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NCAA suggests contact limits for football practice

By John Wiens DC|July 7, 2014|Sports|

The NCAA is suggesting that football teams hold no more than two contact practices per week during the season in guidelines that grew out of a safety and concussion summit early this year.

Practice limits were among several recommendations released Monday by the NCAA, which called them guidelines that could change “in real time” rather than rules passed through legislation.

The practice guidelines also recommend four contact practices per week during the preseason and no more than eight of the 15 sessions during spring football.

The NCAA is also suggesting that schools have independent doctors to evaluate injuries and a “return to learn” process for integrating athletes back into their academic work after they have been diagnosed with a concussion.

The Safety in College Football Summit was in Atlanta in January.

More articles on concussion at Chiro.org

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The Clinical Aspects Of The Acute Facet Syndrome: Results From A Structured Discussion Among European Chiropractors

By Frank M. Painter|July 7, 2014|Acute Facet Syndrome, Chiropractic Care|

The Clinical Aspects Of The Acute Facet Syndrome: Results From A Structured Discussion Among European Chiropractors

The Chiro.Org Blog

SOURCE: Chiropractic & Osteopathy 2009 (Feb 5); 17: 2

Lise Hestbaek, Alice Kongsted, Tue Secher Jensen,
and Charlotte Leboeuf-Yde

Nordic Institute of Chiropractic and Clinical Biomechanics,
Odense M, Denmark.
l.hestbaek@nikkb.dk

Background The term ‘acute facet syndrome’ is widely used and accepted amongst chiropractors, but poorly described in the literature, as most of the present literature relates to chronic facet joint pain. Therefore, research into the degree of consensus on the subject amongst a large group of chiropractic practitioners was seen to be a useful contribution.

Methods During the annual congress of The European Chiropractors Union (ECU) in 2008, the authors conducted a workshop involving volunteer chiropractors. Topics were decided upon in advance, and the participants were asked to form into groups of four or five. The groups were asked to reach consensus on several topics relating to a basic case of a forty-year old man, where an assumption was made that his pain originated from the facet joints. First, the participants were asked to agree on a maximum of three keywords on each of four topics relating to the presentation of pain: 1. location, 2. severity, 3. aggravating factors, and 4. relieving factors. Second, the groups were asked to agree on three orthopaedic and three chiropractic tests that would aid in diagnosing pain from the facet joints. Finally, they were asked to agree on the number, frequency and duration of chiropractic treatment.

Results Thirty-four chiropractors from nine European countries participated. They described the characteristics of an acute, uncomplicated facet syndrome as follows: local, ipsilateral pain, occasionally extending into the thigh with pain and decreased range of motion in extension and rotation both standing and sitting. They thought that the pain could be relieved by walking, lying with knees bent, using ice packs and taking non-steroidal anti-inflammatory drugs, and aggravated by prolonged standing or resting. They also stated that there would be no signs of neurologic involvement or antalgic posture and no aggravation of pain from sitting, flexion or coughing/sneezing.

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Does Inter-vertebral Range of Motion Increase After Spinal Manipulation? A Prospective Cohort Study

By Frank M. Painter|July 4, 2014|Cineradiography, Videofluoroscopy|

Does Inter-vertebral Range of Motion Increase After Spinal Manipulation? A Prospective Cohort Study

The Chiro.Org Blog

SOURCE: Chiropractic & Manual Therapies 2014 (Jul 1); 22: 24 ~ FULL TEXT

Jonathan Branney, Alan C Breen

Institute of Musculoskeletal Research & Clinical Implementation,
Anglo-European College of Chiropractic, 13-15 Parkwood Road,
Bournemouth BH5 2DF, UK

Background Spinal manipulation for nonspecific neck pain is thought to work in part by improving inter-vertebral range of motion (IV-RoM), but it is difficult to measure this or determine whether it is related to clinical outcomes.

Objectives This study undertook to determine whether cervical spine flexion and extension IV-RoM increases after a course of spinal manipulation, to explore relationships between any IV-RoM increases and clinical outcomes and to compare palpation with objective measurement in the detection of hypo-mobile segments.

Method Thirty patients with nonspecific neck pain and 30 healthy controls matched for age and gender received quantitative fluoroscopy (QF) screenings to measure flexion and extension IV-RoM (C1-C6) at baseline and 4-week follow-up between September 2012-13. Patients received up to 12 neck manipulations and completed NRS, NDI and Euroqol 5D-5L at baseline, plus PGIC and satisfaction questionnaires at follow-up. IV-RoM accuracy, repeatability and hypo-mobility cut-offs were determined. Minimal detectable changes (MDC) over 4 weeks were calculated from controls. Patients and control IV-RoMs were compared at baseline as well as changes in patients over 4 weeks. Correlations between outcomes and the number of manipulations received and the agreement (Kappa) between palpated and QF-detected of hypo-mobile segments were calculated.

Results QF had high accuracy (worst RMS error 0.5o) and repeatability (highest SEM 1.1o, lowest ICC 0.90) for IV-RoM measurement. Hypo-mobility cut offs ranged from 0.8o to 3.5o. No outcome was significantly correlated with increased IV-RoM above MDC and there was no significant difference between the number of hypo-mobile segments in patients and controls at baseline or significant increases in IV-RoMs in patients. However, there was a modest and significant correlation between the number of manipulations received and the number of levels and directions whose IV-RoM increased beyond MDC (Rho=0.39, p=0.043). There was also no agreement between palpation and QF in identifying hypo-mobile segments (Kappa 0.04-0.06).

Conclusions This study found no differences in cervical sagittal IV-RoM between patients with non-specific neck pain and matched controls. There was a modest dose-response relationship between the number of manipulations given and number of levels increasing IV-RoM – providing evidence that neck manipulation has a mechanical effect at segmental levels. However, patient-reported outcomes were not related to this.

Keywords: Neck pain; Manipulation; Spine kinematics; Fluoroscopy; Patient-reported outcomes

Background

Neck pain is a common condition which most people experience at some point in their lives, with self-reported incidence rates ranging from 15.5 to 213 per 1000 person years [1] and 12-month prevalence rates around 30-50%. The condition can also be a significant cause of work absence, [2, 3] decreased productivity [4] and increased healthcare costs. [5]

Spinal manipulation, mobilisation, exercise, analgesics, acupuncture and low level laser therapy have all been shown to provide at least some degree of short-term relief of neck pain in the absence of trauma. [6] Spinal manipulation or mobilisation, particularly combined with exercise, appears to confer marginal benefit over other interventions. [7, 8] However, trials investigating manipulation for neck pain have shown conflicting results [9, 10] and while some patients respond well, others derive little benefit. One step towards understanding this would be to further our knowledge of the mechanism of action of manipulation as an intervention.

There is evidence to suggest that manipulation can decrease pain and improve function and that this is probably associated with increased motion. Nansel et al. showed that a single manipulation could reduce asymmetry of passive regional cervical spine motion, [11] while Cassidy et al. and Martinez-Segura et al. independently found that manipulation was associated with both reduced neck pain and increased regional range of neck motion immediately after treatment. [12, 13] However, regional neck range of motion is also influenced by pain, disability and fear of movement, [14] leaving the role of manipulation ambiguous. Furthermore, spinal manipulation targets specific levels, often to improve intervertebral range of motion (IV-RoM), [15] but it is not known if this actually happens, or if reduced IV-RoM is even detectable by clinical examination (palpation). To begin to explain the therapeutic effects of neck manipulation therefore requires an accurate and reproducible means of measuring maximum IV-RoM wherever it occurs in the neck bending sequence, and relating it to symptomatic changes following a course of manipulative treatment. It is also necessary to know whether reduced motion at inter-vertebral levels as detected by palpation as the basis for a manipulation can be verified.

Cineradiography and videofluoroscopy have allowed the visualisation of complete intervertebral motion sequences and have been available for many yearr, [16, 17] but analysis of the motion has been largely qualitative. However, during the last decade considerable progress has been made with detailed measurement of inter-vertebral motion using quantitative fluoroscopy (QF). [18] It is now possible to track fluoroscopic images of lumbar vertebrae continuously throughout lumbar motion in living subjects [19] allowing the measurement of true IV-RoM, regardless of where it occurs during bending. QF has been found to have good reproducibility for this, [20] but has not yet been validated or extensively used in the cervical spine. This study aimed to explore the effects of neck manipulation on IV-RoM in the cervical spine as measured by QF.

The study had four main objectives:

To determine the accuracy, measurement precision and minimal detectable change (MDC) in IV-RoM over a period of treatment
To determine whether cervical spine flexion and extension IV-RoM increases after a course of spinal manipulation for non-specific neck pain and if so, the dose–response associated with such change
To determine if there is any correlation between IV-RoM changes and patient reported outcomes
To compare the frequency of finding inter-vertebral motion hypomobility by palpation and QF measurement.

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Dr Greg Stewart Elected WFC President

By John Wiens DC|June 17, 2014|News|

Source The World Federation of Chiropractic

Dr Greg Stewart

June 10, 2014

The World Federation of Chiropractic (WFC) is pleased to announce that Dr Gregory B Stewart of Winnipeg, Manitoba, Canada was elected President for a 2-year term at the WFC Executive Council Meeting held last month in San Juan, Puerto Rico. He succeeds Dr Dennis Richards of Australia, now Past President.

Dr Stewart, who received a Bachelor of Physical Education from the University of Manitoba (1982), graduated as a Doctor of Chiropractic (cum laude) from the Canadian Memorial Chiropractic College in Toronto in 1986. He has been in fulltime private practice in Winnipeg, Manitoba since that time, and has served on many provincial and national chiropractic committees since 1990. These include committees on the identity of the profession, government relations, ethics, communications, interprofessional collaboration, chiropractic legislation, third party and government service negotiations, clinical practice guidelines and research.

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An International Survey of Pain in Adolescents

By Frank M. Painter|June 11, 2014|Pediatrics|

An International Survey of Pain in Adolescents

The Chiro.Org Blog

SOURCE: BMC Public Health. 2014 (May 13); 14 (1): 447

Michael Swain, Nicholas Henschke, Steven Kamper, Inese Gobina, Veronika Ottová-Jordan, Christopher Maher

Department of Chiropractic,
Faculty of Science,
Macquarie University,
Sydney 2109, Australia.
michael.swain@mq.edu.au

BACKGROUND: A common belief is that pain is uncommon and short lived in adolescents. However, the burden of pain in adolescents is unclear because of limitations in previous research. The aim of this study is to estimate the prevalence of headache, stomach-ache and backache in adolescents and to explore the extent to which these three forms of pain coexist based upon a representative sample of adolescents from 28 countries.

METHODS: Data were analysed from three consecutive waves (1997/98, 2001/02 and 2005/06) of the Health Behavior in School-aged Children: WHO Collaborative Cross-National survey (HBSC). Prevalence estimates are based upon adolescents who reported experiencing headache, stomach-ache or backache at least monthly for the last 6 months.

RESULTS: There were a total of 404,206 participants with a mean (±SD) age of 13.6 (±1.7) years (range 9.8 to 17.3 years). The prevalence of headache was 54.1%, stomach-ache 49.8%, backache 37%, and at least one of the three pains 74.4%. Girls had a higher prevalence of the three pains than boys and the prevalence of pain increased with age. Headache, stomach-ache and backache frequently coexist, for example, of those with headache: 21.2% had headache alone, 31% suffered from both headache and stomach-ache, 12.1% suffered from backache and headache, and 35.7% had all three pains.

There are more articles like this @ our:

Chiropractic Pediatrics Page

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Epidural Corticosteroids for Sciatica

By Frank M. Painter|June 10, 2014|Epidural Steroid Injections, Low Back Pain, Sciatica|

Epidural Corticosteroids for Sciatica

The Chiro.Org Blog

SOURCE: Dynamic Chiropractic

By Deborah Pate, DC, DACBR

Use of epidural steroid injections has increased dramatically in recent years, despite the fact that studies have failed to demonstrate evidence this procedure is clinically helpful (while other studies suggest it may actually be dangerous).

Considering that lack of evidence – not to mention the terrible 2012 outbreak of fungal meningitis / infections [see sidebar] caused by contaminated vials used for epidural corticosteroid injections – it is prudent at least to take a critical look at this procedure, particularly as it relates to conditions doctors of chiropractic treat.

Steroid Injections for Sciatica: Small, Short-Term Relief Only

In a recent meta-analysis of 23 randomized trials involving more than 2,000 patients in which epidural steroid injections were compared with placebo for sciatica, epidural steroid injections produced small, statistically insignificant short-term improvements in leg pain and disability (but not less back pain) compared to placebo. This improvement also was only over a short period of time – two weeks to three months. Beyond 12 months, there was no significant difference between groups. [1]

Side Effects Including Skeletal Deterioration, Fracture Risk

Besides infection, there are other side effects associated with epidural steroid injections: bleeding, nerve damage and dural puncture. Then there are side effects associated with the steroid medication, which include the following: a transient decrease in immunity, high blood sugar, stomach ulcers, avascular necrosis (mainly in the hip joint), cataracts and increased risk of fracture.

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