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Is Chiropractic Useful For Dizziness and Balance?

42184199_sDizziness and imbalance are amongst the most common complaints in older people, and are a growing public health concern since they put older people at a significantly higher risk of falling. A recent study explored the role of chiropractic in the treatment of dizziness/balance disorders through analysis of data from the 2008 National Health Interview Survey (the only year that included a subset of questions about balance and dizziness).  Questions were asked about dizziness, balance and  accompanying health conditions as well as their perceived causes and effects of the dizziness or balance problem. The survey data queried whether people were helped by a variety of practitioners, including chiropractors.   Balance or dizziness problems were reported by 11% of all respondents.  The reported prevalence was 35% for those aged 65 or older.  The authors found that although a small proportion (4.2%) sought chiropractic care for balance and dizziness, those who did were very likely to report that it had helped (OR, 1.73). For those in whom the cause of their balance or dizziness problem was head or neck trauma, the odds ratio for perceiving that they had been helped by a chiropractor was 9.5, compared with OR 0.53 for medical physicians. For those respondents aged 65 years and older, and for those reporting the cause of their balance and dizziness were trauma or neurological or musculoskeletal issues, the OR was even higher (OR, 13.78).

Reference:
Ndetan H, Hawk C, Sekhon VK, Chiusano M. The Role of Chiropractic Care in the Treatment of Dizziness or Balance Disorders: Analysis of National Health Interview Survey Data. J Evid Based Complementary Altern Med. 2016 Apr;21(2):138-42. doi: 10.1177/2156587215604974. Epub 2015 Sep 11. PubMed PMID: 26362851.

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Chiropractic and Midwifery Improve Breastfeeding Rates

A recent study incorporated a clinic of midwives and chiropractors to care for suboptimal feeding through a multidisciplinary approach. Suboptimal breastfeeding is a recognized problem among mothers and health care professionals worldwide. The aim was to assess the impact of care and education on breastfeeding and maternal satisfaction after attending the multidisciplinary clinic. On follow-up, 93% of mothers reported an improvement in feeding as well as satisfaction with the care provided. Prior to treatment, 26% of the infants were exclusively breastfed. At the follow-up survey, 86% of mothers reported exclusive breastfeeding. The relative risk ratio for exclusive breastfeeding after attending the multidisciplinary clinic was 3.6  The results from this study demonstrate high maternal satisfaction and improved breastfeeding rates associated with attending the chiropractic and midwifery clinic.

http://www.ncbi.nlm.nih.gov/pubmed/26763046

 

Happy 120th Birthday Chiropractic!

chiropractic birthday DDCelebrate the founder of chiropractic today, Sept. 18.  Chiropractic’s first adjustment is recognized each year as Chiropractic Founder’s Day. On this day in 1895 (120 years ago), Dr. Daniel David Palmer gave the first chiropractic adjustment. Chiropractic focuses on the relationship between the body’s main structures – the skeleton, the muscles and the nerves – and the patient’s health.  There is substantial evidence supporting the safety and effectiveness of chiropractic treatment for patients seen in chiropractic practice.  Share the word of chiropractic today.

Chiropractic Manipulation Versus Usual Medical Care for Acute and Subacute Low Back Pain

33609004_sLow back pain (LBP) is an extremely common presenting complaint that occurs in greater than 80% of people. Chiropractors care for patients who have no symptoms and those who have symptoms.   Research has demonstrated that chiropractic care in addition to standard medical care improves pain and disability scores, and in another study a subgroup of patients with acute nonspecific LBP – spinal manipulation was significantly better than nonsteroidal anti-inflammatory drug diclofenac and clinically superior to placebo (Spine 2013; 38:540-548).  The study reviewed here sought to compare the effectiveness of manual thrust manipulation (MTM) and manual assisted manipulation (MAM), to usual medical care (UMC) for the treatment of acute and subacute LBP.

This study was a prospective, randomized controlled trial evaluating the comparative effectiveness of manual and mechanical spinal manipulation to usual medical care for the treatment of acute and subacute LBP.  Participants were at least 18 years old and had a new LBP episode within the previous 3 months.  They also were required to have a minimum level of self-rated pain of 3 out of 10 and minimum disability rating of 20 out of 100. Exclusions included: chronic LBP (greater than 3 months duration), previous treatment for the current episode, radicular signs/symptoms, contraindications to SMT, current use of prescription pain medicine.

Participants and treating clinicians were not blinded to treatment allocation but the principal investigator was blinded to treatment assignment and had no interaction with participants.

The study interventions consisted of:

  1. Manual thrust manipulation (MTM) – high velocity low amplitude thrust delivered by a chiropractor to the lower thoracic, lumbar and SI joints in the side posture position as deemed necessary
  1. Mechanical-assisted manipulation (MAM) – certified Activator Methods chiropractor delivered MAM in the prone position to the lower thoracic, lumbar and SI joints as deemed necessary
  1. Usual medical care (UMC) – participants were seen by a board certified physical medicine and rehabilitation medical doctor and prescribed over the counter analgesic and NSAID medications, given advice to stay active and avoid bed rest

All groups had a 4 week course of care.  All groups received an educational booklet describing proper posture and movements during activities of daily living. Both manipulation groups had 8 visits (2 per week x 4 wks).  The UMC group had 3 visits (initial, at 2 weeks and at 4 weeks).  Following the 4 week assessment, participants were free to pursue rehabilitation or manipulation.

The primary outcome was the Oswestry LBP Disability Index (OSW).  Pain intensity ratings were also collected. Outcomes were assessed at baseline, 4 weeks, 3 months and 6 months.  Participants with at least 30% or 50% reductions in an outcome measure were considered to be ‘responders’ and had moderate or substantial improvement respectively.

Results and Conclusions:

  • Manual thrust manipulation by a chiropractor led to greater short term reductions in self-reported pain and disability than manual assisted manipulation (Activator) or usual medical care by a physical medicine and rehabilitation specialist
  • The benefits seen at the end of 4 weeks of care were no longer statistically significant at 3 or 6 months
  • MTM should be considered as an effective short term treatment option for patients with acute and subacute LBP
  • Significantly more patients in the MTM group achieved moderate or substantial reductions in disability and pain scores
  • These results contradict assumptions of therapeutic similarity between manual thrust and mechanical-assisted manipulation

Reference: Schneider M, Haas M, Glick R, Stevans J, Landsittel D. Comparison of spinal manipulation methods and usual medical care for acute and subacute low back pain: a randomized clinical trial. Spine (Phila Pa 1976). 2015 Feb 15;40(4):209-17.

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Chiropractic Has Lowest Total Costs for Low Back Problems in a Major Self-Insured Workforce

Low Back PainStatistics tell us that up to 84% of the general population will report low back pain (LBP) symptoms at some point during their lifetime.  This leads employers seeking to maximize the ratio of outcomes achieved relative to costs incurred (ie, value) for the investments that they are making in their employees. Previous research has found that patients receiving chiropractic care have been found to record lower associations of probability of disability recurrence than patients of physicians and physical therapists.  Given these findings, the authors of this newly published article sought to assess the cost outcomes of treatment approaches to care for back problems in a major self-insured workforce, using published guidelines to focus on low back pain. Results of the study were that care congruent with 10 of 11 guidelines was linked to lower total costs. Of the five patterns of care, complex medical management reported the highest guideline-incongruent use of imaging, surgeries, and medications and had the highest health care costs.  On the other hand, chiropractic reported the lowest rates of guideline-incongruent use of imaging, surgeries, and medications and had the lowest health care costs.

http://www.ncbi.nlm.nih.gov/pubmed/24854253

Podcast

Dr. John Srbely

Myofascial and Chiropractic Research with Dr. Srbely

Dr. John Srbely
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Listen to this great interview with Dr. John Srbely as we talk about his research interests in chiropractic, myofascial pain, myofascial trigger points and central sensitization.  Dr. Srbely is a researcher and Assistant Professor at the University of Guelph in the Department of Human Health and Nutritional Sciences.  He studies the physiologic mechanisms of myofascial trigger points and their role in the clinical expression and treatment of pain and joint/muscle dysfunction in chronic disease. A core theme to his research is the study of central sensitization which is a fundamental neuradaptive process associated with the pathophysiology of pain and disease.

Dr. Srbely’s research expertise and interests lie in the fields of clinical biomechanics and neurophysiology. He has a specific interest in the study of pain and joint function associated with aging and chronic disease such as osteoarthritis, myofascial pain and fibromyalgia. To this extent, he studies the physiologic mechanisms of myofascial trigger points and their role in the clinical expression and treatment of pain and joint/muscle dysfunction in chronic disease. A core theme to his research is the study of central sensitization. Central sensitization is a fundamental neuradaptive process associated with the pathophysiology of pain and disease, however, the impact of central sensitization on the physiologic expression of chronic myofascial pain and human mechanics/pathomechanics in chronic degenerative diseases such as osteoarthritis is poorly understood. Dr. Srbely’s research initiatives aim to develop novel/enhance existing treatment approaches in clinical pain management (diagnosis and treatment) and musculoskeletal biomechanics/pathomechanics associated with chronic diseases and aging.