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.  The cerebellum is known to undergo neuroplastic changes following motor training and is responsible for modulation of motor circuitry.  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 , which allows corrections to be made prior to the time physically needed to receive sensory feedback from distal sources such as the hand. 
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.
School of Psychology,
University of Southampton,
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.
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.  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]
Mi Kyung Lee, Lyndon Amorin-Woods, Vincenzo Cascioli, and Jon Adams
School of Health Professions,
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.
To see if you’re bending correctly, try a simple experiment.
“Stand up and put your hands on your waist,” says Jean Couch, who has been helping people get out of back pain for 25 years at her studio in Palo Alto, Calif.
“Now imagine I’ve dropped a feather in front of your feet and asked to pick it up,” Couch says. “Usually everybody immediately moves their heads and looks down.”
That little look down bends your spine and triggers your stomach to do a little crunch. “You’ve already started to bend incorrectly — at your waist,” Couch says. “Almost everyone in the U.S. bends at the stomach.”
In the process, our backs curve into the letter “C” — or, as Couch says, “We all look like really folded cashews.”
In other words, when we bend over in the U.S., most of us look like nuts!
But in many parts of the world, people don’t look like cashews when they bend over. Instead, you see something very different.
I first noticed this mysterious bending style back in 2014 while covering the Ebola outbreak. We were driving on a back road in the rainforest of Liberia and every now and then, we would pass women working in their gardens. The women had striking silhouettes: They were bent over with their backs nearly straight. But they weren’t squatting with a vertical back. Instead, their backs were parallel to the ground. They looked like tables.
After returning home, I started seeing this “table” bending in photos all around the world — an older woman planting rice in Madagascar, a Mayan woman bending over at a market in Guatemala and women farming grass in northern India. This bending seemed to be common in many places, except in Western societies.
“The anthropologists have noted exactly what you’re saying for years,” says Stuart McGill, at the University of Waterloo in Ontario, Canada, who has been studying the biomechanics of the spine for more than three decades.
“It’s called hip hinging,” McGill says. “And I’ve spent my career trying to prove it’s a better way of bending than what we do.” (more…)
ACA has recently heard from members in a few states that some Blue Cross Blue Shield plans are automatically denying claims that contain the -25 and -59 modifiers. The states we have heard from to date include Illinois, Oklahoma and Texas. The Blues plans in these states are owned by Health Care Service Corporation (HCSC), an umbrella company that also owns the Blues plans in Montana and New Mexico.
ACA has since learned that during the fall, HCSC instituted a code-auditing enhancement to its claims system to “improve auditing of professional and outpatient facility claims that are submitted… by clinically validating modifiers submitted on such claims.” For many chiropractic clinics, this means E/M codes and CPT code 97140 (as well as a few others) may automatically be denied. However, it is important to note that this is not occurring only with chiropractic claims – the code-auditing enhancement applies to all claims with the specified modifiers submitted by any health care professional or outpatient facility.
In some cases, the denials state the modifiers are used inappropriately. In other cases, providers have received letters stating their utilization of the modifier is higher than average. In either case, ACA recommends that chiropractors who receive a denial based on the -25 and/or -59 modifiers appeal the denials if they feel their usage of the modifiers is appropriate.
Before submitting the appeal, review the claim to ensure the modifiers were used appropriately. For example, modifier -25 should be appended to E/M codes performed on the same date as CMT, “if the patient’s condition requires a separately identifiable E/M service, above and beyond the usual pre-service and post-service work associated with the procedure.”
Some specific examples of when it is appropriate to bill for both a CMT and E/M code on the same date of service are: