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One- and Two-year Follow-up of a Randomized Trial of Neck-specific Exercise with or without a Behavioural Approach Compared with Prescription of Physical Activity in Chronic Whiplash Disorder

By Frank M. Painter|October 6, 2022|Chiropractic Management, Whiplash|

One- and Two-year Follow-up of a Randomized Trial of Neck-specific Exercise with or without a Behavioural Approach Compared with Prescription of Physical Activity in Chronic Whiplash Disorder

SOURCE: J Rehabil Med 2016 (Jan); 48 (1): 56–64

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Maria Landén Ludvigsson, MSc, Gunnel Peterson MSc, Åsa Dedering, PhD and Anneli Peolsson, PhD

Department of Medical and Health Sciences,
Division of Physiotherapy,
Linköping University,
SE-581 83 Linköping, Sweden.

Objective: To explore whether neck-specific exercise, with or without a behavioural approach, has benefits after 1 and 2 years compared with prescribed physical activity regarding pain, self-rated functioning/disability, and self-efficacy in management of chronic whiplash.

Patients A total of 216 volunteers with chronic whiplash-associated disorders, grades 2 or 3.

Methods: Participants were randomized to 1 of 3 exercise interventions: neck-specific exercise with or without a behavioural approach, or physical activity prescription. Self-rated pain (visual analogue scale), disability/functioning (Neck Disability Index/Patient Specific Functional Scale) and self-efficacy (Self-Efficacy Scale) were evaluated after 1 and 2 years.

Results: Both neck-specific exercise groups maintained more improvement regarding disability/functioning than the prescribed physical activity group at both time-points (p ≤ 0.02). At 1 year, 61% of subjects in the neck-specific group reported at least 50% pain reduction, compared with 26% of those in the physical activity prescription group (p < 0.001), but at 2 years the difference was not significant.

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WHIPLASH Section and the:

EXERCISE AND CHIROPRACTIC Section

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

By Frank M. Painter|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

The Chiro.Org Blog

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.

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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 Frank M. Painter|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

The Chiro.Org Blog

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.

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WHIPLASH Section

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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 Frank M. Painter|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

The Chiro.Org Blog

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.

FROM: 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.

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BEST PRACTICES Section

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

By Frank M. Painter|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.

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SPINAL PAIN MANAGEMENT Section

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

By Frank M. Painter|September 15, 2022|Chiropractic Management, Stroke and Chiropractic|

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

The Chiro.Org Blog

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.

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STROKE AND CHIROPRACTIC Section

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