The Effect of Combining Manual Therapy with Exercise on the Respiratory Function of Normal Individuals:

A Randomized Control Trial

Objective: The objective of this study was to explore the effect of combining manual therapy with exercise on respiratory function in normal individuals.

Methods: The study design was a randomized control trial. Forced vital capacity (FVC) and forced expiratory volume in the firstsecond (FEV1) were measured in 20 healthy, nonsmoking individuals before and after 3 interventions: exercise only, chiropractic manual therapy only, and manual therapy followed by exercise. The participants, 18 to 28 years of age, were randomly allocated to a control and 3 intervention groups. Each participant underwent 6 sessions of interventions over a 4-week period.

Results: The exercise only group showed a significant decrease in FVC (P = .002, generalized linear model [GLM]) and FEV1 readings (P = .0002, GLM). The manual therapy only group showed a significant increase in FVC (P = .000, GLM) and FEV1 (P = .001, GLM). The group that received both manual therapy and exercise showed increases in FVC and FEV1 immediately after manual therapy followed by an additional increase after exercise. The overall increase in this group was not statistically significant. Participants in the control group showed no change in FVC or FEV1.

Conclusions: Manual therapy appears to increase the respiratory function of normal individuals. The potential for this intervention administered before exercise to permit additional tolerance within the respiratory system that could allow an extended exercise program than was previously possible is discussed.

Source: Engel RM, Vemulpad S. Journal of Manipulative and Physiological Therapeutics. September 2007; Vol. 30, Iss. 7

A study published in the November / December 2000 issue of Today’s Chiropractic gives some insight into the use of chiropractic in combating asthma. Forty seven patients were observed for a two year period. They had been medically diagnosed with persistent asthma ranging from mild persistent in 11 cases, moderate persistent in 28 cases, to severe persistent in 8 cases. The care rendered consisted of specific chiropractic adjustments. The range of visits was from 14 to 44, with the average being 26 during the study period.

All 47 of the study patients showed “a marked improvement ranging from 87 to 100 percent.” Their symptoms improved as well as a decrease in their usage of acute asthma attack medication. Even more impressive was the fact that all of the patients in the study reported maintaining their improvement after a two-year follow up.

Childhood Asthma and Chiropractic

It is estimated that up to 15 million people suffer from asthma. Of those, 14.8 million are children under the age of 18. In 1993 alone, there were 198,000 hospitalizations for asthma. In that same sample year, 342 people under the age of 25 died due to this problem. In money terms, the direct cost of managing a patient with severe asthma has been estimated at more than $18,000 per year.


“The traditional medical treatment for asthma is anti-inflammatory and bronchodilator drugs. In some cases, treatment included syrups such as Preventils, which is usually prescribed on a “taken as needed” basis.

The combination of the drugs above promotes drowsiness and may be habit forming. A patient denied of medication feels they can not breathe properly without it, thus becoming irritable. In some cases they become so irritable that they bring on an asthma attack.”  Source:

From the abstract Case review of a 6-year-old boy who has had asthma since 1991 and his condition since chiropractic intervention. Child was prescribed aerosol inhalers (Beclovert and Vertolin) using them every day, up to three times a day. Adjustments were delivered to the cervical, thoracic and lumbar areas. Significant progress. Could run during soccer games and almost never used his inhaler. Slept more soundly. Hardly ever had bouts with mucous clogged nasal passages. Nasal inhalant use stopped.

Source: Asthma and chiropractic. Garde R. Chiropractic Pediatrics. Vol 1 No.3 Dec, 1994.


Allergy shots used as treatment of asthma in children appears to be ineffective. Studies have proven there were no significant benefits with the shots given to children with moderate to severe asthma.
Dr. N. Franklin Adkinson Jr., John Hopkins University

Nearly 40 million Americans — 25% of the total population — suffer from asthma and other allergy diseases

Source: The New England Journal of Medicine in February of 1992
FROM: Foundation for Chiropractic Education and Research (FCER)

October 24, 2002 Des Moines, Iowa— Patients afflicted with asthma may benefit from spinal manipulation in terms of symptoms, immunological capacity, and endocrine effects, an audience was told on October 5 at the 9th International Conference on Spinal Manipulation in Toronto. The investigative team, headed by Ray Hayek, Ph.D., has been conducting a trial at 16 treatment centers in Australia involving 420 patients with an average age of 46 in an effort to find out what effects spinal manipulation has on symptoms, depression and anxiety, general health status, and the levels of immunity as reflected by the concentrations of both an immunoglobulin (IgA) and an immunosuppressant (cortisol). This investigation draws from several references in the scientific literature which suggest that different forms of manual therapy (including massage) improve the symptomatology and lower cortisol levels in asthma patients.

Dr. Hayek reported that only the patient group which underwent spinal manipulation (by any of four commonly used manipulative treatment protocols) displayed significant improvement in asthma symptoms and depression and anxiety scores.

Simply experiencing structured interviews at the treatment centers or being monitored at home did not yield these improvements. In addition, patients actually undergoing spinal manipulation displayed dramatic increases of IgA and decreases of cortisol through the posttreatment period, suggesting that there were physiological consequences to their manipulative treatments reflecting increased immunological capacities which would be expected to ward off subsequent asthmatic attacks.

These biochemical changes not only suggest that the effects of spinal manipulation are more far-reaching than commonly believed, but that they may be more long-term as well. The gain in immunological capacity achieved with the simultaneous loss of the immunosuppressant cortisol and the increase of the immunoglobulin IgA following spinal manipulation would be expected to reduce the incidence and severity of pathogenic invasion of the airways. There would be less of a risk under these circumstances of compounding the symptoms of asthma.

The immunosuppressing mechanism of glucocorticoids is believed to occur by their reducing the permeability of capillaries, decreasing the migration of white blood cells in inflamed areas, suppressing the release of interleukins, and inhibiting the production of proteolytic enzymes by stabilizing the lysosomal membranes which release them.

This followed contacts that the Director of Research at FCER was able to make with the Australian research community in 1995, taking into consideration the expertise of the investigative team as well as the fact that Australia’s 2 million asthma sufferers have given the Island Continent the dubious distinction of being the asthma capital of the world.

It has been carried out with the support of research grants exceeding a quarter of a million dollars from both the Foundation for Chiropractic Education and Research (FCER) and the National Chiropractic Mutual Insurance Company (NCMIC). This research, which may be highly influential on the future of the chiropractic profession, is still in need of funding. To contribute to this important project, please call FCER at800-637-6244,or donate via the Foundation’s secure website at:

This research represents one of approximately 50 projects administered by FCER since 1990 in the effort to document both the theory and practice of chiropractic to increase its effective integration into healthcare systems worldwide. The conference at which these results were presented is an international forum which FCER has sponsored at different locations worldwide for the past 14 years.