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Concurrent Bell’s Palsy and Facial Pain Improving with Multimodal Chiropractic Therapy: A Case Report and Literature Review

By |October 3, 2022|Bell's Palsy, Chiropractic Management|

Concurrent Bell’s Palsy and Facial Pain Improving with Multimodal Chiropractic Therapy: A Case Report and Literature Review

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SOURCE:   Am J Case Rep 2022 (Sep 19); 23: e937511

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Eric Chun-Pu Chu, Robert J Trager, Alan Te-Chang Chen

New Chiropractic and Physiotherapy Centre,
EC Healthcare,
Kowloon, Hong Kong.



BACKGROUND   Bell’s palsy, also called facial nerve palsy, occasionally   co-occurs with trigeminal neuropathy, which presents as additional facial sensory symptoms and/or neck pain. Bell’s palsy has a proposed viral etiology, in particular when occurring after dental manipulation.

CASE REPORT   A 52-year-old Asian woman presented to a chiropractor with a 3-year history of constant neck pain and left-sided maxillary, eyebrow, and temporomandibular facial pain, paresis, and paresthesia, which began after using a toothpick, causing possible gum trauma. She had previously been treated with antiviral medication and prednisone, Chinese herbal medicine, and acupuncture, but her recovery plateaued at 60% after 1 year. The chiropractor ordered cervical spine magnetic resonance imaging, which demonstrated cervical spondylosis, with no evidence of myelopathy or major pathology. Treatment involved cervical and thoracic spinal manipulation, cervical traction, soft-tissue therapy, and neck exercises. The patient responded positively. At 1-month follow-up, face and neck pain and facial paresis were resolved aside from residual eyelid synkinesis. A literature review identified 12 additional cases in which chiropractic spinal manipulation with multimodal therapies was reported to improve Bell’s palsy. Including the current case, 85% of these patients also had pain in the face or neck.

CONCLUSIONS   This case illustrates improvement of Bell’s palsy and concurrent trigeminal neuropathy with multimodal chiropractic care including spinal manipulation. Limited evidence from other similar cases suggests a role of the trigeminal pathway in these positive treatment responses of Bell’s palsy with concurrent face/neck pain. These findings should be explored with research designs accounting for the natural history of Bell’s palsy.

Keywords:   Bell Palsy, Chiropractic, Manipulation, Spinal, Musculoskeletal Manipulations, Neck Pain, Trigeminal Nerve Diseases


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Background

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Return to Work a Bumpy Road: A Qualitative Study on Experiences of Work Ability and Work Situation in Individuals with Chronic Whiplash-associated Disorders

By |September 29, 2022|Rehabilitation, Whiplash|

Return to Work a Bumpy Road: A Qualitative Study on Experiences of Work Ability and Work Situation in Individuals with Chronic Whiplash-associated Disorders

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SOURCE:   BMC Public Health 2021 (Apr 23); 21 (1): 785

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A Peolsson, A Hermansen, G Peterson, E Nilsing Strid

Department of Health, Medicine and Caring Sciences,
Unit of Physiotherapy,
Linköping University,
Linköping, Sweden.



Background:   Work resumption is a big challenge in the rehabilitation process for individuals with whiplash-associated disorders (WAD). To better meet the needs of individuals with WAD in their return to work process, more knowledge on their experiences and perspectives is needed. The aim of this study was to explore the experiences of work ability and the work situation of individuals who participated in a neck-specific exercise programme for chronic WAD.

Methods:   This qualitative study has an exploratory and descriptive design based on data collected through open-ended interviews with 17 individuals with chronic WAD. Data were analysed inductively using conventional content analysis.

Results:   Analysis of the data yielded the following five categories related to the participants’ narratives on their experiences of work ability and their work situation: Return to work – a process of setbacks and bureaucracy; The need to be understood by health care professionals, and to receive a treatment plan; Individual resources are important for work ability; The consequences of reduced work ability; and Working conditions are important for work ability.

Conclusion:   Individuals with chronic WAD often struggle to return to work. Emotional and practical support from stakeholders is imperative and needs to be strengthened. Participating in a neck-specific exercise programme, including being acknowledged and receiving information about WAD, could positively affect the work ability of WAD sufferers. This study has provided management strategies to improve the ability to work for individuals with chronic WAD, and highlights the need to incorporate a healthy and sustainable return to work in the rehabilitation of individuals with WAD, thereby making their return to work a success.

Keywords:   Neck pain; Occupational health; Qualitative research; Return to work; Whiplash injuries.


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Background

Individuals with chronic with whiplash-associated disorders (WAD) experience a variety of symptoms, including pain and disability, leading to financial consequences for themselves, their employer, and society. [1–3]

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What Does Best Practice Care for Musculoskeletal Pain Look Like? Eleven Consistent Recommendations From High-quality Clinical Practice Guidelines: Systematic Review

By |September 21, 2022|Best Practice Care|

What Does Best Practice Care for Musculoskeletal Pain Look Like? Eleven Consistent Recommendations From High-quality Clinical Practice Guidelines: Systematic Review

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SOURCE:   British J Sports Medicine 2020 (Jan); 54 (2): 79–86
Ivan Lin, Louise Wiles, Rob Waller, Roger Goucke, Yusuf Nagree, Michael Gibberd, Leon Straker, et. al.

WA Centre for Rural Health,
University of Western Australia,
Geraldton, Western Australia, Australia.


      Lancet Digit Health 2022


Objectives:   To identify common recommendations for high-quality care for the most common musculoskeletal (MSK) pain sites encountered by clinicians in emergency and primary care (spinal (lumbar, thoracic and cervical), hip/knee (including osteoarthritis [OA] and shoulder) from contemporary, high-quality clinical practice guidelines (CPGs).

Design:   Systematic review, critical appraisal and narrative synthesis of MSK pain CPG recommendations.

Eligibility criteria:   Included MSK pain CPGs were written in English, rated as high quality, published from 2011, focused on adults and described development processes. Excluded CPGs were for: traumatic MSK pain, single modalities (eg, surgery), traditional healing/medicine, specific disease processes (eg, inflammatory arthropathies) or those that required payment.

Data sources:   Four scientific databases (MEDLINE, Embase, CINAHL and Physiotherapy Evidence Database) and four guideline repositories.

Results:   6,232 records were identified, 44 CPGs were appraised and 11 were rated as high quality (low back pain: 4, OA: 4, neck: 2 and shoulder: 1). We identified 11 recommendations for MSK pain care: ensure care is patient centred, screen for red flag conditions, assess psychosocial factors, use imaging selectively, undertake a physical examination, monitor patient progress, provide education/information, address physical activity/exercise, use manual therapy only as an adjunct to other treatments, offer high-quality non-surgical care prior to surgery and try to keep patients at work.

Conclusion:   These 11 recommendations guide healthcare consumers, clinicians, researchers and policy makers to manage MSK pain. This should improve the quality of care of MSK pain.

Keywords:   education; effectiveness; evidence based; knowledge translation; review.


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Background

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BEST PRACTICES Section

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Low-value Care in Musculoskeletal Health Care: Is There a Way Forward?

By |September 20, 2022|Chiropractic Management, Musculoskeletal Pain|

Low-value Care in Musculoskeletal Health Care: Is There a Way Forward?

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SOURCE:   Pain Practice 2022 (Sep); 22 (Suppl 2): 65–70

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Jan Hartvigsen PhD, Steven J. Kamper PhD, Simon D. French PhD

Department of Sports Science and Clinical Biomechanics,
Center for Muscle and Joint Health,
University of Southern Denmark,
Odense M, Denmark.



Background:   Low-value care that wastes resources and harms patients is prevalent in health systems everywhere.

Methods:   As part of an invited keynote presentation at the Pain in Motion IV conference held in Maastricht, Holland, in May 2022, we reviewed evidence for low-value care in musculoskeletal conditions and discussed possible solutions.

Results:   Drivers of low-value care are diverse and affect patients, clinicians, and health systems everywhere. We show that low-value care for back pian, neck pain, and osteoarthritis is prevalent in all professional groups involved in caring for people who seek care for these conditions. Implementation efforts that aim to reverse low-value care seem to work better if designed using established conceptual and theoretical frameworks.

Conclusion:   Low-value care is prevalent in the care of people with musculoskeletal conditions. Reducing low-value care requires behaviour change among patients and clinicians as well as in health systems. There is evidence that behaviour change can be facilitated through good conceptual and theoretical frameworks but not convincing evidence that it changes patient outcomes.

Keywords:   back pain; clinical guidelines; evidence-based practice; low-value care; osteoarthritis.


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Low-Value Care Is Prevalent In Health Systems

Low-value care is defined as health services that confer little or no benefit to patients or where risk of harm exceeds probable benefit, according to best available evidence. [1] Low-value care is common across health systems globally and includes ineffective screening programs, unnecessary diagnostic testing and imaging, ineffective and harmful treatments, and inefficient organization of health systems. [2, 3] It is estimated that only around 60% of services are in line with best available evidence, 30% is waste, duplication, or low value, and 10% is harmful. [4] Low-value care is not a trivial issue; it adds cost and consumes resources, causes iatrogenic harm, and impedes delivery of high-value care that reliably provides health benefits for individuals and populations. [5]

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Chiropractic Management of Neck Pain Complicated by Symptomatic Vertebral Artery Stenosis and Dizziness

By |September 15, 2022|Chiropractic Management, Stroke and Chiropractic|

Chiropractic Management of Neck Pain Complicated by Symptomatic Vertebral Artery Stenosis and Dizziness

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SOURCE:   American Journal of Case Reports (Sep 14) 2022 [Epub]


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Eric Chun-Pu Chu, Robert J. Trager, Cliff Tao, Linda Yin-King Lee

New York Chiropractic and Physiotherapy Centre,
EC Healthcare,
Kowloon, Hong Kong



BACKGROUND   Vertebrobasilar insufficiency (VBI) is most often caused by vertebrobasilar atherosclerosis, often presenting with dizziness and occasionally neck pain. Little research or guidelines regarding management of neck pain in affected patients exists.

CASE REPORT   A 62–year-old male hypertensive smoker presented to a chiropractor with a 13–year history of insidious-onset neck pain, dizziness, and occipital headache with a Dizziness Handicap Inventory (DHI) of 52%. The patient had known VBI, caused by bilateral vertebral artery plaques, and cervical spondylosis, and was treated with multiple cardiovascular medications. The chiropractor referred patient to a neurosurgeon, who cleared him to receive manual therapies provided manual-thrust cervical spinal manipulative therapy (SMT) was not performed. The chiropractor administered thoracic SMT and cervicothoracic soft tissue manipulation. The neck pain and dizziness mostly resolved by 1 month. At 1–year follow-up, DHI was 0%; at 2 years it was 8%. A literature search revealed 4 cases in which a chiropractor used manual therapies for a patient with VBI. Including the present case, all patients had neck pain, 60% had dizziness, and all were treated with SMT either avoiding manual cervical manipulation altogether or modifying it to avoid or limit cervical rotation, yielding positive outcomes.

CONCLUSIONS   The present and previous cases provide limited evidence that some carefully considered chiropractic manual therapies can afford patients with VBI relief from concurrent neck pain and possibly dizziness. Given the paucity of research, cervical SMT cannot be recommended in such patients. These findings do not apply to vertebral artery dissection, for which SMT is an absolute contraindication.

KEYWORDS: &nbsp Chiropractic; Dizziness; Headache; Manipulation, Spinal; Neck Pain; Vertebral Artery


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Background

Vertebrobasilar insufficiency (VBI), also called posterior circulation insufficiency or vertebrobasilar transient ischemic attack, is defined as a transitory ischemia of the vertebrobasilar circulation [1–3] and is a risk factor for vertebrobasilar stroke. [4, 5]

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A Systematic Review of Chiropractic Care for Fall Prevention: Rationale, State of the Evidence, and Recommendations for Future Research

By |September 14, 2022|Balance, Chiropractic Management, Fall Prevention|

A Systematic Review of Chiropractic Care for Fall Prevention: Rationale, State of the Evidence, and Recommendations for Future Research

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SOURCE:   BMC Musculoskelet Disord 2022 (Sep 5); 23 (1): 844


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Weronika Grabowska, Wren Burton, Matthew H. Kowalski, Robert Vining, Cynthia R. Long, Anthony Lisi, Jeffrey M. Hausdorff, Brad Manor, Dennis Muñoz-Vergara & Peter M. Wayne

Brigham and Women’s Hospital and
Harvard Medical School Division of Preventive Medicine,
Osher Center for Integrative Medicine,
900 Commonwealth Avenue, 3rd Floor,
Boston, MA, 02215, USA.





Background:   Falls in older adults are a significant and growing public health concern. There are multiple risk factors associated with falls that may be addressed within the scope of chiropractic training and licensure. Few attempts have been made to summarize existing evidence on multimodal chiropractic care and fall risk mitigation. Therefore, the broad purpose of this review was to summarize this research to date.

Main text:   Systematic review was conducted following PRISMA guidelines. Databases searched included PubMed, Embase, Cochrane Library, PEDro, and Index of Chiropractic Literature. Eligible study designs included randomized controlled trials (RCT), prospective non-randomized controlled, observational, and cross-over studies in which multimodal chiropractic care was the primary intervention and changes in gait, balance and/or falls were outcomes. Risk of bias was also assessed using the 8-item Cochrane Collaboration Tool. The original search yielded 889 articles; 21 met final eligibility including 10 RCTs. One study directly measured the frequency of falls (underpowered secondary outcome) while most studies assessed short-term measurements of gait and balance. The overall methodological quality of identified studies and findings were mixed, limiting interpretation regarding the potential impact of chiropractic care on fall risk to qualitative synthesis.

Conclusion:   Little high-quality research has been published to inform how multimodal chiropractic care can best address and positively influence fall prevention. We propose strategies for building an evidence base to inform the role of multimodal chiropractic care in fall prevention and outline recommendations for future research to fill current evidence gaps.

Keywords:   Balance; Chiropractic; Chiropractic care; Fall prevention; Falls; Gait.

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VERTIGO and BALANCE Section