About Nasal Cranial Release Technique (NCRT) / Cranial Facial Release (CFR)
Table of Contents:
- I. Definition of NCRT – CFR
- II. Contraindications, Complications and Side Effects
- III NCRT – CFR State’s Scope of Practice Laws
- IV. Published Peer Reviewed Article Abstracts
- V. Unpublished Research Study(s)
- VI Chiropractic Colleges and NCRT – CFR related techniques
- VII Books related to NCRT – CFR
- VIII. Audio and Videotapes related to NCRT – CFR
- IX. “Chiropractic” Interviews related to NCRT – CFR
- X. NCRT Committee
I. DEFINITION OF NCRT/CFR :
“The methods of improving the subluxation complexes or biomechanics of the skull regions of the musculoskeletal system with the use of inflatable devices that assist in the performance of adjustments or manipulations at points of contact upon the nasal passageway regions of the skull.”
Stephen Berman, BSEE, MS, DC, US Patent 5,665,917
1/6/2001
II. CONTRAINDICATIONS, COMPLICATIONS AND SIDE EFFECTS
The following is a list of contraindications, complications and side effects presented from the text Sinusitis and Sinus Pain – Conservative Care Pathways, Western States Chiropractic College, Berman’s article “Skull Dysfunction”, a NCMIC report, Oliver (an observation in private practice), and some research that is important to share.
Contraindications or Cautions:
- 1. Caution should be taken with patients who might have “bleeding disorders”or taking anticoagulant medications, since they might not be a good candidate for this procedure.
- 2. Patients with prior nasal or facial bone surgery, especially with modification of the turbinates are not good candidates for nasal specific because the integrity of the structures is unpredictable. At least one post-surgical case has been reported of a possible fracture of the cribiform plate with CSF leakage due to the nasal specific procedure by NCMIC (National Chiropractic Mutual Insurance Company).
- 3. There has been at least one case reported where an asthma attack was initiated by the nasal specific procedure. [S. Oliver noted this from his private practice experience] It was suggested therefore as a precaution,the clinician should be assured that the patients with a history of asthma have their inhaler with them when they are going to undergo this therapy.
- 4. With a newborn or very young infant, there is a risk of respiratory obstruction accompanying nasal balloon treatment. There has been one documented case where a loose finger cot was inhaled during treatment. Failure of the practitioner to quickly retrieve the finger cot proved fatal. In another case, a child treated in the supine position inhaled mucous causing respiratory obstruction, but was revived by digital clearing of the airway. Berman recommends that necessary emergency equipment should be present when attempting this procedure.
- 5. A recent article was published on this topic which found: A complication from neurocranial restructuring: nasal septum fracture. It was published in Arch Otolaryngol Head Neck Surg 2003 Apr;129(4):472-4. Authored by: Davis GE, Murphy MP, Yueh B, Weymuller EA Jr. from Department of Otolaryngology – Head and Neck Surgery and Health Services, University of Washington, and Health Services Research and Development, Veterans Affairs Puget Sound Health Care System, Seattle 98195-6515, USA. A comment about the article was written entitled, “Neurocranial restructuring” and homeopathy, neither complementary nor alternative.” The comment was published in the Arch Otolaryngol Head Neck Surg. 2003 Dec;129(12):1356-7, and written by Atwood K.
Possible Side Effects:
- 1. Epistaxis can result from the nasal specific procedure and the rare possibility of hemorrhage of ruptured veins.
- 2. Minor soreness over the maxillary-zygomatic or intermaxillary articulations,tenderness of the nasal passage regions, a tingling feeling in the central maxillary incisors, and mild soreness of the gums. In some cases, these mild symptoms persist, though diminishing, for up to several days. Infrequently,a patient might experience a headache after treatment
- 3. Throat irritation due to increased drainage from sinuses may also happen following Nasal Specific Technique although this is temporary and goes away in a short time.
- 4. Occasionally patients will report that they experience significant pain and say they would not undergo the procedure again.
Specific Issues with Nose Bleeding or Epistaxis :
While not a common secondary finding with NCRT, still nose bleeding or epistaxis is something that needs to be considered when their procedure is performed. There are factors, which may predispose patients for epistaxis such as anticoagulant therapies and regular acetylsalicylic acid (aspirin) use [1], upper respiratory infections [2], children with von Willebrand disease [3] and patients with hereditary hemorrhagic telangiectasia (HHT [Osler-Rendu-Weber disease]) [4]. Other types of anticoagulants or blood thinners include: Aspirin, vitamin E, Coumadin, Heparin, garlic, ginger and ginseng. While these may not be a contraindication for NCRT care it would be prudent for the doctor to be prepared to deal with any possible epitaxic event.
What can you do if a patient has a nose bleed (epistaxis)?
1. Nasal packing while commonly used for years in surgical procedures has now been found to be both ineffective and painful [5,6].
2. There are some specific methods suggested by Health911.com, which appear reasonable:
· First: “Don’t lie down!” Always keep your head elevated and above your heart. Breathe through your mouth.
· Sit up straight and tip your head slightly forward. Tilting the head back may cause the blood to run down the throat.
· Stay quiet for a few hours after the bleeding has stopped as exertion may cause the bleeding to start again.
· Before you try to stop the nosebleed, blow your nose hard. This will remove any clots which are keeping the blood vessel open. After getting the clot out the elastic fibers surrounding the vessel will contract around the tiny opening.
· Don’t blow your nose for at least twelve hours after the bleeding has stopped.
· Use an ice pack on the nose. Cold causes blood vessels to constrict, reducing blood flow, swelling and inflammation.
· An ice pack or cold compress on the back of the neck is another remedy. Pressure on the back of the neck restricts flow of blood to the head.
· Press your finger between your lip and gum, pressing upward against the nose. Variations of this remedy are to place a rolled up piece of a brown paper bag, paper towel or gauze, a dime, or a tree leaf in the same position. There is a blood vessel that runs under the upper lip, and these techniques cut down the blood flow and allow the blood to clot.
· Using almost the same technique as above, press the outside of the upper lip just below the nose with your thumb and forefinger and hold for several minutes. This is a vital acupressure point in traditional Chinese medicine.
· For some, pinching the bridge of the nose helps close off the blood vessels. Using a cold compress or ice helps, as the blood vessels constrict faster. This should stop the bleeding in 3-5 minutes. [7].
3. With persistent epistaxis one folk remedy, which has been found effective clinically by practitioners, is the use of vinegar (apple cider). The vinegar can be gently snuffed into the effected nostril or a small cotton ball soaked in the vinegar may be packed lightly into the nostril [4,7].
III NCRT – STATE’S SCOPE OF PRACTICE LAWS
The authors surveyed all state and provincial chiropractic regulatory boards in North America regarding what diagnostic and treatment procedures are permitted by statute in each of their practice acts. The following is from their article as it particularly relates to NCRT called “Nasal Specifics- (Balloon Inflation into Nasal Passages)”.
| Alaska | No Response |
| Alabama | Yes |
| Arkansas | No |
| Arizona | Yes |
| California | No Response |
| Colorado | Yes |
| District of Columbia | No |
| Florida | Yes |
| Georgia | No |
| Hawaii | Qualified Response |
| Iowa | No |
| Idaho | Yes |
| Kansas | Yes |
| Kentucky | Yes |
| Louisiana | No |
| Massachusetts | Yes |
| Maryland | No Response |
| Maine | No |
| Minnesota | Qualified Response |
| Missouri | No Response |
| Mississippi | No |
| Montana | Yes |
| North Carolina | No |
| North Dakota | Yes |
| Nebraska | Yes |
| New Hampshire | No Response |
| New Jersey | No |
| New Mexico | No |
| Nevada | Yes |
| New York | Yes |
| Ohio | No |
| Oklahoma | Yes |
| Oregon | Yes |
| Pennsylvania | Yes |
| Rhode Island | Yes |
| South Carolina | Qualified Response |
| South Dakota | Yes |
| Tennessee | No |
| Texas | Yes |
| Utah | Yes |
| Virginia | No |
| Washington | No |
| Wisconsin | Yes |
| West Virginia | No |
| Wyoming | No |
IV. PUBLISHED PEER REVIEWED ARTICLE ABSTRACTS RELATED TO NCRT
Department of Otolaryngology-Head and Neck Surgery and Health Services, University of Washington, and Health Services Research and Development, Veterans Affairs Puget Sound Health Care System, Seattle 98195-6515, USA.
Abstract The bilateral nasal specific technique is steeped in the archives of anecdotal chiropractic. It is also heavily based on the literature of William G. Sutherland, DO., and many, many others. It is a technique that is dynamic, specific, and incredibly powerful. Many patient have had cranial manipulation, craniosacral therapy, torque release technique, condyle lift,and the list of cranial manipulative techniques goes on. However, to my knowledge,the bilateral nasal specific technique, although not be any means the only method of adjusting or manipulating cranial bones, is by far the most impactful. Indeed, due to the lack of research studies, this places it in the clinical research field at best, and anecdotal research at least.
This article reviews current knowledge of otitis media and proposes conservative interventions for this disorder that are within the scope of practice for most chiropractors. Presented are alternative interventions that are supportable by the literature, are appropriate for chiropractic practice, and could diminish the severity as well as the frequency of repeated infections. The article suggests that nasal specific is one of the procedures that can help prevent future episodes of otitis media, facilitate the healing process, decrease the virulence of the pathogen, or increase the resistance of the patient host.
Abstract: Purpose: This article describes conservative approaches to the diagnosis and treatment of sinusitis and sinus pain. Methodology:A qualitative review of relevant literature is integrated with the consensus opinion and clinical experience of faculty at Western States Chiropractic College (using nominal group and delphi methodologies). Summary: specific, endonasal, and argyrol applications, as well as physiotherapy, nutrition,and joint manipulation. These modalities are useful and may present a useful alternative or adjunct to common medical treatments.
Abstract OBJECTIVE: To demonstrate the use of nasal specific technique in conjunction with other chiropractic interventions in managing chronic head pain. CLINIC FEATURES: A 41-yr-old woman was treated for chronic sinusitis and sinus headaches. She had suffered weight loss and pain over a 2-month period. INTERVENTION AND OUTCOME: Chiropractic manipulation and soft tissue manipulation administered 2-6 times per month for approximately 1 yr had minimal long-term effect on the patient’s head pain. When additional interventions(nasal specific technique and light force cranial adjusting) were added to the treatment regimen, significant relief of symptoms was achieved after the nasal specific technique was performed. The duration of the relief increased with successive therapeutic sessions, with minimally persistent symptoms after 2 months of therapy. CONCLUSION: The nasal specific technique, when used in conjunction with other therapies, may be useful in treating chronic sinus inflammation and pain. Further investigation is needed to identify the usefulness of the nasal specific technique as an independent intervention,the use of the technique in other types of patients and presentations, and the mechanism of therapeutic benefit.
Abstract Individuals commonly report a multitude of factors ort riggers as the cause for the onset of a headache or facial pain. The challenge has always been to understand the many triggers, the diverse symptoms, the chronological characteristics, and the variability of location associated with headache and facial pain. Part I of this article presents theories and hypotheses proposing that the etiology of the final common pathway of headache and facial pain is from pain signals generated within the skull’s joints.The model proposes to explain the variability in the triggers, symptoms,chronological aspects, and location known to be associated with headache and facial pain. The evidence to support these theories is clinical and anecdotal at this time. These theories need controlled investigation. A review of the anatomy of the skull’s joints is provided. Part II of this article is a step-by-step description of the use of a nasal balloon device for the treatment of skull joint dysfunction. A review of the history and use of this and other methods of skull joint treatment is provided.
Abstract The nasal specific technique is currently being used to treat a variety of condition, including cranio-facial asymmetries and aberrations in sight and hearing. The purpose of this study was to perform a controlled,blind investigation of three parameters reportedly changed following the use of nasal specifics. This study is an attempt to secure reliable information about a technique which enjoys increasing acceptance among chiropractors,particularly in the Pacific northwest. In spite of the continued training of future chiropractors in the utilization of this technique, there remains an alarming lack of acceptable scientific evidence to support the claims which have been and are being made. Therefore, the significance of this research lies in its total impact on present knowledge and the clarity it can bring to an area of speculation.
V. UNPUBLISHED RESEARCH STUDIES RELATED TO NCRT
Their study concluded that claims for improved vision and hearing following nasal specific treatment could neither be supported nor refuted. They did find, however, changes in craniofacial measurements that did not reach significance when compared to a control (sham-treated) group.
VI CHIROPRACTIC COLLEGES AND NCRT RELATED TECHNIQUES
A. Western States Chiropractic College:
1. A text was developed for clinicians in the Western States Chiropractic College (WSCC) Clinic System designed for use with patients presenting to the WSCC clinic system with pain over the sinuses and/or other symptoms of rhinitis,upper respiratory infection, sinusitis, or headache pain in which sinusitis a reasonable differential. The primary and main contributing authors are Steven E. Oliver and Ron LeFebvre respectively.
In the section “Management: Specific Procedures” [pages 15 &16] Nasal Specific technique is described as follows:
“Two or three finger cots are unraveled within each other and tied to the end of a sphygmomanometer bulb. The cots are lubricated with a water soluble lubricating gel and guided into the nasal passage ways. The nose is lightly compressed around the valve of the sphygmomanometer bulb. The patient is asked to take a deep breath in and hold it. The practitioner inflates the sphygmomanometer bulb and quickly releases the air valve. This procedure is repeated for each of the six nasal meat uses.” [This was referenced to Stephen Berman’s article “Skull Pain”.
2. Dr. Lester Lamm for the past 14 years has taught classes in clinical ear, nose, and throat with particular emphasis on the Endonasal Technique and Nasal Specific Technique. He has just recently taught three seminars through the post graduate program at Western States Chiropractic College (WSCC), entitled “Chiropractic Management of Common Ear, Nose and Throat Disorders”.
- March 27-28, 2000 Denver Colorado
- April 24-25, 2000 Salt Lake City, Utah
- June 12-13, 2000 Boise, Idaho
This extensive class covered diagnosis and treatment of ear, nose and throat disorders with a “hands-on, skill proficiency lab” to help seminar participants learn how to perform Nasal Specific Technique and other related therapies. Dr. Lamm is the Dean of Postgraduate Education, Deputy to the Vice-President of Academic Affairs, and is a classroom instructor at WSCC.
B. Logan College of Chiropractic
Logan College of Chiropractic has a postgraduate program that teaches a 4-hr EndoNasal Technique, during the Diplomat Chiropractic Neurology (Farmington,CT), Diplomat Chiropractic Rehabilitation #4.
C. Life College of Chiropractic – West
There are reports that Dr. Daniel Murphy has been demonstrating the NCRT technique at Life West for 18 years.
VII BOOKS RELATED TO NCRT
Beatty described, “Inserting a lubricated fingerstall with a wooden applicator and then pumping the fingerstall full of air with a sphygmomanometer bulb ….. He notes that the bulb may be attached to the sphygmomanometer bulb for this purpose.”
One of the earliest intranasal treatments of skull joint dysfunction were known as “finger techniques”. In 1942 Lake, a chiropractor and naturopath, described a finger technique where the practitioner works his/her little finger in the patient’s nostrils and nasal passageways.
Janse et al in 1947, described a technique for distention of the nasal chamber by using a “carefully lubricated and sterile finger cot” attached to the detached cuff Janse et al in 1947 described a technique for distention of the nasal chamber and inflated by using a carefully lubricated and sterile finger cot” attached to the detached cuff of a sphygmomanometer. The cot is inserted into the nasal chamber and inflated by squeezing the bulb of the folded sphygmomanometer cuff. They describe using a slow increase in bulb pressure that causes a “widening and distention of all the sinus openings”into the meatus. Janse advocated releasing the bulb and repeating the procedure several times. No indication or contraindications for the procedure were given in the text.
Finnell, an optometrist and chiropractor, described the nasal specific procedure for “lymph stasis”, deviation of the septum, nasal congestion,ethmoidal irritation causing asthma and frontal and maxillary sinusitis”in the 1951 edition of his EENT manual.
Finnell describes attaching a single finger cot to the bulb of a “blood pressure instrument” with its valve. He advocated attaching the cot to the bulb with a rubber band and inflating it to the size of a fist to check for leaks. The cot would then be deflated and wetted with cold water. Standing beside the patient with the head supported, the cot is introduced into the nose with a lubricated wooden applicator along the floor of the inferiormeatus. When the cot is inserted as far as possible, the wooden applicator is removed, the valve closed and the nostrils squeezed closed. The cot is inflated with a quick pressure on the bulb, forcing the inflated cot into the throat. He describes leaving the cot inflated for 1-2 minutes in the middle and lower meatus. A sharp instrument is kept handy for piercing the cot in the mouth, if necessary.
In 1981 Failor, a chiropractor and naturopath, et al, described a nasal balloon device.
VIII. AUDIO AND VIDEOTAPES RELATED TO NCRT
There are some Video and Audio Tapes of Dr. Stober which we are in the process of locating and hopefully gain access to for the study group.
IX. “CHIROPRACTIC” INTERVIEWS RELATED TO NCRT
The following is an excerpt from: An Interview with Dr. Richard VanRumpt (The purpose of this is to show his early involvement with nasal cranial release technique) 1987 American Chiropractic
Richard VanRumpt DC, Ph.C., graduated from the National College of Chiropractic in 1923 and did postgraduate work at Palmer College of Chiropractic. He is the founder and developer of Directional Non-Force Technique (D.N.F.T.) and has done research and taught thousands of students since 1923. He is 82 years old and retired. This is the first interview and information ever published on Dr. VanRumpt and his technique. He was very well known as a foot adjuster,teacher, and researcher and wrote a pamphlet on foot adjusting that was also printed in one of Dr. Major Bertrand DeJarnette’s books in 1929 or 30.
Interviewer for The American Chiropractor (TAC): What other degrees or qualifications have you acquired?
DR: I earned a Doctor of Science degree in physiotherapy from the Metropolitan School of Physiotherapy by attending night classes for 2 years. I also have a Naturopathic degree I obtained by teaching dissection for 4 years at Philadelphia College of Naturopathy, owned by Dr. Tom Lake. I learned Endonasal and Cranial techniques and taught Endonasal prior to Dr. Lake, although he deserves full credit for popularizing it and writing a book on the subject. We were very good friends.
X. NCRT COMMITTEE
Dr. Stephen Berman a member of the NCRT Committee Study Group notified us, as follows, that following testifying “On Thursday, January 11, 2001, at the Texas Board of Chiropractic Examiners offices in Austin, Texas, I appeared before the Technical Standards committee to give testimony on Nasal Cranial Release Technique. Following my presentation, the committee voted and found that NCRT is “SCOPE OF PRACTICE” in the state of Texas.
He continued “I am confident now that I can prove and establish that NCRT is within the chiropractic scope of practice in any State or other jurisdiction and will make myself available as an expert witness whenever and wherever my services may be useful. “
As of 2011 a Nasal Cranial Release Technique seminar is being organized and developed utlizing up to date methodologies and incorporating SOT and cranial procedures for both assessment and treatment purposes to guide balloon technique and enhance the therapeutic application. Currently this program is being organized by Drs. Adam Del Torto, Glenn Frieder, Michael Pascoe, and Jeffrey Mersky. Anyone else interested in participating in the formation of this teaching seminar (series?) please contact drcblum@aol.com
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