J Manipulative Physiol Ther 1999 (May); 22 (4): 216–220 ~ FULL TEXT
Maxwell J. Walsh, BAppSc(Chiro), GradDipMuscMgt, DipEd,
Barbara I. Polus, PhD, BAppSc(Chiro)
Department of Chiropractic,
Osteopathy & Complementary Medicine,
RMIT, Melbourne, Australia
OBJECTIVE: As part of a randomized clinical trial to determine the efficacy of chiropractic therapy on premenstrual syndrome (PMS), subjects were evaluated for initial underlying spinal dysfunction.
SUBJECTS: Fifty-four subjects with diagnosed PMS (using a Moos PMS questionnaire plus daily symptom monitoring) and 30 subjects with no diagnosable PMS were recruited by newspaper advertising and referrals.
DESIGN: All subjects underwent a full history and physical and chiropractic examination carried out by 1 of 2 fully qualified and registered chiropractors, each with a minimum of 10 years experience. The results of the assessment for the PMS group were compared with those of the non-PMS group.
SETTING: RMIT teaching clinics.
DATA ANALYSIS: The data collected were entered into a spread sheet and contingency tables were created. The data were analyzed by use of chi-squared tests, with the statistical significance being set at P < .05.
RESULTS: The PMS group had a higher percentage of positive responses for each of 12 measured spinal dysfunction indexes except for range of motion of the low back. The indexes where the increase was statistically significant (P < .05) were cervical, thoracic, and low back tenderness, low back orthopedic testing, low back muscle weakness, and the neck disability index. An average of 5.4 of the 12 indexes were positive for the PMS group compared with 3.0 for the non-PMS group.
CONCLUSIONS: A relatively high incidence of spinal dysfunction exists in PMS sufferers compared with a comparable group of non-PMS sufferers. This is suggestive that spinal dysfunction could be a causative factor in PMS and that chiropractic manipulative therapy may offer an alternative therapeutic approach for PMS sufferers.
From the FULL TEXT Article
The PMS group had a high percentage of positive responses for each of the spinal clinical findings assessed. Also, the frequency of positive responses was higher in the PMS group than the non-PMS group, except for range of motion of the low back. The findings where the increase was statistically significant (P < .05) were cervical, thoracic, and low back tenderness, low back orthopedic testing, low back muscle weakness, and the NDI. An average of 5.4 of the 12 findings were positive for the PMS group compared with 3.0 for the non-PMS group.
Most studies indicate a low reliability of clinical tests.  Of the tests used, only spinal tenderness has some demonstrable reliability and validity. [23-25] Nonetheless, the tests used in this study would normally form part of a standard spinal examination done by most chiropractors in practice and are routinely taught in chiropractic colleges. These tests, among others, are used by chiropractors to identify regions of the spine where potential problems exist and to help locate areas where spinal manipulation would be given.
Thus it would appear that, in general, PMS sufferers are likely to have a high frequency of spinal clinical findings as measured by standard clinical examination procedures, and the level is higher than in a comparable group of women who do not suffer from PMS. We theorize that presence of positive spinal clinical findings could be an associated factor in PMS and that the correction of the underlying cause of the positive clinical findings, such as by chiropractic therapy, could reduce PMS symptoms. This warrants further investigation, and a clinical trial has recently been completed by us to assess the efficacy of chiropractic therapy on PMS.
Limitations of the study
In any study examining data on clinical testing, there is always the problem with examiners not performing the tests or interpreting the patient responses in an identical way. Strender et al  suggest that the apparent low reliability of clinical tests is due to more to “the absence of ‘standardization’ of clinical tests.” In this study only two examiners performed the tests, and all attempts were made to standardize procedures and interpretations. A major limitation when comparing the 2 groups is the lack of blinding of the examiners, thus introducing the possibility of examiner bias. The two disability questionnaires were completed by the subjects without examiner intervention and thus do not suffer from this bias to the same degree.
A number of positive spinal clinical findings exist in PMS sufferers, with the frequency of these tending to be higher than those observed in a comparable group of non-PMS sufferers. This is suggestive that the presence of positive spinal clinical findings may be an associated factor in PMS that warrants further investigation.
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