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Monthly Archives: June 2012

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Wake Up – We’re in a Race for Scientific Ownership of Manipulation

By |June 13, 2012|Research, Warning!|

Wake Up – We’re in a Race for Scientific Ownership of Manipulation

The Chiro.Org Blog


SOURCE:   Dynamic Chiropractic

By William Meeker, DC, MPH, FICC


For several years now, many have pointed out that our major clinical intervention, that family of procedures we call adjustments/manipulation, is no longer a “quack” remedy. That designation changed dramatically over a decade ago with the publication of the RAND appropriateness studies, the AHCPR guidelines on back conditions, and a fair number of randomized clinical trials.

Historically, those studies were very powerful in pulling manipulation out of the closet to where it now is – experiencing a great deal more exposure. As a result, we are seeing a renaissance of interest by osteopathic physicians and physical therapists. This in turn has led to a significant increase in the amount of research on manipulation by these professions. They are challenging chiropractic for pre-eminence in this field.

Professions, by definition, “own” their tools and their knowledge. This means that there is a cultural consensus in society that expertise in the use of professional knowledge is invested in a particular profession because that profession knows the most, is the most expert in, and can do the most good for the public with its unique tools. Lawyers know the most about laws because they make laws, study laws and apply laws. You wouldn’t go to a plumber if you had a legal case. Obviously, the situation is analogous for health care.

A citizen should not have any trouble deciding whom to consult for specific kinds of clinical expertise. But the situation for manipulation is becoming increasingly muddy, if the scientific publication record is any indication. We chiropractors do not enjoy an unassailable cultural consensus anymore when it comes to manipulation and adjustments. Chiropractors certainly have some authority by virtue of our history and training, but others are encroaching. We need to recognize that our authority in this area is under concerted and constant attack, and I fear that we may be losing ground. (more…)

Chiropractic Dominates The Spine Journal Downloads in 2011

By |June 12, 2012|Research|

Source Dynamic Chiropractic

The Spine Journal recently announced its “Top 25 Hottest Articles” for 2011. These are the most downloaded articles for the year. The 2011 list is surprising in that 13 of the 25 articles have at least one author who is a doctor of chiropractic.

In addition, 10 of the 25 papers include content relating to spinal manipulation, cervical manipulation or chiropractic; six of those include the terms in their title. Papers that discussed these topics were found to be very popular, ranking first, third, fourth, sixth, 10th, 14th, 15th, 17th, 23rd and 24th.

The top-ranked paper for 2011 is “Efficacy of Spinal Manipulation and Mobilization for Low Back Pain and Neck Pain: A Systematic Review and Best Evidence Synthesis.” Authors include Gert Bronfort, PhD, DC, Mitchell Haas, DC, MA, and Roni L. Evans, DC, MS, representing Northwestern Health Sciences University and the University of Western States. (This was not their only paper in the top six.)

Simon Dagenais, DC, PhD, currently working with Palladian Health in West Seneca, N.Y., led a total of 17 doctors of chiropractic who authored most of the Top 25 Hottest Articles. Here is the list of the chiropractic authors, along with the number of papers they authored in The Spine Journal and where the papers placed on the Top 25 list:

  • Paul B. Bishop, DC, MD, PhD – one paper placing 15th
  • Gert Bronfort, PhD, DC – three papers placing first, fourth and sixth, respectively
  • Simon Dagenais, DC, PhD – six papers placing third, sixth, eighth, 17th, 21st and 24th, respectively
  • Roni L. Evans, DC, MS – three papers placing first, fourth and sixth, respectively
  • Michael D. Freeman, PhD, MPH, DC – one paper placing 24th
  • Ralph E. Gay, DC, MD – one paper placing 24th
  • Mitchell Haas, DC – three papers placing first, sixth and 14th, respectively
  • Scott Haldeman, DC, MD, PhD – three papers placing third, eighth and 17th , respectively
  • Eric L. Hurwitz, DC, PhD – two papers placing seventh and 20th, respectively
  • Greg Kawchuk, DC, PhD – one paper placing sixth
  • Michele J. Maiers, DC, MPH – one paper placing fourth
  • John Mayer, DC, PhD – two papers placing 2st & 24th, respectively
  • Edward F. Owens Jr., MS, DC – one paper placing fourth
  • David Peterson, DC – one paper placing 14th
  • Joel G Pickar, DC, PhD – one paper placing 10th
  • Jeffrey A. Quon, DC, PhD, FCCSC – one paper placing 15th
  • Craig A. Schulz, DC, MS – one paper placing fourth

The majority of papers investigate conservative care versus surgery. Two of the papers that examined “catastrophic complications” and “adverse reactions” in surgical procedures included Eric L. Hurwitz, DC, PhD, as one of the authors. If the Spine Journal‘s 2011 list of the most downloaded papers is any indication, the focus in spine care has clearly moved away from surgery toward more conservative care. This refocus is not only reflected in the research community, but also in the minds of the health care-consuming public and the business community paying the bills.

This trend toward conservative care is likely to continue for the foreseeable future. The cost of surgery, surgical failure rates and the subsequent additional costs continue at unacceptable levels. It has apparently taken an economic crisis to wake people up to the nightmare that is the surgical model.

This is an excellent opportunity to educate patients and their families, friends and co-workers about chiropractic. If nothing else, read the abstracts of The Spine Journal‘s 25 Hottest Articles and share the information with them. As we all know, an educated patient can be an effective source of referrals.

TMJ Trauma and Its Rehabilitation

By |June 12, 2012|Chiropractic Care, Evaluation & Management, TMJ|

TMJ Trauma and Its Rehabilitation

The Chiro.Org Blog


Clinical Monograph 13

By R. C. Schafer, DC, PhD, FICC


TEMPOROMANDIBULAR JOINT DYSFUNCTION

Proper treatment of TMJ dysfunction must be based on a thorough case history, a complete physical workup, an evaluation of the cranial respiratory impulse and craniosacral mechanisms, and a detailed examination of the TMJ, cranium, and cervical spine. Unfortunately, radiographs to determine abnormal joint space are rarely successful unless over 30% of the bone has been destroyed.

A blow to the jaw is easily transmitted to the temporal bones. As mentioned previously, osteopathic research suggests that a subluxated temporal bone is often the focal fault. This is reported to be grossly indicated by flattening (temporal internal rotation) or protrusion (temporal external rotation) of an ear from the skull.

      Symptomatology

The major symptoms of TMJ dysfunction are masticator muscle fatigue and pain, which are usually described as a severe, unilateral (rarely bilateral), dull facial ache that is often fairly localized to an area just anterior to the tragus of the ear. The onset of pain is gradual, progressively increasing over several days or months. It is aggravated by chewing and opening and closing the mouth. Precipitation is often made by eating an apple, a wide yawn, snorkeling, prolonged dental work, playing a wind instrument, prolonged chewing, a bump or pressure on the mandible, sleeping in the prone position, or a cervical whiplash.

You may also enjoy our page on:

Chiropractic and TMJ

and our:

Chiropractic Rehabilitation Page

(more…)

Forearm and Wrist Trauma

By |June 11, 2012|Chiropractic Care, Diagnosis, Evaluation & Management|

Forearm and Wrist Trauma

The Chiro.Org Blog


Clinical Monograph 18

By R. C. Schafer, DC, PhD, FICC



As with most parts of the body, traumatic effects in the forearm or wrist may occur abruptly (eg, fracture, strain, sprain) or be the result of long-term microtrauma (eg, tunnel syndromes, arthritis, entrapment by scar tissue).


     BACKGROUND


Screening injuries of the forearm and wrist

Joint Motion Restriction

Restriction in pronation suggests a disorder at the elbow, radioulnar articulation of the wrist, or within the forearm. Restriction in supination is associated with a disorder of the elbow or radioulnar articulation of the wrist. Thickened tissues may cause compression symptoms. A palpable nontender ganglion may be found on either the dorsal or volar aspect of the wrist, perceived as a pea-size or slightly larger jelly-like cyst.

Significance of Tenderness

Tenderness over the medial collateral ligament, which rises from the medial epicondyle, is a sign of valgus sprain. Muscle tenderness in the wrist flexor-extensor group is characteristic of flexor-pronator strain (eg, tennis, screwdriving motions). Tender, possibly taut, wrist extensors on the lateral aspect are often associated with tennis elbow. Tenderness in the first tunnel on the radial side is a common site for stenosing tenosynovitis associated with a positive Finkelstein’s sign. (more…)

The Use of Botanicals During Pregnancy and Lactation

By |June 10, 2012|Complementary and Alternative Medicine, Supplementation|

The Use of Botanicals During Pregnancy and Lactation

The Chiro.Org Blog


SOURCE: Alt Ther in Health and Med 2009 (Jan); 15 (1): 54-58 ~ FULL TEXT

Tieraona Low Dog, MD

Arizona Center for Integrative Medicine,
University of Arizona Health Sciences Center, Tucson


Women are the largest consumers of healthcare, and this extends to their utilization of complementary and alternative medicine (CAM). Researchers have attempted to uncover the reasons why women turn to CAM in general and to botanical medicine in particular. Desire to have personal control over their health has been cited as the strongest motive for women to use herbal medicine. Second was dissatisfaction with conventional treatment and its disregard for a holistic approach, as well as concerns about the side effects of medications. [1]

These concerns may explain, in part, the fact that many women use herbal remedies during pregnancy. A survey of 578 pregnant women in the eastern United States reported that 45% of respondents had used herbal medicines, [2] and a survey of 588 women in Australia revealed that 36% had used at least 1 herbal product during pregnancy. [2] Women probably feel comfortable using herbal remedies because of their perceived safety, easy access, and the widespread availability of information about them (ie, Internet, magazines, books).

While it is true that many botanicals are mild in both treatment effects and side effects, the data regarding safety during pregnancy are very limited. Given the small sample sizes in clinical trials studying botanicals in pregnant women, only large differences in measures of pregnancy outcomes would likely be detected. For example, if an herb were thought to increase the rate of spontaneous abortion from 6% to 7%, a sample size of more than 19,000 women would be needed (to actually demonstrate that effect). It is highly unlikely that there will be any studies of a botanical (or any drug for that matter) with this large a sample size. (more…)

A QUIZ: Identifying Common and Dangerous Neck Masses

By |June 8, 2012|Continuing Education Credit, Education|

A QUIZ: Identifying Common and Dangerous Neck Masses

The Chiro.Org Blog


SOURCE:   MedScape
Note: Registration is free


Accurate diagnosis of neck masses is critical to minimize morbidity and mortality. However, differentials vary greatly and can be challenging for the physician.

Neck masses are common presenting complaints, but differential diagnoses vary considerably based on patient age and the location of the neck mass. Most neck masses in the pediatric population have an infectious etiology, whereas an adult neck mass is considered to be a malignancy until proven otherwise. Evaluation of a neck mass depends on the history and physical examination; evaluation may also include observation, antibiotics, fine-needle aspiration, open biopsy, neck dissection, or wide local excision.

(more…)