When Chronic Inflammation Prevents Success With Manual Care

Active Hydrogen Adrenal Extracts Alanine Alpha-Linolenic Acid Alpha-Lipoic Acid AMP Amylase Inhibitors Arginine Bee Pollen Beta Carotene Beta-glucan Betaine Beta-Sitosterol Biotin Borage Oil Boron Bovine Cartilage Bovine Colostrum Brewer's Yeast Bromelain Calcium Capsaicin Carnitine Carnosine Chitosan Chloride Chlorophyll Chondroitin Chromium CLA Cobalt Coenzyme Q10 Copper Creatine Cysteine DHA DHEA DMAE EGCG Evening Primrose Oil 5-HTP Fiber (Insoluble) Fiber (Soluble) Fish Oil Flavonoids Fluoride Folate Fumaric Acid GABA Gamma-Linolenic Acid Glucomannan Glucosamine Glutamic Acid Glutamine Glutathione Glycine Grape Seed Extract Histidine HMB Hydroxycitric Acid Indole Inosine Inositol Iodine Ipriflavone Iron Isoleucine Lactase Lecithin Leucine Lipase Lutein Lycopene Lysine Magnesium Malic Acid Manganese Mannose Melatonin Methionine Methoxyisoflavone Molybdenum MSM N-Acetyl Cysteine NADH Naringin Niacin Octacosanol Oligosaccharides Olive Leaf Extract Ornithine Oryzanol PABA Pancreatic Enzymes Pantothenic Acid Phenylalanine Phosphatidylserine Phosphorus Phytic Acid Policosanol Potassium Pregnenolone Probiotics Propolis Psyllium Pyridoxine Pyruvate Quercetin Resveratrol Retinol Riboflavin Ribose Royal Jelly SAMe Selenium Shark Cartilage Silicon Sodium Spirulina Spleen Extracts St. John's Wort Strontium Sulforaphane Sulfur Taurine Thiamine Tocopherol Tea Tree Oil Tyrosine Usnic Acid Valine Vanadium Vinpocetine Vitamin A Vitamin B1 Vitamin B2 Vitamin B3 Vitamin B5 Vitamin B6 Vitamin B9 Vitamin B12 Vitamin C Vitamin D Vitamin H Vitamin K Whey Protein Xylitol Zinc

Abalone Shell (shi jue ming)
Abutilon Seed (dong kui zi)
Acanthopanax Bark (wu jia pi)
Achyranthes (niu xi)
Aconite (fu zi)
Acorus (shi chang pu)
Adenophora Root (nan sha shen)
Agkistrodon (bai hua she)
Agrimony (xian he cao)
Ailanthus Bark (chun pi)
Akebia Fruit (ba yue zha)
Albizzia Bark (he huan pi)
Albizzia Flower (he huan hua)
Alfalfa (medicago sativa)
Alisma (ze xie)
Aloe (lu hui)
Alum (bai fan)
Amber (hu po)
Ampelopsis (bai lian)
Andrographis (chuan xin lian)
Anemarrhena (zhi mu)
Antelope's Horn (ling yang jiao)
Apricot Seed (xing ren)
Areca Peel (da fu pi)
Areca Seed (bing lang)
Arisaema (tian nan xing)
Ark Shell (wa leng zi)
Arnebia (zi cao or ying zi cao)
Arnica (arnica montana)
Artichoke Leaves (Cynara scolymus)
Ash bark (qin pi)
Ashwagandha (withania somniferum)
Aster (zi wan)
Astragalus (huang qi)
Aurantium (zhi ke [qiao])
Bamboo Juice (zhu li)
Bamboo Shavings (zhu ru)
Belamcanda Rhizome (she gan)
Benincasa Peel (dong gua pi)
Benincasa Seed (dong gua xi/ren)
Benzoin (an xi xiang)
Bilberry (yue ju)
Biota Leaf (ce bai ye)
Biota Seed (bai zi ren)
Bitter Melon (ku gua)
Bitter Orange Peel (ju hong)
Black Cohosh (sheng ma)
Black Plum (wu mei)
Black Sesame Seed (hei zhi ma)
Bletilla (bai ji)
Boneset (ze lan)
Borax (peng sha)
Borneol (bing pian)
Bottle Brush (mu zei)
Buddleia (mi meng hua)
Buffalo Horn (shui niu jiao)
Bulrush (pu huang)
Bupleurum (chai hu)
Burdock (niu bang zi)
Camphor (zhang nao)
Capillaris (yin chen hao)
Cardamon Seed (sha ren)
Carpesium (he shi)
Cassia Seed (jue ming zi)
Catechu (er cha)
Cat's Claw (uncaria tomentosa)
Cephalanoplos (xiao ji)
Celosia Seed (qing xiang zi)
Centipede (wu gong)
Chaenomeles Fruit(mu gua)
Chalcanthite (dan fan)
Chebula Fruit (he zi)
Chinese Gall (wu bei zi)
Chinese Raspberry (fu pen zi)
Chrysanthemum (ju hua)
Cibotium (gou ji)
Cinnabar (zhu sha)
Cinnamon (rou gui or gui zhi)
Cistanche (rou cong rong)
Citron (xiang yuan)
Citrus Peel (chen pi)
Clam Shell (hai ge ke/qiao)
Clematis (wei ling xian)
Cloves (ding xiang)
Cnidium Seed (she chuang zi)
Codonopsis (dang shen)
Coix Seed (yi yi ren)
Coptis (huang lian)
Cordyceps (dong chong)
Coriander (hu sui)
Corn Silk (yu mi xu)
Cornus (shan zhu yu)
Corydalis (yan hu suo)
Costus (mu xiang)
Cranberry (vaccinium macrocarpon)
Cremastra (shan ci gu)
Croton Seed (ba dou)
Curculigo (xian mao)
Cuscuta (tu si zi)
Cuttlefish Bone (hai piao xiao)
Cymbopogon (xiang mao)
Cynanchum (bai qian)
Cynomorium (suo yang)
Cyperus (xiang fu)
Dalbergia (jiang xiang)
Damiana (turnera diffusa)
Dandelion (pu gong ying)
Deer Antler (lu rong)
Dendrobium (shi hu)
Devil's Claw (harpagophytum procumbens)
Dianthus (qu mai)
Dichroa Root (chang shan)
Dittany Bark (bai xian pi)
Dong Quai (tang kuei)
Dragon Bone (long gu)
Dragon's Blood (xue jie)
Drynaria (gu sui bu)
Dryopteris (guan zhong)
Earthworm (di long)
Eclipta (han lian cao)
Elder (sambucus nigra or sambucus canadensis)
Elsholtzia (xiang ru)
Ephedra (ma huang)
Epimedium (yin yang huo)
Erythrina Bark (hai tong pi)
Eucalyptus (eucalyptus globulus)
Eucommia Bark (du zhong)
Eupatorium (pei lan)
Euphorbia Root (gan sui or kan sui)
Euryale Seed (qian shi)
Evodia (wu zhu yu)
Fennel (xiao hui xiang)
Fenugreek (hu lu ba)
Fermented Soybeans (dan dou chi)
Flaxseed (ya ma zi)
Fo Ti (he shou wu)
Forsythia (lian qiao)
Frankincense (ru xiang)
Fritillaria (chuan bei mu)
Gadfly (meng chong)
Galanga (gao liang jiang)
Galena (mi tuo seng)
Gambir (gou teng)
Gardenia (zhi zi)
Garlic (da suan)
Gastrodia (tian ma)
Gecko (ge jie)
Gelatin (e jiao)
Genkwa (yuan hua)
Germinated Barley (mai ya)
Ginger (gan [sheng] jiang)
Ginkgo Biloba (yin xing yi)
Ginseng, American (xi yang shen)
Ginseng, Asian (dong yang shen)
Ginseng, Siberian (wu jia shen)
Glehnia (sha shen)
Glorybower (chou wu tong)
Goldenseal (bai mao liang)
Gotu Kola (luei gong gen)
Green Tea (lu cha)
Gymnema (gymnema sylvestre)
Gynostemma (jiao gu lan)
Gypsum (shi gao)
Halloysite (chi shi zhi)
Hawthorn (shan zha)
Hemp Seed (huo ma ren)
Homalomena (qian nian jian)
Honey (feng mi)
Honeysuckle Flower (jin yin hua)
Honeysuckle Stem (ren dong teng)
Houttuynia (yu xing cao)
Huperzia (qian ceng ta)
Hyacinth Bean (bai bian dou)
Hyssop (huo xiang)
Ilex (mao dong qing)
Imperata (bai mao gen)
Indigo (qing dai)
Inula (xuan fu hua)
Isatis Leaf (da qing ye)
Isatis Root (ban lan gen)
Java Brucea (ya dan zi)
Jujube (da zao)
Juncus (deng xin cao)
Kadsura Stem (hai feng teng)
Katsumadai Seed (cao dou kou)
Kelp (kun bu)
Knotweed (bian xu)
Knoxia root (hong da ji)
Kochia (di fu zi)
Lapis (meng shi)
Leech (shui zhi)
Leechee Nut (li zhi he)
Leonorus (yi mu cao)
Lepidium Seed (ting li zi)
Licorice (gan cao)
Ligusticum (chuan xiong)
Ligustrum (nŸ zhen zi)
Lily Bulb (bai he)
Limonite (yu liang shi)
Lindera (wu yao)
Litsea (bi cheng qie)
Lobelia (ban bian lian)
Longan (long yan hua [rou])
Lophatherum (dan zhu ye)
Loquat Leaf (pi pa ye)
Lotus Leaf (he ye)
Lotus Node (ou jie)
Lotus Seed (lian zi)
Lotus Stamen (lian xu)
Luffa (si gua luo)
Lycium Bark (di gu pi)
Lycium Fruit (gou qi zi)
Lygodium (hai jin sha)
Lysimachia (jin qian cao)
Magnetite (ci shi)
Magnolia Bark (hou po)
Magnolia Flower (xin yi hua)
Maitake (grifola frondosa)
Marigold (c. officinalis)
Massa Fermentata (shen qu)
Milk Thistle (silybum marianum)
Millettia (ji xue teng)
Mint (bo he)
Mirabilite (mang xiao)
Morinda Root (ba ji tian)
Mugwort Leaf (ai ye)
Mulberry Bark (sang bai pi)
Mulberry Leaf (sang ye)
Mulberry Twig (sang zhi)
Mullein (jia yan ye)
Musk (she xiang)
Myrrh (mo yao)
Notoginseng (san qi)
Notopterygium (qiang huo)
Nutmeg (rou dou kou)
Oldenlandia (bai hua she she cao)
Omphalia (lei wan)
Onion (yang cong)
Ophicalcite (hua rui shi)
Ophiopogon (mai dong)
Oroxylum Seed (mu hu die)
Oryza (gu ya)
Oyster Shell (mu li)
Passion Flower (passiflora incarnata)
Patrinia (bai jiang cao)
Pau D'Arco (tabebuia avellanedae)
Peach Seed (tao ren)
Pearl (zhen zhu [mu])
Perilla Leaf (su ye)
Perilla Seed (su zi)
Perilla Stem (su geng)
Persimmon (shi di)
Pharbitis Seed (qian niu zi)
Phaseolus (chi xiao dou)
Phellodendron (huang bai)
Phragmites (lu gen)
Picrorhiza (hu huang lian)
Pinellia (ban xia)
Pine Knots (song jie)
Pipe Fish (hai long)
Plantain Seed (che qian zi)
Platycodon (jie geng)
Polygala (yuan zhi)
Polygonatum (huang jing)
Polyporus (zhu ling)
Poppy Capsule (ying su qiao)
Poria (fu ling)
Prickly Ash Peel (hua jiao)
Prinsepia Seed (rui ren/zi)
Prunella (xia ku cao)
Prunus Seed (yu li ren)
Pseudostellaria (tai zi shen)
Psoralea (bu gu zhi)
Pueraria (ge gen)
Pulsatilla (bai tou weng)
Pumice (fu hai shi)
Pumpkin Seed (nan gua zi)
Purslane (ma chi xian)
Pyrite (zi ran tong)
Pyrrosia Leaf (shi wei)
Quisqualis (shi jun zi)
Radish (lai fu zi)
Realgar (xiong huang)
Red Atractylodes (cang zhu)
Red Clover (trifolium pratense)
Red Ochre (dai zhe shi)
Red Peony (chi shao)
Red Sage Root (dan shen)
Rehmannia (shu di huang)
Reishi (ling zhi)
Rhubarb (da huang)
Rice Paper Pith (tong cao)
Rose (mei gui hua)
Rosemary (mi die xiang)
Safflower (hong hua)
Saffron (fan hong hua)
Sandalwood (tan xiang)
Sanguisorba Root (di yu)
Sappan Wood (su mu)
Sargent Gloryvine (hong teng)
Saw Palmetto (ju zong lu)
Schefflera (qi ye lian)
Schisandra (wu wei zi)
Schizonepeta (jing jie)
Scirpus (san leng)
Scopolia (S. carniolica Jacq.)
Scorpion (quan xie)
Scrophularia (xuan shen)
Scutellaria (huang qin)
Sea Cucumber (hai shen)
Sea Horse (hai ma)
Seaweed (hai zao)
Selaginella (shi shang bai)
Senna (fan xie ye)
Shiitake (hua gu)
Siegesbeckia (xi xian cao)
Siler Root (fang feng)
Slippery Elm (ulmus fulva)
Smilax (tu fu ling)
Smithsonite (lu gan shi)
Sophora Flower (huai hua mi)
Sophora Root (ku shen)
Spirodela (fu ping)
Stellaria (yin chai hu)
Stemona (bai bu)
Stephania (fang ji [han])
Sweet Annie (qing hao)
Teasel Root (xu duan)
Tiger Bone (hu gu)
Torreya Seed (fei zi)
Tortoise Plastron (gui ban)
Tremella (bai mu er)
Trichosanthes Fruit (gua lou)
Trichosanthes Root (tian hua fen)
Trichosanthes Seed (gua lou ren)
Tsaoko Fruit (cao guo)
Turmeric (jiang huang)
Turtle Shell (bie jia)
Tussilago (kuan dong hua)
Urtica (xun ma)
Uva ursi (arctostaphylos uva-ursi)
Vaccaria Seed (wang bu lui xing)
Valerian (jie cao)
Veratrum (li lu)
Viola (zi hua di ding)
Vitex (man jing zi)
Walnut (hu tao ren)
Watermelon (xi gua)
White Atractylodes (bai zhu)
White Mustard Seed (bai jie ze)
White Peony (bai shao)
Wild Asparagus (tian men dong)
Windmill Palm (zong lu pi/tan)
Xanthium (cang er zi)
Zedoary (e zhu)

By David Seaman, DC, MS, DABCN

Those of you who read my articles know chronic inflammation is a common theme. I am interested in this topic for a variety of reasons. While in chiropractic college, I was curious as to why some people responded to manipulation and why others did not. In our chiropractic principles classes, we were told that a reason for a lack of success was a "limitation of matter."

At NYCC, we did not use the "Green Books," so I did not look through Stephenson's textbook until I purchased it at the Sherman College bookstore in the 1990s. That was when I first saw the actual list of the 33 Principles of Chiropractic, including Principle #24 – The Limits of Adaptation, where the limitation of matter is described.

So, from the start of my chiropractic education I was curious as to what happens to matter that limits its ability to respond to an adjustment. I was not the only one who considered this issue. In 2009, I borrowed a book from a Palmer graduate and learned about the extensive rehabilitation center at the B.J. Palmer Clinic as early as the mid-1940s. Over the doorway to the exercise center read: "Founded for the restoration of Health to those for whom medical treatment or ordinary chiropractic adjustment and care have proved insufficient."

Clearly, B.J. recognized that a deconditioned patient, i.e., "deconditioned matter," may not respond to manipulation. It is not a surprise that many chiropractors have embraced spinal rehabilitation and reconditioning.

Chronic Inflammation as a Limitation of Matter

My interest has mostly been about the chemistry and neurology of the patient. In other words, I am interested in the "bio" part of biomechanics. That is, I was always curious about what goes wrong with the "bio" that leads to chronic pain and a patient who does not respond to manipulation or rehabilitation efforts.

It turns out the chronic inflammation appears to be a limiting "bio" factor. I discuss this topic in more detail in a recent paper published in Chiropractic & Manual Therapies.¹ The focus of this paper is body mass index (BMI) and pain expression. It should be understood that BMI is just one marker of chronic inflammation; muscular people have an elevated BMI, but no health problems. However, BMI does function as a marker of inflammation and a risk factor for chronic pain when an elevated BMI is caused by excess body fat, especially when there is adiposopathy or "sick fat" syndrome.

In other words, when excess body fat is associated with chronic inflammation, known as adiposopathy, we should view this as a limitation of matter and a promoter of chronic pain.

There are multiple markers of inflammation that can easily be tracked by chiropractors without doing complicated laboratory tests. However, the lab tests that do act as markers of inflammation are very commonly requested. In other words, if you do not routinely run labs, you can request a copy of labs from your patient's medical doctor. Table 1 lists the various markers of inflammation.

Notice in table 1 that there are five metabolic syndrome markers, of which three must be present for a patient to be classified as having the metabolic syndrome. Approximately 25-40 percent of adults have the metabolic syndrome, which is a chronic pro-inflammatory state. These patients have elevated markers of inflammation circulating within their bodies throughout the day and night.

Table 1. Markers of chronic inflammation

Metabolic syndrome	Abnormal value
Fasting blood glucose	≥ 100 mg/dL
Triglycerides	≥ 150 mg/dL
HDL cholesterol	< 50 for women; < 40 men
Blood pressure	≥ 130/85
Waist circumference	> 35" women; > 40" men
Pro-inflammatory markers	Parameters
Two-hour postprandial glucose	<140 mg/dl = normal 140-199 = prediabetes 200+ = diabetes
Fasting triglycerides	<90 mg/dl predicts controlled postprandial response

hsCRP in mg/L (marker of chronic inflammation)	<1.0= normal 1.0-3.0= moderate >3.0 = high

25(OH)D (vitamin D)	32-100 ng/ml (goal >40 ng)

Body mass index (BMI)	18.5-24.9 = normal 25-29.9 = overweight ≥ 30 = obese

Waist/hip ratio women (risk factor for diabetes)	<0.80 = low risk 0.81-.85 = moderate risk >0.85 = high risk
Waist/hip ratio men (risk factor for diabetes)	<0.95 = low risk 0.96-1.0= moderate risk >1.0 = high risk

Lack of sleep	Less than six hours
Sedentary living	Associated with systemic inflammation
Stress	Associated with systemic inflammation
Depression	Associated with systemic inflammation
Poor self-rated health (use HSQ-12)	Associated with systemic inflammation

If NSAIDs relieve pain	Suggests need for dietary balance of omega-6:omega-3 fatty acids

Helping Patients Avoid the Inflammatory Diet

The prevailing view is that this chronic systemic inflammation becomes superimposed over areas dysfunction or injury, which prevents healing and leads to chronic pain. Thus, a patient may not adequately respond to manipulation and rehabilitation. My suggestion is to screen all of your patients for the metabolic syndrome and the other markers of chronic inflammation.

The treatment approach need not be complicated. In other words, un-limiting the limitation of matter is a straightforward process. In my opinion, anyone who is overweight is a "dietary crackhead," as discussed in a previous article. And even normal-weight individuals who want to eat sugar and flour, or have to stop themselves from eating too much, are also dietary crackheads.

See my recent article in DC about how to fight the dietary crackhead.² It involves forcing ourselves to live mostly on lean protein, vegetables, fruit and nuts, which is an anti-inflammatory diet. For more details on the anti-inflammatory diet and anti-inflammatory nutritional supplements, see the May 2013 issue of ACA News.³

References

Seaman DR. Body mass index and musculoskeletal pain: is there a connection? Chiro Man Ther, 2013;21:15.
Seaman DR. "Dietary 'Crackheads' and the Never-Ending Battle Against the Bulging Waistline." Dynamic Chiropractic, April 1, 2013.
Seaman DR. "Anti-Inflammatory Nutrition for Musculoskeletal Pain." ACA News, May 2013.

Dr. David Seaman is the author of Clinical Nutrition for Pain, Inflammation and Tissue Healing and a longtime columnist, writing on clinical nutrition (his current column focus) and the subluxation. For additional information including an extended bio, a printable version of this article and a link to previous articles, visit his columnist page.