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 By Frank M. Painter, D.C. in Chiropractic Care on November 17th, 2012 at 11:17 pm
The Association of Complementary and Alternative Medicine Use and Health Care Expenditures for Back and Neck Problems
The Chiro.Org Blog
SOURCE: Med Care. 2012 (Dec); 50 (12): 1029–1036
The Geisel School of Medicine at Dartmouth & Dartmouth-Hitchcock Medical Center, Department of Orthopaedics, Lebanon, NH
BACKGROUND: Health care costs associated with use of complementary and alternative medicine (CAM) by patients with spine problems have not been studied in a national sample.
OBJECTIVES: To estimate the total and spine-specific medical expenditures among CAM and non-CAM users
with spine problems.
RESEARCH DESIGN: Analysis of the 2002-2008 Medical Expenditure Panel Survey.
SUBJECTS: Adults (above 17 y) with self-reported neck and back problems who did or did not use CAM services.
MEASURES: Survey-weighted generalized linear regression and propensity matching to examine penditure differences between CAM users and non-CAM users while controlling for patient, socioeconomic, and health characteristics.
RESULTS: A total of 12,036 respondents with spine problems were included, including 4306 (35.8%) CAM users (40.8% in weighted sample). CAM users had significantly better self-reported health, education, and comorbidity compared with non-CAM users.
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By Frank M. Painter, D.C. in Chiropractic Care on November 15th, 2012 at 9:31 pm
Orthopedic and Neurologic Procedures in Chiropractic
The Chiro.Org Blog
We would all like to thank Dr. Richard C. Schafer, DC, PhD, FICC for his lifetime commitment to the profession. In the future we will continue to add materials from RC’s copyrighted books for your use.
This is Chapter 3 from RC’s best-selling book:
“Basic Chiropractic Procedural Manual”
These materials are provided as a service to our profession. There is no charge for individuals to copy and file these materials. However, they cannot be sold or used in any group or commercial venture without written permission from ACAPress.
Chapter 3: Orthopedic and Neurologic Procedures in Chiropractic
This chapter presents the general diagnostic methods currently used in differential diagnosis of selected orthopedic and neurologic conditions.
SELECTED NEUROLOGIC PROBLEMS
Overview
The typical patient presents the challenge of differential diagnosis of a number of neurologic conditions. These range from a variety of peripheral neuritides that may be completely reversible to serious degenerations of the central nervous system.
The tendency of the geriatric patient to develop neurologic problems is often related to the aging process: loss of tissue elasticity, particularly that of the musculoskeletal system. This is manifested by greater rigidity of the spinal column with the appearance of fixation subluxations. These, together with dehydration and subsequent thinning of the intervertebral discs, predispose to radiculitis, neuritis, and vasomotor disturbances and metabolic effects on the cord and brain. The neurologic disturbances can be superimposed on already degenerating arteriosclerotic vessels and alter metabolism of the gastrointestinal and other systems, which may cause serious problems unless recognized early and prompt corrective measures are administered.
Types of Neuritides
Peripheral Neuritis
Peripheral neuritis is a general peripheral neuritis such as that which may be present in such disorders as diabetes, anemia, and vitamin deficiency. Diminution of all sensation will be noted, with proprioception affected most. A stocking distribution with an ill-defined border is commonly witnessed. Glove distribution may appear later, along with paresthesias in the distal areas of sensory distribution. The clinical picture does not conform to either dermatome or nerve patterns of distribution. The cause for this is unknown.
Local Neuritis
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By Frank M. Painter, D.C. in Chiropractic Care on November 11th, 2012 at 4:57 pm
Conservative Management of a 31 Year Old Male With Left Sided Low Back and Leg Pain: A Case Report
The Chiro.Org Blog
SOURCE: J Can Chiropr Assoc. 2012 (Sep); 56 (3): 225-232
Emily R. Howell, BPHE(Hons), DC, FCCPOR(C)
Ashbridge’s Health Centre, 1522 Queen St. East, Toronto, ON M4L 1E3. dremilyhowell@hotmail.com
OBJECTIVE: This case study reported the conservative management of a patient presenting with left sided low back and leg pain diagnosed as a left sided L5-S1 disc prolapse/herniation.
CLINICAL FEATURES: A 31-year-old male recreational worker presented with left sided low back and leg pain for the previous 3-4 months that was exacerbated by prolonged sitting.
INTERVENTION AND OUTCOME: The plan of management included interferential current, soft tissue trigger point and myofascial therapy, lateral recumbent manual low velocity, low amplitude traction mobilizations and pelvic blocking as necessary. Home care included heat, icing, neural mobilizations, repeated extension exercises, stretching, core muscle strengthening, as well as the avoidance of prolonged sitting and using a low back support in his work chair. The patient responded well after the first visit and his leg and back pain were almost completely resolved by the third visit.
SUMMARY: Conservative chiropractic care appears to reduce pain and improve mobility in this case of a L5-S1 disc herniation. Active rehabilitative treatment strategies are recommended before surgical referral.
Recent Studies Have Also Shown That:
Back Surgery Fails 74% of the Time
From the FULL TEXT Article
Introduction:
Low back pain has been reported as the chief complaint for 23.6% of patients presenting to chiropractic offices. [1] Disc herniations that lead to nerve-root compromise account for less than 15% of chronic low back pain cases. [2] Over 95% of lumbar disc herniations occur at L4–5 or L5-S1 levels, and only 2% of herniations require surgery, 4% have compression fractures, 0.7% have spinal malignant neoplasms, 0.3% have ankylosing spondylitis and 0.1% have spinal infections. [2, 3]
Leg pain is estimated to be found in 25–57% of all low back pain cases and accounts for large costs, disability, chronicity and severity. [4, 5, 6] Many conservative treatments have been shown to be effective in the management of this condition and are favorable to pursue before considering any surgical interventions, such as: modalities, soft tissue therapy, spinal manipulations or mobilizations, pelvic blocking, McKenzie/end-range loading exercises, lumbar stabilization exercises and neural mobilizations, patient education, reassurance, short-term use of acetaminophen, and nonsteroidal antiinflammatory drugs. [2, 3, 7–24] The purpose of this case report is to describe the successful management of a patient with low back and leg pain.
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By Frank M. Painter, D.C. in Chiropractic Care on November 10th, 2012 at 12:03 pm
Introduction to Chiropractic Physiologic Therapeutics
The Chiro.Org Blog
We would all like to thank Dr. Richard C. Schafer, DC, PhD, FICC for his lifetime commitment to the profession. In the future we will continue to add materials from RC’s copyrighted books for your use.
This is Chapter 10 from RC’s best-selling book:
“Basic Chiropractic Procedural Manual”
These materials are provided as a service to our profession. There is no charge for individuals to copy and file these materials. However, they cannot be sold or used in any group or commercial venture without written permission from ACAPress.
Chapter 10: Introduction to Chiropractic Physiologic Therapeutics
The use of physiotherapy and physical therapy to enhance the effects of the chiropractic adjustment in treatment can be significant in many cases. Superficial heat, diathermy, cold, microwaves, ultrasound, ultraviolet rays, galvanic and sinusoidal currents, traction, hydrotherapy, or therapeutic massage and exercise are among the therapies that may benefit the patient when properly applied. These procedures may help to reduce stiffness in joints, relieve tension, relax muscle spasm, and offer many other physiologic benefits.
Special precautions, however, must be observed when treating patients of advanced age. Special consideration must also be given to indications and contraindications, patient sensitivity, intensity, and duration of treatment.
Special caution must be used with patients that have heart and blood pressure problems, renal failure, diminished sensation or circulation, or an inability to tolerate heat or cold. For example, patients with Raynaud’s disease do not tolerate cold. Patients with other circulatory problems do not tolerate thermotherapy because they have less ability to dissipate the heat. Patients with a distinct loss of sensation will not realize if an area is being overheated or even being burned.
A patient’s tolerance cannot be the only guide to intensities and duration of treatment. Frequent checking, both visually for redness and by palpation to determine over heating, must be done during the treatment period. Reasonable examination, monitoring, and care by the doctor can avoid problems in most instances.
INTRODUCTION
Physiotherapy techniques are frequently used preparatory to the chiropractic adjustment to improve function, relieve spasm, minimize pain, and enhance circulation and drainage. They are often used before primary care to relax the patient and condition tissues, and posttherapy to relive pain and prevent deformities resulting from trauma or disease and to maintain what has been gained in treatment. There are also times when it may be considered primary therapy. Rehabilitation objectives are shown in Table 10.1.
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By John in Chiropractic Care on November 9th, 2012 at 4:08 pm
Sources Foundation for Chiropractic Progress, Cancer Treatment Centers of America
Cancer Treatment Centers of America (CTCA), a national network of hospitals focusing on complex and advanced stage cancer and known for their comprehensive, fully integrated approach to cancer treatment, opened CTCA at Southeastern Regional Medical Center (Southeastern) in Newnan, Georgia with licensed chiropractors offering chiropractic services to all patients. As at CTCA at Southeastern and the other four CTCA hospitals located in Chicago, Philadelphia, Phoenix and Tulsa, chiropractic services are available to all patients as part of the Patient Empowered Care model, where each member of the integrated team comes to the patient – all part of what they call the Mother Standard of care.
Dr. James Rosenberg, National Director of Chiropractic Care at CTCA, encourages patients to make chiropractic care part of their treatment plan.
He says, “Chiropractic care is one of the most commonly practiced and widely accepted therapies utilized today. And at CTCA, it’s a piece of the puzzle. It’s another way in which we’re taking care of the body as a whole.”
“Chiropractic care at CTCA is an important piece to the integrated healthcare approach by providing patients with an evidence-based, low risk approach to care,” shares Dr. Rosenberg, happily interjecting that all CTCA chiropractors currently have a patient waiting list. “A steadfast commitment to excellence continues to fuel the demand for our services.”
See also Chiropractic in an Integrative Cancer Center
By Frank M. Painter, D.C. in Chiropractic Care on October 10th, 2012 at 2:12 pm
The Treatment Experience of Patients With Low Back Pain During Pregnancy
The Chiro.Org Blog
Chiropractic & Manual Therapies 2012 (Oct 9)
Shabnam Sadr, Neda Pourkiani-Allah-Abad and Kent Jason Stuber
Canadian Memorial Chiropractic College, 6100 Leslie Street, Toronto, Ontario M2H 3 J1, Canada
Background Chiropractors regularly treat pregnant patients for low back pain during their pregnancy. An increasing amount of literature on this topic supports this form of treatment; however the experience of the pregnant patient with low back pain and their chiropractor has not yet been explored. The objective of this study is to explore the experience of chiropractic treatment for pregnant women with low back pain, and their chiropractors.
Methods This qualitative study employed semi-structured interviews of pregnant patients in their second or third trimester, with low back pain during their pregnancy, and their treating chiropractors in separate interviews. Participants consisted of 11 patients and 12 chiropractors. The interviews consisted of 10 open-ended questions for patients, and eight open-ended questions for chiropractors, asking about their treatment experience or impressions of treating pregnant patients with LBP, respectively. All interviews were audio-recorded, transcribed verbatim, and reviewed independently by the investigators to develop codes, super-codes and themes. Thematic saturation was reached after the eleventh chiropractor and ninth patient interviews. All interviews were analyzed using the qualitative analysis software N-Vivo 9.
Results Five themes emerged out of the chiropractor and patient interviews. The themes consisted of Treatment and Effectiveness; Chiropractor-Patient Communication; Pregnant Patient Presentation and the Chiropractic Approach to Pregnancy Care; Safety Considerations; and Self-Care.
Conclusions Chiropractors approach pregnant patients with low back pain from a patient-centered standpoint, and the pregnant patients interviewed in this study who sought chiropractic care appeared to find this approach helpful for managing their back pain symptoms.
You may also enjoy our:
Pregnancy and Chiropractic Page
From the Full-Text Article:
Background:
Low back pain (LBP) during pregnancy is reported by approximately 50% to 80% of pregnant women [1-3]. The structural, postural, or hormonal changes that occur during pregnancy, or any combination thereof, may lead to LBP during pregnancy [3]. Treatment options include a range of therapies, such as exercise programs, massage therapy, acupuncture, and chiropractic [4, 5]. Chiropractic care may include spinal manipulative therapy (SMT), mobilizations and soft tissue therapy, as well as exercise prescription. [3] Previous studies and systematic reviews of the literature have indicated the relative safety and effectiveness of chiropractic treatment for LBP during pregnancy. [3, 5, 7]
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By Frank M. Painter, D.C. in Chiropractic Care on September 30th, 2012 at 4:39 pm
The Subluxation – Historical Perspectives Part II
The Chiro.Org Blog
SOURCE: Chiropractic Journal of Australia 2009 (Dec); 39 (4): 143–150
Rolf E. Peters, DC, MCSc, FICC, FACC, FPAC
Editor Chiropractic Journal of Australia
Thanks to Dr. Rolf Peters, editor of the Chiropractic Journal of Australia for permission to republish this Full Text article, exclusively at Chiro.Org!
Subluxation is a term that has been used by the chiropractic profession since its early days. The term, meaning less than a luxation, has been used for millennia, similarly so has manipulation been the preferred intervention to overcome this problem.
This paper reviews some of the early uses of subluxation and manipulation identifying highlights, to help the reader appreciate that subluxation and manipulation, both spinal and general, are as old as civilisation itself.
INDEX TERMS: (MeSH) CHIROPRACTIC; MANIPULATION, CHIROPRACTIC; HISTORY OF MEDICINE; HISTORICAL ARTICLE. (Other): SUBLUXATION.
Introduction
D.D. Palmer stated that he manipulated the spine of Harvey Lillard on 18 September 1895 and restored his hearing after 17 years of deafness, and shortly thereafter gave immediate relief in a case of heart trouble. [ 1] With the advice of a patient, the Reverend Samuel Weed, they coined the word Chiropractic from the Greek words chiro and praxis, meaning done by hand on 14 January 1896. [ 2]
In 1905 D.D., with reference to himself in the third person, stated that
…he does not, nor ever has claimed that vertebrae may be displaced and replaced. He, however, is the first to draw the attention of the public to the difference between a complete luxation known to the medical world as such, and a subluxation as known to the chiropractor as a displacement of the articular processes.
He was the first to write lengthy articles, setting forth that 90 to 95 per cent of all diseases were caused by subluxation of vertebrae, and today no other person has placed such statements in the hands of the public unless copied from those written by D.D. Palmer
He was the first person to adjust, replace vertebrae by the unique method known as Chiropractic, using the spinous and transverse processes as handles.[3] (Emphasis added)
But, what are the facts?
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By Frank M. Painter, D.C. in Chiropractic Care on September 27th, 2012 at 1:17 pm
The Placebo, the Sensory Trick and Chiropractic
The Chiro.Org Blog
Chiropractic J. Australia 2004 (Jun); 34 (2): 58–62
Brian S. Budgell, DC, MSc
School of Health Sciences, Faculty of Medicine, Kyoto University, Kyoto, Japan
Thanks to Dr. Brian S. Budgell and Dr. Rolf Peters, editor of the Chiropractic Journal of Australia for permission to republish this Full Text article, exclusively at Chiro.Org!
Background: As standards for randomised, controlled, clinical trials in medicine evolve, there is debate about whether the RCT model of investigation is appropriate for chiropractic and other forms of so-called “complementary and alternative medicine.” There may be some question as to whether the use of placebo interventions can be justified ethically and scientifically given that experimental treatments must eventually compete in a marketplace where there is often already a clinical alternative which is more effective than placebo. Beyond these concerns, design of an appropriate placebo for chiropractic trials is particularly problematic since the therapeutic component of overall chiropractic treatment may be difficult to isolate.
Objective: To compare placebo interventions in current use in chiropractic clinical research with simple somatic stimuli that produce significant physiological effects in a selected group of patients (those suffering from dystonia).
Methods: A literature search was made using MEDLINE, with the key words dystonia, sensory trick and geste antagoniste. Articles were reviewed for descriptions of these stimuli. The stimuli were compared, in terms of site and modality, with placebo interventions used in recent chiropractic clinical trials.
Results: Stimuli used as placebo procedures in recent chiropractic clinical trials are quite similar, in terms of site and modality, to the “sensory tricks” that either cause substantial temporary relief, or, alternatively, provocation of symptoms in dystonic patients.
Conclusions: Caution should be used in assuming that control (placebo) procedures used in chiropractic clinical trials—procedures that involve physical contact or positioning of patients—lack specific effects on neuromusculoskeletal symptomatology.
INDEX TERMS: (MeSH) PLACEBO, SENSORY TRICK, GESTE ANTAGONISTE, CHIROPRACTIC
INTRODUCTION:
In common parlance, the placebo may be thought of as a sham treatment given to placate the gullible or troublesome patient. In medical practice, it is more often thought of as medication, most often a pill, which has no specific action against the complaint for which it is prescribed. More recently, standards for design of clinical research have demanded more rigorous definition of what has been called “the imaginary term in medicine’s algebraic formula.” [1]
For purposes of pharmacological research, it is possible to select placebo substances that appear, with a very high level of probability, to be physiologically inert in humans, or at least to have no specific action against a disorder that is the target of investigation. Nonetheless, various studies have indicated that such supposedly inert substances may be associated with impressive levels of therapeutic effects, sometimes rivalling the medications, which are known to have specific pharmacological effects. [2]
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By Frank M. Painter, D.C. in Chiropractic Care on September 17th, 2012 at 12:46 pm
Diagnosis and Management of Piriformis Syndrome
The Chiro.Org Blog
SOURCE: J Am Osteopath Assoc. 2008 (Nov); 108 (11): 657-664 ~ FULL TEXT
Lori A. Boyajian-O’Neill, DO, Rance L. McClain, DO, Michele K. Coleman, DO, Pamela P. Thomas, PhD
Department of Family Medicine, Kansas City University of Medicine, Biosciences College of Osteopathic Medicine, 1750 Independence Ave, SEP 358, Kansas City, MO 64106-145, USA.
Piriformis syndrome is a neuromuscular condition characterized by hip and buttock pain. This syndrome is often overlooked in clinical settings because its presentation may be similar to that of lumbar radiculopathy, primary sacral dysfunction, or innominate dysfunction. The ability to recognize piriformis syndrome requires an understanding of the structure and function of the piriformis muscle and its relationship to the sciatic nerve. The authors review the anatomic and clinical features of this condition, summarizing the osteopathic medical approach to diagnosis and management. A holistic approach to diagnosis requires a thorough neurologic history and physical assessment of the patient based on the pathologic characteristics of piriformis syndrome. The authors note that several nonpharmacologic therapies, including osteopathic manipulative treatment, can be used alone or in conjunction with pharmacotherapeutic options in the management of piriformis syndrome.
From the Full-Text Article:
Epidemiologic Considerations
Piriformis syndrome occurs most frequently during the fourth and fifth decades of life and affects individuals of all occupations and activity levels. [7-12] Reported incidence rates for piriformis syndrome among patients with low back pain vary widely, from 5% to 36%. [3, 4, 11] Piriformis syndrome is more common in women than men, possibly because of biomechanics associated with the wider quadriceps femoris muscle angle (ie, “Q angle”) in the os coxae (pelvis) of women. [3]
Difficulties arise in accurately determining the true prevalence of piriformis syndrome because it is frequently confused with other conditions.
Anatomic Characteristics
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By Frank M. Painter, D.C. in Chiropractic Care on September 13th, 2012 at 9:45 pm
Chiropractic Management of a US Army Veteran With Low Back Pain and Piriformis Syndrome
The Chiro.Org Blog
SOURCE: J Chiropr Med. 2012 (Mar); 11 (1): 24-9
Cynthia Chapmana, and Barclay W. Bakkum
Chiropractor, Private Practice, Occoquan Family Chiropractic, PLLC, Occoquan, VA 22125
OBJECTIVE: The purpose of this article is to present the case of a patient with an anatomical anomaly of the piriformis muscle who had a piriformis syndrome and was managed with chiropractic care.
CASE REPORT: A 32-year-old male patient presented to a chiropractic clinic with a chief complaint of low back pain that radiated into his right buttock, right posterior thigh, and right posterior calf. The complaint began 5 years prior as a result of injuries during Airborne School in the US Army resulting in a 60% disability rating from the Veterans Administration. Magnetic resonance imaging demonstrated a mildly decreased intradiscal T2 signal with shallow central subligamentous disk displacement and low-grade facet arthropathy at L5/S1, a hypolordotic lumbar curvature, and accessory superior bundles of the right piriformis muscle without morphologic magnetic resonance imaging evidence of piriformis syndrome.
INTERVENTION AND OUTCOME: Chiropractic treatment included lumbar and sacral spinal manipulation with soft tissue massage to associated musculature and home exercise recommendations. Variations from routine care included proprioceptive neuromuscular facilitation stretches, electric muscle stimulation, acupressure point stimulation, Sacro Occipital Technique pelvic blocking, CranioSacral therapy, and an ergonomic evaluation.
CONCLUSION: A patient with a piriformis anomaly with symptoms of low back pain and piriformis syndrome responded positively to conservative chiropractic care, although the underlying cause of the piriformis syndrome remained.
The Full-Text Article:
Introduction
Piriformis syndrome is an uncommon cause of low back pain and sciatica that results from entrapment and/or irritation of the sciatic nerve in the region of the greater sciatic foramen. [1-4] Although no definitive causative factors are known for this syndrome, the usual source is thought to be an abnormal condition of the piriformis muscle. A common basis of the problem appears to be trauma to the piriformis muscle that results in spasm, edema, and contracture of the muscle, which can cause subsequent compression and entrapment of the sciatic nerve. [2] Other possible etiologies include reflex spasm of the piriformis muscle and an abnormal course of the sciatic nerve through the piriformis muscle. Altered biomechanics of the lower limb, low back, and pelvic regions can lead to stretching and shortening of the piriformis muscle, which can also lead to piriformis syndrome. Although, in 1928, Yeoman [5] first described the clinical picture of what would later be called piriformis syndrome, this diagnosis still remains somewhat controversial. This controversy stems from several factors that include variable and sometimes unclear cause, similarity to other more easily recognizable causes of sciatica, lack of consistent objective diagnostic findings, and relative rarity. Piriformis syndrome had been thought to be a purely clinical diagnosis; but more recently, magnetic resonance imaging (MRI) has begun to be used to help with the diagnosis of this problem. [6]
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By Frank M. Painter, D.C. in Chiropractic Care on September 8th, 2012 at 4:44 pm
When Research Challenges Our Assumptions
The Chiro.Org Blog
SOURCE: ACA News ~ Sept 2012
By Daniel Redwood
When new research, research reviews or practice guidelines support our current beliefs and practices, enthusiasm comes easily. When the 2007 medical practice guidelines on low back pain (LBP) jointly prepared by the American Pain Society and the American College of Physicians recognized spinal manipulation as the only non-pharmacologic method providing “proven benefits” for acute LBP and as one of several methods (including exercise, rehabilitation, acupuncture and yoga) proven effective for chronic LBP, the American Chiropractic Association and doctors of chiropractic (DCs) everywhere welcomed this as a long-overdue recognition of the value of our primary treatment methods.
But when research challenges our assumptions, our responses are understandably mixed. Such findings, if confirmed in multiple studies, may create pressure to change our practice patterns or threaten reimbursement from insurance companies. Like members of other health professions, DCs do not find such developments pleasant. How we and members of other health professions respond to such research says a great deal about who we are, how fully we practice what we preach, and the depth of our commitment to providing the best possible care to our patients.
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By Frank M. Painter, D.C. in Chiropractic Care on August 25th, 2012 at 1:09 pm
Predictors of Outcome in Neck Pain Patients Undergoing Chiropractic Care: Comparison of Acute and Chronic Patients
The Chiro.Org Blog
SOURCE: Chiropractic & Manual Therapies 2012 (Aug 24); 20 (1): 27 ~ FULL TEXT
Cynthia K Peterson, Jennifer Bolton, B. Kim Humphreys
University of Zürich and Orthopaedic University Hospital Balgrist, Forchstrasse 340, 8008 Zürich, Switzerland
Background Neck pain is a common complaint in patients presenting for chiropractic treatment. The few studies on predictors for improvement in patients while undergoing treatment identify duration of symptoms, neck stiffness and number of previous episodes as the strong predictor variables. The purpose of this study is to continue the research for predictors of a positive outcome in neck pain patients undergoing chiropractic treatment.
Methods Acute (< 4 weeks) (n = 274) and chronic (> 3 months) (n = 255) neck pain patients with no chiropractic or manual therapy in the prior 3 months were included. Patients completed the numerical pain rating scale (NRS) and Bournemouth questionnaire (BQ) at baseline prior to treatment. At 1 week, 1 month and 3 months after start of treatment the NRS and BQ were completed along with the Patient Global Impression of Change (PGIC) scale. Demographic information was provided by the clinician. Improvement at each of the follow up points was categorized using the PGIC. Multivariate regression analyses were done to determine significant independent predictors of improvement.
Results Baseline mean neck pain and total disability scores were significantly (p < 0.001and p < 0.008 respectively) higher in acute patients. Both groups reported significant improvement at all data collection time points, but was significantly larger for acute patients. The PGIC score at 1 week (OR = 3.35, 95% CI = 1.13-9.92) and the baseline to 1 month BQ total change score (OR = 1.07, 95% CI = 1.03-1.11) were identified as independent predictors of improvement at 3 months for acute patients. Chronic patients who reported improvement on the PGIC at 1 month were more likely to be improved at 3 months (OR = 6.04, 95% CI = 2.76-13.69). The presence of cervical radiculopathy or dizziness was not predictive of a negative outcome in these patients.
CONCLUSIONS: The most consistent predictor of clinically relevant improvement at both 1 and 3 months after the start of chiropractic treatment for both acute and chronic patients is if they report improvement early in the course of treatment. The co-existence of either radiculopathy or dizziness however do not imply poorer prognosis in these patients.
There are many more articles like this at our:
Chronic Neck Pain and Chiropractic Page
From the FULL TEXT Article:
Background
Patients suffering from neck pain are second only to low back pain patients in terms of the frequency of presentation for chiropractic treatment [1-4]. For many of these patients the precise diagnosis is difficult to ascertain and thus becomes labeled ‘non-specific’ neck pain or neck pain from mechanical dysfunction [1,3-5]. Research evidence has yet to determine with clarity whether spinal manipulative therapy (SMT) or mobilization of the neck is the superior treatment for these patients [1-9] although it appears that both of these treatments have better outcomes when combined with exercise [5,10].
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By Frank M. Painter, D.C. in Chiropractic Care on August 14th, 2012 at 12:53 pm
Value of Chiropractic Services at an On-site Health Center
The Chiro.Org Blog
SOURCE: J Occup Environ Med. 2012 (Aug); 54 (8): 917-921 ~ FULL TEXT
Curt A. Krause, DC; Lisa Kaspin, PhD; Kathleen M. Gorman, MPH; Ross M. Miller, MD, MPH
From the Cerner Healthe Clinic (Dr Krause), Kansas City, MO; Cerner LifeSciences Consulting (Dr Kaspinand and Ms Gorman), Beverly Hills, CA; and Cerner Employer Services (Dr Miller), Cerner Corporation, Beverly Hills, CA.
OBJECTIVE: Chiropractic care offered at an on-site health center could reduce the economic and clinical burden of musculoskeletal conditions.
METHODS: A retrospective claims analysis and clinical evaluation were performed to assess the influence of on-site chiropractic services on health care utilization and outcomes.
RESULTS: Patients treated off-site were significantly more likely to have physical therapy (P < 0.0001) and outpatient visits (P < 0.0001). In addition, the average total number of health care visits, radiology procedures, and musculoskeletal medication use per patient with each event were significantly higher for the off-site group (all P < 0.0001). Last, headache, neck pain, and low back pain-functional status improved significantly (all P < 0.0001).
CONCLUSIONS: These results suggest that chiropractic services offered at on-site health centers may promote lower utilization of certain health care services, while improving musculoskeletal function.
There are numerous similar studies in our:
Cost-Effectiveness of Chiropractic Page
From the FULL TEXT Article:
Discussion
Although previous research has demonstrated the benefits of chiropractic care, to the best of our knowledge this study is the first to evaluate its impact when offered at an on-site health center. [6–10, 14–17] Given the convenience and quality of care provided by on-site health centers, it was hypothesized that on-site chiropractic care would be more beneficial than off-site clinic care. Despite some limitations that may have weakened the conclusions, the findings suggest on-site chiropractic services are associated with lower health care utilization of certain services and improved functional status of musculoskeletal conditions.
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By Frank M. Painter, D.C. in Chiropractic Care on August 11th, 2012 at 12:51 pm
The Nordic Maintenance Care Program: Maintenance Care -
What Happens During the Consultation? Observations and Patient Questionnaires
The Chiro.Org Blog
Chiropractic & Manual Therapies 2012 (Aug 10); 20 (1): 25
Marita Bringsli, Aurora Berntzen, Dorthe B Olsen, Charlotte Leboeuf-Yde and Lise Hestbaek
Background: Because maintenance care (MC) is frequently used by chiropractors in the management of patients with back pain, it is necessary to define the rationale, frequency and indications for MC consultations, and the contents of such consultations. The objectives of the two studies described in this article are: i) to determine the typical spacing between visits for MC patients and to compare MC and non-MC patients, ii) to describe the content of the MC consultation and to compare MC and non-MC patients and iii) to investigate the purposes of the MC program.
Method: In two studies, chiropractors who accepted the MC paradigm were invited to assist with the data collection. In study 1, patients seen by seven different chiropractors were observed by two chiropractic students. They noted the contents of the observed consultations. In study 2, ten chiropractors invited their MC patients to participate in an anonymous survey. Participants filled in a one page questionnaire containing questions on their view of the purposes and contents of their MC consultations. In addition, information was obtained on the duration between appointments in both studies.
Results: There were 178 valid records in study 1, and in study 2 the number of questionnaires received was 373. The time interval between MC visits was close to nine weeks and for non-MC consultations it was two weeks. The content of the consultations in study 1 was similar for MC and non-MC patients with treatment being the most time-consuming element followed by history taking/examination. MC consultations were slightly shorter than non-MC consultations. In study 2, the most common activities reported to have taken place were history taking and manipulative therapy. The most commonly reported purposes were to prevent recurring problems, to maintain best possible function and /or to stay as pain free as possible.
Conclusions: The results from these two studies indicate that MC consultations commonly take place with around two months intervals, and that history taking, examination and treatment are as important components in MC as in non-MC consultations. Further, the results demonstrate that most patients consider the goal to be secondary or tertiary prevention.
The FULL TEXT Article
Background:
Present level of evidence
Maintenance care (MC) is a concept well known among chiropractors, although it is poorly defined and rarely studied. A literature review published in 1996 concluded that there was no scientific evidence to support the claim that MC improves health status and recommended that a series of research actions should be taken [1].
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A Theoretical Basis for Maintenance Spinal Manipulative Therapy for the Chiropractic Profession
The Chiro.Org Blog
SOURCE: J Chiropractic Humanities 2011 (Dec)
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The World Health Organization defines health as being “a state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity”. [ 1 ]
Given this broad definition of health, epistemological constructs borrowed from the social sciences may demonstrate health benefits not disclosed by randomized controlled trials.
Health benefits, such as improvement in self-reported quality-of-life (QOL), behaviors associated with decreased morbidity, patient satisfaction, and decreased health care costs, are reported in the following articles, and they make a compelling statement about the effects of chiropractic on general health.
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OBJECT: The purpose of this article is to discuss a theoretical basis for wellness chiropractic manipulative care and to develop a hypothesis for further investigation.
METHODS: A SEARCH OF PUBMED AND OF THE MANUAL, ALTERNATIVE, AND NATURAL THERAPY INDEX SYSTEM WAS PERFORMED WITH A COMBINATION OF KEY WORDS: chiropractic, maintenance and wellness care, maintenance manipulative care, preventive spinal manipulation, hypomobility, immobility, adhesions, joint degeneration, and neuronal degeneration. Articles were collected, and trends were identified.
RESULTS: The search revealed surveys of doctors and patients, an initial clinical pilot study, randomized control trials, and laboratory studies that provided correlative information to provide a framework for development of a hypothesis for the basis of maintenance spinal manipulative therapy. Maintenance care optimizes the levels of function and provides a process of achieving the best possible health. It is proposed that this may be accomplished by including chiropractic manipulative therapy in addition to exercise therapy, diet and nutritional counseling, and lifestyle coaching.
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TMJ Trauma and Its Rehabilitation
The Chiro.Org Blog
Clinical Monograph 13
By R. C. Schafer, DC, PhD, FICC
TEMPOROMANDIBULAR JOINT DYSFUNCTION
Proper treatment of TMJ dysfunction must be based on a thorough case history, a complete physical workup, an evaluation of the cranial respiratory impulse and craniosacral mechanisms, and a detailed examination of the TMJ, cranium, and cervical spine. Unfortunately, radiographs to determine abnormal joint space are rarely successful unless over 30% of the bone has been destroyed.
A blow to the jaw is easily transmitted to the temporal bones. As mentioned previously, osteopathic research suggests that a subluxated temporal bone is often the focal fault. This is reported to be grossly indicated by flattening (temporal internal rotation) or protrusion (temporal external rotation) of an ear from the skull.
Symptomatology
The major symptoms of TMJ dysfunction are masticator muscle fatigue and pain, which are usually described as a severe, unilateral (rarely bilateral), dull facial ache that is often fairly localized to an area just anterior to the tragus of the ear. The onset of pain is gradual, progressively increasing over several days or months. It is aggravated by chewing and opening and closing the mouth. Precipitation is often made by eating an apple, a wide yawn, snorkeling, prolonged dental work, playing a wind instrument, prolonged chewing, a bump or pressure on the mandible, sleeping in the prone position, or a cervical whiplash.
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Forearm and Wrist Trauma
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Clinical Monograph 18
By R. C. Schafer, DC, PhD, FICC
As with most parts of the body, traumatic effects in the forearm or wrist may occur abruptly (eg, fracture, strain, sprain) or be the result of long-term microtrauma (eg, tunnel syndromes, arthritis, entrapment by scar tissue).
BACKGROUND
Screening injuries of the forearm and wrist
Joint Motion Restriction
Restriction in pronation suggests a disorder at the elbow, radioulnar articulation of the wrist, or within the forearm. Restriction in supination is associated with a disorder of the elbow or radioulnar articulation of the wrist. Thickened tissues may cause compression symptoms. A palpable nontender ganglion may be found on either the dorsal or volar aspect of the wrist, perceived as a pea-size or slightly larger jelly-like cyst.
Significance of Tenderness
Tenderness over the medial collateral ligament, which rises from the medial epicondyle, is a sign of valgus sprain. Muscle tenderness in the wrist flexor-extensor group is characteristic of flexor-pronator strain (eg, tennis, screwdriving motions). Tender, possibly taut, wrist extensors on the lateral aspect are often associated with tennis elbow. Tenderness in the first tunnel on the radial side is a common site for stenosing tenosynovitis associated with a positive Finkelstein’s sign.
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The Basis for Spinal Manipulation: Chiropractic Perspective of Indications and Theory
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SOURCE: J Electromyogr Kinesiol. 2012 (Apr 16)
By Charles N.R. Henderson, DC, PhD
Palmer Center for Chiropractic Research, FL, United States
It is reasonable to think that patients responding to spinal manipulation (SM), a mechanically based therapy, would have mechanical derangement of the spine as a critical causal component in the mechanism of their condition. Consequently, SM practitioners routinely assess intervertebral motion, and treat patients on the basis of those assessments. In chiropractic practice, the vertebral subluxation has been the historical raison d’etre for SM. Vertebral subluxation is a biomechanical spine derangement thought to produce clinically significant effects by disturbing neurological function.
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Where the U.S. Spends its Spine Dollars: Expenditures on Different Ambulatory Services for the Management of Back and Neck Conditions
The Chiro.Org Blog
SOURCE: Spine (Phila Pa 1976). 2012 (Mar 16)
Davis, Matthew A. DC, MPH; Onega, Tracy PhD; Weeks, William MD, MBA; Lurie, Jon MD, MS
Study Design Serial, cross-sectional, nationally representative surveys of non-institutionalized adults.
Objective To examine expenditures on common ambulatory health services for the management of back and neck conditions.
Summary of Background Data Although it is well recognized that national costs associated with back and neck conditions have grown considerably in recent years, little is known about the costs of care for specific ambulatory health services that are used to manage this population.
Methods We used the Medical Expenditure Panel Survey (MEPS) to examine adult (age ≥ 18 years) respondents from 1999 to 2008 who sought ambulatory health services for the management of back and neck conditions. We used complex survey design methods to make national estimates of mean inflation-adjusted annual expenditures on medical care, chiropractic care, and physical therapy per user for back and neck conditions.
Results Approximately 6% of US adults reported an ambulatory visit for a primary diagnosis of a back or neck condition (13.6 million in 2008).
Between 1999 and 2008, the mean inflation-adjusted annual expenditures on medical care for these patients increased by 95% (from $487 to $950); most of the increase was accounted for by increased costs for medical specialists, as opposed to primary care physicians.
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Use of Post-isometric Relaxation in the Chiropractic Management of a 55-year-old Man with Cervical Radiculopathy
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SOURCE: J Canadian Chiropractic Assoc. 2012 (Mar); 56 (1): 9-17 ~ FULL TEXT
Peter Emary, BSc, DC
Private practice: Parkway Back Clinic, 201C Preston Parkway, Cambridge, Ontario, N3H 5E8. Phone: 519-653-2101. E-mail: drpeter@parkwaybackclinic.ca
Introduction
Cervical radiculopathy (CR) is an impingement or inflammatory irritation of the cervical spine nerve root(s), resulting in pain (or numbness) radiating along nerves of the upper extremity; [1,2] the C6 and C7 levels are most often affected. [1,3] Limited research is available on the incidence and prevalence of CR; however, the incidence rate (in Rochester, Minnesota) has been reported at 83.2 cases per 100,000 people per year (107.3/100,000 for males vs. 63.5/100,000 for females), with peak incidence in those aged 50–54 years. [1] A history of physical exertion or major trauma precedes the onset of symptoms in less than 15% of cases. The most common causes are cervical spondylosis and intervertebral disc herniation, [1,3] accounting for approximately 70% and 20% of cases, respectively. [1] In the former, posterior vertebral body osteophytes and/or facet joint/ligamentum flavum hypertrophy encroach upon the intervertebral foramen; posterolateral herniation of disc material results in foraminal encroachment in the latter. In either case, cervical nerve root pain and dysfunction can occur. [4]
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Cervical Radiculopathy: A Systematic Review on Treatment by Spinal Manipulation and Measurement with the Neck Disability Index
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SOURCE: J Canadian Chiropractic Assoc. 2012 (Mar); 56 (1): 18–28 ~ FULL TEXT
Robert J. Rodine, BSc, DC, Howard Vernon, DC, PhD, FCCS(C)
Graduate Student, Graduate Education and Research Programs, Canadian Memorial Chiropractic College, Toronto, Ontario. Private Practice, Smiths Falls, Ontario.12 William Street West, Smiths Falls, Ontario, K7A 1M9.Tel.: (613) 205-0978. E-mail: drrr@restorativehealth.ca.
Cervical radiculopathy (CR), while less common than conditions with neck pain alone, can be a significant cause of neck pain and disability; thus the determination of adequate treatment options for patients is essential. Currently, inadequate scientific literature restricts specific conservative management recommendations for CR. Despite a paucity of evidence for high-velocity low-amplitude (HVLA) spinal manipulation in the treatment for CR, this strategy has been frequently labeled as contraindicated. Scientific support for appropriate outcome measures for CR is equally deficient. While more scientific data is needed to draw firm conclusions, the present review suggests that spinal manipulation may be cautiously considered as a therapeutic option for patients suffering from CR. With respect to outcome measures, the Neck Disability Index appears well-suited for spinal manipulative treatment of CR.
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Radiculopathy and Chiropractic Page
From the FULL TEXT Article
Introduction
Cervical radiculopathy (CR) can be a significant cause of neck pain and disability. The reported annual incidence of CR is 83.2/100,000 persons [1], while the reported prevalence is 3.5/1000 persons. [2] Gender preference varies. [2, 3] Individuals are most commonly affected in the 5th and 6th decades of life. [1, 4] Physical exertion or trauma at onset is rare, involving less than 15%. [1] Causal relationship to an automobile accident ranges from 3–23%. [1, 4]
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Visceral Responses to Spinal Manipulation
The Chiro.Org Blog
SOURCE: J Electromyogr Kinesiol. 2012 (Mar 20)
Philip S. Bolton, Brian Budgell
School of Biomedical Sciences & Pharmacy, Faculty of Health, University of Newcastle, Callaghan NSW 2308, Australia; Centre for Brain and Mental Health Research at the Hunter Medical Research Institute, Newcastle, Australia
While spinal manipulation is widely seen as a reasonable treatment option for biomechanical disorders of the spine, such as neck pain and low back pain, the use of spinal manipulation to treat non-musculoskeletal complaints remains controversial. This controversy is due in part to the perception that there is no robust neurobiological rationale to justify using a biomechanical treatment of the spine to address a disorder of visceral function. This paper therefore looks at the physiological evidence that spinal manipulation can impact visceral function. A structured search was conducted, using PubMed and the Index to Chiropractic Literature, to construct of corpus of primary data studies in healthy human subjects of the effects of spinal manipulation on visceral function. The corpus of literature is not large, and the greatest number of papers concerns cardiovascular function.
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Low-Back Pain, Leg Pain, and Chronic Idiopathic Testicular Pain
Treated with Chiropractic Care
The Chiro.Org Blog
J Altern Complement Med. 2012 (Apr); 18 (4): 420-422
Robert M. Rowell, DC, MS, and Steven J. Rylander, DC, MS
Diagnosis and Radiology Department, Palmer College of Chiropractic, Davenport, IA 52803, USA. robert.rowell@palmer.edu
OBJECTIVES: The purpose of this article is to report the case of a patient who had low-back pain, leg pain, and idiopathic chronic testicular pain and who sought chiropractic care for his low-back and leg pain and received pain relief including his testicular pain.
SUBJECT: A 36-year-old male patient had low-back pain, right leg pain, and testicular pain that was worsening. All had been present for 5 years. He had been seen by several medical physicians and had lumbar magnetic resonance imaging and x-rays performed. All were read as normal. Examination revealed tenderness of the testicles bilaterally with no masses or other abnormality of the testicles or scrotum. Orthopedic and neurological testing was unremarkable. Tenderness rated 8 out of 10 was noted at the L4 spinous process.
INTERVENTION: The patient was treated with Cox Technic (flexion-distraction) of the lumbar spine, receiving a total of 19 treatments over an 8-week time period.
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Initial Case Management Following Trauma
The Chiro.Org Blog
Clinical Monograph 2
By R. C. Schafer, DC, PhD, FICC
Without a doubt, no other health-care approach equals the efficacy of chiropractic in the general field of conservative neuromusculoskeletal rehabilitation.
For many centuries, therapeutic rehabilitation was a product of personal experience passed on from clinician to clinician. In the last 20 years, however, it has become an applied science. In its application, of course, much empiricism remains that can be called an intuitive art –and this is true for all forms of professional health care.
INTRODUCTION
The word trauma means more than the injuries so common with falls, accidents, and contact sports. Taber [1] defines it as “A physical injury or wound often caused by an external force or violence” or “an emotional or psychologic shock that may produce disordered feelings or behavior.” This is an extremely narrow definition for trauma can also be caused by intrinsic forces as seen in common strain. In addition to its cause being extrinsic or intrinsic, with a physical and emotional aspect, it also can be the result of either a strong overt force or repetitive microforces. This latter factor, so important in treating a unique patient’s specific pathophysiology, is too often neglected outside the chiropractic profession.
Taber [1] states rehabilitation is “The process of treatment and education that lead the disabled individual to attainment of maximum function, a sense of well being, and a personally satisfying level of independence. The person requiring rehabilitation may be disabled from a birth defect or from an illness. The combined effects of the individual, family, friends, medical, nursing, allied health personnel, and community resources make rehabilitation possible.” It is surprising that Taber excludes trauma as a prerequisite for rehabilitation for it is the most common factor involved.
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Upper Back and Thoracic Spine Trauma
The Chiro.Org Blog
Clinical Monograph 23
By R. C. Schafer, DC, PhD, FICC
Upper-thoracic spasms and trigger points are common within the milder complaints heard in a chiropractic office. Typical posttraumatic injuries of the posterior thorax involve the large posterior musculature, thoracic spine, spinocostal joints, and tissues supporting and mobilizing the scapula (especially the rhomboids). Upper right abdominal quadrant ailments (eg, gallbladder, liver) commonly refer pain and sometimes tenderness to the right scapular area.
BACKGROUND
Severe biomechanical lesions of the thoracic spine are seen less frequently than those of the cervical or lumbar spine. But when they occur, they may be serious if related to disc protrusion or a dynamic facet defect. Shoulder girdle, rib cage, spinal cord, cerebrospinal fluid flow, and autonomic visceral problems originating in the thoracic spine are far from being scarce. Common biomechanical concerns are the prevention of thoracic hyperkyphosis, flattening, or twisting, as each can be suspected to contribute to both local and distal, acute and chronic possibly health-threatening manifestations.
Thoracic Fixations
The study of the thoracic spine is often perplexing. It was Gillet’s opinion that many fixations found in the thoracic spine were secondary (compensatory) to focal lesions in either the upper cervical spine or the sacroiliac joints. Thus, a maze of potential variables exists. Empiric evidence has suggested that many thoracic problems have their origin in its base, the lumbar spine or lower, while others are reflections of cervical reflexes. Also, a thoracic lesion may manifest symptoms in either the cervical or the lumbar spine. Foremost in an examiner’s thoughts should be the recognition that the thoracic spine is the structural support and sympathetic source for the esophagus, heart, bronchi, lungs, diaphragm, stomach, liver, gallbladder, pancreas, spleen, kidneys, and much of the pelvic contents. Referred pain and tenderness from these organs to the spine are common.
Screening Thoracic Vertebral Fractures
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