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Effects of Chiropractic Care on Dizziness,
Neck Pain, and Balance

Effects of Chiropractic Care on Dizziness, Neck Pain,
and Balance: A Single-group, Preexperimental, Feasibility Study

The Chiro.Org Blog


SOURCE:   Journal of Chiropractic Medicine 2009 (Dec);   8 (4):   156–164

Richard G. Strunk, DC, Cheryl Hawk, DC, PhD

Assistant Professor,
Clinical Sciences/Research,
Cleveland Chiropractic College,
Overland Park, KS.


OBJECTIVE:   This feasibility study was conducted to further the development of a line of investigation into the potential effects of spinal manipulation/manual therapy on cervicogenic dizziness, balance, and neck pain in adults.

METHODS:   A single-group, preexperimental, feasibility study was conducted at a chiropractic college health center and a senior fitness center with a target sample size of 20 patients (40 years or older). Patients were treated by either a clinician or a chiropractic student intern for 8 weeks. The Dizziness Handicap Inventory was the primary outcome measurement, with the Short Form Berg Balance Scale (SF-BBS) and the Neck Disability Index used as secondary outcome measurements.

RESULTS:   Twenty-seven patients were recruited over a period of 13 months. Twenty-one patients enrolled in the study; but because of 2 dropouts, 19 patients completed the treatment. A median Dizziness Handicap Inventory change score of +7 points was calculated for those dizziness patients, with 3 patients improving by at least 18 points, indicating a clinically meaningful change. Seven of the 15 patients who performed the SF-BBS attained at least a 4-point improvement with an effect size of 1.2. A median Neck Disability Index change score of +1 was calculated for those patients with neck pain. Twelve minor adverse reactions were reported by 8 patients, with 3 of those reactions lasting longer than 24 hours.

CONCLUSION:   A large effect size was calculated for the SF-BBS. Most patients demonstrated improved balance, and some showed reduced dizziness and neck pain. Involving interns in care proved feasible. Further studies with comparison groups and larger samples are needed to explore the promising results of this study before any cause and effect relationship can be determined.

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From the FULL TEXT Article

Introduction

Dizziness is a common problem that can often lead to disability or psychologic distress in middle-aged and older adults. [1-3] A subcategory of dizziness is cervicogenic dizziness, characterized by symptoms of sensations of excessive motion, imbalance, or spinning associated with neck pain and stiffness. [4] Cervicogenic dizziness is thought to be caused by abnormal sensory afferent stimulation in the cervical spine. [5] Presently, there is some evidence to advocate the use of spinal manipulation (SM) or other manual therapy (MT) techniques for this condition. Most of the existing studies looking at the effect of SM/MT on cervicogenic Dizziness are either case reports, single-subject designs, or observational studies. [6] Only 2 randomized controlled trials (RCTs) have been published to date; only the study by Reid et al was adequately powered to detect between-group differences. [7, 8] Both RCTs suggested a benefit of MT/SM for dizziness of cervical spine origin. Furthermore, 2 systematic reviews that included not only RCTs but other study designs as well suggest that SM/MT to the cervical spine may be beneficial for individuals with cervicogenic dizziness, especially when these individuals have neck pain and/or cervical spine dysfunction. [6, 9]

Continue reading Effects of Chiropractic Care on Dizziness,
Neck Pain, and Balance

Straighten Up for World Spine Day: New Free App Launches to Help All Ages Improve Posture and Spinal Health

SUp-webbanner-EN

Source Newswire

Musculoskeletal issues are the cause of one-third of missed work − second only to the common cold; poll reveals almost half of Canadians suffered from four or more MSK conditions in the last year.

TORONTO, Oct. 16, 2014 /CNW/ – The Canadian Chiropractic Association (CCA), in partnership with the 10 provincial chiropractic associations, has launched a new app today to mark World Spine Day. The 2014 World Spine Day theme is “Straighten Up and Move”, and the aptly named Straighten Up Canada app aims to accomplish just that—improve posture and spinal health through simple preventative posture exercises. It is the first free Canadian app of its kind.

The Straighten Up Canada app provides users with 12 short exercise videos as well as a tracking feature to monitor progress and share with others through social media. It also includes a “Find a Chiropractor” search function to locate musculoskeletal (MSK) experts nearby.

“Canadians are becoming more sedentary and are experiencing postural issues at an earlier age, due to the increased use of technology in both their personal and professional lives,” explains Dr. Robert David, Chair, Canadian Chiropractic Association. “What most people don’t know is that practising simple exercises daily to adjust poor posture habits is one of the best ways to reduce aches and pains.”

Musculoskeletal conditions account for one-third of missed work in Canada.
Each year, over 11 million Canadians suffer from at least one musculoskeletal condition.1 In fact, low back pain and other MSK conditions account for one-third of missed work in Canada − second only to the common cold. Many MSK problems are the product of poor posture, resulting from using poor body mechanics while engaging in everyday activities, like hunching over computers, tablets or smartphones, lifting children, slouching at a desk or even carrying heavy purses, laptop bags and groceries. Sitting for prolonged periods at work and heavy manual labour can put further strain on the body’s MSK system.

Alison Dantas, Chief Executive Officer, Canadian Chiropractic Association, explains that adopting good posture habits early on is key to minimizing and even avoiding chronic MSK pain in some cases. “As a vital part of every Canadian’s healthcare team, chiropractors are experts in musculoskeletal health and can provide people with preventative measures to promote and maintain a healthy spine. The posture exercises in the Straighten Up Canada app are not only fast and easy, they will help people of all ages prevent, and in some cases even eliminate, their habits around poor posture.”

Almost half of Canadians were afflicted by more than four MSK ailments in the last 12 months; leading symptoms are back pain, stiffness, headaches/migraines, neck and joint pain.
According to research conducted by Ipsos Reid on behalf of the CCA, 43% of Canadians have suffered from four or more MSK issues within the last year. The leading health concerns are back pain and stiffness (53 per cent), headaches and migraines (44 per cent), neck pain (35 per cent) and joint pain (35 per cent). In fact, MSK disorders account for the highest disability costs among all chronic conditions in Canada ($15 billion). 2

“The main goal of the Straighten Up Canada app is to help people become regularly aware of their posture so they can start to correct it themselves,” explains Dr. David. “Another advantage of this app is these exercises can take as little as three minutes to help you reset and become more mindful of your posture. Everyone can find three minutes in their day, and if they do, it may just help them lead a more active and healthy lifestyle resulting in a wide range of long-term health benefits.”

The Straighten Up Canada app is available for free download through the Apple App Store, Google Play Store and on www.straightenupcanada.ca.

Assessment of Patients With Neck Pain

Assessment of Patients With Neck Pain: A Review of Definitions, Selection Criteria, and Measurement Tools

The Chiro.Org Blog


SOURCE:   Journal of Chiropractic Medicine 2010 (Jun);   9 (2):   49–59

Victoria Misailidou, Paraskevi Malliou, Anastasia Beneka,
Alexandros Karagiannidis, and Georgios Godolias

Laboratory Instructor, Department of Physical Therapy,
Technological Educational Institute of Thessaloniki,
57400, Thessaloniki, Greece


OBJECTIVE:   The purpose of this literature review was to synthesize the existing literature on various definitions, classifications, selection criteria, and outcome measures used in different studies in patients with neck pain.

METHODS:   A literature search of MEDLINE and CINAHL through September 2008 was performed to gather articles on the reliability, validity, and utility of a wide variety of outcome measurements for neck pain.

RESULTS:   Different types of definitions appear in the literature based on anatomical location, etiology, severity, and duration of symptoms. Classifications according to severity and duration of pain and the establishment of selection criteria seem to play a crucial role in study designs and in clinical settings to ensure homogeneous groups and effective interventions. A series of objective tests and subjective self-report measures are useful in assessing physical abilities, pain, functional ability, psychosocial well-being, general health status, and quality of life in patients with neck pain. Self-administered questionnaires are commonly used in clinical practice and research projects.

CONCLUSIONS:   Because of multidimensionality of chronic neck pain, more than just one index may be needed to gain a complete health profile of the patient with neck pain. The instruments chosen should be reliable, valid, and able to evaluate the effects of treatment.

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Outcome Assessment Questionnaires Page


From the Full-Text Article:

Introduction

The introduction of evidence-based practice in the last years of the 20th century stimulated the development and research of an enormous number of instruments to assess many types of patient variables. [1] Now, more rehabilitation professionals are familiarizing themselves with the use of outcome measures in clinical practice and for research purposes. [2, 3] Outcomes assessment is primarily designed to establish baselines, to evaluate the effect of an intervention, to assist in goal setting, and to motivate patients to evaluate their treatment. [4, 5] When used in a clinical setting, it can enhance clinical decision making and improve quality of care. [6] Many patients with neck pain visit health care clinics seeking treatment of their problem, and health professionals aim to use the best available evidence for making decisions about therapy. The best evidence comes from randomized clinical trials, systematic reviews, and evidence-based clinical practice guidelines. [7]

Continue reading Assessment of Patients With Neck Pain

Outcomes For Adult Scoliosis Patients
Receiving Chiropractic Rehabilitation

Outcomes For Adult Scoliosis Patients
Receiving Chiropractic Rehabilitation:
A 24-month Retrospective Analysis

The Chiro.Org Blog


SOURCE:   Journal of Chiropractic Medicine 2011 (Sep);   10 (3):   179–184

Mark W. Morningstar, DC

Private Practice, Grand Blanc, MI


OBJECTIVES:   The purpose of this study was to retrospectively report the results of patients who completed an exercise-based chiropractic program and its potential to alter the natural progression of adult scoliosis at 24 months after the clinic portion of treatment was concluded.

METHODS:   A retrospective chart review was conducted at 2 spine clinics in Michigan, USA. Each clinic uses the same chiropractic rehabilitation program to treat patients with adult scoliosis. Multidimensional patient outcomes included radiographic, respiratory, disability, and pain parameters. Outcomes were measured at baseline, at end of active treatment, and at long-term follow-up.

RESULTS:   A total of 28 patients fit the inclusion criteria for the study. The average beginning primary Cobb angle was 44° ± 6°. Patients received the same chiropractic rehabilitation program for approximately 6 months. At the end of active treatment, improvements were recorded in Cobb angle, pain scores, spirometry, and disability rating. All radiographic findings were maintained at 24-month follow-up.

CONCLUSION:   This report is among the first to demonstrate sustained radiographic, self-rated, and physiologic benefits after treatment ceased. After completion of a multimodal chiropractic rehabilitation treatment, a retrospective cohort of 28 adult scoliosis patients reported improvements in pain, Cobb angle, and disability immediately following the conclusion of treatment and 24 months later.

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From the Full-Text Article:

Introduction:

Approximately 68% of scoliotic curvatures greater than 30° at skeletal maturity tend to progress at a linear rate, regardless of the type of scoliosis curvature pattern. [1-3] Asymmetrical gravitational loading on the spine and disk elements leads to asymmetric degeneration. [4, 5] This cyclic process ultimately causes the adult scoliosis to progress and negatively affect quality of life later. [2] Therefore, as other authors have already discussed, [6] the only way to improve the asymmetrical degenerative environment is to promote symmetry of the global spine, thus removing asymmetrical gravitational loading.

Continue reading Outcomes For Adult Scoliosis Patients
Receiving Chiropractic Rehabilitation

Vertebral Artery Dissection in a Patient Practicing Self-manipulation of the Neck

Vertebral Artery Dissection in a Patient Practicing Self-manipulation of the Neck

The Chiro.Org Blog


SOURCE:   Journal of Chiropractic Medicine 2011 (Dec);   10 (4):   283–287

John S. Mosby, DC, MD, Stephen M. Duray, PhD

Division of Clinics,
Palmer College of Chiropractic,
Davenport, IA 52803, USA


OBJECTIVE:   The purpose of this case report is to describe a patient who regularly practiced self-manipulation of her neck who presented with shoulder and neck pain and was undergoing a vertebral artery dissection.

CLINICAL FEATURES:   A 42-year-old female patient sought care for left shoulder pain with a secondary complaint of left lower neck pain. Twelve days prior, she had had “the worst headache of her life,” which began in her left lower cervical spine and extended to her left temporal region. The pain was sudden and severe, was described as sharp and burning, and lasted 3 hours. She reported nausea, vomiting, and blurred vision.

INTERVENTION AND OUTCOME:   Initial history and examination suggested that the patient’s head and neck pain was not musculoskeletal in origin, but vascular. She repeatedly requested that an adjustment be performed, but instead was referred to the local emergency department for further evaluation. Magnetic resonance angiogram revealed a dissection of the left vertebral artery from C6 to the C2-C3 interspace and a 3-mm dissecting pseudoaneurysm at the C3 level. She underwent stent-assisted percutaneous transluminal angioplasty combined with antiplatelet therapy (clopidogrel) and experienced a good outcome.

CONCLUSION:   This case suggests that careful history taking and awareness of the symptoms of VAD are necessary in cases of sudden head and neck pain. More research is needed on the relationship between vertebral artery dissection and self-manipulation of the neck.

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From the Full-Text Article:

Introduction

Vertebral artery dissection (VAD) is one cause of stroke in patients who are younger than 45 years old. [1-4] It is estimated that 1 to 1.5 per 100 000 individuals in the United States will experience this condition. [5, 6] Common presenting symptoms are headache and neck pain; thus, many of these patients may present for chiropractic care. As these symptoms are nonspecific and may be related to a number of underlying conditions, it can be difficult to properly diagnose a VAD. [7] Currently, medical treatment of this condition includes administration of anticoagulant drugs. [8]

Vertebral artery dissection is the result of a flap-like tear in the tunica intima of the vertebral artery. Because of this tear, blood enters into the tunica media causing a hematoma in the vessel wall. Although the mechanism of this condition is well documented, little research has been conducted concerning the clinical presentation of VAD. [9] Cassidy et al [10] and Murphy [11] recently suggested that some patients visiting chiropractic clinics with complaints of head and neck pain may have undiagnosed VAD. These patients may undergo cervical spinal manipulation for this pain, further complicating their VAD through a thromboembolic event. [10]

Continue reading Vertebral Artery Dissection in a Patient Practicing Self-manipulation of the Neck

Methicillin-resistant Staphylococcus aureus:
An Overview for Manual Therapists

Methicillin-resistant Staphylococcus aureus:
An Overview for Manual Therapists

The Chiro.Org Blog


SOURCE:   Journal of Chiropractic Medicine 2012 (Mar);   11 (1):   64–76

Bart N. Green, MSEd, DC, Claire D. Johnson, MSEd, DC,
Jonathon Todd Egan, DC, MPH, Michael Rosenthal, PT, DSc, ATC, CDR,
Erin A. Griffith, DO, Marion Willard Evans, DC, PhD

Chiropractor, Chiropractic Division,
Department of Physical and Occupational Therapy,
Naval Medical Center, San Diego, CA


OBJECTIVE:   Methicillin-resistant Staphylococcus aureus (MRSA) is associated with difficult-to-treat infections and high levels of morbidity. Manual practitioners work in environments where MRSA is a common acquired infection. The purpose of this review is to provide a practical overview of MRSA as it applies to the manual therapy professions (eg, physical and occupational therapy, athletic training, chiropractic, osteopathy, massage, sports medicine) and to discuss how to identify and prevent MRSA infections in manual therapy work environments.

METHODS:   PubMed and CINAHL were searched from the beginning of their respective indexing years through June 2011 using the search terms MRSA, methicillin-resistant Staphylococcus aureus, and Staphylococcus aureus. Texts and authoritative Web sites were also reviewed. Pertinent articles from the authors’ libraries were included if they were not already identified in the literature search. Articles were included if they were applicable to ambulatory health care environments in which manual therapists work or if the content of the article related to the clinical management of MRSA.

RESULTS:   Following information extraction, 95 citations were included in this review, to include 76 peer-reviewed journal articles, 16 government Web sites, and 3 textbooks. Information was organized into 10 clinically relevant categories for presentation. Information was organized into the following clinically relevant categories: microbiology, development of MRSA, risk factors for infection, clinical presentation, diagnostic tests, screening tests, reporting, treatment, prevention for patients and athletes, and prevention for health care workers.

CONCLUSION:   Methicillin-resistant S aureus is a health risk in the community and to patients and athletes treated by manual therapists. Manual practitioners can play an essential role in recognizing MRSA infections and helping to control its transmission in the health care environment and the community. Essential methods for protecting patients and health care workers include being aware of presenting signs, patient education, and using appropriate hand and clinic hygiene.


From the FULL TEXT Article:

Introduction

Methicillin-resistant Staphylococcus aureus (MRSA) is a substantial public health problem worldwide, causing significant morbidity and mortality [1] and elevated health care costs. [2] There were an estimated 94,360 invasive MRSA infections in the United States in 2005, causing more than 18,000 deaths per year. [1] Methicillin-resistant S aureus prevalence has increased over the last 10 years; MRSA-related hospital discharges have doubled over 10 years, with hospital discharges for MRSA skin and soft tissue infection tripling since 2004. [3] Infections caused by MRSA are associated with longer hospital stays [4, 5] and an increased financial burden on society, costing an estimated US $14.5 billion for all inpatient days in 2003. [5] An example of the increased morbidity and mortality associated with MRSA can be seen when comparing the yearly infection rates and mortality rates in the United States for MRSA, AIDS, viral hepatitis, and tuberculosis. Methicillin-resistant S aureus is estimated to cause more infections than the other diseases combined (Fig 1A) and more deaths per year than AIDS (Fig 1B).

Continue reading Methicillin-resistant Staphylococcus aureus:
An Overview for Manual Therapists

Clinical Presentation of a Patient with Thoracic Myelopathy

Clinical Presentation of a Patient with Thoracic Myelopathy at a Chiropractic Clinic

The Chiro.Org Blog


SOURCE:   Journal of Chiropractic Medicine 2012 (Sep);   11 (2):   115–120

Charles W. Gay, Mark D. Bishop, and Jacqueline L. Beres

Graduate Research Assistant,
Rehabilitation Science Doctoral Program,
University of Florida, Gainesville, FL.


INTRODUCTION:   The purpose of this case report is to describe the clinical presentation, examination findings, and management decisions of a patient with thoracic myelopathy who presented to a chiropractic clinic.

CASE REPORT/METHODS:   After receiving a diagnosis of a diffuse arthritic condition and kidney stones based on lumbar radiograph interpretation at a local urgent care facility, a 45-year-old woman presented to an outpatient chiropractic clinic with primary complaints of generalized low back pain, bilateral lower extremity paresthesias, and difficulty walking. An abnormal neurological examination result led to an initial working diagnosis of myelopathy of unknown cause. The patient was referred for a neurological consult.

RESULTS:   Computed tomography revealed severe multilevel degenerative spondylosis with diffuse ligamentous calcification, facet joint hypertrophy, and disk protrusion at T9-10 resulting in midthoracic cord compression. The patient underwent multilevel spinal decompressive surgery. Following surgical intervention, the patient reported symptom improvement.

CONCLUSION:   It is important to include a neurologic examination on all patients presenting with musculoskeletal complaints, regardless of prior medical attention. The ability to recognize myelopathy and localize the lesion to a specific spinal region by clinical examination may help prioritize diagnostic imaging decisions as well as facilitate diagnosis and treatment.

KEYWORDS:   Spinal stenosis; Thoracic vertebrae


From the FULL TEXT Article:

Introduction

Narrowing (stenosis) of the spinal canal may result in myelopathy anywhere along the spinal axis where the spinal cord is present. A common cause of acquired stenosis resulting in myelopathy is degenerative changes (spondylosis). [1] These pathological changes are the same in the thoracic spine as those changes found in the lumbar and cervical regions and increase with age, [2] yet the frequency of myelopathy as a result of these changes is less in the thoracic spine than in the cervical spine. [1, 3, 4] These opinions are based on clinical observations, small surgical cohorts, and case reports and not on large population studies. Consequently, much is still unknown about the point prevalence, morbidity, and financial and social costs of the insidious development of stenotic myelopathy due to thoracic spondylosis. In addition, the clinical presentation of thoracic spondylotic myelopathy presenting to nonsurgical clinics is not widely described. Unlike some other causes of thoracic myelopathy that may present acutely, degenerative spondylotic myelopathy progresses insidiously over a period of time, leading to varying clinical presentations. [1, 4, 5] Thoracic myelopathy is often a vague manifestation of a mixture of signs and symptoms including sensorimotor dysfunction in the trunk and/or lower extremities, diffuse and/or well-localized pain in the thoracic or lumbar regions, radiculopathy, and possible urinary disturbances. [1, 3, 4]

Unlike cervical myelopathy, where clinical presentations have been previously described in the chiropractic literature, no such chiropractic case reports exist for thoracic myelopathy. Therefore, the purpose of this case report is to describe a clinical presentation, examination findings, and management decisions for a patient with thoracic myelopathy.

Continue reading Clinical Presentation of a Patient with Thoracic Myelopathy

Manipulative and Rehabilitative Therapy as a Treatment of Idiopathic Scoliosis Without Psychological Sequelae

Manipulative and Rehabilitative Therapy as a Treatment of Idiopathic Scoliosis Without Psychological Sequelae

The Chiro.Org Blog


SOURCE:   Journal of Chiropractic Medicine 2012 (Jun);   11 (2):   109–114

Jorge H. Villafañe, PT, MSc, PhD, Guillermo B. Silva, MSc, PhD, Andrea Dughera, MSc

Physical Therapist, Department of Physical Therapy,
Residenze Sanitarie Assistenziali
“A. Maritano,” Sangano, Italy.


OBJECTIVE:   The purpose of this case report is to describe management and outcomes of a patient with scoliosis.

CLINICAL FEATURES:   A 9-year-old female patient with a double curve pattern with Cobb angles of 18° and 24° (thoracic/thoracolumbar) compatible with scoliosis presented for physical therapy treatment.

INTERVENTION AND OUTCOME:   Physiotherapy treatment with a combination of manipulative and rehabilitation techniques was used. After finishing the treatment, the patient had Cobb angles of 7° and 11°, an improvement of 55% and 54%, respectively. After 6 months, these effects were maintained, as the patient had Cobb angles of 11° and 11°. The clinical appearance of the patient improved after the course of care. The patient was evaluated for psychological outcomes by applying the following tests: Scoliosis Research Society 22, Bad Sobernheim Stress, and the Brace Questionnaire The patient had the maximum score in all tests at the conclusion of therapy.

CONCLUSION:   The patient responded favorably to manipulative and rehabilitation techniques. At the end of care, the patient did not show psychological sequelae with selected outcome measures.


From the Full-Text Article:

Introduction:

Adolescent idiopathic scoliosis, the most common form of scoliosis, is a structural 3-dimensional deformity of the spine and trunk that occurs in otherwise healthy children during puberty. [1] Curvatures less than 10° are viewed as a variation of normal, as those curves have little potential for progression. [2, 3] Idiopathic scoliosis is estimated to affect about 2% to 3% of young females. [1, 4-6]

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The conventional treatment of a child or an adolescent with idiopathic scoliosis often lasts months or years. [7] Not only does the disease produce a visible deformity of the body, but also the treatment itself may cause psychological stress and induce stress reactions. [7] Wearing a corrective brace at school or outside home is the reason for both physical and psychological discomfort because there is still an insufficient level of acceptance of such a treatment at school society. [7] Outcomes from psychosocial and health-related quality of life (QoL) studies indicate that body image is a complex and significant issue for patients with scoliosis and their clinicians. [8] In patients with adolescent idiopathic scoliosis, the prevalence of associated psychological disorders may be as high as 19%. [9, 10]

Continue reading Manipulative and Rehabilitative Therapy as a Treatment of Idiopathic Scoliosis Without Psychological Sequelae

Pulmonary Embolism in a Female Collegiate Cross-country Runner Presenting as Nonspecific Back Pain

Pulmonary Embolism in a Female Collegiate Cross-country Runner Presenting as Nonspecific Back Pain

The Chiro.Org Blog


SOURCE:   Journal of Chiropractic Medicine 2012 (Sep);   11 (3):   215–220

Warren H. Landesberg, DC, DACBSP

Doctor of Chiropractic, Private Practice,
Briarcliff Manor, NY.


OBJECTIVE:   The purpose of this case report is to describe a female athlete with back and right scapular pain due to pulmonary embolism.

CLINICAL FEATURES:   A 20-year-old female collegiate cross-country runner presented to a chiropractic clinic with pain in the right scapular area that was severe, stabbing, and worsened with respiration. She had a cough and experienced difficulty lying on her right side. She had an elevated d-dimer. Chest radiograph demonstrated pleural effusion, prompting a thoracic computed tomographic angiogram that showed a large right lower lobe embolus and pulmonary infarct.

INTERVENTION AND OUTCOME:   The patient was hospitalized, prescribed anticoagulant therapy, and monitored for 6 months. She was able to return to competitive running 8 months later.

CONCLUSION:   This case raises awareness of the occurrence of birth control medication for the purpose of enhanced performance in female athletes and the associated risks of using this medication for enhanced performance.


From the FULL TEXT Article:

Introduction

Oral contraceptive (OC) use has become more widespread in female athletes. Reports suggest that the use of OCs to enhance performance increased substantially in the 1990s, approaching 50% of female athletes. [1] This figure is believed to be similar to the percentage of women taking OCs for birth control. [1] It has been reported that nearly 50% of female team sport athletes and 83% of elite-level athletes used OCs. [1] Risk factors for thromboembolic disease are believed to be far less among athletes than the general population, but there have been reported cases. [2] Despite the popularity, there is no conclusive evidence that OC use has any benefit to enhanced athletic performance. [3]

Continue reading Pulmonary Embolism in a Female Collegiate Cross-country Runner Presenting as Nonspecific Back Pain

Resolution of Hearing Loss After Chiropractic Manipulation

Resolution of Hearing Loss
After Chiropractic Manipulation

The Chiro.Org Blog


SOURCE:   Topics in Integrative Health Care 2014 (Sep 30);   5 (3) ~ FULL TEXT

Melissa Ferranti, DC, Kimberly Keene, DC, Chelsea Prothero, DC

Assistant Professor and Faculty Clinician
Palmer College of Chiropractic
Port Orange, FL, USA


Introduction:   While chiropractic care is often associated with the treatment of musculoskeletal conditions, there are other, non-musculoskeletal conditions which may benefit from spinal manipulation (SM). This paper reports on the return of hearing in a woman treated with chiropractic adjustments after 8 months of lack of improvement through allopathic care. Pre and post audiograms were used for comparison.

Case Presentation:   In this report, a 46 year old white female with neck pain, tinnitus, and hearing loss was treated with cervical spinal manipulation with positive results. A pre-treatment audiogram indicated low-frequency hearing loss, worse in the left ear.

Intervention and Outcomes:   After being unsuccessfully medically treated over an 8 month period, she sought chiropractic care for the above symptoms. After 3 chiropractic adjustments, her hearing and associated symptoms were significantly improved. She received 12 treatments over a 4-month period. When asked to rate her hearing and fullness sensation in the ear on a Patient Specific Functional Scale with a 0-10 measure, where 0 is no deficits and 10 is completely impaired, initially she rated her symptoms as 7, and 5 months after the conclusion of care, her rating dropped to 1. Following treatment her audiogram was normal.

Conclusion:   This report details the condition and treatment of a female patient with cervicalgia and associated hearing loss (HL). Possible mechanisms for these results are discussed. This case along with others previously published,1-4 aid in the consideration of (SM) as a possible intervention for HL associated with cervicalgia.


From the Full-Text Article:

Introduction

While there have been anecdotal accounts of resolution of hearing loss following spinal manipulation (SM), and several case studies published, [1-4] no randomized controlled trials (RCTs) are present in the scientific literature in which patients with hearing loss (HL) are randomly treated with SM, placebo, or other interventions.

In 2003-2004 the prevalence of speech-frequency HL in United States adults was estimated to be 16.1%. [5] HL, which can lead to functional decline and depression, is the most wide spread sensory impairment in aging people. It is the 3rd most common chronic condition in older Americans, after hypertension and arthritis. [6]

Audiograms test the ability to hear sounds. Sounds vary based on their loudness (intensity) and the speed of sound wave vibrations (tone). In detailed audiometry, hearing is normal if one can hear tones from 250 Hz – 8,000 Hz at 25 dB or lower. The minimum intensity (volume) required to hear a tone is graphed. An attachment called a bone oscillator is placed against the bone behind each ear (mastoid bone) to test bone conduction. [7]

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Exploring Patient Satisfaction

Exploring Patient Satisfaction: A Secondary Analysis of a Randomized Clinical Trial of Spinal Manipulation, Home Exercise, and Medication for Acute and Subacute Neck Pain

The Chiro.Org Blog


SOURCE:   J Manipulative Physiol Ther 2014 (Sep 5)


Brent D. Leininger, DC, Roni Evans, DC, PhD,
Gert Bronfort, DC, PhD

Research Fellow, Integrative Health & Wellbeing Research Program,
Center for Spirituality & Healing, University of Minnesota,
Minneapolis, MN.
lein0122@umn.edu


OBJECTIVE:   The purpose of this study was to assess satisfaction with specific aspects of care for acute neck pain and explore the relationship between satisfaction with care, neck pain, and global satisfaction.

METHODS:   This study was a secondary analysis of patient satisfaction from a randomized trial of spinal manipulation therapy (SMT) delivered by doctors of chiropractic, home exercise and advice (HEA) delivered by exercise therapists, and medication (MED) prescribed by a medical doctors for acute/subacute neck pain. Differences in satisfaction with specific aspects of care were analyzed using a linear mixed model. The relationship between specific aspects of care and (1) change in neck pain (primary outcome of the randomized trial) and (2) global satisfaction were assessed using Pearson’s correlation and multiple linear regression.

RESULTS:   Individuals receiving SMT or HEA were more satisfied with the information and general care received than MED group participants. Spinal manipulation therapy and HEA groups reported similar satisfaction with information provided during treatment; however, the SMT group was more satisfied with general care. Satisfaction with general care (r = -0.75 to -0.77; R2 = 0.55-0.56) had a stronger relationship with global satisfaction compared with satisfaction with information provided (r = -0.65 to 0.67; R2 = 0.39-0.46). The relationship between satisfaction with care and neck pain was weak (r = 0.17-0.38; R2 = 0.08-0.21).

CONCLUSIONS:   Individuals with acute/subacute neck pain were more satisfied with specific aspects of care received during spinal manipulation therapy or home exercise interventions compared to receiving medication. The relationship between neck pain and satisfaction with care was weak.

Key Indexing Terms:   Neck Pain, Patient Satisfaction, Musculoskeletal Manipulations, Exercise Therapy, Pharmaceutical Preparations, Clinical Trial, Chiropractic


From the FULL TEXT Article:

Introduction

Neck pain is one of the most commonly reported health complaints in primary care settings. [1, 2] As concern for costs and side effects related to treating spinal pain conditions continues to grow, the search for effective, patient-centered treatments has become paramount. Patient satisfaction has become a widely advocated means for measuring patients’ preferences and views related to treatment quality in clinical practice. [3] Furthermore, it is recommended as a core outcome domain for chronic pain clinical trials by the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials group. [4]

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The Cellular and Molecular Biology of the Intervertebral Disc:
A Clinician’s Primer

The Cellular and Molecular Biology
of the Intervertebral Disc: A Clinician’s Primer

The Chiro.Org Blog


SOURCE:   J Can Chiropr Assoc. 2014 (Sep);   58 (3):   246–257

W. Mark Erwin, DC, PhD and Katherine E. Hood, DC

Assistant Professor, Divisions of Neurological and Orthopaedic Surgery,
University of Toronto, Toronto Western Hospital;
Scientist, Toronto Western Research Institute;
Associate Professor, Research Canadian Memorial Chiropractic College.


Clinicians routinely encounter patients suffering from both degenerative and acute spinal pain, often as a consequence of pathology affecting the intervertebral disc (IVD). The IVD is a complex structure essential to spinal function and is subject to degenerative disease and injury. However, due to the complexity of spinal pain syndromes it is often difficult to determine the extent of the IVD’s contribution to the genesis of spinal pain. The location of the IVD is within close proximity to vital neural elements and may in the event of pathological change or injury compromise those structures. It is therefore important that clinicians performing manual therapy understand the cellular and molecular biology of the IVD as well as its clinical manifestation of degeneration/injury in order to safely manage and appreciate the role played by the disc in the development of mechanical spinal pain syndromes.

Keywords:   spine, degenerative, pain, disc, intervertebral


The Full-Text Article:

Introduction:

The intervertebral disc (IVD) is a complex structure positioned between two adjacent vertebrae where in addition to protecting the spinal cord and segmental spinal nerves it confers flexibility, multi-axial spinal motion and load transmission to the spine. The IVD is vulnerable to injury and degeneration often leading to pain syndromes however much remains to be discovered concerning the development of axial and radicular pain syndromes, the biology of the disc and the capacity of the IVD to repair itself after injury. [1] From the clinician’s perspective, familiarity with the biology of the IVD is vital in order to understand the natural history of disc-related injury/illness and to develop appropriate therapeutic strategies. The purpose of this review is to provide an overview of the salient characteristics of IVD pathology with a particular emphasis upon degenerative disease and its role in the generation of clinical spinal pain syndromes.

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The disc as an organ:

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A Clinician’s Primer

September 18, 2014 – Happy 119th Anniversary!

September 18, 2014 – Happy 119th Anniversary!

The Chiro.Org Blog


SOURCE:   Palmer Website Archives


Chiropractic turns 119 today. At Palmer, it’s also referred to as Founder’s Day. Wish DD and all of us success for the next 119 years. We are on a roll!

Chiropractic Treatment Helps
Back-Related Leg Pain

Chiropractic Treatment Helps
Back-Related Leg Pain

The Chiro.Org Blog


Spinal Manipulation and Home Exercise With Advice for Subacute and Chronic Back-Related Leg Pain: A Trial With Adaptive Allocation

SOURCE:   Annals of Internal Medicine 2014 (Sep 16); 161 (6): 381-391

Gert Bronfort, DC, PhD; Maria A. Hondras, DC, MPH;
Craig A. Schulz, DC, MS; Roni L. Evans, DC, PhD;
Cynthia R. Long, PhD; and Richard Grimm, MD, PhD

University of Minnesota, Northwestern Health Sciences University, and Berman Center for Outcomes and Clinical Research at the Minneapolis Medical Research Foundation,
Minneapolis, Minnesota, and
Palmer Center for Chiropractic Research, Davenport, Iowa


Chiropractic Treatment Helps Back-Related Leg Pain

FROM:   MedPage Today ~ September 16, 2014

By Shara Yurkiewicz , Staff Writer, MedPage Today

Patients with back-related leg pain who received spinal manipulative therapy (SMT) plus home exercise and advice (HEA) had less leg pain, lower back pain, and disability after 12 weeks than patients who received home exercise and advice alone, researchers reported.

At 1 year, those differences were no longer significant, wrote Gert Bronfort, DC, PhD, at Northwestern Health Sciences University in Bloomington, Minn., and colleagues in a study appearing in Annals of Internal Medicine. But patients experienced more global improvement, higher satisfaction, and lower medication use, the researchers reported.

The findings suggest that SMT in addition to HEA could be a safe and effective conservative, short-term treatment approach for back-related leg pain, the authors said.

“Prior to this study, SMT was considered a viable treatment option of what is known as ‘uncomplicated low back pain,’ which is low back pain without radiating pain to the leg,” authors Bronfort and Roni Evans, DC, PhD, at the University of Minnesota in Minneapolis, wrote in an email to MedPage Today.

“This study shows that for patients without progressive neurological deficits and serious identifiable causes (e.g., spinal fracture, etc.) SMT, coupled with home exercise and advice, may be helpful, and should be considered,” they added.

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Back-Related Leg Pain

Study offers suggestions on what to do when sex is a pain in the back

Source Canada.com
SHERYL UBELACKER, THE CANADIAN PRESS

10188848

Professor Stuart McGill demonstrates the motion of the spine during sex in a handout photo. Contrary to popular belief, spooning is not always the best sex position for those with a bad back, according to new research from the University of Waterloo. THE CANADIAN PRESS/HO-University of Waterloo

For many people, intimacy in the bedroom often takes a back seat to low back pain, say researchers, who have scientifically determined the best sexual positions to prevent spinal muscles from seizing up at an inopportune moment.

In what they believe is the first biomechanical study of its kind, researchers at the University of Waterloo have found that certain positions are better than others for keeping different kinds of back pain at bay.

And they’ve thrown out the long-held belief that spooning — where partners lie sideways curled back to front — is the only pose for back-saving sex.

“Before now, spooning was often recommended by physicians as the one position that fit all. But as we’ve discovered, that is not the case,” said Natalie Sidorkewicz, a PhD candidate and lead author of the paper published Thursday in the journal Spine.

“What that failed to do was recognize that there are all sorts of triggers for back pain,” she said from Waterloo, Ont. “So someone may find relief in one position that may cause pain for someone else.”

To conduct the study, the researchers recruited 10 heterosexual couples, with an average age of about 30, to have sexual intercourse in a controlled laboratory setting.

Each participant was fitted with remote sensors, which tracked how their spines moved when they engaged in five common sex positions. Infrared and electromagnetic motion capture systems — such as those used to animate figures in video games and films — showed how the men’s and women’s spines flexed when they assumed each position.

“So we were able to actually determine what angle the spine is at, at each moment in time that they’re having sex,” said Sidorkewicz, adding that electrodes on participants’ skin also captured activity in their core and hip muscles.

The findings were used to create an atlas, or set of guidelines, that recommends different sex positions and thrusting techniques based on what movements trigger a patient’s pain.
Continue reading Study offers suggestions on what to do when sex is a pain in the back