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Spinal Manipulation

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.
dremilyhowell@hotmail.com

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

Introduction:

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.

 

Discussion:

There are more articles like this @ our:

Low Back Pain and Chiropractic Page and the:

Chiropractic and Sciatica Page

(more…)

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The Placebo, the Sensory Trick and Chiropractic

By |September 27, 2012|Chiropractic Care, Placebo, Spinal Manipulation|

The Placebo, the Sensory Trick and Chiropractic

The Chiro.Org Blog

SOURCE:   Chiropractic J. Australia 2004 (Jun); 34 (2): 58–62

Brian S. Budgell, DC, MSc

School of Health Sciences,
Faculty of Medicine,
Kyoto University, Kyoto, Japan

Thanks to Dr. Brian S. Budgell and Dr. Rolf Peters, editor of the Chiropractic Journal of Australia for permission to republish this Full Text article, exclusively at Chiro.Org!

Background:   As standards for randomised, controlled, clinical trials in medicine evolve, there is debate about whether the RCT model of investigation is appropriate for chiropractic and other forms of so-called “complementary and alternative medicine.” There may be some question as to whether the use of placebo interventions can be justified ethically and scientifically given that experimental treatments must eventually compete in a marketplace where there is often already a clinical alternative which is more effective than placebo. Beyond these concerns, design of an appropriate placebo for chiropractic trials is particularly problematic since the therapeutic component of overall chiropractic treatment may be difficult to isolate.

Objective:   To compare placebo interventions in current use in chiropractic clinical research with simple somatic stimuli that produce significant physiological effects in a selected group of patients (those suffering from dystonia).

Methods:   A literature search was made using MEDLINE, with the key words dystonia, sensory trick and geste antagoniste. Articles were reviewed for descriptions of these stimuli. The stimuli were compared, in terms of site and modality, with placebo interventions used in recent chiropractic clinical trials.

Results:   Stimuli used as placebo procedures in recent chiropractic clinical trials are quite similar, in terms of site and modality, to the “sensory tricks” that either cause substantial temporary relief, or, alternatively, provocation of symptoms in dystonic patients.

Conclusions:   Caution should be used in assuming that control (placebo) procedures used in chiropractic clinical trials—procedures that involve physical contact or positioning of patients—lack specific effects on neuromusculoskeletal symptomatology.

INDEX TERMS: (MeSH)   PLACEBO, SENSORY TRICK, GESTE ANTAGONISTE, CHIROPRACTIC

You may also want to refer to our:

The Problem with Placebos/Shams Page

 

 

INTRODUCTION:

In common parlance, the placebo may be thought of as a sham treatment given to placate the gullible or troublesome patient. In medical practice, it is more often thought of as medication, most often a pill, which has no specific action against the complaint for which it is prescribed. More recently, standards for design of clinical research have demanded more rigorous definition of what has been called “the imaginary term in medicine’s algebraic formula.” [1]

For purposes of pharmacological research, it is possible to select placebo substances that appear, with a very high level of probability, to be physiologically inert in humans, or at least to have no specific action against a disorder that is the target of investigation. Nonetheless, various studies have indicated that such supposedly inert substances may be associated with impressive levels of therapeutic effects, sometimes rivalling the medications, which are known to have specific pharmacological effects. [2]

(more…)

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A Replication of the Ernst Study“Adverse Effects of Spinal Manipulation: A Systematic Review”

By |September 24, 2012|Iatrogenic Injury, Spinal Manipulation|

A Replication of the Ernst Study
“Adverse Effects of Spinal Manipulation: A Systematic Review”

The Chiro.Org Blog

SOURCE:   Chiropractic & Manual Therapies 2012 (Sep 21)

Peter J. Tuchin, GradDipChiro, DipOHS, PhD

Macquarie University, Bld E5A Rm 355,
Waterloo Rd, North Ryde,
Sydney, NSW 2109, Australia

Objective   To assess the significance of adverse events after spinal manipulation therapy (SMT) by replicating and critically reviewing a paper commonly cited when reviewing adverse events of SMT as reported by Ernst. (J R Soc Med. 2007 (Jul); 100 (7): 330-338).

Method   Replication of a 2007 Ernest paper to compare the details recorded in this paper to the original source material. Specific items that were assessed included the time lapse between treatment and the adverse event, and the recording of other significant risk factors such as diabetes, hyperhomocysteinemia, use of oral contraceptive pill, any history of hypertension, atherosclerosis and migraine.

Results   The review of the 32 papers discussed by Ernst found numerous errors or inconsistencies from the original case reports and case series. These errors included alteration of the age or sex of the patient, and omission or misrepresentation of the long term response of the patient to the adverse event. Other errors included incorrectly assigning spinal manipulation therapy (SMT) as chiropractic treatment when it had been reported in the original paper as delivered by a non-chiropractic provider (e.g. Physician).

The original case reports often omitted to record the time lapse between treatment and the adverse event, and other significant clinical or risk factors. The country of origin of the original paper was also overlooked, which is significant as chiropractic is not legislated in many countries. In 21 of the cases reported by Ernest to be chiropractic treatment, 11 were from countries where chiropractic is not legislated.

Conclusion   The number of errors or omissions in the 2007 Ernest paper, reduce the validity of the study and the reported conclusions. The omissions of potential risk factors and the timeline between the adverse event and SMT could be significant confounding factors. Greater care is also needed to distinguish between chiropractors and other health practitioners when reviewing the application of SMT and related adverse effects.

 

The Full-Text Article:

Introduction

The use of a treatment by health care providers requires examination of the evidence of effectiveness and assessment of the evidence for risks or adverse events (AE) caused by the treatment [1]. Spinal manipulation therapy (SMT) has strong evidence for treatment of low back pain, neck pain, headache and migraine [2-6]. This is supported by numerous systematic reviews of a large number of randomized controlled trials [7-10] (more…)

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Conservative Chiropractic Management of Urinary Incontinence Using Applied Kinesiology: A Retrospective Case-series Report

By |September 12, 2012|Myofascial Disorder, Myofascial Trigger Points, Spinal Manipulation, Urinary Incontinence|

Conservative Chiropractic Management of Urinary Incontinence Using Applied Kinesiology: A Retrospective Case-series Report

The Chiro.Org Blog

SOURCE:   J Chiropr Med. 2012 (Mar); 11 (1): 49–57 ~ FULL TEXT

Scott C. Cuthbert and Anthony L. Rosner

Chief Clinician, Chiropractic Health Center, PC, Pueblo, CO 81004

OBJECTIVE:   The purpose of this case series is to describe the chiropractic management of 21 patients with daily stress and occasional total urinary incontinence (UI).

CLINICAL FEATURES:   Twenty-one case files of patients 13 to 90 years of age with UI from a chiropractic clinic were reviewed. The patients had a 4-month to 49-year history of UI and associated muscle dysfunction and low back and/or pelvic pain. Eighteen wore an incontinence pad throughout the day and night at the time of their appointments because of unpredictable UI.

INTERVENTION AND OUTCOME:   Patients were evaluated for muscle impairments in the lumbar spine, pelvis, and pelvic floor and low back and/or hip pain. Positive manual muscle test results of the pelvis, lumbar spine muscles, and pelvic floor muscles were the most common findings. Lumbosacral dysfunction was found in 13 of the cases with pain provocation tests (applied kinesiology sensorimotor challenge); in 8 cases, this sensorimotor challenge was absent. Chiropractic manipulative therapy and soft tissue treatment addressed the soft tissue and articular dysfunctions. Chiropractic manipulative therapy involved high-velocity, low-amplitude manipulation; Cox flexion distraction manipulation; and/or use of a percussion instrument for the treatment of myofascial trigger points. Urinary incontinence symptoms resolved in 10 patients, considerably improved in 7 cases, and slightly improved in 4 cases. Periodic follow-up examinations for the past 6 years, and no less than 2 years, indicate that for each participant in this case-series report, the improvements of UI remained stable.

CONCLUSION:   The patients reported in this retrospective case series showed improvement in UI symptoms that persisted over time.

 

From the Full-Text Article:

Introduction

Urinary incontinence (UI) occurs when there is leakage of urine involuntarily, most commonly in older patients. [1] Fantl et al [2] state that incontinence affects 4 of 10 women and 1 of 10 men during their lifetime, and about 17% of children younger than 15 years. A large postpartum study of the prevalence of UI found that 45% of women experienced UI at 7 years postpartum. Thirty-one percent who were initially continent in the postpartum period became incontinent in the future. [3] (more…)

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Predictors of Outcome in Neck Pain Patients

By |August 25, 2012|Chiropractic Care, Chronic Pain, Neck Pain, Radiculopathy, Spinal Manipulation|

Predictors of Outcome in Neck Pain Patients Undergoing Chiropractic Care: Comparison of Acute and Chronic Patients

The Chiro.Org Blog

SOURCE:   Chiropractic & Manual Therapies 2012 (Aug 24); 20 (1): 27

Cynthia K Peterson, Jennifer Bolton, B. Kim Humphreys

University of Zürich and Orthopaedic University Hospital Balgrist, Forchstrasse 340, 8008 Zürich, Switzerland

Background   Neck pain is a common complaint in patients presenting for chiropractic treatment. The few studies on predictors for improvement in patients while undergoing treatment identify duration of symptoms, neck stiffness and number of previous episodes as the strong predictor variables. The purpose of this study is to continue the research for predictors of a positive outcome in neck pain patients undergoing chiropractic treatment.

Methods   Acute (< 4 weeks) (n = 274) and chronic (> 3 months) (n = 255) neck pain patients with no chiropractic or manual therapy in the prior 3 months were included. Patients completed the numerical pain rating scale (NRS) and Bournemouth questionnaire (BQ) at baseline prior to treatment. At 1 week, 1 month and 3 months after start of treatment the NRS and BQ were completed along with the Patient Global Impression of Change (PGIC) scale. Demographic information was provided by the clinician. Improvement at each of the follow up points was categorized using the PGIC. Multivariate regression analyses were done to determine significant independent predictors of improvement.

Results   Baseline mean neck pain and total disability scores were significantly (p < 0.001and p < 0.008 respectively) higher in acute patients. Both groups reported significant improvement at all data collection time points, but was significantly larger for acute patients. The PGIC score at 1 week (OR = 3.35, 95% CI = 1.13-9.92) and the baseline to 1 month BQ total change score (OR = 1.07, 95% CI = 1.03-1.11) were identified as independent predictors of improvement at 3 months for acute patients. Chronic patients who reported improvement on the PGIC at 1 month were more likely to be improved at 3 months (OR = 6.04, 95% CI = 2.76-13.69). The presence of cervical radiculopathy or dizziness was not predictive of a negative outcome in these patients.

CONCLUSIONS:   The most consistent predictor of clinically relevant improvement at both 1 and 3 months after the start of chiropractic treatment for both acute and chronic patients is if they report improvement early in the course of treatment. The co-existence of either radiculopathy or dizziness however do not imply poorer prognosis in these patients.

There are more articles like this @ our:

Chronic Neck Pain and Chiropractic Page and the

A Clinical Model for the Diagnosis and Management Page

 

From the FULL TEXT Article:

Background

Patients suffering from neck pain are second only to low back pain patients in terms of the frequency of presentation for chiropractic treatment [1-4]. For many of these patients the precise diagnosis is difficult to ascertain and thus becomes labeled ‘non-specific’ neck pain or neck pain from mechanical dysfunction [1,3-5]. Research evidence has yet to determine with clarity whether spinal manipulative therapy (SMT) or mobilization of the neck is the superior treatment for these patients [1-9] although it appears that both of these treatments have better outcomes when combined with exercise [5,10]. (more…)

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The Nordic Maintenance Care Program: Maintenance Care – What Happens During the Consultation? Observations andPatient Questionnaires

By |August 11, 2012|Chiropractic Care, Maintenance Care, Spinal Manipulation|

The Nordic Maintenance Care Program: Maintenance Care –
What Happens During the Consultation? Observations and Patient Questionnaires

The Chiro.Org Blog

Chiropractic & Manual Therapies 2012 (Aug 10); 20 (1): 25

Marita Bringsli, Aurora Berntzen, Dorthe B Olsen, Charlotte Leboeuf-Yde and Lise Hestbaek

Background:   Because maintenance care (MC) is frequently used by chiropractors in the management of patients with back pain, it is necessary to define the rationale, frequency and indications for MC consultations, and the contents of such consultations. The objectives of the two studies described in this article are: i) to determine the typical spacing between visits for MC patients and to compare MC and non-MC patients, ii) to describe the content of the MC consultation and to compare MC and non-MC patients and iii) to investigate the purposes of the MC program.

Method:   In two studies, chiropractors who accepted the MC paradigm were invited to assist with the data collection. In study 1, patients seen by seven different chiropractors were observed by two chiropractic students. They noted the contents of the observed consultations. In study 2, ten chiropractors invited their MC patients to participate in an anonymous survey. Participants filled in a one page questionnaire containing questions on their view of the purposes and contents of their MC consultations. In addition, information was obtained on the duration between appointments in both studies.

Results:   There were 178 valid records in study 1, and in study 2 the number of questionnaires received was 373. The time interval between MC visits was close to nine weeks and for non-MC consultations it was two weeks. The content of the consultations in study 1 was similar for MC and non-MC patients with treatment being the most time-consuming element followed by history taking/examination. MC consultations were slightly shorter than non-MC consultations. In study 2, the most common activities reported to have taken place were history taking and manipulative therapy. The most commonly reported purposes were to prevent recurring problems, to maintain best possible function and /or to stay as pain free as possible.

Conclusions:   The results from these two studies indicate that MC consultations commonly take place with around two months intervals, and that history taking, examination and treatment are as important components in MC as in non-MC consultations. Further, the results demonstrate that most patients consider the goal to be secondary or tertiary prevention.

 

The FULL TEXT Article

Background:

Present level of evidence

Maintenance care (MC) is a concept well known among chiropractors, although it is poorly defined and rarely studied. A literature review published in 1996 concluded that there was no scientific evidence to support the claim that MC improves health status and recommended that a series of research actions should be taken [1]. (more…)

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