Frank M. Painter

Recognition of Spontaneous Vertebral Artery Dissection

By Frank M. Painter|February 25, 2015|Diagnosis, Vertebral Artery|

Recognition of Spontaneous Vertebral Artery Dissection Preempting Spinal Manipulative Therapy: A Patient Presenting With Neck Pain and Headache for Chiropractic Care

The Chiro.Org Blog

SOURCE: J Chiropr Med. 2014 (Jun); 13 (2): 90-95 ~ FULL TEXT

Ross Mattox, DC, [a], Linda W. Smith, DC, [b] and
Norman W. Kettner, DC, DACBR, FICC [c]

a Diagnostic Imaging Resident,
Department of Radiology,
Logan University, Chesterfield, MO
ude.nagol@xottam.ssor

b Chiropractic Physician,
Private Practice, St. Louis, MO

c Chair, Department of Radiology,
Logan University, Chesterfield, MO

OBJECTIVE: The purpose of this case report is to describe a patient who presented to a chiropractic physician for evaluation and treatment of neck pain and headache.

CLINICAL FEATURES: A 45-year-old otherwise healthy female presented for evaluation and treatment of neck pain and headache. Within minutes, non-specific musculoskeletal symptoms progressed to neurological deficits, including limb ataxia and cognitive disturbances. Suspicion was raised for cerebrovascular ischemia and emergent referral was initiated.

INTERVENTION AND OUTCOME: Paramedics were immediately summoned and the patient was transported to a local hospital with a working diagnosis of acute cerebrovascular ischemia. Multiplanar computed tomographic and magnetic resonance imaging with contrast revealed vertebral artery dissection of the V2 segment in the right vertebral artery. Anticoagulation therapy was administered and the patient was discharged without complications after 5 days in the hospital.

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Elongated Styloid Processes and Calcified Stylohyoid Ligaments in a Patient With Neck Pain: Implications for Manual Therapy Practice

By Frank M. Painter|February 23, 2015|Diagnosis, Vertebral Artery|

Elongated Styloid Processes and Calcified Stylohyoid Ligaments in a Patient With Neck Pain: Implications for Manual Therapy Practice

The Chiro.Org Blog

SOURCE: J Chiropr Med. 2014 (Jun); 13 (2): 128–133 ~ FULL TEXT

Bart N. Green, DC, MSEd,a,b, LCDR Kristin M. Browske, MD,
and CAPT Michael D. Rosenthal, PT, DSc, ATC

a Chiropractor,
Department of Physical and Occupational Therapy,
Naval Medical Center, San Diego, CA

b Associate Editor,
Publications Department,
National University of Health Sciences,
Lombard, IL

Corresponding author at:
Marine Corps Air Station Miramar,
Branch Health Clinic,
PO Box 452002,
San Diego, CA 92145-2002. Tel.: + 1 858 577 9948
lim.yvan.dem@neerg.traB

Objective The purpose of this paper is to present a case of a patient with neck pain, tinnitus, and headache in the setting of bilateral elongated styloid processes (ESP) and calcified stylohyoid ligaments (CSL), how knowledge of this anatomical variation and symptomatic presentation affected the rehabilitation management plan for this patient, and to discuss the potential relevance of ESPs and CSLs to carotid artery dissection.

Clinical features A 29-year-old male military helicopter mechanic presented for chiropractic care for chronic pain in the right side of his neck and upper back, tinnitus, and dizziness with a past history of right side parietal headaches and tonsillitis. Conventional radiographs showed C6 and C7 spinous process fractures, degenerative disc disease at C6/7, and an elongated right styloid process with associated calcification of the left stylohyoid ligament. Volumetric computerized tomography demonstrated calcification of the stylohyoid ligaments bilaterally.

Intervention and outcome Given the proximity of the calcified stylohyoid apparatus to the carotid arteries, spinal manipulation techniques were modified to minimize rotation of the neck. Rehabilitation also included soft tissue mobilization and stretching, corrective postural exercises, and acupuncture. An otolaryngologist felt that the symptoms were not consistent with Eagle syndrome and the tinnitus was associated with symmetric high frequency hearing loss, likely due to occupational noise exposure. Initially, the patient’s symptoms improved but plateaued by the fifth visit.

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Chiropractic Management of an 81-Year-Old Man with Parkinson Disease Signs and Symptoms

By Frank M. Painter|February 21, 2015|Chiropractic Care, Gait Disorder, Parkinson Disease, Premenstrual Syndrome|

Chiropractic Management of an 81-Year-Old Man
with Parkinson Disease Signs and Symptoms

The Chiro.Org Blog

SOURCE: J Chiropr Med. 2014 (Jun); 13 (2): 116–120

Joesph Bova, DC [1] and Adam Sergent, DC [2]

1 Private Practice, Latham NY.
2 Assistant Professor,
Faculty Clinician,
Palmer College of Chiropractic Florida,
Port Orange, FL

Objective The purpose of this case report is to describe the chiropractic management of a patient with Parkinson disease.

Clinical features An 81-year-old male with a 12-year history of Parkinson disease sought chiropractic care. He had a stooped posture and a shuffling gait. He was not able to ambulate comfortably without the guidance of his walker. The patient had a resting tremor, most notably in his right hand. Outcome measures were documented using the Parkinson’s Disease Questionaire-39 (PDQ-39) and patient subjective reports.

Intervention and outcome The patient was treated with blue-lensed glasses, vibration stimulation therapy, spinal manipulation, and eye-movement exercises. Within the first week of treatment, there was a reduction in symptoms, improvement in ambulation, and tremor.

Conclusion For this particular patient, the use of alternative treatment procedures appeared to help his Parkinson disease signs and symptoms.

Key indexing terms: Parkinson disease, Tremor, Gait disorder, Chiropractic

From the FULL TEXT Article:

Introduction

Parkinson disease (PD) is a neurodegenerative brain disorder that progresses slowly in most patients. [1] When approximately 60% to 80% of the dopamine producing cells are damaged, cardinal motor symptoms such as akinesia, rigidity, and tremor begin to appear. [1] A small number of patients have a direct mutation that causes it, but genetic predisposition and environmental factors are most commonly the cause. [1] PD is a central nervous system disorder resulting from destruction of the substantia nigra, which initiates dopamine release, an inhibitory transmitter. [2–4] The lack of dopamine causes a continuous excitatory signal to be sent to the corticospinal tract of the spinal cord, causing over-excitation of the motor cortex; this over-excitation creates the typical PD symptoms. [2–4]

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Spinal Pain in Adolescents

By Frank M. Painter|February 2, 2015|Pediatrics, Spinal Joint Pain, Spinal Manipulation|

Spinal Pain in Adolescents: Prevalence, Incidence, and Course: A School-based Two-year Prospective Cohort Study in 1,300 Danes Aged 11-13

The Chiro.Org Blog

SOURCE: BMC Musculoskelet Disord. 2014 (May 29); 15: 187 ~ FULL TEXT

Ellen Aartun, Jan Hartvigsen, Niels Wedderkopp, and Lise Hestbaek

Department of Sports Science and Clinical Biomechanics,
University of Southern Denmark,
Odense, Denmark

BACKGROUND: The severity and course of spinal pain is poorly understood in adolescents. The study aimed to determine the prevalence and two-year incidence, as well as the course, frequency, and intensity of pain in the neck, mid back, and low back (spinal pain).

METHODS: This study was a school-based prospective cohort study. All 5th and 6th grade students (11-13 years) at 14 schools in the Region of Southern Denmark were invited to participate (N=1,348). Data were collected in 2010 and again two years later, using an e-survey completed during school time.

RESULTS: The lifetime prevalence of spinal pain was 86% and 89% at baseline and follow-up, respectively. A group of 13.6% (95% CI: 11.8, 15.6) at baseline and 19.5% (95% CI: 17.1, 22.0) at follow-up reported that they had pain frequently. The frequency of pain was strongly associated with the intensity of pain, i.e., the majority of the participants reported their pain as relatively infrequent and of low intensity, whereas the participants with frequent pain also experienced pain of higher intensity. The two-year incidence of spinal pain varied between 40% and 60% across the physical locations. Progression of pain from one to more locations and from infrequent to more frequent was common over the two-year period.

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A Randomized Controlled Trial Comparing a Multimodal Intervention and Standard Obstetrics Care for Low Back and Pelvic Pain in Pregnancy

By Frank M. Painter|February 1, 2015|Low Back Pain, Pregnancy|

A Randomized Controlled Trial Comparing a Multimodal Intervention and Standard Obstetrics Care for Low Back and Pelvic Pain in Pregnancy

The Chiro.Org Blog

SOURCE: Am J Obstet Gynecol. 2013 (Apr); 208 (4): 295.e1-7 ~ FULL TEXT

James W. George, DC, Clayton D. Skaggs, DC,
Paul A. Thompson, PhD, D. Michael Nelson, MD, PhD,
Jeffrey A. Gavard, PhD, Gilad A. Gross, MD

Chiropractic Science Division,
College of Chiropractic,
Logan University,
Chesterfield, MO, USA.

OBJECTIVE: Women commonly experience low back pain during pregnancy. We examined whether a multimodal approach of musculoskeletal and obstetric management (MOM) was superior to standard obstetric care to reduce pain, impairment, and disability in the antepartum period.

STUDY DESIGN: A prospective, randomized trial of 169 women was conducted. Baseline evaluation occurred at 24-28 weeks’ gestation, with follow-up at 33 weeks’ gestation. Primary outcomes were the Numerical Rating Scale (NRS) for pain and the Quebec Disability Questionnaire (QDQ). Both groups received routine obstetric care. Chiropractic specialists provided manual therapy, stabilization exercises, and patient education to MOM participants.

RESULTS: The MOM group demonstrated significant mean reductions in Numerical Rating Scale scores (5.8 ± 2.2 vs 2.9 ± 2.5; P < .001) and Quebec Disability Questionnaire scores (4.9 ± 2.2 vs 3.9 ± 2.4; P < .001) from baseline to follow-up evaluation. The group that received standard obstetric care demonstrated no significant improvements.

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Manual Therapy Followed by Specific Active Exercises Versus a Placebo Followed by Specific Active Exercises

By Frank M. Painter|January 31, 2015|exercise, Spinal Manipulation|

Manual Therapy Followed by Specific Active Exercises Versus a Placebo Followed by Specific Active Exercises on the Improvement of Functional Disability in Patients with Chronic Non Specific Low Back Pain: A Randomized Controlled Trial

The Chiro.Org Blog

SOURCE: BMC Musculoskelet Disord. 2012 (Aug 28); 13: 162

Pierre Balthazard, Pierre de Goumoens, Gilles Rivier,
Philippe Demeulenaere, Pierluigi Ballabeni, and Olivier Dériaz

Physiotherapy Department,
HES-SO University of Applied Sciences Western Switzerland-HESAV,
Avenue de Beaumont,
Lausanne 1011, Switzerland.
pbalthaz@hecvsante.ch

BACKGROUND: Recent clinical recommendations still propose active exercises (AE) for CNSLBP. However, acceptance of exercises by patients may be limited by pain-related manifestations. Current evidences suggest that manual therapy (MT) induces an immediate analgesic effect through neurophysiologic mechanisms at peripheral, spinal and cortical levels. The aim of this pilot study was first, to assess whether MT has an immediate analgesic effect, and second, to compare the lasting effect on functional disability of MT plus AE to sham therapy (ST) plus AE.

METHODS: Forty-two CNSLBP patients without co-morbidities, randomly distributed into 2 treatment groups, received either spinal manipulation/mobilization (first intervention) plus AE (MT group; n = 22), or detuned ultrasound (first intervention) plus AE (ST group; n = 20). Eight therapeutic sessions were delivered over 4 to 8 weeks. Immediate analgesic effect was obtained by measuring pain intensity (Visual Analogue Scale) before and immediately after the first intervention of each therapeutic session. Pain intensity, disability (Oswestry Disability Index), fear-avoidance beliefs (Fear-Avoidance Beliefs Questionnaire), erector spinae and abdominal muscles endurance (Sorensen and Shirado tests) were assessed before treatment, after the 8th therapeutic session, and at 3- and 6-month follow-ups.

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About Frank M. Painter

Recognition of Spontaneous Vertebral Artery Dissection

Recognition of Spontaneous Vertebral Artery Dissection Preempting Spinal Manipulative Therapy: A Patient Presenting With Neck Pain and Headache for Chiropractic Care

Elongated Styloid Processes and Calcified Stylohyoid Ligaments in a Patient With Neck Pain: Implications for Manual Therapy Practice

Elongated Styloid Processes and Calcified Stylohyoid Ligaments in a Patient With Neck Pain: Implications for Manual Therapy Practice

Chiropractic Management of an 81-Year-Old Man with Parkinson Disease Signs and Symptoms

Chiropractic Management of an 81-Year-Old Man with Parkinson Disease Signs and Symptoms

Spinal Pain in Adolescents

Spinal Pain in Adolescents: Prevalence, Incidence, and Course: A School-based Two-year Prospective Cohort Study in 1,300 Danes Aged 11-13

A Randomized Controlled Trial Comparing a Multimodal Intervention and Standard Obstetrics Care for Low Back and Pelvic Pain in Pregnancy

A Randomized Controlled Trial Comparing a Multimodal Intervention and Standard Obstetrics Care for Low Back and Pelvic Pain in Pregnancy

Manual Therapy Followed by Specific Active Exercises Versus a Placebo Followed by Specific Active Exercises

Manual Therapy Followed by Specific Active Exercises Versus a Placebo Followed by Specific Active Exercises on the Improvement of Functional Disability in Patients with Chronic Non Specific Low Back Pain: A Randomized Controlled Trial

Chiropractic Management of an 81-Year-Old Man
with Parkinson Disease Signs and Symptoms