Archive for category Research

Abstract

Objective:

To describe the results from chiropractic care of a patient presenting with a breech pregnancy using the Webster Technique analysis with Activator Adjusting Instrument thrust.

Clinical Features:

A 30 year old woman in her 34th week of pregnancy with her second child presented for a regular chiropractic visit after having an ultrasound that determined the baby was in a breech position. She had a previous cesarean section and was continuing chiropractic care with hopes of avoiding another cesarean section.

Intervention and Outcome:

Webster Technique was used to analyze the patient and a light force adjusting instrument (Activator Adjusting Instrument) was used to administer an adjustment. Trigger point therapy was also performed according to Webster protocol. After three adjustments, the fetus moved from a breech position to a normal vertex or head down position.

Conclusion:

Webster Technique protocol while using the Activator Adjusting Instrument along with trigger point therapy was successful in decreasing sacral subluxation and the fetus assumed a normal vertex position according to a follow-up ultrasound.


Journal of Pediatric, Maternal & Family Health – Chiropractic ~ Volume 2012 ~ Issue 3 ~ Pages 66-68.

Author information: Miranda Abbott, DC. Private practice, Appleton, Wisconsin, USA.

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Abstract

OBJECTIVE:

The purpose of this study was to evaluate the mechanical allodynia in animals after immobilization and chiropractic manipulation using the Activator instrument (Activator Methods International, Phoenix, Ariz) through the Von Frey test in an animal model that had its hind limb immobilized as a form to induce mechanical allodynia.

METHOD:

Eighteen adult male Wistar rats were used and divided into 3 groups: control group (C) (n = 6) that was not immobilized; immobilized group (I) (n = 6) that had its right hind limb immobilized; immobilized and adjusted group (IAA) (n = 6) that had its right hind limb immobilized and received chiropractic manipulation after. The mechanical allodynia was induced through the right hind limb immobilization. At the end of the immobilization period, the first Von Frey test was performed, and after that, 6 chiropractic manipulations on the tibial tubercle were made using the Activator instrument. After the manipulation period, Von Frey test was performed again.

RESULTS:

It was observed that after the immobilization period, groups I and IAA had an exacerbation of mechanical allodynia when compared with group C (P < .001) and that after the manipulation, group IAA had a reversion of these values (P < .001), whereas group I kept a low pain threshold when compared with group C (P < .001).

CONCLUSION:

This study demonstrates that immobilization during 4 weeks was sufficient to promote mechanical allodynia. Considering the chiropractic manipulation using the Activator instrument, it was observed that group IAA had decreased levels of mechanical allodynia, obtaining similar values to group C.


J Manipulative Physiol Ther. 2012 Jan;35(1):18-25. [PMID:22054875]

Author information: Trierweiler J, Göttert DN, Gehlen G. Academic of Chiropractic from the University Feevale, Laboratory of Comparative Histophysiology, ICS, University Feevale, Novo Hamburgo, RS, Brazil.

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Abstract

BACKGROUND:

Chiropractic spinal manipulation (CSM) is an alternative treatment for back pain. The autonomic nervous system is often involved in spinal dysfunction. Although studies on the effects of CSM have been performed, no chiropractic study has examined regional cerebral metabolism using positron emission tomography (PET).

OBJECTIVE:

The aim of the present study was to investigate the effects of CSM on brain responses in terms of cerebral glucose metabolic changes measured by [18F] fluorodeoxyglucose positron emission tomography (FDG-PET).

METHODS:

Twelve male volunteers were recruited. Brain PET scanning was performed twice on each participant, at resting and after CSM. Questionnaires were used for subjective evaluations. A visual analogue scale (VAS) was rated by participants before and after chiropractic treatment, and muscle tone and salivary amylase were measured.

RESULTS:

Increased glucose metabolism was observed in the inferior prefrontal cortex, anterior cingulated cortex, and middle temporal gyrus, and decreased glucose metabolism was found in the cerebellar vermis and visual association cortex, in the treatment condition (P < .001). Comparisons of questionnaires indicated a lower stress level and better quality of life in the treatment condition. A significantly lower VAS was noted after CSM. Cervical muscle tone and salivary amylase were decreased after CSM. Conclusion The results of this study suggest that CSM affects regional cerebral glucose metabolism related to sympathetic relaxation and pain reduction.


Altern Ther Health Med. 2011 Nov-Dec;17(6):12-7. [PMID:22314714]

Author information: Ogura T, Tashiro M, Masud M, Watanuki S, Shibuya K, Yamaguchi K, Itoh M, Fukuda H, Yanai K. Division of Cyclotron Nuclear Medicine, Tohoku University, Sendai, Japan.

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ABSTRACT:

Objective:

The purpose of this study was to quantify  interexaminer reliability of a standardized supine leg check procedure  used to screen for leg-length inequality.

Methods:

Two doctors of chiropractic used a standardized  supine leg check procedure to examine 50 volunteers for leg-length  inequality. The order of examination was randomized. The side and  magnitude of leg-length inequality were determined to the nearest 1/8  in. Subjects and examiners were blinded. Interexaminer reliability was  assessed with a Bland-Altman plot, tolerance table of absolute  differences, a quadratic weighted κ statistic for quantitative scores,  and a Gwet’s first-order agreement coefficient for dichotomous ratings.

Results:

The quadratic weighted κ statistic to quantify the  reliability of the rating scale was 0.44 (95% confidence interval,  0.21-0.67), indicating moderate reliability. The 2 examiners agreed  exactly 32% of the time, within 1/8 in 58% of the time, within 3/16 in  72% of the time, and within 3/8 in 92% of the time. The Bland-Altman  plot revealed possible heterogeneity in reliability that requires  additional study. The examiners agreed on the presence of a leg-length  inequality of at least 1/8 in in 40 (80%) of 50 subjects (first-order  agreement coefficient, 0.76), suggesting good agreement for this  diagnostic category.

Conclusion:

The examiners showed moderate reliability in  assessing leg-length inequality at 1/8-in increments and good  reliability in determining the presence of a leg-length inequality.


J Manipulative Physiol Ther. 2011 May;34(4):239-46. [PMID:21621725]

Author information: Woodfield HC, Gerstman BB, Olaisen RH, Johnson DF. Upper Cervical Research Foundation, Raleigh, NC, USA.

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ABSTRACT:

Objective:

To investigate the ability of the neurological examination to identify the specific level of a disc herniation in patients with sciatica and confirmed disc herniation.

Summary of Background Data:

Tests included in a neurological examination theoretically provide accurate diagnostic information about the level of the herniated disc. However, there is currently very little evidence about the diagnostic accuracy of individual tests or combinations of tests.

Methods:

The study included 283 patients with sciatica and confirmed disc herniation from a previous randomized controlled trial. The reference test for the current study was the MRI scan, reported for level of disc herniation. Index tests investigated were a neurologist’s overall impression of the level of disc herniation, individual neurological tests (e.g., sensation testing) and multiple test findings (i.e., the number of positive tests). The index tests were performed blinded to the MRI results. The diagnostic accuracy of the index tests in predicting herniations at the lower three lumbar discs was investigated using area under the curve (AUC), sensitivity and specificity.

Results:

None of the individual neurological tests from the clinical examination were highly accurate for identifying the level of disc herniation (AUC < 0.75). The outcome of multiple test findings was slightly more accurate but did not produce high sensitivity and specificity. The dermatomal pain location was generally the most informative individual neurological test. The overall suspected level of disc herniation rated by the neurologist after a full examination of the patient was more accurate than individual tests. At L4/5 and L5/S1 herniations the AUC for neurologist ratings was 0.79 and 0.80 respectively.

Conclusions:

The current study did not find evidence to support the accuracy of individual tests from the neurological examination in identifying the level of disc herniation demonstrated on MRI. A neurologist’s overall impression was moderately accurate in identifying the level of disc herniation.


Spine (Phila Pa 1976). 2011 May 15;36(11):E712-9. [PMID:21224761]

Author information: Hancock MJ, Koes B, Ostelo R, Peul W. Faculty of Health Sciences, University of Sydney, Australia.

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Objective: Several studies have reported the effects of various specific cervical chiropractic adjustments on blood pressure(1-5) and pulse rate.(1-3) However, those studies have been criticized due to small sample size and various methodological concerns. The purpose of this randomized controlled trial (RCT) was to measure the effects of specific cervical (C3 to Occiput [“C0”]) chiropractic adjustments on blood pressure (BP) and pulse rate (PR) in a larger sample size of both normotensive and hypertensive humans.

 

Methods: After IRB approval, Informed Consent was  obtained and 331 human subjects who met the inclusion  criteria were randomly assigned to one of three groups:  Control (N=108; no treatment, no placebo); Placebo Treatment (N=117; sham adjustment with inactive device); or Active Treatment (N=106; adjustment with active device). Subjects were seated in a relaxing climate-controlled room for a minimum of 15 minutes prior to obtaining a baseline blood pressure (BP) (systolic and diastolic) and pulse rate (PR) measurement with an electronic oscillometric BP monitor. The subjects were then moved to chairs stationed according to the study group in which they were assigned. Subjects had another BP and PR measured (“anxiety” BP and PR measurements) after being called upon for active treatment, placebo treatment, or no treatment at all. Active treatment involved the use of the Activator IV(6) adjusting instrument to correct subluxations detected according to the Activator Methods Chiropractic Technique for cervical vertebrae C3 to C0. Placebo treatment was performed with an Activator II8 adjusting instrument in the “off” position which mimics all aspects of the treatment that is administered when in the “on” position but no manipulative force is delivered. Following active treatment (or placebo treatment or no treatment), subjects had their BP and PR measured once again.

 

Results: Subjects ranged in age from 18 to 85 years old (mean age = 52) and 64% of them were female. Systolic and diastolic BP decreased significantly (p<0.0001) in the active treatment group, whereas no significant changes occurred in the placebo treatment and control groups. Similarly, PR decreased significantly (p<0.0001) in the active treatment group, whereas no significant changes occurred in the placebo treatment and control groups.

 

Discussion: Similar smaller studies, utilizing various chiropractic adjusting techniques, served as the foundation for this larger and important RCT. The results of this RCT indicate, with strong statistical significance, that specific cervical (C3 to C0) chiropractic adjustments decrease systolic and diastolic BP, as well as PR.

 

Conclusion: This significant and important RCT demonstrates that specific cervical chiropractic adjustments decrease BP and PR. In follow-up to this RCT, a longitudinal pilot study of both normotensive and hypertensive subjects is currently in progress by the authors to determine how long a decrease in BP and PR is sustained following specific cervical chiropractic adjustments. Given the worldwide burden of hypertension and its adverse effects on health, further studies on the effects of chiropractic adjustments on BP and PR are warranted.


Fourth Place Research Prize at the 11th WFC Biennial Congress in Rio de Janiero, Brazil.

Author information: Steven Roffers, Laura Huber, David Morris, Anquonette Stiles, Derek Barton, Therese House

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ABSTRACT:

Objective:

The purpose of this case study is to describe the clinical course and treatment of a female patient with intermittent low back pain (LBP) that was associated with a uterine adenomyosis.

Clinical Features:

A 45-year-old woman presented for chiropractic care with intermittent LBP of 4 years’ duration. History revealed concurrent dysmenorrhea, menorrhagia, and a uterine leiomyoma (fibroid). Physical and radiological examination findings were unremarkable, and the LBP was not reproducible.

Intervention and Outcome:

Activator Methods chiropractic adjustments/manipulations were given twice per week for 4 months with moderate results. The frequency and duration of low back and pelvic pains were reduced; however, the severity remained constant. A further gynecological opinion was sought, a transvaginal ultrasound was performed, and the patient’s diagnosis was changed from leiomyoma to adenomyosis.

Conclusion:

In this case report, a woman presented with a 4-year history of intermittent LBP, which was sometimes associated with menstruation. Despite being diagnosed with uterine adenomyosis, she received some relief from chiropractic care.


J Chiropr Med. 2011 Mar; 10(1): 64–69. [PMC3110405]

Reference: Anne M. Jensen MSc, DC; Brutawit Bewketu BS; Douglas Sanford MSS, DC, CCSP. Parker Research Institute, Parker College of Chiropractic, Dallas, TX, USA.


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Abstract

OBJECTIVES:

The primary aim of this study was to estimate the prevalence of fall risk factors in older chiropractic patients. The secondary aim was to investigate the quality-of-life status of older chiropractic patients and to see whether a history of falling was related to quality-of-life status.

METHODS:

A cross-sectional study was conducted at 12 chiropractic practices throughout Auckland, New Zealand, and Melbourne, Australia. The study involved gaining a profile of health status, fall history, and fall risk from active chiropractic patients who were 65 years or older.

RESULTS:

One hundred ten older chiropractic patients were approached, and 101 agreed to participate in this study (response rate, 91.8%). Thirty-five percent of participants had experienced at least 1 fall in the previous 12 months. Of those that had fallen, 80% had at least a minor injury, with 37% of fallers requiring medical attention and 6% suffering a serious injury. The prevalence of most fall risk factors was consistent with published data for community-dwelling older adults. Quality of life of older chiropractic patients appeared to be good, but fallers reported a lower physical component summary score compared with nonfallers (P = .04).

CONCLUSIONS:

A portion of the older chiropractic patients sampled in this study had a substantial risk of falling. This risk could be assessed on a regular basis for the presence of modifiable fall risk factors, and appropriate advice, given when fall risks are identified.


J Manipulative Physiol Ther. 2011 Feb;34(2):78-87.  [PMID:21334539]

Author information: Holt KR, Noone PL, Short K, Elley CR, Haavik H. Research Department, New Zealand College of Chiropractic, Auckland, New Zealand.


Full text article available here

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Abstract:

Purpose:

This study investigated the immediate effects of audible joint sounds following a supine T3-T4 spinal thrust manipulation on the autonomic nervous system activity using a fully automated pupillometry system in patients with chronic neck pain. An additional aim was to determine if audible sounds as perceived by the therapist were associated with the reduction of pain following manipulation.

Methods:

One hundred subjects with chronic neck pain completed the study protocol. The Mann-Whitney U test was used to compare the change scores of the 3 measuring points between the one-pop and multiple-pop groups. Subjects were randomized into either a manipulation or a mobilization group. A method of automated pupillometry was used in this study to capture pupil responsiveness.

Results:

The analysis showed that there was no significant difference between the 2 groups (P N .05). The Kruskal-Wallis test was used to compare the median change scores between the mobilization, no-pop, and pop groups. The analysis showed that there was no statistically significant difference in the amount of change in pupil diameter between the 3 groups (P N .05). The Mann-Whitney U test demonstrated that the no-pop group (P = .031) and the multiple-pop group (P = .014) had a significant reduction of pain; however, it did not reach the minimal clinically significant level of 13 mm on the visual analog scale.

Conclusions:

The results of this study provided evidence that the presence of joint sounds does not influence the overall activity of the autonomic nervous system following a thrust manipulation or contribute to the reduction of pain in patients with chronic neck pain.


J Manipulative Physiol Ther. 2011 Jan;34(1):37-45. [PMID:21237406]

Author information: Rob Sillevis, PT, DPT, PhD, MTC and Joshua Cleland, PT, PhD. Integrated Therapy Practice PC, Hobart, IN, USA.

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Abstract

BACKGROUND:

Neck pain of a mechanical nature is a common complaint seen by practitioners of manual medicine, who use a multitude of methods to treat the condition. It is not known, however, if any of these methods are superior in treatment effectiveness. This trial was stopped due to poor recruitment. The purposes of this report are (1) to describe the trial protocol, (2) to report on the data obtained from subjects who completed the study, (3) to discuss the problems we encountered in conducting this study.

METHODS:

A pragmatic randomised clinical trial was undertaken. Patients who met eligibility criteria were randomised into three groups. One group was treated using specific segmental high velocity low amplitude manipulation (diversified), another by specific segmental mobilisation, and a third group by the Activator instrument. All three groups were also treated for any myofascial distortions and given appropriate exercises and advice. Participants were treated six times over a three-week period or until they reported being pain free. The primary outcome measure for the study was Patient Global Impression of Change (PGIC); secondary outcome measures included the Short-Form Health Survey (SF-36v2), the neck Bournemouth Questionnaire, and the numerical rating scale for pain intensity. Participants also kept a diary of any pain medication taken and noted any perceived adverse effects of treatment. Outcomes were measured at four points: end of treatment, and 3, 6, and 12 months thereafter.

RESULTS:

Between January 2007 and March 2008, 123 patients were assessed for eligibility, of these 47 were considered eligible, of which 16 were allocated to manipulation, 16 to the Activator instrument and 15 to the mobilisation group. Comparison between the groups on the PGIC adjusted for baseline covariants did not show a significant difference for any of the endpoints. Within group analyses for change from baseline to the 12-month follow up for secondary outcomes were significant for all groups on the Bournemouth Questionnaire and for pain, while the mobilisation group had a significant improvement on the PCS and MCS subscales of the SF-36v2. Finally, there were no moderate, severe, or long-lasting adverse effects reported by any participant in any group.

CONCLUSIONS:

Although the small sample size must be taken into consideration, it appears that all three methods of treating mechanical neck pain had a long-term benefit for subacute neck pain, without moderate or serious adverse events associated with any of the treatment methods. There were difficulties in recruiting subjects to this trial. This pragmatic trial should be repeated with a larger sample size.


Chiropr Osteopat. 2010 Jul 9;18:20. [PMID:20618936]

Author information: Gemmell H, Miller P. Anglo-European College of Chiropractic Bournemouth, Dorset, UK.


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