75 When Chronic Inflammation Prevents Success With Manual Care
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Dynamic Chiropractic – August 1, 2013, Vol. 31, Issue 15

When Chronic Inflammation Prevents Success With Manual Care

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


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

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