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

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

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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Chiropractic Management of a Patient With Chronic Fatigue

Chiropractic Management of a Patient With Chronic Fatigue: A Case Report

The Chiro.Org Blog


SOURCE:   J Chiropractic Medicine 2016 (Dec); 15( 4): 314—320

Christopher T. Arick, DC, MS

Clinical Sciences Department,
National University of Health Sciences,
Pinellas Park, FL


OBJECTIVE:   The purpose of this case report was to describe the examination and management of a patient with chronic fatigue.

CLINICAL FEATURES:   A 34-year-old woman presented to a chiropractic clinic with complaints of fatigue and inability to lose weight for 2 years. When tested, she was found to have high serum thyroglobulin antibodies, low serum vitamin D3, low saliva dehydroepiandrosterone-sulfate, and low saliva total and diurnal cortisol.

INTERVENTION AND OUTCOME:   The patient was placed on an anti-inflammatory ancestral diet and given recommendations to decrease the aerobic intensity of her exercise routine. On the basis of the result of conventional and functional laboratory tests, she was prescribed a treatment plan of targeted supplementation. After 12 weeks of application of dietary, lifestyle, and supplementation recommendations, the patient reported experiencing increased energy and weight loss of 15 pounds. Her thyroglobulin antibodies returned within reference range, salivary cortisol increased and closely followed the proper circadian rhythm, and dehydroepiandrosterone-sulfate increased.

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Happy Father’s Day! (2017)

Happy Father’s Day! (2017)

The Chiro.Org Blog



Happy Father’s Day

to Chiropractic Fathers,

wherever you may be!

Chiropractic Management of a Patient With Neck-Tongue Syndrome

Chiropractic Management of a Patient With
Neck-Tongue Syndrome: A Case Report

The Chiro.Org Blog


SOURCE:   J Chiropractic Medicine 2016 (Dec);   15 (4):   321–324

Craig S. Roberts, DC

Private Practice,
Nevada City, CA


OBJECTIVE:   The purpose of this case report was to describe the chiropractic management of a patient with neck-tongue syndrome (NTS).

CLINICAL FEATURES:   A 34-year-old female patient sought treatment at a chiropractic clinic for symptoms involving neck pain associated with left-sided paresthesia of the tongue that had persisted for >2 years. A diagnosis of NTS was made.

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Rethinking the Fear Avoidance Model

Rethinking the Fear Avoidance Model: Toward a Multidimensional Framework of Pain-related Disability

The Chiro.Org Blog


SOURCE:   Pain. 2013 (Nov); 154 (11): 2262–2265

Timothy H. Wideman, Gordon G. J. Asmundson,
Rob J. E. M Smeets, Alex J. Zautra,

School of Medicine,
Johns Hopkins University,
Baltimore, MD, USA.


Introduction

Nearly 20 years ago the Fear Avoidance Model (FAM) was advanced to explain the development and persistence of disabling low back pain. The model has since inspired productive research and has become the leading paradigm for understanding disability associated with musculoskeletal pain conditions. The model has also undergone recent expansion by addressing learning, motivation and self-regulation theory [10, 34]. In contrast to these extensions, however, one relatively constant aspect of the model is the recursive series of fear-related cognitive, affective, and behavioral processes shown in Figure 1 [31, 32, 34].

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The Biopsychosocial Model and Chiropractic

The Biopsychosocial Model and Chiropractic:
A Commentary with Recommendations for
the Chiropractic Profession

The Chiro.Org Blog


SOURCE:   Chiropractic & Manual Therapies 2017 (Jun 7); 25: 16

Jordan A. Gliedt, Michael J. Schneider, Marion W. Evans,
Jeff King and James E. Eubanks Jr

College of Chiropractic,
Logan University


There is an increasing awareness, interest and acceptance of the biopsychosocial (BPS) model by all health care professionals involved with patient care. The areas of spine care and pain medicine are no exception, and in fact, these areas of health care are a major centerpiece of the movement from the traditional biomedical model to a BPS model of patient assessment and delivery of care. The chiropractic approach to health care has a history that is grounded in key aspects of the BPS model. The profession has inherently implemented certain features of the BPS model throughout its history, perhaps without a full understanding or realization. The purpose of this paper is to present an overview of the BPS model, its relationship with spine care and pain management, and to discuss the BPS model, particularly psychosocial aspects, in the context of its historical relationship with chiropractic. We will also provide recommendations for the chiropractic profession as it relates to successful adoption of a full integration of the BPS model.

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Food Groups and Risk of All-cause Mortality

Food Groups and Risk of All-cause Mortality: A Systematic Review and Meta-Analysis of Prospective Studies

The Chiro.Org Blog


SOURCE:   Am J Clin Nutr. 2017 (Jun); 105 (6): 1462-1473

Lukas Schwingshackl, Carolina Schwedhelm,
Georg Hoffmann, Anna-Maria Lampousi et al.

German Institute of Human Nutrition Potsdam-Rehbruecke,
Nuthetal, Germany;


Background:   Suboptimal diet is one of the most important factors in preventing early death and disability worldwide.

Objective:   The aim of this meta-analysis was to synthesize the knowledge about the relation between intake of 12 major food groups, including whole grains, refined grains, vegetables, fruits, nuts, legumes, eggs, dairy, fish, red meat, processed meat, and sugar-sweetened beverages, with risk of all-cause mortality.

Design:   We conducted a systematic search in PubMed, Embase, and Google Scholar for prospective studies investigating the association between these 12 food groups and risk of all-cause mortality. Summary relative risks (RRs) and 95% CIs were estimated with the use of a random effects model for high-intake compared with low-intake categories, as well as for linear and nonlinear relations. Moreover, the risk reduction potential of foods was calculated by multiplying the RR by optimal intake values (serving category with the strongest association) for risk-reducing foods or risk-increasing foods, respectively.

Results:   With increasing intake (for each daily serving) of

whole grains   (RR: 0.92; 95% CI: 0.89, 0.95),
vegetables   (RR: 0.96; 95% CI: 0.95, 0.98),
fruits   (RR: 0.94; 95% CI: 0.92, 0.97),
nuts   (RR: 0.76; 95% CI: 0.69, 0.84), and
fish   (RR: 0.93; 95% CI: 0.88, 0.98)

the risk of all-cause mortality decreased;

higher intake of

red meat   (RR: 1.10; 95% CI: 1.04, 1.18) and
processed meat   (RR: 1.23; 95% CI: 1.12, 1.36)

was associated with an increased risk of all-cause mortality in a linear dose-response meta-analysis.

A clear indication of nonlinearity was seen for the relations between vegetables, fruits, nuts, and dairy and all-cause mortality. Optimal consumption of risk-decreasing foods results in a 56% reduction of all-cause mortality, whereas consumption of risk-increasing foods is associated with a 2-fold increased risk of all-cause mortality.

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Quantifying the Impact of NSAID-associated
Adverse Events

Quantifying the Impact of NSAID-associated
Adverse Events

The Chiro.Org Blog


SOURCE:   Am J Manag Care. 2013 (Nov); 19 (14 Suppl): s267–272

Michael Fine, MD

Health Net
736 Kendall Dr
Laguna Beach, CA 92651


Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used among patients experiencing many different types of pain, including inflammatory, acute pain (eg, injury, low back pain, headache, postoperative pain), and chronic pain (eg, rheumatoid arthritis, osteoarthritis).

However, both traditional NSAIDs and second-generation NSAIDs (cyclooxygenase-2 inhibitors) can lead to very expensive and serious adverse events. Gastrointestinal, cardiovascular, and renal complications associated with NSAIDs have been shown to be dose-dependent. In 2005, to help minimize these risks, the US Food and Drug Administration issued a public health advisory stating that “NSAIDs should be administered at the lowest effective dose for the shortest duration consistent with individual patient treatment goals.”

This article reviews the undue clinical and economic burden associated with NSAID-related serious adverse events.


From the FULL TEXT Article:

Introduction

Nonsteroidal anti-inflammatory drugs (NSAIDs) are the cornerstone of pain management in patients who have inflammatory, acute pain (eg, headache, postoperative pain, and orthopedic fractures), and chronic pain (eg, rheumatoid arthritis, osteoarthritis, and gout). [1, 2] Approximately 70% of people 65 years or older use NSAIDs at least once per week, with half of them taking at least 7 doses per week. In 2000, more than 111 million prescriptions were written for NSAIDs in the United States, at an approximate cost of $4.8 billion. [3] The use of NSAIDs is likely to increase even more as the US population continues to age and experience painful conditions that are more common among older adults. [4]

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Adverse Events

Chiropractic Gains Ground During Texas Legislative Session

Chiropractic Gains Ground During Texas Legislative Session

The Chiro.Org Blog


SOURCE:   Texas Chiropractic Association ~ May 30, 2017


Texas Gov. Greg Abbott signed into law Senate Bill 304, continuing the Texas Board of Chiropractic Examiners (TBCE) and upholding the right of licensed doctors of chiropractic in Texas to diagnose patients. It caps a historic legislative session for the chiropractic profession in Texas.

The Texas Board of Chiropractic Examiners is a state agency that regulates the chiropractic profession in Texas. Along with other state health care agencies, TBCE was under review by the Texas Sunset Advisory Commission last year. With the governor’s signature, the state’s chiropractic board will continue through Sept. 1, 2029, in addition to several other modifications to increase patient safety.

Also included in the bill was specific language to be incorporated into the Texas Chiropractic Act that clarifies the right of Texas chiropractors to diagnose. This nullifies a 2016 decision by the Travis County District Court in the Texas Medical Association vs. Texas Board of Chiropractic Examiners law suit in which diagnosis was deemed to exceed the scope of practice. With the signing of Senate Bill 304, the matter of diagnosis is settled.

“If the district court’s ruling had been allowed to stand, Texas would have been the only state in which chiropractors are not allowed to diagnose,” said Tyce Hergert, DC, of Grapevine, Texas, president of the Texas Chiropractic Association (TCA) and a chiropractor who practices in Southlake, Texas. “Without this right, it would endanger patient safety and potentially affect insurance reimbursement. We thank the governor for recognizing the importance of this issue and creating greater access to chiropractic care for the citizens of Texas.”

TCA is awaiting the governor’s signature on two other key bills:

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Prescription Rights and
Expanded Practice Page

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Influences of Lumbar Disc Herniation on the Kinematics in Multi-segmental Spine, Pelvis, and Lower Extremities During Five Activities of Daily Living

Influences of Lumbar Disc Herniation on the Kinematics in Multi-segmental Spine, Pelvis, and Lower Extremities During Five Activities of Daily Living

The Chiro.Org Blog


SOURCE:   BMC Musculoskelet Disord. 2017 (May 25); 18 (1): 216

Shengzheng Kuai, Wenyu Zhou, Zhenhua Liao,
Run Ji, Daiqi Guo, Rui Zhang and
Weiqiang Liu

Department of Mechanical Engineering,
Tsinghua University,
Haidian District,
Beijing, 100084, China.


BACKGROUND:   Low back pain (LBP) is a common problem that can contribute to motor dysfunction. Previous studies reporting the changes in kinematic characteristics caused by LBP present conflicting results. This study aimed to apply the multisegmental spinal model to investigate the kinematic changes in patients with lumbar disc herniation (LDH) during five activities of daily living (ADLs).

METHODS:   Twenty-six healthy subjects and 7 LDH patients participated in this study and performed level walking, stair climbing, trunk flexion, and ipsilateral and contralateral pickups. The angular displacement of the thorax, upper lumbar (ULx), lower lumbar (LLx), pelvis, hip, and knee was calculated using a modified full-gait-model in the AnyBody modeling system.

RESULTS:   In the patient group, the ULx almost showed no sagittal angular displacement while the LLx remained part of the sagittal angular displacement during trunk flexion and the two pickups. In the two pickups, pelvic tilt and lower extremities’ flexion increased to compensate for the deficiency in lumbar motion. LDH patients exhibited significantly less pelvic rotation during stair climbing and greater pelvic rotation in other ADLs, except in contralateral pickup. In addition, LDH patients demonstrated more antiphase movement in the transverse plane between ULx and LLx, during level walking and stair climbing, between thorax and pelvis in the two pickups.

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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:

Introduction

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:

Background

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