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Dr. Stephen Kaufman                                            

Denver, CO                                                                                                                      



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Chronic Fatigue Syndrome : A Highly Effective Approach Using Manipulative Treatment 

 Abstract:  A manipulative treatment (or “body work”) is described which has been very effective in the treatment of chronic fatigue syndrome.  This approach involves no medication, and can easily be used as an adjunct to other natural methods such as nutritional therapy, food allergy removal, heavy metal detox, etc. The importance of structural  treatment in illness is discussed.


   Marilyn was a 33 year old career woman, whose father was a chiropractor. When seen in my office she had a five year history of chronic fatigue syndrome, which came on following a flu. She had marked irritable bowel symptoms, headaches, difficulty sleeping, fever, swollen lymph nodes, and low back pain. She had had previously unsuccessful chiropractic and nutritional care . After five weeks of treatment, all of her symptoms completely resolved.

   Arla was a 50 year old dentist with a 3 year history of chronic fatigue syndrome. She barely had the energy to work at her practice. All previous work -ups had been unrevealing. After being treated for several weeks, her symptoms disappeared, and she went on to develop a full size practice.

   Marie came in with the longest typed list  of symptoms I had ever seen. She had severe fatigue, was unable to work or exercise, and was the mother of two. Her symptoms included almost every one of  the usual chronic fatigue line up. After a month of treatment she was symptom free. She began running, and went back to work.

   Chronic fatigue syndrome is a debilitating illness characterized by severe fatigue lasting longer than 6 months, which causes a reduction of at least 50% in one's daily leisure and employment activities. Other symptoms present  often include fever, swollen lymph nodes, headaches, multiple joint pains,   sleep disturbances, irritable bowel syndrome, etc.

   There is extensive discussion in the medical and alternative  literature regarding the etiological agents in CFS.  Some feel the cause is  viruses, yeast, fungus, bacteria ,mycoplasma, or other infectious agents.  Others discuss nutrient deficiencies, food or environmental allergies or toxins, or other chemical causes.  Because the syndrome often (but not always) starts after a cold or flu, it used to be referred to as post viral fatigue syndrome.  The occasional existence of it in multiple  members of the same family argues for an infectious or common environmental agent.  The term “chronic fatigue immune deficiency syndrome” implies a failure of proper immune response.  In spite of all this, agreement on the offending agent(s) remains elusive.

   Practitioners of all these approaches report successes with their methods.  I also utilize extensive nutritional support, environmental clean-up and avoidance, food allergy and yeast elimination, etc.  These approaches obviously have great merit.  What I wish to describe here is an adjunctive approach utilizing applied kinesiological methods and soft tissue manipulation.  Although some of these techniques involve training in specific chiropractic methods, the most significant ones can be applied by any skilled body worker.  I have treated several hundred patients with CFS in the past twenty years and have well over an 85% success rate. Almost all patients return to completely normal functioning. Unemployed patients typically return to work. Results seem to be long-lasting. No medication is involved, and there is therefore no danger of side effects  or dependency from  this treatment.


   From a biomechanical or structural point of view, the following disorders are always examined for, and commonly found and treated.

  1) Abdominal trigger Points: There are areas of trigger points or muscle spasm all along the rectus abdominus muscle. When pressed, these trigger points often cause radiating pain in bizarre patterns. For example, an area of abdominal spasm when pressed may refer pain up to the substernal area, down to the anterior or lateral thigh, around to the back, or over to the contralateral abdomen! There are usually many areas of tenderness on chronic fatigue patients. However, with treatment by ischemic compression as described by Travell (1) or Prudden(2), the areas will usually normalize, often within three or four sessions. When this is done along with the other manipulations, the patient usually has a marked improvement in their symptoms, and an increase in energy levels. This technique is a modified version of one described in Hara Diagnosis, by Matsumoto and Birch (3)

  2) Sacroileac Joint Dysfunction. CFS patients often have a malpositioned sacroileac joint. This is corrected by standard Applied Kinesiology methods, usually involving pelvic wedges, as developed by George Goodheart, D. C. (5) and  described in Walther (4). The sacroileac lesion is an old concept in chiropractic and osteopathic literature. It is one of the central focuses in Sacro Occipital Technique (7). Because of the size of the joint and it's location, a disturbance here may give rise to reflex disturbances throughout the body. Goodheart  (5)  in  his writings on Applied Kinesiology has theorized that it often accompanies adrenal dysfunction, contributing to consequent fatigue.

  3) Upper cervical dysfunction. This often gives rise to headaches, neck pain, and in many cases that I have seen, frequent and  lingering colds. I correct slight malpositions (chiropractic subluxations) in the cervical vertebrae by a technique I developed of gently opening up the cervical facets by lightly pressing the transverse processes of the cervical vertebrae. In the past I have used cervical adjustments and often found that that worked well. However some patients cannot tolerate that approach, so I developed a much gentler, more acceptable one. Interestingly, every patient that I have seen with frequent (often monthly) and lasting colds has responded to  this treatment of their cervical column. After several weeks of treatment, their colds stop and occur at the "normal" level  of once or twice a year. I have seen many children and adults with this problem of lowered immune function and so far all have responded to this treatment.

  4)Lower thoracic-upper lumbar spinal fixation. This area of the spine provides nerve supply to the adrenal glands. I believe that treatment to the spine here strongly stimulates adrenal hormone function. I occasionally manipulate this area with spinal adjustments but usually I apply the previously mentioned treatment of loosening the spinal facet joints. This often causes a marked improvement in energy and immediate increase in vital capacity, because of it's effect on the diaphragm. Possibly a lot of the improvement in energy levels from soft tissue manipulation is due to this increase in ventilatory capacity and the consequent improvement in tissue oxygen saturation.

  5) Myofascial release of the gastrocnemius muscles. I don't know why this works, but in Applied Kinesiological thinking the gastrocnemius  muscles are related to adrenal function. I speculate that this may be due to parasympathetic  inhibition through the S1 nerve root (this innervates the gastrocs), but truly I have no idea. What I have observed is that myofascial release of the gastrocs often causes a person's stuffed or draining nasal sinuses to open up, and they often have more energy following treatment. Regardless of the exact mechanism involved, it seems to help.

  6) Spinal adjustment of thoracic fixaations. The thoracic spine is the one area that I do consistently adjust. Chronic fatigue patients often have irritable bowel symptoms, and the greater, lesser, and least splanchnic nerves innervate the digestive system and come from the thoracic segments. Additionally, respiratory function can be positively influenced by treating thoracic fixations, either through spinal adjustments or the non-force method previously described.

  7) Manipulation of neurolymphatic reflexes for the adrenal glands, thyroid, gonads, liver, and small intestine.  Frank Chapman, an osteopath in the early 20th century, observed that  there are reflexes on the front and back of the torso which, when rubbed, are of benefit in generally encouraging normal functioning of related organs. For example, rubbing the sixth intercostal space on the right, front and back, seemed to aid liver function.    Goodheart revived this method in the 60's and made it an essential part of applied kinesiology protocol. (4)(5)

  8) Myofascial release of the teres minor ,quadriceps, and pectoralis major sternal muscles. As mentioned for the gastrocs, treatment of these muscles seems to enhance the functioning of their related internal organs, the thyroid, liver, and small intestines.

  9) Myofascial release of the neck flexors and extensors. This often helps open up blocked sinuses and reduce post nasal drainage. This is not surprising and can certainly be explained by improved circulation and lymphatic drainage of the head and neck. Teitelbaum in  his book From Fatigued to Fantastic (6) mentions a connection between chronic sinus problems and fatigue. I think  there is a lot to this and future research may along these lines would be valuable.

  10)  Ileocecal valve misfunction. This is a common area of attention in Applied Kinesiololgy. Specific symptoms often include bowel dysfunction, headaches, low back pain, etc. Attention here is an important therapy to reduce toxicity in CFS patients, and especially those with a candida involvement. Although candida and yeast infections are usually treated via chemical means with anti fungals ( natural or otherwise), much of the symptomatology associated with these syndromes will resolve by manipulation of the ileocecal valve. Goodheart defined this syndrome in the early 70's,(4) (5),  and I have often seen it dramatically improve patient's symptoms. In other words, proper  mechanical functioning of the gut will often be enough to eliminate the offending organism.

  11) Improvement of diaphragmatic dysfunction. The diaphragm is the second most important muscle in the body. Improper respiration can easily be seen to lead to fatigue. We certainly need air to utilize energy. If  diaphragm  function is suboptimal, each breath short changes us of oxygen by a slight amount. At the end of the day, this can add up to a lot!

  13) Correction of sleep disorders. Sleep disorders are often the causative agent in chronic fatigue. Any patient with fatigue should be carefully questioned about her sleep patterns. It is foolish to treat a patient with low energy by giving them stimulants when in fact they don't sleep well at night. Stimulants to improve their energy , (even natural ones like DHEA, B1,and herbs that stimulate adrenal function) may worsen their sleep and compound their problem. Instead, attention should be focused on getting normal sleep.  Often, relieving trigger points and myofascial discomfort in the neck can help restore normal sleep patterns.  Specific acupuncture points for insomnia may  be utilized including H7, P6, An mien 1 and 2, and ear acupuncture. I have also found areas on the lower part of the sternum and rib cage which produce a marked relaxation response and greatly improved sleep when treated. Nutrients which can be of great help in insomnia are 5HTP, melatonin, CDP choline, calcium, magnesium, potassium, theanine, inositol, niacinamide, valerian and the lately maligned kava (which the German government has just restricted).

  14) Bowel Dysfunction and Irritable Bowel Syndrome. The fatigued patient may  be constipated or have diarrhea. Watch out for the chronically constipated cases of chronic fatigue syndrome! I have seen some patients who move their bowels once every 7-1o days! No doctor ever asked them about their bowel habits! Obviously, we know as natural practitioners that daily(or close to daily) elimination is important. These people will get a lot more energy as their bowel function and consequent auto toxemia is improved. (Isn't it a wonder that orthodox medicine still teaches that once weekly elimination is "normal", even in a patient who is crippled with CFS symptoms?)

   I have found an  extremely useful treatment  for chronic constipation is to stimulate acupuncture points  LI 2, LI 4, S36, S40,  GB 34,  and Liv 3, usually with 30 seconds of digital pressure to each point, or with a tei shin instrument. This treatment is often effective even in patients with constipation of decades long standing. It is quite effective in infants and young children.


   Physical manipulation of the body’s structure is an often overlooked factor in illness in alternative medicine. The emphasis  of most “alternative” practitioners is on chemistry (nutrition, IV therapies, herbals, pharmaceuticals, etc.), psychology (the various forms of mind body therapy) or perhaps energetic medicine (acupuncture, homeopathy, therapeutic touch,etc.)  Structural therapies such as chiropractic and osteopathic manipulation, deep tissue therapies, cranial sacral therapy, etc. are most often thought of as applicable to musculoskeletal disorders.  The founders of chiropractic and osteopathy, with perhaps a 19th century naïveté,  certainly envisioned their techniques as having a much broader scope. Further developments of the past hundred years have born that out.  Many forms of “ body work” are widely practiced, but often even their practitioners  may be unaware of their true potential for effectiveness. Applied Kinesiology as developed by Goodheart  in particular has aimed for a very broad range of symptomatologies.

   Chronic fatigue syndrome, with it’s wide range of symptoms, responds very well to a combination of physical interventions. This approach is not widely known for this disorder, but deserves to be.  A future paper will address nutritional protocols for chronic fatigue. These are quite effective but in my opinion are much  slower to take effect than when they are combined with soft tissue manipulation. Patients using the combined protocol in the vast majority of cases will feel much better in four to six weeks, and often sooner.


Stephen J. Kaufman, D. C. , is a practicing chiropractor in Denver, Colorado. He has practiced chiropractic, applied kinesiology, myofascial and trigger point therapies, acupuncture, acupressure, Thought Field Therapy, yoga, and cranial osteopathy since 1978. He has developed many new techniques in soft tissue therapy and has published over 75 professional papers. He can be reached at  (303) 756-9567. 


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