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Chiropractic Students Versus Emergency Care Practitioners in Simulated Musculoskeletal Emergencies

By Frank M. Painter|November 11, 2025|All About Chiropractic, Care Plans, Cervical Disk Herniation, Chiropractic Education, Chiropractic Management, Diagnosis, Escalation of Care, Evidence-based Medicine|

Chiropractic Students Versus Emergency Care Practitioners in Simulated Musculoskeletal Emergencies

The Chiro.Org Blog

SOURCE: Health SA 2025 (Oct 31): 30: 3195

Ivanna Balanco • Helen Slabber • Christopher Yelverton

Department of Chiropractic,
Faculty of Health Sciences,
University of Johannesburg,
Johannesburg, South Africa.

Background: As primary contact practitioners, chiropractors and emergency care practitioners (ECPs are first points of access for patients with musculoskeletal (MSK) complaints. A comparison of their diagnostic competency in distinguishing these presentations from underlying emergency pathologies remains an understudied area.

Aim: To compare the diagnostic abilities of Master of Health Science (MHSc) chiropractic students and ECPs in distinguishing MSK from emergency conditions.

Setting: The research was conducted at the University of Johannesburg, Faculty of Health Sciences, simulation laboratory.

Methods: First-year (n = 10) and second-year Master’s (n = 10) chiropractic students and ECPs (n = 10) were assessed using standardised patient scenarios: meningitis, disc herniation and stroke, and assessed on diagnostic assessment, diagnosis and clinical and diagnostic investigation referrals.

Results: Second-year MHSc students outperformed ECPs in the clinical management of a disc herniation case (Case 2; p < 0.01). Diagnostic accuracy was high (> 90%) for meningitis and stroke across all groups. Differences in investigation preferences emerged, with chiropractic students favouring advanced imaging and ECPs recommending more basic tests. No significant performance differences were found in the other two cases.

Conclusion: Based on a simulated assessment, chiropractic students demonstrated equivalent competence to emergency care practitioners (ECPs) in diagnosing emergencies, but outperformed them in managing an MSK condition. These preliminary findings suggest chiropractors could contribute to the management of MSK burden in emergency departments.

Contribution: MHSc chiropractic training enhances diagnostic proficiency in differentiating MSK disorders from emergent pathologies, an important competency for safe and effective practice as primary contact practitioners.

Keywords: chiropractic; clinical competence; diagnosis; emergency medical services; musculoskeletal disease; simulation.

From the FULL TEXT Article:

Introduction

Musculoskeletal (MSK) conditions represent a significant global health burden, ranking as the second leading cause of disability worldwide and affecting approximately one in five working-age adults (Lowe, Taylor & Hill 2017; Weinstein 2016). Back pain, a prevalent MSK complaint, contributes substantially to reduced work productivity, absenteeism and healthcare costs (Ingram & Symmons 2018; Menke 2003). This high prevalence strains healthcare systems, leading to long wait times for specialist care, including surgery (Joshipura & Gosselin 2020).

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Nociplastic Pain: An Introduction

By Frank M. Painter|October 21, 2025|Chronic Low Back Pain, Chronic Neck Pain, Chronic Pain, Nociplastic Pain|

Nociplastic Pain: An Introduction

The Chiro.Org Blog

SOURCE: J Can Chiropr Assoc 2025 (Aug); 69 (2): 131–144

Christopher B. Roecker, DC, MS • Samuel M. Schut, DC

VA Puget Sound Health Care System,
Care Rehabilitation Care Services,
Everett, Washington.

Chronic pain is common in chiropractic practice and often presents without clear evidence of tissue injury. Nociplastic pain is a recently defined concept that highlights altered nociceptive processing within the nervous system. This newer understanding of pain provides insight into chronic conditions such as chronic back or neck pain, chronic headaches, and fibromyalgia. These conditions are commonly encountered in chiropractic practice but may be challenging to address using traditional models. This commentary introduces nociplastic pain, outlining potential mechanisms and relevance to chiropractic care. We advocate a collaborative, multimodal management approach that includes patient education, exercise promotion, and functional goal-setting within a biopsychosocial framework. Understanding nociplastic pain equips chiropractors to support patients with complex chronic pain through compassionate, evidence-based care that addresses the whole person.

Keywords: back; biopsychosocial; central sensitization; chiropractic; chronic; fibromyalgia; headache; interdisciplinary health teams; management; neck; neuropathic; nociception; nociplastic; pain; widespread chronic pain.

From the FULL TEXT Article:

Introduction

Advances in pain science continue to transform our understanding of pain mechanisms. Traditionally, pain has been mechanistically classified as either nociceptive or neuropathic in nature, and cases that did not fall easily into one of these categories were often labeled as idiopathic or pejoratively suggestive of malingering. [1] This framework, however, was incomplete and left many patients without a clear explanation for their symptoms. By 2017, sufficient evidence had accumulated to describe a third pain mechanistic descriptor (i.e., type of pain), characterized by alterations in nociceptive processing. [2–4] This new understanding of pain is now recognized as nociplastic pain. [5–8]

Table 1

Nociplastic pain is defined as “pain that arises from altered nociception despite no clear evidence of actual or threatened tissue damage causing the activation of peripheral nociceptors or evidence for disease or lesion of the somatosensory system causing the pain” (Table 1). [5, 8] The purpose of this commentary is to introduce nociplastic pain, its purported pathophysiologic mechanisms, management strategies, and its implications for clinical decision-making within the chiropractic profession.

Nociplastic pain

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Lithium Deficiency and the Onset of Alzheimer’s Disease

By Frank M. Painter|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 Frank M. Painter|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 Frank M. Painter|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 Frank M. Painter|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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