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Spinal Manipulation

Manual Therapy Followed by Specific Active Exercises Versus a Placebo Followed by Specific Active Exercises

By |January 31, 2015|exercise, Spinal Manipulation|

Manual Therapy Followed by Specific Active Exercises Versus a Placebo Followed by Specific Active Exercises on the Improvement of Functional Disability in Patients with Chronic Non Specific Low Back Pain: A Randomized Controlled Trial

The Chiro.Org Blog

SOURCE:   BMC Musculoskelet Disord. 2012 (Aug 28);   13:   162

Pierre Balthazard, Pierre de Goumoens, Gilles Rivier,
Philippe Demeulenaere, Pierluigi Ballabeni, and Olivier Dériaz

Physiotherapy Department,
HES-SO University of Applied Sciences Western Switzerland-HESAV,
Avenue de Beaumont,
Lausanne 1011, Switzerland.

BACKGROUND:   Recent clinical recommendations still propose active exercises (AE) for CNSLBP. However, acceptance of exercises by patients may be limited by pain-related manifestations. Current evidences suggest that manual therapy (MT) induces an immediate analgesic effect through neurophysiologic mechanisms at peripheral, spinal and cortical levels. The aim of this pilot study was first, to assess whether MT has an immediate analgesic effect, and second, to compare the lasting effect on functional disability of MT plus AE to sham therapy (ST) plus AE.

METHODS:   Forty-two CNSLBP patients without co-morbidities, randomly distributed into 2 treatment groups, received either spinal manipulation/mobilization (first intervention) plus AE (MT group; n = 22), or detuned ultrasound (first intervention) plus AE (ST group; n = 20). Eight therapeutic sessions were delivered over 4 to 8 weeks. Immediate analgesic effect was obtained by measuring pain intensity (Visual Analogue Scale) before and immediately after the first intervention of each therapeutic session. Pain intensity, disability (Oswestry Disability Index), fear-avoidance beliefs (Fear-Avoidance Beliefs Questionnaire), erector spinae and abdominal muscles endurance (Sorensen and Shirado tests) were assessed before treatment, after the 8th therapeutic session, and at 3- and 6-month follow-ups.

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Tissue Damage Markers After a Spinal Manipulation in Healthy Subjects

By |January 29, 2015|Safety, Spinal Manipulation|

Tissue Damage Markers After a Spinal Manipulation in Healthy Subjects: A Preliminary Report of a Randomized Controlled Trial

The Chiro.Org Blog

SOURCE:   Dis Markers. 2014; 2014 :815379

A. Achalandabaso, G. Plaza-Manzano, R. Lomas-Vega, A. Martínez-Amat,
M. V. Camacho, M. Gassó, F. Hita-Contreras, and F. Molina

Centro de Fisioterapia y Psicología Soluciona,
18002 Granada, Spain.

Spinal manipulation (SM) is a manual therapy technique frequently applied to treat musculoskeletal disorders because of its analgesic effects. It is defined by a manual procedure involving a directed impulse to move a joint past its physiologic range of movement (ROM). In this sense, to exceed the physiologic ROM of a joint could trigger tissue damage, which might represent an adverse effect associated with spinal manipulation. The present work tries to explore the presence of tissue damage associated with SM through the damage markers analysis. Thirty healthy subjects recruited at the University of Jaén were submitted to a placebo SM (control group; n = 10), a single lower cervical manipulation (cervical group; n = 10), and a thoracic manipulation (n = 10). Before the intervention, blood samples were extracted and centrifuged to obtain plasma and serum. The procedure was repeated right after the intervention and two hours after the intervention.


Review Of Methods Used By Chiropractors To Determine The Site For Applying Manipulation

By |July 13, 2014|Chiropractic Care, Spinal Manipulation|

Review Of Methods Used By Chiropractors To Determine The Site For Applying Manipulation

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SOURCE:   Chiropractic & Manual Therapies 2013 (Oct 21); 21 (1): 36

John J Triano, Brian Budgell, Angela Bagnulo,
Benjamin Roffey, Thomas Bergmann, Robert Cooperstein,
Brian Gleberzon, Christopher Good, Jacquelyn Perron
and Rodger Tepe

Canadian Memorial Chiropractic College,
6100 Leslie St,
Toronto, Ontario, Canada.

BACKGROUND:   With the development of increasing evidence for the use of manipulation in the management of musculoskeletal conditions, there is growing interest in identifying the appropriate indications for care. Recently, attempts have been made to develop clinical prediction rules, however the validity of these clinical prediction rules remains unclear and their impact on care delivery has yet to be established. The current study was designed to evaluate the literature on the validity and reliability of the more common methods used by doctors of chiropractic to inform the choice of the site at which to apply spinal manipulation.

METHODS:   Structured searches were conducted in Medline, PubMed, CINAHL and ICL, supported by hand searches of archives, to identify studies of the diagnostic reliability and validity of common methods used to identify the site of treatment application. To be included, studies were to present original data from studies of human subjects and be designed to address the region or location of care delivery. Only English language manuscripts from peer-reviewed journals were included. The quality of evidence was ranked using QUADAS for validity and QAREL for reliability, as appropriate. Data were extracted and synthesized, and were evaluated in terms of strength of evidence and the degree to which the evidence was favourable for clinical use of the method under investigation.

RESULTS:   A total of 2594 titles were screened from which 201 articles met all inclusion criteria. The spectrum of manuscript quality was quite broad, as was the degree to which the evidence favoured clinical application of the diagnostic methods reviewed. The most convincing favourable evidence was for methods which confirmed or provoked pain at a specific spinal segmental level or region. There was also high quality evidence supporting the use, with limitations, of static and motion palpation, and measures of leg length inequality. Evidence of mixed quality supported the use, with limitations, of postural evaluation. The evidence was unclear on the applicability of measures of stiffness and the use of spinal x-rays. The evidence was of mixed quality, but unfavourable for the use of manual muscle testing, skin conductance, surface electromyography and skin temperature measurement.

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Spinal Manipulation Epidemiology: Systematic Review of Cost Effectiveness Studies

By |February 7, 2014|Cost-Effectiveness, Epidemiology, Spinal Manipulation|

Spinal Manipulation Epidemiology: Systematic Review of Cost Effectiveness Studies

The Chiro.Org Blog

SOURCE:   J Electromyogr Kinesiol. 2012 (Oct); 22 (5): 655–662 ~ FULL TEXT

Michaleff ZA, Lin CW, Maher CG, van Tulder MW.

The George Institute for Global Health, The University of Sydney, Missenden Road, Sydney, NSW 2050, Australia.

BACKGROUND:   Spinal manipulative therapy (SMT) is frequently used by health professionals to manage spinal pain. With many treatments having comparable outcomes to SMT, determining the cost-effectiveness of these treatments has been identified as a high research priority.

OBJECTIVE:   To investigate the cost-effectiveness of SMT compared to other treatment options for people with spinal pain of any duration.

METHODS:   We searched eight clinical and economic databases and the reference lists of relevant systematic reviews. Full economic evaluations conducted alongside randomised controlled trials with at least one SMT arm were eligible for inclusion. Two authors independently screened search results, extracted data and assessed risk of bias using the CHEC-list.

RESULTS:   Six cost-effectiveness and cost-utility analysis were included. All included studies had a low risk of bias scoring =16/19 on the CHEC-List. SMT was found to be a cost-effective treatment to manage neck and back pain when used alone or in combination with other techniques compared to general practitioner (GP = MD) care, exercise and physiotherapy.

CONCLUSIONS:   This review supports the use of SMT in clinical practice as a cost-effective treatment when used alone or in combination with other treatment approaches. However, as this conclusion is primarily based on single studies more high quality research is needed to identify whether these findings are applicable in other settings.


From the Full-Text Article:


Spinal pain, including neck pain and back pain, is a common condition in modern society (Woolf and Pfleger, 2003;   Côté et al., 2003 ). It presents major social and economic burdens due to the high levels of chronicity and resultant long term disability which are associated with high costs in health care and losses of productivity (e.g. sick leave) (Woolf and Pfleger, 2003). While existing practice guidelines inform the individual, clinicians and policy makers on the effectiveness of a range of interventions, few provide information on the cost-effectiveness of treatments. It is arguable that cost-effectiveness of treatment is an equally important consideration as effectiveness, as all health administrators need to make decisions about how they allocate scarce health resources.

Economic evaluations are frequently conducted alongside randomised controlled trials of treatment effectiveness and involve the identification, measurement, valuation and then comparison of the costs and consequences (benefits) of two or more alternatives (Drummond et al., 2005). Economic evaluations are most useful when the treatments under question have been evaluated in terms of efficacy (can the treatment work in those who comply with the recommendations), effectiveness (is the treatment acceptable and does the treatment work in those who the treatment is offered) and availability (is the treatment accessible to all who would benefit from it). The result of an economic evaluation supplements the evidence base on treatment effectiveness by providing information on the efficiency or “value for money ” of treatment alternatives (Drummond et al., 2005). This information can be used to inform consumers, insurers, governments and policy makers where the health budget should be spent.

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Changes in Vertebral Artery Blood Flow Following Various Head Positions and Cervical Spine Manipulation

By |January 25, 2014|Spinal Manipulation, Stroke, Vertebral Artery|

Changes in Vertebral Artery Blood Flow Following Various Head Positions and Cervical Spine Manipulation

The Chiro.Org Blog

SOURCE:   J Manipulative Physiol Ther. 2014 (Jan);   37 (1):   22–31

Jairus J. Quesnele, DC, John J. Triano, DC, PhD,
Michael D. Noseworthy, PhD, Greg D. Wells, PhD

Chiropractor, Private Practice,
Division of Graduate Studies, Clinical Sciences,
Canadian Memorial Chiropractic College,
Toronto, Ontario, Canada

OBJECTIVE:   The objective of the study was to investigate the cerebrovascular hemodynamic response of cervical spine positions including rotation and cervical spine manipulation in vivo using magnetic resonance imaging technology on the vertebral artery (VA).

METHODS:   This pilot study was conducted as a blinded examiner cohort with 4 randomized clinical tasks. Ten healthy male participants aged 24 to 30 years (mean, 26.8 years) volunteered to participate in the study. None of the participants had a history of disabling neck, arm, or headache pain within the last 6 months. They did not have any current or history of neurologic symptoms. In a neutral head position, physiologic measures of VA blood flow and velocity at the C1-2 spinal level were obtained using phase-contrast magnetic resonance imaging after 3 different head positions and a chiropractic upper cervical spinal manipulation. A total of 30 flow-encoded phase-contrast images were collected over the cardiac cycle, in each of the 4 conditions, and were used to provide a blood flow profile for one complete cardiac cycle. Differences between flow (in milliliters per second) and velocity (in centimeters per second) variables were evaluated using repeated-measures analysis of variance.

RESULTS:   The side-to-side difference between ipsilateral and contralateral VA velocities was not significant for either velocities (P = .14) or flows (P = .19) throughout the conditions. There were no other interactions or trends toward a difference for any of the other blood flow or velocity variables.

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A Diagnosis-based Clinical Decision Rule For Spinal Pain Part 2: Review Of The Literature

By |January 13, 2014|Chiropractic Education, Clinical Decision-making, Diagnosis, Spinal Manipulation|

A Diagnosis-based Clinical Decision Rule For Spinal Pain Part 2: Review Of The Literature

The Chiro.Org Blog

SOURCE:   Chiropractic & Osteopathy 2008 (Aug 11); 16: 7

Donald R Murphy, Eric L Hurwitz, and Craig F Nelson

Rhode Island Spine Center,
Pawtucket, RI 02860, USA

BACKGROUND:   Spinal pain is a common and often disabling problem. The research on various treatments for spinal pain has, for the most part, suggested that while several interventions have demonstrated mild to moderate short-term benefit, no single treatment has a major impact on either pain or disability. There is great need for more accurate diagnosis in patients with spinal pain. In a previous paper, the theoretical model of a diagnosis-based clinical decision rule was presented. The approach is designed to provide the clinician with a strategy for arriving at a specific working diagnosis from which treatment decisions can be made. It is based on three questions of diagnosis. In the current paper, the literature on the reliability and validity of the assessment procedures that are included in the diagnosis-based clinical decision rule is presented.

METHODS:   The databases of Medline, Cinahl, Embase and MANTIS were searched for studies that evaluated the reliability and validity of clinic-based diagnostic procedures for patients with spinal pain that have relevance for questions 2 (which investigates characteristics of the pain source) and 3 (which investigates perpetuating factors of the pain experience). In addition, the reference list of identified papers and authors’ libraries were searched.

RESULTS:   A total of 1769 articles were retrieved, of which 138 were deemed relevant. Fifty-one studies related to reliability and 76 related to validity. One study evaluated both reliability and validity.

CONCLUSION:   Regarding some aspects of the DBCDR, there are a number of studies that allow the clinician to have a reasonable degree of confidence in his or her findings. This is particularly true for centralization signs, neurodynamic signs and psychological perpetuating factors. There are other aspects of the DBCDR in which a lesser degree of confidence is warranted, and in which further research is needed.


From the FULL TEXT Article:


Accurate diagnosis or classification of patients with spinal pain has been identified as a research priority [1]. We presented in Part 1 the theoretical model of an approach to diagnosis in patients with spinal pain [2]. This approach incorporated the various factors that have been found, or in some cases theorized, to be of importance in the generation and perpetuation of neck or back pain into an organized scheme upon which a management strategy can be based. The authors termed this approach a diagnosis-based clinical decision rule (DBCDR). The DBCDR is not a clinical prediction rule. It is an attempt to identify aspects of the clinical picture in each patient that are relevant to the perpetuation of pain and disability so that these factors can be addressed with interventions designed to improve them. The purpose of this paper is to review the literature on the methods involved in the DBCDR regarding reliability and validity and to identify those areas in which the literature is currently lacking.

The Three Essential Questions of Diagnosis

The DBCDR is based on what the authors refer to as the 3 essential questions of diagnosis [2]. The answers to these questions supply the clinician with the most important information that is required to develop an individualized diagnosis from which a management strategy can be derived.

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