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A Regional Interdependence Model of Dysfunction

By |April 25, 2017|Musculoskeletal Dysfunction|

A Regional Interdependence Model of Musculoskeletal Dysfunction:
Research, Mechanisms, and Clinical Implications

The Chiro.Org Blog

SOURCE:   J Man Manip Ther. 2013 (May); 21 (2): 90-102

Derrick G Sueki, Joshua A Cleland,
and Robert S Wainner

Department of Physical Therapy,
Mount St Mary’s College,
Los Angeles, CA, USA.

The term regional interdependence or RI has recently been introduced into the vernacular of physical therapy and rehabilitation literature as a clinical model of musculoskeletal assessment and intervention. The underlying premise of this model is that seemingly unrelated impairments in remote anatomical regions of the body may contribute to and be associated with a patient’s primary report of symptoms. The clinical implication of this premise is that interventions directed at one region of the body will often have effects at remote and seeming unrelated areas.

The formalized concept of RI is relatively new and was originally derived in an inductive manner from a variety of earlier publications and clinical observations. However, recent literature has provided additional support to the concept. The primary purpose of this article will be to further refine the operational definition for the concept of RI, examine supporting literature, discuss possible clinically relevant mechanisms, and conclude with a discussion of the implications of these findings on clinical practice and research.

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Prevalence of Low Back Pain in Adolescents

By |April 24, 2017|Chiropractic Research, Scoliosis|

Prevalence of Low Back Pain in Adolescents with Idiopathic Scoliosis: A Systematic Review

The Chiro.Org Blog

SOURCE:   Chiropractic & Manual Therapies 2017 (Apr 20); 25: 10

Jean Théroux, Norman Stomski, Christopher J. Hodgetts,
Ariane Ballard, Christelle Khadra, Sylvie Le May and
Hubert Labelle

Research Center,
Sainte-Justine University Hospital Center
School of Health Profession,
Murdoch University

Background   Adolescent idiopathic scoliosis is the most common spinal deformity occurring in adolescents and its established prevalence varies from 2 to 3%. Adolescent idiopathic scoliosis has been identified as a potential risk factor for the development of low back pain in adolescents. The purpose of this study was to systematically review studies of the prevalence of low back pain in adolescents with idiopathic scoliosis in order to establish the quality of the evidence and determine whether the prevalence estimates could be statistically pooled.

Methods   Systematic electronic searches were undertaken in PubMed, CINAHL, and CENTRAL without any restrictions. Studies were eligible for inclusion if they reported the prevalence of low back pain in adolescents with idiopathic scoliosis. Studies were excluded if they detailed the prevalence of pain in post-surgical subjects or were published in languages other than English or French. Data were reported qualitatively, since there was insufficient evidence for statistical pooling.

Results   The electronic search strategies yielded 1811 unique studies. Only two studies fulfilled the eligibility criteria. The prevalence of low back pain in adolescents with idiopathic scoliosis ranged from 34.7 to 42.0%. However, these prevalence estimates should be viewed cautiously as the included studies were at high risk of bias.

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Scoliosis and Chiropractic Page

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Elevated Production of Inflammatory Mediators Including Nociceptive Chemokines in Patients With Neck Pain: A Cross-Sectional Evaluation

By |April 23, 2017|Chronic Neck Pain|

Elevated Production of Inflammatory Mediators Including Nociceptive Chemokines in Patients With Neck Pain: A Cross-Sectional Evaluation

The Chiro.Org Blog

J Manipulative Physiol Ther. 2011 (Oct);   34 (8):   498–505

Julita A. Teodorczyk-Injeyan, PhD, John J. Triano, DC, PhD, Marion McGregor, DC, PhD,
Linda Woodhouse, PT, PhD, H. Stephen Injeyan, PhD, DC

Associate Professor,
Graduate Education and Research Programs,
Canadian Memorial Chiropractic College,
Toronto, Ontario, Canada

OBJECTIVE:   This study investigated whether the production of inflammatory mediators and chemotactic cytokines (chemokines) is altered in patients with chronic and recurrent neck pain (NP).

METHODS:   Cross-sectional data evaluating blood and serum samples were obtained from 27 NP patients and 13 asymptomatic (control) subjects recruited from a chiropractic outpatient clinic. Cell cultures were activated by lipopolysaccharide (LPS) and phytoheamagglutinin for 24 to 48 hours. The levels of tumor necrosis factor α (TNF-α), monocyte chemotactic protein 1, also known as CCL2 (CCL2/MCP-1), and macrophage inflammatory protein 1α or CCL3 (CCL3/MIP-1α) were determined by specific immunoassays. Serum levels of nitric oxide metabolites were evaluated simultaneously, in vanadium III-reduced samples, by Griess reaction.

RESULTS:   Low levels of constitutive (spontaneous) TNF-α production were present in 7 of the 27 cultures from patients with NP. Both LPS-induced TNF-α production and inducer (LPS/phytoheamagglutin)-stimulated production of CCL2 were significantly elevated (P = .00) in patients compared with controls. In patients, the constitutive synthesis of CCL3 occurred significantly more frequently (P = .00) and ranged from 30 to more than 2000 pg/mL. Finally, serum levels of nitric oxide were significantly elevated (P = .00) in NP patients.

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Chronic Neck Pain and Chiropractic Page and the:

Chiropractic and Spinal Pain Management

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Elevated Production of Nociceptive CC-chemokines

By |April 22, 2017|Low Back Pain, Spinal Joint Pain|

Elevated Production of Nociceptive CC-chemokines and sE-selectin in Patients with Low Back Pain and the Effects of Spinal Manipulation: A Non-randomized Clinical Trial

The Chiro.Org Blog

SOURCE:   Clin J Pain. 2017 (Apr 19) [Epub]

Julita A. Teodorczyk-Injeyan, PhD,
Marion McGregor, PhD, DC,
John J. Triano, DC, PhD,
H. Stephen Injeyan, PhD, DC

Graduate Education and Research Programs,
Canadian Memorial Chiropractic College,
Toronto, Ontario, Canada

BACKGROUND:   The involvement of inflammatory components in the pathophysiology of low back pain is poorly understood. It has been suggested that spinal manipulative therapy (SMT) may exert anti-inflammatory effects.

PURPOSE:   To determine the involvement of inflammation-associated chemokines (CC series) in the pathogenesis of non-specific low back pain and to evaluate the effect of SMT on that process.

METHODS:   Patients presenting with non-radicular, non-specific low back pain (minimum pain score 3 on 10 point visual analogue scale, VAS) were recruited according to stringent inclusion criteria. They were evaluated for appropriateness to treat using a high velocity low amplitude manipulative thrust (HVLT) in the lumbar-lumbosacral region. Blood samples were obtained at baseline and following the administration of a series of 6 HVLTs on alternate days over the period of two weeks. The in vitro levels of CC chemokines (CCL2, CCL3 and CCL4) production and plasma levels of an inflammatory biomarker, soluble E-selectin, were determined at baseline and at the termination of treatments two weeks later.

RESULTS:   Compared with asymptomatic controls baseline production of all chemokines was significantly elevated in acute (P=0.004 – <0.0001), and that of CCL2 and CCL4 in chronic LBP patients (P<0.0001). Furthermore, CCL4 production was significantly higher (P<0.0001) in the acute versus chronic LBP group. sE-selectin levels were significantly higher (P=0.003) in chronic but not in acute LBP patients. Following SMT, patient reported outcomes showed significant (P<0.0001) improvements in VAS and ODI scores. This was accompanied by a significant decline in CCL 3 production (P<0.0001) in both groups of patients. Change scores for CCL4 production differed significantly (P<0.0001) only for the acute LBP cohort, and no effect on the production of CCL2 or plasma sE-selectin levels was noted in either group.

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Low Back Pain and Chiropractic Page and the:

Chiropractic and Spinal Pain Management

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Workers’ Compensation, Return to Work, and Lumbar Fusion

By |April 18, 2017|Chronic Low Back Pain|

Workers’ Compensation, Return to Work, and Lumbar Fusion for Spondylolisthesis

The Chiro.Org Blog

SOURCE:   Orthopedics. 2016 (Jan); 39 (1): e1-8

Joshua T. Anderson, BS; Arnold R. Haas, BS, BA;
Rick Percy, PhD; Stephen T. Woods, MD;
Uri M. Ahn, MD; Nicholas U. Ahn, MD

Department of Orthopaedics (JTA, NUA),
University Hospitals Case Medical Center, Cleveland,
Case Western Reserve University School of Medicine (JTA),
Cleveland, and the Ohio Bureau of Workers’ Compensation (ARH, RP, STW),
Columbus, Ohio; and the
New Hampshire NeuroSpine Institute (UMA),
Bedford, New Hampshire

This is an interesting follow-up to a 2011 study drawn from the Ohio Bureau of Workers’ Compensation database.
[Startling New Study Reveals That Back Surgery Fails 74% of the Time]

In the 2011 study, two years AFTER surgery, only 26 percent had returned to work.
That translated to a resounding 74% failure rate!

In this current study, researchers reviewed the files of 686 workers who underwent fusion surgery for spondylolisthesis between 1993 and 2013, revealing that only 29.9% of them ever returned to work (for at least 6 months).   The failure rate (meaning return-to-work) was 70.1%.

Clearly, it’s time to consider more conservative approaches, like early referral for chiropractic care, long before they become chronic pain patients.

The Abstract:

Lumbar fusion for spondylolisthesis is associated with consistent outcomes in the general population. However, workers’ compensation is a risk factor for worse outcomes. Few studies have evaluated prognostic factors within this clinically distinct population. The goal of this study was to identify prognostic factors for return to work among patients with workers’ compensation claims after fusion for spondylolisthesis. The authors used International Classification of Diseases, Ninth Revision, and Current Procedural Terminology codes to identify 686 subjects from the Ohio Bureau of Workers’ Compensation who underwent fusion for spondylolisthesis from 1993 to 2013.

Positive return to work status was recorded in patients who returned to work within 2 years of fusion and remained working for longer than 6 months. The criteria for return to work were met by 29.9% (n=205) of subjects. The authors used multivariate logistic regression analysis to identify prognostic factors for return to work.

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Low Back Pain and Chiropractic Page

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A Qualitative Study of Changes in Expectations Over Time Among Patients with Chronic Low Back Pain Seeking Four CAM Therapies

By |April 16, 2017|Chiropractic Care, Chronic Pain|

A Qualitative Study of Changes in Expectations Over Time Among Patients with Chronic Low Back Pain Seeking Four CAM Therapies

The Chiro.Org Blog

SOURCE:   BMC Complement Altern Med. 2015 (Feb 5); 15: 12

Emery R Eaves, Karen J Sherman, Cheryl Ritenbaugh,
Clarissa Hsu, Mark Nichter, Judith A Turner,
and Daniel C Cherkin

Department of Family and Community Medicine &
School of Anthropology,
University of Arizona,
Tucson, AZ, USA.

BACKGROUND:   The relationship between patient expectations about a treatment and the treatment outcomes, particularly for Complementary and Alternative Medicine (CAM) therapies, is not well understood. Using qualitative data from a larger study to develop a valid expectancy questionnaire for use with participants starting new CAM therapies, we examined how participants’ expectations of treatment changed over the course of a therapy.

METHODS:   We conducted semi-structured qualitative interviews with 64 participants initiating one of four CAM therapies (yoga, chiropractic, acupuncture, massage) for chronic low back pain. Participants just starting treatment were interviewed up to three times over a period of 3 months. Interviews were transcribed verbatim and analyzed using a qualitative mixed methods approach incorporating immersion/crystallization and matrix analysis for a decontexualization and recontextualization approach to understand changes in thematic emphasis over time.

RESULTS:   Pre-treatment expectations consisted of conjecture about whether or not the CAM therapy could relieve pain and improve participation in meaningful activities. Expectations tended to shift over the course of treatment to be more inclusive of broader lifestyle factors, the need for long-term pain management strategies and attention to long-term quality of life and wellness. Although a shift toward greater acceptance of chronic pain and the need for strategies to keep pain from flaring was observed across participants regardless of therapy, participants varied in their assessments of whether increased awareness of the need for ongoing self-care and maintenance strategies was considered a “positive outcome”. Regardless of how participants evaluated the outcome of treatment, participants from all four therapies reported increased awareness, acceptance of the chronic nature of pain, and attention to the need to take responsibility for their own health.

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Alternative Medicine Articles Section and the:

Chiropractic and Spinal Pain Page

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