http://www.chiromt.com The latest research articles published by Chiropractic & Manual Therapies 2013-05-20T00:00:00Z Background: Back pain is one of the most common complaints that patients report to physicians and two-thirds of the population has an elevated body mass index (BMI), indicating they are either overweight or obese. It was once assumed that extra body weight would stress the low back and lead to pain, however, researchers have reported inconsistencies association between body weight and back pain. In contrast, more recent studies do indicate that an elevated BMI is associated with back pain and other musculoskeletal pain syndromes due to the presence of a chronic systemic inflammatory state, suggesting that the relationship between BMI and musculoskeletal pains be considered in more detail.ObjectiveTo describe how an elevated BMI can be associated with chronic systemic inflammation and pain expression. To outline measurable risk factors for chronic inflammation that can be used in clinical practice and discuss basic treatment considerations.DiscussionAdiposopathy, or "sick fat" syndrome, is a term that refers to an elevated BMI that is associated with a chronic systemic inflammatory state most commonly referred to as the metabolic syndrome. The best available evidence suggests that the presence of adiposopathy determines if an elevated BMI will contribute to musculoskeletal pain expression. It is not uncommon for physicians to fail to identify the presence of adiposopathy/metabolic syndrome. Conclusion: Patients with an elevated BMI should be further examined to identify inflammatory factors associated with adiposopathy, such as the metabolic syndrome, which may be promoting back pain and other musculoskeletal pain syndromes. http://www.chiromt.com/content/21/1/15 David Seaman Chiropractic & Manual Therapies 2013, null:15 2013-05-20T00:00:00Z doi:10.1186/2045-709X-21-15 http://commons.wikimedia.org/wiki/File%3AOverweight_waistline.jpg /content/figures/2045-709X-21-15-toc.gif Chiropractic & Manual Therapies 2045-709X ${item.volume} 15 2013-05-20T00:00:00Z PDF As exhibited throughout the medical literature over many decades, there is a lack of uniformity in the manner in which spine pain patients have historically qualified for and received manipulation under anesthesia (MUA). Also, for different professions that treat the same types of spinal conditions via the same means, fundamental MUA decision points vary within the published protocols of different professional associations. The more recent chiropractic literature communicates that the evidence to support the efficacy of MUA of the spine remains largely anecdotal. In addition, it has been reported that the types of spinal conditions most suitable for MUA are without clear-cut consensus, with various indications for MUA of the low back resting wholly upon the opinions and experiences of MUA practitioners. This article will provide a narrative review of the MUA literature, followed by a commentary about the current lack of high quality research evidence, the anecdotal and consensus basis of existing clinical protocols, as well as related professional, ethical and legal concerns for the chiropractic practitioner. The limitations of the current medical literature related to MUA via conscious/deep sedation need to be recognized and used as a guide to clinical experience when giving consideration to this procedure. More research, in the form of controlled clinical trials, must be undertaken if this procedure is to remain a potential treatment option for chronic spine pain patients in the chiropractic clinical practice. http://www.chiromt.com/content/21/1/14 Dennis DiGiorgi Chiropractic & Manual Therapies 2013, null:14 2013-05-14T00:00:00Z doi:10.1186/2045-709X-21-14 /content/figures/2045-709X-21-14-toc.gif Chiropractic & Manual Therapies 2045-709X ${item.volume} 14 2013-05-14T00:00:00Z PDF This article describes and discusses the case of an adolescent male with lumbar intervertebral disc injury characterized by chronic low back pain (LBP) and antalgia. A 13-year-old boy presented for care with a complaint of chronic LBP and subsequent loss of quality of life. The patient was examined and diagnosed by means of history, clinical testing and use of imaging. He had showed failure in natural history and conservative management relief in both symptomatic and functional improvement, due to injury to the intervertebral joints of his lower lumbar spine. Discogenic LBP in the young adolescent population must be considered, particularly in cases involving even trivial minor trauma, and in those in which LBP becomes chronic. More research is needed regarding long-term implications of such disc injuries in young people, and how to best conservatively manage these patients. A discussion of discogenic LBP pertaining to adolescent disc injury is included. http://www.chiromt.com/content/21/1/13 Chris Carter Lyndon Amorin-Woods Arockia Doss Chiropractic & Manual Therapies 2013, null:13 2013-04-26T00:00:00Z doi:10.1186/2045-709X-21-13 /content/figures/2045-709X-21-13-toc.gif Chiropractic & Manual Therapies 2045-709X ${item.volume} 13 2013-04-26T00:00:00Z XML ObjectiveThe purpose of this case report is to describe a patient who presented with a case of peroneal neuropathy that was originally diagnosed and treated as a L5 radiculopathy.Clinical features: A 53-year old female registered nurse presented to a private chiropractic practice with complaints of left lateral leg pain. Three months earlier she underwent elective left L5 decompression surgery without relief of symptoms.Intervention and outcome: Lumbar spine MRI seven months prior to lumbar decompression surgery revealed left neural foraminal stenosis at L5-S1. The patient symptoms resolved after she stopped crossing her legs. Conclusion: This report discusses a case of undiagnosed peroneal neuropathy that underwent lumbar decompression surgery for a L5 radiculopathy. This case study demonstrates the importance of a thorough clinical examination and decision making that ensures proper patient diagnosis and management. http://www.chiromt.com/content/21/1/12 Michael Reife Christopher Coulis Chiropractic & Manual Therapies 2013, null:12 2013-04-22T00:00:00Z doi:10.1186/2045-709X-21-12 /content/figures/2045-709X-21-12-toc.gif Chiropractic & Manual Therapies 2045-709X ${item.volume} 12 2013-04-22T00:00:00Z PDF Background: Chiropractors receive training in nutrition during their education, previous surveys have found that chiropractors frequently provide recommendations to patients relating to nutrition and dietary supplement intake. However, it has not been ascertained which specific supplements chiropractors recommend or the types of health conditions for which supplement recommendations are made.ObjectiveThe purpose of this study was to determine which dietary supplements are most commonly recommended by chiropractors in the province of Saskatchewan,Canada and the health conditions for which supplement recommendations are made.DesignAn online survey of licensed chiropractors practicing in the province of Saskatchewan, Canada was distributed three times following online and in-person notifications of the survey.Statistical analyses performedDescriptive statistics were reported, predominantly in the form of means and proportions. Results: A response rate of 45% was obtained. All of the respondents (100%) indicated providing nutritional advice or counselling to patients, while nearly all (99%) indicated providing dietary supplement recommendations to patients. Respondents estimated that they provide nutritional advice or counselling to 31% of their patients on average, and recommend dietary supplements to an average of 25% of their patients. The most commonly recommended supplements were glucosamine sulfate, multivitamins, vitamin C, vitamin D, calcium, omega-3 fatty acids, and probiotics. The most common reasons to recommend dietary supplements were for “general health and wellness” (82% of respondents), “bone health” (74%), “rheumatologic, arthritic, degenerative, or inflammatory conditions’ (72%), and “acute and/or chronic musculoskeletal conditions” (65%). Conclusion: The majority of respondents indicated providing nutritional counselling and recommendations for dietary supplements to their patients. Respondents generally recommend a small number of dietary supplements and provide these recommendations and counselling to fewer than half of their patients on average, while tending to focus on conditions most closely related to the scope of practice of chiropractors. The findings of this study may have been limited by selection bias owing to the low response rate and as those who respond to surveys are often more likely to respond positively. http://www.chiromt.com/content/21/1/11 Kent Stuber Paul Bruno Kevyn Kristmanson Zara Ali Chiropractic & Manual Therapies 2013, null:11 2013-03-07T00:00:00Z doi:10.1186/2045-709X-21-11 Creative commons attribution for pic By Ragesoss (Own work) [CC-BY-SA-3.0-2.5-2.0-1.0 (http://creativecommons.org/licenses/by-sa/3.0) or GFDL (http://www.gnu.org/copyleft/fdl.html)], via Wikimedia Commons /content/figures/2045-709X-21-11-toc.gif Chiropractic & Manual Therapies 2045-709X ${item.volume} 11 2013-03-07T00:00:00Z XML Background: Low back pain (LBP) is a prevalent condition and has been found to be recurrent and persistent in a majority of cases. Chiropractors have a preventive strategy, maintenance care (MC), aimed towards minimizing recurrence and progression of such conditions. The indications for recommending MC have been identified in the Nordic countries from hypothetical cases. This study aims to investigate whether these indications are indeed used in the clinical encounter. Methods: Data were collected in a multi-center observational study in which patients consulted a chiropractor for their non-specific LBP. Patient baseline information was a) previous duration of the LBP, b) the presence of previous episodes of LBP and c) early improvement with treatment. The chiropractors were asked if they deemed each individual patient an MC candidate. Logistic regression analyses (uni– and multi-level) were used to investigate the association of the patient variables with the chiropractor’s decision. Results: The results showed that “previous episodes” with LBP was the strongest predictor for recommending MC, and that the presence of all predictors strengthens the frequency of this recommendation. However, there was considerable heterogeneity among the participating chiropractors concerning the recommendation of MC. Conclusions: The study largely confirms the clinical use of the previously identified indications for recommending MC for recurrent and persistent LBP. Previous episodes of LBP was the strongest indicator. http://www.chiromt.com/content/21/1/10 Iben Axén Lennart Bodin Chiropractic & Manual Therapies 2013, null:10 2013-03-06T00:00:00Z doi:10.1186/2045-709X-21-10 /content/figures/2045-709X-21-10-toc.gif Chiropractic & Manual Therapies 2045-709X ${item.volume} 10 2013-03-06T00:00:00Z XML Study designLiterature ReviewObjectivesThe objective of this literature review was to determine if postural sway changes in association with manual therapeutic interventions and to investigate whether any changes occur in healthy individuals or in association with pain intensity.Summary of Background dataImproving postural stability has been proposed as a goal of manual therapeutic interventions. So far, no literature review has addressed whether there is supportive evidence for this and if so, what factors may be associated or causative for observed sway alterations.Search methodsSeven online databases (PubMed, MEDLINE, EMBASE, CINAHL, Web of Science, ScienceDirect and the Cochrane library) were systematically searched followed by a manual search of the retrieved papers.Selection criteriaStudies comparing postural sway derived from bipedal force plate measurements in association with a manual therapeutic intervention, ideally compared to a control group.Data collection and analysisTwo reviewers independently screened titles and abstracts for relevance, conducted the data extraction and the risk of bias assessment which was conducted using the RTI item bank. A descriptive analysis was conducted as the heterogeneous study designs prevented pooling of data. Results: Nine studies of varying methodological quality met the inclusion criteria. No direct comparison of data across the studies was possible. There was no evidence that manual interventions lead to a change in postural sway in healthy individuals regardless of the body regions addressed by the intervention. There was some indication that postural sway may change at follow-up measurements in pain sufferers; however, this may be due to variations in pain intensity rather than resulting from the intervention itself. Conclusions: There is no conclusive scientific evidence that manual therapeutic interventions may exhibit any immediate or long-term effect on COP excursions. Any changes in sway may be attributable to decreases in pain intensity. http://www.chiromt.com/content/21/1/9 Alexander Ruhe René Fejer Bruce Walker Chiropractic & Manual Therapies 2013, null:9 2013-02-04T00:00:00Z doi:10.1186/2045-709X-21-9 /content/figures/2045-709X-21-9-toc.gif Chiropractic & Manual Therapies 2045-709X ${item.volume} 9 2013-02-04T00:00:00Z XML IntroductionPractice-based research is a challenge as clinicians are busy with their patients and any participation in research activities will be secondary to the needs of the patients and the clinic. As a result, it is difficult to obtain high compliance among clinicians. A method to enhance compliance in multicentre practice-based research has been developed and refined for use in the chiropractic setting and possibly also by other researchers in different settings.MethodThis manual provides a stringent step-by-step approach for conducting clinic-based research. It describes the competencies and requirements of an effective working group, how to recruit participating clinicians and how to empower, encourage and support these clinicians to obtain good compliance.DiscussionThe main advantage of the method is the high compliance of participating clinicians compared to many other clinical studies. Difficulties with the method are described and suggestions for solutions are presented. Conclusions: This manual is a description of a method that may be of use for clinical researchers in the chiropractic setting. http://www.chiromt.com/content/21/1/8 Iben Axén Charlotte Leboeuf-Yde Chiropractic & Manual Therapies 2013, null:8 2013-02-01T00:00:00Z doi:10.1186/2045-709X-21-8 /content/figures/2045-709X-21-8-toc.gif Chiropractic & Manual Therapies 2045-709X ${item.volume} 8 2013-02-01T00:00:00Z XML Background: The number of households in the United States that are not proficient in the English language is growing and presenting a challenge to the health care system. Over nineteen percent of the US population speak a language other than English in the home. This increase in language discordance generates a greater need to find and implement accommodations in the clinical setting to insure accurate and efficient diagnosis and treatment as well as provide for patient safety. Aim: The purpose of this study is to determine the percentage of patients accessing the chiropractic college teaching clinics who are not proficient in the English language and to what extent the colleges provide accommodations for that language disparity. Methods: The clinic directors and deans of the Association of Chiropractic Colleges were surveyed via an on-line survey engine. The survey queried the percentage of the patient population that is not English language proficient, the accommodations the college currently has in place, if the college has a language specific consent to treat document and if the college has a written policy concerning patients without English proficiency. Results: Fifty percent of the contacted chiropractic colleges responded to the survey. In the respondent college clinics 16.5% of the patient population is not proficient in English, with over 75% speaking Spanish. All but one of the respondents provide some level of accommodation for the language non-concordance. Forty five percent of the responding colleges employ a language specific consent to treat form. The implementation of accommodations and the use of a language specific consent to treat form is more prevalent at colleges with a higher percentage of non-English speaking patients. Conclusions: The percentage of patients with limited English proficiency accessing services at the teaching clinics of the chiropractic colleges mirrors the numbers in the general population. There is a wide disparity in the accommodations that the individual colleges make to address this language discordance. There is a need to further develop accurate and meaningful accommodations to address language disparity in the chiropractic teaching clinics. http://www.chiromt.com/content/21/1/7 Richard Saporito Chiropractic & Manual Therapies 2013, null:7 2013-02-01T00:00:00Z doi:10.1186/2045-709X-21-7 /content/figures/2045-709X-21-7-toc.gif Chiropractic & Manual Therapies 2045-709X ${item.volume} 7 2013-02-01T00:00:00Z XML Background: Tracking how clinicians treat patients provides an opportunity to explore how the clinical management of common musculoskeletal disorders evolves over time. We present an uncontrolled before-after study of a primary care physician’s management of low back pain and describe how his involvement in an interprofessional collaborative practice was associated with a change in the management of patients with low back pain.MethodData from the electronic medical record of one primary care physician who participated in a study of a model of chiropractic-medical collaboration were retrospectively collected. Records of a sample of consecutive patients prior to the start (i.e. pre-study, n = 51) and at the end of the collaborative study (i.e. study, n = 49) were collected. Results: Demographics were similar in both groups but median number of physician visits (2.5 and 1.0), average prescriptions per patients (1.24 and 0.47), and total number of narcotic prescriptions (14 and 6) differed between pre-study and study groups, respectively. Separate analysis of only the records of low back pain study patients revealed that 61% were referred for chiropractic care during the study period. Patients who were not referred had more neurological deficits and leg pain but back pain severity and average number of prescriptions was about the same. Referred patients in the study group had about 25% fewer physician visits and imaging requests. Conclusion: Based on this study of a single primary care physician, we hypothesize that doctors may change their prescribing behaviours and consultation rate for patients with low back pain when engaged in interprofessional collaborative care. Further research is required to test this observation in the population. http://www.chiromt.com/content/21/1/6 Silvano Mior Brian Gamble Jan Barnsley Pierre Côté Elie Côté Chiropractic & Manual Therapies 2013, null:6 2013-02-01T00:00:00Z doi:10.1186/2045-709X-21-6 /content/figures/2045-709X-21-6-toc.gif Chiropractic & Manual Therapies 2045-709X ${item.volume} 6 2013-02-01T00:00:00Z XML