Journal of Manipulative and Physiological Therapeutics Volume 22 • Number 9 • November/December 1999 0161-4754/99/$8.00 + 0 76/1/102739 © 1999 JMPT 559 INTRODUCTION Chiropractors are occupied primarily with the treatment of painful backs; however, historically they have dealt with many kinds of ailments. More than 100 years ago, D.D. Palmer, the founder of chiropractic, reported his first chiro- practic patient to have been a partially deaf man, in whom he diagnosed “a vertebra racked from its normal position.” 1 The man’s hearing was restored soon after a chiropractic adjust- ment to the fourth thoracic vertebra. 1 Since then, many chiropractors have had the dual role of treating painful conditions of the spine and attending to vari- ous symptoms and signs indicative of visceral conditions. This practice is based on the concept that abnormalities in the spinal column may cause nerve interference, which in turn can induce disorders or diseases involving segmentally related visceral organs. Spectacular “cures” have been reported, based solely on clinical observations. In modern chiropractic practice, particularly in Scandi- navia, clinicians appear to be moving away from the organic concept to the muskuloskeletal symptomatic relief model. Thus, in a recent Swedish study, a nonmuskuloskeletal prob- lem was reported as the primary symptom only by 1 of 625 chiropractic patients. 2 The 2 main reasons for this shift may be an improved acad- emic standard, resulting in a reduced number of practitioners who are willing to base their practice solely on anatomic- physiologic-based hypotheses and a desire on the part of chi- ropractic practitioners to be included in mainstream health care, making it necessary to curtail the scope of practice to make it more evidence-based. Much has been written on the subject of spinal manipula- tive therapy (SMT) and somatovisceral conditions. Nansel and Szlazak, 3 in a review of 350 articles appearing over the last 75 years on this subject, conclude that suitable evidence is lacking for the rationale of the somatovisceral theory. The authors argue instead that somatic dysfunction of the spine may create signs and symptoms that mimic internal organ disease. Hence, the removal of the spinal dysfunction may remove the symptoms and signs of an organic disease or dis- order that never was there in the first place. a Senior researcher, the Medical Research Unit, Amtsrådhuset, Torvet, Denmark, previously Nordic Institute for Chiropractic and Clinical Biomechanics, Odense, Denmark. b Private practice of chiropractic, Stockholm, Sweden. c Private practice of chiropractic, Lund, Sweden. d Private practice of chiropractic, Linköping, Sweden. Practical and financial assistance was given by the Swedish Chiropractors’ Association. Funding was also provided by the European Chiropractors’ Union. Submit reprint requests to: Charlotte Leboeuf-Yde, DC, PhD, Se- nior researcher, the Medical Research Unit, Amtsrådhuset, Torvet, Postbox 142, DK-6950 Ringkøbing, Denmark; fecy@ringamt.dk. Paper submitted March 11, 1999. ORIGINAL ARTICLES The Types and Frequencies of Improved Nonmuskuloskeletal Symptoms Reported After Chiropractic Spinal Manipulative Therapy Charlotte Leboeuf-Yde, DC, PhD, a Iben Axén, DC, b Gregers Ahlefeldt, DC, b Per Lidefelt, DC, c Annika Rosenbaum, BAppSc (Chiro), d and Thomas Thurnherr, DC b ABSTRACT Objective: To investigate the frequency and types of improved nonmuskuloskeletal symp- toms reported after chiropractic spinal ma- nipulative therapy. Design: Retrospective information obtained by chiropractors through standardized inter- view of patients on return visit within 2 weeks of previous treatment. Set t ing: The private practice of 87 Swedish chi- ropractors (response rate 81%). Subject s: Twenty consecutive (presumably naïve) patients per chiropractor (1504 valid questionnaires returned, 86% of opti- mal number of replies). Intervention: Spinal manipulation with or without additional therapy provided by chiropractors. Main Outcome Measures: Self-reported improved nonmuskulo- skeletal symptoms (reactions). Result s: At least 1 reaction was reported after the previous treatment in 21% to 25% of cases. Of these responses, 26% were related to the airway passages (usually reported as “easier to breathe”), 25% were related to the digestive system (mostly report- ed as “improved function”), 14% were clas- sified under eyes/vision (usually reported as “improved vision”), and 14% under heart/ circulation (about half of these reported as “improved circulation”). The number of spinal areas treated was positively associated with the number of reactions. Conclusion: A minority of chiropractic patients report having positive nonmuskuloskeletal reactions after spinal manipulative therapy but such reports cluster predominantly around specific symptoms. It would be interesting to find out if these can be verified objectively and, if so, to investigate if they are caused by the treatment or if they are signs of natural varia- tions in human physiology. (J Manipulative Physiol Ther 1999; 22:559-64) Key Indexing Terms: Chiropractic Manipulation; Muskuloskel- etal System; Side Effects; Digestion; Circulation; Respiration; Vision