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Chiropractic Nimmo Receptor-Tonus Technique and McKenzie Self-Therapy Program in the Management of Adjacent Segment Disease: A Case Report

By |January 17, 2022|Adjacent Segment Disease, Case Studies, McKenzie, Myofascial Disorder, Myofascial Trigger Points|

Chiropractic Nimmo Receptor-Tonus Technique and McKenzie Self-Therapy Program in the Management of Adjacent Segment Disease: A Case Report

The Chiro.Org Blog

SOURCE:   J Chiropractic Medicine 2020 (Dec); 19 (4): 249–259

Emsal Salik, MD PhD; Ali Donat, DC; Mustafa Hulisi Ağaoğlu, DC

Chiropractic Program,
Health Sciences Institute,
Bahcesehir University,
Besiktas, Istanbul, Turkey

Objective:   The objective of the present study objective was to describe adjacent segment disease (ASD) from a chiropractic management prospective and subsequently to stimulate further research into the chiropractic therapeutic effects on such cases and to contribute to chiropractic literature.

Clinical features:   A 44–year-old woman had a history of lumbar stabilization revision operation by pedicle screw fixation for spondylolisthesis. Her intractable back pain episodes, which were diagnosed as ASD, began shortly after this surgery. At presentation, she was taking pregabalin 75 mg 2 times a day for postoperative neuropathic pain without any pain relief. Clinical testing revealed myofascial tender points reproducing the pain.

Intervention and outcome:   After taking the case history and performing a physical examination, the patient was managed with chiropractic Nimmo receptor-tonus technique in combination with McKenzie exercises. Nimmo was applied by manually pressing on clinically relevant points for 5 to 15 seconds in 11 visits over 3 weeks. The patient by herself did McKenzie exercises 5 to 10 times a day for 10 to 12 repetitions over 2 months. After 3 weeks of therapy, visual analog scale and Oswestry Disability Index scores were improved. Furthermore, because of the amelioration of the patient’s symptoms, her neurosurgeon successfully discontinued pregabalin 75 mg 2 times a day without negative consequences to care.

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Association Between Centralization and Directional Preference

By |June 3, 2018|Chronic Neck Pain, McKenzie|

Association Between Centralization and Directional Preference and Functional and Pain Outcomes in Patients With Neck Pain

The Chiro.Org Blog

SOURCE:   J Orthop Sports Phys Ther. 2014 (Feb); 44 (2): 68–75

Susan L. Edmond, PT, DSc, OCS, Guillermo Cutrone, PT, DSc, OCS, Cert MDT, FAAOMPT, Mark Werneke, PT, MS, Dip MDT et. al.

The State University of New Jersey,
Newark, NJ.

STUDY DESIGN:   Retrospective cohort.

OBJECTIVES:   In subjects with neck pain, the present study aimed (1) to describe the prevalence of centralization (CEN), noncentralization (non-CEN), directional preference (DP), and no directional preference (no DP); (2) to determine if age, sex, fear-avoidance beliefs about physical activity, number of comorbid conditions, or symptom duration varies among subjects who demonstrate CEN versus non-CEN and DP versus no DP; and (3) to determine if CEN and/or DP are associated with changes in function and pain.

BACKGROUND:   CEN and DP are prevalent among patients with low back pain and should be considered when determining treatment strategies and predicting outcomes; however, these findings are not well investigated in patients with neck pain.

METHODS:   Three hundred four subjects contributed data. CEN and DP prevalence were calculated, as was the association between CEN and DP, and age, sex, number of comorbid conditions, fear-avoidance beliefs, and symptom duration. Multivariate models assessed whether CEN and DP predicted change in function and pain.

RESULTS:   CEN and DP prevalence were 0.4 and 0.7, respectively. Younger subjects and those with fewer comorbid conditions were more likely to centralize; however, subjects who demonstrated DP were more likely to have acute symptoms. Subjects who centralized experienced, on average, a 3.6-point (95% confidence interval: -0.3, 7.4) improvement in function scores, whereas subjects with a DP averaged a 5.4-point (95% confidence interval: 0.8, 10.0) improvement. Neither CEN nor DP was associated with pain outcomes.

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Directional Preference and Functional Outcomes Among Subjects Classified at High Psychosocial Risk Using STarT

By |May 14, 2018|McKenzie|

Directional Preference and Functional Outcomes Among Subjects Classified at High Psychosocial Risk Using STarT

The Chiro.Org Blog

SOURCE:   Physiother Res Int. 2018 (Mar 14) [Epub]

Mark W. Werneke, Susan Edmond, Michelle Young, David Grigsby, Brian McClenahan, Troy McGill

Doctoral Programs in Physical Therapy,
Rutgers, The State University of New Jersey,
Newark, NJ, USA

BACKGROUND AND PURPOSE:   Physiotherapy has an important role in managing patients with non-specific low back pain who experience elevated psychosocial distress or risk for chronic disability. In terms of evidence-based physiotherapy practice, cognitive-behavioural approaches for patients at high psychosocial risk are the recommended management to improve patient treatment outcomes. Evidence also suggests that directional preference (DP) is an important treatment effect modifier for prescribing specific exercises for patients to improve outcomes. Little is known about the influence of treatment techniques based on DP on outcomes for patients classified as high psychosocial risk using the Subgroups for Targeted Treatment (STarT Back Screening Tool). This study aimed to examine the association between functional status (FS) at rehabilitation discharge for patients experiencing low back pain classified at high STarT psychosocial risk and whose symptoms showed a DP versus No-DP.

METHODS:   High STarT risk patients (n = 138) completed intake surveys, that is, the lumbar FS of Focus On Therapeutic Outcomes, Inc., and STarT, and were evaluated for DP by physiotherapists credentialed in McKenzie methods. The FS measure of Focus On Therapeutic Outcomes, Inc., was repeated at discharge. DP and No-DP prevalence rates were calculated. Associations between first-visit DP and No-DP and change in FS were assessed using univariate and multivariate regression models controlling for 11 risk-adjusted variables.

RESULTS:   One hundred nine patients classified as high STarT risk had complete intake and discharge FS and DP data. Prevalence rate for DP was 65.1%. A significant and clinically important difference (7.98 FS points; p = .03) in change in function at discharge between DP and No-DP was observed after controlling for all confounding variables in the final model.


Conservative Management of a 31 Year Old Male With Left Sided Low Back and Leg Pain

By |November 11, 2012|Chiropractic Care, McKenzie, Rehabilitation, Spinal Manipulation|

Conservative Management of a 31 Year Old Male With Left Sided Low Back and Leg Pain: A Case Report

The Chiro.Org Blog

SOURCE:   J Can Chiropr Assoc. 2012 (Sep);   56 (3):   225-232

Emily R. Howell, BPHE(Hons), DC, FCCPOR(C)

Ashbridge’s Health Centre,
1522 Queen St. East,
Toronto, ON M4L 1E3.

OBJECTIVE:   This case study reported the conservative management of a patient presenting with left sided low back and leg pain diagnosed as a left sided L5-S1 disc prolapse/herniation.

CLINICAL FEATURES:   A 31-year-old male recreational worker presented with left sided low back and leg pain for the previous 3-4 months that was exacerbated by prolonged sitting.

INTERVENTION AND OUTCOME:   The plan of management included interferential current, soft tissue trigger point and myofascial therapy, lateral recumbent manual low velocity, low amplitude traction mobilizations and pelvic blocking as necessary. Home care included heat, icing, neural mobilizations, repeated extension exercises, stretching, core muscle strengthening, as well as the avoidance of prolonged sitting and using a low back support in his work chair. The patient responded well after the first visit and his leg and back pain were almost completely resolved by the third visit.

SUMMARY:   Conservative chiropractic care appears to reduce pain and improve mobility in this case of a L5-S1 disc herniation. Active rehabilitative treatment strategies are recommended before surgical referral.

Recent Studies Have Also Shown That:

Back Surgery Fails 74% of the Time

From the FULL TEXT Article


Low back pain has been reported as the chief complaint for 23.6% of patients presenting to chiropractic offices. [1]   Disc herniations that lead to nerve-root compromise account for less than 15% of chronic low back pain cases. [2]   Over 95% of lumbar disc herniations occur at L4–5 or L5-S1 levels, and only 2% of herniations require surgery, 4% have compression fractures, 0.7% have spinal malignant neoplasms, 0.3% have ankylosing spondylitis and 0.1% have spinal infections. [2, 3]

Leg pain is estimated to be found in 25–57% of all low back pain cases and accounts for large costs, disability, chronicity and severity. [4, 5, 6] Many conservative treatments have been shown to be effective in the management of this condition and are favorable to pursue before considering any surgical interventions, such as: modalities, soft tissue therapy, spinal manipulations or mobilizations, pelvic blocking, McKenzie/end-range loading exercises, lumbar stabilization exercises and neural mobilizations, patient education, reassurance, short-term use of acetaminophen, and nonsteroidal antiinflammatory drugs. [2, 3, 7–24] The purpose of this case report is to describe the successful management of a patient with low back and leg pain.



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