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Frank M. Painter

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About Frank M. Painter

I was introduced to Chiro.Org in early 1996, where my friend Joe Garolis helped me learn HTML, the "mark-up language" for websites. We have been fortunate that journals like JMPT have given us permission to reproduce some early important articles in Full-Text format. Maintaining the Org website has been, and remains, my favorite hobby.

Why Aren’t Chiropractic Physicians Treating More Children with Complex Diagnoses?

By |December 6, 2019|Pediatrics|

Why Aren’t Chiropractic Physicians Treating More Children with Complex Diagnoses? A Commentary on Documenting P.A.R.T. for Diagnosing and Treating Special Needs Children

The Chiro.Org Blog

SOURCE:   Journal of Clinical Chiropractic Pediatrics 2019 (Nov); 18 (2)

Eric Epstein, DC, Jean Elizabeth Grabowski and Richard Duenas, DC, DABCN

Kentuckiana Children’s Center,
Louisville, KY

According to the Centers for Medicare and Medicaid Services (CMS) guidelines, chiropractors are deemed physicians in the Medicare system and for consistency throughout the term chiropractic physician will encompass chiropractor, chiropractic doctor, doctor of chiropractic and chiropractic physician. Chiropractic physicians must document subluxation of the spine through x-ray or physical examination.

The documentation of subluxation of the spine through physical examination includes the identification of two out of four criteria including:

Range of motion abnormality,
Tissue tone, texture, and temperature abnormality (P.A.R.T.)

with at least one of the two criteria being either A or R.

Since special needs children often have difficulty expressing pain, and/or experiencing pain the way a typical child can, it is necessary to understand approaches to the special needs child that allow the doctor to evaluate and treat the child, as well as comply with insurance mandates to establish medical necessity.

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The Effect of Spinal Manipulation on Brain Neurometabolites in Chronic Nonspecific Low Back Pain Patients

By |December 3, 2019|Low Back Pain, Neurology|

The Effect of Spinal Manipulation on Brain Neurometabolites in Chronic Nonspecific Low Back Pain Patients: A Randomized Clinical Trial

The Chiro.Org Blog

SOURCE:   Irish Journal of Medical Science 2019 (Nov 26) [Epub]

Daryoush Didehdar, Fahimeh Kamali, Amin Kordi Yoosefinejad, Mehrzad Lotfi

Department of Physical Therapy,
School of Rehabilitation Sciences,
Shiraz University of Medical Sciences,
Shiraz, Iran.

BACKGROUND:   In patients with chronic nonspecific low back pain (NCLBP), brain function changes due to the neuroplastic changes in different regions.

AIM:   The current study aimed to evaluate the brain metabolite changes after spinal manipulation, using proton magnetic resonance spectroscopy (1H-MRS).

METHODS:   In the current study, 25 patients with NCLBP aged 20-50 years were enrolled. Patients were randomly assigned to lumbopelvic manipulation or sham. Patients were evaluated before and 5 weeks after treatment by the Numerical Rating Scale (NRS), the Oswestry Disability Index (ODI), and 1H-MRS.

RESULTS:   After treatment, severity of pain and functional disability were significantly reduced in the treatment group vs. sham group (p < 0.05). After treatment, N-acetyl aspartate (NAA) in thalamus, insula, dorsolateral prefrontal cortex (DLPFC) regions, as well as choline (Cho) in the thalamus, insula, and somatosensory cortex (SSC) regions, had increased significantly in the treatment group compared with the sham group (p < 0.05). A significant increase was further observed in NAA in thalamus, anterior cingulate cortex (ACC), and SCC regions along with Cho metabolite in thalamus and SCC regions after treatment in the treatment group compared with the baseline measures (p < 0.05).

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LOW BACK Section


Chiropractic Maintenance Care – What’s New?
A Systematic Review of the Literature

By |November 22, 2019|Maintenance Care|

Chiropractic Maintenance Care – What’s New?
A Systematic Review of the Literature

The Chiro.Org Blog

SOURCE:   Chiropractic & Osteopathy 2019 (Non 21); 27: 63

Axén Iben, Hestbaek Lise & Leboeuf-Yde Charlotte

Karolinska Institutet,
Institute of Environmental Medicine,
Unit of Intervention and Implementation Research for Worker Health,
Nobels väg 13, 171 77,
Stockholm, Sweden

Background   Maintenance Care is a traditional chiropractic approach, whereby patients continue treatment after optimum benefit is reached. A review conducted in 1996 concluded that evidence behind this therapeutic strategy was lacking, and a second review from 2008 reached the same conclusion. Since then, a systematic research program in the Nordic countries was undertaken to uncover the definition, indications, prevalence of use and beliefs regarding Maintenance Care to make it possible to investigate its clinical usefulness and cost-effectiveness. As a result, an evidence-based clinical study could be performed. It was therefore timely to review the evidence.

Method   Using the search terms “chiropractic OR manual therapy” AND “Maintenance Care OR prevention”, PubMed and Web of Science were searched, and the titles and abstracts reviewed for eligibility, starting from 2007. In addition, a search for “The Nordic Maintenance Care Program” was conducted. Because of the diversity of topics and study designs, a systematic review with narrative reporting was undertaken.

Results   Fourteen original research articles were included in the review. Maintenance Care was defined as a secondary/tertiary preventive approach, recommended to patients with previous pain episodes, who respond well to chiropractic care. Maintenance Care is applied to approximately 30% of Scandinavian chiropractic patients. Both chiropractors and patients believe in the efficacy of Maintenance Care. Four studies investigating the effect of chiropractic Maintenance Care were identified, with disparate results on pain and disability of neck and back pain. However, only one of these studies utilized all the existing evidence when selecting study subjects and found that Maintenance Care patients experienced fewer days with low back pain compared to patients invited to contact their chiropractor ‘when needed’. No studies were found on the cost-effectiveness of Maintenance Care.

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Stability: From Biomechanical Concept to Chiropractic Practice

By |November 21, 2019|Spinal Stability|

Stability: From Biomechanical Concept to Chiropractic Practice

The Chiro.Org Blog

SOURCE:   J Can Chiropr Assoc 1999 (Jun); 43 (2): 75–88

Stuart M McGill, PhD

Faculty of Applied Health Sciences,
Department of Kinesiology,
University of Waterloo,
Waterloo, Ontario, Canada N2L 3G1.

This paper formalizes stability in a clinician-friendly way and then discusses ways for chiropractors to ensure stability of spinal joints that may have their stability compromized from manipulation.

KEY WORDS: lumbar stability, chiropractic, exercise, manipulation.

From the FULL TEXT Article:


The purpose of this paper is to develop a scientific foundation and formalize the notion of stability as it pertains to the spine, and then discuss some implications of stability for advancing spine rehabilitation and clinical practice. The intention was to write a reader-friendly synthesis where only minimal references were provided. This invited review will complement my last review written for this journal 10 years ago. Over the intervening time we have established the UW-CMCC Chiropractic Research Clinic and have been conducting research with CMCC researchers. While we have been investigating the biomechanical effects of manipulation, we will need to perform additional experiments to provide a synthesis of sufficient utility for chiropractic practice. Look forward to this report in another couple of years.

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Musculoskeletal Healthcare:
Have we Over-egged the Pudding?

By |November 16, 2019|Musculoskeletal Complaints|

Musculoskeletal Healthcare:
Have we Over-egged the Pudding?

The Chiro.Org Blog

SOURCE:   International J Rheumatic Diseases 2019 (Nov); 22 (11): 1957–1960

Christopher G. Maher Mary O’Keeffe Rachelle Buchbinder I. A. Harris

Institute for Musculoskeletal Health,
Sydney, NSW, Australia

Editorial Comment:

This paper details significant issues with the current allopathic approach to managing musculoskeletal (MSK) complaints. The authors pull no punches, and are to be commended. We have discussed some the underflying issues previously.

The reality is that medical schools do not devote enough time to reviewing the MSK system. In 1998 the Journal of Bone and Joint Surgery decried this problem, and numerous articles followed over the next 11 years, when I finally lost interest in compiling them.

You may want to review that review the series of 12 more articles on the subject, but I prefer the idea of offering chiropractic as a referral option for busy MDs who are swamped with patients with MSK comlaints, who often don’t respond well to pain killers or passive therapies. Think how much happier those MDs will be when their patients thank them for making the referral.

From the FULL TEXT Article:


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Headache Page and the:

Low Back Pain Page and the:

Chronic Neck Pain Page


Nonpharmacological Treatment of Army Service Members with Chronic Pain Is Associated with Fewer Adverse Outcomes After Transition to the Veterans Health Administration

By |November 12, 2019|Low Back Pain, Veterans|

Nonpharmacological Treatment of Army Service Members with Chronic Pain Is Associated with Fewer Adverse Outcomes After Transition to the Veterans Health Administration

The Chiro.Org Blog

SOURCE:   J Gen Intern Med. 2019 (Oct 28) [Epub]

Esther L. Meerwijk, PhD, MSN , Mary Jo Larson, PhD, MPA, Eric M. Schmidt, PhD, Rachel Sayko Adams, PhD, MPH, Mark R. Bauer, MD, Grant A. Ritter, PhD, Chester Buckenmaier III, MD, and Alex H. S. Harris, PhD, MS

VA Health Services Research & Development,
Center for Innovation to Implementation (Ci2i),
VA Palo Alto Health Care System,
Menlo Park, CA, USA.

BACKGROUND:   Potential protective effects of nonpharmacological treatments (NPT) against long-term pain-related adverse outcomes have not been examined.

OBJECTIVE:   To compare active duty U.S. Army service members with chronic pain who did/did not receive NPT in the Military Health System (MHS) and describe the association between receiving NPT and adverse outcomes after transitioning to the Veterans Health Administration (VHA).

DESIGN AND PARTICIPANTS:   A longitudinal cohort study of active duty Army service members whose MHS healthcare records indicated presence of chronic pain after an index deployment to Iraq or Afghanistan in the years 2008-2014 (N = 142,539). Propensity score-weighted multivariable Cox proportional hazard models tested for differences in adverse outcomes between the NPT group and No-NPT group.

EXPOSURES:   NPT received in the MHS included acupuncture/dry needling, biofeedback, chiropractic care, massage, exercise therapy, cold laser therapy, osteopathic spinal manipulation, transcutaneous electrical nerve stimulation and other electrical manipulation, ultrasonography, superficial heat treatment, traction, and lumbar supports.

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Low Back Pain Page