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Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain

Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians

The Chiro.Org Blog


SOURCE:   Ann Intern Med. 2017 (Feb 14) [Epub] ~ FULL TEXT

Amir Qaseem, MD, PhD, MHA; Timothy J. Wilt, MD, MPH;
Robert M. McLean, MD; Mary Ann Forciea, MD;
for the Clinical Guidelines Committee of the American College of Physicians (*)

From the American College of Physicians
and Penn Health System,
Philadelphia, Pennsylvania;
Minneapolis Veterans Affairs Medical Center,
Minneapolis, Minnesota; and
Yale School of Medicine,
New Haven, Connecticut.


The American College of Physicians (ACP) released updated guidelines this week that recommend the use of noninvasive, non-drug treatments for low back pain before resorting to drug therapies, which were found to have limited benefits. One of the non-drug options cited by ACP is spinal manipulation.

Chiropractors, who diagnose and treat musculoskeletal disorders, are experts in spinal manipulation.

DESCRIPTION: &nbsp The American College of Physicians (ACP) developed this guideline to present the evidence and provide clinical recommendations on noninvasive treatment of low back pain.

METHODS: &nbsp Using the ACP grading system, the committee based these recommendations on a systematic review of randomized, controlled trials and systematic reviews published through April 2015 on noninvasive pharmacologic and nonpharmacologic treatments for low back pain. Updated searches were performed through November 2016. Clinical outcomes evaluated included reduction or elimination of low back pain, improvement in back-specific and overall function, improvement in health-related quality of life, reduction in work disability and return to work, global improvement, number of back pain episodes or time between episodes, patient satisfaction, and adverse effects.

TARGET AUDIENCE AND PATIENT POPULATION: &nbsp The target audience for this guideline includes all clinicians, and the target patient population includes adults with acute, subacute, or chronic low back pain.

RECOMMENDATION 1:   Given that most patients with acute or subacute low back pain improve over time regardless of treatment, clinicians and patients should select nonpharmacologic treatment with superficial heat (moderate-quality evidence), massage, acupuncture, or spinal manipulation (low-quality evidence). If pharmacologic treatment is desired, clinicians and patients should select nonsteroidal anti-inflammatory drugs or skeletal muscle relaxants (moderate-quality evidence). (Grade: strong recommendation).

WARNING:   Before following Recommendation #1,
please review the

Contra-indications to NSAIDS use

.

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Glucose Metabolic Changes in the Brain and Muscles of Patients with Nonspecific Neck Pain Treated by Spinal Manipulation Therapy

Glucose Metabolic Changes in the Brain and Muscles of Patients with Nonspecific Neck Pain Treated by Spinal Manipulation Therapy: A [18F]FDG PET Study

The Chiro.Org Blog


SOURCE:   Evid Based Complement Alternat Med 2017 (Jan 12);
2017: 4345703
~ FULL TEXT

Akie Inami, Takeshi Ogura,
Shoichi Watanuki, Md. Mehedi Masud,
Katsuhiko Shibuya, Masayasu Miyake, et al.

Division of Cyclotron Nuclear Medicine,
Cyclotron and Radioisotope Center,
Tohoku University,
Sendai, Japan.


Objective.   The aim of this study was to investigate changes in brain and muscle glucose metabolism that are not yet known, using positron emission tomography with [18F]fluorodeoxyglucose ([18F]FDG PET).

Methods.   Twenty-one male volunteers were recruited for the present study. [18F]FDG PET scanning was performed twice on each subject: once after the spinal manipulation therapy (SMT) intervention (treatment condition) and once after resting (control condition). We performed the SMT intervention using an adjustment device. Glucose metabolism of the brain and skeletal muscles was measured and compared between the two conditions. In addition, we measured salivary amylase level as an index of autonomic nervous system (ANS) activity, as well as muscle tension and subjective pain intensity in each subject.

Results.   Changes in brain activity after SMT included activation of the dorsal anterior cingulate cortex, cerebellar vermis, and somatosensory association cortex and deactivation of the prefrontal cortex and temporal sites. Glucose uptake in skeletal muscles showed a trend toward decreased metabolism after SMT, although the difference was not significant. Other measurements indicated relaxation of cervical muscle tension, decrease in salivary amylase level (suppression of sympathetic nerve activity), and pain relief after SMT.

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Individual Courses of Low Back Pain in Adult Danes

Individual Courses of Low Back Pain in Adult Danes: A Cohort Study with 4-Year and 8-Year Follow-up

The Chiro.Org Blog


SOURCE:   BMC Musculoskelet Disord. 2017 (Jan 21); 18 (1): 28

Per Kjaer, Lars Korsholm, Charlotte Leboeuf-Yde,
Lise Hestbaek and Tom Bendix

Department of Sports Science and Clinical Biomechanics,
University of Southern Denmark,
Campusvej 55, DK-5230,
Odense M, Denmark.


BACKGROUND: &nbsp Few longitudinal studies have described the variation in LBP and its impact over time at an individual level. The aims of this study were to:

1)   determine the prevalence of LBP in three surveys over a 9-year period in the Danish general population, using five different definitions of LBP,

2)   study their individual long-term courses, and

3)   determine the odds of reporting subsequent LBP when having reported previous LBP.

METHODS: &nbsp A cohort of 625 men and women aged 40 was sampled from the general population. Questions about LBP were asked at ages 41, 45 and 49, enabling individual courses to be tracked across five different definitions of LBP. Results were reported as percentages and the prognostic influence on future LBP was reported as odds ratios (OR).

RESULTS: &nbsp Questionnaires were completed by 412 (66%), 348 (56%) and 293 (47%) persons respectively at each survey. Of these, 293 (47%) completed all three surveys. The prevalence of LBP did not change significantly over time for any LBP past year: 69, 68, 70%; any LBP past month: 42, 48, 41%; >30 days LBP past year: 25, 27, 24%; seeking care for LBP past year: 28, 30, 36%; and non-trivial LBP, i.e. LBP >30 days past year including consequences: 18, 20, 20%. For LBP past year, 2/3 remained in this category, whereas four out of ten remained over the three time-points for the other definitions of LBP. Reporting LBP defined in any of these ways significantly increased the odds for the same type of LBP 4 years later. For those with the same definition of LBP at both 41 and 45 years, the risk of also reporting the same at 49 years was even higher, regardless of definition, and most strongly for seeking care and non-trivial LBP (OR 17.6 and 18.4) but less than 11% were in these groups.

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Australian study indicates common painkillers ineffective for back pain

Commonly used non-steroidal anti-inflammatory drugs used to treat back pain provide little benefit and may make things worse according to new research from The George Institute for Global Health.

The findings of the systematic review, published in the Annals of the Rheumatic Diseases, reveal only one in six patients treated with the pills, also known as NSAIDs, achieve any significant reduction in pain.

The study is the latest work from The George Institute questioning the effectiveness of existing medicines for treating back pain. Earlier research has already demonstrated paracetamol does not speed recovery or reduce pain for acute low back pain, and opioids provide minimal benefit over placebo.

Lead author Associate Professor Manuela Ferreira says the study highlights an urgent need to develop new therapies to treat back pain which affects 80 per cent of Australians during their lifetime.

A/Prof Ferreira, Senior Research Fellow at The George Institute and at the Institute of Bone and Joint Research, said: “Back pain is the leading cause of disability worldwide and is commonly managed by prescribing medicines such as anti-inflammatories. But our results show anti-inflammatory drugs actually only provide very limited short term pain relief. They do reduce the level of pain, but only very slightly, and arguably not of any clinical significance.”

A/Prof Ferreira added: “When you factor in the side effects which are very common, it becomes clear that these drugs are not the answer to providing pain relief to the many millions of Australians who suffer from this debilitating condition every year.”

The team at The George Institute, which examined 35 trials involving more than 6000 people, also found patients taking anti-inflammatories were 2.5 times more likely to suffer from gastro-intestinal problems such as stomach ulcers and bleeding.

Research Fellow Gustavo Machado, of The George Institute and the School of Medicine at the University of Sydney, said: “Millions of Australians are taking drugs that not only don’t work very well, they’re causing harm. We need treatments that will actually provide substantial relief of these people’s symptoms.

“Better still we need a stronger focus on preventing back pain in the first place. We know that education and exercise programs can substantially reduce the risk of developing low back pain.”

Most clinical guidelines currently recommend NSAIDs as the second line analgesics after paracetamol, with opioids coming at third choice.

 

Chiropractic Rehabilitation of a Scoliosis Family:
Results from a 9-Year Follow-Up

Chiropractic Rehabilitation of a Scoliosis Family:
Results from a 9-Year Follow-Up

The Chiro.Org Blog


SOURCE:   Journal of Therapy and Rehab 2017 (Jan); 5 (1): 29–35

Mark W. Morningstar, Aatif Siddiqui,
Clayton Stitzel, Brian Dovorany

Natural Wellness & Pain Relief Center,
Grand Blanc, MI, USA


Scoliosis bracing is typically prescribed when the curvature reaches to between 30°–50°. Although there has been a vast amount of bracing literature published, the results remain equivocal. Many patients face issues of compliance, comfort, and decreased self-esteem due to social stigmas with bracing. This has caused many patients to seek non-bracing options. Although these treatments are plausible, they lack the research background that bracing has. Therefore, many physicians are reluctant to prescribe exercise-based rehabilitation for their scoliosis patients.

This study reports on 3 patients who sought non-bracing, exercise-based chiropractic rehabilitation for their scoliosis. Their results before, after, and at long term follow up are included.

Key words:   Chiropractic, Scoliosis, Spine, Rehabilitation


From the Full-Text Article:

Introduction

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Results from a 9-Year Follow-Up

Clinical Effects of Spinal Manipulation in the Management of Children and Young Adults Diagnosed With Autism Spectrum Disorder

Clinical Effects of Spinal Manipulation in the Management of Children and Young Adults Diagnosed With Autism Spectrum Disorder – A Systematic Review of the Literature

The Chiro.Org Blog


SOURCE:   J Clin Chiro Peds 2016 (Dec); 15 (3): 1280–1291

Sabine Kronau DO, MSc Paed Ost, Bettina Thiel Dipl.-Ing.,
Anne Jäkel DPhil, Torsten Liem DO, MSc Ost, MSc Paed Ost

Osteopathie Schule Deutschland,
Mexikoring 19, 22297
Hamburg, Germany


Background:   Autism spectrum disorders (ASD) are classified as pervasive developmental disorders that permanently affect essential mental functions. Symptoms include quality-related disorders in areas of social interaction, verbal and non-verbal communication, the variability of behaviours and specific learning disabilities. Abnormalities in development are already apparent in early childhood.

Aim:   To identify evidence for the clinical benefits of manual therapy of the musculoskeletal system in children diagnosed with ASD.

Methods:   The following databases and search interfaces were searched from Database start up until October 2015: Bio Med Central, Chiropractic Library Collaboration, Clinical Trials, Cochrane library, Dimdi, EBSCO host, Pubmed, Pubmed central, Medline Plus, Osteopathic research Digital repository, Osteopathic Research Web, and Physiotherapy Evidence Database. Further searches included journals provided by the University of Wales and the University of Duisburg-Essen. Studies were included if participants were children and young adults aged 0-21 years; studies published in English, German, or French; a diagnosis of autism or ASD, and study designs of randomized clinical trial, case-control studies, case series, case reports, and single subject studies (N of 1), which include manual therapeutic interventions of the musculoskeletal system. Two authors independently screened the studies for inclusion criteria, extracted the data and assessed for risk of bias. Methodological quality of randomized clinical trials was assessed by the Downs and Black tool. Quality of reporting for case series and case reports was assessed with the appropriate checklists provided by the QUAlity and Transparency Of health Research (EQUATOR) network.

Results:   Included in the review were one randomized clinical trial (uncontrolled), one case series, and 11 case reports. The methodological quality of the included randomised clinical trial was rated as being poor. Quality of reporting for the included case series and case reports was also insufficient. All included studies used spinal manipulation, and indicated an improvement in autistic symptoms after the manual therapeutic intervention.

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Mild Traumatic Brain Injury After Motor Vehicle Collisions:
What Are the Symptoms and Who Treats Them?

Mild Traumatic Brain Injury After Motor Vehicle Collisions: What Are the Symptoms and Who Treats Them? A Population-Based 1-Year Inception Cohort Study

The Chiro.Org Blog


SOURCE:   Arch Phys Med Rehab 2014 (Mar); 95 (3 Sup): S286–294

Jan Hartvigsen, PhD, Eleanor Boyle, PhD,
J. David Cassidy, PhD, DrMedSc,
Linda J. Carroll, PhD

Institute of Sports Science and Clinical Biomechanics,
University of Southern Denmark,
Odense, Denmark;
Nordic Institute of Chiropractic and Clinical Biomechanics,
Odense, Denmark.


OBJECTIVE:   To describe the 1-year course of symptoms following mild traumatic brain injury (MTBI) sustained in a motor vehicle collision as well as patterns of care-seeking.

DESIGN:   One-year follow-up of a population-based inception cohort.

SETTING:   The province of Saskatchewan, Canada, with a population of about 1,000,000 inhabitants.

PARTICIPANTS:   Persons (N=1716) sustaining an MTBI during a car collision between November 1997 and December 1999.

INTERVENTIONS:   Not applicable.

MAIN OUTCOME MEASURES:   We report the prevalence of sleep disturbances, tiredness, dizziness, forgetfulness, vision problems, hearing problems, headache, neck pain, mid back pain, and low back pain at 6 weeks and 3, 6, 9, and 12 months postcollision. At the same time points, we report self-reported care-seeking from registered health care professionals.

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What Are the Symptoms and Who Treats Them?

Dose-response of Spinal Manipulation for Cervicogenic Headache: Study Protocol for a Randomized Controlled Trial

Dose-response of Spinal Manipulation for Cervicogenic Headache: Study Protocol for a Randomized Controlled Trial

The Chiro.Org Blog


Chiropractic & Manual Therapies 2016 (Jun 8); 24: 23 ~ FULL TEXT

Linda Hanson, Mitchell Haas, Gert Bronfort, Darcy Vavrek, Craig Schulz, Brent Leininger, Roni Evans, Leslie Takaki and Moni Neradilek

Center for Outcome Studies,
The University of Western States,
2900 NE 132nd Ave,
Portland, OR 97230 USA.


BACKGROUND:   Cervicogenic headache is a prevalent and costly pain condition commonly treated by chiropractors. There is evidence to support the effectiveness for spinal manipulation, but the dose of treatment required to achieve maximal relief remains unknown. The purpose of this paper is to describe the methodology for a randomized controlled trial evaluating the dose-response of spinal manipulation for chronic cervicogenic headache in an adult population.

METHODS/DESIGN:   This is a mixed-methods, two-site, prospective, parallel groups, observer-blind, randomized controlled trial conducted at university-affiliated research clinics in the Portland, OR and Minneapolis, MN areas. The primary outcome is patient reported headache frequency. Other outcomes include self-reported headache intensity, disability, quality of life, improvement, neck pain intensity and frequency, satisfaction, medication use, outside care, cervical motion, pain pressure thresholds, health care utilization, health care costs, and lost productivity. Qualitative interviews are also conducted to evaluate patients’ expectations of treatment.

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GRADE: An Emerging Consensus on Rating Quality of Evidence and Strength of Recommendations

GRADE: An Emerging Consensus on Rating Quality of Evidence and Strength of Recommendations

The Chiro.Org Blog


Brit Med J 2008 (Apr 26); 336 (7650): 924–926 ~ FULL TEXT

Gordon H Guyatt, Andrew D Oxman, Gunn E Vist,
Regina Kunz, Yngve Falck-Ytter

G H Guyatt
CLARITY Research Group,
Department of Clinical Epidemiology and Biostatistics,
Room 2C12, 1200 Main Street,
West Hamilton, ON, Canada L8N 3Z5


Guidelines are inconsistent in how they rate the quality of evidence and the strength of recommendations. This article explores the advantages of the GRADE system, which is increasingly being adopted by organisations worldwide.


From the FULL TEXT Article

Summary points

  • Failure to consider the quality of evidence can lead to misguided recommendations; hormone replacement therapy for post-menopausal women provides an instructive example
  • High quality evidence that an intervention’s desirable effects are clearly greater than its undesirable effects, or are clearly not, warrants a strong recommendation
  • Uncertainty about the trade-offs (because of low quality evidence or because the desirable and undesirable effects are closely balanced) warrants a weak recommendation
  • Guidelines should inform clinicians what the quality of the underlying evidence is and whether recommendations are strong or weak
  • The Grading of Recommendations Assessment, Development and Evaluation (GRADE ) approach provides a system for rating quality of evidence and strength of recommendations that is explicit, comprehensive, transparent, and pragmatic and is increasingly being adopted by organisations worldwide

Introduction:

Guideline developers around the world are inconsistent in how they rate quality of evidence and grade strength of recommendations. As a result, guideline users face challenges in understanding the messages that grading systems try to communicate. Since 2006 the BMJ has requested in its “Instructions to Authors” on bmj.com that authors should preferably use the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system for grading evidence when submitting a clinical guidelines article. What was behind this decision?

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Interdisciplinary Practice Models for Older Adults With Back Pain

Interdisciplinary Practice Models for Older Adults With Back Pain: A Qualitative Evaluation

The Chiro.Org Blog


SOURCE:   Gerontologist. 2017 (Jan 11) [Epub]

Stacie A. Salsbury, PhD, RN, Christine M. Goertz, DC, PhD,
Robert D. Vining, DC, Maria A. Hondras, DC, MPH, PhD,
Andrew A. Andresen, MD, Cynthia R. Long, PhD,
Kevin J. Lyons, PhD, Lisa Z. Killinger, DC and
Robert B. Wallace, MD, MS

Palmer Center for Chiropractic Research,
Palmer College of Chiropractic,
Davenport, Iowa.


PURPOSE:   Older adults seek health care for low back pain from multiple providers who may not coordinate their treatments. This study evaluated the perceived feasibility of a patient-centered practice model for back pain, including facilitators for interprofessional collaboration between family medicine physicians and doctors of chiropractic.

DESIGN AND METHODS:   This qualitative evaluation was a component of a randomized controlled trial of 3 interdisciplinary models for back pain management: usual medical care; concurrent medical and chiropractic care; and collaborative medical and chiropractic care with interprofessional education, clinical record exchange, and team-based case management. Data collection included clinician interviews, chart abstractions, and fieldnotes analyzed with qualitative content analysis. An organizational-level framework for dissemination of health care interventions identified norms/attitudes, organizational structures and processes, resources, networks-linkages, and change agents that supported model implementation.

RESULTS:   Clinicians interviewed included 13 family medicine residents and 6 chiropractors. Clinicians were receptive to interprofessional education, noting the experience introduced them to new colleagues and the treatment approaches of the cooperating profession. Clinicians exchanged high volumes of clinical records, but found the logistics cumbersome. Team-based case management enhanced information flow, social support, and interaction between individual patients and the collaborating providers. Older patients were viewed positively as change agents for interprofessional collaboration between these provider groups.

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Manipulation of Dysfunctional Spinal Joints Affects Sensorimotor Integration in the Prefrontal Cortex

Manipulation of Dysfunctional Spinal Joints Affects Sensorimotor Integration in the Prefrontal Cortex: A Brain Source Localization Study

The Chiro.Org Blog


SOURCE:   Neural Plast. 2016 (Mar 7); 2016: 3704964 ~ FULL TEXT

Dina Lelic, Imran Khan Niazi, Kelly Holt,
Mads Jochumsen, Kim Dremstrup,
Paul Yielder, Bernadette Murphy,
Asbjørn Mohr Drewes, and Heidi Haavik

Mech-Sense,
Department of Gastroenterology and Hepatology,
Aalborg University Hospital,
9000 Aalborg, Denmark


Objectives.   Studies have shown decreases in N30 somatosensory evoked potential (SEP) peak amplitudes following spinal manipulation (SM) of dysfunctional segments in subclinical pain (SCP) populations. This study sought to verify these findings and to investigate underlying brain sources that may be responsible for such changes.

Methods.   Nineteen subclinical pain volunteers attended two experimental sessions, SM and control in random order. SEPs from 62-channel EEG cap were recorded following median nerve stimulation (1000 stimuli at 2.3 Hz) before and after either intervention. Peak-to-peak amplitude and latency analysis was completed for different SEPs peak. Dipolar models of underlying brain sources were built by using the brain electrical source analysis. Two-way repeated measures ANOVA was used to assessed differences in N30 amplitudes, dipole locations, and dipole strengths.

Results.   SM decreased the N30 amplitude by 16.9 ± 31.3% (P = 0.02), while no differences were seen following the control intervention (P = 0.4). Brain source modeling revealed a 4-source model but only the prefrontal source showed reduced activity by 20.2 ± 12.2% (P = 0.03) following SM.

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Metabolic Syndrome Components Are Associated with Intervertebral Disc Degeneration

Metabolic Syndrome Components Are Associated with Intervertebral Disc Degeneration: The Wakayama Spine Study

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SOURCE:   PLoS One. 2016 (Feb 3); 11 (2): e0147565 ~ FULL TEXT

Masatoshi Teraguchi, Noriko Yoshimura,
Hiroshi Hashizume, Shigeyuki Muraki, et al

Department of Orthopaedic surgery,
Wakayama Medical University,
811-1 Kimiidera,
Wakayama, 641-8509, Japan.


OBJECTIVE:   The objective of the present study was to examine the associations between metabolic syndrome (MS) components, such as overweight (OW), hypertension (HT), dyslipidemia (DL), and impaired glucose tolerance (IGT), and intervertebral disc degeneration (DD).

DESIGN:   The present study included 928 participants (308 men, 620 women) of the 1,011 participants in the Wakayama Spine Study. DD on magnetic resonance imaging was classified according to the Pfirrmann system. OW, HT, DL, and IGT were assessed using the criteria of the Examination Committee of Criteria for MS in Japan.

RESULTS:   Multivariable logistic regression analysis revealed that OW was significantly associated with cervical, thoracic, and lumbar DD (cervical: odds ratio [OR], 1.28; 95% confidence interval [CI], 0.92-1.78; thoracic: OR, 1.75; 95% CI, 1.24-2.51; lumbar: OR, 1.87; 95% CI, 1.06-3.48). HT and IGT were significantly associated with thoracic DD (HT: OR, 1.54; 95% CI, 1.09-2.18; IGT: OR, 1.65; 95% CI, 1.12-2.48). Furthermore, subjects with 1 or more MS components had a higher OR for thoracic DD compared with those without MS components (vs. no component; 1 component: OR, 1.58; 95% CI, 1.03-2.42; 2 components: OR, 2.60; 95% CI, 1.62-4.20; ≥3 components: OR, 2.62; 95% CI, 1.42-5.00).

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Discussion Paper: Evidence-Based Practice and Chiropractic

Discussion Paper: Evidence-Based Practice and Chiropractic

The Chiro.Org Blog


Chiropractic Journal of Australia 2016; 44: 308–319 ~ FULL TEXT

Phillip Ebrall

Southern Cross University, Australia;
International Medical University, Malaysia;
Tokyo College of Chiropractic, Japan.


Objective:   To present an objective interpretation of the literature reporting evidence based medicine or practice and to raise discussion points based on those findings which, if explored, may advance the chiropractic profession in both its academic and clinical activities.

Data Sources and Synthesis:   The indexed literature and URLs identified by on-line searching. A contextual narrative identifies specific points that may be worthy of formal discussion, either by individual authors preparing papers for publication, or by symposia.

Conclusion:   Evidence based medicine is thought by some to have had its day. The concept of best practice seems embedded within chiropractic education. Whether they appreciate it or not, most chiropractors practice a rich form of evidence based practice into which they inject their experience as a chiropractor and the characteristics including preferences of the patient.

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Cervical Spine Disorders and its Association with Tinnitus: The “Triple” Hypothesis

Cervical Spine Disorders and its Association with Tinnitus: The “Triple” Hypothesis

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SOURCE:   Med Hypotheses. 2017 (Jan); 98: 2–4 ~ FULL TEXT

Federica Bressi, Manuele Casale, et al

Department of Physical and Rehabilitation Medicine,
Campus Bio-Medico University,
Rome, Italy.


Subjective tinnitus and cervical spine disorders (CSD) are among the most common complaints encountered by physicians. Although the relationship between tinnitus and CSD has attracted great interest during the past several years, the pathogenesis of tinnitus induced by CSD remains unclear.

Conceivably, cervical spine disorders could trigger a somatosensory pathway-induced disinhibition of dorsal cochlear nucleus (DCN) activity in the auditory pathway; furthermore, CSD can cause inner ear blood impairment induced by vertebral arteries hemodynamic alterations and trigeminal irritation.

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Impact of Spinal Manipulation on Cortical Drive to Upper and Lower Limb Muscles

Impact of Spinal Manipulation on Cortical Drive to Upper and Lower Limb Muscles

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SOURCE:   Brain Sci. 2016 (Dec 23); 7 (1). pii: E2 ~ FULL TEXT

Heidi Haavik, Imran Khan Niazi, Mads Jochumsen,
Diane Sherwin, Stanley Flavel, and Kemal S. Türker

Centre for Chiropractic Research,
New Zealand College of Chiropractic,
Auckland 1060, New Zealand.


This study investigates whether spinal manipulation leads to changes in motor control by measuring the recruitment pattern of motor units in both an upper and lower limb muscle and to see whether such changes may at least in part occur at the cortical level by recording movement related cortical potential (MRCP) amplitudes.

In experiment one, transcranial magnetic stimulation input-output (TMS I/O) curves for an upper limb muscle (abductor pollicus brevis; APB) were recorded, along with F waves before and after either spinal manipulation or a control intervention for the same subjects on two different days. During two separate days, lower limb TMS I/O curves and MRCPs were recorded from tibialis anterior muscle (TA) pre and post spinal manipulation. Dependent measures were compared with repeated measures analysis of variance, with p set at 0.05.

Spinal manipulation resulted in a 54.5% ± 93.1% increase in maximum motor evoked potential (MEPmax) for APB and a 44.6% ± 69.6% increase in MEPmax for TA. For the MRCP data following spinal manipulation there were significant difference for amplitude of early bereitschafts-potential (EBP), late bereitschafts potential (LBP) and also for peak negativity (PN).

The results of this study show that spinal manipulation leads to changes in cortical excitability, as measured by significantly larger MEPmax for TMS induced input-output curves for both an upper and lower limb muscle, and with larger amplitudes of MRCP component post manipulation. No changes in spinal measures (i.e., F wave amplitudes or persistence) were observed, and no changes were shown following the control condition. These results are consistent with previous findings that have suggested increases in strength following spinal manipulation were due to descending cortical drive and could not be explained by changes at the level of the spinal cord.

Spinal manipulation may therefore be indicated for the patients who have lost tonus of their muscle and/or are recovering from muscle degrading dysfunctions such as stroke or orthopaedic operations and/or may also be of interest to sports performers.

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