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Mobilization and Manipulation of the Cervical Spine in Patients with Cervicogenic Headache: Any Scientific Evidence?

By |April 13, 2016|Headache|

Mobilization and Manipulation of the Cervical Spine in Patients with Cervicogenic Headache: Any Scientific Evidence?

The Chiro.Org Blog

SOURCE:   Front Neurol. 2016 (Mar 21); 7: 40 ~ FULL TEXT

Jodan D. Garcia, Stephen Arnold, Kylie Tetley,
Kiel Voight, and Rachael Anne Frank

Department of Physical Therapy,
Georgia State University ,
Atlanta, GA , USA.

Cervical mobilization and manipulation are frequently used to treat patients diagnosed with cervicogenic headache (CEH); however, there is conflicting evidence on the efficacy of these manual therapy techniques. The purpose of this review is to investigate the effects of cervical mobilization and manipulation on pain intensity and headache frequency, compared to traditional physical therapy interventions in patients diagnosed with CEH. A total of 66 relevant studies were originally identified through a review of the literature, and the 25 most suitable articles were fully evaluated via a careful review of the text.

Ultimately, 10 studies met the inclusion criteria:

(1) randomized controlled trial (RCT) or open RCT; the study contained at least two separate groups of subjects that were randomly assigned either to a cervical spine mobilization or manipulation or a group that served as a comparison

(2) subjects must have had a diagnosis of CEH

(3) the treatment group received either spinal mobilization or spinal manipulation, while the control group received another physical therapy intervention or placebo control, and

(4) the study included headache pain and frequency as outcome measurements.

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Effectiveness of Chiropractic Care to Improve Sensorimotor Function

By |April 11, 2016|Vertigo|

Effectiveness of Chiropractic Care to Improve Sensorimotor Function Associated With Falls Risk in Older People: A Randomized Controlled Trial

The Chiro.Org Blog

SOURCE:   J Manipulative Physiol Ther. 2016 (Apr 2) [Epub]

Kelly R. Holt, BSc (Chiro), Heidi Haavik, BSc (Chiro), PhD,
Arier Chi Lun Lee, PhD, Bernadette Murphy, DC, PhD, C.
Raina Elley, MBChB, PhD

Research Fellow, Centre for Chiropractic Research,
New Zealand College of Chiropractic,
Mt. Wellington, Auckland, New Zealand

OBJECTIVE:   This study assessed whether 12 weeks of chiropractic care was effective in improving sensorimotor function associated with fall risk, compared with no intervention, in community-dwelling older adults living in Auckland, New Zealand.

METHODS:   Sixty community-dwelling adults older than 65 years were enrolled in the study. Outcome measures were assessed at baseline, 4 weeks, and 12 weeks and included proprioception (ankle joint position sense), postural stability (static posturography), sensorimotor function (choice stepping reaction time), multisensory integration (sound-induced flash illusion), and health-related quality of life (SF-36).

RESULTS:   Over 12 weeks, the chiropractic group improved compared with the control group in choice stepping reaction time (119 milliseconds; 95% confidence interval [CI], 26-212 milliseconds; P = .01) and sound-induced flash illusion (13.5%; 95% CI, 2.9%-24.0%; P = .01). Ankle joint position sense improved across the 4- and 12-week assessments (0.20°; 95% CI, 0.01°-0.39°; P = .049). Improvements were also seen between weeks 4 and 12 in the SF-36 physical component of quality of life (2.4; 95% CI, 0.04-4.8; P = .04) compared with control.

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A Path Analysis of the Effects of the Doctor-patient Encounter and Expectancy in an Open-label Randomized Trial of Spinal Manipulation for the Care of Low Back Pain

By |April 9, 2016|Low Back Pain|

A Path Analysis of the Effects of the Doctor-patient Encounter and Expectancy in an Open-label Randomized Trial of Spinal Manipulation for the Care of Low Back Pain

The Chiro.Org Blog

SOURCE:   BMC Complement Altern Med. 2014 (Jan 13); 14: 16

Mitchell Haas, Darcy Vavrek, Moni B Neradilek, and
Nayak Polissar

Center for Outcomes Studies,
University of Western States,
2900 NE 132nd Ave,
Portland, OR, USA.

BACKGROUND:   The doctor-patient encounter (DPE) and associated patient expectations are potential confounders in open-label randomized trials of treatment efficacy. It is therefore important to evaluate the effects of the DPE on study outcomes.

METHODS:   Four hundred participants with chronic low back pain (LBP) were randomized to four dose groups: 0, 6, 12, or 18 sessions of spinal manipulation from a chiropractor. Participants were treated three times per week for six weeks. They received light massage control at visits when manipulation was not scheduled. Treating chiropractors were instructed to have equal enthusiasm for both interventions. A path analysis was conducted to determine the effects of dose, patient expectations of treatment success, and DPE on LBP intensity (100-point scale) at the end of care (6 weeks) and primary endpoint (12 weeks). Direct, indirect, and total standardized effects (βtotal) were computed. Expectations and DPE were evaluated on Likert scales. The DPE was assessed as patient-rated perception of chiropractor enthusiasm, confidence, comfort with care, and time spent.

RESULTS:   The DPE was successfully balanced across groups, as were baseline expectations. The principal finding was that the magnitude of the effects of DPE on LBP at 6 and 12 weeks (|β|total = 0.22 and 0.15, p < .05) were comparable to the effects of dose of manipulation at those times (|β|total = 0.11 and 0.12, p < .05). In addition, baseline expectations had no notable effect on follow-up LBP. Subsequent expectations were affected by LBP, DPE, and dose (p < .05).

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Comparison of Spinal Manipulation Methods and Usual Medical Care for Acute and Subacute Low Back Pain

By |April 7, 2016|Low Back Pain|

Comparison of Spinal Manipulation Methods and Usual Medical Care for Acute and Subacute Low Back Pain: A Randomized Clinical Trial

The Chiro.Org Blog

SOURCE:   Spine (Phila Pa 1976). 2015 (Feb 15); 40 (4): 209–217

Schneider, Michael DC, PhD, Haas, Mitchell DC, MA
Glick, Ronald MD, Stevans, Joel DC, Landsittel, Doug PhD

School of Health and Rehabilitation Sciences,
Clinical and Translational Science Institute,
University of Pittsburgh,
Pittsburgh, PA

STUDY DESIGN:   Randomized controlled trial with follow-up to 6 months.

OBJECTIVE:   This was a comparative effectiveness trial of manual-thrust manipulation (MTM) versus mechanical-assisted manipulation (MAM); and manipulation versus usual medical care (UMC).

SUMMARY OF BACKGROUND DATA:   Low back pain (LBP) is one of the most common conditions seen in primary care and physical medicine practice. MTM is a common treatment for LBP. Claims that MAM is an effective alternative to MTM have yet to be substantiated. There is also question about the effectiveness of manipulation in acute and subacute LBP compared with UMC.

METHODS:   A total of 107 adults with onset of LBP within the past 12 weeks were randomized to 1 of 3 treatment groups: MTM, MAM, or UMC. Outcome measures included the Oswestry LBP Disability Index (0-100 scale) and numeric pain rating (0-10 scale). Participants in the manipulation groups were treated twice weekly during 4 weeks; subjects in UMC were seen for 3 visits during this time. Outcome measures were captured at baseline, 4 weeks, 3 months, and 6 months.

RESULTS:   Linear regression showed a statistically significant advantage of MTM at 4 weeks compared with MAM (disability = –8.1, P = 0.009; pain = –1.4, P = 0.002) and UMC (disability = –6.5, P = 0.032; pain = –1.7, P < 0.001). Responder analysis, defined as 30% and 50% reductions in Oswestry LBP Disability Index scores revealed a significantly greater proportion of responders at 4 weeks in MTM (76%; 50%) compared with MAM (50%; 16%) and UMC (48%; 39%). Similar between-group results were found for pain: MTM (94%; 76%); MAM (69%; 47%); and UMC (56%; 41%). No statistically significant group differences were found between MAM and UMC, and for any comparison at 3 or 6 months.

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Systematic Review and Meta-analysis of Chiropractic Care

By |March 26, 2016|Stroke|

Systematic Review and Meta-analysis of Chiropractic Care and Cervical Artery Dissection:
No Evidence for Causation

The Chiro.Org Blog

SOURCE:   Cureus 2016 (Feb 16);   8 (2):   e498

Ephraim W. Church, MD,   Emily P. Sieg, MD,
Omar Zalatimo, MD,   Namath S. Hussain, MD,
Michael Glantz, MD,   Robert E. Harbaugh, MD

Department of Neurosurgery,
Penn State Hershey Medical Center

BACKGROUND:   Case reports and case control studies have suggested an association between chiropractic neck manipulation and cervical artery dissection (CAD), but a causal relationship has not been established. We evaluated the evidence related to this topic by performing a systematic review and meta-analysis of published data on chiropractic manipulation and CAD.

METHODS:   Search terms were entered into standard search engines in a systematic fashion. The articles were reviewed by study authors, graded independently for class of evidence, and combined in a meta-analysis. The total body of evidence was evaluated according to GRADE criteria.

RESULTS:   Our search yielded 253 articles. We identified two class II and four class III studies. There were no discrepancies among article ratings (i.e., kappa=1). The meta-analysis revealed a small association between chiropractic care and dissection (OR 1.74, 95% CI 1.26-2.41). The quality of the body of evidence according to GRADE criteria was “very low.”

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A Giant in Chiropractic Radiology: Remembering Dr. Lindsay Rowe (1956-2016)

By |March 23, 2016|News|

Source Dynamic Chiropractic

By Deborah Pate, DC, DACBR

Lindsay Rowe, DC, MD, DACBR, was a giant in the field of chiropractic radiology who enjoyed careers as a chiropractor, medical doctor, radiologist and educator.

A distinguished international lecturer and author, he wrote more than 50 scientific papers and numerous book chapters; and together with Dr. Terry Yochum, co-authored the internationally respected text Essentials of Skeletal Radiology, now in its third edition. It is the standard text in most chiropractic colleges and has been enthusiastically reviewed in scientific journals such as The New England Journal of Medicine and Radiology.

Dr. Rowe earned his chiropractic degree (MAppSc – Chiropractic) with honors from the Royal Melbourne Institute of Technology in Melbourne, Australia. He subsequently practiced chiropractic and later earned board certification in chiropractic radiology at a time when few chiropractors entered into the specialty. He chaired the Department of Radiology at Canadian Memorial Chiropractic College in Toronto, Ontario. Later, he held the same position at Northwestern College of Chiropractic in Minneapolis, Minn.

Dr. Rowe received a medical degree from the University of Newcastle, Australia, followed by residencies in emergency medicine and diagnostic and interventional radiology at the same institution. He was associate professor at the University of Newcastle, an adjunct professor at Northwestern Health Sciences University and Murdoch University, staff radiologist at the Center for Diagnostic Imaging (a national medical imaging network) and John Hunter Hospital in Melbourne. He was also a prolific presenter at professional meetings in Australia and many countries around the world.

Dr. Rowe’s accomplishments in skeletal radiology have contributed much to the advancement of chiropractic’s acceptance in the medical community, especially chiropractic radiology. He was a leader and a trailblazer, bridging the gap between allopathic and chiropractic; creating respect for our profession within the modern health care community.

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