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A Videofluoroscopy-based Tracking Algorithm for Quantifying the Time Course of Human Intervertebral Displacements

A Videofluoroscopy-based Tracking Algorithm for Quantifying the Time Course of Human Intervertebral Displacements

The Chiro.Org Blog


Comput Methods Biomech Biomed Engin. 2017 (Mar 15): 1-9

Christian Balkovec, Jim H. Veldhuis,
John W. Baird, G. Wayne Brodland &
Stuart M. McGill

Department of Kinesiology,
University of Waterloo,
Waterloo, Canada.


The motions of individual intervertebral joints can affect spine motion, injury risk, deterioration, pain, treatment strategies, and clinical outcomes. Since standard kinematic methods do not provide precise time-course details about individual vertebrae and intervertebral motions, information that could be useful for scientific advancement and clinical assessment, we developed an iterative template matching algorithm to obtain this data from videofluoroscopy images.

To assess the bias of our approach, vertebrae in an intact porcine spine were tracked and compared to the motions of high-contrast markers. To estimate precision under clinical conditions, motions of three human cervical spines were tracked independently ten times and vertebral and intervertebral motions associated with individual trials were compared to corresponding averages. Both tests produced errors in intervertebral angular and shear displacements no greater than 0.4° and 0.055 mm, respectively.

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Spinal Alignment and Cervical Curve Page

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Subclinical Neck Pain and the Effects of Cervical Manipulation on Elbow Joint Position Sense

Subclinical Neck Pain and the Effects of Cervical Manipulation on Elbow Joint Position Sense

The Chiro.Org Blog


SOURCE:   J Manipulative Physiol Ther. 2011 (Feb); 34 (2): 88–97

Heidi Haavik, PhD, BSc (Chiro),
Bernadette Murphy, PhD, DC

New Zealand College of Chiropractic,
Auckland, New Zealand.
heidi.haavik@nzchiro.co.nz


OBJECTIVE:   The objectives of this study were to investigate whether elbow joint position sense (JPS) accuracy differs between participants with a history of subclinical neck pain (SCNP) and those with no neck complaints and to determine whether adjusting dysfunctional cervical segments in the SCNP group improves their JPS accuracy.

METHOD:   Twenty-five SCNP participants and 18 control participants took part in this pre-post experimental study. Elbow JPS was measured using an electrogoniometer (MLTS700, ADInstruments, New Zealand). Participants reproduced a previously presented angle of the elbow joint with their neck in 4 positions: neutral, flexion, rotation, and combined flexion/rotation. The experimental intervention was high-velocity, low-amplitude cervical adjustments, and the control intervention was a 5-minute rest period. Group JPS data were compared, and it was assessed pre and post interventions using 3 parameters: absolute, constant, and variable errors.

RESULTS:   At baseline, the control group was significantly better at reproducing the elbow target angle. The SCNP group’s absolute error significantly improved after the cervical adjustments when the participants’ heads were in the neutral and left-rotation positions. They displayed a significant overall decrease in variable error after the cervical adjustments. The control group participants’ JPS accuracy was worse after the control intervention, with a significant overall effect in absolute and variable errors. No other significant effects were detected.

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Neurology subsection

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Association Between the Type of First Healthcare Provider and the Duration of Financial Compensation for Occupational Back Pain

Association Between the Type of First Healthcare Provider and the Duration of Financial Compensation for Occupational Back Pain

The Chiro.Org Blog


SOURCE:   Journal of Occupational Rehabilitation 2016 (Sep 17)

Marc-André Blanchette, Michèle Rivard, Clermont E. Dionne, Sheilah Hogg-Johnson, Ivan Steenstra

Public Health PhD Program,
School of Public Health,
University of Montreal,
Montreal, QC, Canada.


Objective   To compare the duration of financial compensation and the occurrence of a second episode of compensation of workers with occupational back pain who first sought three types of healthcare providers.

Methods   We analyzed data from a cohort of 5,511 workers who received compensation from the Workplace Safety and Insurance Board for back pain in 2005. Multivariable Cox models controlling for relevant covariables were performed to compare the duration of financial compensation for the patients of each of the three types of first healthcare providers. Logistic regression was used to compare the occurrence of a second episode of compensation over the 2-year follow-up period.

Results   Compared with the workers who first saw a physician (reference), those who first saw a chiropractor experienced shorter first episodes of 100 % wage compensation (adjusted hazard ratio [HR] = 1.20 [1.10-1.31], P value < 0.001), and the workers who first saw a physiotherapist experienced a longer episode of 100 % compensation (adjusted HR = 0.84 [0.71-0.98], P value = 0.028) during the first 149 days of compensation. The odds of having a second episode of financial compensation were higher among the workers who first consulted a physiotherapist (OR = 1.49 [1.02-2.19], P value = 0.040) rather than a physician (reference).

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Early Predictors of Lumbar Spine Surgery After Occupational Back Injury

Early Predictors of Lumbar Spine Surgery After Occupational Back Injury: Results From a Prospective Study of Workers in Washington State

The Chiro.Org Blog


SOURCE:   Spine (Phila Pa 1976). 2013 (May 15); 38 (11): 953–964

Benjamin J. Keeney, PhD, Deborah Fulton-Kehoe, PhD, MPH, Judith A. Turner, PhD, Thomas M. Wickizer, PhD, Kwun Chuen Gary Chan, PhD, and Gary M. Franklin, MD, MPH


Department of Orthopaedics,
Geisel School of Medicine at Dartmouth College,
Lebanon, NH 03756, USA.


STUDY DESIGN:   Prospective population-based cohort study.

OBJECTIVE:   To identify early predictors of lumbar spine surgery within 3 years after occupational back injury.

SUMMARY OF BACKGROUND DATA:   Back injuries are the most prevalent occupational injury in the United States. Few prospective studies have examined early predictors of spine surgery after work-related back injury.

METHODS:   Using Disability Risk Identification Study Cohort (D-RISC) data, we examined the early predictors of lumbar spine surgery within 3 years among Washington State workers, with new workers compensation temporary total disability claims for back injuries. Baseline measures included worker-reported measures obtained approximately 3 weeks after claim submission. We used medical bill data to determine whether participants underwent surgery, covered by the claim, within 3 years. Baseline predictors (P < 0.10) of surgery in bivariate analyses were included in a multivariate logistic regression model predicting lumbar spine surgery. The area under the receiver operating characteristic curve of the model was used to determine the model’s ability to identify correctly workers who underwent surgery.

RESULTS:   In the D-RISC sample of 1885 workers, 174 (9.2%) had a lumbar spine surgery within 3 years. Baseline variables associated with surgery (P < 0.05) in the multivariate model included higher Roland-Morris Disability Questionnaire scores, greater injury severity, and surgeon as first provider seen for the injury. Reduced odds of surgery were observed for those younger than 35 years, females, Hispanics, and those whose first provider was a chiropractor. Approximately 42.7% of workers who first saw a surgeon had surgery, in contrast to only 1.5% of those who saw a chiropractor. The area under the receiver operating characteristic curve of the multivariate model was 0.93 (95% confidence interval, 0.92-0.95), indicating excellent ability to discriminate between workers who would versus would not have surgery.

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This On-site Chiropractic Clinic Is Saving a Minnesota Manufacturer Big Money

This On-site Chiropractic Clinic Is Saving
a Minnesota Manufacturer Big Money

The Chiro.Org Blog


SOURCE:   The Star Tribune ~ Jan 1, 2017   

By Christopher Cassirer

Northwestern Health Sciences University
Bloomington, MN.


A year into the project, workers report that they are feeling better and like having health care services at their job. Statistics show that they are incurring injuries at much lower rates. They are also recovering quicker when they do get hurt.

And when it comes to the bottom line, the results have been better than Friendship Homes and Northwestern expected. For every $1 that the company has invested in the program, it is saving $8 by avoiding more-costly and less-effective treatments, spending less on insurance payments and keeping more workers on the job in the first place, which generates savings through less lost tine for workers and less overtime to compensate for absences.

As our nation struggles to find an affordable, effective future for health care, some answers may come from an experiment at a midsize employer in Montevideo, Minn.

Friendship Homes, with 180 employees, is one of the largest employers in the town of 5,400 about 130 miles west of the Twin Cities. The company builds prefabricated homes. And like many in construction and related industries, it has struggled to help its employees with back and muscle pain and other injuries caused by strain and overuse.

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Cost-Effectiveness of Chiropractic Page

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Effects of 12 Weeks of Chiropractic Care on Central Integration of Dual Somatosensory Input in Chronic Pain Patients

Effects of 12 Weeks of Chiropractic Care on Central Integration of Dual Somatosensory Input in Chronic Pain Patients: A Preliminary Study

The Chiro.Org Blog


SOURCE:   J Manipulative Physiol Ther. 2017 (Feb 10) [Epub]

Heidi Haavik, PhD, BSc (Chiro), Imran Khan Niazi, PhD,
Kelly Holt, PhD, BSc (Chiro), Bernadette Murphy, PhD, DC

Centre for Chiropractic,
New Zealand College of Chiropractic,
Mount Wellington,
Auckland, New Zealand.


OBJECTIVE:   The purpose of this preliminary study was to assess whether the dual somatosensory evoked potential (SEP) technique is sensitive enough to measure changes in cortical intrinsic inhibitory interactions in patients with chronic neck or upper extremity pain and, if so, whether changes are associated with changes in pain scores.

METHODS:   The dual peripheral nerve stimulation SEP ratio technique was used for 6 subjects with a history of chronic neck or upper limb pain. SEPs were recorded after left or right median and ulnar nerve stimulation at the wrist. SEP ratios were calculated for the N9, N13, P14-18, N20-P25, and P22-N30 peak complexes from SEP amplitudes obtained from simultaneous median and ulnar stimulation divided by the arithmetic sum of SEPs obtained from individual stimulation of the median and ulnar nerves. Outcome measures of SEP ratios and subjects’ visual analog scale rating of pains were recorded at baseline, after a 2-week usual care control period, and after 12 weeks of multimodal chiropractic care (chiropractic spinal manipulation and 1 or more of the following: exercises, peripheral joint adjustments/manipulation, soft tissue therapy, and pain education).

RESULTS:   A significant decrease in the median and ulnar to median plus ulnar ratio and the median and ulnar amplitude for the cortical P22-N30 SEP component was observed after 12 weeks of chiropractic care, with no changes after the control period. There was a significant decrease in visual analog scale scores (both for current pain and for pain last week).

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Neurology subsection

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The Association of Complementary and Alternative Medicine Use and Health Care Expenditures for Back and Neck Problems

The Association of Complementary and Alternative Medicine Use and Health Care Expenditures for Back and Neck Problems

The Chiro.Org Blog


SOURCE:   Med Care. 2012 (Dec); 50 (12): 1029–1036

Brook I. Martin, PhD MPH, Mary M. Gerkovich, PhD, Richard A. Deyo, MD, MPH, Karen J. Sherman, PhD, MPH, Daniel C. Cherkin, PhD, Bonnie K. Lind, PhD, Christine M. Goertz, DC, PhD, and William E. Lafferty, MD

Department of Orthopaedics,
The Geisel School of Medicine at Dartmouth &
Dartmouth-Hitchcock Medical Center,
Lebanon, NH 03756, USA.


This first national study of CAM/chiropractic expenditures for spine conditions finds that neither adds to overall medical spending.

From Page 23:   A recent study of 12,036 records in the Medical Expenditure Panel Survey (MEPS) investigated the costs of treating patients with low back and neck pain (Martin et al., 2012). The study estimated the expenditures for care among complementary and alternative medicine (chiropractic, homeopathy, herbalism, acupuncture, and massage) users relative to non-users. This study included a chiropractic-specific analysis of expenditures for chiropractic users versus non-users, as approximately 75% of all complementary and alternative medicine services were rendered by doctors of chiropractic.

Survey data were analyzed for the years 2002–2008. The
analysis demonstrated that seeing a CAM/chiropractic provider did not add to overall medical spending. In fact,
adjusted annual healthcare costs among chiropractic users were $424 lower for spine-related costs when compared to non-CAM users.

Additionally, those who used complementary and alternative providers, including doctors of chiropractic, had significantly lower hospitalization expenditures.


BACKGROUND:   Health care costs associated with use of complementary and alternative medicine (CAM) by patients with spine problems have not been studied in a national sample.

OBJECTIVES:   To estimate the total and spine-specific medical expenditures among CAM and non-CAM users with spine problems.

RESEARCH DESIGN:   Analysis of the 2002-2008 Medical Expenditure Panel Survey.

SUBJECTS:   Adults (above 17 y) with self-reported neck and back problems who did or did not use CAM services.

MEASURES:   Survey-weighted generalized linear regression and propensity matching to examine expenditure differences between CAM users and non-CAM users while controlling for patient, socioeconomic, and health characteristics.

RESULTS:   A total of 12,036 respondents with spine problems were included, including 4,306 (35.8%) CAM users (40.8% in weighted sample). CAM users had significantly better self-reported health, education, and comorbidity compared with non-CAM users. Adjusted annual medical costs among CAM users was $424 lower (95% confidence interval: $240, $609; P<0.001) for spine-related costs, and $796 lower (95% confidence interval: $121, $1,470; P = 0.021) for total health care cost than among non-CAM users. Average expenditure for CAM users, based on propensity matching, was $526 lower for spine-specific costs (P<0.001) and $298 lower for total health costs (P = 0.403). Expenditure differences were primarily due to lower inpatient expenditures among CAM users.

There are more articles like this @ our:

Cost-Effectiveness of Chiropractic Page

and our

Chronic Neck Pain and Chiropractic Page

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Psychological and Behavioral Differences Between Low Back Pain Populations

Psychological and Behavioral Differences Between Low Back Pain Populations: A Comparative Analysis of Chiropractic, Primary and Secondary Care Patients

The Chiro.Org Blog


SOURCE:   BMC Musculoskelet Disord. 2015 (Oct 19); 16: 306

Andreas Eklund, Gunnar Bergström,
Lennart Bodin and Iben Axén

Karolinska Institutet,
Institute of Environmental Medicine,
Unit of Intervention and Implementation Research,
Nobels väg 13, S-171 77,
Stockholm, Sweden.


BACKGROUND:   Psychological, behavioral and social factors have long been considered important in the development of persistent pain. Little is known about how chiropractic low back pain (LBP) patients compare to other LBP patients in terms of psychological/behavioral characteristics.

METHODS:   In this cross-sectional study, the aim was to investigate patients with LBP as regards to psychosocial/behavioral characteristics by describing a chiropractic primary care population and comparing this sample to three other populations using the MPI-S instrument. Thus, four different samples were compared.

A: Four hundred eighty subjects from chiropractic primary care clinics.

B: One hundred twenty-eight subjects from a gainfully employed population (sick listed with high risk of developing chronicity).

C: Two hundred seventy-three subjects from a secondary care rehabilitation clinic.

D: Two hundred thirty-five subjects from secondary care clinics.

The Swedish version of the Multidimensional Pain Inventory (MPI-S) was used to collect data. Subjects were classified using a cluster analytic strategy into three pre-defined subgroups (named adaptive copers, dysfunctional and interpersonally distressed).

RESULTS:   The data show statistically significant overall differences across samples for the subgroups based on psychological and behavioral characteristics. The cluster classifications placed (in terms of the proportions of the adaptive copers and dysfunctional subgroups) sample A between B and the two secondary care samples C and D.

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Biopsychosocial Model Page

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A Systematic Review Comparing the Costs of Chiropractic Care to other Interventions for Spine Pain in the United States

A Systematic Review Comparing the Costs of Chiropractic Care to other Interventions for Spine Pain in the United States

The Chiro.Org Blog


SOURCE:   BMC Health Serv Res. 2015 (Oct 19) ~ FULL TEXT

Simon Dagenais, O’Dane Brady, Scott Haldeman
and Pran Manga

Spine Research LLC,
540 Main Street #7,
Winchester, MA, 01890, USA.


BACKGROUND:   Although chiropractors in the United States (US) have long suggested that their approach to managing spine pain is less costly than other health care providers (HCPs), it is unclear if available evidence supports this premise.

METHODS:   A systematic review was conducted using a comprehensive search strategy to uncover studies that compared health care costs for patients with any type of spine pain who received chiropractic care or care from other HCPs. Only studies conducted in the US and published in English between 1993 and 2015 were included. Health care costs were summarized for studies examining:

1.   private health plans
2.   workers’ compensation (WC) plans, and
3.   clinical outcomes.

The quality of studies in the latter group was evaluated using a Consensus on Health Economic Criteria (CHEC) list.

RESULTS:   The search uncovered 1,276 citations and 25 eligible studies, including 12 from private health plans, 6 from WC plans, and 7 that examined clinical outcomes. Chiropractic care was most commonly compared to care from a medical physician, with few details about the care received. Heterogeneity was noted among studies in patient selection, definition of spine pain, scope of costs compared, study duration, and methods to estimate costs. Overall, cost comparison studies from private health plans and WC plans reported that health care costs were lower with chiropractic care. In studies that also examined clinical outcomes, there were few differences in efficacy between groups, and health care costs were higher for those receiving chiropractic care. The effects of adjusting for differences in sociodemographic, clinical, or other factors between study groups were unclear.

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The Effect of Spinal Manipulation on Deep Experimental Muscle Pain in Healthy Volunteers

The Effect of Spinal Manipulation on Deep Experimental Muscle Pain in Healthy Volunteers

The Chiro.Org Blog


SOURCE:   Chiropractic & Manual Therapies 2015 (Sep 7);   23:   25

Søren O’Neill, Øystein Ødegaard-Olsen and Beate Søvde

Institute of Regional Health Research,
University of Southern Denmark,
Campusvej 55, Odense, 5230 DK Denmark ;

Spine Centre of Southern Denmark,
Lillebælt Hospital, Østre Hougvej 55,
Middelfart, 5500 DK Denmark


BACKGROUND:   High-velocity low-amplitude (HVLA) spinal manipulation is commonly used in the treatment of spinal pain syndromes. The mechanisms by which HVLA-manipulation might reduce spinal pain are not well understood, but often assumed to relate to the reduction of biomechanical dysfunction. It is also possible however, that HVLA-manipulation involves a segmental or generalized inhibitory effect on nociception, irrespective of biomechanical function. In the current study it was investigated whether a local analgesic effect of HVLA-manipulation on deep muscle pain could be detected, in healthy individuals.

METHODS AND MATERIALS:   Local, para-spinal muscle pain was induced by injection of 0.5 ml sterile, hyper-tonic saline on two separate occasions 1 week apart. Immediately following the injection, treatment was administered as either a) HVLA-manipulation or b) placebo treatment, in a randomized cross-over design. Both interventions were conducted by an experienced chiropractor with minimum 6 years of clinical experience. Participants and the researcher collecting data were blinded to the treatment allocation. Pain scores following saline injection were measured by computerized visual analogue pain scale (VAS) (0-100 VAS, 1 Hz) and summarized as a) Pain duration, b) Maximum VAS, c) Time to maximum VAS and d) Summarized VAS (area under the curve). Data analysis was performed as two-way analysis of variance with treatment allocation and session number as explanatory variables.

RESULTS:   Twenty-nine healthy adults (mean age 24.5 years) participated, 13 women and 16 men. Complete data was available for 28 participants. Analysis of variance revealed no statistically significant difference between active and placebo manipulation on any of the four pain measures.

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Chiropractic and Spinal Pain Page and the:

Subluxation Neurology Section

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A Comparison of Chiropractic Manipulation Methods and Usual Medical Care for Low Back Pain

A Comparison of Chiropractic Manipulation Methods and Usual Medical Care for Low Back Pain: A Randomized Controlled Clinical Trial

The Chiro.Org Blog


SOURCE:   J Altern Complement Med. 2014 (May);   20 (5):   A22–23

Michael Schneider, Mitchell Haas, Joel Stevans,
Ronald Glick, Doug Landsittel

University of Pittsburgh,
Pittsburgh, PA, USA


Purpose:   The primary aim of this study was to compare manual and mechanical methods of spinal manipulation (Activator) for patients with acute and sub-acute low back pain. These are the two most common methods of spinal manipulation used by chiropractors, but there is insufficient evidence regarding their comparative effectiveness against each other. Our secondary aim was to compare both methods with usual medical care.

Methods:   In a randomized comparative effectiveness trial, we randomized 107 participants with acute and sub-acute low back pain to: 1) usual medical care; 2) manual side-posture manipulation; and 3) mechanical manipulation (Activator). The primary outcome was self-reported disability (Oswestry) at four weeks. Pain was rated on a 0 to 10 numerical rating scale. Pain and disability scores were regressed on grouping variables adjusted for baseline covariates.

Results:   Manual manipulation demonstrated a clinically important and statistically significant reduction of disability and pain compared to Activator (adjusted mean difference=7.9 and 1.3 points respectively, P< .05) and compared to usual medical care (7.0 and 1.8 points respectively, P<.05). There were no significant adjusted mean differences between Activator and usual medical care in disability and pain (0.9 and 0.5 points respectively, P>.05).

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Low Back Pain and Chiropractic

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The Death Knell for the Prescription Rights Movement?

The Death Knell for the Prescription Rights Movement?

The Chiro.Org Blog


SOURCE:   A Chiro.Org Editorial


This blog has posted extensively on the nascent prescription rights movement since early 2010.

The recent release (2-14-17) of American College of Physician’s new study ”Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain” appears to raise an evidence-based obstacle in the path to adding Rx rights to our profession.

In essence it recommends AGAINST prescribing drugs, although in a nod to prescribers, it does state:

“If pharmacologic treatment is desired, clinicians and patients should select nonsteroidal anti-inflammatory drugs or skeletal muscle relaxants”

A review of this complete study and its supporting documents, in particular the new review titled: ” Systemic Pharmacologic Therapies for Low Back Pain” clearly reveals that:

— nonsteroidal anti-inflammatory drugs had smaller benefits for chronic low back pain than previously observed

— skeletal muscle relaxants are effective for short-term pain relief in acute low back pain but caused sedation.

If a majority of DCs choose to pursue prescription rights, that is their privilege. Based on Organized Medicine’s reactions against this movement in key States, this looks to be an extended and expensive uphill battle.

I can’t help but wonder: If DCs expended the same amount effort in developing relationships by referring needy patients for drug-based co-management, whether they might achieve wider professional acceptance, cooperation and increased market-share via embracing our status as a non-drug provider?

Continue reading The Death Knell for the Prescription Rights Movement?

Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain

Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians

The Chiro.Org Blog


SOURCE:   Ann Intern Med. 2017 (Feb 14) [Epub] ~ FULL TEXT

Amir Qaseem, MD, PhD, MHA; Timothy J. Wilt, MD, MPH;
Robert M. McLean, MD; Mary Ann Forciea, MD;
for the Clinical Guidelines Committee of the American College of Physicians (*)

From the American College of Physicians
and Penn Health System,
Philadelphia, Pennsylvania;
Minneapolis Veterans Affairs Medical Center,
Minneapolis, Minnesota; and
Yale School of Medicine,
New Haven, Connecticut.


The American College of Physicians (ACP) released updated guidelines this week that recommend the use of noninvasive, non-drug treatments for low back pain before resorting to drug therapies, which were found to have limited benefits. One of the non-drug options cited by ACP is spinal manipulation.

Chiropractors, who diagnose and treat musculoskeletal disorders, are experts in spinal manipulation.

DESCRIPTION: &nbsp The American College of Physicians (ACP) developed this guideline to present the evidence and provide clinical recommendations on noninvasive treatment of low back pain.

METHODS: &nbsp Using the ACP grading system, the committee based these recommendations on a systematic review of randomized, controlled trials and systematic reviews published through April 2015 on noninvasive pharmacologic and nonpharmacologic treatments for low back pain. Updated searches were performed through November 2016. Clinical outcomes evaluated included reduction or elimination of low back pain, improvement in back-specific and overall function, improvement in health-related quality of life, reduction in work disability and return to work, global improvement, number of back pain episodes or time between episodes, patient satisfaction, and adverse effects.

TARGET AUDIENCE AND PATIENT POPULATION: &nbsp The target audience for this guideline includes all clinicians, and the target patient population includes adults with acute, subacute, or chronic low back pain.

RECOMMENDATION 1:   Given that most patients with acute or subacute low back pain improve over time regardless of treatment, clinicians and patients should select nonpharmacologic treatment with superficial heat (moderate-quality evidence), massage, acupuncture, or spinal manipulation (low-quality evidence). If pharmacologic treatment is desired, clinicians and patients should select nonsteroidal anti-inflammatory drugs or skeletal muscle relaxants (moderate-quality evidence). (Grade: strong recommendation).

WARNING:   Before following Recommendation #1,
please review the

Contra-indications to NSAIDS use

.

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Guidelines Section

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Glucose Metabolic Changes in the Brain and Muscles of Patients with Nonspecific Neck Pain Treated by Spinal Manipulation Therapy

Glucose Metabolic Changes in the Brain and Muscles of Patients with Nonspecific Neck Pain Treated by Spinal Manipulation Therapy: A [18F]FDG PET Study

The Chiro.Org Blog


SOURCE:   Evid Based Complement Alternat Med 2017 (Jan 12);
2017: 4345703
~ FULL TEXT

Akie Inami, Takeshi Ogura,
Shoichi Watanuki, Md. Mehedi Masud,
Katsuhiko Shibuya, Masayasu Miyake, et al.

Division of Cyclotron Nuclear Medicine,
Cyclotron and Radioisotope Center,
Tohoku University,
Sendai, Japan.


Objective.   The aim of this study was to investigate changes in brain and muscle glucose metabolism that are not yet known, using positron emission tomography with [18F]fluorodeoxyglucose ([18F]FDG PET).

Methods.   Twenty-one male volunteers were recruited for the present study. [18F]FDG PET scanning was performed twice on each subject: once after the spinal manipulation therapy (SMT) intervention (treatment condition) and once after resting (control condition). We performed the SMT intervention using an adjustment device. Glucose metabolism of the brain and skeletal muscles was measured and compared between the two conditions. In addition, we measured salivary amylase level as an index of autonomic nervous system (ANS) activity, as well as muscle tension and subjective pain intensity in each subject.

Results.   Changes in brain activity after SMT included activation of the dorsal anterior cingulate cortex, cerebellar vermis, and somatosensory association cortex and deactivation of the prefrontal cortex and temporal sites. Glucose uptake in skeletal muscles showed a trend toward decreased metabolism after SMT, although the difference was not significant. Other measurements indicated relaxation of cervical muscle tension, decrease in salivary amylase level (suppression of sympathetic nerve activity), and pain relief after SMT.

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Neurology subsection

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Individual Courses of Low Back Pain in Adult Danes

Individual Courses of Low Back Pain in Adult Danes: A Cohort Study with 4-Year and 8-Year Follow-up

The Chiro.Org Blog


SOURCE:   BMC Musculoskelet Disord. 2017 (Jan 21); 18 (1): 28

Per Kjaer, Lars Korsholm, Charlotte Leboeuf-Yde,
Lise Hestbaek and Tom Bendix

Department of Sports Science and Clinical Biomechanics,
University of Southern Denmark,
Campusvej 55, DK-5230,
Odense M, Denmark.


BACKGROUND: &nbsp Few longitudinal studies have described the variation in LBP and its impact over time at an individual level. The aims of this study were to:

1)   determine the prevalence of LBP in three surveys over a 9-year period in the Danish general population, using five different definitions of LBP,

2)   study their individual long-term courses, and

3)   determine the odds of reporting subsequent LBP when having reported previous LBP.

METHODS: &nbsp A cohort of 625 men and women aged 40 was sampled from the general population. Questions about LBP were asked at ages 41, 45 and 49, enabling individual courses to be tracked across five different definitions of LBP. Results were reported as percentages and the prognostic influence on future LBP was reported as odds ratios (OR).

RESULTS: &nbsp Questionnaires were completed by 412 (66%), 348 (56%) and 293 (47%) persons respectively at each survey. Of these, 293 (47%) completed all three surveys. The prevalence of LBP did not change significantly over time for any LBP past year: 69, 68, 70%; any LBP past month: 42, 48, 41%; >30 days LBP past year: 25, 27, 24%; seeking care for LBP past year: 28, 30, 36%; and non-trivial LBP, i.e. LBP >30 days past year including consequences: 18, 20, 20%. For LBP past year, 2/3 remained in this category, whereas four out of ten remained over the three time-points for the other definitions of LBP. Reporting LBP defined in any of these ways significantly increased the odds for the same type of LBP 4 years later. For those with the same definition of LBP at both 41 and 45 years, the risk of also reporting the same at 49 years was even higher, regardless of definition, and most strongly for seeking care and non-trivial LBP (OR 17.6 and 18.4) but less than 11% were in these groups.

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Low Back Pain and Chiropractic

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