Benjamin D. Holmes
Abstract Background Spine related disorders entail biological (somatic), psychological, and social factors. Though biological factors are often emphasized, psychosocial considerations may not be receiving proper attention in the chiropractic field. Chiropractors treat spine complaints and therefore should be trained in the full spectrum of the biopsychosocial model. This study examines the use of psychosocial related terminology in United States doctor of chiropractic program (DCP) curricula, the Council on Chiropractic Education (CCE) standards, and the National Board of Chiropractic Examiners (NBCE) test plans. Methods Nineteen academic course catalogs, CCE curricular standards and meta-competencies, and NBCE test plans were studied. Terms containing “psycho”, “soci”, “mental”, “econom”, “cultur”, “emotion”, “determinant”, “public”, “communit”, “neighbor”, “behav”, or “cognitive” were identified in each document. Frequency of use, context of use, thematic categorization, and percentage of use compared to overall content were calculated and described. Results ‘Public’ is the most commonly used psychosocial related term in DCP curricula. ‘Determinant’ was used in 1 DCP curriculum. The number of courses with psychosocial related terminology in course titles and course descriptions ranged from 1 to 5 and 3 to 12, respectively. Most terms are found in clinical skills, special populations, and other miscellaneous courses, with fewer terms found in psychology and public health courses. Terminology use in course titles and descriptions compared to overall content ranges from 3.40 to 14.86%. CCE uses terminology 17 times across 5 (out of 8) total meta-competencies. NBCE includes terminology in test plans I and II, but not III or IV. Conclusions Despite evidence suggesting the influential role of psychosocial factors in determinants of health and healthcare delivery, these factors are poorly reflected in United States DCP curricula. This underappreciation is further evidenced by the lack of representation of psychosocial terminology in NBCE parts III and IV test plans. The reasons for this are theoretical; lack of clarity or enforcement of CCE meta-competencies may contribute.
Chiropractic, Diseases of the musculoskeletal system
Casper Glissmann Nim, Henrik Hein Lauridsen, Søren O’Neill
et al.
Abstract Background The chiropractic profession is split between those practicing evidence-based and those whose practice is honed by vitalism. The latter has been coined ‘chiropractic conservatism’. In Denmark, the chiropractic education program is university-based in close collaboration with a medical faculty. We wanted to investigate if such conservative attitudes were present in this environment. Our objectives were to i) determine the level of chiropractic conservatism, ii) investigate if this was linked to academic year of study, iii) determine the level of clinical appropriateness, and iv) to investigate if this was affected by the level of conservatism among students in a chiropractic program, where the students are taught alongside medical students at the University of Southern Denmark (SDU). Methods A cross-sectional survey of 146 (response-rate 76%) 3rd to 5th year pre-graduate students and 1st year postgraduate clinical interns from the chiropractic degree course at the University of Southern Denmark was conducted during autumn of 2019. The students’ levels of conservatism were dichotomized into appropriate/inappropriate, summed up, and used in a linear regression model to determine the association with academic year of study. Thereafter, the conservatism score was categorized into four groups (from low -1- to high -4-). Conservatism groups were cross-tabulated with the ability to answer appropriately on nine cases concerning i) contra-indications, ii) non-indications, and iii) indications for spinal manipulation and analyzed using logistic regression. Results Generally, the Danish chiropractic students had low conservatism scores, decreasing with increasing academic year of study. Seventy percent of the students were placed in the two lowest conservative groups. The level of conservatism (categories 1–3) was moderately (but not statistically significantly) associated with an inability to recognize non-indications to treatment. Three outliers (category 4), however, revealed a highly inappropriate handling of the clinical cases. Conclusions Chiropractic students enrolled at a university-based course closely integrated with a medical teaching environment are not immune to chiropractic conservatism. However, the course appears to attenuate it and limit its effect on clinical decision-making compared to other educational institutions.
Chiropractic, Diseases of the musculoskeletal system
In 2018, I performed a Chiropractic Sessions research—through ICMBIO's volunteer program—with ICMBIO and IBAMA PREVFOGO Firefighters from Chapada dos Veadeiros National Park in the state of Goiás totalizing 111 firefighters. The goal was to use Chiropractic to improve their Quality of Life and better adapt them to develop a higher performance in action (putting down forest fires). The Chiropractor is a health technician specialized in the spinal that is dedicated on minimizing and correcting spinal subluxations(blockages in the central nervous system) to help improve the functioning of the body as a whole (immunity and performance improvements, better adaptation to any kinds of stress). A worldwide validated, quality of life questionnaire (WHOQOL) was applied at the beginning and ending and the data was tabulated. The graphics show that, in general, the 4 domains evaluated in the WHOQOL questionnaire had a better result (physical, psychological, social relations and environment) after chiropractic ajustments.