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Manual Therapies for Primary Chronic Headaches

Chiro.Org Blog: This is to our knowledge the first systematic review regarding the efficacy of manual therapy randomized clinical trials (RCT) for primary chronic headaches. A comprehensive English literature search on CINHAL, Cochrane, Medline, Ovid and PubMed identified 6 RCTs all investigating chronic tension-type headache (CTTH). One study applied massage therapy and five studies applied physiotherapy. Four studies were considered to be of good methodological quality by the PEDro scale. All studies were pragmatic or used no treatment as a control group, and only two studies avoided co-intervention, which may lead to possible bias and makes interpretation of the results more difficult. The RCTs suggest that massage and physiotherapy are effective treatment options in the management of chronic tension-type headache (CTTH) […]

Running Exercise Strengthens the Intervertebral Disc

Chiro.Org Blog: Via quantitative assessment of physical activity we further find that accelerations at fast walking and slow running (2 m/s), but not high-impact tasks, lower intensity walking or static positions, correlated to positive IVD characteristics. These findings represent the first evidence in humans that exercise can be beneficial for the IVD and provide support for the notion that specific exercise protocols may improve IVD material properties in the spine. We anticipate that our findings will be a starting point to better define exercise protocols and physical activity profiles for IVD anabolism in humans. […]

Complementary and Integrative Medicine
in the Management of Headache

Chiro.Org Blog: Headaches, including primary headaches such as migraine and tension-type headache, are a common clinical problem. Complementary and integrative medicine (CIM), formerly known as complementary and alternative medicine (CAM), uses evidence informed modalities to assist in the health and healing of patients. CIM commonly includes the use of nutrition, movement practices, manual therapy, traditional Chinese medicine, and mind-body strategies. This review summarizes the literature on the use of CIM for primary headache and is based on five meta-analyses, seven systematic reviews, and 34 randomized controlled trials (RCTs). […]

Take the Guideline Challenge

Chiro.Org Blog: The American Osteopathic Association developed guidelines for low back pain, which includes spinal manipulation, in 2010 and then updated them in 2016. [2] The American Physical Therapy Association has had low back pain guidelines since 2012. [3] In March, the chiropractic profession also took a leadership role in this area when the American Chiropractic Association adopted both the American College of Physician’s recent low back pain guideline [4], as well as the Clinical Compass (formerly CCGPP) [5] Clinical Practice Guideline: Chiropractic Care for Low Back Pain. [6] […]

Clinical Classification in Low Back Pain: Best-evidence Diagnostic Rules Based on Systematic Reviews

Chiro.Org Blog: This is the first comprehensive systematic review of diagnostic accuracy studies that evaluate clinical examination findings for their ability to identify the most common patho-anatomical disorders in the lumbar spine. In some diagnostic categories we have sufficient evidence to recommend a CDR. In others, we have only preliminary evidence that needs testing in future studies. Most findings were tested in secondary or tertiary care. Thus, the accuracy of the findings in a primary care setting has yet to be confirmed. […]

Joint Manipulation: Toward a General Theory of High-Velocity, Low-Amplitude Thrust Techniques

Chiro.Org Blog: High-velocity, low-amplitude thrust (HVLAT) techniques are widely used in manual therapies and nearly always produce a “cracking” noise. This is considered a cavitation event [1, 2] for the metacarpophalangeal (MCP) joint and is produced by the sudden separation, or “gapping,” of the joint surfaces. In clinical practice, the force to do this is applied manually. It is assumed that the event is the same mechanism in both spinal and peripheral joints, as it involves the same types of structures. For example, similar characteristics were found for joint noises (ie, “cracks”) in both the MCP joint and the cervical apophysial joint. [3] In addition, it was found that gapping occurred in lumbar adjusting procedures. [4] Various terms have been used for the lesion that is treated with HVLAT. [5] In this paper, the term “joint dysfunction” will be used. […]

AMI Model Working in Florida: Functional Improvements, Reduced Utilization Costs by Medicaid Patients

Chiro.Org Blog: Alternative Medicine Integration (AMI) originally achieved recognition within the chiropractic community for its unique HMO model that utilized doctors of chiropractic as primary-care physicians (PCPs) and the portal of entry into an integrated health care delivery system, inclusive of hospitals, MDs and MD specialists and outpatient facilities. Contracted with Blue Cross Blue Shield’s HMO-Illinois, AMI’s integrated IPA demonstrated excellent clinical and cost outcomes. […]

An Integrated Approach to Chronic Pain

Chiro.Org Blog: Findings from a unique Medicaid pilot project in Rhode Island involving high-use Medicaid recipients from two health plans were recently presented to the state’s Department of Health, [1] demonstrating stellar outcomes with regard to medication use, ER visits, health care costs and patient satisfaction.   Since 2012, Rhode Island Medicaid “Community of Care” enrollees suffering from chronic pain have participated in an integrated chronic pain program administered by Advanced Medicine Integration. Longtime readers will recall that for nearly two decades, AMI has been coordinating chiropractic and integrated care services in various states to help address the chronic pain epidemic in a community-based, integrated fashion. [2-3] […]

New Canadian Opioid Guidelines Recommends Chiropractic As Care Option

Chiro.Org Blog: A new Canadian guideline published today (May 8, 2017) in the Canadian Medical Association Journal (CMAJ) strongly recommends doctors to consider non-pharmacologic therapy, including chiropractic, in preference to opioid therapy for chronic non-cancer pain. […]

The Return of Color Vision Secondary to Macular Degeneration After Chiropractic Care

Chiro.Org Blog: The patient was adjusted based on location of her subluxations (intersegmental joint dysfunction). She had 17 treatments over 8 month. A thermography study was performed of the face before and after treatment and a more symmetrical thermal pattern was obtained. Her spinal pain reduced. She also unexpectedly had a return of color vision in her left eye. […]

For Bad Backs, It May Be Time to Rethink Biases About Chiropractors

For Bad Backs, It May Be Time to Rethink Biases About Chiropractors

The Chiro.Org Blog

SOURCE:   The New York Times ~ 5-01-2017 Aaron E. Carroll, MD, MS

Indiana University School of Medicine

About two of every three people will probably experience significant low back pain at some point. A physician […]

Spinal Manipulative Therapy Has an Immediate Effect on Thermal Pain Sensitivity in People With Low Back Pain

Chiro.Org Blog: Inhibition of A-delta fiber-mediated pain perception was similar for all groups. However, inhibition of temporal summation was observed only in participants receiving SMT, suggesting a modulation of dorsal horn excitability that was observed primarily in the lumbar innervated area. […]

Areas of Capsaicin-Induced Secondary Hyperalgesia and Allodynia Are Reduced by a Single Chiropractic Adjustment

Chiro.Org Blog: The results confirmed that topical capsaicin induced inflammatory reactions based on occurrence of hyperalgesia and allodynia, augmented pain perception, and increased blood flow following capsaicin application compared with the control session. When compared with N-SMT, spontaneous pain was rated significantly lower post-SMT (P <.014). In addition, areas of both secondary hyperalgesia and allodynia decreased after SMT (hyperalgesia: P <.007; allodynia: P <.003). However, there was no significant treatment effect for local blood flow. […]

The Influence of Expectation on Spinal Manipulation Induced Hypoalgesia: An Experimental Study in Normal Subjects

Chiro.Org Blog: The current study replicates prior findings of c- fiber mediated hypoalgesia in the lower extremity following SMT and this occurred regardless of expectation. A significant increase in pain perception occurred following SMT in the low back of participants receiving negative expectation suggesting a potential influence of expectation on SMT induced hypoalgesia in the body area to which the expectation is directed. […]

Individual Expectation: An Overlooked, But Pertinent, Factor in the Treatment of Individuals Experiencing Musculoskeletal Pain

Chiro.Org Blog: Physical therapists consider many factors in the treatment of patients with musculoskeletal pain. The current literature suggests expectation is an influential component of clinical outcomes related to musculoskeletal pain for which physical therapists frequently do not account. The purpose of this clinical perspective is to highlight the potential role of expectation in the clinical outcomes associated with the rehabilitation of individuals experiencing musculoskeletal pain. The discussion focuses on the definition and measurement of expectation, the relationship between expectation and outcomes related to musculoskeletal pain conditions, the mechanisms through which expectation may alter musculoskeletal pain conditions, and suggested ways in which clinicians may integrate the current literature regarding expectation into clinical practice. […]