ChiroZine ARTICLES OF INTEREST
 
   
Welcome to the Articles of Interest Section of ChiroZine.
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ChiroZine Articles of Interest

This section was compiled by Frank M. Painter, D.C.
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   Frankp@chiro.org

Alternative Care Chiropractic

If there are terms in these articles you don't understand, you can get a definition from the Merriam Webster Medical Dictionary. If you want information about a specific disease, you can access the Merck Manual. You can also search Pub Med for more abstracts on this, or any other health topic.


Other
Pages:
Nutrition Section Women's Health Kids Need Care Too!


Safety of Chiropractic Cost-Effectiveness Patient Satisfaction


Iatrogenic Injury Antibiotic Abuse Indoor Air Quality


Low Back Pain Headache Page Radiculopathy


Backpack Page Repetitive Stress The Shoulder


Menopause Relief Pediatrics Section Subluxation Complex


Alternative Medicine Approaches Forward Head Posture


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Pierce Technique (PST) Results System
The Pierce Results System is a biomechanical analysis of spine kinematics (or motion), utilizing “stress” views of the spine (flexion, extension, rotation, and/or lateral bending views where required) or videofluoroscopy (VF, or “moving x-ray” studies) to determine the loss of spinal function, which is at the “core” of the “vertebral subluxation”.


Maintenance Care, Wellness and Chiropractic
A Chiro.Org article collection

Chiropractors have recommended spinal adjustments for correction and prevention of musculoskeletal and visceral conditions for a significant period of time. Let's review the literature supporting wellness and maintenance care.


Adverse Drug Events in Children
Pediatrics 2008 (Apr);   121 (4):   e927–935

Adverse drug event rates in hospitalized children are substantially higher than previously described. Most adverse drug events resulted in temporary harm, but 22% were classified as preventable.
[Editorial Commentary: The findings that only 3.7% of adverse events find their way into hospital error reports is very alarming, and suggests that previous reports have only documented the tip of the iceberg.]


Predictors For Immediate Improvement With Chiropractic
J Manipulative Physiol Ther 2008 (Mar);   31 (3):   172–183

Data, collected from 28,807 treatment consultations and 19,722 new patients, revealed that presenting symptoms of "neck pain," "shoulder, arm pain," "reduced neck, shoulder, arm movement, stiffness," "headache," "upper, mid back pain," and "none or one presenting symptom" emerged in the final model as significant predictors for immediate improvement with care. The presence of any 4 of these predictors raised the probability for an immediate improvement in presenting symptoms after treatment from 70% to approximately 95%.


Chiropractic Effective For Chronic Dysmenorrhea
J Manipulative Physiol Ther 2008 (Mar);   31 (3):   237–246

A group of 16 women, who had experienced symptoms of primary dysmenorrhea for an average of 12 years, all achieved significant reductions in pain following a 4-week period chiropractic care.


Do 40% of Patients Seek Wellness Care?
J Can Chiropr Assoc 2008 (Aug);   52 (3):   175–184

This new survey reveals that a much higher percentage of chiropractic patients seek more than “musculoskeletal care” than has previously been recognized. Carefully worded questionnaires provided to 1316 patients revealed that more than 40% of patients seeking care reported doing so for the purpose of “optimizing health” or “preventing illness” (including the prevention and/or early intervention of potential risk factors) . These findings differ from a previous World Federation of Chiropractic survey, which indicated less than 5–10% of patients seeking care for non-musculoskeletal conditions.


Study Confirms Chiropractic's Cost Effectiveness
J Manipulative Physiol Ther 2007 (May);   30 (4):   263–269

A new retrospective analysis of 70,274 member-months in a 7-year period within an IPA, comparing medical management to chiropractic management, demonstrated decreases of 60.2% in-hospital admissions, 59.0% hospital days, 62.0% outpatient surgeries and procedures, and 85% pharmaceutical costs when compared with conventional medicine IPA performance. This clearly demonstrates that chiropractic nonsurgical nonpharmaceutical approaches generates reductions in both clinical and cost utilization when compared with PCPs using conventional medicine alone.
There are many other articles like this at the Chiropractic Cost Effectiveness Page


Antibiotic Use In Infants Linked To Asthma
Chest 2007 (Jun); 131 (6): 1753–1759

This article, published in the June issue of CHEST, the peer-reviewed journal of the American College of Chest Physicians (ACCP), reports that children receiving antibiotics in the first year of life were at greater risk for developing asthma by age 7 than those not receiving antibiotics. The risk for asthma doubled in children receiving antibiotics for nonrespiratory infections, as well as in children who received multiple antibiotic courses and who did not live with a dog during the first year.


Chiropractic Reduces Blood Pressure
J Human Hypertension 2007;   21 (5):   347–352

In this University of Chicago randomized, double blind, placebo-controlled trial, chiropractic adjusting of the upper cervical spine was associated with marked and sustained reductions in blood pressure, similar in magnitude to the use of two-drug combination therapy.


Diagnosis and Treatment of Low Back Pain
Ann of Int Med 2007 (Oct 2);   147 (7):   478–491

Low back pain is the fifth most common reason for all physician visits in the United States [1, 2]. Approximately one quarter of U.S. adults reported having low back pain lasting at least 1 whole day in the past 3 months [2], and 7.6% reported at least 1 episode of severe acute low back pain (see Glossary) within a 1-year period [3]. Low back pain is also very costly: Total incremental direct health care costs attributable to low back pain in the U.S. were estimated at $26.3 billion in 1998 [4]. In addition, indirect costs related to days lost from work are substantial, with approximately 2% of the U.S. work force compensated for back injuries each year [5]. You will enjoy these recommendations because their ONLY recommendation for active treatment of acute low back pain is spinal adjusting (manipulation).


Does Facet Joint Inflammation Induce Radiculopathy?
Spine 2007 (Feb 15);   32 (4):   406–412

The association between lumbar facet joint inflammation and radiculopathy was investigated using behavioral, histologic, and immunohistochemical testing in rats. When inflammation was induced in a facet joint, inflammatory reactions spread to nerve roots, and leg symptoms were induced by chemical factors. These results support the possibility that facet joint inflammation induces radiculopathy.


Editorial:  
End Medical Mis-Management of LBP

The medical “debate” has been going on for years...is spinal adjusting (a.k.a manipulation) effective for Low Back Pain? The original Meade study (British Medical Journal 1990) demonstrated that chiropractic was much more effective for LBP than conventional medical care.

In 1993 the province of Ontario, Canada hired the esteemed health care economist Pran Manga, PhD to examine the benefits of chiropractic care for low back pain (LBP) and to make a set of recommendations on how to contain and reduce health care costs. His report
A Study to Examine the Effectiveness and Cost-Effectiveness of Chiropractic Management of Low-Back Pain cited research demonstrating that: (1) chiropractic manipulation is safer than medical management for LBP;   (2) that spinal manipulation is less safe or effective when performed by non-chiropractic professionals;   (3) that there is an overwhelming body of evidence indicating that chiropractic management of low-back pain is more cost-effective than medical management;   (4) and that there would be highly significant cost savings if more management of LBP was transferred from medical physicians to chiropractors. He also stated that “A very good case can be made for making chiropractors the gatekeepers for management of low-back pain in the Workers' Compensation System in Ontario.

In 1994, organized medicine was horrified when the Agency for Health Care Policy and Research (AHCPR) publications confirmed the untested, questionable or harmful nature of many current medical therapies for LBP , and also stated that, of all forms of management they reviewed, only chiropractic care could both reduce pain AND improve function.

In 1995, Meade did a follow-up to his 1990 BMJ article, again publishing in the
British Medical Journal. It demonstrated that those treated by chiropractic derive more benefit and long term satisfaction than those treated by hospitals, especially for those who suffered from chronic (or long-term) low back pain!

A recent study in
SPINE Journal reveals that health care expenditures for back pain sufferers was a staggering $90.7 billion in 1998, and that prescription drugs accounted for more than 15% of that figure. This is alarming, since muscle relaxants have been associated with slower recovery rates, and steroid injections offer minimal relief.   One needs to ask why drug costs continue to climb with a track record like that? Even care by physical therapists has been shown to prolong recovery from low back pain.

A chronic pain study at the University of Washington School of Medicine recently compared which
treatments were most effective at reducing pain for neuromuscular diseases and found that chiropractic scored the highest pain relief rating (7.33 out of 10), scoring higher than the relief provided by either nerve blocks (6.75) or opioid analgesics (6.37). WOW!!!

A recent
4-year retrospective study of 700,000 health plan members revealed that offering chiropractic services within a managed-care environment could save insurers 27% in back pain episode-related costs! The Cost-effectiveness Page documents many other studies with similar findings.

In December 2004, the
British Medical Research Council published 2 papers in the British Medical Journal demonstrating both the efficacy and cost-effectiveness of chiropractic compared with medical management.   These two studies revealed:
  Spinal Manipulation, with or without exercise, improved symptoms more than medical care did at both 3 and 12 months.
  The authors concluded: “We believe that this is the first study of physical therapy for low back pain to show convincingly that both manipulation alone and manipulation followed by exercise provide cost effective additions to care in general practice.”

The most recent in a long line of articles showing the clear superiority of chiropractic management was
published in May of 2007 . Clinical and cost utilization based on 70,274 member-months over a 7-year period demonstrated decreases of 60.2% in-hospital admissions, 59.0% less hospital days, 62.0% less outpatient surgeries and procedures, and 85% less pharmaceutical costs when compared with conventional medicine IPA performance.

That is rather significant savings, is it not?

So...what's the holdup?



Inappropriate Use of the Title Chiropractor
Chiropractic & Osteopathy 2006 (Aug 22);   14 (1):   16 ~ FULL TEXT

The results of this year-long prospective review suggests that the words chiropractor and chiropractic manipulation are often used inappropriately by European biomedical researchers when reporting apparent associations between cervical spine manipulation and symptoms suggestive of traumatic injury. Furthermore, in those cases reported here, the spurious use of terminology seems to have passed through the peer-review process without correction. Additionally, these findings provide further preliminary evidence, beyond that already provided by Terrett, that the inappropriate use of the title chiropractor and term chiropractic manipulation may be a significant source of over-reporting of the link between the care provided by chiropractors and injury.
You may also want to read this Editorial Comment by the author.


Are German Orthopedic Surgeons Killing People With Chiropractic?
Journal of Neurology 2006 (Mar 6) ~ FULL TEXT

Editorial Commentary: I present for your review an abstract from the Journal of Neurology. This abstract blatantly conceals the facts stated in the body of the paper when it states that “we describe 36 patients with vertebral artery dissections and prior chiropractic neck manipulation”. When I read that sentence, I am led to believe that “real-live chiropractors” (meaning licensed Doctors of Chiropractic, who received their training at a CCE/WCCE accredited schools) were the ones to provide the “chiropractic neck manipulation”. Unfortunately, that couldn't be further from the truth! BR> You may review other articles like this in the Stroke and Chiropractic Page



Four Articles Which Describe the Relationship Between the Upper Cervical Spine, Headaches, and Chronic Head Pain

1. 
Atrophy of Suboccipital Muscles in Chronic Pain Patients
We have observed previously unreported muscle atrophy in the rectus capitis posterior minor (RCPMI) muscles of a group of chronic pain patients. We hypothesize that chronic pain, in this select group of patients, is a consequence of tramua that occurs to the C1 dorsal ramus during whiplash.

2. 
Magnetic Resonance Imaging of the Upper Cervical Spine
We are currently using MRI to investigate the functional integrity of the upper cervical spine. We started out looking for hypertonic muscles in a population of patients who were suffering from chronic head and neck pain. My first task was to collect MRI data and to identify suboccipital muscles within the MR images.

3. 
Anatomic Relation Between the Rectus Capitis Posterior Minor Muscle and the Spinal Dura Mater
We observed that the PAO membrane was securely fixed to the surface of the dural tube by multitudinous fine connective tissue fibers. There was no real interlaminar space between these two structures and they appeared to function as a single entity. The influence of the RCPMI muscle on the dura mater was artificially produced in the hemisected specimen. Artificially functioning the muscle produced obvious movement of the spinal dura between the occiput and the atlas, and resultant fluid movement was observed to the level of the pons and cerebellum.

4. 
Visualization of the Muscle-Dural Bridge in the Visible Human Female Data Set
SPINE Journal 1995;   20 (23):   2484–2486

It has been speculated that the function of the muscle dural bridge may be to prevent folding of the dura mater during hyperextension of the neck. Also, clinical evidence suggests that the muscle dural bridge may play an important role the pathogenesis of the cervicogenic headaches.



What is the Identity of the Chiropractic Profession?
The World Federation of Chiropractic (WFC) just completed a 2-year comprehensive identity consultation that lead to describing our profession as the spinal health care experts in the health care system. Read all about it now!


Editorial:  
End Medical Mis-Management of Musculoskeletal Complaints

Q.   Are medical doctors well trained to diagnose or treat musculoskeletal complaints?

A.   Read the unsettling answer in this series of articles


Educational Deficiencies in Musculoskeletal Medicine
Journal of Bone and Joint Surgery 2002 (Apr);   84–A (4):   604–608

According to the standard suggested by the program directors of internal medicine residency departments, a large majority of the examinees once again failed to demonstrate basic competency in musculoskeletal medicine on the examination. It is therefore reasonable to conclude that medical school preparation in musculoskeletal medicine is inadequate. NOTE: This is a follow-up article to the study cited below, which demonstrated that medical students were inadequately trained to diagnose and treat musculoskeletal complaints. What would the headlines scream if, after 4 years, chiropractors had failed to improve their skills in musculoskeletal assessment and management? Ask your self why medicine is shown more slack?


The Adequacy of Medical School Education in Musculoskeletal Medicine
Journal of Bone and Joint Surgery 1998 (Oct);   80-A (10):   1421–1427

This is the original article, which found that 82 per cent of medical school graduates failed a valid musculoskeletal competency examination. They concluded that "we therefore believe that medical school preparation in musculoskeletal medicine is inadequate" and that medical students were inadequately trained to diagnose and treat musculoskeletal complaints.


Educating Medical Students About Musculoskeletal Problems: Are Community Needs Reflected in the Curricula of Canadian Medical Schools?
Journal of Bone and Joint Surgery 2001 (Sept);   83-A (9):   1317–1320

Musculoskeletal problems are a common reason why patients present for medical treatment. The purpose of the present study was to review the curricula of Canadian medical schools to determine whether they prepare their students for the demands of practice with respect to musculoskeletal problems. The curriculum analysis revealed that, on the average, medical schools in Canada devoted 2.26% (range, 0.61% to 4.81%) of their curriculum time to musculoskeletal education. Our literature review and survey of local family physicians revealed that between 13.7% and 27.8% of North American patients presenting to a primary care physician have a chief symptom that is directly related to the musculoskeletal system. (So they conclude:) There is a marked discrepancy between the musculoskeletal knowledge and skill requirements of a primary care physician and the time devoted to musculoskeletal education in Canadian medical schools.


A Comparison of Chiropractic Student Knowledge Versus Medical Residents
Proceedings of the World Federation of Chiropractic Congress 2001 Pgs. 255

A previously published knowledge questionnaire designed by chief orthopedic residents was given to a Chiropractic student group for comparison to the results of the medical resident group. Based on the marking scale determined by the chief residents, the Chiropractic group (n = 51) showed statistically significant higher average grade than the orthopedic residents. Expressed in other terms, 70% of chiropractic students passed the knowledge questionnaire, compared to an 80% failure rate for the orthopedic residents.


Musculoskeletal Knowledge: How Do You Stack Up?
Physician and Sportsmedicine 2002; 30 (8) August

One of every 4 or 5 primary care visits is for a musculoskeletal problem. Yet undergraduate and graduate training for this burden of illness continues to constitute typically less than 5% of the medical curriculum. This is an area of clear concern, but also one in which sports medicine practitioners can assume leadership.


Musculoskeletal Curricula in Medical Education
Physician and Sportsmedicine 2004 (Nov); 32 (11)

It's 8:00 pm on a Monday night. Just as you're getting ready to put your 5-year-old son to bed, he falls from a chair, landing on his wrist. It quickly swells, requiring a visit to a nearby urgent care clinic. At the clinic, a pleasant young resident takes a history, performs a physical exam, and orders an x-ray to evaluate the injury. You are told that nothing is broken, and a wrist splint is placed. The following day, however, you receive a phone call from the clinic informing you that upon further review of the radiographs, a fracture was detected, and your son will need a cast for definitive treatment. This scenario, while fictitious, is not unusual. According to some studies, up to 10% of wrist fractures are missed at the initial evaluation.1 While pediatric fractures are often difficult to detect, this example highlights a problem that continues to plague medical education: inadequate instruction in musculoskeletal medicine in both medical school and residency training.


Adequacy of Education in Musculoskeletal Medicine
J Bone Joint Surg Am 2005 (Feb);87 (2):   310–314

In this study, 334 medical students, residents and staff physicians, specializing in various fields of medicine, were asked to take a basic cognitive examination consisting of 25 short-answer questions - the same type of test administered in the original JBJS 1998 study. The average score among medical doctors, students and residents who took the exam in 2005 was 2.7 points lower than those who took the exam in 1998. Just over half of the staff physicians (52%) scored a passing grade or higher on the 2005 exam. Only 21% of the residents registered a passing grade, and only 5% of the medical students passed the exam. Overall, Seventy-nine percent of the participants failed the basic musculoskeletal cognitive examination.


More Evidence of Educational Inadequacies in Musculoskeletal Medicine
Clin Orthop Relat Res 2005 (Aug);   (437):   251–259

A modified version of an exam used to assess the competency of incoming interns at the University of Pennsylvania was used to assess the competency of medical students during various stages of their training at the University of Washington. Despite generally improved levels of competency with each year at medical school, less than 50% of fourth-year students showed competency. These results suggested that the curricular approach toward teaching musculoskeletal medicine at this medical school was insufficient and that competency increased when learning was reinforced during the clinical years.


Why is the Bone and Joint Decade Important?
Welcome to the United States Bone and Joint Decade

The Bone and Joint Decade initiative is a global campaign to improve quality of life for people with musculoskeletal conditions and to advance understanding and treatment of these conditions through research, prevention, and education. 1 The Decade aims to raise the awareness of the increasing societal impact of musculoskeletal injuries and disorders; empower patients to participate in decisions about their care; increase funding for prevention activities and research; and promote cost-effective prevention and treatment of musculoskeletal injuries and disorders.



Steroid Injections Offer Little Relief for Lower Back Pain
Amer Acad Orthop Surgeons Presentation ~ March 10, 2004

A randomized, controlled trial has shown an epidural or translaminar steroid injection is ineffective for the relief of lower back pain. "I'm not saying that steroids don't work. I'm just saying there's definite reason to question whether they work or not," Dr. Daniel Steinitz, an orthopedic surgeon at Belleville General Hospital in Ontario, said in an interview after his presentation at the American Academy of Orthopedic Surgeons meeting here. Dr. Steinitz, who worked on the study during his residency at McGill University in Montreal, said steroid injections for lumbar pain are popular but research on their use over the past 40 years has produced conflicting results. Nor is the procedure benign, with dural puncture leading to headache being one of the more common complications.


Effects of a Managed Chiropractic Benefit on the Use of Specific Diagnostic and Therapeutic Procedures in the Treatment of Low Back and Neck Pain
J Manipulative Physiol Ther 2005 (Oct);   28 (8):   564–569

For the treatment of low back and neck pain, the inclusion of a chiropractic benefit resulted in a significant reduction in the rates of surgery, advanced imaging, inpatient care, and plain-film radiographs. This effect was greater on a per-episode basis than on a per-patient basis.
There are more articles like this in the Cost-Effectiveness Page and the Low Back Pain Page.


Cost-effectiveness of Medical and Chiropractic Care for Acute and Chronic Low Back Pain
J Manipulative Physiol Ther 2005 (Oct);   28 (8):   555–563

Acute and chronic chiropractic patients experienced better outcomes in pain, functional disability, and patient satisfaction. Chiropractic care appeared relatively cost-effective for the treatment of chronic LBP. Chiropractic and medical care performed comparably for acute patients. Practice-based clinical outcomes were consistent with systematic reviews of spinal manipulation efficacy: manipulation-based therapy is at least as good as and, in some cases, better than other therapeusis. This evidence can guide physicians, payers, and policy makers in evaluating chiropractic as a treatment option for low back pain.
There are more articles like this in the Cost-Effectiveness Page and the Low Back Pain Page.


Chronic Pain in Persons With Neuromuscular Disease
Clin J Pain 2005 (Jan);   21 (1):   18–26

In this paper, researchers in a medical school rehabilitation department were interested in finding out what treatments were most effective at reducing pain for neuromuscular diseases (like amyotrophic lateral sclerosis and myotonic muscular dystrophies).
Chiropractic scored the highest pain relief rating (7.33 out of 10), scoring higher than the relief provided by either nerve blocks (6.75) or opioid analgesics (6.37). WOW!!!


The “Best Practice” Initiative
A Chiro.Org article collection

Learn the distinction between Guidelines and Best Practices, and find out more about the progress of the Council on Chiropractic Guidelines and Practice Parameters.


Treatment of Bipolar, Seizure, and Sleep Disorders and Migraine Headaches Utilizing a Chiropractic Technique
J Manipulative Physiol Ther 2004 (Mar);   27 (3):   E5 ~ FULL TEXT

At initial examination, evidence of a subluxation stemming from the upper cervical spine was found through thermography and radiography. Chiropractic care using an upper cervical technique was administered to correct and stabilize the patient's upper neck injury. Assessments at baseline, 2 months, and 4 months were conducted by the patient's neurologist. After 1 month of care, the patient reported an absence of seizures and manic episodes and improved sleep patterns. After 4 months of care, seizures and manic episodes remained absent and migraine headaches were reduced from 3 per week to 2 per month. After 7 months of care, the patient reported the complete absence of symptoms. Eighteen months later, the patient remains asymptomatic.
You may enjoy other reports like this in our: Case Reports Section.


Comparative Analysis of Individuals With and Without Chiropractic Coverage: Patient Characteristics, Utilization, and Costs
Arch Intern Med 2004 (Oct 11);   164 (18):   1985-1892

A 4-year retrospective claims data analysis comparing more than 700,000 health plan members within a managed care environment found that members had lower annual total health care expenditures, utilized x-rays and MRIs less, had less back surgeries, and for patients with chiropractic coverage, compared with those without coverage, also had lower average back pain episode-related costs ($289 vs $399, P<.001). The authors concluded: “Access to managed chiropractic care may reduce overall health care expenditures through several effects, including (1) positive risk selection; (2) substitution of chiropractic for traditional medical care, particularly for spine conditions; (3) more conservative, less invasive treatment profiles; and (4) lower health service costs associated with managed chiropractic care.”
You will also enjoy this recent press release about this study.
There are more articles like this at our: Cost-Effectiveness Page.


First Report on a US Project Analyzing Chiropractic
and Medical Interprofessional Relationships

J Interprof Care 2004 (Aug);   18 (3):   320-321

Evidence points to increased utilization of complementary and alternative medicine services (CAM), although little knowledge exists about the coordination or integration of CAM with conventional health care. The project described here explores two dimensions of the relationship between chiropractors and conventional allopathic primary care physicians in the U.S., using two modes of data collection. All chiropractors (DCs) and medical primary care providers (MDPCPs) in Iowa were surveyed in 2003 to measure patterns of referrals/consults and bidirectional communication between the two practitioner types. In addition, nine focus groups made up of both academic and community leaders in their respective fields were convened throughout 2002 and 2003, to gather information about the conceptual formulation and barriers and facilitators of the design, delivery and implementation of practice-based research networks (PBRNs) that would include both CAM and medical providers.


Fostering Critical Thinking Skills:
A Strategy for Enhancing Evidence Based Wellness Care

Chiropractic & Osteopathy 2005 (Sep 8)   Volume 13 (1): 19 ~ FULL TEXT

Chiropractic has traditionally regarded itself a wellness profession. As wellness care is postulated to play a central role in the future growth of chiropractic, the development of a wellness ethos acceptable within conventional health care is desirable. This paper describes a unit which prepares chiropractic students for the role of “wellness coaches”. Emphasis is placed on providing students with exercises in critical thinking in an effort to prepare them for the challenge of interfacing with an increasingly evidence based health care system.
You'll find more articles like this at our Evidence-based Practice Page


Florida Judge Rules That SEMG Has Demonstrated Medical Value
FEB. 16, 2005 -   Florida insurers can no longer deny reimbursement of charges for surface electromyography (SEMG) in personal injury (PI) cases. A Florida administrative judge struck down a rule that had denied reimbursement of SEMGs because they were “not medically necessary”.


Alternatives in Cancer Pain Treatment:
The Application of Chiropractic Care

Semin Oncol Nurs 2005 (Aug);   21 (3):   184–189

The judicial use of chiropractic services in cancer patients appears to offer many economical and effective strategies for reducing the pain and suffering of cancer patients, as well as providing the potential to improve patient health overall.
You'll find more articles like this at our: Chiropractic And Cancer Page


Determining the Relationship Between Cervical Lordosis and Neck Complaints
J Manipulative Physiol Ther 2005 (Mar);   28 (3):   187-193

In a study of 277 lateral cervical x-rays, patients with lordosis of 20° or less were more likely to have cervicogenic symptoms (P < .001). The association between cervical pain and lordosis of 0° or less was significant (P < .0001). The odds that a patient with cervical pain had a lordosis of 0° or less was 18 times greater than for a patient with a noncervical complaint. Patients with cervical pain had less lordosis and this was consistent over all age ranges.
You'll find more articles like this at our: Spinal Allignment and Function Page


NSAIDs and Musculoskeletal Treatment: What Is the Clinical Evidence?
PHYSICIAN AND SPORTSMEDICINE 2003 (Jan);   31 (1)

Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly prescribed for musculoskeletal injuries because the conditions are believed to be inflammatory in nature. However, because inflammation is a necessary component in the healing process, decreasing inflammation may prove counterproductive. Also, many tendon injuries called 'tendinitis' are, in fact, degenerative and not inflammatory conditions.   An analysis of the pathophysiology and healing of musculoskeletal injuries questions the use of NSAIDs in many treatment protocols. Because NSAIDs have profound side effects, they should not automatically be the first choice for treating musculoskeletal injuries.
You'll find more articles like this at our: Iatrogenic Injury Page


Upper Crossed Syndrome and Its Relationship to Cervicogenic Headache
J Manipulative Physiol Ther 2004 (Jul);   27 (6):   414-420

The principles of upper crossed syndrome and the use of exercise, chiropractic care, and myofascial release in the treatment of cervicogenic headache are discussed. A review of the literature indicates that analyzing muscle imbalance as well as vertebral subluxation may increase the effectiveness of chiropractic treatment for cervicogenic headache.
You'll find more articles like this at our: Rehabilitation Diplomate Information Page


Efficacy of Preventive Spinal Manipulation for Chronic Low-Back Pain and Related Disabilities: A Preliminary Study
J Manipulative Physiol Ther 2004 (Oct);   27 (8):   509-514

This study demonstrated two important points: (1) Chiropractic is effective for chronic low back pain (LBP), and (2) that ongoing supportive care can reduce disability levels, as measured by the Oswestry Low Back Pain Disability questionnaire.
You'll find more articles like this at our: Maintenance Care, Wellness and Chiropractic Page


American Chiropractic Association Files Lawsuit
Against ACN in Federal Court

American Chiropractic Association ~ June 13, 2006

The American Chiropractic Association (ACA) today asked the U.S. District Court in Miami to allow ACA to join as a plaintiff in the pending nationwide class action lawsuit Solomon v. Anthem, et al., and further asked that ACN Group, Inc. and United Healthcare Services, Inc. be named as additional defendants in the case. The ACA alleges that ACN participated with other managed care companies in the case in a conspiracy to illegally and systematically underpay providers by denying reimbursement for medically necessary treatment.


Medicare Revises Requirements For Chiropractic Billing
Center for Medicare and Medicaid ~ FULL TEXT

The Center for Medicare and Medicaid Services (CMS) has issued revised requirements for chiropractic billing of active/corrective treatment and maintenance therapy. As of 10-01-2004 every chiropractic claim (those containing HCPCS code 98940, 98941, 98942) should include the Acute Treatment (AT) modifier if active/corrective treatment is being performed.


A Survey of Practice Patterns and the Health Promotion and Prevention Attitudes of US Chiropractors. Maintenance Care: Part I
J Manipulative Physiol Ther 2000 (Jan);   23 (1):   1–9

Despite educational, philosophic, and political differences, US chiropractors come to a consensus about the purpose and composition of MC. Not withstanding the absence of scientific support, they believe that it is of value to all age groups and a variety of conditions from stress to musculoskeletal and visceral conditions. This strong belief in the preventive and health promotion value of MC motivates them to recommend this care to most patients. This, in turn, results in a high level of preventive services and income averaging an estimated $50,000 per chiropractic practice in 1994. The data suggest that the amount of services and income generated by preventive and health-promoting services may be second only to those from the treatment of low-back pain. The response from this survey also suggests that the level of primary care, health promotion and prevention activities of chiropractors surpasses that of other physicians.


Maintenance Care: Health Promotion Services Administered to US Chiropractic Patients Aged 65 and Older, Part II
J Manipulative Physiol Ther 2000 (Jan);   23 (1):   10–19

Rupert, Manello, and Sandefur surveyed 311 chiropractic patients, aged 65 years, who had received “maintenance care” for 5 years. Chiropractic patients receiving maintenance care, when compared with US citizens of the same age, spent only 31% of the national average for health care services and reported a 50% reduction in medical provider visits. The health habits of patients receiving maintenance care were better overall than the general population, including decreased use of cigarettes and nonprescription drugs. Furthermore, 95.8% believed the care to be either “considerably” or “extremely” valuable. There are more articles like this in the Chiropractic and General Health Improvement Section.


An Investigation into the Validity of Cervical Spine Motion Palpation Using Subjects with Congenital Block Vertebrae as a 'Gold Standard'
BMC Musculoskelet Disord 2004 (Jun 15);   5 (1):   19 ~ FULL TEXT

Twenty fourth year chiropractic students examined the cervical spines of three subjects with single level congenital block vertebrae, using two commonly employed motion palpation tests. The examiners, who were blinded to the presence of congenital block vertebrae, were asked to identify the most hypomobile segment(s). This study indicates that relatively inexperienced examiners are capable of correctly identifying inter-segmental fixations (CBV) in the cervical spine using 2 commonly employed motion palpation tests. The use of a 'gold standard' (CBV) in this study and the substantial agreement achieved lends support to the validity of motion palpation in detecting major spinal fixations in the cervical spine.


Communication Between General Practitioners and Chiropractors
J Manipulative Physiol Ther 2001 (Jan);   24 (1):   12–16

A total of 115 questionnaires (46%) were returned. Almost all of the general practitioners had at least heard of chiropractic. Most information came from patients who were treated by chiropractors (78%). Only 10% of the general practitioners refer their patients to a chiropractor on a regular basis. Referral of patients was found to be significantly related to the general practitioners' perceived knowledge of chiropractic and positive opinions regarding their past communications with chiropractors. More than 80% of the general practitioners said that they were interested in receiving (or continuing to receive) feedback reports, even if they did not personally refer the patient to the chiropractor. Chiropractic feedback reports often seem to contain confusing terminology (40%), which might negatively influence communication (66%). General practitioners preferred a typed (88%), short (69%) feedback report, preferably sent after the last treatment (72%).


Chiropractic Care: Is It Substitution Care or Add-on Care
in Corporate Medical Plans?

J Occup Environ Med 2004 (Aug);   46 (8):   847—855

An analysis of claims data from a managed care health plan was performed to evaluate whether patients use chiropractic care as a substitution for medical care or in addition to medical care. For the 4-year study period, there were 3,129,752 insured member years in the groups with chiropractic coverage and 5,197,686 insured member years in the groups without chiropractic coverage. These results (of this file review) indicate that patients use chiropractic care as a direct substitution for medical care.
You'll find more articles like this at our: Cost-Effectiveness Page


Predictive Factors for Neck and Shoulder Pain:
A Longitudinal Study in Young Adults

Spine 2004 (Aug 1);   29 (15):   1662—1669

This random sample of 826 high school students was investigated when they were 15 to 18 years old, and again at 22 to 25 years of age, to estimate the prevalence and incidence of neck and shoulder pain in young adults, and to identify the associated and predictive factors of neck and shoulder pain based on a 7-year follow-up. In 7 years, the prevalence of weekly neck and shoulder pain increased from 17% to 28%. Among those who were asymptomatic at baseline, 6-month incidence of occasional or weekly neck and shoulder pain was 59% 7 years later. In young adults, the incidence of neck and shoulder pain is high, and the associated factors of neck and shoulder pain are already multifactorial in a young population.
You'll find more articles like this at our: Shoulder Page


Occupational Injuries Suffered by Classical Musicians Through Overuse
Clinical Chiropractic 2004 (Jun);   7 (2):   55—66

There is a high rate of injury to professional classical musicians and teachers that can be disruptive to practice and potentially threatening to careers. Females and string players were discovered to be of particular risk. The majority of injuries were to the shoulder and proximal thoracic spine and the absence of injuries in amateur players suggests a relationship to overuse. The author suggests that the incorporation of postural and ergonomic into musical education and chiropractic treatment programmes for classical musicians and teachers could be of benefit.
You'll find more articles like this at our: Repetitive Stress Disorders Page


The Medical Monopoly:
Protecting Consumers Or Limiting Competition?

The Cato Institute

Nonphysician providers of medical care are in high demand in the United States. But licensure laws and federal regulations limit their scope of practice and restrict access to their services. The result has almost inevitably been less choice and higher prices for consumers. Safety and consumer protection issues are often cited as reasons for restricting nonphysician services. But the restrictions appear not to be based on empirical findings. Studies have repeatedly shown that qualified nonphysician providers--such as midwives, nurses, and chiropractors--can perform many health and medical services traditionally performed by physicians--with comparable health outcomes, lower costs, and high patient satisfaction. Licensure laws appear to be designed to limit the supply of health care providers and restrict competition to physicians from nonphysician practitioners. The primary result is an increase in physician fees and income that drives up health care costs.


Breathing Normal - And Then Some
Charles Masarsky, DC

In the 1980s, two chiropractic practitioners in Virginia published a report on breathing capacity in a series of new patients.1,2 They measured the liters of air exhaled by their patients when forcing out a full breath; this measurement is called forced vital capacity, often abbreviated to FVC. They also measured the liters of air exhaled in the first second of forcing out a full breath; this measurement is called forced expiratory volume in one second, often abbreviated to FEV-1. When repeat measurements were taken after one to three chiropractic adjustments, both FVC and FEV-1 had improved significantly.


Economic Case for the Integration of Chiropractic Services
into the Health Care System

J Manipulative Physiol Ther 2000 (Feb);   23 (2):   118—122

For much of its history, chiropractic care has been both an alternative therapeutic paradigm and separate from or marginal to the mainstream health care system. Over the past decade, the situation has changed somewhat in that chiropractic care is gradually being integrated within a variety of health care delivery organizations. According to Triano et al,1 by the application of evidence-based health care and good business, there is a surge in cooperation and integration among chiropractors, allopathic physicians, allied health care providers, ancillary therapists, and respective support staff. There is, however, no quantification of the level of integration. Integration may also be more true of the United States than elsewhere. The overall position of chiropractic care as alternative and separate still predominates. This situation does not serve the interests of the chiropractic profession nor the public well. There is a persuasive economic case for a radical shift in the role of chiropractic care to one that may succinctly be described as alternative and mainstream. The chiropractic profession must preserve its identity and its unique therapeutic paradigm and continue to be seen as an alternative to other health care professions, especially medical doctors. However, it should also become mainstream and thus widely available and accessible to the public by being integrated into the wide variety of health care delivery organizations that collectively constitute the health care system.


Chiropractic-primary Care, Neuromusculoskeletal Care, or Musculoskeletal Care? Results of a Survey of Chiropractic College Presidents, Chiropractic Organization Leaders, and Connecticut-licensed Doctors of Chiropractic
J Manipulative Physiol Ther 2003 (Oct);   26 (8):   510–523

Upon review of the literature and term definitions, interpretation of the statutes pertaining to chiropractic practice, results of both surveys, and review of the chiropractic college mission statements, the committee concluded that the Connecticut-licensed DC, by education, licensure, definition, and intraprofessional consensus, qualifies as a PCP.


Death by Medicine
Life Extension Magazine ~ March 2004

No one had ever analyzed and combined ALL of the published literature dealing with injuries and deaths caused by government-protected medicine. That has now changed. A group of researchers meticulously reviewed the statistical evidence and their findings are absolutely shocking. This fully referenced report shows the number of people having in-hospital, adverse reactions to prescribed drugs to be 2.2 million per year. The number of unnecessary antibiotics prescribed annually for viral infections is 20 million per year. The number of unnecessary medical and surgical procedures performed annually is 7.5 million per year. The number of people exposed to unnecessary hospitalization annually is 8.9 million per year. The most stunning statistic, however, is that the total number of deaths caused by conventional medicine is an astounding 783,936 per year.
You'll find more articles like this at our: Iatrogenic Injury Page


Spinal Manipulation May Benefit Asthma Patients
Foundation for Chiropractic Education and Research (FCER)

Patients afflicted with asthma may benefit from spinal manipulation in terms of symptoms, immunological capacity, and endocrine effects, an audience was told on October 5 at the 9th International Conference on Spinal Manipulation in Toronto. The investigative team, headed by Ray Hayek, Ph.D., has been conducting a trial at 16 treatment centers in Australia involving 420 patients with an average age of 46 in an effort to find out what effects spinal manipulation has on symptoms, depression and anxiety, general health status, and the levels of immunity as reflected by the concentrations of both an immunoglobulin (IgA) and an immunosuppressant (cortisol).


Safety of Spinal Manipulation in the Treatment of Lumbar Disk Herniations:
A Systematic Review and Risk Assessment

J Manipulative Physiol Ther 2004 (Mar);   27 (3):   197–210

An estimate of the risk of spinal manipulation causing a clinically worsened disk herniation or CES in a patient presenting with LDH is calculated from published data to be less than 1 in 3.7 million. The apparent safety of spinal manipulation, especially when compared with other "medically accepted" treatments for LDH, should stimulate its use in the conservative treatment plan of LDH.


CCE Backs Off on Physical Therapy Requirements
Today's Chiropractic 2004 (Mar)

With a surprising policy reversal, the Council on Chiropractic Education (CCE) Board of Directors voted in its semi-annual business meeting in Scottsdale, Ariz., to table the proposal recommending physiological therapeutics be included in the required curricular offerings in accredited Doctor of Chiropractic Degree Programs.


Chiropractic: Does It Work?
MSNBC Report ~ Wednesday, October 06, 1999

Despite a spell of negative publicity for chiropractic medicine, the practice has never been more popular: The number of chiropractic visits per capita has doubled in the past 20 years. Do chiropractors offer more than just a good back rub? Experts say yes.


Accuracy of Data in Medical Abstracts of Published Research Articles
Nutrition Science News ~ September 1999

Researchers randomly selected 44 articles from each of five medical journals, including Lancet and The New England Journal of Medicine. The results, published in JAMA showed that between 18 and 68 percent of the 264 abstracts evaluated were inaccurate, meaning there were omissions or inconsistencies between the data in the abstract and the data in the body, tables and figures of the main article. The results are especially troubling because abstracts are widely used, often separate from their text, as in MEDLINE and other databases, and data taken from the abstracts may be reported and disseminated in other works, in other formats and in the media.
You may also enjoy the JAMA Editorial (Mar 24, 1999) titled:
The Need for Concrete Improvement in Abstract Quality.



The Cost-effectiveness of Chiropractic
A Chiro.Org article collection

The cost advantages for chiropractic for matched conditions appear to be so dramatic that Pran Manga, the aforementioned Canadian health economist, has concluded that doubling the utilization of chiropractic services from 10% to 20% may realize savings as much as $770 million in direct costs and $3.8 billion in indirect costs.20 When iatrogenic effects [yet to be discussed] are factored in, the cost advantages of spinal manipulation as a treatment alternative become even more prominent.


Patient Satisfaction With Chiropractic
A Chiro.Org article collection

For matched back pain conditions, patient satisfaction with chiropractic treatment has invariably been shown to be significantly greater than that with conventional management [administered by a primary care physician, an orthopedist, or an HMO provider]. Read the results of a variety of studies right here!


Visit Time as a Framework for Reimbursement:
Time Spent with Chiropractors and Acupuncturists

Altern Ther Health Med 2003 (Sep);   9 (5):   88-94

For both chiropractic and acupuncture, certain visit factors, provider characteristics, and procedures increase visit length, many of which parallel those observed in conventional medical settings. Thus, a similar time-based payment scheme may be a reasonable starting point for developing methods for reimbursing CAM providers.


Does Pain Affect Your Job Performance?
To Your Health ChiroWeb Newsletter

The average employee misses several days of work each year because of the common cold; two or three more for personal or family emergencies; and a few extra "just because." With the exception of those seven or eight days, plus scheduled vacation time and holidays, the average employee spends his or her time engaged in blissful work productivity, right? Well, not exactly. Just because you're at work doesn't necessarily mean you're being productive. In fact, according to a study published in the Journal of the American Medical Association, U.S. employers lose more than $60 billion a year because workers aren't as productive as they could be. The culprit: pain.


Clinical Perceptions of the Risk of Vertebral Artery Dissection After Cervical Manipulation: The Effect of Referral Bias
Spine J 2002 (Sep);   2 (5):   334-342

For the 10-year period 1988 to 1997, there were 23 cases of vertebral artery dissection after cervical manipulation reported to the CCPA that represents 85% of practicing chiropractors in Canada. Based on the survey, an estimated 134,466,765 cervical manipulations were performed during this 10-year period. This gave a calculated rate of vertebral artery dissection after manipulation of 1:5,846,381 cervical manipulations. Based on the number of practicing chiropractors and neurologists during the period of this study, 1 of every 48 chiropractors and one of every two neurologists would have been made aware of a vascular complication from cervical manipulation that was reported to the CCPA during their practice lifetime.
You'll find more articles like this at our: Stroke and Chiropractic Page


Cervical Spine Curvature During Simulated Whiplash
Clin Biomech (Bristol, Avon) 2004 (Jan);   19 (1):   1-9

Average peak lower cervical spine extension first exceeded the physiological limits (P<0.05) at a horizontal T1 acceleration of 5 g. Average peak upper cervical spine extension exceeded the physiological limit at 8 g, while peak upper cervical spine flexion never exceeded the physiological limit. In the S-shape phase, lower cervical spine extension reached 84% of peak extension during whiplash. Both the upper and lower cervical spine are at risk for extension injury during rear-impact. Flexion injury is unlikely.


Congress Approves Plan to Test Expanded Medicare Access to DCs
www.acatoday.com

The current Medicare program imposes an arbitrary limit on the covered services that can be offered by America's 60,000 doctors of chiropractic and sought by millions of older chiropractic patients. Under current law, a chiropractor may only provide Medicare beneficiaries with a single covered service (manual manipulation of the spine to correct a subluxation) despite the fact that they are licensed in all 50 states to provide additional services that are currently covered under Medicare, including x-rays and other diagnostic tests and physiotherapy services. The ACA has long contended that Medicare's arbitrary limit on chiropractic services is harmful to patients and costly to taxpayers. The four-site, two-year demonstration, will likely have a profound impact in rural and medically underserved areas where beneficiaries will no longer be forced to visit a second or third provider to receive the full range of necessary services.


Cervical Spine Geometry Correlated to Cervical Degenerative Disease in a Symptomatic Group
J Manipulative Physiol Ther 2003 (Jul);   26 (6):   341-346

Chiropractors have long maintained that loss of spinal curvature was a sign of loss of function that leads to degenerative joint disease. This paper discusses "5 geometric variables from the lateral cervical spine that were predictive 79% of the time for cervical degenerative joint disease."


Osteopathic Manipulation No Better Than Sham Therapy
for Chronic Back Pain?

Here's another study with the unusual finding that the sham and the active treatment groups both fared similarly...that is, both groups improved, compared to the control group. It would be interesting to know the exact nature of the sham they were using. The Placebo/Sham Page is devoted to this issue...the difficulty in designing a truly inert sham or placebo for a manipulative trial.


Effects of Inclusion of a Chiropractic Benefit on the Utilization of Health Care Resources in Managed Health Care Plan
A four-year longitudinal study using administrative claims data compared 700,000 health plan members with chiropractic coverage to 1 million health plan members without chiropractic coverage. This study demonstrates that the inclusion of a chiropractic benefit in a managed health care plan results in a reduction in the overall utilization of health care resources, and thereby, cost savings. There are four mechanism that produce this cost reduction: 1. A favorable selection process; 2. A substitution effect of chiropractic care for medical care; 3. Lower rates of use of high cost procedures; 4. Lower cost management of care episodes by chiropractors.
You might also enjoy this sidebar article on this topic.


Is the Sagittal Configuration of the Cervical Spine Changed in Women with Chronic Whiplash Syndrome? A Comparative Computer-assisted Radiographic Assessment
J Manipulative Physiol Ther 2002 (Nov-Dec);   25 (9):   550-555

The whiplash group showed a decreased ratio between the lower versus upper cervical spine but comparisons between groups were not statistically significant. The whiplash group was in a significantly more flexed position at the C4-C5 level compared with the asymptomatic group (P =.007). The reliability measures have to be strengthened to render these results definitely conclusive.
You'll find more articles like this at our: Chiropractic and Spinal Allignment Page


HIPAA Compliance Page
A Chiro.Org article collection

Are you compliant? Here's access to pertinent information of value!


Manual Therapy Eases Neck Pain, Cheaply
WebMD Medical News ~ Thursday, April 24, 2003

A hands-on approach to treating neck pain by manual therapy may help people get better faster and at a lower cost than more traditional treatments, according to a new study. After seven and 26 weeks, the study found significant improvements in recovery rates in the manual therapy group compared to the others. For example, at week seven, 68% of the manual therapy group had recovered from their neck pain vs. 51% in the physical therapy group and 36% in the medical care group.
You may also enjoy the FULL TEXT article in the British Medical Journal 2003 (Apr 26).


Back, Neck, and Shoulder Pain in Finnish Adolescents:
National Cross Sectional Surveys

British Medical Journal 2002 (Oct 5);   325 (7367):   743-745

Prevalence of pain in the back and neck was greater in the 1990s than in the 1980s and increased steadily from 1993 to 1997. Pain of the neck and shoulder and pain of the lower back was much more common in 1999 than in 1991 and in 2001 than in 1999. Pain was more common among girls and older groups: pain of the neck and shoulder affected 24% of girls and 12% of boys in 14 year olds, 38% of girls and 16% of boys in 16 year olds, and 45% of girls and 19% of boys in 18 year olds; pain in the lower back affected 8% of girls and 7% of boys in 14 year olds, 14% of girls and 11% of boys in 16 year olds, and 17% of boys and 13% of girls in 18 year olds.


Sacral Stress Fractures:
Tracking Down Nonspecific Pain in Distance Runners

PHYSICIAN AND SPORTSMEDICINE 2003 (Feb);   31 (2)

Sacral stress fractures are an underrecognized cause of low-back and gluteal pain in distance runners. The combination of low bone density and increased activity blurs the boundary between fatigue and insufficiency fractures in many runners. MRI is the preferred radiologic technique because of its ability to localize the site of injury and rule out tumors, disk disease, or sacroiliitis. By identifying the condition early, clinicians contribute to a favorable outcome and help most athletes return to full activity in 12 to 14 weeks.


Veterans Affairs (VA) Chiropractic Advisory Committee
Read about the progress in bringing chiropractic care to veterans. You may also enjoy this article by Cynthia S. Vaughn, DC, FICC, one of the 5 chiropractic advisors to the committee.


Expectations of Chiropractic Treatment: What Are the Expectations of New Patients Consulting a Chiropractor, and Do Chiropractors and Patients Have Similar Expectations?
J Manipulative Physiol Ther 2002 (Jun);   25 (5):   300-305

This survey of 30 chiropractors and 336 patients in Sweden showed that both groups had many similar goals and expectations for treatment. There were several differences in treatment expectations, however. Patients had significantly lower expectations of treatment success than their doctors, yet higher expectations for advice and exercise. Patients also disagreed with their doctors of chiropractic on how many treatments were necessary, expecting significant relief in 1-2 visits rather than the 4-5 visits chiropractors felt necessary for relief. Expectations can impact care outcomes, so this paper suggests that chiropractors may have to address this issue with patients.


Is Chiropractic Evidence Based? A Pilot Study
J Manipulative Physiol Ther 2003 (Jan);   26 (1):   47 ~ FULL TEXT

When patients were used as the denominator, the majority of cases in a chiropractic practice were cared for with interventions based on evidence from good-quality, randomized clinical trials. When compared to the many other studies of similar design that have evaluated the extent to which different medical specialties are evidence based, chiropractic practice was found to have the highest proportion of care (68.3%) supported by good-quality experimental evidence.


Chiropractic Board Fines Physical Therapist
for Performing Spinal Manipulation

In what is believed to be the first case of its kind in state history, an Arkansas physical therapist has been fined $10,000 by the state board of chiropractic examiners for allegedly performing spinal manipulation on two people, including a private investigator posing as a patient. Should the board's ruling stand, it would be the first time a physical therapist has been disciplined by a chiropractic board in Arkansas, and could start a political battle between physical therapists and doctors of chiropractic over scope of practice.


Manual Therapy, Physical Therapy, or Continued Care by a General Practitioner for Patients with Neck Pain. A Randomized, Controlled Trial
Ann Intern Med 2002 (May 21);   136 (10):   713-722

Neck pain is a common problem, but the effectiveness of frequently applied conservative therapies has never been directly compared. In this study, manual therapy was a favorable treatment option for patients with neck pain compared with physical therapy or continued care by a general practitioner.


Spinal Manipulation May Benefit Asthma Patients
Foundation for Chiropractic Education and Research (FCER)

Patients afflicted with asthma may benefit from spinal manipulation in terms of symptoms, immunological capacity, and endocrine effects, an audience was told on October 5 at the 9th International Conference on Spinal Manipulation in Toronto. The investigative team, headed by Ray Hayek, Ph.D., has been conducting a trial at 16 treatment centers in Australia involving 420 patients with an average age of 46 in an effort to find out what effects spinal manipulation has on symptoms, depression and anxiety, general health status, and the levels of immunity as reflected by the concentrations of both an immunoglobulin (IgA) and an immunosuppressant (cortisol).


Functional Deficits in Athletes with a History of Low Back Pain:
A Pilot Study

Arch Phys Med Rehabil 2002 (Dec);   83 (12):   1753-1758

This study found that asymptomatic athletes who had a recent history of LBP were significantly slower in a shuttle run then their peers. It is likely that all these athletes received typical medical treatment (muscle relaxants or pain pills). It would be interesting to compare a post-chiropractic care group to the medically-treated group to see how chiropractic fares.


Pilot Study Will Examine The Cost Savings of Chiropractic
ACA has approved plans to hire a national actuarial firm to conduct a pilot study on the cost savings of chiropractic care. One goal of the study is to persuade payers to stop paying for more traditional forms of care that do not work and to switch to a patient-favored and value-added set of chiropractic benefits as core insurance benefits. Results of the pilot study should be available by the end of the first quarter of 2003.


What to Do about “Yellow Flags”
“Yellow flags” are risk factors associated with chronic pain or disability. They are subjective and have a significant psychosocial predominance. Examples include negative coping strategies, poor self-efficacy beliefs, fear-avoidance behavior, and distress. Whereas “red flags” require urgent attention, further testing and possibly specialist referral, “yellow flags” only require a shift in the focus of care. Psychological screening via history taking has low sensitivity and predictive value for identifying distressed patients, thus formal screening of some sort, such as with a questionnaire, is recommended.
You may want to check out the Outcome Assessment Page for more on this topic.


Do First Impressions Count? A Comparison of Subjective and Psychologic Assessment of Spinal Patients
Eur Spine J 1998;   7 (3):   218-223

Psychologic factors may have a major influence on the outcome of treatment for back pain. Psychologic disturbance is manifest as emotional distress and may be associated with inappropriate symptoms and signs. Few outcome studies describe the patient population in terms of their psychologic profile.


Randomised Clinical Trial of Manipulative Therapy and Physiotherapy for Persistent Back and Neck Complaints: Results of One Year Follow Up
British Medical Journal 1992 (Mar 7);   304 (6827):   601-605

Manipulative therapy and physiotherapy are better than general practitioner and placebo treatment. Furthermore, manipulative therapy is slightly better than physiotherapy after 12 months.


Sagittal Alignment of Cervical Flexion and Extension:
Lateral Radiographic Analysis

Spine 2002 (Aug 1);   27 (15):   E348-E355

There has been controversy over the impact of spinal structure and it's impact on function. This Spine Journal article found: “The results suggest that alterations in the static alignment of the cervical curvature cause alterations in the dynamic kinematics of the cervical spine during cervical flexion-extension.”


Manual Medicine Diversity:
Research Pitfalls and the Emerging Medical Paradigm

J Am Osteopath Assoc 2001 (Aug);   101 (8):   441-444 ~ FULL TEXT

Recent studies published in leading medical journals have concluded that chiropractic treatment is not particularly helpful for relieving asthma and migraine symptoms because even though study participants showed notable improvement in symptoms, those subjects who received sham manual medicine treatments also showed improvement. Yet the sham treatment received by control groups in these studies is reminiscent in many ways of traditional osteopathic manipulation. This seems to represent not only a failure to recognize the value of many manual medicine techniques but also an ignorance of the broad spectrum of manual medicine techniques used by various practitioners, from osteopathic physicians to chiropractors to physical therapists.
You may enjoy more articles like this at our Problem with Placebos Page in our Chiropractic Research Section.


Vitamins for Chronic Disease Prevention in Adults: Clinical Applications
JAMA 2002 (Jun 19);   287 (23):   3127-3129 ~ FULL TEXT

Reversing a long-standing anti-vitamin policy, the Journal of the American Medical Association just advised all adults to take at least one multivitamin pill each day. It now appears that people who get enough vitamins may be able to prevent such common chronic illnesses as cancer, heart disease and osteoporosis, according to Drs. Robert H. Fletcher and Kathleen M. Fairfield of Harvard University, who wrote the journal's new guidelines. The last time the journal prepared a comprehensive review of vitamins, about 20 years ago, it concluded that multivitamins were a waste of time and money. People could get all the nutrients they needed from their diet, it advised. Oh, the times they are 'a changing! There are many more articles like this in the NUTRITION Section.


Cervicogenic Hearing Loss
HNO 1994 (Oct);   42 (10):   604-613

Findings in 62 patients suffering from vertebragenic hearing disorders are reported before and after chiropractic management. Results indicate that these hearing disorders are reversible, as demonstrated by audiometry and OAE. The therapy of choice is chiropractic manipulation of the upper cervical spine. The commoness of vertebragenic hearing disorders emphasizes their clinical and forensic importance. You can review many other articles on chiropractic and Hearing Loss in the Research Section.


Placebo Surgery
Chiropractic Journal 2002; September

          Many scientists and clinicians consider the placebo-controlled trial the "gold standard" for evidence-based practice. Interestingly, surgical procedures are often exempt from such scrutiny. Ethical considerations are considered barriers to the use of placebo-controlled investigations for surgical procedures. [3,4] Interestingly, there have been five studies where placebo surgery was used as a control. The placebo group generally did as well or better than the group receiving the real operation.   You may enjoy more articles like this at the Problem with Placebos Page in our Chiropractic Research Section.


Chronic Spinal Pain Syndromes: A Clinical Pilot Trial Comparing Acupuncture, A Nonsteroidal Anti-inflammatory Drug, and Spinal Manipulation
J Manipulative Physiol Ther 1999 (July);   22 (6):   376-381

The consistency of the results provides, in spite of several discussed shortcomings of this pilot study, evidence that in patients with chronic spinal pain syndromes spinal manipulation, if not contraindicated, results in greater improvement than acupuncture and medicine.


Missed Cervical Spine Fracture-dislocations:
The Importance of Clinical and Radiographic Assessment

J Manipulative Physiol Ther 2002 (May);   25 (4):   263-269

Cervical spine fracture-dislocations are often missed during standard radiographic examinations in emergency department settings. Chiropractors are encouraged to perform a comprehensive evaluation of patients presenting with cervical trauma even if they have had prior x-ray films reported as normal.


Back and Neck Problems Among Dentists and Dental Auxiliaries
J Contemp Dent Pract 2001 (Aug 15);   2 (3):   17-30

In the practice of dentistry, stress, tension, and postural practices can contribute to back and neck problems. Two hundred and four dentists and dental auxiliary (87 males and 117 females) in Riyadh city, Saudi Arabia were surveyed to determine the prevalence of postural problems. The candidates were interviewed and observed during practice. The data obtained showed that 111 (54.4%) of the subjects complained of neck pain and 150 (73.5%) complained of back pain.


The New Palmer Center for Chiropractic Research Prepares to Open
On Saturday August 10, 2002 Senator Tom Harkin (IA) joined Palmer President Guy Riekeman, President of the Board Vicky Palmer, Chancellor Mike Crawford, and Research Vice-President Bill Meeker, D.C. for the ribbon-cutting ceremony at the newly renovated Palmer Center for Chiropractic Research. It is hoped that the Center will open for business on the Founder's Day on Sept 12,2002.


Trigon Blue Cross Blue Shield of Virginia Balks at Providing Evidence for its Lower Chiropractic Payments
ACA obtained a court order March 18 from the federal court in Abingdon, VA hearing ACA vs. Trigon that requires Trigon Blue Cross Blue Shield of Virginia to respond to specific questions about the manner in which it determines reimbursement rates for chiropractic services, and specifically to explain why the company pays doctors of chiropractic less than medical doctors for the same exact services.


Unsubstantiated Claims in Patient Brochures from the Largest State, Provincial, and National Chiropractic Associations and Research Agencies
J Manipulative Physiol Ther 2002 (Jun);   25 (5):   347 ~ FULL TEXT

What precisely, after all, is “scientific validation? ” With the goal of substantiating claims from any health care provider, it would be of interest to the authors to consult a recent assessment of the clinical guidelines for the management of low back pain developed in 11 countries. Here, one would expect that, given that the available scientific evidence is a fixed quantity, the guidelines should be similar, irrespective of their country of origin. In terms of such features as diagnostic triaging or the recognition of psychosocial factors in low back pain, they are. In terms of patient information, muscle relaxants, exercise therapy, or (most importantly for this discussion) spinal manipulation, however, major disparities exist. This would suggest that, despite the best of intentions, an absolute gold standard of scientific validation may not exist- although attempts to achieve this goal must not be discouraged.


Etiology of Foot Hyperpronation: Embryological Perspective
J Bodywork and Movement Ther 2002 (Jan);   6 (1):   37-46 ~ FULL TEXT

Thanks to Brian A Rothbart, D.P.M., Ph.D., FACFO and the editor of JBMT for letting us post this article exclusively on Chiro.Org!


Patient Satisfaction With the Chiropractic Clinical Encounter: Report From a Practice-based Research Program
Journal of the Neuromusculoskeletal System 2001:   9 (4):   109-117

Researchers examined aspects of clinical care in chiropractic practices and determined patient satisfaction with treatment. Nearly 3,000 adult patients reported that: 88% felt their DC always respected their opinion; 85% said their DC always listened to them carefully and explained treatment clearly: and that 76% felt their DC involved them in decisions "as much as they wanted" .


Clinical Guidelines for the Management of Low Back Pain in Primary Care: An International Comparison
SPINE 2001 (Nov 15);   26 (22):   2504-2513

Clinical guidelines from 11 different countries published from 1994 until 2000 were included in this review. The content of the guidelines appeared to be quite similar regarding the diagnostic classification (diagnostic triage) and the use of diagnostic and therapeutic interventions. You may review more articles like this in the LOW BACK PAIN Section and the LOWBACK GUIDELINES Section.


Patients Using Chiropractors in North America:
Who Are They, and Why Are They in Chiropractic Care?

SPINE (Phila Pa 1976) 2002;   27 (3) Feb 1:   291–298

The authors surveyed randomly sampled chiropractors (n = 131) at six study sites and systematically sampled chiropractic patients seeking care from participating chiropractors on 1 day (n = 1275). More than 70% of patients specified back and neck problems as their health problem for which they sought chiropractic care. Roland-Morris scores for chiropractic back pain patients were similar to values reported for medical back pain patients. The health attitudes and beliefs of chiropractors and their patients were similar. Patients were very satisfied with their care.


Chiropractic: A Profession at the Crossroads
of Mainstream and Alternative Medicine

Ann Intern Med 2002 (Feb 5);   136 (3):   216-227

Chiropractic is a large and well-established health care profession in the United States. In this overview, we briefly examine the development of chiropractic from humble and contentious beginnings to its current state at the crossroads of alternative and mainstream medicine.


Manipulative Therapy: Just a Placebo?
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.


The Role of the Chiropractic Adjustment in the Care and Treatment of 332 Children with Otitis Media
Jou Clin Chiro Ped 1997 (Oct);   2 (2)

To our knowledge this is the first time that tympanography has been used as an objectifying tool with respect to the efficacy of the chiropractic adjustment in the treatment of children with otitis media. In addition, the role of the occipital adjustment needs to be examined. This study begins the process of examining the role of the vertebral cranial subluxation complex in the pathogenesis of otitis media, and the efficacy of the chiropractic adjustment in its resolution.


Dr. Daniel Redwood: A Translator Of Ideas
“What we, as chiropractors and as members of this broader movement, have the potential to bring to people are not only our techniques, but our world view," he explains. "People are really hungry for that. To the degree that we can live it ourselves and share it with them, we - and they - will be the better for it. There’s great diversity within our profession, and I view that as strength. Each of us, through our experiences, our studies, and our deepest callings, are drawn to certain philosophies and certain methods.”


Five comments on the Mercy Guidelines for Chiropractic Quality Assurance of the Mercy Center Consensus Conference
There are three general disclaimers in the Mercy Guidelines. You need to be familiar with all of them.


Arnold Schwarzenegger Continues to Champion Chiropractic
Arnold Schwarzenegger has reaped the benefits of chiropractic treatment for many years, and gives credit to the care he received from DC Franco Columbu for helping him continue competition when he would have not been able to do so otherwise.


Utilization, Cost, and Effects of Chiropractic Care on Medicare Program Costs
This June 2001 study was commissioned by the ACA, and is the first study of its type to compare the global, per capita Medicare expenditures of chiropractic patients to those of non-chiropractic patients receiving care in the federal Medicare program.


The Use and Role of Sport Chiropractors in the National Football League:
A Short Report

J Manipulative Physiol Ther 2002;   25 (3) Mar-Apr:   E2

There is significant chiropractic participation in US professional football. Certified athletic trainers see a role for the sport chiropractor in the NFL, primarily as a spinal specialist treating low back and other musculoskeletal injuries. A substantial majority of NFL trainers have developed cooperative relationships with chiropractors, with 77% having referred a player to a chiropractor. Thirty-one percent of NFL teams have a chiropractor officially on staff, and an additional 12% of teams refer players to chiropractors but do not directly retain these chiropractors.


Chiropractic Research Retrospective
  George McClelland, D.C.

Thirty years ago, when I finished chiropractic college, chiropractic research was an oxymoron. In fact, research specific to spinal manipulative therapy, or more specifically chiropractic manipulative therapy/adjustment as performed by doctors of chiropractic, just didn’t exist. Since that time, this has changed dramatically-especially over the last 20 years. In fact, it was only 20 years ago this year that the first peer-reviewed, and subsequently indexed, scientific journal was developed in the chiropractic profession, now known as the Journal of Manipulative and Physiological Therapeutics (JMPT). Even 13 years ago, there was only this one scientific journal in the chiropractic profession. Today, there are more than 10 peer-reviewed scientific chiropractic journals in North America alone.


Chiropractic Care of a Patient with Vertebral Subluxations and Unsuccessful Surgery of the Cervical Spine
J Manipulative Physiol Ther 2001;   24 (7) Sept:   477-482

The chiropractic care of a patient with neck pain and left upper extremity radiculopathy after cervical diskectomy is presented. Marked resolution of the patient's symptoms was obtained concomitant with a reduction in subluxation findings at multiple levels despite the complicating history of an unsuccessful cervical spine surgery. This is the first report in the indexed literature of chiropractic care after an unsuccessful cervical spine surgery.


The Evolution of Chiropractic - Science & Theory
Scott Haldeman, D.C., M.D., Ph.D.

I have had the privilege of being associated with chiropractic and chiropractic ideas all of my life through my father and grandmother, both of whom were practicing chiropractors. I have also been lucky to have participated in one of the most exciting phases in the evolution of chiropractic over the past 35 years. I thought that it would be of interest to younger researchers and clinicians to present my views on how the profession has evolved to its current position in society and how this evolution has impacted our understanding of chiropractic. I plan to discuss how we can put the changes in the role of science over the past 100 years in perspective and how these changes are likely to impact our lives as researchers, chiropractors, and physicians studying and treating patients with spinal disorders.


The "White House Commission on Complementary and Alternative Medicine Policy" Info Page
NOTE:   This page has moved to the Alternative-Medicine Articles Section, which may be found on the CAM drop-down on our new tan toolbar, located at the top of each section's home page. Please update your links. This page is designed to keep you on top of the government's review of complementary/alternative practices (CAM), as well as collecting the testimony of selected speakers.


Do You Own Chiropractic?
This is the 27th year of the “modern era” of chiropractic. Why 27? It has now been that many years since the NINCDSa conference, “ The Research Status of Spinal Manipulative Therapy.” When this historic, federally funded conference officially opened, scientific investigations of spinal manipulation and chiropractic were strongly represented among its invited participants. In 1975, this event was equivalent to a face-off in hockey or the coin-toss in football. The game had begun...and has been no less brutal.


Chiropractic Can Celebrate - President Bush Signs the VA Bill
President Bush finally put pen to paper on the night of Jan. 23 to pass H.R. 3447, the Department of Veterans Affairs Health Care Programs Enhancement Act of 2001, a bill that includes a mandate to establish a permanent chiropractic benefit within the Department of Veterans Affairs (DVA) health care system.


Anterior T6 Subluxation Syndrome: Neurospinal Dysfunction within a Vertebral Subluxation Complex
Chiropr J Aust 2000;   30 (4) Dec:   127-137

This paper serves to examine the signs and symptoms associated with the subluxation of a particular vertebral segment at T6, as well as the characteristics of a distinct type of vertebral subluxation involving this segmental ( “ Anterior Thoracic Subluxation Complex ” or ATSC). The characteristic signs and symptoms associated with this segmental complex, particularly dyspepsia, have been designated the “ Anterior 7-6 Subluxation Syndrome ”.

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