October 2017
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Recommendations to the Musculoskeletal Health Network

Chiro.Org Blog: The preparedness of the musculoskeletal professions for providing appropriate care is demonstrated by the development of care algorithms based on the current best-available research evidence. [51] Such algorithms would help healthcare gate-keepers, such as GPs, to steer suitable patients towards early access and appropriate treatment for their back pain, with a view to reduce morbidity and prevent chronicity. An algorithm, such as the one proposed by Baker et al (2012) requires little modification to conform to Western Australian requirements and can be used in various professional contexts. The chiropractic profession, for example, has also developed a consensus-led definition and approach to wellness/wellbeing care that would act as a model to facilitate to correct management and treatment of non-malignant back pain within a multidisciplinary context. In fact, musculoskeletal clinicians, such as chiropractors, already implement the majority of the health promotion and wellness/wellbeing strategies recommended in both the SPMoC (2009) and the Western Australian Health Promotion Strategic Framework 2012–2016 with their private patients. [52] The same would easily translate to the public healthcare system and be used by other musculoskeletal clinicians. […]

Effectiveness of Manual Therapy for Chronic Tension-type Headache

Chiro.Org Blog: We performed a pragmatic, randomised clinical trial to evaluate the effect of manual therapy compared to usual care by the general practitioner. Based on this trial, we conclude that manual therapy provides an effective intervention for patients with chronic tension-type headache (CTTH) and, thereby, an effective option for referral for the general practitioner. […]

Amount of Health Care and Self-care Following a Randomized Clinical Trial Comparing Flexion-distraction with Exercise Program for Chronic Low Back Pain

Chiro.Org Blog: Participants in the physical therapy group demonstrated on average significantly more visits to any health care provider and to a general practitioner during the year after trial care (p < 0.05). No group differences were noted in the number of visits to a chiropractor or physical therapist. Self-care was initiated by nearly every participant in both groups.   During a one-year follow-up, participants previously randomized to physical therapy attended significantly more health care visits than those participants who received chiropractic care. […]

The Reduction of Asthma Symptoms and Medication After Chiropractic Care

Chiro.Org Blog: This case study of a 5-year-old male with asthma following chiropractic treatment suggests that his asthma symptoms were reduced and controlled with chiropractic care. The quick and sudden change following chiropractic treatment eliminates natural history, which is seen sometimes in the allergenic type asthma cases where children outgrow the asthma. He was able to reduce the use of medications and demonstrate that chiropractic care reduced the chances of the symptoms worsening during episodes of exacerbation. Further investigation is warranted. […]

Chiropractic Management of a Patient With Neck-Tongue Syndrome

Chiro.Org Blog: Neck-tongue syndrome (NTS) presents with unilateral upper neck or occipital pain and altered sensation in the ipsilateral half of the tongue that is aggravated by neck movement. [1] The prevalence of NTS in adults is estimated to be 2.2 individuals out of 1,000. [2] The paper that reported this figure was based on examination of 1,838 individuals aged 18–64 and not on individuals who sought care. The number of patients seeking care for NTS is likely to be lower than 2.2 out of 1,000. The low number of case studies reported in the literature (approximately 50 cases involving individuals aged 6–65 years have been described in the literature [3]) and the lack of mention of the syndrome in common orthopedic texts attest to this. […]

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). […]

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. […]

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

Chiro.Org Blog: About two of every three people will probably experience significant low back pain at some point. A physician like me might suggest any number of potential treatments and therapies. But one I never considered was a referral for spinal manipulation. It appears I may have been mistaken. For initial treatment of lower back pain, it may be time for me (and other physicians) to rethink our biases. […]

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. […]

A Qualitative Study of Changes in Expectations Over Time Among Patients with Chronic Low Back Pain Seeking Four CAM Therapies

Chiro.Org Blog: Participants seeking one of four CAM therapies focused most of their expectations and hopes during initial interviews on whether or not the treatment could lessen their pain. In later interviews, where self-care was included in the interview guide, emphasis tended to be broader, shifting from needing to be “fixed” to an emphasis on the body as a work in progress, in need of ongoing attention and care from both the patient and the CAM practitioner. This trend toward attention to management, self-care and wellness, and increased acceptance of pain as chronic, was reported by participants seeking all four therapies. We also noted that this overall shift over time was evaluated in various ways by participants, depending on how they were able to orient their sense of self and understanding of illness toward ongoing management and engagement. […]

Characteristics of Chiropractic Practitioners, Patients, and Encounters in Massachusetts and Arizona

Chiro.Org Blog: Data for 2,550 chiropractic patient visits were recorded. Care for low back, head and neck pain accounted for almost three quarters of visits. Extremity conditions and wellness care accounted for approximately half of the remaining visits. Spinal and soft tissue examinations were the most frequently reported diagnostic procedures (80% and 56% of visits, respectively), and high-velocity spinal manipulation techniques were the most frequently reported therapeutic procedures (almost 85% of visits). Rehabilitation exercises, thermal modalities, electric stimulation, and counseling/education/self-care were each performed during approximately 25% of visits. Approximately 85% of patients seen were self-referred, whereas only approximately 5% came from medical physicians. Approximately 35% of visits had an expected source of payment directly from the patient. Approximately 80% of visits ended with a plan for the patient to return at a specified time. […]

Do Older Adults with Chronic Low Back Pain Differ from Younger Adults in Regards to Baseline Characteristics and Prognosis?

Chiro.Org Blog: A total of 14,479 participants were included in the study. Of these 3,087 (21%) patients were older adults, 6,071 (42%) were middle aged and 5,321 (37%) were young adults. At presentation older adults were statistically different to the middle aged and younger adults for most characteristics measured (e.g. less intense back pain, more leg pain and more depression); however, the differences were small. The change in pain and disability over 12 months did not differ between age groups. […]