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.
Manual therapy is beneficial for common shoulder conditions.
Low-level laser therapy is beneficial for common shoulder conditions.
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.
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.
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.
A recent article by Poulsen et al (2013) contributes to our understanding of the literature regarding chiropractic and lower extremity conditions – particularly hip osteoarthritis. Hip osteoarthritis (OA) is a common joint disease and when symptomatic can have significant impact on regular daily activities. Recently, hip OA has been linked to higher mortality rates. In end stage hip OA, joint replacement surgery is an appropriate and cost-effective treatment but a long-term cohort study has documented that only 20% of patients with radiographic hip OA have had surgery 11-28 years after the initial diagnosis. Therefore, non-surgical interventions with documented effectiveness become essential for patients who do not need, or choose not to have surgery.
Although guidelines recommend patient education (PE) programs as a core intervention, systematic reviews are contradictory in conclusions regarding their effectiveness on pain and function in hip OA. Manual therapy (MT) has been proposed as an adjunct intervention to exercise for patients with hip OA but evidence is based on a single randomized clinical trial (RCT). The authors of the current study realized this gap in the literature and decided to investigate the effectiveness of a patient education (PE) program with or without the added effect of manual therapy (MT) compared to a minimal control intervention (MCI).
The design of this study was a single-center proof-of-principle three-arm parallel group RCT. Inclusion criteria were: Unilateral hip pain >3 months’ duration, age 40-80 years, radiographic hip OA defined as minimal joint space width (JSW) measurement <2.00 mm or a side difference in minimal JSW >10%, and, ability to speak and read Danish. The study took place at the Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Denmark.
During the first 2 months of recruitment, 3 exclusion criteria were added to the original criteria: patients who had had MT within the previous twelve months; patients who rated their pain severity as 1 or 2 on the numerical rating scale (NRS); patients with polyarthritis.
The 3 groups in the study were: 1) MCI; 2) PE; 3) PE + MT.
For the MCI group, a nurse provided written advice on a home stretching program derived from the PE program together with 5-10-min instruction.
The PE group, originally termed ‘Hip School’ was taught by a physiotherapist with 11 years experience. The PE program included two individual sessions and three group sessions.
In the combined PE and MT group, manual therapy was administered by a chiropractor with 20 years of clinical experience. MT was scheduled twice a week for the 6-week intervention period and treatment was individualized to each patient depending on examination findings. MT consisted of: trigger point release therapy (TPPR), muscular stretching by muscle energy technique (MET) and joint manipulation.
The primary outcome was pain severity rated on an 11-box NRS, measured after 6 weeks of intervention. Patients were asked to rate the worst pain experienced during the previous week. Secondary outcome measures were the Hip Disability and Osteoarthritis Outcome Score (HOOS) ranging from 0-100, worst to best; patients’ perceived global effect of interventions, percentage in each group having classified themselves as improved; passive hip range of motion (ROM); use of pain medication at 12 months and hip replacement surgery within the 12 month follow-up period.
A total of 111 patients were included in the analyses at the primary end point at 6 weeks
In the combined group (PE + MT), a clinically relevant reduction in pain severity compared to the MCI of 1.90 points was achieved
Effect size (Cohen’s d) for the PE + MT minus the MCI was 0.92 (large effect)
The number of patients in each group experiencing pain reduction of at least 25% from baseline to 6 weeks was PE = 8, PE +MT = 21 and MCI = 7
Number needed to treat for PE + MT was 3
No difference was found between the PE and MCI groups
At 12 months, not including patients receiving hip surgery the statistically significant difference favoring PE + MT was maintained
All HOOS (pain, symptoms, ADLs, Sport/Rec, QOL) subscales demonstrated clinically relevant and statistically significant superiority, p < 0.05 for the PE + MT group when compared to the MCI group
Mean differences between PE and MCI were small (range 4 to 1) and not statistically significant, p > 0.05
Effect sizes for HOOS subscales for PE + MT minus MCI ranged between 0.75 and 1.08
No changes in hip ROM noted between groups
For primary care patients with 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
Note that patient education alone was not superior to the minimal control intervention
So, what does this study tell us? This trial demonstrated clinical and statistically significant improvements in pain, symptoms and disability for a combined intervention consisting of manual therapy provided by a chiropractor and patient education when compared to a minimal control intervention including home stretching.
Reference: Poulsen E, Hartvigsen J, Christensen HW, Roos EM, Vach W, Overgaard S. Patient education with or without manual therapy compared to a control group in patients with osteoarthritis of the hip. A proof-of-principle three-arm parallel group randomized clinical trial. Osteoarthritis Cartilage. 2013 Oct;21(10):1494-503.
https://chiropracticscience.com/wp-content/uploads/2016/05/1066881_high-1.jpg330440Dean Smith, DC, PhDhttps://chiropracticscience.com/wp-content/uploads/2017/01/chiroscience-logo-website-title-300x167.jpgDean Smith, DC, PhD2016-05-02 21:09:502016-05-02 21:09:50Hip Osteoarthritis – Improvements in Pain and Disability with Care Provided by a Chiropractor
Much is known about the injury mechanisms of concussion injuries in the acute phase, but there is little evidence to support many of the theories regarding postconcussion syndrome (PCS). A potential, and very treatable, cause of this chronic condition is cervical spine dysfunction due to co-existing whiplash-type injury. Based on previously established tissue injury thresholds, acceleration/deceleration of the head and neck sufficient to cause traumatic brain injury is also likely to cause injury to the joints and soft tissues of the neck. It has also been well established that injury and/or dysfunction of the cervical spine can result in numerous signs and symptoms synonymous with concussion, including headaches, dizziness, cognitive as well as visual dysfunction. Given our current level of evidence, skilled, manual therapy-related assessment and rehabilitation of cervical spine dysfunction should be considered for chronic symptoms following concussion injuries.
Dr. Lindsay Gorrell and I discuss her research regarding spinal manipulation, the vertebral artery and reporting of adverse events. Lindsay Gorrell completed her clinical training in Chiropractic and a Master of Research (The effect of manual and instrument applied cervical spine manipulation on mechanical neck pain) at Macquarie University, Australia. She then completed a PhD (Musculoskeletal Biomechanical and Electromyographical Responses Associated with Spinal Manipulation) under the supervision of Drs Walter Herzog and Jay Triano at The University of Calgary, Canada. She is now working as an International Research Fellow at the Balgrist University Hospital, University of Zurich, Switzerland. Lindsay is also studying a Master of Science in Medical Education at The University of Oxford, England.
Lindsay’s research interests are centered on investigating: i) the delivery of spinal manipulation; ii) the physiological responses and clinical outcomes occurring in response to spinal manipulation; and iii) the safety of the manual therapy. This requires different experimental approaches depending on the research question of interest. Most recently, she has published on the relationship between the amount of strain experienced by the vertebral artery, the 3D movements of the head and neck and the forces applied by clinicians during cervical spine manipulation and physiological responses to cervical and upper thoracic spinal manipulation. Lindsay has maintained part-time clinical practice since graduation.
Dr. Brian Anderson DC, MPH, MS, PhD is an Assistant Professor within the Palmer Center for Chiropractic Research (PCCR) at the Palmer College of Chiropractic, where his research is focused on evaluation of nonpharmacological spine care delivery in the US. His background includes 15 years of clinical experience as a licensed chiropractic physician in a variety of settings, including private practice, a hospital-based integrative medicine center, and a chiropractic academic teaching clinic. He has also been an educator for the past 15 years, teaching courses at the undergraduate, graduate, and post-graduate level. With a passion to better understand and contribute to conservative spine care research, he enrolled in a PhD program in Health Sciences in 2015 with a focus on Health Services Research. His dissertation was titled “A Secondary Analysis Of Insurance Claims Data To Determine The Association Between Provider Type And Treatment Escalation In Musculoskeletal Disorders”, which is a topic he continues to investigate currently. In this interview, we discuss his journey from chiropractor to researcher, and several of his publications.
After graduating with his PhD in 2019, he joined the faculty at the Palmer Center for Chiropractic Research, where he participated in a pilot clinical study as a treating clinician, developed relationships with several research collaborators, and made progress towards developing his own research program.
Dr. Anderson’s research has been presented at many academic conferences, for which he has received several best paper awards. He is currently a co-investigator and primary analyst on a R15 grant titled “Spinal Manipulative Therapy vs Prescription Drug Therapy for Care of Aged Medicare Beneficiaries with Neck Pain”. He was recently awarded a 2-year Loan Repayment Award through the National Center for Complementary & Integrative Health (NCCIH), and also participated in the Fall 2022 cohort of the US Bone & Joint Young Investigators Initiative.
https://chiropracticscience.com/wp-content/uploads/2022/11/DrBrianAnderson.jpg500400Dean Smith, DC, PhDhttps://chiropracticscience.com/wp-content/uploads/2017/01/chiroscience-logo-website-title-300x167.jpgDean Smith, DC, PhD2022-11-17 16:31:562022-11-17 16:31:57060- Dr. Brian Anderson Discusses Chiropractic, Treatment Escalation, Medical Services
In this interview, Dr. Scali discusses with me the upper cervical spine and myodural bridge (connective tissue between suboccipital muscles and the cervical spinal dura mater). Dr. Frank Scali grew up in Valley Stream, Long Island, New York, and studied Neuroscience at Stony Brook University. In 2009, he received his Doctorate in Chiropractic at Logan University in Chesterfield, Missouri. During his time in medical school, Dr. Frank Scali professionally prosected cadaveric specimens for Gray’s Anatomy and illustrated for multiple journals and textbooks, including the Oxford Handbook of Bariatric Surgery. While attending medical school, he published multiple non-variant anatomical findings in the medical literature and served as an Ad Hoc Reviewer in Journals such as The Spine Journal, The Anatomical Record, Surgical and Radiological Anatomy, and others. In 2018, he graduated with his MD from AUC School of Medicine with fifty-four publications, including textbook contributions and a patent for a medical device.
Dr. Scali is board certified in Chiropractic and Medicine. His current title is Assistant Professor of Medical Education and Anatomy at the California University of Science and Medicine. At CUSM, Dr. Scali serves as the Director of the ATLAS Lab Center, is the Director of the USMLE Board Preparation, and is the Course Director for MSK/Derm, Surgical Anatomy, and the Step 1/2CK Board Prep course. He was inducted into the Sigma Xi Scientific Research & Honor Society in 2020 and serves on the Editorial Board for the Journal of Medicine since 2019. As Assistant Professor of Medical Education, Dr. Scali has achieved dozens of teaching awards in Medical Foundations, MSK/Derm, Neuroscience, Reproductive Medicine, and Medical Board Preparation courses. Because of his innovative teaching style, in 2021, Dr. Scali became the inaugural recipient of the Robert Suskind & Leslie Lewinter-Suskind Pre-Clinical Faculty of the Year award.
Dr. Samuel Howarth is an Associate Professor, Director of Human Performance Research and the McMorland Family Research Chair in Mechanobiology at the Canadian Memorial Chiropractic College. He also holds adjunct positions at Ontario Tech University, University of Toronto, University of Guelph and Memorial University of Newfoundland. Dr. Howarth obtained his PhD in kinesiology from the University of Waterloo in 2011, focusing on biomechanics and more specifically related to the spine. His current research is directed toward biomechanical analysis of human movement focusing on functional tasks used in daily life and clinical practice. A fundamental component of this work, and scientific inquiry in general, is measurement and data handling. Once a topic primarily relevant to researchers, the proliferation of low-cost sensors capable of providing clinicians with a seemingly unimaginable amount data extends the conversation on the acquisition and interpretation of measurements to the clinical environment.
https://chiropracticscience.com/wp-content/uploads/2021/07/DrSamHowarth.jpg451325Dean Smith, DC, PhDhttps://chiropracticscience.com/wp-content/uploads/2017/01/chiroscience-logo-website-title-300x167.jpgDean Smith, DC, PhD2021-07-06 16:06:412021-07-06 16:06:46056- Issues with Measurement in Science and Clinical Practice – Dr. Samuel Howarth
Dr. Joyce Miller, semi-retired, is a guest paediatrics researcher at AECC University College, Bournemouth, England. She previously worked full-time as Lead Tutor for MSc Musculoskeletal Health of Paediatrics, undergrad paediatrics and evidence based clinical practice at AECC University College. An Associate Professor, she pioneered the busy infant and child practice in the teaching clinic approximately 25 years ago at AECC. She is a busy researcher and has authored more than 80 articles published in peer reviewed journals and conducted over 180 seminars world-wide. She was a certified Brazelton neonate examiner, awarded from Cambridge University and a diplomat of the Royal College Paediatrics and Child Health Nutrition Programme and a fellow of the Royal College of Chiropractors and British Chiropractic Association. Along with Bournemouth University’s midwifery team from the School of Health and Social Care, in 2013 has developed an AECC-BU breastfeeding clinic located on the University Campus. This is an inter-disciplinary clinic where midwives and chiropractors (and students) manage difficult feeding cases together and learn together. She focuses on the care of the neonate and infants, obtaining her PhD in musculoskeletal health of the infant in 2013. She has undergraduate degrees in education and psychology and a post-graduate diplomate in chiropractic orthopaedics. She authored the book, Evidence Based Chiropractic Care for Infants in 2019, co-edits Journal Clinical Chiropractic Pediatrics and continues to mentor graduate students.
https://chiropracticscience.com/wp-content/uploads/2020/05/drjoycemiller.jpg385450Dean Smith, DC, PhDhttps://chiropracticscience.com/wp-content/uploads/2017/01/chiroscience-logo-website-title-300x167.jpgDean Smith, DC, PhD2020-10-29 15:48:062020-10-30 19:43:58053- Dr. Joyce Miller and Evidence Based Chiropractic Care for Infants
Dr. William Reed is an Associate Professor in the School of Health Professions, Department of Physical Therapy at University of Alabama at Birmingham. He is the director of the Mechanisms of Spinal Manual Therapy Laboratory. His research is directed towards determining the peripheral and central mechanisms of spinal manipulation (manual therapy) for the treatment of musculoskeletal pain. He is also the Interim Co-Director of the PhD program in Rehabilitation Science at the University of Alabama at Birmingham. Here we discuss some of Dr. William Reed’s research starting with his introduction to research as a chiropractic student in 1994 then we’ll discuss his work with Dr. Joel Pickar, his K01 award topic, and progressing to his latest line of research on characterization of a rat LBP model and spinal mobilization mechanisms.
Kevin Haussler, DVM, DC, PhD and I discuss his research regarding chiropractic and horses. In particular we discuss four themes in this interview: 1) How chiropractic techniques can be applied to horses; 2) How do you know you are making a difference (objective outcome measures)?; 3) Effects of mobilization versus manipulation in horses; 4)Controlled clinical trials in horses with acute versus chronic back pain.
Dr. Haussler graduated from The Ohio State University, College of Veterinary Medicine in 1988 and completed a small animal internship in Sacramento, CA. To further his training in the conservative management of spinal-related disorders, he pursued human training at Palmer College of Chiropractic-West and completed a veterinary chiropractic certification program in 1993. He attended the University of California-Davis to attain a PhD focusing on spinal pathology and pelvic biomechanics in Thoroughbred racehorses. Post-doctorate training involved evaluation of in-vivo spinal kinematics in horses at Cornell University. While at Cornell, he directed the newly formed Integrative Medicine Service which provided chiropractic, acupuncture and physical therapy services to both small and large animals. Currently, he is an Associate Professor at the Orthopaedic Research Center at Colorado State University and is involved in teaching, clinical duties, and research into the objective assessment of musculoskeletal pain, spinal dysfunction and the application of physical therapy and rehabilitation. Dr. Haussler is a charter diplomate of the American College of Veterinary Sports Medicine and Rehabilitation and is currently a course instructor for the Equine Rehabilitation Certification course co-branded by the University of Tennessee and Colorado State University.
https://chiropracticscience.com/wp-content/uploads/2019/12/DrHaussler.png360360Dean Smith, DC, PhDhttps://chiropracticscience.com/wp-content/uploads/2017/01/chiroscience-logo-website-title-300x167.jpgDean Smith, DC, PhD2020-01-08 10:48:142020-01-08 10:50:01049- Veterinary Chiropractic, Horses and Research with Dr. Kevin Haussler
Geoffrey Bove, DC, PhD, and I discuss his research regarding inflammation within peripheral nerves, chiropractic principles, manual therapies, repetitive motion disorders and much more. Dr. Bove is a graduate of Hampshire College, Canadian Memorial Chiropractic College, and the University of North Carolina, Chapel Hill. He is currently a professor at the University of New England, in Biddeford Maine (USA). Dr. Bove’s research has focused on the effect of inflammation on small diameter axons within peripheral nerves, a topic directed by founding chiropractic principles. He also studies the effects of manual therapies on common painful conditions, such as repetitive motion disorders and postoperative visceral adhesions.
https://chiropracticscience.com/wp-content/uploads/2018/09/DrGeoffreyBove.jpg453400Dean Smith, DC, PhDhttps://chiropracticscience.com/wp-content/uploads/2017/01/chiroscience-logo-website-title-300x167.jpgDean Smith, DC, PhD2018-10-04 00:02:542018-10-04 00:08:38039- Inflammation of Peripheral Nerves, Chiropractic Principles, Manual Therapies and More with Dr. Geoffrey Bove
Dr. 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!
https://chiropracticscience.com/wp-content/uploads/2018/02/DrCraigMoore.jpg399309Dean Smith, DC, PhDhttps://chiropracticscience.com/wp-content/uploads/2017/01/chiroscience-logo-website-title-300x167.jpgDean Smith, DC, PhD2018-03-16 23:00:312018-03-16 23:00:31031- Dr. Craig Moore: Role of Chiropractors in the Management of Headaches
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