Dr. Steven Passmore

Chiropractic Science Podcast with Dr. Steven Passmore

Dr. Dean Smith will be hosting a podcast interview with Dr. Steven Passmore this Thursday, September 24th at 2 pm (EST).

Passmore Headshot 2012Steven Passmore, DC, PhD.  Dr. Passmore is Assistant Professor in the Faculty of Kinesiology & Recreation Management at the University of Manitoba. His expertise deals with human perceptual learning and motor control.  Dr. Passmore utilizes his theoretical and applied background in perceptual motor behaviour to explore performance-based outcome measures in an attempt to objectively determine population characteristics, movement outcomes and sustainability of interventions.  We will discuss Dr. Passmore’s chiropractic and performance related research. To hear the podcast live, go to chirocredit.com/chiropracticscience and login for instructions (Not a member? Create an account for free).

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.

Dr. John Srbely

004- 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.

 

Partnership with ChiroCredit.com

online-ce-logoChiropractic Science, LLC is proud to announce a strategic partnership with ChiroCredit.com to bring Chiropractors FREE Webinars (podcast replays will be available) during which there will be interviews with Chiropractic Experts that are performing cutting edge Chiropractic Research (non CE event).

We plan on providing one Chiropractic Science webinar each month so that Chiropractic Physicians can stay up to date in real time with the developing research and to incorporate the latest evidence into your Chiropractic Practice.

Past topics that are available for download include Chiropractic Neurophysiology and How Chiropractic Adjustments Work, Chiropractic Pediatrics and the research of Dr. Gregory Cramer. Login and under Notices, click on the link for Chiropractic Research. www.chirocredit.com/chiropracticscience

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Cervical Spine in Post Concussion Syndrome

postconcussionsyndromeMuch is known about the injury mechanisms of concussion injuries in the acute phase, but there is little evidence to support many of the theories regarding postconcussion syndrome (PCS).  A potential, and very treatable, cause of this chronic condition is cervical spine dysfunction due to co-existing whiplash-type injury.  Based on previously established tissue injury thresholds, acceleration/deceleration of the head and neck sufficient to cause traumatic brain injury is also likely to cause  injury to the joints and soft tissues of the neck. It has also been well established that injury and/or dysfunction of the cervical spine can result in numerous signs and symptoms synonymous with concussion, including headaches, dizziness, cognitive as well as visual dysfunction.  Given our current level of evidence, skilled, manual therapy-related assessment and rehabilitation of cervical spine dysfunction should be considered for chronic symptoms following concussion injuries.

http://www.ncbi.nlm.nih.gov/pubmed/26138797

 

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 Adjustments Reduce Fatigue and Increase Neural Drive

chiropractic adjustmentOver 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 Taylor et al) has hypothesized that the joint 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.  Many studies show that chiropractic adjustments result in changes to sensorimotor integration within the central nervous system.

A new study sought to investigate possible neural plastic changes with spinal manipulation by measuring H-reflexes and V-waves.  The H-reflex is an electrically evoked response that operates via the same neuronal circuitry as stretch reflexes.  The H (Hoffmann) reflex may be useful to assess motoneuron excitability in vivo while also reflecting presynaptic inhibition of Ia afferent synapses.  The so-called V-wave, which is an electrophysiological variant of the H-reflex, can be recorded during maximal voluntary motor contractions. The elicited V-wave response may be used to reflect the level of efferent neural drive from spinal α-motoneurons during maximal voluntary contraction (MVC).

Results of the study:

  • the threshold to elicit the H-reflex significantly decreased by 8.5% in the spinal manipulation group
  • the SEMGs showed a significant drop in the power spectrum after controls but there was no fatigue demonstrated in the power spectrum after spinal manipulation
  • for study 1: maximal voluntary contraction as determined by SEMG increased significantly by 59.5% after spinal manipulation and decreased significantly by 13.3% after control
  • for study 2: maximal voluntary contraction increased significantly by 16.1% after spinal manipulation and decreased significantly by 11.4% after control
  • the V-wave amplitude (V/Mmax ratio) increased significantly by 45% after spinal manipulation and reduced significantly by 23% after control

Key Points

  • This study is the first to indicate that chiropractic adjustments can induce significant changes in the net excitability for the low-threshold motor units/and or alters the synaptic efficacy of the Ia synapse
  • the improvements in maximal voluntary contraction following spinal manipulation are likely attributed to the increased descending drive and/or modulation in afferents
  • spinal manipulation prevents fatigue
  • these results suggest that spinal manipulation may be indicated as part of the treatment for the patients who have lost tonus of their muscle and/or are recovering from muscle dysfunction such as stroke or orthopedic operations
  • These findings will also be of interest to athletes and perhaps the general public

 

Dr. Bernadette Murphy

003- Chiropractic Neurophysiology with Dr. Bernadette Murphy

Dr. Bernadette Murphy
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Listen to this great interview with Dr. Bernadette Murphy. This is an interview that all chiropractors and students will want to listen to! We talk about many interesting concepts such as the current state of neurophysiology research within chiropractic, neural adaptation in humans and the role of chiropractic adjustments in aiding the re-establishment of appropriate neuromuscular connections, how a chiropractic adjustment works and much more.  She is at the forefront of research regarding the neurophysiology of chiropractic.  Dr. Murphy graduated from Queens University in 1985 and the Canadian Memorial Chiropractic College in 1989 before moving to New Zealand where she completed her MSc (1992) and PhD (1998) in Human Neurophysiology at the University of Auckland. She was a fulltime faculty member in the Department of Sport and Exercise Science from 1999-2007, where she established an MSc in Exercise Rehabilitation.  In January 2008, she returned to Canada and took on the role of Head of Kinesiology in the Faculty of Health Sciences at the University of Ontario Institute of Technology (UOIT).  She is the Director of the Human Neurophysiology and Rehabilitation Laboratory. The overall theme of her research is neural adaptation in humans and the role of physical interventions such as spinal manipulation and exercise in aiding the re-establishment of appropriate neuromuscular connections.  She has previously been awarded the World Federation of Chiropractic best scientific paper award (1995) and 3rd prize in 2007; the New Zealand Chiropractor of the year (2004) and the 2010 Ontario Chiropractic Association award for most significant contributions to research.  She has supervised numerous award winning Masters and PhD students and received significant research funding in New Zealand, Australia and Canada.

 

Dr. Smith and Dr. Murphy at University of Ontario Institute of Technology

 Dr. Murphy and Dr. Smith at University of Ontario Institute of Technology

 

Dr. Katie Pohlman

002- Chiropractic Pediatric Research with Dr. Katherine Pohlman

Dr. Katherine Pohlman, Katie PohlmanListen to my chiropractic research interview with Dr. Katherine Pohlman.  Dr. Pohlman is a graduate student with the Department of Pediatrics. She earned a BSc in Biology from The Ohio State University and a Doctor of Chiropractic and MSc in Clinical Research both from the Palmer College of Chiropractic. In addition to her education, Dr. Pohlman has also had the opportunity to be the lead clinical project manager for several US federally funded clinical trials, including the largest trial in chiropractic history conducted in active-duty military personnel and a CIHR-funded team grant. Her overall goal is to become an independent clinician scientist investigating the safety and effectiveness and complementary and alternative medicines, especially chiropractic care, for use among the pediatric population.

We discuss several of the articles below:

1. Practice patterns of doctors of chiropractic with a pediatric diplomate: a cross-sectional survey.
Pohlman KA, Hondras MA, Long CR, Haan AG.
BMC Complement Altern Med. 2010 Jun 14;10:26. doi: 10.1186/1472-6882-10-26.
PMID: 20546582 [PubMed – indexed for MEDLINE] Free PMC Article
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2. Otitis media and spinal manipulative therapy: a literature review.
Pohlman KA, Holton-Brown MS.
J Chiropr Med. 2012 Sep;11(3):160-9. doi: 10.1016/j.jcm.2012.05.006.
PMID: 23449823 [PubMed] Free PMC Article
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3. Study protocol for patient response to spinal manipulation – a prospective observational clinical trial on physiological and patient-centered outcomes in patients with chronic low back pain.
Xia T, Wilder DG, Gudavalli MR, DeVocht JW, Vining RD, Pohlman KA, Kawchuk GN, Long CR, Goertz CM.
BMC Complement Altern Med. 2014 Aug 8;14:292. doi: 10.1186/1472-6882-14-292.
PMID: 25106673 [PubMed – indexed for MEDLINE] Free PMC Article
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4. Barriers to Implementing a Reporting and Learning Patient Safety System: Pediatric Chiropractic Perspective.
Pohlman KA, Carroll L, Hartling L, Tsuyuki RT, Vohra S.
J Evid Based Complementary Altern Med. 2016 Apr;21(2):105-9. doi: 10.1177/2156587215609191.
PMID: 26438719 [PubMed – indexed for MEDLINE]
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5. Core Competencies of the Certified Pediatric Doctor of Chiropractic: Results of a Delphi Consensus Process.
Hewitt E, Hestbaek L, Pohlman KA.
J Evid Based Complementary Altern Med. 2016 Apr;21(2):110-4. doi: 10.1177/2156587215622769.
PMID: 26739669 [PubMed – indexed for MEDLINE]
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Risk of Injury Following Visits to Health Professionals

Aging ChiropracticThere are physiologic changes associated with aging. There are also health conditions that occur more commonly with advancing age. These changes and conditions increase an older adult’s vulnerability to injuries. A recent study investigated risk of injury to Medicare beneficiaries with an office visit for a neuromusculoskeletal problem to chiropractors and primary care physicians.  Specifically, investigators looked at the risk of injury within 7 days of those treated by chiropractic spinal manipulation vs. those evaluated by a primary care physician.  Results showed that risk of injury to the head, neck or trunk within 7 days was 76% lower among subjects with a chiropractic office visit as compared to those who saw a primary care physician.