Research

Wake Up – We’re in a Race for Scientific Ownership of Manipulation

By Frank M. Painter|June 13, 2012|Research, Warning!|

Wake Up – We’re in a Race for Scientific Ownership of Manipulation

SOURCE: Dynamic Chiropractic

By William Meeker, DC, MPH, FICC

For several years now, many have pointed out that our major clinical intervention, that family of procedures we call adjustments/manipulation, is no longer a “quack” remedy. That designation changed dramatically over a decade ago with the publication of the RAND appropriateness studies, the AHCPR guidelines on back conditions, and a fair number of randomized clinical trials.

Historically, those studies were very powerful in pulling manipulation out of the closet to where it now is – experiencing a great deal more exposure. As a result, we are seeing a renaissance of interest by osteopathic physicians and physical therapists. This in turn has led to a significant increase in the amount of research on manipulation by these professions. They are challenging chiropractic for pre-eminence in this field.

Professions, by definition, “own” their tools and their knowledge. This means that there is a cultural consensus in society that expertise in the use of professional knowledge is invested in a particular profession because that profession knows the most, is the most expert in, and can do the most good for the public with its unique tools. Lawyers know the most about laws because they make laws, study laws and apply laws. You wouldn’t go to a plumber if you had a legal case. Obviously, the situation is analogous for health care.

A citizen should not have any trouble deciding whom to consult for specific kinds of clinical expertise. But the situation for manipulation is becoming increasingly muddy, if the scientific publication record is any indication. We chiropractors do not enjoy an unassailable cultural consensus anymore when it comes to manipulation and adjustments. Chiropractors certainly have some authority by virtue of our history and training, but others are encroaching. We need to recognize that our authority in this area is under concerted and constant attack, and I fear that we may be losing ground. (more…)

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Chiropractic Dominates The Spine Journal Downloads in 2011

By John Wiens DC|June 12, 2012|Research|

Source Dynamic Chiropractic

The Spine Journal recently announced its “Top 25 Hottest Articles” for 2011. These are the most downloaded articles for the year. The 2011 list is surprising in that 13 of the 25 articles have at least one author who is a doctor of chiropractic.

In addition, 10 of the 25 papers include content relating to spinal manipulation, cervical manipulation or chiropractic; six of those include the terms in their title. Papers that discussed these topics were found to be very popular, ranking first, third, fourth, sixth, 10^th, 14^th, 15^th, 17^th, 23^rd and 24^th.

The top-ranked paper for 2011 is “Efficacy of Spinal Manipulation and Mobilization for Low Back Pain and Neck Pain: A Systematic Review and Best Evidence Synthesis.” Authors include Gert Bronfort, PhD, DC, Mitchell Haas, DC, MA, and Roni L. Evans, DC, MS, representing Northwestern Health Sciences University and the University of Western States. (This was not their only paper in the top six.)

Simon Dagenais, DC, PhD, currently working with Palladian Health in West Seneca, N.Y., led a total of 17 doctors of chiropractic who authored most of the Top 25 Hottest Articles. Here is the list of the chiropractic authors, along with the number of papers they authored in The Spine Journal and where the papers placed on the Top 25 list:

Paul B. Bishop, DC, MD, PhD – one paper placing 15^th
Gert Bronfort, PhD, DC – three papers placing first, fourth and sixth, respectively
Simon Dagenais, DC, PhD – six papers placing third, sixth, eighth, 17^th, 21^st and 24^th, respectively
Roni L. Evans, DC, MS – three papers placing first, fourth and sixth, respectively
Michael D. Freeman, PhD, MPH, DC – one paper placing 24^th
Ralph E. Gay, DC, MD – one paper placing 24^th
Mitchell Haas, DC – three papers placing first, sixth and 14^th, respectively
Scott Haldeman, DC, MD, PhD – three papers placing third, eighth and 17^th , respectively
Eric L. Hurwitz, DC, PhD – two papers placing seventh and 20^th, respectively
Greg Kawchuk, DC, PhD – one paper placing sixth
Michele J. Maiers, DC, MPH – one paper placing fourth
John Mayer, DC, PhD – two papers placing 2^st & 24^th, respectively
Edward F. Owens Jr., MS, DC – one paper placing fourth
David Peterson, DC – one paper placing 14^th
Joel G Pickar, DC, PhD – one paper placing 10^th
Jeffrey A. Quon, DC, PhD, FCCSC – one paper placing 15^th
Craig A. Schulz, DC, MS – one paper placing fourth

The majority of papers investigate conservative care versus surgery. Two of the papers that examined “catastrophic complications” and “adverse reactions” in surgical procedures included Eric L. Hurwitz, DC, PhD, as one of the authors. If the Spine Journal‘s 2011 list of the most downloaded papers is any indication, the focus in spine care has clearly moved away from surgery toward more conservative care. This refocus is not only reflected in the research community, but also in the minds of the health care-consuming public and the business community paying the bills.

This trend toward conservative care is likely to continue for the foreseeable future. The cost of surgery, surgical failure rates and the subsequent additional costs continue at unacceptable levels. It has apparently taken an economic crisis to wake people up to the nightmare that is the surgical model.

This is an excellent opportunity to educate patients and their families, friends and co-workers about chiropractic. If nothing else, read the abstracts of The Spine Journal‘s 25 Hottest Articles and share the information with them. As we all know, an educated patient can be an effective source of referrals.

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Visceral Responses to Spinal Manipulation

By Frank M. Painter|June 3, 2012|Chiropractic Care, Research, Spinal Manipulation, Subluxation|

Visceral Responses to Spinal Manipulation

The Chiro.Org Blog

SOURCE: J Electromyogr Kinesiol. 2012 (Mar 20)

Philip S. Bolton, Brian Budgell

School of Biomedical Sciences & Pharmacy,
Faculty of Health, University of Newcastle,
Callaghan NSW 2308, Australia;

Centre for Brain and Mental Health Research at the
Hunter Medical Research Institute,
Newcastle, Australia

While spinal manipulation is widely seen as a reasonable treatment option for biomechanical disorders of the spine, such as neck pain and low back pain, the use of spinal manipulation to treat non-musculoskeletal complaints remains controversial. This controversy is due in part to the perception that there is no robust neurobiological rationale to justify using a biomechanical treatment of the spine to address a disorder of visceral function. This paper therefore looks at the physiological evidence that spinal manipulation can impact visceral function. A structured search was conducted, using PubMed and the Index to Chiropractic Literature, to construct of corpus of primary data studies in healthy human subjects of the effects of spinal manipulation on visceral function. The corpus of literature is not large, and the greatest number of papers concerns cardiovascular function. (more…)

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Nature and Nurture: World‐first Discovery Sheds New Light On Congenital Birth Defects

By John Wiens DC|April 6, 2012|Research|

Hypoxia, or a period of low oxygen during pregnancy, combined with a genetic risk factor of having only one functioning copy of a gene, dramatically increases the chances of a baby being born with congenital scoliosis.

Source Science Daily

Scientists have made a landmark discovery that could help women minimize or even avoid the risk of having a baby born with congenital birth defects. The study is published April 5 in the international journal Cell.

The scientists, from universities in Australia, Japan, Canada and the United States, including Arizona State University, show for the first time how “nature” and “nurture” interact to increase the severity and likelihood of developing birth defects, including abnormalities in the heart, kidneys, brain, limbs and cranio‐facial regions (cleft palate).

They show how hypoxia, or a period of low oxygen during pregnancy, combined with a genetic risk factor of having only one functioning copy of a gene, dramatically increases the chances of a baby being born with congenital scoliosis, a malformation of the spine that affects around 1 in 1,000. (more…)

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WHO Focuses on Aging Population for World Health Day

By John Wiens DC|March 12, 2012|Research|

Between 2000 and 2050, the proportion of the world’s population over 60 years will double from about 11 percent to 22 percent.

Source Occupational Health and Safety

One of the biggest social transformations is population aging. Soon, the world will have more older people than children and more people of very old age than ever before. The World Health Organization is focusing on aging and health for World Health Day on April 7.

The world will have more people who live to see their 80s or 90s than ever before. The number of people aged 80 years or older, for example, will have almost quadrupled to 395 million between 2000 and 2050. There is no historical precedent for a majority of middle-aged and older adults having living parents, as is already the case today. More children will know their grandparents and even their great-grandparents.

With that in mind Chiropractic and Manual Therapy has just published the first paper in a thematic series on chiropractic care in older adults. This thematic series provides an overview of current best evidence in key aspects of evaluation and management of chiropractic care for older adults. Individual articles address the magnitude of musculo-skeletal problems in the elderly population, diagnostic challenges for chiropractors and other manual therapists seeing elderly patients, the evidence for chiropractic and manual therapy in the care of the elderly and also imaging modalities for musculo-skeletal disorders in the elderly including utility, validity and cost.

You can download the provisional pdf here.

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The Role of Chiropractic Care in Older Adults

By Frank M. Painter|February 26, 2012|Chiropractic Care, Health Care Reform, Research, Spinal Manipulation|

The Role of Chiropractic Care in Older Adults

The Chiro.Org Blog

SOURCE: Chiropractic & Manual Therapies 2012 (Feb 21), 20: 3

Paul E Dougherty, Cheryl Hawk, Debra K Weiner,
Brian Gleberzon, Kari Andrew, Lisa Killinger

There are a rising number of older adults; in the US alone nearly 20% of the population will be 65 or older by 2030. Chiropractic is one of the most frequently utilized types of complementary and alternative care by older adults, used by an estimated 5% of older adults in the U.S. annually. Chiropractic care involves many different types of interventions, including preventive strategies. This commentary by experts in the field of geriatrics, discusses the evidence for the use of spinal manipulative therapy, acupuncture, nutritional counseling and fall prevention strategies as delivered by doctors of chiropractic. Given the utilization of chiropractic services by the older adult, it is imperative that providers be familiar with the evidence for and the prudent use of different management strategies for older adults.

Introduction:

By 2030, nearly one in five U.S. residents is expected to be age 65 or older [1]. An estimated 14% of patients treated by doctors of chiropractic (DCs) are 65 and older [2]. The most common reason for an older adult to see a DC is musculoskeletal pain, most often lower back pain [3]. Although the most common reason for older adults seeking chiropractic care is for musculoskeletal symptoms, DCs may also provide a diverse range of services to these patients [4] .Given this fact, for the purpose of this manuscript chiropractic care will be defined as; “the provision by a doctor of chiropractic of services related to patient assessment, maintenance of health, prevention of illness, and treatment of illness or injury.” The focus of this manuscript is to describe the evidence for achievement of some of these goals in the older adult population. The purpose of this manuscript is to present an overview of information to the practicing chiropractor on utilization of specific management tools. This is not meant to be a systematic review of the literature or an evidence based guideline. The authors each have personal experience in evaluating and treating older adults as well as established expertise in research and publication in these areas. The authors recognize that there is a need for further research in the area of management of the older adult by DC’s and discuss in the conclusion future research considerations. (more…)

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