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Low Back Pain

Chiropractic Spinal Manipulation for Low Back Pain of Pregnancy

By |July 31, 2018|Low Back Pain, Pregnancy|

Chiropractic Spinal Manipulation for Low Back Pain of Pregnancy: A Retrospective Case Series

The Chiro.Org Blog

SOURCE:   J Midwifery Womens Health 2006 (Jan); 51 (1): e7-10

Anthony J. Lisi

University of Bridgeport College of Chiropractic.

Low back pain is a common complaint in pregnancy, with a reported prevalence of 57% to 69% and incidence of 61%. Although such pain can result in significant disability, it has been shown that as few as 32% of women report symptoms to their prenatal provider, and only 25% of providers recommend treatment. Chiropractors sometimes manage low back pain in pregnant women; however, scarce data exist regarding such treatment. This retrospective case series was undertaken to describe the results of a group of pregnant women with low back pain who underwent chiropractic treatment including spinal manipulation. Seventeen cases met all inclusion criteria.

The overall group average Numerical Rating Scale pain score decreased from 5.9 (range 2-10) at initial presentation to 1.5 (range 0-5) at termination of care. Sixteen of 17 (94.1%) cases demonstrated clinically important improvement. The average time to initial clinically important pain relief was 4.5 (range 0-13) days after initial presentation, and the average number of visits undergone up to that point was 1.8 (range 1-5). No adverse effects were reported in any of the 17 cases. The results suggest that chiropractic treatment was safe in these cases and support the hypothesis that it may be effective for reducing pain intensity.

From the FULL TEXT Article:

INTRODUCTION

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Can a Bothersome Course of Pelvic Pain From Mid-pregnancy

By |July 29, 2018|Low Back Pain, Pregnancy|

Can a Bothersome Course of Pelvic Pain From Mid-pregnancy to Birth be Predicted? A Norwegian Prospective Longitudinal SMS-Track Study

The Chiro.Org Blog

SOURCE:   BMJ Open. 2018 (Jul 25); 8 (7): e021378

Stefan Malmqvist, Inger Kjaermann, Knut Andersen, Anne Marie Gausel, Inger Økland, Jan Petter Larsen, Kolbjorn S Bronnick

The Norwegian Centre for Movement Disorders,
Stavanger University Hospital,
Stavanger, Norway.

OBJECTIVE:   To explore if pregnant women with pelvic girdle pain (PGP), subgrouped following the results from two clinical tests with high validity and reliability, differ in demographic characteristics and weekly amount of days with bothersome symptoms through the second half of pregnancy.

DESIGN:   A prospective longitudinal cohort study.

PARTICIPANTS:   Pregnant women with pelvic and lumbopelvic pain due for their second-trimester routine ultrasound examination.

SETTING:   Obstetric outpatient clinic at Stavanger University Hospital, Norway.

METHODS:   Women reporting pelvic and lumbopelvic pain completed a questionnaire on demographic and clinical features. They were clinically examined following a test procedure recommended in the European guidelines for the diagnosis and treatment of PGP. Women without pain symptoms completed a questionnaire on demographic data. All women were followed weekly through an SMS-Track survey until delivery.

PRIMARY AND SECONDARY OUTCOME MEASURES:   The outcome measures were the results from clinical diagnostic tests for PGP and the number of days per week with bothersome pelvic pain.

RESULTS:   503 women participated. 42% (212/503) reported pain in the lumbopelvic region and 39% (196/503) fulfilled the criteria for a probable PGP diagnosis. 27% (137/503) reported both the posterior pelvic pain provocation (P4) and the active straight leg raise (ASLR) tests positive at baseline in week 18, revealing 7.55 (95% CI 5.54 to 10.29) times higher mean number of days with bothersome pelvic pain compared with women with both tests negative. They presented the highest scores for workload, depressed mood, pain level, body mass index, Oswestry Disability Index and the number of previous pregnancies. Exercising regularly before and during pregnancy was more common in women with negative tests.

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Low Back Pain: A Major Global Problem For Which

By |June 26, 2018|Low Back Pain|

Low Back Pain: A Major Global Problem For Which the Chiropractic Profession Needs to Take More Care

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SOURCE:   Chiropractic & Manual Therapies 2018 (Jun 25); 26: 28

Simon D. French, Aron S. Downie and Bruce F. Walker

Department of Chiropractic,
Faculty of Science and Engineering,
Macquarie University,
Sydney, Australia

An important series of papers have been published in the Lancet. These papers provide a comprehensive update for the major global problem of low back pain, and the challenges that low back pain presents to healthcare practitioners and policy makers. Chiropractors are well placed to reduce the burden of low back pain, but not all that chiropractors do is supported by robust, contemporary evidence. This commentary summarises the Lancet articles. We also make suggestions for how the chiropractic profession should most effectively help people with low back pain by implementing practices supported by high quality evidence.

This is just one article from a series of 4:

The Lancet 2018 Series on Low Back Pain

From the Full-Text Article

Background

Low back pain is a major global problem and it is getting worse. [1] An important series of articles in the journal Lancet, authored by world leading authorities on low back pain evidence, has drawn international attention to how enormous the problem is. The Lancet authors also discussed how low back pain is being poorly managed by healthcare systems around the globe, including emerging issues in low and middle-income countries. [2–4] This commentary will summarise the main findings of these Lancet papers, and provide some suggestions for how the chiropractic profession should respond to the global challenge that is low back pain.

The Lancet papers

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Effect of Usual Medical Care Plus Chiropractic Care vs Usual

By |May 23, 2018|Low Back Pain, Veterans|

Effect of Usual Medical Care Plus Chiropractic Care vs Usual Medical Care Alone
on Pain and Disability Among US Service Members With Low Back Pain.
A Comparative Effectiveness Clinical Trial

The Chiro.Org Blog

SOURCE:   JAMA Network Open. 2018 (May 18); 1 (1): e180105

Christine M. Goertz, DC, PhD 1; Cynthia R. Long, PhD 1; Robert D. Vining, DC 1; Katherine A. Pohlman, DC, MS 2; Joan Walter, JD, PA 3; Ian Coulter, PhD 4

(1) Palmer College of Chiropractic,
Palmer Center for Chiropractic Research,
Davenport, Iowa

(2) Parker University Research Institute,
Dallas, Texas

(3) Samueli Institute for Information Biology,
Silver Spring, Maryland

(4) RAND Corporation,
Santa Monica, California

Importance   It is critically important to evaluate the effect of nonpharmacological treatments on low back pain and associated disability.

Objective   To determine whether the addition of chiropractic care to usual medical care results in better pain relief and pain-related function when compared with usual medical care alone.

Design, Setting, and Participants   A 3–site pragmatic comparative effectiveness clinical trial using adaptive allocation was conducted from September 28, 2012, to February 13, 2016, at 2 large military medical centers in major metropolitan areas and 1 smaller hospital at a military training site. Eligible participants were active-duty US service members aged 18 to 50 years with low back pain from a musculoskeletal source.

Interventions   The intervention period was 6 weeks. Usual medical care included self-care, medications, physical therapy, and pain clinic referral. Chiropractic care included spinal manipulative therapy in the low back and adjacent regions and additional therapeutic procedures such as rehabilitative exercise, cryotherapy, superficial heat, and other manual therapies.

Main Outcomes and Measures   Coprimary outcomes were low back pain intensity (Numerical Rating Scale; scores ranging from 0 [no low back pain] to 10 [worst possible low back pain]) and disability (Roland Morris Disability Questionnaire; scores ranging from 0–24, with higher scores indicating greater disability) at 6 weeks. Secondary outcomes included perceived improvement, satisfaction (Numerical Rating Scale; scores ranging from 0 [not at all satisfied] to 10 [extremely satisfied]), and medication use. The coprimary outcomes were modeled with linear mixed-effects regression over baseline and weeks 2, 4, 6, and 12.

Results   Of the 806 screened patients who were recruited through either clinician referrals or self-referrals, 750 were enrolled (250 at each site). The mean (SD) participant age was 30.9 (8.7) years, 175 participants (23.3%) were female, and 243 participants (32.4%) were nonwhite. Statistically significant site × time × group interactions were found in all models. Adjusted mean differences in scores at week 6 were statistically significant in favor of usual medical care plus chiropractic care compared with usual medical care alone overall for low back pain intensity (mean difference, –1.1; 95% CI, –1.4 to –0.7), disability (mean difference, –2.2; 95% CI, –3.1 to –1.2), and satisfaction (mean difference, 2.5; 95% CI, 2.1 to 2.8) as well as at each site. Adjusted odd ratios at week 6 were also statistically significant in favor of usual medical care plus chiropractic care overall for perceived improvement (odds ratio = 0.18; 95% CI, 0.13–0.25) and self-reported pain medication use (odds ratio = 0.73; 95% CI, 0.54–0.97). No serious related adverse events were reported.

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Manipulation and Mobilization for Treating Chronic Low Back Pain

By |May 17, 2018|Low Back Pain|

Manipulation and Mobilization for Treating Chronic Low Back Pain: A Systematic Review and Meta-analysis

The Chiro.Org Blog

SOURCE:   Spine J. 2018 (May);   18 (5):   866–879

Ian D. Coulter, PhD, Cindy Crawford, BA, Eric L. Hurwitz, DC, PhD, Howard Vernon, DC, PhD, Raheleh Khorsan, PhD, Marika Suttorp Booth, MS, Patricia M. Herman, ND, PhD

RAND Corporation,
1776 Main St,
Santa Monica, CA 90407-2138, USA

BACKGROUND CONTEXT:   Mobilization and manipulation therapies are widely used to benefit patients with chronic low back pain. However, questions remain about their efficacy, dosing, safety, and how these approaches compare with other therapies.

PURPOSE:   The present study aims to determine the efficacy, effectiveness, and safety of various mobilization and manipulation therapies for treatment of chronic low back pain.

STUDY DESIGN/SETTING:   This is a systematic literature review and meta-analysis.

OUTCOME MEASURES:   The present study measures self-reported pain, function, health-related quality of life, and adverse events.

METHODS:   We identified studies by searching multiple electronic databases from January 2000 to March 2017, examining reference lists, and communicating with experts. We selected randomized controlled trials comparing manipulation or mobilization therapies with sham, no treatment, other active therapies, and multimodal therapeutic approaches. We assessed risk of bias using Scottish Intercollegiate Guidelines Network criteria. Where possible, we pooled data using random-effects meta-analysis. Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) was applied to determine the confidence in effect estimates. This project is funded by the National Center for Complementary and Integrative Health under Award Number U19AT007912.

RESULTS:   Fifty-one trials were included in the systematic review. Nine trials (1,176 patients) provided sufficient data and were judged similar enough to be pooled for meta-analysis. The standardized mean difference for a reduction of pain was SMD=–0.28, 95% confidence interval (CI) –0.47 to –0.09, p=.004; I2=57% after treatment; within seven trials (923 patients), the reduction in disability was SMD=–0.33, 95% CI –0.63 to –0.03, p=.03; I2=78% for manipulation or mobilization compared with other active therapies. Subgroup analyses showed that manipulation significantly reduced pain and disability, compared with other active comparators including exercise and physical therapy (SMD=–0.43, 95% CI –0.86 to 0.00; p=.05, I2=79%; SMD=–0.86, 95% CI –1.27 to –0.45; p<.0001, I2=46%). Mobilization interventions, compared with other active comparators including exercise regimens, significantly reduced pain (SMD=–0.20, 95% CI –0.35 to –0.04; p=.01; I2=0%) but not disability (SMD=–0.10, 95% CI –0.28 to 0.07; p=.25; I2=21%). Studies comparing manipulation or mobilization with sham or no treatment were too few or too heterogeneous to allow for pooling as were studies examining relationships between dose and outcomes. Few studies assessed health-related quality of life. Twenty-six of 51 trials were multimodal studies and narratively described.

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Spinal Manipulative Therapy and Other Conservative Treatments

By |April 12, 2018|Guidelines, Low Back Pain|

Spinal Manipulative Therapy and Other Conservative Treatments for Low Back Pain:
A Guideline From the Canadian Chiropractic Guideline Initiative

The Chiro.Org Blog

SOURCE:   J Manipulative Physiol Ther. 2018 (Mar 29) [Epub]

André E. Bussières, DC, FCCS(C), PhD, Gregory Stewart, DC, Fadi Al-Zoubi, PT, MSc, Philip Decina, DC, Martin Descarreaux, DC, PhD, Danielle Haskett, BSc, Cesar Hincapié, DC, PhD, Isabelle Pagé, DC, MSc, Steven Passmore, DC, PhD, John Srbely, DC, PhD, Maja Stupar, DC, PhD, Joel Weisberg, DC, Joseph Ornelas, DC, PhD

School of Physical and Occupational Therapy,
Faculty of Medicine, McGill University,
Montreal, Québec, Canada

OBJECTIVE: &nbsp The objective of this study was to develop a clinical practice guideline on the management of acute and chronic low back pain (LBP) in adults. The aim was to develop a guideline to provide best practice recommendations on the initial assessment and monitoring of people with low back pain and address the use of spinal manipulation therapy (SMT) compared with other commonly used conservative treatments.

METHODS: &nbsp The topic areas were chosen based on an Agency for Healthcare Research and Quality comparative effectiveness review, specific to spinal manipulation as a nonpharmacological intervention. The panel updated the search strategies in Medline. We assessed admissible systematic reviews and randomized controlled trials for each question using A Measurement Tool to Assess Systematic Reviews and Cochrane Back Review Group criteria. Evidence profiles were used to summarize judgments of the evidence quality and link recommendations to the supporting evidence. Using the Evidence to Decision Framework, the guideline panel determined the certainty of evidence and strength of the recommendations. Consensus was achieved using a modified Delphi technique. The guideline was peer reviewed by an 8-member multidisciplinary external committee.

RESULTS: &nbsp For patients with acute (0-3 months) back pain, we suggest offering advice (posture, staying active), reassurance, education and self-management strategies in addition to SMT, usual medical care when deemed beneficial, or a combination of SMT and usual medical care to improve pain and disability. For patients with chronic (>3 months) back pain, we suggest offering advice and education, SMT or SMT as part of a multimodal therapy (exercise, myofascial therapy or usual medical care when deemed beneficial). For patients with chronic back-related leg pain, we suggest offering advice and education along with SMT and home exercise (positioning and stabilization exercises).

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