http://www.chiromt.com The most accessed research articles published by Chiropractic & Manual Therapies 2012-04-20T00:00:00Z Background: The purpose of this report is to provide a succinct but comprehensive summary of the scientific evidence regarding the effectiveness of manual treatment for the management of a variety of musculoskeletal and non-musculoskeletal conditions. Methods: The conclusions are based on the results of systematic reviews of randomized clinical trials (RCTs), widely accepted and primarily UK and United States evidence-based clinical guidelines, plus the results of all RCTs not yet included in the first three categories. The strength/quality of the evidence regarding effectiveness was based on an adapted version of the grading system developed by the US Preventive Services Task Force and a study risk of bias assessment tool for the recent RCTs. Results: By September 2009, 26 categories of conditions were located containing RCT evidence for the use of manual therapy: 13 musculoskeletal conditions, four types of chronic headache and nine non-musculoskeletal conditions. We identified 49 recent relevant systematic reviews and 16 evidence-based clinical guidelines plus an additional 46 RCTs not yet included in systematic reviews and guidelines.Additionally, brief references are made to other effective non-pharmacological, non-invasive physical treatments. Conclusions: Spinal manipulation/mobilization is effective in adults for: acute, subacute, and chronic low back pain; migraine and cervicogenic headache; cervicogenic dizziness; manipulation/mobilization is effective for several extremity joint conditions; and thoracic manipulation/mobilization is effective for acute/subacute neck pain. The evidence is inconclusive for cervical manipulation/mobilization alone for neck pain of any duration, and for manipulation/mobilization for mid back pain, sciatica, tension-type headache, coccydynia, temporomandibular joint disorders, fibromyalgia, premenstrual syndrome, and pneumonia in older adults. Spinal manipulation is not effective for asthma and dysmenorrhea when compared to sham manipulation, or for Stage 1 hypertension when added to an antihypertensive diet. In children, the evidence is inconclusive regarding the effectiveness for otitis media and enuresis, and it is not effective for infantile colic and asthma when compared to sham manipulation.Massage is effective in adults for chronic low back pain and chronic neck pain. The evidence is inconclusive for knee osteoarthritis, fibromyalgia, myofascial pain syndrome, migraine headache, and premenstrual syndrome. In children, the evidence is inconclusive for asthma and infantile colic. http://www.chiroandosteo.com/content/18/1/3 Gert Bronfort Mitchell Haas Roni Evans Brent Leiniger John Triano Chiropractic & Manual Therapies 2010, null:3 2010-02-25T00:00:00Z doi:10.1186/1746-1340-18-3 /content/figures/1746-1340-18-3-toc.gif Chiropractic & Manual Therapies 2045-709X ${item.volume} 3 2010-02-25T00:00:00Z XML Background: Psychostimulants are first line of therapy for paediatric and adolescent AD/HD. The evidence suggests that up to 30% of those prescribed stimulant medications do not show clinically significant outcomes. In addition, many children and adolescents experience side-effects from these medications. As a result, parents are seeking alternate interventions for their children. Complementary and alternative medicine therapies for behavioural disorders such as AD/HD are increasing with as many as 68% of parents having sought help from alternative practitioners, including chiropractors.ObjectiveThe review seeks to answer the question of whether chiropractic care can reduce symptoms of inattention, impulsivity and hyperactivity for paediatric and adolescent AD/HD. Methods: Electronic databases (Cochrane CENTRAL register of Controlled Trials, Cochrane Database of Systematic reviews, MEDLINE, PsycINFO, CINAHL, Scopus, ISI Web of Science, Index to Chiropractic Literature) were searched from inception until July 2009 for English language studies for chiropractic care and AD/HD. Inclusion and exclusion criteria were applied to select studies. All randomised controlled trials were evaluated using the Jadad score and a checklist developed from the CONSORT (Consolidated Standards of Reporting Trials) guidelines. Results: The search yielded 58 citations of which 22 were intervention studies. Of these, only three studies were identified for paediatric and adolescent AD/HD cohorts. The methodological quality was poor and none of the studies qualified using inclusion criteria. Conclusions: To date there is insufficient evidence to evaluate the efficacy of chiropractic care for paediatric and adolescent AD/HD. The claim that chiropractic care improves paediatric and adolescent AD/HD, is only supported by low levels of scientific evidence. In the interest of paediatric and adolescent health, if chiropractic care for AD/HD is to continue, more rigorous scientific research needs to be undertaken to examine the efficacy and effectiveness of chiropractic treatment. Adequately-sized RCTs using clinically relevant outcomes and standardised measures to examine the effectiveness of chiropractic care verses no-treatment/placebo control or standard care (pharmacological and psychosocial care) are needed to determine whether chiropractic care is an effective alternative intervention for paediatric and adolescent AD/HD. http://www.chiroandosteo.com/content/18/1/13 Fay Karpouzis Rod Bonello Henry Pollard Chiropractic & Manual Therapies 2010, null:13 2010-06-02T00:00:00Z doi:10.1186/1746-1340-18-13 /content/figures/1746-1340-18-13-toc.gif Chiropractic & Manual Therapies 2045-709X ${item.volume} 13 2010-06-02T00:00:00Z XML Background: The safety of spinal manipulation during pregnancy and the postpartum periods has been a matter of debate among manual therapists. Spinal manipulative therapy during these periods is a commonly performed intervention as musculoskeletal pain is common in these patients. To date there has not been an evaluation of the literature on this topic exclusively. Methods: A literature search was conducted on PubMed, CINAHL and the Index to Chiropractic Literature along with reference searching for articles published in English and French in the peer-reviewed literature that documented adverse effects of spinal manipulation during either pregnancy or postpartum. Case reports, case series, and any other clinical study designs were deemed acceptable for inclusion, as were systematic reviews. The appropriate Scottish Intercollegiate Guidelines Network (SIGN) tools were used to rate included articles for quality when applicable. Results: Five articles identifying adverse events in seven subjects following spinal manipulation were included in this review, along with two systematic reviews. The articles were published between 1978 and 2009. Two articles describing adverse effects from spinal manipulation on two postpartum patients were included, while the remaining three articles on five patients with adverse effects following spinal manipulation were on pregnant patients. Injury severity ranged from minor injury such as increasing pain after treatment that resolved within a few days to more severe injuries including fracture, stroke, and epidural hematoma. SIGN scores of the prospective observational cohort study and systematic reviews indicated acceptable quality. Conclusions: There are only a few reported cases of adverse events following spinal manipulation during pregnancy and the postpartum period identified in the literature. While improved reporting of such events is required in the future, it may be that such injuries are relatively rare. http://chiromt.com/content/20/1/8 Kent Stuber Shari Wynd Carol Ann Weis Chiropractic & Manual Therapies 2012, null:8 2012-03-28T00:00:00Z doi:10.1186/2045-709X-20-8 /content/figures/2045-709X-20-8-toc.gif Chiropractic & Manual Therapies 2045-709X ${item.volume} 8 2012-03-28T00:00:00Z XML Background: Hypotheses on somatovisceral dysfunction often assume interference by stretch orcompression of the nerve supply to visceral structures. The purpose of this study is toexamine the potential of pelvic visceral movement to create tension of the loose connectivetissue that contains the fine branches of the inferior hypogastric nerve plexus. Methods: Twenty eight embalmed human cadavers were examined. Pelvic visceral structures weredisplaced by 5 N unidirectional tension and the associated movement of the endopelvic fasciacontaining the inferior hypogastric plexus that this caused was measured. Results: Most movement of the fascia containing the inferior hypogastric plexus was obtained bypulling the rectosigmoid junction or broad ligament of the uterus. The plexus did not crossany vertebral joints and the fascia containing it did not move on pulling the hypogastricnerve. Conclusions: Uterine and rectosigmoid displacement produce most movement of the fascia containing thehypogastric nerve plexus, potentially resulting in nerve tension. In the living this might occuras a consequence of menstruation, pregnancy or constipation. This may be relevant tosomatovisceral reflex theories of the effects of manual therapy on visceral conditions. http://www.chiromt.com/content/20/1/13 Ian Johnson Chiropractic & Manual Therapies 2012, null:13 2012-04-20T00:00:00Z doi:10.1186/2045-709X-20-13 /content/figures/2045-709X-20-13-toc.gif Chiropractic & Manual Therapies 2045-709X ${item.volume} 13 2012-04-20T00:00:00Z PDF Background: Studies of back pain are typically based on the assumption that symptoms from different parts of the spine are distinctive entities. Recently, however, the assumption that back pain is a site-specific disorder has been challenged, suggesting that localized back pain should be seen as part of a general musculoskeletal syndrome.ObjectivesTo describe and compare the patterns of reporting of pain and consequences of pain in the three spinal regions. Methods: In all, 34,902 (74%) twin individuals representative of the general Danish population, aged 20 to 71, participated in a cross-sectional nation-wide survey. Identical questions from the Standardised Nordic Questionnaire for each of the three spinal regions were used for lumbar, mid-back and neck pain respectively: Pain past year, pain ever, radiating pain, and consequences of back pain (care-seeking, reduced physical activities, sick-leave, change of work/work duties and disability pension). The relative prevalence estimates of these variables were compared for the three spinal regions. Results: The relative proportions of individuals with pain ever, who also reported to have had pain in the past year varied between 75% and 80%, for the three spinal regions. The proportions of individuals with pain in the past year and for various pain durations were also very similar. Regardless if pain was reported in the lumbar, thoracic or cervical regions, the proportions of individuals reporting radiating pain were equally large. The relative number of consequences was the same across the spinal regions, as were the relative proportions of each these consequences. However, low back pain resulted more often in some kind of consequence compared to the consequences of pain in the neck and mid back. Conclusions: Back pain and its consequences share many characteristics and may, at least in a general population, be regarded as the same condition regardless of where the pain happens to manifest itself. However, because some exceptions were noted for the lumbar spine, separate entities for a smaller group of individuals with back pain cannot be ruled out. http://www.chiromt.com/content/20/1/11 Charlotte Leboeuf-Yde Rene Fejer Jan Nielsen Kirsten Kyvik Jan Hartvigsen Chiropractic & Manual Therapies 2012, null:11 2012-04-05T00:00:00Z doi:10.1186/2045-709X-20-11 /content/figures/2045-709X-20-11-toc.gif Chiropractic & Manual Therapies 2045-709X ${item.volume} 11 2012-04-05T00:00:00Z PDF Background: Side bridge endurance protocols have been suggested to evaluate lateral trunk flexor and/orspine stabilizer muscles. To date, no study has investigated muscle recruitment andfatigability during these protocols. Therefore the purpose of our study was to quantify fatigueparameters in various trunk muscles during a modified side bridge endurance task (i.e. alateral isometric hold test on a 45degrees roman chair apparatus) and determine which primary trunkmuscles get fatigued during this task. It was hypothesized that the ipsilateral external obliqueand lumbar erector spinae muscles will exhibit the highest fatigue indices. Methods: Twenty-two healthy subjects participated in this study. The experimental session included leftand right lateral isometric hold tasks preceded and followed by 3 maximal voluntarycontractions in the same position. Surface electromyography (EMG) recordings wereobtained bilaterally from the external oblique, rectus abdominis, and L2 and L5 erectorspinae. Statistical analysis were conducted to compare the right and left maximal voluntarycontractions (MVC), surface EMG activities, right vs. left holding times and decay rate of themedian frequency as the percent change from the initial value (NMFslope). Results: No significant left and right lateral isometric hold tests differences were observed neither forholding times (97.2 +/- 21.5 sec and 96.7 +/- 24.9 sec respectively) nor for pre and post fatigueroot mean square during MVCs. However, participants showed significant decreases ofMVCs between pre and post fatigue measurements for both the left and right lateral isometrichold tests. Statistical analysis showed that a significantly NMFslope of the ipsilateral externaloblique during both conditions, and a NMFslope of the contralateral L5 erector spinae duringthe left lateral isometric hold test were steeper than those of the other side's respectivemuscles. Although some participants presented positive NMFslope for some muscles, eachmuscle presented a mean negative NMFslope significantly different from 0. Conclusions: Although the fatigue indices suggest that the ipsilateral external oblique and contralateral L5erector spinae show signs of muscle fatigue, this task seems to recruit a large group of trunkmuscles. Clinicians should not view this task as evaluating specifically lateral trunk flexors,but rather as providing an indication of the general endurance and stabilisation capacity of thetrunk. http://www.chiromt.com/content/20/1/12 Isabelle Pagé Martin Descarreaux Chiropractic & Manual Therapies 2012, null:12 2012-04-19T00:00:00Z doi:10.1186/2045-709X-20-12 /content/figures/2045-709X-20-12-toc.gif Chiropractic & Manual Therapies 2045-709X ${item.volume} 12 2012-04-19T00:00:00Z PDF ABSTRACTIntroductionA body of basic science and clinical research has been generated on the manual muscle test (MMT) since its first peer-reviewed publication in 1915. The aim of this report is to provide an historical overview, literature review, description, synthesis and critique of the reliability and validity of MMT in the evaluation of the musculoskeletal and nervous systems. Methods: Online resources were searched including Pubmed and CINAHL (each from inception to June 2006). The search terms manual muscle testing or manual muscle test were used. Relevant peer-reviewed studies, commentaries, and reviews were selected. The two reviewers assessed data quality independently, with selection standards based on predefined methodologic criteria. Studies of MMT were categorized by research content type: inter- and intra-examiner reliability studies, and construct, content, concurrent and predictive validity studies. Each study was reviewed in terms of its quality and contribution to knowledge regarding MMT, and its findings presented. Results: More than 100 studies related to MMT and the applied kinesiology chiropractic technique (AK) that employs MMT in its methodology were reviewed, including studies on the clinical efficacy of MMT in the diagnosis of patients with symptomatology. With regard to analysis there is evidence for good reliability and validity in the use of MMT for patients with neuromusculoskeletal dysfunction. The observational cohort studies demonstrated good external and internal validity, and the 12 randomized controlled trials (RCTs) that were reviewed show that MMT findings were not dependent upon examiner bias. Conclusion: The MMT employed by chiropractors, physical therapists, and neurologists was shown to be a clinically useful tool, but its ultimate scientific validation and application requires testing that employs sophisticated research models in the areas of neurophysiology, biomechanics, RCTs, and statistical analysis. http://www.chiroandosteo.com/content/15/1/4 Scott Cuthbert George Goodheart Chiropractic & Manual Therapies 2007, null:4 2007-03-06T00:00:00Z doi:10.1186/1746-1340-15-4 /content/figures/1746-1340-15-4-toc.gif Chiropractic & Manual Therapies 2045-709X ${item.volume} 4 2007-03-06T00:00:00Z XML Background: Chiropractic in Australia has seen many changes over the past 30 years. Some of these changes have advanced the professional status of chiropractic, improved undergraduate training and paved the way for a research culture. Unfortunately, other changes or lack of changes, have hindered the growth, public utilisation and professional standing of chiropractic in Australia. This article explores what influences have impacted on the credibility, advancement and public utilisation of chiropractic in Australia.DiscussionThe 1970's and 1980's saw a dramatic change within the chiropractic profession in Australia. With the advent of government regulation, came government funded teaching institutions, quality research and increased public acceptance and utilisation of chiropractic services. However, since that time the profession appears to have taken a backward step, which in the author's opinion, is directly linked to a shift by sections of the profession to the fundamentalist approach to chiropractic and the vertebral subluxation complex. The abandonment, by some groups, of a scientific and evidenced based approach to practice for one founded on ideological dogma is beginning to take its toll.SummaryThe future of chiropractic in Australia is at a crossroads. For the profession to move forward it must base its future on science and not ideological dogma. The push by some for it to become a unique and all encompassing alternative system of healthcare is both misguided and irrational. http://chiromt.com/content/19/1/11 John Reggars Chiropractic & Manual Therapies 2011, null:11 2011-05-21T00:00:00Z doi:10.1186/2045-709X-19-11 /content/figures/2045-709X-19-11-toc.gif Chiropractic & Manual Therapies 2045-709X ${item.volume} 11 2011-05-21T00:00:00Z XML Background: Chiropractic (Greek: done by hand) is a health care profession concerned with the diagnosis, treatment and prevention of disorders of the neuromusculoskeletal system and the effects of these disorders on general health. There is an emphasis on manual techniques, including joint adjustment and/or manipulation, with a particular focus on joint subluxation (World Health Organization 2005) or mechanical lesion and restoring function. The chiropractor's role in wellness care, prevention and treatment of injury or illness is based on education in anatomy and physiology, nutrition, exercise and healthy lifestyle counseling as well as referral to other health practitioners. Depending on education, geographic location, scope of practice, as well as consumer preference, chiropractors may assume the role of primary care for families who are pursuing a more natural and holistic approach to health care for their families.ObjectiveTo present a perspective on current management of the paediatric patient by members of the chiropractic profession and to make recommendations as to how the profession can safely and effectively manage the paediatric patient.DiscussionThe chiropractic profession holds the responsibility of ethical and safe practice and requires the cultivation and mastery of both an academic foundation and clinical expertise that distinguishes chiropractic from other disciplines.Research into the effectiveness of chiropractic care for paediatric patients has lagged behind that of adult care, but this is being addressed through educational programs where research is now being incorporated into academic tracks to attain advanced chiropractic degrees. Conclusion: Studies in the United States show that over the last several decades, chiropractors are the most common complementary and alternative medicine providers visited by children and adolescents. Chiropractors continue to seek integration with other healthcare providers to provide the most appropriate care for their paediatric patients.In the interest of what is best for the paediatric population in the future, collaborative efforts for research into the effectiveness and safety of chiropractic care as an alternative healthcare approach for children should be negotiated and are welcomed. http://www.chiroandosteo.com/content/18/1/16 Sharon Vallone Joyce Miller Annica Larsdotter Jennifer Barham-Floreani Chiropractic & Manual Therapies 2010, null:16 2010-06-02T00:00:00Z doi:10.1186/1746-1340-18-16 /content/figures/1746-1340-18-16-toc.gif Chiropractic & Manual Therapies 2045-709X ${item.volume} 16 2010-06-02T00:00:00Z XML Background: Reports of musculoskeletal injuries that some chiropractic students experienced while in the role of adjustor became increasingly evident and developed into the basis of this study. The main objective of this study was to survey a select student population and identify, by gender, the specific types of musculoskeletal injuries they experienced when learning adjustive techniques in the classroom, and performing them in the clinical setting. Methods: A survey was developed to record musculoskeletal injuries that students reported to have sustained while practicing chiropractic adjustment set-ups and while delivering adjustments. The survey was modeled from similar instruments used in the university's clinic as well as those used in professional practice. Stratified sampling was used to obtain participants for the study. Data reported the anatomical areas of injury, adjustive technique utilized, the type of injury received, and the recovery time from sustained injuries. The survey also inquired as to the type and area of any past physical injuries as well as the mechanism(s) of injury. Results: Data obtained from the study identified injuries of the shoulder, wrist, elbow, neck, low back, and mid-back. The low back was the most common injury site reported by females, and the neck was the most common site reported by males. The reported wrist injuries in both genders were 1% male complaints and 17% female complaints. A total of 13% of female respondents reported shoulder injuries, whereas less than 1% of male respondents indicated similar complaints. Conclusion: The data collected from the project indicated that obtaining further information on the subject would be worthwhile, and could provide an integral step toward developing methods of behavior modification in an attempt to reduce and/or prevent the incidence of musculoskeletal injuries. http://www.chiroandosteo.com/content/14/1/17 Debra Bisiacchi Laura Huber Chiropractic & Manual Therapies 2006, null:17 2006-08-24T00:00:00Z doi:10.1186/1746-1340-14-17 /content/figures/1746-1340-14-17-toc.gif Chiropractic & Manual Therapies 2045-709X ${item.volume} 17 2006-08-24T00:00:00Z XML