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Case Study Resolution of Psoriasis Secondary to Chiropractic Using The Toftness System Technique: A Case Report __________________________________________________________________________________________ Yoshitaka Tsuji D.C. Abstract Private Practice of Chiropractic, Kishiwada, Osaka, Japan Objective: Psoriasis is an immune disorder with dermatological manifestations whose cause is unknown. For this reason, in the clinical settings of modern medicine, supportive measures such as drugs are primarily used to address the problem. However, those symptomatic treatments have been recognized to be associated with side effects, exacerbation of the disease, or no improvement. The aim of this study was to examine the efficacy of the Toftness System on psoriasis. Clinical Features: An 85-year-old male with psoriasis which affected almost his entire body underwent care using the Toftness System of chiropractic. Intervention and Outcome: Patient was seen a total of 30 times over a three month period. Toftness System chiropractic technique was utilized while reducing vertebral subluxations. Dramatic improvements were observed Conclusion: Significant improvement of patient’s skin condition was observed, which confirmed some degree of positive effect of the Toftness System in the treatment of psoriasis. Key Words: Toftness System of Chiropractic, Psoriasis, Immune Disorder, Subluxation, Electromagnetic Energies ____________________________________________________________________________________________________________ Introduction Psoriasis is one of the most common conditions of inflammatory keratosis with no known cause. It is categorized into five groups depending on the state of the condition. The groups include plaque psoriasis, guttate psoriasis, pustular psoriasis, psoriatic erythrodermia, and psoriatic arthritis.1 Patients with psoriasis develop Psoriasis patches of skin with dry white, silvery dandruff-like scales. These scales may be attached to red and slightly raised skin rashes. There is a clear border between the diseased patches of skin and healthy skin, although the boundary appears obscure when it becomes a chronic disease. The common lodging sites for psoriasis include the scalp, extensor surfaces of the elbows and knees, areas where there is a lot of friction, and the lumbosacral region. A. Vertebral Subluxation Res. May 4, 2011 15 Psoriasis may develop due to scars or mechanical irritations, known as Keobner phenomenon. The skin rashes could spread to the whole body in some cases. In the initial stage, it starts with one or more small patches, which grow together to form bigger patches. The skin rashes are difficult to heal, and often diagnosed as psoriasis by a dermatologist.2 Patients with extremely severe skin manifestations are constantly under stress from the disease, consequently causing serious and constant distress whenever awake or asleep. Psoriasis is a typical chronic and refractory disease. Skin rashes of psoriasis are unique in that when the thick scales are scraped with a wooden spatula, petechial bleeding immediately occurs. This is called Auspitz sign. There are many with psoriasis in Europe and the United States. In recent years, the number has increased in Japan as well. It is estimated that there are about 100,000 patients who suffer from psoriasis and other similar diseases.2 In Japan, many believe that psoriasis is contagious because it is pronounced “kansen” and means “infection.” This discrimination and bias have caused many patients significant psychological damage, eventually leading to psychological disorders. Although it is not conclusive, it is said that one’s constitutional factors (genetic predispositions) combined with external factors (such as climate change, psychological stress, fatigue, communicable disease) and internal factors (such as obesity, hyperlipidemia, diabetes) might be a cause of psoriasis. It is believed that high fat intake contributed to the increased number of cases seen in post-war Japan. Generally speaking, patients are not given dietary restrictions, but they should be cautious and avoid diets which may harm one’s general heath because it may also adversely affect their psoriasis.2 The treatment options are extensive and include emollients, salicylic acid, coal tar, anthralin, corticosteroids, calcipotriol, tazarotene, methotrexate, topical and oral retinoid, topical and oral calcineurin inhibitors, immunosuppressants, immunemodulartory agents (biologics), and ultraviolet light therapy.3 This case will report on an adult male with psoriasis undergoing successful chiropractic care utilizing the Toftness Technique. Case Report Patient History The patient was an 85-year-old male, exhibiting skin irritations over his entire body. These irritations are seen in Figure 3 on the face, upper and lower extremities, and torso. The patient was suffering from extreme skin itchiness, soreness, and heat sensation. He also had symptoms suggesting possible prostate cancer. Noticeable swelling in the lower extremities and abdominal bloating were observed. The patient was feeling a sense of loss and stress in his advanced age. 16 A. Vertebral Subluxation Res. May 4, 2011 Within a month of onset, the skin irritations became very severe and spread over the entire body. He began exhibiting various symptoms of psoriasis. The symptoms included severe skin itchiness, soreness, and heat sensation. He became physically and psychologically uncomfortable due to lack of sleep and stress. The patient went to see a specialist. Upon examination and testing, he was diagnosed with inflammatory keratinization of the skin, psoriasis. The patient was suspected to have prostate cancer with abnormal immune and hormonal systems, but no specific cause was identified. Oral medication and ointment (steroids) were prescribed by the specialist. The patient was told to monitor his condition. Unfortunately, his condition increasingly worsened day by day. At the discretion of the patient and with the approval of the specialist, the patient stopped using any of the prescribed medications and sought out chiropractic care. Intervention The patient received a total of 30 Toftness System adjustments over a three month period. Locations subject to care included sacrum, lumbar, thoracic and cervical regions, occipital and abdomen. The skin conditions of psoriasis were visually evaluated using a scale from 1-10, with 10 being the worst. This was recorded each visit. The Toftness System Toftness System treatment was developed in Cumberland, WI by I. N. Toftness D.C., Ph. C., approximately 7 decades ago. In this technique, a palpation enhancement device (Figure1) is used to detect negative millimeter-wavelength electromagnetic waves emitted from the body. The examiner holds the palpation enhancement device close to the patient’s body and uses his/her fingers to detect the electromagnetic energies to determine the location and the order/sequence of treatment. Also, the doctor monitors the amount and direction of pressure applied as well as the duration of treatment. An applicator similar to a pressure gauge with graduations (Figure 2) or a finger is used to apply the pressure. The amount of pressure is low and gentle enough (approximately 100g) to be used on anyone without concerns or fear regardless of age.4,5 According to the chiropractic literature, the Toftness System has been effective in treating those with pain syndromes and in those with back pain.6-10 Correlations were seen in electromagnetic field, heart rate variability, and visual analog recordings.11-14 Other studies have looked at reliability, subluxation detection, and thermographic evaluation.15-18 Two other studies looked at the effect of Toftness on otitis media in children and on allergic dermatitis in an infant.19, 20 Psoriasis Outcomes The results from the visual skin evaluation are plotted in Graph 1. It shows a gradual decline each visit, eventually reaching 0 by the 11th visit and remaining there for the remainder of the care plan. Improvement in the condition of the skin was seen in Figures 3-10, following Toftness System care. The patient fell asleep during the initial session and was thereafter able to sleep and rest well at night. Dramatic improvement was observed after just one session. (Figure 4) After the 3rd session, the swelling of the lower extremities and abdominal bloating have lessened. (Figure 6) On some days itchiness was felt more than others; until about the 10th treatment, some itchiness was felt while sleeping and from the pressure of the underwear, etc., but it gradually subsided. (Figure 8) Given the unusually hot and humid summer season, the patient felt some skin itchiness or soreness especially after perspiration, but primary symptoms of skin itchiness, soreness, and heat sensation had improved. 2. 3. 4. 5. 6. 7. 8. Discussion 9. This case demonstrates that the Toftness System of Chiropractic indeed had some positive effects on a patient suffering from psoriasis. Toftness System care is believed to affect the autonomic nervous system and hormonal system. This in turn improves the innate ability of the body to heal and defend itself. In this case, the condition of psoriasis was improved and helped the patient to recover. 10. 11. Conclusion This case described an adult male with psoriasis undergoing successful chiropractic care utilizing the Toftness Technique. Further research is warranted in this area to draw conclusions, as this is only a single case study. 12. Acknowledgments 13. I wish to give my sincere thanks to Dr. Choken Yara, David R. Toftness, DC, Brian J. Snyder, DC, and John Q. Zhang, MD, PhD for their guidance in the philosophy, science and technique of the Toftness System of Chiropractic and for their assistance in preparing this paper. Similarly, I would like to thank the members of the Japan Association of Advanced Toftness System for their fellowship and support. And finally, I would like to pay my compliments to Youko Smith for her work in providing the English translation from the original manuscript of this paper. 14. 15. References 16. 1. Psoriasis Shimizu, Hiroshi Textbook of Modern Dermatology. Nakayama Shoten, 2005: 241. Psoriasis Web Site; “Fighting and Overcoming Psoriasis” a forum for information exchange for psoriasis patients in Japan. http://sweetmemory.sakura.ne.jp/kansen/kansen0 1.html Merck Manuals 18th Edition; Online Medical Library. http://merckmanual.jp/mmpej/sec10/ch116/ch11 6b.html?qt=%E4%B9%BE%E7%99%AC&alt=sh Brian J. Snyder, D.C. Thermographic evaluation for the role of the sensometer: evidence in the Toftenss System of chiropractic adjusting. Thomas Turley, D.C. The Toftenss System of Chiropractic. Snyder BJ, Zhang J. Toftness system of chiropractic adjusting on pain syndromes: a pilot study in a multicenter setting J Chiropr Med. 2007 Mar; 6(1):15-19. Sanders GE, Snyder BJ. Evaluation of the Toftness system of chiropractic adjusting for subjects with chronic back pain and chronic tension headaches. Chiropr Tech. 1996.Feb 8(1):3-9. Gemmell HA, Jacobson BH, Sutton L. Toftness spinal correction in the treatment of migraine: A case study. Chiropr Tech. 1994 May 6 (2):57-60. Gemmell HA. Treatment of chronic low back pain with low force manipulation. Chiropr J Aust. 1992 Jun 22(2):54-60. Hawkinson EJ, Sanders GE, Snyder BJ. Evaluation of the Toftness system of chiropractic adjusting for the relief of acute pain of musculoskeletal origin. Chiropr Tech. 1992 May4 (2):57-60. Snyder BJ, Zhang J. Toftness system of chiropractic adjusting on back pain and electromagnetic field and heart rate variability. Poster presentation; the Association of Chiropractic Colleges' Thirteenth Annual Conference, 2006. J Chiropr Educ. 2006 Spr; 20(1):101. Snyder BJ, Zhang J. The effect of low force chiropractic adjustments for 4 weeks on body surface electromagnetic field J Manipulative Physiol Ther. 2005 Mar/Apr; 28(3):159-163. Snyder BJ, Vernor L, Zhang J. The effect of low force chiropractic adjustments on body surface electromagnetic field J Can Chiropr Assoc. 2004 Mar;48(1):29-35. Snyder BJ, Toftness D, Nosco D, Balcavage W, Nindl G, Zhang J. Comparison of a triaxial fluxgate magnetometer and Toftness sensometer for body surface EMF measurement. J Can Chiropr Assoc. 2004 Dec;48(4):273-281. Gemmell HA, Heng BJ. Interexaminer reliability of the Toftness instrument for determining need and side of sacral adjustment. Chiropr Tech. 1994 Feb (6:1) 17-19. Gemmell HA, Jacobson BH. Association between level of acute spine pain and level of sustained pressure used in the Toftness adjustment. Chiropr Tech. 1993 Nov (5:4) 150-151. A. Vertebral Subluxation Res. May 4, 2011 17 17. Gemmell HA, Jacobson BH, Heng BJ. Interexaminer reliability of the Toftness radiation detector for determining the presence of upper cervical subluxation.Chiropr Tech. 1990 Feb (2:1) 10-12. 18. Snyder BJ. Thermographic evaluation for the role of the sensometer: Evidence in the Toftness system of chiropractic adjusting. Chiropr Tech. 1999 May (11:2)57-61. Figure 1. Palpation Enhancement Device 19. Zhang JQ, Snyder BJ. Effect of the Toftness Chiropractic Adjustments for Children with Acute Otitis Media. Journal of Vertebral Subluxation Res. March 29, 2004, pp 1-4. 20. Fujimoto, Takashi Resolution of Allergic Dermatitis in an Infant Undergoing Toftness Technique. Journal of Vertebral Subluxation Res. June 21, 2006 Figure 2. Pressure Applicator Graph 1 Visual evaluation of skin conditions of psoriasis on scale 1-10. Degree of severity, 10 being the most severe, is displayed on the Y-axis. Treatment number is displayed on the X-axis. There were a total of 30 visits in approximately 4 months. 18 A. Vertebral Subluxation Res. May 4, 2011 Psoriasis Figures 3-10: The following figures show improvement on the skin over the course of treatment. Figure 3. Psoriasis Back and legs during first visit Figure 4. Back, legs, and feet during the second visit A. Vertebral Subluxation Res. May 4, 2011 19 Figure 5. Back, legs, and feet during third visit 20 A. Vertebral Subluxation Res. May 4, 2011 Figure 6. visit Back, legs, and feet during 4th Psoriasis Figure 7. Psoriasis Back, legs, and feet during 5th visit Figure 8. visit Back, legs, and feet during 10th A. Vertebral Subluxation Res. May 4, 2011 21 Figure 9. 22 Back, legs, and feet during 20th visit A. Vertebral Subluxation Res. May 4, 2011 Figure 10. Back, legs, and feet during 30th visit Psoriasis