Chiropractic Care

Low Back Pain in Primary Care: A Description of 1250 Patients

By Frank M. Painter|October 17, 2015|Chiropractic Care, Chronic Pain, Low Back Pain|

Low Back Pain in Primary Care: A Description of 1250 Patients with Low Back Pain in Danish General and Chiropractic Practice

SOURCE: Int J Family Med. 2014 (Nov 4); 2014: 106102 ~ FULL TEXT

Lise Hestbaek, Anders Munck, Lisbeth Hartvigsen,
Dorte Ejg Jarbøl, Jens Søndergaard, and Alice Kongsted

Department of Sports Science and Clinical Biomechanics,
University of Southern Denmark,
5230 Odense, Denmark
l.hestbaek@nikkb.dk

Study Design. Baseline description of a multicenter cohort study.

Objective. To describe patients with low back pain (LBP) in both chiropractic and general practice in Denmark.

Background. To optimize standards of care in the primary healthcare sector, detailed knowledge of the patient populations in different settings is needed. In Denmark, most LBP-patients access primary healthcare through chiropractic or general practice.

Methods. Chiropractors and general practitioners recruited adult patients seeking care for LBP. Extensive baseline questionnaires were obtained and descriptive analyses presented separately for general and chiropractic practice patients, Mann-Whitney rank sum test and Pearson’s chi-square test, were used to test for differences between the two populations.

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Altered Central Integration of Dual Somatosensory Input After Cervical Spine Manipulation

By Frank M. Painter|October 9, 2015|Chiropractic Care, Spinal Manipulation, Subluxation|

Altered Central Integration of Dual Somatosensory Input After Cervical Spine Manipulation

The Chiro.Org Blog

SOURCE: J Manipulative Physiol Ther. 2010 (Mar); 33 (3): 178–188 ~ FULL TEXT

Heidi Haavik Taylor, PhD, BSc, Bernadette Murphy, PhD, DC

Director of Research,
New Zealand College of Chiropractic,
Auckland, New Zealand.
heidi.taylor@nzchiro.co.nz

OBJECTIVE: The aim of the current study was to investigate changes in the intrinsic inhibitory interactions within the somatosensory system subsequent to a session of spinal manipulation of dysfunctional cervical joints.

METHOD: Dual peripheral nerve stimulation somatosensory evoked potential (SEP) ratio technique was used in 13 subjects with a history of reoccurring neck stiffness and/or neck pain but no acute symptoms at the time of the study. Somatosensory evoked potentials were recorded after median and ulnar nerve stimulation at the wrist (1 millisecond square wave pulse, 2.47 Hz, 1 x motor threshold). The SEP ratios were calculated for the N9, N11, N13, P14-18, N20-P25, and P22-N30 peak complexes from SEP amplitudes obtained from simultaneous median and ulnar (MU) stimulation divided by the arithmetic sum of SEPs obtained from individual stimulation of the median (M) and ulnar (U) nerves.

RESULTS: There was a significant decrease in the MU/M + U ratio for the cortical P22-N30 SEP component after chiropractic manipulation of the cervical spine. The P22-N30 cortical ratio change appears to be due to an increased ability to suppress the dual input as there was also a significant decrease in the amplitude of the MU recordings for the same cortical SEP peak (P22-N30) after the manipulations. No changes were observed after a control intervention.

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Do Participants With Low Back Pain Who Respond to Spinal Manipulative Therapy Differ Biomechanically?

By Frank M. Painter|September 1, 2015|Chiropractic Care, Low Back Pain, Spinal Manipulation|

Do Participants With Low Back Pain Who Respond to Spinal Manipulative Therapy Differ Biomechanically From Nonresponders, Untreated Controls or Asymptomatic Controls?

The Chiro.Org Blog

SOURCE: Spine 2015 (Sep 1); 40 (17): 1329–1337 ~ FULL TEXT

Wong, Arnold Y. L. PT, MPhil, PhD; Parent, Eric C. PT, PhD;
Dhillon, Sukhvinder S. MB, ChB, CCST; Prasad, Narasimha PhD;
Kawchuk, Gregory N. DC, PhD

Department of Rehabilitation Sciences,
The Hong Kong Polytechnic University,
Kowloon, Hong Kong

Department of Physical Therapy,
University of Alberta,
Alberta, Canada

FROM: University of Alberta ~ 8-31-2015

Researchers at the University of Alberta have found that spinal manipulation—applying force to move joints to treat pain, a technique most often used by chiropractors and physical therapists — does indeed have immediate benefits for some patients with low-back pain but does not work for others with low-back pain. And though on the surface this latest conflict might appear to muddy the waters further, the results point to the complexity of low-back pain and the need to treat patients differently, says lead author Greg Kawchuk.“This study shows that, just like some people respond differently to a specific medication, there are different groups of people who respond differently to spinal manipulation.”

In a non-randomized control study, individuals with low-back pain received spinal manipulation during two treatment sessions that spanned a week. Participants reported their pain levels and disability levels after spinal manipulation, and researchers used ultrasound, MRI and other diagnostics to measure changes in each participant’s back, including muscle activity, properties within the intervertebral discs, and spinal stiffness.

A control group of participants with low-back pain underwent similar clinical examinations but did not receive spinal manipulation. A third group — those who did not have low-back pain symptoms — were also evaluated.

The people who responded to spinal manipulation reported less pain right away and showed improvement in back muscle thickness, disc diffusion and spinal stiffness. Those changes were great enough to exceed or equal the measures in the control groups and stayed that way for the week of treatment, the research team found.
A patient receives spinal manipulation treatment.

Kawchuk, who practised as a chiropractor before going on to obtain his PhD in biomechanics and bioengineering, said the results do not advocate one way or another for spinal manipulation but help explain why there has been so much conflicting data about its merits.

“Clearly there are some people with a specific type of back pain who are responding to this treatment and there are some people with another type of back pain who do not. But if you don’t know that and you mix those two groups together, you get an artificial average that doesn’t mean anything,” Kawchuk explained.

The research team is still fine-tuning how to distinguish who is a responder or non-responder before spinal manipulation is given; however, this study shows it can be used to identify an effective treatment course.

“Spinal manipulation acts so rapidly in responders that it could be used as a screening tool to help get the right treatment to the right patient at the right time.”

The study did not investigate the long-term effects of spinal manipulation, but this is next on the list for the researchers.

STUDY DESIGN: Nonrandomized controlled study.

OBJECTIVE: To determine whether patients with low back pain (LBP) who respond to spinal manipulative therapy (SMT) differ biomechanically from nonresponders, untreated controls or asymptomatic controls.

SUMMARY OF BACKGROUND DATA: Some but not all patients with LBP report improvement in function after SMT. When compared with nonresponders, studies suggest that SMT responders demonstrate significant changes in spinal stiffness, muscle contraction, and disc diffusion. Unfortunately, the significance of these observations remains uncertain given methodological differences between studies including a lack of controls.

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Craniocervical Chiropractic Procedures – A Précis of Upper Cervical Chiropractic

By Frank M. Painter|August 9, 2015|Chiropractic Care, Upper Cervical Adjusting|

Craniocervical Chiropractic Procedures – A Précis of Upper Cervical Chiropractic

The Chiro.Org Blog

SOURCE: J Can Chiropr Assoc 2015 (Jun); 59 (2): 173–192 ~ FULL TEXT

H. Charles Woodfield, III, BPhm, DC, Craig York, DC.
Roderic P. Rochester, DC, Scott Bales, DC,
Mychal Beebe, DC, Bryan Salminen, DC,
Jeffrey N. Scholten, DC .

Director of Research –
Upper Cervical Research Foundation,
Minneapolis, MN

Presented here is a narrative review of upper cervical procedures intended to facilitate understanding and to increase knowledge of upper cervical chiropractic care. Safety, efficacy, common misconceptions, and research are discussed, allowing practitioners, chiropractic students, and the general public to make informed decisions regarding utilization and referrals for this distinctive type of chiropractic care. Upper cervical techniques share the same theoretical paradigm in that the primary subluxation exists in the upper cervical spine. These procedures use similar assessments to determine if spinal intervention is necessary and successful once delivered. The major difference involves their use of either an articular or orthogonal radiograph analysis model when determining the presence of a misalignment. Adverse events following an upper cervical adjustment consist of mild symptomatic reactions of short-duration (< 24-hours). Due to a lack of quality and indexed references, information contained herein is limited by the significance of literature cited, which included non-indexed and/or non-peer reviewed sources.

KEYWORDS: adverse events; atlas; cervical; chiropractic; chiropractic adjustment; craniocervical

From the Full-Text Article:

Introduction:

The indexed literature reports the existence of many upper cervical (UC) procedures. [1, 2] Presented here is a brief narrative review or narrative description of upper cervical techniques (UCT) with the intention of increasing knowledge and understanding regarding their effectiveness and utilization. Procedural similarities and differences between UCT are examined. As chiropractic goes the way of other healing professions through stratification into specialties, this characterization of upper cervical procedures can create appreciation and clarity both inside and outside the profession.

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What Effect Does Chiropractic Treatment Have on Gastrointestinal (GI) Disorders

By Frank M. Painter|August 6, 2015|Chiropractic Care, Gastrointestinal Disorders, Visceral Disease|

What Effect Does Chiropractic Treatment Have on Gastrointestinal (GI) Disorders: A Narrative Review of the Literature

The Chiro.Org Blog

SOURCE: J Can Chiropr Assoc 2015 (Jun); 59 (2): 122–133 ~ FULL TEXT

Katherine Angus, BSc(Kin), DC, Sepideh Asgharifar, BSc(Hons), DC,
Brian Gleberzon, DC, MHSc

Chiropractic and Health Associates Clinic,
1 St. Clair Ave West, Suite 404,
Toronto, Ontario.

The purpose of this study was to provide a narrative review of the literature of studies describing the management of disorders of the gastro-intestinal (GI) tract using ‘chiropractic therapy’ broadly defined here as spinal manipulation therapy, mobilizations, soft tissue therapy, modalities and stretches. Search limiters include access to full text studies published between 1980 and November 2012 in peer-reviewed journals, English language only involving human subjects. Twenty-one articles were found that met our inclusion criteria. Retrievable articles varied from case reports to clinical trials to review articles of management options. The majority of articles chronicling patient experiences under chiropractic care reported they demonstrated mild to moderate improvements in presenting symptoms. No adverse side effects were reported. This suggests chiropractic care can be considered as an adjunctive therapy for patients with various GI conditions providing there are no co-morbidities.

KEYWORDS: chiropractic; gastro-intestinal; manipulation; therapy

From the FULL TEXT Article

Introduction

The purpose of this paper was to conduct a narrative review of the literature that investigated the effectiveness of chiropractic treatment for gastrointestinal (GI) disorders. A previous review by Gleberzon et al [1] reviewed the literature from 2007 to 2011 that investigated the use of one type of chiropractic treatment (spinal manipulative therapy) for pediatric health conditions one of which was colic, often considered a type of GI condition effecting infants [Authors’ note: there is considerable debate whether or not ‘infantile colic’ is a GI condition, or simply ‘baby back pain’ and there is debate if the method used to monitor its existence (crying time) is a subjective or objective outcome measure. [1] That debate notwithstanding, for the purposes of this report, we have included colic as a GI condition].

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Back Pain in Adolescents With Idiopathic Scoliosis

By Frank M. Painter|June 30, 2015|Chiropractic Care, Scoliosis|

Back Pain in Adolescents With Idiopathic Scoliosis: Epidemiological Study for 43,630 Pupils in Niigata City, Japan

The Chiro.Org Blog

SOURCE: Eur Spine J. 2011 (Feb); 20 (2): 274–279 ~ FULL TEXT

Tsuyoshi Sato, Toru Hirano, Takui Ito, Osamu Morita, Ren Kikuchi,
Naoto Endo, and Naohito Tanabe

Department of Orthopedic Surgery,
Niigata Prefectural Shibata Hospital,
Shibata, Japan.
tsuyoshis1@mac.com

There have been a few studies regarding detail of back pain in adolescents with idiopathic scoliosis (IS) as prevalence, location, and severity. The condition of back pain in adolescents with IS was clarified based on a cross-sectional study using a questionnaire survey, targeting a total of 43,630 pupils, including all elementary school pupils from the fourth to sixth grade (21,893 pupils) and all junior high pupils from the first to third year (21,737 pupils) in Niigata City (population of 785,067), Japan.

32,134 pupils were determined to have valid responses (valid response rate: 73.7%). In Niigata City, pupils from the fourth grade of elementary school to the third year of junior high school are screened for scoliosis every year. This screening system involves a three-step survey, and the third step of the survey is an imaging and medical examination at the Niigata University Hospital.

In this study, the pupils who answered in the questionnaire that they had been advised to visit Niigata University Hospital after the school screening were defined as Scoliosis group (51 pupils; 0.159%) and the others were defined as No scoliosis group (32,083 pupils). The point and lifetime prevalence of back pain, the duration, the recurrence, the severity and the location of back pain were compared between these groups.

The severity of back pain was divided into three levels (level 1 no limitation in any activity; level 2 necessary to refrain from participating in sports and physical activities, and level 3 necessary to be absent from school). The point prevalence was 11.4% in No scoliosis group, and 27.5% in Scoliosis group. The lifetime prevalence was 32.9% in No scoliosis group, and 58.8% in Scoliosis group. According to the gender- and school-grade-adjusted odds ratios (OR), Scoliosis group showed a more than twofold elevated odds of back pain compared to No scoliosis group irrespective of the point or lifetime prevalence of back pain (OR, 2.29; P = 0.009 and OR, 2.10; P = 0.012, respectively).

Scoliosis group experienced significantly more severe pain, and of a significantly longer duration with more frequent recurrences in comparison to No scoliosis group. Scoliosis group showed significantly more back pain in the upper and middle right back in comparison to No scoliosis group. These findings suggest that there is a relationship between pain around the right scapula in Scoliosis group and the right rib hump that is common in IS.

From the Full-Text Article:

Introduction:

Most patients with adolescent idiopathic scoliosis (AIS) visit the hospital when a trunk deformity, such as rib or lumbar hump and waist asymmetry, is pointed out either after the school screening or by family members, and it is rare for these patients to visit the hospital due to back pain. However, some adolescent patients with idiopathic scoliosis (IS) do complaint of back pain in outpatient clinics. Previously, it had been accepted that special attention should be paid to patients with scoliosis who experienced back pain, because it was thought that might be additional pathologies such as an occult syrinx, spinal cord tumors, or neuromuscular disorders [4, 6, 20].

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