Chiropractic Care

Chiropractic Approach to the Management of Children

By Frank M. Painter|May 18, 2014|Chiropractic Care, Education, Pediatrics|

Chiropractic Approach to the Management of Children

SOURCE: Chiropractic & Osteopathy 2010 (Jun 2); 18: 16 ~ FULL TEXT

Sharon A Vallone, Joyce Miller, Annica Larsdotter, and Jennifer Barham-Floreani

Private Practice,
Connecticut, USA.
svallonedc@aol.com

Background Chiropractic (Greek: done by hand) is a health care profession concerned with the diagnosis, treatment and prevention of disorders of the neuromusculoskeletal system and the effects of these disorders on general health. There is an emphasis on manual techniques, including joint adjustment and/or manipulation, with a particular focus on joint subluxation (World Health Organization 2005) or mechanical lesion and restoring function. The chiropractor’s role in wellness care, prevention and treatment of injury or illness is based on education in anatomy and physiology, nutrition, exercise and healthy lifestyle counseling as well as referral to other health practitioners. Depending on education, geographic location, scope of practice, as well as consumer preference, chiropractors may assume the role of primary care for families who are pursuing a more natural and holistic approach to health care for their families.

Objective To present a perspective on current management of the paediatric patient by members of the chiropractic profession and to make recommendations as to how the profession can safely and effectively manage the paediatric patient.

Discussion The chiropractic profession holds the responsibility of ethical and safe practice and requires the cultivation and mastery of both an academic foundation and clinical expertise that distinguishes chiropractic from other disciplines.

Research into the effectiveness of chiropractic care for paediatric patients has lagged behind that of adult care, but this is being addressed through educational programs where research is now being incorporated into academic tracks to attain advanced chiropractic degrees.

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Outcomes of Acute and Chronic Patients With Magnetic Resonance Imaging

By Frank M. Painter|May 6, 2014|Chiropractic Care, Disc Injury, Low Back Pain|

Outcomes of Acute and Chronic Patients With Magnetic Resonance Imaging-Confirmed Symptomatic Lumbar Disc Herniations Receiving High-Velocity, Low-Amplitude, Spinal Manipulative Therapy: A Prospective Observational Cohort Study With One-Year Follow-Up

The Chiro.Org Blog

SOURCE: J Manipulative Physiol Ther 2014 (Mar); 37 (3): 155-163

Serafin Leemann, DC, Cynthia K. Peterson, RN, Christof Schmid, DC, Bernard Anklin, DC, B. Kim Humphreys, DC, PhD

Professor, Chiropractic Medicine and Radiology departments, Orthopaedic University Hospital Balgrist, University of Zürich, Zürich, Switzerland. cynthia.peterson@balgrist.ch

Objective The purposes of this study were to evaluate patients with low-back pain (LBP) and leg pain due to magnetic resonance imaging–confirmed disc herniation who are treated with high-velocity, low-amplitude spinal manipulation in terms of their short-, medium-, and long-term outcomes of self-reported global impression of change and pain levels at various time points up to 1 year and to determine if outcomes differ between acute and chronic patients using a prospective, cohort design.

Methods This prospective cohort outcomes study includes 148 patients (between ages of 18 and 65 years) with LBP, leg pain, and physical examination abnormalities with concordant lumbar disc herniations. Baseline numerical rating scale (NRS) data for LBP, leg pain, and the Oswestry questionnaire were obtained. The specific lumbar spinal manipulation was dependent upon whether the disc herniation was intraforaminal or paramedian as seen on the magnetic resonance images and was performed by a doctor of chiropractic. Outcomes included the patient’s global impression of change scale for overall improvement, the NRS for LBP, leg pain, and the Oswestry questionnaire at 2 weeks, 1, 3, and 6 months, and 1 year after the first treatment. The proportion of patients reporting “improvement” on the patient’s global impression of change scale was calculated for all patients and acute vs chronic patients. Pretreatment and posttreatment NRS scores were compared using the paired t test. Baseline and follow-up Oswestry scores were compared using the Wilcoxon test. Numerical rating scale and Oswestry scores for acute vs chronic patients were compared using the unpaired t test for NRS scores and the Mann-Whitney U test for Oswestry scores. Logistic regression analysis compared baseline variables with “improvement.”

Results Significant improvement for all outcomes at all time points was reported (P < .0001). At 3 months, 90.5% of patients were “improved” with 88.0% “improved” at 1 year. Although acute patients improved faster by 3 months, 81.8% of chronic patients reported “improvement” with 89.2% “improved” at 1 year. There were no adverse events reported.

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A Randomized Controlled Trial Comparing A Multimodal Intervention and Standard Obstetrics Care For Low Back and Pelvic Pain In Pregnancy

By Frank M. Painter|April 5, 2014|Chiropractic Care, Low Back Pain, Pregnancy|

A Randomized Controlled Trial Comparing A Multimodal Intervention and Standard Obstetrics Care For Low Back and Pelvic Pain In Pregnancy

The Chiro.Org Blog

SOURCE: Am J Obstet Gynecol. 2013 (Apr); 208 (4): 295. e1-7

James W. George, DC; Clayton D. Skaggs, DC;
Paul A. Thompson, PhD; D. Michael Nelson, MD, PhD;
Jeffrey A. Gavard, PhD; Gilad A. Gross, MD

Chiropractic Science Division,
College of Chiropractic,
Logan University, Chesterfield, MO, USA

OBJECTIVE: Women commonly experience low back pain during pregnancy. We examined whether a multimodal approach of musculoskeletal and obstetric management (MOM) was superior to standard obstetric care to reduce pain, impairment, and disability in the antepartum period.

STUDY DESIGN: A prospective, randomized trial of 169 women was conducted. Baseline evaluation occurred at 24-28 weeks’ gestation, with follow-up at 33 weeks’ gestation. Primary outcomes were the Numerical Rating Scale (NRS) for pain and the Quebec Disability Questionnaire (QDQ). Both groups received routine obstetric care. Chiropractic specialists provided manual therapy, stabilization exercises, and patient education to MOM participants.

RESULTS: The MOM group demonstrated significant mean reductions in Numerical Rating Scale scores (5.8 ± 2.2 vs 2.9 ± 2.5; P < .001) and Quebec Disability Questionnaire scores (4.9 ± 2.2 vs 3.9 ± 2.4; P < .001) from baseline to follow-up evaluation. The group that received standard obstetric care demonstrated no significant improvements.

CONCLUSION: A multimodal approach to low back and pelvic pain in mid pregnancy benefits patients more than standard obstetric care.

From the Full-Text Article:

Introduction

Musculoskeletal pain in pregnant women commonly is viewed as transient, physiologic, and self-limited. However, most women report either low back pain (LBP) or pelvic pain (PP) during pregnancy [1-6] and the morbidity that is associated with such complaints. [7, 8] Moreover, up to 40% of patients report musculoskeletal pain during the 18 months after delivery, [2, 7, 9, 10] and one-fifth of these women have severe LBP that leads to major personal, social, or economic problems. [7, 9, 11] Pregnancy-related LBP contributes substantially to health care costs. For example, one-fifth of pregnant women in Scandinavian countries experience back pain as an indication for up to 7 weeks of sick leave in the perinatal period. [7, 9] Ninety-four percent of women who experienced LBP in an index pregnancy have recurrent symptoms with subsequent pregnancy, and two-thirds of these patients experience disability and require sick leave during pregnancy. Notably, 19% of women with pain in an initial pregnancy report avoidance of a future pregnancy out of fear of recurrence of the musculoskeletal symptoms. [11]

Most past investigations that have evaluated interventions to reduce morbidity in women with LBP/PP during pregnancy have used modalities that have included prescription exercise, [12] manual manipulation, [13] education, [14] acupuncture, [15] or pelvic belts. [16] Recently, a multimodal randomized trial compared osteopathic manipulation to usual obstetric care and sham ultrasonic therapy on 144 participants. [13] Importantly, this trial did not include behavioral and exercise therapies. We conducted a prospective, randomized, masked clinical trial to test the hypothesis that a multimodal approach of manual therapy, exercise, and education for LBP/PP in pregnant women is superior to standard obstetric care (STOB) for the reduction of pain, impairment, and disability in the ante-partum period.

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Outcomes Of Pregnant Patients With Low Back Pain Undergoing Chiropractic Treatment: A Prospective Cohort Study With Short Term, Medium Term and 1 Year Follow-up

By Frank M. Painter|April 4, 2014|Chiropractic Care, Low Back Pain, Pregnancy|

Outcomes Of Pregnant Patients With Low Back Pain Undergoing Chiropractic Treatment: A Prospective Cohort Study With Short Term, Medium Term and 1 Year Follow-up

The Chiro.Org Blog

SOURCE: Chiropractic & Manual Therapies 2014 (Apr 1); 22 (1): 15 ~ FULL TEXT

Cynthia K Peterson, Daniel Mühlemann,
Barry Kim Humphreys

Department of Chiropractic Medicine,
Orthopaedic University Hospital Balgrist,
University of Zürich,
Forchstrasse 340, Zürich, Switzerland

BACKGROUND: Low back pain in pregnancy is common and research evidence on the response to chiropractic treatment is limited. The purposes of this study are 1) to report outcomes in pregnant patients receiving chiropractic treatment; 2) to compare outcomes from subgroups; 3) to assess predictors of outcome.

METHODS: Pregnant patients with low back or pelvic pain, no contraindications to manipulative therapy and no manual therapy in the prior 3 months were recruited.Baseline numerical rating scale (NRS) and Oswestry questionnaire data were collected. Duration of complaint, number of previous LBP episodes, LBP during a previous pregnancy, and category of pain location were recorded.The patient’s global impression of change (PGIC) (primary outcome), NRS, and Oswestry data (secondary outcomes) were collected at 1 week, 1 and 3 months after the first treatment. At 6 months and 1 year the PGIC and NRS scores were collected. PGIC responses of ‘better or ‘much better’ were categorized as ‘improved’.The proportion of patients ‘improved’ at each time point was calculated. Chi-squared test compared subgroups with ‘improvement’. Baseline and follow-up NRS and Oswestry scores were compared using the paired t-test. The unpaired t-test compared NRS and Oswestry scores in patients with and without a history of LBP and with and without LBP during a previous pregnancy. Anova compared baseline and follow-up NRS and Oswestry scores by pain location category and category of number of previous LBP episodes. Logistic regression analysis also was also performed.

RESULTS: 52% of 115 recruited patients ‘improved’ at 1 week, 70% at 1 month, 85% at 3 months, 90% at 6 months and 88% at 1 year. There were significant reductions in NRS and Oswestry scores (p < 0.0005). Category of previous LBP episodes number at one year (p = 0.02) was related to ‘improvement’ when analyzed alone, but was not strongly predictive in logistic regression. Patients with more prior LBP episodes had higher 1 year NRS scores (p = 0.013).

CONCLUSIONS: Most pregnant patients undergoing chiropractic treatment reported clinically relevant improvement at all time points. No single variable was strongly predictive of ‘improvement’ in the logistic regression model.

From the Full-Text Article:

Background

Low back and pelvic pain in pregnant women is such a common phenomenon that it is often considered a normal part of the pregnancy [1-3]. However, the high prevalence of this problem (50-80% of women) and the impact that this may have on their quality of life, as well as the fact that back pain during pregnancy is commonly linked to low back pain persisting after pregnancy, mandates that it be taken seriously by health care practitioners [1-6]. Many of these patients rate their back pain as moderate to severe with a small percentage claiming to be significantly disabled by the pain [6-8].

Pregnancy-related low back pain is most often divided into 3 categories based on location. These are: lumbar spine pain (LP), posterior pelvic pain (PPP), or a combination of these two [1, 2, 9], with posterior pelvic pain reported to be the most common presentation [1, 10] and the location most specific for pregnant patients [9]. However, other authors have used 4 categories for pelvic only pain, including anterior pain at the pubic symphysis (symphysiolysis) but excluding lumbar spine pain [11].

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Outcomes From Magnetic Resonance Imaging–Confirmed Symptomatic Cervical Disk Herniation Patients Treated With High-Velocity, Low-Amplitude Spinal Manipulative Therapy

By Frank M. Painter|February 4, 2014|Cervical Disk Herniation, Chiropractic Care|

Outcomes From Magnetic Resonance Imaging–Confirmed Symptomatic Cervical Disk Herniation Patients Treated With High-Velocity, Low-Amplitude Spinal Manipulative Therapy: A Prospective Cohort Study With 3-Month Follow-Up

The Chiro.Org Blog

SOURCE: J Manipulative Physiol Ther 2013 (Oct); 36 (8): 461–467

Cynthia K. Peterson, RN, DC, M.Med.Ed,
Christof Schmid, DC, Serafin Leemann, DC,
Bernard Anklin, DC, B. Kim Humphreys, DC, PhD

Professor, Department of Chiropractic Medicine,
Faculty of Medicine, Orthopedic University Hospital Balgrist,
University of Zürich, Zürich, Switzerland.

OBJECTIVE: The purpose of this study was to investigate outcomes of patients with cervical radiculopathy from cervical disk herniation (CDH) who are treated with spinal manipulative therapy.

METHODS: Adult Swiss patients with neck pain and dermatomal arm pain; sensory, motor, or reflex changes corresponding to the involved nerve root; and at least 1 positive orthopaedic test for cervical radiculopathy were included. Magnetic resonance imaging-confirmed CDH linked with symptoms was required. Baseline data included 2 pain numeric rating scales (NRSs), for neck and arm, and the Neck Disability Index (NDI). At 2 weeks, 1 month, and 3 months after initial consultation, patients were contacted by telephone, and the NDI, NRSs, and patient’s global impression of change data were collected. High-velocity, low-amplitude spinal manipulations were administered by experienced doctors of chiropractic. The proportion of patients responding “better” or “much better” on the patient’s global impression of change scale was calculated. Pretreatment and posttreatment NRSs and NDIs were compared using the Wilcoxon test. Acute vs subacute/chronic patients’ NRSs and NDIs were compared using the Mann-Whitney U test.

RESULTS: Fifty patients were included. At 2 weeks, 55.3% were “improved,” 68.9% at 1 month and 85.7% at 3 months. Statistically significant decreases in neck pain, arm pain, and NDI scores were noted at 1 and 3 months compared with baseline scores (P < .0001). Of the subacute/chronic patients, 76.2% were improved at 3 months.

CONCLUSIONS: Most patients in this study, including subacute/chronic patients, with symptomatic magnetic resonance imaging-confirmed CDH treated with spinal manipulative therapy, reported significant improvement with no adverse events.

Introduction

Symptomatic compression of a cervical nerve root occurs in approximately 83.2 of every 100000 persons and is caused by disk herniations, degenerative spondylosis, or a combination of the [2] . Degenerative stenosis leading to narrowing of the intervertebral foramen is reported to be the most common cause of nerve root compression. [1]The C6 and C7 nerve roots are most frequently involved, often resulting in severe pain and disability. [1, 2] Symptoms can arise from the nerve root compression, inflammation, or both and include pain in a radicular distribution, paresthesias in a dermatomal pattern, decreased relevant reflex, and weakness of the muscles innervated by the nerve root. [3]

Patients with radiculopathy from cervical disk herniations (CDHs), the second most common cause of cervical nerve root compression, typically have acute neck pain with associated arm pain following the distribution of the involved nerve root, although the arm pain may be the predominant symptom. [3, 4]However, it is important to recognize that disk protrusions are also a common finding on magnetic resonance imaging (MRI) scans of asymptomatic people. [5-7]One study found that 63% of asymptomatic athletic males older than 40 years had protruding disks in the cervical spine. [5]In another study, disk protrusion with demonstrable spinal cord compression was noted in 7.6% of asymptomatic subjects over the age of 50 years. [6]However, extruded disk herniations and cord compression are unusual findings in asymptomatic individuals. [7]

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Costs of Routine Care For Infant Colic in the UK and Costs

By Frank M. Painter|February 2, 2014|Chiropractic Care, Colic, Cost-Effectiveness, Randomized Controlled Trial|

Costs of Routine Care For Infant Colic in the UK and Costs of Chiropractic Manual Therapy as a Management Strategy Alongside a RCT For This Condition

The Chiro.Org Blog

SOURCE: J Clin Chiropr Pediatr 2013 (Jun); 14 (1): 1063–1069

Joyce E. Miller, BS, DC, DABCO

Anglo-European College of Chiropractic,
Bournemouth, UK.

This paper is a follow-up cost comparison of the medical and chiropractic care provided in Dr. Miller’s RTC study:

Efficacy of Chiropractic Manual Therapy on Infant Colic: A Pragmatic Single-Blind, Randomized Controlled Trial
J Manipulative Physiol Ther. 2012 (Oct); 35 (8): 600–607

This RTC cast new and significant insight onto previous colic trials:

In this study, it was found that knowledge of treatment by the parent did not appear to contribute to the observed treatment effects. This was a major criticism of earlier colic studies, and thus may help support their conclusions.

That study revealed that excessively crying infants were 5 times less likely to cry significantly, if they were treated with chiropractic manual therapy, and that chiropractic care reduced their crying times by about 50%, compared with those infants provided solely medical management.

Background: There is a small body of published research (six research studies and a Cochrane review) suggesting that manual therapy is effective in the treatment of infant colic. Research from the UK has shown that the costs of NHS treatment are high (£65 million [USD100 million] in 2001) with no alleviation of the condition.

Objectives: The objectives of this study were to: investigate the cost of the inconsolable nocturnal crying infant syndrome which is popularly known as infant colic in the first 20 weeks of life, estimate the costs of different types of treatment commonly chosen by parents for a colicky infant for a week of care or an episode of care, investigate the cost of chiropractic manual therapy intervention aimed at reducing the hours of infant crying alongside a randomized controlled trial (RCT) showing effectiveness of treatment.

Design: Economic evaluation incorporating a RCT.

Methods: A cost analysis was conducted using data from a RCT conducted in a three-armed single-blinded trial that randomized excessively crying infants into one of three groups: a) routine chiropractic manual therapy (CMT), b) CMT with parent blinded or c) no treatment control group with parent blinded. These costs were compared with costs of caring for infant colic from Unit Costs of Health and Social Care, UK, 2011. It has been widely estimated that 21% of infants in the UK present annually to primary care for excessive crying and this calculated to 167,000 infants (to the nearest 1,000) used in the cost analysis as there were 795,249 infants in the UK in mid-2010 according to the UK Office of National Statistics, 2011.

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