Chiropractic Care

Spinal Manipulative Therapy and Exercise For Seniors with Chronic Neck Pain

By Frank M. Painter|March 6, 2015|Chiropractic Care, Chronic Pain, Neck Pain|

Spinal Manipulative Therapy and Exercise For Seniors with Chronic Neck Pain

SOURCE: Spine J. 2014 (Sep 1); 14 (9): 1879–1889

Michele Maiers, DC, MPH, Gert Bronfort, DC, PhD,
Roni Evans, DC, MS, Jan Hartvigsen, DC, PhD,
Kenneth Svendsen, MS, Yiscah Bracha, MS,
Craig Schulz, DC, MS, Karen Schulz, DC,
Richard Grimm, MD, PhD

Northwestern Health Sciences University,
Wolfe-Harris Center for Clinical Studies,
2501 W. 84th St, Bloomington, MN 55431, USA
mmaiers@nwhealth.edu

BACKGROUND CONTEXT: Neck pain, common among the elderly population, has considerable implications on health and quality of life. Evidence supports the use of spinal manipulative therapy (SMT) and exercise to treat neck pain; however, no studies to date have evaluated the effectiveness of these therapies specifically in seniors.

PURPOSE: To assess the relative effectiveness of SMT and supervised rehabilitative exercise, both in combination with and compared to home exercise (HE) alone for neck pain in individuals ages 65 years or older.

STUDY DESIGN/SETTING: Randomized clinical trial.

PATIENT SAMPLE: Individuals 65 years of age or older with a primary complaint of mechanical neck pain, rated =3 (0-10) for 12 weeks or longer in duration.

OUTCOME MEASURES: Patient self-report outcomes were collected at baseline and 4, 12, 26, and 52 weeks after randomization. The primary outcome was pain, measured by an 11-box numerical rating scale. Secondary outcomes included disability (Neck Disability Index), general health status (Medical Outcomes Study Short Form-36), satisfaction (7-point scale), improvement (9-point scale), and medication use (days per week).

METHODS: This study was funded by the US Department of Health and Human Services, Health Resources and Services Administration. Linear mixed model analyses were used for comparisons at individual time points and for short- and long-term analyses. Blinded evaluations of objective outcomes were performed at baseline and 12 weeks. Adverse event data were collected at each treatment visit.

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Chiropractic Management of an 81-Year-Old Man with Parkinson Disease Signs and Symptoms

By Frank M. Painter|February 21, 2015|Chiropractic Care, Gait Disorder, Parkinson Disease, Premenstrual Syndrome|

Chiropractic Management of an 81-Year-Old Man
with Parkinson Disease Signs and Symptoms

The Chiro.Org Blog

SOURCE: J Chiropr Med. 2014 (Jun); 13 (2): 116–120

Joesph Bova, DC [1] and Adam Sergent, DC [2]

1 Private Practice, Latham NY.
2 Assistant Professor,
Faculty Clinician,
Palmer College of Chiropractic Florida,
Port Orange, FL

Objective The purpose of this case report is to describe the chiropractic management of a patient with Parkinson disease.

Clinical features An 81-year-old male with a 12-year history of Parkinson disease sought chiropractic care. He had a stooped posture and a shuffling gait. He was not able to ambulate comfortably without the guidance of his walker. The patient had a resting tremor, most notably in his right hand. Outcome measures were documented using the Parkinson’s Disease Questionaire-39 (PDQ-39) and patient subjective reports.

Intervention and outcome The patient was treated with blue-lensed glasses, vibration stimulation therapy, spinal manipulation, and eye-movement exercises. Within the first week of treatment, there was a reduction in symptoms, improvement in ambulation, and tremor.

Conclusion For this particular patient, the use of alternative treatment procedures appeared to help his Parkinson disease signs and symptoms.

Key indexing terms: Parkinson disease, Tremor, Gait disorder, Chiropractic

From the FULL TEXT Article:

Introduction

Parkinson disease (PD) is a neurodegenerative brain disorder that progresses slowly in most patients. [1] When approximately 60% to 80% of the dopamine producing cells are damaged, cardinal motor symptoms such as akinesia, rigidity, and tremor begin to appear. [1] A small number of patients have a direct mutation that causes it, but genetic predisposition and environmental factors are most commonly the cause. [1] PD is a central nervous system disorder resulting from destruction of the substantia nigra, which initiates dopamine release, an inhibitory transmitter. [2–4] The lack of dopamine causes a continuous excitatory signal to be sent to the corticospinal tract of the spinal cord, causing over-excitation of the motor cortex; this over-excitation creates the typical PD symptoms. [2–4]

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Risk of Stroke After Chiropractic Spinal Manipulation in Medicare B Beneficiaries Aged 66 to 99 Years With Neck Pain

By Frank M. Painter|January 30, 2015|Chiropractic Care, Stroke|

Risk of Stroke After Chiropractic Spinal Manipulation in Medicare B Beneficiaries Aged 66 to 99 Years With Neck Pain

The Chiro.Org Blog

SOURCE: J Manipulative Physiol Ther. 2015 (Feb); 38 (2): 93–101 ~ FULL TEXT

James M. Whedon, DC, MS, Yunjie Song, PhD, Todd A. Mackenzie, PhD,
Reed B. Phillips, DC, PhD, Timothy G. Lukovits, MD, Jon D. Lurie, MD, MS

The Dartmouth Institute for Health Policy & Clinical Practice,
Dartmouth College,
Grantham, NH.
james.m.whedon@hitchcock.org

OBJECTIVE: The purpose of this study was to quantify risk of stroke after chiropractic spinal manipulation, as compared to evaluation by a primary care physician, for Medicare beneficiaries aged 66 to 99 years with neck pain.

METHODS: This is a retrospective cohort analysis of a 100% sample of annualized Medicare claims data on 1 157 475 beneficiaries aged 66 to 99 years with an office visit to either a chiropractor or primary care physician for neck pain. We compared hazard of vertebrobasilar stroke and any stroke at 7 and 30 days after office visit using a Cox proportional hazards model. We used direct adjusted survival curves to estimate cumulative probability of stroke up to 30 days for the 2 cohorts.

RESULTS: The proportion of subjects with stroke of any type in the chiropractic cohort was 1.2 per 1000 at 7 days and 5.1 per 1000 at 30 days. In the primary care cohort, the proportion of subjects with stroke of any type was 1.4 per 1000 at 7 days and 2.8 per 1000 at 30 days. In the chiropractic cohort, the adjusted risk of stroke was significantly lower at 7 days as compared to the primary care cohort (hazard ratio, 0.39; 95% confidence interval, 0.33-0.45), but at 30 days, a slight elevation in risk was observed for the chiropractic cohort (hazard ratio, 1.10; 95% confidence interval, 1.01-1.19).

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Immediate Effect of Spinal Manipulative Protocols on Kicking Speed Performance in Soccer Players

By Frank M. Painter|January 15, 2015|Chiropractic Care, Sport Performance|

A Non-randomised Experimental Feasibility Study Into the Immediate Effect of Three Different Spinal Manipulative Protocols on Kicking Speed Performance in Soccer Players

The Chiro.Org Blog

SOURCE: Chiropractic & Manual Therapies 2015 (Jan 13)

Kyle Colin Deutschmann, Andrew Douglas Jones, Charmaine Maria Korporaal

Department of Chiropractic and Somatology,
Chiropractic Programme,
Durban University of Technology,
Durban, South Africa

Background The most utilized soccer kicking method is the instep kicking technique. Decreased motion in spinal joint segments results in adverse biomechanical changes within in the kinematic chain. These changes may be linked to a negative impact on soccer performance. This study tested the immediate effect of lumbar spine and sacroiliac manipulation alone and in combination on the kicking speed of uninjured soccer players.

Methods This 2010 prospective, pre-post experimental, single-blinded (subject) required forty asymptomatic soccer players, from regional premier league teams, who were purposively allocated to one of four groups (based on the evaluation of the players by two blinded motion palpators). Segment dysfunction was either localized to the lumbar spine (Group 1), sacroiliac joint (Group 2), the lumbar spine and sacroiliac joint (Group 3) or not present in the sham laser group (Group 4). All players underwent a standardized warm-up before the pre-measurements. Manipulative intervention followed after which post-measurements were completed. Measurement outcomes included range of motion changes (digital inclinometer); kicking speed (Speed Trac™ Speed Sport Radar) and the subjects’ perception of a change in kicking speed. SPSS version 15.0 was used to analyse the data, with repeated measures ANOVA and a p-value <0.05 (CI 95%).

Results Lumbar spine manipulation resulted in significant range of motion increases in left and right rotation. Sacroiliac manipulation resulted in no significant changes in the lumbar range of motion. Combination manipulative interventions resulted in significant range of motion increases in lumbar extension, right rotation and right SI joint flexion. There was a significant increase in kicking speed post intervention for all three manipulative intervention groups (when compared to sham). A significant correlation was seen between Likert based-scale subjects’ perception of change in kicking speed post intervention and the objective results obtained.

Conclusions This pilot study showed that lumbar spine manipulation combined with SI joint manipulation, resulted in an effective intervention for short-term increases in kicking speed / performance. However, the lack of an a priori analysis, a larger sample size and an unblinded outcome measures assessor requires that this study be repeated, addressing these concerns and for these outcomes to be validated.

From the FULL TEXT Article:

Introduction

The instep kicking technique is the most commonly used kicking technique in soccer, which allows the development of an optimum kicking speed [1-3]. This kicking technique requires that the power is generated through the co-ordinated effort of the muscles and the motion of all the joints involved (viz. lumbar spine, sacroiliac joint, hip, knee and foot and ankle) [4, 5]. Thus, this kicking technique’s biomechanics are seen as a segmented motion pattern sequence which initiates from the at the spine and moves distally down the open biomechanical chain [4-7]. As, the lumbar spine and sacroiliac joint are both proximal parts of this biomechanical chain, they form the basis for motion which follows the open chain movement pattern, and thus initiate the forward motion during kicking [2, 5]. Thus musculoskeletal co-ordination forms the basis for the kicking action and closely controls the compression forces being transferred towards the spine, stabilising and keeping the upper body balanced and upright, whilst transmitting the requires forces down the kinematic chain [8].

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Risk of Traumatic Injury Associated with Chiropractic Spinal Manipulation in Medicare Part B Beneficiaries Aged 66-99

By Frank M. Painter|December 12, 2014|Chiropractic Care, Stroke|

Risk of Traumatic Injury Associated with Chiropractic Spinal Manipulation in Medicare Part B Beneficiaries Aged 66-99

The Chiro.Org Blog

SOURCE: Spine (Phila Pa 1976). 2014 (Dec 9) [Epub ahead of print]

James M Whedon, DC, MS; Todd A Mackenzie, PhD;
Reed B Phillips, DC, PhD; Jon D Lurie, MD, MS

The Dartmouth Institute for Health Policy and Clinical Practice,
Lebanon, NH

Southern California University of Health Sciences,
Whittier, CA

Study Design. Retrospective cohort study

Objective. In older adults with a neuromusculoskeletal complaint, to evaluate risk of injury to the head, neck or trunk following an office visit for chiropractic spinal manipulation, as compared to office visit for evaluation by primary care physician

Summary of Background Data. The risk of physical injury due to spinal manipulation has not been rigorously evaluated for older adults, a population particularly vulnerable to traumatic injury in general.

Methods. We analyzed Medicare administrative data on Medicare B beneficiaries aged 66-99 with an office visit in 2007 for a neuromusculoskeletal complaint. Using a Cox proportional hazards model, we evaluated for adjusted risk of injury within 7 days, comparing two cohorts: those treated by chiropractic spinal manipulation vs. those evaluated by a primary care physician. We used direct adjusted survival curves to estimate the cumulative probability of injury. In the chiropractic cohort only, we used logistic regression to evaluate the effect of specific chronic conditions on likelihood of injury.

Results. The adjusted risk of injury in the chiropractic cohort was lower as compared to the primary care cohort (hazard ratio 0.24; 95% CI 0.23-0.25). The cumulative probability of injury in the chiropractic cohort was 40 injury incidents per 100,000 subjects, as compared to 153 incidents per 100,000 subjects in the primary care cohort. Among subjects who saw a chiropractic physician, the likelihood of injury was increased in those with a chronic coagulation defect, inflammatory spondylopathy, osteoporosis, aortic aneurysm and dissection, or long-term use of anticoagulant therapy.

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Resolution of Hearing Loss After Chiropractic Manipulation

By Frank M. Painter|October 8, 2014|Chiropractic Care, Hearing Loss|

Resolution of Hearing Loss After Chiropractic Manipulation

The Chiro.Org Blog

SOURCE: Topics in Integrative Health Care 2014 (Sep 30); 5 (3)

Melissa Ferranti, DC, Kimberly Keene, DC,
Chelsea Prothero, DC

Assistant Professor and Faculty Clinician
Palmer College of Chiropractic
Port Orange, FL, USA

Introduction: While chiropractic care is often associated with the treatment of musculoskeletal conditions, there are other, non-musculoskeletal conditions which may benefit from spinal manipulation (SM). This paper reports on the return of hearing in a woman treated with chiropractic adjustments after 8 months of lack of improvement through allopathic care. Pre and post audiograms were used for comparison.

Case Presentation: In this report, a 46 year old white female with neck pain, tinnitus, and hearing loss was treated with cervical spinal manipulation with positive results. A pre-treatment audiogram indicated low-frequency hearing loss, worse in the left ear.

Intervention and Outcomes: After being unsuccessfully medically treated over an 8 month period, she sought chiropractic care for the above symptoms. After 3 chiropractic adjustments, her hearing and associated symptoms were significantly improved. She received 12 treatments over a 4-month period. When asked to rate her hearing and fullness sensation in the ear on a Patient Specific Functional Scale with a 0-10 measure, where 0 is no deficits and 10 is completely impaired, initially she rated her symptoms as 7, and 5 months after the conclusion of care, her rating dropped to 1. Following treatment her audiogram was normal.

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