Posts

In this upcoming interview, John M. Mayer, DC, PhD, CCRP, FACSM will discuss his extensive clinical and research experience in occupational health, wellness, and therapeutic exercise. Dr. Mayer has led teams on numerous clinical trials across the country on various aspects of wellness, clinical management, and prevention funded through federal, state, industry, and foundation sources, including the largest single financial commitment by the US Department of Homeland Security on low back injury prevention in firefighters. Please comment below if you have any questions for us during the interview. I might choose some of them for our conversation.

Chiropractic Neck AdjustmentThere is a growing trend of chiropractic use in adults. In a recent survey of US adults who used chiropractic services, back pain (63.0%) and neck pain (30.2%) were the most prevalent health problems for chiropractic consultations and the majority of users reported chiropractic helping a great deal with their health problem and improving overall health or well-being. Most of the survey respondents reported consulting a chiropractor for general wellness or disease prevention (43.3%), to improve their energy (16.3%), or to improve athletic or sports performance (15.4%). Many reported positive outcomes of chiropractic utilization agreeing that such care had helped them to improve overall health and make them feel better (66.9%), to sleep better (41.9%), and to reduce stress or to relax (40.2%). Almost half of all adults surveyed (47.9%) felt that chiropractic was very important for maintaining health and well-being, and another 30% felt it was somewhat important.

Reference: Adams J, Peng W, Cramer H, Sundberg T, Moore C, Amorin-Woods L, Sibbritt D, Lauche R. The Prevalence, Patterns, and Predictors of Chiropractic Use Among US Adults: Results From the 2012 National Health Interview Survey. Spine (Phila Pa 1976). 2017 Dec 1;42(23):1810-1816.

In this update, I will summarize key points from recent scientific literature regarding the practice of chiropractic, patient profiles, utilization rates, chiropractic assessment and care methods.  Much of the information comes from the excellent work of Beliveau et al (2017) who did a scoping review and used 337 articles from across the globe. I have provided references to other key papers also.

Chiropractors practice in over 100 countries.  There are 90 existing national chiropractic associations across the world. Chiropractic has become one of the most commonly used health professions in the United States and Europe. A substantial proportion of US adults utilize chiropractic services and report associated positive outcomes for overall well-being and/or specific health problems for which concurrent conventional care was common (1). Chiropractors provide a significant amount of care for patients with many health conditions including low back and neck pain. The profession is a major participant in the health care expenditures of the United States and Denmark. As an example, here in the United States in 2015, chiropractors provided 18.6 million clinical services under Medicare and overall spending for chiropractic services was estimated at USD $12.5 billion (Beliveau et al, 2017).

According to the American Chiropractic Association (2), there are 77,000 chiropractors in the United States with roughly another 3,000 chiropractors that work in academic and management roles. There are approximately 10,000 chiropractic students in 18 nationally accredited, chiropractic doctoral programs across the United States with 2,500 chiropractors entering the work environment each year. Estimates indicate that chiropractors treat more than 35 million Americans (adults and children) annually. Chiropractors are designated as physician-level providers in the vast majority of states and the federal Medicare program. The essential services provided by chiropractors are also available in federal health delivery systems, including those administered by Medicaid, the U.S. Departments of Veterans Affairs (VA) and Defense, Federal Employees Health Benefits Program, Federal Workers’ Compensation, and all state workers’ compensation programs. Chiropractic is currently offered at 75 VA facilities and 66 military hospitals/clinics.

National and international guidelines include chiropractic (spinal manipulation) for low back pain (LBP) and neck pain. A short summary (3-4) of recent guidelines include:

  • For acute and chronic LBP, a review of clinical practice guidelines (CPGs) on the noninvasive management of LBP and 3 national CPGs published since 2016 in the United States (Agency for Healthcare Research and Quality [AHRQ] comparative effectiveness review [CER]), the UK (National Institute for Care Excellence [NICE]), and Denmark (Denmark National Guideline) recommend considering manual therapy, including SMT, mobilization, or soft tissue techniques such as massage
  • An additional CPG, by the American College of Physicians (ACP), recommends clinicians select nonpharmacologic treatment for acute and chronic LBP (superficial heat, massage, acupuncture, and SMT) before pharmacologic treatment options

Chiropractic utilization rates

  • Across the world, 52 studies (Beliveau et al, 2017) have found the median 12-month use of chiropractic services was 9.1% and lifetime utilization was 22.2%
  • In Canada and the United States there has been an increased 12 month utilization rate from 10% to 11.7% and from 7.2% to 10.7% respectively from the 1980’s until 2015

Who delivers spinal manipulation?

  • Among the 8.5% of US adults who reported receiving manipulation, 97.6% saw chiropractors according to the 2012 National Health Interview Survey (5)

Reasons for seeing a chiropractor

  • For the general population, the most common reasons for seeking care from a chiropractor included: low back pain (49.7%), neck pain (22.5%), extremity problem (10%), wellness/maintenance (7.5%), hip pain (7%), headache (5.5%)
  • For the pediatric population, the most common reasons for seeking care from a chiropractor included: musculoskeletal conditions (44%), excessive crying (19.8%), neurologic conditions (17.9%), gastrointestinal conditions (17.5%), ear/nose/throat conditions (8.3%) and infection (7%) (Beliveau et al, 2017)

Profile of chiropractic patients

  • People who sought chiropractic care were more likely to be female with a median age of 43.4 years
  • 3% of the chiropractic patient population were employed, and a smaller proportion were either retired, unemployed, or students
  • People with disabilities constituted only 1.4% of chiropractic patients (Beliveau et al, 2017)

Types of chiropractic assessments used in practice

  • The most common assessment methods included: static palpation (89.3%), motion palpation (86.5%), spinal examination (79.5%), orthopedic examination (71.8%), neurological examination (64.6%) (Beliveau et al, 2017)

Types of chiropractic treatment provided

  • Across the globe, spinal manipulation (79.3%), soft-tissue therapy (35.1%), formal patient education (31.3%), nutritional supplements (30.9%), exercise instruction/prescription (26%)
  • Interestingly the NBCE (National Board of Chiropractic Examiners) found that in the US: 98.8% of chiropractors provide ergonomic/postural advice, 98.5% of chiropractors provide physical fitness/exercise promotion and 97% of chiropractors provide nutritional/dietary recommendations (Beliveau et al, 2017)

References:

Main Source: Beliveau PJH, Wong JJ, Sutton DA et al. The chiropractic profession: a scoping review of utilization rates, reasons for seeking care, patient profiles, and care provided. Chiropr Man Therap. 2017 Nov 22;25:35.

1. Adams J, Peng W, Cramer H, Sundberg T, Moore C, Amorin-Woods L, Sibbritt D, Lauche R. The Prevalence, Patterns, and Predictors of Chiropractic Use Among US Adults: Results From the 2012 National Health Interview Survey. Spine (Phila Pa 1976). 2017 Dec 1;42(23):1810-1816.

2. https://www.acatoday.org/Patients/Why-Choose-Chiropractic/Key-Facts

3. Wong JJ, Côté P, Sutton DA, et al. Clinical practice guidelines for the noninvasive management of low back pain: A systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. Eur J Pain 2016;21(2):201-16.

4. Bussières AE, Gauthier CA, Fournier G, Descarreaux M. Spinal manipulative therapy for low back pain-time for an update. Can Fam Physician. 2017 Sep;63(9):669-672.

5. Forte ML, Maiers M. Functional Limitations in Adults Who Utilize Chiropractic or Osteopathic Manipulation in the United States: Analysis of the 2012 National Health Interview Survey. J Manipulative Physiol Ther. 2017 Nov -Dec;40(9):668-675.

There was a low recurrence rate (using a stringent definition of recurrence) in a large population of patients with low back pain (LBP) up to 1 year after chiropractic care. However, the vast majority of patients were not pain free after 1 year. This is the conclusion of a recent observational study published in the Journal of Manipulative and Physiological Therapeutics.

Patients in the study were located in Switzerland.  Seven hundred and twenty-two patients with LBP (375 male) completed the Numeric Rating Scale for pain (NRS) and the Oswestry Disability Index (ODI) before chiropractic treatment and 1, 3, 6, and 12 months later (ODI up to 3 months). Patients were then categorized based on pain rating scores into “fast recovery,” “slow recovery,” “recurrent,” “chronic,” and “others.”

Based on these pain ratings, 13.4% of the patients were categorized as recurrent. The recurrent pattern significantly differed from fast recovery in duration of complaint. The duration of complaint before treatment was the main predictor for recurrence. Specifically, a subacute duration, defined in the present study as longer than 14 days, significantly increased the odds for an unfavorable course of LBP, which is of clinical relevance.

Reference: Knecht C, Humphreys BK, Wirth B. An Observational Study on Recurrences of Low
Back Pain During the First 12 Months After Chiropractic Treatment. J Manipulative
Physiol Ther. 2017 Jul – Aug;40(6):427-433.

 

 

shoulder pain manual therapyShoulder 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.

 

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.


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).

 

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.

 

adobestock_69723890Low 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.

A 2014 prospective, cohort, outcomes study involving 115 pregnant women with low back or pelvic pain participated in the study.  Baseline numerical rating scale (NRS) of pain intensity and Oswestry Low Back Pain Disability Index questionnaire data were collected.  In addition, The patient’s global impression of change (PGIC) (primary outcome), NRS, and Oswestry data (secondary outcomes) were collected at 1 week, 1 and 3 months after the first treatment.  Then, at 6 months and 1 year the PGIC and NRS scores were collected again. PGIC responses of ‘better’ or ‘much better’ were categorized as ‘improved’. Chiropractic treatment was pragmatic and left to the discretion of the treating clinician.

Results:

  • 52% of 115 recruited patients ‘improved’ at 1 week, 70% at 1 month, 85% at 3 months, 90% at 6 months and 88% at 1 year.
  • There were significant reductions in NRS and Oswestry scores
  • Patients with more prior LBP episodes had higher 1 year NRS scores

Most pregnant patients with low back or pelvic pain undergoing chiropractic treatment reported clinically relevant improvement at all time points.

Reference: Peterson CK, Mühlemann D, Humphreys BK. Outcomes of pregnant patients with low back pain undergoing chiropractic treatment: a prospective cohort study with short term, medium term and 1 year follow up. Chiropr Man Therap. 2014 Apr 1;22(1):15.

 

adobestock_42898239Infantile 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.

To date, several randomized trials examining chiropractic care for children with colic have been reported, and although these trials demonstrate some reduction in crying, weaknesses in study methodologies have limited the evidence they provide.  Based on these previous studies, there is some but not definitive evidence to make a recommendation of manual therapy for the excessively crying baby.

The purpose of this study was to try to address methodological weaknesses in the scientific literature by conducting a single-blind, randomized controlled trial comparing chiropractic manual therapy with no treatment and to determine whether parents’ knowledge of treatment biases their report of change in infant crying.

Infants with unexplained persistent crying (colic) verified by a baseline crying diary of 3 days or more and presenting to the Anglo-European College of Chiropractic were included in the study. Other inclusion criteria included: patients had to be younger than 8 weeks, born at a gestational age of 37 weeks or later, and had a birth weight of 2500 grams or more and show no signs of other conditions or illness.  One hundred and four infants participated.

Parents completed a questionnaire (baseline) and their child was then randomized to 1 of 3 groups.  In 2 of the 3 groups, infants received treatment, and in the third, no treatment was administered.  For one of the treatment groups, the parent was able to observe the treatment and knew that the infant was being treated.  Parents in the other two groups were seated behind a screen and could not observe their child. Therefore, parents in these two groups were ‘blind’ as to whether their infant received treatment or not.  To be clear, the 3 groups were: (i) infant treated/parent aware, (ii) infant treated/parent unaware (blinded), and (iii) infant not treated/parent unaware (blinded).

Chiropractic care was delivered by a chiropractic intern and involved low force tactile pressure to spinal joints and paraspinal muscles where dysfunction was noted on palpation. The manual therapy, estimated at 2 N of force, was given at the area of involvement without rotation of the spine. Treatment duration lasted up to 10 days, and the number of treatments during this period were influenced by examination findings and parent reports. Treatment was stopped if parents reported their infant was symptom-free. Infants in the blinded groups were placed by the parent on the examination table and then parents sat behind a screen that blinded observation. Patients in the no-treatment group were not touched by the intern and/or clinician.

Outcome measures included crying time as assessed by a 24 hour crying diary ending either 10 days after baseline or at discharge – whichever was sooner.  Crying time was extracted from the diaries.  A global improvement scale (GIS) was completed at either 10 days or discharge by parents and assessed their ratings of change since baseline (e.g., worse to much improvement).

Key findings of this study were:

  • Compared with baseline, by day 10, there was a significant decrease in crying time -44.4%,  51.2%, and 18.6% in the treatment groups ([Blinded] and [Not Blinded]) and the no-treatment group, respectively
  • In parents blinded to treatment allocation, using 2 or less hours of crying per day to determine a clinically significant improvement in crying time, the increased odds of improvement in treated infants compared with those not receiving treatment were statistically significant at day 8 (adjusted odds ratio [OR], 8.1) and at day 10 (adjusted OR, 11.8)
  • There was a similar greater odds of improvement with treatment compared with no treatment using the global improvement scale
  • The number needed to treat was 3 (indicating that 3 infants need to be treated to gain one additional improvement in crying time over no treatment)

In summary, this study found that excessively crying infants were at least 5 times less likely to cry if they were treated with chiropractic manual therapy than if they were not treated.  Infants who were treated were equally likely to improve, whether the parents were blinded to treatment or not.

Reference:  Miller JE, Newell D, Bolton JE. Efficacy of chiropractic manual therapy on infant colic: a pragmatic single-blind, randomized controlled trial. J Manipulative Physiol Ther. 2012 Oct;35(8):600-7.

 

 

 

 

Podcast

Join Dr. John Mayer and I as we discuss his extensive clinical and research experience in therapeutic exercise, wellness, chiropractic and first responders.  John M. Mayer, DC, PhD, CCRP, FACSM is the Lincoln Endowed Chair in Biomechanical & Chiropractic Research, Executive Director of the Center for Neuromusculoskeletal Research, and Professor of the School of Physical Therapy & Rehabilitation Sciences, Morsani College of Medicine, University of South Florida. He is Director of Research and Innovation for U.S. Spine & Sport Foundation, Chief Scientific Officer of Excellcior LLC, and Co-Founder of Pillar of Health LLC

Dr. Mayer obtained a Doctor of Chiropractic (DC) degree from the National College of Chiropractic (currently known as National University of Health Sciences) and a PhD degree in Exercise Science/Science Education from Syracuse University. He is a licensed Chiropractic Physician in the state of Florida, a Fellow of the American College of Sports Medicine (FACSM), and a Certified Clinical Research Professional (CCRP) from the Society of Clinical Research Associates. He has extensive clinical and research experience in occupational health, wellness, and therapeutic exercise. Dr. Mayer has led teams on numerous clinical trials across the country on various aspects of wellness, clinical management, and prevention funded through federal, state, industry, and foundation sources, including the largest single financial commitment by the US Department of Homeland Security on low back injury prevention in firefighters. He serves on the Scientific Secretariat for the Global Spine Care Initiative and Clinical and the Scientific Advisory Board for World Spine Care. Dr. Mayer received the 2012 Safety Award from Tampa Fire Rescue, 2014 “Researcher of the Year” Award by the American Chiropractic Association, and 2015 “Outstanding Research Achievement Award” by USF.

View Dr. Mayer’s research publications on Research Gate.

Here is a listing of the articles we discussed today:

1. Effect of Lumbar Progressive Resistance Exercise on Lumbar Muscular Strength and Core Muscular Endurance in Soldiers.
Mayer JM, Childs JD, Neilson BD, Chen H, Koppenhaver SL, Quillen WS.
Mil Med. 2016 Nov;181(11):e1615-e1622.
PMID: 27849497 [PubMed – indexed for MEDLINE]
Similar articles
2. Impact of a supervised worksite exercise program on back and core muscular endurance in firefighters.
Mayer JM, Quillen WS, Verna JL, Chen R, Lunseth P, Dagenais S.
Am J Health Promot. 2015 Jan-Feb;29(3):165-72. doi: 10.4278/ajhp.130228-QUAN-89.
PMID: 24524384 [PubMed – indexed for MEDLINE]
Similar articles
3. Worksite back and core exercise in firefighters: Effect on development of lumbar multifidus muscle size.
Mayer JM, Nuzzo JL.
Work. 2015;50(4):621-7. doi: 10.3233/WOR-141831.
PMID: 24448017 [PubMed – indexed for MEDLINE]
Similar articles
4. Evidence-informed management of chronic low back pain with lumbar extensor strengthening exercises.
Mayer J, Mooney V, Dagenais S.
Spine J. 2008 Jan-Feb;8(1):96-113. doi: 10.1016/j.spinee.2007.09.008. Review.
PMID: 18164458 [PubMed – indexed for MEDLINE]
Similar articles

 

Dr. Alice KongstedJoin Dr. Kongsted and I as we discuss her unique role as an author of the recent groundbreaking Lancet series of articles on Low Back Pain as well as many other topics. Alice Kongsted, DC, PhD graduated from the University of Southern Denmark in 1999 and completed her PhD at the Faculty of Health Sciences at the University of Southern Denmark in 2005. Up till 2009 she had clinical work as a chiropractor alongside her academic work, mainly in an outpatient hospital department. Currently she holds a position as senior researcher at the Nordic Institute of Chiropractic and Clinical Biomechanics (NIKKB) and a position as Associate Professor at the Department of Sports Science and Clinical Biomechanics at University of Southern Denmark. At NIKKB she has set up a network of chiropractic primary care research clinics that regularly participates in data collection for research purposes, the data being made available to researchers both inside and outside NIKKB. Her research interests concern spinal pain with a focus on primary care. This includes investigating the prognosis of spinal pain and why people have different outcomes.

Lately, she has been much occupied with a large project exploring ways to implement evidence-based care in practice. She has an interest in methodology and has taught PhD courses on prognostic research at University of Southern Denmark and at Curtin University in Perth, Australia. Alice Kongsted is an Associate Editor of BMC Musculoskeletal Disorders and she is a member of the editorial board for Chiropractic & Manual Therapies. She has been involved in The Danish Health Authority’s development of three national clinical guidelines for treatment of lumbar radiculopathy, cervical radiculopathy and of non-specific neck pain. She was part of the Lancet Low Back Pain Series Working Group that published three papers in March 2018 to call for worldwide recognition of the disability associated with back pain and the need for prioritizing this globally growing problem. This Lancet series will be a focus of our conversation today.

Visit Dr. Kongsted’s research profile at researchgate.net.

Here is a list of articles Dr. Kongsted mentions during the interview:

1. Prevention and treatment of low back pain: evidence, challenges, and promising directions.
Foster NE, Anema JR, Cherkin D, Chou R, Cohen SP, Gross DP, Ferreira PH, Fritz JM, Koes BW, Peul W, Turner JA, Maher CG; Lancet Low Back Pain Series Working Group.
Lancet. 2018 Mar 20. pii: S0140-6736(18)30489-6. doi: 10.1016/S0140-6736(18)30489-6. [Epub ahead of print] Review.
PMID: 29573872 [PubMed – as supplied by publisher]
Similar articles
2. Low back pain: a call for action.
Buchbinder R, van Tulder M, Öberg B, Costa LM, Woolf A, Schoene M, Croft P; Lancet Low Back Pain Series Working Group.
Lancet. 2018 Mar 20. pii: S0140-6736(18)30488-4. doi: 10.1016/S0140-6736(18)30488-4. [Epub ahead of print]
PMID: 29573871 [PubMed – as supplied by publisher]
Similar articles
3. What low back pain is and why we need to pay attention.
Hartvigsen J, Hancock MJ, Kongsted A, Louw Q, Ferreira ML, Genevay S, Hoy D, Karppinen J, Pransky G, Sieper J, Smeets RJ, Underwood M; Lancet Low Back Pain Series Working Group.
Lancet. 2018 Mar 20. pii: S0140-6736(18)30480-X. doi: 10.1016/S0140-6736(18)30480-X. [Epub ahead of print] Review.
PMID: 29573870 [PubMed – as supplied by publisher]
Similar articles
4. Identifying subgroups of patients using latent class analysis: should we use a single-stage or a two-stage approach? A methodological study using a cohort of patients with low back pain.
Nielsen AM, Kent P, Hestbaek L, Vach W, Kongsted A.
BMC Musculoskelet Disord. 2017 Feb 1;18(1):57. doi: 10.1186/s12891-017-1411-x.
PMID: 28143458 [PubMed – indexed for MEDLINE] Free PMC Article
Similar articles
5. What have we learned from ten years of trajectory research in low back pain?
Kongsted A, Kent P, Axen I, Downie AS, Dunn KM.
BMC Musculoskelet Disord. 2016 May 21;17:220. doi: 10.1186/s12891-016-1071-2.
PMID: 27209166 [PubMed – indexed for MEDLINE] Free PMC Article
Similar articles

 

Dr. Carolina Kolberg and I discuss her research dealing with the effect of chiropractic care on oxidative stress blood markers. Dr. Kolberg has a degree in chiropractic from the Anhembi Morumbi University in São Paulo, Brazil (2004), and she completed her Masters (2009) and PhD (2013) in Biological Sciences: Physiology at the Federal University of Rio Grande do Sul (UFRGS). Her research interests include the neurophysiology of pain and physiological effects of chiropractic treatment. Dr. Kolberg’s thesis on oxidative stress blood markers in patients with chronic back or neck pain treated with high-velocity and low-amplitude manipulation support the hypothesis that HVLA spinal manipulation leads to an antioxidant effect which, in turn, could be related to the analgesic response. Being the first chiropractor graduated in Brazil with a PhD, her goal is to promote the interest of Brazilians’ young chiropractors in research.

Dr. Kolberg is a member of the Research Committee of the WFC, is the Chair of the Research Committee of the Latin American Federation of Chiropractic (FLAQ) and a member of the editorial board of the Journal Coluna/Columna (ISSN 1808-1851), the official scientific publication of the Brazilian Spine Society and affiliated Societies. Dr. Kolberg is active in clinical practice; she is a Physiology professor at the University Center of the Serra Gaúcha (FSG) in the south of Brazil and is an associate researcher at the Neurobiology group from the Federal University of Rio Grande do Sul.

View Dr. Kolberg’s research at researchgate.net.

Here are the research articles we discussed in this episode:

1. Peripheral oxidative stress blood markers in patients with chronic back or neck pain treated with high-velocity, low-amplitude manipulation.
Kolberg C, Horst A, Moraes MS, Duarte FC, Riffel AP, Scheid T, Kolberg A, Partata WA.
J Manipulative Physiol Ther. 2015 Feb;38(2):119-29. doi: 10.1016/j.jmpt.2014.11.003. Epub 2014 Dec 5.
PMID: 25487299 [PubMed – indexed for MEDLINE] Free Article
Similar articles
2. Effect of high-velocity, low-amplitude treatment on superoxide dismutase and glutathione peroxidase activities in erythrocytes from men with neck pain.
Kolberg C, Horst A, Moraes MS, Kolberg A, Belló-Klein A, Partata WA.
J Manipulative Physiol Ther. 2012 May;35(4):295-300. doi: 10.1016/j.jmpt.2012.04.010.
PMID: 22632589 [PubMed – indexed for MEDLINE]
Similar articles
3. Effects of high-velocity, low-amplitude manipulation on catalase activity in men with neck pain.
Kolberg C, Horst A, Kolberg A, Belló-Klein A, Partata WA.
J Manipulative Physiol Ther. 2010 May;33(4):300-7. doi: 10.1016/j.jmpt.2010.03.002.
PMID: 20534317 [PubMed – indexed for MEDLINE]
Similar articles

 

Dr. Craig Moore, Chiropractic, HeadachesDr. Craig Moore discusses the role of chiropractors in the management of headaches. Some areas of discussion we touch upon include the societal impact and costs associated with headaches; prevalence of headaches in the community; prevalence of headache in chiropractic clinical settings; why do people turn to chiropractors; current level of evidence for chiropractic treatment of different headache types; what do the headache guidelines recommend for each headache; what should a chiropractor consider when examining a headache patient (history and examination).

Dr. Craig Moore is the director of a multi-disciplinary allied-health clinic in Crows Nest, Sydney. His clinic focus is toward the diagnosis and management of musculoskeletal disorders and in headache disorders in particular (migraine, tension-type headache, cervicogenic headache).

Dr. Moore has completed a Masters of Clinical Trials Research and is currently enrolled at the University of Technology Sydney, doing a PhD in Public Health – focused on the chiropractic management of headache disorders. As a founding member of the Australian Chiropractic Research Network (ACORN) he has a strong interest in supporting the development of chiropractic research through the utilization of this practice-based research network project. He has numerous publications in the scientific literature in such journals as Spine, BMC Neurology, JMPT, BMC Musculoskeletal Disorders and Headache to name a few. Dr. Moore is also a CARL Fellow!

See Dr. Moore’s research at researchgate.net.

Here are the articles we mentioned during the podcast:

1. The treatment of migraine patients within chiropractic: analysis of a nationally representative survey of 1869 chiropractors.
Moore C, Adams J, Leaver A, Lauche R, Sibbritt D.
BMC Complement Altern Med. 2017 Dec 4;17(1):519. doi: 10.1186/s12906-017-2026-3.
PMID: 29202816 [PubMed – indexed for MEDLINE] Free PMC Article
Similar articles
2. A cross-sectional examination of the profile of chiropractors recruited to the Australian Chiropractic Research Network (ACORN): a sustainable resource for future chiropractic research.
Adams J, Peng W, Steel A, Lauche R, Moore C, Amorin-Woods L, Sibbritt D.
BMJ Open. 2017 Sep 29;7(9):e015830. doi: 10.1136/bmjopen-2017-015830.
PMID: 28965091 [PubMed – in process] Free PMC Article
Similar articles
3. The Prevalence, Patterns, and Predictors of Chiropractic Use Among US Adults: Results From the 2012 National Health Interview Survey.
Adams J, Peng W, Cramer H, Sundberg T, Moore C, Amorin-Woods L, Sibbritt D, Lauche R.
Spine (Phila Pa 1976). 2017 Dec 1;42(23):1810-1816. doi: 10.1097/BRS.0000000000002218.
PMID: 28459779 [PubMed – in process]
Similar articles
4. A critical review of manual therapy use for headache disorders: prevalence, profiles, motivations, communication and self-reported effectiveness.
Moore CS, Sibbritt DW, Adams J.
BMC Neurol. 2017 Mar 24;17(1):61. doi: 10.1186/s12883-017-0835-0. Review.
PMID: 28340566 [PubMed – indexed for MEDLINE] Free PMC Article
Similar articles
5. A workforce survey of Australian chiropractic: the profile and practice features of a nationally representative sample of 2,005 chiropractors.
Adams J, Lauche R, Peng W, Steel A, Moore C, Amorin-Woods LG, Sibbritt D.
BMC Complement Altern Med. 2017 Jan 5;17(1):14. doi: 10.1186/s12906-016-1542-x.
PMID: 28056964 [PubMed – indexed for MEDLINE] Free PMC Article
Similar articles

 

 

 

 

Dr. Dean SmithListen as Dr. Gregory Cramer interviews Dr. Dean Smith regarding his research involving chiropractic as well as exercise on response time, letters to editor and case studies. Dr. Dean Smith is a senior clinical faculty member in the Department of Kinesiology and Health at Miami University. He also maintains a private practice of chiropractic in Eaton, Ohio at Essence of Wellness Chiropractic Center. He is founder and host of Chiropractic Science – this podcast. Chiropractic Science is dedicated to publicizing chiropractic research through podcast interviews with leading chiropractic scientists.

In his private practice, Dr. Smith incorporates lifestyle intervention (exercise, nutrition, other non-drug methods) with chiropractic adjustments and other manual methods to encourage wellness. He has been in practice now for 20+ years. Dr. Smith’s education includes a bachelor’s degree in human biology, a master’s degree in exercise science, a doctor of chiropractic degree and a PhD in brain and cognitive science with a focus on motor behavior and postural control.

His research interests lie broadly in the area of human movement and coordination. He is most interested in how chiropractic, exercise and rehabilitation affect human performance. His scientific articles have been published in such journals as Human Movement Science, Journal of Manipulative and Physiological Therapeutics, Journal of Strength and Conditioning Research, Chiropractic Research Journal, Chiropractic and Osteopathy and The Open Neurology Journal.

Dr. Smith has played several competitive sports such as soccer, hockey and golf. He had a varsity golf scholarship at Miami University where he now teaches and does research. He has provided chiropractic care to professional athletes including Women’s Tennis Association tour pros at the Canadian Open. He also works with varsity university and high school athletes. Dr. Smith is also an Internationally Certified Chiropractic Sports Practitioner (ICCSP).

Here is a link to Dr. Smith’s research articles on research gate.

Below are some articles we discuss in this podcast episode:

Dr. Pierre Côté Listen as Dr. Pierre Côté and I discuss his involvement in hugely impactful research on stroke, lumbar disc herniations and neck pain.  He provides chiropractors with key information that helps de-mystify these topics. Pierre Côté DC, PhD is an epidemiologist. In 2013, he was awarded the prestigious Canada Research Chair in Disability Prevention and Rehabilitation from the Canadian Government. He is currently an Associate Professor in the Faculty of Health Sciences at the University of Ontario Institute of Technology, director of the UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation and an Associate Professor in the Dalla Lana School of Public Health at the University of Toronto. Dr. Côté graduated from the Canadian Memorial Chiropractic College in 1989. In 1996, he obtained a Master’s Degree in Surgery from the University of Saskatchewan. He completed his PhD in epidemiology at the University of Toronto in 2002. In 2003, he received a New Investigator Award from the Canadian Institutes of Health Research.

Dr. Côté was a member of the scientific secretariat of the 2000-2010 Bone and Joint Task Force on Neck Pain and its Associated Disorders; a large international collaboration aimed at synthesizing the scientific evidence on the problem of neck pain. In 2010, he reviewed and proposed modifications to the definition of catastrophic impairment related to traffic collision for the Financial Services Commission of Ontario. More recently in 2012, he was mandated by the Government of Ontario to develop evidence- based Clinical Practice Guidelines for the management of traffic injuries. He submitted his report on the management of Common Traffic injuries to the Ontario Government in 2015. Dr. Côté’s research focuses on understanding the etiology, prognosis and evidence-based management of musculoskeletal pain and disability and mental health. Dr. Côté has published more than 200 scientific papers in prestigious peer-reviewed journals such as the New England Journal of Medicine, the Annals of Internal Medicine, Pain and the American Journal of Epidemiology. His 2017 Google Scholar h-index is 56 and it is 48 according to Scopus.

Website: www.cdpr-research.org

You can find a listing of Dr. Côté’s research at researchgate.

Below are the articles we discuss in this interview:

1. Chiropractic care and risk for acute lumbar disc herniation: a population-based self-controlled case series study.
Hincapié CA, Tomlinson GA, Côté P, Rampersaud YR, Jadad AR, Cassidy JD.
Eur Spine J. 2017 Oct 16. doi: 10.1007/s00586-017-5325-y. [Epub ahead of print]
PMID: 29038870 [PubMed – as supplied by publisher]
Similar articles
2. Risk of vertebrobasilar stroke and chiropractic care: results of a population-based case-control and case-crossover study.
Cassidy JD, Boyle E, Côté P, He Y, Hogg-Johnson S, Silver FL, Bondy SJ.
Spine (Phila Pa 1976). 2008 Feb 15;33(4 Suppl):S176-83. doi: 10.1097/BRS.0b013e3181644600. Erratum in: Spine (Phila Pa 1976). 2010 Mar 1;35(5):595.
PMID: 18204390 [PubMed – indexed for MEDLINE]
Similar articles
3. Management of neck pain and associated disorders: A clinical practice guideline from the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration.
Côté P, Wong JJ, Sutton D, Shearer HM, Mior S, Randhawa K, Ameis A, Carroll LJ, Nordin M, Yu H, Lindsay GM, Southerst D, Varatharajan S, Jacobs C, Stupar M, Taylor-Vaisey A, van der Velde G, Gross DP, Brison RJ, Paulden M, Ammendolia C, David Cassidy J, Loisel P, Marshall S, Bohay RN, Stapleton J, Lacerte M, Krahn M, Salhany R.
Eur Spine J. 2016 Jul;25(7):2000-22. doi: 10.1007/s00586-016-4467-7. Epub 2016 Mar 16. Review.
PMID: 26984876 [PubMed – in process]
Similar articles
4. The annual incidence and course of neck pain in the general population: a population-based cohort study.
Côté P, Cassidy JD, Carroll LJ, Kristman V.
Pain. 2004 Dec;112(3):267-73.
PMID: 15561381 [PubMed – indexed for MEDLINE]
Similar articles

In this interview, Dr. Axén and I discuss the trajectories of low back pain, the characteristics of chiropractic patients with low back pain and practice based research. Iben Axén is a chiropractor in private practice in Stockholm, Sweden, who started to engage in practice-based research in the 1990’s. In 2011, she earned her PhD at Karolinska Institutet (KI) in Stockholm. She previously held a post-doc position shared between KI and the University of Southern Denmark. Currently she is an Associate professor in Musculoskeletal Health at the Karolinska Institutet. Her research centers on chiropractic care for low back pain (LBP). She has published work regarding predictors of treatment outcome, the clinical course and episodes of LBP and of subgrouping patients. Further, she is involved in the Nordic Maintenance Care Program, including the use of, indications for and outcomes of prevention. Iben Axen’s work is mainly based ondata from multicentre longitudinal studies. She is a firm believer in engaging chiropractic clinicians in data collection as part of the implementation process. In several studies, she has used a novel way of frequently measuring outcome using mobile phones and text messages, which allow for detailed studies of conditions that vary over time, for instance LBP.

View Dr. Axen’s research here.

Below are the articles discussed in this episode:

1. “Typical” chiropractic patients- can they be described in terms of recovery patterns?
Axén I, Leboeuf-Yde C.
Chiropr Man Therap. 2017 Aug 9;25:23. doi: 10.1186/s12998-017-0152-0. eCollection 2017.
PMID: 28804617 [PubMed] Free PMC Article
Similar articles
2. What have we learned from ten years of trajectory research in low back pain?
Kongsted A, Kent P, Axen I, Downie AS, Dunn KM.
BMC Musculoskelet Disord. 2016 May 21;17:220. doi: 10.1186/s12891-016-1071-2.
PMID: 27209166 [PubMed – in process] Free PMC Article
Similar articles
3. Trajectories of low back pain.
Axén I, Leboeuf-Yde C.
Best Pract Res Clin Rheumatol. 2013 Oct;27(5):601-12. doi: 10.1016/j.berh.2013.10.004. Epub 2013 Oct 10. Review.
PMID: 24315142 [PubMed – indexed for MEDLINE]
Similar articles
4. Conducting practice-based projects among chiropractors: a manual.
Axén I, Leboeuf-Yde C.
Chiropr Man Therap. 2013 Feb 1;21(1):8. doi: 10.1186/2045-709X-21-8.
PMID: 23369259 [PubMed] Free PMC Article
Similar articles
5. The Nordic maintenance care program: the clinical use of identified indications for preventive care.
Axén I, Bodin L.
Chiropr Man Therap. 2013 Mar 6;21(1):10. doi: 10.1186/2045-709X-21-10.
PMID: 23497707 [PubMed] Free PMC Article
Similar articles

Dr. Eklund and I discuss topics such as: the effect and cost-effectiveness of Chiropractic Maintenance Care (MC) in a population with recurrent and persistent LBP, the demarcation of a LBP episode, psychological and behavioral characteristics of chiropractic patients compared to the other primary care patients, and predictive properties of the West-Haven Yale Multidimensional Pain Inventory (MPI-S) among patients with recurrent and persistent LBP receiving chiropractic care.

Andreas Eklund, DC, PhD graduated from the Anglo European College of Chiropractic 2002 and was in full time Chiropractic practice up until 2012 when he was enrolled in a PhD program at Karolinska Institutet.

In 2015 he was a co-founder of a multidisciplinary rehab unit, which today employs 23 persons working as an integrated team of health professionals, Chiropractors, Physiotherapists, Occupational therapists, Dietitians, and massage therapists.
He earned his PhD degree in 2016, and the title of his thesis was “Recurrent and persistent low back pain – course and prevention”. He currently works as a post Doc at Karolinska Institutet along with his clinical duties. At the moment he also serves as the chair of the scientific committee of the Swedish Chiropractic Association.

See Dr. Eklund’s profile at researchgate.

Below are the articles we discussed in this interview:

1. Absence of low back pain to demarcate an episode: a prospective multicentre study in primary care.
Eklund A, Jensen I, Lohela-Karlsson M, Leboeuf-Yde C, Axén I.
Chiropr Man Therap. 2016 Feb 18;24:3. doi: 10.1186/s12998-016-0085-z. eCollection 2016.
PMID: 26893824 [PubMed] Free PMC Article
Similar articles
2. Do psychological and behavioral factors classified by the West Haven-Yale Multidimensional Pain Inventory (Swedish version) predict the early clinical course of low back pain in patients receiving chiropractic care?
Eklund A, Bergström G, Bodin L, Axén I.
BMC Musculoskelet Disord. 2016 Feb 12;17:75. doi: 10.1186/s12891-016-0933-y.
PMID: 26867930 [PubMed – indexed for MEDLINE] Free PMC Article
Similar articles
3. Psychological and behavioral differences between low back pain populations: a comparative analysis of chiropractic, primary and secondary care patients.
Eklund A, Bergström G, Bodin L, Axén I.
BMC Musculoskelet Disord. 2015 Oct 19;16:306. doi: 10.1186/s12891-015-0753-5.
PMID: 26483193 [PubMed – indexed for MEDLINE] Free PMC Article
Similar articles
4. Prevention of low back pain: effect, cost-effectiveness, and cost-utility of maintenance care – study protocol for a randomized clinical trial.
Eklund A, Axén I, Kongsted A, Lohela-Karlsson M, Leboeuf-Yde C, Jensen I.
Trials. 2014 Apr 2;15:102. doi: 10.1186/1745-6215-15-102.
PMID: 24690201 [PubMed – indexed for MEDLINE] Free PMC Article
Similar articles

Dr. Donald MurphyI 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. Donald Murphy is Medical Director of the Spine Care Program for Care New England, a large multi-hospital system in Rhode Island where he oversees the development and implementation of an integrated spine care pathway.  He is also Clinical Assistant Professor in the Department of Family Medicine at Alpert Medical School of Brown University.  His other faculty appointments include Professor, Part-Time University Faculty at Southern California University of Health Sciences and Adjunct Associate Professor of Research at New York Chiropractic College.  Dr. Murphy has been admitted as a Fellow of the Royal College of Chiropractors in the United Kingdom.  Dr. Murphy has served on the Expert Panel for several spine care guidelines, including those of the American College of Environmental and Occupational Medicine, American College of Physicians and American Pain Society.

Dr. Murphy has 29 years’ experience practicing and teaching primary spine care and has nearly 100 publications in peer-reviewed scientific journals and book chapters.  He is the lead instructor for the certification course for Primary Spine Practitioners offered by the University of Pittsburgh.  His recent books, Clinical Reasoning in Spine Pain, Volume I and II serve as the required texts for that course.  His consulting activities include assisting hospitals, healthcare systems and insurers implement high-value spine care services through Spine Care Partners, LLC.

Here are Dr. Murphy’s textbooks that were discussed in the interview. Click on the books to examine and purchase.

Clinical Reasoning in Spine Pain, Dr. MurphyCRISP Dr. Murphy

 

 

 

 

 

 

 

 

 

See Dr. Murphy’s scientific articles on researchgate.

Articles that we discuss in this interview are below:

1. Spine Care as a Framework for the Chiropractic Identity.
Schneider M, Murphy D, Hartvigsen J.
J Chiropr Humanit. 2016 Nov 4;23(1):14-21. eCollection 2016 Dec. Review.
PMID: 27920614 [PubMed – in process] Free PMC Article
Similar articles
2. Comparison of non-surgical treatment methods for patients with lumbar spinal stenosis: protocol for a randomized controlled trial.
Schneider M, Ammendolia C, Murphy D, Glick R, Piva S, Hile E, Tudorascu D, Morton SC.
Chiropr Man Therap. 2014 May 10;22:19. doi: 10.1186/2045-709X-22-19. eCollection 2014.
PMID: 24872875 [PubMed] Free PMC Article
Similar articles
3. The usefulness of clinical measures of psychologic factors in patients with spinal pain.
Murphy DR, Hurwitz EL.
J Manipulative Physiol Ther. 2011 Nov;34(9):609-13. doi: 10.1016/j.jmpt.2011.09.009. Epub 2011 Oct 21.
PMID: 22018754 [PubMed – indexed for MEDLINE]
Similar articles

 

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.

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

Here is a link to Dr. Long’s webpage at Palmer Center for Chiropractic Research.

Dr. Long mentioned the following paper in the show “Illustrating risk difference and number needed to treat from a randomized controlled trial of spinal manipulation for cervicogenic headache“.