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Monthly Archives: July 2015


Brain Atrophy in Cognitively Impaired Elderly

By |July 29, 2015|Alzheimer's Disease, Supplementation|

Brain Atrophy in Cognitively Impaired Elderly:
The Importance of Long-chain ω-3 Fatty Acids
and B Vitamin Status in a Randomized Controlled Trial

The Chiro.Org Blog

SOURCE:   Am J Clin Nutr. 2015 (Jul);   102 (1):   215–221

Fredrik Jernerén, Amany K Elshorbagy, Abderrahim Oulhaj,
Stephen M Smith, Helga Refsum, and A David Smith

From the Oxford Project to Investigate Memory and Ageing (OPTIMA),
Department of Pharmacology,
University of Oxford, Oxford, United Kingdom;

This study provides clarity to earlier studies that found that B vitamins and/or Omega-3 fatty acids were found to slow brain loss in areas of the brain associated with Alzheimer’s disease.

In a 2010 study, Smith et al. [1] (in the Oxford Project to Investigate Memory and Ageing study) gave 271 individuals with mild cognitive impairment high-dose B vitamins for 2 years.   Pre- and post-MRI studies were done, and they demonstrated that the B vitamin group experienced 30-percent slower rates of brain atrophy, on average, and in some cases patients experienced reductions as high as 53 percent.

In a 2012 study, Bowman et al. [2] (in the Oregon Brain Aging Study) reviewed blood nutrient levels in 104 dementia-free elders.   They found two nutrient biomarker patterns (NBPs) that were associated with more favorable cognitive and MRI measures: one was high plasma levels of the vitamins B, C, D, and E, and the second NBP was high plasma marine omega-3 fatty acids.   They also demonstrated that high trans fat blood levels were associated with less favorable cognitive function and less total cerebral brain volumes.

When this article was pre-released, the New York Times ran a banner headline titled:
4 Vitamins That Strengthen Older Brains. [3]

In a 2013 study, Douaud et al. [4] provided high-dose B-vitamin treatment to elderly subjects with increased dementia risk for 2 years.   They found that B vitamins reduced brain shrinkage and reduced levels of plasma total homocysteine (tHcy).   This is important because many cross-sectional and prospective studies have shown that high tHcy levels are associated with cognitive impairment, Alzheimer’s disease (AD), and vascular dementia.

The current study also helps explain why some trials that focused solely on the B vitamins or Omega-3s had mixed results. Apparently having high blood levels of BOTH the B vitamins AND Omega-3 fatty acids provides better results in preventing the deterioration of brain tissue in Alzheimer’s patients.


  1. Homocysteine-lowering by B Vitamins Slows the Rate of Accelerated Brain Atrophy in Mild Cognitive Impairment: A Randomized Controlled Trial
    PLoS One. 2010 (Sep 8); 5 (9): e12244

  2. Nutrient Biomarker Patterns, Cognitive Function, and MRI Measures of Brain Aging
    Neurology. 2012 (Jan 24); 78 (4): 241–249

  3. 4 Vitamins That Strengthen Older Brains
    The New York Times ~ January 2, 2012

  4. Preventing Alzheimer’s Disease-related Gray Matter Atrophy by B-vitamin Treatment
    Proc Natl Acad Sci U S A. 2013 (Jun 4); 110 (23): 9523–9528


Multiple Venous Thromboses Presenting as Mechanical Low Back Pain in an 18-Year-Old Woman

By |July 28, 2015|Diagnosis|

Multiple Venous Thromboses Presenting as Mechanical Low Back Pain in an 18-Year-Old Woman

The Chiro.Org Blog

SOURCE:   J Chiropr Med. 2015 (Jun);   14 (2):   83–89

Andrée-Anne Marchand, DC, Jean-Alexandre Boucher, DC,
Julie O’Shaughnessy, DC, MSc

Université du Québec à Trois-Rivières,
3351 Boul. Des Forges. C.P 500, Trois-Rivières,
Québec, Canada, G9A 5H7

Objective   The purpose of this case report is to describe a patient who presented with acute musculoskeletal symptoms but was later diagnosed with multiple deep vein thrombosis (DVT).

Clinical Features   An 18-year-old female presented to a chiropractic clinic with left lumbosacral pain with referral into the posterior left thigh. A provisional diagnosis was made of acute myofascial syndrome of the left piriformis and gluteus medius muscles. The patient received 3 chiropractic treatments over 1 week resulting in 80% improvement in pain intensity. Two days later, a sudden onset of severe abdominal pain caused the patient to seek urgent medical attention. A diagnostic ultrasound of the abdomen and pelvis were performed and interpreted as normal. Following this, the patient reported increased pain in her left leg. Evaluation revealed edema of the left calf and decreased left lower limb sensation. A venous Doppler ultrasound was ordered.

Intervention and Outcomes   Doppler ultrasound revealed reduction of the venous flow in the femoral vein area. An additional ultrasonography evaluation revealed an extensive DVTs affecting the left femoral vein and iliac axis extending towards the vena cava. Upon follow-up with a hematologist, the potential diagnosis of May-Thurner syndrome was considered based on the absence of blood dyscrasias and sustained anatomical changes found in the left common iliac vein at its junction with the right common iliac artery. A week following discharge, she presented with chest pain and was diagnosed with venous thromboembolism. The patient was successfully treated with anticoagulation therapy and insertion of a vena cava filter.


High Prevalence of Daily and Multi-site pain — A Cross-sectional Population-based Study Among 3000 Danish Adolescents

By |July 19, 2015|back pain, Pediatrics|

High Prevalence of Daily and Multi-site pain — A Cross-sectional Population-based Study Among 3000 Danish Adolescents

The Chiro.Org Blog

SOURCE:   BMC Pediatr. 2013 (Nov 19);   13:   191 ~ FULL TEXT

Michael S Rathleff, Ewa M Roos, Jens L Olesen, and Sten Rasmussen

Aarhus University,
Vennelyst Boulevard 9,
8000 Aarhus C, Denmark.

BACKGROUND:   Daily pain and multi-site pain are both associated with reduction in work ability and health-related quality of life (HRQoL) among adults. However, no population-based studies have yet investigated the prevalence of daily and multi-site pain among adolescents and how these are associated with respondent characteristics. The purpose of this study was to investigate the prevalence of self-reported daily and multi-site pain among adolescents aged 12-19 years and associations of almost daily pain and multi-site pain with respondent characteristics (sex, age, body mass index, HRQoL and sports participation).

METHODS:   A population-based cross-sectional study was conducted among 4,007 adolescents aged 12-19 years in Denmark. Adolescents answered an online questionnaire during physical education lessons. The questionnaire contained a mannequin divided into 12 regions on which the respondents indicated their current pain sites and pain frequency (rarely, monthly, weekly, more than once per week, almost daily pain), characteristics, sports participation and HRQoL measured by the EuroQoL 5D. Multivariate regression was used to calculate the odds ratio for the association between almost daily pain, multi-site pain and respondent characteristics.

RESULTS:   The response rate was 73.7%. A total of 2,953 adolescents (62% females) answered the questionnaire. 33.3% reported multi-site pain (pain in > 1 region) while 19.8% reported almost daily pain. 61% reported current pain in at least one region with knee and back pain being the most common sites. Female sex (OR: 1.35-1.44) and a high level of sports participation (OR: 1.51-2.09) were associated with increased odds of having almost daily pain and multi-site pain. Better EQ-5D score was associated with decreased odds of having almost daily pain or multi-site pain (OR: 0.92-0.94).

CONCLUSION:   In this population-based cohort of school-attending Danish adolescents, nearly two out of three reported current pain and, on average, one out of three reported pain in more than one body region. Female sex, and high level of sports participation were associated with increased odds of having almost daily pain and multi-site pain. The study highlights an important health issue that calls for investigations to improve our understanding of adolescent pain and our capacity to prevent and treat this condition.

From the Full-Text Article:

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Chiropractic Pediatrics Page


Is Back Pain During Childhood or Adolescence Associated with Muscle Strength, Muscle Endurance or Aerobic Capacity?

By |July 18, 2015|back pain, Pediatrics|

Is Back Pain During Childhood or Adolescence Associated with Muscle Strength, Muscle Endurance or Aerobic Capacity: Three Systematic Literature Reviews with one Meta-analysis

The Chiro.Org Blog

SOURCE:   Chiropractic & Manual Therapies 2015 (Jul 16);   23:   21 ~ FULL TEXT

Arnaud Lardon, Charlotte Leboeuf-Yde, and
Christine Le Scanff

EA 4532 CIAMS,
Université Paris-Sud, UFR STAPS,
Orsay, 91405, France

Background   Back pain is a common condition during childhood and adolescence. The causes of back pain are largely unknown but it seems plausible that some physical factors such as back muscle strength, back muscle endurance and aerobic capacity may play a role in its development, in particular in the early years.

Objectives   The objectives of this review were to investigate in childhood and adolescence 1) if muscular strength in trunk extension is associated with back pain, 2) if muscular endurance in trunk extension is associated with back pain and 3) if aerobic capacity is associated with back pain.

Design   Three systematic critical literature reviews with one meta-analysis.

Methods   Systematic searches were made in June 2014 in PubMed, Embase and SportDiscus including longitudinal, retrospective or cross-sectional studies on back pain for subjects <20 years. Articles were accepted if they were written in French or English. The review process followed the AMSTAR recommendations. The possibility of conducting a meta-analysis was assessed for each research question.

Results   Four articles were included for the first objective, four for the second and three for the last. None of the included articles found an association between back muscle strength in extension and back pain. For the second objective, a protective association between back muscle endurance in extension and back pain was found, later confirmed in a meta-analysis (OR = 0.75, 95 % CI 0.58-0.98). The association between aerobic capacity and back pain is not clear.

Conclusions   High back muscle endurance in extension appears protective of back pain in youngsters, but the roles of high back muscle strength in extension and aerobic capacity are less clear.

Keywords:   Back pain; Adolescent; Children; Back muscle endurance; Back muscle strength; Aerobic capacity; Meta-analysis; Systematic review

From the Full-Text Article:


Pain is relatively common in childhood and adolescence [1]. For example, in a population of circa 3000 adolescents, 61 % reported musculoskeletal pain at least in one area [2]. Back pain (BP) was noted to be the second most common type with 25 % reporting daily complaints [2]. BP is common during childhood and has been shown to be a predictor of low back pain (LBP) in adulthood [3]. Therefore, more knowledge is needed about BP in the early years, as attention needs to be focused on this period of life.

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Chiropractic Pediatrics Section


The Chiropractic Hospital-Based Interventions Research Outcomes Study

By |July 10, 2015|Evidence-based Medicine, Low Back Pain|

The Chiropractic Hospital-Based Interventions Research Outcomes Study: Consistency of Outcomes Between Doctors of Chiropractic Treating Patients With Acute Lower Back Pain

The Chiro.Org Blog

SOURCE:   J Manipulative Physiol Ther. 2015 (Jun 24) ~ FULL TEXT

Jeffrey A. Quon, DC, MHSc, PhD, FCCS(C), Paul B. Bishop, DC, MD, PhD,
Brian Arthur, DC, MSc

Clinical Associate Professor,
Faculty of Medicine,
School of Population and Public Health,
University of British Columbia


Within mainstream health care, the customary management of low back pain (LBP) by primary care medical physicians is often not evidence based. Interestingly, clinical practice guidelines (CPG) for the treatment of acute mechanical LBP, for example, have been developed independently by multidisciplinary expert panels in 12 countries. [1-12]

The recommendations from those guidelines have been further accompanied by rigorous systematic reviews of the evidence [13-15] rather than expert consensus alone, [1] and, to date, they have generally endorsed the use of the following conservative modalities:

(1) reassurance about the favorable natural history of acute LBP,

(2) early activation,

(3) time-limited nonsteroidal anti-inflammatory medication
(barring contraindications
), and

(4) spinal manipulative therapy (SMT).

Despite widespread dissemination of CPG for LBP, compliance with this knowledge in general and with the SMT component in particular has been limited among mainstream health care providers. This is particularly true among family medical physicians, [16-18] whose personal beliefs about effective LBP care are often discordant with what is known from external research evidence. [19, 20] Yet, ironically, family medical physicians account for most office visits for LBP in many North American jurisdictions. [21]

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Low Back Pain and Chiropractic Page


Inter-examiner Reliability of the Interpretation of Paraspinal Thermographic Pattern Analysis

By |July 5, 2015|Technique|

Inter-examiner Reliability of the Interpretation of Paraspinal Thermographic Pattern Analysis

The Chiro.Org Blog

SOURCE:   J Can Chiropr Assoc 2015 (Jun);   59 (2):   157-164 ~ FULL TEXT

Barbara A. Mansholt, DC, MS, Robert D. Vining, DC,
Cynthia R. Long, PhD, Christine M. Goertz, DC, PhD

Associate Professor, Clinic,
Palmer College of Chiropractic

INTRODUCTION:   A few spinal manipulation techniques use paraspinal surface thermography as an examination tool that informs clinical-decision making; however, inter-examiner reliability of this interpretation has not been reported. The purpose of this study was to report inter-examiner reliability for classifying cervical paraspinal thermographic findings.

METHODS:   Seventeen doctors of chiropractic self-reporting a minimum of 2 years of experience using thermography classified thermographic scans into categories (full pattern, partial +, partial, partial -, and adaptation). Kappa statistics (k) were calculated to determine inter-examiner reliability.

RESULTS:   Overall inter-examiner reliability was fair (k=0.43). There was good agreement for identifying full pattern (k=0.73) and fair agreement for adaptation (k=0.55). Poor agreement was noted in partial categories (k=0.05-0.22).

CONCLUSION:   Inter-examiner reliability demonstrated fair to good agreement for identifying comparable (full pattern) and disparate (adaptation) thermographic findings; agreement was poor for those with moderate similarity (partial). Further research is needed to determine whether thermographic findings should be used in clinical decision-making for spinal manipulation.

From the FULL TEXT Article:


Doctors of chiropractic (DCs) use complex clinical decision-making when determining where, when, and when not to perform spinal manipulation. [1] Factors considered may include the diagnosis, symptom severity, presence of co-morbid conditions, patient preferences, and other examination findings [2, 3] such as static or segmental motion palpation, [4, 5] posture analysis, leg length analysis, [6] biomechanical interpretation of spinal radiographs, the presence of spinal/paraspinal tenderness, and abnormal muscle tone. [7] Some chiropractic spinal manipulation techniques, particularly those focusing on upper cervical manipulation, use thermographic and other diagnostic instruments to provide primary information to determine whether treatment should or should not occur. [8] The use of unique diagnostic instrumentation is not new to the chiropractic profession. B.J. Palmer, considered the “developer” of chiropractic, used an instrument called the electroencephaloneuromentimpograph and later, the neurocalometer. [9] The neurocalometer was the predecessor of the current nervo-scope, which is still used by some practitioners using the Gonstead technique system. [10, 11]

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