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Clinical Examination Findings as Prognostic Factors in Low Back Pain

Clinical Examination Findings as Prognostic Factors in Low Back Pain: A Systematic Review of the Literature

The Chiro.Org Blog


SOURCE:   Chiropractic & Manual Therapies 2015 (Mar 23); 23: 13

Lisbeth Hartvigsen, Alice Kongsted, and Lise Hestbaek

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


BACKGROUND:   There is a strong tradition of performing a clinical examination of low back pain (LBP) patients and this is generally recommended in guidelines. However, establishing a pathoanatomic diagnosis does not seem possible in most LBP patients and clinical tests may potentially be more relevant as prognostic factors. The aim of this review of the literature was to systematically assess the association between low-tech clinical tests commonly used in adult patients with acute, recurrent or chronic LBP and short- and long-term outcome.

METHODS:   MEDLINE, Embase, and MANTIS were searched from inception to June 2012. Prospective clinical studies of adult patients with LBP with or without leg pain and/or signs of nerve root involvement or spinal stenosis, receiving non-surgical or no treatment, which investigated the association between low-tech clinical tests and outcome were included. Study selection, data extraction and appraisal of study quality were performed independently by two reviewers.

RESULTS:   A total of 5,332 citations were retrieved and screened for eligibility, 342 articles were assessed as full text and 49 met the inclusion criteria. Due to clinical and statistical heterogeneity, qualitative synthesis rather than meta-analysis was performed. Associations between clinical tests and outcomes were often inconsistent between studies. In more than one third of the tests, there was no evidence of the tests being associated with outcome. Only two clinical tests demonstrated a consistent association with at least one of the outcomes: centralization and non-organic signs.

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Happy Thanksgiving (2017)

Happy Thanksgiving (2017)

The Chiro.Org Blog


All of us at Chiro.Org want to wish our readers and friends
a very happy Thanksgiving.


JFK’s assassination aided by his bad back, records show

Source CNN

Every November the United States remembers Camelot: a shining time of promise led by John F. Kennedy, the nation’s youngest president brought to an abrupt and bloody end on this day in 1963. While conspiracy theorists debate who pulled the trigger, there’s another culprit that often goes unmentioned: Kennedy’s lifelong struggle with back pain.

It was his habit of wearing a tightly laced back brace that may have kept him from recoiling to the floor of his car after the assassin’s first bullet struck him in the neck.

“The brace was a firmly bound corset, around his hips and lower back and higher up,” said Dr. Thomas Pait, a spinal neurosurgeon who co-authored a paper about Kennedy’s failed back surgeries and other treatments such as manipulation under anesthesia.  “He tightly laced it and put a wide Ace bandage around in a figure eight around his trunk. If you think about it, if you have that brace all the way up your chest, above your nipples, and real tight, are you going to be able to bend forward?”

Read more on the CNN website.

The Infant with Dysfunctional Feeding Patterns

The Infant with Dysfunctional Feeding Patterns –
The Chiropractic Assessment

The Chiro.Org Blog


SOURCE:   J Clin Chiropractic Pediatrics 2016 (May);   15 (2)

Sharon Vallone, DC, FICCP and
Faraneh Carnegie-Hargreaves, DC

Private practice,
South Windsor,
Connecticut, USA


The World Health Organization recommends exclusive breastfeeding for the first 6 months of an infant’s life, followed by the introduction of complementary foods while breastfeeding for 2 years and beyond. Early and consistent breastfeeding support can often make the difference in a dyad’s ability to establish a functional breastfeeding relationship. While challenged dyads can sometimes accomplish competent breastfeeding given appropriate support, necessary interventions, and an opportunity to learn; timing is critical when a neonate has not been transferring adequate milk volume or is managing feeding in a passive or compensatory manner.

Chiropractors should be most familiar with the diagnosis and treatment of musculoskeletal dysfunctions that could result in an inability to feed. They should also recognize and treat the compensatory changes that will develop in a healthy, neurotypical neonate who is challenged by an inability to feed efficiently in order to prevent the evolution of long term physiologic and postural ramifications.

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Evaluation and Treatment of Breastfeeding Difficulties Associated with Cervicocranial Dysfunction

Evaluation and Treatment of Breastfeeding Difficulties Associated with Cervicocranial Dysfunction:
A Chiropractic Perspective

The Chiro.Org Blog


SOURCE:   J Clin Chiropractic Pediatrics 2016 (Dec); 15 (3): 1301

Sharon Vallone, DC, FICCP

Private Practice,
KIDSPACE Adaptive Play and Wellness,
South Windsor, Connecticut, USA


Increasingly, parents are presenting to the chiropractic office with the chief complaint of breastfeeding dysfunction. Early and consistent breastfeeding support is paramount to the dyad’s ability to establish a functional breastfeeding relationship. It is critical that chiropractors treating this population recognize feeding dysfunction and understand the mechanics of breastfeeding, what might alter those mechanics, and the importance of the role of the International Board Certified Lactation Consultant (IBCLC) in supporting the restoration of functional breastfeeding after the chiropractic adjustments have reduced the neuromusculoskeletal (NMSK) dysfunction. This paper outlines some of the mechanical dysfunctions that might interfere with the normal transfer of milk for a neonate.

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Prevalence of Musculoskeletal Dysfunction in Infants Presenting for Chiropractic Care in Norway

Prevalence of Musculoskeletal Dysfunction in Infants Presenting for Chiropractic Care in Norway: A Cross-sectional Study

The Chiro.Org Blog


SOURCE:   J Clin Chiropractic Pediatrics 2017 (Sep); 16(1): 1355

Catherin Alvestad Slettebo, DC, MSc, Joyce E. Miller, DC, PhD

AECC University,
Bournemouth, UK


Background:   Musculoskeletal (MSK) injuries are common though considered under-recognized at birth. There are no gold standard routines for examination of the musculoskeletal system in infants, and very little research that investigates clinical examination and MSK findings in infants under the age of six months.

Objectives:   The objectives were to determine the prevalence of neck dysfunction, postural spine problems, and their possible association with parent reported behavioral problems such as suboptimal breastfeeding and supine sleeping in infants younger than six months of age. The aim of this study was to observe any associations between MSK problems of infancy and common behavioral and public health issues. Methods: This is a cross sectional questionnaire based observational study in a clinical population. Mothers of infants presented to chiropractic clinics in Norway filled in a questionnaire on the first visit, and this was followed by a clinical examination and questionnaire completed by the Doctors of Chiropractic on the same day.

Results:   In total, 90 infants enrolled in the study. A total of 56 infants (66%) had postural problems. Favorite side of cervical rotation (N=41; 75%) was the most common dysfunction in supine lying. Neck hyperextension was present in 21 infants (38%). The inability to rotate their head equally side to side was present in 49 children (54%). In total 22 (24%) of the infants did not have the ability to sleep or lie comfortably supine. Suboptimal breastfeeding was reported by 22 (25%) parents, and 10 (12%) of the mothers reported pain during feeding. TMJ imbalance was identified in 16 infants (19%). There were statistically significant associations between suboptimal breastfeeding and TMJ imbalance, suboptimal rooting/sucking reflexes, inability to turn head and neck equally and painful breastfeeding, respectively.

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Chiropractic Management of Infantile Torticollis With Associated Abnormal Fixation of One Eye

Chiropractic Management of Infantile Torticollis With Associated Abnormal Fixation of One Eye: A Case Report

The Chiro.Org Blog


SOURCE:   J Chiropr Med 2015 (Mar); 14 (1): 51-56

Mette Hobaek Siegenthaler, DC, MSc

Holbeinpraxis,
Swiss Academy for Chiropractic,
Berne, Switzerland.


OBJECTIVE:   The purpose of this case report is to describe the chiropractic management of a child with abnormal fixation of one eye and torticollis.

CLINICAL FEATURES:   A mother presented with a concern regarding her 23-month-old son who had a history of torticollis and an abnormal fixation of the right eye. She noticed the head tilt when he was about 7 months old and abnormal alignment of the right eye when the boy was 18 months old. At 15 months when he took his first steps, his head tilt became worse. At 21 months old, a neurological and orthopedic examination at the regional university children`s hospital ruled out presence of a tumor of the cervical spine or posterior fossa. The orthopedist sent the baby for chiropractic evaluation and treatment. Chiropractic exam found decreased active and passive range of motion in the cervical spine and no evidence of mass or contracture of the sternocleidomastoid muscle. Segmental palpation showed a decreased joint play and pain reaction at level C1/C2 on the right.

INTERVENTION AND OUTCOME:   The chiropractic treatment consisted of spinal manipulative therapy of the cervical spine in addition to massage and stretching of the neck muscles. Within a period of 4 weeks (3 chiropractic treatments) the torticollis was nearly resolved and the abnormal fixation of the right eye was no longer apparent. No relapse of the symptomatology was observed at a follow-up consultation at 26 months.

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Pediatric Patients in Swiss Chiropractic Clinics

Pediatric Patients in Swiss Chiropractic Clinics:
A Questionnaire Survey

The Chiro.Org Blog


SOURCE:   J Manipulative Physiol Ther. 2017 (Oct 24) [Epub]

Mette Hobaek Siegenthaler, DC, MSc

Holbeinpraxis,
Swiss Academy for Chiropractic,
Berne, Switzerland


OBJECTIVES:   The purpose of this study was to investigate practice characteristics of chiropractors who treat pediatric patients in Swiss chiropractic clinics.

METHODS:   An online survey questionnaire was created and tested for face and content validity. Participation by Swiss chiropractors was voluntary and anonymous and completed November to December 2015. The data were analyzed using SPSS. The analysis consisted of descriptive statistics.

RESULTS:   The sample consisted of 144 chiropractors, which represented a 53% response rate, and 98% of the responding practitioners treated patients younger than age 18. The proportion of pediatric patients treated was 8.7%. The most common pediatric age groups were schoolchildren and adolescents, with infants younger than 6 months being the third most common. Musculoskeletal complaints were the most common conditions treated in all age groups. In children younger than 2 years old, nonmusculoskeletal conditions were well represented. Prophylactic examination was common among children 6 years and younger.

A total of 61% of responding chiropractors received direct referrals from medical doctors and 56% received direct referrals from pediatricians. The most common age groups for referrals from pediatricians were schoolchildren and adolescents. Only 15% of the chiropractors wrote reports about their pediatric patients to their pediatrician often or regularly; 90% of the responding chiropractors stated they rarely or never refer to a pediatric specialist, and 80% of the chiropractors have never or have rarely been invited to attend medical congresses or to teach the pediatric health care community about chiropractic care for children.

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Conservative Care of Pediatric Acquired Torticollis: A Report of 2 Cases

Conservative Care of Pediatric Acquired Torticollis:
A Report of 2 Cases

The Chiro.Org Blog


SOURCE:   J Chiropr Med. 2017 (Sep);   16 (3):   252-256

Morgan D. Young, DC, Jessie L. Young, DC

Research Department,
Palmer College of Chiropractic West,
San Jose, California.


OBJECTIVE:   The purpose of this case report is to describe the conservative management of 2 cases of acquired torticollis in children under 3 years of age.

CLINICAL FEATURES:   Both patients awoke with painful, stiff, twisted necks the day after play in a bouncy house. Range of motion was limited, and hypertonic muscles were palpated. Their neurologic and physical evaluation was consistent with a diagnosis of acquired torticollis of musculoskeletal origin.

INTERVENTION AND OUTCOMES:   Both children were treated with chiropractic care that consisted of light myofascial release, use of an Activator instrument, and home stretching. Patients improved in pain and range of motion immediately posttreatment and returned to normal ranges in 1 or 2 visits.

Continue reading Conservative Care of Pediatric Acquired Torticollis: A Report of 2 Cases

Unresolved Congenital Torticollis and Its Consequences: A Report of 2 Cases

Unresolved Congenital Torticollis and Its Consequences: A Report of 2 Cases

The Chiro.Org Blog


SOURCE:   J Chiropr Med. 2017 (Sep);   16 (3):   257-261

Mette Hobaek Siegenthaler, DC, MSc

Holbeinpraxis,
Swiss Academy for Chiropractic,
Berne, Switzerland.


OBJECTIVE:   The purpose of this report was to describe the clinical presentation and case management of 2 children with congenital torticollis.

CLINICAL FEATURES:   Two male children (ages 6 and 10 years) presented to a chiropractic clinic with a history of congenital torticollis. They showed signs and symptoms of postural deficiency and developmental delay: posterior plagiocephaly, facial scoliosis, head tilt, compensatory thoracic scoliosis, decreased range of motion in the cervical spine, palpable decreased segmental motion of the upper cervical spine, and an age-related delay in throwing and catching a ball and in one-leg standing.

INTERVENTION AND OUTCOME:   Both children received chiropractic care (spinal manipulative therapy) and physical therapy (therapeutic exercises, including neck, back, and coordination exercises). Each patient responded favorably with improvement in both structural (posture) and functional (range of motion of the spine and coordination) deficits.

Continue reading Unresolved Congenital Torticollis and Its Consequences: A Report of 2 Cases

Military Report More Complementary and Alternative Medicine Use Than Civilians

Military Report More Complementary and Alternative Medicine Use Than Civilians

The Chiro.Org Blog


SOURCE:   J Altern Complement Med. 2013 (Jun); 19 (6): 509–517

Christine Goertz, DC, PhD, Bernadette P. Marriott, PhD,
Michael D. Finch, PhD, Robert M. Bray, PhD,
Thomas V. Williams, PhD, Laurel L. Hourani, PhD,
Louise S. Hadden, BA, Heather L. Colleran, PhD,
and Wayne B. Jonas, MD

Palmer College of Chiropractic,
Davenport, IA 52803, USA.


OBJECTIVES:   The study objective was to estimate complementary and alternative medicine (CAM) use among active duty military and compare data with civilian use.

DESIGN:   A global survey on CAM use in the 12 previous months was conducted. Final participants (16,146) were stratified by gender, service, region, and pay grade. Analysis included prevalence of CAM use, demographic and lifestyle characteristics.

RESULTS:   Approximately 45% of respondents reported using at least one type of CAM therapy. Most commonly used therapies were as follows: prayer for one’s own health (24.4%), massage therapy (14.1%), and relaxation techniques (10.8%). After exclusion of prayer for one’s own health, adjusting to the 2000 U.S. census, overall CAM use in the military (44.5%) was higher than that in comparable civilian surveys (36.0% and 38.3%).

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Regular Use of Medication for Musculoskeletal Pain and Risk of Long-term Sickness Absence

Regular Use of Medication for Musculoskeletal Pain and Risk of Long-term Sickness Absence: A Prospective Cohort Study Among the General Working Population

The Chiro.Org Blog


SOURCE:   Eur J Pain. 2017 (Feb); 21 (2): 366–373

E. Sundstrup, M.D. Jakobsen, S.V. Thorsen, L.L. Andersen

National Research Centre for the Working Environment,
Copenhagen, Denmark.

Physical Activity and Human Performance group, SMI,
Department of Health Science and Technology,
Aalborg University, Denmark.


BACKGROUND:   The aim was to determine the prospective association between use of pain medication – due to musculoskeletal pain in the low back, neck/shoulder and hand/wrist – and long-term sickness absence.

METHODS:   Cox-regression analysis was performed to estimate the prospective association between regular use of pain medication and long-term sickness absence (LTSA; at least 6 consecutive weeks) among 9,544 employees from the general working population (Danish Work Environment Cohort Study 2010) and free from LTSA during 2009-2010. The fully adjusted model was controlled for age, gender, body mass index, smoking, leisure physical activity, job group, physical activity at work, psychosocial work environment, pain intensity, mental health and chronic disease.

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Use of Integrative Medicine in the
United States Military Health System

Use of Integrative Medicine in the
United States Military Health System

The Chiro.Org Blog


SOURCE:   Evid Based Comp Alternat Med. 2017 (Jun 13)

Cathaleen Madsen, Megan Vaughan, and
Tracey Pérez Koehlmoos

Uniformed Services University of the Health Sciences,
Bethesda, MD, USA.


Integrative medicine (IM) is a model of care which uses both conventional and nonconventional therapies in a “whole person” approach to achieve optimum mental, physical, emotional, spiritual, and environmental health, and is increasingly popular among patients and providers seeking to relieve chronic or multifactorial conditions. The US Department of Defense (DoD) shows particular interest in and usage of IM for managing chronic conditions including the signature “polytrauma triad” of chronic pain, traumatic brain injury (TBI), and posttraumatic stress disorder (PTSD) among its beneficiaries in the Military Health System (MHS).

These modalities range from conventional nondrug, nonsurgical options such as cognitive-behavioral therapy to nonconventional options such as acupuncture, chiropractic, and mind-body techniques. These are of particular interest for their potential to relieve symptoms without relying on opiates, which impair performance and show high potential for abuse while often failing to provide full relief.

This review describes the use of IM in the MHS, including definitions of the model, common therapies and potential for use, and controversy surrounding the practice. More research is needed to build a comprehensive usage analysis, which in turn will inform sound clinical and financial practice for the MHS and its beneficiaries.


From the FULL TEXT Article:

Introduction

Integrative medicine (IM) is a current healthcare paradigm which promotes a “whole person” approach to health through coordinated use of appropriate therapies originating both inside and outside of conventional medicine. Though often conflated with complementary and alternative medicine (CAM), changes in the definition of these terms make this conflation technically inaccurate.

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United States Military Health System

Provider and Patient Perspectives on Opioids and Alternative Treatments for Managing Chronic Pain

Provider and Patient Perspectives on Opioids and Alternative Treatments for Managing Chronic Pain:
A Qualitative Study

The Chiro.Org Blog


SOURCE:   BMC Fam Pract. 2017 (Mar 24); 17 (1): 164

Lauren S. Penney, Cheryl Ritenbaugh, Lynn L. DeBar,
Charles Elder and Richard A. Deyo

South Texas Veterans Health Care System,
7400 Merton Minter Blvd,
San Antonio, TX, 78229, USA


BACKGROUND:   Current literature describes the limits and pitfalls of using opioid pharmacotherapy for chronic pain and the importance of identifying alternatives. The objective of this study was to identify the practical issues patients and providers face when accessing alternatives to opioids, and how multiple parties view these issues.

METHODS:   Qualitative data were gathered to evaluate the outcomes of acupuncture and chiropractic (A/C) services for chronic musculoskeletal pain (CMP) using structured interview guides among patients with CMP (n = 90) and primary care providers (PCPs) (n = 25) purposively sampled from a managed care health care system as well as from contracted community A/C providers (n = 14). Focus groups and interviews were conducted patients with CMP with varying histories of A/C use. Plan PCPs and contracted A/C providers took part in individual interviews. All participants were asked about their experiences managing chronic pain and experience with and/or attitudes about A/C treatment. Audio recordings were transcribed and thematically coded. A summarized version of the focus group/interview guides is included in the Additional file 1.

RESULTS:   We identified four themes around opioid use:

(1)   attitudes toward use of opioids to manage chronic pain;

(2)   the limited alternative options for chronic pain management;

(3)   the potential of acupuncture and chiropractic (A/C) care as a tool to help manage pain; and

(4)   the complex system around chronic pain management.

Despite widespread dissatisfaction with opioid medications for pain management, many practical barriers challenged access to other options. Most of the participants’ perceived A/C care as helpful for short term pain relief. We identified that problems with timing, expectations, and plan coverage limited A/C care potential for pain relief treatment.

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Chiropractic and Spinal Pain Management

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The Amazing Halloween Costume

The Amazing Halloween Costume

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