Spinal Manipulation

The Effect of Application Site of Spinal Manipulative Therapy (SMT) on Spinal Stiffness

By Frank M. Painter|October 28, 2013|Chiropractic Research, Spinal Manipulation|

The Effect of Application Site of Spinal Manipulative Therapy (SMT) on Spinal Stiffness

SOURCE: Spine J. 2013 Oct 16 [Epub ahead of print]

Tiffany L. Edgecombe, PhD, Greg N. Kawchuk, DC, PhD, Cynthia R. Long, PhD, Joel G. Pickar, DC, PhD

Department of Physical Therapy, University of Alberta, 8205 114 St, Corbett Hall, Edmonton, AB, Canada T6G 2G4

BACKGROUND CONTEXT: Like other factors that can influence treatment efficacy (eg, dosage, frequency, time of day), the site of treatment application is known to affect various physical interventions such as topical anesthetics and cardiopulmonary resuscitation. Like these examples, spinal manipulative therapy (SMT) is a physical intervention that may exhibit maximal benefit when directed to a specific site. Whereas numerous studies of SMT efficacy have produced mixed results, few studies have taken into account the site of SMT application.

PURPOSE: To determine if the site of SMT application modulates the effect of SMT in an anesthetized feline model.

STUDY DESIGN: Spinal manipulative therapy applied to specific anatomic locations randomized in a Latin square design with a no-SMT control.

OUTCOME MEASURES: Physiologic measures (spinal stiffness).

METHODS: Simulated SMT was delivered by a validated mechanical apparatus to the intact lumbar spine of eight anesthetized felines at four unique sites: L6 spinous process, left L6 lamina, left L6 mammillary process, and L7 spinous process. To measure spinal stiffness, a separate indentation load was applied mechanically to the L6 spinous process before and after each SMT application. Spinal stiffness was calculated from the resulting force-displacement curve as the average stiffness (k) and terminal instantaneous stiffness (TIS).

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A Comprehensive Review of Chiropractic Research

By Frank M. Painter|May 14, 2013|Chiropractic Care, Evidence-based Medicine, Spinal Manipulation|

A Comprehensive Review of Chiropractic Research

The Chiro.Org Blog

You will love this Comprehensive Review of Chiropractic Research, by Anthony L. Rosner, Ph.D., Director of Research and Education for the Foundation for Chiropractic Education and Research (FCER) until its demise (1992-2007), and current Director of Research for the International College of Applied Kinesiology (USA).

I. Introduction

A. Perspectives:

In the space of just 115 years from its inception, chiropractic has emerged as the third largest healthcare profession in the United States offering diagnostic as well as therapeutic services to patients. It has reached this lofty height driven by research which has made particularly dramatic strides over the past 30 years, supported by a budget which represents merely an infinitesimal fraction of that applied to medical and pharmaceutical research.

Like all health professions, chiropractic regularly tests the effectiveness, safety, and costs of its approaching health care. Studies continue to show that chiropractors offer the public a viable alternative to invasive healthcare (drugs, surgery) especially in the treatment of musculoskeletal problems such as back, neck, and headache pain. But chiropractic treatments are likewise effective in the treatment of non-musculoskeletal health issues, including infantile colic, enuresis, asthma, dysmenorrheal, otitis media, hypertension, and heart rate variability. And few medical professions outside of chiropractic can offer such healthcare solutions with equal safety and cost records.

Having been historically been placed in the category of “alternative and complementary” medicine, chiropractic because of its rapid growth in its research has now been deemed to have reached the crossroads of mainstream and alternative medicine. [1] As a hybrid, it appears to have successfully incorporated many of the research methodologies of orthodox medicine while striving to maintain its distinct healthcare paradigm. Indeed, when the practitioner’s primary means of patient care and published randomized clinical trials supporting that intervention are matched, chiropractic can be shown to enjoy a higher percentage of interventions thus supported when compared to such other medical disciplines as general practice, inpatient general surgery, dermatology, or hematology-oncology. [2] In other words, chiropractic can now claim to have attained at least as much of a scientific grounding as other medical interventions based upon its research.

So what is it that one means by chiropractic research? The research related to the practice of chiropractic, to be reviewed in this chapter, has been presented in multiple dimensions, including:

Published clinical articles;
Literature reviews;
Surveys and public opinion research;
Analyses of insurance claims [actuarial research]; and
Guidelines

B. First major interdisciplinary cohort study:

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Spinal Manipulation: The Right Choice For Relieving Low Back Pain

By Frank M. Painter|April 24, 2013|Chiropractic Care, Low Back Pain, Placebo, Randomized Controlled Trial, Spinal Manipulation|

Spinal Manipulation: The Right Choice for Relieving Low Back Pain

The Chiro.Org Blog

Spinal High-velocity Low Amplitude Manipulation in Acute Nonspecific Low Back Pain: A Double-blinded Randomized Controlled Trial in Comparison With Diclofenac and Placebo

Spine 2013 (Apr 1); 38 (7): 540–548

von Heymann, Wolfgang J. Dr. Med; Schloemer, Patrick Dipl. Math; Timm, Juergen Dr. RER, NAT, PhD; Muehlbauer, Bernd Dr. Med

Competence Center for Clinical Studies; and †Institute for Biometrics, University of Bremen, Bremen, Germany

Thanks to Dynamic Chiropractic for access to these Key Findings from the study

“There was a clear difference between the treatment groups: the subjects [receiving] spinal manipulation showed a faster and quantitatively more distinct reduction in the RMS” (compared to subjects receiving diclofenac therapy).

“Subjects [also] noticed a faster and quantitatively more distinct reduction in [their] subjective estimation of pain after manipulation. … A similar observation was made when comparing the somatic part of the SF-12 inventory … indicating that the subjects experienced better quality of life after the spinal manipulation compared to diclofenac.”

“The rescue medication was calculated both for the mean cumulative dose (numbers of 500 mg paracetamol tablets) and for the number of days on which rescue medication was taken. … In the diclofenac arm, the patients on average took almost 3 times as many tablets and the number of days [taking the tablets] was almost twice as high” compared to patients in the manipulation arm. While the authors note that these results were not significant due to large between-individual variations (meaning a few patients could have taken many tablets, throwing off the overall totals), it still suggests that value of spinal manipulation vs. drug therapy (because even if both patient groups had taken the same amount of rescue medication for the same number of days, it wouldn’t discount the fact that patients in the manipulation group showed significant improvement on outcome variables compared to patients in the diclofenac group).

The Abstract (more…)

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More on Chiropractic Cost Effectiveness

By Frank M. Painter|April 17, 2013|Chiropractic Care, Cost-Effectiveness, Spinal Manipulation|

More on Chiropractic Cost Effectiveness

The Chiro.Org Blog

SOURCE: J Electromyogr Kinesiol. 2012 (Oct); 22 (5): 655-662

Spinal Manipulation Epidemiology: Systematic Review of Cost Effectiveness Studies

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. zmichaleff@georgeinstitute.org.au

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 GP care, exercise and physiotherapy.

There are many more articles like this @ our:

Cost-Effectiveness of Chiropractic Page

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Clinical Disorders and the Sensory System

By Frank M. Painter|April 11, 2013|Chiropractic Education, Diagnosis, Education, Evaluation & Management, General Health, Health Promotion, Neurology, Orthopedic Tests, Radiculopathy, Spinal Manipulation|

Clinical Disorders and the Sensory System

The Chiro.Org Blog

We would all like to thank Dr. Richard C. Schafer, DC, PhD, FICC for his lifetime commitment to the profession. In the future we will continue to add materials from RC’s copyrighted books for your use.

This is Chapter 4 from RC’s best-selling book:

“Basic Principles of Chiropractic Neuroscience”

These materials are provided as a service to our profession. There is no charge for individuals to copy and file these materials. However, they cannot be sold or used in any group or commercial venture without written permission from ACAPress.

Chapter 8: Clinical Disorders and the Sensory System

This chapter describes those sensory mechanisms, joint signals, and abnormal sensations (eg, pain, thermal abnormalities) that have particular significance within clinical diagnosis. The basis and differentiation of pain are described, as are the related subjects of trigger points and paresthesia. The chapter concludes with a description of the neurologic basis for the evaluation of the sensory system and the sensory fibers of the cranial nerves.

THE ANALYSIS OF PAIN
IN THE CLINICAL SETTING

Although all pain does not have organic causes, there is no such thing as “imagined” pain. Pain that can be purely isolated as a structural, functional, or an emotional effect is rare. More likely, all three are superimposed upon and interlaced with each other in various degrees of status. This is also true for neural, vascular, lymphatic, and hormonal mechanisms.

Common Causes of Pain and Paresthesia

The common causes of pain and paresthesia are:

(1) obvious direct trauma or injury;

(2) reflex origins in musculoskeletal lesions, which deep pressure often exaggerates, such as trigger areas;

(3) peripheral nerve injury (eg, causalgia), which results in an intense burning superficial pain;

(4) the presence of nerve inflammations and degeneration of the peripheral or CNS, which frequently cause other changes indicative of such lesions; (more…)

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The Quality of Reports on Cervical Arterial Dissection Following Cervical Spinal Manipulation

By Frank M. Painter|March 27, 2013|Evidence-based Medicine, Spinal Manipulation, Stroke|

The Quality of Reports on Cervical Arterial Dissection Following Cervical Spinal Manipulation

The Chiro.Org Blog

SOURCE: PLoS ONE 2013 (Mar 20); 8 (3): e59170

Shari Wynd, Michael Westaway, Sunita Vohra, Greg Kawchuk

Texas Chiropractic College,
Pasadena, Texas, United States of America.

Background Cervical artery dissection (CAD) and stroke are serious harms that are sometimes associated with cervical spinal manipulation therapy (cSMT). Because of the relative rarity of these adverse events, studying them prospectively is challenging. As a result, systematic review of reports describing these events offers an important opportunity to better understand the relation between adverse events and cSMT. Of note, the quality of the case report literature in this area has not yet been assessed.

Purpose 1) To systematically collect and synthesize available reports of CAD that have been associated with cSMT in the literature and
2) assess the quality of these reports.

Methods A systematic review of the literature was conducted using several databases. All clinical study designs involving CADs associated with cSMT were eligible for inclusion. Included studies were screened by two independent reviewers for the presence/absence of 11 factors considered to be important in understanding the relation between CAD and cSMT.

Results Overall, 43 articles reported 901 cases of CAD and 707 incidents of stroke reported to be associated with cSMT. The most common type of stroke reported was ischemic stroke (92%). Time-to-onset of symptoms was reported most frequently (95%). No single case included all 11 factors.

Conclusions This study has demonstrated that the literature infrequently reports useful data toward understanding the association between cSMT, CADs and stroke. Improving the quality, completeness, and consistency of reporting adverse events may improve our understanding of this important relation.

Copyright: © 2013 Wynd et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Funding: Greg Kawchuk receives salary support from the Canada Research Chairs program. Sunita Vohra receives salary support from Alberta Innovates-Health Solutions. Training support for Shari Wynd was provided by the Alberta Canadian Institutes of Health Research (CIHR) Training Program in Bone and Joint Health. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: The authors have declared that no competing interests exist.

From the Full-Text Article:

Introduction

In the area of harms reporting, one topic that has received significant attention is cervical spinal manipulation therapy (cSMT), an intervention most often administered by chiropractors [1, 2] to treat musculoskeletal complaints of the head and neck [3] including headaches [4]. If harms are associated with cSMT, they most commonly involve additional head and neck pain [2]. While these adverse events tend to be self-limiting [2], more serious adverse events have been reported such as neurovascular sequelae and stroke. More specifically, injuries such as cervical artery dissection (CAD), whether vertebral, internal carotid, or vertebrobasilar, have been reported to be associated with cSMT [5-7]. Although this subset of adverse events appears to occur infrequently [1, 8, 9], understanding the relation between CADs, stroke and cSMT is important given the medical [7], societal [1], economic [9], and legal [8] implications of any event leading to cerebrovascular compromise.

Read the rest of this Full Text article now!

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