Spinal Manipulation

Outcomes For Adult Scoliosis Patients Receiving Chiropractic Rehabilitation: A 24-month Retrospective Analysis

By Frank M. Painter|September 5, 2011|Rehabilitation, Scoliosis, Spinal Manipulation|

Outcomes For Adult Scoliosis Patients Receiving Chiropractic Rehabilitation: A 24-month Retrospective Analysis

SOURCE: J Chiropractic Medicine 2011 (Sep); 10 (3): 179–184

By Mark Morningstar DC, FACSP, FRCCM, FAAIM

Objectives: The purpose of this study was to retrospectively report the results of patients who completed an exercise-based chiropractic program and its potential to alter the natural progression of adult scoliosis at 24 months after the clinic portion of treatment was concluded.

Methods: A retrospective chart review was conducted at 2 spine clinics in Michigan, USA. Each clinic uses the same chiropractic rehabilitation program to treat patients with adult scoliosis. Multidimensional patient outcomes included radiographic, respiratory, disability, and pain parameters. Outcomes were measured at baseline, at end of active treatment, and at long-term follow-up.

Results: (more…)

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Application of a Diagnosis-Based Clinical Decision Guide in Patients with Neck Pain

By Frank M. Painter|September 3, 2011|Guidelines, Neck Pain, Spinal Manipulation|

Application of a Diagnosis-Based Clinical Decision Guide in Patients with Neck Pain

The Chiro.Org Blog

SOURCE: Chiropractic & Manual Therapies 2011 (Aug 27)

Donald R Murphy, DC, DACAN, and
Eric L Hurwitz, DC, PhD

Background: Neck pain (NP) is a common cause of disability. Accurate and efficacious methods of diagnosis and treatment have been elusive. A diagnosis-based clinical decision guide (DBCDG; previously referred to as a diagnosis-based clinical decision rule) has been proposed which attempts to provide the clinician with a systematic, evidence-based guide in applying the biopsychosocial model of care. The approach is based on three questions of diagnosis. The purpose of this study is to present the prevalence of findings using the DBCDG in consecutive patients with NP.

Methods: Demographic, diagnostic and baseline outcome measure data were gathered on a cohort of NP patients examined by one of three examiners trained in the application of the DBCDG.

Results: Data were gathered on 95 patients. Signs of visceral disease or potentially serious illness were found in 1%. Centralization signs were found in 27%, segmental pain provocation signs were found in 69% and radicular signs were found in 19%. Clinically relevant myofascial signs were found in 22%. Dynamic instability was found in 40%, oculomotor dysfunction in 11.6%, fear beliefs in 31.6%, central pain hypersensitivity in 4%, passive coping in 5% and depression in 2%.

Conclusion: The DBCDG can be applied in a busy private practice environment. Further studies are needed to investigate clinically relevant means to identify central pain hypersensitivity, oculomotor dysfunction, poor coping and depression, correlations and patterns among the diagnostic components of the DBCDG as well as interexaminer reliability, validity and efficacy of treatment based on the DBCDG.

The FULL TEXT Article

BACKGROUND

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Chronic Neck Pain and Chiropractic Page and the

A Clinical Model for the Diagnosis and Management Page

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Manipulative Therapy: Just a Placebo?

By Frank M. Painter|August 24, 2011|Placebo, Spinal Manipulation|

Manipulative Therapy: Just a Placebo?

The Chiro.Org Blog

SOURCE: Dynamic Chiropractic

By John J. Triano, DC, PhD

Excerpted from: Triano J: Manipulative Therapy in the Management of Pain.
Clinical Pain Management: A Practical Approach 3rd Edition,
Lippincott, Williams & Wilkins Pub, November 2001.

Chiropractic care, particularly spinal manipulation or adjustment, is an increasingly frequent topic in medicine and health care policy circles. As evidence has accumulated to support use of these services, there is frequent reference to a presumption of placebo effect being the mechanism of favorable responses reported in the literature. These charges are easily refuted by specific data. In my experience, a professional head-on response silences these critiques and allows the discussion to refocus on a much more useful topic: appropriate use the paragraphs that follow were crafted as a part of a book chapter on the role of chiropractic manipulation in management of pain the basis often used to set the stage for a claim of a placebo effect. An effective rejoinder follows.

Discourse on manipulation usually raises the question of placebo effect. A frequent observation is that chiropractic patients are more satisfied by their treatment experience than when they are attended by other proaviders. [1, 2]

A number of elements contribute to this popular contentment, including physician-patient interaction. Manipulation treatment often requires several encounters involving physical contact and direct physician attention over a focused time interval. Can these factors be responsible for the perceived clinical benefits?

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The Problem with Placebos/Shams Page

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Spinal Manipulation May Help Reduce Spinal Degenerative Joint Disease and Disability

By Frank M. Painter|August 18, 2011|Degenerative Joint Disease, Spinal Manipulation|

Spinal Manipulation May Help Reduce Spinal Degenerative Joint Disease and Disability: PART I and II

The Chiro.Org Blog

SOURCE: Dynamic Chiropractic

By James Brantingham, DC, CCF , Randy Snyder, DC, CCFC, and David Biedebach, DC, CCFC

Has the hypomobile manipulable joint lesion been demonstrated to exist? Historically the manipulable joint lesion has, from the beginning of the chiropractic profession, been described as a painful stiff joint. [1, 2] Joint stiffness, commonly called hypomobility (also known in the chiropractic profession as “fixation”) has become by consensus one of the most important aspects of the manipulable joint lesion in the professions of chiropractic, osteopathy, and manual medicine. [3, 4] Nearly 100 years of clinical agreement between three separate professions supports the existence of such a lesion although research now supports its existence.

Loss of full, or global, range of motion in the lumbar or cervical spines is an indirect proof that the segmental hypomobile manipulable vertebral joint lesion exists, because it is a fact that loss of full global range of motion occurs and such stiffness is considered an objective factor in chronic back pain. [5] therefore, even if this decreased range of motion is a mixture of hypermobile and hypomobile joints (i.e., a mixture of loose and stiff joints) there must be intervertebral hypomobility for global hypomobility to exist. Randomized controlled trials of manipulation documenting decreased global range of motion, and post-treatment global range of motion are growing. [6-12]

A meta-analysis of clinical trials of spinal manipulation performed by Anderson et al., clearly and strongly demonstrated that spinal manipulation is effective in restoring or increasing global, and therefore segmental lumbar mobility. Mead et al., documented post-manipulation treatment restored or increased lumbar mobility: data proving that the hypomobile manipulable joint lesion must have existed prior to treatment, and that manipulation restored to these hypomobile joints fuller mobility (Fig 1.). [6] Other studies have documented similar results. Nansel and his associates have demonstrated in three, multiply blinded, controlled studies, in which goniometer measurements confirmed cervical range of motion or global end range asymmetries or hypomobility, that after chiropractic high velocity low amplitude manipulation, statistically significant increased mobility was restored to the global and therefore segmental hypomobility areas: proof that global and therefore segmental hypomobility was returned to more normal mobility by manipulation. [14-16] (more…)

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Immune Responses to Spinal Manipulation

By Frank M. Painter|May 1, 2011|Immune Function, Research, Spinal Manipulation|

Immune Responses to Spinal Manipulation

The Chiro.Org Blog

SOURCE: Dynamic Chiropractic ~ May 6, 2011

By Malik Slosberg, DC, MS

For many years, chiropractors have observed in their own practices that their patients sometimes demonstrate improvements of complaints related to immune problems: the disappearance or lessening of allergy symptoms, quicker recovery from or less frequent and severe colds and other respiratory infections, and so on.

In the scientific literature, there have been occasional case reports that corroborate such findings, but no sound evidence to really document their veracity. These clinical observations remain suspended in that grey area unsubstantiated by scientific data to confirm their validity. Significant limitations of changes attributed to spinal manipulation in individual patients include

1) there is never a control group;
2) there is no blinding;
3) the improvement may simply be due to time;
4) they may be a nonspecific effect of care and attention;
5) it may be a regression to the mean; or
6) the result may be due to something other than spinal manipulation.In some large studies, it has been found that chiropractic care for nonmusculoskeletal conditions is only weakly to moderately successful, but rarely harmful. [1-2] The most recent and thorough systematic literature review found that the evidence for effectiveness of spinal manipulation was inconclusive for nonmusculoskeletal conditions. [3]

Despite the lack of evidence of clinical effectiveness for nonmusculoskeletal conditions, a series of recent studies from several international research groups is systematically building the case that spinal manipulation appears to reduce the production of pro-inflammatory cytokines and increase the blood levels of immunoregulatory cytokines. Cytokines are small cell-signaling protein molecules that are secreted by numerous cells of the immune system and are a category of signaling molecules used extensively in intercellular communication.

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Chiropractic and Immune Function Page

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Predictors For Success Of Spinal Manipulation For Neck Pain

By Frank M. Painter|April 19, 2011|Neck Pain, Research, Spinal Manipulation|

Predictors For Success Of Spinal Manipulation For Neck Pain

The Chiro.Org Blog

SOURCE: J Manipulative Physiol Ther. 2011 (Mar); 34 (3): 144–152

Manuel Ssavedra-Hernández, PT, Adelaida M. Castro-Sánchez, PT, PhD, César Fernández-de-las-Peñas, PT, DO, PhD, Joshua A. Cleland, PT, PhD, Ricardo Ortega-Santiago, PT, MS, Manuel Arroyo-Morales, MD, PT, PhD

Department of Nursing and Physical Therapy,
Universidad de Almería, Spain.

This newly published JMPT study attempted to identify those prognostic clinical factors that may potentially identify, a priori, patients with mechanical neck pain who are likely to experience a rapid and successful response to spinal manipulation of the cervical and thoracic spine.

Data from 81 subjects were included in the analysis, of which 50 had experienced a successful outcome (61.7%). Five variables were found to be associated with a positive response:

Initial pain intensity greater than 4.5 points
Cervical extension less than 46°
Hypomobility at T1 vertebra (more…)

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