Much 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.
Low 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:
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
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
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
https://chiropracticscience.com/wp-content/uploads/2015/06/33609004_s.jpg450313Dean Smith, DC, PhDhttps://chiropracticscience.com/wp-content/uploads/2017/01/chiroscience-logo-website-title-300x167.jpgDean Smith, DC, PhD2015-06-22 17:30:512015-06-22 17:51:00Chiropractic Manipulation Versus Usual Medical Care for Acute and Subacute Low Back Pain
Over 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
There 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.
https://chiropracticscience.com/wp-content/uploads/2014/12/Aging-Chiropractic.jpg450300Dean Smith, DC, PhDhttps://chiropracticscience.com/wp-content/uploads/2017/01/chiroscience-logo-website-title-300x167.jpgDean Smith, DC, PhD2014-12-16 01:38:492014-12-16 01:38:49Risk of Injury Following Visits to Health Professionals
Statistics 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.
https://chiropracticscience.com/wp-content/uploads/2014/07/1066878_high.jpg330248Dean Smith, DC, PhDhttps://chiropracticscience.com/wp-content/uploads/2017/01/chiroscience-logo-website-title-300x167.jpgDean Smith, DC, PhD2014-07-13 03:04:152014-07-13 03:28:28Chiropractic Has Lowest Total Costs for Low Back Problems in a Major Self-Insured Workforce
Much 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.
