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The Mechanics of Neck Manipulation With Special Consideration of the Vertebral Artery

By Frank M. Painter|November 22, 2012|Chiropractic Care, Stroke|

The Mechanics of Neck Manipulation With Special Consideration of the Vertebral Artery

SOURCE: J Can Chiropr Assoc. 2002 (Sep); 46 (3): 134–136

Dr. W Herzog, BSc, PhD and Dr. B Symons, DC

University of Calgary,
2500 University Drive N.W., Calgary,
Alberta, Canada T2N 1N4.
walter@kin.ucalgary.ca

In recent weeks, we have learnt that chiropractors may have to carefully review the application of high-speed, low-amplitude spinal manipulative treatments to the neck. The concern is the possible risk associated with neck manipulation. Specifically, vertebral artery dissection, or ther mechanical injury, are an acknowledged, albeit a very low, risk.

The vast amount of research on vertebrobasilar injury in the past has been focused on blood flow through the vertebral artery during diagnostic, and before and after manipulative treatment. There was (is) concern that vertebral artery occlusion may occur during neck manipulation, and that a lack of blood supply to the brain may lead to a series of complications. This line of argument has always struck us as weak, because a high-speed, low-amplitude thrust to the cervical spine lasts typically less than 150 ms, and the brain has sufficient oxygen to survive such a small amount of (possible) loss of blood flow from one of its many supply arteries.

Another way of attempting to gain insight into the possible risk of neck manipulation and vertebrobasilar accidents is a statistical (epidemiological) approach. The basic question that people would like to answer is: are people who receive neck manipulative treatments at a greater risk of vertebrobasilar accidents than people who do not receive such treatments? On the surface, this approach seems feasible, and so it would be, if the occurrence of such accidents was high (let’s say one time in a hundred or a thousand). However, it appears that we deal with incidence rates (if there is an actual incidence) of one in several millions (i.e. very low). Therefore, any statistical pproach has a miniscule power, and a couple of “fluke accidents” (i.e., accidents that occur, let’s say in a chiropractic clinic, but in reality have nothing to do with the chiropractic treatment) may produce a “statistical error” that may persist for years in a community as small as Canada. Also, using an epidemiological approach, the question of “cause and effect” cannot be resolved.

When starting to tackle the problem of the mechanics of neck manipulative treatments three years ago with my student B. Symons (DC), we were surprised that, to the best of our knowledge, there were no data on what actually happens mechanically to the vertebral artery during cervical spinal manipulation. I was further surprised, when asked to review a case on a vertebrobasilar accident, that one of the arguments went as follows: Pathology revealed no dissection of the vertebral artery, therefore, the vertebrobasilar accident cannot be associated with chiropractic treatment.

Discussing this particular statement within the chiropractic community, it became apparent that mechanical injury to the vertebral artery was an accepted, but very, very very rare occurrence; but nevertheless, accepted. And all this without a shred of scientific evidence about the mechanics of the vertebral artery during cervical manipulation.

So, when does the vertebral artery, or for that matter, any tissue, become injured?

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Lives Lived – Ronald Gitelman, DC

By John Wiens DC|November 22, 2012|News|

Source Globe and Mail

by Howard Vernon, DC

Chiropractor, husband, father, outdoorsman, craftsman. Born Jan. 26, 1937, in Trenton, Ont., died Oct. 7, 2012, in Toronto from pancreatic cancer, aged 75.

Whether it was seeing a patient, delivering a lecture, casting his handmade fly rod, carving a piece of wood into a beautiful bowl or walking with his beloved granddaughter, Jennie, nobody did it better than Ron.

He had a zest for life, a love of each day, a sense of humanity, a passion to experience things, and the most engaging smile.

Growing up in a small town close to countryside, Ron had an affinity to nature his whole life. He was happiest in the country, and sought it out all his life.

He was a natural athlete. While playing tennis as a teen, he developed a shoulder problem and an orthopedic specialist told him he needed an operation and that his tennis career was over.

Ron could not accept this, so he rode his bike up the mountain to the office of a man whom the kids used to call a quack who broke bones. Ron thought perhaps the man could help him.

The man was named Dr. Halett, and he was Trenton’s chiropractor. He examined the shoulder, and had Ron back on the courts, free of pain, in two weeks.

That encounter ignited the spark that led Ron to the Canadian Memorial Chiropractic College.

After graduation, he devoted 40 years to his patients, his educational institution and the profession at large.

From 1963 to 1978, he made several fundamental contributions to chiropractic science: He developed the first scientific database for chiropractors; delivered a lecture at the 1975 National Institutes of Health conference on spinal manipulation, one of the few chiropractors to speak there; and was instrumental in developing chiropractic research.

Ron continued to practise until 2007, when he retired to his cherished chalet in the Beaver Valley near Georgian Bay, where he could devote all his time to his family, his many pastimes and his love of nature. He contributed greatly to the maintenance of the Beaver River.

Ron revelled in the successes of his children, who grew up to be a world-renowned bridge player, a nature conservationist and a teacher. He loved nothing more than to have his close and extended family enjoy the chalet and all the outdoor experiences it provided.

As Ron’s final illness emerged, he said he’d had a great go at life and his bucket was empty, though he thought there might be one last “permit” still in the bucket (still hoping to catch the big one!).

He challenged his illness like he did every other problem in life – head-on and with a sense of determination.

We know that Ron would want us to catch and release, stop and smell the forest, laugh at a good joke and celebrate life the way he did.

We lost a great friend, healer and teacher.

Howard Vernon is Ron’s friend.

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What Is the Role Of Chiropractic Care in Prevention or Reduction of Musculoskeletal Injuries in Children?

By Frank M. Painter|November 19, 2012|Chiropractic Care, Pediatrics|

What Is the Role Of Chiropractic Care in Prevention or Reduction of Musculoskeletal Injuries in Children?

The Chiro.Org Blog

SOURCE: J Manipulative Physiol Ther. 2012 (Sep); 35 (7): 493–513

Chiropractic Care and Public Health: Answering Difficult Questions About Safety, Care Through the Lifespan, and Community Action

Lise Hestbaek, DC, PhD

Back and neck pain are common ailments in school age children with prevalence rates ranging from 5% to 74%. [38, 39] The prevalence of low back pain increases from preadolescence to early adulthood, [38, 40] but after that, the prevalence rates change surprisingly little. [41] A similar pattern is seen for neck pain, [41] but less is known about the course of other musculoskeletal disorders throughout life. However, extremity complaints are found frequently in children. [42]

It has been demonstrated that children and adolescents with musculoskeletal complaints have a higher risk of having these problems as adults. [43-45] Pain and aberrant musculoskeletal function are known to have other consequences with regard to health. Long-lasting pain conditions, including back pain, have been associated with a generally decreased pain threshold, [46-48] which seems to develop alongside pain, because patients did not have a higher pain threshold than asymptomatic subjects before the onset of back pain. [49] If this process is initiated in childhood, it is likely to increase the impact of minor trauma or overuse in everyday life and thus may induce a lifelong cascade of negative health events, resulting in poorer general health and lower quality of life.

Another possible consequence of musculoskeletal disorders in childhood is pain becoming a barrier to physical activity. Children who are injured while performing sport activities [42, 50] may avoid or stop the activity that caused the original injury. It is also plausible that continued pain or discomfort may reduce motivation to participate and enjoy physical activities. Reduction in activity can have serious health implications over time. It is established that physical activity is one of the most important factors relating to several lifestyle disorders such as diabetes and cardiovascular disease, [51, 52] and it has been shown that increased physical activity in youth can reduce the risk of these disorders in adulthood. [53, 54] Moreover, health habits throughout the lifespan are established in youth, [55, 56] and therefore, promoting and maintaining a healthy level of physical activity in children and adolescence are essential to improve public health. Thus, an important element to reach lifelong health is to optimize musculoskeletal health.

You may also enjoy our:

Chiropractic Pediatrics Page

(more…)

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The Association of Complementary and Alternative Medicine Use and Health Care Expenditures for Back and Neck Problems

By Frank M. Painter|November 17, 2012|Chiropractic Care, Complementary and Alternative Medicine, Cost-Effectiveness|

The Association of Complementary and Alternative Medicine Use and Health Care Expenditures for Back and Neck Problems

The Chiro.Org Blog

SOURCE: Med Care. 2012 (Dec); 50 (12): 1029–1036

The Geisel School of Medicine at Dartmouth & Dartmouth-Hitchcock Medical Center, Department of Orthopaedics, Lebanon, NH

BACKGROUND: Health care costs associated with use of complementary and alternative medicine (CAM) by patients with spine problems have not been studied in a national sample.

OBJECTIVES: To estimate the total and spine-specific medical expenditures among CAM and non-CAM users
with spine problems.

RESEARCH DESIGN: Analysis of the 2002-2008 Medical Expenditure Panel Survey.

SUBJECTS: Adults (above 17 y) with self-reported neck and back problems who did or did not use CAM services.

MEASURES: Survey-weighted generalized linear regression and propensity matching to examine penditure differences between CAM users and non-CAM users while controlling for patient, socioeconomic, and health characteristics.

RESULTS: A total of 12,036 respondents with spine problems were included, including 4306 (35.8%) CAM users (40.8% in weighted sample). CAM users had significantly better self-reported health, education, and comorbidity compared with non-CAM users. (more…)

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Orthopedic and Neurologic Procedures in Chiropractic

By Frank M. Painter|November 15, 2012|Chiropractic Care, Diagnosis, Neurology, Orthopedic Tests, Rehabilitation|

Orthopedic and Neurologic Procedures in Chiropractic

The Chiro.Org Blog

We would all like to thank Dr. Richard C. Schafer, DC, PhD, FICC for his lifetime commitment to the profession. In the future we will continue to add materials from RC’s copyrighted books for your use.

This is Chapter 3 from RC’s best-selling book:
“Basic Chiropractic Procedural Manual”

These materials are provided as a service to our profession. There is no charge for individuals to copy and file these materials. However, they cannot be sold or used in any group or commercial venture without written permission from ACAPress.

Chapter 3: Orthopedic and Neurologic Procedures in Chiropractic

This chapter presents the general diagnostic methods currently used in differential diagnosis of selected orthopedic and neurologic conditions.

SELECTED NEUROLOGIC PROBLEMS

Overview

The typical patient presents the challenge of differential diagnosis of a number of neurologic conditions. These range from a variety of peripheral neuritides that may be completely reversible to serious degenerations of the central nervous system.

The tendency of the geriatric patient to develop neurologic problems is often related to the aging process: loss of tissue elasticity, particularly that of the musculoskeletal system. This is manifested by greater rigidity of the spinal column with the appearance of fixation subluxations. These, together with dehydration and subsequent thinning of the intervertebral discs, predispose to radiculitis, neuritis, and vasomotor disturbances and metabolic effects on the cord and brain. The neurologic disturbances can be superimposed on already degenerating arteriosclerotic vessels and alter metabolism of the gastrointestinal and other systems, which may cause serious problems unless recognized early and prompt corrective measures are administered.

Types of Neuritides

Peripheral Neuritis

Peripheral neuritis is a general peripheral neuritis such as that which may be present in such disorders as diabetes, anemia, and vitamin deficiency. Diminution of all sensation will be noted, with proprioception affected most. A stocking distribution with an ill-defined border is commonly witnessed. Glove distribution may appear later, along with paresthesias in the distal areas of sensory distribution. The clinical picture does not conform to either dermatome or nerve patterns of distribution. The cause for this is unknown.

Local Neuritis (more…)

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Children from middle class families more likely to suffer peanut allergy

By John Wiens DC|November 13, 2012|Food Sensitivity|

Suggests that oversanitization might suppress the natural development of the immune system

Source The Telegraph

Children who have a peanut allergy tend to come from wealthier families, researchers have suggested.

Scientists say that this backs up the hygiene hypothesis that cleaner homes tend to increase the risk of childhood allergies.

They found that high income and hygiene habits could be increasing susceptibility as they discovered a link between peanut allergy in children and their families socio-economic status.

With the number of peanut allergies among children increasing the team from the American College of Allergy, Asthma, and Immunology (ACAAI) believe that one reason might be due to the wealth of their families.

The theory suggests that a lack of early childhood exposure to germs increases the chance for allergic diseases, that over sanitisation might suppress the natural development of the immune system.

Peanut allergy can be life-threatening with sufferers going into anaphylactic shock, but more commonly it causes itching in the mouth, a rash and swelling of the face, lips, eyes and tongue.

Study author Dr Sandy Yip said: “Overall household income is only associated with peanut sensitization in children aged one to nine years.

“This may indicate that development of peanut sensitization at a young age is related to affluence, but those developed later in life are not.”

Her team looked at 8,306 patients, 776 of which had an elevated antibody level to peanuts.

Peanut allergy was generally higher in men and racial minorities across all age groups. The researchers also found that peanut specific antibody levels peaked between the ages of 10 and 19, but tapered off after middle age.

ACAAI president Doctor Stanley Fineman said: “While many children can develop a tolerance to food allergens as they age, only 20 per cent will outgrow a peanut allergy.

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