There are various forms of research, and some of the most rigorous are in the form of randomized controlled studies. In such studies, the doctor and patient are blinded to an intervention, there is a control group, and often a sham comparative intervention is used. These types of studies are very expensive and challenging to perform and are not conducive to the study of manual therapy interventions such as chiropractic. While our chiropractic academic community struggles with obtaining funds for these types of studies and figuring out the best study designs that can yield the most clinically useful information, the case report remains what doctors in clinical practice have to share findings. Since 2009. the Sacro Occipital Technique" Organization - USA has held annual Sacro Occipital Technique Research Conferences. Most of the presentations are case reports from doctors predominately in clinical practice. Major Bertrand DeJarnette. DO. DC. the developer of sacro occipital technique, felt research was an essential part of being a chiropractor and necessary for the future of the chiropractic profession. As early as July 1935. Major DeJarnette was a featured speaker presenting clinical research at the 40th Anniversary Convention 1895-1935 of the National Chiropractic Association. Research was always his passion, and in an interview in 1982. DeJarnettc reiterated. "As far back as chiropractic college. I saw the need fora more scientific basis for chiropractic theory. My own personal physical problems had not been solved by medicine, osteopathy, or chiropractic: so I began experimenting on myself. I'm still at it. and I can see no end of the need for continuous research in chiropractic1." "Research in chiropractic must go on forever. Someone must do this type of work, for it simply will not take care of itself. A profession cannot stand still. Momentum must constantly be generated. Chiropractic research needs many things it docs not now have2." DcJarncttc concluded that. "We must respect each other's beliefs. We must support our colleges and associations. We must work together and unite as a profession. And we must at all times be proud of chiropractic and proud of our calling as chiropractors1."" With all of this in mind. I wish to share clinical case studies from these conferences so that they may spark an interest in a topic and help a doctor treat a specific clinical presentation. I also hope it encourages a doctor who has treated an interesting case to share this with the whole chiropractic community in the form of a published case report. In this article, we will review three studies from the first Sacro Occipital Technique Research Conference in 2009. During the course of sharing these articles, there also will be a focus on discussing specific terminology so we can better place case reports in their proper place in the development of evidence-based practice for the chiropractic profession. Case Report #1: Sacro occipital technique, stability testing, and tai chi or yoga: A case report. Both yoga and tai chi can help patients with specific joint difficulties to find ways of performing exercise at their personal limits and still develop improved flexibility and stability. A 65-> car-old female presented with generalized back and neck pain. She noted that when performing tai chi and yoga, she could not accomplish movements that included flexion at the hip while standing. Evaluation demonstrated a sacroiliac joint hypcrmobility syndrome and treatment focused on supine pelvic block placement with functional reassessments. Follow ing the first office visit for this condition, the patient immediately demonstrated a well-balanced "tree pose." but could only accomplish the kicking portion of the tai chi movement when sacroiliac trochantcr belt was applied. Study Implications: Utilizing yoga and tai chi postures may help a patient determine when chiropractic care may be appro- priate and sets up a patient-drh en healthcare interaction, which is preferable to both doctor and patient. Case Report #2: Alterations of dyspeptic signs and symptoms on patients presenting with gastro-esophageal reflux disease receiving chiropractic treatment. Know ledge on the incidence. prevalence, and natural history of gastrocsophageal rcllux disease (GERD) is limited. The objective of this study was to investigate the alterations of dyspeptic signs and symptoms in patients presenting with GERD following chiropractic treatment. The study sample was composed of 10 individuals sent for chiropractic treatment by a gastroenterologist surgeon. A high digestive endoscopv exam was performed on all individuals before and after eight sessions of chiropractic manipulative reilex technique (CMRT) treatments. A GERD symptom questionnaire and the results from high digestive endoscopv exams were used to evaluate dyspeptic signs and symptoms. At the end of chiropractic treatment, a statistically significant global reduction of GERD symptoms was observed (p=0.0002), especially on the evaluation of prc and post-treatment postprandial pyrosis data (p=0.000004). Through endoscopic examina- tions on the 10 patients, the findings noted a 58% improvement of esophagitis caused by GERD. Study Implications: These types of studies help support chiropractic care of nonniusculoskclctal conditions and suggest that chiropractic may affect reflex responses of the autonomic nervous system, which in turn may alter visceral functioning. Case #3: Sacro occipital technique, cranial technique, "faux" fibronn algia syndrome, and self-reported improvement in vision: A report of four patients. This case series includes reviews of four patients who presented previously as diagnosed with fibromyalgia syndrome (FMS). Based on the patients" response to care, the patients were later rediagnosed as having a condition better described as a fibromyalgia mimicry or "faux fibromyalgia" syndrome (FFMS). Treatment consisted of category two (sacroiliac joint instability) analysis and treatment. SOT1 extremity techniques, and cranial sutural analysis and treatment. Weeks later, as the patient's symptoms stabilized, therapy rehabilitative exercises were employed using therapeutic bands and a "rcboundcr." Within six weeks of SOT and cranial care, symptoms resoh eel for these four patients to the point that, as long as they were within a few days of receiving care, they were asymptomatic. As their FFMS symptoms resolved a concurrent improvement in vision that involved improved acuity or color discernment. Study Implications: As study increases in chiropractic myo-fascial and neurological relationships, we may better gain a grasp of why some patients presenting with musculoskclctal conditions may have simultaneous, self-reported positive non-musculoskelctal results, such as an improvement of vision. I hope to share regular updates of articles that have been presented at the SOT" research conferences as a means to stimulate thought, offer some clinical insights, and suggest avenues for further research and exploration. References: 1. DcJarnette MB. Cornerstone. The American Chiropractor. Jul/ Aug 1982:82:22.23.28.34. DcJarnette MB. The History of Sacro Occipital Technic. Pri vately Published: Nebraska City. NB. 1958:27. BarrTM. Sacro occipital technique, stability testing, and tai chi or yoga: A case report. 1st Annual Sacro Occipital Technique Research Conference Proceedings: Las Vegas. NV. 2009: 8-11. Dal Bcllo F. Dal Bcllo V. Santos LN. Raupp JM. Alterations on dyspeptic signs and symptoms on patients presenting with gas- trocsophageal reflux disease receiving chiropractic treatment. 1st Annual Sacro Occipital Technique Research Conference Proceedings: Las Vegas. NV. 2009: 22-3. Kicrstyn S. Blum CL. Sacro occipital technique, cranial technique, "faux" fibromyalgia syndrome and self-reported improvement in vision: A report of four patients. 1st Annual Sacro Occipital Technique Research Conference Proceedings: Las Vegas. NV. 2009:48-51. Charles L. Blum. IX* is in private practice Santa Monica, California, director of research for Sacro Occipital Technique Organization - USA, adjunct research faculty at Cleveland Chiropractic College and teaches the Sacro Occipital Tech- nii/iie (SOT) elective class al Palmer C \>llege qfC liiropractic - West and Southern California University of Health Sciences.
