Biomechanics Research Laboratory,
Department of Orthopaedics and Rehabilitation,
Yale University School of Medicine,
New Haven, CT 06520-8071, USA.
Clinical reports and research studies have documented the behavior of chronic low back and neck pain patients. A few hypotheses have attempted to explain these varied clinical and research findings. A new hypothesis, based upon the concept that subfailure injuries of ligaments (spinal ligaments, disc annulus and facet capsules) may cause chronic back pain due to muscle control dysfunction, is presented. The hypothesis has the following sequential steps. Single trauma or cumulative microtrauma causes subfailure injuries of the ligaments and embedded mechanoreceptors. The injured mechanoreceptors generate corrupted transducer signals, which lead to corrupted muscle response pattern produced by the neuromuscular control unit.
Muscle coordination and individual muscle force characteristics, i.e. onset, magnitude, and shut-off, are disrupted. This results in abnormal stresses and strains in the ligaments, mechanoreceptors and muscles, and excessive loading of the facet joints. Due to inherently poor healing of spinal ligaments, accelerated degeneration of disc and facet joints may occur. The abnormal conditions may persist, and, over time, may lead to chronic back pain via inflammation of neural tissues. The hypothesis explains many of the clinical observations and research findings about the back pain patients. The hypothesis may help in a better understanding of chronic low back and neck pain patients, and in improved clinical management.
Physicians are frequently confronted with patients complaining of fatigue, tiredness and low energy levels. In the absence of underlying disease, these symptoms could be caused by a lack of vitamins and minerals. Certain risk groups like the elderly and pregnant women are well-recognized. Our aim was, therefore, to find out if other, less well-established groups might also be at risk.
Thus, the objectives of this review are: to describe the inter-relationship between micronutrients, energy metabolism and well-being; identify risk groups for inadequate micronutrient intake; and explore the role of micronutrient supplementation in these groups. A review of the literature identified an important group at risk of inadequate micronutrient intake: young adults, often women, with a demanding lifestyle who are physically active and whose dietary behaviour is characterized by poor choices and/or regular dieting. Micronutrient supplementation can alleviate deficiencies, but supplements must be taken for an adequate period of time.
From the FULL TEXT Article:
Every doctor is familior wi1b the patient who presents complaining of a lack of energy. tiredness and exhaustion, and for whom thorough examination and even routine laboratory tests do not provide a satisfactory explanation for their symptoms. Without any underlying diseases, might these symptoms be caused by a lack of vitamins and minerals?
Tyler J. Lane, Rebbecca Lilley, Sheilah Hogg-Johnson, Anthony D. LaMontagne, Malcolm R. Sim, Peter M. Smith
Department of Epidemiology and Preventive Medicine,
School of Public Health and Preventive Medicine,
Monash University, Level 2,
553 St Kilda Road,
Melbourne, VIC, 3004, Australia.
Purpose To assess the impact of workplace-based return-to-work (RTW) Coordinators’ interpersonal and functional activities on RTW outcomes.
Methods Multivariable logistic regression analyses of cross-sectional and longitudinal survey responses of 632 injured workers with at least 10 days of work absence in Victoria, Australia, adjusting for demographic and other workplace factors. Outcome was being back at work for at least 1 month, measured at both baseline and 6 month follow-up survey. Participant responses to stressfulness of Coordinator interactions were dichotomised into good and poor and evaluated as a proxy for Coordinators’ interpersonal activities, while having a RTW plan was evaluated as a proxy for functional activities.
Results At baseline, RTW plans doubled the odds of RTW (OR 2.02; 95% CI 1.40-2.90) and attenuated the impact of good Coordinator interactions (1.14; 0.77-1.70). At 6-month follow-up, the opposite was observed: good interactions nearly doubled odds of RTW (1.90; 1.22-2.95) while RTW plans were non-significant (1.02; 0.68-1.54).
Simon D. French, Aron S. Downie and Bruce F. Walker
Department of Chiropractic,
Faculty of Science and Engineering,
An important series of papers have been published in the Lancet. These papers provide a comprehensive update for the major global problem of low back pain, and the challenges that low back pain presents to healthcare practitioners and policy makers. Chiropractors are well placed to reduce the burden of low back pain, but not all that chiropractors do is supported by robust, contemporary evidence. This commentary summarises the Lancet articles. We also make suggestions for how the chiropractic profession should most effectively help people with low back pain by implementing practices supported by high quality evidence.
From the Full-Text Article
Low back pain is a major global problem and it is getting worse.  An important series of articles in the journal Lancet, authored by world leading authorities on low back pain evidence, has drawn international attention to how enormous the problem is. The Lancet authors also discussed how low back pain is being poorly managed by healthcare systems around the globe, including emerging issues in low and middle-income countries. [2–4] This commentary will summarise the main findings of these Lancet papers, and provide some suggestions for how the chiropractic profession should respond to the global challenge that is low back pain.
Stacie A. Salsbury, Robert D. Vining, Donna Gosselin and Christine M. Goertz
Palmer Center for Chiropractic Research,
Palmer College of Chiropractic,
Background While chiropractors are integrating into multidisciplinary settings with increasing frequency, the perceptions of medical providers and patients toward adding chiropractors to existing healthcare teams is not well-understood. This study explored the qualities preferred in a chiropractor by key stakeholders in a neurorehabilitation setting.
Methods This qualitative analysis was part of a multi-phase, organizational case study designed to evaluate the planned integration of a chiropractor into a multidisciplinary rehabilitation team. The setting was a 62–bed rehabilitation specialty hospital located in the northeastern United States. Participants included patients, families, community members, and professional staff of the administrative, medical, nursing, and therapy departments. Data collection consisted of audiotaped, individual interviews and profession-specific focus groups guided by a semi-structured interview schedule. Transcripts were imported into a qualitative data analysis program for data analysis. An iterative coding process using thematic content analysis categorized key themes and domains.
Results Sixty participants were interviewed in June 2015, including 48 staff members, 6 patients, 4 family members, and 2 community members. Our analysis generated a conceptual model of The Preferred Chiropractor for Multidisciplinary Rehabilitation Settings composed of 5 domains and 13 themes. The domain, Patient-Centeredness, or the provision of healthcare that is respectful, responsive, and inclusive of the patient’s values, preferences, and needs, was mentioned in all interviews and linked to all other themes. The Professional Qualities domain highlighted clinical acumen, efficacious treatment, and being a safe practitioner. Interpersonal Qualities encouraged chiropractors to offer patients their comforting patience, familiar connections, and emotional intelligence. Interprofessional Qualities emphasized teamwork, resourcefulness, and openness to feedback as characteristics to enhance the chiropractor’s ability to work within an interdisciplinary setting. Organizational Qualities, including personality fit, institutional compliance, and mission alignment were important attributes for working in a specific healthcare organization.
Michael J. Garner, MSc, Michael Birmingham, PhD, Peter Aker, MSc, DC, David Moher, PhD,
Jeff Balon, DC, MD, Dirk Keenan, DC, and Pran Manga, PhD
Carlington Community and Health Services,
Ottawa, Ontario, Canada.
BACKGROUND: The use of complementary and alternative medicine has been increasing in Canada despite the lack of coverage under the universal public health insurance system. Physicians and other healthcare practitioners are now being placed in multidisciplinary teams, yet little research on integration exists.
OBJECTIVE: We sought to investigate the effect of integrating chiropractic on the attitudes of providers on two healthcare teams.
DESIGN: A mixed methods design with both quantitative and qualitative components was used to assess the healthcare teams. Assessment occurred prior to integration, at midstudy, and at the end of the study (18 months).
SETTING: Multidisciplinary healthcare teams at two community health centers in Ottawa, Ontario, participated in the study.
PATIENTS/PARTICIPANTS: All physicians, nurse practitioners, and degree-trained nurses employed at two study sites were approached to take part in the study.
INTERVENTION: A chiropractor was introduced into each of the two healthcare teams.
MAIN OUTCOME MEASURES: A quantitative questionnaire assessed providers’ opinions, experiences with collaboration, and perceptions of chiropractic care. Focus groups were used to encourage providers to communicate their experiences and perceptions of the integration and of chiropractic.
RESULTS: Twelve providers were followed for the full 18 months of integration. The providers expressed increased willingness to trust the chiropractors in shared care (F value = 7.18; P = .004). Questions regarding the legitimacy (F value = 12.33; P < .001) and effectiveness (F value = 11.17; P < .001) of chiropractic became increasingly positive by study end.