Chiropractic Care

Adolescent Idiopathic Scoliosis Treated by Spinal Manipulation: A Case Study

By Frank M. Painter|June 22, 2013|Chiropractic Care, Scoliosis|

Adolescent Idiopathic Scoliosis Treated by Spinal Manipulation: A Case Study

SOURCE: J Altern Complement Med. 2008 (Jul); 14 (6): 749–751

Kao-Chang Chen, Elley H.H. Chiu

Division of Acupuncture and Chinese Traumatology, Department of TCM, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan, Republic of China.

OBJECTIVE: This report of one case illustrates the potential effect of chiropractic manipulative therapy on back pain and curve progression in the at-risk, skeletally immature patient with adolescent idiopathic scoliosis.

CLINICAL FEATURES: A 15-year-old girl experienced right thoracic scoliosis for 4 years. She received regular (medical) rehabilitation and brace treatment for 4 years, but the curvature of the thoracic spine still progressed. The Cobb angle was 46 degrees and surgical intervention was suggested to prevent significant deformity, which may be accompanied by cardiopulmonary compromise.

INTERVENTION AND OUTCOME: This patient was treated with spinal manipulation two times per week for 6 weeks at the outset, which was gradually decreased in frequency. After 18 months of consecutive treatment, follow-up radiographs and examinations were conducted. The Cobb angle decreased by 16 degrees. Meanwhile, the patient’s lower backache eased and there was also an improvement in defecation frequency, which had been problematic.

Learn more about Scoliosis @ our:

Scoliosis and Chiropractic Page

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Early Adolescent Lumbar Intervertebral Disc Injury: A Case Study

By Frank M. Painter|June 20, 2013|Chiropractic Care, Disc Injury, Pediatrics|

Early Adolescent Lumbar Intervertebral Disc Injury: A Case Study

The Chiro.Org Blog

SOURCE: Chiropractic & Manual Therapies 2013 (Apr 26); 21: 13

Chris T Carter, Lyndon G Amorin-Woods and Arockia Doss

School of Health Professions,
Murdoch University,
Murdoch, Western Australia, Australia

This article describes and discusses the case of an adolescent male with lumbar intervertebral disc injury characterized by chronic low back pain (LBP) and antalgia. A 13-year-old boy presented for care with a complaint of chronic LBP and subsequent loss of quality of life. The patient was examined and diagnosed by means of history, clinical testing and use of imaging. He had showed failure in natural history and conservative management relief in both symptomatic and functional improvement, due to injury to the intervertebral joints of his lower lumbar spine. Discogenic LBP in the young adolescent population must be considered, particularly in cases involving even trivial minor trauma, and in those in which LBP becomes chronic. More research is needed regarding long-term implications of such disc injuries in young people, and how to best conservatively manage these patients. A discussion of discogenic LBP pertaining to adolescent disc injury is included.

The Full-Text Article:

Background

LBP in children and adolescence is an important and increasing problem, and prevalence increases with age [1]. Systematic review and meta-analysis studies of LBP in adolescence found mean LBP point prevalence and one-year prevalence for adolescents to be around 12%, and 33% respectively [2,3]. Watson et al. [4] reported a one month period prevalence of 24% in schoolchildren aged 11–14 years in northwest England. Historically considered as trivial and non-limiting, LBP in this age-group may have both immediate and long-term consequences for an important proportion of those affected [4]. Risk factors have been debated, although ergonomics of school furniture, school bag weight and mechanics, trauma, history of scoliosis, and involvement of strenuous physical activity may be associative or causative factors in young persons with LBP [5]. There is also increasing evidence that psychological and psychosocial factors may play a significant influence in the aetiology of LBP in this age group [6, 7].

There are many more articles like this in our:

Chiropractic Pediatrics Section

You will also enjoy our:

Disc Herniation and Chiropractic Page

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A Comprehensive Review of Chiropractic Research

By Frank M. Painter|May 14, 2013|Chiropractic Care, Evidence-based Medicine, Spinal Manipulation|

A Comprehensive Review of Chiropractic Research

The Chiro.Org Blog

You will love this Comprehensive Review of Chiropractic Research, by Anthony L. Rosner, Ph.D., Director of Research and Education for the Foundation for Chiropractic Education and Research (FCER) until its demise (1992-2007), and current Director of Research for the International College of Applied Kinesiology (USA).

I. Introduction

A. Perspectives:

In the space of just 115 years from its inception, chiropractic has emerged as the third largest healthcare profession in the United States offering diagnostic as well as therapeutic services to patients. It has reached this lofty height driven by research which has made particularly dramatic strides over the past 30 years, supported by a budget which represents merely an infinitesimal fraction of that applied to medical and pharmaceutical research.

Like all health professions, chiropractic regularly tests the effectiveness, safety, and costs of its approaching health care. Studies continue to show that chiropractors offer the public a viable alternative to invasive healthcare (drugs, surgery) especially in the treatment of musculoskeletal problems such as back, neck, and headache pain. But chiropractic treatments are likewise effective in the treatment of non-musculoskeletal health issues, including infantile colic, enuresis, asthma, dysmenorrheal, otitis media, hypertension, and heart rate variability. And few medical professions outside of chiropractic can offer such healthcare solutions with equal safety and cost records.

Having been historically been placed in the category of “alternative and complementary” medicine, chiropractic because of its rapid growth in its research has now been deemed to have reached the crossroads of mainstream and alternative medicine. [1] As a hybrid, it appears to have successfully incorporated many of the research methodologies of orthodox medicine while striving to maintain its distinct healthcare paradigm. Indeed, when the practitioner’s primary means of patient care and published randomized clinical trials supporting that intervention are matched, chiropractic can be shown to enjoy a higher percentage of interventions thus supported when compared to such other medical disciplines as general practice, inpatient general surgery, dermatology, or hematology-oncology. [2] In other words, chiropractic can now claim to have attained at least as much of a scientific grounding as other medical interventions based upon its research.

So what is it that one means by chiropractic research? The research related to the practice of chiropractic, to be reviewed in this chapter, has been presented in multiple dimensions, including:

Published clinical articles;
Literature reviews;
Surveys and public opinion research;
Analyses of insurance claims [actuarial research]; and
Guidelines

B. First major interdisciplinary cohort study:

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Clinical Biomechanics: Scoliosis

By Frank M. Painter|May 8, 2013|Chiropractic Care, Chiropractic Education, Rehabilitation, Scoliosis|

Clinical Biomechanics: Scoliosis

The Chiro.Org Blog

We would all like to thank Dr. Richard C. Schafer, DC, PhD, FICC for his lifetime commitment to the profession. In the future we will continue to add materials from RC’s copyrighted books for your use.

This is Chapter 13 from RC’s best-selling book:

“Clinical Biomechanics:
Musculoskeletal Actions and Reactions”

Second Edition ~ Wiliams & Wilkins

These materials are provided as a service to our profession. There is no charge for individuals to copy and file these materials. However, they cannot be sold or used in any group or commercial venture without written permission from ACAPress.

Chapter 13: Scoliosis

In traditional medicine, scoliosis is commonly ignored until gross cosmetic effects or signs of structural destruction are witnessed. In chiropractic, however, even minor degrees of distortion should be considered at the time of spinal analysis because of their subtle biomechanical and neurologic consequences, and to halt potential progression at an early stage. To give a better appreciation of these points, this chapter describes the general structural, examination, and biomechanical concerns that should be considered, along with the highlights of conservative therapy.

GENERAL CONSIDERATIONS

The Spinal Curves [1-9]

A curved column has increased resistance to compression forces. This is just as true in the spine, as for a rib or long bone. Most authorities consider the spine to have four major curves: anteriorly convex curves at the cervical and lumbar areas and, anteriorly concave curves at the thoracic and sacral levels. Cailliet considers the coccyx a curve, but this curve is usually considered an extension of the sacral curve. A few authorities consider the atlanto-occipital junction as a separate anteriorly convex curve. Regardless, the spinal curves offer the vertebral column increased inflexibility and shock-absorbing capability while still maintaining an adequate degree of stiffness and stability between vertebral segments (Fig. 13.1).

Structural vs Functional Curves

The adult thoracic and sacral anteriorly concave curves are firm structural arcs as the result of their vertebral bodies being shorter anteriorly than posteriorly. The normal kyphosis of the adult thoracic and sacral curves is quite similar to that of the fetal spine. This is not true for the anteriorly convex cervical and lumbar regions where the curves are essentially the result of their soft tissue wedge-shaped IVDs. It is for this reason that the cervical and lumbar curves readily flatten in the supine position, while the thoracic kyphosis reduces only a slight amount.

There is a clinical correlation of disc wedging to disc disease. Most disc lesions are found in the cervical and lumbar regions where the greatest degree of physiologic wedging occurs. This appears to be true in both hyperlordosis and an exceptionally flat cervical or lumbar curve.

Effect of Bipedism

An adult discless spine would resemble that of the newborn. Since animals that walk on four legs and infants prior to assuming the erect position do not have the physiologic curves of the erect adult, it can be assumed that these curves are the result of bipedism. In the erect position, the lower lumbar area is especially subjected to considerable shearing stress. [10, 11]

Overall Balance

Although the spine is often considered as the central pillar of the body, this is only true when the spine is viewed from the anterior or posterior aspect. When viewed laterally, the spine lies distinctly posterior to the thoracic body mass essentially because of the space-occupying heart (Fig. 13.2), It lies much more centrally in the cervical and lumbar regions. An abundance of body mass also lies anterior to the midline in the head, which must be held by erector and check ligament strength if a thoracic “hump” or a flattened cervical curve are to be avoided.

You may also enjoy our

Scoliosis and Chiropractic Page

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Spinal Manipulation: The Right Choice For Relieving Low Back Pain

By Frank M. Painter|April 24, 2013|Chiropractic Care, Low Back Pain, Placebo, Randomized Controlled Trial, Spinal Manipulation|

Spinal Manipulation: The Right Choice for Relieving Low Back Pain

The Chiro.Org Blog

Spinal High-velocity Low Amplitude Manipulation in Acute Nonspecific Low Back Pain: A Double-blinded Randomized Controlled Trial in Comparison With Diclofenac and Placebo

Spine 2013 (Apr 1); 38 (7): 540–548

von Heymann, Wolfgang J. Dr. Med; Schloemer, Patrick Dipl. Math; Timm, Juergen Dr. RER, NAT, PhD; Muehlbauer, Bernd Dr. Med

Competence Center for Clinical Studies; and †Institute for Biometrics, University of Bremen, Bremen, Germany

Thanks to Dynamic Chiropractic for access to these Key Findings from the study

“There was a clear difference between the treatment groups: the subjects [receiving] spinal manipulation showed a faster and quantitatively more distinct reduction in the RMS” (compared to subjects receiving diclofenac therapy).

“Subjects [also] noticed a faster and quantitatively more distinct reduction in [their] subjective estimation of pain after manipulation. … A similar observation was made when comparing the somatic part of the SF-12 inventory … indicating that the subjects experienced better quality of life after the spinal manipulation compared to diclofenac.”

“The rescue medication was calculated both for the mean cumulative dose (numbers of 500 mg paracetamol tablets) and for the number of days on which rescue medication was taken. … In the diclofenac arm, the patients on average took almost 3 times as many tablets and the number of days [taking the tablets] was almost twice as high” compared to patients in the manipulation arm. While the authors note that these results were not significant due to large between-individual variations (meaning a few patients could have taken many tablets, throwing off the overall totals), it still suggests that value of spinal manipulation vs. drug therapy (because even if both patient groups had taken the same amount of rescue medication for the same number of days, it wouldn’t discount the fact that patients in the manipulation group showed significant improvement on outcome variables compared to patients in the diclofenac group).

The Abstract (more…)

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Sports Management: Leg, Ankle, and Foot Injuries

By Frank M. Painter|April 23, 2013|Chiropractic Care, Chiropractic Education, Chiropractic Technique, Clinical Decision-making, Education, Gait Analysis, Rehabilitation, Sports Management|

Sports Management: Leg, Ankle, and Foot Injuries

The Chiro.Org Blog

We would all like to thank Dr. Richard C. Schafer, DC, PhD, FICC for his lifetime commitment to the profession. In the future we will continue to add materials from RC’s copyrighted books for your use.

This is Chapter 27 from RC’s best-selling book:

“Chiropractic Management of Sports and Recreational Injuries”

Second Edition ~ Wiliams & Wilkins

These materials are provided as a service to our profession. There is no charge for individuals to copy and file these materials. However, they cannot be sold or used in any group or commercial venture without written permission from ACAPress.

Chapter 27: Leg, Ankle, and Foot Injuries

The lower leg, ankle, and foot work as a functional unit. Total body weight above is transmitted to the leg, ankle hinge, and foot in the upright position, and this force is greatly multiplied in locomotion. Thus the ankle and foot are uniquely affected by trauma and static deformities infrequently seen in other areas of the body.

Injuries of the Leg

The most common injuries in this area are bruises, muscle strains, tendon lesions, postural stress, anterior and posterior compression syndromes, and tibia and fibula fractures. Bruises of the lower leg are less frequent than those of the thigh or knee, but the incidence of intrinsic strain, sprain, and stress fractures are much greater.

A continual program of running and jogging is typical of most sports. The result is often strengthening of the antigravity muscles at the expense of the gravity muscles — producing a dynamic imbalance unless both gravity and antigravity muscles are developed simultaneously. An anatomic or physiologic short leg as little as an eighth of an inch can affect a stride and produce an overstrain in long-distance track events.

Bruises and Contusions

The most common bruise of the lower extremity is that of the shin where disability may be great as the poorly protected tibial periosteum is usually involved. Skin splits in this area can be most difficult to heal. Signs of suppuration indicate referral to guard against periostitis and osteomyelitis.

Management. Treat as any skin-bone bruise with cold packs and antibacterial procedures, and shield the area with padding during competitive activity. When long socks are worn, the incidence of shinbone injuries is reduced. An old but effective protective method in professional football that does not add weight is to place four or five sheets of slick magazine pages around the shin that are secured by a cotton sock which is covered by the conventional sock. A blow to the shin is reduced to about a third of its force as the paper slips laterally on impact.

GASTROCNEMIUS CONTUSION

This is a common and most debilitating injury in contact sports. It is characterized by severe calf tenderness, abnormal muscle firmness of the engorged muscle, and inability to raise the heel during weight bearing.

Management. Treat with cold packs, compression, and elevation for 24 hr. Follow with mild heat and contrast baths. Massage is contraindicated as it might disturb muscle repair. The danger of ossification is less in the calf than in the thigh, but management must incorporate precautions against adhesions.

TRAUMATIC PHLEBITIS

Contusion to the greater saphenous vein may lead to rupture resulting in extensive swelling, ecchymosis, redness and other signs of local phlebitis. Tenderness will be found along the course of the vascular channel. During treatment, referral should be made upon the first signs of thrombosis.

Management. Management is by rest, cold, compression, and elevation for at least 24 hr. Later, progressive ambulation, mild heat, and contrast baths should be utilized. Progressive exercises may begin in 4-6 days. When competitive activity is resumed, the area should be provided extra protection.

NERVE CONTUSIONS (more…)

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