2012 November

Efficacy of Chiropractic Manual Therapy on Infant Colic: A Pragmatic Single-Blind, Randomized Controlled Trial

By Frank M. Painter|November 25, 2012|Chiropractic Care, Colic, Pediatrics|

Efficacy of Chiropractic Manual Therapy on Infant Colic: A Pragmatic Single-Blind, Randomized Controlled Trial

SOURCE: J Manipulative Physiol Ther. 2012 (Oct); 35 (8): 600–607

Joyce E. Miller, BS, DC, David Newell, PhD, and
Jennifer E. Bolton, PhD

Associate Professor,
Anglo-European College of Chiropractic,
Bournemouth, UK.
jmiller@aecc.ac.uk.

Dr. Miller wrote a follow-up to this study, a cost comparison of the medical and chiropractic care provided in her earlier RTC study, titled:

Costs of Routine Care For Infant Colic in the UK and Costs of Chiropractic Manual Therapy as a Management Strategy Alongside a RCT For This Condition
J Clinical Chiropractic Peds 2013 (Jun); 14 (1): 1063–1069

This RTC cast new and significant insights into previous colic trials:

Chiropractic care lowered overall costs more than 400% compared with medical management
The current study revealed that excessively crying infants were 5 times less likely to cry significantly, if they were treated with chiropractic manual therapy, and that chiropractic care reduced their crying times by about 50%, compared with those infants provided solely medical management.

OBJECTIVE: The purpose of this study was to determine the efficacy of chiropractic manual therapy for infants with unexplained crying behavior and if there was any effect of parental reporting bias.

METHODS: Infants with unexplained persistent crying (infant colic) were recruited between October 2007 and November 2009 at a chiropractic teaching clinic in the United Kingdom. Infants younger than 8 weeks were randomized to 1 of 3 groups: (i) infant treated, parent aware; (ii) infant treated, parent unaware; and (iii) infant not treated, parent unaware. The primary outcome was a daily crying diary completed by parents over a period of 10 days. Treatments were pragmatic, individualized to examination findings, and consisted of chiropractic manual therapy of the spine. Analysis of covariance was used to investigate differences between groups.

RESULTS: One hundred four patients were randomized. In parents blinded to treatment allocation, using 2 or less hours of crying per day to determine a clinically significant improvement in crying time, the increased odds of improvement in treated infants compared with those not receiving treatment were statistically significant at day 8 (adjusted odds ratio [OR], 8.1; 95% confidence interval [CI], 1.4-45.0) and at day 10 (adjusted OR, 11.8; 95% CI, 2.1-68.3). The number needed to treat was 3. In contrast, the odds of improvement in treated infants were not significantly different in blinded compared with nonblinded parents (adjusted ORs, 0.7 [95% CI, 0.2-2.0] and 0.5 [95% CI, 0.1-1.6] at days 8 and 10, respectively).

CONCLUSIONS: In this study, chiropractic manual therapy improved crying behavior in infants with colic. The findings showed that knowledge of treatment by the parent did not appear to contribute to the observed treatment effects in this study. Thus, it is unlikely that observed treatment effect is due to bias on the part of the reporting parent.

Introduction

Excessive infant crying in otherwise healthy infants, traditionally called infant colic, continues to be an enigmatic condition with no known cause and no known cure. [1-3] Afflicting between 10% to 30% of all infants and consuming significant health care resources, [2] infant colic is a problem for parents and clinicians, both of whom try a wide range of therapies with often disappointing results.

You may review the earlier Colic studies at:

The Infantile Colic and Chiropractic Page

and you may also enjoy our

Chiropractic Pediatrics Page

Despite decades of research, a clear pathogenesis has not been elucidated. Notwithstanding, what is clear is that underlying disease is rare in the excessively crying baby [4] and that half of those affected recover by 6 months of age, [5] with a small proportion at risk of injury [6] or long-term developmental problems. [7-9] In an effort to help their child with what appears to be a painful condition, some parents choose complementary and alternative medicine (CAM), including chiropractic manual therapy. [9-12] To date, several randomized trials have been reported, [13-19] and although these trials demonstrate some reduction in crying, weaknesses in study methodologies have compromised their contribution to the evidence base. [20-23]

(more…)

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Vertebral artery strains during high-speed, low amplitude cervical spinal manipulation.

By John Wiens DC|November 23, 2012|Research|

J Electromyogr Kinesiol . 2012 Oct;22(5):740-6. doi: 10.1016/j.jelekin.2012.03.005. Epub 2012 Apr 5.

Herzog W, Leonard TR, Symons B, Tang C, Wuest S.

Abstract

Spinal manipulative therapy (SMT) has been recognized as an effective treatment modality for many back, neck and musculoskeletal problems. One of the major issues of the use of SMT is its safety, especially with regards to neck manipulation and the risk of stroke. The vast majority of these accidents involve the vertebro-basilar system, specifically the vertebral artery (VA) between C2/C1. However, the mechanics of this region of the VA during SMT are unexplored. Here, we present first ever data on the mechanics of this region during cervical SMT performed by clinicians. VA strains obtained during SMT are significantly smaller than those obtained during diagnostic and range of motion testing, and are much smaller than failure strains. We conclude from this work that cervical SMT performed by trained clinicians does not appear to place undue strain on VA, and thus does not seem to be a factor in vertebro-basilar injuries.

The October 2012 issue is devoted to the study of spinal manipulation.

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The Mechanics of Neck Manipulation With Special Consideration of the Vertebral Artery

By Frank M. Painter|November 22, 2012|Chiropractic Care, Stroke|

The Mechanics of Neck Manipulation With Special Consideration of the Vertebral Artery

The Chiro.Org Blog

SOURCE: J Can Chiropr Assoc. 2002 (Sep); 46 (3): 134–136

Dr. W Herzog, BSc, PhD and Dr. B Symons, DC

University of Calgary,
2500 University Drive N.W., Calgary,
Alberta, Canada T2N 1N4.
walter@kin.ucalgary.ca

In recent weeks, we have learnt that chiropractors may have to carefully review the application of high-speed, low-amplitude spinal manipulative treatments to the neck. The concern is the possible risk associated with neck manipulation. Specifically, vertebral artery dissection, or ther mechanical injury, are an acknowledged, albeit a very low, risk.

The vast amount of research on vertebrobasilar injury in the past has been focused on blood flow through the vertebral artery during diagnostic, and before and after manipulative treatment. There was (is) concern that vertebral artery occlusion may occur during neck manipulation, and that a lack of blood supply to the brain may lead to a series of complications. This line of argument has always struck us as weak, because a high-speed, low-amplitude thrust to the cervical spine lasts typically less than 150 ms, and the brain has sufficient oxygen to survive such a small amount of (possible) loss of blood flow from one of its many supply arteries.

Another way of attempting to gain insight into the possible risk of neck manipulation and vertebrobasilar accidents is a statistical (epidemiological) approach. The basic question that people would like to answer is: are people who receive neck manipulative treatments at a greater risk of vertebrobasilar accidents than people who do not receive such treatments? On the surface, this approach seems feasible, and so it would be, if the occurrence of such accidents was high (let’s say one time in a hundred or a thousand). However, it appears that we deal with incidence rates (if there is an actual incidence) of one in several millions (i.e. very low). Therefore, any statistical pproach has a miniscule power, and a couple of “fluke accidents” (i.e., accidents that occur, let’s say in a chiropractic clinic, but in reality have nothing to do with the chiropractic treatment) may produce a “statistical error” that may persist for years in a community as small as Canada. Also, using an epidemiological approach, the question of “cause and effect” cannot be resolved.

When starting to tackle the problem of the mechanics of neck manipulative treatments three years ago with my student B. Symons (DC), we were surprised that, to the best of our knowledge, there were no data on what actually happens mechanically to the vertebral artery during cervical spinal manipulation. I was further surprised, when asked to review a case on a vertebrobasilar accident, that one of the arguments went as follows: Pathology revealed no dissection of the vertebral artery, therefore, the vertebrobasilar accident cannot be associated with chiropractic treatment.

Discussing this particular statement within the chiropractic community, it became apparent that mechanical injury to the vertebral artery was an accepted, but very, very very rare occurrence; but nevertheless, accepted. And all this without a shred of scientific evidence about the mechanics of the vertebral artery during cervical manipulation.

So, when does the vertebral artery, or for that matter, any tissue, become injured?

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Lives Lived – Ronald Gitelman, DC

By John Wiens DC|November 22, 2012|News|

Source Globe and Mail

by Howard Vernon, DC

Chiropractor, husband, father, outdoorsman, craftsman. Born Jan. 26, 1937, in Trenton, Ont., died Oct. 7, 2012, in Toronto from pancreatic cancer, aged 75.

Whether it was seeing a patient, delivering a lecture, casting his handmade fly rod, carving a piece of wood into a beautiful bowl or walking with his beloved granddaughter, Jennie, nobody did it better than Ron.

He had a zest for life, a love of each day, a sense of humanity, a passion to experience things, and the most engaging smile.

Growing up in a small town close to countryside, Ron had an affinity to nature his whole life. He was happiest in the country, and sought it out all his life.

He was a natural athlete. While playing tennis as a teen, he developed a shoulder problem and an orthopedic specialist told him he needed an operation and that his tennis career was over.

Ron could not accept this, so he rode his bike up the mountain to the office of a man whom the kids used to call a quack who broke bones. Ron thought perhaps the man could help him.

The man was named Dr. Halett, and he was Trenton’s chiropractor. He examined the shoulder, and had Ron back on the courts, free of pain, in two weeks.

That encounter ignited the spark that led Ron to the Canadian Memorial Chiropractic College.

After graduation, he devoted 40 years to his patients, his educational institution and the profession at large.

From 1963 to 1978, he made several fundamental contributions to chiropractic science: He developed the first scientific database for chiropractors; delivered a lecture at the 1975 National Institutes of Health conference on spinal manipulation, one of the few chiropractors to speak there; and was instrumental in developing chiropractic research.

Ron continued to practise until 2007, when he retired to his cherished chalet in the Beaver Valley near Georgian Bay, where he could devote all his time to his family, his many pastimes and his love of nature. He contributed greatly to the maintenance of the Beaver River.

Ron revelled in the successes of his children, who grew up to be a world-renowned bridge player, a nature conservationist and a teacher. He loved nothing more than to have his close and extended family enjoy the chalet and all the outdoor experiences it provided.

As Ron’s final illness emerged, he said he’d had a great go at life and his bucket was empty, though he thought there might be one last “permit” still in the bucket (still hoping to catch the big one!).

He challenged his illness like he did every other problem in life – head-on and with a sense of determination.

We know that Ron would want us to catch and release, stop and smell the forest, laugh at a good joke and celebrate life the way he did.

We lost a great friend, healer and teacher.

Howard Vernon is Ron’s friend.

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What Is the Role Of Chiropractic Care in Prevention or Reduction of Musculoskeletal Injuries in Children?

By Frank M. Painter|November 19, 2012|Chiropractic Care, Pediatrics|

What Is the Role Of Chiropractic Care in Prevention or Reduction of Musculoskeletal Injuries in Children?

The Chiro.Org Blog

SOURCE: J Manipulative Physiol Ther. 2012 (Sep); 35 (7): 493–513

Chiropractic Care and Public Health: Answering Difficult Questions About Safety, Care Through the Lifespan, and Community Action

Lise Hestbaek, DC, PhD

Back and neck pain are common ailments in school age children with prevalence rates ranging from 5% to 74%. [38, 39] The prevalence of low back pain increases from preadolescence to early adulthood, [38, 40] but after that, the prevalence rates change surprisingly little. [41] A similar pattern is seen for neck pain, [41] but less is known about the course of other musculoskeletal disorders throughout life. However, extremity complaints are found frequently in children. [42]

It has been demonstrated that children and adolescents with musculoskeletal complaints have a higher risk of having these problems as adults. [43-45] Pain and aberrant musculoskeletal function are known to have other consequences with regard to health. Long-lasting pain conditions, including back pain, have been associated with a generally decreased pain threshold, [46-48] which seems to develop alongside pain, because patients did not have a higher pain threshold than asymptomatic subjects before the onset of back pain. [49] If this process is initiated in childhood, it is likely to increase the impact of minor trauma or overuse in everyday life and thus may induce a lifelong cascade of negative health events, resulting in poorer general health and lower quality of life.

Another possible consequence of musculoskeletal disorders in childhood is pain becoming a barrier to physical activity. Children who are injured while performing sport activities [42, 50] may avoid or stop the activity that caused the original injury. It is also plausible that continued pain or discomfort may reduce motivation to participate and enjoy physical activities. Reduction in activity can have serious health implications over time. It is established that physical activity is one of the most important factors relating to several lifestyle disorders such as diabetes and cardiovascular disease, [51, 52] and it has been shown that increased physical activity in youth can reduce the risk of these disorders in adulthood. [53, 54] Moreover, health habits throughout the lifespan are established in youth, [55, 56] and therefore, promoting and maintaining a healthy level of physical activity in children and adolescence are essential to improve public health. Thus, an important element to reach lifelong health is to optimize musculoskeletal health.

You may also enjoy our:

Chiropractic Pediatrics Page

(more…)

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The Association of Complementary and Alternative Medicine Use and Health Care Expenditures for Back and Neck Problems

By Frank M. Painter|November 17, 2012|Chiropractic Care, Complementary and Alternative Medicine, Cost-Effectiveness|

The Association of Complementary and Alternative Medicine Use and Health Care Expenditures for Back and Neck Problems

The Chiro.Org Blog

SOURCE: Med Care. 2012 (Dec); 50 (12): 1029–1036

The Geisel School of Medicine at Dartmouth & Dartmouth-Hitchcock Medical Center, Department of Orthopaedics, Lebanon, NH

BACKGROUND: Health care costs associated with use of complementary and alternative medicine (CAM) by patients with spine problems have not been studied in a national sample.

OBJECTIVES: To estimate the total and spine-specific medical expenditures among CAM and non-CAM users
with spine problems.

RESEARCH DESIGN: Analysis of the 2002-2008 Medical Expenditure Panel Survey.

SUBJECTS: Adults (above 17 y) with self-reported neck and back problems who did or did not use CAM services.

MEASURES: Survey-weighted generalized linear regression and propensity matching to examine penditure differences between CAM users and non-CAM users while controlling for patient, socioeconomic, and health characteristics.

RESULTS: A total of 12,036 respondents with spine problems were included, including 4306 (35.8%) CAM users (40.8% in weighted sample). CAM users had significantly better self-reported health, education, and comorbidity compared with non-CAM users. (more…)

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Monthly Archives: November 2012

Efficacy of Chiropractic Manual Therapy on Infant Colic: A Pragmatic Single-Blind, Randomized Controlled Trial

Efficacy of Chiropractic Manual Therapy on Infant Colic: A Pragmatic Single-Blind, Randomized Controlled Trial

Vertebral artery strains during high-speed, low amplitude cervical spinal manipulation.

Abstract

The Mechanics of Neck Manipulation With Special Consideration of the Vertebral Artery

The Mechanics of Neck Manipulation With Special Consideration of the Vertebral Artery

Lives Lived – Ronald Gitelman, DC

What Is the Role Of Chiropractic Care in Prevention or Reduction of Musculoskeletal Injuries in Children?

What Is the Role Of Chiropractic Care in Prevention or Reduction of Musculoskeletal Injuries in Children?

The Association of Complementary and Alternative Medicine Use and Health Care Expenditures for Back and Neck Problems

The Association of Complementary and Alternative Medicine Use and Health Care Expenditures for Back and Neck Problems