Chiropractic Spinal Manipulative Therapy Research Articles

Chiropractic spinal manipulative therapy for acute neck pain: A 4-arm clinical placebo randomized controlled trial. A prospective study protocol

Introduction Neck pain poses enormous individual and societal costs worldwide. Spinal manipulative therapy and Non-Steroidal Anti-Inflammatory Drug treatment are frequently used despite a lack of compelling efficacy data. This protocol describes a multicentre 4-arm, clinical placebo randomized controlled trial (RCT), investigating the efficacy of chiropractic spinal manipulative therapy (CSMT) versus sham CSMT, ibuprofen, and placebo medicine for acute neck pain. This superiority study will employ parallel groups, featuring a 1:1:1:1 allocation ratio. Material and methods We will randomize 320 participants equally into four groups: CSMT, sham CSMT, ibuprofen, or placebo medicine. CSMT groups are single-blinded, while the medicine groups are double-blinded. Data will be collected at baseline (Day 0), during treatment and post-treatment. The primary endpoint will assess the difference in mean pain intensity from Day 0 to Day 14 on a numeric rating scale 0–10; the CSMT group is compared to sham CSMT, ibuprofen, and placebo medicine groups, respectively. Secondary endpoints will assess mean pain intensity and mean duration at different time points, and adverse events, blinding success, and treatment satisfaction, including comparison between ibuprofen and placebo medicine. Power calculation is based on a mean neck pain rating of 5 at Day 0, with standard deviation of 1 in all groups. Mean pain reduction at Day 14 is expected to be 60% in the CSMT group, 40% in sham CSMT and ibuprofen groups, and 20% in the placebo medicine group. A linear mixed model will compare the mean values for groups with corresponding 95% confidence intervals. P values below 0.017 will be considered statistically significant. All analyses will be conducted blinded from group allocation. Discussion This RCT aims towards the highest research standards possible for manual-therapy RCTs owing to its two placebo arms. If CSMT and/or ibuprofen proves to be effective, it will provide evidence-based support for CSMT and/or ibuprofen for acute neck pain. Trial registration ClinicalTrials.gov identifier: NCT05374057. EU Clinical Trials Register: EudraCT number: 2021-005483-21.

Association between chiropractic spinal manipulation and gabapentin prescription in adults with radicular low back pain: retrospective cohort study using US data

ObjectivesRadicular low back pain (rLBP) is often treated off-label with gabapentin or by chiropractors using chiropractic spinal manipulative therapy (CSMT). To date, no studies have examined the association between these...

Mechanisms of chiropractic spinal manipulative therapy for patients with chronic primary low back pain: protocol for a mechanistic randomised placebo-controlled trial

IntroductionChronic low back pain (CLBP) is a highly prevalent and disabling condition. Identifying subgroups of patients afflicted with CLBP is a current research priority, for which a classification system based...

A retrospective analysis of the incidence of severe adverse events among recipients of chiropractic spinal manipulative therapy

This study examined the incidence and severity of adverse events (AEs) of patients receiving chiropractic spinal manipulative therapy (SMT), with the hypothesis that < 1 per 100,000 SMT sessions results in a grade ≥ 3 (severe) AE. A secondary objective was to examine independent predictors of grade ≥ 3 AEs. We identified patients with SMT-related AEs from January 2017 through August 2022 across 30 chiropractic clinics in Hong Kong. AE data were extracted from a complaint log, including solicited patient surveys, complaints, and clinician reports, and corroborated by medical records. AEs were independently graded 1–5 based on severity (1-mild, 2-moderate, 3-severe, 4-life-threatening, 5-death). Among 960,140 SMT sessions for 54,846 patients, 39 AEs were identified, two were grade 3, both of which were rib fractures occurring in women age > 60 with osteoporosis, while none were grade ≥ 4, yielding an incidence of grade ≥ 3 AEs of 0.21 per 100,000 SMT sessions (95% CI 0.00, 0.56 per 100,000). There were no AEs related to stroke or cauda equina syndrome. The sample size was insufficient to identify predictors of grade ≥ 3 AEs using multiple logistic regression. In this study, severe SMT-related AEs were reassuringly very rare.

Guideline-concordant utilization of magnetic resonance imaging in adults receiving chiropractic manipulative therapy vs other care for radicular low back pain: a retrospective cohort study.

BackgroundLumbar magnetic resonance imaging (LMRI) is often performed early in the course of care, which can be discordant with guidelines for non-serious low back pain. Our primary hypothesis was that adults receiving chiropractic spinal manipulative therapy (CSMT) for incident radicular low back pain (rLBP) would have reduced odds of early LMRI over 6-weeks’ follow-up compared to those receiving other care (a range of medical care, excluding CSMT). As a secondary hypothesis, CSMT recipients were also expected to have reduced odds of LMRI over 6-months’ and 1-years’ follow-up.MethodsA national 84-million-patient health records database including large academic healthcare organizations (TriNetX) was queried for adults age 20–70 with rLBP newly-diagnosed between January 31, 2012 and January 31, 2022. Receipt or non-receipt of CSMT determined cohort allocation. Patients with prior lumbar imaging and serious pathology within 90 days of diagnosis were excluded. Propensity score matching controlled for variables associated with LMRI utilization (e.g., demographics). Odds ratios (ORs) of LMRI over 6-weeks’, 6-months’, and 1-years’ follow-up after rLBP diagnosis were calculated.ResultsAfter matching, there were 12,353 patients per cohort (mean age 50 years, 56% female), with a small but statistically significant reduction in odds of early LMRI in the CSMT compared to other care cohort over 6-weeks’ follow-up (9%, 10%, OR [95% CI] 0.88 [0.81–0.96] P = 0.0046). There was a small but statistically significant increase in odds of LMRI among patients in the CSMT relative to the other care cohort over 6-months’ (12%, 11%, OR [95% CI] 1.10 [1.02–1.19], P < 0.0174) and 1-years’ follow-up (14%, 12%, OR [95% CI] 1.21 [1.13–1.31], P < 0.0001).ConclusionsThese results suggest that patients receiving CSMT for newly-diagnosed rLBP are less likely to receive early LMRI than patients receiving other care. However, CSMT recipients have a small increase in odds of LMRI over the long-term. Both cohorts in this study had a relatively low rate of early LMRI, possibly because the data were derived from academic healthcare organizations. The relationship of these findings to other patient care outcomes and cost should be explored in a future randomized controlled trial.RegistrationOpen Science Framework (https://osf.io/t9myp). Supplementary InformationThe online version contains supplementary material available at 10.1186/s12891-022-05462-y.

Association between chiropractic spinal manipulative therapy and benzodiazepine prescription in patients with radicular low back pain: a retrospective cohort study using real-world data from the USA

ObjectivesAlthough chiropractic spinal manipulative therapy (CSMT) and prescription benzodiazepines are common treatments for radicular low back pain (rLBP), no research has examined the relationship between these interventions. We hypothesise that...

Qualitative Analysis of Illness Representations and Coping Perceptions Among Older Adults With Chronic Spinal Disability: “A Thought in the Back of My Mind”

ObjectiveThe purpose of this study was to explore older adults’ illness representations, their beliefs about health, and their coping perceptions of chronic spinal disability. MethodsThis qualitative descriptive study used structured interviews that were completed during a randomized trial of non-pharmacological management of spine-related disability with chiropractic spinal manipulative therapy and exercise. Dual coders conducted a descriptive thematic analysis of 50 randomly selected transcripts supported by qualitative data management software. The Common-Sense Model provided an organizing framework for coding and interpretation. ResultsFifty participants (34 women, median age: 68 years) described 4 illness representations, 4 coping styles, and 6 coping strategies for their management of spinal disability. Illness representations formed a continuum of little-to-no health impact to bothersome symptoms to heightened symptom intensity to unmanaged pain and/or disability. Most participants adopted either self-care or self-management coping styles, but some used healthcare-seeking or fear avoidance with worsening symptoms or interference with employment or preferred activities. Participants mentioned 6 coping strategies for spinal disability. Distraction included position changes, hobbies, and supportive relationships. Limitation focused on rest and/or relaxation, restricted movements, and activity modifications. Prevention enhanced self-care knowledge, posture and/or ergonomics, nutrition, and stress management. Movement emphasized stretching, home exercise and/or walking, and exercise therapy. Palliation augmented patient comfort through the use of heat and/or ice, over-the-counter medicine, and spinal manipulation. Avoidance strategies included missing employment, stopping house and/or yard work, and prescription medication. ConclusionThe community-dwelling older adults in this study offered varied illness representations of their chronic spinal disability. Most participants combined and personalized coping strategies to minimize pain and symptom impact; thus, representations may influence the coping styles adopted by older persons to manage their spinal conditions. A quote from a participant that pain was “a thought in the back of my mind” suggests the presence of cognitive and emotional processes that may influence individual perceptions and feelings about their spinal symptoms or conditions. These findings suggest that there may be a broader role for spine care clinicians to include teaching older people about self-management strategies to better cope with spinal disabilities.

A Pilot Longitudinal Study of 3-Dimensional Head and Neck Kinematics During Functional Tasks in Individuals With Chronic Idiopathic Neck Pain Either Wait-Listed for or Receiving Chiropractic Spinal Manipulative Therapy With Exercise

ObjectiveThe purpose of this study was to determine if there is a relationship between pain and movement kinematics during functional tasks, evaluated over time, in individuals with chronic idiopathic neck pain. MethodsTen participants with chronic idiopathic neck pain performed 2 functional tasks (overhead reach to the right and putting on a seatbelt) while evaluated using 8 Oqus 300+ cameras. Kinematic variables included joint angles and range of motion (ROM) (°), head segment relative to neck segment (head-neck [HN]); and head/neck segment relative to upper thoracic segment (head/neck-trunk), velocity (m/s), and time (% of movement phase). Pain was quantified using a 100-mm visual analog scale. Linear mixed effects regression models were used to analyze associations between pain and kinematic variables adjusting for treatment group. ResultsFor overhead reach, higher pain was associated with less HN peak rotation at baseline (β = –0.33; 95% CI −0.52 to –0.14, P = .003) and less HN total rotation ROM at 6 months (β = –0.19; 95% CI –0.38 to –0.003, P = .048). For the seatbelt task, higher pain was associated with less HN peak rotation (β = –0.52; 95% CI −0.74 to –0.30 to –0.74, P < .001) and less HN total rotation ROM at baseline (β = –0.32; 95% CI –0.53 to –0.10, P = .006). No other movement variables demonstrated meaningful relationships with pain for the reach or seatbelt tasks. ConclusionHigher pain is associated with less HN peak and total rotation during functional reaching tasks requiring head rotation. Recognizing altered functional kinematics in individuals with chronic neck pain may assist patient management.

Remission of Primary Headache Associated With Sexual Activity in a Woman After Chiropractic Spinal Manipulation: A Case Study

ObjectivePrimary headache associated with sexual activity (PHASA) is rare but recognized by the International Classification of Headache Disorders. Although triptans and indomethacin have been suggested as a pharmacological treatment option for acute treatment, indomethacin can be administered preemptively, and β-blockers has been proposed as a treatment option for prophylactic management, pharmacologic efficacy remains uncertain. Manual therapy for PHASA has not been studied and thus has no scientifically proven effect. The purpose of this case study is to present a successful case of chiropractic care for a patient with PHASA. Clinical FeaturesThis case study presents a case where a 19-year-old white European female student presented to a primary care chiropractic clinic complaining of mainly left-sided intense headache, which had acute onset right before or during orgasm. The patient had never suffered headaches before this, and the intense headache never occurred outside sexual activity nor during intercourse if she did not reach orgasm. The diagnosis of PHASA was later confirmed by a hospital neurologist with extensive experience in headache diagnostics. Intervention and OutcomesAfter 7 manual therapy sessions consisting of spinal manipulative therapy at the lumbosacral area conducted by an experienced chiropractor, the patient reported remission of her PHASA, which remained as such at a 12-month follow-up. ConclusionThis case study generates the observational hypothesis that a patient with PHASA may respond to chiropractic spinal manipulative therapy. The underlying mechanisms for this symptom amelioration are, however, unclear.

143. Chiropractors treating patients with acute lower back pain in a spine treatment pathway model: a five-year prospective cohort study

BACKGROUND CONTEXT Patient access to current best evidence primary care treatment for acute lower back remains highly problematic. Treatment pathway models have the potential to improve patient access to care, provide seamless transitions from one form of treatment to another, optimize clinical outcomes, improve cost-effectiveness and reduce progression to chronic illness /pain. A standardized protocol of hospital-based outpatient clinic chiropractic lumbar spinal manipulative therapy (CSMT) as a component of care for patients with acute lower back pain (ALBP) has been previously validated. PURPOSE To determine the feasibility and patient satisfaction of a community-based standardized chiropractic treatment protocol as a component of a primary care spine treatment pathway in the treatment of patients with ALBP. STUDY DESIGN/SETTING Feasibility prospective cohort study. PATIENT SAMPLE Inclusion: Patients with ALBP without radiculopathy of less than 24 weeks; Exclusion: Red flag conditions; SPECT scan positive facet arthropathy; > Grade IV Thompson lumbar disc degeneration at one or more levels; relevant DSM 5 diagnoses; third-party insurer involvement. OUTCOME MEASURES Willingness to participate of ALBP patients and community chiropractors. Rate of compliance with a standardized treatment protocol in community-based chiropractors. Patient wait times, satisfaction scores, pre- and post-VAS and ODI scores, need for additional imaging, rate of discharge from hospital outpatient clinic. METHODS Community-based chiropractors from three British Columbia Provincial Health Regions agreed to accept referrals from a hospital-supervised primary care spine program to treat ALBP patients with a standardized protocol comprised of a maximum four-week course of lumbar spine CSMT only and a lumbar spine flexibility instruction exercise program. Participating patients were seen for follow-up in the hospital spine outpatient clinic at four and eight weeks post-treatment. RESULTS Over the five-year duration of the study, 368/380 (97%) of eligible patients and 21/26 (81%) of community-based chiropractors agreed to participate. Seventeen of 21 chiropractors (81%) consistently administered treatment within the boundaries of the standardized research study protocol. VAS and ODI scores improved significantly in 320/368 (87%) patients. The average wait time for access to treatment was 7.4 days. Eighty-two percent of patients reported high satisfaction scores. The rate of required additional diagnostic imaging was 3%. Rates of discharge from the hospital spine program outpatient clinic with no requested follow-up by six months was 86%. CONCLUSIONS A standardized protocol of CSMT and flexibility exercise instruction administered by community-based chiropractors to a specific cohort of patients with ALBP is a feasible component of a primary care spine treatment pathway. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Friday, September 28, 2018 9:00 AM–10:00 AM best papers Friday: 148. Biological and clinical outcomes of chiropractic spinal manipulative therapy in the treatment of patients with acute inflammatory radiculopathy secondary to lumbar disc herniation: a pilot study

BACKGROUND CONTEXT Acute sciatica secondary to lumbar disc herniation (AS/LDH) is thought to be caused by mechanical compression of the spinal nerve root and/or chemical inflammatory mechanisms involving pro-inflammatory cytokines (IC) such as interleukin (IL)-1α, IL-8and tumor necrosis factor (TNF)-α). Although chiropractic high velocity low amplitude (HVLA) spinal manipulative therapy (CSMT) is commonly used to treat AS/LDH patients, randomized controlled studies demonstrating efficacy have not been carried out to date. In addition, preliminary studies have reported decreases in serum ICs following CSMT. PURPOSE To evaluate the feasibility of conducting a randomized controlled trial (RCT) of the clinical and biological effects of chiropractic spinal manipulative therapy (CSMT) on in vivo IC expression and clinical outcomes in patients with acute sciatica and lumbosacral disc herniation (AS/LDH). STUDY DESIGN/SETTING Randomized controlled clinical trial. Enzyme linked immunosorbent assay (ELISA) of serum and disc tissue inflammatory cytokine content. PATIENT SAMPLE Inclusion: AS/LDH ofless than 6 months’ duration with a McCulloch criteria score of 5/5. Exclusion: red flag condition, cauda equina syndrome, progressive neurological deficit. OUTCOME MEASURES VAS and Roland Morris Disability scores and serum IC levels at baseline, 6, 12 and 24 weeks. Physical examination findings of nerve root tension signs, motor and sensory spinal nerve root deficit and Schober's test of lumbar flexion recorded at all data collection points. IC levels measured by ELISA in disc tissue, nerve root and disc lavagate collected in patients undergoing surgery. METHODS Patients with AS/LDH of less than 16 weeks duration were randomized to 6 weeks of CSMT or the approximately 6 weeks surgical wait list. Standardized neurological and lumbar spine examinations, VAS and Roland Morris Disability scores, and serum IC levels were assessed at baseline, 6, 12 and 24 weeks. ICs were also measured in disc tissue, nerve root and disc lavagate collected during surgery. Research ethics approval was obtained. RESULTS A total of 40 of 44 (91%) invited patients participated and were randomized. A total of 13 patients avoided surgery. Post-CSMT improvement was associated with longer duration of sciatica, absence of cross-over sign and motor deficit, reduced lumbar flexion increment and lower IC levels at baseline. CONCLUSIONS It appears feasibleto conduct a RCT with patients randomized to CSMT or a waitlist control group. There may be a sub-group of AS/LDH patients who will significantly benefit from HVLA CSMT. A large scale clinical trial is now required to test this preliminary finding.

Dose-response and efficacy of spinal manipulation for care of cervicogenic headache: a dual-center randomized controlled trial

Background ContextThe optimal number of visits for the care of cervicogenic headache (CGH) with spinal manipulative therapy (SMT) is unknown. PurposeThe present study aimed to identify the dose-response relationship between visits for SMT and chronic CGH outcomes and to evaluate the efficacy of SMT by comparison with a light-massage control. Study Design/SettingThis is a two-site, open-label randomized controlled trial. Patient SampleParticipants were 256 adults with chronic CGH. Outcome MeasuresThe primary outcome was days with CGH in the previous 4 weeks evaluated at the 12- and 24-week primary end points. Secondary outcomes included CGH days at remaining end points, pain intensity, disability, perceived improvement, medication use, and patient satisfaction. MethodsParticipants were randomized to four dose levels of chiropractic SMT: 0, 6, 12, or 18 sessions. They were treated three times per week for 6 weeks and received a focused light-massage control at sessions when SMT was not assigned. Linear dose effects and comparisons with the no-manipulation control group were evaluated at 6, 12, 24, 39, and 52 weeks. The present study was funded by the National Center for Complementary and Integrative Health (R01AT006330) and is registered at ClinicalTrials.gov (NCT01530321). The authors declare no conflicts of interest. ResultsA linear dose-response was observed for all follow-ups, a reduction of approximately 1 CGH day/4 weeks per additional 6 SMT visits (p<.05); a maximal effective dose could not be determined. Cervicogenic headache days/4 weeks were reduced from about 16 to 8 for the highest and most effective dose of 18 SMT visits. Mean differences in CGH days/4 weeks between 18 SMT visits and control were −3.3 (p=.004) and −2.9 (p=.017) at the primary end points, and were similar in magnitude at the remaining end points (p<.05). Differences between other SMT doses and control were smaller in magnitude (p>.05). Cervicogenic headache intensity showed no important improvement nor differed by dose. Other secondary outcomes were generally supportive of the primary outcome. ConclusionsThere was a linear dose-response relationship between SMT visits and days with CGH. For the highest and most effective dose of 18 SMT visits, CGH days were reduced by half and about 3 more days per month than for the light-massage control.

Cervical extension traction as part of a multimodal rehabilitation program relieves whiplash-associated disorders in a patient having failed previous chiropractic treatment: a CBP® case report.

[Purpose] To present the case of the non-surgical restoration of cervical lordosis in a patient suffering from chronic whiplash syndrome including chronic neck pain and daily headaches resulting from previous whiplash. [Subject and Methods] A 31 year old female presented with a chief complaint of chronic neck pain and headaches for 12 years, correlating temporally with a sustained whiplash. These symptoms were not significantly relieved by previous chiropractic spinal manipulative therapy. The patient had cervical hypolordosis and was treated with Chiropractic BioPhysics® protocol including extension exercises, manual adjustments and cervical extension traction designed to increase the cervical lordosis. [Results] The patient received 30 treatments over approximately 5-months. Upon re-assessment, there was a significant increase in global C2–C7 lordosis, corresponding with the reduction in neck pain and headaches. [Conclusion] This case adds to the accumulating evidence that restoring lordosis may be key in treating chronic whiplash syndrome. We suggest that patients presenting with neck pain and/or headaches with cervical hypolordosis be treated with a program of care that involves cervical extension traction methods to restore the normal cervical lordosis.

Adverse events in a chiropractic spinal manipulative therapy single-blinded, placebo, randomized controlled trial for migraineurs

BackgroundUnlike pharmacological randomized controlled trials (RCTs), manual-therapy RCTs do not always report adverse events (AEs). The few manual-therapy RCTs that provide information on AEs are frequently without details, such as the type and-, severity of the AE and reason for withdrawal. ObjectiveTo prospectively report all AEs in a chiropractic spinal manipulative therapy (CSMT) RCT. DesignA prospective 3-armed, single-blinded, placebo, RCT. MethodsSeventy migraineurs were randomized to the CSMT or a placebo, with 12 intervention sessions over three months. The recommendations by CONSORT and the International Headache Society's Task Force on AEs in migraine RCTs were followed. A standardized reporting scheme designed for pharmacological RCTs was used, and the AEs were described as frequencies and percentages within each group. The 95% confidence intervals (CIs) for the percentages (absolute risk) of AEs in each group were calculated when possible. Attributable risk (%) and relative risk were calculated with the corresponding 95% CIs. ResultsAEs were assessed in 703 sessions, with 355 in the CSMT group and 348 in the placebo group. Local tenderness was the most common AE, reported by 11.3% and 6.9% of the CSMT group and the placebo group, respectively, and tiredness on the intervention day was reported by 8.5% and 1.4% of CSMT group and the placebo group, respectively. The highest attributable risk was for tiredness on the treatment day, 7.0% (CI 3.9–10.2%) which presented a relative risk of 5.9 (CI 2.3–15.0). ConclusionsAEs were mild and transient, and severe or serious AEs were not observed.

ACC Research Agenda Conference 2018: Peer Reviewer Acknowledgments and Abstracts of Proceedings

ACC Research Agenda Conference 2018: Peer Reviewer Acknowledgments and Abstracts of Proceedings

Chiropractic manipulative therapy of the thoracic spine in combination with stretch and strengthening exercises, in improving postural kyphosis in woman

Purpose: This study serves to determine the effectiveness of either chiropractic spinal manipulative therapy to the thoracic spine or stretch and strengthening exercises (stretching the pectoralis major muscle and strengthening the rhomboid, middle and inferior trapezius muscles) versus the combined treatment of chiropractic spinal manipulative therapy to the thoracic spine in conjunction with stretch and strengthening exercises.Method: A randomised study design with thirty female participants between the ages of twenty and thirty nine was selected. Group 1 (n = 10) received chiropractic spinal manipulative therapy to the thoracic spine. Group 2 (n = 10) received chiropractic spinal manipulative therapy to the thoracic spine as well as stretch and strengthening exercises i.e. stretching the pectoralis major muscles and strengthening the rhomboid, middle and inferior trapezius muscles. Group 3 (n = 10) received stretch and strengthening exercises. The stretch and strengthening exercises were performed in the consultation rooms to ensure that the participants were complying with the treatment and doing the exercises properly. The study consisted of seven consultations for Group 1 (they received treatment once a week for six weeks) and for Groups 2 and 3 there were nineteen consultations (they received three treatments a week for six weeks). Objective data was recorded at the beginning of the first, fourth and seventh consultations for Group 1, and the first, tenth and nineteenth consultations for Groups 2 and 3. On the seventh consultation (for Group 1) and nineteenth consultation for Groups 2 and 3, only data collection was done. Objective data were obtained by using the Flexicurve® Ruler measurements for the angle of kyphosis. Visual analysis was done by taking lateral (sagittal) view photographs at the beginning of the initial and final consultations.Results: Statistical analysis revealed significant statistical changes for the intragroup results for all three groups. No significant statistical difference was found between the groups for the inter-group analysis.Conclusion: The study showed that all three treatment protocols for Groups 1, 2, and 3 were effective. However, Group 1 had not shown a great improvement in their postural kyphosis, Group 3 had shown a relatively good improvement in their posture, while Group 2 had shown the best results with regards to improvement of the participants' posture. Therefore, in conclusion, Groups 2 and 3 treatment protocols can be used effectively to treat postural kyphosis but Group 2's treatment protocol, consisting of chiropractic spinal manipulative therapy to the thoracic spine in combination with stretch and strengthening exercises, will yield the best results.

Chiropractic spinal manipulative therapy for migraine: a three‐armed, single‐blinded, placebo, randomized controlled trial

Background and purposeTo investigate the efficacy of chiropractic spinal manipulative therapy (CSMT) for migraineurs.MethodsThis was a prospective three‐armed, single‐blinded, placebo, randomized controlled trial (RCT) of 17 months duration including 104 migraineurs with at least one migraine attack per month. The RCT was conducted at Akershus University Hospital, Oslo, Norway. Active treatment consisted of CSMT, whereas placebo was a sham push manoeuvre of the lateral edge of the scapula and/or the gluteal region. The control group continued their usual pharmacological management. The RCT consisted of a 1‐month run‐in, 3 months intervention and outcome measures at the end of the intervention and at 3, 6 and 12 months follow‐up. The primary end‐point was the number of migraine days per month, whereas secondary end‐points were migraine duration, migraine intensity and headache index, and medicine consumption.ResultsMigraine days were significantly reduced within all three groups from baseline to post‐treatment (P < 0.001). The effect continued in the CSMT and placebo group at all follow‐up time points, whereas the control group returned to baseline. The reduction in migraine days was not significantly different between the groups (P > 0.025 for interaction). Migraine duration and headache index were reduced significantly more in the CSMT than the control group towards the end of follow‐up (P = 0.02 and P = 0.04 for interaction, respectively). Adverse events were few, mild and transient. Blinding was strongly sustained throughout the RCT.ConclusionsIt is possible to conduct a manual‐therapy RCT with concealed placebo. The effect of CSMT observed in our study is probably due to a placebo response.

Chiropractic manipulative therapy of the thoracic spine in combination with stretch and strengthening exercises, in improving postural kyphosis in woman

PurposeThis study serves to determine the effectiveness of either chiropractic spinal manipulative therapy to the thoracic spine or stretch and strengthening exercises (stretching the pectoralis major muscle and strengthening the rhomboid, middle and inferior trapezius muscles) versus the combined treatment of chiropractic spinal manipulative therapy to the thoracic spine in conjunction with stretch and strengthening exercises. MethodA randomised study design with thirty female participants between the ages of twenty and thirty nine was selected. Group 1 (n = 10) received chiropractic spinal manipulative therapy to the thoracic spine. Group 2 (n = 10) received chiropractic spinal manipulative therapy to the thoracic spine as well as stretch and strengthening exercises i.e. stretching the pectoralis major muscles and strengthening the rhomboid, middle and inferior trapezius muscles. Group 3 (n = 10) received stretch and strengthening exercises. The stretch and strengthening exercises were performed in the consultation rooms to ensure that the participants were complying with the treatment and doing the exercises properly. The study consisted of seven consultations for Group 1 (they received treatment once a week for six weeks) and for Groups 2 and 3 there were nineteen consultations (they received three treatments a week for six weeks). Objective data was recorded at the beginning of the first, fourth and seventh consultations for Group 1, and the first, tenth and nineteenth consultations for Groups 2 and 3. On the seventh consultation (for Group 1) and nineteenth consultation for Groups 2 and 3, only data collection was done. Objective data were obtained by using the Flexicurve® Ruler measurements for the angle of kyphosis. Visual analysis was done by taking lateral (sagittal) view photographs at the beginning of the initial and final consultations. ResultsStatistical analysis revealed significant statistical changes for the intragroup results for all three groups. No significant statistical difference was found between the groups for the inter-group analysis. ConclusionThe study showed that all three treatment protocols for Groups 1, 2, and 3 were effective. However, Group 1 had not shown a great improvement in their postural kyphosis, Group 3 had shown a relatively good improvement in their posture, while Group 2 had shown the best results with regards to improvement of the participants' posture. Therefore, in conclusion, Groups 2 and 3 treatment protocols can be used effectively to treat postural kyphosis but Group 2's treatment protocol, consisting of chiropractic spinal manipulative therapy to the thoracic spine in combination with stretch and strengthening exercises, will yield the best results.

Improvement in balance, pallesthesia, gait and tandem walk after chiropractic spinal manipulative therapy and functional neurological rehabilitation.

Event Abstract Back to Event Improvement in balance, pallesthesia, gait and tandem walk after chiropractic spinal manipulative therapy and functional neurological rehabilitation. Paula Rhodes1* and Xavier Barreto-Alderondo1 1 Life University, Center for Health and Optimum Performance Outpatient Clinic, United States Background: A 66-year-old Caucasian male and former paint contractor presented on September 11, 2015 with complaints of poor balance, an unsteady “shuffling” gait and fatigue of his leg muscles which he had first noticed in approximately January of 2015. He had stopped his dance lessons in April 2015 due to these complaints, but had started them again in September 2015. His wife had died two years before, and dance was an important social event in which he wanted to be able to fully participate. Methods: A detailed chiropractic and functional neurological examination was performed, which revealed that ambulation was slow and deliberate, as were his speech, gestures and general affect. He was unable to perform tandem walk. Hypertonicity of his cervical spine musculature was noted. His gait lacked any right or left arm swing, and he dragged his right foot when he walked. Pallesthesia (vibration sense) was absent on his left foot up to five inches above the left medial malleolus. Heel–to-shin testing was poor on the left. A treatment plan involving peripheral somatosensory stimulation, active and passive movement exercises, specific ocular exercises including gaze stabilization, sensorimotor therapies and chiropractic spinal manipulative therapy (SMT) was applied. He was compliant in performing home exercises including walking outside for exercise. Results: Improvement in some findings occurred in approximately four months, and in other findings in approximately 10 months as additional therapies were applied. Pallesthesia was restored completely to the left foot. His gait produced arm swing, and his right foot no longer dragged though he still did not lift it as high as the left. He was able to perform tandem walk for at least 8 steps before losing his balance. He reported that his dance instructor noticed improvement in his ability to be stable and to dance. His emotional state went from being depressed and fearful of the future, to being hopeful, proactively involved in his therapies and enjoying social engagement. Conclusion: Improvement in a 66-year-old male’s balance, pallesthesia, ambulation, and tandem walk as a result of chiropractic functional neurological therapy suggests that chiropractic and brain-based therapies may have a place in the treatment of these symptoms in the aging population. Acknowledgements Beatrice Tapia, DC, DACNB Susan Esposito, DC, DACNB Linda Mullin, DC Keywords: pallesthesia, Vibration sense, shuffling gait, tandem walk, Arm swing Conference: International Symposium on Clinical Neuroscience: Clinical Neuroscience for Optimization of Human Function, Orlando, United States, 7 Oct - 9 Oct, 2016. Presentation Type: Poster Presentation Topic: Abstracts ISCN 2016 Citation: Rhodes P and Barreto-Alderondo X (2016). Improvement in balance, pallesthesia, gait and tandem walk after chiropractic spinal manipulative therapy and functional neurological rehabilitation.. Front. Neurol. Conference Abstract: International Symposium on Clinical Neuroscience: Clinical Neuroscience for Optimization of Human Function. doi: 10.3389/conf.fneur.2016.59.00066 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: 01 Sep 2016; Published Online: 07 Sep 2016. * Correspondence: Dr. Paula Rhodes, Life University, Center for Health and Optimum Performance Outpatient Clinic, Marietta, GA, 30060, United States, paular412@gmail.com Login Required This action requires you to be registered with Frontiers and logged in. 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Chiropractic spinal manipulative therapy and functional neurological rehabilitation results in improvement of fine motor control after an MCA infarct

Chiropractic spinal manipulative therapy and functional neurological rehabilitation results in improvement of fine motor control after an MCA infarct