Translational research defined
In translational research, findings from laboratory, clinical or population studies
are transformed into clinical or population-based applications to improve health
by reducing disease incidence, morbidity and mortality.
By its collaborative nature, translational research is mutually beneficial to
scientists and clinicians alike. While clinicians benefit from the new tools that
scientists are giving them, the clinicians are in turn able to pass their own
observations back to the scientists, who then generate further investigation.
The push for translational science and research began in 2002 at the National
Institutes of Health—or NIH—which is part of the U.S. Department of Health
and Human Services. By 2005, NIH Director Elias Zerhouni, M.D., was proclaiming
that it was time for the research community “to translate the remarkable
scientific innovations we are witnessing into health gains for the nation.”
Interest in translational research soon caught on at Palmer College. Last year,
the College began drafting “The Palmer Vision,” a document that sets a fiveyear
course for Palmer, including the Palmer Center for Chiropractic Research
(PCCR). According to Executive Director for Research Christine Goertz Choate,
D.C., Ph.D., “As part of the visioning process, we held a series of planning sessions
and determined together that pursuing translational research in chiropractic
fit right into Palmer’s vision.”
Funding for the future of chiropractic research
Palmer’s Executive Director for Research
Christine Goertz Choate, D.C., Ph.D.
Along with being the first chiropractic college to pursue translational research,
Palmer is also the first to be awarded federal funding to implement it. In June,
the Palmer Center for Chiropractic Research received funding of up to $2.63 million
from the National Center for Complementary and Alternative Medicine, or
NCCAM—a component of the NIH—to establish the Developmental Center for
Clinical and Translational Science in Chiropractic.
Said Dr. Goertz Choate, “This grant award makes
possible the next logical step in the development
of the PCCR as we move beyond the strong platform
we are building in basic science research toward our
over-arching goal of establishing a strong translational
research center for chiropractic.”
NCCAM Director Josephine Briggs, M.D.,
speaking to Palmer’s Research Department on
a May 2008 visit to the Davenport Campus.
NCCAM Director Josephine Briggs, M.D., visited the
PCCR this spring to tour the facility. “We need to support
translational research to build a strong evidence
base for complementary and alternative medicine,” said
Dr. Briggs. “Only when that evidence base is constructed
will we have the information that the public and
practitioners need. I commend Palmer for leading this
effort in chiropractic research.”
DCCTSC: Working together for the common good
The Developmental Center for Clinical and Translational
Science in Chiropractic, or DCCTSC, is a fouryear,
multidisciplinary consortium of complementary
and alternative healthcare institutions that are joining
forces for research. It is the fourth developmental center
awarded by the NIH to Palmer since 1997.
The new center was created to promote greater communication and collaboration
among 10 investigators at Palmer and their partners at the University of Iowa, the
University of Miami, Chicago’s Loyola University Stritch School of Medicine and
Edward Hines Jr. Veterans Affairs Hospital.
The DCCTSC is being led by Dr. Goertz Choate, its principal investigator, and
contains three projects, ranging from a study on the effects of upper cervical
manipulation on hypertension to a study that explores the feasibility of having a
“placebo adjustment” when conducting chiropractic research.
Project 1: Hypertension and the NUCCA Technique
A recent pilot study in the Journal of Human Hypertension found that a chiropractic
technique developed by the National Upper Cervical Chiropractic Association
(NUCCA) was effective in lowering high blood pressure within a small group of
hypertension patients. This method of adjusting the atlas subluxation complex is
based on three-dimensional X-ray studies that determine the correct line of drive
or vector of force.
The PCCR is expanding on the study under the co-direction of Dr. Goertz Choate
and Gervasio Lamas, M.D., a cardiovascular scientist at the University of Miami.
Dr. Lamas is known for his expertise in large, complex, multi-site clinical trials.
“We chose to replicate the pilot project because if the findings are reproducible,
the results could have broad public health importance,” said Dr. Goertz Choate.
“More than 50 million Americans suffer from hypertension, and any new treatment
that has the potential to benefit patients with high blood pressure should
be carefully evaluated.”
Because the NUCCA Technique is not widely used by chiropractors, toggle recoil
will also be evaluated in the study.
“Despite the wide availability of effective treatments, only about 30 percent of
hypertensive patients achieve blood pressure goals,” said Dr. Goertz Choate.
“Therefore, there is a need to investigate alternative treatments that are not subject
to the limitations of traditional therapies.”
Project 2: Help for people with jaw pain
Many people suffer from temporomandibular disorders (TMD), which encompass
a wide variety of problems including difficulty in opening or closing the mouth or
pain in the jaw. In some cases, people have significant levels of constant pain
and/or mechanical dysfunction. While numerous approaches have been used in
an effort to treat TMD, none of them have been shown to work very well.
A few years ago, one chiropractic technique, Activator Methods, appeared to
have good results with patients who had TMD. In a small case series study of
nine people with TMD, each of whom were treated with the Activator, all
showed marked improvement.
PCCR Associate Professor James DeVocht, D.C., Ph.D.,
attaches a surface electromyographic (EMG) electrode
to monitor the activity level of muscles in the neck.
These encouraging results led to the PCCR’s current four-year study on TMD. It is
being co-directed by PCCR Associate Professor James DeVocht, D.C., Ph.D.,
Davenport ’83, and Clark Stanford, D.D.S., Ph.D. Dr. Stanford is the associate
dean for Research and director of the Office of Clinical Research and the Dental
Clinical Research Center of the University of Iowa’s Institute for Clinical and
This study will involve 80 participants with TMD
to compare Activator Methods to splint therapy, the
approach most commonly used by dentists. The
Activator Methods care will be provided by Walter
Schaeffer, D.C., Davenport ’86, who is the primary
developer of the TMD aspect of the Activator technique.
The splint therapy care will be provided at
the University of Iowa.
“If all goes well and the results continue to be
promising, the next step would be to request
funding for a full-scale randomized control trial
involving a larger number of participants and more
than one treatment location,” said Dr. DeVocht.
Project 3: A placebo for chiropractic
The third DCCTSC project involves the development
of a sham chiropractic procedure for
neck pain that would play a role similar to a
placebo pill in pharmaceutical studies.
PCCR Associate Professor Ram Gudavalli, Ph.D.,
left, observing PCCR Senior Clinician Robert
Vining, D.C., as he gets into proper position to
demonstrate distraction of the lower cervical spine.
“It is a challenge for chiropractors to develop sham
procedures because the treatments involve manual
contact with the patient,” said PCCR Associate
Professor M. Ram Gudavalli, Ph.D. Dr. Gudavalli is
co-leading the project with Avinash G. Patwardhan,
Ph.D., professor at the Loyola University Stritch
School of Medicine in Maywood, Ill., and director
of the Musculoskeletal Biomechanics Laboratory at
Edward Hines Jr. Veterans Affairs Hospital in
Hines, Ill. Past collaborations between the two
have resulted in research on neck pain, low back
pain and biomechanics.
“The ideal sham procedure should not have any
therapeutic effect, and at the same time, the
patients should believe that they are receiving
treatment,” said Dr. Gudavalli. “This allows us to directly compare active treatment
with a placebo treatment so that we can learn more about the specific patient benefit
received from the active treatment.”
In order to ensure the study’s success, only individuals who have not received this
type of adjustment before will be considered for the study, as experienced patients
would know firsthand the difference between a placebo adjustment and a real one.
Translational research at the campus level
The PCCR involves research on all three of Palmer’s campuses. In addition to
faculty clinicians, students on the Davenport Campus and West Campus often
take part in various research studies, a trend that is expected to evolve even
further as the Florida Campus expands its research efforts over the next year.
Davenport Campus assisting students with Toggle Recoil project
PCCR Associate Professor Edward Owens,
D.C., shows how to deliver a thrust on a
speeder board, which, when fitted with a
transducer, can measure the thrust and force
of adjustments made in Toggle Recoil classes.
In a recent study, Drs. DeVocht and Gudavalli, along with PCCR Associate
Professor Edward Owens, D.C., collaborated with Toggle Recoil Instructor
Ramneek Bhogal, D.C., Davenport ’02, and Department Technique Chair John
Strazewski, D.C., Davenport ’79. They created a force/time profile of both upper
cervical technique students and instructors when they delivered thrusts on a
small device called a “speeder board.”
A speeder board has a drop mechanism like the headpiece of a toggle table,
which is used by toggle students to practice delivering thrusts. For this
study, a force transducer was placed within a speeder board and its output
fed into a computer. The data from each thrust was then mapped out on a
graph—similar to how a seismograph
measures earthquakes—with the peak
showing the maximum force of the
thrust. Additional data will allow for
quantitative analysis to be done later.
Because toggle recoil adjustments must
be delivered both quickly and with the
right amount of force, this approach is
expected to become an important tool
for helping chiropractic students
improve their skills. Plus, a new journal
club has been formed to review
similar work by other researchers and
to discuss how to best utilize this technology for
West Campus acute neck pain study yields results
Neck pain is a condition that, according to some studies,
affects almost half of the U.S. population. Acute
neck pain—or ANP—is a sudden onset of neck pain,
which has been present for a short period of time. It’s
often caused by whiplash or sports injuries and, in time,
may progress to the sub acute and chronic phases.
West Campus Director of Technique and Research Robert
Cooperstein, D.C., left, and Associate Professor Michael
Haneline, D.C., M.P.H., who both worked on the acute
neck pain study in the West Campus Research Lab.
“Very little information has been published on ANP, including its treatment
with chiropractic care, yet chiropractors commonly treat the condition,”
said Associate Professor Michael Haneline, D.C., M.P.H., who has been
leading a study on ANP since 2004. “It is a difficult study to pursue
because acute neck pain can progress from acute to sub acute to chronic
The recently completed study involved a network of practicing chiropractors
who collected data on their ANP patients before forwarding it to the
West Campus research center for analysis. The findings are expected to be
submitted to peer reviewed journals by early fall. While no control group
was utilized in this study for comparison, and no claims of cause and effect
can be made based on its results, the study provides valuable information
on chiropractic and ANP.
“As far as the potential benefits of this study, it will mainly provide previously
unknown information about how ANP patients respond to chiropractic
care,” said Dr. Haneline. “This is important and useful information
to have and will lay the groundwork for future studies on chiropractic care
Florida Campus to build cell and molecular biology lab
Currently there is little knowledge available on how chiropractic works at
cellular and molecular levels. But a new cell and molecular biology lab
planned for the Florida Campus may show how chiropractic may work on
some aging-related diseases and provide the scientific mechanisms behind it.
Florida Campus Director of Research Dr. Liang Zhang
is spearheading a new cell and molecular biology lab.
“The aging population is growing rapidly in this country,” said Liang Zhang,
M.D., Ph.D., who recently became the director of Research on the Florida
Campus. “Thus, aging issues are increasingly important to people, for both
prevention and treatment.”
Dr. Zhang chose to join Palmer after working for several years in pharmacology
at the University of Illinois at Chicago College of Medicine. “I like
the concepts of surgery-free and drug-free preventive care advocated by
chiropractic,” said Dr. Zhang. “And Palmer is the leader in chiropractic.”
He also believes the work that will be performed in the new lab compliments
the College’s venture into translational research.
“If a scientist wants to know more about chiropractic care as it is delivered
in the practitioner’s office, he or she can team with field doctors for a clinical
study,” added Dr. Zhang. “Or if a field doctor is interested in answering
mechanistic questions, he or she can come to our lab to get their feet wet.
Our plan is to both facilitate our understanding of chiropractic and disseminate
effective techniques in field practice.”