Source The Vancouver Sun

by Dr Don Nixdorf

Research is key to developing better treatments and care protocols to eliminate disease and stay healthy.  The chiropractic profession is fortunate to have twelve Canadian Chiropractic Research Foundation (CCRF) research chairs in major universities across the country, each of which conducts and contributes to world class research.  But the more significant benefits to weaving these research chairs into the fabric of academia are the interdisciplinary connections and collaborations that result.  There is no other time in history where we have seen so many different health professions coming together with one common goal: improving healthcare.

When many different health professionals work together, patients routinely experience better care and are on average better prepared to care for themselves.  There are several examples of this in practice already.  St. Michael’s Hospital in Toronto uses a multi-disciplinary approach to treat and manage back pain.  Community health clinics with nurse practitioners, dentists, nutritionists and several other health care providers are peppered throughout Canada and experience tremendous success in the amount of patients they can treat and the quality of the care that is delivered.  Let’s also not forget our amazing Canadian athletes who benefit from a team healthcare approach.  It makes perfect sense that patients benefit from having multiple perspectives of expertise that work together to treat the whole person, not just the corner of their body with a problem.

In an effort to gain further momentum to this type of approach and increase collaboration in the academic community, several chiropractic doctors out of McMaster University came together to form the McMaster Chiropractic Working Group in 2009.  Dr. Steven Passmore DC, PhD, a researcher from the University of Manitoba is one of the founding members of this group that aims to raise the profile of chiropractic in the university setting through credible research and collaborative efforts.  With the exception of the CCRF researchers in universities, chiropractic education and advancement is primarily through chiropractic schools and funded almost entirely by chiropractic doctors.  Even after earning his PhD from McMaster in 2012, Dr. Passmore continues to be a part of this initiative that is setting an example for others across the country.  BC is already investigating the potential of a local working group based on the McMaster model.

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Source European Heart Journal

Humans evolved being exposed for about half of the day to the light of the sun. Nowadays, exposure to sunlight is actively discouraged for fear of skin cancer, and contemporary lifestyles are associated with long hours spent under artificial light indoors. Besides an increasing appreciation for the adverse effects of these life-style-related behavioural changes on our chronobiology, the balance between the beneficial and harmful effects of sunlight on human health is the subject of considerable debate, in both the scientific and popular press, and the latter is of major public health significance. While there is incontrovertible evidence that ultraviolet radiation (UVR) in the form of sunlight is a significant predisposing factor for non-melanoma and melanoma skin cancers in pale skinned people,  a growing body of data suggest general health benefits brought about by sunlight.

The researchers propose that many of the beneficial effects of sunlight, particularly those related to cardiovascular health, are mediated by mechanisms that are independent of melatonin, vitamin D, and exposure to UVB alone. Specifically, they suggest that the skin is a significant store of nitric oxide (NO)-related species that can be mobilized by sunlight and delivered to the systemic circulation to exert coronary vasodilator and cardioprotective as well as antihypertensive effects. They further hypothesize that this dermal NO reservoir is a product of local production and dietary supply with nitrate-rich foods.

The full article (pdf) is available on the European Heart Journal website.

J Electromyogr Kinesiol. 2012 Oct;22(5):740-6. doi: 10.1016/j.jelekin.2012.03.005. Epub 2012 Apr 5.

Herzog W, Leonard TR, Symons B, Tang C, Wuest S.

Chiropractic care for older people may reduce deaths and injuries from falls according to researchers taking part in a study by Auckland University and the Chiropractic Research Centre (CRC) at the New Zealand College of Chiropractic on the neurophysiological effects of chiropractic on the brain.

According to chiropractor, PhD candidate and principal investigator of the study Dr Kelly Holt, falls often occur due to a decline in nervous system function with advancing age. This can lead to a loss of balance, or poor control of the limbs, which dramatically increases the risk of falling.

Dr Holt says: `Already it is estimated that in New Zealand slips, trips and falls cost almost $300 million per year in treatment and rehabilitation costs and as the population ages this will likely get worse.’ He says that ‘falls result in approximately 450 deaths per year in New Zealand and for older adults in particular, a fall can lead to a downward spiral that involves a loss of confidence, a cessation of day to day activities and eventually increased frailty and even death.’

ABSTRACT: The Effects of Manual Therapy on Balance and Falls: A Systematic Review
Journal of Manipulative and Physiological Therapeutics March/April 2012, Holt et al

Objective

The purpose of this study was to review the scientific literature on the effects of manual therapy interventions on falls and balance.

Methods

This systematic review included randomized and quasi-randomized controlled trials that investigated the effects of manual therapy interventions on falls or balance. Outcomes of interest were rate of falls, number of fallers reported, and measures of postural stability. Data sources included searches through June 2011 of Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, MEDLINE, EMBASE, CINAHL, PsycINFO, Allied and Complimentary Medicine, Current Controlled Trials, Manual Alternative and Natural Therapy Index System, Index to the Chiropractic Literature, National Institutes of Health (USA), and Google Scholar.

Results

Eleven trials were identified that met the inclusion criteria. Most trials had poor to fair methodological quality. All included trials reported outcomes of functional balance tests or tests that used a computerized balance platform. Nine of the 11 trials reported some statistically significant improvements relating to balance after an intervention that included a manual therapy component. The ability to draw conclusions from a number of the studies was limited by poor methodological quality or very low participant numbers. A meta-analysis was not performed due to heterogeneity of interventions and outcomes. Only 2 small trials included falls as an outcome measure, but as a feasibility study and a pilot study, no meaningful conclusions could be drawn about the effects of the intervention on falls.

Conclusion

A limited amount of research has been published that supports a role for manual therapy in improving postural stability and balance. More well-designed controlled trials with sufficient participant numbers are required to draw meaningful clinical conclusions about the role that manual therapies may play in preventing falls or improving postural stability and balance.

Wake Up – We’re in a Race for Scientific Ownership of Manipulation

The Chiro.Org Blog

SOURCE: Dynamic Chiropractic

Source Dynamic Chiropractic

The Spine Journal recently announced its “Top 25 Hottest Articles” for 2011. These are the most downloaded articles for the year. The 2011 list is surprising in that 13 of the 25 articles have at least one author who is a doctor of chiropractic.

In addition, 10 of the 25 papers include content relating to spinal manipulation, cervical manipulation or chiropractic; six of those include the terms in their title. Papers that discussed these topics were found to be very popular, ranking first, third, fourth, sixth, 10^th, 14^th, 15^th, 17^th, 23^rd and 24^th.

The top-ranked paper for 2011 is “Efficacy of Spinal Manipulation and Mobilization for Low Back Pain and Neck Pain: A Systematic Review and Best Evidence Synthesis.” Authors include Gert Bronfort, PhD, DC, Mitchell Haas, DC, MA, and Roni L. Evans, DC, MS, representing Northwestern Health Sciences University and the University of Western States. (This was not their only paper in the top six.)

Simon Dagenais, DC, PhD, currently working with Palladian Health in West Seneca, N.Y., led a total of 17 doctors of chiropractic who authored most of the Top 25 Hottest Articles. Here is the list of the chiropractic authors, along with the number of papers they authored in The Spine Journal and where the papers placed on the Top 25 list:

• Paul B. Bishop, DC, MD, PhD – one paper placing 15^th
• Gert Bronfort, PhD, DC – three papers placing first, fourth and sixth, respectively
• Simon Dagenais, DC, PhD – six papers placing third, sixth, eighth, 17^th, 21^st and 24^th, respectively
• Roni L. Evans, DC, MS – three papers placing first, fourth and sixth, respectively
• Michael D. Freeman, PhD, MPH, DC – one paper placing 24^th
• Ralph E. Gay, DC, MD – one paper placing 24^th
• Mitchell Haas, DC – three papers placing first, sixth and 14^th, respectively
• Scott Haldeman, DC, MD, PhD – three papers placing third, eighth and 17^th , respectively
• Eric L. Hurwitz, DC, PhD – two papers placing seventh and 20^th, respectively
• Greg Kawchuk, DC, PhD – one paper placing sixth
• Michele J. Maiers, DC, MPH – one paper placing fourth
• John Mayer, DC, PhD – two papers placing 2^st & 24^th, respectively
• Edward F. Owens Jr., MS, DC – one paper placing fourth
• David Peterson, DC – one paper placing 14^th
• Joel G Pickar, DC, PhD – one paper placing 10^th
• Jeffrey A. Quon, DC, PhD, FCCSC – one paper placing 15^th
• Craig A. Schulz, DC, MS – one paper placing fourth

The majority of papers investigate conservative care versus surgery. Two of the papers that examined “catastrophic complications” and “adverse reactions” in surgical procedures included Eric L. Hurwitz, DC, PhD, as one of the authors. If the Spine Journal‘s 2011 list of the most downloaded papers is any indication, the focus in spine care has clearly moved away from surgery toward more conservative care. This refocus is not only reflected in the research community, but also in the minds of the health care-consuming public and the business community paying the bills.

This trend toward conservative care is likely to continue for the foreseeable future. The cost of surgery, surgical failure rates and the subsequent additional costs continue at unacceptable levels. It has apparently taken an economic crisis to wake people up to the nightmare that is the surgical model.

This is an excellent opportunity to educate patients and their families, friends and co-workers about chiropractic. If nothing else, read the abstracts of The Spine Journal‘s 25 Hottest Articles and share the information with them. As we all know, an educated patient can be an effective source of referrals.

Visceral Responses to Spinal Manipulation

The Chiro.Org Blog

SOURCE: J Electromyogr Kinesiol. 2012 (Mar 20)

Hypoxia, or a period of low oxygen during pregnancy, combined with a genetic risk factor of having only one functioning copy of a gene, dramatically increases the chances of a baby being born with congenital scoliosis.

Source Science Daily

Scientists have made a landmark discovery that could help women minimize or even avoid the risk of having a baby born with congenital birth defects. The study is published April 5 in the international journal Cell.

The scientists, from universities in Australia, Japan, Canada and the United States, including Arizona State University, show for the first time how “nature” and “nurture” interact to increase the severity and likelihood of developing birth defects, including abnormalities in the heart, kidneys, brain, limbs and cranio‐facial regions (cleft palate).

They show how hypoxia, or a period of low oxygen during pregnancy, combined with a genetic risk factor of having only one functioning copy of a gene, dramatically increases the chances of a baby being born with congenital scoliosis, a malformation of the spine that affects around 1 in 1,000.

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Between 2000 and 2050, the proportion of the world’s population over 60 years will double from about 11 percent to 22 percent.

Source Occupational Health and Safety

One of the biggest social transformations is population aging. Soon, the world will have more older people than children and more people of very old age than ever before. The World Health Organization is focusing on aging and health for World Health Day on April 7.

The world will have more people who live to see their 80s or 90s than ever before. The number of people aged 80 years or older, for example, will have almost quadrupled to 395 million between 2000 and 2050. There is no historical precedent for a majority of middle-aged and older adults having living parents, as is already the case today. More children will know their grandparents and even their great-grandparents.

With that in mind Chiropractic and Manual Therapy has just published the first paper in a thematic series on chiropractic care in older adults. This thematic series provides an overview of current best evidence in key aspects of evaluation and management of chiropractic care for older adults. Individual articles address the magnitude of musculo-skeletal problems in the elderly population, diagnostic challenges for chiropractors and other manual therapists seeing elderly patients, the evidence for chiropractic and manual therapy in the care of the elderly and also imaging modalities for musculo-skeletal disorders in the elderly including utility, validity and cost.

You can download the provisional pdf here.

The Trials of Evidence:
Interpreting Research and the Case for Chiropractic

The Chiro.Org Blog

The Chiropractic Report ~ July 2011

The Role of Chiropractic Care in Older Adults ~ FULL TEXT

The Chiro.Org Blog

Chiropractic & Manual Therapies 2012 (Feb 21), 20: 3

By 2030, nearly one in five U.S. residents is expected to be age 65 or older [1]. An estimated 14% of patients treated by doctors of chiropractic (DCs) are 65 and older [2]. The most common reason for an older adult to see a DC is musculoskeletal pain, most often lower back pain [3]. Although the most common reason for older adults seeking chiropractic care is for musculoskeletal symptoms, DCs may also provide a diverse range of services to these patients [4] .Given this fact, for the purpose of this manuscript chiropractic care will be defined as; “the provision by a doctor of chiropractic of services related to patient assessment, maintenance of health, prevention of illness, and treatment of illness or injury.” The focus of this manuscript is to describe the evidence for achievement of some of these goals in the older adult population. The purpose of this manuscript is to present an overview of information to the practicing chiropractor on utilization of specific management tools. This is not meant to be a systematic review of the literature or an evidence based guideline. The authors each have personal experience in evaluating and treating older adults as well as established expertise in research and publication in these areas. The authors recognize that there is a need for further research in the area of management of the older adult by DC’s and discuss in the conclusion future research considerations.

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Chiropractic Research & Practice
State of the Art

The Chiro.Org Blog

Cleveland Chiropractic College

Chiropractic was born in the United States in the late 19th century and the U.S. is home to approximately 65,000 of the world’s 90,000 chiropractors. [1] The chiropractic profession is the third largest independent health profession in the Western world, after medicine and dentistry. Doctors of chiropractic are licensed throughout the English-speaking world and in many other nations as primary contact providers, licensed for both diagnosis and treatment without medical referral. In 2005, the World Health Organization (WHO) published WHO Guidelines on Basic Training and Safety in Chiropractic, which documented the status of chiropractic education and practice worldwide and sought to ensure high standards in nations where chiropractic is in the early stages of development. [2]

Rigorous educational standards are supervised by government-recognized accrediting agencies in many nations, including CCE in the United States. After fulfilling college science prerequisites similar to those required to enter medical schools, chiropractic students must complete a chiropractic college program of four academic years, which includes a wide range of courses in anatomy, physiology, pathology, and diagnosis, as well as spinal adjusting, physiotherapy, rehabilitation, public health and nutrition.

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One current trend into fighting antibiotic resistant bacteria is developing a new class refered to as antimicrobial peptides (AMP’s). However a newly published study published¹ a proof of concept that bacteria will develop not only resistance to these new drugs but to our own innate immune response peptides as well.

A very nice summary of the findings was published in the latest issue of The Scientist online magazine.²

1. G. J. L. Habets, Michelle, and Michael Brockhurst. “Therapeutic
antimicrobial peptides may compromise natural immunity .” Biology Letters. N.p., n.d. Web. 23 Feb. 2012. <http://rsbl.royalsocietypublishing.org/content/early/2012/01/20/rsbl.2011.1203

2. Richards, Sabrina. “Antimicrobial Cross-Resistance Risk | The Scientist.” The Scientist. N.p., 24 Jan. 2012. Web. 23 Feb. 2012. <http://the-scientist.com/2012/01/24/antimicrobial-cross-resistance-risk/

Acupuncture and Chiropractic Care for Chronic Pain
in an Integrated Health Plan: A Mixed Methods Study

The Chiro.Org Blog

SOURCE: BMC Complement Altern Med. 2011 (Nov 25); 11 (1): 118 ~ FULL TEXT

One man’s long, noisy, asymmetrical adventure gets him a high five.

Source Scientific American

By Steve Mirsky

The latest physical anthropology research indicates that the human evolutionary line never went through a knuckle-walking phase. Be that as it may, we definitely entered, and have yet to exit, a knuckle-cracking phase. I would run out of knuckles (including those on my feet) trying to count how many musicians wouldn’t dream of playing a simple scale without throwing off a xylophonelike riff on their knuckles first. But despite the popularity of this practice, most known knuckle crackers have probably been told by some expert—whose advice very likely began, “I’m not a doctor, but …”—that the behavior would lead to arthritis.

One M.D. convincingly put that amateur argument to rest with a study published back in 1998 in the journal Arthritis & Rheumatism entitled “Does Knuckle Cracking Lead to Arthritis of the Fingers?” The work of sole author Donald Unger was back in the news in early October when he was honored as the recipient of this year’s Ig Nobel Prize in Medicine.

The Igs, for the uninitiated, are presented annually on the eve of the real Nobel Prizes by the organization Improbable Research for “achievements that first make people laugh, and then make them think.” In Unger’s case, I thought about whether his protocol might be evidence that he is obsessive-compulsive. From his publication: “For 50 years, the author cracked the knuckles of his left hand at least twice a day, leaving those on the right as a control. Thus, the knuckles on the left were cracked at least 36,500 times, while those on the right cracked rarely and spontaneously.”

Unger undertook his self and righteous research because, as he wrote, “During the author’s childhood, various renowned authorities (his mother, several aunts and, later, his mother-in-law [personal communication]) informed him that cracking his knuckles would lead to arthritis of the fingers.” He thus used a half-century “to test the accuracy of this hypothesis,” during which he could cleverly tell any unsolicited advice givers that the results weren’t in yet.

Continue reading …

Source Enhanced Online News

The Federal government has awarded the University of South Florida (USF), School of Physical Therapy & Rehabilitation Sciences $1.42 million to research the effectiveness of specific exercise interventions for reducing the risk of back injuries amongst some of the nation’s most vulnerable — firefighters and military personnel.

“Back injury is a primary condition that dramatically affects our nation’s heroes — cited as a top reason for disability and early retirement amongst firefighters, and a top non-combat reason for service men and women being displaced from active duty,” says John Mayer, D.C., Ph.D, associate professor and Lincoln College Endowed Chair in Biomechanical and Chiropractic Research at USF, and lead researcher in the $715,000 Department of Defense (DOD) and $701,000 Federal Emergency Management Agency (FEMA) studies. “These studies will be the first to be led by a Doctor of Chiropractic at a major university that will attempt to identify the preventive outcomes of applying specific exercise interventions amongst firefighters and soldiers.”

Each study will be conducted in several phases carried out over the next few years.

With research already in progress, the FEMA study will include 106 participants headquartered at a Tampa, Fla., fire department. Participants will undergo 24 weeks of bi-weekly supervised training sessions consisting of particular stability and resistance exercises with the goal of improving back muscular endurance — commonly documented as a direct link to back pain.

Expected to begin in spring 2012, the DOD study will include 600 active duty US Army soldiers and will provide a perspective that complements traditional directions of treatment-focus. Instead, the study will assess preventive methods by implementing and evaluating targeted high intensity exercise interventions designed to strengthen the back extensor muscles.

“Chiropractic engagement with regards to specific exercise interventions and their potential to prevent back conditions has continued to gain momentum,” says Mayer. “Federal agencies are now recognizing the skills of Doctors of Chiropractic to address prevention and treatment of back injury for our national heroes.”

To learn more about either study, visit www.health.usf.edu.

Why You Should Not Stop Taking Your Vitamins

The Chiro.Org Blog

SOURCE: The Huffington Post ~ 10-20-2011

It depends. To be exact, it depends on the quality of the science, and the very nature of scientific research. It is very hard to know things exactly through science. The waste bin of science is full of fallen heroes like Premarin, Vioxx and Avandia (which alone was responsible for 47,000 excess cardiac deaths since it was introduced in 1999).

That brings us to the latest apparent casualty, vitamins. The recent media hype around vitamins is a classic case of drawing the wrong conclusions from good science.

Remember how doctors thought that hormone replacement therapy was the best thing since sliced bread and recommended it to every single post-menopausal woman? These recommendations were predicated on studies that found a correlation between using hormones and reduced risk of heart attacks. But correlation does not prove cause and effect. It wasn’t until we had controlled experiments like the Women’s Health Initiative that we learned Premarin (hormone replacement therapy) was killing women, not saving them.

A new study “proving” that vitamins kill people is hitting front pages and news broadcasts across the country. This study does not prove anything.

This latest study from the Archives of Internal Medicine of 38,772 women found that “several commonly used dietary vitamin and mineral supplements may be associated with increased total mortality”. The greatest risk was from taking iron after menopause (which no doctor would ever recommend in a non-menstruating human without anemia).

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The Direction of Chiropractic Pediatric Research
A Q&A w/ Dr. Brian Kelly, Life West President

The Chiro.Org Blog

SOURCE: Dynamic Chiropractic

Application of a Diagnosis-Based Clinical Decision Guide
in Patients with Low Back Pain

The Chiro.Org Blog

Chiropractic & Manual Therapies 2011 (Oct 22); 19: 26

Low back pain (LBP) affects approximately 80% of adults at some time in life [1] and occurs in all ages [2, 3]. Despite billions being spent on various diagnostic and treatment approaches, the prevalence and disability related to LBP has continued to increase [4]. There has been a recent movement toward comparative effectiveness research [5], i.e., research that determines which treatment approaches are most effective for a given patient population. In addition, there is increased recognition of the importance of practice-based research which generates data in a “real world” environment as a tool for conducting comparative effectiveness research [6, 7]. This movement calls for greater participation of private practice environments in clinical research [7].

One of the reasons often given for the meager benefits that have been found with various LBP treatments is that these treatments are generally applied generically, without regard for specific characteristics of each patient, whereas the LBP population is a heterogeneous group, requiring individualized care [8]. Developing a strategy by which treatments can be targeted to the specific needs of patients has been identified as a research priority [9, 10].

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Mightier Than the Sword — Using Research to Promote and Defend Chiropractic

The Chiro.Org Blog

SOURCE: Thanks to the ACA News

An Invitation To Participate in the ICON
Practice-Based Research Program

The Chiro.Org Blog

Cheryl Hawk, DC, PhD, Research Program Director at Logan College of Chiropractic, invites all D.C.s to participate in a new practice-based research program titled:
ICON — The Integrated Chiropractic Outcomes Network

ICON Phase 2 will be conducted in October 2011. It involves a one-day sample from your practice. This program is modeled on the National Ambulatory Medical Care Survey, conducted by the U.S. government with medical and osteopathic physicians. The purpose of the ICON–2 project is to describe DCs’ and NDs’ prevention and health promotion practices, and then to compare them to those of MDs and DOs.

The U.S. Agency for Healthcare Research and Quality (AHRQ) defines a Practice-Based Research Network (PBRN) as a group of clinicians and practices working together in ambulatory care to answer community-based health care questions and translate research findings into practice.

PBRNs address research questions that require a real-world setting to be answered. Ambulatory care settings, partnering with academic institutions, form the “laboratory” in which these research questions are pursued.

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Findings of the Bone and Joint Decade Neck Pain Task Force:
Interview with Scott Haldeman, DC, MD, PhD

The Chiro.Org Blog

SOURCE: Health Insights Today

An Interview by Daniel Redwood, DC

The Evolution of Chiropractic — Science & Theory

The Chiro.Org Blog

By Scott Haldeman, D.C., M.D., Ph.D.

Excerpt from Keynote Presentation at the International Conference on Spinal Manipulation

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.

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The Inherent Problems With Randomized Controlled Trials (RCTs)

The Chiro.Org Blog

FROM: J Manip Physiol Ther 2003 (Sep); 26 (7): 460–467 ~ FULL TEXT

Designs are presented in descending order of rigor.

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Director of Chiropractic Research Testifies at the National Institute of Medicine

The Chiro.Org Blog

Foundation for Chiropractic Education and Research

The Institute of Medicine is a private, non-governmental organization that initiates studies in areas of medical care out of appropriations made available to federal agencies. It is a branch of the National Academy of Sciences, which was created by the federal government to be an advisor on scientific and technological matters.

The following is Dr. Rosner’s presentation to the Institute of Medicine.

The Use of CAM by the American Public

INTRODUCTION

My dear colleagues:

I want to thank the Institute of Medicine (IOM) for two reasons; first, for inviting my testimony this afternoon, but especially for carrying what I believe is the unfulfilled work of both the National Center for Complementary and Alternative Medicine and the White House Commission on Complementary and Alternative Medicine an essential step forward by calling us to the table today.

I also want to offer my strongest assent and congratulations to the Institute for its most pertinent and insightful assessment of American healthcare — first, in its forthright reporting of medical errors in 1999; [1] second, in providing one of the most equitable definitions among the many offered for “primary care; [1] [2] ” and finally, for having published two years ago the most candid and uncompromising assessments of U.S. healthcare, Crossing the Quality Chasm: A New Health System for the 21st Century. [3]

This last publication courageously concluded that “the American healthcare system is in need of a fundamental change,” especially because “what is perhaps most disturbing is the absence of real progress toward restructuring health care systems to address both quality and cost concerns. . . .” [3]

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