Dr. Jonathan Field

Patient Reported Outcomes and Care Response with Dr. Jonathan Field

Dr. Jonathan FieldDr. Field and I discuss the clinical significance of patient reported outcomes and Care Response. Care Response is a free and pragmatic system to help practices gather and report clinical outcome and patient satisfaction information with minimal work from practice staff.  Dr. Field is a clinical and NHS services lead at the Back2Health partnership providing community based MSK services to NHS and private patients. He has an active interest in research particularly relating to the impact of non-physical factors on recovery of chiropractic patients and the use of patients reports of changes in their health status (PROMs) and their experiences with care (PREMS).

This interest has been developed through a MSc and most recently by submission of his PhD Thesis on ‘Collecting and predicting patient reported outcomes in chiropractic practice’. Dr. Field chairs the Pain Faculty of the RCC which seeks to help chiropractors improve their evidence based management of patients presenting with the symptom of pain. To help practices interested in patient centred and outcome focused care Dr. Field has developed the Care Response system to facilitate the collection and collation of PROM and PREM data. This system is provided free to any practitioner who wishes to use it, and it has been adopted by over two hundred clinicians around Europe and Australasia thanks to funding from the European Chiropractic Union and European Academy of Chiropractic it is available in 7 languages.

Learn more about Care Response.

Care Response Dr. Jonathan Field

Take a look at Dr. Field’s publications at researchgate.

Here are the articles we discuss in this interview.

1. The impact of patient-reported outcome measures in clinical practice for pain: a systematic review.
Holmes MM, Lewith G, Newell D, Field J, Bishop FL.
Qual Life Res. 2017 Feb;26(2):245-257. doi: 10.1007/s11136-016-1449-5. Review.
PMID: 27815820 [PubMed – in process] Free PMC Article
Similar articles
2. Clinical Outcomes in a Large Cohort of Musculoskeletal Patients Undergoing Chiropractic Care in the United Kingdom: A Comparison of Self- and National Health Service-Referred Routes.
Field JR, Newell D.
J Manipulative Physiol Ther. 2016 Jan;39(1):54-62. doi: 10.1016/j.jmpt.2015.12.003.
PMID: 26837228 [PubMed – indexed for MEDLINE]
Similar articles
3. Reconceptualising patient-reported outcome measures: what could they mean for your clinical practice
Holmes MM, Bishop FL, Field J
Pain News 2016, Vol 14(2) 79 –82

 

chiropractic neck pain whiplash
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The Treatment of Neck Pain–Associated Disorders and Whiplash-Associated Disorders

chiropractic neck pain whiplashA clinical practice guideline on the management of neck pain–associated disorders (NADs) and whiplash-associated disorders (WADs) was recently developed and replaces existing chiropractic guidelines on these topics (Bussières, Stewart et al, 2016). The Guideline Development Group of the Canadian Chiropractic Guideline Initiative (CCGI) conducted the updated guidelines. They considered recently published systematic reviews on NAD and WAD from the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. Below is a brief summary of the guidelines.  Please refer to the numerous links in this blog post to gain access to the original paper and the full guidelines which are freely available.

Neck pain and its associated disorders (NAD), including headache and radiating pain into the arm and upper back, are common. These disorders often result in significant social, psychological, and economic burden.  Neck pain is a common reason for people to seek chiropractic care.

Motor vehicle collisions most commonly are associated with neck pain related to whiplash-associated disorders (WADs). Whiplash-associated disorders also affect the daily functioning of our patients in terms of considerable pain, suffering, disability, and costs.  Whiplash-associated disorders are defined as an injury to the neck that occurs with sudden acceleration or deceleration of the head and neck relative to other body parts.  Symptoms of WADs commonly include headache, stiffness, shoulder and back pain, numbness, dizziness, sleeping difficulties, fatigue, and cognitive deficits.

The 2000-2010 Bone and Joint Decade Task Force on Neck Pain and its Associated Disorders recommended that all types of neck pain, including WADs, be included under the classification of NAD.  The 4 grades of NAD are:

  • I – No signs or symptoms suggestive of major structural pathology and no or minor interference with activities of daily living
  • II – No signs or symptoms of major structural pathology, but major interference with activities of daily living
  • III – No signs or symptoms of major structural pathology, but presence of neurologic signs such as decreased deep tendon reflexes, weakness or sensory deficits
  • IV – Signs or symptoms of major structural pathology (e.g., fracture, tumor, infection)

After searching and synthesizing the latest scientific literature on these topics, the guideline committee provided their recommendations.  Below is the summary of the recommendations.  The full guideline and accompanying documents are available from the CCGI website at www.chiroguidelines.org. There are excellent resources for practitioners and patients available from this website including exercise videos and forms.

Global summary of recommendations: A multimodal approach including manual therapy, self-management advice and exercise is an effective treatment strategy for both recent onset and persistent neck pain and whiplash associated disorders.

A) Summary of Recommendations for Grades I-III Neck Pain and Associated Disorders (NAD)

  • For recent-onset (0-3 months) neck pain grades I-II, based on patient preference and practitioner experience we suggest offering advice with:
    • multimodal care;
    • manipulation or mobilization;
    • Range of motion home exercises or multimodal manual therapy.
  • For recent-onset (0-3 months) neck pain grade III, based on patient preference and practitioner experience we suggest offering advice with:
    • supervised graded strengthening exercises.
  • For persistent (>3 months) neck pain grades I-II, based on patient preference and practitioner experience we suggest offering advice with:
    • multimodal care or stress self-management;
    • multimodal care or advice alone;
    • manipulation in conjunction with soft tissue therapy;
    • supervised yoga; supervised group exercise; supervised strengthening exercises or home exercises;
    • mixed supervised and unsupervised high-intensity strength training or advice alone for workers with persistent neck and shoulder pain;
    • high dose massage.
  • For persistent (>3 months) neck pain grade III, based on patient preference and practitioner experience we suggest offering advice with:
    • multimodal care or advice alone;
    • mixed supervised and unsupervised high-intensity strength training or advice alone for workers with persistent neck and shoulder pain.

B) Summary of Recommendations for Grade I-III Whiplash and Associated Disorders (WAD)

  • For recent onset (0-3 months) whiplash grades I-III, based on patient preference and practitioner experience we suggest offering advice with:
    • multimodal care.
  • For persistent (>3 months) whiplash grades I-II, based on patient preference and practitioner experience we suggest offering advice with:
    • supervised exercise or advice alone.

Source: Bussières AE, Stewart G, Al-Zoubi F et al. The Treatment of Neck Pain-Associated Disorders and Whiplash-Associated Disorders: A Clinical Practice Guideline. J Manipulative Physiol Ther. 2016 Oct;39(8):523-564.

Dr. Martin Descarreaux

Learning to Adjust and Neuromuscular Responses to Manipulation with Martin Descarreaux, DC, PhD

Dr. Martin Descarreaux and I discuss his research regarding learning to perform chiropractic adjustments, neuromuscular responses following spinal manipulation and several other studies.  Dr. Descarreaux graduated from the UQTR’s first cohort of the chiropractic program in 1998, and completed a PhD in kinesiology at the Université Laval 6 years later. He is now a full professor in the Human Kinetics Department (UQTR), and an invited professor and researcher at the Institut Franco-Européen de Chiropraxie, in Paris and Toulouse. His current research projects involve the characterization of the neurophysiological and biomechanical effects of spinal manipulation, the various effects of pain and pain-related psychological components on trunk neuromuscular strategies, as well as spinal manipulation learning, as can attest the numerous articles he has published on these topics. Over the years, he has developed several strategies to better integrate motor learning principles, which have been shared with students, professors and those responsible for clinical training within chiropractic teaching institutions not only in Canada, but also in Europe. His work in this specific area has contributed to the characterization of the adjustment learning sequence, and showed the importance of augmented feedback in the technical training of future chiropractors. He is currently the Director of graduate studies in human kinetics and director of the Groupe de recherche sur les affections neuromusculosquelettiques at UQTR.

Take a look at Dr. Descarreaux’s publications at researchgate.

Here are the links to the articles we discussed in this interview:

1. Effects of practice variability on spinal manipulation learning.
Marchand AA, Mendoza L, Dugas C, Descarreaux M, Pagé I.
J Chiropr Educ. 2017 Jan 25. doi: 10.7899/JCE-16-8. [Epub ahead of print]
PMID: 28121458 [PubMed – as supplied by publisher]
Similar articles
2. Influence of Lumbar Muscle Fatigue on Trunk Adaptations during Sudden External Perturbations.
Abboud J, Nougarou F, Lardon A, Dugas C, Descarreaux M.
Front Hum Neurosci. 2016 Nov 14;10:576.
PMID: 27895569 [PubMed – in process] Free PMC Article
Similar articles
3. Physiological and Psychological Predictors of Short-Term Disability in Workers with a History of Low Back Pain: A Longitudinal Study.
Dubois JD, Cantin V, Piché M, Descarreaux M.
PLoS One. 2016 Oct 26;11(10):e0165478. doi: 10.1371/journal.pone.0165478.
PMID: 27783666 [PubMed – in process] Free PMC Article
Similar articles
4. Neuromechanical response to spinal manipulation therapy: effects of a constant rate of force application.
Nougarou F, Pagé I, Loranger M, Dugas C, Descarreaux M.
BMC Complement Altern Med. 2016 Jun 2;16:161. doi: 10.1186/s12906-016-1153-6.
PMID: 27249939 [PubMed – indexed for MEDLINE] Free PMC Article
Similar articles
5. Systematic Augmented Feedback and Dependency in Spinal Manipulation Learning: a Randomized Comparative Study.
Lardon A, Cheron C, Pagé I, Dugas C, Descarreaux M.
J Manipulative Physiol Ther. 2016 Mar-Apr;39(3):185-91. doi: 10.1016/j.jmpt.2016.02.002.
PMID: 27016338 [PubMed – in process]
Similar articles
6. Effects of a prehabilitation program on patients’ recovery following spinal stenosis surgery: study protocol for a randomized controlled trial.
Marchand AA, Suitner M, O’Shaughnessy J, Châtillon CÉ, Cantin V, Descarreaux M.
Trials. 2015 Oct 27;16:483. doi: 10.1186/s13063-015-1009-2.
PMID: 26507388 [PubMed – indexed for MEDLINE] Free PMC Article
Similar articles
Dr. Michele Maiers

Patient Perspectives, Integrative Care and Health Policy with Dr. Michele Maiers

Dr. Michele Maiers

Dr. Michele Maiers and I discuss the patient perspective in chiropractic clinical trials, integrative care and  leveraging research to inform health care policy.

“We’re drowning in information and starving for knowledge.”   ~Rutherford Rogers

This axiom aptly characterizes how many see research as it relates to health care delivery.  Dr. Maiers’ professional goal is to facilitate the pragmatic use of research to both inform clinical practice and shape public health policy. Her research has focused on clinical trials that answer practical questions, including, are patient outcomes improved with co-management by different provider types? Is short term treatment or long term management a better approach for chronic musculoskeletal conditions? What aspects of care matter most to patients? It is essential that the information gained in these and other studies is translated into knowledge that improves patient care, policy guidelines, access and reimbursement. Dr. Maiers is excited about her work because she believes in the capacity for integrative and complementary professions to be a positive force to improving the landscape of health care.  When not at work, she enjoys traveling, reading, running and baking pies.

See Dr. Maiers publications on researchgate.

Here are the links to the articles we discussed in this interview:

1. What do patients value about spinal manipulation and home exercise for back-related leg pain? A qualitative study within a controlled clinical trial.
Maiers M, Hondras MA, Salsbury SA, Bronfort G, Evans R.
Man Ther. 2016 Dec;26:183-191. doi: 10.1016/j.math.2016.09.008.
PMID: 27705840 [PubMed – in process]
Similar articles
2. Adverse events among seniors receiving spinal manipulation and exercise in a randomized clinical trial.
Maiers M, Evans R, Hartvigsen J, Schulz C, Bronfort G.
Man Ther. 2015 Apr;20(2):335-41. doi: 10.1016/j.math.2014.10.003.
PMID: 25454683 [PubMed – indexed for MEDLINE]
Similar articles
3. Perceived value of spinal manipulative therapy and exercise among seniors with chronic neck pain: a mixed methods study.
Maiers M, Vihstadt C, Hanson L, Evans R.
J Rehabil Med. 2014 Nov;46(10):1022-8. doi: 10.2340/16501977-1876.
PMID: 25258045 [PubMed – indexed for MEDLINE] Free Article
Similar articles
4. Spinal manipulative therapy and exercise for seniors with chronic neck pain.
Maiers M, Bronfort G, Evans R, Hartvigsen J, Svendsen K, Bracha Y, Schulz C, Schulz K, Grimm R.
Spine J. 2014 Sep 1;14(9):1879-89. doi: 10.1016/j.spinee.2013.10.035.
PMID: 24225010 [PubMed – indexed for MEDLINE]
Similar articles
5. Integrative care for the management of low back pain: use of a clinical care pathway.
Maiers MJ, Westrom KK, Legendre CG, Bronfort G.
BMC Health Serv Res. 2010 Oct 29;10:298. doi: 10.1186/1472-6963-10-298.
PMID: 21034483 [PubMed – indexed for MEDLINE] Free PMC Article
Similar articles

DC2017 – Chiropractic Research and Funding

In addition to the profession’s largest presentation of research abstracts, DC2017 has added a Researcher’s Forum for Saturday, March 18 that will focus on funding opportunities from around the globe followed by a general discussion of all things research. See you there! https://www.acatoday.org/DC2017

1400 Introduction – WFC Research Council Chair and Vice-Chair
1410 Funding opportunities around the globe
NCCIH, USA – Wendy Weber or delegate (10 min total)
ECCRE, Europe – Henrik Wulff Christensen or delegate (10 min total)
CCRF, Canada – Alison Dantas / Ronda Parks or delegate (10 min total)
CAA, Australia – Scott Charlton or delegate (10 min total)
COCA, Australia – Simon French or delegate (10 min total)
CRC, England – Elisabeth Angier or delegate – (10 min total)
Crowd-Sourced Funding – Greg Kawchuk – (10 min total)
Questions – (10 min)

Break 15:30 – 16:00

16:00 Open Research Forum (all) – WFC Research Council Chair and Vice-Chair
An open forum for all attendees to discuss research topics related to the profession
1730 – End

Dr. Alan Breen

Spine Dynamics, Spine Control and Chiropractic with Dr. Alan Breen

Alan BreenDr. Alan Breen and I discuss spine dynamics and spine control along with quantitative fluoroscopy in chiropractic research and practice. Dr. Alan Breen graduated from the Canadian Memorial Chiropractic College in 1967, then travelled in North America, Australia and Europe before starting a part time teaching post at the Anglo-European College of Chiropractic (AECC) in Bournemouth UK in 1971, he established a practice in Salisbury in 1974, which continues. In 1986 Dr. Breen became Director of Research at AECC and focussed on musculoskeletal research and epidemiology, encouraging staff to undertake doctoral studies. In 1999 he became director of a new musculoskeletal research institute – the Institute for Musculoskeletal Research and Clinical Implementation, where he continues to work. Dr. Breen is also Professor of Musculoskeletal Research in the Faculty of Science and Technology at Bournemouth University.

Dr. Breen published the first epidemiology paper by a chiropractor in a medical journal in 1977 then built a collaboration that resulted in a trial by the Medical Research Council in the UK. This was published in 1991 and had a positive outcome for chiropractors. His PhD project, which was completed in 1991, involved the invention of Quantitative Fluoroscopy, a technology that measures inter-vertebral motion in living subjects and which has now entered clinical use. He is a former member of the World Federation of Chiropractic’s Research Council.

Here is the link to Dr. Alan Breen’s website at the Institute for Musculoskeletal Research and Clinical Implementation.

To view Dr. Breen’s research publications please visit researchgate.

Here are the links to the articles we discussed in this interview:

1. Relationships between Paraspinal Muscle Activity and Lumbar Inter-Vertebral Range of Motion.
du Rose A, Breen A.
Healthcare (Basel). 2016 Jan 5;4(1). pii: E4. doi: 10.3390/healthcare4010004.
PMID: 27417592 [PubMed] Free PMC Article
Similar articles
2. Proportional lumbar spine inter-vertebral motion patterns: a comparison of patients with chronic, non-specific low back pain and healthy controls.
Mellor FE, Thomas PW, Thompson P, Breen AC.
Eur Spine J. 2014 Oct;23(10):2059-67. doi: 10.1007/s00586-014-3273-3.
PMID: 24676852 [PubMed – indexed for MEDLINE]
Similar articles
3. Does inter-vertebral range of motion increase after spinal manipulation? A prospective cohort study.
Branney J, Breen AC.
Chiropr Man Therap. 2014 Jul 1;22:24. doi: 10.1186/s12998-014-0024-9.
PMID: 25035795 [PubMed] Free PMC Article
Similar articles
4. Measurement of intervertebral motion using quantitative fluoroscopy: report of an international forum and proposal for use in the assessment of degenerative disc disease in the lumbar spine.
Breen AC, Teyhen DS, Mellor FE, Breen AC, Wong KW, Deitz A.
Adv Orthop. 2012;2012:802350. doi: 10.1155/2012/802350.
PMID: 22666606 [PubMed] Free PMC Article
Similar articles

 

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Increase in Cortical Drive Following Spinal Manipulation


Chiropractic care is commonly thought to have a beneficial effect on the functioning of the human body by affecting the nervous system. Evidence indicates that chiropractic adjustments result in plastic changes in sensorimotor integration within the central nervous system in human participants, particularly within the prefrontal cortex. Adjustments appear to alter the net excitability of the low-threshold motor units, increase cortical drive, and prevent fatigue (see this blog).  This same group of researchers have more recently found an increase cortical drive to upper and lower extremity muscles following manipulation as measured by motor evoked potential. The researchers suggested the effects were due to descending cortical drive and could not be explained by changes at the level of the spinal cord (although they can’t rule that out completely).  Two experiments were conducted.  In experiment one, transcranial magnetic stimulation input–output (TMS I/O) curves for an upper limb muscle (abductor pollicus brevis; APB) were recorded, along with F waves prior to and after either spinal manipulation or a control intervention for the same subjects on two different days. During these two separate days, lower limb TMS I/O curves and movement related cortical potentials (MRCPs) were recorded from tibialis anterior muscle (TA) before and after spinal manipulation. Spinal manipulation resulted in a 54.5% ± 93.1% increase in maximum motor evoked potential (MEPmax) for APB and a 44.6% ± 69.6% increase in MEPmax for TA. 
They conclude that “Spinal manipulation may therefore be indicated for the patients who have lost tonus of their muscle and or are recovering from muscle degrading dysfunctions such as stroke or orthopaedic operations. These results may also be of interest to sports performers. We suggest these findings should be followed up in the relevant populations.”

Reference: Haavik H, Niazi IK, Jochumsen M, Sherwin D, Flavel S, Türker KS. Impact of Spinal Manipulation on Cortical Drive to Upper and Lower Limb Muscles. Brain Sci. 2016 Dec 23;7(1).

 

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Improvement in Cervical Disc Herniation Symptoms with Spinal Manipulation

Subacute and chronic patients with MRI confirmed symptomatic disc herniation treated with spinal manipulation were statistically (and clinically) significantly more likely to report improvement at 3 months compared with the nerve root injection. This prospective cohort study had 104 patients, 52 patients treated with cervical nerve root injection (CNRI) and 52 patients treated with spinal manipulation by a chiropractor. Baseline numerical rating scale (NRS) pain data were collected. Three months after treatment, numerical rating score pain levels were recorded and overall “improvement” was assessed using the Patient Global Impression of Change scale. Responses that were “much better” or “better” were considered to be “improved.” The proportion of patients “improved” was calculated for each treatment method and compared. The NRS and NRS change scores for the 2 groups were compared at baseline and 3 months.  Results showed that there was no significant difference in outcomes between acute patients treated with cervical nerve root blocks and those treated with spinal manipulation at 3 months. However, when comparing the 3-month outcomes for the subacute/chronic patients, more than 78% of patients treated with SMT reported clinically relevant improvement compared with 37.5% of patients receiving a single CNRI. There were no adverse events for patients in either treatment group and the cost of treatment was similar for the 2 treatment procedures.

Reference: Peterson CK, Pfirrmann CW, Hodler J, Leemann S, Schmid C, Anklin B, Humphreys
BK. Symptomatic, Magnetic Resonance Imaging-Confirmed Cervical Disk Herniation Patients: A Comparative-Effectiveness Prospective Observational Study of 2 Age- and Sex-Matched Cohorts Treated With Either Imaging-Guided Indirect Cervical Nerve Root Injections or Spinal Manipulative Therapy. J Manipulative Physiol Ther. 2016 Mar-Apr;39(3):210-7.

Dr. Scott Haldeman - Pioneering Chiropractic Research, Chiropractic Science
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Top 5 Downloaded Chiropractic Podcasts of 2016

Thanks for listening to the chiropractic science podcast this year.  Here are the top 5 downloads for 2016.  Happy holidays! Look for more great speakers in 2017!

Dr. Scott Haldeman - Pioneering Chiropractic Research, Chiropractic Science

1. Dr. Scott Haldeman

DrJanHartvigsenthumbnail

2. Dr. Jan Hartvigsen

Heidi_Haavik_web

3. Dr. Heidi Haavik

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4. Dr. Greg Kawchuk

Dr. Lise Hestbaek

5. Dr. Lise Hestbæk

 

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Spinal Manipulation Alters Somatosensory Processing in the Prefrontal Cortex

adobestock_49611047Over the last decade, research has demonstrated that spinal manipulation can change various aspects of nervous system function, including muscle reflexes, cognitive processing, reaction time, and the speed at which the brain processes information. One research group from New Zealand (Haavik et al) has hypothesized that the articular dysfunction part of the chiropractic clinical construct, the vertebral subluxation, results in altered afferent input to the central nervous system (CNS) that modifies the way in which the CNS processes and integrates all subsequent sensory input. This processing (i.e., sensorimotor integration) is a central nervous system (CNS) function that appears most vulnerable to altered inputs.

Investigators utilizing techniques such as transcranial magnetic stimulation and somatosensory evoked electroencephalographic (EEG) potentials have suggested that neuroplastic changes occur in the brain (e.g. primary sensory cortex, primary motor cortex, prefrontal cortex, basal ganglia, and cerebellum).  Inducing and recording somatosensory evoked potentials (SEPs) is emerging in scientific literature relating to spinal manipulation (SM). There is evidence to support that SEPs are able to elucidate differences in cortical activity associated with SM. Studies with only a few recording EEG electrodes allow investigation of evoked potential amplitudes and latencies and have shown changes in the N30 somatosensory evoked potential (SEP) amplitudes following spinal manipulation.  The N30 response from the frontal lobe peak reflects sensory integration.

With recent advances in the spatial resolution of EEG, it is becoming possible to better anatomically localize the signal.  With this study, the authors aimed to utilize brain electrical source analysis to explore which brain sources are responsible for changes in N30 amplitude following a single session of spinal manipulation.

Nineteen young (average age 26 years) subclinical pain volunteers were included in the study. Subclinical pain (SCP) refers to recurrent spinal ache, pain, or stiffness for which the subject had not sought treatment. Subjects were excluded if they had: no evidence of spinal dysfunction, they were in current pain, they had sought previous treatment for their spinal issues, or they had contraindications to receiving spinal manipulation. The EEG signals were recorded with the Neuroscan System from 62 scalp electrodes using the extended 10-20 system montage. Supine subjects received electrical stimulations applied to the median nerve at the right wrist to evoke SEPs. Two trials of 1000 pulses were given in each session: one trial before treatment (control or chiropractic) and one trial after the treatment.

The entire spine and both sacroiliac joints were assessed for segmental dysfunction and adjusted where they were deemed necessary by an experienced chiropractor. Assessment for dysfunction included tenderness to palpation of the relevant joints, restricted intersegmental range of motion, asymmetric muscle tension, and any abnormal or blocked joint play and end-feel of the joints. The control (sham) involved one of the investigators (not a chiropractor) simulating a chiropractic treatment session. This included passive and active movements of the subject’s head, spine, and body, similar to what was done by the chiropractor who provided the actual chiropractic treatment.

Results:

  • SEPs were successfully recorded in all subjects
  • the majority of subjects were able to correctly guess which intervention group they were in (SM or sham)
  • there was a significant post-intervention difference between the two groups – specifically the N30 amplitude was reduced in the spinal manipulation group following the treatment, while it remained stable in the control group
  • source localization indicated that the prefrontal cortex tended to have the highest strength during the time interval between 20 and 60 ms
  • source strength analysis revealed that chiropractic treatment reduced the strength of the prefrontal source, while all the other strengths remained stable

Key Points:

  • Results from this study confirmed that spinal manipulation of dysfunctional spinal segments reduces the N30 SEP peak amplitude and demonstrated that this change is taking place in the prefrontal cortex
  • This suggests that, at least in part, the mechanisms by which spinal manipulation improves performance are due to a change in function at the prefrontal cortex
  • It is possible that the mechanisms behind pain relief following spinal manipulation in low level pain patients are due to improved sensorimotor integration and appropriate motor control, as this is the key function of the prefrontal cortex

Source: Lelic D, Niazi IK, Holt K, Jochumsen M, Dremstrup K, Yielder P, Murphy B, Drewes AM, Haavik H. Manipulation of Dysfunctional Spinal Joints Affects Sensorimotor Integration in the Prefrontal Cortex: A Brain Source Localization Study. Neural Plast. 2016;2016:3704964.