Chiropractic Rehabilitation
Diplomate Information Page

This section was compiled by Frank M. Painter, D.C.
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If there are terms in these articles you don't understand, you can get a definition from the Merriam Webster Medical Dictionary.   If you want information about a specific disease, you can access the Merck Manual.   You can also search Pub Med for more abstracts on this, or any other health topic.

Jump to: Rehab Articles Rehab References Rehab Links
Patient Satisfaction Cost-Effectiveness Safety of Chiropractic

Exercise + Chiropractic Chiropractic Rehab Integrated Care

Headache Adverse Events Disc Herniation

Chronic Neck Pain Low Back Pain Whiplash Section

Conditions That Respond Alternative Medicine Approaches to Disease

Interesting Rehab Articles

Back Complaints in the Elders - Chiropractic (BACE-C):
Protocol of an International Cohort Study of Older
Adults with Low Back Pain Seeking Chiropractic Care

Chiropractic & Manual Therapies 2020 (Apr 1); 28 (1): 17 ~ FULL TEXT

This study, to our knowledge, is the first large-scale, prospective, multicenter, international cohort study to be conducted in a chiropractic setting to focus on older adults with low back pain consulting a chiropractor. By understanding the clinical course, satisfaction and safety of chiropractic treatment of this common debilitating condition in the aged population, this study will provide input for informing future clinical trials.

Complementary and Integrated Health Approaches:
What Do Veterans Use and Want

J Gen Intern Med. 2019 (Jul); 34 (7): 1192–1199 ~ FULL TEXT

In the past year, 52% used any complementary and integrative health (CIH) approach, with 44% using massage therapy, 37% using chiropractic, 34% using mindfulness, 24% using other meditation, and 25% using yoga. For nine CIH approaches, pain and stress reduction/relaxation were the two most frequent reasons veterans gave for using them. Overall, 84% said they were interested in trying/learning more about at least one CIH approach, with about half being interested in six individual CIH approaches (e.g., massage therapy, chiropractic, acupuncture, acupressure, reflexology, and progressive relaxation). Veterans appeared to be much more likely to use each CIH approach outside the VHA vs. within the VHA.
There are more materials like this at our Chiropractic Care For Veterans Page

The Development of a Global Chiropractic Rehabilitation
Competency Framework by the World Federation of Chiropractic

Chiropractic & Manual Therapies 2019 (May 29); 27: 29 ~ FULL TEXT

The World Health Organization (WHO), in its Rehabilitation 2030 A Call for Action, identified the need to strengthen rehabilitation in health systems to meet the growing demands of current and future populations. Greater access to rehabilitation services is required to secure the achievement of the United Nation's third Sustainable Development Goal, "Ensure healthy lives and promote well-being for all at all ages". To support this mandate, WHO issued a call for non-governmental organizations, associations and institutions to share their rehabilitation-related competency frameworks which will be used to construct a global rehabilitation competency framework.

Differential Patient Responses to Spinal Manipulative Therapy
and their Relation to Spinal Degeneration and
Post-treatment Changes in Disc Diffusion

European Spine Journal 2019 (Feb); 28 (2): 259–269 ~ FULL TEXT

There was no significant difference in structural features between SMT responders and non-responders. However, SMT responders demonstrate a trend of a lower prevalence of severely degenerated facets and relatively high baseline ADC values of the L4–5 discs. Interestingly, SMT responders demonstrate post-SMT increases in apparent diffusion coefficient (ADC) values of discs associated with painful segments. These results suggest that SMT responses may be related to some underlying structural responses. Our findings provide a new hypothesis/direction for further investigating the underlying nature of the differential response to SMT, possible mechanisms of SMT and the existence of treatment-specific forms of LBP.
There are more materials like this at our Disc Derangement and Chiropractic Page

Chiropractic Treatment Including Instrument-assisted Manipulation
for Non-specific Dizziness and Neck Pain in Community-dwelling
Older People: A Feasibility Randomised Sham-controlled Trial

Chiropractic & Manual Therapies 2018 (May 10); 26: 14

Recruitment of participants in this setting was difficult and expensive. However, a larger trial may be feasible at a specialised dizziness clinic within a rehabilitation setting. Compliance was acceptable and the outcome measures used were well accepted and responsive.
There are more materials like this at our Vertigo, Balance and Chiropractic Page

Systematic Review of Nondrug, Nonsurgical
Treatment of Shoulder Conditions

J Manipulative Physiol Ther 2017 (Jun); 40 (5): 293–319 ~ FULL TEXT

Twenty-five systematic reviews and 44 RCTs met inclusion criteria. Low- to moderate-quality evidence supported the use of manual therapies for all 4 shoulder conditions. Exercise, particularly combined with physical therapy protocols, was beneficial for shoulder impingement syndrome (SIS) and adhesive capsulitis (AC). For SIS, moderate evidence supported several passive modalities. For RC, physical therapy protocols were found beneficial but not superior to surgery in the long term. Moderate evidence supported extracorporeal shockwave therapy for calcific tendinitis RC. Low-level laser was the only modality for which there was moderate evidence supporting its use for all 4 conditions.
There are more materials like this at our Shoulder Page

The Influence of Curricular and Extracurricular Learning
Activities on Students' Choice of Chiropractic Technique

J Chiropractic Education 2016 (Mar); 30 (1): 30–36 ~ FULL TEXT

Students (at Southern California University of Health Sciences) appear to have the same practice technique preferences as practicing chiropractors. The chiropractic technique curriculum and the students' experience with chiropractic practitioners seem to have the greatest influence on their choice of chiropractic technique for future practice. Extracurricular activities, including technique clubs and seminars, although well attended, showed a lesser influence on students' practice technique preferences.
There are more materials like this at our Chiropractic Technique Page

Review Of Methods Used By Chiropractors To Determine
The Site For Applying Manipulation

Chiropractic & Manual Therapies 2013 (Oct 21); 21 (1): 36 ~ FULL TEXT
A considerable range of methods is in use for determining where in the spine to administer spinal manipulation. The currently published evidence falls across a spectrum ranging from strongly favourable to strongly unfavourable in regard to using these methods. In general, the stronger and more favourable evidence is for those procedures which take a direct measure of the presumptive site of care-methods involving pain provocation upon palpation or localized tissue examination. Procedures which involve some indirect assessment for identifying the manipulable lesion of the spine-such as skin conductance or thermography-tend not to be supported by the available evidence.
There are more materials like this at our Spinal Palpation Page

Shoulder Injuries: A Functional Perspective
ACA News 2013 (Aug): 34–35

The rotator cuff, as all doctors of chiropractic know, is actually composed of four separate muscles: the supraspinatus, the infraspinatus, the teres minor and the subscapularis. Most of the approximately 2 million people who seek care for rotator cuff injuries in the United States every year have injured the supraspinatus, but the involvement of at least one of the other muscles is more common than was previously thought, says Dale Huntington, DC, owner of the Huntington Chiropractic Clinic in Springdale, Ark. “We used to think these tears were just in the super-spinatus 90 percent of the time. Now we’re realizing that, in the converging of these tendons, the infraspinatus is often being torn as well.”
There are more materials like this at our Shoulder Page

A Regional Interdependence Model of Musculoskeletal Dysfunction:
Research, Mechanisms, and Clinical Implications

J Man Manip Ther. 2013 (May); 21 (2): 90-102

The term regional interdependence or RI has recently been introduced into the vernacular of physical therapy and rehabilitation literature as a clinical model of musculoskeletal assessment and intervention. The underlying premise of this model is that seemingly unrelated impairments in remote anatomical regions of the body may contribute to and be associated with a patient's primary report of symptoms. The clinical implication of this premise is that interventions directed at one region of the body will often have effects at remote and seeming unrelated areas.

Clinical Decision Rules, Spinal Pain Classification and
Prediction of Treatment Outcome: A Discussion of
Recent Reports in the Rehabilitation Literature

Chiropractic & Manual Therapies 2012 (Jun 22); 20   (1): 19 ~ FULL TEXT

Clinical decision rules are an increasingly common presence in the biomedical literature and represent one strategy of enhancing clinical-decision making with the goal of improving the efficiency and effectiveness of healthcare delivery. In the context of rehabilitation research, clinical decision rules have been predominantly aimed at classifying patients by predicting their treatment response to specific therapies. Traditionally, recommendations for developing clinical decision rules propose a multistep process (derivation, validation, impact analysis) using defined methodology. Research efforts aimed at developing a "diagnosis-based clinical decision rule" have departed from this convention. Recent publications in this line of research have used the modified terminology "diagnosis-based clinical decision guide." Modifications to terminology and methodology surrounding clinical decision rules can make it more difficult for clinicians to recognize the level of evidence associated with a decision rule and understand how this evidence should be implemented to inform patient care. We provide a brief overview of clinical decision rule development in the context of the rehabilitation literature and two specific papers recently published in Chiropractic and Manual Therapies.
There are more materials like this at our Clinical Prediction Rules Page

A Systematic Review on the Effectiveness of Physical and
Rehabilitation Interventions for Chronic
Non-specific Low Back Pain

European Spine Journal 2011 (Jan); 20 (1): 19–39 ~ FULL TEXT

In total 83 randomized controlled trials met the inclusion criteria: exercise therapy (n = 37), back school (n = 5), TENS (n = 6), low level laser therapy (n = 3), behavioural treatment (n = 21), patient education (n = 1), traction (n = 1), and multidisciplinary treatment (n = 6).   Compared to usual care, exercise therapy improved post-treatment pain intensity and disability, and long-term function.   Behavioural treatment was found to be effective in reducing pain intensity at short-term follow-up compared to no treatment/waiting list controls.   Finally, multidisciplinary treatment was found to reduce pain intensity and disability at short-term follow-up compared to no treatment/waiting list controls.
There are more materials like this at our Low Back Pain Page

Neuromuscular Training for Sports Injury Prevention:
A Systematic Review

Med Sci Sports Exerc. 2010 (Mar); 42 (3): 413–421

A March 2010 systematic review conducted in Germany underscores the value of neuromuscular training in preventing sports injuries. They concluded that “On the basis of the results of seven high-quality studies, this review showed evidence for the effectiveness of proprioceptive/ neuromuscular training in reducing the incidence of certain types of sports injuries among adolescent and young adult athletes during pivoting sports.”

Recognizing the Value of Chiropractic for Chronic Pain
Dynamic Chiropractic 2008 (Sep 23); 26 (20):

The guidelines actually recommend manipulation for chronic, persistent low back or neck pain and cervicogenic headache. [2] This is significant because in the past, the guidelines failed to recommend manipulation, even when other treatment strategies (medication, etc.) were rated as less effective.
There are more materials like this at our Chronic Neck Pain Page

A Comparison of Symptomatic and Asymptomatic Office Workers
Performing Monotonous Keyboard Work –
1:   Neck and Shoulder Muscle Recruitment Patterns

Manual Therapy 2005 (Nov); 10 (4): 270–280

Results suggested that symptomatic individuals had altered muscle recruitment patterns that persisted throughout the sustained occupational task, while discomfort increased with time-at-task. These findings indicate that altered muscle recruitment patterns observed in the symptomatic subjects preceded the onset of task discomfort, and this finding may have important implications for the etiology of work-related neck and upper limb disorders.

A Comparison of Symptomatic and Asymptomatic Office Workers
Performing Monotonous Keyboard Work –
2: Neck and Shoulder Kinematics

Manual Therapy 2005 (Nov); 10 (4): 270–280

Prolonged static posture has been identified as a major risk factor for work-related neck and upper limb disorders (WRNULD) in computer users. Previous research has mainly examined working postures in healthy pain-free individuals. The present study examined whether symptomatic subjects exhibited the same kinematic patterns as asymptomatic controls during a prolonged computer task.

Exercises for Mechanical Neck Disorders
Cochrane Database Syst Rev 2005 (Jul 20); 3: CD004250

The evidence summarised in this systematic review indicates that specific exercises may be effective for the treatment of acute and chronic MND, with or without headache. To be of benefit, a stretching and strengthening exercise program should concentrate on the musculature of the cervical, shoulder-thoracic area, or both. A multimodal care approach of exercise, combined with mobilisation or manipulation for subacute and chronic MND with or without headache, reduced pain, improved function, and global perceived effect in the short and long term.
There are more materials like this at our Exercise and Chiropractic Page

Psychosocial Factors and their Role in Chronic Pain:
A Brief Review of Development and Current Status

Chiropractic & Osteopathy 2005 (Apr 27); 13 (1): 6 ~ FULL TEXT

The belief that pain is a direct result of tissue damage has dominated medical thinking since the mid 20th Century. Several schools of psychological thought proffered linear causal models to explain non-physical pain observations such as phantom limb pain and the effects of placebo interventions. Psychological research has focused on identifying those people with acute pain who are at risk of transitioning into chronic and disabling pain, in the hope of producing better outcomes.
There are more materials like this at our Biopsychosocial Model Page

Chiropractic Management of Intractable Chronic Whiplash Syndrome
Clinical Chiropractic 2004 (Mar): 7 (1): 16–23

The management protocol in this case consisted of chiropractic spinal manipulative therapy, soft tissue work and post-isometric relaxation (PIR) techniques to address biomechanical somatic dysfunction. In addition, active rehabilitation exercises, self-stretches and proprioceptive exercises were utilised to address postural and muscle imbalance. On the seventh treatment, the patient reported no neck pain, no headaches and unrestricted cervical spine range of motion. At 4 months follow-up, the patient continued to be free of headaches and neck stiffness and reported only mild, intermittent neck pain.
There are more materials like this at our Whiplash Page

Upper Crossed Syndrome and Its Relationship
to Cervicogenic Headache

J Manipulative Physiol Ther 2004 (Jul); 27 (6): 414–420 ~ FULL TEXT

The principles of upper crossed syndrome and the use of exercise, chiropractic care, and myofascial release in the treatment of cervicogenic headache are discussed. A review of the literature indicates that analyzing muscle imbalance as well as vertebral subluxation may increase the effectiveness of chiropractic treatment for cervicogenic headache
There are more materials like this at our Forward Head Posture Page

Structural Rehabilitation of the Spine and Posture:
Rationale for Treatment Beyond the
Resolution of Symptoms

J Manipulative Physiol Ther 1998 (Jan); 21 (1): 37–50

Because mechanical loading of the neuromusculoskeletal tissues plays a vital role in influencing proper growth and repair, chiropractic rehabilitative care should focus on the normalization/minimization of aberrant stresses and strains acting on spinal tissues. Manipulation alone cannot restore body postures or improve an altered sagittal spinal curve. Therefore, postural chiropractic adjustments, active exercises and stretches, resting spinal blocking procedures, extension traction and ergonomic education are deemed necessary for maximal spinal rehabilitation. Chiropractic studies that demonstrate structural improvements are sorely lacking and needed. The use of passive treatment modalities as the sole means of chiropractic intervention for the management of patients suffering with neuromusculoskeletal dysfunction no longer has a place in modern chiropractic practice after the acute phase of healing has passed.

   Articles Supporting the Use of Proprioceptive Training   

Impaired Postural Control of the Lumbar Spine is Associated
with Delayed Muscle Response Times in Patients with
Chronic Idiopathic Low Back Pain

SPINE (Phila Pa 1976) 2001 (Apr 1); 26 (7): 724–730

Patients with chronic low back pain demonstrated poorer postural control of the lumbar spine and longer trunk muscle response times than healthy control volunteers.

Variations in Balance and Body Sway in Middle-aged Adults,
Subjects With Healthy Backs Compared with Subjects
with Low-back Dysfunction

SPINE (Phila Pa 1976) 1991 (Mar); 16 (3): 325–330

Compared with Healthy Back subjects, in the most stable and then the least stable balance positions, the LBP subjects demonstrated significantly greater postural sway, kept their center of force (COF) significantly more posterior, and were significantly less likely to be able to balance on one foot with eyes closed. Based on subjective observations, the LBP subjects were more likely to fulcrum about the hip and back to maintain uprightness in challenging balance tasks compared with healthy controls who maintained their fulcrum for the COF around the ankle.

   End Proprioceptive (Balance) Training   

Can Doctors Delegate Care to Unlicensed Assistants?
ChiroCode Institute Newsletter 2004

Providers using CPT are instructed to pick the code that most accurately identifies the service performed. Therapeutic procedure codes 97110 – 97546 are defined in the Physical Medicine & Rehabilitation section of CPT to include: "Physician or therapist required to have direct (one-on-one) patient contact" [during the reported procedure]. Some have argued that the codes permit a doctor to bill for this code by an unlicensed therapist since CPT’s definition does not say "licensed" therapist. But that argument is found to be invalid by contacting CPT for clarification, where CPT reports that the term therapist is referring to anyone who is licensed to perform the service.

Passive Care and Active Rehabilitation in a Patient
With Failed Back Surgery Syndrome

J Manipulative Physiol Ther 1996 (Jan); 19 (1): 41–47

A multifactorial treatment approach using passive care plus active rehabilitative exercises can be effective in the treatment of chronic low back pain associated with failed back surgery syndrome. Chiropractors who are trained in rehabilitation techniques will be well prepared to provide comprehensive care to such patients.

Isolated Lumbar Strengthening in the Rehabilitation
of Chronic Low Back Pain

J Manipulative Physiol Ther 1996 (Feb); 19 (2): 124–133

The patient underwent a functional restoration program consisting of isolated lumbar extensor progressive resistance exercise (PRE) on a MedX lumbar instrument, PRE to ancillary musculature, progressive aerobic exercise, static stretching and proprioceptive exercises. She showed a 368% increase in average lumbar isometric strength, 41% increase in isolated lumbar sagittal plane range of motion and decrease in pain. The patient returned to school after 8 wk of care; at 18-month check-up, she remained asymptomatic. Functional restoration, even with uncertain diagnosis, can be effective in the resolution of chronic low back pain.

Acute Ankle Sprains:
Keys to Diagnosis and Return to Play

Physician and Sportsmedicine 2002 (Dec); 30 (12) ~ FULL TEXT

The diagnosis and treatment of acute ankle injuries present challenges to both primary care physicians and orthopedic specialists. Determining the position of the ankle when the injury occurred may help distinguish sprains from fractures so that unnecessary x-rays can be avoided. Stepwise rehabilitation restores function and diminishes the risk of reinjury. Physicians can stress functional measures of recovery to objectively assess readiness for return to play and balance the risks of incomplete rehabilitation against the desire for an early return to sports.

Rehabilitating Ankle Sprains
Physician and Sportsmedicine 2002 (Aug); 30 (8) ~ FULL TEXT

Ankle sprains are very common, accounting for 20% to 40% of all sports-related injuries.1,2 These injuries are known to recur often and create prolonged disability.2,3 Ankle sprains are classified into grades 1, 2, 3, which generally correspond to mild, moderate, or severe. They are also classified into three anatomic types: lateral, medial, and syndesmosis. This protocol focuses on lateral sprains of all grades.

When to Return to Play After an Ankle Sprain
Physician and Sportsmedicine 2002 (Dec); 30 (12) ~ FULL TEXT

An ankle sprain may not seem like a big deal, but returning to play without proper rehabilitation will increase your chances of injuring your ankle again -- maybe even more seriously. Taking the time to fully recover will actually put you back in the game faster. The checklist on the other side of this page will take the guesswork out of knowing when you are ready to return to play safely.

Shoulder Dislocation in Young Athletes
Physician and Sportsmedicine 2002 (Dec); 30 (12) ~ FULL TEXT

A fall onto an outstretched arm or a collision on the playing field often leads to an acute anterior shoulder dislocation for high school- and college-age athletes. The diagnosis is usually made by history and physical exam. The angle of impact is an important diagnostic clue. If no neurologic contraindications or signs of acute fracture are seen, radiographs are unnecessary, and early reduction before the onset of muscle spasm is essential. Recent advances in arthroscopic techniques have dramatically reduced the high incidence of recurrent instability in young elite athletes, though nonoperative management with immobilization is still an excellent option.
There are other shoulder articles in our Shoulder Girdle Page.

Osteoarthritis of the Glenohumeral Joint
Nonsurgical Treatment Options

Physician and Sportsmedicine 2002 (Apr); 30 (4) ~ FULL TEXT

Athletes at risk include weight lifters, baseball players, softball players, and those who play racket sports such as tennis, racquetball, and squash. Glenohumeral osteoarthritis (GHOA) seems to result from pure instability, rotator cuff arthropathy, fracture, or postsurgical trauma and predominately affects older men. GHOA generally involves the glenoid rather than the humeral side of the joint,3 which will influence rehabilitation.

The Role of Nutrition in Rehabilitation and Sports Medicine: Part I
Dynamic Chiropractic (June 19, 1995)

This interview with Dr. Luke Bucci discusses the needs for protein, minerals, and vitamins in healing, as well as the superiority of glucosamine hydrochloride for joint healing. You will also enjoy Part II of the series.

Scientific Support for Low–Cost Exercise Programs
Back Letter 2000; 15 (7): 73, 82 ~ FULL TEXT

This one year research project reported lower costs with "active care" vs.physical therapies approaches. At the 12 month survey they reported: "All three groups maintained similar improvements in pain intensity and frequency at this juncture, but only the two group exercise programs maintained long–term gains in self–reported disability."

Award-Winning Study Finds That Current Diagnostic Techniques
Cannot Identify Pain of Discogenic Origin

Back Letter 2000; 15(6): 61, 68–69 ~ FULL TEXT

The best predictor of a painful HIZ in this study was an abnormal result on psychometric testing (tests for the presence of psychological distress). "What we showed is that the amount of discomfort that many patients have with discographic injection is most closely related to psychological and social issues," said Carragee. This suggests, according to Carragee, that low back pain may have physical, psychological, and emotional dimensions. He noted the importance of treating the whole person with back pain, not just the anatomic abnormalities.

Immobilization or Early Mobilization After
an Acute Soft–Tissue Injury?

Physician and Sportsmedicine 2000 (Mar); 28 (3) ~ FULL TEXT

Acute soft-tissue injuries such as muscle-tendon strains, ligament sprains, and ligament or tendon ruptures occur frequently in sports and exercise. Without correct diagnosis and proper treatment, they may result in long-term breaks in training and competition. Far too often, injuries become chronic and end careers of competitive athletes or force recreational athletes to abandon their favorite activity. For these reasons, an increased focus has been on finding ways to ensure optimal healing. In this regard, the question has centered on immobilization or early mobilization in treatment.

Shoulder Muscle Dysfunction and the Golf Swing:
Important Treatment and Educational Considerations

Dynamic Chiropractic (May 1, 2000)

While watching the golf swing, it's obvious that shoulder muscles are used to create a powerful swing. Not so obvious are the details of shoulder muscle activity during the swing. Fortunately, a handful of electromyographic studies have given us a better understanding of shoulder muscle function during the golf swing.3, 4, 5 These studies demonstrate that rotator cuff muscles (particularly the subscapularis), the latissimus dorsi and pectoralis major are highly active during the golf swing.

Documentation of Physical Capacity: It's Purpose in Rehabilitation
Dynamic Chiropractic (April 3, 2000)

Patients need clear goals to change behavior. Workers' compensation case managers also want to see a clearly expressed goal of care. Alongside identification of activity intolerances from functional questionnaires (e.g. Oswestry), examination of physical capacity deficits provides objective, quantifiable data from which realistic end points or goals of care can be established.

Appropriate Warmup Prior to Rehab Therapy
Dynamic Chiropractic (June 28, 1999)

Warming up before exercise is a generally accepted practice. For patients involved in rehabilitative therapy -- and for athletes, also -- it is common to warm up before undergoing activity with the intention of improving performance and reducing the chance of injuries. 2 This is especially true if a strenuous workout is expected.

An Overview of Tonic and Phasic Muscles
Dynamic Chiropractic (May 17, 1999)

The primary function of postural (or tonic) muscles is to maintain upright (trunk) posture, and that phasic muscles are responsible for rapid motions. There are other differences as well. These include the following:

Vladimir Janda Citation Collection
Shortcuts are provided to the PubMed abstracts of all the articles which are available online.

Behavioral Responses to Examination:
A Reappraisal of the Interpretation of "Nonorganic Signs"

SPINE (Phila Pa 1976) 1998 (Nov 1): 23 (21); 2367–2371

Waddell et al in 1980 developed a standardized assessment of behavioral responses to examination. The signs were associated with other clinical measures of illness behavior and distress, and are not simply a feature of medicolegal presentations. Despite clear caveats about the interpretation of the signs, they have been misinterpreted and misused both clinically and medicolegally. Behavioral responses to examination provide useful clinical information, but need to be interpreted with care and understanding. Isolated signs should not be overinterpreted. Behavioral signs are not on their own a test of credibility or faking.

Complementary Care: When Is It Appropriate?
Who Will Provide It?

Annals of Internal Medicine 1998 (Jul 1); 129: 65–66 ~ FULL TEXT

The Agency for Health Care Policy and Research (AHCPR) recently made history when it concluded that spinal manipulative therapy is the most effective and cost-effective treatment for acute low back pain (1). The 1994 guidelines for acute low back pain developed by AHCPR concluded that spinal manipulation hastens recovery from acute low back pain and recommended that this therapy be used in combination with or as an alternative to nonsteroidial anti-inflammatory drugs (1). At the same time, AHCPR concluded that various traditional methods, such as bed rest, traction, and other physical and pharmaceutical therapies were less effective than spinal manipulation and cautioned against lumbar surgery except in the most severe cases. Perhaps most significantly, the guidelines state that unlike nonsurgical interventions, spinal manipulation offers both pain relief and functional improvement. One might conclude that for acute low back pain not caused by fracture, tumor, infection, or the cauda equina syndrome, spinal manipulation is the treatment of choice.

Congruence between Decisions To Initiate Chiropractic
Spinal Manipulation for Low Back Pain and
Appropriateness Criteria in North America

Annals of Internal Medicine 1998 (Jul 1); 129: 9–17 ~ FULL TEXT

The proportion of chiropractic spinal manipulation judged to be congruent with appropriateness criteria is similar to proportions previously described for medical procedures; thus, the findings provide some reassurance about the appropriate application of chiropractic care. However, more than one quarter of patients were treated for indications that were judged inappropriate. The number of inappropriate decisions to use chiropractic spinal manipulation should be decreased.
   Responses to the above AIM Article from our Viewers

The Effects of Abdominal Muscle Coactivation
on Lumbar Spine Stability

SPINE (Phila Pa 1976) 1998 (Jan 1); 23 (1): 86–91; discussion 91–92

The activation of human trunk muscles has been found to involve coactivation of antagonistic muscles, which has not been adequately predicted by biomechanical models. Antagonistic activation of abdominal muscles might produce flexion moments resulting from abdominal pressurization. Qualitatively, antagonistic activity also has been attributed to the need to stabilize the spine.

Guide to Assessing Psychosocial Yellow Flags in Acute Low Back Pain:
Risk Factors for Long–Term Disability and Work Loss

New Zealand Guidelines Group ~ FULL TEXT

This guide is to be used in conjunction with the New Zealand Acute Low Back Pain Guide. It provides an overview of risk factors for long–term disability and work loss, and an outline of methods to assess these at risk. Identification should lead to appropriate early management targeted towards the prevention of chronic pain and disability.

What is the Natural History for Lower Back Pain?
We have all heard the statistics that say 83% of patients are better in 6 weeks. Is this universally advertised short term outcome true? What do we mean by better? If our goal is to improve the quality of care for back pain patients then we first need to establish benchmark outcomes of recovery. If improvement is the goal then 90% of patients are improving after only 3 weeks. But, if asymptomatic is the goal then only 46% reached this goal after 7 weeks. If not having any activity limitations due to pain is the goal, as AHCPR suggests, then only 38% have achieved this goal by 7 weeks.

Evaluation of Specific Stabilizing Exercise in the Treatment
of Chronic Low Back Pain With Radiologic Diagnosis of
Spondylolysis or Spondylolisthesis

SPINE (Phila Pa 1976) 1997 (Dec 15); 22 (24): 2959–2967

A "specific exercise" treatment approach appears more effective than other commonly prescribed conservative treatment programs in patients with chronically symptomatic spondylolysis or spondylolisthesis.


Rehabilitation References

Chiropractors as the Spinal Health Care Experts
A Chiro.Org article collection

Enjoy these learned articles about chiropractors as first-contact Spinal Health Care Experts.

Rehabilitation Monographs by R. C. Schafer, DC, PhD, FICC
A Chiro.Org article collection

Enjoy this selection of topical rehabilitation articles by the most-published (and revered) chiropractic author. You might also enjoy Dr. Schafer's Dynamic Chiropractic articles.   Thanks to the ACAPress for access to these materials!

Rehab Articles by Craig Liebenson, D.C.
A Chiro.Org article collection

There's now 107 articles to choose from, arranged in categories, as well as links to his JMPT and JBMT articles.
Craig Liebenson, D.C. literally wrote the book on spinal rehabilitation.     Dr. Liebenson is highly regarded among chiropractors, medical physicians, and physical therapists alike in the field of spinal rehabilitation around the world.   He has studied and taught with Professors Vladimir Janda and Karel Lewit from the Czech Republic - pioneers in functional rehabilitation and manual medicine, as well as many others who have revolutionized the field.   Many of them are also contributors to his text.

Rehab Articles by Kim Christensen, D.C.
A Chiro.Org article collection

There's 73 informative articles to choose from.   Kim D. Christensen, DC, CCSP, DACRB, is a popular speaker at conventions and is a postgraduate faculty member at numerous Chiropractic colleges.   He recently received the “Founding Father” award at the annual ACA meeting from the American Chiropractic Rehabilitation Board.   Dr. Christensen is the author of numerous publications and texts encompassing musculoskeletal rehabilitation and nutrition.

The SOAP Notes Page
A Chiro.Org article collection

This new page will gather articles discussing SOAP notes.

The Biopsychosocial Model
A Chiro.Org article collection

This new page will gather articles discussing the bio-psycho-social components of patient presentation and care.

Physiotherapy and Rehabilitation Guidelines for the Chiropractic Profession
Council on Chiropractic Physiological Therapeutics and Rehabilitation
This article was copied with permission from the ACRB website in the late 90's, and was reformatted to make it easier to read. Please note that some of the CPT codes mentioned may be out of date now. No attempt has been made to re-write Dr. Christensen's article to keep it up-to-date.

Spinal Rehab Goals ~ General Overview
A Chiro.Org article collection

Review the 3 phases of spinal rehabilitation.

   Helpful Reference Pages:
Chronic Neck Pain Disc Derangement Documentation Page
Evidence-based Practice Forward Head Posture Guidelines Page
Headache Page Journals Page Low Back Pain
Outcome Assessment Shoulder Page Whiplash Page

Rehabilitation Links

   American Chiropractic Rehabilitation Board (ACRB)

   American College of Chiropractic Orthopedists (ACCO)

All About Chiropractic

Chiropractic Journals

The Documentation Section

Forward Head Posture Page

Guidelines Collection @ Chiro.Org

Headache Section

Medical Journal Collection @

Other Chiropractic Diplomate Sites

Outcome Assessment Page @ Chiro.Org

Soft Tissue and Provocative Test Grading Schemes w/ References

Useful TOOLS for the DC

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