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Posterior, Lateral, and Anterior Hip Pain Due to Musculoskeletal Origin

By Frank M. Painter|July 7, 2017|Hip Pathology|

Posterior, Lateral, and Anterior Hip Pain Due to Musculoskeletal Origin: A Narrative Literature Review of History, Physical Examination, and Diagnostic Imaging

SOURCE: J Chiropractic Medicine 2016 (Dec); 15 (4): 281–293

Patrick J. Battaglia, DC, Kevin D’Angelo, DC,
Norman W. Kettner, DC, DACBR

Department of Radiology,
Logan University, Chesterfield, MO.

OBJECTIVE: The purpose of this study was to present a narrative review of the literature of musculoskeletal causes of adult hip pain, with special attention to history, physical examination, and diagnostic imaging.

METHODS: A narrative review of the English medical literature was performed by using the search terms “hip pain” AND “anterior,” “lateral,” and “posterior.” Additionally, specific entities of hip pain or pain referral sources to the hip were searched for. We used the PubMed search engine through January 15, 2016.

RESULTS: Musculoskeletal sources of adult hip pain can be divided into posterior, lateral, and anterior categories. For posterior hip pain, select considerations include lumbar spine and femoroacetabular joint referral, sacroiliac joint pathology, piriformis syndrome, and proximal hamstring tendinopathy. Gluteal tendinopathy and iliotibial band thickening are the most common causes of lateral hip pain. Anterior hip pain is further divided into causes that are intra-articular (ie, labral tear, osteoarthritis, osteonecrosis) and extra-articular (ie, snapping hip and inguinal disruption [athletic pubalgia]). Entrapment neuropathies and myofascial pain should also be considered in each compartment. A limited number of historical features and physical examination tests for evaluation of adult hip pain are supported by the literature and are discussed in this article. Depending on the clinical differential, the gamut of diagnostic imaging modalities recommended for accurate diagnosis include plain film radiography, computed tomography, magnetic resonance imaging, skeletal scintigraphy, and ultrasonography.

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How Can Latent Trajectories of Back Pain Be Translated

By Frank M. Painter|July 6, 2017|Clinical Prediction Rule, Trajectories of Back Pain|

How Can Latent Trajectories of Back Pain Be Translated into Defined Subgroups?

The Chiro.Org Blog

SOURCE: BMC Musculoskelet Disord. 2017 (Jul 3); 18 (1): 285

Alice Kongsted, PhD, Lise Hestbaek, PhD
and Peter Kent, PhD

Nordic Institute of Chiropractic and Clinical Biomechanics,
Campusvej 55, DK-5230,
Odense M, Denmark.

BACKGROUND: Similar types of trajectory patterns have been identified by Latent Class Analyses (LCA) across multiple low back pain (LBP) cohorts, but these patterns are impractical to apply to new cohorts or individual patients. It would be useful to be able to identify trajectory subgroups from descriptive definitions, as a way to apply the same definitions of mutually exclusive subgroups across populations. In this study, we investigated if the course trajectories of two LBP cohorts fitted with previously suggested trajectory subgroup definitions, how distinctly different these subgroups were, and if the subgroup definitions matched with LCA-derived patterns.

METHODS: Weekly measures of LBP intensity and frequency during 1 year were available from two clinical cohorts. We applied definitions of 16 possible trajectory subgroups to these observations and calculated the prevalence of the subgroups. The probability of belonging to each of eight LCA-derived patterns was determined within each subgroup. LBP intensity and frequency were described within subgroups and the subgroups of ‘fluctuating’ and ‘episodic’ LBP were compared on clinical characteristics.

RESULTS: All of 1077 observed trajectories fitted with the defined subgroups. ‘Severe episodic LBP’ was the most frequent pattern in both cohorts and ‘ongoing LBP’ was almost non-existing. There was a clear relationship between the defined trajectory subgroups and LCA-derived trajectory patterns, as in most subgroups, all patients had high probabilities of belonging to only one or two of the LCA patterns. The characteristics of the six defined subgroups with minor LBP were very similar. ‘Fluctuating LBP’ subgroups were significantly more distressed, had more intense leg pain, higher levels of activity limitation, and more negative expectations about future LBP than ‘episodic LBP’ subgroups.

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Cortical Changes in Chronic Low Back Pain

By Frank M. Painter|July 3, 2017|Cortical Changes, Low Back Pain|

Cortical Changes in Chronic Low Back Pain: Current State of the Art and Implications for Clinical Practice

The Chiro.Org Blog

SOURCE: Man Ther. 2011 (Feb); 16 (1): 15-20

Benedict Martin Wand, Luke Parkitny,
Neil Edward O’Connell, Hannu Luomajoki,
James Henry McAuley, Michael Thacker,
G. Lorimer Moseley

School of Health Sciences,
The University of Notre Dame Australia,
Fremantle, WA, Australia

There is increasing evidence that chronic pain problems are characterised by alterations in brain structure and function. Chronic back pain is no exception. There is a growing sentiment, with accompanying theory, that these brain changes contribute to chronic back pain, although empirical support is lacking. This paper reviews the structural and functional changes of the brain that have been observed in people with chronic back pain. We cast light on the clinical implications of these changes and the possibilities for new treatments but we also advise caution against concluding their efficacy in the absence of solid evidence to this effect.

From the Full-Text Article:

Introduction

Chronic musculoskeletal pain is almost by definition a problem for which previous treatment has been unsuccessful. The clinical stories of patients with problems such as chronic low back pain (CLBP), fibromyalgia, and late whiplash associated disorder are usually ones of confusing and conflicting diagnoses and multiple treatment failures. Diagnosis and treatment has traditionally focused on what Robinson and Apkarian (2009) have called ‘end organ dysfunction’. That is, clinicians and researchers have looked to structural and functional abnormalities within the musculoskeletal system for a driver of the clinical condition and treatment has sought to normalise peripheral pathology and mechanics (stretch it, splint it, remove it, anaesthetise or denervate it). In general terms the ‘end organ dysfunction’ approach might be considered to have proven unsuccessful for these conditions (see for e.g. van Tulder et al., 2006a; van Tulder et al., 2006b). Neuroimaging studies have revealed numerous structural and functional changes within the brains of people with chronic musculoskeletal pain and there is growing opinion that these changes may contribute to the development and maintenance of the chronic pain state (Apkarian et al., 2009; Tracey and Bushnell, 2009). In this model of chronic pain the brain is seen as an explicit target for treatment and several treatment strategies have been developed and modified to fit this aim. Although there are data available on a range of chronic painful disorders, we will focus here on the cortical changes observed in patients with CLBP and the possible clinical implications for this population.

Brain changes in people with CLBP

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Association of Spinal Manipulative Therapy With Clinical Benefit and Harm for Acute Low Back Pain

By Frank M. Painter|June 30, 2017|Low Back Pain|

Association of Spinal Manipulative Therapy With Clinical Benefit and Harm for Acute Low Back Pain: Systematic Review and Meta-analysis

The Chiro.Org Blog

SOURCE: JAMA. 2017 (Apr 11); 317 (14): 1451–1460

Neil M. Paige, MD, MSHS, Isomi M. Miake-Lye, BA,
Marika Suttorp Booth, MS, Jessica M. Beroes, BS,
Aram S. Mardian, MD, Paul Dougherty, DC,
Richard Branson, DC, Baron Tang, PT, DPT,
Sally C. Morton, PhD, Paul G. Shekelle, MD, PhD

West Los Angeles Veterans Affairs Medical Center,
Los Angeles, California

This is just one article from a series of 5:

The Non-pharmacologic Therapies Low Back Pain

Commentary from the Illinois Chiropractic Society

JAMA Endorses Spinal Manipulation

For the second time in as many months, a prominent medical journal has endorsed spinal manipulation for the management of low back pain. [1] On April 11th 2017, JAMA published a systematic review of 26 randomized clinical trials in order to evaluate the safety and effectiveness of spinal manipulation for low back pain.

The authors concluded:

“Among patients with acute low back pain, spinal manipulative therapy was associated with improvements in pain and function with only transient minor musculoskeletal harms.”

This study comes on the heels of a February 2017 Clinical Practice Guideline from the American College of Physicians recommending spinal manipulation for acute, sub-acute, and chronic low back pain (LBP). [2]

These high-quality studies in respected medical journals add to a growing list of scientific support for spinal manipulation therapy (SMT). So why are our offices not flooded with medical referrals? An editorial accompanying the JAMA study provides perspective as to why some medical providers may be reluctant to refer to chiropractic physicians:

“Spinal manipulative therapy (SMT) is a controversial treatment option for low back pain, perhaps in part because it is most frequently administered by chiropractors. Chiropractic therapy is not widely accepted by some traditional health care practitioners. This may be, at least in part, because some early practitioners of chiropractic care rejected the germ theory, immunizations, and other scientific advances.

However, chiropractic care is popular today with the US public. According to a 2012 report, among patients with back or neck pain, approximately 30% sought care from a chiropractor. In a 2013 survey by Consumer Reports magazine involving 14,000 subscribers with low back pain, chiropractic care had the largest proportion of “highly satisfied” patients. Among approximately 4000 respondents who had seen a chiropractor, 59% were highly satisfied compared with 55% who saw a physical therapist and 34% who saw a primary care physician.

“Serious complications (related to SMT) are extremely rare… if spinal manipulation is at least as effective and as safe as conventional care, it may be an appropriate choice for patients with uncomplicated low back pain”. [3]

The emerging health care model dictates that all providers embrace proven clinically effective treatments, regardless of long-standing philosophical bias. If we expect medical providers to advance their thinking to accept validated chiropractic therapies, we must first be willing to reciprocate. By working together to provide evidence-based patient-centric care, we can advance our profession to become the undeniable first choice for both patients and providers.

References:

Paige NM, Miake-Lye IM, Booth MS, et al.
Association of Spinal Manipulative Therapy With Clinical Benefit and Harm
for Acute Low Back Pain; Systematic Review and Meta-analysis
JAMA. 2017 (Apr 11); 317 (14): 1451–1460
Qaseem A, Wilt TJ, McLean RM, Forciea MA, for the Clinical Guidelines Committee
of the American College of Physicians.
Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain:
A Clinical Practice Guideline From the American College of Physicians
Ann Intern Med. 2017 (Apr 4); 166 (7): 514–530
Deyo RA.
The Role of Spinal Manipulation in the Treatment of Low Back Pain
JAMA. 2017 (Apr 11); 317 (14): 1418-1419

The Abstract:

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Alternative Medicine and Absenteeism

By Frank M. Painter|June 25, 2017|Alternative Medicine, Complementary and Alternative Medicine|

Alternative Medicine, Worker Health, and Absenteeism in the United States

The Chiro.Org Blog

SOURCE: Complement Ther Med. 2017 (Jun); 32: 116–128

Kate Rybczynski

Department of Economics,
University of Waterloo,
200 University Avenue West,
Waterloo, ON N2L 3G1, Canada

Health related absenteeism costs an estimated $153 billion annually in the United States (Witters and Agrawal, 2011). Chronic conditions (major contributors to absenteeism) are often successfully managed by Complementary and Alternative Medicine (CAM). As CAM becomes an increasingly visible component of healthcare, firms may wish to consider whether CAM therapies can help reduce illness-related absenteeism. This paper aims to extend the literature on healthcare utilization and absenteeism by exploring whether CAM treatment is associated with fewer workdays missed due to illness.

METHODS: Using the 2007 National Health Interview Survey (NHIS) and propensity score matching (PSM), this study estimates the relationship between visits to CAM practitioners, health, and illness-related absenteeism.

RESULTS: In a sample of 8,820 workers, the average annual number of workdays lost due to illness is 3.69. Visiting an acupuncturist correlates with lower absenteeism among men (1.182 fewer workdays missed, p<0.05), whereas visiting a naturopathic doctor correlates with 2.359 and 2.521 fewer workdays missed for women and men, respectively (both p<0.001). Active mind-body practices, massage, chiropractic and acupuncture treatments are all significantly associated with improved health.

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Neural Response During Mechanically Assisted Spinal Manipulation

By Frank M. Painter|June 25, 2017|Instrument Adjusting|

Neural Response During a Mechanically Assisted Spinal Manipulation in an Animal Model: A Pilot Study

The Chiro.Org Blog

SOURCE: J Nov Physiother Phys Rehabil. 2015 (Sep); 2 (2): 20–27 ~ FULL TEXT

William R. Reed, DC, PhD,
Michael A.K. Liebschner, PhD,
Randall S. Sozio, BS, LATG,
Joel G. Pickar, DC, PhD,
Maruti R. Gudavalli, PhD

Palmer Center for Chiropractic Research,
Davenport, IA, USA.

INTRODUCTION: Mechanoreceptor stimulation is theorized to contribute to the therapeutic efficacy of spinal manipulation. Use of mechanically-assisted spinal manipulation (MA-SM) devices is increasing among manual therapy clinicians worldwide. The purpose of this pilot study is to determine the feasibility of recording in vivo muscle spindle responses during a MA-SM in an intervertebral fixated animal model.

METHODS: Intervertebral fixation was created by inserting facet screws through the left L5-6 and L6-7 facet joints of a cat spine. Three L6muscle spindle afferents with receptive fields in back muscles were isolated. Recordings were made during MA-SM thrusts delivered to the L7 spinous process using an instrumented Activator IV clinical device.

RESULTS: Nine MA-SM thrusts were delivered with peak forces ranging from 68-122N and with thrust durations of less than 5ms. High frequency muscle spindle discharge occurred during MA-SM. Following the MA-SM, muscle spindle responses included returning to pre-manipulation levels, slightly decreasing for a short window of time, and greatly decreasing for more than 40s.

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Instrument Adjusting
a.k.a. Mechanically-assisted Adjustments

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