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Spinal Manipulative Therapy and Exercise For Seniors with Chronic Neck Pain

Spinal Manipulative Therapy and Exercise For Seniors with Chronic Neck Pain

The Chiro.Org Blog


SOURCE:   Spine J. 2014 (Sep 1);   14 (9):   1879–1889

Michele Maiers, DC, MPH, Gert Bronfort, DC, PhD,
Roni Evans, DC, MS, Jan Hartvigsen, DC, PhD,
Kenneth Svendsen, MS, Yiscah Bracha, MS,
Craig Schulz, DC, MS, Karen Schulz, DC,
Richard Grimm, MD, PhD

Northwestern Health Sciences University,
Wolfe-Harris Center for Clinical Studies,
2501 W. 84th St, Bloomington, MN 55431, USA
mmaiers@nwhealth.edu


BACKGROUND CONTEXT:   Neck pain, common among the elderly population, has considerable implications on health and quality of life. Evidence supports the use of spinal manipulative therapy (SMT) and exercise to treat neck pain; however, no studies to date have evaluated the effectiveness of these therapies specifically in seniors.

PURPOSE:   To assess the relative effectiveness of SMT and supervised rehabilitative exercise, both in combination with and compared to home exercise (HE) alone for neck pain in individuals ages 65 years or older.

STUDY DESIGN/SETTING:   Randomized clinical trial.

PATIENT SAMPLE:   Individuals 65 years of age or older with a primary complaint of mechanical neck pain, rated =3 (0-10) for 12 weeks or longer in duration.

OUTCOME MEASURES:   Patient self-report outcomes were collected at baseline and 4, 12, 26, and 52 weeks after randomization. The primary outcome was pain, measured by an 11-box numerical rating scale. Secondary outcomes included disability (Neck Disability Index), general health status (Medical Outcomes Study Short Form-36), satisfaction (7-point scale), improvement (9-point scale), and medication use (days per week).

METHODS:   This study was funded by the US Department of Health and Human Services, Health Resources and Services Administration. Linear mixed model analyses were used for comparisons at individual time points and for short- and long-term analyses. Blinded evaluations of objective outcomes were performed at baseline and 12 weeks. Adverse event data were collected at each treatment visit.

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Is There a Role for Neck Manipulation in
Elderly Falls Prevention? – An Overview

Is There a Role for Neck Manipulation in
Elderly Falls Prevention? – An Overview

The Chiro.Org Blog


SOURCE:   J Can Chiropr Assoc. 2015 (Mar);   59 (1):   53–63

Julie C. Kendall, BAppSc, MClinChiro [1]
Jan Hartvigsen, DC, PhD [2]
Simon D. French, BAppSc(Chiro), MPH, PhD [3]
Michael F. Azari, BAppSc(Chiro), BSc(Hons), PhD* [1,4]

1 Discipline of Chiropractic, School of Health Sciences,
RMIT University, Melbourne, Australia

2 Department of Sports Science and Clinical Biomechanics,
University of Southern Denmark and Nordic Institute of
Chiropractic and Clinical Biomechanics, Odense, Denmark

3 School of Rehabilitation Therapy, Queens University,
Kingston, Canada

4 Health Innovations Research Institute, RMIT University,
Melbourne, Australia


Many risk factors exist for falls in the elderly. Dizziness is an important risk factor for such falls. Spinal pain has also been identified as a risk factor for these falls. In this overview of the literature, we examine studies, including trials, of neck manipulation for neck pain, unsteadiness and falls risk relevant to the elderly. We also examine two related, but not mutually exclusive, mechanisms through which a putative beneficial effect may be mediated. These are the effects of neck manipulation on neck pain and on non-specific dizziness. We focus on the available evidence primarily in terms of clinical data rather than laboratory-based measures of balance. We conclude that chiropractors may have a role in falls prevention strategies in the subpopulation of the elderly that suffer from mechanical neck pain or dysfunction and non-specific dizziness. However, this role remains to be rigorously studied and properly defined.

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Introduction

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Elderly Falls Prevention? – An Overview

Identification of Internal Carotid Artery Dissection

Identification of Internal Carotid Artery Dissection in Chiropractic Practice

The Chiro.Org Blog


SOURCE:   J Can Chiropr Assoc. 2004 (Sep);   48 (3):   206-210

Michael T Haneline, DC, MPH and Gary Lewkovich, DC

Palmer College of Chiropractic West,
Palmer Center for Chiropractic Research,
90 E. Tasman Drive,
San Jose, CA 95134
michael.haneline@palmer.edu


Internal carotid artery dissection (ICAD) is a condition involving separation of the artery’s intimal lining from its medial division, with subsequent extension of the dissection along varying distances of the artery, usually in the direction of blood flow. ICAD may produce cerebral ischemia due to occlusion of the involved artery. This occlusion may occur at or near the site of the dissection, or “downstream” as a result of embolization from a dislodged thrombus fragment. The problem any chiropractic physician faces in identifying ICAD patients is that the condition may present without any symptoms or the symptoms may appear benign (e.g., headache, neck pain or cervicogenic dizziness). Consequently, it may be impossible to identify some ICAD patients, especially in the early stages of the pathology. As the ICAD progresses and neural blood flow is compromised, the symptom picture typically manifests more completely. The chiropractic physician must be alert to characteristic findings of a progressing ICAD, since an immediate referral to a medical specialist may be required.

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The Etiology of Cervical Artery Dissection

The Etiology of Cervical Artery Dissection

The Chiro.Org Blog


SOURCE:   J Chiropr Med. 2007 (Summer);   6 (3):   110-120

Michael T. Haneline [a], and Anthony L. Rosner [b]

a   Professor,
Palmer College of Chiropractic West,
Department of Research, San Jose, CA 95134
michael.haneline@palmer.edu

b   Professor,
Parker College of Chiropratic,
Brookline, MA 02446


The etiology of cervical artery dissection (CAD) is unclear, although a number of risk factors have been reported to be associated with the condition. On rare occasions, patients experience CAD after cervical spine manipulation, making knowledge about the cervical arteries, the predisposing factors, and the pathogenesis of the condition of interest to chiropractors. This commentary reports on the relevant anatomy of the cervical arteries, developmental features of CAD, epidemiology of the condition, and mechanisms of dissection. The analysis of CAD risk factors is confusing, however, because many people are exposed to mechanical events and known pathophysiological associations without ever experiencing dissection. No cause-and-effect relationship has been established between cervical spine manipulation and CAD, but it seems that cervical manipulation may be capable of triggering dissection in a susceptible patient or contributing to the evolution of an already existing CAD. Despite the many risk factors that have been proposed as possible causes of CAD, it is still unknown which of them actually predispose patients to CAD after cervical spine manipulation.


From the FULL TEXT Article:

Introduction

The etiology of cervical artery dissection (CAD) is, for the most part, unclear; and what has been proposed as an explanation for its pathogenesis is largely hypothetical. [1] Furthermore, when dealing with a particular case of CAD, the pathogenesis is especially speculative. [2] Nevertheless, a number of risk factors have been reported to be associated with the condition, including connective tissue abnormalities, hypertension, recent infection, migraine headache, the use of oral contraceptives, and others. Of special interest to chiropractors is the role cervical spine manipulation (CSM) plays, if any, in the pathogenesis of CAD. Indeed, patients do experience CAD on rare occasions after CSM, making knowledge about the cervical arteries, the predisposing factors, and the pathogenesis of the condition important for chiropractors.

Anatomy of the cervical arteries

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Recognition of Spontaneous Vertebral Artery Dissection

Recognition of Spontaneous Vertebral Artery Dissection Preempting Spinal Manipulative Therapy: A Patient Presenting With Neck Pain and Headache for Chiropractic Care

The Chiro.Org Blog


SOURCE:   J Chiropr Med. 2014 (Jun);   13 (2):   90-95

Ross Mattox, DC, [a], Linda W. Smith, DC, [b] and
Norman W. Kettner, DC, DACBR, FICC [c]

a   Diagnostic Imaging Resident,
Department of Radiology,
Logan University, Chesterfield, MO
ude.nagol@xottam.ssor

b   Chiropractic Physician,
Private Practice, St. Louis, MO

c   Chair, Department of Radiology,
Logan University, Chesterfield, MO


OBJECTIVE:   The purpose of this case report is to describe a patient who presented to a chiropractic physician for evaluation and treatment of neck pain and headache.

CLINICAL FEATURES:   A 45-year-old otherwise healthy female presented for evaluation and treatment of neck pain and headache. Within minutes, non-specific musculoskeletal symptoms progressed to neurological deficits, including limb ataxia and cognitive disturbances. Suspicion was raised for cerebrovascular ischemia and emergent referral was initiated.

INTERVENTION AND OUTCOME:   Paramedics were immediately summoned and the patient was transported to a local hospital with a working diagnosis of acute cerebrovascular ischemia. Multiplanar computed tomographic and magnetic resonance imaging with contrast revealed vertebral artery dissection of the V2 segment in the right vertebral artery. Anticoagulation therapy was administered and the patient was discharged without complications after 5 days in the hospital.

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Elongated Styloid Processes and Calcified Stylohyoid Ligaments in a Patient With Neck Pain: Implications for Manual Therapy Practice

Elongated Styloid Processes and Calcified Stylohyoid Ligaments in a Patient With Neck Pain: Implications for Manual Therapy Practice

The Chiro.Org Blog


SOURCE:   J Chiropr Med. 2014 (Jun);   13 (2):   128–133

Bart N. Green, DC, MSEd,a,b, LCDR Kristin M. Browske, MD,
and CAPT Michael D. Rosenthal, PT, DSc, ATC

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

b   Associate Editor,
Publications Department,
National University of Health Sciences,
Lombard, IL

Corresponding author at:
Marine Corps Air Station Miramar,
Branch Health Clinic,
PO Box 452002,
San Diego, CA 92145-2002. Tel.: + 1 858 577 9948
lim.yvan.dem@neerg.traB


Objective   The purpose of this paper is to present a case of a patient with neck pain, tinnitus, and headache in the setting of bilateral elongated styloid processes (ESP) and calcified stylohyoid ligaments (CSL), how knowledge of this anatomical variation and symptomatic presentation affected the rehabilitation management plan for this patient, and to discuss the potential relevance of ESPs and CSLs to carotid artery dissection.

Clinical features   A 29-year-old male military helicopter mechanic presented for chiropractic care for chronic pain in the right side of his neck and upper back, tinnitus, and dizziness with a past history of right side parietal headaches and tonsillitis. Conventional radiographs showed C6 and C7 spinous process fractures, degenerative disc disease at C6/7, and an elongated right styloid process with associated calcification of the left stylohyoid ligament. Volumetric computerized tomography demonstrated calcification of the stylohyoid ligaments bilaterally.

Intervention and outcome   Given the proximity of the calcified stylohyoid apparatus to the carotid arteries, spinal manipulation techniques were modified to minimize rotation of the neck. Rehabilitation also included soft tissue mobilization and stretching, corrective postural exercises, and acupuncture. An otolaryngologist felt that the symptoms were not consistent with Eagle syndrome and the tinnitus was associated with symmetric high frequency hearing loss, likely due to occupational noise exposure. Initially, the patient’s symptoms improved but plateaued by the fifth visit.

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Chiropractic Management of an 81-Year-Old Man
With Parkinson Disease Signs and Symptoms

Chiropractic Management of an 81-Year-Old Man
With Parkinson Disease Signs and Symptoms

The Chiro.Org Blog


SOURCE:   J Chiropr Med. 2014 (Jun);   13 (2):   116–120

Joesph Bova, DC [1] and Adam Sergent, DC [2]

1   Private Practice, Latham NY.
2   Assistant Professor,
Faculty Clinician,
Palmer College of Chiropractic Florida,
Port Orange, FL


Objective   The purpose of this case report is to describe the chiropractic management of a patient with Parkinson disease.

Clinical features   An 81-year-old male with a 12-year history of Parkinson disease sought chiropractic care. He had a stooped posture and a shuffling gait. He was not able to ambulate comfortably without the guidance of his walker. The patient had a resting tremor, most notably in his right hand. Outcome measures were documented using the Parkinson’s Disease Questionaire-39 (PDQ-39) and patient subjective reports.

Intervention and outcome   The patient was treated with blue-lensed glasses, vibration stimulation therapy, spinal manipulation, and eye-movement exercises. Within the first week of treatment, there was a reduction in symptoms, improvement in ambulation, and tremor.

Conclusion   For this particular patient, the use of alternative treatment procedures appeared to help his Parkinson disease signs and symptoms.

Key indexing terms:   Parkinson disease, Tremor, Gait disorder, Chiropractic


From the FULL TEXT Article:

Introduction

Parkinson disease (PD) is a neurodegenerative brain disorder that progresses slowly in most patients. [1] When approximately 60% to 80% of the dopamine producing cells are damaged, cardinal motor symptoms such as akinesia, rigidity, and tremor begin to appear. [1] A small number of patients have a direct mutation that causes it, but genetic predisposition and environmental factors are most commonly the cause. [1] PD is a central nervous system disorder resulting from destruction of the substantia nigra, which initiates dopamine release, an inhibitory transmitter. [2–4] The lack of dopamine causes a continuous excitatory signal to be sent to the corticospinal tract of the spinal cord, causing over-excitation of the motor cortex; this over-excitation creates the typical PD symptoms. [2–4]

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Chiropractic identity, role and future: a survey of North American chiropractic students

Source Chiropractic and Manual Therapies

Jordan A Gliedt, Cheryl Hawk, Michelle Anderson, Kashif Ahmad, Dinah Bunn,Jerrilyn Cambron, Brian Gleberzon, John Hart, Anupama Kizhakkeveettil, Stephen M Perle, Michael Ramcharan, Stephanie Sullivan and Liang Zhang

Abstract

Background

The literature pertaining to chiropractic students’ opinions with respect to the desired future status of the chiropractic physician is limited and is an appropriate topic worthy of study. A previous pilot study was performed at a single chiropractic college. This current study is an expansion of this pilot project to collect data from chiropractic students enrolled in colleges throughout North America.

Objective

The purpose of this study is to investigate North American chiropractic students’ opinions concerning professional identity, role and future.

Methods

A 23-item cross-sectional electronic questionnaire was developed. A total of 7,455 chiropractic students from 12 North American English-speaking chiropractic colleges were invited to complete the survey. Survey items encompassed demographics, evidence-based practice, chiropractic identity and setting, and scope of practice. Data were collected and descriptive statistical analysis was performed.

Results

A total of 1,247 (16.7% response rate) questionnaires were electronically submitted. Most respondents agreed (34.8%) or strongly agreed (52.2%) that it is important for chiropractors to be educated in evidence-based practice. A majority agreed (35.6%) or strongly agreed (25.8%) the emphasis of chiropractic intervention is to eliminate vertebral subluxations/vertebral subluxation complexes. A large number of respondents (55.2%) were not in favor of expanding the scope of the chiropractic profession to include prescribing medications with appropriate advanced training. Most respondents estimated that chiropractors should be considered mainstream health care practitioners (69.1%). Several respondents (46.8%) think that chiropractic research should focus on the physiological mechanisms of chiropractic adjustments.

Conclusion

The chiropractic students in this study showed a preference for participating in mainstream health care, report an exposure to evidence-based practice, and desire to hold to traditional chiropractic theories and practices. The majority of students would like to see an emphasis on correction of vertebral subluxation, while a larger percent found it is important to learn about evidence-based practice. These two key points may seem contradictory, suggesting cognitive dissonance. Or perhaps some students want to hold on to traditional theory (e.g., subluxation-centered practice) while recognizing the need for further research to fully explore these theories. Further research on this topic is needed.

Spinal Pain in Adolescents

Spinal Pain in Adolescents: Prevalence, Incidence, and Course: A School-based Two-year Prospective Cohort Study in 1,300 Danes Aged 11-13

The Chiro.Org Blog


SOURCE:   BMC Musculoskelet Disord. 2014 (May 29);   15:   187 ~ FULL TEXT

Ellen Aartun, 1*, Jan Hartvigsen, 1, 2, Niels Wedderkopp, 3 and Lise Hestbaek, 1, 2

* Corresponding author: Ellen Aartun
eaartun@health.sdu.dk

1 Department of Sports Science and Clinical Biomechanics,
University of Southern Denmark,
Odense, Denmark

2 Nordic Institute of Chiropractic and Clinical Biomechanics,
Odense, Denmark

3 Institute of Regional Health Services Research,
Sygehus Lillebælt,
University of Southern Denmark,
Middelfart, Denmark


BACKGROUND:   The severity and course of spinal pain is poorly understood in adolescents. The study aimed to determine the prevalence and two-year incidence, as well as the course, frequency, and intensity of pain in the neck, mid back, and low back (spinal pain).

METHODS:   This study was a school-based prospective cohort study. All 5th and 6th grade students (11-13 years) at 14 schools in the Region of Southern Denmark were invited to participate (N=1,348). Data were collected in 2010 and again two years later, using an e-survey completed during school time.

RESULTS:   The lifetime prevalence of spinal pain was 86% and 89% at baseline and follow-up, respectively. A group of 13.6% (95% CI: 11.8, 15.6) at baseline and 19.5% (95% CI: 17.1, 22.0) at follow-up reported that they had pain frequently. The frequency of pain was strongly associated with the intensity of pain, i.e., the majority of the participants reported their pain as relatively infrequent and of low intensity, whereas the participants with frequent pain also experienced pain of higher intensity. The two-year incidence of spinal pain varied between 40% and 60% across the physical locations. Progression of pain from one to more locations and from infrequent to more frequent was common over the two-year period.

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A Randomized Controlled Trial Comparing a Multimodal Intervention and Standard Obstetrics Care for Low Back and Pelvic Pain in Pregnancy

A Randomized Controlled Trial Comparing a Multimodal Intervention and Standard Obstetrics Care for Low Back and Pelvic Pain in Pregnancy

The Chiro.Org Blog


SOURCE:   Am J Obstet Gynecol. 2013 (Apr);   208 (4):   295.e1-7

James W. George, DC, Clayton D. Skaggs, DC, Paul A. Thompson, PhD,
D. Michael Nelson, MD, PhD, Jeffrey A. Gavard, PhD, Gilad A. Gross, MD

Chiropractic Science Division,
College of Chiropractic,
Logan University,
Chesterfield, MO, USA.
james.george@logan.edu


OBJECTIVE:   Women commonly experience low back pain during pregnancy. We examined whether a multimodal approach of musculoskeletal and obstetric management (MOM) was superior to standard obstetric care to reduce pain, impairment, and disability in the antepartum period.

STUDY DESIGN:   A prospective, randomized trial of 169 women was conducted. Baseline evaluation occurred at 24-28 weeks’ gestation, with follow-up at 33 weeks’ gestation. Primary outcomes were the Numerical Rating Scale (NRS) for pain and the Quebec Disability Questionnaire (QDQ). Both groups received routine obstetric care. Chiropractic specialists provided manual therapy, stabilization exercises, and patient education to MOM participants.

RESULTS:   The MOM group demonstrated significant mean reductions in Numerical Rating Scale scores (5.8 ± 2.2 vs 2.9 ± 2.5; P < .001) and Quebec Disability Questionnaire scores (4.9 ± 2.2 vs 3.9 ± 2.4; P < .001) from baseline to follow-up evaluation. The group that received standard obstetric care demonstrated no significant improvements.

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Manual Therapy Followed by Specific Active Exercises

Manual Therapy Followed by Specific Active Exercises Versus a Placebo Followed by Specific Active Exercises on the Improvement of Functional Disability in Patients with Chronic Non Specific Low Back Pain: A Randomized Controlled Trial

The Chiro.Org Blog


SOURCE:   BMC Musculoskelet Disord. 2012 (Aug 28);   13:   162

Pierre Balthazard, Pierre de Goumoens, Gilles Rivier, Philippe Demeulenaere,
Pierluigi Ballabeni, and Olivier Dériaz

Physiotherapy Department,
HES-SO University of Applied Sciences Western Switzerland-HESAV,
Avenue de Beaumont,
Lausanne 1011, Switzerland.
pbalthaz@hecvsante.ch


BACKGROUND:   Recent clinical recommendations still propose active exercises (AE) for CNSLBP. However, acceptance of exercises by patients may be limited by pain-related manifestations. Current evidences suggest that manual therapy (MT) induces an immediate analgesic effect through neurophysiologic mechanisms at peripheral, spinal and cortical levels. The aim of this pilot study was first, to assess whether MT has an immediate analgesic effect, and second, to compare the lasting effect on functional disability of MT plus AE to sham therapy (ST) plus AE.

METHODS:   Forty-two CNSLBP patients without co-morbidities, randomly distributed into 2 treatment groups, received either spinal manipulation/mobilization (first intervention) plus AE (MT group; n = 22), or detuned ultrasound (first intervention) plus AE (ST group; n = 20). Eight therapeutic sessions were delivered over 4 to 8 weeks. Immediate analgesic effect was obtained by measuring pain intensity (Visual Analogue Scale) before and immediately after the first intervention of each therapeutic session. Pain intensity, disability (Oswestry Disability Index), fear-avoidance beliefs (Fear-Avoidance Beliefs Questionnaire), erector spinae and abdominal muscles endurance (Sorensen and Shirado tests) were assessed before treatment, after the 8th therapeutic session, and at 3- and 6-month follow-ups.

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Risk of Stroke After Chiropractic Spinal Manipulation in Medicare B Beneficiaries Aged 66 to 99 Years With Neck Pain

Risk of Stroke After Chiropractic Spinal Manipulation in Medicare B Beneficiaries Aged 66 to 99 Years With Neck Pain

The Chiro.Org Blog


SOURCE:   J Manipulative Physiol Ther. 2015 (Jan 14) [Epub ahead of print]

James M. Whedon, DC, MS, Yunjie Song, PhD, Todd A. Mackenzie, PhD,
Reed B. Phillips, DC, PhD, Timothy G. Lukovits, MD, Jon D. Lurie, MD, MS

The Dartmouth Institute for Health Policy & Clinical Practice,
Dartmouth College,
Grantham, NH.
james.m.whedon@hitchcock.org


OBJECTIVE:   The purpose of this study was to quantify risk of stroke after chiropractic spinal manipulation, as compared to evaluation by a primary care physician, for Medicare beneficiaries aged 66 to 99 years with neck pain.

METHODS:   This is a retrospective cohort analysis of a 100% sample of annualized Medicare claims data on 1 157 475 beneficiaries aged 66 to 99 years with an office visit to either a chiropractor or primary care physician for neck pain. We compared hazard of vertebrobasilar stroke and any stroke at 7 and 30 days after office visit using a Cox proportional hazards model. We used direct adjusted survival curves to estimate cumulative probability of stroke up to 30 days for the 2 cohorts.

RESULTS:   The proportion of subjects with stroke of any type in the chiropractic cohort was 1.2 per 1000 at 7 days and 5.1 per 1000 at 30 days. In the primary care cohort, the proportion of subjects with stroke of any type was 1.4 per 1000 at 7 days and 2.8 per 1000 at 30 days. In the chiropractic cohort, the adjusted risk of stroke was significantly lower at 7 days as compared to the primary care cohort (hazard ratio, 0.39; 95% confidence interval, 0.33-0.45), but at 30 days, a slight elevation in risk was observed for the chiropractic cohort (hazard ratio, 1.10; 95% confidence interval, 1.01-1.19).

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Tissue Damage Markers After a Spinal Manipulation in Healthy Subjects

Tissue Damage Markers After a Spinal Manipulation in Healthy Subjects: A Preliminary Report of a Randomized Controlled Trial

The Chiro.Org Blog


SOURCE:   Dis Markers. 2014; 2014 :815379

A. Achalandabaso, G. Plaza-Manzano, R. Lomas-Vega, A. Martínez-Amat,
M. V. Camacho, M. Gassó, F. Hita-Contreras, and F. Molina

Centro de Fisioterapia y Psicología Soluciona,
18002 Granada, Spain.


Spinal manipulation (SM) is a manual therapy technique frequently applied to treat musculoskeletal disorders because of its analgesic effects. It is defined by a manual procedure involving a directed impulse to move a joint past its physiologic range of movement (ROM). In this sense, to exceed the physiologic ROM of a joint could trigger tissue damage, which might represent an adverse effect associated with spinal manipulation. The present work tries to explore the presence of tissue damage associated with SM through the damage markers analysis. Thirty healthy subjects recruited at the University of Jaén were submitted to a placebo SM (control group; n = 10), a single lower cervical manipulation (cervical group; n = 10), and a thoracic manipulation (n = 10). Before the intervention, blood samples were extracted and centrifuged to obtain plasma and serum. The procedure was repeated right after the intervention and two hours after the intervention.

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Adding Chiropractic Manipulative Therapy to Standard Medical Care for Patients with Acute Low Back Pain:

Adding Chiropractic Manipulative Therapy to Standard Medical Care for Patients with Acute Low Back Pain: Results of a Pragmatic Randomized Comparative Effectiveness Study

The Chiro.Org Blog


SOURCE:   Spine (Phila Pa 1976). 2013 (Apr 15);   38 (8):   627–634

Goertz, Christine M. DC, PhD; Long, Cynthia R. PhD;
Hondras, Maria A. DC, MPH; Petri, Richard MD;
Delgado, Roxana MS; Lawrence, Dana J. DC, MMedEd, MA;
Owens, Edward F. MS, DC; Meeker, William C. DC, MPH

Palmer Center for Chiropractic Research,
Davenport, IA 52803, USA.
christine.goertz@palmer.edu


STUDY DESIGN:   Randomized controlled trial.

OBJECTIVE:   To assess changes in pain levels and physical functioning in response to standard medical care (SMC) versus SMC plus chiropractic manipulative therapy (CMT) for the treatment of low back pain (LBP) among 18 to 35-year-old active-duty military personnel.

SUMMARY OF BACKGROUND DATA:   LBP is common, costly, and a significant cause of long-term sick leave and work loss. Many different interventions are available, but there exists no consensus on the best approach. One intervention often used is manipulative therapy. Current evidence from randomized controlled trials demonstrates that manipulative therapy may be as effective as other conservative treatments of LBP, but its appropriate role in the healthcare delivery system has not been established.

METHODS:   Prospective, 2-arm randomized controlled trial pilot study comparing SMC plus CMT with only SMC. The primary outcome measures were changes in back-related pain on the numerical rating scale and physical functioning at 4 weeks on the Roland-Morris Disability Questionnaire and back pain functional scale (BPFS).

RESULTS:   Mean Roland-Morris Disability Questionnaire scores decreased in both groups during the course of the study, but adjusted mean scores were significantly better in the SMC plus CMT group than in the SMC group at both week 2 (P < 0.001) and week 4 (P = 0.004). Mean numerical rating scale pain scores were also significantly better in the group that received CMT. Adjusted mean back pain functional scale scores were significantly higher (improved) in the SMC plus CMT group than in the SMC group at both week 2 (P < 0.001) and week 4 (P = 0.004).

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Life-Threatening Conditions That Walk:
A Clinician’s Review

Life-Threatening Conditions That Walk:
A Clinician’s Review

The Chiro.Org Blog


SOURCE:   J Amer Chiropr Assoc 2013 (Sept);   50 (5):   8-17

David J. Schimp, DC, DACNB, DAAPM

Clinician and Associate Professor
Texas Chiropractic College


Dr. Schimp describes the six most common undiagnosed life-threatening conditions encountered by chiropractors.

ABSTRACT

Chiropractors are hybrid physicians with a broad skill set. DCs need the diagnostic acumen of orthopedists and neurologists, a fine manual therapist’s hands, a psychologist’s insights, and the capacity to instantly respond to the unexpected. As front-line health care professionals, we may find ourselves serving as ER physicians. When a previously undiagnosed life- threatening condition shows up, we must recognize the problem and triage the patient appropriately. This article will review the six most common undiagnosed life-threatening conditions encountered by chiropractors.

Keywords:   cancer, abdominal aortic aneurysm, deep-vein thrombosis, pulmonary embolism, venous thromboembolism, stroke, cerebrovascular accident, subdural hematoma, myocardial infarction, red flag assessment, life- threatening conditions, chiropractor, chiropractic physician


INTRODUCTION

Daniel, et al., have identified the six most common life-threatening conditions that a chiropractic physician is likely to encounter in clinical practice. [1] The goal of this article is to translate the current evidence-based knowledge of these conditions into a quick-scan diagnostic and management reference for cancer, abdominal aortic aneurysm, venous thromboembolism, stroke, myocardial infarction, and subdural hematoma.



I. CANCER

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A Clinician’s Review