Nondrug and Nonsurgical Treatment of Shoulder Conditions
Shoulder pain is one of the most common musculoskeletal disorders. The lifetime prevalence is estimated to be in the range of 6.7–66.7%. Shoulder pain and stiffness may reduce family life or social life functions as well as reduce productive activities. It also has a strong statistical correlation with somatizing tendency and poor mental health. There are many cases of shoulder pain that have not improved over time, remain persistent, or occur repeatedly. The prognosis becomes poorer the longer the illness is present. A review of the effectiveness of conservative nondrug, nonsurgical interventions, either alone or in combination, for conditions of the shoulder was published in the Journal of Manipulative and Physiological Therapeutics in June, 2017. Shoulder conditions addressed in the article were shoulder impingement syndrome (SIS), rotator cuff-associated disorders (RCs), adhesive capsulitis (AC), and nonspecific shoulder pain. Eligibility criteria for the scientific studies included randomized controlled trials (RCTs), systematic reviews, or meta-analyses. Treatments included nondrug, nonsurgical procedures. Results indicated low- to moderate-quality evidence supporting the use of manual therapies for all 4 shoulder conditions. Exercise, particularly combined with physical therapy protocols, was beneficial for SIS and AC. For SIS, moderate evidence supported several passive modalities. For RC, physical therapy protocols were found beneficial but not superior to surgery in the long term. Moderate evidence supported extracorporeal shockwave therapy for calcific tendinitis RC. Low-level laser was the only modality for which there was moderate evidence supporting its use for all 4 conditions.
Bottom line:
- Manual therapy is beneficial for common shoulder conditions.
- Low-level laser therapy is beneficial for common shoulder conditions.
- Exercise protocols are beneficial for SIS and AC.
A 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 (
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 (
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 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.
Low back pain is one of the most common and often disabling problems in pregnancy. The prevalence of pregnancy related low back pain (PLBP) or pelvic girdle pain (PGP) is 20% to 90% with most studies reporting more than 50% prevalence. PGP is almost 2x more common than lumbar pain. 25% of all postpartum women suffer from PGP and/or PLBP.
Infantile colic is one of the significant challenges of parenthood. It is one of the common reasons for pediatrician visits during the child’s first 3 months of life. Infantile colic is a prevalent and distressing condition for which there is no proven standard therapy, which motivates parents to seek alternatives. It is defined as paroxysms of crying lasting more than 3 hours a day, occurring more than 3 days in any week for 3 weeks (aka rule of 3) in a healthy baby aged 2 weeks to 4 months. Colic remains a poorly understood phenomenon affecting up to 30% of babies, with underlying organic causes of excessive crying accounting for less than 5% of cases. Laboratory tests and radiological examinations are unnecessary if the infant is gaining weight normally and has a normal physical examination.
Research on chiropractic spinal manipulation (CSM) has been conducted extensively worldwide, and its efficacy on musculoskeletal symptoms has been well documented. Previous studies have documented potential relationships between spinal dysfunction and the autonomic nervous system and that chiropractic treatment affects the autonomic nervous system. 
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Chiropractic care holds potential value for the treatment of a variety of limb conditions. For patients with osteoarthritis (OA) of the hip, a combined intervention of manual therapy provided by a chiropractor and patient education was more effective than a minimal control intervention.
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 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.
I am really excited that in this interview, we’ll discuss topics such as: spine care as a framework for the chiropractic identity (as well as primary spine care), psychologic factors in spinal pain, lumbar spinal stenosis and, the Clinical Reasoning in Spine Pain (CRISP) protocols.
Dr. Cynthia Long and I discuss the importance of statistics in chiropractic science. We talk about the role of statistics in research, when to involve a biostatistician into the research process, and the top statistical terms (such as power, effect size, significance, confidence intervals and many more). Dr. Long is Professor and Director of Research at Palmer College of Chiropractic, Davenport, IA, and Director of the Office of Data Management & Biostatistics (ODM) at the Palmer Center of Chiropractic Research (PCCR). She holds an M.S. degree in statistics from Iowa State University and a Ph.D. in biostatistics from the University of Iowa. Dr. Long joined the faculty of the PCCR at its inception in 1995 and contributed to developing PCCR’s research infrastructure, in particular creating the ODM to support the research design, data management and data analysis needs of PCCR research investigators. Since 2000, she has directed the ODM staff as data coordinating centers for 15 on-site, off-site and multi-site federally-funded clinical trials of chiropractic care. Dr. Long is the principal investigator of “Expanding Evidence-Based Clinical Practice and Research Across the Palmer College of Chiropractic”, a grant awarded by the National Center of Complementary and Integrative Health of the National Institutes of Health. She is also the director of Palmer’s MS in Clinical Research where she teaches 10 credit hours of biostatistics. She is on the editorial boards of JMPT and JCCA and has just completed a 3-year term as an elected member of the American Statistical Association board of directors.
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 
Dr. Michele Maiers and I discuss the patient perspective in chiropractic clinical trials, integrative care and leveraging research to inform health care policy.
Dr. 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. Mitch Haas and I discuss the dose-response relationship between chiropractic and health outcomes as well as chiropractors in public health. Dr. Haas has been an integral member of the research division at the 
James DeVocht, DC, PhD and I discuss research regarding the effect of chiropractic care on special operations forces reaction and response times, the biomechanical aspects of chiropractic care on patients, the cervical flexion-relaxation phenomenon and chiropractic treatment of temporomandibular disorders.
William Weeks MD, PhD, MBA and I discuss topics such as: how doctors of chiropractic supply health care services, how patients use such services, and how best to integrate chiropractic with other health care providers; health care delivery science; value in spine care and; opioid overuse in back pain. Dr. Weeks is Professor of Psychiatry and of Community and Family Medicine at The Geisel School of Medicine at Dartmouth. There, he works at The Dartmouth Institute for Health Policy and Clinical Practice as a Senior Research Scientist, where he teaches in Masters programs and conducts research on health economics, healthcare value, the complementary and alternative medicine market, and geographic variation in health services utilization in France. Dr. Weeks has published over 150 peer-reviewed manuscripts examining economic and business aspects of health care services utilization and delivery, physicians’ return on educational investment, health care delivery science, and healthcare value. He received his MD from the University of Texas Medical Branch at Galveston, his MBA from Columbia University, and his PhD in Economics from the Aix-Marseille School of Economics and Management. Dr. Weeks has been honored with the 2009 National Rural Health Association Outstanding Researcher Award and the 2016 Jerome F McAndrews award for excellence in research from the National Chiropractic Mutual Insurance Corporation Group. During 2016, Dr. Weeks holds the Fulbright-Toqueville Distinguished Chair at Aix-Marseille University.
Dr. Hartvigsen and I discuss some important issues facing the profession including: 1) What is Evidence Based Practice?; 2) How do we build chiropractic’s academic capacity (and what are the barriers)?; 3) The Chiropractic Profession in the Mainstream; 4) How can we get the research out to chiropractors and the public?; 5) Musculoskeletal health in the context of general health; 6) The current situation in Australia (pediatric chiropractic).
