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Frank M. Painter

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About Frank M. Painter

I was introduced to Chiro.Org in early 1996, where my friend Joe Garolis helped me learn HTML, the "mark-up language" for websites. We have been fortunate that journals like JMPT have given us permission to reproduce some early important articles in Full-Text format. Maintaining the Org website has been, and remains, my favorite hobby.

The Identity, Role, Setting, and Future of Chiropractic Practice

By |March 8, 2018|Chiropractic Identity|

The Identity, Role, Setting, and Future of Chiropractic Practice: A Survey of Australian and New Zealand Chiropractic Students

The Chiro.Org Blog

SOURCE:   J Chiropractic Education 2018 (Mar 6) [Epub]

Katie E. de Luca, BAppSci (Ex and Sp Sci), MChiro, PhD, Jordan A. Gliedt, DC, Matthew Fernandez, BSpSc, MChiro, PhD, Greg Kawchuk, DC, PhD, and Michael S. Swain, BChiroSc, MChiro, MPhil

Chiropractic Academy for Research Leadership
24 Salmon Circuit,
South West Rocks,
New South Wales 2431, Australia

OBJECTIVE:   To evaluate Australian and New Zealand chiropractic students’ opinions regarding the identity, role setting, and future of chiropractic practice

METHODS:   An online, cross-sectional survey was administered to chiropractic students in all chiropractic programs in Australia and New Zealand. The survey explored student viewpoints about the identity, role/scope, setting, and future of chiropractic practice as it relates to chiropractic education and health promotion. Associations between the number of years in the program, highest degree preceding chiropractic education, institution, and opinion summary scores were evaluated by multivariate analysis of variance tests.

RESULTS:   A total of 347 chiropractic students participated in the study. For identity, most students (51.3%) hold strongly to the traditional chiropractic theory but also agree (94.5%) it is important that chiropractors are educated in evidence-based practice. The main predictor of student viewpoints was a student’s chiropractic institution (Pillai’s trace =.638, F[16, 1368] = 16.237, p < .001). Chiropractic institution explained over 50% of the variance around student opinions about role/scope of practice and approximately 25% for identity and future practice.

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The Chiropractic Identity Page


Dose-Response and Efficacy of Spinal Manipulation for Care of Cervicogenic Headache

By |March 7, 2018|Cervicogenic Headache|

Dose-Response and Efficacy of Spinal Manipulation for Care of Cervicogenic Headache:
A Dual-Center Randomized Controlled Trial

The Chiro.Org Blog

SOURCE:   Spine J. 2018 (Feb 23) [Epub]

Mitchell Haas, DC, MAa, Gert Bronfort, DC, PhD, Roni Evans, DC, PhD, Craig Schulz, DC, MSa, Darcy Vavrek, ND, MS, Leslie Takaki, MA, Linda Hanson, DC, MS, Brent Leininger, DC, MS, Moni B. Neradilek, MS

Integrative Health & Wellbeing Research Program,
Earl E. Bakken Center for Spirituality & Healing,
University of Minnesota,
420 Delaware Street SE,
Minneapolis, MN, USA, 55455.

BACKGROUND CONTEXT:   The optimal number of visits for the care of cervicogenic headache (CGH) with spinal manipulative therapy (SMT) is unknown.

PURPOSE:   To identify the dose-response relationship between visits for SMT and chronic CGH outcomes; to evaluate the efficacy of SMT by comparison with a light massage control.

STUDY DESIGN/SETTING:   Two-site, open-label randomized controlled trial.

PATIENT SAMPLE:   Participants were 256 adults with chronic CGH.

OUTCOME MEASURES:   The primary outcome was days with CGH in the prior 4 weeks evaluated at the 12- and 24-week primary endpoints. Secondary outcomes included CGH days at remaining endpoints, pain intensity, disability, perceived improvement, medication use, and patient satisfaction.

METHODS:   Participants were randomized to 4 dose levels of chiropractic SMT: 0, 6, 12, or 18 sessions. They were treated 3 times per week for 6 weeks and received a focused light-massage control at sessions when SMT was not assigned. Linear dose effects and comparisons to the no-manipulation control group were evaluated at 6, 12, 24, 39, and 52 weeks. This study was funded by the National Center for Complementary and Integrative Health (R01AT006330) and is registered at (NCT01530321). The authors declare no conflicts of interest.

RESULTS:   A linear dose-response was observed for all follow-ups, a reduction of approximately 1 CGH day/4 weeks per additional 6 SMT visits (p< .05); a maximal effective dose could not be determined. CGH days/4 weeks were reduced from about 16 to 8 for the highest and most effective dose of 18 SMT visits. Mean differences in CGH days/4 weeks between 18 SMT visits and control were -3.3 (p=.004) and -2.9 (p=.017) at the primary endpoints, and similar in magnitude at the remaining endpoints (p<.05). Differences between other SMT doses and control were smaller in magnitude (p > .05). CGH intensity showed no important improvement nor differed by dose. Other secondary outcomes were generally supportive of the primary.

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Headache and Chiropractic Page


Subclinical Recurrent Neck Pain and its Treatment Impacts Motor Training-induced Plasticity of the Cerebellum and Motor Cortex

By |March 3, 2018|Subluxation|

Subclinical Recurrent Neck Pain and its Treatment Impacts Motor Training-induced Plasticity of the Cerebellum and Motor Cortex

The Chiro.Org Blog

SOURCE:   PLoS One. 2018 (Feb 28); 13 (2): e0193413

Julianne K. Baarbé, Paul Yielder, Heidi Haavik, Michael W. R. Holmes, Bernadette Ann Murphy

Division of Neurology,
Krembil Research Institute,
University Health Network,
Toronto, Ontario, Canada.

The cerebellum processes pain inputs and is important for motor learning. Yet, how the cerebellum interacts with the motor cortex in individuals with recurrent pain is not clear. Functional connectivity between the cerebellum and motor cortex can be measured by a twin coil transcranial magnetic stimulation technique in which stimulation is applied to the cerebellum prior to stimulation over the motor cortex, which inhibits motor evoked potentials (MEPs) produced by motor cortex stimulation alone, called cerebellar inhibition (CBI). Healthy individuals without pain have been shown to demonstrate reduced CBI following motor acquisition. We hypothesized that CBI would not reduce to the same extent in those with mild-recurrent neck pain following the same motor acquisition task. We further hypothesized that a common treatment for neck pain (spinal manipulation) would restore reduced CBI following motor acquisition. Motor acquisition involved typing an eight-letter sequence of the letters Z,P,D,F with the right index finger. Twenty-seven neck pain participants received spinal manipulation (14 participants, 18–27 years) or sham control (13 participants, 19–24 years). Twelve healthy controls (20–27 years) also participated. Participants had CBI measured; they completed manipulation or sham control followed by motor acquisition; and then had CBI re-measured. Following motor acquisition, neck pain sham controls remained inhibited (58 ± 33% of test MEP) vs. healthy controls who disinhibited (98 ± 49% of test MEP, P<0.001), while the spinal manipulation group facilitated (146 ± 95% of test MEP, P<0.001). Greater inhibition in neck pain sham vs. healthy control groups suggests that neck pain may change cerebellar-motor cortex interaction. The change to facilitation suggests that spinal manipulation may reverse inhibitory effects of neck pain.

From the Full-Text Article:


The neck is linked biomechanically and neurologically to the upper limbs, and yet, we know little about the mechanisms by which altered sensory feedback from the neck due to pain, fatigue, and altered posture affects upper limb sensorimotor integration (SMI) and the ability to learn new motor skills. [1–4] Motor learning refers to the acquisition or improvement of a motor skill with practice. [5] The cerebellum is known to undergo neuroplastic changes following motor training and is responsible for modulation of motor circuitry. [6] It plays a key role in processing sensory input to predict sensory consequences of movement for online motor corrections as well as for updating body schema in feedforward models of motor control [7], which allows corrections to be made prior to the time physically needed to receive sensory feedback from distal sources such as the hand. [8]

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Chiropractic Subluxation Neurology section


The Manipulative Therapies: Osteopathy and Chiropractic

By |March 2, 2018|Alternative Medicine, Complementary Medicine|

The Manipulative Therapies: Osteopathy and Chiropractic

The Chiro.Org Blog

SOURCE:   British Medical Journal 1999 (Oct 30); 319 (7218): 1176-1179

Andrew Vickers and Catherine Zollman

Osteopathy and chiropractic share a common origin. Their roots can be found in folk traditions of “bone setting,” and both were systematised in the late 19th century in the United States: Daniel D Palmer, the founder of chiropractic, is said to have met with Andrew Taylor Still, the founder of osteopathy, before setting up his own school. The therapies remain relatively similar, and many textbooks and journals are relevant to both. The term “manipulative therapy” refers to both osteopathy and chiropractic.

From the FULL TEXT Article:


Osteopathy and chiropractic are therapies of the musculoskeletal system: practitioners work with bones, muscles, and connective tissue, using their hands to diagnose and treat abnormalities of structure and function.

The best known technique is the “high velocity thrust,” a short, sharp motion usually applied to the spine. This maneuver is designed to release structures with a restricted range of movement. High velocity thrusts often produce the sound of joint “cracking,” which is associated with manipulative therapy. There are various methods of delivering a high velocity thrust. Chiropractors are more likely to push on vertebrae with their hands, whereas osteopaths tend use the limbs to make levered thrusts. That said, osteopathic and chiropractic techniques are converging, and much of their therapeutic repertoire is shared.

You may also enjoy the rest of:

BMJ’s   “ABC of Complementary Medicine” series


Bad is More Powerful Than Good: The Nocebo Response in Medical Consultations

By |February 28, 2018|Nocebo|

Bad is More Powerful Than Good: The Nocebo Response in Medical Consultations

The Chiro.Org Blog

SOURCE:   Am J Med. 2015 (Feb);   128 (2):   126–9

Maddy Greville-Harris, PhD, Paul Dieppe, MD

School of Psychology,
University of Southampton,
United Kingdom.

Although there has been a lot of research looking at the placebo response, nocebo responses in the healthcare setting have been largely overlooked. This article explores the potential role of negative patient-doctor communication in facilitating nocebo responses in the medical consultation. We suggest that invalidation, that is, communicating a lack of understanding and acceptance to the patient (albeit unintentionally), is a key factor in understanding the nocebo response. This article reviews evidence from the experimental and healthcare setting, which suggests that the negative effects of invalidation may be stronger than we think.

KEYWORDS:   Communicating understanding; Doctor–patient interaction; Health communication; Invalidation; Nocebo response; Placebo response; Validation

Much attention has been given to the so-called placebo response, that is, people getting better in response to sham or dummy treatments that contain no active ingredient. [1] The opposite nocebo response, that is, people getting worse in response to sham interventions, has also been recognized for a long time, but has resulted in less attention from health researchers, [2, 3] who often focus on the ethical concerns around knowingly inducing such responses. [4–6]

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The Problem with Placebos/Shams Page


The Use of Nutritional Guidance Within Chiropractic Patient Management

By |February 26, 2018|Nutrition|

The Use of Nutritional Guidance Within Chiropractic Patient Management: A Survey of 333 Chiropractors from the ACORN Practice-based Research Network

The Chiro.Org Blog

SOURCE:   Chiropractic & Manual Therapies 2018 (Feb 20); 26: 7

Mi Kyung Lee, Lyndon Amorin-Woods, Vincenzo Cascioli, and Jon Adams

School of Health Professions,
Murdoch University,
Perth, Australia.

BACKGROUND:   Food consumption and nutritional status affect an individual’s health throughout their life-course and an unhealthy diet is a major risk factor for the current global burden of chronic disease. The promotion of health and good nutrition through healthy eating requires the active involvement of all health professionals including chiropractors. This paper reports findings from the first nationally representative examination of the use of nutritional guidance within chiropractic patient management in Australia.

METHODS:   A sample of 1000 practising chiropractors was randomly selected from the Australian Chiropractic Research Network (ACORN) practice-based research network database for a cross-sectional study and 33% participated in the online survey in November 2016. The questionnaire, based on previous designs used in similar surveys and nutrition resources developed by the National Health and Medical Research Council, was pretested prior to the survey. Pearson’s Chi square and bivariate logistic regression were undertaken to explore relationships with variables of interest.

RESULTS:   The demographic details of the respondents are similar to those of the chiropractic workforce registered in Australia. Most chiropractors provided nutritional advice as part of their patient care and around a quarter provided specific dietary advice to their patients, including the use of nutrition supplements. Nutrition-related conditions most commonly encountered by the chiropractors were musculoskeletal, usually inflammatory in origin. Common nutritional assessment methods used included questioning patients to assess their nutritional and health status and physical appearance. Most of the participants provided nutritional resources to their patients in their clinics. However, the Australian Dietary Guidelines and the accompanying Australian Guide to Healthy Eating were not well utilised by the respondents. Australian chiropractors often referred patients with nutrition issues to qualified dietitians and other health professionals when deemed necessary.

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Nutrition Section