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Immediate Effects on Pressure Pain Threshold Following a Single Cervical Spine Manipulation in Healthy Subjects

By Frank M. Painter|November 17, 2015|Pain Relief|

Immediate Effects on Pressure Pain Threshold Following a Single Cervical Spine Manipulation in Healthy Subjects

SOURCE: J Orthop Sports Phys Ther. 2007 (Jun); 37 (6): 325

CéSar Fernández-De-Las-Peñas, PT, PhD, Marta Pérez-De-Heredia, OT

Department of Physical Therapy,
Occupational Therapy,
Physical Medicine and Rehabilitation,
Universidad Rey Juan Carlos,
Alcorcön, Spain

DESIGN: A placebo, control, repeated-measures, single-blinded randomized study.

OBJECTIVES: To compare the immediate effects on pressure pain threshold (PPT) tested over the lateral elbow region following a single cervical high-velocity low-amplitude (HVLA) thrust manipulation, a sham-manual application (placebo), or a control condition; and to analyze if a different effect was evident on the side ipsilateral to, compared to the side contralateral to, the intervention.

BACKGROUND: Previous studies investigating the effects of spinal manual therapy used passive mobilization procedures. There is a lack of studies exploring the effect of cervical manipulative interventions.

METHODS: Fifteen asymptomatic volunteers (7 male, 8 female; aged 19-25 years) participated in this study. Each subject attended 3 experimental sessions on 3 separate days, at least 48 hours apart. At each session, subjects received either the manipulation, placebo, or control intervention provided by an experienced therapist. The manipulative intervention was directed at the posterior joint of the C5-6 vertebral level. PPT over the lateral epicondyle of both elbows was assessed preintervention and 5 minutes postintervention by an examiner blinded to the treatment allocation of the subject. A 3-way analysis of covariance (ANCOVA) with intervention, side, and time as factors, and gender as covariate, was used to evaluate changes in PPT.

RESULTS: The analysis of variance detected a significant effect for intervention (F = 31.46, P < .001) and for time (F = 33.81, P < .001), but not for side (F = 0.303, P > .5). A significant interaction between intervention and time (F = 15.74, P < .001) was also found. Gender did not influence the comparative analysis (F = 0.252, P > .6). Post hoc analysis revealed that the application of a HVLA thrust manipulation produced a greater increase of PPT in both elbows, as compared to placebo or control interventions (P < .001). No significant changes in PPT levels were found after the placebo and control interventions (P > .6). Within-group effect sizes were large for PPT levels in both elbows after the manipulative procedure (d > 1.0), but small after placebo or control intervention (d < 0.1).

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Wellness-related Use of Common Complementary Health Approaches Among Adults

By Frank M. Painter|November 16, 2015|Chiropractic Care, Complementary Medicine|

Wellness-related Use of Common Complementary Health Approaches Among Adults: United States, 2012

The Chiro.Org Blog

SOURCE: Natl Health Stat Report. 2015 (Nov 4); (85): 1–12 ~ FULL TEXT

Barbara J. Stussman, B.A., Lindsey I. Black, M.P.H.,
Patricia M. Barnes, M.A., and Tainya C. Clarke, Ph.D., M.P.H.,
and Richard L. Nahin, Ph.D., M.P.H.

National Institutes of Health
National Center for Health Statistics

Objective This 12 page National Institutes of Health report presents national estimates of selected wellness-related reasons for the use of natural product supplements, yoga, and spinal manipulation among U.S. adults in 2012. Self-reported perceived health outcomes were also examined.

Methods Data from 34,525 adults aged 18 and over collected as part of the 2012 National Health Interview Survey were analyzed for this report. In particular, whether adults who used selected complementary health approaches did so to treat a specific health condition or for any of five wellness-related reasons was examined, as well as whether these adults perceived that this use led to any of nine health-related outcomes. Sampling weights were used to produce national estimates that are representative of the civilian noninstitutionalized U.S. adult population.

Results Users of natural product supplements and yoga were more likely to have reported using the approach for a wellness reason than for treatment of a specific health condition, whereas more spinal manipulation users reported using it for treatment rather than for wellness. The most common wellness-related reason reported by users of each of the three approaches was for ‘‘general wellness or disease prevention.’’ The majority of users of all three health approaches reported that they perceived this use improved their overall health and made them feel better. Yoga users perceived higher rates of all of the self-reported wellness-related health outcomes than users of natural product supplements or spinal manipulation.

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Maintenance Care, Wellness and Chiropractic Page

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Immediate Effects of Spinal Manipulative Therapy on Regional Antinociceptive Effects in Myofascial Tissues in Healthy Young Adults

By Frank M. Painter|November 14, 2015|Chiropractic Care, Myofascial Disorder|

Immediate Effects of Spinal Manipulative Therapy on Regional Antinociceptive Effects in Myofascial Tissues in Healthy Young Adults

The Chiro.Org Blog

SOURCE: J Manipulative Physiol Ther. 2013 (Jul); 36 (6): 333–341 ~ FULL TEXT

John Z. Srbely, DC PhD, Howard Vernon, DC, PhD,
David Lee, DC, Miranda Polgar, BSc

Department of Human Health and Nutritional Science,
University of Guelph, Guelph,
Ontario, Canada

OBJECTIVE: The purpose of this study was to investigate if spinal manipulative therapy (SMT) can evoke immediate regional antinociceptive effects in myofascial tissues by increasing pressure pain thresholds (PPTs) over myofascial trigger points in healthy young adults.

METHODS: A total of 36 participants (19 men, 17 women; age, 28.0 [5.3] years; body mass index, 26.5 [5.7] kg/m(2)) with clinically identifiable myofascial trigger points in the infraspinatus and gluteus medius muscles were recruited from the University of Guelph, Ontario, Canada. Participants were randomly allocated to 2 groups. Participants in the test group received chiropractic SMT targeted to the C5-C6 spinal segment. Participants in the control group received sham SMT. The PPT was recorded from the right infraspinatus and gluteus medius muscles at baseline (preintervention) and 1, 5, 10, and 15 minutes postintervention.

RESULTS: Three participants were disqualified, resulting in a total of 33 participants analyzed. Significant increases in the pressure pain thresholds (PPT) [decreased pain sensitivity] were observed in the test infraspinatus group when compared with test gluteus medius, control infraspinatus, and control gluteus medius groups (P < .05). No significant differences in PPT were observed at any time point when comparing test gluteus medius, control infraspinatus, and control gluteus medius groups (P > .05).

CONCLUSIONS: This study showed that SMT evokes short-term regional increases in PPT within myofascial tissues in healthy young adults.

Key Indexing Terms: Manipulation, Myofascial Pain Syndrome, Myofascial Trigger Point, Pain Threshold, Chiropractic

From the Full-Text Article:

Introduction

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Myofascial Trigger Point Page

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Acupuncture and Chiropractic Care Utilization

By Frank M. Painter|November 9, 2015|Acupuncture, Chiropractic Care|

Acupuncture and Chiropractic Care: Utilization and Electronic Medical Record Capture

The Chiro.Org Blog

SOURCE: Am J Manag Care. 2015 (Jul 1); 21 (7): e414-21 ~ FULL TEXT

Charles Elder, MD, MPH; Lynn DeBar, PhD, MPH;
Cheryl Ritenbaugh, PhD, MPH; et. al

Kaiser Permanente Northwest,
Center for Health Research,
3800 N Interstate Ave,
Portland, OR 97227
Charles.Elder@kpchr.org

This recent study, published in the American Journal of Managed Care, underscores why so many chiropractic patients have to go “out of network” in order to get the care they need: Managed care appears to be be effectively locking them out. This study reviews chiropractic and acupuncture utilization by adults with chronic musculoskeletal pain at Kaiser Permanente Northwest, an HMO.

Evidently, physician referral for acupuncture is strictly limited to chronic pain complaints, while referral for chiropractic benefits is limited to acute pain. This is why 43-54% of those individuals who sought chiropractic care had to seek “out-of-plan” (aka out-of-pocket) care.

Physician referrals within this Kaiser program was tipped in favor of acupuncture, with 55% of them being referred for care, versus only 9% of the chiropractic patients.

Thanks to Dynamic Chiropractic for their brief review of this study!

OBJECTIVES: To describe acupuncture and chiropractic use among patients with chronic musculoskeletal pain (CMP) at a health maintenance organization, and explore issues of benefit design and electronic medical record (EMR) capture.

STUDY DESIGN: Cross-sectional survey.

METHODS: Kaiser Permanente members meeting EMR diagnostic criteria for CMP were invited to participate. The survey included questions about self-identified presence of chronic musculoskeletal pain, use of acupuncture and chiropractic care, use of ancillary self-care modalities, and communication with conventional medicine practitioners. Analysis of survey data was supplemented with a retrospective review of EMR utilization data.

RESULTS: Of 6068 survey respondents, 32% reported acupuncture use, 47% reported chiropractic use, 21% used both, and 42% used neither. For 25% of patients using acupuncture and 43% of those using chiropractic care, utilization was undetected by the EMR. Thirty-five percent of acupuncture users and 42% of chiropractic users did not discuss this care with their health maintenance organization (HMO) clinicians. Among chiropractic users, those accessing care out of plan were older (P < .01), were more likely to use long-term opioids (P = .03), and had more pain diagnoses (P = .01) than those accessing care via clinician referral or self-referral. For acupuncture, those using the clinician referral mechanism exhibited these same characteristics.

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Chiropractors Included in New Danish Muscle and Joint Health Research Team

By Frank M. Painter|November 6, 2015|Chiropractic Research|

Chiropractors Included in New Danish Muscle and Joint Health Research Team

The Chiro.Org Blog

SOURCE: WFC Quarterly World Report 2015 (Sep) (see page 5) ~ FULL TEXT

A team of leading researchers, including chiropractors, have founded a new research institute that aims to become a top centre for musculoskeletal health.

The researchers, from the University of Southern Denmark, have founded the
Center for Muscle and Joint Health.

With a stated aim of reducing the burden of musculoskeletal health, investigators will look at pain and functional loss in joints.

Research has previously shown that a Dane loses an average of seven years of good quality of life due to pain and functional problems related to the musculoskeletal system. Muscle and joint disorders now constitute the major cause of functional impairment of populations in Europe – larger than other common disorders like depression, dementia and heart disease.

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Where the United States Spends its Spine Dollars

By Frank M. Painter|November 5, 2015|Low Back Pain, Neck Pain|

Where the United States Spends its Spine Dollars: Expenditures on Different Ambulatory Services for the Management of Back and Neck Conditions

The Chiro.Org Blog

SOURCE: Spine 2012 (Sep 1); 37 (19): 1693–1701 ~ FULL TEXT

Matthew A. Davis, DC, MPH

The Dartmouth Institute for Health Policy and Clinical Practice,
Lebanon, NH 03766, USA.
matthew.a.davis@dartmouth.edu

STUDY DESIGN: Serial, cross-sectional, nationally representative surveys of noninstitutionalized US adults.

OBJECTIVE: To examine expenditures on common ambulatory health services for the management of back and neck conditions.

SUMMARY OF BACKGROUND DATA: Although it is well recognized that national costs associated with back and neck conditions have grown considerably in recent years, little is known about the costs of care for specific ambulatory health services that are used to manage this population.

METHODS: We used the Medical Expenditure Panel Survey to examine adult (aged 18 yr or older) respondents from 1999 to 2008 who sought ambulatory health services for the management of back and neck conditions. We used complex survey design methods to make national estimates of mean inflation-adjusted annual expenditures on medical care, chiropractic care, and physical therapy per user for back and neck conditions.

RESULTS: Approximately 6% of US adults reported an ambulatory visit for a primary diagnosis of a back or neck condition (13.6 million in 2008). Between 1999 and 2008, the mean inflation-adjusted annual expenditures on medical care for these patients increased by 95% (from $487 to $950); most of the increase was accounted for by increased costs for medical specialists, as opposed to primary care physicians. During the study period, the mean inflation-adjusted annual expenditures on chiropractic care were relatively stable; although physical therapy was the most costly service overall, in recent years those costs have contracted.

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Chronic Neck Pain and Chiropractic Page

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