Chiropractic Procedures Research Articles

Intervertebral Movements and Changes in Intervertebral Foraminal Morphology in the Lumbar Spine During a Chiropractic Procedure: A Cadaveric Study

Intervertebral Movements and Changes in Intervertebral Foraminal Morphology in the Lumbar Spine During a Chiropractic Procedure: A Cadaveric Study

Changes in Intradiscal Pressure During Flexion-Distraction Type of Chiropractic Procedure: A Pilot Cadaveric Study

Changes in Intradiscal Pressure During Flexion-Distraction Type of Chiropractic Procedure: A Pilot Cadaveric Study

Patients receiving chiropractic care in a neurorehabilitation hospital: a descriptive study.

ObjectivesIndividuals rehabilitating from complex neurological injury require a multidisciplinary approach, which typically does not include chiropractic care. This study describes inpatients receiving multidisciplinary rehabilitation including chiropractic care for brain injury, spinal cord injury (SCI), stroke, and other complex neurological conditions.DesignChiropractic services were integrated into Crotched Mountain Specialty Hospital (CMSH) through this project. Patient characteristics and chiropractic care data were collected to describe those receiving care and the interventions during the first 15 months when chiropractic services were available.SettingCMSH, a 62-bed subacute multidisciplinary rehabilitation, skilled nursing facility located in Greenfield, New Hampshire, USA.ResultsPatient mean (SD) age (n=27) was 42.8 (13) years, ranging from 20 to 64 years. Males (n=18, 67%) and those of white race/ethnicity (n=23, 85%) comprised the majority. Brain injury (n=20) was the most common admitting condition caused by trauma (n=9), hemorrhage (n=7), infarction (n=2), and general anoxia (n=2). Three patients were admitted for cervical SCI, 1 for ankylosing spondylitis, 1 for traumatic polyarthropathy, and 2 for respiratory failure with encephalopathy. Other common comorbid diagnoses potentially complicating the treatment and recovery process included myospasm (n=13), depression (n=11), anxiety (n=10), dysphagia (n=8), substance abuse (n=8), and candidiasis (n=7). Chiropractic procedures employed, by visit (n=641), included manual myofascial therapies (93%), mechanical percussion (83%), manual muscle stretching (75%), and thrust manipulation (65%) to address patients with spinal-related pain (n=15, 54%), joint or regional stiffness (n= 14, 50%), and extremity pain (n=13, 46%). Care often required adapting to participant limitations or conditions. Such adaptations not commonly encountered in outpatient settings where chiropractic care is usually delivered included the need for lift assistance, wheelchair dependence, contractures, impaired speech, quadriplegia/paraplegia, and the presence of feeding tubes and urinary catheters.ConclusionPatients suffered significant functional limitations and comorbidity resulting in modifications to the typical delivery of chiropractic care. Chiropractic services focused on relieving musculoskeletal pain and stiffness.

Lumbar extension traction alleviates symptoms and facilitates healing of disc herniation/sequestration in 6-weeks, following failed treatment from three previous chiropractors: a CBP® case report with an 8 year follow-up.

[Purpose] To present the outcome of a patient, having sciatica and MRI-verified disc herniation/sequestration who underwent Chiropractic BioPhysics® (CBP®) protocol designed to improve the lumbar lordosis. [Subject and Methods] A 56-year-old male suffered from chronic low back pain and recent sciatica due to lumbar disc herniation despite being under continuous care from three previous chiropractors. Radiographic analysis revealed a lumbar hypolordosis and MRI confirmed disc herniation and sequestration at L4–L5. Generalized decreased lumbar range of motion and multiple positive orthopedic and neurologic tests were present. [Results] After 26 treatments of CBP lumbar extension traction over 9-weeks a total reduction of the disc herniation and sequestration occurred with concomitant improvement in neurologic symptoms. Continuing maintenance treatments, an 8 year follow-up shows no relapse of condition and patient remained in good health. [Conclusion] A patient with lumbar disc herniation/sequestration was successfully treated with CBP technique procedures including lumbar extension traction that achieved a significant healing of herniation and significant reduction in symptoms not obtained following traditional chiropractic procedures alone. The quick reduction in lumbar disc herniation would appear to be related to a segmental disc unloading force produced during extension traction procedures for increasing the lumbar curvature.

Relationship between craniocervical orientation and center of force of occlusion in adults

Objective: Clinical observation and anecdotal reports suggest changes can occur to dental occlusion following intervention with the National Upper Cervical Chiropractic Association (NUCCA) procedure. This case controlled study discerned if occlusion changes are measurable using a dental force plate (T-Scan®) following an adjustment to the craniocervical junction (CCJ).Methods: A degree of case control was established by active patients being assessed twice prior to and following intervention. Before–after intervention assessment included posture evaluation and dental occlusion (T-Scan®).Results: Findings suggest that changes in posture and occlusion can be observed after the NUCCA chiropractic procedure. Not all patients demonstrated a more balanced contact pattern following the adjustment, indicating a need for further investigation.Discussion: These findings may suggest interconnectivity between the CCJ and an individual’s occlusal contacts and support the need for further integration between chiropractors and dentists seeking to co-manage temporomandibular joint disorders.

Prevalence of adverse effects among students taking technique classes: A retrospective study.

Objective : The main objective of this study was to determine characteristics of injuries experienced by students while learning chiropractic procedures in the classroom. Methods : Injury was defined as any physical adverse effect such as pain, stiffness, headache, and muscle spasm. Survey questions included age, sex, role, anatomical areas of injury, adjustive technique utilized, types of injury, treatment (if any), and recovery time. The survey was administered among the students in the 5th, 6th, and 8th trimesters of our doctor of chiropractic program. Only students who had completed one or more chiropractic procedures courses at the institution were asked to participate in the study. Results : Female recipients had a higher prevalence of adverse effects as the recipient of the adjustment than did male recipients. The most common site for injury overall was the lower back. The relationship between recipient role and sacroiliac joint injury and the relationship between adjustor role and wrist/hand injury were statistically significant. Students were more likely to be injured in the beginning of their technique education. Conclusion : This study suggests that students in technique courses learning adjustive procedures experience minor adverse physical effects related to the physical skills being learned. Strategies for prevention need to be considered.

A Cochrane Review of Combined Chiropractic Interventions for Low-Back Pain

Cochrane systematic review of randomized controlled trials. To determine the effects of combined chiropractic interventions on pain, disability, back-related function, overall improvement, and patient satisfaction in adults with low-back pain (LBP). Chiropractors commonly use a combination of interventions to treat people with LBP, but little is known about the effects of this care. We used a comprehensive search strategy. All randomized trials comparing combined chiropractic interventions (rather than spinal manipulation alone) with no treatment or other therapies were included. At least two authors selected studies, assessed bias risk, and extracted data. Descriptive synthesis and meta-analyses were performed. We included 12 studies involving 2887 LBP participants. Three studies had low risk of bias. Included studies evaluated a range of chiropractic procedures in a variety of subpopulations with LBP. For acute and subacute LBP, chiropractic interventions improved short- and medium-term pain (standardized mean difference [SMD] -0.25 [95% CI: -0.46 to -0.04] and MD -0.89 [95%CI: -1.60 to -0.18]) compared with other treatments, but there was no significant difference in long-term pain (MD -0.46 [95% CI -1.18 to 0.26]). Short-term improvement in disability was greater in the chiropractic group compared to other therapies (SMD -0.36 [95% CI: -0.70 to -0.02]). However, the effect was small and studies contributing to these results had high risk of bias. There was no difference in medium- and long-term disability. No difference was demonstrated for combined chiropractic interventions for chronic LBP and studies that had a mixed population of LBP. Combined chiropractic interventions slightly improved pain and disability in the short term and pain in the medium term for acute/subacute LBP. However, there is currently no evidence that supports or refutes that these interventions provide a clinically meaningful difference for pain or disability in people with LBP when compared to other interventions.

Combined chiropractic interventions for low-back pain.

Chiropractors commonly use a combination of interventions to treat people with low-back pain (LBP). To determine the effects of combined chiropractic interventions (that is, a combination of therapies, other than spinal manipulation alone) on pain, disability, back-related function, overall improvement, and patient satisfaction in adults with LBP, aged 18 and older. We searched: The Cochrane Back Review Group Trials Register (May 2009), CENTRAL (The Cochrane Library 2009, Issue 2), and MEDLINE (from January 1966), EMBASE (from January 1980), CINAHL (from January 1982), MANTIS (from Inception) and the Index to Chiropractic Literature (from Inception) to May 2009. We also screened references of identified articles and contacted chiropractic researchers. All randomised trials comparing the use of combined chiropractic interventions (rather than spinal manipulation alone) with no treatment or other therapies. At least two review authors selected studies, assessed the risk of bias, and extracted the data using standardised forms. Both descriptive synthesis and meta-analyses were performed. We included 12 studies involving 2887 participants with LBP. Three studies had low risk of bias. Included studies evaluated a range of chiropractic procedures in a variety of sub-populations of people with LBP.No trials were located of combined chiropractic interventions compared to no treatment. For acute and subacute LBP, chiropractic interventions improved short- and medium-term pain (SMD -0.25 (95% CI -0.46 to -0.04) and MD -0.89 (95%CI -1.60 to -0.18)) compared to other treatments, but there was no significant difference in long-term pain (MD -0.46 (95% CI -1.18 to 0.26)). Short-term improvement in disability was greater in the chiropractic group compared to other therapies (SMD -0.36 (95% CI -0.70 to -0.02)). However, the effect was small and all studies contributing to these results had high risk of bias. There was no difference in medium- and long-term disability. No difference was demonstrated for combined chiropractic interventions for chronic LBP and for studies that had a mixed population of LBP. Combined chiropractic interventions slightly improved pain and disability in the short-term and pain in the medium-term for acute and subacute LBP. However, there is currently no evidence that supports or refutes that these interventions provide a clinically meaningful difference for pain or disability in people with LBP when compared to other interventions. Future research is very likely to change the estimate of effect and our confidence in the results.

Designing an Optical Bendloss Sensor for Clinical ForcMeasurement

For many clinicians, their effectiveness is dependent on the force they manually apply to their patients. However, current care strategies lack quantitative feedback making it difficult to provide consistent care over time and among several clinicians. We have developed a disposable force-sensing glove that provides real-time quantitative feedback in the clinical setting. To minimally affect a clinician's function, obtain maximal signal to noise in a medical environment, and maintain patient safety, a fiber optic sensor has been developed for this application. A disposable nitrile glove with embedded fiber optic force sensor has been developed and initially tested for clinical efficacy. The sensor's design is based on the bendloss properties of optical fiber whereby the attenuation of light through a fiber is related to the bending of that fiber through a series of corrugated teeth. The sensor is fabricated in two parts, sandwiching the fiber between alternating teeth. When force is applied across the sensor, the teeth engage the fiber and bend it along an elastic, repeating profile. the specific light attenuation is dependent on the amount of bending that the fiber experiences between the teeth and can be used to measure the load applied to the sensor. Fabricated at 10×8×1 mm, the sensor achieves an appropriate clinical thickness and minimally affects normal clinical thickness and minimally affects normal clinical function. It provides real-time force feedback up to 90 lbs with 0.1 lb resolution. The sensitivity of the sensor follows an exponential relationship with strong agreement to theoretical calculations. Because the calibration curve is non-linear, the sensor is most sensitive at low forces allowing detection of extremely delicate forces such as the pulse from the carotid artery. Each glove is fabricated with a single sensor embedded in the fingertip or palm and a magnetic connector couples the glove with a non-disposable wrist cuff. The wrist cuff houses the power supply, light source, and photodetectors. The fibers are nonpermanently coupled to their respective sources and detectors completing the optical path from source, through the fiber and sensor, to the detector. The light intensity is then transmitted to the display module which calibrates and displays the force graphically in real-time. The display module records, summarizes, and stores the data from each clinical session allowing clinicians to collaborate on treatment protocols and provide consistent care over time. Initial results from current clinical trials with physical therapists at the University of Minnesota have indicated improved recovery time after surgery. Twenty-four ACL reconstruction patients have been monitored post-operation for five weeks and the experimental group treated with the glove has demonstrated significantly faster recovery to normal range of motion than the control group. It has been suggested that the quantification of patient evaluation allowed the clinicians to recommend adjustments to at-home stretching regimens, contributing to faster healing times. Similar clinical studies are planned for chiropractic care and other physical therapy procedures. This fiberoptic force sensing glove represents a new biomedical tool which can impact patient evaluation and care by providing clinicians with a quantified sense of touch.

Seventh Cervical Rib Associated with Subclavian Artery Occlusion and Multiple Infarcts

A cervical rib, or supernumerary (extra) rib arising from the 7th cervical vertebra, is a congenital abnormality that occurs in less than 1% of the population. Clinically, it can cause obscure nervous or vascular symptoms and be difficult to diagnose. In this rare case, a 37-year-old woman developed a subclavian artery occlusion after undergoing a chiropractic manipulation for neck, shoulder, and arm pain. The occlusion led to multiple cerebellar infarcts, frontal subarachnoid hemorrhage, myocardial infarction, and right-hand vascular compromise. The patient was subsequently diagnosed with a 7th cervical rib, which likely caused compression of the subclavian artery after a hyperextension injury sustained during the chiropractic procedure. The departments of vascular surgery, neurosurgery, cardiology, and neurology collaborated to review all elements of the patient's diagnosis and care. After the patient was stabilized, she spent 6 weeks in acute inpatient rehabilitation; upon discharge, her symptoms were greatly improved but still present. Three months later, the patient underwent a subclavian-artery-to-axillary-artery bypass with resection of the left cervical rib. She tolerated surgery well with no complications. As a result of the devastating insults sustained secondary to the presence of the 7th cervical rib and her subclavian artery occlusion, this patient faced months of recovery. Treatment involved a structured interdisciplinary plan of care.

Atlas vertebra realignment and achievement of arterial pressure goal in hypertensive patients: a pilot study

Anatomical abnormalities of the cervical spine at the level of the Atlas vertebra are associated with relative ischaemia of the brainstem circulation and increased blood pressure (BP). Manual correction of this mal-alignment has been associated with reduced arterial pressure. This pilot study tests the hypothesis that correcting mal-alignment of the Atlas vertebra reduces and maintains a lower BP. Using a double blind, placebo-controlled design at a single center, 50 drug naïve (n=26) or washed out (n=24) patients with Stage 1 hypertension were randomized to receive a National Upper Cervical Chiropractic (NUCCA) procedure or a sham procedure. Patients received no antihypertensive meds during the 8-week study duration. The primary end point was changed in systolic and diastolic BP comparing baseline and week 8, with a 90% power to detect an 8/5 mm Hg difference at week 8 over the placebo group. The study cohort had a mean age 52.7+/-9.6 years, consisted of 70% males. At week 8, there were differences in systolic BP (-17+/-9 mm Hg, NUCCA versus -3+/-11 mm Hg, placebo; P<0.0001) and diastolic BP (-10+/-11 mm Hg, NUCCA versus -2+/-7 mm Hg; P=0.002). Lateral displacement of Atlas vertebra (1.0, baseline versus 0.04 degrees week 8, NUCCA versus 0.6, baseline versus 0.5 degrees , placebo; P=0.002). Heart rate was not reduced in the NUCCA group (-0.3 beats per minute, NUCCA, versus 0.5 beats per minute, placebo). No adverse effects were recorded. We conclude that restoration of Atlas alignment is associated with marked and sustained reductions in BP similar to the use of two-drug combination therapy.

ヒトにおける咀嚼運動の再検討カイロプラクティックなどを併用した顎関節症の症例研究より

ヒトにおける咀嚼運動の再検討カイロプラクティックなどを併用した顎関節症の症例研究より

Chiropractic Care of a Geriatric Patient with an Acute Fracture-Subluxation of the Eighth Thoracic Vertebra

Objective To describe the chiropractic care of a geriatric patient with complaints of midthoracic and low back pain. Clinical Features A 74-year-old woman sought chiropractic care with complaints of thoracic spinal pain following a fall. Palpation findings included hypertonicity and tenderness along with painful muscle spasms in the paraspinal musculature of the thoracolumbar spine. Limited range of thoracolumbar motion was found on extension and lateral flexion, most notably on right lateral flexion, with pain. Radiographic examination revealed a compression fracture at T8, in addition to spinographic listings. Signs of sprain injury were also detected at T8. Intervention and Outcome The patient was cared for with contact-specific, high-velocity, low-amplitude adjustments to sites of vertebral subluxations and at the T8 fracture-subluxation. The patient's response to care was positive. Conclusion This case report describes the clinical features, care, and results of 1 geriatric patient with a thoracic compression fracture-subluxation treated with specific chiropractic procedures. The patient had an apparent decrease in pain as a result of the treatment. Due to the inherent limitations of a case report, it is inappropriate to generalize this outcome.

Dural port therapy

Introduction Dural port therapy (DPT) is a chiropractic procedure which can be used effectively with Sacro-Occipital Technique (SOT) procedures and which uses the sacrum as a lever to influence and balance the spine and cranium by way of the meningeal system. Discussion Rationale and research is presented to explain the basis behind DPT's method of affecting the craniospinal system and its relationship to the meninges. Though the procedure can be used with most conditions, DPT appears to be safe to use with osteoporotic conditions, fractured vertebrae, and other conditions where a “thrust” to the spine may be contraindicated. Basic methods of using DPT are presented along with alternative methods which can be applied when the basic methods are not sufficient. Conclusion DPT reduces sacral, spinal, and cranial dura meningeal tension, lesions, torque and stress, as well as dural sleeve vasomotor interference. The possibility that the doctor can influence the nervous system directly in such a powerful manner warrants further investigation.

Chiropractic: a profession at the crossroads of mainstream and alternative medicine.

Chiropractic is a large and well-established health care profession in the United States. In this overview, we briefly examine the development of chiropractic from humble and contentious beginnings to its current state at the crossroads of alternative and mainstream medicine. Chiropractic has taken on many of the attributes of an established profession, improving its educational and licensing systems and substantially increasing its market share in the past two decades. The public increasingly uses chiropractic largely for spinal pain syndromes and appears to be highly satisfied with the results. Of all the so-called alternative professions, chiropractic has made the largest inroads into private and public health care financing systems and is increasingly viewed as an effective specialty by many in the medical profession. Much of the positive evolution of chiropractic can be ascribed to a quarter century-long research effort focused on the core chiropractic procedure of spinal manipulation. This effort has helped bring spinal manipulation out of the investigational category to become one of the most studied forms of conservative treatment for spinal pain. Chiropractic theory is still controversial, but recent expansion in federal support of chiropractic research bodes well for further scientific development. The medical establishment has not yet fully accepted chiropractic as a mainstream form of care. The next decade should determine whether chiropractic maintains the trappings of an alternative health care profession or becomes fully integrated into all health care systems.

Headache and the cervical spine: a critical review.

Headache related to the cervical spine is often misdiagnosed and treated inadequately because of confusing and varying terminology. Primary headaches such as tension-type headache and migraine are incorrectly categorized as "cervicogenic" merely because of their occipital localization. Cervicogenic headache as described by Sjaastad presents as a unilateral headache of fluctuating intensity increased by movement of the head and typically radiates from occipital to frontal regions. Definition, pathophysiology; differential diagnoses and therapy of cervicogenic headache are demonstrated. Ipsilateral blockades of the C2 root and/or greater occipital nerve allow a differentiation between cervicogenic headache and primary headache syndromes such as migraine or tension-type headache. Neither pharmacological nor surgical or chiropractic procedures lead to a significant improvement or remission of cervicogenic headache. Pains of various anatomical regions possibly join into a common anatomical pathway, then present as cervicogenic headache, which should therefore be understood as a homogeneous but also unspecific pattern of reaction.

The Effects of Music Versus Silence on Measures of State Anxiety, Perceived Relaxation, and Physiological Responses of Patients Receiving Chiropractic Interventions

This study examined the effects of music versus silence on measures of state anxiety, perceived relaxation, and physiological responses of chiropractic patients prior to and immediately following chiropractic treatment interventions. Subjects (N = 30) were randomly assigned to one of 3 conditions. The control group (I) was instructed to relax in silence. The first experimental group (II) listened to a preferred style of music with relaxation instruction. The other experimental group (III) listened to New Age music with deep-breathing visualization relaxation instruction. State anxiety inventory, 10-point Likert tension scale rating, and blood pressure measurements were administered before and after chiropractic procedures for each condition. Additionally, a questionnaire was completed posttreatment. Significant differences (p < .05) were found from pretest to posttest among the 3 groups for state anxiety and the Likert scale ratings for tension. There was no significant difference for physiological measurements across conditions.

Headache and the cervical spine. A critical review

Headache in association with the cervical spine is often misdiagnosed and treated inadequately due to confusing and varying terminology. Primary headaches such as tension-type headache and migraine are incorrectly categorized as "cervicogenic" merely because of their occipital localization. Cervicogenic headache described by Sjastaad presents as a unilateral headache of fluctuating intensity increased by movement of the head and typically radiating from occipital to frontal regions. Definition, pathophysiology, differential diagnosis and therapy of cervicogenic headache shall be demonstrated. Ipsilateral blockades of the C2/ C3 root and/or the major occipital nerve allow a differentiation between migraine and other primary headache syndromes. Neither pharmacological nor surgical or chiropractic procedures lead to an improvement or remission of cervicogenic headache. Pain of various anatomical regions possibly join into a common anatomical pathway then presenting as cervicogenic headache, which should therefore be understood as a homogeneous but also unspecific pattern of reaction.

Individual and population doses in Manitoba from chiropractic x-ray procedures

Manitoba (population of 1.0 million) has a total of 37 chiropractors who perform X-rays on behalf of the 100 practising chiropractors. In 1987 these specialists performed approximately 33300 spinal X-ray studies. Of the three main types of studies done, cervical spine examinations contribute the lowest patient does (average HE of 26 mu Sv) while thoracic and lumbar spine examinations show a considerably higher patient dose (HE in the range 240-410 mu Sv). The average patient HE was determined to be 220 mu Sv. Lumbar spine examinations account for 45% of all chiropractic X-ray examinations, and contribute 84% of the collective dose. Cervical spine examinations also account for 45% of chiropractic X-ray examinations, but contribute only 5% of the collective dose with thoracic spine examinations contributing the 11% balance of the collective dose. Patients undergoing chiropractic procedures involving exposure to X-rays account for about 3.6% of all diagnostic X-ray procedures in this province. The per caput dose contribution from chiropractic practice was calculated to be 7.3 mu Sv which is estimated to be about 1.2% of the total population dose from diagnostic procedures employing ionising radiation.