Archive for category Research

Abstract

OBJECTIVE:

To evaluate diagnostic and biomechanical correlates and treatment outcomes of manipulative/adjustive care in patients highly selected for sacroiliac joint syndrome (SIJS).

DESIGN:

Descriptive case series, 1 wk baseline, 1 yr follow-up.

SETTING:

Private chiropractic practice.

PATIENTS:

Ten out of 153 consecutive new patients (4 male and 6 female) with “primary,” chronic, uncomplicated SIJS were selected over an 11-mo period on the basis of painful SIJ and provocation tests.

MAIN OUTCOME MEASURES:

Back pain (visual analogue scale), Oswestry disability index, lumbar provocation tests and biomechanical measures of gait and postural sway.

INTERVENTION:

Six-wk regimen of mechanical force, manually assisted, short lever adjustments (MFMA) with an Activator instrument.

RESULTS:

Pain decreased significantly from a mean baseline value of 25 to 12 (t = 2.28; p < .05). Likewise, the average disability scores diminished from 28 to 13% (t = 2.3; p < .05), and a reduction in the number of positive provocation tests was noted (Fisher Exact Probability range Z = 0.025-0.045). Gait and sway parameters were indistinguishable from normals, before or after treatment. Response to the 1-yr follow-up questionnaire (6/10) revealed stability of symptoms at a low level.

CONCLUSIONS:

While the majority of subjects recorded some degree of positive outcome, we conclude that: a) discrete SIJS remains difficult to diagnose, but may be possible by judicious choice of screening tests; b) MFMA may benefit some patients with chronic SIJ pain; and c) gait and sway measurement yielded no correlation with clinical conditions.


J Manipulative Physiol Ther. 1993 Feb;16(2):82-90. [PMID:8445358]

Author information: Osterbauer PJ, De Boer KF, Widmaier R, Petermann E, Fuhr AW. National Institute of Chiropractic Research, Phoenix, AZ 85018.

 

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Abstract

Bell’s palsy is a relatively common, painful, unilateral facial paralysis of unknown etiology. While often claimed to be successfully treated by chiropractic methods, no standard treatment approach is generally recognized within the profession, nor has any report of chiropractic treatment of this condition been reported in the literature. This article discusses two cases of Bell’s palsy successfully treated by mechanical force, manually assisted chiropractic adjusting technique combined with high-voltage electrotherapy. While these two cases do not necessarily represent any rule for the chiropractic treatment of Bell’s palsy by the methods used, or for other chiropractic methods that may be used, they do represent an initial time/treatment “baseline” by which future inter- and intratechnique comparisons may be made for the determination of relative effectiveness.


J Manipulative Physiol Ther. 1992 Nov-Dec;15(9):596-8. [PMID:1469344]

Author information: Frach JP, Osterbauer PJ, Fuhr AW. Activator Methods, Inc., Phoenix, AZ 85060-0317.

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Abstract:

Bell’s Palsy is a relatively common, painful, unilateral facial paralysis of unknown etiology. While often claimed to be successfully treated by chiropractic methods, no standard treatment approach is generally recognized within the profession, nor has any report of chiropractic adjusting technique combined with high-voltage electrotherapy. While these two cases do not necessarily represent any rule for the chiropractic treatment of Bell’s Palsy by the methods used, or for other chiropractic methods that may be used, they do represent an initial time/treatment “base-line” by which future inter-and intratechnique comparisons may be made for the determination of relative effectiveness.


J Manipulative Physiol Ther. 1992 Nov-Dec;15(9):596-8. [PMID:1469344]

Author information: Frach JP, Osterbauer PJ, Fuhr AW. Activator Methods, Inc., Phoenix, AZ 85060-0317.

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Abstract

OBJECTIVE:

Finite helical axis parameters (FHAP) of the cervical spine and clinical measures were obtained to evaluate neck function and the clinical effects of spinal manipulative therapy in patients with “whiplash” (WL) type neck injury.

DESIGN:

Descriptive case series, 1 yr follow-up.

SETTING:

Three private chiropractic practices.

SUBJECTS:

Ten consecutive new patients with a history of neck injury, nine asymptomatic, volunteer controls.

INTERVENTIONS:

A 6-wk regimen of short lever manually assisted adjustments with an Activator Instrument, while acute, four patients received interferential electrotherapy.

MAIN OUTCOME MEASURES:

Cervical FHAP during normal movements, neck pain (visual analogue scale), active cervical range of motion and follow-up questionnaire.

RESULTS:

Based on six patients, the FHAPs appeared to mirror the clinical condition, being markedly deviant from the patterns observed in the control group for at least one or more of the tracking tasks for all but one of the patients. Mean pain scores decreased from 44.1 to 10.5 (t = 4.93; p < .0001) and mean total range of motion increased from 234 to 297 degrees (t = 5.68; p < .0001). At 1 yr, seven respondents noted stability of their symptoms at or near the level reported immediately after the 6-wk treatment period.

CONCLUSIONS:

Based on these preliminary data: a) FHAPs may aid in diagnosing and monitoring treatment of neck dysfunction, b) spinal manipulative therapy may be beneficial to some patients with neck injury and future study is warranted as a means to promote recovery of patients with neck injuries.


J Manipulative Physiol Ther. 1992 Oct;15(8):501-11. [PMID:1402410]

Author information: Osterbauer PJ, Derickson KL, Peles JD, DeBoer KF, Fuhr AW, Winters JM. Whiplash Analysis, Inc., Phoenix, AZ 85018.

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Abstract

In this case, a 23-month old female with  chronic otitis media who has undergone traditional medical treatment  with no relief of symptoms finds sustained improvement with chiropractic  care. A mechanism for the etiology of chronic otitis media is  suggested.


Chiropr. 1992; 8(2):38-9.

Author information: Phillips NJ. Private practice of chiropractic, Galion, OH, USA.

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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:

Non-specific adjusting procedures, whether employed with short or long levers, is used to increase mobility in a number of motion segments at the same time. In theory, the procedure involved passive movement of joints through their physiological range without exceeding their passive end range (e.g., no cavitation produced). Like most adjustive procedures, there is a lack of data to provide a basis for decision making, leaving room for opinion on the use of these procedures. This brief discussion will outline what I feel are important considerations in the practice of non-specific contact adjusting.

Discussion:

While non-specific adjusting has received an established rating at the Mercy Conference, non-specific procedures such as the anterior thoracic adjustment and lumbar roll, and the master cervical are often accompanied by multiple audible releases indicating caviation has occured. In these instances, the lines are blurred between manipulation and mobilization. A major question remains to be studied: Are specific lesions present which warrant specific procedures, or will general mobilization create movement that will effect all areas of putative hypomobility and are thereby justified? Who are suitable candidates for these procedures? Several additional questions are also of interest:

a. Are these procedures safe? Biomechanical modeling data suggest that forces generate during lumbar side posture rotary adjustments may exceed safe ranges in some individuals.

  1. In the cervical region vertebral artery syndrome is a concern; the risk of which may or may not be detectable by provocation tests.
  2. In the thoracic spine rib fractures are also a concern. We need to develop ways to carefully select the procedures are used.

b. What are the long term effects of repetitive treatment over time?


Reference: Arlan W. Fuhr,DC. Proceedings California Chiropractic Foundation’s 7th Annual Conference on Research & Education, Palm Springs CA, June 19-21, 1992, pp. 256-7.

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Abstract

OBJECTIVES:

Chiropractic mechanical force, manually assisted short lever adjusting is a spinoff of the specific toggle recoil adjusting techniques, which were based on the original chiropractic subluxation theory propounded by Daniel David Palmer in 1895. This article reviews: a) the principles of the chiropractic subluxation complex from the standpoint of its historical origin and present-day scientific status; b) the purpose and objectives of specific spinal manipulative techniques; c) the use of mechanical adjusting instruments to effect a velocity/direction controlled adjustive thrust; and d) an assessment of scientific and clinical data relating to the biomechanical and neurological aspects of mechanical force, manually assisted short lever adjusting.

DATA SOURCES:

Prime sources were from the National Library of Medicine’s on-line Index Medicus database, the Chirolars Research Resource Retrieval database, the Chiropractic Research Abstract Collection and the Chiropractic Library Consortium’s reference works. Direct search of other nonindexed chiropractic sources was limited to those available in the collection of the National Institute of Chiropractic Research. Early information never documented by publication was obtained by written personal communication.

STUDY SELECTION:

The principal author selected articles reporting data (as opposed to anecdotal reports) from conference proceedings and peer-reviewed journals.

DATA EXTRACTION:

Data quality was assessed based on experimental conditions such as sample size, study design and statistical analysis.

DATA SYNTHESIS:

While mechanical force, manually assisted short lever adjusting seemingly is capable of beneficially altering the cause/effect relationship of spinal subluxations, more research in the nature of controlled clinical trials is needed to ascertain its benefits in the chiropractic treatment of specific conditions.

CONCLUSIONS:

Basic research is needed in order to establish the scientific basis for the chiropractic subluxation syndrome regardless of the technique employed.


J Manipulative Physiol Ther. 1992 Jun;15(5):309-17. [PMID:1302464]

Author information: Osterbauer PJ, Fuhr AW, Hildebrandt RW. Activator Methods, Inc. Phoenix, AZ.

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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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