Chiropractic Clinic Research Articles

Chiropractic Response to a Spontaneous Vertebral Artery Dissection

ObjectiveThe purpose of this case report is to describe a case in which early detection and proper follow-up of spontaneous vertebral artery dissection led to satisfactory outcomes. Clinical FeaturesA 34-year old white woman reported to a chiropractic clinic with a constant burning pain at the right side of her neck and shoulder with a limited ability to turn her head from side to side, periods of blurred vision, and muffled hearing. Dizziness, visual and auditory disturbances, and balance difficulty abated within 1hour of onset and were not present at the time of evaluation. A pain drawing indicated burning pain in the suboccipital area, neck, and upper shoulder on the right and a pins and needles sensation on the dorsal surface of both forearms. Turning her head from side-to-side aggravated the pain, and the application of heat brought temporary relief. The Neck Disability Index score of 44 placed the patient’s pain in the most severe category. Intervention and OutcomeThe patient was not treated on the initial visit but was advised of the possibility of a vertebral artery or carotid artery dissection and was recommended to the emergency department for immediate evaluation. The patient declined but later was convinced by her chiropractor to present to the emergency department. A magnetic resonance angiogram of the neck and carotid arteries was performed showing that the left vertebral artery was hypoplastic and appeared to terminate at the left posterior inferior cerebellar artery. There was an abrupt moderately long segment of narrowing involving the right vertebral artery beginning near the junction of the V1 and V2 segments. The radiologist noted a concern regarding right vertebral artery dissection. Symptoms resolved and the patient was cleared of any medications but advised that if symptoms reoccurred she was to go for emergency care immediately. ConclusionRecognition and rapid response by the chiropractic physician provided the optimum outcome for this particular patient.

Multiple Venous Thromboses Presenting as Mechanical Low Back Pain in an 18-Year-Old Woman

ObjectiveThe purpose of this case report is to describe a patient who presented with acute musculoskeletal symptoms but was later diagnosed with multiple deep vein thrombosis (DVT). Clinical FeaturesAn 18-year-old female presented to a chiropractic clinic with left lumbosacral pain with referral into the posterior left thigh. A provisional diagnosis was made of acute myofascial syndrome of the left piriformis and gluteus medius muscles. The patient received 3 chiropractic treatments over 1 week resulting in 80% improvement in pain intensity. Two days later, a sudden onset of severe abdominal pain caused the patient to seek urgent medical attention. A diagnostic ultrasound of the abdomen and pelvis were performed and interpreted as normal. Following this, the patient reported increased pain in her left leg. Evaluation revealed edema of the left calf and decreased left lower limb sensation. A venous Doppler ultrasound was ordered. Intervention and OutcomesDoppler ultrasound revealed reduction of the venous flow in the femoral vein area. An additional ultrasonography evaluation revealed an extensive DVTs affecting the left femoral vein and iliac axis extending towards the vena cava. Upon follow-up with a hematologist, the potential diagnosis of May-Thurner syndrome was considered based on the absence of blood dyscrasias and sustained anatomical changes found in the left common iliac vein at its junction with the right common iliac artery. A week following discharge, she presented with chest pain and was diagnosed with venous thromboembolism. The patient was successfully treated with anticoagulation therapy and insertion of a vena cava filter. ConclusionAlthough DVTs are common in the general population, presence in low-risk individuals may be overlooked. In the presence of subtle initial clinical signs such as those described in this case report, clinicians should keep a high index of suspicion for a DVT. Rapid identification of such clinical signs in association with a lack of objective examination findings warrants further evaluation due to potentially negative outcomes.

Acute episodic centrally maintained vestibulopathy in a patient with multiple sclerosis managed with brain and vestibular rehabilitative approach: a case report

Event Abstract Back to Event Acute episodic centrally maintained vestibulopathy in a patient with multiple sclerosis managed with brain and vestibular rehabilitative approach: a case report Troy May1 and Derek Barton2* 1 May Chiropractic Clinic, United States 2 Carrick Institute, United States Background A 31-year-old female patient presented to a functional neurology clinic with an idiopathic acute episode of vertigo which was constant and of varying intensity beginning four days prior. The patient reported a sensation of spinning to the left and falling backward and rated the level of disorientation she felt as 6/10 with 10 being severely disoriented. She reported head pain over the right parietal region and a seven year history of multiple sclerosis confirmed by MRI. The patient stated she was unable to work and had difficulty eating due to her level of disorientation. Methods Neurological examination revealed unsteady and guarded gait, mild slurring of speech, and distressed demeanor. The patient demonstrated an inability to hold steady gaze with square wave intrusions during gaze holding assessment. She also had horizontal square wave jerks during pursuit testing with pursuits to the left being more difficult. Romberg test was positive with the patient falling backward and to the left. The patient had intersegmental dysfunction of the upper cervical spine. The patient was diagnosed with a centrally maintained vestibulopathy and a treatment plan was implemented immediately. The patient received five right Halmagyi head thrusts and three three-second passes of upward optokinetic stimuli. Gaze stability exercises were then performed in the horizontal plane with passive sinusoidal movements to a central target. Gaze stability was first performed supine and then in a seated position. Manipulation of the second cervical vertebra was also performed. Results The patient experienced immediate improvement of her subjective complaints of disorientation and head pain. She rated her level of disorientation as 2/10 following Halmagyi head thrusts. Objective improvements were seen in the patient's ability to hold steady gaze on a target during gaze fixation and Romberg testing was performed without any fall. The patient followed up for the next two days in the office with only a minor increase in symptoms. The patient was treated with a similar protocol and given at-home therapy exercises of horizontal 1x viewing for two minutes every two hours. Conclusions This case follows the treatment of a centrally maintained vestibular issue in a patient suffering from multiple sclerosis. The patient experienced immediate relief from her symptoms after a protocol utilizing brain activation and vestibular stimulation. Further investigation is necessary to determine if this approach would be beneficial for a larger population of multiple sclerosis patients suffering with vertigo issues. Keywords: Multiple Sclerosis, Vertigo, Dizziness, Neuro rehabilitation, falls Conference: International Symposium on Clinical Neuroscience: TBI and Neurodegeneration, Orlando, Florida, United States, 10 Dec - 14 Dec, 2015. Presentation Type: Poster Presentation Topic: Case Reports for Poster Presentation Citation: May T and Barton D (2015). Acute episodic centrally maintained vestibulopathy in a patient with multiple sclerosis managed with brain and vestibular rehabilitative approach: a case report. Front. Neurol. Conference Abstract: International Symposium on Clinical Neuroscience: TBI and Neurodegeneration. doi: 10.3389/conf.fneur.2015.58.00027 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 31 Oct 2015; Published Online: 02 Nov 2015. * Correspondence: Dr. Derek Barton, Carrick Institute, Cape Canaveral, FL, United States, derekabarton@gmail.com Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers Troy May Derek Barton Google Troy May Derek Barton Google Scholar Troy May Derek Barton PubMed Troy May Derek Barton Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.

RAPID RESTORATION OF MOTORIC FUNCTION IN A POST-STROKE FEMALE PATIENT

Event Abstract Back to Event RAPID RESTORATION OF MOTORIC FUNCTION IN A POST-STROKE FEMALE PATIENT Kelsey Brenner1, Paula Rhodes1 and Susan Esposito1* 1 Life University, United States Background: A fifty seven year old female presented to a functional neurology unit of a chiropractic clinic for evaluation and treatment of left-sided hemiparesis sustained subsequent to a right-sided middle cerebral artery infarct two weeks prior. She utilized a cane for ambulation, exhibiting the characteristic spastic circumduction gait. She complained of loss of sensation on the left side of her face and body, had a deficit of short-term memory, and felt fatigued and depressed. Methods: Speech was dysarthric and slow. All sensation was absent on the left side of her face and body. She was unable to use her left hand for grasping or reaching and had poor to no control of her left leg and foot. Treatment included gaze stabilization exercises, saccades and pursuits, sensory stimulation of upper and lower extremities, complex movements, supine gait training, and mirror box therapy. She was seen twice a week for 8 weeks, and diligently performed home exercises. Results: By third visit, the patient regained motor control of her left fingers. By the seventh visit she regained motor control and sensation of the left side of her tongue. At the eighth visit, the patient could run with her arms raised overhead, she had full control of her left hand and fingers, and she had a restoration of normal speech. Conclusion: With each visit, large gains in function were noted, culminating after 8 weeks in resolution of all signs and symptoms. Near complete and rapid resolution of left hemiparesis in this case points to the importance and effectiveness of early functional neurological intervention in cases of stroke. Further research in functional neurologic treatment in the early stages post-stroke is warranted. Keywords: Funnctional Neurology, stroke rehabilitation, Hemi-paresis, Memory Disorders, Chiropractic Conference: International Symposium on Clinical Neuroscience: TBI and Neurodegeneration, Orlando, Florida, United States, 10 Dec - 14 Dec, 2015. Presentation Type: Poster Presentation Topic: Case Reports for Poster Presentation Citation: Brenner K, Rhodes P and Esposito S (2015). RAPID RESTORATION OF MOTORIC FUNCTION IN A POST-STROKE FEMALE PATIENT. Front. Neurol. Conference Abstract: International Symposium on Clinical Neuroscience: TBI and Neurodegeneration. doi: 10.3389/conf.fneur.2015.58.00036 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 31 Oct 2015; Published Online: 02 Nov 2015. * Correspondence: Dr. Susan Esposito, Life University, Marietta, Georgia, 30060, United States, susan.esposito@life.edu Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers Kelsey Brenner Paula Rhodes Susan Esposito Google Kelsey Brenner Paula Rhodes Susan Esposito Google Scholar Kelsey Brenner Paula Rhodes Susan Esposito PubMed Kelsey Brenner Paula Rhodes Susan Esposito Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.

Informed consent for chiropractic care: Comparing patients' perceptions to the legal perspective

PurposeThis study explored chiropractic patients' perceptions of exchanging risk information during informed consent and compared them with the legal perspective of the informed consent process. MethodsInterviews were conducted with 26 participants, recruited from chiropractic clinics. Transcripts were analysed using a constant comparative method of analysis. FindingsParticipants experienced informed consent as an on-going process where risk information informed their decisions to receive treatment throughout four distinct stages. In the first stage, information acquired prior to arriving at the clinic for treatment shaped perceptions of risk. In stage two, participants assessed the perceived competence of their practitioners. Participants then signed the consent form and discussed the risks with their practitioners. Finally, they communicated with their practitioners during treatment to ensure their pain threshold was not crossed. ConclusionThese findings suggest that chiropractic patients perceive informed consent as a process involving communication with their practitioners, and that it is possible to educate patients about the risks associated with treatment while satisfying the legal requirements of informed consent.

Acceleration of clinician hand movements during spinal manipulative therapy

This study used an observational design to examine the kinematics of spinal manipulative therapy (SMT) by determining the acceleration characteristics of the manipulative input at the cervical, thoracic, and lumbar spinal regions. Studies of SMT have been restricted to measuring the forces that result from the manipulative input. Several studies have indicated the rate of force development is a key parameter of clinically delivered SMT. Despite this, the movement strategies employed during SMT, including acceleration, have not been directly measured. Participants (n = 29) were recruited from a private practice chiropractic clinic. A wireless accelerometer attached to the clinician's hand was used to characterize the thrust phase of the SMT treatments. Significant differences were found across each spinal region for acceleration amplitude parameters (p < 0.0001). Post-hoc analysis indicated that amplitudes significantly increased in order from thoracic to cervical to lumbar regions (p < 0.0001). Spinal level was also a significant factor in determining the temporal parameters of hand acceleration during SMT (p < 0.0005). This study provides a description of the acceleration properties of clinically delivered SMT. Consistent with that reported for SMT forces, acceleration amplitudes varied significantly across spinal regions with relatively little differences in acceleration latencies. Notably, acceleration amplitudes and latencies were not associated with each other within spinal regions. These findings indicate that changes in acceleration amplitude, rather than latency, are used to tailor SMT to individuals.

Comparison of two methods of collecting healthcare usage data in chiropractic clinics: patient-report versus documentation in patient files.

BackgroundThe use of patient-reported questionnaires to collect information on costs associated with routine healthcare services, such as chiropractic, represents a less labour intensive alternative to retrieving these data from patient files. The aim of this paper was to compare patient-report versus patient files for the collection of data describing healthcare usage in chiropractic clinics.MethodsAs part of a prospective single cohort multi-centre study, data on the number of visits made to chiropractic clinics determined using patient-reported questionnaires or as recorded in patient files were compared three months following the start of treatment. These data were analysed for agreement using the Intraclass Correlation Coefficient (ICC) and the 95% Limits of Agreement.ResultsEighty-nine patients that had undergone chiropractic care were included in the present study. The two methods yielded an ICC of 0.83 (95% CI = 0.75 to 0.88). However, there was a significant difference between the data collection methods, with an average of 0.6 (95% CI = 0.25 to 1.01) additional visits reported in patient files. The 95% Limits of Agreement ranged from 3 fewer visits to 4 additional visits in patient files relative to the number of visits recalled by patients.ConclusionThere was some discrepancy between the number of visits made to the clinic recalled by patients compared to the number recorded in patient files. This should be taken into account in future evaluations of costs of treatments.

Chiropractic Care of a Patient With Neurogenic Heterotopic Ossification of the Anterior Longitudinal Ligament After Traumatic Brain Injury: A Case Report

ObjectiveThe purpose of this case report is to describe the use of chiropractic care for a patient with neurogenic heterotopic ossification of the anterior longitudinal ligament in the cervical spine and soft tissues of the right hip after a traumatic brain injury and right femur fracture. Clinical FeaturesA 25-year-old military officer was referred to a hospital-based chiropractic clinic with complaints of pain and stiffness of the neck and back along with reduced respiratory excursions that began several months after a motor vehicle accident in which he had a traumatic brain injury. The patient had a fractured right femur from the accident, which had since been treated surgically, but had complications of heterotopic ossification in the soft tissues of the hip. His overall pain level was 3 of 10 on a verbal pain scale during use of oxycodone HCL/acetaminophen. Chest excursion was initially measured at .5 cm. Intervention and OutcomeWith the intent to restore respiratory chest motion and to reduce the patient's back and neck pain, the patient was placed on a program of chiropractic and myofascial manipulation, exercise therapy, and respiratory therapy. After a year of care, the patient rated overall pain at 3 of 10 verbal pain scale level but was no longer taking medications for pain and an increase in respiratory chest excursions measured at 3.5 cm. ConclusionThis case demonstrated that chiropractic treatment provided benefit to a patient with heterotopic ossification concurrent with musculoskeletal pain.

Parents' choice of non-supine sleep position for newborns: a cross-sectional study

The objective of this study was to investigate the sleeping position of infants attending an outpatient clinic, considering the influences of the back to sleep (BTS) campaign. A paper survey was given to 678 parents who presented their infant (under 1 year of age) to the paediatric chiropractic clinic for care asking their infant's sleep position. Of the total survey sample, 50‥ of parents selected the supine position as the preferred position they placed the baby to sleep, 19‥ of parents preferred to place their babies prone, 34‥ on the babies side and 2‥ selected other. Some mothers selected more than one preferred sleeping position. The initial decline of mothers using non-supine positioning, seen shortly after the implementation of the BTS campaign, is no longer evident. Recent research implies approximately half of infants are now placed in a non-compliant sleeping position. If an infant’s most preferred sleeping position is not that of current guidelines, manual therapy such as chiropractic care should be sought to help infants sleep supine with comfort.

Parents’ choice of non-supine sleep position for newborns: A cross-sectional study

The objective of this study was to investigate the sleeping position of infants attending an outpatient clinic, considering the influences of the Back to Sleep (BTS) campaign. A paper survey was given to 678 parents who presented their infant (under 1 year of age) to the paediatric chiropractic clinic for care, asking their infant's sleep position. Of the total survey sample, 50% of parents selected the supine position as the preferred position they placed the baby to sleep, 19% selected prone, 34% placed the baby on their side and 2% selected ‘other’. Some parents selected more than one preferred sleeping position. The initial decline of parents using non-supine positioning, seen shortly after the implementation of the BTS campaign, is no longer evident. Recent research implies approximately half of infants are now placed in a non-compliant sleeping position. If an infant's preferred sleeping position is not that of current guidelines, manual therapy such as chiropractic care should be sought to help infants sleep supine with comfort.

Bladder and Bowel Symptoms Among Adults Presenting With Low Back Pain to an Academic Chiropractic Clinic: Results of a Preliminary Study

ObjectiveThe purposes of this study were to estimate the 1-month point prevalence of bowel and bladder symptoms (BBS) among adult chiropractic patients and to evaluate associations between these symptoms and low back pain (LBP). MethodsPatients 18 years or older presenting to a chiropractic college academic health clinic between March 25 and April 25, 2013, were asked to complete a symptom screening questionnaire. Descriptive statistics, binary logistic regression, Fisher exact test, and P values were calculated from the sample. ResultsThe sample included 140 of 1300 patients who visited the clinic during the survey period (11%). Mean age was 47.5 (range 18-79) years. LBP was the primary chief complaint in 42%. The 1-month point prevalence of any bladder symptoms was 75%, while the rate for bowel symptoms was 62%; 55% reported both BBS. Binary logistic regression analyses showed no statistically significant association between a chief complaint of LBP and combined BBS (OR = 1.67, P = .164). ConclusionThe prevalence of bowel and bladder symptoms in chiropractic patients was high. There was no statistically significant association between these symptoms and LBP in this group of patients seeking care for LBP.

Using the STarT Back Tool: Does timing of stratification matter?

It is likely that individuals with nonspecific LBP (nsLBP) constitute a heterogenic group and targeting treatment appropriately to those most likely to respond is of major relevance.The STarT Back Tool (SBT) has been developed to stratify patients into risk groups to aid management choices. However, there is controversy over its generalisability and uncertainty as to the timing of use.This study investigated whether SBT categorisation early in a course of treatment would prove more prognostic than categorising patients at baseline.Seven hundred and forty nine patients over the age of 16 were recruited at 11 chiropractic clinics within the UK. The SBT was used to categorise these patients at presentation and 2 days following initial treatment with patient characteristics and condition specific markers also collected at baseline. The primary outcome was the Patient Global Impression of Change (PGIC) collected at 14, 30 and 90 days following the initial visit.In this population undergoing chiropractic care, patients had similar outcomes irrespective of their STarT back risk ranking.Multivariate prognostic models included only the post initial visit SBT as an independent predictor of favourable outcome for the medium risk group but only at 30 days. Follow up improvement was dominated by previous improvement in 30 and 90-day models.Over one third of patients swapped SBT risk groups in the 2 day period between initial stratification and post initial visit although there was little difference in eventual improvement at follow-up. Understanding the impact of timing of SBT stratification is indicated.

Chiropractic Treatment of Lateral Epicondylitis: A Case Report Utilizing Active Release Techniques

ObjectiveThe purpose of this report is to describe the chiropractic management of a case of lateral epicondylitis with active release techniques (ART). Clinical featuresA 48-year-old white man presented to a chiropractic clinic with a complaint of left lateral elbow pain that began 2 years previous with insidious onset. The patient reported an inability to play 18 consecutive holes of golf due to the pain. Intervention and outcomeTreatment consisted of 5 sessions of ART (a soft tissue technique that is applied to muscles, fascia, tendons, ligaments, and nerves) applied to the left elbow soft tissue over a duration of 3 weeks. The patient reported an absence of pain and ability to consistently play 18 consecutive holes of golf up to 3 times per week at 4 and 8 weeks post-treatment. ConclusionThis patient with lateral epicondylitis responded favorably to chiropractic treatment using the application of ART, as demonstrated by reduced pain and increased functional outcomes.

Treatment of Bell's Palsy Using Monochromatic Infrared Energy: A Report of 2 Cases

ObjectiveThe purpose of the study is to describe the use of monochromatic infrared energy (MIRE) therapy in the management of 2 patients with Bell's palsy. Clinical featuresTwo patients presented to a chiropractic clinic with Bell's palsy that was diagnosed by a medical physician. Both patients were treated using MIRE. The acute patient was a 32-year-old male. He presented with left facial palsy 1 day before the consultation. He was unable to puff the left cheek and close the left eyelid. He had difficulty raising the left eyebrow. The chronic case was a 46-year-old lady. Prior to the first consultation, she was treated with corticosteroid and electro-acupuncture for one and a half years, with incomplete recovery. When first seen, the left corner of mouth drooped and she had difficulty raising her left eyebrow. Intervention and outcomeMonochromatic infrared energy therapy, emitting 890 nm infrared light, was placed on the post-auricular area, pre-auricular area, the temple and mandibular area of the affected side. Each treatment lasted 30 minutes. Photographs were taken every week to document changes. The acute case received 19 treatments in 6 weeks. He reported an improvement of 95%. The chronic case received a total of 45 treatments in 9 months. She rated an improvement of 50%. At the conclusion of treatment, she was able to close her left eyelid and puff her left cheek but still could not raise her left eyebrow. ConclusionThese 2 patients seemed to respond to a different degree to the MIRE therapy. As 71% of patients with Bell's palsy recover uneventfully without any treatment, the present study describes the course of care but cannot confirm the effectiveness of MIRE therapy in the management of Bell's palsy.

Ultrasonography and Radiography to Identify Early Post Traumatic Myosistis Ossificans in an 18-Year-Old Male: A Case Report

ObjectiveThe purpose of this case report is to describe a patient with post traumatic myositis ossificans (PTMO) of the anterior thigh following blunt trauma and discuss the incidence, clinical presentation, management, and imaging findings. Clinical featuresAn 18-year-old male presented to a chiropractic clinic with a chief complaint of left knee pain and reduced range of motion after an impact injury to his left anterior thigh during hurdling 6 weeks earlier. Immediately after the injury, he presented to the emergency department where radiography of the left knee was negative and he was diagnosed with a muscle sprain. Follow-up radiography and ultrasonography of the left knee in a chiropractic radiology department revealed ossification consistent with PTMO within his vastus intermedius. Intervention and outcomeThe patient underwent a course of rehabilitation for 2 months including ice, class IV cold laser and vibration applied to his anterior thigh, and myofascial release of his quadriceps musculature with targeted and progressive rehabilitative exercises. His left knee pain resolved within 2 weeks of care. He resumed sports participation (American football) pain-free, while wearing protective padding over the affected thigh, 1 month after presentation, which was approximately 2 1/2 months following his injury. ConclusionThis case demonstrates that ultrasonography may have the capability to detect early phases of PTMO approximately 2 weeks prior to radiographic evidence and to monitor progression throughout its course.

Cox Decompression Manipulation and Guided Rehabilitation of a Patient With a Post Surgical C6-C7 Fusion With Spondylotic Myelopathy and Concurrent L5-S1 Radiculopathy

ObjectiveThe purpose of this case report is to describe combined treatment utilizing Cox distraction manipulation and guided rehabilitation for a patient with spine pain and post-surgical C6-7 fusion with spondylotic myelopathy and L5-S1 radiculopathy. Clinical featuresA 38-year-old man presented to a chiropractic clinic with neck pain and a history of an anterior cervical spine plate fusion at C6-7 after a work related accident 4 years earlier. He had signs and symptoms of spondolytic myelopathy and right lower back, right posterior thigh pain and numbness. Intervention and outcomeThe patient was treated with Cox technique and rehabilitation. The patient experienced a reduction of pain on a numeric pain scale from 8/10 to 3/10. The patient was seen a total of 12 visits over 3 months. No adverse effects were reported. ConclusionsA patient with a prior C6-7 fusion with spondylotic myelopathy and concurrent L5-S1 radiculopathy improved after a course of rehabilitation and Cox distraction manipulation. Further research is needed to establish its efficiency.

Sonography of Occult Rib and Costal Cartilage Fractures: A Case Series

ObjectiveThe purpose of this case series is to describe the use of diagnostic ultrasound (US) in the detection of occult rib and costal cartilage fractures presenting as chest wall pain to a chiropractic clinic. Clinical featuresThree patients presented with chest wall pain and tenderness. Two of the patients presented with acute chest wall injury and 1 carried a previous diagnosis of rib fracture after trivial trauma 2 months earlier. Intervention and outcomesDiagnostic US was selected as a non-ionizing imaging tool for these patients after negative digital radiography studies. All fractures were considered isolated as there was no associated injury, such as pneumothorax. Both of the acute cases were followed up to complete healing (evidence of osseous union) using US. All patients eventually achieved pain-free status. ConclusionIn these cases, US was more sensitive than radiography for diagnosing these cases of acute rib and costal cartilage fractures. Early recognition of rib injury could avoid potential complications from local manipulative therapy.

Interdisciplinary Management of Deep Vein Thrombosis During Rehabilitation of Acute Rupture of the Anterior Cruciate Ligament: A Case Report

ObjectiveThe purpose of this case report is to describe a patient who experienced deep venous thrombosis (DVT) during pre-operative rehabilitation of an acute rupture of an anterior cruciate ligament (ACL) reconstruction graft, to increase awareness of DVT occurring in a healthy individual after periodic immobilization, and to describe the interdisciplinary management for this patient. Clinical featuresA 30-year-old male was referred to a chiropractic clinic for presurgical treatment of a left ACL rupture and medial meniscus tear confirmed at magnetic resonance imaging. During the course of preoperative rehabilitation, the patient became limited in ambulation and presented for a routine rehabilitation visit. During this visit, he experienced increased leg swelling, pain and tenderness. The patient was assessed for DVT and was referred to the local emergency department for further evaluation where multiple DVTs were found in the left popliteal, posterior tibial, and peroneal veins. Intervention/outcomeThe patient was treated with a 17-week course of warfarin during which time the clinical signs and symptoms of DVT resolved. Meanwhile, the patient completed the rehabilitation treatment plan in preparation for ACL reconstruction without further complications. ConclusionsThis case raises awareness that DVT may occur in a healthy individual after periodic immobilization. While there may be controversy regarding the appropriate application of pharmaceutical anticoagulants in patients with DVT of the leg, the most risk averse strategy is for a short duration prescription medication with compression stockings. Through interdisciplinary management, the patient experienced a successful outcome.

Reliability, responsiveness and interpretability of the neck disability index-Dutch version in primary care.

To establish an evidence-based recommendation for the pragmatic use of the Neck Disability Index-Dutch Version (NDI-DV) in primary care based on an assessment of the reliability, the responsiveness, and the interpretability of the NDI-DV. At baseline, the NDI-DV was completed by 337 patients with neck pain presenting to 97 chiropractic clinics in Belgium and the Netherlands. Three months after inclusion, 265 patients provided data to assess the responsiveness and interpretability. Reliability was assessed in 155 patients (retested after 10 days) by calculating the intra-class correlation coefficient for agreement (ICCagreement) and the measurement error (standard error of measurement, SEM), the latter resulting in the smallest detectable change (SDC). The minimal important change (MIC) was assessed by the anchor-based MIC distribution using self-reported perceived recovery as anchor. We tested interpretability by relating SDC to MIC. The ICCagreement was 0.88. The SEMagreement was 1.95 resulting in a SDC of 5.40. The NDI-DV appeared to be responsive, being able to distinguish improved from stable patients with an area under the curve of 0.85. The MIC was 4.50. The NDI-DV has good reliability and responsiveness and may be used in clinical practice in Belgium and the Netherlands. A change score of 5 is important for patients, but has a 7 % chance to be due to measurement error.

Prevention of low back pain: effect, cost-effectiveness, and cost-utility of maintenance care – study protocol for a randomized clinical trial

BackgroundLow back pain (LBP) is a prevalent condition and a socioeconomic problem in many countries. Due to its recurrent nature, the prevention of further episodes (secondary prevention), seems logical. Furthermore, when the condition is persistent, the minimization of symptoms and prevention of deterioration (tertiary prevention), is equally important. Research has largely focused on treatment methods for symptomatic episodes, and little is known about preventive treatment strategies.Methods/DesignThis study protocol describes a randomized controlled clinical trial in a multicenter setting investigating the effect and cost-effectiveness of preventive manual care (chiropractic maintenance care) in a population of patients with recurrent or persistent LBP.Four hundred consecutive study subjects with recurrent or persistent LBP will be recruited from chiropractic clinics in Sweden. The primary outcome is the number of days with bothersome pain over 12 months. Secondary measures are self-rated health (EQ-5D), function (the Roland Morris Disability Questionnaire), psychological profile (the Multidimensional Pain Inventory), pain intensity (the Numeric Rating Scale), and work absence.The primary utility measure of the study is quality-adjusted life years and will be calculated using the EQ-5D questionnaire. Direct medical costs as well as indirect costs will be considered.Subjects are randomly allocated into two treatment arms: 1) Symptom-guided treatment (patient controlled), receiving care when patients feel a need. 2) Preventive treatment (clinician controlled), receiving care on a regular basis. Eligibility screening takes place in two phases: first, when assessing the primary inclusion/exclusion criteria, and then to only include fast responders, i.e., subjects who respond well to initial treatment. Data are collected at baseline and at follow-up as well as weekly, using SMS text messages.DiscussionThis study investigates a manual strategy (chiropractic maintenance care) for recurrent and persistent LBP and aims to answer questions regarding the effect and cost-effectiveness of this preventive approach. Strict inclusion criteria should ensure a suitable target group and the use of frequent data collection should provide an accurate outcome measurement. The study utilizes normal clinical procedures, which should aid the transferability of the results.Trial registrationClinical trials.gov; NCT01539863, February 22, 2012. The first patient was randomized into the study on April 13th 2012.