Your Immune System and Our Services
How We Help Your Health
The conversation about immune function is bigger than COVID-19 infection alone.
A healthy functioning immune system is critical to overall health and wellness. It is vital to the body’s innate ability to seek balance in health sometimes referred to as homeostasis, as Cannon referred to as the ‘Wisdom of the Body”[1].
The conversation that all the experts in public health have been promoting is to use every means available to support one’s immune system during the pandemic. (Adequate sleep, good nutrition, frequent hand washing with soap, etc.) There are other factors to consider as well. For example, the stress every member of the public, first responders, and health care professionals are feeling as a result of the changes in our everyday lives from the global pandemic. This stress is creating unprecedented levels of anxiety, and fear in some. Scientific evidence has validated that long-term exposure to stress negatively effects the immune system.
The issue of anxiety and stress has become so prevalent that the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) have begun promoting information to the public. From the CDC’s website “Stress during an infectious disease outbreak can include:
Among the recommendations to support oneself through the stress includes, ‘take care of your body’.[2] “Psychological conditions, such as stress or depression, are known to compromise immune defenses and increase the likelihood of infections.”[3]
Wayne Jonas, MD in his book, How Healing Works, wrote about the principles of healing, “In condition after condition, system after system, and person after person, I found three common factors that induced healing:
(1) the rituals that helped a person have a meaningful experience,
(2) the support of the whole person, and
(3) the regular stimulation of a biological response.
The specific treatments and agents used varied by person, culture, theory, and place, but the processes were the same. Whole systems science showed us that a person is an ecosystem – more like a garden to be cultivated than a car to be fixed.”[4]
Universal Health Institute supports the whole person.
[1] Ramsay DS, Woods SC. Clarifying the roles of homeostasis and allostasis in physiological regulation. Psychol Rev. 2014;121(2):225-47.
[2] Centers for Disease Control and Prevention. Manage Anxiety & Stress. 2020 March 14, 2020 [cited 2020 March 18, 2020]; A plain language discussion of managing stress with links to other information. Available from: https://www.cdc.gov/coronavirus/2019- ncov/prepare/managing-stressanxiety.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronaviru s%2F2019-ncov%2Fabout%2Fcoping.html.
[3] Wheway J, Mackay CR, Newton RA, et al. A fundamental bimodal role for neuropeptide Y1 receptor in the immune system. J Exp Med. 2005;202(11):1527-38.
[4] Jonas WB. How healing works: get well and stay well using your hidden power to heal. First edition. ed. 2018, California: Lorena Jones Books, Ten Speed Press. ix, 326 pages.
RESEARCH
Your Immune System,
How Chiropractic Care Can Help
“The overall function of the immune system is to prevent or limit infection…The immune system can distinguish between normal, healthy cells and unhealthy cells by recognizing a variety of “danger” cues called danger-associated molecular patterns (DAMPs). Cells may be unhealthy because of infection or because of cellular damage caused by non-infectious agents like sunburn or cancer. Infectious microbes such as viruses and bacteria release another set of signals recognized by the immune system called pathogen-associated molecular patterns (PAMPs)… When the immune system first recognizes these signals, it responds to address the problem. If an immune response cannot be activated when there is sufficient need, problems arise, like infection. On the other hand, when an immune response is activated without a real threat or is not turned off once the danger passes, different problems arise, such as allergic reactions and autoimmune disease.
The immune system is complex and pervasive…All immune cells come from precursors in the bone marrow and develop into mature cells through a series of changes that can occur in different parts of the body.”[13]
Two Pillars of the Immune System The Immune system is built upon two pillars – the innate immunity and adaptive immunity (sometimes referred to as acquired immunity.[14-17]
Innate Immunity is the nonspecific first line of defense in our immune system. Innate has not been sensitized by external actions such as previous infections of vaccinations. It is not stimulated by specific antigens.
Adaptive Immunity, sometimes referred to as acquired or specific immunity is a subset of the immune system that develops very specialized responses as a result of exposure to pathogens. The system creates immunological memory to create an enhanced response to protect if the same pathogen exposure happens at a subsequent time. The adaptive immune system sometimes has challenges distinguishing between harmful and harmless foreign molecules, which is associated with conditions such as hay fever or seasonal allergies.
What is measured to study immune function? Researchers conducting scientific investigation start with a theory or hypothesis and determine what can be measured to gather valid information to answer whether the theory or hypothesis has merit. In looking at immune function, the below are a snapshot of measurements that are used in research to measure issues related to immunity.
A professional librarian conducted a systematic literature of seven databases. Only 18 controlled studies were evaluated based on the a priori criteria. The effects of high velocity, low amplitude spinal manipulation were evaluated. An association between the spinal manipulation and the autonomic nervous system was confirmed through multiple measurers. The authors noted a need for high-quality studies that include patients, well characterized for pain duration and outcome measure baseline values and address the relation between changes in neurophysiology and pain.[26]
In a study of 21 young men with cervical pain and shoulder stiffness but without abnormalities in neck-to-shoulder MR images and without history of any prior treatments were evaluated. An MRI examination of the neck to shoulder area was conducted on all patients. The MR images were used as a reference for the anatomical locations of cervical muscles in the PET imaging. After spinal manipulation, PET imaging was conducted, cervical muscle tension was measured bilaterally at the superior part of the trapezius muscle using a tissue hardness meter and the mean value of three measurements were recorded. Salivary amylase levels were also measured for each subject using an amylase monitor to evaluate changes in autonomic nervous system (ANS) function.
The researchers “observed metabolic changes in the brain and skeletal muscles, as well as reductions in subjective pain, muscle tension, and salivary amylase, after spinal manipulation intervention. These results may be associated with reduced sympathetic nerve activity, suggesting that spinal manipulation induces a kind of relaxation similar to that achieved by biofeedback. The brain response to spinal manipulation may reflect the psychophysiological relaxation that accompanies reduced sympathetic nerve activity.[27]
A 2005 basic science review of chiropractic summarized the state of the science in several areas including the nervous system response to chiropractic spinal manipulation. The review confirmed that between 1997 and 2005 the basic science body of evidence confirming a relationship between chiropractic spinal manipulation and the central nervous system. They concluded, basic science studies support chiropractic theory that spinal subluxation and spinal manipulation impact neurologic function. In addition, the interdependence of nervous, endocrine, and immune systems has been discussed here. These studies suggest mechanisms by which spinal influences may mediate a clinically significant impact on immune function [28]
The Nervous System and the Immune System Cross-Talk “Considerable evidence has mounted to support active communication between the nervous system and the immune system. The nervous system, including the brain and the peripheral divisions can either stimulate or inhibit various activities of both the innate and adaptive immune systems. Conversely, the immune system, through the release of cytokines, can influence the activity of the nervous system. Several excellent reviews have addressed the subjects of nervous and immune system “cross-talk” in great detail. Very recently, however, several peptides, recognized initially for their neural or neuroendocrine signaling functions have been shown to exhibit potent antimicrobial activity. This discovery signals the possibility that the nervous system, through utilization of these peptides, has the capacity to deliver anti-infective agents directly to innervated sites localized with great spatial specificity and delivered rapidly. The nervous and neuroendocrine systems, in principle, have the potential to serve a direct immune function.”[29]
The aforementioned Cramer, et. Al, 2005 review notes, “The central nervous system and immune system share modulator and receptor mechanisms by which the two systems communicate. Their interaction maintains both basal and stress-related homeostasis through two major pathways: the systemic sympathetic nervous system (SNS) and hypothalamic-pituitary-adrenal (HPA) axis… The immune system is now thought to be ‘tuned’ by contrasting neural influences…When internal or external influences disturb homeostasis, both the SNS and HPA axis are activated, thereby increasing the peripheral levels of catecholamines and glucocorticoids to restore the steady state of the internal milieu. The review notes the most extensive body of science regarding chiropractic and the immune system at the time was by Brennan. Two noted findings were that a single spinal manipulation “enhanced polymorphonuclear cell activity that was associated with a slight, but statistically significant, rise in plasma substance P.” In another study they found patients presenting with neuromusculoskeletal complaints had reduced numbers of circulating natural killer cells; but these cells were not functionally impaired.[28]
A 2018 article reporting on the study design of clinical trial designed to provide knowledge regarding the underlying mechanisms of the effects of Spinal manipulation provided the following analysis of the evidence: “Chiropractic care including spinal manipulative therapy (SMT) has been found to be a safe, effective and cost-effective non-invasive treatment for some types of spinal pain. SMT has both local and regional pain reducing effects as well as central nervous system effects such as a general reduction of pain sensitivity. SMT is thought to decrease pain by mechanically affecting muscular and joint function (i.e. normalizing muscle tone and improving joint mobility). However, recent experimental research has suggested that SMT may also be influencing the incoming /ascending pain signals (local nociceptive input affecting dorsal horn excitability or temporal summation) and/or the excitability of the central pain regulating mechanisms. A systematic review concluded that short-term sympathetic upregulation can be found with SMT, regardless of the spinal area being treated. This raises the question of whether the pain reducing effect of SMT is associated with a modulation of autonomic nervous system (ANS) activity.”[30]
The International Chiropractic Association issued this report in April, 2020 and will continue adding to this list of studies that may be of interest to our patients and the greater health community at large.
The following studies include a review of the literature on the effects of spinal adjustment (manipulation) on immune function. The list also includes those studies in which biomarkers which also play a role in immune function are studied.
The review found the studies varied in study design, quality, and outcomes. The conclusion after the review was that a moderate level of evidence existed in the eight studies which found that spinal manipulation influences various biomarkers typically identified as ones not only involved in pain perception/modulation but also play an important role in inflammation, tissue healing and immune response. Studies in the review found that Spinal Manipulation influences various biochemical markers. Spinal Manipulation can increase Substance P, neurotensin, oxytocin and interleukin levels and may influence cortisol levels post-intervention.[32]
There were differences in mediators both within their own start and finish measures as well as between groups. Researchers documented significant differences existing in the levels of the studied chemokines between low back pain patients and the asymptomatic controls. Several of the chemokines studied were significantly augmented in acute low back pain patients when compared to the control patients. The production of one of the measured chemokines, CCL4, was significantly higher in the acute low back pain patients than the chronic low back pain patients at baseline, while the other measurements were not significantly different. Conversely, while the plasma content of sE-selectin varied somewhat between groups, compared with controls, the levels were not significantly different in the acute low back pain group but were significantly elevated in the chronic low back pain group. The outcomes after the two-week intervention period found that the mean chemokine production declined across the board in both groups of low back pain patients while remaining essentially unchanged in the asymptomatic group. The spinal manipulation protocol had no statistically significant effect on the sE-selectin production which remained significantly elevated in chronic low back pain patients and unchanged in the acute patients. This is the first step in evaluating the effect of chiropractic on chemokines and sE-selectin and what the changes may or may not mean in relation to both the inflammatory markers and immune system function. One of the still unanswered questions is whether the decline in certain chemokines production after spinal manipulation produces an immune response that provides a statistically significant level of protection against any or all bacterial or viral infection presentations to the body. Another unanswered question is whether or not a full adjustment, not just one thrust, provides a different response in the chemokine and sE-selectin responses.[33]
It is important to remember that the first forms of evidence, the precursor to formal research, is observation and anecdotal evidence. The observation that those who use chiropractic regularly and do not become ill with colds, flu, and other community shared illnesses is frequent within the profession and should not be ignored. It should instead lay the groundwork for a multi-site research study conducted within ICA Affiliated Chiropractic Colleges to study the whole person, all systems within the body and the health outcomes over time with regular chiropractic care. In this type of study, qualitative and quantitative analysis can take place, including the effects on the immune system. We cannot leave the study of immune function to small, well intentioned studies looking at a single spinal manipulation. We need a replication of what happens in chiropractic routinely. A secondary opportunity is practice-based research networks that can gather credible data for the development of peer-reviewed journal reports.
After the publication of the first edition of this report, the ICA was contacted by academic researchers who suggest that chiropractic colleges do not have the capacity in their research departments to conduct such research. The ICA shares this statement without a qualifier on its merit and notes, that if chiropractic colleges have not yet had the ability to develop this research capacity, then we as a community need to work to grow this capacity and to develop positive affiliations with other academic institutions to achieve the capacity to have well designed clinical and basic science research conducted.
No discussion of immune function and chiropractic can be complete without including the history of chiropractic during the 1918 influenza outbreak known commonly as the Spanish Flu.
Chiropractors are all taught the history of chiropractic including the account prepared by Wayne R. Rhodes, DC in writing about the history of chiropractic in the state of Texas. While this is not a scientific paper, it was published by Dr. Rhodes’ peers in the Texas Chiropractic Association. It is provided for information purposes.
“The 1917 – 1918 influenza epidemic swept silently across the world bringing death and fear to homes in every land. Disease and pestilence, especially the epidemics, are little understood even now and many of the factors that spread them are still mysterious shadows, but in 1917-1918 almost nothing was known about prevention, protection, treatment or cure of influenza. The whole world stood at its mercy, or lack of it.”
He continues, “Chiropractors got fantastic results from influenza patients…” The statistics speak for themselves: In 1918, a time when there were no validated treatments for flu, the epidemic killed millions world-wide. While the below data were gathered by the Osteopathic Association, the data were not prepared in a scientific article and subjected to the peer review process of journals. The information was gathered in Davenport, Iowa, home of Palmer College and reported across the country in meetings and even in newspapers.[42, 43]
Data Provided from the 1918 Spanish Flu Comparing Treatment/Death Numbers | ||||
Location | Patients Treated by Medical Doctors (MDs) | Deaths in Medical Patients | Number of Patients Treated by Doctors of Chiropractic (DCs) | Deaths in Chiropractic Patients |
Davenport, Iowa | 4,953 | 274 | 1,635 | 1 |
State of Iowa | 93,590 | 6,116 (1 in 15 deaths) | (Excluding Davenport)– 4,735 | 6 |
State of Oklahoma | 3,490 | 7 | ||
In Oklahoma, after medical doctors gave up 233 patients as lost, chiropractors were called in with 208 survivors and 25 deaths | ||||
Nationally | 46394 | 54 | ||
New York City Influenza | For every 10,0000 | 950 | For every 10,000 | 25 |
New York City Pneumonia | For every 10,000 | 6400 | For every 10,000 | 100 |
In addition to the above data from the United States, Chiropractic is known to have been used during the 1918 Influenza outbreak in France. Dr. S.T. McMurrain (DC) provided care in the influenza ward of Base Hospital No. 84 in Perigau. The medical officer in charge during the outbreak sent all influenza patients for chiropractic adjustments. The outcomes were so impressive that Dr. McMurrain would be commissioned in the Sanitary Corps. [44]
Chiropractic is a health care discipline which emphasizes the inherent recuperative power of the body to heal itself without the use of drugs or surgery. The practice of chiropractic focuses on the relationship between structure (primarily the spine) and function (as coordinated by the nervous system) and how that relationship affects the preservation and restoration of health. It is founded upon the principle that the body’s innate recuperative power is affected by and integrated through the nervous system.
The current global health crisis surrounding the COVID-19 Pandemic has resulted in changes in our everyday lives and has created increased levels of stress and anxiety, and fear. Scientific evidence has validated that long-term exposure to stress negatively effects the immune system.
As an essential health care provider, the chiropractic doctor is in a unique position to assist their patients during this time of heightened stress. Although there are no clinical trials to substantiate a direct causal relationship between the chiropractic adjustment and increased protection from the COVID-19 virus, there is a growing body of evidence that there is a relationship between the nervous system and the immune system.
Additional References:
13. National Institute of Allergy and Infectious Diseases, National Institutes of Health. Immune System Research – Overview of the immune system. Immune System Research 2013 December 30, 2013 [cited 2020 March 18]; Available from: https://www.niaid.nih.gov/research/immune-system-research https://www.niaid.nih.gov/research/immune-system-overview https://www.niaid.nih.gov/research/immune-response-features https://www.niaid.nih.gov/research/immune-cells https://www.niaid.nih.gov/research/immune-tolerance https://www.niaid.nih.gov/research/immune-system-disorders https://www.niaid.nih.gov/research/research-frontiers-immune-system
14. Turvey SE, Broide DH. Innate immunity. J Allergy Clin Immunol. 2010;125(2 Suppl 2):S24-32.
15. Li G, Yaohua Fan Y, Lai Y, et al. Coronavirus infections and immune responses. J Med Virol. 2020; 92(4):424-32.
16. Margulies DH, Jiang J, Natarajan K. Structure and function of molecular chaperones that govern immune peptide loading. Subcell Biochem. 2019;93:321-37.
17. Lee HS, Belkhadir Y. Damage control: cellular logic in the root immune response. Cell Host Microbe. 2020;27(3):308-10.
18. Schwart M. Protective autoimmunity as a T-cell response to central nervou system trauma: prospects for therapeutic vaccines. Prog Neurobiol. 2001;65(5):489-96.
19. Teodorczyk-Injeyan JA, Sparkes BG, Mills GB, et al. Impairment of T cell activation in burn patients: a possible mechanism of thermal injury-induced immunosuppression. Clin Exp Immunol. 1986;65(3):570-81.
20. Sokol CL, Luster AD. The chemokine system in innate immunity. Perspect Biol. 2015;7(5): a016303. doi: 10.1101/cshperspect.a016303
21. Li, C. and K. Kim, Neuropeptides. WormBook. 2008 Sep 25:1-36. doi: 10.1895/wormbook.1.142.1.
22. Li FX, Xu F, Lin X, et al. The role of substance P in the regulation of bone and cartilage metabolic activity. Front Endocrinol. 2020;11:77. doi: 10.3389/fendo.2020.00077
23. Teodorczyk-Injeyan JA, Injeyan HS, McGregor M, Harris GM, Ruegg R. Enhancement of in vitro interleukin-2 production in normal subjects following a single spinal manipulative treatment. Chiropr Osteopat. 2008;16:5. doi: 10.1186/1746-1340-16-5.
24. Grant MD, Smail FM, Rosenthal KL. Cytotoxic T-lymphocytes that kill autologous CD4+ lymphocytes are associated with CD4+ lymphocyte depletion in HIV-1 infection. J Acquir Immune Defic Syndr.1994;7(6):571-9.
25. Gnatienko, N, Lioznov D, Raj A, et al. Design of a randomized controlled trial to link infectious and Narcology Care (LINC-II) in St. Petersburg, Russia. Addict Sci Clin Pract. 2020;15(1):1. doi: 10.1186/s13722-020-0179-8
26. Wirth B, Gassner A, de Bruin ED, et al. Neurophysiological effects of high velocity and low amplitude spinal manipulation in symptomatic and asymptomatic humans: a systematic literature review. Spine. 2019;44(15):E914-E926.
27. Inami A, Ogura T, Watanuki S, et al. Glucose metabolic changes in the brain and muscles of patients with nonspecific neck pain treated by spinal manipulation therapy: a [(18)F]FDG PET study. Evid Based Complement Alternat Med. 2017:4345703.
28. Cramer G, Budgell B, Henderson C, Khalsa P, Pickar J. Basic science research related to chiropractic spinal adjusting: the state of the art and recommendations revisited. J Manipulative Physiol Ther. 2006;29(9):726-61.
29. Brogden KA, Guthmiller JM, Salzet M, Zasloff M. The nervous system and innate immunity: the neuropeptide connection. Nat Immunol. 2005;6(6):558-64.
30. Galaasen Bakken A, Axén I, Eklund A, O’Neill S. The effect of spinal manipulative therapy on heart rate variability and pain in patients with chronic neck pain: a randomized controlled trial. Trials. 2019;20(1):590.
31. Fidelibus JC. An overview of neuroimmunomodulation and a possible correlation with musculoskeletal system function. J Manipulative Physiol Ther. 1989;12(4):289-92.
32. Kovanur-Sampath K, Mani R, Cotter J, Gisselman AS, Tumilty S. Changes in biochemical markers following spinal manipulation-a systematic review and meta-analysis. Musculoskelet Sci Pract. 2017;29:120-31.
33. Teodorczyk-Injeyan JA, McGregor M, Triano JJ, Injeyan SH. Elevated production of nociceptive CC Chemokines and sE-Selectin in patients with low back pain and the effects of spinal manipulation: a nonrandomized clinical trial. Clin J Pain. 2018;34(1):68-75.
34. Lohman EB, Pacheco GR, The immediate effects of cervical spine manipulation on pain and biochemical markers in females with acute non-specific mechanical neck pain: a randomized clinical trial. J Man Manip Ther. 2019;27(4):186-96.
35. Teodorczyk-Injeyan JA, Injeyan HS, Ruegg R. Spinal manipulative therapy reduces inflammatory cytokines but not substance P production in normal subjects. J Manipulative Physiol Ther. 2006;29(1):14-21.
36. Selano JL, Hightower BC, Pfleger B, Collins KF, Grostic JD. The effects of specific upper cervial adjustments on the CD4 counts of HIV positive patients. Chiropr Res J. 1994;3(1):32-39.
37. Slosberg M. Immune responses to spinal manipulation. In Dynamic Chiropractic. 2011;29(10). https://www.dynamicchiropractic.com/mpacms/dc/article.php?id=55320
38. Zhang L, Yao CH. The physiological role of tumor necrosis factor in human immunity and its potential implications in spinal manipulative therapy: a narrative literature review. J Chiropr Med. 2016;15(3):190-6.
39. Ormos G, Mehrishi JN, Bakacs T. Reduction in high blood tumor necrosis factor-alpha levels after manipulative therapy in 2 cervicogenic headache patients. J Manipulative Physiol Ther. 2009;32(7):586-91.
40. Bolton PS. Reflex effects of vertebral subluxations: the peripheral nervous system. An update. J Manipulative Physiol Ther. 2000;23(7):512-3.
41. Budgell BS. Reflex effects of subluxation: the autonomic nervous system. J Manipulative Physiol Ther. 2000;23(2):104-6.
42. Advertisement, What Chiropractic Really Does, in The News Democrat. 1919: Paducah, KY. p. 5.
43. McKay HJ. Spanish Influenza, in The Ogden Standard. 1920: Ogden, Utah. p. 9.
44. Rhodes WR. The official history of chiropractic in Texas. 1978, Austin: Texas Chiropractic Association. 188 p.
Thank you to the International Chiropractic Association for providing this information for all.