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Systematic Review of Self-Reported Prognosis in Adults After Mild Traumatic Brain Injury

Systematic Review of Self-Reported Prognosis in Adults After Mild Traumatic Brain Injury: Results of the International Collaboration on Mild Traumatic Brain Injury Prognosis

The Chiro.Org Blog


Arch Phys Med Rehabil. 2014 (Mar); 95 (3 Suppl): S132–151

J. David Cassidy, PhD, DrMedSc, Carol Cancelliere, DC, MPH,
Linda J. Carroll, PhD, Pierre Côté, DC, PhD,
Cesar A. Hincapié, DC, MHSc, Lena W. Holm, et al.

Institute of Sports Science and Clinical Biomechanics,
Faculty of Health, University of Southern Denmark,
Odense, Denmark


OBJECTIVE:   To update the mild traumatic brain injury (MTBI) prognosis review published by the World Health Organization Task Force in 2004.

DATA SOURCES:   MEDLINE, PsycINFO, Embase, CINAHL, and SPORTDiscus were searched from 2001 to 2012. We included published, peer-reviewed studies with more than 30 adult cases.

STUDY SELECTION:   Controlled trials and cohort and case-control studies were selected according to predefined criteria. Studies had to assess subjective, self-reported outcomes. After 77,914 titles and abstracts were screened, 299 articles were eligible and reviewed for scientific quality. This includes 3 original International Collaboration on MTBI Prognosis (ICoMP) research studies.

DATA EXTRACTION:   Eligible studies were critically appraised using the Scottish Intercollegiate Guidelines Network criteria. Two reviewers independently reviewed each study and tabled data from accepted articles. A third reviewer was consulted for disagreements.

DATA SYNTHESIS:   Evidence from accepted studies was synthesized qualitatively into key findings, and prognostic information was prioritized according to design as exploratory or confirmatory. Of 299 reviewed studies, 101 (34%) were accepted and form our evidence base of prognostic studies. Of these, 23 addressed self-reported outcomes in adults, including 2 of the 3 original ICoMP research studies. These studies show that common postconcussion symptoms are not specific to MTBI/concussion and occur after other injuries as well. Poor recovery after MTBI is associated with poorer premorbid mental and physical health status and with more injury-related stress. Most recover over 1 year, but persistent symptoms are more likely in those with more acute symptoms and more emotional stress.

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Sport Concussion Knowledge and Clinical Practices

Sport Concussion Knowledge and Clinical Practices: A Survey of Doctors of Chiropractic With Sports Certification

The Chiro.Org Blog


SOURCE:   J Chiropractic Medicine 2015 (Sep);   14 (3):   169–175

William J. Moreau, DC, DACBSP, CSCS,
Dustin C. Nabhan, DC, DACBSP, CSCS, RMSK,
Taylor Walden, BA

Managing Director,
United States Olympic Committee,
Colorado Springs, CO


OBJECTIVE:   The purpose of this study is to describe the knowledge base and clinical practices regarding concussion by sports-certified doctors of chiropractic.

METHODS:   A 21–item survey was distributed to the 312 attendees of the 2014 American Chiropractic Board of Sports Physicians Sports Sciences Symposium. Results were measured by frequency analysis and descriptive statistics for all surveys completed by sports-certified chiropractors.

RESULTS:   Seventy-six surveys were returned by sports-certified doctors of chiropractic. All (N = 76) 100% of respondents believe that the evaluation of concussion should be performed by a health care provider with training in concussion. The respondents actively assess and manage concussion in adults (96%), adolescents (95%), and children (75%). A majority (79%) of respondents believe that the Sideline Concussion Assessment Tool–3 represents a current standard of care for the sideline evaluation of the athlete who possibly has sustained a sport concussion. Most respondents agreed or strongly agreed that manual therapies may be appropriate in certain circumstances in adults (80%) and minors (80%).

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The Reduction of Asthma Symptoms and Medication After Chiropractic Care

The Reduction of Asthma Symptoms and Medication After Chiropractic Care

The Chiro.Org Blog


SOURCE:   Chiropractic J Australia 2017;   45:   138–143

Thomas A. Brozovich D.C.

Clinical Sciences,
Palmer College of Chiropractic,
Davenport, IA USA


Objective:   To discuss the chiropractic management of a patient with asthma who was treated using chiropractic care.

Clinical features:   A 5–year-old male with a history of asthma for 3–1/2 years sought chiropractic care for his asthma symptoms, which included tightness of the chest, shortness of breath, nasal congestion, and nonproductive cough that were not responding to allopathic treatment.

Intervention and Outcome:   He was adjusted based on location of his subluxations (intersegmental joint dysfunction). He had 5 treatments over 3 days. Treatment consisted of chiropractic adjustment to the cervical and thoracic region. We observed a quick and drastic reduction in his symptoms and he has been able to reduce all of his medication over the next few months with the exception of a rescue inhaler of albuterol, which he needs only infrequently.

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Fish-oil Supplementation Enhances the Effects of Strength Training in Elderly Women

Fish-oil Supplementation Enhances the Effects of Strength Training in Elderly Women

The Chiro.Org Blog


SOURCE:   Am J Clin Nutr. 2012 (Feb); 95 (2): 428–436

Cintia LN Rodacki, André LF Rodacki,
Gleber Pereira, Katya Naliwaiko,

Paraná Federal University,
Setor de Ciências Biológicas,
Curitiba, Paraná, Brazil.


BACKGROUND:   Muscle force and functional capacity generally decrease with aging in the older population, although this effect can be reversed, attenuated, or both through strength training. Fish oil (FO), which is rich in n-3 (omega-3) polyunsaturated fatty acids (PUFAs), has been shown to play a role in the plasma membrane and cell function of muscles, which may enhance the benefits of training. The effect of strength training and FO supplementation on the neuromuscular system of the elderly has not been investigated.

OBJECTIVE:   The objective was to investigate the chronic effect of FO supplementation and strength training on the neuromuscular system (muscle strength and functional capacity) of older women.

DESIGN:   Forty-five women (aged 64 ± 1.4 y) were randomly assigned to 3 groups. One group performed strength training only (ST group) for 90 d, whereas the others performed the same strength-training program and received FO supplementation (2 g/d) for 90 d (ST90 group) or for 150 d (ST150 group; supplemented 60 d before training). Muscle strength and functional capacity were assessed before and after the training period.

RESULTS:   No differences in the pretraining period were found between groups for any of the variables. The peak torque and rate of torque development for all muscles (knee flexor and extensor, plantar and dorsiflexor) increased from pre- to posttraining in all groups. However, the effect was greater in the ST90 and ST150 groups than in the ST group. The activation level and electromechanical delay of the muscles changed from pre- to posttraining only for the ST90 and ST150 groups. Chair-rising performance in the FO groups was higher than in the ST group.

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Schoolbags and Back Pain in Children Between 8 and 13 Years

Schoolbags and Back Pain in Children Between 8 and 13 Years: A National Study

The Chiro.Org Blog


SOURCE:   Br J Pain. 2017 (May); 11 (2): 81–86 ~ FULL TEXT

Karl Spiteri, Maria-Louisa Busuttil,
Samuel Aquilina, Dorothy Gauci,
Erin Camilleri, and Victor Grech

Malta Association of Physiotherapists,
Gzira, Malta.


Schoolbag weight in schoolchildren is a recurrent and contentious issue within the educational and health sphere. Excessive schoolbag weight can lead to back pain in children, which increases the risk of chronic back pain in adulthood. There is limited research regarding this among the Maltese paediatric population. A cross-sectional study was undertaken across all schools in Malta among students aged 8–13 years (inclusive). Data were collected using a questionnaire detailing schoolbag characteristics, self-reported pain and demographic variables, such as age and gender. Structured interviews with participants were also carried out by physiotherapists. A total of 4,005 participants were included in the study, with 20% of the total Malta schoolchildren population. Over 70% of the subjects had a schoolbag that exceeded the recommended 10% bag weight to body ratio. A total of 32% of the sample complained of back pain, with 74% of these defining it as low in intensity on the face pain scale-revised. The presence of back pain was statistically related to gender, body mass index (BMI), school and bag weight to body weight ratio. After adjusting for other factors, self-reported back pain in schoolchildren is independently linked to carrying heavy schoolbags. This link should be addressed to decrease the occurrence of back pain in this age group.


From the FULL TEXT Article:

Introduction

Carrying schoolbags and school attendance is a daily routine for students. The incorrect handling of schoolbags with excessive bag weight can lead to back pain in children. [1–4
] It is recommended that the total weight of the schoolbag does not exceed 10% of body weight. [1] The development of back pain in children is of concern since it increases the risk of developing chronic back pain in adulthood. [5] Studies have shown that the prevalence of low back pain in schoolchildren ranges from 25% to 55% in those aged between 10 and 15 years. [6–8] In most cases, the pain intensity is relatively low.[7]

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Posterior, Lateral, and Anterior Hip Pain Due to Musculoskeletal Origin

Posterior, Lateral, and Anterior Hip Pain Due to Musculoskeletal Origin: A Narrative Literature Review of History, Physical Examination, and Diagnostic Imaging

The Chiro.Org Blog


SOURCE:   J Chiropractic Medicine 2016 (Dec); 15 (4): 281–293

Patrick J. Battaglia, DC, Kevin D’Angelo, DC,
Norman W. Kettner, DC, DACBR

Department of Radiology,
Logan University, Chesterfield, MO.


OBJECTIVE:   The purpose of this study was to present a narrative review of the literature of musculoskeletal causes of adult hip pain, with special attention to history, physical examination, and diagnostic imaging.

METHODS:   A narrative review of the English medical literature was performed by using the search terms “hip pain” AND “anterior,” “lateral,” and “posterior.” Additionally, specific entities of hip pain or pain referral sources to the hip were searched for. We used the PubMed search engine through January 15, 2016.

RESULTS:   Musculoskeletal sources of adult hip pain can be divided into posterior, lateral, and anterior categories. For posterior hip pain, select considerations include lumbar spine and femoroacetabular joint referral, sacroiliac joint pathology, piriformis syndrome, and proximal hamstring tendinopathy. Gluteal tendinopathy and iliotibial band thickening are the most common causes of lateral hip pain. Anterior hip pain is further divided into causes that are intra-articular (ie, labral tear, osteoarthritis, osteonecrosis) and extra-articular (ie, snapping hip and inguinal disruption [athletic pubalgia]). Entrapment neuropathies and myofascial pain should also be considered in each compartment. A limited number of historical features and physical examination tests for evaluation of adult hip pain are supported by the literature and are discussed in this article. Depending on the clinical differential, the gamut of diagnostic imaging modalities recommended for accurate diagnosis include plain film radiography, computed tomography, magnetic resonance imaging, skeletal scintigraphy, and ultrasonography.

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How Can Latent Trajectories of Back Pain be Translated into Defined Subgroups?

How Can Latent Trajectories of Back Pain be Translated into Defined Subgroups?

The Chiro.Org Blog


SOURCE:   BMC Musculoskelet Disord. 2017 (Jul 3); 18 (1): 285

Alice Kongsted, PhD, Lise Hestbaek, PhD
and Peter Kent, PhD

Nordic Institute of Chiropractic and Clinical Biomechanics,
Campusvej 55, DK-5230,
Odense M, Denmark.


BACKGROUND:   Similar types of trajectory patterns have been identified by Latent Class Analyses (LCA) across multiple low back pain (LBP) cohorts, but these patterns are impractical to apply to new cohorts or individual patients. It would be useful to be able to identify trajectory subgroups from descriptive definitions, as a way to apply the same definitions of mutually exclusive subgroups across populations. In this study, we investigated if the course trajectories of two LBP cohorts fitted with previously suggested trajectory subgroup definitions, how distinctly different these subgroups were, and if the subgroup definitions matched with LCA-derived patterns.

METHODS:   Weekly measures of LBP intensity and frequency during 1 year were available from two clinical cohorts. We applied definitions of 16 possible trajectory subgroups to these observations and calculated the prevalence of the subgroups. The probability of belonging to each of eight LCA-derived patterns was determined within each subgroup. LBP intensity and frequency were described within subgroups and the subgroups of ‘fluctuating’ and ‘episodic’ LBP were compared on clinical characteristics.

RESULTS:   All of 1077 observed trajectories fitted with the defined subgroups. ‘Severe episodic LBP’ was the most frequent pattern in both cohorts and ‘ongoing LBP’ was almost non-existing. There was a clear relationship between the defined trajectory subgroups and LCA-derived trajectory patterns, as in most subgroups, all patients had high probabilities of belonging to only one or two of the LCA patterns. The characteristics of the six defined subgroups with minor LBP were very similar. ‘Fluctuating LBP’ subgroups were significantly more distressed, had more intense leg pain, higher levels of activity limitation, and more negative expectations about future LBP than ‘episodic LBP’ subgroups.

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Cortical Changes in Chronic Low Back Pain

Cortical Changes in Chronic Low Back Pain: Current State of the Art and Implications for Clinical Practice

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SOURCE:   Man Ther. 2011 (Feb); 16 (1): 15-20

Benedict Martin Wand, Luke Parkitny,
Neil Edward O’Connell, Hannu Luomajoki,
James Henry McAuley, Michael Thacker,
G. Lorimer Moseley

School of Health Sciences,
The University of Notre Dame Australia,
Fremantle, WA, Australia


There is increasing evidence that chronic pain problems are characterised by alterations in brain structure and function. Chronic back pain is no exception. There is a growing sentiment, with accompanying theory, that these brain changes contribute to chronic back pain, although empirical support is lacking. This paper reviews the structural and functional changes of the brain that have been observed in people with chronic back pain. We cast light on the clinical implications of these changes and the possibilities for new treatments but we also advise caution against concluding their efficacy in the absence of solid evidence to this effect.


From the Full-Text Article:

Introduction

Chronic musculoskeletal pain is almost by definition a problem for which previous treatment has been unsuccessful. The clinical stories of patients with problems such as chronic low back pain (CLBP), fibromyalgia, and late whiplash associated disorder are usually ones of confusing and conflicting diagnoses and multiple treatment failures. Diagnosis and treatment has traditionally focused on what Robinson and Apkarian (2009) have called ‘end organ dysfunction’. That is, clinicians and researchers have looked to structural and functional abnormalities within the musculoskeletal system for a driver of the clinical condition and treatment has sought to normalise peripheral pathology and mechanics (stretch it, splint it, remove it, anaesthetise or denervate it). In general terms the ‘end organ dysfunction’ approach might be considered to have proven unsuccessful for these conditions (see for e.g. van Tulder et al., 2006a; van Tulder et al., 2006b). Neuroimaging studies have revealed numerous structural and functional changes within the brains of people with chronic musculoskeletal pain and there is growing opinion that these changes may contribute to the development and maintenance of the chronic pain state (Apkarian et al., 2009; Tracey and Bushnell, 2009). In this model of chronic pain the brain is seen as an explicit target for treatment and several treatment strategies have been developed and modified to fit this aim. Although there are data available on a range of chronic painful disorders, we will focus here on the cortical changes observed in patients with CLBP and the possible clinical implications for this population.


Brain changes in people with CLBP

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Association of Spinal Manipulative Therapy With Clinical Benefit and Harm for Acute Low Back Pain

Association of Spinal Manipulative Therapy With Clinical Benefit and Harm for Acute Low Back Pain: Systematic Review and Meta-analysis

The Chiro.Org Blog


SOURCE:   JAMA. 2017 (Apr 11); 317 (14): 1451–1460

Neil M. Paige, MD, MSHS, Isomi M. Miake-Lye, BA,
Marika Suttorp Booth, MS, Jessica M. Beroes, BS,
Aram S. Mardian, MD, Paul Dougherty, DC,
Richard Branson, DC, Baron Tang, PT, DPT,
Sally C. Morton, PhD, Paul G. Shekelle, MD, PhD

West Los Angeles Veterans Affairs Medical Center,
Los Angeles, California


Commentary from the Illinois Chiropractic Society

JAMA Endorses Spinal Manipulation

For the second time in as many months, a prominent medical journal has endorsed spinal manipulation for the management of low back pain. [1]   On April 11th 2017, JAMA published a systematic review of 26 randomized clinical trials in order to evaluate the safety and effectiveness of spinal manipulation for low back pain.

The authors concluded:

“Among patients with acute low back pain, spinal manipulative therapy was associated with improvements in pain and function with only transient minor musculoskeletal harms.”

This study comes on the heels of a February 2017 Clinical Practice Guideline from the American College of Physicians recommending spinal manipulation for acute, sub-acute, and chronic low back pain (LBP). [2]

These high-quality studies in respected medical journals add to a growing list of scientific support for spinal manipulation therapy (SMT). So why are our offices not flooded with medical referrals? An editorial accompanying the JAMA study provides perspective as to why some medical providers may be reluctant to refer to chiropractic physicians:

“Spinal manipulative therapy (SMT) is a controversial treatment option for low back pain, perhaps in part because it is most frequently administered by chiropractors. Chiropractic therapy is not widely accepted by some traditional health care practitioners. This may be, at least in part, because some early practitioners of chiropractic care rejected the germ theory, immunizations, and other scientific advances.

However, chiropractic care is popular today with the US public. According to a 2012 report, among patients with back or neck pain, approximately 30% sought care from a chiropractor. In a 2013 survey by Consumer Reports magazine involving 14,000 subscribers with low back pain, chiropractic care had the largest proportion of “highly satisfied” patients. Among approximately 4000 respondents who had seen a chiropractor, 59% were highly satisfied compared with 55% who saw a physical therapist and 34% who saw a primary care physician.

“Serious complications (related to SMT) are extremely rare… if spinal manipulation is at least as effective and as safe as conventional care, it may be an appropriate choice for patients with uncomplicated low back pain”. [3]

The emerging health care model dictates that all providers embrace proven clinically effective treatments, regardless of long-standing philosophical bias.   If we expect medical providers to advance their thinking to accept validated chiropractic therapies, we must first be willing to reciprocate. By working together to provide evidence-based patient-centric care, we can advance our profession to become the undeniable first choice for both patients and providers.


References:

  1. Paige NM, Miake-Lye IM, Booth MS, et al.
    Association of Spinal Manipulative Therapy With Clinical Benefit and Harm
    for Acute Low Back Pain; Systematic Review and Meta-analysis

    JAMA. 2017 (Apr 11);   317 (14):   1451–1460

  2. Qaseem A, Wilt TJ, McLean RM, Forciea MA, for the Clinical Guidelines Committee
    of the American College of Physicians.
    Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain:
    A Clinical Practice Guideline From the American College of Physicians

    Ann Intern Med. 2017 (Apr 4);   166 (7):   514–530

  3. Deyo RA.
    The Role of Spinal Manipulation in the Treatment of Low Back Pain.
    JAMA. 2017;   317 (14):   1418-1419

The Abstract:

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Alternative Medicine, Worker Health, and Absenteeism in the United States

Alternative Medicine, Worker Health,
and Absenteeism in the United States

The Chiro.Org Blog


SOURCE:   Complement Ther Med. 2017 (Jun); 32: 116–128

Kate Rybczynski

Department of Economics,
University of Waterloo,
200 University Avenue West,
Waterloo, ON N2L 3G1, Canada


Health related absenteeism costs an estimated $153 billion annually in the United States (Witters and Agrawal, 2011).   Chronic conditions (major contributors to absenteeism) are often successfully managed by Complementary and Alternative Medicine (CAM). As CAM becomes an increasingly visible component of healthcare, firms may wish to consider whether CAM therapies can help reduce illness-related absenteeism. This paper aims to extend the literature on healthcare utilization and absenteeism by exploring whether CAM treatment is associated with fewer workdays missed due to illness.

METHODS:   Using the 2007 National Health Interview Survey (NHIS) and propensity score matching (PSM), this study estimates the relationship between visits to CAM practitioners, health, and illness-related absenteeism.

RESULTS:   In a sample of 8,820 workers, the average annual number of workdays lost due to illness is 3.69. Visiting an acupuncturist correlates with lower absenteeism among men (1.182 fewer workdays missed, p<0.05), whereas visiting a naturopathic doctor correlates with 2.359 and 2.521 fewer workdays missed for women and men, respectively (both p<0.001). Active mind-body practices, massage, chiropractic and acupuncture treatments are all significantly associated with improved health.

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Neural Response During a Mechanically Assisted Spinal Manipulation in an Animal Model

Neural Response During a Mechanically Assisted Spinal Manipulation in an Animal Model: A Pilot Study

The Chiro.Org Blog


SOURCE:   J Nov Physiother Phys Rehabil. 2015 (Sep);   2 (2):   20–27 ~ FULL TEXT

William R. Reed, DC, PhD,
Michael A.K. Liebschner, PhD,
Randall S. Sozio, BS, LATG,
Joel G. Pickar, DC, PhD,
Maruti R. Gudavalli, PhD

Palmer Center for Chiropractic Research,
Davenport, IA, USA.


INTRODUCTION:   Mechanoreceptor stimulation is theorized to contribute to the therapeutic efficacy of spinal manipulation. Use of mechanically-assisted spinal manipulation (MA-SM) devices is increasing among manual therapy clinicians worldwide. The purpose of this pilot study is to determine the feasibility of recording in vivo muscle spindle responses during a MA-SM in an intervertebral fixated animal model.

METHODS:   Intervertebral fixation was created by inserting facet screws through the left L5-6 and L6-7 facet joints of a cat spine. Three L6muscle spindle afferents with receptive fields in back muscles were isolated. Recordings were made during MA-SM thrusts delivered to the L7 spinous process using an instrumented Activator IV clinical device.

RESULTS:   Nine MA-SM thrusts were delivered with peak forces ranging from 68-122N and with thrust durations of less than 5ms. High frequency muscle spindle discharge occurred during MA-SM. Following the MA-SM, muscle spindle responses included returning to pre-manipulation levels, slightly decreasing for a short window of time, and greatly decreasing for more than 40s.

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Characteristics of Paraspinal Muscle Spindle Response to Mechanically Assisted Spinal Manipulation

Characteristics of Paraspinal Muscle Spindle Response to Mechanically Assisted Spinal Manipulation: A Preliminary Report

The Chiro.Org Blog


SOURCE:   J Manipulative Physiol Ther. 2017 (Jun 17) [Epub]

William R. Reed, DC, PhD,
Joel G. Pickar, DC, PhD,
Randall S. Sozio, BS, LATG,
Michael A.K. Liebschner, PhD,
Joshua W. Little, DC, PhD,
Maruti R. Gudavalli, PhD

Palmer Center for Chiropractic Research,
Palmer College of Chiropractic,
Davenport, IA


OBJECTIVES:   The purpose of this preliminary study is to determine muscle spindle response characteristics related to the use of 2 solenoid powered clinical mechanically assisted manipulation (MAM) devices.

METHODS:   L6 muscle spindle afferents with receptive fields in paraspinal muscles were isolated in 6 cats. Neural recordings were made during L7 MAM thrusts using the Activator V (Activator Methods Int. Ltd., Phoenix, AZ) and/or Pulstar (Sense Technology Inc., Pittsburgh, PA) devices at their 3 lowest force settings. Mechanically assisted manipulation response measures included   (a)   the time required post-thrust until the first action potential,   (b)   differences in mean frequency (MF) and mean instantaneous frequency (MIF) 2 seconds before and after MAM, and   (c)   the time required for muscle spindle discharge (MF and MIF) to return to 95% of baseline after MAM.

RESULTS:   Depending on device setting, between 44% to 80% (Pulstar) and 11% to 63% (Activator V) of spindle afferents required >6 seconds to return to within 95% of baseline MF values; whereas 66% to 89% (Pulstar) and 75% to 100% (Activator V) of spindle responses returned to within 95% of baseline MIF in <6 seconds after MAM. Nonparametric comparisons between the 22 N and 44 N settings of the Pulstar yielded significant differences for the time required to return to baseline MF and MIF.

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Neural Responses to the Mechanical Characteristics of High Velocity, Low Amplitude Spinal Manipulation: Effect of Specific Contact Site

Neural Responses to the Mechanical Characteristics of High Velocity, Low Amplitude Spinal Manipulation: Effect of Specific Contact Site

The Chiro.Org Blog


SOURCE:   Man Ther. 2015 (Dec); 20 (6): 797–804

William R. Reed, Cynthia R. Long,
Gregory N. Kawchuk, and Joel G. Pickar

Palmer Center for Chiropractic Research,
Davenport, IA, USA.


BACKGROUND:   Systematic investigations are needed identifying how variability in the biomechanical characteristics of spinal manipulation affects physiological responses. Such knowledge may inform future clinical practice and research study design.

OBJECTIVE:   To determine how contact site for high velocity, low amplitude spinal manipulation (HVLA-SM) affects sensory input to the central nervous system.

DESIGN:   HVLA-SM was applied to 4 specific anatomic locations using a no-HVLA-SM control at each location randomized in an 8×8 Latin square design in an animal model.

METHODS:   Neural activity from muscle spindles in the multifidus and longissimus muscles were recorded from L6 dorsal rootlets in 16 anesthetized cats. A posterior to anterior HVLA-SM was applied through the intact skin overlying the L6 spinous process, lamina, inferior articular process and L7 spinous process. HVLA-SMs were preceded and followed by simulated spinal movement applied to the L6 vertebra. Change in mean instantaneous discharge frequency (ΔMIF) was determined during the thrust and the simulated spinal movement.

RESULTS:   All contact sites increased L6 muscle spindle discharge during the thrust. Contact at all L6 sites significantly increased spindle discharge more than at the L7 site when recording at L6. There were no differences between L6 contact sites. For simulated movement, the L6 contact sites but not the L7 contact site significantly decreased L6 spindle responses to a change in vertebral position but not to movement to that position.

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Changes in Muscle Spasticity in Patients With Cerebral Palsy After Spinal Manipulation

Changes in Muscle Spasticity in Patients With Cerebral Palsy After Spinal Manipulation: Case Series

The Chiro.Org Blog


SOURCE:   J Chiropractic Medicine 2016 (Dec); 15 (4): 299—304

Oleh Kachmar, MD, PhD, Taras Voloshyn, MD,
and Mykhailo Hordiyevych, MD

Innovative Technologies Department,
International Clinic of Rehabilitation,
Truskavets, Ukraine.


OBJECTIVE:   The purpose of this case series was to report quantitative changes in wrist muscle spasticity in children with cerebral palsy after 1 spinal manipulation (SM) and a 2-week course of treatment.

METHODS:   Twenty-nine patients, aged 7 to 18 years, with spastic forms of cerebral palsy and without fixed contracture of the wrist, were evaluated before initiation of treatment, after 1 SM, and at the end of a 2-week course of treatment. Along with daily SM, the program included physical therapy, massage, reflexotherapy, extremity joint mobilization, mechanotherapy, and rehabilitation computer games for 3 to 4 hours’ duration. Spasticity of the wrist flexor was measured quantitatively using a Neuroflexor device, which calculates the neural component (NC) of muscle tone, representing true spasticity, and excluding nonneural components, caused by altered muscle properties: elasticity and viscosity.

RESULTS:   Substantial decrease in spasticity was noted in all patient groups after SM. The average NC values decreased by 1.65 newtons (from 7.6 ± 6.2 to 5.9 ± 6.5) after 1 SM. Another slight decrease of 0.5 newtons was noted after a 2-week course of treatment. In the group of patients with minimal spasticity, the decrease in NC after the first SM was almost twofold-from 3.93 ± 2.9 to 2.01 ± 1.0. In cases of moderate spasticity, NC reduction was noted only after the 2-week course of intensive treatment.

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Chiropractic Management of a Patient With Chronic Fatigue

Chiropractic Management of a Patient With Chronic Fatigue: A Case Report

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SOURCE:   J Chiropractic Medicine 2016 (Dec); 15( 4): 314—320

Christopher T. Arick, DC, MS

Clinical Sciences Department,
National University of Health Sciences,
Pinellas Park, FL


OBJECTIVE:   The purpose of this case report was to describe the examination and management of a patient with chronic fatigue.

CLINICAL FEATURES:   A 34-year-old woman presented to a chiropractic clinic with complaints of fatigue and inability to lose weight for 2 years. When tested, she was found to have high serum thyroglobulin antibodies, low serum vitamin D3, low saliva dehydroepiandrosterone-sulfate, and low saliva total and diurnal cortisol.

INTERVENTION AND OUTCOME:   The patient was placed on an anti-inflammatory ancestral diet and given recommendations to decrease the aerobic intensity of her exercise routine. On the basis of the result of conventional and functional laboratory tests, she was prescribed a treatment plan of targeted supplementation. After 12 weeks of application of dietary, lifestyle, and supplementation recommendations, the patient reported experiencing increased energy and weight loss of 15 pounds. Her thyroglobulin antibodies returned within reference range, salivary cortisol increased and closely followed the proper circadian rhythm, and dehydroepiandrosterone-sulfate increased.

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