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Low Speed Frontal Crashes and Low Speed Rear Crashes

Low Speed Frontal Crashes and Low Speed Rear Crashes: Is There a Differential Risk for Injury?

The Chiro.Org Blog

SOURCE:   Annu Proc Assoc Adv Automot Med. 2002; 46: 79–91

Croft AC, Haneline MT, Freeman MD

Spine Research Institute of San Diego,
San Diego, California, USA.

We compared male and female subjects in crash tests in which each subject experienced both frontal and rear impacts. Crash speed and other crash parameters were held constant. We believe this was the first experiment using an independent variable of crash vector and dependent variables of head linear acceleration and volunteer qualitative tolerance.

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Memorial Day (2017)
In Memory of Those Who Have Fallen

Memorial Day (2017)
In Memory of Those Who Have Fallen

The Chiro.Org Blog

The Bivouac of the Dead

The muffled drum’s sad roll has beat
The soldier’s last tattoo’
No more on life’s parade shall meet
That brave and fallen few;

On Fame’s eternal camping ground
Their silent tents are spread;
But Glory guards with solemn round
The bivouac of the dead.

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In Memory of Those Who Have Fallen

Manual Therapies for Primary Chronic Headaches

Manual Therapies for Primary Chronic Headaches: A Systematic Review of Randomized Controlled Trials

The Chiro.Org Blog

SOURCE:   J Headache Pain. 2014 (Oct 2); 15: 67 ~ FULL TEXT

Aleksander Chaibi and Michael Bjørn Russell

Head and Neck Research Group,
Research Centre, Akershus University Hospital,
1478 Lørenskog, Oslo, Norway.

This is to our knowledge the first systematic review regarding the efficacy of manual therapy randomized clinical trials (RCT) for primary chronic headaches. A comprehensive English literature search on CINHAL, Cochrane, Medline, Ovid and PubMed identified 6 RCTs all investigating chronic tension-type headache (CTTH). One study applied massage therapy and five studies applied physiotherapy. Four studies were considered to be of good methodological quality by the PEDro scale. All studies were pragmatic or used no treatment as a control group, and only two studies avoided co-intervention, which may lead to possible bias and makes interpretation of the results more difficult. The RCTs suggest that massage and physiotherapy are effective treatment options in the management of chronic tension-type headache (CTTH).

One of the RCTs showed that physiotherapy reduced headache frequency and intensity statistical significant better than usual care by the general practitioner. The efficacy of physiotherapy at post-treatment and at 6 months follow-up equals the efficacy of tricyclic antidepressants. Effect size of physiotherapy was up to 0.62. Future manual therapy RCTs are requested addressing the efficacy in chronic migraine with and without medication overuse. Future RCTs on headache should adhere to the International Headache Society’s guidelines for clinical trials, i.e., frequency as primary end-point, while duration and intensity should be secondary end-point, avoid co-intervention, includes sufficient sample size and follow-up period for at least 6 months.

KEYWORDS:   Randomized clinical trials, Primary chronic headache, Manual therapies, Massage, Physiotherapy, Chiropractic

From the FULL TEXT Article:


Primary chronic headaches i.e. chronic migraine (CM), chronic tension-type headache (CTTH) and chronic cluster headache has significant health, economic and social costs. About 3% of the general population suffers from chronic headache with female predominance [1]. The International Classification of Headache Disorders III β (ICDH–III β) defines CM as ≥15 headache days/month for at least 3 months with features of migraine in ≥8 days/month, CTTH is defined as on average ≥15 days/month with tension-type headache for at least 3 months, and chronic cluster headache as attacks at least every other day for more than 1 year without remission, or with remissions lasting <1 month [2].

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Running Exercise Strengthens the Intervertebral Disc

Running Exercise Strengthens the Intervertebral Disc

The Chiro.Org Blog

SOURCE:   Scientific Reports 2017 (Apr 19); 7: 45975 ~ FULL TEXT

Daniel L. Belavý,a, Matthew J. Quittner,
Nicola Ridgers, Yuan Ling,
David Connell, and Timo Rantalainen

Deakin University,
School of Exercise and Nutrition Sciences,
Institute for Physical Activity and Nutrition,
221 Burwood Highway,
Burwood, Victoria, 3125, Australia.

There is currently no evidence that the intervertebral discs (IVDs) can respond positively to exercise in humans. Some authors have argued that IVD metabolism in humans is too slow to respond anabolically to exercise within the human lifespan. Here we show that chronic running exercise in men and women is associated with better IVD composition (hydration and proteoglycan content) and with IVD hypertrophy. Via quantitative assessment of physical activity we further find that accelerations at fast walking and slow running (2 m/s), but not high-impact tasks, lower intensity walking or static positions, correlated to positive IVD characteristics. These findings represent the first evidence in humans that exercise can be beneficial for the IVD and provide support for the notion that specific exercise protocols may improve IVD material properties in the spine. We anticipate that our findings will be a starting point to better define exercise protocols and physical activity profiles for IVD anabolism in humans.

From the Full-Text Article:


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Complementary and Integrative Medicine
in the Management of Headache

Complementary and Integrative Medicine
in the Management of Headache

The Chiro.Org Blog

SOURCE:   BMJ. 2017 (May 16); 357: j1805

Denise Millstine, Christina Y Chen, Brent Bauer

Integrative Medicine Section,
Department of General Internal Medicine;
Women’s Health Internal Medicine,
Mayo Clinic, Scottsdale, AZ 85260

Headaches, including primary headaches such as migraine and tension-type headache, are a common clinical problem. Complementary and integrative medicine (CIM), formerly known as complementary and alternative medicine (CAM), uses evidence informed modalities to assist in the health and healing of patients. CIM commonly includes the use of nutrition, movement practices, manual therapy, traditional Chinese medicine, and mind-body strategies. This review summarizes the literature on the use of CIM for primary headache and is based on five meta-analyses, seven systematic reviews, and 34 randomized controlled trials (RCTs).

The overall quality of the evidence for CIM in headache management is generally low and occasionally moderate. Available evidence suggests that traditional Chinese medicine including acupuncture, massage, yoga, biofeedback, and meditation have a positive effect on migraine and tension headaches. Spinal manipulation, chiropractic care, some supplements and botanicals, diet alteration, and hydrotherapy may also be beneficial in migraine headache. CIM has not been studied or it is not effective for cluster headache. Further research is needed to determine the most effective role for CIM in patients with headache.

From the FULL TEXT Article:


Headache is one of the most common clinical problems seen by healthcare providers. [1] Primary headache, as defined by the International Classification of Headache Disorders (ICHD), comprises headaches caused by independent pathophysiology, not by secondary causes, and includes tension-type headache, migraine, and cluster headaches. [2]

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Integrated Health Care and Chiropractic Page

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in the Management of Headache

Elon Musk’s chiropractic connection

Source Regina Leader-Post

Dr. Scott Haldeman is a board certified Neurologist in active clinical practice in Santa Ana, California. He currently is a distinguished Professor at the University of California, the Chairman of the Research Council for the World Federation of Chiropractic and the Founder/President of World Spine Care.


Accomplished in his own right, he also happens to be the uncle of one of the worlds great innovators, Elon Musk. Read how the young Musk spent time on the Haldeman family farm in Saskatchewan. Both Scott’s father and his grandmother (Musk’s great-grandmother) were chiropractors. In fact, Almeda Haldeman became Canada’s first known chiropractor in the early 1900’s.

You can read the rest of the story here.

Information on the Haldeman’s and other chiropractic pioneers can be found in Dr J.C. Keating’s notes in our Chiropractic History section.

Take the Guideline Challenge

Take the Guideline Challenge

The Chiro.Org Blog

SOURCE:   ACA News ~ May 15, 2017

By Christine Goertz, DC, PhD

Dr. Goertz is senior scientific advisor for the ACA. She also serves as vice chancellor for research and health policy at Palmer College of Chiropractic and is the CEO of the Spine Institute for Quality (Spine IQ)

In my last blog post, I talked about the unprecedented opportunity the chiropractic profession has to make a critical difference in areas of great public health impact, such as low back pain. I strongly believe that if we do the right thing right now, the chiropractic profession is uniquely positioned to significantly impact the quality of spine care delivery, increasing access to chiropractic care for millions of patients who desperately need conservative treatment for spine-related conditions. The flipside is that if we don’t take right action now, chiropractic risks becoming a marginalized profession that’s on the outside looking in as other health care providers take ownership of musculoskeletal conditions and spinal manipulation.

So what is right action? Recently, I asked this question of several of my colleagues who influence policy at the highest levels of research and/or health care delivery in the United States. One of those people was Francis Collins, MD, PhD, director of the National Institutes of Health. [1] Dr. Collins responded by saying:

Chiropractic’s commitment to evidence-based practice and to addressing gaps in the scientific basis of chiropractic care is vital for the progress of the field. Robust research on the safety and effectiveness of chiropractic therapies in the management of common musculoskeletal complaints must continue to be a high priority for the profession. Advancing evidence-based chiropractic care will further the integration of chiropractic into medical systems at a time when the need for effective approaches to improve outcomes for patients with chronic pain could not be more pressing.

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Low Back Pain Guidelines Page and the:

Best Practices in Chiropractic Page

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Clinical Classification in Low Back Pain: Best-evidence Diagnostic Rules Based on Systematic Reviews

Clinical Classification in Low Back Pain: Best-evidence Diagnostic Rules Based on Systematic Reviews

The Chiro.Org Blog

SOURCE:   BMC Musculoskelet Disord. 2017 (May 12); 18 (1): 188

Tom Petersen, Mark Laslett and
Carsten Juhl

Back Center Copenhagen,
Mimersgade 41, 2200,
Copenhagen N, Denmark.

A clinical decision rule “is a clinical tool that quantifies the individual contributions that various components of the history, physical examination, and basic laboratory results make toward the diagnosis, prognosis, or likely response to treatment in a patient. Clinical decision rules attempt to formally test, simplify, and increase the accuracy of clinicians’ diagnostic and prognostic assessments”   [23].

This is probably the best and most comprehensive review you will read this year, as it drills down into the findings and treatment of:

  • Intervertebral disc issues
  • Facet joint issues
  • Sacroiliac joint
  • Nerve root involvement
  • Spinal stenosis
  • Spondylolisthesis
  • Fracture
  • Myofascial pain
  • Peripheral nerve issues
  • Central sensitization

Take the time and enjoy this extensive review

BACKGROUND:   Clinical examination findings are used in primary care to give an initial diagnosis to patients with low back pain and related leg symptoms. The purpose of this study was to develop best evidence Clinical Diagnostic Rules (CDR] for the identification of the most common patho-anatomical disorders in the lumbar spine; i.e. intervertebral discs, sacroiliac joints, facet joints, bone, muscles, nerve roots, muscles, peripheral nerve tissue, and central nervous system sensitization.

METHODS:   A sensitive electronic search strategy using MEDLINE, EMBASE and CINAHL databases was combined with hand searching and citation tracking to identify eligible studies. Criteria for inclusion were: persons with low back pain with or without related leg symptoms, history or physical examination findings suitable for use in primary care, comparison with acceptable reference standards, and statistical reporting permitting calculation of diagnostic value. Quality assessments were made independently by two reviewers using the Quality Assessment of Diagnostic Accuracy Studies tool. Clinical examination findings that were investigated by at least two studies were included and results that met our predefined threshold of positive likelihood ratio ≥ 2 or negative likelihood ratio ≤ 0.5 were considered for the CDR.

RESULTS:   Sixty-four studies satisfied our eligible criteria. We were able to construct promising CDRs for symptomatic intervertebral disc, sacroiliac joint, spondylolisthesis, disc herniation with nerve root involvement, and spinal stenosis. Single clinical test appear not to be as useful as clusters of tests that are more closely in line with clinical decision making.

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Joint Manipulation: Toward a General Theory of High-Velocity, Low-Amplitude Thrust Techniques

Joint Manipulation: Toward a General Theory of High-Velocity, Low-Amplitude Thrust Techniques

The Chiro.Org Blog

SOURCE:   J Chiropractic Humanities 2017 (Mar); 20 (1): 1–9

Andrew S. Harwich, D.O.

The Bridge House Practice,
154 Caledonian Road,
Kings Cross, London, UK, N1 9RD

Objective   The objective of this study was to describe the initial stage of a generalized theory of high-velocity, low-amplitude thrust (HVLAT) techniques for joint manipulation.

Methods   This study examined the movements described by authors from the fields of osteopathy, chiropractic, and physical therapy to produce joint cavitation in both the metacarpophalangeal (MCP) joint and the cervical spine apophysial joint. This study qualitatively compared the kinetics, the similarities, and the differences between MCP cavitation and cervical facet joint cavitation. A qualitative vector analysis of forces and movements was undertaken by constructing computer-generated, simplified graphical models of the MCP joint and a typical cervical apophysial joint and imposing the motions dictated by the clinical technique.

Results   Comparing the path to cavitation of 2 modes of HVLAT for the MCP joint, namely, distraction and hyperflexion, it was found that the hyperflexion method requires an axis of rotation, the hinge axis, which is also required for cervical HVLAT. These results show that there is an analogue of cervical HVLAT in one of the MCP joint HVLATs.

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AMI Model Working in Florida: Functional Improvements, Reduced Utilization Costs by Medicaid Patients

AMI Model Working in Florida: Functional Improvements, Reduced Utilization Costs
by Medicaid Patients

The Chiro.Org Blog

SOURCE:   Dynamic Chiropractic

Background:   Alternative Medicine Integration (AMI) originally achieved recognition within the chiropractic community for its unique HMO model that utilized doctors of chiropractic as primary-care physicians (PCPs) and the portal of entry into an integrated health care delivery system, inclusive of hospitals, MDs and MD specialists and outpatient facilities. Contracted with Blue Cross Blue Shield’s HMO-Illinois, AMI’s integrated IPA demonstrated excellent clinical and cost outcomes.

These outcomes were published in the June 2007 issue of JMPT and reviewed in the June 4, 2007 issue of DC. [1] In July 2007, AMI received the national endorsement of the Congress of Chiropractic State Associations (COCSA) for its outcomes-based model of chiropractic medical management.

AMI also has been documenting the clinical and cost outcomes of its holistic, patient-centered disease management program for chronic pain patients enrolled in the Florida Medicaid system. While pharmaceutically oriented disease-management programs for diabetes, hypertension, COPD and heart disease have become staples of compliance-driven, cost-containment measures offered by insurance companies and managed-care organizations, largely unnoticed by media and consumers is the growth of costs associated with chronic pain, which has become the number-one cost driver for Medicaid and the commercial populations. Coupled with the national health care trend of increased pharmaceutical usage and its associated issues of prescription drug complications, contraindications, addiction to painkillers and accidental death inherent and measurable within the conventional medical model, treatment costs for chronic pain-related diagnoses continue to escalate.

AMI’s initial three-year findings suggest integrating complementary and alternative medicine with conventional care management approaches in the Florida Medicaid system reduces the cost of care for the payer and improves the quality of life for the patient. All indications point to the conclusion that an integrative approach to treating the “whole” person is effective in this patient population.

To chiropractors and other practitioners of natural medicine, this is not a surprise. Chances are you have anecdotal stories of patient improvement within this vulnerable and challenging population. However, what is noteworthy is that since April 2004, AMI has successfully worked with the state of Florida to provide services to those beneficiaries who have been diagnosed with chronic fatigue syndrome, chronic back pain, chronic neck pain and/or fibromyalgia. AMI’s holistic nurse case managers integrate the conventional medical care these beneficiaries receive with CAM services from providers including chiropractors, acupuncturists, massage therapists, nutritionists, pharmacists and registered nurse care managers.

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An Integrated Approach to Chronic Pain

An Integrated Approach to Chronic Pain

The Chiro.Org Blog

SOURCE:   Dynamic Chiropractic ~ May 2017

By Peter W. Crownfield, Executive Editor

A Rhode Island Medicaid pilot program is yielding
significant benefits and savings.

Findings from a unique Medicaid pilot project in Rhode Island involving high-use Medicaid recipients from two health plans were recently presented to the state’s Department of Health, [1] demonstrating stellar outcomes with regard to medication use, ER visits, health care costs and patient satisfaction.

Since 2012, Rhode Island Medicaid “Community of Care” enrollees suffering from chronic pain have participated in an integrated chronic pain program administered by Advanced Medicine Integration. Longtime readers will recall that for nearly two decades, AMI has been coordinating chiropractic and integrated care services in various states to help address the chronic pain epidemic in a community-based, integrated fashion. [2-3]

AMI’s integrated chronic pain program is designed to “reduce pain levels, improve function and overall health outcomes, reduce emergency room costs, and through a holistic approach and behavioral change models, educate members in self-care and accountability.”

The program features holistic nurse case management with referrals to CAM providers including chiropractors, massage therapists and acupuncturists; and patient education including stress-reduction tips and more.

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New Canadian Opioid Guidelines Recommends Chiropractic As Care Option

Guideline for Opioid Therapy and Chronic
Noncancer Pain

The Chiro.Org Blog

SOURCE:   CMAJ 2017 (May 8); 189 (18): E659–E666

Jason W. Busse, DC PhD,   Samantha Craigie, MSc,   David N. Juurlink, MD PhD, D.   Norman Buckley, MD,   Li Wang, PhD,   Rachel J. Couban, MA MISt,   Thomas Agoritsas, MD PhD,   Elie A. Akl, MD PhD,   Alonso Carrasco-Labra, DDS MSc,   Lynn Cooper, BES,   Chris Cull, Bruno R. da Costa, PT PhD,   Joseph W. Frank, MD MPH,   Gus Grant, AB LLB MD,   Alfonso Iorio, MD PhD,   Navindra Persaud, MD MSc,   Sol Stern, MD,   Peter Tugwell, MD MSc,   Per Olav Vandvik, MD PhD,   Gordon H. Guyatt, MD MSc

Jason W. Busse
Department of Anaesthesia
McMaster University

New Canadian Opioid Guidelines Recommendss
Chiropractic As Care Option

FROM:   World Federation of Chiropractic
Monday, May 8, 2017

A new Canadian guideline published today (May 8, 2017) in the Canadian Medical Association Journal (CMAJ) strongly recommends doctors to consider non-pharmacologic therapy, including chiropractic, in preference to opioid therapy for chronic non-cancer pain.

The guideline is the product of an extensive review of evidence involving stakeholders from medical, non-medical, regulatory, and patient stakeholders.

The lead author, Dr Jason Busse DC, PhD is a graduate of Canadian Memorial Chiropractic College and is an Associate Professor in the Department of Anaesthesia at McMaster University. Other authors of the guideline include those from the fields of physiotherapy, dentistry, public health and medicine.

Chronic non-cancer pain (CNCP) is defined as pain lasting more than 3 months that is not associated with malignancy. It is estimated that up to 20% of adult Canadians suffer with CNCP and, the guideline says, is the leading cause of health resource utilization and disability among working age adults.

Behind the USA, Canada has the second-highest level of opioid prescribing in the world. It is an enormous issue, with a doubling of admissions to publicly-funded opioid-related treatment programs between 2004 and 2012. In 2015, over 2000 Canadians died of opioid overdose, with final figures expected to be higher in 2016. Many of these deaths were associated with Fentanyl, the same opioid cited as being the cause of death of the musician Prince in 2016. Other commonly used opioid drugs are Percocet, OxyContin, Dilaudid and morphine.

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The Return of Color Vision Secondary to Macular Degeneration After Chiropractic Care

The Return of Color Vision Secondary to Macular Degeneration After Chiropractic Care

The Chiro.Org Blog

SOURCE:   Chiropractic J Australia 2017;   45 (1):   38–43

Thomas A. Brozovich D.C

Palmer College of Chiropractic,
1000 Brady St,
Davenport, IA 52803, USA

Objective:   To discuss the chiropractic management of a patient whose unilateral color vision loss associated with macular degeneration resolved after treatment.

Clinical Features:   A 66-year-old female with a history of cervical, thoracic and lumbar pain and a four-year history of macular degeneration of the left eye resulting in a loss of color vision sought chiropractic care for primarily her spinal pain. Initially she was not requesting care for her loss of color vision. She reported having multiple recent traumas (falls) injuring her cervical, thoracic and lumbar region.

Intervention and Outcome:   The patient was adjusted based on location of her subluxations (intersegmental joint dysfunction).  She had 17 treatments over 8 month.  A thermography study was performed of the face before and after treatment and a more symmetrical thermal pattern was obtained.  Her spinal pain reduced.  She also unexpectedly had a return of color vision in her left eye. 

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For Bad Backs, It May Be Time to Rethink Biases About Chiropractors

For Bad Backs, It May Be Time to Rethink Biases About Chiropractors

The Chiro.Org Blog

SOURCE:   The New York Times ~ 5-01-2017

Aaron E. Carroll, MD, MS

Indiana University School of Medicine

About two of every three people will probably experience significant low back pain at some point. A physician like me might suggest any number of potential treatments and therapies. But one I never considered was a referral for spinal manipulation.

It appears I may have been mistaken. For initial treatment of lower back pain, it may be time for me (and other physicians) to rethink our biases.

Spinal manipulation — along with other less traditional therapies like heat, meditation and acupuncture — seems to be as effective as many other more medical therapies we prescribe, and as safe, if not safer.

Most back pain resolves over time, so interventions that focus on relief of symptoms and allow the body to heal are ideal. Many of these can be nonpharmacological in nature, like the work done by chiropractors or physical therapists.

Physicians are traditionally wary of spinal manipulation (applying pressure on bones and joints), in part because the practitioners are often not doctors and also because a few chiropractors have claimed they can address conditions that have little to do with the spine. Patients with back pain haven’t seemed as skeptical. A large survey of them from 2002 through 2008 found that more than 30 percent sought chiropractic care, significantly more than those who sought massage, acupuncture or homeopathy.

Continue reading For Bad Backs, It May Be Time to Rethink Biases About Chiropractors

Spinal Manipulative Therapy Has an Immediate Effect on Thermal Pain Sensitivity in People With Low Back Pain

Spinal Manipulative Therapy Has an Immediate Effect on Thermal Pain Sensitivity in People With Low Back Pain: A Randomized Controlled Trial

The Chiro.Org Blog

SOURCE:   Phys Ther. 2009 (Dec); 89 (12): 1292–1303

Parvaneh Mohammadian, PhD, Antonio Gonsalves, DC,
Chris Tsai, DC, Thomas Hummel, MD, and
Thomas Carpenter, DC

Department of Physical Therapy,
University of Florida,
Gainesville, FL 32610-0154, USA.

BACKGROUND:   Current evidence suggests that spinal manipulative therapy (SMT) is effective in the treatment of people with low back pain (LBP); however, the corresponding mechanisms are unknown. Hypoalgesia is associated with SMT and is suggestive of specific mechanisms.

OBJECTIVE:   The primary purpose of this study was to assess the immediate effects of SMT on thermal pain perception in people with LBP. A secondary purpose was to determine whether the resulting hypoalgesia was a local effect and whether psychological influences were associated with changes in pain perception.

DESIGN:   This study was a randomized controlled trial.

SETTING:   A sample of convenience was recruited from community and outpatient clinics.

PARTICIPANTS:   Thirty-six people (10 men, 26 women) currently experiencing LBP participated in the study. The average age of the participants was 32.39 (SD=12.63) years, and the average duration of LBP was 221.79 (SD=365.37) weeks.

INTERVENTION AND MEASUREMENTS:   Baseline demographic and psychological measurements were obtained, followed by quantitative sensory testing to assess temporal summation and Adelta fiber-mediated pain perception. Next, participants were randomly assigned to ride a stationary bicycle, perform low back extension exercises, or receive SMT. Finally, the same quantitative sensory testing protocol was reassessed to determine the immediate effects of each intervention on thermal pain sensitivity.

RESULTS:   Hypoalgesia to A-delta fiber-mediated pain perception was not observed. Group-dependent hypoalgesia of temporal summation specific to the lumbar innervated region was observed. Pair-wise comparisons indicated significant hypoalgesia in participants who received SMT, but not in those who rode a stationary bicycle or performed low back extension exercises. Psychological factors did not significantly correlate with changes in temporal summation in participants who received SMT.

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