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Altered Central Integration of Dual Somatosensory Input
After Cervical Spine Manipulation

Altered Central Integration of Dual Somatosensory Input After Cervical Spine Manipulation

The Chiro.Org Blog

SOURCE:   J Manipulative Physiol Ther. 2010 (Mar);   33 (3):   178–188

Heidi Haavik Taylor, PhD, BSc, Bernadette Murphy, PhD, DC

Director of Research,
New Zealand College of Chiropractic,
Auckland, New Zealand.

OBJECTIVE:   The aim of the current study was to investigate changes in the intrinsic inhibitory interactions within the somatosensory system subsequent to a session of spinal manipulation of dysfunctional cervical joints.

METHOD:   Dual peripheral nerve stimulation somatosensory evoked potential (SEP) ratio technique was used in 13 subjects with a history of reoccurring neck stiffness and/or neck pain but no acute symptoms at the time of the study. Somatosensory evoked potentials were recorded after median and ulnar nerve stimulation at the wrist (1 millisecond square wave pulse, 2.47 Hz, 1 x motor threshold). The SEP ratios were calculated for the N9, N11, N13, P14-18, N20-P25, and P22-N30 peak complexes from SEP amplitudes obtained from simultaneous median and ulnar (MU) stimulation divided by the arithmetic sum of SEPs obtained from individual stimulation of the median (M) and ulnar (U) nerves.

RESULTS:   There was a significant decrease in the MU/M + U ratio for the cortical P22-N30 SEP component after chiropractic manipulation of the cervical spine. The P22-N30 cortical ratio change appears to be due to an increased ability to suppress the dual input as there was also a significant decrease in the amplitude of the MU recordings for the same cortical SEP peak (P22-N30) after the manipulations. No changes were observed after a control intervention.

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Chronic Neck Pain and Chiropractic Page

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After Cervical Spine Manipulation

World Spine Day – October 16th, 2015


World Spine Day is a part of the Bone and Joint Decade Action Week which occurs each year in October. The 16th of October is the day dedicated as World Spine Day.

The theme “Straighten Up and Move” was introduced in 2012 and emphasized the importance of healthy spinal posture and activity which promote body awareness and minimizes the day-to-day wear and tear on a person’s spine. The theme of posture and movement supports the BJD’s Vision of “Keep People Moving”. The intent of WSD is to bring people from all walks of life – patients, health providers, health care organizations, associations and governments to help ease this global burden.

The aims of WSD:

  1. Raise awareness about spinal health and spine disorders within the interdisciplinary health care community and amongst public policy decision-makers and the general public;
  2. To provide an opportunity for and encourage ongoing discussion about the burden of spinal disorders; and
  3. To promote an interdisciplinary, collaborative approach to easing the burden of spinal disorders.

WSD Theme 2015- “Your Back at Work”

In 2015 a new theme is being introduced for WSD- “Your Back at Work”.  It is anticipated that this theme will continue for the next 2-3 years, building on the “Straighten Up and Move” theme.

Prevention, education and management of spine disorders in the workplace are of utmost importance and this year’s theme provides an important opportunity to highlight the importance of global, regional and local initiatives to address the burden of MSK disorders in the workplace.

World Spine Day Toolkit

A Proposed Model With Possible Implications for Safety and Technique Adaptations for Chiropractic Spinal Manipulative Therapy for Infants and Children

A Proposed Model With Possible Implications for Safety and Technique Adaptations for Chiropractic Spinal Manipulative Therapy for Infants and Children

The Chiro.Org Blog

SOURCE:   J Manipulative Physiol Ther. 2013 (Jul 8) [Epub]

Aurélie M. Marchand, DC, MScACPP

Doctor of Chiropractic,
Private Practice,
Padova, Italy.

OBJECTIVE:   A literature review of tensile strength of adults and pediatric human spine specimens was performed to gather information about biomechanical forces and spinal differences of adults and children and to synthesize these findings into a scaling model to guide safety and clinical decisions for spinal manipulative therapy (SMT) for children and infants.

METHODS:   The literature search was performed using PubMed from inception to November 2012 with no filters or language restrictions. The search included terms related to pediatric spine biomechanics and tensile strength. Studies included those in which human tensile strengths necessary to create anatomical damage in the cervical, thoracic, or lumbar spine of pediatric human subjects were recorded. The pediatric population was defined as human subjects from birth to 18 years old. Biomechanical findings were used to propose a scaling model based on specimen age and differences in tensile strengths. A model of care was proposed using the scaling model and the existing literature on pediatric technique adaptations.

RESULTS:   Nine experimental studies were selected, 5 in the pediatric population (46 specimens) and 4 in the adult population (47 specimens). Mean tensile strengths were estimated, and ratios were used to describe differences between 4 age groups. The preliminary model of care proposed includes maximum loading forces by age group. From these studies, a model showed a nonlinear increase in the cervical spine tensile strengths based on specimen age.

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Chiropractic Pediatrics Section

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Prognostic Factors for Recurrences in Neck Pain Patients Up to 1 Year After Chiropractic Care

Prognostic Factors for Recurrences in Neck Pain Patients Up to 1 Year After Chiropractic Care

The Chiro.Org Blog

SOURCE:   J Manipulative Physiol Ther. 2015 (Sep 15) [Epub]

Anke Langenfeld, MS, [1] B. Kim Humphreys, DC, PhD, [2]
Jaap Swanenburg, PhD, [3] Cynthia K. Peterson, RN, DC, MMedEd, PhD [2]

1 PhD Student, CAPHRI School of Public Health and Primary Care,
Department of Epidemiology, Maastricht University,
Maastricht, The Netherlands;

OBJECTIVE:   Information about recurrence and prognostic factors is important for patients and practitioners to set realistic expectations about the chances of full recovery and to reduce patient anxiety and uncertainty. Therefore, the purpose of this study was to assess recurrence and prognostic factors for neck pain in a chiropractic patient population at 1 year from the start of the current episode.

METHODS:   Within a prospective cohort study, 642 neck pain patients were recruited by chiropractors in Switzerland. After a course of chiropractic therapy, patients were followed up for 1 year regarding recurrence of neck pain. A logistic regression analysis was used to assess prognostic factors for recurrent neck pain. The independent variables age, pain medication usage, sex, work status, duration of complaint, previous episodes of neck pain and trauma onset, numerical rating scale, and Bournemouth questionnaire for neck pain were analyzed. Prognostic factors that have been identified in previous studies to influence recovery of neck pain are psychologic distress, poor general health at baseline, and a previous history of pain elsewhere.

RESULTS:   Five hundred forty five patients (341 females), with a mean age of 42.1 years (SD, 13.1) completed the 1-year follow-up period. Fifty-four participants (11%) were identified as “recurrent.” Prognostic factors associated with recurrent neck pain were previous episodes of neck pain and increasing age.

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Chronic Neck Pain and Chiropractic Page

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Report of the NIH Task Force on Research Standards for Chronic Low Back Pain

Report of the NIH Task Force on Research Standards for Chronic Low Back Pain

The Chiro.Org Blog

SOURCE:   Int J Ther Massage Bodywork. 2015 (Sep 1); 8 (3): 16–33

Richard A. Deyo, MD, MPH, Samuel F. Dworkin, DDS, PhD,
Dagmar Amtmann, PhD, Gunnar Andersson, MD, PhD,
David Borenstein, MD, Eugene Carragee, MD,
John Carrino, MD, MPH, Roger Chou, MD, Karon Cook, PhD,
Anthony DeLitto, PT, PhD, Christine Goertz, DC, PhD,
Partap Khalsa, DC, PhD, John Loeser, MD, Sean Mackey, MD, PhD,
James Panagis, MD, James Rainville, MD, Tor Tosteson, ScD,
Dennis Turk, PhD, Michael Von Korff, ScD, and Debra K. Weiner, MD

Oregon Health and Sciences University,
Portland, OR.

Despite rapidly increasing intervention, functional disability due to chronic low back pain (cLBP) has increased in recent decades. We often cannot identify mechanisms to explain the major negative impact cLBP has on patients’ lives. Such cLBP is often termed non-specific, and may be due to multiple biologic and behavioral etiologies. Researchers use varied inclusion criteria, definitions, baseline assessments, and outcome measures, which impede comparisons and consensus. The NIH Pain Consortium therefore charged a Research Task Force (RTF) to draft standards for research on cLBP. The resulting multidisciplinary panel recommended using 2 questions to define cLBP; classifying cLBP by its impact (defined by pain intensity, pain interference, and physical function); use of a minimal data set to describe research participants (drawing heavily on the PROMIS methodology); reporting “responder analyses” in addition to mean outcome scores; and suggestions for future research and dissemination. The Pain Consortium has approved the recommendations, which investigators should incorporate into NIH grant proposals. The RTF believes these recommendations will advance the field, help to resolve controversies, and facilitate future research addressing the genomic, neurologic, and other mechanistic substrates of chronic low back pain. We expect the RTF recommendations will become a dynamic document, and undergo continual improvement.

KEYWORDS: &nbsp NIH Task Force; chronic low back pain; low back pain; minimum dataset; research standards

From the FULL TEXT Article:


The Institute of Medicine recently estimated that chronic pain affects about 100 million adults in the United States, with an estimated annual cost of $635 billion, including direct medical expenditures and loss of work productivity. [3] Activity-limiting low back pain (LBP), in particular, has a world-wide lifetime prevalence of about 39% and a similar annual prevalence of 38%. [61] The majority of people having LBP experience recurrent episodes. [62] The use of all interventions for treating chronic LBP (cLBP) increased from 1995–2010, including surgery, pharmacological, and non-pharmacological approaches. Despite increased utilization, however, the prevalence of symptoms and expenditures has increased. [37, 70, 91]

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Low Back Pain and Chiropractic Page

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The 120th Anniversary of Chiropractic

The 120th Anniversary of Chiropractic

The Chiro.Org Blog

SOURCE:   Palmer College of Chiropractic

Happy Founder’s Day!

Most likely, this is the very first graduating class of Chiropractors in Davenport, Iowa.

Click on the graphic to see a larger version.

This year marks 120 years since chiropractic was founded.

Traditionally, Founder’s Day is celebrated on Sept. 18, the date which is on or near the anniversary of the first chiropractic adjustment by D.D. Palmer in Davenport, Iowa, in 1895.

Founder’s Day is the perfect opportunity to share chiropractic with the world!

Post information about it on your website, Facebook page and profile, Twitter, Instagram and anywhere else.

Need some content? Check out the results of the:

Gallup-Palmer report.

Thanks to Palmer College for access to this material!

How to Proceed When Evidence-based Practice Is Required But Very Little Evidence Available?

How to Proceed When Evidence-based Practice Is Required But Very Little Evidence Available?

The Chiro.Org Blog

SOURCE:   Chiropractic & Manual Therapies 2013 (Jul 10); 21 (1): 24 ~ FULL TEXT

Charlotte Leboeuf-Yde, Olivier Lanlo and Bruce F Walker

The Spine Research Centre,
Hospital Lillebaelt, and Institute for Regional Health Research,
University of Southern Denmark,
Middelfart, Denmark.

BACKGROUND:   All clinicians of today know that scientific evidence is the base on which clinical practice should rest. However, this is not always easy, in particular in those disciplines, where the evidence is scarce. Although the last decades have brought an impressive production of research that is of interest to chiropractors, there are still many areas such as diagnosis, prognosis, choice of treatment, and management that have not been subjected to extensive scrutiny.

DISCUSSION:   In this paper we argue that a simple system consisting of three questions will help clinicians deal with some of the complexities of clinical practice, in particular what to do when clear clinical evidence is lacking. Question 1 asks: are there objectively tested facts to support the concept? Question 2: are the concepts that form the basis for this clinical act or decision based on scientifically acceptable concepts? And question three; is the concept based on long-term and widely accepted experience? This method that we call the “Traffic Light System” can be applied to most clinical processes.

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The Evidence-based Practice Page

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Do Participants With Low Back Pain Who Respond to Spinal Manipulative Therapy

Do Participants With Low Back Pain Who Respond to Spinal Manipulative Therapy Differ Biomechanically From Nonresponders, Untreated Controls or Asymptomatic Controls?

The Chiro.Org Blog

SOURCE:   Spine (Phila Pa 1976) 2015 (Sep 1);   40 (17):   1329–1337 ~ FULL TEXT

Wong, Arnold Y. L. PT, MPhil, PhD; Parent, Eric C. PT, PhD;
Dhillon, Sukhvinder S. MB, ChB, CCST; Prasad, Narasimha PhD;
Kawchuk, Gregory N. DC, PhD

Department of Rehabilitation Sciences,
The Hong Kong Polytechnic University,
Kowloon, Hong Kong

Department of Physical Therapy,
University of Alberta,
Alberta, Canada

FROM: University of Alberta ~ 8-31-2015

Researchers at the University of Alberta have found that spinal manipulation—applying force to move joints to treat pain, a technique most often used by chiropractors and physical therapists — does indeed have immediate benefits for some patients with low-back pain but does not work for others with low-back pain. And though on the surface this latest conflict might appear to muddy the waters further, the results point to the complexity of low-back pain and the need to treat patients differently, says lead author Greg Kawchuk.

“This study shows that, just like some people respond differently to a specific medication, there are different groups of people who respond differently to spinal manipulation.”

In a non-randomized control study, individuals with low-back pain received spinal manipulation during two treatment sessions that spanned a week. Participants reported their pain levels and disability levels after spinal manipulation, and researchers used ultrasound, MRI and other diagnostics to measure changes in each participant’s back, including muscle activity, properties within the intervertebral discs, and spinal stiffness.

A control group of participants with low-back pain underwent similar clinical examinations but did not receive spinal manipulation. A third group — those who did not have low-back pain symptoms — were also evaluated.

The people who responded to spinal manipulation reported less pain right away and showed improvement in back muscle thickness, disc diffusion and spinal stiffness. Those changes were great enough to exceed or equal the measures in the control groups and stayed that way for the week of treatment, the research team found.
A patient receives spinal manipulation treatment.

Kawchuk, who practised as a chiropractor before going on to obtain his PhD in biomechanics and bioengineering, said the results do not advocate one way or another for spinal manipulation but help explain why there has been so much conflicting data about its merits.

“Clearly there are some people with a specific type of back pain who are responding to this treatment and there are some people with another type of back pain who do not. But if you don’t know that and you mix those two groups together, you get an artificial average that doesn’t mean anything,” Kawchuk explained.

The research team is still fine-tuning how to distinguish who is a responder or non-responder before spinal manipulation is given; however, this study shows it can be used to identify an effective treatment course.

“Spinal manipulation acts so rapidly in responders that it could be used as a screening tool to help get the right treatment to the right patient at the right time.”

The study did not investigate the long-term effects of spinal manipulation, but this is next on the list for the researchers.

STUDY DESIGN:   Nonrandomized controlled study.

OBJECTIVE:   To determine whether patients with low back pain (LBP) who respond to spinal manipulative therapy (SMT) differ biomechanically from nonresponders, untreated controls or asymptomatic controls.

SUMMARY OF BACKGROUND DATA:   Some but not all patients with LBP report improvement in function after SMT. When compared with nonresponders, studies suggest that SMT responders demonstrate significant changes in spinal stiffness, muscle contraction, and disc diffusion. Unfortunately, the significance of these observations remains uncertain given methodological differences between studies including a lack of controls.

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Low Back Pain and Chiropractic Page

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First-Contact Care With a Medical vs Chiropractic Provider

First-Contact Care With a Medical vs Chiropractic Provider After Consultation With a Swiss Telemedicine Provider: Comparison of Outcomes, Patient Satisfaction, and Health Care Costs in Spinal, Hip, and Shoulder Pain Patients

The Chiro.Org Blog

SOURCE:   J Manipulative Physiol Ther. 2015 (Aug 15)] ~ FULL TEXT

Taco A.W. Houweling, DC, MRes, PhD, Andrea V. Braga, MD, MBA,
Thomas Hausheer, DC, arco Vogelsang, DC,
Cynthia Peterson, RN, DC, MMedEd,
B. Kim Humphreys, DC, PhD

Postdoctoral Research Fellow,
Department of Chiropractic Medicine,
University Hospital Balgrist, Forchstrasse 340, 8008
Zürich, Switzerland.

OBJECTIVE:   The purpose of this study was to identify differences in outcomes, patient satisfaction, and related health care costs in spinal, hip, and shoulder pain patients who initiated care with medical doctors (MDs) vs those who initiated care with doctors of chiropractic (DCs) in Switzerland.

METHODS:   A retrospective double cohort design was used. A self-administered questionnaire was completed by first-contact care spinal, hip, and shoulder pain patients who, 4 months previously, contacted a Swiss telemedicine provider regarding advice about their complaint. Related health care costs were determined in a subsample of patients by reviewing the claims database of a Swiss insurance provider.

RESULTS:   The study sample included 403 patients who had seen MDs and 316 patients who had seen DCs as initial health care providers for their complaint. Differences in patient sociodemographic characteristics were found in terms of age, pain location, and mode of onset. Patients initially consulting MDs had significantly less reduction in their numerical pain rating score (difference of 0.32) and were significantly less likely to be satisfied with the care received (odds ratio = 1.79) and the outcome of care (odds ratio = 1.52). No significant differences were found for Patient’s Global Impression of Change ratings. Mean costs per patient over 4 months were significantly lower in patients initially consulting DCs (difference of CHF 368; US $368).

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Low Back Pain and Chiropractic Page

and our:

The Shoulder Girdle & Chiropractic Page

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Chiropractic Physicians Call for Conservative Treatments for Pain Management Amid Prescription Painkiller Epidemic

Source American Chiropractic Association

American Chiropractic Association launches 2015 public awareness campaign aimed at curbing opioid overuse and abuse

During National Chiropractic Health Month (NCHM) in October, the American Chiropractic Association (ACA) will work with thousands of doctors of chiropractic (DCs), chiropractic assistants (CAs) and chiropractic doctoral students nationwide to bring attention to the public health crisis caused by pain, and in particular the overuse of prescription painkillers, with this year’s theme #PainFreeNation. The campaign is part of the profession’s ongoing efforts to educate the public about the value of exhaustingconservative forms of care for both acute and chronic pain before resorting to higher risk options, such as opioids.

“Opioid medications involve the risk of overuse and addiction. Beyond the risks of overuse and addiction, prescription drugs that numb pain may convince a patient that a musculoskeletal condition is less severe than it is, or that it has healed. This misunderstanding can lead to overexertion and a delay in the healing process or even to permanent injury,” said ACA President Anthony Hamm, DC.

President Hamm noted that people in pain should be informed of all management strategies, including non-drug approaches such as chiropractic, to reduce their risk of overuse and addiction.

Each patient is unique, and care plans should be tailored to focus on what is the safest, most effective treatment for the individual. Chiropractic physicians stand ready to work together with medical physicians to help address this epidemic that has caused unnecessary suffering, enormous loss of human potential and massive financial and personal costs,” he added.

Fortunately, health care quality organizations have begun to recognize the value of this conservative, multidisciplinary approach. Earlier this year, the Joint Commission, which certifies more than 20,000 health care organizations and programs in the United States, including every major hospital, revised its pain management standard to include chiropractic services and acupuncture. Clinical experts in pain management who provide input to the commission’s standards affirmed that treatment strategies may consider both pharmacologic and nonpharmacologic approaches.   


During NCHM this fall, ACA will offer chiropractic physicians resources to help them share information about their conservative approach and why it is especially significant to today’s health care consumers amidst the opioid epidemic.

Craniocervical Chiropractic Procedures –
A Précis of Upper Cervical Chiropractic

Craniocervical Chiropractic Procedures –
A Précis of Upper Cervical Chiropractic

The Chiro.Org Blog

SOURCE:   J Can Chiropr Assoc 2015 (Jun);   59 (2):   173–192 ~ FULL TEXT

H. Charles Woodfield, III, BPhm, DC, Craig York, DC.
Roderic P. Rochester, DC, Scott Bales, DC,
Mychal Beebe, DC, Bryan Salminen, DC,
Jeffrey N. Scholten, DC .

Director of Research –
Upper Cervical Research Foundation,
Minneapolis, MN

Presented here is a narrative review of upper cervical procedures intended to facilitate understanding and to increase knowledge of upper cervical chiropractic care. Safety, efficacy, common misconceptions, and research are discussed, allowing practitioners, chiropractic students, and the general public to make informed decisions regarding utilization and referrals for this distinctive type of chiropractic care. Upper cervical techniques share the same theoretical paradigm in that the primary subluxation exists in the upper cervical spine. These procedures use similar assessments to determine if spinal intervention is necessary and successful once delivered. The major difference involves their use of either an articular or orthogonal radiograph analysis model when determining the presence of a misalignment. Adverse events following an upper cervical adjustment consist of mild symptomatic reactions of short-duration (< 24-hours). Due to a lack of quality and indexed references, information contained herein is limited by the significance of literature cited, which included non-indexed and/or non-peer reviewed sources.

KEYWORDS:   adverse events; atlas; cervical; chiropractic; chiropractic adjustment; craniocervical

From the Full-Text Article:


The indexed literature reports the existence of many upper cervical (UC) procedures. [1, 2] Presented here is a brief narrative review or narrative description of upper cervical techniques (UCT) with the intention of increasing knowledge and understanding regarding their effectiveness and utilization. Procedural similarities and differences between UCT are examined. As chiropractic goes the way of other healing professions through stratification into specialties, this characterization of upper cervical procedures can create appreciation and clarity both inside and outside the profession.

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Chiropractic Technique Page

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A Précis of Upper Cervical Chiropractic

What Effect Does Chiropractic Treatment Have on Gastrointestinal (GI) Disorder

What Effect Does Chiropractic Treatment Have on Gastrointestinal (GI) Disorders: A Narrative Review of the Literature

The Chiro.Org Blog

SOURCE:   J Can Chiropr Assoc 2015 (Jun);   59 (2):   122–133 ~ FULL TEXT

Katherine Angus, BSc(Kin), DC, Sepideh Asgharifar, BSc(Hons), DC,
Brian Gleberzon, DC, MHSc

Chiropractic and Health Associates Clinic,
1 St. Clair Ave West, Suite 404,
Toronto, Ontario.

The purpose of this study was to provide a narrative review of the literature of studies describing the management of disorders of the gastro-intestinal (GI) tract using ‘chiropractic therapy’ broadly defined here as spinal manipulation therapy, mobilizations, soft tissue therapy, modalities and stretches. Search limiters include access to full text studies published between 1980 and November 2012 in peer-reviewed journals, English language only involving human subjects. Twenty-one articles were found that met our inclusion criteria. Retrievable articles varied from case reports to clinical trials to review articles of management options. The majority of articles chronicling patient experiences under chiropractic care reported they demonstrated mild to moderate improvements in presenting symptoms. No adverse side effects were reported. This suggests chiropractic care can be considered as an adjunctive therapy for patients with various GI conditions providing there are no co-morbidities.

KEYWORDS:  chiropractic; gastro-intestinal; manipulation; therapy

From the FULL TEXT Article


The purpose of this paper was to conduct a narrative review of the literature that investigated the effectiveness of chiropractic treatment for gastrointestinal (GI) disorders. A previous review by Gleberzon et al [1] reviewed the literature from 2007 to 2011 that investigated the use of one type of chiropractic treatment (spinal manipulative therapy) for pediatric health conditions one of which was colic, often considered a type of GI condition effecting infants [Authors’ note: there is considerable debate whether or not ‘infantile colic’ is a GI condition, or simply ‘baby back pain’ and there is debate if the method used to monitor its existence (crying time) is a subjective or objective outcome measure. [1] That debate notwithstanding, for the purposes of this report, we have included colic as a GI condition].

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Conditions That Respond Well to Chiropractic Page

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Validity of Palpation of the C1 Transverse Process

Validity of Palpation of the C1 Transverse Process: Comparison with a Radiographic Reference Standard

The Chiro.Org Blog

SOURCE:   J Can Chiropr Assoc 2015 (Jun);   59 (2):   91–100 ~ FULL TEXT

Robert Cooperstein,MA, DC, Morgan Young,DC, Makani Lew,DC

Palmer West College of Chiropractic
Palmer Center for Chiropractic Research

Primary goal:   to determine the validity of C1 transverse process (TVP) palpation compared to an imaging reference standard.

METHODS:   Radiopaque markers were affixed to the skin at the putative location of the C1 TVPs in 21 participants receiving APOM radiographs. The radiographic vertical distances from the marker to the C1 TVP, mastoid process, and C2 TVP were evaluated to determine palpatory accuracy.

RESULTS:   Interexaminer agreement for radiometric analysis was “excellent.” Stringent accuracy (marker placed ±4mm from the most lateral projection of the C1 TVP) = 57.1%; expansive accuracy (marker placed closer to contiguous structures) = 90.5%. Mean Absolute Deviation (MAD) = 4.34 (3.65, 5.03) mm; root-mean-squared error = 5.40mm.

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Brain Atrophy in Cognitively Impaired Elderly

Brain Atrophy in Cognitively Impaired Elderly:
The Importance of Long-chain ω-3 Fatty Acids
and B Vitamin Status in a Randomized Controlled Trial

The Chiro.Org Blog

SOURCE:   Am J Clin Nutr. 2015 (Jul);   102 (1):   215–221

Fredrik Jernerén, Amany K Elshorbagy, Abderrahim Oulhaj,
Stephen M Smith, Helga Refsum, and A David Smith

From the Oxford Project to Investigate Memory and Ageing (OPTIMA),
Department of Pharmacology,
University of Oxford, Oxford, United Kingdom;

This study provides clarity to earlier studies that found that B vitamins and/or Omega-3 fatty acids were found to slow brain loss in areas of the brain associated with Alzheimer’s disease.

In a 2010 study, Smith et al. [1] (in the Oxford Project to Investigate Memory and Ageing study) gave 271 individuals with mild cognitive impairment high-dose B vitamins for 2 years.   Pre- and post-MRI studies were done, and they demonstrated that the B vitamin group experienced 30-percent slower rates of brain atrophy, on average, and in some cases patients experienced reductions as high as 53 percent.

In a 2012 study, Bowman et al. [2] (in the Oregon Brain Aging Study) reviewed blood nutrient levels in 104 dementia-free elders.   They found two nutrient biomarker patterns (NBPs) that were associated with more favorable cognitive and MRI measures: one was high plasma levels of the vitamins B, C, D, and E, and the second NBP was high plasma marine omega-3 fatty acids.   They also demonstrated that high trans fat blood levels were associated with less favorable cognitive function and less total cerebral brain volumes.

When this article was pre-released, the New York Times ran a banner headline titled:
4 Vitamins That Strengthen Older Brains. [3]

In a 2013 study, Douaud et al. [4] provided high-dose B-vitamin treatment to elderly subjects with increased dementia risk for 2 years.   They found that B vitamins reduced brain shrinkage and reduced levels of plasma total homocysteine (tHcy).   This is important because many cross-sectional and prospective studies have shown that high tHcy levels are associated with cognitive impairment, Alzheimer’s disease (AD), and vascular dementia.

The current study also helps explain why some trials that focused solely on the B vitamins or Omega-3s had mixed results. Apparently having high blood levels of BOTH the B vitamins AND Omega-3 fatty acids provides better results in preventing the deterioration of brain tissue in Alzheimer’s patients.


  1. Homocysteine-lowering by B Vitamins Slows the Rate of Accelerated Brain Atrophy in Mild Cognitive Impairment: A Randomized Controlled Trial
    PLoS One. 2010 (Sep 8); 5 (9): e12244

  2. Nutrient Biomarker Patterns, Cognitive Function, and MRI Measures of Brain Aging
    Neurology. 2012 (Jan 24); 78 (4): 241–249

  3. 4 Vitamins That Strengthen Older Brains
    The New York Times ~ January 2, 2012

  4. Preventing Alzheimer’s Disease-related Gray Matter Atrophy by B-vitamin Treatment
    Proc Natl Acad Sci U S A. 2013 (Jun 4); 110 (23): 9523–9528

Continue reading Brain Atrophy in Cognitively Impaired Elderly

Multiple Venous Thromboses Presenting as Mechanical Low Back Pain in an 18-Year-Old Woman

Multiple Venous Thromboses Presenting as Mechanical Low Back Pain in an 18-Year-Old Woman

The Chiro.Org Blog

SOURCE:   J Chiropr Med. 2015 (Jun);   14 (2):   83–89

Andrée-Anne Marchand, DC, Jean-Alexandre Boucher, DC,
Julie O’Shaughnessy, DC, MSc

Université du Québec à Trois-Rivières,
3351 Boul. Des Forges. C.P 500, Trois-Rivières,
Québec, Canada, G9A 5H7

Objective   The purpose of this case report is to describe a patient who presented with acute musculoskeletal symptoms but was later diagnosed with multiple deep vein thrombosis (DVT).

Clinical Features   An 18-year-old female presented to a chiropractic clinic with left lumbosacral pain with referral into the posterior left thigh. A provisional diagnosis was made of acute myofascial syndrome of the left piriformis and gluteus medius muscles. The patient received 3 chiropractic treatments over 1 week resulting in 80% improvement in pain intensity. Two days later, a sudden onset of severe abdominal pain caused the patient to seek urgent medical attention. A diagnostic ultrasound of the abdomen and pelvis were performed and interpreted as normal. Following this, the patient reported increased pain in her left leg. Evaluation revealed edema of the left calf and decreased left lower limb sensation. A venous Doppler ultrasound was ordered.

Intervention and Outcomes   Doppler ultrasound revealed reduction of the venous flow in the femoral vein area. An additional ultrasonography evaluation revealed an extensive DVTs affecting the left femoral vein and iliac axis extending towards the vena cava. Upon follow-up with a hematologist, the potential diagnosis of May-Thurner syndrome was considered based on the absence of blood dyscrasias and sustained anatomical changes found in the left common iliac vein at its junction with the right common iliac artery. A week following discharge, she presented with chest pain and was diagnosed with venous thromboembolism. The patient was successfully treated with anticoagulation therapy and insertion of a vena cava filter.

Continue reading Multiple Venous Thromboses Presenting as Mechanical Low Back Pain in an 18-Year-Old Woman