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Monthly Archives: April 2016

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Vertebral Artery Dissection as a Cause of
Cervical Radiculopathy

By |April 19, 2016|Stroke|

Vertebral Artery Dissection as a Cause
of Cervical Radiculopathy

The Chiro.Org Blog


SOURCE:   Asian Spine J. 2013 (Dec); 7 (4): 335–338

Benjamin Isaac Silbert, Mark Khangure, and
Peter Linton Silbert

Department of Neurology,
Royal Perth Hospital,
Perth, Australia.


The acute onset of neck pain and arm weakness is most commonly due to cervical radiculopathy or inflammatory brachial plexopathy. Rarely, extracranial vertebral artery dissection may cause radiculopathy in the absence of brainstem ischemia. We describe a case of vertebral artery dissection presenting as cervical radiculopathy in a previously healthy 43-year-old woman who presented with proximal left arm weakness and neck pain aggravated by movement. Cervical magnetic resonance imaging (MRI) and angiography revealed dissection of the left vertebral artery with an intramural hematoma compressing the left C5 and C6 nerve roots. Antiplatelet treatment was commenced, and full power returned after 2 months. Recognition of vertebral artery dissection on cervical MRI as a possible cause of cervical radiculopathy is important to avoid interventions within the intervertebral foramen such as surgery or nerve root sleeve injection. Treatment with antithrombotic agents is important to prevent secondary ischemic events.

KEYWORDS:   Cervical spine; Neck pain; Radiculopathy; Vertebral artery dissection


From the FULL TEXT Article:

Introduction

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Chiropractic Response to a Spontaneous Vertebral Artery Dissection

By |April 18, 2016|Stroke|

Chiropractic Response to a Spontaneous Vertebral Artery Dissection

The Chiro.Org Blog


SOURCE:   J Chiro Med 2015 (Sep); 14 (3): 183–190 ~ FULL TEXT

Gary Tarola, DC, and Reed B. Phillips, DC

Private Practice,
Lehigh Valley Medical Network,
Allentown, PA.


OBJECTIVE:   The purpose of this case report is to describe a case in which early detection and proper follow-up of spontaneous vertebral artery dissection led to satisfactory outcomes.

CLINICAL FEATURES:   A 34-year old white woman reported to a chiropractic clinic with a constant burning pain at the right side of her neck and shoulder with a limited ability to turn her head from side to side, periods of blurred vision, and muffled hearing. Dizziness, visual and auditory disturbances, and balance difficulty abated within 1 hour of onset and were not present at the time of evaluation. A pain drawing indicated burning pain in the suboccipital area, neck, and upper shoulder on the right and a pins and needles sensation on the dorsal surface of both forearms. Turning her head from side-to-side aggravated the pain, and the application of heat brought temporary relief. The Neck Disability Index score of 44 placed the patient’s pain in the most severe category.

INTERVENTION AND OUTCOME:   The patient was not treated on the initial visit but was advised of the possibility of a vertebral artery or carotid artery dissection and was recommended to the emergency department for immediate evaluation. The patient declined but later was convinced by her chiropractor to present to the emergency department. A magnetic resonance angiogram of the neck and carotid arteries was performed showing that the left vertebral artery was hypoplastic and appeared to terminate at the left posterior inferior cerebellar artery. There was an abrupt moderately long segment of narrowing involving the right vertebral artery beginning near the junction of the V1 and V2 segments. The radiologist noted a concern regarding right vertebral artery dissection. Symptoms resolved and the patient was cleared of any medications but advised that if symptoms reoccurred she was to go for emergency care immediately.

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Mobilization and Manipulation of the Cervical Spine in Patients with Cervicogenic Headache: Any Scientific Evidence?

By |April 13, 2016|Headache|

Mobilization and Manipulation of the Cervical Spine in Patients with Cervicogenic Headache: Any Scientific Evidence?

The Chiro.Org Blog


SOURCE:   Front Neurol. 2016 (Mar 21); 7: 40 ~ FULL TEXT

Jodan D. Garcia, Stephen Arnold, Kylie Tetley,
Kiel Voight, and Rachael Anne Frank

Department of Physical Therapy,
Georgia State University ,
Atlanta, GA , USA.


Cervical mobilization and manipulation are frequently used to treat patients diagnosed with cervicogenic headache (CEH); however, there is conflicting evidence on the efficacy of these manual therapy techniques. The purpose of this review is to investigate the effects of cervical mobilization and manipulation on pain intensity and headache frequency, compared to traditional physical therapy interventions in patients diagnosed with CEH. A total of 66 relevant studies were originally identified through a review of the literature, and the 25 most suitable articles were fully evaluated via a careful review of the text.

Ultimately, 10 studies met the inclusion criteria:

(1) randomized controlled trial (RCT) or open RCT; the study contained at least two separate groups of subjects that were randomly assigned either to a cervical spine mobilization or manipulation or a group that served as a comparison

(2) subjects must have had a diagnosis of CEH

(3) the treatment group received either spinal mobilization or spinal manipulation, while the control group received another physical therapy intervention or placebo control, and

(4) the study included headache pain and frequency as outcome measurements.

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Effectiveness of Chiropractic Care to Improve Sensorimotor Function Associated With Falls Risk in Older People

By |April 11, 2016|Vertigo|

Effectiveness of Chiropractic Care to Improve Sensorimotor Function Associated With Falls Risk in Older People: A Randomized Controlled Trial

The Chiro.Org Blog


SOURCE:   J Manipulative Physiol Ther. 2016 (Apr 2) [Epub]

Kelly R. Holt, BSc (Chiro), Heidi Haavik, BSc (Chiro), PhD,
Arier Chi Lun Lee, PhD, Bernadette Murphy, DC, PhD, C.
Raina Elley, MBChB, PhD

Research Fellow, Centre for Chiropractic Research,
New Zealand College of Chiropractic,
Mt. Wellington, Auckland, New Zealand


OBJECTIVE:   This study assessed whether 12 weeks of chiropractic care was effective in improving sensorimotor function associated with fall risk, compared with no intervention, in community-dwelling older adults living in Auckland, New Zealand.

METHODS:   Sixty community-dwelling adults older than 65 years were enrolled in the study. Outcome measures were assessed at baseline, 4 weeks, and 12 weeks and included proprioception (ankle joint position sense), postural stability (static posturography), sensorimotor function (choice stepping reaction time), multisensory integration (sound-induced flash illusion), and health-related quality of life (SF-36).

RESULTS:   Over 12 weeks, the chiropractic group improved compared with the control group in choice stepping reaction time (119 milliseconds; 95% confidence interval [CI], 26-212 milliseconds; P = .01) and sound-induced flash illusion (13.5%; 95% CI, 2.9%-24.0%; P = .01). Ankle joint position sense improved across the 4- and 12-week assessments (0.20°; 95% CI, 0.01°-0.39°; P = .049). Improvements were also seen between weeks 4 and 12 in the SF-36 physical component of quality of life (2.4; 95% CI, 0.04-4.8; P = .04) compared with control.

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“What is the Chiropractic Subluxation” Page

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The Vertigo, Balance, and Chiropractic Page

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A Path Analysis of the Effects of the Doctor-patient Encounter and Expectancy in an Open-label Randomized Trial of Spinal Manipulation for the Care of Low Back Pain

By |April 9, 2016|Low Back Pain|

A Path Analysis of the Effects of the Doctor-patient Encounter and Expectancy in an Open-label Randomized Trial of Spinal Manipulation for the Care of Low Back Pain

The Chiro.Org Blog


SOURCE:   BMC Complement Altern Med. 2014 (Jan 13); 14: 16

Mitchell Haas, Darcy Vavrek, Moni B Neradilek, and
Nayak Polissar

Center for Outcomes Studies,
University of Western States,
2900 NE 132nd Ave,
Portland, OR, USA.


BACKGROUND:   The doctor-patient encounter (DPE) and associated patient expectations are potential confounders in open-label randomized trials of treatment efficacy. It is therefore important to evaluate the effects of the DPE on study outcomes.

METHODS:   Four hundred participants with chronic low back pain (LBP) were randomized to four dose groups: 0, 6, 12, or 18 sessions of spinal manipulation from a chiropractor. Participants were treated three times per week for six weeks. They received light massage control at visits when manipulation was not scheduled. Treating chiropractors were instructed to have equal enthusiasm for both interventions. A path analysis was conducted to determine the effects of dose, patient expectations of treatment success, and DPE on LBP intensity (100-point scale) at the end of care (6 weeks) and primary endpoint (12 weeks). Direct, indirect, and total standardized effects (βtotal) were computed. Expectations and DPE were evaluated on Likert scales. The DPE was assessed as patient-rated perception of chiropractor enthusiasm, confidence, comfort with care, and time spent.

RESULTS:   The DPE was successfully balanced across groups, as were baseline expectations. The principal finding was that the magnitude of the effects of DPE on LBP at 6 and 12 weeks (|β|total = 0.22 and 0.15, p < .05) were comparable to the effects of dose of manipulation at those times (|β|total = 0.11 and 0.12, p < .05). In addition, baseline expectations had no notable effect on follow-up LBP. Subsequent expectations were affected by LBP, DPE, and dose (p < .05).

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Low Back Pain and Chiropractic Page

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Comparison of Spinal Manipulation Methods and Usual Medical Care for Acute and Subacute Low Back Pain

By |April 7, 2016|Low Back Pain|

Comparison of Spinal Manipulation Methods and Usual Medical Care for Acute and Subacute Low Back Pain: A Randomized Clinical Trial

The Chiro.Org Blog


SOURCE:   Spine (Phila Pa 1976). 2015 (Feb 15); 40 (4): 209–217

Schneider, Michael DC, PhD, Haas, Mitchell DC, MA
Glick, Ronald MD, Stevans, Joel DC, Landsittel, Doug PhD

School of Health and Rehabilitation Sciences,
Clinical and Translational Science Institute,
University of Pittsburgh,
Pittsburgh, PA


STUDY DESIGN:   Randomized controlled trial with follow-up to 6 months.

OBJECTIVE:   This was a comparative effectiveness trial of manual-thrust manipulation (MTM) versus mechanical-assisted manipulation (MAM); and manipulation versus usual medical care (UMC).

SUMMARY OF BACKGROUND DATA:   Low back pain (LBP) is one of the most common conditions seen in primary care and physical medicine practice. MTM is a common treatment for LBP. Claims that MAM is an effective alternative to MTM have yet to be substantiated. There is also question about the effectiveness of manipulation in acute and subacute LBP compared with UMC.

METHODS:   A total of 107 adults with onset of LBP within the past 12 weeks were randomized to 1 of 3 treatment groups: MTM, MAM, or UMC. Outcome measures included the Oswestry LBP Disability Index (0-100 scale) and numeric pain rating (0-10 scale). Participants in the manipulation groups were treated twice weekly during 4 weeks; subjects in UMC were seen for 3 visits during this time. Outcome measures were captured at baseline, 4 weeks, 3 months, and 6 months.

RESULTS:   Linear regression showed a statistically significant advantage of MTM at 4 weeks compared with MAM (disability = –8.1, P = 0.009; pain = –1.4, P = 0.002) and UMC (disability = –6.5, P = 0.032; pain = –1.7, P < 0.001). Responder analysis, defined as 30% and 50% reductions in Oswestry LBP Disability Index scores revealed a significantly greater proportion of responders at 4 weeks in MTM (76%; 50%) compared with MAM (50%; 16%) and UMC (48%; 39%). Similar between-group results were found for pain: MTM (94%; 76%); MAM (69%; 47%); and UMC (56%; 41%). No statistically significant group differences were found between MAM and UMC, and for any comparison at 3 or 6 months.

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Low Back Pain and Chiropractic Page

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