CASE STUDY
The Resolution of Chronic Colitis with Chiropractic
Care Leading to Increased Fertility
Charles L. Blum, DC
ABSTRACT
Introduction: A 32-year-old female presented at my office for
chiropractic care of her chronic colitis and did not disclose her
condition of infertility during the course of care at this office.
There appears to be some relationship between chiropractic care
and relief of some visceral conditions relating to the colon and
female reproductive organs.
Methods: Chiropractic care and specifically Sacro Occipital
Technique’s (SOT) such as R+C factors utilizing orthopedic
block placement and cervical stairstep procedures, occipital fi-
ber analysis and treatment, bloodless surgery: chiropractic ma-
Introduction
A 32-year-old female presented at my office for chiropractic
care of her chronic colitis. She had chronic condition of loose
stools, which had been unresponsive to various care modalities
attempted over 12 years. At the initial office visit and during
the course of treatment the patient did not inform me that she
and her husband had been attempting to start a family for over
7 years.
Manipulative therapeutic treatment of colon related and other
visceral conditions through influence to the musculoskeletal and
neurological systems is associated with somatovisceral and
viscerosomatic relationships have some support in the litera-
ture.1-5 Chiropractic treatments have been suggested as a pos-
sible mode of therapy for care of colitis amenable to manipula-
tive and visceral manipulation.6-7
Some female related disorders have also been found to be
positively affected by manipulative therapies.8-15
In a study by McNabb16 and also Browning17 a relationship
was found between chiropractic for pelvic pain and gyneco-
logical dysfunction. The study by NcMabb investigated treat-
ment of a female patient presenting with lower neck, upper back,
severe pelvic pain complicated by progressive dysmenorrhea,
and infertility. Chiropractic treatment to the sacroiliac joint,
L4, T11, C2 and C1 along with soft tissue mobilization, spinal
Charles Blum, DC, Private Practice,1752 Ocean Park Boulevard,
Santa Monica, CA 90405, 310-392-9795, drcblum@aol.com
The Resolution of Chronic Colitis with Chiropractic Care Leading to Increased Fertility
nipulative reflex technique (CMRT), and category one block
placement and protocol were employed.
Results: The patient had her chronic condition of colitis re-
lieved and relatively simultaneously became pregnant after giv-
ing up on allopathic fertility treatments for 7 years.
Conclusion: As with all single subject case studies it is diffi-
cult to extrapolate finding from one result to treatment to the
populous at large, however due to the success in this case fur-
ther studies appear to be indicated.
Key Words: Chiropractic, Sacro Occipital Technique, SOT,
Infertility, Fertility, Colitis, Bloodless Surgery, CMRT.
stretching exercises and postural habit modification were em-
ployed. The treatment helped relieve the patient’s persistent
symptomatology and by one year following stabilization she
was able to become pregnant by “natural means.” The patient
and her husband were previously evaluated for fertility issues
and after treatment for some minor issues were still unable to
conceive. McNabb states that, “It is significant to note that no
anatomical pathology was observed during any of the exami-
nations performed. It is also my impression, that the timing in
the cessation of the pelvic symptoms and the ability to con-
ceive was not coincidental.”15
Case History
A 32-year-old female patient complaining of chronic colitis
of 12 years was treated by Sacro Occipital Technique (SOT)
protocol. Her major presenting symptomatology consisted of
C2 related to R + C Factors, an occipital fiber line two area 4th
lumbar relationship, and category one dysfunction. Treatment
began at intervals of 2 times a week for 2 weeks, then 1 time a
week for 6 weeks, and then she was seen 1-3 times a month for
4 months until her stools normalized and this condition was
maintained. The treatment involved adjusting L4 and C2, treat-
ing L4 (S4) with occipital fiber neutralization and SOT colon
visceral manipulative reflex techniques (bloodless surgery: chi-
ropractic manipulative reflex technique CMRT), and category
one adjustive protocol techniques.
J. Vertebral Subluxation Res., August 31, 2003 1
 Approximately one month following quiescence of her coli-
tis, stabilization of her category one indicators, R + C factors,
and occipital fiber reflexes the patient indicated to me that she
was pregnant. At the time I was not aware that this had been a
significant issue for her and her husband, however she informed
me that they had been attempting to have a child for over 7
years. After repeated attempts she indicated that they had given
up over one year prior to commencement of treatment and they
were considering adoption as an alternative.
Methods
SOT methods involved treatment based on R+ C factors,
utilizing orthopedic blocking and cervical Stairstep procedures,
occipital fiber evaluation and treatment, CMRT procedures for
the colon, and category one protocol. A typical treatment would
entail palpation of R+C factors utilizing the cervical spine to
direct lumbar involvement and treatment with orthopedic block
placement. Then the patient would be placed in category one
block position while occipital fibers were analyzed and neu-
tralized. The category one procedures would be completed and
then the patient would turn over and placed herself supine on
the table at which time her cervical spine would be treated with
the cervical stairstep and finishing with CMRT procedures for
L4.
R+ C Factors
As the name Sacro Occipital Technique (SOT) implies,
DeJarnette, a chiropractor and osteopath, found a relationship
between the sacrum and occiput, as well as between the cervi-
cal and lumbar vertebra.18 He described that a relationship ex-
ists between the atlas and the 5th lumbar vertebra, axis and the
4th lumbar vertebra and so forth, following that pattern all the
way to the mid thoracic region. He called this relationship R +
C factors (for resistance and contraction ) and found that each
vertebra within a pair affected one another.
For example, when there is rotation of the L4 spinous to the
right side there will be sensitivity at the ipsilateral transverse
process of C2. As the L4 spinous is rotated to the right, by way
of block placement or doctor’s hand pressure, sensitivity at C2’s
transverse process will subside. When there is an inferiority of
L4 transverse process or disc compression at L4/L5 there will
be sensitivity at the ipsilateral lateral aspect of the spinous pro-
cess of C2. As L4 is decompressed sensitivity at the lateral
spinous process will subside.
These concepts have been readily used and are broadly ac-
cepted in the field of chiropractic and there are some theories
as to why this relationship exists. They vary from fascial and
mycological interrelationships, referred pain patterns, and fa-
cilitating tonic neck reflexes involving intersegmental spinal
pathways. Apparently “Lovett Brother” relationships19 can af-
fect or be affected either in a cervical to lumbar caudal direc-
tion or lumbar to cervical cephalad direction. That would mean
trauma or altered function of a lumbar vertebra could also af-
fect its cervical component and trauma to a cervical vertebra
could affect its lumbar component.20-1
SOT Orthopedic Block Placement:
One method called “Orthopedic Block Techniques”20-3 uses
wedges or blocks placed in specific positions to “de-rotate” the
The Resolution of Chronic Colitis with Chiropractic Care Leading to Increased Fertility
spine and affect lumbar vertebral inferiority or rotation.
DeJarnette noted that the orthopedic block technique “approach
is extremely valuable in multiple vertebral rotations as it per-
mits proper muscle conformation as the correction is being made
and the correction is made without force diminishing any pos-
sibility of trauma.
Pelvic block placement for rotation of the lumbar vertebra is
on the contralateral side of spinous rotation at the region in-
between the ASIS and greater trochanter. This position is some-
times seen as advantageous when there is no desire to affect a
PI/AS ilium rotation during the process of lumbar correction.
The spinous process can be adjusted by rotating the vertebra
determined by the cervical indicator, towards the side of block
placement. With lumbar inferiorities associated with lateral
cervical spinous process sensitivity, blocks can be placed at 45
degree angles caudally under the prone patient’s bilateral ASIS’s.
Then while in the position cephalward pressure is applied to
the ipsilateral lamina of the lumbar vertebra by thumb pressure
until cervical tenderness subsides.
Cervical Stairstep
When lumbar spine subluxations are persistent or when there
is a primary cervical subluxation SOT has a method called the
“cervical stairstep technique” which according to DeJarnette
will localize and correct “loosened motor units” of the cervical
vertebra. He recommends using a treatment called the “figure
eight” which he describes as the “ideal cervical technique as it
involves no violent motions or thrusting forces, rather a gentle
controlled motion to reset the processes of the loosened cervi-
cal motor units.”20,25 The “resetting of the vertebra” involves a
mechanical repositioning of the vertebra normalizing any limi-
tations in ranges of motion during stairstep range of motion
testing.
Occipital Fiber Evaluation and Treatment
DeJarnette has correlated the development of nodules within
suboccipital fibers with specific segmental levels of spinal dys-
function. These fibers appear to be near the aponeurosis of the
cervical musculature where it attaches to the occiput. He fur-
ther hypothesizes that these nodules may result from prolonged
golgi tendon organ stimulation and various reflex mechanisms
resulting from cervical, thoracic and lumbar subluxations.20,26
DeJarnette determined that these occipital lines can be used to
identify visceral and CSF dysfunction.
Locating the occipital fibers is usually accomplished with
the patient prone, and the doctor’s both hands beginning pal-
pating at the occipitomastoid suture. At the occipitomastoid
suture the first of seven longitudinal occipital fibers are located
on line one. Proceeding medialward these fibers are palpated,
seven bilaterally, to the inion (external occipital protuberance)
inferior border. Occipital line one, has seven distinct fibers
from the medial occipitomastoid to the nuchal border. When a
fiber is identified on occipital line one as painful to fingertip
pull by following the fiber, inferiorward approximately 1 centi-
meter you can feel a round hard small nodule if line two is
involved. Each occipital fiber and line has a specific group of
vertebra in their reflex arc. Line two is related to visceral influ-
ences and relate to the care given in this particular case his-
tory.20,27
J. Vertebral Subluxation Res., August 31, 2003 2
 Occipital Line Two Reflex Chart
Occipital 1 2
Thoracic 1-2-10 3-11-12
Lumbar
Sacral
Occipital line two indicates pathology or subclinical pathol-
ogy of the viscus producing a reflex arc from vertebral level to
cerebral level and helps to delineate a specific vertebral pattern
relating to each of the seven fibers. Whichever vertebra has
greater palpatory pain over the transverse process associated
with the active fiber determines the vertebra from which the
reflex arises and is the neutralization point.20,27
The line two occipital fiber is the major indicator of the source
of abnormal stimuli that has resulted in viscus fixation. The
vertebral source of stimuli lies within the reflex arc of the ma-
jor occipital fiber. The major occipital fiber is contracted and
manipulated thoroughly and firmly enough to arouse its full
pain perception. While this manipulation is going on, the in-
dex finger of the other hand is placed over the right or left trans-
verse process of the involved vertebrae. The transverse pro-
cess contact is held while the occipital fiber is stimulated. When
the contact point at the transverse process nodule responds, there
will be increased palpation of warmth and moisture. At this
point a pisiform contact is made over the transverse process
with a gentle thrust (posterior to anterior).20,27
With the lumbar vertebra 1, 2 and 4 there is an exception to
the vertebral occipital fiber line two neutralization and treat-
ment. When lumbars 1, 2 & 4 are involved with transverse
process nodulations, contact is placed on the ipsilateral sacral
area, while the occipital fiber is manipulated. An occipital area
six would indicate involvement of thoracic 8 or lumbar 4.
Should the right or left transverse process of lumbar 4 harbor
the nodular painful area, the finger contact would be over sac-
ral foramina 4 during the occipital fiber manipulation, and pisi-
form thrust (posterior to anterior) would be given to the ipsilat-
eral sacral foramina 4. When lumbar three or five are involved
with the painful nodulation, neutralization contact and treat-
ment are the same as for the other thoracic vertebra.20,27
Bloodless Surgery: CMRT
SOT has various methods of affecting the viscerosomatic
and somatovisceral component of a subluxation complex. The
procedures for diagnosing and treating the vertebra, viscera,
and its neurological reflex arch are called “Bloodless Surgery”
or CMRT (Chiropractic Manipulative Reflex Technique).
CMRT was originally called bloodless surgery but was updated
when DeJarnette changed its name to CMRT in the 1960s.
Dr. DeJarnette in his books on Bloodless Surgery and Chi-
ropractic Manipulative Reflex Techniques (CMRT) indicated
that, “any subluxation of the spine may be reflexly produced
by the occiput.” When a subluxation is present for long dura-
tions, this vertebral subluxation will affect the cerebrospinal
system exciting the associated paravertebral musculature. “The
excited muscle contracts and disturbs the vasomotor system as
The Resolution of Chronic Colitis with Chiropractic Care Leading to Increased Fertility
3 4 5 6 7
4-5 6 7 8 9
1 2 3 4 5
1 2 4
it relates to the spinal muscles and spinal cord.” The vasomo-
tor reaction then affects the sympathetic system, and becomes
involved in a reflex fixation.28
Bloodless Surgery is indicated when an occipital line two
fiber is present and the associated vertebra involved has a nod-
ule over its transverse process. The splinting of the muscula-
ture controls motion, but destroys normal circulation to the in-
nervated areas. The destruction of necessary blood and lymph
flow sets the stage for viscus pathology. The viscus pathology
makes necessary a new arrangement of defense through reflex
fixation of soft tissues.27 Bloodless Surgery “seeks to remove
this soft tissue fixation, and through such removal, restore func-
tion by restoring circulation.”28
Various theories have been proposed for the occipital fiber
activation in chronic viscerosomatic or somatovisceral dysfunc-
tion. One relates the position of eyes, which is generally found
to normally focus its direction perpendicular to gravity. To
maintain this position as postures and neuromuscular imbal-
ance occurs, the head position is modulated by the suboccipital
musculature, to a large extent. Through muscular triangulation
DeJarnette determined specific suboccipital nodulation related
to specific chronic vertebral malpositioning particularly in the
thoracolumbar region. This process of analysis and correction
is performed through the occipital fiber analysis, correction and
Bloodless Surgery procedures.27
DeJarnette had specific bloodless surgery procedures for
treatment for each of the thoracolumbar vertebra. The L4 —
occipital fiber 6 line two condition was determined by DeJarnette
to be related to a colon syndrome or its dysfunction. Following
treatment of the occipital fiber and sacral foramina 4, specific
clavicular and colon palpation were performed and determina-
tion was made whether the patient was presenting with colon
overactivity or stasis, that was treated, and then a technique to
balance the viscerosomatic reflex arc, postganglionic technique,
was performed.27
Clavicular Colon Reflex and Treatment
When palpating the clavicular reflex (inferior to superior
pressure) the most lateral inferior portion of the clavicle is usu-
ally painful in colon stasis or constipation while the medial in-
ferior portion of the clavicle is usually painful to underside pal-
pation in colon over-activity or diarrhea. To determine the
point(s) of greater colon dysfunction specific method of palpa-
tion is performed. The colon is palpated in its entirety while
the patient is supine. The doctor’s left hand palpates the right
colon and the doctor’s right hand palpates the left colon, each
working in unison. This palpation starts at the center of the
ascending and descending colon and move inferiorward. Then
returns to the center and move cephalward and across the trans-
J. Vertebral Subluxation Res., August 31, 2003 3
 verse colon meeting at the midline. The most painful area(s)
are selected as the treating point(s).27
The patient was found to have medial clavicular sensitivity
and complaints of colon overactivity, diarrhea, and colitis there-
fore the treatment focused on calming and slowing the peristal-
tic activity of the colon. The procedure to treat this colon
overactivity involved the doctor contacting the inferior medial
surface of the most sensitive clavicle. The doctor’s other hand
contacts the most painful colon area and moves to reverse the
direction of the normal action of the colon. This is performed
with medium, still pressures as the clavicle thumb manipulates
the clavicular area and continued until the whole colon has been
treated.27
SOT Category System of Diagnosis and Treatment
Dr. DeJarnette surmised that not all subluxations affected
the body the same way: some affected the dural/meningeal sys-
tem, some the musculoskeletal system, and others the ligamen-
tous system. He was able to distinguish and systematize these
subluxations into 3 main categories, create an analysis of these
categories, and devise specific treatments for each.
Category 3 occurs when the spine over-compensates for un-
corrected chronic pelvic instability, it leads to serious injury to
the intervertebral discs and the patient often presents with se-
vere back pain, sciatica, and antalgia. Category 2 is associated
with the ligamentous portion of the SI joint when it is over-
stretched or sprained, the body can’t support itself against grav-
ity. The entire musculoskeletal system compensates by tensing
various muscles in irregular patterns creating joint irritation,
spasm, and pain. The category two patient presents with a vari-
ety of musculoskeletal complaints including back and neck pain,
headaches, extremity problems, and TMJ.20
The patient in this case history presented with a category 1
condition, which is a disturbance of the dural/meningeal sys-
tem that has its origin near the sacral base, where the dura at-
taches near the second sacral tubercle. When the synovial por-
tion of the SI joint subluxates, pathomechanical motion trac-
tions the dura. Both mechanical tension and neural irritation of
the dura have far-reaching consequences affecting nerves as
they exit from the spinal canal, targeting organs and viscera,
movement of CSF, affecting cranial motion, and purported to
effect neural function in general. Clinically, a patient with a
category one lesion may often present with somato-visceral and
viscero-somatic complaints as well as back pain.
Category one focuses on the anterior aspect of the sacroiliac
joint, with the meningeal attachments within the sacral canal.
The meningeal attachments converge within the second sacral
canal segment via the dura mater. The pia mater connects to
the coccyx via the filum terminale. Under normal circumstances,
these meningeal attachments create a balanced tension occur-
ring in the anterior aspect of the sacroiliac joint. Imbalance
within the meninges and associated structures can create a “le-
sion” at the anterior sacroiliac joint. Usually this lesion creates
a torsion of the pelvis, therefore, affecting the entire body from
a neuromuscular point of view.20
The category one patient is treated with a specific method of
bilateral pelvic block placement. The prone patient has a supe-
rior block placed under the ASIS 45 degrees caudalward under
The Resolution of Chronic Colitis with Chiropractic Care Leading to Increased Fertility
the long leg side while the inferior block is placed under the
greater trochanter 45 degrees cephalward under the short leg
side. After approximately 6-8 minutes of the patient resting
with the blocks underneath his/her pelvis an adjustment is usu-
ally made to the sacral or iliac portion of the sacroiliac depend-
ing on specific neuromyological reflex points located in the
sacrospinalis and gluteal muscles. Then a test is performed
called the SB+/- cough test to determine the status of the
meninges in the lumbosacral region.20
DeJarnette developed a method of determining whether the
meninges, as they attach to the second sacral segment, are in
flexion or extension. The term “SB+” is associated with
meningeal extension or increased sacral meningeal/neural ten-
sion. “SB-” is associated with meningeal flexion or decreased
sacral meningeal/neural tension. SB+ and SB- meningeal ten-
sion are determined by placing the practitioner’s thumb gently
over the fifth lumbar vertebrae while the patient is in a relaxed,
prone position. The doctor’s thumb is placed over the patient’s
fifth lumbar vertebrae spinous and then asked to cough so the
doctor can evaluate motion at the fifth lumbar vertebrae by re-
sultant movement of the thumb. One position might be
ceilingward with a “bounce” upon the cough. This would be
termed “SB+.” When the thumb “jerks” cephalward, it is called
“SB-.” A bouncing toward the ceiling, with an equal move-
ment toward the cranium of the patient, is considered a bal-
anced SB+/- or a balanced tension of the meninges in the pelvic
region.20
The patient had SB+ findings and which was treated with
bilateral block placement under the ASIS on both sides with
both blocks facing 45 degrees caudalward. The sacrum is aided
with pressure to the sacral apex on inhalation as the patient
uses their hands to contact the head of the treatment table to
apply traction through pulling themselves superiorly simulta-
neously. As this is performed for 4-5 intervals the spine is
monitored for any changes in vascularity at a specific vertebral
level. The most sensitive of the spinous processes in the region
of decreased vascularity is contacted and adjusted inferior to
superior at the height of patient’s inhalation.20
Discussion
Since the early 20th century chiropractic doctors have used
visceral manipulative and chiropractic treatment involving
viscerosomatic and somatovisceral reflexes to treat organ re-
lated dysfunction.28-9 Sacro occipital technique (SOT) incorpo-
rates bloodless surgery: CMRT into its treatment DeJarnette in
1939 stated, “Bloodless surgery, unlike incisive surgery, does
not remove viscera, nor does it sever tissues. Bloodless sur-
gery seeks to return viscera to normal position, remove pres-
sure from impinged structures, free nerves and blood vessels,
restore normal lymph channels, and by so doing encourages
normal circulation, respiration, elimination, secretion and ex-
cretion.”28
“Bloodless surgery is an art and science which can not be
learned in one single year. It is more complicated than incisive
surgery, because in incisive surgery it is possible to see within,
while in bloodless surgery, you must feel through and visualize
the conditions that exist within. It requires much time in which
to develop the necessary touch that is so all-important to this
J. Vertebral Subluxation Res., August 31, 2003 4
 science of healing. Bloodless surgery does not require strength
for its success, rather it requires an exact anatomical knowl-
edge of the structures under consideration, their normal posi-
tion and relationship to adjoining structures, and a visualiza-
tion of the path over which these structures have traveled to
gain their present abnormal position. The correct knowledge
of tissue and visceral position, normal and abnormal, directs
the bloodless surgeon in his or her manipulations for correc-
tion.”28
SOT category protocols and bloodless surgery: CMRT pro-
cedures have been found to be helpful in conditions related to
specific female disorders such as uterine fibroids12 and idio-
pathic secondary amenorrhea.15 SOT protocol for lumbosacral
pain has also found a relationship between the viscerosomatic
and somatovisceral influences, which can sometimes necessi-
tate CMRT evaluation and treatment.30 The visceral interrela-
tionships with the spine are an integral aspect of SOT care, and
CMRT offers the chiropractor the ability to affect this visceral
component of the neurological reflex arc.31-2
Conclusion
It is of extreme interest that the patient was not treated for
any condition related to her issue of infertility and that coinci-
dentally as her colon began functioning more normally she con-
currently became able to conceive. In a study by Browning it
was found that a mechanical lesion of the lumbar spine with
secondary impairment of lower sacral nerve root function, can
have a clinical presentation highlighted by various combina-
tions of symptoms of bladder, bowel, gynecologic, and sexual
dysfunction.17 The findings of this case history also appear to
corroborate the findings of the Browning study.
As with all single subject case studies it is difficult to ex-
trapolate finding from one result to treatment to the populous at
large. It is also to difficult to clearly document a cause and
effect regarding the care the patient received here at this office
and her subsequent ability to become pregnant. However due
to the prolonged nature of her inability to become pregnant and
the close proximity of her relief from colitis due the chiroprac-
tic care she received, further studies would certainly appear in-
dicated. With the profound intensive invasive protocols used
allopathically to treat infertility, a trial of chiropractic care as a
conservative method based on this case would seem efficacious
or at least warrant further investigation.
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