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Frank M. Painter

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.
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Lithium Deficiency and the Onset of Alzheimer’s Disease

By |September 18, 2025|Alzheimer's Disease|

Lithium Deficiency and the Onset of Alzheimer’s Disease

The Chiro.Org Blog

SOURCE:   Nature 2025 (Aug 6) [EPUB]

Liviu Aron • Zhen Kai Ngian • Chenxi Qiu • Jaejoon Choi • Marianna Liang •
Derek M Drake • Sara E Hamplova • Ella K Lacey • Perle Roche • Monlan Yuan< • Saba S Hazaveh • Eunjung A Lee • David A Bennett • Bruce A Yankner

Department of Genetics,
Harvard Medical School,
Boston, MA, USA.

You may want to read this in-depth review of this study, created by PBS News.

The author interviewed the Harvard scientists, and this review is a testament to clarity and quality journalism, before you jump into reading this dense and complex study.

You will be glad that you did.

The earliest molecular changes in Alzheimer’s disease (AD) are poorly understood. [1-5] Here we show that endogenous lithium (Li) is dynamically regulated in the brain and contributes to cognitive preservation during ageing. Of the metals we analysed, Li was the only one that was significantly reduced in the brain in individuals with mild cognitive impairment (MCI), a precursor to AD. Li bioavailability was further reduced in AD by amyloid sequestration.

We explored the role of endogenous Li in the brain by depleting it from the diet of wild-type and AD mouse models. Reducing endogenous cortical Li by approximately 50% markedly increased the deposition of amyloid-β and the accumulation of phospho-tau, and led to pro-inflammatory microglial activation, the loss of synapses, axons and myelin, and accelerated cognitive decline.

These effects were mediated, at least in part, through activation of the kinase GSK3β. Single-nucleus RNA-seq showed that Li deficiency gives rise to transcriptome changes in multiple brain cell types that overlap with transcriptome changes in AD.

Replacement therapy with lithium orotate, which is a Li salt with reduced amyloid binding, prevents pathological changes and memory loss in AD mouse models and ageing wild-type mice.

These findings reveal physiological effects of endogenous Li in the brain and indicate that disruption of Li homeostasis may be an early event in the pathogenesis of AD. Li replacement with amyloid-evading salts is a potential approach to the prevention and treatment of AD.

From the Full-Text Article:

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Effect of Chiropractic Intervention on Oculomotor and Attentional Visual Outcomes in Young Adults With Long-Term Mild Traumatic Brain Injury: A Randomized Controlled Trial

By |September 7, 2025|Mild Traumatic Brain Injury, Pediatrics|

Effect of Chiropractic Intervention on Oculomotor and Attentional Visual Outcomes in Young
Adults With Long-Term Mild Traumatic Brain Injury: A Randomized Controlled Trial

The Chiro.Org Blog

SOURCE:   J Manipulative Physiol Ther 2024 (Jan); 47 (1-4): 1–11

Alice E. Cade PhD • Philip R.K. Turnbull PhD

Department Optometry & Vision Science,
University of Auckland, Auckland, New Zealand;
Centre for Chiropractic Research,
New Zealand College of Chiropractic,
Auckland, New Zealand.

Objective:   This study aimed to establish if chiropractic care can improve oculomotor and cognitive symptoms in individuals with persistent postconcussion syndrome (PPCS).

Methods:   A single-blind, randomized controlled intervention study recorded baseline computerized eye-tracker assessment (CEA) outcomes in 40 young adults with PPCS following mild traumatic brain injury. Participants were randomly allocated to either a chiropractic or age-matched active control intervention, and the change in CEA outcomes following intervention was compared between the chiropractic and control groups. A battery of CEAs including egocentric localization, fixation stability, pursuit, saccades, Stroop, and the vestibulo-ocular reflex, were used to assess oculomotor function, visual attention/processing, and selective attention.

Results:   Relative to the control group, participants receiving the chiropractic intervention scored better in the Stroop test (P < .001), had improved gaze stability during both vestibulo-ocular reflex (P < .001) and fixation stability (P = .009), and a lower vertical error in egocentric localization (P < .001). However, performance was poorer in pursuits, where they had an increased tracking error (P < .001).

Conclusion:   Chiropractic care in participants with PPCS significantly improved static and dynamic gaze stability, and performance in the Stroop test, compared with a control intervention. These results suggest that chiropractic care can offer a novel avenue for alleviating certain visual and cognitive symptoms in patients with PPCS. It also adds to the growing evidence that suggests that some longstanding PPCS visual symptoms may have a spinal or proprioceptive basis.

Keywords:   Brain Concussion; Chiropractic; Eye-Tracking Technology; Postconcussion Syndrome; Proprioception.

From the Full-Text Article:

Introduction

Traumatic brain injury (TBI) is a change in typical brain function that affects neurologic function after an external force to the head. [1, 2] Diagnosis and categorization of TBI severity is currently subjective, open to bias, and predicting an individual’s outcome after injury is challenging. [3, 4] Although symptoms can vary depending on the neurologic area of injury, visual symptoms are common following even mild TBI (MTBI) owing to the many areas of the brain involved in processing vision [5] and controlling the eyes. Visual symptoms can include oculomotor dysfunction including disorders of convergence and accommodation, poorer fixation, slower or less accurate saccades, poorer pursuit movements, and modification of the vestibulo-ocular reflex (VOR). [6]

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Brain Mechanisms of Anticipated Painful Movements and Their Modulation by Manual Therapy in Chronic Low Back Pain

By |September 3, 2025|Chronic Low Back Pain, Fear Avoidance, Neurology|

Brain Mechanisms of Anticipated Painful Movements and Their Modulation by Manual Therapy in Chronic Low Back Pain

The Chiro.Org Blog

SOURCE:   J Pain 2018 (Nov); 19 (11): 1352–1365

Dan-Mikael Ellingsen • Vitaly Napadow • Ekaterina Protsenko • Ishtiaq Mawla • Matthew H Kowalski • David Swensen • Deanna O’Dwyer-Swensen • Robert R Edwards • Norman Kettner • Marco L Loggia

A. A. Martinos Center for Biomedical Imaging,
Department of Radiology,
Massachusetts General Hospital,
Harvard Medical School,
Boston, Massachusetts.

Heightened anticipation and fear of movement-related pain has been linked to detrimental fear-avoidance behavior in chronic low back pain (cLBP). Spinal manipulative therapy (SMT) has been proposed to work partly by exposing patients to nonharmful but forceful mobilization of the painful joint, thereby disrupting the relationship among pain anticipation, fear, and movement. Here, we investigated the brain processes underpinning pain anticipation and fear of movement in cLBP, and their modulation by SMT, using functional magnetic resonance imaging. Fifteen cLBP patients and 16 healthy control (HC) subjects were scanned while observing and rating video clips depicting back-straining or neutral physical exercises, which they knew they would have to perform at the end of the visit. This task was repeated after a single session of spinal manipulation (cLBP and HC group) or mobilization (cLBP group only), in separate visits. Compared with HC subjects, cLBP patients reported higher expected pain and fear of performing the observed exercises. These ratings, along with clinical pain, were reduced by SMT. Moreover, cLBP, relative to HC subjects, demonstrated higher blood oxygen level-dependent signal in brain circuitry that has previously been implicated in salience, social cognition, and mentalizing, while observing back straining compared with neutral exercises. The engagement of this circuitry was reduced after SMT, and especially the spinal manipulation session, proportionally to the magnitude of SMT-induced reduction in anticipated pain and fear. This study sheds light on the brain processing of anticipated pain and fear of back-straining movement in cLBP, and suggests that SMT may reduce cognitive and affective-motivational aspects of fear-avoidance behavior, along with corresponding brain processes. PERSPECTIVE: This study of cLBP patients investigated how SMT affects clinical pain, expected pain, and fear of physical exercises. The results indicate that one of the mechanisms of SMT may be to reduce pain expectancy, fear of movement, and associated brain responses.

Keywords:   Expectation; Fear-avoidance; Pain anticipation; Physical exercise; Spinal Manipulative Therapy; chronic Low Back Pain; functional Magnetic Resonance Imaging.

From the FULL TEXT Article:

Background

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Barriers and Facilitators to Self-management in People With Back-related Leg Pain

By |July 27, 2025|Uncategorized|

Barriers and Facilitators to Self-management in People With Back-related Leg Pain

The Chiro.Org Blog

SOURCE: Chiropractic & Manual Therapies 2025 (May 5); 33: 17 ~ FULL TEXT

  OPEN ACCESS   

Anna-Marie L Ziegler • Don Thorpe • Douglas Kennedy • Craig Schulz
Stacie A Salsbury • Gert Bronfort • Roni Evans

Integrative Health and Wellbeing Research Program
University of Minnesota,
Mayo Memorial Building C504,
420 Delaware Street,
Minneapolis, MN, 55414, USA.

Background:   Back related leg pain (BRLP) is a problematic subset of low back pain, leading to greater pain, loss of function and health related care costs. While evidence suggests self-management is effective, patient implementation can be sub-optimal. The purpose of this study is to identify barriers and facilitators to self-management for persons experiencing BRLP within the context of a controlled clinical trial and to map these to theory-informed intervention elements that can be addressed by front-line healthcare providers, informing the design and implementation of future theory-driven self-management interventions for this population.

Methods:   This study was a qualitative secondary analysis of a 2-site, pragmatic, parallel group, randomized clinical trial (participants enrolled 2007-10) of spinal manipulative therapy (SMT) and home exercise and advice (HEA) compared to HEA alone for persons with subacute or chronic BRLP. We used deductive and inductive content analysis, to describe self-management facilitators and barriers among trial participants, map these to behavior change elements in the Behavior Change Wheel (BCW) Framework, and identify potentially modifiable, theory-intervention elements which may be addressed with guidance by healthcare providers. Baseline characteristics of participants were descriptively analyzed using SAS (University Edition).

Results:   Of 40 participants, the majority identified as white (n = 24, 85%) and of non-Hispanic or Latino ethnicity (n = 38, 95%). Average participant age was 57 years old (range 29-80). Frequent facilitators included ease of exercises, knowing how to manage condition, atmosphere created by staff, therapeutic alliance, effectiveness of exercises or treatment, goal of reducing pain, and intentions of continuing exercises. Frequent barriers included time constraints, pain, and lacking confidence in treatment. Barriers were mapped to all 9 Intervention Functions, most common being modelling and education. Frequently identified Behavior Change Techniques included information, feedback, self-monitoring, graded tasks, restructuring, social support, goal setting, reviewing goals, and action planning.

Conclusion:   This study identified barriers and facilitators to engaging in self-management for participants in a pragmatic, randomized clinical trial. A rigorous systematic intervention mapping process utilizing the BCW was used for describing what participants need and how their needs may be met. These findings may support the design of future self-management interventions for persons experiencing BRLP.

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Retrospective Review of Case Records of School-aged Children Receiving Chiropractic Care

By |May 11, 2025|Chiropractic Care, Pediatrics|

Retrospective Review of Case Records of School-aged Children Receiving Chiropractic Care

The Chiro.Org Blog

SOURCE:   J Bodyw Mov Ther 2025 (Jun): 42: 948–954

  OPEN ACCESS   

Jenna Duehr • Lona Cook • Amanda Blonigen • Alice Cade • Tanja Glucina • Monika Buerger
Stephanie Sullivan • Tyson Perez • Muhammed Samran Navid
Imran Khan Niazi • Heidi Haavik

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

Background:   Chiropractic care is utilized in school aged children for a variety of health complaints, including headaches, postural issues, nocturnal enuresis, neurodevelopmental disorders, and back pain. Chiropractic care, with its ability to impact sensorimotor integration, motor control and the prefrontal cortex, could therefore potentially benefit school aged children.

Methods:   In this retrospective case series, records of patients presenting for chiropractic care at an onsite school chiropractic clinic were reviewed. Patients underwent 12 weeks of chiropractic care and completed three questionnaires and two sets of neurophysiological scans. The data from these questionnaires and scans were combined, averaged, and statistically analyzed.

Results:   One hundred and eighty records of children aged 5-18 years from nine schools were included in the overall analyses. Statistically significant improvements were noted in the ‘health and activities’ sub-section and overall score of the Pediatric Quality of Life Inventory™ and in the hyperactivity domain of the Strengths and Difficulties questionnaire.

Conclusion:   This retrospective review of case records from children attending an onsite school chiropractic clinic has demonstrated some changes in health-related quality of life following a period of 12 weeks of chiropractic care. Further research using a clinical trial design is needed to extrapolate the findings and to assess causation.

Keywords:   Chiropractic; Heart-rate variability; Neurodevelopmental disorders; Neurophysiology; Quality of life; School children; Surface electromyography; Thermography.

From the Full-Text Article:

Introduction

Childhood is a period of huge growth and development. The health and experiences of children during this critical time can have long-term impacts on disease rates, mental health, and overall well-being for the rest of their lives(Drozdz et al., 2021; Goodman et al., 2011; Middlebrooks., 2007; Marcus et al., 2022; Bellis et al., 2019). However, the health and wellbeing of children today is showing some alarming areas of decline and concern (Lebrun-Harris et al., 2022). Data from the National Survey of Children’s health in the US from 2016 to 2020 showed an increase in rates of anxiety, depression, behavioral disorders, and obesity (Lebrun-Harris et al., 2022)). The survey also showed declining rates of preventative medical visits, daily physical activity, and parents mental health (Lebrun-Harris et al., 2022). The decline in key areas of health is also evident from more historical data from the 2007 and 2011/2012 National Survey of Children’s Health (Initiative et al., 2024) which showed higher rates in many of the domains related to good health (preventative medical visits, physical activity) and lower rates of obesity, suggesting that the decline in key areas of children’s health has been evident for nearly two decades.

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Trends in Chiropractic Care and Physical Rehabilitation Use Among Adults with Low Back Pain in the United States, 2002 to 2018

By |April 24, 2025|Chiropractic Care, Cost-Effectiveness, Low Back Pain|

Trends in Chiropractic Care and Physical Rehabilitation Use Among Adults with Low Back Pain in the United States, 2002 to 2018

The Chiro.Org Blog

SOURCE:   J Gen Intern Med. 2023 (Oct 19); 39 (4): 578–586

Eric J Roseen • Kushang V Patel • Rachel Ward • Xinyao de Grauw
Steven J Atlas • Stephen Bartels • Julie J Keysor • Jonathan F Bean

Section of General Internal Medicine,
Department of Medicine, Boston University,
Chobanian & Avedision School of Medicine and
Boston Medical Center,
Boston, MA, USA.

Background   While nonpharmacologic treatments are increasingly endorsed as first-line therapy for low back pain (LBP) in clinical practice guidelines, it is unclear if use of these treatments is increasing or equitable.

Objective   Examine national trends in chiropractic care and physical rehabilitation (occupational/physical therapy (OT/PT)) use among adults with LBP.

Design/Setting   Serial cross-sectional analysis of the National Health Interview Survey, 2002 to 2018.

Participants   146,087 adults reporting LBP in prior 3 months.

Methods   We evaluated the association of survey year with chiropractic care or OT/PT use in prior 12 months. Logistic regression with multilevel linear splines was used to determine if chiropractic care or OT/PT use increased after the introduction of clinical guidelines. We also examined trends in use by age, sex, race, and ethnicity. When trends were similar over time, we present differences by these demographic characteristics as unadjusted ORs using data from all respondents.

Results   Between 2002 and 2018, less than one-third of adults with LBP reported use of either chiropractic care or OT/PT. Rates did not change until 2016 when uptake increased with the introduction of clinical guidelines (2016–2018 vs 2002–2015, OR` =` 1.15; 95% CI: 1.10–1.19). Trends did not differ significantly by sex, race, or ethnicity (p for interactions` >` 0.05). Racial and ethnic disparities in chiropractic care or OT/PT use were identified and persisted over time. For example, compared to non-Hispanic adults, either chiropractic care or OT/PT use was lower among Hispanic adults (combined OR` =` 0.62, 95% CI: 0.65–0.73). By contrast, compared to White adults, Black adults had similar OT/PT use (OR` =` 0.98; 95% CI: 0.94–1.03) but lower for chiropractic care use (OR` =` 0.50; 95% CI: 0.47–0.53).

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