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Chiropractic Manipulative Reflex Technique

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Major Bertrand DeJarnette, DO, DC

Major Bertrand DeJarnette, DO, DC
Born December 23, 1899
LaMonte, MO
Died May 31, 1992
St. Mary's Hospital, Nebraska City, NB
Nationality Flag usa.gif United States
Education Chiropractic
Alma mater 1924 he graduated from the Nebraska College of Chiropractic
Occupation Developer of Chiropractic Technique (Sacro Occipital Technique)
Years active 1924 to 1990
Home town Nebraska City, NB
Known for Developer of Sacro Occipital Technique and Chiropractic Manipulative Reflex Technique (CMRT)
Title Chiropractor, Osteopath
Spouse(s) Todde De Jarnette

History

Originally called “Bloodless Surgery,” Chiropractic manipulative reflex technique (CMRT) encompasses the relationship between somatovisceral and viscerosomatic reflexes and therefore between the somatic and autonomic nervous systems. R. J. Last in his book "Anatomy: Regional and Applied" points out:

"There is only one nervous system. It supplies the body wall and limbs (somatic) and viscera (autonomic). Its plan is simple. It consists of afferent (sensory) and efferent (motor) pathways, with association and commissural pathways to connect and coordinate the two. There is no more than this, in spite of the many pages devoted to its study."[1]

Bloodless Surgery

Bloodless Surgery was historically used in chiropractic as a term describing soft tissue treatment affecting an organ and its related vertebral relationship or viscerosomatic and somatovisceral reflexes.[2][3] Bloodless surgery was also used to describe methods of manipulating joints and soft tissue without related to the viscera.[4]

James F. McGinnis was a chiropractor that relocated to California in the early 1920s, where he earned a naturopathic doctorate. In the 1930s he became one of the best known of several chiropractic bloodless surgeons and traveled around the nation to teach his methods.[2] Around this time Major Bertrand DeJarnette, DO, DC, developer of sacro occipital technique, was also practicing and teaching extensive methods of bloodless surgery. DeJarnette published a comprehensive book on the topic entitled, “Technic and Practice of Bloodless Surgery” in 1939, which remains the most complete discussion on the topic to date.[3]

Chiropractic Manipulative Reflex Technique (CMRT)

DeJarnette continued to teach and practice bloodless surgery through the 1940s and began its modification to use more reflex applications and referred pain indicators as a method of affecting organ symtomatology. In the 1950s he furthered his investigations into reflexes and their affect on the viscera and related vertebra. By the early 1960s DeJarnette modified the nature of sacro occipital technique’s method of bloodless surgery from its 1939 procedures, which might take 2-4 hours of preparation and treatment, to procedures that could be practiced in a span of 15 minutes.[5][6] For multiple reasons he decided to change the name of his method of affecting referred pain pathways, viscerosomatic / somatovisceral reflexes, and direct organ manipulation to chiropractic manipulative reflex technique (CMRT).

Biological Plausibility

CMRT is used as a method of treating the spine or vertebral visceral syndromes associated with viscerosomatic or somatovisceral reflexes,[7][8][9] dysafferentation at the spinal joint complex,[10] and visceral mimicry type somatic relationships.[11]

Treatment involves location and analysis of an affected vertebra in a reflex arc by way of occipital fiber muscular palpation, similar to trigger point analysis or Dvorak and Dvorak's spondylogenic reflex syndromes.[12] Once specific vertebra reflex arcs are located, corroborated with referred pain pathways, and clinical symtomatology, then the specific vertebra to be treated is isolated by pain provocation, muscle tension, and vasomotor symtomatology. Often times if a vertebral dysfunction is chronic or unresponsive to chiropractic spinal manipulation then a viscerosomatic or somatovisceral component is evaluated.[13] Treatment of the viscerosomatic or somatovisceral component is performed using soft tissue manipulation, myofascial release techniques and reflex balancing methods.[6]

CMRT Protocol Review

In essence, CMRT involves using occipital fiber reflexes, which are palpated for patient sensitivity and then vertebra found in a specific reflex arc related to thge occipital fiber are palpated also for sensitivity. While CMRT protocols need more reliability and validity study, the palpation for pain does help its reliability since palpation for pain alone has been shown to have reliability.

The sensitive vertebra in that reflex arc are then evaluated to determine if they have any visceral referred pain patterns. A patient clinical history is taken to guide any possible diagnosis. Lastly laboratory tests can be used to further help hone in on where treatment needs to be focused.

The treatment involves treating the reflex arc from the occipital fiber to the vertebra, adjusting the vertebra, and performing specific visceral reflex and organ manipulation. If this alone helps then nutritional and dietary modifications may not be needed. If nutritional and dietary modification are added and still there is no positive response referral for allopathic, acupuncture, or other allied health practitioners may be indicated.

Training

CMRT is part of the SOT certification program through the Sacro Occipital Technique Organization - USA (SOTO-USA) which has a complete certification program offered both through individual regional seminars as well as through the post-graduate departments of New York Chiropractic College (NYCC), Southern California University of Health Sciences (SCUHS), and Northwestern Health Sciences University .

SOTO-USA's regional seminar program offers individual SOT courses taught by our certified instructors for those who want to learn the basics of SOT as well as those seeking certification. These courses are offered at varying times throughout the country. You can check out the Events and Seminar page on our website at www.soto-usa.org for course listings.

There are three certification levels: certified SOT practitioner (CSP) which requires 44 hours of accredited course work, certified SOT cranial practitioner (CSCP) which requires a (CSP) plus an additional 40 hours of accredited cranial course work, and a certified SOT pediatric practitioner which can be taken separately and requires 32 accredited hours.

SOTO-USA's basic SOT spinal adjusting program is a 24-hour program that is taught in two weekends and includes the anatomy, physiology and philosophy of SOT as well as all evaluation and adjusting procedures for the spine and pelvis. Classes to treat specific extremity distortion patterns and viscerosomatic/somatovisceral reflex imbalance (Chiropractic Manipulative Reflex Technique – CMRT) are part of the CSP certification. Cranial courses can be taken individually dependent on the practitioners needs and each covers a specific area of cranial corrective procedures. Only licensed DC’s or students are allowed to take our SOT courses.

Goals

SOTO-USA is a (501 c3) nonprofit organization formed to promote the awareness, understanding and utilization of the Sacro Occipital Technique method of chiropractic as founded and developed by Dr. Major Bertrand DeJarnette. Its main goals are to educate and instruct chiropractors in the philosophy, art and science of Sacro Occipital Technique (SOT) and to promote evidence informed, clinically significant advances in chiropractic and SOT technique.

In a continuing effort to offer the latest information in addition to the Clinical Symposium, SOTO-USA offers special opportunities for hands-on teaching of Sacro Occipital Technique to licensed chiropractors and chiropractic students. SOTO-USA has annual research conferences where doctors in clinical practice can learn how to write and present their findings in a profession research format both in conference proceedings at with platform presentations in front of peers for review and questions. SOTO-USA has regularly contributed to chiropractic and interdisciplinary research conferences to support both chiropractic and further investigate SOT and its related methodologies.

SOTO - USA looks to not only lead the chiropractic profession into the 21st century but to champion the concept that through understanding and cooperation between all disciplines, excellence in patient care can be achieved. CMRT is one aspect of SOT that can help the chiropractic profession to contribute to allied healthcare co-treatment opportunities. This has been discussed in various CMRT related articles indicating chiropractic collaboration with acupuncturists[14], veterinarians[15][16], cardiologists[17], gynecologists[18][19], gastrointestinal specialists [20][21], and others[22]. To SOTO-USA future of chiropractic and healthcare will take place with interdisciplinary and co-management of patients in cooperation with our allied healthcare partners.

Future Research

Treating any visceral condition with CMRT or chiropractic is challenging because not all visceral conditions will respond to this care. Studies looking for the subset of patients that will best be served or developing a prediction instrument, has not been done to date. Hopefully some of our researchers in the colleges interested in non-musculoskeletal relationships and chiropractic will consider some collaborative action in this regard.

Bloodless surgery, was used and taught by SOT chiropractors since 1939 and was practiced extensively in the 1930s and 40s. Since the 1960s it has been called CMRT, and focuses predominately on the vertebra and viscerosomatic/somatovisceral reflex relationships. CMRT is listed as a chiropractic technique throughout the chiropractic literature.[23][24][25][26][27] SOT clinicians using these methods of CMRT for years, are publishing their methods in the literature, helping to develop an evidence base for this method of care.[18][19][28][29][30][31][22][17]

CMRT, just like all of chiropractic and manual healthcare warrants further clinical study. A review of what has been presented at recent chiropractic research conferences relating to CMRT suggests some evidence for CMRT's efficacy. At the past four SOT Research Conferences there have been published studies supporting patient care with CMRT.[32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48]

Recently there have been articles presented at chiropractic research conferences supporting the use of CMRT relating to a small randomized controlled study (RCT)[20], monitoring response to CMRT with pre and post endoscopic studies[21], animals responding to CMRT after being non-responsive to other chiropractic care[15][16], and even reversing application of CMRT reflexes which helped a patient with situs inversus.[49]

SOT Related Publications

The following are SOT related publications in peer review journals, chiropractic or interdisciplinary research conferences, non-peer review journals, and proceedings from the Annual SOT Research Conferences. These articles either directly relate to SOT patient management or support the use of cranial, TMJ, and pelvic block related assessments and treatments.

SOTO-USA has gathered all the full text SOT or cranial peer reviewed articles into two compendiums one for literature from 1984-2000 and another from 2000-2005. SOTO-USA is currently working on the compendium from 2005-2010 and expect to have it published by 2012. Along with the SOTO-USA annual SOT Research Conference Proceedings the compendiums are also sent complementary to all chiropractic colleges nationally in the United States.

Texts written by M. B. DeJarnette relating to Bloodless Surgery or Chiropractic Manipulative Reflex Technique (CMRT)

Link to List of Journals

Peer Reviewed Journals- CMRT

Link to List of Journals

Research Conference Proceedings - CMRT

Link to List of Papers

Non Peer-Reviewed Journals - CMRT

Link to List of Journals

SOT Research Conferences - CMRT

Link to List of Journals

References

  1. Last, RJ (1978). New York, NY. p. 20. 
  2. 2.0 2.1 Keating, JC (1999). "James F. McGinnis, D.C., N.D., C.P. (1873-1947): Spinographer, Educator, Marketer and Bloodless Surgeon". Chiropractic History 18 (2): 63-79. 
  3. 3.0 3.1 DeJarnette, MB (1939). Technic and practice of bloodless surgery. Nebraska City, NB: Privately Published. 
  4. Taylor, H (Jul 1995). "Sir Herbert Barker: Bone- Setter and Early Advocate of "Bloodless Surgery"". J Am Chiropr Assoc 32 (7): 27-32. 
  5. DeJarnette, MB (1981). Chiropractic Manipulative Reflex Technique. Nebraska City, NB: Privately Published. 
  6. 6.0 6.1 Blum, CL; Monk R (2004). Chiropractic Manipulative Reflex Technique. Sparta, NC. 
  7. Budgell, BS (Feb 2000). "Reflex effects of subluxation: the autonomic nervous system". J Manip Physiol Ther 23 (2): 104-6. 
  8. Budgell, BS (Dec 1999). "Spinal Manipulative Therapy and Visceral Disorder". Chiropr J Australia 29 (4): 123-8. 
  9. Sato, A (Jan 1992). "The reflex effects of spinal somatic nerve stimulation on visceral function". J Manip Physiol Ther 15 (1): 57-61. 
  10. Seaman, DR; Winterstein JF (May 1998). "Dysafferentation: A Novel Term to Describe the Neuropathophysiological Effects of Joint Complex Dysfunction". J Manip Physiol Ther 21 (4): 267-80. 
  11. Szlazak, M; Seaman DR, Nansel D (Mar 1997). "Somatic Dysfunction and the Phenomenon of Visceral Disease Simulation: A Probable Explanation for the Apparent Effectiveness of Somatic Therapy in Patients Presumed to be Suffering from True Visceral Disease". J Manip Physiol Ther 20 (3): 218-24. 
  12. Dvorak, J; Dvorak V (1988), Manual Medicine: Diagnostics (Translated from German), Stuttgart, Germany: Theime Verlag, pp. 326-33 
  13. Heese, N (Mar 1988). "Viscerosomatic Pre- and Post- Ganglionic Technique". Am Chiro: 16-22. 
  14. Benner, CD }coauthors= Blum CL (Spr 2012). "CMRT and acupuncture in the treatment of dysmenorrhea (oligomenorhea): A case report". J Chiropr Edu 26 (1): 117. 
  15. 15.0 15.1 Thompson, JE }coauthors= Bockhold H, Blum CL (Spr 2010). "Sacro Occipital Technique: Occipital Fiber Technique on Equine". J Chiropr Edu 24 (1): 142. 
  16. 16.0 16.1 Thompson, JE }coauthors= Bockhold H, Blum CL (Spr 2012). "Sacro Occipital Technique: Occipital Fiber Technique on Canine". J Chiropr Edu 26 (1): 135. 
  17. 17.0 17.1 Blum, CL }coauthors= Globe G (Spr 2006). "Angina visceral mimicry syndrome: A proposed collaborative integrative treatment model". J Chiropr Edu 20 (1): 51-2. 
  18. 18.0 18.1 Courtis, G; Young M (Apr 1998). "Chiropractic management of idiopathic secondary amenorrhea: a review of two cases". Br J Chiropr 2 (1): 12-4. 
  19. 19.0 19.1 Cook, K; Rasmussen S (Dec 1992). "Visceral Manipulation and the Treatment of Uterine Fibroids: A Case Report". J Am Chiropr 29 (12): 39-41. 
  20. 20.0 20.1 Butafava, J; Dal Bello F, Blum CL (Spr 2012). "The alterations of the dyspeptic signs and symptoms of patients with gastritis following chiropractic treatment: A small randomized controlled study". J Chiropr Edu 26 (1): 85. 
  21. 21.0 21.1 Dal Bello, F }coauthors= Dal Bello V, Raupp JM, Santos LN (Spr 2010). "Alterations of dyspepetic signs and symptoms in patients presenting with gastroesophageal reflux disease following chiropractic treatment". J Chiropr Edu 24 (1): 124. 
  22. 22.0 22.1 Holbeck, M; Tomson A, Blum, CL, Monk R (Jun 2005). "The Effects of the Sacro-Occipital Technique on the Quality of Life in Lung Cancer Patients Undergoing Chemotherapy and Radiation Treatment". Proceedings of the Integration of Complementary and Alternative Medicine into Clinical Practice: Evidence-Based Medicine (Baltimore, MD: John Hopkins University): 1-6. 
  23. Peterson, DH; Bergman, TF (1988), Chiropractic Technique: Principles and Procedures, St. Louis, MO: Mosby, pp. 493,497 
  24. Gleberzon, BJ (2002). "Chiropractic 'name techniques': a review of the literature". Eur J Chiropr 49: 242-3. 
  25. Gleberzon, BJ (2000). "Chiropractic 'name techniques': a review of the literature". J Can Chiropr Assoc 45 (2): 86-99. 
  26. Bergmann, TF (May 1993). "Various Forms of Chiropractic Technique". Chiropr Tech 5 (2): 53-5. 
  27. Cooperstein, R; Gleberzon, BJ (Apr 2004), Technique Systems in Chiropractic, New York, NY: Churchill Livingstone, pp. 209, 211, 214, 217 
  28. Blum, CL (1999). "Role of Chiropractic and Sacro Occipital Technique in Asthma". Chiropr Tech 10 (4): 174-180. 
  29. Blum, CL (Aug 2003). "The resolution of chronic colitis with chiropractic care leading to increased fertility". J Vert Sublux Res: 1-5. 
  30. Blum, CL (Dec 2006). "Normalization of Blood and Urine Measures Following Reduction of Vertebral Subluxations in a Patient Diagnosed with Early Onset Diabetes Mellitus: A Case Study". J Vert Sublux Res: 1-6. 
  31. Blum, CL (Dec 2006). "Resolution of gallbladder visceral or mimicry pain, subsequent to surgical intervention". International Research and Philosophy Symposium (Spartanburg, SC: Sherman College of Chiropractic): 1-6. 
  32. Getzoff, H (May 2012). "A study of the nature of SOT occipital line fibers: A retrospective case series of 65 patients". 4th Annual Sacro Occipital Technique Research Conference Proceedings (Atlanta, GA: Sacro Occipital Technique Organization - USA): 42-47. 
  33. Thompson, JE; Bockhold H, Blum CL (May 2012). "Sacro Occipital Technique: Occipital Fiber Technique and CMRT for Treatment of Canine Fecal Incontinence". 4th Annual Sacro Occipital Technique Research Conference Proceedings (Atlanta, GA: Sacro Occipital Technique Organization - USA): 101-6. 
  34. Thompson, JE; Bockhold H, Blum CL (May 2012). "Sacro Occipital Technique: Occipital Fiber Technique (OFT) on Equine with Shortness of Breath and Chronic Sinusitis". 4th Annual Sacro Occipital Technique Research Conference Proceedings (Atlanta, GA: Sacro Occipital Technique Organization - USA): 107-11. 
  35. Benner, CD; Blum CL (May 2011). "CMRT and acupuncture in the treatment of dysmenorrhea (oligomenorhea): A case report". 3rd Annual Sacro Occipital Technique Research Conference Proceedings (Nashville, TN: Sacro Occipital Technique Organization - USA): 30-5. 
  36. Blum, CL (May 2011). "Chiropractic, sacro occipital technique, and treatment of patients with nonmusculoskeletal conditions such as asthma or allergies". 3rd Annual Sacro Occipital Technique Research Conference Proceedings (Nashville, TN: Sacro Occipital Technique Organization - USA): 36-40. 
  37. Blum, CL (May 2011). "Hyperhidrosis: Is there a chiropractic solution?". 3rd Annual Sacro Occipital Technique Research Conference Proceedings (Nashville, TN: Sacro Occipital Technique Organization - USA): 41-7. 
  38. Butafava, J; Dal Bello F, Blum CL (May 2011). "The alterations of the dyspeptic signs and symptoms of patients with gastritis following chiropractic treatment: A small randomized controlled study". 3rd Annual Sacro Occipital Technique Research Conference Proceedings (Nashville, TN: Sacro Occipital Technique Organization - USA): 54-7. 
  39. Rosen, MG; Blum CL (May 2011). "Chiropractic care of a two year-old diagnosed with reflux and a hiatal hernia: A case report". 3rd Annual Sacro Occipital Technique Research Conference Proceedings (Nashville, TN: Sacro Occipital Technique Organization - USA): 102-6. 
  40. Benner, CD; Blum CL (May 2010). "Integrating SOT and acupuncture for the treatment of asthma: A case report". 2nd Annual Sacro Occipital Technique Research Conference Proceedings (New Orleans, LA: Sacro Occipital Technique Organization - USA): 58-61. 
  41. Rosen, MG; Blum CL (May 2010). "Chiropractic care of pediatric nonmusculoskeletal conditions: A retrospective patient survey". 2nd Annual Sacro Occipital Technique Research Conference Proceedings (New Orleans, LA: Sacro Occipital Technique Organization - USA): 122-4. 
  42. Thompson, JE; Bockhold H, Blum CL (May 2010). "Sacro Occipital Technique: Occipital Fiber Technique (OFT) on Equine with Shortness of Breath and Chronic Sinusitis". 2nd Annual Sacro Occipital Technique Research Conference Proceedings (New Orleans, LA: Sacro Occipital Technique Organization - USA): 150-2. 
  43. Dal Bello, F; Dal Bello V, Santos LN, Raupp JM (Oct 2009). "Alterations on dyspeptic signs and symptoms on patients presenting with gastroesophageal reflux disease receiving chiropractic treatment". 1st Annual Sacro Occipital Technique Research Conference Proceedings (Las Vegas, NV: Sacro Occipital Technique Organization - USA): 22-3. 
  44. Blum, CL; DeJarnette MB (Oct 2009). "The development of SOT occipital fiber technique: A case report". 1st Annual Sacro Occipital Technique Research Conference Proceedings (Las Vegas, NV: Sacro Occipital Technique Organization - USA): 31-3. 
  45. Klingensmith, RD (Oct 2009). "Chiropractic manipulative reflex technique (CMRT) treatment for GERD of a 3 year old male child: A case report". 1st Annual Sacro Occipital Technique Research Conference Proceedings (Las Vegas, NV: Sacro Occipital Technique Organization - USA): 52-4. 
  46. Mitchell, GA (Oct 2009). "Sacro occipital technique treatment of hiatal (hiatus) hernia presentation: A case report". 1st Annual Sacro Occipital Technique Research Conference Proceedings (Las Vegas, NV: Sacro Occipital Technique Organization - USA): 62-4. 
  47. Thompson, JE; Bockhold H, Blum CL (Oct 2009). "Occipital fiber technique on canine". 1st Annual Sacro Occipital Technique Research Conference Proceedings (Las Vegas, NV: Sacro Occipital Technique Organization - USA): 85-7. 
  48. Thompson, JE; Bockhold H, Blum CL (Oct 2009). "Occipital fiber technique on equine". 1st Annual Sacro Occipital Technique Research Conference Proceedings (Las Vegas, NV: Sacro Occipital Technique Organization - USA): 88-90. 
  49. Zablotney, J }coauthors= Blum CL (Spr 2009). "Chiropractic care and the Situs Inversus patient: Modifying technique to match anatomy". J Chiropr Edu 21 (1): 119. 

External Links

  1. Other research compilations and an assortment of SOT and CMRT books can be found here:SOTO-USA.org Website
  2. SOTO-USA - SOT Research Conferences
  3. 4th Annual SOT Research Conference
  4. 3rd Annual SOT Research Conference
  5. 2nd Annual SOT Research Conference
  6. 1st Annual SOT Research Conference