Stephanie G. B. Sullivan

Introduction: Chiropractic research has traditionally focused on subjective, pain-related outcomes; however, emerging evidence suggests that chiropractic care may also influence neurophysiological functioning. This pilot study aimed to assess the feasibility of a neurophysiological assessment battery and explore differences in brain and autonomic nervous system (ANS) responses following genuine versus sham chiropractic adjustments. Methods: In this pilot quasi-experimental, sham-controlled trial, 30 adults received a single session of either genuine or sham instrument-assisted chiropractic care. Resting-state electroencephalography (EEG) and electrocardiography (ECG) were collected at baseline, immediately post-intervention, and one week later. Feasibility outcomes included study procedures and participant blinding. Exploratory outcomes included changes in EEG functional connectivity (FC) and heart rate variability (HRV). Results: The study protocol was feasible to implement, and participant blinding was successful. Compared with sham care, genuine chiropractic care was associated with increased resting-state FC within a broadly distributed cluster spanning cortical regions of the brain’s extended triple-network, including the medial frontoparietal, dorsolateral frontoparietal, and mid-cingulo-insular networks, in the delta and theta frequency bands. No between-group differences were observed for HRV measures. Discussion: These findings suggest that genuine chiropractic adjustments may differentially influence resting-state functional connectivity within large-scale brain networks compared with sham care. Although no effects on HRV were observed, the neurophysiological findings support further investigation in a fully powered randomized controlled trial to confirm these effects and determine their clinical significance. Trial registration and funding: This trial was prospectively registered at ClinicalTrials.gov (NCT05249530) and funded by Life University (Marietta, GA, USA).

Background: This commentary describes perspectives from workshop attendees at a North American educational conference on the chiropractic profession and its relationship with whole health. Whole Health is a paradigm shift within healthcare settings and funding agencies in the United States that utilizes a systems framework to transform healthcare. Whole health frameworks emphasize biopsychosocial well-being as defined by individuals, families, and communities, and leverages interprofessional, team-based approaches to promote well-being, disease prevention, and restoration of health. Main body: Two separate, 60-minute workshop sessions were convened at the 2025 Association of Chiropractic Colleges Education Conference and Research Agenda Conference to discuss whole health and chiropractic. Attendees ( n = 105) included chiropractic academicians, researchers, practitioners, students, and organizational leaders from institutions largely based in the United States. Participants in 14 small groups discussed (1) ways the chiropractic profession aligns with whole health, and (2) how chiropractors can contribute to whole health in clinical practice and healthcare education. Notes taken by group scribes were collected from each workshop and generated 401 distinct comments. Thematic analysis with an inductive approach was used to group and define key topics that emerged from the data. Aspects of the chiropractic profession were described as historically being aligned with whole health for its foundational philosophy in innate healing and resilience, and for espousing person-centeredness and patient values. Themes describing the future contribution of chiropractic to whole health include evidence-based practice; communication and advocacy; integration into the broader healthcare system; and forward-facing education. There was overlap between past and future when considering holism; therapeutic alliance and patient empowerment for self-care; direct access; therapeutic conservatism; preventive health and lifestyle medicine; and longitudinal care. Conclusions: The whole health paradigm presents an opportunity for chiropractors to be recognized contributors within multidisciplinary teams, using their expertise to aid chronic disease prevention, patient empowerment, and health care delivery innovations. Continued education and training, policy changes, and further research are required for the chiropractic profession to best serve patients and provide value within a whole health framework.

Background: Few manual chiropractic high velocity, low amplitude (HVLA) type shams have been validated in research. The proposed project is a randomized controlled trial (RCT) designed to assess a novel, full-spine, manual sham chiropractic maneuver and its blinding success. Objective: This study aims to evaluate the blinding integrity of participants receiving a genuine or sham chiropractic maneuver. We will also be evaluating the effects of genuine chiropractic treatments relative to sham chiropractic treatments by measuring several neurophysiological mechanisms. Methods: Participants (N=60) will be recruited from in and around Marietta, Georgia, United States. They will undergo a chiropractic physical exam and health history review with a licensed chiropractor and be randomized to either a sham or genuine chiropractic group (1:1 ratio). Participants, outcome assessors, and data analysts will be blinded to group allocation. The genuine group will receive diversified HVLA chiropractic spinal manipulative therapy (SMT), while the sham group will receive a novel chiropractic HVLA-emulating therapy. Each participant will attend 2 sessions spaced 1 week apart. Assessments will consist of blinding surveys postsessions (both visits) and presession (second visit). Additionally, we will measure gait parameters. The primary outcome of interest is blinding measured via the Bang Blinding Index (Bang BI). Secondary aims include measuring blinding via the James Blinding Index (James BI) and exploring the potential differential effects of genuine versus sham SMT on gait parameters. Results: This study is being supported and internally funded by the Dr. Sid E. Williams Center for Chiropractic Research at Life University in Marietta, Georgia, United States. Our study was prospectively registered on clinicaltrials.gov (NCT06931600) on March 28, 2025, and the first participant was enrolled on May 5, 2025. As of December 10, 2025, 18 participants have completed the trial. Projections for completing data collection, data analysis, and manuscript submission are Summer 2026, Fall 2026, and Winter 2027, respectively. Conclusions: The significance of the current RCT will be in its ability to inform whether our novel, full-spine, manual sham SMT protocol successfully blinds participants, suggesting feasibility for future clinical trials, as well as assessing for secondary outcome measures between groups.

Objective: This scoping review aimed to map the volume (number of studies) and nature (topics and designs) of chiropractic education research and scholarly publications on chiropractic learners and programs worldwide. Introduction: Despite the expansion of the chiropractic profession and its recognition by entities such as the World Health Organization, a gap exists in comprehending the international landscape of chiropractic education. No prior studies have systematically mapped the volume and nature of chiropractic education research and scholarly publications. A scoping review of chiropractic education research and scholarly publications is needed to guide future policy development, research agendas, and educational initiatives within the chiropractic profession. Inclusion criteria: Publications in the indexed literature on chiropractic students, graduates, academics, and programs in any chiropractic education setting were included. Studies focused on chiropractic programs and education for chiropractic students or chiropractors worldwide were considered for inclusion. All research designs, literature reviews, descriptive studies, and commentaries were included. Methods: This scoping review was conducted according to JBI methodology for scoping reviews and was reported in line with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). The databases PubMed (NLM), Scopus, CINAHL via EBSCOhost, Index to Chiropractic Literature, Biblioteca Virtual em Saúde, and Educational Resources Information Center were searched from their inception to November 5 and 6, 2023, with no language limits. Data were extracted for primary topics, study designs, and regions of the included documents and entered in Covidence by paired independent reviewers. The findings were organized into figures and tables with a narrative description. Results: The search identified 7494 documents. After deduplication, 5041 were screened for relevance, of which 667 were selected for full-text review. From these, 598 were selected for data extraction. The chiropractic education topics included values/ethical competence (n=3), personal/behavioral competence (n=34), knowledge and cognitive competence (n=49), functional and clinical competence (n=93), and program-relevant research (n=419). Most designs were quantitative (n=391), followed by descriptive reports (n=91), qualitative (n=43), mixed methods (n=40), commentaries (n=22), and literature reviews (n=11). Chiropractic education was most studied in the United States (n=359), Australia (n=116), and Canada (n=106). Conclusions: This scoping review reports the volume and nature of indexed publications relating to chiropractic learners and programs worldwide. This body of literature contains learner competencies in knowledge, skills, and attitudes, as well as studies about chiropractic programs. The increasing number of publications and proportion of study designs over time show that chiropractic scholars and programs are engaged in collecting, analyzing, and distributing data relevant to education and training. The map of professional competencies in the chiropractic education literature shows that the profession possesses the fundamental traits needed to contribute to the global health care workforce. Review registration: Open Science Framework https://osf.io/9b3ap Supplemental digital content: French- [http://links.lww.com/SRX/A94], Spanish- [http://links.lww.com/SRX/A93] Mandarin- [http://links.lww.com/SRX/A87], Portuguese- [http://links.lww.com/SRX/A88], Malaysian- [http://links.lww.com/SRX/A90], and Welsh-language [http://links.lww.com/SRX/A89] translations of the abstract are available.

The purpose of this study was to determine whether tenderness would improve after chiropractic manipulative therapy (CMT) in patients with lower back pain. This study was a consecutive case series of 98 patients who completed an initial trial of CMT (1-6 weeks of care) in a private practice from 2018-2021. Charts were retrospectively reviewed. Variables included algometric measurement of L5 paraspinal pressure pain thresholds (PPTs), Modified Oswestry Disability Index (ODI), Numeric Rating Scale (NRS) pain ratings for location and maximum intensity of self-rated back and/or leg pain, as well as level and location of pain reported during posterior oblique trunk movement (operationalized Kemp Test). Statistical analysis included Wilcoxon Signed Rank Test and the Repeated Measures Correlation Test. Statistically significant improvements (P < .05) for 13 of 15 clinical measures included back and leg pain, ODI, PPT asymmetry and thresholds, and Kemp Test provocation. ODI scores were inversely associated with increases in paraspinal PPTs both on the right [r_rm = -0.59] and left [r_rm = -0.61] and Kemp Test provocation correlated moderately and inversely with PPTs at L5 both before and after CMT. Findings suggest that there were correlations between tenderness, back and leg pain, ODI, and clinical tests after CMT.

Objective: To investigate chiropractic students’ preferences and perceptions of remote learning with a secondary aim of comparing individuals with and without learning challenges.Methods: Following the mandatory period of remote education, a 33-question, mixed-methods, anonymous online survey was distributed from March to September 2021 to a single-campus chiropractic student body with an estimated sample study population of N = 1375. Demographic variables, self-reported learning challenges, technology skills, and perceptions of remote and on-ground learning delivery modalities were gathered. Percentages, measures of central tendency, and chi-square tests were performed on the data.Results: There were 117 participants (8.5%), of whom 63.2% were female (n = 74) and 87.2% (n = 102) were aged 18–34 years. Self-identified learning challenges were present in 33.3% (n = 39) of participants, of whom 28 stated they had attention-deficit/hyperactivity disorder or attention-deficit disorder. More than 85.5% (n = 100) of participants agreed they were proficient with the necessary technology. For basic science classes with a lecture and lab component, 61.5% (n = 72) preferred on-ground labs and remote lectures. Participants agreed that remote lectures and on-ground labs were a good use of time (75.2% [n = 88] and 79.5% [n = 93], respectively). There was a significant χ2 between individuals with and without learning challenges for the perception of “stimulating and interesting” (p = .044) and “attention” (p = .001) for on-ground lectures.Conclusion: Chiropractic students preferred remote and on-ground education differentially for labs and lectures. On-ground labs provided greater perceived educational benefits; perceived benefits of remote lecture courses were only modestly supported. Students with self-identified learning challenges presented with some differences related to perception of on-ground lectures.

Objective: Faced with COVID-19 safety protocols that severely limited the ability to conduct chiropractic technique instruction in the usual manner, our university invested the resources to develop a new mannequin lab for hands-on training, which would help supplement the loss of person-to-person contact. Methods: Training mannequins could enable student learning of palpation and adjustment skills while avoiding close human–human contact. The university had developed a mannequin over the previous 4 years consisting of a full-sized human torso with individually movable and palpable vertebrae, pelvis, and thighs. In the mannequin, 64 pressure sensors are attached to particular vertebral and skeletal landmarks and provide feedback on palpation location and level of force applied. We assembled 3 teams to produce 20 copies of that mannequin for student use. Results: Mannequins were produced in 7 weeks, and space was built out for a special lab. Faculty members are developing classroom procedures to introduce the mannequin to students, phase in the skills from static and motion palpation, and practice thrust performance. Conclusion: The production run was successful, and the resulting equipment, well-received by students and faculty. In addition to helping teach manual skills, the lab serves as a platform for educational research to test the efficacy of mannequin-based training protocols. With the pressure sensors on known locations along the spine, future research may be able to test the ability of students to identify and contact specific target locations for adjustive thrusts.

Hypertension is a multifactorial condition that is among the leading causes of mortality worldwide. Regulation of blood pressure greatly depends upon the activity of the autonomic nervous system. Alterations in the autonomic nervous system can lead to hypertension. In addition to nervous system control and individual physiologic state, various genes can directly influence autonomic responses. The complexity of blood pressure control is reflected in the 20-30% of individuals resistant to traditional pharmacological treatment, this indicates the need for alternative interventions. This article provides an integrative review and discussion of the key neurophysiologic and genetic factors that contribute to blood pressure regulation, the autonomic nervous system (ANS) and manual therapy literature, and the manual therapy and blood pressure literature. To assess the effects of chiropractic on the management of hypertension we searched articles published from 1980 to 2019 in PubMed, the Index to Chiropractic Literature and CINAHL, using the keywords: chiropractic, spinal manipulation, hypertension, and blood pressure. We found 38 original studies that analyzed the effect of chiropractic therapy on hypertension. Of these studies, 10 were case reports and the statistical significance of the effects of chiropractic on blood pressure was not evaluated on these articles, so we focused on the remaining 28 articles. The results of the review relative to chiropractic care were promising, but often contradictory, suggesting more research should be done. In consideration of the complexity of ANS blood pressure control, an evaluation of patient presenting physiologic and genetic characteristics is recommended and could provide valuable insight relative to the likelihood of patient blood pressure related responsiveness to care (www.actabiomedica.it)