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  By Frank M. Painter, D.C. in Chiropractic Care on January 19th, 2013 at 8:40 pm
The Association of Complementary and Alternative Medicine Use and Health Care Expenditures for Back and Neck Problems
The Chiro.Org Blog
Med Care. 2012 (Dec); 50 (12): 1029–1036
Brook I. Martin, PhD MPH, Mary M. Gerkovich, PhD, Richard A. Deyo, MD, MPH, Karen J. Sherman, PhD, MPH, Daniel C. Cherkin, PhD, Bonnie K. Lind, PhD, Christine M. Goertz, DC, PhD, and William E. Lafferty, MD
Department of Orthopaedics, The Geisel School of Medicine at Dartmouth & Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756, USA. brook.i.martin@dartmouth.edu
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 expenditure 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. Adjusted annual medical costs among CAM users was $424 lower (95% confidence interval: $240, $609; P<0.001) for spine-related costs, and $796 lower (95% confidence interval: $121, $1470; P = 0.021) for total health care cost than among non-CAM users. Average expenditure for CAM users, based on propensity matching, was $526 lower for spine-specific costs (P<0.001) and $298 lower for total health costs (P = 0.403). Expenditure differences were primarily due to lower inpatient expenditures among CAM users.
CONCLUSIONS: CAM users did not add to the overall medical spending in a nationally representative sample with neck and back problems. As the causal associations remain unclear in these cross-sectional data, future research exploring these cost differences might benefit from research designs that minimize confounding.
There are many more articles like this @ our:
Cost-Effectiveness of Chiropractic Page and our
Chronic Neck Pain and Chiropractic Page
From the Dynamic Chiropractic Article:
Chiropractic Costs: A National Perspective
First national study of CAM / chiropractic expenditures for spine conditions finds neither adds to overall medical spending.
Continue reading …
By John in Nutrition on January 13th, 2013 at 1:57 pm
Source Cochrane Summaries
Antioxidant supplements for prevention of mortality in healthy participants and patients with various diseases
Bjelakovic G, Nikolova D, Gluud LL, Simonetti RG, Gluud C
Previous research on animal and physiological models suggests that antioxidant supplements have beneficial effects that may prolong life. Some observational studies also suggest that antioxidant supplements may prolong life, whereas other observational studies demonstrate neutral or harmful effects. Our Cochrane review from 2008 demonstrated that antioxidant supplements seem to increase mortality. This review is now updated.
The present systematic review included 78 randomised clinical trials. In total, 296,707 participants were randomised to antioxidant supplements (beta-carotene, vitamin A, vitamin C, vitamin E, and selenium) versus placebo or no intervention. Twenty-six trials included 215,900 healthy participants. Fifty-two trials included 80,807 participants with various diseases in a stable phase (including gastrointestinal, cardiovascular, neurological, ocular, dermatological, rheumatoid, renal, endocrinological, or unspecified diseases). A total of 21,484 of 183,749 participants (11.7%) randomised to antioxidant supplements and 11,479 of 112,958 participants (10.2%) randomised to placebo or no intervention died. The trials appeared to have enough statistical similarity that they could be combined. When all of the trials were combined, antioxidants may or may not have increased mortality depending on which statistical combination method was employed; the analysis that is typically used when similarity is present demonstrated that antioxidant use did slightly increase mortality (that is, the patients consuming the antioxidants were 1.03 times as likely to die as were the controls). When analyses were done to identify factors that were associated with this finding, the two factors identified were better methodology to prevent bias from being a factor in the trial (trials with ‘low risk of bias’) and the use of vitamin A. In fact, when the trials with low risks of bias were considered separately, the increased mortality was even more pronounced (1.04 times as likely to die as were the controls). The potential damage from vitamin A disappeared when only the low risks of bias trials were considered. The increased risk of mortality was associated with beta-carotene and possibly vitamin E and vitamin A, but was not associated with the use of vitamin C or selenium. The current evidence does not support the use of antioxidant supplements in the general population or in patients with various diseases.
Authors’ conclusions:
We found no evidence to support antioxidant supplements for primary or secondary prevention. Beta-carotene and vitamin E seem to increase mortality, and so may higher doses of vitamin A. Antioxidant supplements need to be considered as medicinal products and should undergo sufficient evaluation before marketing.
Abstract included here.
By John in General Health on January 11th, 2013 at 12:28 pm
ILInet provides an interactive activity level indicator of Flu-Like Illness for the United States.
By Frank M. Painter, D.C. in Chiropractic Care on January 8th, 2013 at 8:58 pm
Comparison of Outcomes in Neck Pain Patients With and Without Dizziness
The Chiro.Org Blog
Chiropractic & Manual Therapies 2013 (Jan 7); 21: 3
B Kim Humphreys and Cynthia Peterson
University of Zürich and Orthopaedic University Hospital Balgrist, Forchstrasse 340, 8008 Zürich, Switzerland
Background The symptom ‘dizziness’ is common in patients with chronic whiplash related disorders. However, little is known about dizziness in neck pain patients who have not suffered whiplash. Therefore, the purposes of this study are to compare baseline factors and clinical outcomes of neck pain patients with and without dizziness undergoing chiropractic treatment and to compare outcomes based on gender.
Methods This prospective cohort study compares adult neck pain patients with dizziness (n = 177) to neck pain patients without dizziness (n = 228) who presented for chiropractic treatment, (no chiropractic or manual therapy in the previous 3 months). Patients completed the numerical pain rating scale (NRS) and Bournemouth questionnaire (BQN) at baseline. At 1, 3 and 6 months after start of treatment the NRS and BQN were completed along with the Patient Global Impression of Change (PGIC) scale. Demographic information was also collected. Improvement at each follow-up data collection point was categorized using the PGIC as ‘improved’ or ‘not improved’. Differences between the two groups for NRS and BQN subscale and total scores were calculated using the unpaired Student’s t-test. Gender differences between the patients with dizziness were also calculated using the unpaired t-test.
Results Females accounted for 75% of patients with dizziness. The majority of patients with and without dizziness reported clinically relevant improvement at 1, 3 and 6 months with 80% of patients with dizziness and 78% of patients without dizziness being improved at 6 months. Patients with dizziness reported significantly higher baseline NRS and BQN scores, but at 6 months there were no significant differences between patients with and without dizziness for any of the outcome measures. Females with dizziness reported higher levels of depression compared to males at 1, 3 and 6 months (p = 0.007, 0.005, 0.022).
Conclusions Neck pain patients with dizziness reported significantly higher pain and disability scores at baseline compared to patients without dizziness. A high proportion of patients in both groups reported clinically relevant improvement on the PGIC scale. At 6 months after start of chiropractic treatment there were no differences in any outcome measures between the two groups.
There are many more articles like this @ our:
Vertigo and Chiropractic Page and our:
Whiplash and Chiropractic Page
Introduction
The complaint of neck pain is second only to low back pain in terms of common musculoskeletal problems in society today with a lifetime prevalence of 26-71% and a yearly prevalence of 30-50%. [1, 2] Most concerning is that many patients, particularly those in the working population or who have suffered whiplash trauma, will become chronic and continue to report pain and disability for greater than 6-months. [3-6] In terms of symptoms, dizziness and unsteadiness are the most frequent complaints following pain for chronic whiplash sufferers with up to 70% of patients reporting these problems. [7, 8] Apart from whiplash trauma, little is known about dizziness in the chronic neck pain population and much remains unknown about the etiology of chronic neck pain in general. [9]
Gender differences in reporting pain intensity is currently a topic of debate. Recent research suggests that females report more pain because they feel pain more intensely than males over a variety of musculoskeletal complaints. [10, 11] Furthermore, LeResche suggests that these differences may not be taken into account by health care providers, leading to less than optimal pain management for females. [12] However gender differences in neck pain patients with or without dizziness have not been described with respect to clinical outcomes over time.
Therefore, the purposes of this study on neck pain patients receiving chiropractic care are twofold:
- to compare baseline variables and the clinical outcomes of neck pain patients with and without dizziness in terms of clinically relevant ‘improvement’, pain, disability, and psychosocial variables over a 6-month period;
- to evaluate gender differences for neck pain patients with dizziness in terms of clinically relevant ‘improvement’, pain, disability, and psychosocial variables in a longitudinal study.
Continue reading …
By Frank M. Painter, D.C. in Chiropractic Care on January 6th, 2013 at 1:54 pm
Clinical Biomechanics: Mechanical Concepts and Terms
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 2 from RC’s best-selling book:
“Clinical Biomechanics:
Musculoskeletal Actions and Reactions”
Second Edition ~ Wiliams & Wilkins
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 2: Mechanical Concepts and Terms
All motor activities such as walking, running, jumping, squatting, pushing, pulling, lifting, and throwing are examples of dynamic musculoskeletal mechanics. To better appreciate the sometimes simple and often complex factors involved, this chapter reviews the basic concepts and terms involved in maintaining static equilibrium. Static equilibrium is the starting point for all dynamic activities.
Energy and Mass
Biomechanics is constantly concerned with a quantity of matter (whatever occupies space, a mass) to which a force has been applied. Such a mass is often the body as a whole, a part of the body such as a limb or segment, or an object such as a load to be lifted or an exercise weight. By the same token, the word “body” refers to any mass; ie, the human body, a body part, or any object.
Energy
Energy is the power to work or to act. Body energy is that force which enables it to overcome resistance to motion, to produce a physical effect, and to accomplish work. The body’s kinetic energy, the energy level of the body due to its motion, is reflected solely in its velocity, and its potential energy is reflected solely in its position. Mathematically, kinetic energy is half the mass times the square of the velocity: m/2 X V524. In a closed system where there are no external forces being applied, the law of conservation of mechanical energy states that the sum of kinetic energy and potential energy is equal to a constant for that system.
Potential energy (PE), measured in newton meters or joules, is also stored in the body as a result of tissue displacement or deformation, like a wound spring or a stretched bowstring or tendon. It is expressed mathematically in the equation PE = mass X gravitational acceleration X height of the mass relative to a chosen reference level (eg, the earth’s surface). Thus, a 100-lb upper body balanced on L5 of a 6-ft person has a potential energy of about 300 ft-lb relative the ground.
The Center of Mass
The exact center of an object’s mass is sometimes referred to as the object’s center of gravity. When an object’s mass is evenly distributed throughout, the center of mass is located at the object’s geometric center. In the human body, however, this is infrequently true, and the center of mass is located towards the heavier, often larger, aspect. When considering the body as a whole, the center of mass in the anatomic position, for instance, is constantly shifted during activity when weight is shifted from one area to another during locomotion or when weight is added to or subtracted from the body.
The term weight is not synonymous with the word mass. Body weight refers to the pull of gravity on body mass. Mass is the quotient obtained by dividing the weight of a body by the acceleration due to gravity (32 ft/sec524). Each of these terms has a different unit of measurement. Weight is measured in pounds or kilograms, while mass is measured by a body’s weight divided by the gravitational constant. The potential energy of gravity can be simply visualized as an invisible spring attached between the body’s center of mass and the center of the earth. The pull is always straight downward so that more work is required to move the body upward than horizontally (Fig. 2.1).
Newton’s Laws of Mechanics
Continue reading …
By Frank M. Painter, D.C. in Chiropractic Care on January 3rd, 2013 at 3:22 pm
Clinical Biomechanics: General Spinal Biomechanics
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 6 from RC’s best-selling book:
“Clinical Biomechanics:
Musculoskeletal Actions and Reactions”
Second Edition ~ Wiliams & Wilkins
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 6: General Spinal Biomechanics
This chapter discusses the vertebral column as a whole and serves as a foundation for the following three chapters that consider the regional aspects of the spine and pelvis. Emphasis here is on gross structure, function, spinal kinematics, and other general biomechanical implications.
Background
The vertebral column is a mechanical marvel in that it must afford both rigidity and flexibility.
The Spine as a Whole
The segmental design of the vetebral column allows adequate motion among the head, trunk, and pelvis; affords protection of the spinal cord; transfers weight forces and bending moments of the upper body to the pelvis; offers a shockabsorbing apparatus; and serves as a pivot for the head. Without stabilization from the spine, the head and upper limbs could not move evenly, smoothly, or support the loads imposed upon them (Fig. 6.1).
Essentially because of its various adult curvatures, the bony spine is anatomically divided into the seven cervical vertebrae, the twelve thoracic vertebrae, the five lumbar vertebrae, and the ossified five sacral and four coccygeal segments. From C1 to S1, the articulating parts of these vertebrae are the vertebral bodies, which are separated by intervertebral discs (IVD’s), and the posterior facet joints. The IVD’s tend to be static weight-bearing joints, while the facets function as dynamic sliding and gliding joints.
WEIGHT DISTRIBUTION
The flexible vertebral column is balanced upon its base, the sacrum. In the erect position, weight is transferred across the sacroiliac joints to the ilia, then to the hips, and then to the lower extremities. In the sitting position, weight is transferred from the sacroiliac joints to the ilia, and then to the ischial tuberosities.
SPINAL LENGTH
About 75% of spinal length is contributed by the vertebral bodies, while 25% of its length is composed of disc material. The contribution by the discs, however, is not spread evenly throughout the spine. About 20% of cervical and thoracic length is from disc height, while approximately 30% of lumbar length is from disc height. In all regions, the contribution by the discs diminishes with age.
Development of the Spine
In brief, development occurs in three stages: mesenchymal, chondrification, and ossification.
MESENCHYMAL AND CHONDRIFICATION ORIGINS
Just prior to the 4th week of embryonic development, a vertebral segment begins to develop as paired condensations of mesenchyme (somites) around the longitudinal notochord and dorsal neural tube. One or usually two chondrification centers appear (6 weeks) in the centrum and begin to form a cartilaginous model surrounded by anterior and posterior longitudinal ligaments which are complete by 7-8 weeks. Chondrification centers also form in the neural arches and costal processes. A thick ring of nonchrondrous cells establishes the model IVD around the longitudinal string of beaded notochordal segments (Fig. 6.2).
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By John in Health Care on December 30th, 2012 at 1:57 pm
Source NY Times
The doctor was dumbfounded: a drug that used to cost $50 was now selling for $28,000 for a 5-milliliter vial.
The physician, Dr. Ladislas Lazaro IV, remembered occasionally prescribing this anti-inflammatory, named H.P. Acthar Gel, for gout back in the early 1990s. Then the drug seemed to fade from view. Dr. Lazaro had all but forgotten about it, until a sales representative from a company called Questcor Pharmaceuticals appeared at his office and suggested that he try it for various rheumatologic conditions.
“I’ve never seen anything like this,” Dr. Lazaro, a rheumatologist in Lafayette, La., says of the price increase.
How the price of this drug rose so far, so fast is a story for these troubled times in American health care — a tale of aggressive marketing, questionable medicine and, not least, out-of-control costs. At the center of it is Questcor, which turned the once-obscure Acthar into a hugely profitable wonder drug and itself into one of Wall Street’s highest fliers.
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By John in Nutrition on December 30th, 2012 at 1:35 pm
Source Science Daily
Animals with persistently lower insulin stay trim even as they indulge themselves on a high-fat, all-you-can-eat buffet.
When we eat too much, obesity may develop as a result of chronically high insulin levels, not the other way around. That’s according to new evidence in mice reported in the December 4th Cell Metabolism, a Cell Press publication, which challenges the widespread view that rising insulin is a secondary consequence of obesity and insulin resistance.
The new study helps to solve this chicken-or-the-egg dilemma by showing that animals with persistently lower insulin stay trim even as they indulge themselves on a high-fat, all-you-can-eat buffet. The findings come as some of the first direct evidence in mammals that circulating insulin itself drives obesity, the researchers say.
The results are also consistent with clinical studies showing that long-term insulin use by people with diabetes tends to come with weight gain, says James Johnson of the University of British Columbia.
“We are very inclined to think of insulin as either good or bad, but it’s neither,” Johnson said. “This doesn’t mean anyone should stop taking insulin; there are nuances and ranges at which insulin levels are optimal.”
Continue reading …
Too Sweet to Be Good?
The Potential Health Hazards of Artificial Sweeteners
The Chiro.Org Blog
SOURCE: Dynamic Chiropractic
By Claudia Anrig, DC
With worldwide obesity rates doubling in the past three decades, is it any surprise that artificial sweeteners have been gaining popularity? Beginning with the creation of saccharin, “sugar substitutes” have become the supposed answer to a dieter’s prayer – and part of the daily diet of many of our children.
Let’s review the various sugar substitutes on the market today to appreciate what they are and why they may not be the best option in terms of your patients’ – and your – health.
Aspartame: NutraSweet or Equal
This sugar substitute was discovered in 1965 by accident while chemist James Schlatter was testing an anti-ulcer drug. [1] Aspartame gained FDA approval in 1981 and was approved in 1983 for use in carbonated beverages, where it is most commonly found now as the primary sweetener for most diet sodas. [2]
Aspartame accounts for over 75 percent of the adverse reactions to food additives reported to the FDA and has been linked to serious medical reactions. [3, 4] Researchers and physicians studying these reactions have concluded that the following chronic illnesses can worsen when ingesting aspartame: brain tumors, multiple sclerosis, epilepsy, chronic fatigue syndrome, Parkinson’s disease, Alzheimer’s, mental retardation, lymphoma, birth defects, fibromyalgia, and diabetes. [4]
Continue reading …
By John in General Health on December 23rd, 2012 at 12:39 pm
Source Health.com
Going to work when you have a chronic pain-causing condition can be difficult or even downright impossible, depending on the job. Studies have shown that people with rheumatoid arthritis are more likely to change jobs, reduce their hours, be fired, and retire early than people without the condition.
If you have chronic pain and are in the workforce, you should try to find an occupation that isn’t too physically demanding and allows you to work at your own pace.
Best: Administrative assistant
Sitting at a desk all day is not ideal for someone with painful joints. Working as an administrative assistant, however, could have its benefits. You may not have to perform a lot of repetitive movements, unless it’s typing. Also, this position probably comes with some flexibility—it’s important to be able to move around when you need to and take breaks as necessary.
A 2012 study out of the University of Georgia found that administrative assistants and office staff in general had the fewest reported injuries of the occupations studied.
Worst: Landscaping
If you have a green thumb, it’s wise to limit your talents to your own yard. Landscaping tasks like pruning that involve frequent use of hand tools can cause pain in the small joints.
Landscaping also requires a lot of bending, stooping over, and kneeling, which can cause pain in joints, particularly the knees. Finally, it also involves lifting and hauling, sometimes in wheelbarrows, which can cause back pain.
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By Frank M. Painter, D.C. in Chiropractic Care on December 19th, 2012 at 1:00 pm
Choice: It Really Does Matter!
The Chiro.Org Blog
SOURCE: Spine (Phila Pa 1976). 2012 Dec 12. [Epub ahead of print]
This review, by scientists at the Department of Orthopaedics at the Geisel School of Medicine, clearly suggests that the first doctor you choose to see will have a profound effect on whether you end up having spinal surgery.
Just look at these stats:
42.7% of workers who first saw a surgeon ended in surgery, as opposed to only
1.5% of those who (first) saw a chiropractor.
The authors conclude: “There was a very strong association between surgery and first provider seen for the injury, even after adjustment for other important variables.”
The Abstract:
Early Predictors of Lumbar Spine Surgery after Occupational Back Injury: Results from a Prospective Study of Workers in Washington State
Keeney, Benjamin J. PhD; Fulton-Kehoe, Deborah PhD, MPH; Turner, Judith A. PhD; Wickizer, Thomas M. PhD; Chan, Kwun Chuen Gary PhD; Franklin, Gary M. MD, MPH
Study Design Prospective population-based cohort study
Objective To identify early predictors of lumbar spine surgery within 3 years after occupational back injury
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By Frank M. Painter, D.C. in Chiropractic Care on December 17th, 2012 at 2:22 pm
New Oregon LBP Guidelines: Try Chiropractic First
The Chiro.Org Blog
SOURCE: Dynamic Chiropractic
By Vern Saboe, DC, DACAN, DABFP, FACO
Lobbyist, Oregon Chiropractic Association
The new State of Oregon Evidence-Based Clinical Guidelines for the Evaluation and Management of Low Back Pain recommends spinal manipulation as the only nonpharmacological treatment for acute lower back pain. The guidelines, which have been adopted by the Oregon Health Authority, are a collaborative effort between the Center for Evidence-Based Practice, Oregon Corporation for Health Care Quality, Oregon Health and Sciences University’s Center for Evidence-based Policy, and the new Oregon Health Evidence Review Commission.
The Oregon Chiropractic Association (OCA) repeatedly gave written and oral testimony that the original draft guidelines placed too much emphasis on drugs and surgery. A close review of the original algorithm, “Management of Low Back Pain (LBP) (Image 2), relative to “#23 Signs or symptoms of radiculopathy or spinal stenosis,” reveals this. For example, if subsequent special imaging (MRI) revealed concordant nerve root impingement or spinal stenosis (#25), the original draft algorithm led the clinician into a surgical or other invasive procedure “dead end,” meaning there was no contingency for conservative chiropractic treatment (#26).
Image 2
—> Now Discontinued
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“No Offense, Doctor, But I Want a Referral for My Pain”
The Chiro.Org Blog
SOURCE: Medscape Education Community CME
NOTE: Establish your free account with Medscape to participate
Charles P. Vega, MD
Case Presentation
You are seeing a 42-year-old woman whom you diagnosed with fibromyalgia 4 weeks ago. Her main complaint continues to be diffuse, dull body pain, but she also reports occasional numbness in both hands. She says that she has felt fatigue for the past several years, and she blames poor sleep for this. She denies depression but says that she gets tearful when she thinks about her chronic symptoms and how they have limited her from what she has wanted to accomplish.
The patient was treated initially with some education regarding fibromyalgia and its manifestations, followed by several supporting phone calls from your staff. She was given a prescription for an exercise program, which she tried twice but could not continue due to exacerbation of her symptoms. She was also given a prescription for amitriptyline 50 mg at bedtime, which she stopped after 2 days due to dry mouth and increased fatigue.
Two weeks ago, you prescribed duloxetine 20 mg daily. She comes to your clinic today to tell you that this medication has had no effect on her symptoms. She tells you that she likes you as a person, but she requests that she be referred to someone who can treat her illness more effectively.
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By Frank M. Painter, D.C. in Chiropractic Care on November 25th, 2012 at 2:42 pm
Efficacy of Chiropractic Manual Therapy on Infant Colic:
A Pragmatic Single-Blind, Randomized Controlled Trial
The Chiro.Org Blog
J Manipulative Physiol Ther. 2012 (Oct); 35 (8): 600–607
Joyce E. Miller, BS, DC, David Newell, PhD,
Jennifer E. Bolton, PhD
Associate Professor, Anglo-European College of Chiropractic, Bournemouth, UK. jmiller@aecc.ac.uk.
OBJECTIVE: The purpose of this study was to determine the efficacy of chiropractic manual therapy for infants with unexplained crying behavior and if there was any effect of parental reporting bias.
METHODS: Infants with unexplained persistent crying (infant colic) were recruited between October 2007 and November 2009 at a chiropractic teaching clinic in the United Kingdom. Infants younger than 8 weeks were randomized to 1 of 3 groups: (i) infant treated, parent aware; (ii) infant treated, parent unaware; and (iii) infant not treated, parent unaware. The primary outcome was a daily crying diary completed by parents over a period of 10 days. Treatments were pragmatic, individualized to examination findings, and consisted of chiropractic manual therapy of the spine. Analysis of covariance was used to investigate differences between groups.
RESULTS: One hundred four patients were randomized. In parents blinded to treatment allocation, using 2 or less hours of crying per day to determine a clinically significant improvement in crying time, the increased odds of improvement in treated infants compared with those not receiving treatment were statistically significant at day 8 (adjusted odds ratio [OR], 8.1; 95% confidence interval [CI], 1.4-45.0) and at day 10 (adjusted OR, 11.8; 95% CI, 2.1-68.3). The number needed to treat was 3. In contrast, the odds of improvement in treated infants were not significantly different in blinded compared with nonblinded parents (adjusted ORs, 0.7 [95% CI, 0.2-2.0] and 0.5 [95% CI, 0.1-1.6] at days 8 and 10, respectively).
CONCLUSIONS: In this study, chiropractic manual therapy improved crying behavior in infants with colic. The findings showed that knowledge of treatment by the parent did not appear to contribute to the observed treatment effects in this study. Thus, it is unlikely that observed treatment effect is due to bias on the part of the reporting parent.
Introduction
Excessive infant crying in otherwise healthy infants, traditionally called infant colic, continues to be an enigmatic condition with no known cause and no known cure. [ 1-3] Afflicting between 10% to 30% of all infants and consuming significant health care resources, [ 2] infant colic is a problem for parents and clinicians, both of whom try a wide range of therapies with often disappointing results.
You may review the earlier Colic studies at:
The Infantile Colic and Chiropractic Page
and you may also enjoy our
Chiropractic Pediatrics Page
Despite decades of research, a clear pathogenesis has not been elucidated. Notwithstanding, what is clear is that underlying disease is rare in the excessively crying baby [4] and that half of those affected recover by 6 months of age, [5] with a small proportion at risk of injury [6] or long-term developmental problems. [7-9] In an effort to help their child with what appears to be a painful condition, some parents choose complementary and alternative medicine (CAM), including chiropractic manual therapy. [9-12] To date, several randomized trials have been reported, [13-19] and although these trials demonstrate some reduction in crying, weaknesses in study methodologies have compromised their contribution to the evidence base. [20-23]
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By John in Research on November 23rd, 2012 at 12:24 pm
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.
Abstract
Spinal manipulative therapy (SMT) has been recognized as an effective treatment modality for many back, neck and musculoskeletal problems. One of the major issues of the use of SMT is its safety, especially with regards to neck manipulation and the risk of stroke. The vast majority of these accidents involve the vertebro-basilar system, specifically the vertebral artery (VA) between C2/C1. However, the mechanics of this region of the VA during SMT are unexplored. Here, we present first ever data on the mechanics of this region during cervical SMT performed by clinicians. VA strains obtained during SMT are significantly smaller than those obtained during diagnostic and range of motion testing, and are much smaller than failure strains. We conclude from this work that cervical SMT performed by trained clinicians does not appear to place undue strain on VA, and thus does not seem to be a factor in vertebro-basilar injuries.
Crown Copyright © 2012. Published by Elsevier Ltd. All rights reserved.
The October 2012 issue is devoted to the study of spinal manipulation.
By Frank M. Painter, D.C. in Chiropractic Care on November 22nd, 2012 at 6:13 pm
The Mechanics of Neck Manipulation With Special Consideration of the Vertebral Artery
The Chiro.Org Blog
SOURCE: J Can Chiropr Assoc. 2002 (Sep); 46 (3): 134–136
Dr. W Herzog, BSc, PhD and Dr. B Symons, DC
University of Calgary, 2500 University Drive N.W., Calgary, Alberta, Canada T2N 1N4. Tel: 403-220-8525; Fax: 403-284-3553; email: walter@kin.ucalgary.ca
In recent weeks, we have learnt that chiropractors may have to carefully review the application of high-speed, low-amplitude spinal manipulative treatments to the neck. The concern is the possible risk associated with neck manipulation. Specifically, vertebral artery dissection, or ther mechanical injury, are an acknowledged, albeit a very low, risk.
The vast amount of research on vertebrobasilar injury in the past has been focused on blood flow through the vertebral artery during diagnostic, and before and after manipulative treatment. There was (is) concern that vertebral artery occlusion may occur during neck manipulation, and that a lack of blood supply to the brain may lead to a series of complications. This line of argument has always struck us as weak, because a high-speed, low-amplitude thrust to the cervical spine lasts typically less than 150 ms, and the brain has sufficient oxygen to survive such a small amount of (possible) loss of blood flow from one of its many supply arteries.
Another way of attempting to gain insight into the possible risk of neck manipulation and vertebrobasilar accidents is a statistical (epidemiological) approach. The basic question that people would like to answer is: are people who receive neck manipulative treatments at a greater risk of vertebrobasilar accidents than people who do not receive such treatments? On the surface, this approach seems feasible, and so it would be, if the occurrence of such accidents was high (let’s say one time in a hundred or a thousand). However, it appears that we deal with incidence rates (if there is an actual incidence) of one in several millions (i.e. very low). Therefore, any statistical pproach has a miniscule power, and a couple of “fluke accidents” (i.e., accidents that occur, let’s say in a chiropractic clinic, but in reality have nothing to do with the chiropractic treatment) may produce a “statistical error” that may persist for years in a community as small as Canada. Also, using an epidemiological approach, the question of “cause and effect” cannot be resolved.
When starting to tackle the problem of the mechanics of neck manipulative treatments three years ago with my student B. Symons (DC), we were surprised that, to the best of our knowledge, there were no data on what actually happens mechanically to the vertebral artery during cervical spinal manipulation. I was further surprised, when asked to review a case on a vertebrobasilar accident, that one of the arguments went as follows: Pathology revealed no dissection of the vertebral artery, therefore, the vertebrobasilar accident cannot be associated with chiropractic treatment.
Discussing this particular statement within the chiropractic community, it became apparent that mechanical injury to the vertebral artery was an accepted, but very, very very rare occurrence; but nevertheless, accepted. And all this without a shred of scientific evidence about the mechanics of the vertebral artery during cervical manipulation.
So, when does the vertebral artery, or for that matter, any tissue, become injured?
Continue reading …
By John in News on November 22nd, 2012 at 12:32 pm
Source Globe and Mail
by Howard Vernon, DC
Chiropractor, husband, father, outdoorsman, craftsman. Born Jan. 26, 1937, in Trenton, Ont., died Oct. 7, 2012, in Toronto from pancreatic cancer, aged 75.
Whether it was seeing a patient, delivering a lecture, casting his handmade fly rod, carving a piece of wood into a beautiful bowl or walking with his beloved granddaughter, Jennie, nobody did it better than Ron.
He had a zest for life, a love of each day, a sense of humanity, a passion to experience things, and the most engaging smile.
Growing up in a small town close to countryside, Ron had an affinity to nature his whole life. He was happiest in the country, and sought it out all his life.
He was a natural athlete. While playing tennis as a teen, he developed a shoulder problem and an orthopedic specialist told him he needed an operation and that his tennis career was over.
Ron could not accept this, so he rode his bike up the mountain to the office of a man whom the kids used to call a quack who broke bones. Ron thought perhaps the man could help him.
The man was named Dr. Halett, and he was Trenton’s chiropractor. He examined the shoulder, and had Ron back on the courts, free of pain, in two weeks.
That encounter ignited the spark that led Ron to the Canadian Memorial Chiropractic College.
After graduation, he devoted 40 years to his patients, his educational institution and the profession at large.
From 1963 to 1978, he made several fundamental contributions to chiropractic science: He developed the first scientific database for chiropractors; delivered a lecture at the 1975 National Institutes of Health conference on spinal manipulation, one of the few chiropractors to speak there; and was instrumental in developing chiropractic research.
Ron continued to practise until 2007, when he retired to his cherished chalet in the Beaver Valley near Georgian Bay, where he could devote all his time to his family, his many pastimes and his love of nature. He contributed greatly to the maintenance of the Beaver River.
Ron revelled in the successes of his children, who grew up to be a world-renowned bridge player, a nature conservationist and a teacher. He loved nothing more than to have his close and extended family enjoy the chalet and all the outdoor experiences it provided.
As Ron’s final illness emerged, he said he’d had a great go at life and his bucket was empty, though he thought there might be one last “permit” still in the bucket (still hoping to catch the big one!).
He challenged his illness like he did every other problem in life – head-on and with a sense of determination.
We know that Ron would want us to catch and release, stop and smell the forest, laugh at a good joke and celebrate life the way he did.
We lost a great friend, healer and teacher.
Howard Vernon is Ron’s friend.
By Frank M. Painter, D.C. in Announcement on November 20th, 2012 at 7:27 pm
By Frank M. Painter, D.C. in Chiropractic Care on November 19th, 2012 at 12:59 pm
What Is the Role Of Chiropractic Care in Prevention or Reduction of Musculoskeletal Injuries in Children?
The Chiro.Org Blog
SOURCE:Chiropractic Care and Public Health: Answering Difficult Questions About Safety, Care Through the Lifespan, and Community Action
J Manipulative Physiol Ther. 2012 (Sep); 35 (7): 493–513
Lise Hestbaek, DC, PhD
Back and neck pain are common ailments in school age children with prevalence rates ranging from 5% to 74%. [38, 39] The prevalence of low back pain increases from preadolescence to early adulthood, [38, 40] but after that, the prevalence rates change surprisingly little. [41] A similar pattern is seen for neck pain, [41] but less is known about the course of other musculoskeletal disorders throughout life. However, extremity complaints are found frequently in children. [42]
It has been demonstrated that children and adolescents with musculoskeletal complaints have a higher risk of having these problems as adults. [43-45] Pain and aberrant musculoskeletal function are known to have other consequences with regard to health. Long-lasting pain conditions, including back pain, have been associated with a generally decreased pain threshold, [46-48] which seems to develop alongside pain, because patients did not have a higher pain threshold than asymptomatic subjects before the onset of back pain. [49] If this process is initiated in childhood, it is likely to increase the impact of minor trauma or overuse in everyday life and thus may induce a lifelong cascade of negative health events, resulting in poorer general health and lower quality of life.
Another possible consequence of musculoskeletal disorders in childhood is pain becoming a barrier to physical activity. Children who are injured while performing sport activities [42, 50] may avoid or stop the activity that caused the original injury. It is also plausible that continued pain or discomfort may reduce motivation to participate and enjoy physical activities. Reduction in activity can have serious health implications over time. It is established that physical activity is one of the most important factors relating to several lifestyle disorders such as diabetes and cardiovascular disease, [51, 52] and it has been shown that increased physical activity in youth can reduce the risk of these disorders in adulthood. [53, 54] Moreover, health habits throughout the lifespan are established in youth, [55, 56] and therefore, promoting and maintaining a healthy level of physical activity in children and adolescence are essential to improve public health. Thus, an important element to reach lifelong health is to optimize musculoskeletal health.
You may also enjoy our:
Chiropractic Pediatrics Page
Continue reading …
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.
Continue reading …
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
Continue reading …
By John in Food Sensitivity on November 13th, 2012 at 4:52 pm
Suggests that oversanitization might suppress the natural development of the immune system
Source The Telegraph
Children who have a peanut allergy tend to come from wealthier families, researchers have suggested.
Scientists say that this backs up the hygiene hypothesis that cleaner homes tend to increase the risk of childhood allergies.
They found that high income and hygiene habits could be increasing susceptibility as they discovered a link between peanut allergy in children and their families socio-economic status.
With the number of peanut allergies among children increasing the team from the American College of Allergy, Asthma, and Immunology (ACAAI) believe that one reason might be due to the wealth of their families.
The theory suggests that a lack of early childhood exposure to germs increases the chance for allergic diseases, that over sanitisation might suppress the natural development of the immune system.
Peanut allergy can be life-threatening with sufferers going into anaphylactic shock, but more commonly it causes itching in the mouth, a rash and swelling of the face, lips, eyes and tongue.
Study author Dr Sandy Yip said: “Overall household income is only associated with peanut sensitization in children aged one to nine years.
“This may indicate that development of peanut sensitization at a young age is related to affluence, but those developed later in life are not.”
Her team looked at 8,306 patients, 776 of which had an elevated antibody level to peanuts.
Peanut allergy was generally higher in men and racial minorities across all age groups. The researchers also found that peanut specific antibody levels peaked between the ages of 10 and 19, but tapered off after middle age.
ACAAI president Doctor Stanley Fineman said: “While many children can develop a tolerance to food allergens as they age, only 20 per cent will outgrow a peanut allergy.
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.
Continue reading …
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.
Continue reading …
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
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