Archive for category Conference Presentation

Introduction:

Changes in apparent leg length (LL) (leg  retraction) have been used by many as a means of locating subluxation in  various joints. The leg check is based on the assumption that unequal  muscular contraction (e.g. hyper irritable muscles) about the spine and  pelvis have the ability to retract one leg relative to the other.  Despite claims of usefulness, many problems are inherent in the prone  leg check such as: a) measurement error; b) subject positioning by the  examiner (expectancy bias); c) interference with the surface of the  examination table; d) possible overwhelming effects of large muscles  over smaller intersegmental muscles and; e) lack of information of the  validity of subluxation (eg. segmental aberration) and it’s supposed  neurological effects. While observation of leg retraction has not yet been  correlated with patient outcome or health measures, it is implied that  the phenomenon apparent changes in LL occur due to altered tonic neck  and back reflexes which coordinate spinal movements and posture. A video  recording has been made of a patient who exhibited an unusually large  amount of leg retraction which appeared to be due to asymmetrical  contraction of their supra-pelvic musculature upon maneuvers such as  tucking their chin.

Objective:

The purpose of this study is to quantify  the involuntary movements which nave been observed about the spine,  pelvis and extremities using a 2D motion analysis system.

Methods:

A subject exhibiting a large involuntary leg  retraction will be sought. The patient will be positioned prone on an  adjusting table. Retro reflective markers will be placed about their  spine, pelvis and extremities. The markers will be recorded by two video  cameras during maneuvers which cause the leg to retract.

Results:

This data will yield 2D maker locations which will be used to quantify the amount and type of movement.

Conclusion:

Despite claims of utility of the prone leg  check to locate subluxation and treatment success, many confounders  occur. Lack of objective documentation and theoretical basis of the leg  retraction phenomena has hindered its acceptance as an examination  procedure. Only indirect evidence exists for its validity in several  small observational studies where it was used to determine were to  adjust. Motion analysis, and EMG studies may help in understanding the  physiology of this phenomena using. Further work is necessary to  correlate the relationship of leg retraction to other methods of  subluxation assessment, treatment outcome and patient health status, if  any.


Reference: Paul J. Osterbauer,DC; Arlan W. Fuhr,DC. Proceedings of the California Chiropractic Foundation’s 7th Annual  Conference on Research and Education, June 19-21,1992; pp.291-292.

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INTRODUCTION

Back pain is frequently accompanied by pain radiating in to the  buttock and above the knee. In severe cases it can extend below the  knee into the foot. Precise diagnosis, of the cause of leg pain is  difficult due to a multiplicity of, causes. First. it can be due to  referral from structures of the spine and pelvis, such as facet,  sacroiliac joints, spinal ligaments, and muscles. This type of pain is  characterized by a diffuse ache. Second, impingement of the nerve roots  which join to form the sciatic nerve. by mechanical means is possible  (e.g.. disc bulge, muscular tension, bony architecture. etc.) or by  swelling secondary to inflammation. If the nerve roots are affected the  pattern of pain usually follows specific derma tomes, and may be  accompanied by one or more neurologic symptom’s. These two causes may  occur concomitantly, creating a confusing clinical picture. While  special examinations such as electro diagnostic tests and imaging  studies may be helpful in making a diagnosis, they are not always  definitive and require close correlation with clinical findings.

Despite reports of effectiveness for treatments such as bed  rest, surgery, exercises, injections, physical therapy modalities and  chiropractic manipulation, no standard approach is recognized in the  profession. This is not surprising since it has been estimated that 80%  of patients with painful sciatic radiation are said to recover in within  3 months. (1) Few reports are available documenting cases and long term  follow-up with standard outcome measures (e.g., Oswestry disability  questionnaire[OLBQ], visual analog scale, or orthopedic tests). (2) This  study presents a case of chronic sciatica treated by mechanical force,  manually assisted short lever adjusting, high voltage electrotherapy and  a video assisted, home stretching program documented with common, easy  to use, outcome assessment tools over a period of two years.


Reference: Paul J. Osterbauer. D.C., Arlan w. Fuhr. D.C.  Activator Methods Inc. Phoenix, Arizona; Proceedings of the  California Chiropractic Foundation’s 293 7th Annual Conference on  Research and Education , Palm Springs , CA , June 19-21, 1992, pp. 293-5.

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Introduction:

Low back pain (LBP) is a common health  problem among the elderly, affecting up to 90% of the over 65  population, and accounting for nearly $1 billion per year in Medicare  payments alone. By far the greatest single cause of low back pain in the  elderly is mechanical derangements occurring within the confines of the  lumbar spine as a consequence of chronic degenerative joint disease  which, in itself, is often painless and of little or no clinical  significance. Most of these cases (many of whom are presently being  unsuccessfully treated in medical clinics and/or hospitals) would quite  likely respond very well to routine office-based conservative  chiropractic care. However, insofar as there is no conclusive data to  support any particular method of chiropractic treatment for these cases,  nor has there been any standardized procedures established by which  such data might be collected for analysis, the issue is problematic  inasmuch as most chiropractic physicians have had little training in  clinical research methodology. Therefore, a “practitioner scientist”  protocol was developed whereby selected office-based chiropractic  physicians would collect the necessary data and provide treatment  according to specified procedures under the direction of an experienced  clinical researcher. Basic inclusion/exclusion criteria were chosen for a  standardized approach to the diagnosis of mechanical low back pain in  the elderly and its treatment by conservative chiropractic technics.

Inclusion criteria are as follows:

  1. Age: 65 and over
  2. Present episode of LBP greater than three months duration
  3. Greater than 20 percent Modified Oswestry disability score (MODS)
  4. Primary pain localized to the lumbar spine (L1-S1)
  5. No prior chiropractic or medical treatment for present episode of LBP
  6. No radicular or neurological symptoms
  7. Any three of the following positive orthopedic tests:
    1. Kemp’s test (include only if it increased lumbar pain)
    2. Adam’s and supported Adam’s test (both equally cause pain in the lumbar spine)
    3. Goldthwait’s test (evokes lumbar pain or makes it worse, does not increase radiation of pain into the leg)
    4. Hyperextension test
    5. Pain evoked on spinous process percussion which seated patient’s lumbar spine is flexed

     

    Exclusion criteria are as follows:

    1. History of serious medical illness
    2. Psychological disturbances
    3. Recent trauma (major bruises; fractures; auto accidents; etc.)
    4. Leg or buttock pain of suspected neurological involvement
    5. Obesity
    6. Anomalies such as spondylolisthesis
    7. Uncertain diagnosis
    8. referred pain of viscero-somatic origin
    9. Change in diagnosis; new symptoms; deteriorating health while study is underway
    10. More than two weeks of missed appointments

    Reference: Paul J. Osterbauer, DC, Tom DeVita, DC,  Arlan W. Fuhr, DC. Proceedings of the FCER’s Third Annual International Conference on  Spinal Manipulation. Washington. D.C., April 12-13. 1991. pp. 230-1.

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