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Clovelly Family Chiropractic Centre : Research Articles

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Chiropractic Care and the Risk of Vertebrobasilar Stroke: Results of a Case–control Study in U.S. Commercial and Medicare Advantage Populations (2015)

Thomas M Kosloff, David Elton, Jiang Tao and Wade M Bannister

Background: There is controversy surrounding the risk of manipulation, which is often used by chiropractors, with respect to its association with vertebrobasilar artery system (VBA) stroke. The objective of this study was to compare the associations between chiropractic care and VBA stroke with recent primary care physician (PCP) care and VBA stroke.

Methods: The study design was a case–control study of commercially insured and Medicare Advantage (MA) health plan members in the U.S. population between January 1, 2011 and December 31, 2013. Administrative data were used to identify exposures to chiropractic and PCP care. Separate analyses using conditional logistic regression were conducted for the commercially insured and the MA populations. The analysis of the commercial population was further stratified by age ( periods. A secondary descriptive analysis was conducted to determine the relevance of using chiropractic visits as a proxy for exposure to manipulative treatment.

Results: There were a total of 1,829 VBA stroke cases (1,159 – commercial; 670 – MA). The findings showed no significant association between chiropractic visits and VBA stroke for either population or for samples stratified by age. In both commercial and MA populations, there was a significant association between PCP visits and VBA stroke incidence regardless of length of hazard period. The results were similar for age-stratified samples. The findings of the secondary analysis showed that chiropractic visits did not report the inclusion of manipulation in almost one third of stroke cases in the commercial population and in only 1 of 2 cases of the MA cohort.

Conclusions: We found no significant association between exposure to chiropractic care and the risk of VBA stroke. We conclude that manipulation is an unlikely cause of VBA stroke. The positive association between PCP visits and VBA stroke is most likely due to patient decisions to seek care for the symptoms (headache and neck pain) of arterial dissection. We further conclude that using chiropractic visits as a measure of exposure to manipulation may result i unreliable estimates of the strength of association with the occurrence of VBA stroke.


Treatment of the Sacroiliac Joint in Patients with Leg Pain: A Randomized-controlled Trial (2013)

Visser LH, et al.

Purpose: The sacroiliac joint (SIJ) may be a cause of sciatica. The aim of this study was to assess which treatment is successful for SIJ-related back and leg pain.

Methods: Using a single-blinded randomised trial, we assessed the short-term therapeutic efficacy of physiotherapy, manual therapy, and intra-articular injection with local corticosteroids in the SIJ in 51 patients with SIJ-related leg pain. The effect of the treatment was evaluated after 6 and 12 weeks.

Results: Of the 51 patients, 25 (56 %) were successfully treated. Physiotherapy was successful in 3 out of 15 patients (20 %), manual therapy in 13 of the 18 (72 %), and intra-articular injection in 9 of 18 (50 %) patients (p = 0.01). Manual therapy had a significantly better success rate than physiotherapy (p = 0.003).

Conclusion: In this small single-blinded prospective study, manual therapy appeared to be the choice of treatment for patients with SIJ-related leg pain. A second choice of treatment to be considered is an intra-articular injection.


Evidence Based Guidelines for the Chiropractic Treatment of Adults with Neck Pain (2014)

Bryans R, Decina D et al

Objective: The purpose of this study was to develop evidence-based treatment recommendations for the treatment of nonspecific (mechanical) neck pain in adults.

Results: Forty-one randomized controlled trials meeting the inclusion criteria and scoring a low risk of bias were used to develop 11 treatment recommendations.

Strong recommendations were made for the treatment of chronic neck pain with manipulation, manual therapy, and exercise in combination with other modalities. Strong recommendations were also made for the treatment of chronic neck pain with stretching, strengthening, and endurance exercises alone. Moderate recommendations were made for the treatment of acute neck pain with manipulation and mobilization in combination with other modalities.

Moderate recommendations were made for the treatment of chronic neck pain with mobilization as well as massage in combination with other therapies. A weak recommendation was made for the treatment of acute neck pain with exercise alone and the treatment of chronic neck pain with manipulation alone.

Thoracic manipulation and trigger point therapy could not be recommended for the treatment of acute neck pain. Transcutaneous nerve stimulation, thoracic manipulation, laser, and traction could not be recommended for the treatment of chronic neck pain.

Conclusions: Interventions commonly used in chiropractic care improve outcomes for the treatment of acute and chronic neck pain. Increased benefit has been shown in several instances where a multimodal approach to neck pain has been used.


Foot Posture, Foot Function and Low Back Pain: the Framingham Foot Study (2013)

Meinz HB, Dufour AB, Riskowski JL, Hilstrom HJ and Hannan MT

Background: Low back pain is a highly prevalent problem world-wide. Abnormal foot posture and function have been pro-posed as possible risk factors for low back pain, but this has not been explored in detail.

Conclusion: This is the first population-based study to examine the associations of foot posture and function with low back pain using objective biomechanical measurements. The findings suggest that pronated foot function may contribute to the development of low back symptoms in women. Interventions which modify abnormal foot function, such as foot orthoses, may therefore have a role in the prevention and treatment of low back pain.  Abstract

Adding Chiropractic to Standard Medical Care for Patients with Acute Lower Back Pain (2013)

Christine M. Goertz, DC, PhD, * Cynthia R. Long, PhD, * Maria A. Hondras, DC, MPH, * Richard Petri, MD, † Roxana Delgado, MS, ‡ Dana J. Lawrence, DC, MMedEd, MA, §Edward F. Owens, Jr, MS, DC, and William C. Meeker ,DC, MPH

Objective: To assess changes in pain levels and physical functioning in response to standard medical care (SMC) versus SMC plus chiropractic manipulative therapy (CMT) for the treatment of low back pain (LBP) among 18 to 35-year-old active-duty military personnel.

Conclusion: The results of this trial suggest that CMT in conjunction with SMC offers a significant advantage for decreasing pain and improving physical functioning when compared with only standard care, for men and women between 18 and 35 years of age with acute LBP. Abstract

The Effect of a Sports Chiropractic Manual Therapy Interventions on the Prevention of Back Pain, Hamstring and Lower Limb Injuries in Semi-elite Australia Rules Footballers; RCT (2010)

Wayne Hoskins  PhD , Henry Pollard  PhD

Background: Hamstring injuries are the most common injury in Australian Rules football. It was the aims to investigate whether a sports chiropractic manual therapy intervention protocol provided in addition to the current best practice management could prevent the occurrence of and weeks missed due to hamstring and other lower-limb injuries at the semi-elite level of Australian football.

Conclusions: This study demonstrated a trend towards lower limb injury prevention with a significant reduction in primary lower limb muscle strains and weeks missed due to non-contact knee injuries through the addition of a sports chiropractic intervention to the current best practice management. Abstract

Spinal High-Velocity Low Amplitude Manipulation in Acute Nonspecific Low Back Pain

Wolfgang J. von Heymann , Dr. Med ,* Patrick Schloemer , Dipl. Math ,† Juergen Timm , Dr. RER, NAT, PhD ,† and Bernd Muehlbauer , Dr. Med *

Objective: To investigate in acute nonspecific low back pain (LBP) the effectiveness of spinal high-velocity low-amplitude (HVLA) manipulation compared with the non-steroidal anti-inflammatory drug diclofenac and with placebo.
Conclusion:In a subgroup of patients with acute nonspecific LBP, spinal manipulation was significantly better than non-steroidal anti-inflammatory drug diclofenac and clinically superior to placebo.

Does Maintained Spinal Manipulation Therapy for Chronic Nonspecific Low Back Pain Result in Better Long-Term Outcome?

Mohammed K. Senna , MD , and Shereen A. Machaly , MD

Objective: To assess the effectiveness of spinal manipulation therapy (SMT) for the management of chronic nonspecific low back pain (LBP) and to determine the effectiveness of maintenance SMT in long-term reduction of pain and disability levels associated with chronic low back conditions after an initial phase of treatments.
Conclusion: SMT is effective for the treatment of chronic nonspecific LBP. To obtain long-term benefit, this study suggests maintenance SM after the initial intensive manipulative therapy. Abstract

Vertebral artery strains during high-speed, low amplitude cervical spinal manipulation (2011)

W. Herzog, T.R. Leonard, B. Symons, C. Tang, S. Wuest

Abstract: Spinal manipulative therapy (SMT) has been recognized as an effective treatment modality for many back, neck and musculoskeletal problems. One of the major issues of the use of SMT is its safety, especially with regards to neck manipulation and the risk of stroke. The vast majority of these accidents involve the vertebro-basilar system, specifically the vertebral artery (VA) between C2/C1. However, the mechanics of this region of the VA during SMT are unexplored. Here, we present first ever data on the mechanics of this region during cervical SMT performed by clinicians. VA strains obtained during SMT are significantly smaller than those obtained during diagnostic and range of motion testing, and are much smaller than failure strains. We conclude from this work that cervical SMT performed by trained clinicians does not appear to place undue strain on VA, and thus does not seem to be a factor in vertebro-basilar injuries. Abstract

Risk of Vertebrobasilar Stroke and Chiropractic Care (2008)

J. David Cassidy, DC, PhD, DrMedSc, Eleanor Boyle, PhD,* Pierre Cote´, DC, PhD,*†‡Yaohua He, MD, PhD,* Sheilah Hogg-Johnson, PhD,†§ Frank L. Silver, MD, FRCPC and Susan J. Bondy, PhD†

Objective: To investigate associations between chiropractic visits and vertebrobasilar artery (VBA) stroke and to contrast this with primary care physician (PCP) visits and VBA stroke.

Conclusion: VBA stroke is a very rare event in the population. The increased risks of VBA stroke associated with chiropractic and PCP visits is likely due to patients with headache and neck pain from VBA dissection seeking care before their stroke. We found no evidence of excess risk of VBA stroke associated chiropractic care compared to primary care. Abstract

Femur Head Height Error on Pelvic A-P Xrays with Alterations of Source to Image Distance, Central Ray Position and Object to Film Distance (2006)

Slane, Peter R & Bull, Peter W

Objective: To identify those factors that produce leg-length insufficiency (LLI) projection errors on AP pelvic x-rays: altered source-to-image distance (SID), altered central ray (CR) position, or altered object-to-film distance (OFD). Conclusion: The use of standard AP full-spine x-ray centred at X, and the standard AP lumbo- pelvic x-ray centred at U, to determine LLI is invalid due to the possibility of high LLI error at these CR positions created by pelvic rotation. This work calls into question the validity of measuring LLI with x-ray unless a CR at FH is used with a SID of 180 cm. Abstract

The Chiropractic Hospital-based Interventions Research Outcomes(CHIRO) Study: a randomized controlled trial on the effectiveness of clinical practice guidelines in the medical and chiropractic management of patients with acute mechanical low back pain (2010)

Paul B. Bishop, DC, MD, PhDa,b,*, Jeffrey A. Quon, DC, PhD, FCCSCc, Charles G. Fisher, MD, MHSc, FRCSCa,b, Marcel F.S. Dvorak, MD, FRCSCa,b

Background Context: Evidence-based clinical practice guidelines (CPGs) for the management of patients with acute mechanical low back pain (AM-LBP) have been defined on an international scale. Multicenter clinical trials have demonstrated that most AM-LBP patients do not receive CPG-based treatments. To date, the value of implementing full and exclusively CPG based treatment remains unclear.

Results: Ninety-two patients were recruited, with 36 SC and 35 UC patients completing all follow-up visits. Baseline prognostic variables were evenly distributed between groups. The primary outcome, the unadjusted mean improvement in RDQ scores, was significantly greater in the SC group than in the UC group (p5.003). Regarding unadjusted mean changes in secondary outcomes, improvements in RDQ scores were also greater in the SC group at other time points, particularly at 24 weeks (p5.004). Similarly, improvements in SF-36 PF scores favoured the SC group at all time points; however, these differences were not statistically significant. Abstract

The Neurogenic Pathogenesis of Migraine; A Commentary (2006)

Wayne T Hoskins  PhD , Henry P Pollard PhD  and Peter Tuchin

Abstract: Migraine has been described as an incapacitating condition with economic consequences for both society and healthcare systems. Physician consultations and medication costs represent the most substantial direct costs, while indirect costs through loss of productivity and disability are also significant.

This paper discusses currently accepted models of migraine pathogenesis with emphasis on the most recent literature. If the pathogenesis of migraine is more clearly understood, research may identify at what level chiropractic and spinal manipulative therapy (SMT) might influence it. Abstract

NSAIDs and Musculoskeletal Treatment: What Is the Clinical Evidence? (2003)

Steven D. Stovitz, MD Robert J. Johnson, MD

Abstract: Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly prescribed for musculoskeletal injuries because the conditions are believed to be inflammatory in nature. However, because inflammation is a necessary component in the healing process, decreasing inflammation may prove counterproductive. Also, many tendon injuries called ‘tendinitis’ are, in fact, degenerative and not inflammatory conditions. An analysis of the pathophysiology and healing of musculoskeletal injuries questions the use of NSAIDs in many treatment protocols. Because NSAIDs have profound side effects, they should not automatically be the first choice for treating musculoskeletal injuries. Abstract

The Chiropractic Report- The Role of Sports Chiropractic (2008)

David Chapman-Smith LL.B. (Hons.)

The Role of Sports Chiropractic – in Olympics, World Games and Elite Sport. Scope of Practice. Education of the Sports Chiropractor – FICS. Research in Sports Chiropractic. The Federation Internationale de Chiropratique du Sport or International Federation of Sports Chiropractic (FICS). Abstract

Successful management of hamstring injuries in Australian Rules footballers: two case reports (2005)

Wayne T Hoskins*  PhD and Henry P Pollard  PhD

Abstract: Hamstring injuries are the most prevalent injury in Australian Rules football. There is a lack of evidence based literature on the treatment, prevention and management of hamstring injuries, although it is agreed that the etiology is complicated and multi-factorial. We present two cases of hamstring injury that had full resolution after spinal manipulation and correction of lumbar-pelvic biomechanics. There was no recurrence through preventative treatment over a twelve and sixteen week period. The use of spinal manipulation for treatment or prevention of hamstring injury has not been documented in sports medicine literature and should be further investigated in prospective randomized controlled trials. Abstract

Enhanced Chiropractic Coverage Under OHIP as a Means of Reducing Health Care Costs, Attaining Better Health Outcomes and Achieving Equitable Access to Health Services (1998)

Pran Manga, Ph.D. Doug Angus


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