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Spinal Manipulative Therapy and Exercise For Seniors with Chronic Neck Pain

By Frank M. Painter|March 6, 2015|Chiropractic Care, Chronic Pain, Neck Pain|

Spinal Manipulative Therapy and Exercise For Seniors with Chronic Neck Pain

SOURCE: Spine J. 2014 (Sep 1); 14 (9): 1879–1889

Michele Maiers, DC, MPH, Gert Bronfort, DC, PhD,
Roni Evans, DC, MS, Jan Hartvigsen, DC, PhD,
Kenneth Svendsen, MS, Yiscah Bracha, MS,
Craig Schulz, DC, MS, Karen Schulz, DC,
Richard Grimm, MD, PhD

Northwestern Health Sciences University,
Wolfe-Harris Center for Clinical Studies,
2501 W. 84th St, Bloomington, MN 55431, USA
mmaiers@nwhealth.edu

BACKGROUND CONTEXT: Neck pain, common among the elderly population, has considerable implications on health and quality of life. Evidence supports the use of spinal manipulative therapy (SMT) and exercise to treat neck pain; however, no studies to date have evaluated the effectiveness of these therapies specifically in seniors.

PURPOSE: To assess the relative effectiveness of SMT and supervised rehabilitative exercise, both in combination with and compared to home exercise (HE) alone for neck pain in individuals ages 65 years or older.

STUDY DESIGN/SETTING: Randomized clinical trial.

PATIENT SAMPLE: Individuals 65 years of age or older with a primary complaint of mechanical neck pain, rated =3 (0-10) for 12 weeks or longer in duration.

OUTCOME MEASURES: Patient self-report outcomes were collected at baseline and 4, 12, 26, and 52 weeks after randomization. The primary outcome was pain, measured by an 11-box numerical rating scale. Secondary outcomes included disability (Neck Disability Index), general health status (Medical Outcomes Study Short Form-36), satisfaction (7-point scale), improvement (9-point scale), and medication use (days per week).

METHODS: This study was funded by the US Department of Health and Human Services, Health Resources and Services Administration. Linear mixed model analyses were used for comparisons at individual time points and for short- and long-term analyses. Blinded evaluations of objective outcomes were performed at baseline and 12 weeks. Adverse event data were collected at each treatment visit.

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Is There a Role for Neck Manipulation in Elderly Falls Prevention? – An Overview

By Frank M. Painter|March 3, 2015|Vertigo|

Is There a Role for Neck Manipulation in Elderly Falls Prevention? – An Overview

The Chiro.Org Blog

SOURCE: J Can Chiropr Assoc. 2015 (Mar); 59 (1): 53–63 ~ FULL TEXT

Julie C. Kendall, BAppSc, MClinChiro [1]
Jan Hartvigsen, DC, PhD [2]
Simon D. French, BAppSc(Chiro), MPH, PhD [3]
Michael F. Azari, BAppSc(Chiro), BSc(Hons), PhD* [1,4]

1 Discipline of Chiropractic, School of Health Sciences,
RMIT University, Melbourne, Australia

2 Department of Sports Science and Clinical Biomechanics,
University of Southern Denmark and Nordic Institute of
Chiropractic and Clinical Biomechanics, Odense, Denmark

3 School of Rehabilitation Therapy, Queens University,
Kingston, Canada

4 Health Innovations Research Institute, RMIT University,
Melbourne, Australia

Many risk factors exist for falls in the elderly. Dizziness is an important risk factor for such falls. Spinal pain has also been identified as a risk factor for these falls. In this overview of the literature, we examine studies, including trials, of neck manipulation for neck pain, unsteadiness and falls risk relevant to the elderly. We also examine two related, but not mutually exclusive, mechanisms through which a putative beneficial effect may be mediated. These are the effects of neck manipulation on neck pain and on non-specific dizziness. We focus on the available evidence primarily in terms of clinical data rather than laboratory-based measures of balance. We conclude that chiropractors may have a role in falls prevention strategies in the subpopulation of the elderly that suffer from mechanical neck pain or dysfunction and non-specific dizziness. However, this role remains to be rigorously studied and properly defined.

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Identification of Internal Carotid Artery Dissection

By Frank M. Painter|February 27, 2015|Carotid Artery Dissection, Diagnosis|

Identification of Internal Carotid Artery Dissection in Chiropractic Practice

The Chiro.Org Blog

SOURCE: J Can Chiropr Assoc. 2004 (Sep); 48 (3): 206-210 ~ FULL TEXT

Michael T Haneline, DC, MPH and Gary Lewkovich, DC

Palmer College of Chiropractic West,
Palmer Center for Chiropractic Research,
90 E. Tasman Drive,
San Jose, CA 95134
michael.haneline@palmer.edu

Internal carotid artery dissection (ICAD) is a condition involving separation of the artery’s intimal lining from its medial division, with subsequent extension of the dissection along varying distances of the artery, usually in the direction of blood flow. ICAD may produce cerebral ischemia due to occlusion of the involved artery. This occlusion may occur at or near the site of the dissection, or “downstream” as a result of embolization from a dislodged thrombus fragment. The problem any chiropractic physician faces in identifying ICAD patients is that the condition may present without any symptoms or the symptoms may appear benign (e.g., headache, neck pain or cervicogenic dizziness). Consequently, it may be impossible to identify some ICAD patients, especially in the early stages of the pathology. As the ICAD progresses and neural blood flow is compromised, the symptom picture typically manifests more completely. The chiropractic physician must be alert to characteristic findings of a progressing ICAD, since an immediate referral to a medical specialist may be required.

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From the FULL TEXT Article:

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The Etiology of Cervical Artery Dissection

By Frank M. Painter|February 26, 2015|Diagnosis, Vertebral Artery|

The Etiology of Cervical Artery Dissection

The Chiro.Org Blog

SOURCE: J Chiropr Med. 2007 (Summer); 6 (3): 110-120 ~ FULL TEXT

Michael T. Haneline [a], and Anthony L. Rosner [b]

a Professor,
Palmer College of Chiropractic West,
Department of Research, San Jose, CA 95134
michael.haneline@palmer.edu

b Professor,
Parker College of Chiropratic,
Brookline, MA 02446

The etiology of cervical artery dissection (CAD) is unclear, although a number of risk factors have been reported to be associated with the condition. On rare occasions, patients experience CAD after cervical spine manipulation, making knowledge about the cervical arteries, the predisposing factors, and the pathogenesis of the condition of interest to chiropractors. This commentary reports on the relevant anatomy of the cervical arteries, developmental features of CAD, epidemiology of the condition, and mechanisms of dissection. The analysis of CAD risk factors is confusing, however, because many people are exposed to mechanical events and known pathophysiological associations without ever experiencing dissection. No cause-and-effect relationship has been established between cervical spine manipulation and CAD, but it seems that cervical manipulation may be capable of triggering dissection in a susceptible patient or contributing to the evolution of an already existing CAD. Despite the many risk factors that have been proposed as possible causes of CAD, it is still unknown which of them actually predispose patients to CAD after cervical spine manipulation.

From the FULL TEXT Article:

Introduction

The etiology of cervical artery dissection (CAD) is, for the most part, unclear; and what has been proposed as an explanation for its pathogenesis is largely hypothetical. [1] Furthermore, when dealing with a particular case of CAD, the pathogenesis is especially speculative. [2] Nevertheless, a number of risk factors have been reported to be associated with the condition, including connective tissue abnormalities, hypertension, recent infection, migraine headache, the use of oral contraceptives, and others. Of special interest to chiropractors is the role cervical spine manipulation (CSM) plays, if any, in the pathogenesis of CAD. Indeed, patients do experience CAD on rare occasions after CSM, making knowledge about the cervical arteries, the predisposing factors, and the pathogenesis of the condition important for chiropractors.

Anatomy of the cervical arteries

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Recognition of Spontaneous Vertebral Artery Dissection

By Frank M. Painter|February 25, 2015|Diagnosis, Vertebral Artery|

Recognition of Spontaneous Vertebral Artery Dissection Preempting Spinal Manipulative Therapy: A Patient Presenting With Neck Pain and Headache for Chiropractic Care

The Chiro.Org Blog

SOURCE: J Chiropr Med. 2014 (Jun); 13 (2): 90-95 ~ FULL TEXT

Ross Mattox, DC, [a], Linda W. Smith, DC, [b] and
Norman W. Kettner, DC, DACBR, FICC [c]

a Diagnostic Imaging Resident,
Department of Radiology,
Logan University, Chesterfield, MO
ude.nagol@xottam.ssor

b Chiropractic Physician,
Private Practice, St. Louis, MO

c Chair, Department of Radiology,
Logan University, Chesterfield, MO

OBJECTIVE: The purpose of this case report is to describe a patient who presented to a chiropractic physician for evaluation and treatment of neck pain and headache.

CLINICAL FEATURES: A 45-year-old otherwise healthy female presented for evaluation and treatment of neck pain and headache. Within minutes, non-specific musculoskeletal symptoms progressed to neurological deficits, including limb ataxia and cognitive disturbances. Suspicion was raised for cerebrovascular ischemia and emergent referral was initiated.

INTERVENTION AND OUTCOME: Paramedics were immediately summoned and the patient was transported to a local hospital with a working diagnosis of acute cerebrovascular ischemia. Multiplanar computed tomographic and magnetic resonance imaging with contrast revealed vertebral artery dissection of the V2 segment in the right vertebral artery. Anticoagulation therapy was administered and the patient was discharged without complications after 5 days in the hospital.

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Elongated Styloid Processes and Calcified Stylohyoid Ligaments in a Patient With Neck Pain: Implications for Manual Therapy Practice

By Frank M. Painter|February 23, 2015|Diagnosis, Vertebral Artery|

Elongated Styloid Processes and Calcified Stylohyoid Ligaments in a Patient With Neck Pain: Implications for Manual Therapy Practice

The Chiro.Org Blog

SOURCE: J Chiropr Med. 2014 (Jun); 13 (2): 128–133 ~ FULL TEXT

Bart N. Green, DC, MSEd,a,b, LCDR Kristin M. Browske, MD,
and CAPT Michael D. Rosenthal, PT, DSc, ATC

a Chiropractor,
Department of Physical and Occupational Therapy,
Naval Medical Center, San Diego, CA

b Associate Editor,
Publications Department,
National University of Health Sciences,
Lombard, IL

Corresponding author at:
Marine Corps Air Station Miramar,
Branch Health Clinic,
PO Box 452002,
San Diego, CA 92145-2002. Tel.: + 1 858 577 9948
lim.yvan.dem@neerg.traB

Objective The purpose of this paper is to present a case of a patient with neck pain, tinnitus, and headache in the setting of bilateral elongated styloid processes (ESP) and calcified stylohyoid ligaments (CSL), how knowledge of this anatomical variation and symptomatic presentation affected the rehabilitation management plan for this patient, and to discuss the potential relevance of ESPs and CSLs to carotid artery dissection.

Clinical features A 29-year-old male military helicopter mechanic presented for chiropractic care for chronic pain in the right side of his neck and upper back, tinnitus, and dizziness with a past history of right side parietal headaches and tonsillitis. Conventional radiographs showed C6 and C7 spinous process fractures, degenerative disc disease at C6/7, and an elongated right styloid process with associated calcification of the left stylohyoid ligament. Volumetric computerized tomography demonstrated calcification of the stylohyoid ligaments bilaterally.

Intervention and outcome Given the proximity of the calcified stylohyoid apparatus to the carotid arteries, spinal manipulation techniques were modified to minimize rotation of the neck. Rehabilitation also included soft tissue mobilization and stretching, corrective postural exercises, and acupuncture. An otolaryngologist felt that the symptoms were not consistent with Eagle syndrome and the tinnitus was associated with symmetric high frequency hearing loss, likely due to occupational noise exposure. Initially, the patient’s symptoms improved but plateaued by the fifth visit.

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