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We’re not ‘just treating’ back and neck pain

WorldSpineChiropracticWe’re not ‘just treating’ back and neck pain!  We are reducing the leading global burden of disease! Low back pain causes more global disability than any other condition.  Neck pain is the 4th leading cause of global disability.

Reference: Hoy D, March L, Brooks P, Blyth F, Woolf A, Bain C, Williams G, Smith E, Vos T, Barendregt J, Murray C, Burstein R, Buchbinder R. The global burden of low back pain: estimates from the Global Burden of Disease 2010 study. Ann Rheum Dis. 2014 Jun;73(6):968-74.

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Is Chiropractic Useful For Dizziness and Balance?

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

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

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Chiropractic and Midwifery Improve Breastfeeding Rates

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

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

 

Happy 120th Birthday Chiropractic!

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

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

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

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

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

The study interventions consisted of:

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

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

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

Results and Conclusions:

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

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

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

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

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

Podcast

Dr. Kent Stuber

013- Patient Centered Chiropractic Care with Dr. Kent Stuber

Dr. Kent StuberDr. Kent Stuber discusses his research interests, his role as editor of the Journal of the Canadian Chiropractic Association and how chiropractors can get involved in research. Kent Stuber has been in practice in Calgary, Alberta, Canada for nearly 14 years. He did his chiropractic training at CMCC. He completed a Master of Science degree in Health and Social Care Research from the University of Sheffield in 2008. He is currently a MPhil/PhD student at the University of South Wales, studying patient-centeredness in chiropractic.

Kent is an Adjunct Professor in CMCC’s Division of Graduate Education and Research. He has published over 30 articles in over a dozen different peer-reviewed scientific journals. His research interests include patient-centered care, sports injuries, spinal stenosis, the psychometric properties and use of orthopaedic testing, as well as the treatment of pregnancy-related musculoskeletal conditions.

Kent is a member of the International Task Force on Diagnosis and Management of Lumbar Spinal Stenosis as well as the Guideline Implementation Group (GIG) of the Canadian Chiropractic Association’s Clinical Practice Guideline Initiative. In July 2015, Kent became the fifth Editor-in-Chief of the Journal of the Canadian Chiropractic Association, a peer-reviewed journal now in its 60th year of publication.

Dr. Stuber was born and raised in Calgary. He obtained a Bachelor of Science degree in Cellular, Molecular & Microbial Biology from the University of Calgary before moving to Toronto where he graduated Magna Cum Laude with Clinic Honours from the Canadian Memorial Chiropractic College (CMCC) in 2002.  Dr. Stuber’s post graduate education courses have included Graston Technique®, Active Release Techniques®, Kinesiotaping, Low-Tech Lumbar Spinal Stabilization Training, Managing Neck Pain Conditions, Evaluation and Management of Neck and Arm Pain, courses from the Titleist Performance Institute, and Taping and Support Techniques for Sports Practitioners.  You can visit Dr. Stuber’s practice at: http://www.momentumhealth.ca.

Visit the Journal of the Canadian Chiropractic Association.  The Journal of the Canadian Chiropractic Association (JCCA) is the official, peer reviewed, quarterly research publication of the Canadian Chiropractic Association (CCA). Published since 1957 and searchable from 1986 on this site and from 1978 in PubMed, the JCCA publishes research papers, commentaries and editorials relevant to the practice of chiropractic.

View Dr. Stuber’s publications on researchgate.com.

Here are the articles we discuss during the interview:

1. Assessing patient-centered care in patients with chronic health conditions attending chiropractic practice: protocol for a mixed-methods study.
Stuber KJ, Langweiler M, Mior S, McCarthy PW.
Chiropr Man Therap. 2016 May 9;24:15. doi: 10.1186/s12998-016-0095-x.
PMID: 27162609 [PubMed] Free PMC Article
Similar articles
2. ISSLS Prize Winner: Consensus on the Clinical Diagnosis of Lumbar Spinal Stenosis: Results of an International Delphi Study.
Tomkins-Lane C, Melloh M, Lurie J, Smuck M, Battié MC, Freeman B, Samartzis D, Hu R, Barz T, Stuber K, Schneider M, Haig A, Schizas C, Cheung JP, Mannion AF, Staub L, Comer C, Macedo L, Ahn SH, Takahashi K, Sandella D.
Spine (Phila Pa 1976). 2016 Aug 1;41(15):1239-46. doi: 10.1097/BRS.0000000000001476.
PMID: 26839989 [PubMed – in process]
Similar articles
3. Chiropractic treatment of lumbar spinal stenosis: a review of the literature.
Stuber K, Sajko S, Kristmanson K.
J Chiropr Med. 2009 Jun;8(2):77-85. doi: 10.1016/j.jcm.2009.02.001.
PMID: 19646390 [PubMed] Free PMC Article
Similar articles
4. Core stability exercises for low back pain in athletes: a systematic review of the literature.
Stuber KJ, Bruno P, Sajko S, Hayden JA.
Clin J Sport Med. 2014 Nov;24(6):448-56. doi: 10.1097/JSM.0000000000000081. Review.
PMID: 24662572 [PubMed – indexed for MEDLINE]
Similar articles
5. Chiropractic treatment of pregnancy-related low back pain: a systematic review of the evidence.
Stuber KJ, Smith DL.
J Manipulative Physiol Ther. 2008 Jul-Aug;31(6):447-54. doi: 10.1016/j.jmpt.2008.06.009. Review.
PMID: 18722200 [PubMed – indexed for MEDLINE]
Similar articles
6. The treatment experience of patients with low back pain during pregnancy and their chiropractors: a qualitative study.
Sadr S, Pourkiani-Allah-Abad N, Stuber KJ.
Chiropr Man Therap. 2012 Oct 9;20(1):32. doi: 10.1186/2045-709X-20-32.
PMID: 23046615 [PubMed] Free PMC Article
Similar articles
Dr. Cheryl Hawk

011- Health Promotion, Wellness and Chiropractic Guidelines with Dr. Cheryl Hawk

Cheryl-Hawk-thumbnailIn this episode Cheryl Hawk, DC, PhD, CHES discusses chiropractic maintenance vs. wellness care, various chiropractic guidelines on low back pain, health promotion and pediatric care as well as her two new books. Dr. Cheryl Hawk is an author of over 100 publications in peer-reviewed scientific journals. She has designed and taught courses on wellness and health promotion to health professions students and in post-graduate education. She has also collaborated on the design and implementation of an online wellness certification program for health professionals, with Will Evans, DC, PhD, MCHES, and Michael Perko, PhD, CHES, FAAHE, offered by the National Wellness Institute. She received her Doctor of Chiropractic degree in 1976 from the National University of Health Sciences and practiced full-time for 12 years. In 1991, she earned a PhD in Preventive Medicine from the University of Iowa and also became a Certified Health Education Specialist (CHES). She is the author, with Will Evans, DC, PhD, MCHES, of Health Promotion and Wellness: An Evidence-Based Guide to Clinical Preventive Services. She is currently co-chair of the Research Working Group of the Academic Consortium for Complementary and Alternative Health Care. She has been named “Researcher of the Year” by both the American Chiropractic Association (2003) and the Foundation for Chiropractic Education and Research (2005). Her areas of interest are health promotion and prevention, practice-based research and health services research.

And…Dr. Hawk is also working on two upcoming books, Evidence-based Chiropractic Practice and Careers in Chiropractic. Although they won’t be published until 2017, there’s never been anything like it for chiropractic. This will be 2 entire volumes written NOT for chiropractors, but for potential patients, other providers, and potential chiropractic students!

As mentioned in the interview,  please find a link to the link to the CCGPP/Clinical Compass website and materials at http://clinicalcompass.org/

After CCGPP teams with specific skills review and rate all information gathered from multiple databases (synthesis), this information is then translated into easily usable tools (the “Chiropractic Clinical Compass©”). The synthesis is not the Compass©, it is merely an evidence stratification for the most common conditions seen by chiropractic doctors. CCGPP recognizes that information in this format is difficult to digest and implement. To assist comprehension and ease of application, the synthesis will be translated for use in the treatment room via a DIER (Dissemination, Implementation, Evaluation, and Revision) process (see Powerpoint presentation on the Introduction page of this website for more details on this process). This process will ultimately produce the Chiropractic Clinical Compass©. In addition, in today’s ever-changing health care environment, the literature synthesis can be used for many purposes and CCGPP is flexible and responsive to rapidly changing trends and needs.

The goals of CCGPP/Clinical Compass are:

  • To promote the improvement of the quality of chiropractic services and of the professional reputation of doctors of chiropractic
  • To promote the intellectual, academic, and clinical integrity of chiropractic practice
  • To promote the intellectual, academic, and clinical integrity of practice guidelines and PR

Please support CCGPP/Clinical Compass by donations at http://clinicalcompass.org/donate

For a list of Dr. Hawk’s scientific publications please click here.

Here is a list of the publications we discuss during this interview:

1. The Role of Chiropractic Care in the Treatment of Dizziness or Balance Disorders: Analysis of National Health Interview Survey Data.
Ndetan H, Hawk C, Sekhon VK, Chiusano M.
J Evid Based Complementary Altern Med. 2016 Apr;21(2):138-42. doi: 10.1177/2156587215604974.
PMID: 26362851 [PubMed – indexed for MEDLINE]
Similar articles
2. Consensus process to develop a best-practice document on the role of chiropractic care in health promotion, disease prevention, and wellness.
Hawk C, Schneider M, Evans MW Jr, Redwood D.
J Manipulative Physiol Ther. 2012 Sep;35(7):556-67. doi: 10.1016/j.jmpt.2012.05.002.
PMID: 22742964 [PubMed – indexed for MEDLINE]
Similar articles
3. Chiropractic and public health: current state and future vision.
Johnson C, Baird R, Dougherty PE, Globe G, Green BN, Haneline M, Hawk C, Injeyan HS, Killinger L, Kopansky-Giles D, Lisi AJ, Mior SA, Smith M.
J Manipulative Physiol Ther. 2008 Jul-Aug;31(6):397-410. doi: 10.1016/j.jmpt.2008.07.001.
PMID: 18722194 [PubMed – indexed for MEDLINE]
Similar articles
4. A framework for chiropractic training in clinical preventive services.
Hawk C, Evans MW Jr.
Chiropr Man Therap. 2013 Aug 20;21(1):28. doi: 10.1186/2045-709X-21-28.
PMID: 23962353 [PubMed] Free PMC Article
Similar articles
5. Clinical Practice Guideline: Chiropractic Care for Low Back Pain.
Globe G, Farabaugh RJ, Hawk C, Morris CE, Baker G, Whalen WM, Walters S, Kaeser M, Dehen M, Augat T.
J Manipulative Physiol Ther. 2016 Jan;39(1):1-22. doi: 10.1016/j.jmpt.2015.10.006.
PMID: 26804581 [PubMed – indexed for MEDLINE]
Similar articles
6. Best Practices for Chiropractic Care of Children: A Consensus Update.
Hawk C, Schneider MJ, Vallone S, Hewitt EG.
J Manipulative Physiol Ther. 2016 Mar-Apr;39(3):158-68. doi: 10.1016/j.jmpt.2016.02.015.
PMID: 27040034 [PubMed – in process] Free Article
Similar articles

 

Dr. Steven Passmore

005- Human Performance with Dr. Steven Passmore

Passmore Headshot 2012

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Listen to Dr. Dean Smith interview Dr. Passmore regarding the science relating chiropractic to human performance. Dr. Passmore is Assistant Professor in the Faculty of Kinesiology & Recreation Management at the University of Manitoba.  He also holds adjunct appointments in the College of Rehabilitation Sciences at the University of Manitoba, the Research Department at New York Chiropractic College, and the University of Ontario Institute of Technology.  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.  Dr. Passmore practiced as a chiropractor in the Buffalo Veterans Affairs Medical Center (2007-09), and is currently in practice in Manitoba. He has held competitive grants from the Canadian Institutes for Health Research (CIHR), the Worker’s Compensation Board of Manitoba (WCB), Research Manitoba (RM), the Manitoba Medical Service Foundation (MMSF), and the Alexander Gibson Fund.

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.