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Monthly Archives: June 2017

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Association of Spinal Manipulative Therapy With Clinical Benefit and Harm for Acute Low Back Pain

By |June 30, 2017|Low Back Pain|

Association of Spinal Manipulative Therapy With Clinical Benefit and Harm for Acute Low Back Pain: Systematic Review and Meta-analysis

The Chiro.Org Blog


SOURCE:   JAMA. 2017 (Apr 11); 317 (14): 1451–1460

Neil M. Paige, MD, MSHS, Isomi M. Miake-Lye, BA,
Marika Suttorp Booth, MS, Jessica M. Beroes, BS,
Aram S. Mardian, MD, Paul Dougherty, DC,
Richard Branson, DC, Baron Tang, PT, DPT,
Sally C. Morton, PhD, Paul G. Shekelle, MD, PhD

West Los Angeles Veterans Affairs Medical Center,
Los Angeles, California


Commentary from the Illinois Chiropractic Society

JAMA Endorses Spinal Manipulation

For the second time in as many months, a prominent medical journal has endorsed spinal manipulation for the management of low back pain. [1]   On April 11th 2017, JAMA published a systematic review of 26 randomized clinical trials in order to evaluate the safety and effectiveness of spinal manipulation for low back pain.

The authors concluded:

“Among patients with acute low back pain, spinal manipulative therapy was associated with improvements in pain and function with only transient minor musculoskeletal harms.”

This study comes on the heels of a February 2017 Clinical Practice Guideline from the American College of Physicians recommending spinal manipulation for acute, sub-acute, and chronic low back pain (LBP). [2]

These high-quality studies in respected medical journals add to a growing list of scientific support for spinal manipulation therapy (SMT). So why are our offices not flooded with medical referrals? An editorial accompanying the JAMA study provides perspective as to why some medical providers may be reluctant to refer to chiropractic physicians:

“Spinal manipulative therapy (SMT) is a controversial treatment option for low back pain, perhaps in part because it is most frequently administered by chiropractors. Chiropractic therapy is not widely accepted by some traditional health care practitioners. This may be, at least in part, because some early practitioners of chiropractic care rejected the germ theory, immunizations, and other scientific advances.

However, chiropractic care is popular today with the US public. According to a 2012 report, among patients with back or neck pain, approximately 30% sought care from a chiropractor. In a 2013 survey by Consumer Reports magazine involving 14,000 subscribers with low back pain, chiropractic care had the largest proportion of “highly satisfied” patients. Among approximately 4000 respondents who had seen a chiropractor, 59% were highly satisfied compared with 55% who saw a physical therapist and 34% who saw a primary care physician.

“Serious complications (related to SMT) are extremely rare… if spinal manipulation is at least as effective and as safe as conventional care, it may be an appropriate choice for patients with uncomplicated low back pain”. [3]

The emerging health care model dictates that all providers embrace proven clinically effective treatments, regardless of long-standing philosophical bias.   If we expect medical providers to advance their thinking to accept validated chiropractic therapies, we must first be willing to reciprocate. By working together to provide evidence-based patient-centric care, we can advance our profession to become the undeniable first choice for both patients and providers.


References:

  1. Paige NM, Miake-Lye IM, Booth MS, et al.
    Association of Spinal Manipulative Therapy With Clinical Benefit and Harm
    for Acute Low Back Pain; Systematic Review and Meta-analysis

    JAMA. 2017 (Apr 11);   317 (14):   1451–1460

  2. Qaseem A, Wilt TJ, McLean RM, Forciea MA, for the Clinical Guidelines Committee
    of the American College of Physicians.
    Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain:
    A Clinical Practice Guideline From the American College of Physicians

    Ann Intern Med. 2017 (Apr 4);   166 (7):   514–530

  3. Deyo RA.
    The Role of Spinal Manipulation in the Treatment of Low Back Pain
    JAMA. 2017 (Apr 11);   317 (14):   1418-1419

The Abstract:

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Low Back Pain and Chiropractic Page

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Alternative Medicine, Worker Health, and Absenteeism in the United States

By |June 25, 2017|Alternative Medicine, Complementary and Alternative Medicine|

Alternative Medicine, Worker Health,
and Absenteeism in the United States

The Chiro.Org Blog


SOURCE:   Complement Ther Med. 2017 (Jun); 32: 116–128

Kate Rybczynski

Department of Economics,
University of Waterloo,
200 University Avenue West,
Waterloo, ON N2L 3G1, Canada


Health related absenteeism costs an estimated $153 billion annually in the United States (Witters and Agrawal, 2011).   Chronic conditions (major contributors to absenteeism) are often successfully managed by Complementary and Alternative Medicine (CAM). As CAM becomes an increasingly visible component of healthcare, firms may wish to consider whether CAM therapies can help reduce illness-related absenteeism. This paper aims to extend the literature on healthcare utilization and absenteeism by exploring whether CAM treatment is associated with fewer workdays missed due to illness.

METHODS:   Using the 2007 National Health Interview Survey (NHIS) and propensity score matching (PSM), this study estimates the relationship between visits to CAM practitioners, health, and illness-related absenteeism.

RESULTS:   In a sample of 8,820 workers, the average annual number of workdays lost due to illness is 3.69. Visiting an acupuncturist correlates with lower absenteeism among men (1.182 fewer workdays missed, p<0.05), whereas visiting a naturopathic doctor correlates with 2.359 and 2.521 fewer workdays missed for women and men, respectively (both p<0.001). Active mind-body practices, massage, chiropractic and acupuncture treatments are all significantly associated with improved health.

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Neural Response During a Mechanically Assisted Spinal Manipulation in an Animal Model

By |June 25, 2017|Instrument Adjusting|

Neural Response During a Mechanically Assisted Spinal Manipulation in an Animal Model: A Pilot Study

The Chiro.Org Blog


SOURCE:   J Nov Physiother Phys Rehabil. 2015 (Sep);   2 (2):   20–27 ~ FULL TEXT

William R. Reed, DC, PhD,
Michael A.K. Liebschner, PhD,
Randall S. Sozio, BS, LATG,
Joel G. Pickar, DC, PhD,
Maruti R. Gudavalli, PhD

Palmer Center for Chiropractic Research,
Davenport, IA, USA.


INTRODUCTION:   Mechanoreceptor stimulation is theorized to contribute to the therapeutic efficacy of spinal manipulation. Use of mechanically-assisted spinal manipulation (MA-SM) devices is increasing among manual therapy clinicians worldwide. The purpose of this pilot study is to determine the feasibility of recording in vivo muscle spindle responses during a MA-SM in an intervertebral fixated animal model.

METHODS:   Intervertebral fixation was created by inserting facet screws through the left L5-6 and L6-7 facet joints of a cat spine. Three L6muscle spindle afferents with receptive fields in back muscles were isolated. Recordings were made during MA-SM thrusts delivered to the L7 spinous process using an instrumented Activator IV clinical device.

RESULTS:   Nine MA-SM thrusts were delivered with peak forces ranging from 68-122N and with thrust durations of less than 5ms. High frequency muscle spindle discharge occurred during MA-SM. Following the MA-SM, muscle spindle responses included returning to pre-manipulation levels, slightly decreasing for a short window of time, and greatly decreasing for more than 40s.

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Instrument Adjusting
a.k.a. Mechanically-assisted Adjustments

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Characteristics of Paraspinal Muscle Spindle Response to Mechanically Assisted Spinal Manipulation

By |June 24, 2017|Instrument Adjusting|

Characteristics of Paraspinal Muscle Spindle Response to Mechanically Assisted Spinal Manipulation: A Preliminary Report

The Chiro.Org Blog


SOURCE:   J Manipulative Physiol Ther. 2017 (Jun 17) [Epub]

William R. Reed, DC, PhD,
Joel G. Pickar, DC, PhD,
Randall S. Sozio, BS, LATG,
Michael A.K. Liebschner, PhD,
Joshua W. Little, DC, PhD,
Maruti R. Gudavalli, PhD

Palmer Center for Chiropractic Research,
Palmer College of Chiropractic,
Davenport, IA


OBJECTIVES:   The purpose of this preliminary study is to determine muscle spindle response characteristics related to the use of 2 solenoid powered clinical mechanically assisted manipulation (MAM) devices.

METHODS:   L6 muscle spindle afferents with receptive fields in paraspinal muscles were isolated in 6 cats. Neural recordings were made during L7 MAM thrusts using the Activator V (Activator Methods Int. Ltd., Phoenix, AZ) and/or Pulstar (Sense Technology Inc., Pittsburgh, PA) devices at their 3 lowest force settings. Mechanically assisted manipulation response measures included   (a)   the time required post-thrust until the first action potential,   (b)   differences in mean frequency (MF) and mean instantaneous frequency (MIF) 2 seconds before and after MAM, and   (c)   the time required for muscle spindle discharge (MF and MIF) to return to 95% of baseline after MAM.

RESULTS:   Depending on device setting, between 44% to 80% (Pulstar) and 11% to 63% (Activator V) of spindle afferents required >6 seconds to return to within 95% of baseline MF values; whereas 66% to 89% (Pulstar) and 75% to 100% (Activator V) of spindle responses returned to within 95% of baseline MIF in <6 seconds after MAM. Nonparametric comparisons between the 22 N and 44 N settings of the Pulstar yielded significant differences for the time required to return to baseline MF and MIF.

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Instrument Adjusting
a.k.a. Mechanically-assisted Adjustments

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Neural Responses to the Mechanical Characteristics of High Velocity, Low Amplitude Spinal Manipulation: Effect of Specific Contact Site

By |June 23, 2017|Subluxation|

Neural Responses to the Mechanical Characteristics of High Velocity, Low Amplitude Spinal Manipulation: Effect of Specific Contact Site

The Chiro.Org Blog


SOURCE:   Man Ther. 2015 (Dec); 20 (6): 797–804

William R. Reed, Cynthia R. Long,
Gregory N. Kawchuk, and Joel G. Pickar

Palmer Center for Chiropractic Research,
Davenport, IA, USA.


BACKGROUND:   Systematic investigations are needed identifying how variability in the biomechanical characteristics of spinal manipulation affects physiological responses. Such knowledge may inform future clinical practice and research study design.

OBJECTIVE:   To determine how contact site for high velocity, low amplitude spinal manipulation (HVLA-SM) affects sensory input to the central nervous system.

DESIGN:   HVLA-SM was applied to 4 specific anatomic locations using a no-HVLA-SM control at each location randomized in an 8×8 Latin square design in an animal model.

METHODS:   Neural activity from muscle spindles in the multifidus and longissimus muscles were recorded from L6 dorsal rootlets in 16 anesthetized cats. A posterior to anterior HVLA-SM was applied through the intact skin overlying the L6 spinous process, lamina, inferior articular process and L7 spinous process. HVLA-SMs were preceded and followed by simulated spinal movement applied to the L6 vertebra. Change in mean instantaneous discharge frequency (ΔMIF) was determined during the thrust and the simulated spinal movement.

RESULTS:   All contact sites increased L6 muscle spindle discharge during the thrust. Contact at all L6 sites significantly increased spindle discharge more than at the L7 site when recording at L6. There were no differences between L6 contact sites. For simulated movement, the L6 contact sites but not the L7 contact site significantly decreased L6 spindle responses to a change in vertebral position but not to movement to that position.

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Changes in Muscle Spasticity in Patients With Cerebral Palsy After Spinal Manipulation

By |June 18, 2017|Cerebral Palsy, Uncategorized|

Changes in Muscle Spasticity in Patients With Cerebral Palsy After Spinal Manipulation: Case Series

The Chiro.Org Blog


SOURCE:   J Chiropractic Medicine 2016 (Dec); 15 (4): 299—304

Oleh Kachmar, MD, PhD, Taras Voloshyn, MD,
and Mykhailo Hordiyevych, MD

Innovative Technologies Department,
International Clinic of Rehabilitation,
Truskavets, Ukraine.


OBJECTIVE:   The purpose of this case series was to report quantitative changes in wrist muscle spasticity in children with cerebral palsy after 1 spinal manipulation (SM) and a 2-week course of treatment.

METHODS:   Twenty-nine patients, aged 7 to 18 years, with spastic forms of cerebral palsy and without fixed contracture of the wrist, were evaluated before initiation of treatment, after 1 SM, and at the end of a 2-week course of treatment. Along with daily SM, the program included physical therapy, massage, reflexotherapy, extremity joint mobilization, mechanotherapy, and rehabilitation computer games for 3 to 4 hours’ duration. Spasticity of the wrist flexor was measured quantitatively using a Neuroflexor device, which calculates the neural component (NC) of muscle tone, representing true spasticity, and excluding nonneural components, caused by altered muscle properties: elasticity and viscosity.

RESULTS:   Substantial decrease in spasticity was noted in all patient groups after SM. The average NC values decreased by 1.65 newtons (from 7.6 ± 6.2 to 5.9 ± 6.5) after 1 SM. Another slight decrease of 0.5 newtons was noted after a 2-week course of treatment. In the group of patients with minimal spasticity, the decrease in NC after the first SM was almost twofold-from 3.93 ± 2.9 to 2.01 ± 1.0. In cases of moderate spasticity, NC reduction was noted only after the 2-week course of intensive treatment.

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Cerebral Palsy and Chiropractic Page

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