What is Parkinson's disease (PD) according to medical science? PD is a progressive neurological condition affecting movements such as walking, talking and writing. PD has three main symptoms which are tremor, muscle and limb rigidity & stiffness and slowness of movement. Other symptoms include loss of balance, constipation, tingling & prickling sensations in the limbs, tiredness and depression. However, the tiredness and depression I contend are as a result of contracting the disease and not a symptom of the disease. According to American Parkinson Disease Association Inc.[1] "Parkinson's disease is caused by the degeneration of the pigmented neurons in the Substantia Nigra of the brain, resulting in decreased dopamine availability." It is this decreased dopamine phenomena which is the focus of much of the current research and the target for therapeutic drug intervention. There would, however, appear to be other treatment alternatives which need to be investigated.

One particular doctor Fernandez Noda[2] has done some work which really interests me and I contend his work confirms that injury to the cervical spine as I describe on my website is a major contributor to the development of PD if not the main causal factor in the disease. If this is the conclusion then maybe upper cervical chiropractic can help people with Parkinson’s disease? The first paper I would like to refer to by Fernandez Noda and Lopez[3] in 1984 which describes a surgical technique for a condition referred to as thoracic outlet syndrome (TOS) in later papers cerebellar thoracic outlet syndrome (CTOS) and cerebral thoracic neurovascular syndrome (CTNVS). The doctors carried out surgery on 71 patients presenting with TOS which “the signs and symptoms are considered to be caused by neurovascular compression through boney, muscular or ligamental structures in the thoracic outlet.” Reported symptoms include paresthesias (tingling, prickling, burning-abnormal sensations), pain, weakness, dizziness, transient blindness, fainting and coldness in fingers/hands/face. The paper discusses complete (100%) removal of the signs and symptoms following division/section of the anterior scalene muscle compressing neurological and vascular structures in the region (thoracic outlet just above the clavicle), with no recurrence of symptoms.

In another paper Fernandez Noda et al[4] conclude that “Parkinson’s disease is a complication of CTOS, caused by insufficient irrigation of the dopamine producing cells and subsequent reduction of dopamine secretion.” Using a surgical technique to perform a division of the scalene muscles (scalenotomy) in order to remove neurovascular compression the authors achieved excellent results with 5% of patients reported completely cured of Parkinson’s symptoms and a further 80% showing significant improvement and able to reduce their dependence on medication. The authors state “After operation, these patients continue to take anti-Parkinson drugs etc. in progressively decreasing quantities until symptoms abate and further medication is unnecessary.” Further they conclude “compression is produced by the anterior scalene muscles and the cervical ribs at the level of C6-7. The faulty irrigation of the cerebellum and cerebral cells produces CTOS and its complications, notable among which are ipsilateral paralysis and Parkinson’s disease.”

A single case report by Sell et al[5] discusses a “tight anterior scalene muscle” resulting in “entrapment of the left vertebral artery” about 2cm from its origin when the patient turned her head to the left. If the patient turned her head “excessively to the left” she would present with, amongst other brain stem symptoms, “global binocular blindness” which would “quickly return to normal when she turned her head to the right”. The surgeons discovered that the scalene muscles (anterior and middle) were also compressing the lower cord of the brachial plexus. These muscular compressions of neurovascular structures are important in forming the conclusion that upper cervical chiropractic can and does assist in relief on CTOS symptoms and more than likely Parkinson’s disease symptoms.

Fernandez Noda et al[6] paper describes “the role of compression of the vertebral, subclavian arteries, internal mammary, internal carotid arteries, brachial plexus and coiling and kinking of the vertebral and basilar arteries, the faulty irrigation of blood supply and oxygen of the cerebellum and basal ganglia of the brain.” Basically their conclusion is that this compression which is caused by the “anterior scalene muscles and the cervical ribs at the level of the C6-7 vertebrae; by the sternocleidomastoid at the level of the cervical atlas; coiling and kinking of the vertebral, basilar and the internal carotid arteries” produces the symptoms of Parkinson’s because the effect of the compression of these vital structures is to “decrease secretion of dopamine at the level of the basial ganglia (putamen, caudate, thalamus)”. The authors discuss PET scanning which reveals that the illnesses “epilepsy, memory deficit, agnosia, dementia, Huntington’s disease, chronic schizophrenia and manic depression … demonstrate intermittent and patchy decreases in blood flow”. They report significant improvements in people with all these diseases and 88% healing results for Alzheimer’s disease. They also report having operated on 17 patients with multiple sclerosis and 12 having “shown great improvement”. They conclude with a view that the neurovascular compression mentioned earlier which, in their opinion results in reduced oxygenated blood to the dopamine producing cells, can be relieved by their surgical technique (scalenotomy) and the results are positive in “CTOS symptomatic Parkinson’s disease, Alzheimer’s disease, psychological disturbances by hypoxia, epilepsy, multiple sclerosis, hemodynamic parkinsonism and impending gangrene of the upper extremities.”

Fernandez Noda et al[7] in this 2002 paper have renamed the syndrome to cerebral thoracic neurovascular syndrome (CTNVS) when they discovered that the internal carotid arteries were part of the syndrome (pg. 58) and in their abstract reiterate conclusions from the previous papers, “decreased blood supply to the cerebellum and basal ganglia is the cause of the CTNVS and its neurological complications, among which are ipsilateral paralysis, symptomatic Parkinson’s disease, functional Alzheimer’s disease, multiple sclerosis and others.” They further reinforce that the symptoms associated with these diseases are caused by compression of vital neurological (e.g. nerves and nerve plexuses) and vascular structures (arteries and veins) both at the C6-7 level and at the level of the cervical atlas (C1), by muscles such as the anterior and middle scalenes, the sternocleidomastoid and other neck muscles. The compression causes “sporadical insufficient blood supply and oxygen to the cerebellum, brain and the twelve cranial pair nerves”. They list great improvements in many patients with these diseases when they carry out their surgical procedure to remove the compression on the neurovascular structures. As mentioned before this surgery involves removing muscle which causes the compression. They state “all symptoms disappeared after surgery” in many cases involving the different diseases. They list the symptoms of CTNVS on page 56[8] of the paper under the heading “Symptomatology produced by CTNVS”. This list includes all of the symptoms which have been demonstrated to be relieved with treatment by upper cervical chiropractors. If you also refer to my symptoms at http://www.upcspine.com/greg4.htm you will note how closely my symptoms at the time correlated with CTNVS. I wonder what Fernandez Noda and his colleagues would say to those doctors who told my friends that Parkinson’s disease was not related to the neck.

On my website you will also find that I frequently refer to compression of vital neurological and vascular structures by the muscles which have the job of holding the head atop the cervical spine. It makes complete sense that if one’s head has been shifted on the atlas due to trauma then muscle imbalance, spasm and compression of vital structures will result. I think that Fernandez Noda et al have done a wonderful job of explaining exactly what the causal mechanisms of human disease are and I continue to wonder why their work is not more widely heralded by medical organizations. If you look closely at people with Parkinson’s or any other disease you will notice the signs of muscle imbalance, poor posture, muscles struggling and fighting to maintain balance.

1.	Could CTNVS be nothing more than a subluxation of atlas?
		a. My conclusion is most definitely yes!
2.	Can people with CTNVS and thus Parkinson’s or other disease be helped with upper cervical chiropractic?
		a. In my opinion - Yes!
3.	Should conservative treatment (a.k.a. upper cervical treatment) be tried before invasive procedures?
		a. Of course - Yes!

A video-tape of a dissection of the cervical spine[9] is also interesting because it demonstrates the anatomy of the cervical sine and the scalene muscles very well. About 36.5 minutes into the videotape, thoracic outlet syndrome (TOS) and tests are demonstrated and explained. The authors suggest compression of the brachial plexus and other neurovascular structures (e.g. carotid sheath which contains the jugular vein, carotid artery and sympathetic chain) in and around the scalenes can occur. The close proximity of soft tissues and bony structures create the potential for compressive and tensile forces on the neurovascular structures in this area. It is emphasized that proper position of the head and neck a vital to a healthy cervical spine. If you get to watch the tape, think about an off centre head and what might happen to the cervical spine muscles as they try to hold the head erect. In my opinion TOS, CTOS and CTNVS are the result of an upper cervical subluxation and it follows that correction by specific upper cervical chiropractors can relieve myriad symptoms associated with these syndromes without the need for invasive surgery.

A paper by Herrera-Marschitz, Utsumi and Ungerstedt[10] is very interesting and it has nothing to do with humans. Experiments were done on rats which when subjected to decreases in dopamine; scoliosis of the spine was a direct result. In fact, “rats with the strongest dopamine depletion (greater than 95%) and the strongest rotational responses showed the sharpest spinal deviation and skeletal deformity. These findings agree with the clinical observations that scoliosis occurs in patients with Parkinson's disease and its direction is correlated with the side of the major signs and symptoms of parkinsonism.” This could further reinforce that Parkinson’s and other diseases are a result of an upper cervical subluxation as it is well known and well recorded that upper cervical subluxations result in scoliosis (see my February 2004 newsletter about fibromyalgia).

Chiropractic and Parkinson’s disease

A search for Parkinson’s research and chiropractic does not turn up voluminous studies. I believe this to be a function of research funding which usually is channeled toward pharmaceutical outcomes. It would be a brave doctor who recommended to a research organization or government body that funding is directed towards chiropractic research! There are however a couple of studies worthy of mention. The first is a case report by Elster[11] an upper cervical chiropractor from Colorado, USA. This is the case report of a 60 year old man who was diagnosed with PD at age 53. Elster used “paraspinal digital infrared imaging” and “precision upper cervical radiographic series” of x-rays and cites “6,000 peer-reviewed and indexed articles” as well as “blind studies comparing thermographic results to CT-scan, MRI, EMG, myelography and surgery, thermography was shown to have a high degree of sensitivity (99.2%), specificity (up to 98%), predictive value and reliability”.

The author discovered through her upper cervical methodology that the patient had “right laterality of the atlas.” In other words, the patient had an upper cervical subluxation of atlas. After receiving consent, “treatment began with an adjustment to correct the right laterality of atlas.” The adjustment was performed using the knee-chest adjustment technique which is described on my site at http://www.upcspine.com/tech12.htm and the usual protocols associated with that technique were followed.

Following further treatment by the end of the 2nd week of care the patient “reported greater range of motion in his neck, improved sleep, better energy, and decreased stiffness in his overall body.” Utilizing the United Parkinson’s Disease Rating Scale (UPDRS) a “re-evaluation revealed a reduction in symptoms” accompanied with an overall “43% improvement”. Other improvements not listed in the UPDRS understated the improvement as “it did not take into consideration other associated symptoms, such as spinal pain, insomnia and fatigue”. The patient continues under the care of Elster and maintains the improvement as well as exhibiting no deterioration in condition. He has also started a regular exercise and training program.

The patient reported a history of trauma “6 specific incidents” prior to the onset of symptoms including significant trauma to the head. Elster concludes with some theories as to the connection between the head injuries, the upper cervical subluxation and the onset of PD. One theory suggests that “sympathetic malfunction occurred, possibly causing a decrease in cerebral blood flow compromising a patient’s substantia nigra”. She rightly states that this one case does not confirm a link between an upper cervical subluxation and PD, however combined with the CTNVS studies and other known facts about the consequences of upper cervical subluxations it is not hard to make the connection. It only needs to be researched.

A second article by Elster[12] a copy of which can be found at http://www.erinelster.com/Articles/parkinsons_article%20_07_00.html which discusses 10 cases and the results “revealed a substantial improvement in subjective and objective findings in 6 out of 10 patients and mild improvement in 2 patients. The final 2 patients remain unchanged.” All patients had atlas subluxations which were visible on precision upper cervical x-rays.

In another paper by Burcon[13] finds remarkably consistent findings in a number of patient’s with a variety of conditions. All exhibit upper cervical subluxations and all improved following upper cervical chiropractic intervention. Burcon concludes with the theory amongst others “ pressure exerted by the subluxated atlas causes a combination of problems including, decreased blood supply to the occipital portion of the brain; pressure on the nuclei of cranial nerves V (trigeminal) and VIII (vestibulocochlear); nerve-root irritation of cranial nerve VIII.” These would seem to be in agreement with Fernandez Noda with respect to decreased blood flow and cranial nerve impairment. Reduced blood flow to cranial nerve VIII for example most likely would result in hearing disorders like tinnitus and deafness. Interestingly in some Doppler sonography studies[14,15] , of people with tinnitus, blood flow is significantly reduced in the vertebral artery on the side of the tinnitus.

Someone Please Save the Pope!

There are a number of celebrities who have been diagnosed with PD most notably Mohammed Ali, Michael J. Fox and the of course the Pope. In just about every photo that I have seen of Michael J Fox he favors having his head forward and to the right and side-on photos would “seem” to indicate loss of cervical curve. The photo on this page is an example http://mjftribute.tripod.com/mikephoto3.htm. Now I’m not saying that this is definitive, however a quick check by Michael himself may reveal that he does have right head tilt and has had it for some length of time. A tilted head is often a result of atlas subluxation. Has he had a head injury? Probably. Has Mohammed Ali had a head injury? Yes!

Upon observing the posture of Pope John Paul II on many occasions and looking at some photos at http://przewodnik.iq.pl/fatima/page_02.htm, I have to conclude that he exhibits the ‘classic’ upper cervical (atlas) subluxation, exaggerated thoracic kyphosis and lower spine compensatory subluxation. His head is so far forward that compression of neurovascular structures in his neck and of the brachial plexuses as suggested by Fernandez Noda et al is highly likely. The forward head carriage of the Pope is NOT a normal part of the aging process which some people would have us believe. It is due to cumulative trauma throughout one’s life, subluxating atlas, which never gets corrected. I would further suggest that because of the ‘link’ between upper cervical subluxations and hearing disorders, the Pope is more than likely exhibiting both tinnitus and deafness. Why don’t his doctors address the Pope’s obvious postural anomalies? Please someone save the Pope!

Parkinson’s Danger

People who suffer head injury are four times more likely to develop Parkinson’s disease. The study also found that this risk increases eightfold for people with a head trauma requiring hospitalization and 11-fold for those with a severe head injury, characterized by long loss of consciousness and brain bruising. Lead author Dr James Bower, a Mayo Clinic neurologist, says: “I was surprised by the strength of the association and was also surprised that the average head trauma was about 20 years before the start of the disease.” Details of the study are published in Neurology.

Compiled by Kym Nicoll
Sydney Morning Herald (Sydney, Australia) Thursday 22 May 2003 Health & Science section P.1