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 may access the Merck Manual. Or you may do your own search @ Pub Med.
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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”.
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 would say if, after 4 years, our profession had failed to improve it's skills in musculoskeletal assessment and management? Ask your self why medicine is shown more slack than we are?
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.
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. There are more articles like this in the 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. There are more articles like this in the 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.
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.
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.
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
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 1999 (Mar 24); 281 (12): 1110—1111, 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 Editorial ~ JAMA 1999 (Mar 24); 281 (12): 1129—1130 on this topic.
The Cost-effectiveness of Chiropractic
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
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 can review many other articles on the relationship between spinal adjusting/manipulation and the vertebral artery in the Stroke 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.
HIPAA Compliance Page
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): 326 (7395): 911.
Back, Neck, and Shoulder Pain in Finnish Adolescents:
National Cross Sectional Surveys
Brit Med Jou 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.
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.
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 Section for more information 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.
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.
Vitamins for Chronic Disease Prevention in Adults:
Clinical Applications
JAMA 2002 (June 19); 287 (23): 3127-3129 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.
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" .
Patients Using Chiropractors in North America:
Who Are They, and Why Are They in Chiropractic Care?
SPINE 2002 (Feb 1); 27 (3): 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.”
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 ”.
Alternative-Medicine Articles in all Recent Journals – Collected NOTE: The Alternative Healing Articles/Abstracts Section has moved, and 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 as needed. Many NEW additions! Review the new British
Complementary Medicine recommendations. Check out a wide variety of articles on the growing popularity of Alt–med
in America. Also, check out the 1993 NEJM article, by David M. Eisenberg, which first generated all the "medical" interest in alternative forms of care.
The Chiropractic Research Page NOTE: The Chiropractic Research Section has moved, and may be found on the
RESEARCH drop-down on our new tan toolbar, located at the top of each section's home page. Please update your links as needed. This section showcases articles, abstracts, grant proposals and information pertaining to the ever-growing body of Chiropractic Research. Please feel free to contribute!
The DOCUMENTATION Section NOTE: The Documentation Section has moved, and may be found on the
CHIROPRACTIC TOOLS drop-down on our new tan toolbar, located at the top of each section's home page. Please update your links as needed. This new Section is devoted to a full description of what is considered "complete" patient file documentation, as described by National Associations and Third party Payors. It is the intention of this page to inform our profession about the most efficient means of communicating patient information, as well as outlining what is considered an "adequate" presentation. It is not the intention of this Documentation section to create standards –– just to clarify them.
Chiropractic Integration or Isolation: What Price?
Robert Mootz, D.C.
Despite all of the advances and inroads our profession has made, we remain outsiders in many ways, particularly in the world of conventional health care. In the past, this was due in great measure to the ostracism of organized medicine. Today, I suspect it is primarily our own fear of success and all it might entail. As a profession, we want the accolades and rewards that mainstream recognition has to offer, but often seem to shun the responsibilities, competition, and additional work required to achieve it.
Chiropractic Use of Glucosamine Sulfate in the Treatment of Osteoarthritis
J Manipulative Physiol Ther 1997; 20(6); 400-404
The rationales for using NSAIDs in the treatment of osteoarthritis is controversial and openly contested. Given the detrimental effects of NSAIDs on joints and other organs, their use should be discouraged and their classification as a first choice conservative treatment should be abolished. (emphasis added) A truly effective and conservative approach to the treatment of osteoarthritis should include chiropractic manipulation, essential nutrient supplementation, exogenous administration of glucosamine sulfate and rehabilitative stretches and exercises to maintain joint function.
Single-blind Randomised Controlled Trial of Chemonucleolysis and Manipulation in the Treatment of Symptomatic Lumbar Disc Herniation
European Spine Journal 2000; 9 (3): 202–207
Crude cost analysis suggested an overall financial advantage from manipulation. Because manipulation produced a 12-month outcome that was equivalent to chemonucleolysis, it can be considered as an option for the treatment of symptomatic lumbar disc herniation, at least in the absence of clear indications for surgery. Further study into the value of manipulation at a more acute stage is warranted.
The House Approves Chiropractic Care to Veterans in All VA Medical Centers
The Department of Veterans' Affairs (DVA) has been dragging its feet for a number of years on incorporating chiropractic within its medical centers. On Oct. 16, 2001, the 31-member House Veterans' Affairs Committee, chaired by Christopher Smith (R-NJ), acted. It approved, with only one dissenting vote, legislation (H.R. 2792) to mandate chiropractic benefits in the Department of Veterans Affairs (DVA), and placed it on the House calendar for consideration.
Mid-Thoracic Dysfunction: A Key Perpetuating Factor of Pain in the Locomotor System
Mid-thoracic dysfunction involves increased kyphosis of the thoracic spine from T4-T8, usually the result of prolonged sitting in a constrained posture. Thoracic, lumbopelvic and cervicocranial posture are interrelated as links in a chain (see Figure 1). When excessive slumping becomes habitual, according to Brügger, it is called the sternosymphyseal syndrome.
Upper Cervical Chiropractic Management of a Multiple Sclerosis Patient: A Case Report
Journal of Vertebral Subluxation Research 2001; 4 (2) May
This case report revealed that this specific upper cervical procedure (thermal imaging, cervical radiographs, and knee-chest adjustments) was associated with a successful outcome for a patient with Multiple Sclerosis. Post MRI’s, post thermographic scans, and the patient’s neurologist’s evaluation all suggested the intervention of upper cervical chiropractic care may have stimulated a reversal in the progression of Multiple Sclerosis.
Chiropractic Care in Pregnancy for Safer, Easier Births
Jeanne Ohm, D.C.
Another important reason for chiropractic care throughout pregnancy is to help establish balance in the mother’s pelvis. Because of a lifetime of stress and trauma to her spine and pelvis, her pelvic opening may be compromised, resulting in a less than optimum passage for the baby. Williams Obstetrics Text tells us that, "Any contraction of the pelvic diameters that diminish the capacity of the pelvis can create dystocia (difficulty) during labor." You can find more articles like this in the Pediatric Section.
Models of Vertebral Subluxation: A Review
Journal of Vertebral Subluxation Research 1996; 1 (1): 1–6
Enjoy this Adobe Acrobat file (59 KB) from the first issue of JVSR, a review of clinical models of the vertebral subluxation, including neurobiological mechanisms. Models reviewed include the subluxation complex model, subluxation degeneration, nerve compression, dysafferentation, the neurodystrophic model and segmental facilitation. Clinical models, including the segmental, postural, and tonal approaches are discussed. You may also want to review our Subluxation Articles Section.
What's in a Name? The Labelling of Back Pain
Medl Journal of Australia 2000; 173 (16 Oct): 400 –1 ~ FULL TEXT
Diagnostic labels are important in the management of patients. Patients expect a name for their condition. A label shows that the doctor knows what is wrong. But such labels should not be incorrect or specious, lest they lead to therapeutic misadventure.
