Episode

Dr. Daniels and I discuss some of his publications dealing with prior spine surgery, medications for low back pain, suicide prevention, and health promotion. Dr. Clint Daniels is chiropractic section chief at VA Puget Sound Health Care System in Tacoma, Washington where he supervises a team of 9 chiropractors and is a resident director. He serves on the VA chiropractic Field Advisory Committee as the Research Coordinator, is a scientific commission board member for Clinical Compass, and is appointed to the Washington State Health Technology Clinical Committee. He is a 2010 chiropractic graduate from Logan University, where he also received his Master of Science in Sports Science and Rehabilitation. He worked in private practice for 4 years, and then joined VA and was the first graduate of the St. Louis VA chiropractic integrated clinical practice residency program. He has authored and contributed to numerous scientific publications on the topics of chiropractic integration into veteran and military facilities, postsurgical spine pain, suicide prevention, chiropractic best practices, and numerous case reports on a variety clinical presentations.

Please find Dr. Daniel’s researchgate.net profile here.

Here are the articles we discuss in this episode.

1.Manipulative and manual therapies in the management of patients with prior lumbar surgery: A systematic review.Daniels CJ, Cupler ZA, Gliedt JA, Walters S, Schielke AL, Hinkeldey NA, Golley DJ, Hawk C.Complement Ther Clin Pract. 2021 Feb;42:101261. doi: 10.1016/j.ctcp.2020.101261. Epub 2020 Nov 17.PMID: 33276229
2.Systematic review of guideline-recommended medications prescribed for treatment of low back pain.Price MR, Cupler ZA, Hawk C, Bednarz EM, Walters SA, Daniels CJ.Chiropr Man Therap. 2022 May 13;30(1):26. doi: 10.1186/s12998-022-00435-3.PMID: 35562756 Free PMC article. Review.
3.The chiropractor’s role in primary, secondary, and tertiary prevention of suicide: a clinical guide.Cupler ZA, Daniels CJ, Anderson DR, Anderson MT, Napuli JG, Tritt ME.J Can Chiropr Assoc. 2021 Aug;65(2):137-155.PMID: 34658386 Free PMC article.
4.The Role of Chiropractic Care in Providing Health Promotion and Clinical Preventive Services for Adult Patients with Musculoskeletal Pain: A Clinical Practice Guideline.Hawk C, Amorin-Woods L, Evans MW , Jr, Whedon JM, Daniels CJ, Williams RD , Jr, Parkin-Smith G, Taylor DN, Anderson D, Farabaugh R, Walters SA, Schielke A, Minkalis AL, Crivelli LS, Alpers C, Hinkeldey N, Hoang J, Caraway D, Whalen W, Cook J, Redwood D.J Altern Complement Med. 2021 Oct;27(10):850-867. doi: 10.1089/acm.2021.0184. Epub 2021 Jul 26.PMID: 34314609

Dr. Matt Fernandez is a registered chiropractor in Australia and is currently a senior lecturer at Central Queensland University (CQU), where he teaches and supervises students in the Master of Chiropractic program. Prior to his CQU appointment, he was a lecturer at the Department of Chiropractic, Macquarie University. Matt is very passionate about research and following the completion of his PhD at the University of Sydney, he now leads various research projects and supervises research students. He also regularly presents his research at conferences in targeted areas that advances the knowledge and understanding of chiropractic through physical activity, exercise and patient education interventions. Matt is also a member of the inaugural CARL fellows.

In this episode, we discuss physical activity, exercise, practice guidelines, and the chiropractic profession.

Please find Dr. Fernandez’s researchgate.net profile here.

Here are the articles we discuss in this episode.

1.Physical activity promotion in chiropractic: a systematic review of clinician-based surveys.Fernandez M, Young A, Milton K, Pinhiero M, de Luca K, Ferreira P, Hebert J.Chiropr Man Therap. 2022 Dec 13;30(1):55. doi: 10.1186/s12998-022-00467-9.PMID: 36514061 Free PMC article. Review.
2.GLA:D® Back Australia: a mixed methods feasibility study for implementation.Fernandez M, Young A, Kongsted A, Hartvigsen J, Barton C, Wallis J, Kent P, Kawchuk G, Jenkins H, Hancock M, French SD.Chiropr Man Therap. 2022 Apr 7;30(1):17. doi: 10.1186/s12998-022-00427-3.PMID: 35392935 Free PMC article.
3.The prevalence and determinants of physical activity promotion by Australian chiropractors: A cross sectional study.Fernandez M, Moore C, Eklund A, Swain M, de Luca K, Sibbritt D, Adams J, Peng W.Complement Ther Med. 2019 Aug;45:172-178. doi: 10.1016/j.ctim.2019.06.012. Epub 2019 Jun 18.PMID: 31331556

Dr. Robert Trager is a chiropractic physician and researcher at University Hospitals, in Cleveland, Ohio, in the United States. In this episode, we discuss his research covering a variety of clinically focused topics at the intersection of medicine and chiropractic, ranging from case reports to health service utilization. Dr. Trager first became interested in research when he was an undergraduate student at Northeastern University, where took part in a co-op program that got him hands-on experience in a research laboratory. He then attended Logan University, graduating in 2013, and has since practiced in an integrative healthcare setting.

Please find Dr. Trager’s researchgate.net profile here.

Here are the articles we discuss in this episode. We also talked about the article that Dr. Brian Anderson and I discussed on episode 61 of the podcast.

1.Association between chiropractic spinal manipulation and lumbar discectomy in adults with lumbar disc herniation and radiculopathy: retrospective cohort study using United States’ data.Trager RJ, Daniels CJ, Perez JA, Casselberry RM, Dusek JA.BMJ Open. 2022 Dec 16;12(12):e068262. doi: 10.1136/bmjopen-2022-068262.PMID: 36526306 Free PMC article.
2.Chiropractic case reports: a review and bibliometric analysis.Trager RJ, Dusek JA.Chiropr Man Therap. 2021 Apr 28;29(1):17. doi: 10.1186/s12998-021-00374-5.PMID: 33910610 Free PMC article. Review.

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.  

View Dr. Gorrell’s researchgate page here.

Below are the research studies that we discuss in this episode.

1.The reporting of adverse events following spinal manipulation in randomized clinical trials-a systematic review.Gorrell LM, Engel RM, Brown B, Lystad RP.Spine J. 2016 Sep;16(9):1143-51. doi: 10.1016/j.spinee.2016.05.018. Epub 2016 May 27.PMID: 27241208 Review.
2.Differences in force-time parameters and electromyographic characteristics of two high-velocity, low-amplitude spinal manipulations following one another in quick succession.Gorrell LM, Conway PJ, Herzog W.Chiropr Man Therap. 2020 Dec 8;28(1):67. doi: 10.1186/s12998-020-00355-0.PMID: 33287851 Free PMC article.
3.Kinematics of the head and associated vertebral artery length changes during high-velocity, low-amplitude cervical spine manipulation.Gorrell LM, Kuntze G, Ronsky JL, Carter R, Symons B, Triano JJ, Herzog W.Chiropr Man Therap. 2022 Jun 1;30(1):28. doi: 10.1186/s12998-022-00438-0.PMID: 35650649 Free PMC article.
4.Vertebral arteries do not experience tensile force during manual cervical spine manipulation applied to human cadavers.Gorrell LM, Sawatsky A, Edwards WB, Herzog W.J Man Manip Ther. 2022 Nov 15:1-9. doi: 10.1080/10669817.2022.2148048. Online ahead of print.PMID: 36382347
Dr. Brian Anderson

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.

View Dr. Anderson’s publications at researchgate.net.

Here are the articles we discuss in this episode:

1.Risk of Treatment Escalation in Recipients vs Nonrecipients of Spinal Manipulation for Musculoskeletal Cervical Spine Disorders: An Analysis of Insurance Claims.Anderson BR, McClellan WS, Long CR.J Manipulative Physiol Ther. 2021 Jun;44(5):372-377. doi: 10.1016/j.jmpt.2021.03.001. Epub 2021 Aug 6.PMID: 34366149
2.The Effect of Reduced Access to Chiropractic Care on Medical Service Use for Spine Conditions Among Older Adults.Davis M, Yakusheva O, Liu H, Anderson B, Bynum J.J Manipulative Physiol Ther. 2021 Jun;44(5):353-362. doi: 10.1016/j.jmpt.2021.05.002. Epub 2021 Aug 8.PMID: 34376317 Free PMC article.
3.The Relationship Between Healthcare Provider Availability and Conservative Versus Non-conservative Treatment for Back Pain Among Older Americans.Anderson BR, Yakusheva O, Liu H, Bynum JPW, Davis MA.J Gen Intern Med. 2022 Mar;37(4):992-994. doi: 10.1007/s11606-021-06889-0. Epub 2021 May 24.PMID: 34031853 No abstract available.
4.Three Patterns of Spinal Manipulative Therapy for Back Pain and Their Association With Imaging Studies, Injection Procedures, and Surgery: A Cohort Study of Insurance Claims.Anderson BR, McClellan SW.J Manipulative Physiol Ther. 2021 Nov-Dec;44(9):683-689. doi: 10.1016/j.jmpt.2022.03.010. Epub 2022 Jun 24.PMID: 35753873
Dr Frank Scali

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.

Visit Dr. Scali’s research at researchgate.net and view his faculty page.

Here are the articles we discuss during this episode:

1.Anatomical connection between the rectus capitis posterior major and the dura mater.Scali F, Marsili ES, Pontell ME.Spine (Phila Pa 1976). 2011 Dec 1;36(25):E1612-4. doi: 10.1097/BRS.0b013e31821129df.PMID: 21278628
2.Investigation of meningomyovertebral structures within the upper cervical epidural space: a sheet plastination study with clinical implications.Scali F, Pontell ME, Nash LG, Enix DE.Spine J. 2015 Nov 1;15(11):2417-24. doi: 10.1016/j.spinee.2015.07.438. Epub 2015 Jul 22.PMID: 26210227
3.Histological analysis of the rectus capitis posterior major’s myodural bridge.Scali F, Pontell ME, Enix DE, Marshall E.Spine J. 2013 May;13(5):558-63. doi: 10.1016/j.spinee.2013.01.015. Epub 2013 Feb 11.PMID: 23406969
4.The Posterior Atlantooccipital Membrane: The Anchor for the Myodural Bridge and Meningovertebral Structures.Scali F, Ohno A, Enix D, Hassan S.Cureus. 2022 May 30;14(5):e25484. doi: 10.7759/cureus.25484. eCollection 2022 May.PMID: 35686279 Free PMC article.
Dr. Carlos Gevers

Dr. Carlos Gevers joins me to discuss mechanisms of spinal manipulation, particularly as they relate to central sensitization and neuroinflammation. He also shares a study on Tumor Necrosis Factor-Alpha in Urine Samples of Patients With Chronic Low Back Pain Undergoing Chiropractic Care.

Carlos Gevers Montoro is a second-generation chiropractor. He graduated from Life Chiropractic College West in 2003 as Valedictorian and the recipient of the Clinical Excellence Citation award. After practicing for a few years in Spain and France, he was instrumental in the opening of the Madrid College of Chiropractic (MCC), where he still lectures. His contributions at the MCC were mostly related to the clinical sciences. In parallel, he served for seven years as the President of the Spanish Chiropractic Association, being involved in chiropractic politics and policy at the national and international level.

In 2018 he decided to switch gears and take a completely new path in the research arena. He started his PhD in Pain Neurosciences at UQTR – University of Montreal joint program under the supervision of Prof. Mathieu Piché. His PhD studies are partially funded, by a prestigious grant from the Government of Quebec. His line of research and his first publications are mostly focused on mechanisms of spinal manipulation, particularly as they relate to central sensitization and neuroinflammation. These two phenomena seem to be strongly implicated in the development of chronic pain syndrome and other conditions.

Check out Dr. Carlos Gevers researchgate profile page.

Here are the articles we discuss in this episode:

1.Presence of Tumor Necrosis Factor-Alpha in Urine Samples of Patients With Chronic Low Back Pain Undergoing Chiropractic Care: Preliminary Findings From a Prospective Cohort Study.Gevers-Montoro C, Romero-Santiago M, Losapio L, Conesa-Buendía FM, Newell D, Álvarez-Galovich L, Piché M, Ortega-De Mues A.Front Integr Neurosci. 2022 Apr 12;16:879083. doi: 10.3389/fnint.2022.879083. eCollection 2022.PMID: 35492573 Free PMC article.
2.Chiropractic Spinal Manipulation Prevents Secondary Hyperalgesia Induced by Topical Capsaicin in Healthy Individuals.Gevers-Montoro C, Provencher B, Northon S, Stedile-Lovatel JP, Ortega de Mues A, Piché M.Front Pain Res (Lausanne). 2021 Jul 20;2:702429. doi: 10.3389/fpain.2021.702429. eCollection 2021.PMID: 35295504 Free PMC article.
3.Neurophysiological mechanisms of chiropractic spinal manipulation for spine pain.Gevers-Montoro C, Provencher B, Descarreaux M, Ortega de Mues A, Piché M.Eur J Pain. 2021 Aug;25(7):1429-1448. doi: 10.1002/ejp.1773. Epub 2021 Apr 15.PMID: 33786932 Review.

In this episode, Dr. Meier discusses how people move differently in the presence of (or in anticipation of) pain. Changes in motor control may play an important role in musculoskeletal pain. His lab uses a cross-disciplinary approach that combines neuroscience and movement biomechanics to provide new insights into the role of potential interactions between movement behavior, psychological factors and supraspinal mechanisms in the development and maintenance of persistent low back pain. We’ll touch also on fear avoidance and pain related movement avoidance.  Dr. Michael L. Meier is a senior pain researcher and group leader at the Department of Chiropractic Medicine at the University of Zurich. He received his master’s degree in neuropsychology and his doctorate in cognitive neuroscience from the University of Zurich, focusing on the processing of pain and nociception in the brain. In 2019, he received a grant from the Swiss National Science Foundation (SNF) to study the role of movement behavior and cortical processes in the development and persistence of low back pain. A hallmark of his work is linking research from different disciplines such as biomechanics, neuroscience, and psychology, shedding light on novel interacting pathomechanisms underlying persistent low back pain whose pathoanatomical cause is often unclear.

Please see Dr. Michael Meier’s research profile at researchgate.net.  Further information and links to his research can be found at the Balgrist University Hospital website.

Below are the articles Dr. Michael Meier and I discuss in this episode:

1.
Fear-avoidance beliefs are associated with reduced lumbar spine flexion during object lifting in pain-free adults.
Knechtle D, Schmid S, Suter M, Riner F, Moschini G, Senteler M, Schweinhardt P, Meier ML.
Pain. 2021 Jun 1;162(6):1621-1631. doi: 10.1097/j.pain.0000000000002170.
PMID: 33323888 Free PMC article.
2.
Neural responses of posterior to anterior movement on lumbar vertebrae: a functional magnetic resonance imaging study.
Meier ML, Hotz-Boendermaker S, Boendermaker B, Luechinger R, Humphreys BK.
J Manipulative Physiol Ther. 2014 Jan;37(1):32-41. doi: 10.1016/j.jmpt.2013.09.004. Epub 2013 Nov 12.
PMID: 24229849
3. Identifying Motor Control Strategies and Their Role in Low Back Pain: A Cross-Disciplinary Approach Bridging Neurosciences With Movement Biomechanics.
Schmid Stefan, Bangerter Christian, Schweinhardt Petra, Meier Michael L.
Frontiers in Pain Research. 2021 Aug;(2):42. doi: 10.3389/fpain.2021.715219

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. 

See more of Dr. Reed’s research at researchgate.net.

The articles we discuss in this episode include:

1.
Chiropractic management of primary nocturnal enuresis.
Reed WR, Beavers S, Reddy SK, Kern G.
J Manipulative Physiol Ther. 1994 Nov-Dec;17(9):596-600.
PMID: 7884329 Clinical Trial.
2.
Relationship between Biomechanical Characteristics of Spinal Manipulation and Neural Responses in an Animal Model: Effect of Linear Control of Thrust Displacement versus Force, Thrust Amplitude, Thrust Duration, and Thrust Rate.
Reed WR, Cao DY, Long CR, Kawchuk GN, Pickar JG.
Evid Based Complement Alternat Med. 2013;2013:492039. doi: 10.1155/2013/492039. Epub 2013 Jan 20.
PMID: 23401713 Free PMC article.
3.
Paraspinal Muscle Spindle Response to Intervertebral Fixation and Segmental Thrust Level During Spinal Manipulation in an Animal Model.
Reed WR, Pickar JG.
Spine (Phila Pa 1976). 2015 Jul 1;40(13):E752-9. doi: 10.1097/BRS.0000000000000915.
PMID: 25856263 Free PMC article.
4.
Neural responses to the mechanical characteristics of high velocity, low amplitude spinal manipulation: Effect of specific contact site.
Reed WR, Long CR, Kawchuk GN, Pickar JG.
Man Ther. 2015 Dec;20(6):797-804. doi: 10.1016/j.math.2015.03.008. Epub 2015 Mar 27.
PMID: 25841562 Free PMC article.
5.
Spinal Mobilization Prevents NGF-Induced Trunk Mechanical Hyperalgesia and Attenuates Expression of CGRP.
Reed WR, Little JW, Lima CR, Sorge RE, Yarar-Fisher C, Eraslan M, Hurt CP, Ness TJ, Gu JG, Martins DF, Li P.
Front Neurosci. 2020 Apr 30;14:385. doi: 10.3389/fnins.2020.00385. eCollection 2020.
PMID: 32425750 Free PMC article.

 

Check out related chiropractic science podcasts on neurophysiology and the brain.

Martha Funabashi, is a PhD currently working as a clinical research scientist at CMCC. She is also a CARL fellow and the co-lead study coordinator of SafetyNET – an international and multidisciplinary research team to support patient safety among spinal manipulative therapy (SMT) providers. Martha has a Bachelor’s Degree in Physiotherapy and a Master’s Degree in Neuroscience from the University of Sao Paulo – Brazil. She completed her PhD in Rehabilitation Sciences at the University of Alberta under the supervision of Dr. Greg Kawchuk and her post-doctoral fellowship also at the University of Alberta with Dr. Sunita Vohra. Martha’s research interests and passion are on the SMT’s biomechanics, underlying mechanisms, force-time characterization and its safety aspects. Martha has 26 peer-reviewed scientific journal publications, over 40 conference presentations and is on the editorial boards for peer review journals, such as Chiropractic and Manual Therapies. Martha has won research prizes, including the New Investigator Award at the World Federation of Chiropractic Conference 2017 and works in collaboration with emerging and well-known researchers around the world.

Dr. Funabashi’s email is: [email protected]

See Dr. Funabashi’s publications at researchgate.net.

Here is a list of the articles Dr. Funabashi and I discussed on the podcast.

1. SafetyNET Community-based patient safety initiatives: development and application of a Patient Safety and Quality Improvement Survey.
  Funabashi M, Pohlman KA, Mior S, O’Beirne M, Westaway M, De Carvalho D, El-Bayoumi M, Haig B, Wade DJ, Thiel HW, Cassidy JD, Hurwitz E, Kawchuk GN, Vohra S.
  J Can Chiropr Assoc. 2018 Dec;62(3):130-142.
  PMID: 30662067 [PubMed] Free PMC Article
  Similar articles
2. Tissue loading created during spinal manipulation in comparison to loading created by passive spinal movements.
  Funabashi M, Kawchuk GN, Vette AH, Goldsmith P, Prasad N.
  Sci Rep. 2016 Dec 1;6:38107. doi: 10.1038/srep38107.
  PMID: 27905508 [PubMed – indexed for MEDLINE] Free PMC Article
  Similar articles
3. Does the application site of spinal manipulative therapy alter spinal tissues loading?
  Funabashi M, Nougarou F, Descarreaux M, Prasad N, Kawchuk GN.
  Spine J. 2018 Jun;18(6):1041-1052. doi: 10.1016/j.spinee.2018.01.008. Epub 2018 Jan 31.
  PMID: 29355792 [PubMed – indexed for MEDLINE]
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