Chiropractic Care

The Subluxation – Historical Perspectives Part II

By Frank M. Painter|September 30, 2012|Chiropractic Care, Subluxation|

The Subluxation – Historical Perspectives Part II

SOURCE: Chiropractic Journal of Australia 2009 (Dec); 39 (4): 143–150

Rolf E. Peters, DC, MCSc, FICC, FACC, FPAC
Editor, Chiropractic Journal of Australia

Thanks to Dr. Rolf Peters, editor of the Chiropractic Journal of Australia for permission to republish this Full Text article, exclusively at Chiro.Org!

Subluxation is a term that has been used by the chiropractic profession since its early days. The term, meaning less than a luxation, has been used for millennia, similarly so has manipulation been the preferred intervention to overcome this problem.

This paper reviews some of the early uses of subluxation and manipulation identifying highlights, to help the reader appreciate that subluxation and manipulation, both spinal and general, are as old as civilisation itself.

INDEX TERMS: (MeSH) CHIROPRACTIC; MANIPULATION, CHIROPRACTIC; HISTORY OF MEDICINE; HISTORICAL ARTICLE. (Other): SUBLUXATION.

Introduction

D.D. Palmer stated that he manipulated the spine of Harvey Lillard on 18 September 1895 and restored his hearing after 17 years of deafness, and shortly thereafter gave immediate relief in a case of heart trouble. [1] With the advice of a patient, the Reverend Samuel Weed, they coined the word Chiropractic from the Greek words chiro and praxis, meaning done by hand on 14 January 1896. [2]

In 1905 D.D., with reference to himself in the third person, stated that

…he does not, nor ever has claimed that vertebrae may be displaced and replaced. He, however, is the first to draw the attention of the public to the difference between a complete luxation known to the medical world as such, and a subluxation as known to the chiropractor as a displacement of the articular processes.

He was the first to write lengthy articles, setting forth that 90 to 95 per cent of all diseases were caused by subluxation of vertebrae, and today no other person has placed such statements in the hands of the public unless copied from those written by D.D. Palmer

He was the first person to adjust, replace vertebrae by the unique method known as Chiropractic, using the spinous and transverse processes as handles.[3] (Emphasis added)

But, what are the facts?

This is just one of many articles @:

The Chiropractic Subluxation Page

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The Placebo, the Sensory Trick and Chiropractic

By Frank M. Painter|September 27, 2012|Chiropractic Care, Placebo, Spinal Manipulation|

The Placebo, the Sensory Trick and Chiropractic

The Chiro.Org Blog

SOURCE: Chiropractic J. Australia 2004 (Jun); 34 (2): 58–62

Brian S. Budgell, DC, MSc

School of Health Sciences,
Faculty of Medicine,
Kyoto University, Kyoto, Japan

Thanks to Dr. Brian S. Budgell and Dr. Rolf Peters, editor of the Chiropractic Journal of Australia for permission to republish this Full Text article, exclusively at Chiro.Org!

Background: As standards for randomised, controlled, clinical trials in medicine evolve, there is debate about whether the RCT model of investigation is appropriate for chiropractic and other forms of so-called “complementary and alternative medicine.” There may be some question as to whether the use of placebo interventions can be justified ethically and scientifically given that experimental treatments must eventually compete in a marketplace where there is often already a clinical alternative which is more effective than placebo. Beyond these concerns, design of an appropriate placebo for chiropractic trials is particularly problematic since the therapeutic component of overall chiropractic treatment may be difficult to isolate.

Objective: To compare placebo interventions in current use in chiropractic clinical research with simple somatic stimuli that produce significant physiological effects in a selected group of patients (those suffering from dystonia).

Methods: A literature search was made using MEDLINE, with the key words dystonia, sensory trick and geste antagoniste. Articles were reviewed for descriptions of these stimuli. The stimuli were compared, in terms of site and modality, with placebo interventions used in recent chiropractic clinical trials.

Results: Stimuli used as placebo procedures in recent chiropractic clinical trials are quite similar, in terms of site and modality, to the “sensory tricks” that either cause substantial temporary relief, or, alternatively, provocation of symptoms in dystonic patients.

Conclusions: Caution should be used in assuming that control (placebo) procedures used in chiropractic clinical trials—procedures that involve physical contact or positioning of patients—lack specific effects on neuromusculoskeletal symptomatology.

INDEX TERMS: (MeSH) PLACEBO, SENSORY TRICK, GESTE ANTAGONISTE, CHIROPRACTIC

You may also want to refer to our:

The Problem with Placebos/Shams Page

INTRODUCTION:

In common parlance, the placebo may be thought of as a sham treatment given to placate the gullible or troublesome patient. In medical practice, it is more often thought of as medication, most often a pill, which has no specific action against the complaint for which it is prescribed. More recently, standards for design of clinical research have demanded more rigorous definition of what has been called “the imaginary term in medicine’s algebraic formula.” [1]

For purposes of pharmacological research, it is possible to select placebo substances that appear, with a very high level of probability, to be physiologically inert in humans, or at least to have no specific action against a disorder that is the target of investigation. Nonetheless, various studies have indicated that such supposedly inert substances may be associated with impressive levels of therapeutic effects, sometimes rivalling the medications, which are known to have specific pharmacological effects. [2]

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Diagnosis and Management of Piriformis Syndrome

By Frank M. Painter|September 17, 2012|Chiropractic Care, Diagnosis, Piriformis Syndrome|

Diagnosis and Management of Piriformis Syndrome

The Chiro.Org Blog

SOURCE: J Am Osteopath Assoc. 2008 (Nov); 108 (11): 657-664 ~ FULL TEXT

Lori A. Boyajian-O’Neill, DO, Rance L. McClain, DO,
Michele K. Coleman, DO, Pamela P. Thomas, PhD

Department of Family Medicine, Kansas City University of Medicine,
Biosciences College of Osteopathic Medicine,
1750 Independence Ave, SEP 358,
Kansas City, MO 64106-145, USA.

Piriformis syndrome is a neuromuscular condition characterized by hip and buttock pain. This syndrome is often overlooked in clinical settings because its presentation may be similar to that of lumbar radiculopathy, primary sacral dysfunction, or innominate dysfunction. The ability to recognize piriformis syndrome requires an understanding of the structure and function of the piriformis muscle and its relationship to the sciatic nerve. The authors review the anatomic and clinical features of this condition, summarizing the osteopathic medical approach to diagnosis and management. A holistic approach to diagnosis requires a thorough neurologic history and physical assessment of the patient based on the pathologic characteristics of piriformis syndrome. The authors note that several nonpharmacologic therapies, including osteopathic manipulative treatment, can be used alone or in conjunction with pharmacotherapeutic options in the management of piriformis syndrome.

From the Full-Text Article:

Epidemiologic Considerations

Piriformis syndrome occurs most frequently during the fourth and fifth decades of life and affects individuals of all occupations and activity levels. [7-12] Reported incidence rates for piriformis syndrome among patients with low back pain vary widely, from 5% to 36%. [3, 4, 11] Piriformis syndrome is more common in women than men, possibly because of biomechanics associated with the wider quadriceps femoris muscle angle (ie, “Q angle”) in the os coxae (pelvis) of women. [3]

You may also want to review

Post-isometric Relaxation (PIR) of the Psoas

Difficulties arise in accurately determining the true prevalence of piriformis syndrome because it is frequently confused with other conditions.

Anatomic Characteristics (more…)

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Chiropractic Management of a US Army Veteran With Low Back Pain and Piriformis Syndrome

By Frank M. Painter|September 13, 2012|Chiropractic Care, Low Back Pain, Piriformis Syndrome|

Chiropractic Management of a US Army Veteran With Low Back Pain and Piriformis Syndrome

The Chiro.Org Blog

SOURCE: J Chiropr Med. 2012 (Mar); 11 (1): 24-9

Cynthia Chapman, and Barclay W. Bakkum

Chiropractor, Private Practice,
Occoquan Family Chiropractic, PLLC,
Occoquan, VA 22125

OBJECTIVE: The purpose of this article is to present the case of a patient with an anatomical anomaly of the piriformis muscle who had a piriformis syndrome and was managed with chiropractic care.

CASE REPORT: A 32-year-old male patient presented to a chiropractic clinic with a chief complaint of low back pain that radiated into his right buttock, right posterior thigh, and right posterior calf. The complaint began 5 years prior as a result of injuries during Airborne School in the US Army resulting in a 60% disability rating from the Veterans Administration. Magnetic resonance imaging demonstrated a mildly decreased intradiscal T2 signal with shallow central subligamentous disk displacement and low-grade facet arthropathy at L5/S1, a hypolordotic lumbar curvature, and accessory superior bundles of the right piriformis muscle without morphologic magnetic resonance imaging evidence of piriformis syndrome.

INTERVENTION AND OUTCOME: Chiropractic treatment included lumbar and sacral spinal manipulation with soft tissue massage to associated musculature and home exercise recommendations. Variations from routine care included proprioceptive neuromuscular facilitation stretches, electric muscle stimulation, acupressure point stimulation, Sacro Occipital Technique pelvic blocking, CranioSacral therapy, and an ergonomic evaluation.

CONCLUSION: A patient with a piriformis anomaly with symptoms of low back pain and piriformis syndrome responded positively to conservative chiropractic care, although the underlying cause of the piriformis syndrome remained.

You may also want to review

Post-isometric Relaxation (PIR) of the Psoas

The Full-Text Article:

Introduction

Piriformis syndrome is an uncommon cause of low back pain and sciatica that results from entrapment and/or irritation of the sciatic nerve in the region of the greater sciatic foramen. [1-4] Although no definitive causative factors are known for this syndrome, the usual source is thought to be an abnormal condition of the piriformis muscle. A common basis of the problem appears to be trauma to the piriformis muscle that results in spasm, edema, and contracture of the muscle, which can cause subsequent compression and entrapment of the sciatic nerve. [2] Other possible etiologies include reflex spasm of the piriformis muscle and an abnormal course of the sciatic nerve through the piriformis muscle. Altered biomechanics of the lower limb, low back, and pelvic regions can lead to stretching and shortening of the piriformis muscle, which can also lead to piriformis syndrome. Although, in 1928, Yeoman [5] first described the clinical picture of what would later be called piriformis syndrome, this diagnosis still remains somewhat controversial. This controversy stems from several factors that include variable and sometimes unclear cause, similarity to other more easily recognizable causes of sciatica, lack of consistent objective diagnostic findings, and relative rarity. Piriformis syndrome had been thought to be a purely clinical diagnosis; but more recently, magnetic resonance imaging (MRI) has begun to be used to help with the diagnosis of this problem. [6] (more…)

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When Research Challenges Our Assumptions

By Frank M. Painter|September 8, 2012|Chiropractic Care, Evidence-based Medicine, Guidelines, Health Care Reform, Health Promotion|

When Research Challenges Our Assumptions

The Chiro.Org Blog

SOURCE: ACA News ~ Sept 2012

By Daniel Redwood

When new research, research reviews or practice guidelines support our current beliefs and practices, enthusiasm comes easily. When the 2007 medical practice guidelines on low back pain (LBP) jointly prepared by the American Pain Society and the American College of Physicians recognized spinal manipulation as the only non-pharmacologic method providing “proven benefits” for acute LBP and as one of several methods (including exercise, rehabilitation, acupuncture and yoga) proven effective for chronic LBP, the American Chiropractic Association and doctors of chiropractic (DCs) everywhere welcomed this as a long-overdue recognition of the value of our primary treatment methods.

But when research challenges our assumptions, our responses are understandably mixed. Such findings, if confirmed in multiple studies, may create pressure to change our practice patterns or threaten reimbursement from insurance companies. Like members of other health professions, DCs do not find such developments pleasant. How we and members of other health professions respond to such research says a great deal about who we are, how fully we practice what we preach, and the depth of our commitment to providing the best possible care to our patients. (more…)

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Predictors of Outcome in Neck Pain Patients

By Frank M. Painter|August 25, 2012|Chiropractic Care, Chronic Pain, Neck Pain, Radiculopathy, Spinal Manipulation|

Predictors of Outcome in Neck Pain Patients Undergoing Chiropractic Care: Comparison of Acute and Chronic Patients

The Chiro.Org Blog

SOURCE: Chiropractic & Manual Therapies 2012 (Aug 24); 20 (1): 27

Cynthia K Peterson, Jennifer Bolton, B. Kim Humphreys

University of Zürich and Orthopaedic University Hospital Balgrist, Forchstrasse 340, 8008 Zürich, Switzerland

Background Neck pain is a common complaint in patients presenting for chiropractic treatment. The few studies on predictors for improvement in patients while undergoing treatment identify duration of symptoms, neck stiffness and number of previous episodes as the strong predictor variables. The purpose of this study is to continue the research for predictors of a positive outcome in neck pain patients undergoing chiropractic treatment.

Methods Acute (< 4 weeks) (n = 274) and chronic (> 3 months) (n = 255) neck pain patients with no chiropractic or manual therapy in the prior 3 months were included. Patients completed the numerical pain rating scale (NRS) and Bournemouth questionnaire (BQ) at baseline prior to treatment. At 1 week, 1 month and 3 months after start of treatment the NRS and BQ were completed along with the Patient Global Impression of Change (PGIC) scale. Demographic information was provided by the clinician. Improvement at each of the follow up points was categorized using the PGIC. Multivariate regression analyses were done to determine significant independent predictors of improvement.

Results Baseline mean neck pain and total disability scores were significantly (p < 0.001and p < 0.008 respectively) higher in acute patients. Both groups reported significant improvement at all data collection time points, but was significantly larger for acute patients. The PGIC score at 1 week (OR = 3.35, 95% CI = 1.13-9.92) and the baseline to 1 month BQ total change score (OR = 1.07, 95% CI = 1.03-1.11) were identified as independent predictors of improvement at 3 months for acute patients. Chronic patients who reported improvement on the PGIC at 1 month were more likely to be improved at 3 months (OR = 6.04, 95% CI = 2.76-13.69). The presence of cervical radiculopathy or dizziness was not predictive of a negative outcome in these patients.

CONCLUSIONS: The most consistent predictor of clinically relevant improvement at both 1 and 3 months after the start of chiropractic treatment for both acute and chronic patients is if they report improvement early in the course of treatment. The co-existence of either radiculopathy or dizziness however do not imply poorer prognosis in these patients.

There are more articles like this @ our:

Chronic Neck Pain and Chiropractic Page and the

A Clinical Model for the Diagnosis and Management Page

From the FULL TEXT Article:

Background

Patients suffering from neck pain are second only to low back pain patients in terms of the frequency of presentation for chiropractic treatment [1-4]. For many of these patients the precise diagnosis is difficult to ascertain and thus becomes labeled ‘non-specific’ neck pain or neck pain from mechanical dysfunction [1,3-5]. Research evidence has yet to determine with clarity whether spinal manipulative therapy (SMT) or mobilization of the neck is the superior treatment for these patients [1-9] although it appears that both of these treatments have better outcomes when combined with exercise [5,10]. (more…)

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