Archive for category Research

Abstract:

Objective:

The purpose of this article is to describe chiropractic management of a 5-year-old boy with urinary and bowel incontinence.

Clinical Features:

A 5-year-old boy presented with the primary symptoms of a complete lack of bowel and bladder control with prior surgical correction for lumbar meningocele, spinal lipoma, and tethered spinal cord. Examination revealed spinal and pelvic dysfunction.

Intervention and Outcome:

Chiropractic treatment methods included using the Activator adjusting instrument and shortwave diathermy to the lumbar spine and sacrum. A total of 5 treatments were initially provided over a period of 4 weeks. After the initial treatment period, he was able to maintain satisfactory control of his bladder and bowel, day and night, for a period of approximately 6 months. A second course of treatments was initiated approximately 6 months later because of a recurrence of bladder and bowel incontinence. Four additional treatments were provided over a period of 4 weeks. This second course of treatment reestablished satisfactory control of bladder and bowel function.

Conclusion:

For this patient, chiropractic care was successful in establishing satisfactory bladder and bowel control.


J Chiropr Med. 2010 Mar;9(1):28-31. [PMID:21629396]

Author information: Kamrath KR. Chiropractor, Private Practice, Hutchinson, MN 55350.


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Abstract

OBJECTIVE:

The purpose of this case report is to describe the response to chiropractic care of a pediatric patient with complaints of neck pain; headaches; and hand, leg, and foot pain after head trauma and the reports of changes in the patient’s history of chronic fatigue, vomiting, and coughing.

CLINICAL FEATURES:

A 6-year-old girl was pushed into a playground slide, hitting her head and resulting in acute complaints of her “neck and brain hurting” and hand, foot, and occasional leg pain. In addition, the patient had a several-year history of unexplained fatigue, vomiting, and coughing spells. She had a neck pain disability index of 17.8%; left lateral and rotational head tilt; cervical antalgic lean; loss of cervical range of motion; anterior cervical translation; and spasm, tenderness, trigger points, and edema along the cervical and thoracic spine.

INTERVENTION AND OUTCOME:

The patient was cared for using Activator Methods protocol. After the fifth treatment, all the patient’s symptoms dissipated, with a complete return to normal activity and spinal stability after 9 treatments. At 19 weeks, her spine continued to be asymptomatic; and her neck disability index was 0%.

CONCLUSION:

This case demonstrated that the Activator Method of chiropractic care had a beneficial effect for this pediatric patient.


J Chiropr Med. 2009 Sep;8(3):131-6. [PMID:19703669]

Author information: Roberts J, Wolfe T. HealthQuest Chiropractic, Farmington, ME 04938.


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Abstract

BACKGROUND:

With continued popularity of complementary and alternative medicine (CAM) therapies for children, their safety and effectiveness are of high concern for both CAM and conventional therapy providers. Chiropractic is the most popular form of practitioner-based CAM therapies for children.

OBJECTIVE:

The objective of this study was to describe the practice of pediatric chiropractic, including its safety and effectiveness.

DESIGN:

This study used a cross-sectional survey.

SETTING:

A practice-based research network was used for this study.

PATIENTS/PARTICIPANTS:

Participants were chiropractors and parents of pediatric patients (aged < or =18 years) attending chiropractic visits ranging from one to 12 visits.

INTERVENTION:

This is a survey study. No interventions were rendered in the completion of this study.

MAIN OUTCOME MEASURES:

Demographics, clinical presentations, treatment-associated aggravations, complications and improvements.

RESULTS:

The indicated primary reason for chiropractic care of children was “wellness care.” With respect to condition-based presentations, musculoskeletal conditions were the most common, in addition to nonmusculoskeletal conditions of childhood. The most common techniques used were diversified technique, Gonstead technique, Thompson technique, and activator methods. Treatment-associated complications were not indicated by the chiropractic and parent responders. Chiropractor responders indicated three adverse events per 5,438 office visits from the treatment of 577 children. The parent responders indicated two adverse events from 1,735 office visits involving the care of 239 children. Both sets of responders indicated a high rate of improvement with respect to the children’s presenting complaints, in addition to salutary effects unrelated to the children’s initial clinical presentations.


Explore (NY). 2009 Sep-Oct;5(5):290-5. [PMID:19733815]

Author information: Alcantara 1, Ohm J, Kunz D. International Chiropractic Pediatric Association, Media, PA, USA.

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Abstract

BACKGROUND:

The purpose of this study was to examine heart rate variability (HRV) in the presence or the absence of pain in the lower back, while receiving one chiropractic treatment at L5 from either a manually assisted mechanical force (Activator) or a traditional diversified technique spinal manipulation.

METHODS:

A total of 51 participants were randomly assigned to a control (n = 11), 2 treatment, or 2 sham groups (n = 10 per group). Participants underwent an 8-minute acclimatizing period. The HRV tachygram (RR interval) data were recorded directly into a Suunto watch (model T6; FitzWright Company Ltd, Langley, British Columbia, Canada). We analyzed the 5-minute pretreatment and posttreatment intervals. The spectral analysis of the tachygram was performed with Kubios software.

RESULTS:

All groups decreased in value except the control group that reacted in the opposite direction, when comparing the pretests and posttests for the high-frequency component. The very low frequency increased in all groups except the control group. The low frequency decreased in all groups except the sham pain-free group. The low frequency-high frequency ratio decreased in the treatment pain group by 0.46 and in the sham pain-free group by 0.26. The low frequency-high frequency ratio increase was 0.13 for the sham pain group, 0.04 for the control group, and 0.34 for the treatment pain-free group. The mean RR increased by 11.89 milliseconds in the sham pain-free group, 18.65 milliseconds in the treatment pain group, and 13.14 milliseconds in the control group. The mean RR decreased in the treatment pain-free group by 1.75 milliseconds and by 0.01 milliseconds in the sham pain group.

CONCLUSION:

Adjusting the lumbar vertebrae affected the lumbar parasympathetic nervous system output for this group of participants. Adaptation in the parasympathetic output, reflected by changes in high frequency, low frequency, and very low frequency, may be independent of type of adjustment. Therefore, the group differences found in the modulation of the HRV would seem to be related to the presence or absence of pain. The autonomic nervous system response may be specific and sensitive to its effectors organ.


J Manipulative Physiol Ther. 2009 May;32(4):277-86. [PMID:19447264]

Author information: Roy RA, Boucher JP, Comtois AS. Université du Québec à Montréal, Département de Kinanthropologie, CP 8888, Succursale Centre-Ville, Montréal, Québec, Canada.

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Abstract

OBJECTIVE:

The purpose of this study was to evaluate the interexaminer reliability of a leg length analysis protocol between an experienced chiropractor and an inexperienced chiropractic student who has undergone an intensive training program.

METHODS:

Fifty participants, aged from 18 to 55 years, were recruited from the New Zealand College of Chiropractic teaching clinic. An experienced chiropractor and a final-year chiropractic student were the examiners. Participants were examined for leg length inequality in the prone straight leg and flexed knee positions by each of the examiners. The examiners were asked to record which leg appeared shorter in each position. Examiners were blinded to each other’s findings. kappa statistics and percent agreement between examiners were used to assess interexaminer reliability.

RESULTS:

kappa analysis revealed substantial interexaminer reliability in both leg positions and also substantial agreement when straight and flexed knee results were combined for each participant. kappa scores ranged from 0.61, with 72% agreement, for the combined positions to 0.70, with 87% agreement, for the extended knee position. All of the kappa statistics analyzed surpassed the minimal acceptable standard of 0.40 for a reliability trial such as this.

CONCLUSION:

This study revealed good interexaminer reliability of all aspects of the leg length analysis protocol used in this study.


J Manipulative Physiol Ther. 2009 Mar-Apr;32(3):216-22. [PMID:19362232]

Author information: Holt KR, Russell DG, Hoffmann NJ, Bruce BI, Bushell PM, Taylor HH. esearch Department, New Zealand College of Chiropractic, Auckland, New Zealand.

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Abstract

The purpose of this study was to survey 200 randomly selected post-1980 graduates of the Canadian Memorial Chiropractic College practicing in five Canadian provinces to determine which, if any, technique systems they sought out instruction in and/or are utilizing either primarily or secondarily for patient care. Using a systematic sampling approach, 83 eligible data sets were received. Respondents reported to have sought out instruction in a total of 187 technique systems other than Diversified technique. In addition, although 86% of respondents stated they primarily used Diversified technique in practice, they reportedly used 134 different technique systems secondarily for patient care. This calculates to an average of 2.27 different techniques used per respondent. Future studies should survey a larger percentage of practitioners to better assess the validity of these findings.


J Can Chiropr Assoc. 2009 Mar; 53(1): 32–39. [PMCID: PMC2652629]

Author information: Chad Mykietiuk, DC, Megan Wambolt, BSc(Hon), DC, Travis Pillipow, BSc, DC, Christa Mallay, BA, DC, and Brian J. Gleberzon, BA, DC. Applied Chiropractic & Clinical Sciences Departments, Canadian Memorial Chiropractic College, 6100 Leslie St, Toronto, ON M2H 3J1.


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Summary

Background:

Trigger points are a common cause of severe and  disabling pain in chiropractic practice. While trigger points may be  found in any skeletal muscle the majority are found in the upper  trapezius. Relatively few studies have investigated non-invasive  treatments for upper trapezius trigger points. Common manual therapy  treatments utilized for upper trapezius trigger points in chiropractic  include manual pressure and myofascial release. The purpose of this  study was to compare the effect of a single treatment of ischaemic  compression and activator trigger point therapy on active upper  trapezius trigger points.

Methods:

Fifty-two subjects with active upper trapezius  trigger points met the participation criteria and were randomised to an  ischaemic compression or activator trigger point therapy group. The  primary outcome measure was Patient Global Impression of Change.  Secondary outcome measures were an 11-point numerical rating scale for  change in pain, and change in pressure pain threshold using an algometer  for trigger point sensitivity. While the treating clinician and  subjects were not masked to treatment assignment, the examiner was blind  to treatment assignment until data analyses were completed. An  independent t-test was used to compare the groups at baseline on the  continuous variables. The Mann—Whitney U-test was used to compare the  groups at baseline on the non-continuous variables. Relative risk ratios  of improvement for the primary and secondary outcome measures were  calculated with 95% confidence intervals for clinical significance.

Results:

Seventy volunteers were screened  with 25 subjects randomised to the ischaemic compression group and 27 to  the activator trigger point therapy group. There was no significant  difference between the groups in any of the baseline variables. On the  primary outcome measure both groups improved (78% of those in the  activator group and 72% in the ischaemic compression group). Relative  risk for improvement of 1.00 suggested that those treated with the  Activator instrument were no more likely to improve than those treated  with ischaemic compression (95% CI = 0.73—1.37). For the secondary  outcome measure of pain reduction 41% of those treated with the  Activator instrument improved compared to 36% of those in the ischaemic  compression group. Those treated with the Activator instrument were 13%  more likely to improve than those treated with ischaemic compression.  However this relative risk of 1.13 in favour of the activator group was  not significant (95% CI = 0.57— 2.26). For the secondary outcome of  reduction in trigger point sensitivity 32% of those in the ischaemic  compression group improved compared to 30% in the activator group. Those  treated with ischaemic compression were 8% more likely to improve;  however, the relative risk of 1.08 was not significant (95% CI =  0.48—2.44). As risk of improvement on the outcome measures between the  groups was not significantly different, number needed to treat was not  calculated.

Conclusion:

Based on the primary outcome  measure the results suggest that both ischaemic compression and  Activator trigger point therapy have an equal immediate clinically  important effect on upper trapezius trigger point pain.


Clin Chiropr. (2008) 11(4):175-181.

Author information: Gemmel H, Allen A. Anglo-European College of Chiropractic, 13-15 Parkwood Road, Bournemouth, BH5 2DF, United Kingdom.

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Abstract

OBJECTIVE:

The purpose of this case report was to describe the observation of the manipulation of the fourth rib followed by the reproducible, rapid return of heart rate to normal in a patient with paroxysmal supraventricular tachycardia.

CLINICAL FEATURES:

A male patient had paroxysmal supraventricular tachycardia. He was evaluated using standard methods of palpation. He was followed over a 6-year period.

INTERVENTION AND OUTCOME:

The patient was treated during episodes of supraventricular tachycardia (SVT) with instrument-assisted manipulation of the fourth rib without treatment of any other segments. Tachycardia was eliminated after rib manipulation within less than 2 minutes. Over a 6-year period, effective control of episodes of SVT was consistently achieved associated with manipulation of the fourth rib.

CONCLUSIONS:

This case study is suggestive of a relationship between SVT and misalignment of the fourth rib. Controlled studies are necessary to validate this observation.


J Manipulative Physiol Ther. 2008 Jun;31(5):389-91. [PMID:18558281]

Author information: Julian MR. Private practice, Reston, VA 20191, USA.

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Abstract

OBJECTIVE:

Digitized infrared segmental thermometry (DIST) is a tool used for measuring cutaneous temperature (CT). This project ascertains the effect of a manually assisted mechanical force producing a chiropractic adjustment in the lumbar spine after the Activator Methods Chiropractic Technique on CT during 2 different time recording periods (TRPs).

METHODS:

Sixty-six healthy subjects (36 women and 30 men) without acute low back conditions or symptoms were recruited. Subjects were randomly divided into 2 groups based on the length of the acclimatization period (8 or 30 minutes; TRP(8) and TRP(30), respectively). In turn, each recording period group was divided into 3 subgroups (n = 11 per subgroup): treatment, sham, and control subgroups. Bilateral DIST was conducted at L-4 (TRP(30)) and L-5 (TRP(8)) using infrared cameras (Subluxation Station Insight 7000; Chiropractic Leadership Alliance, Mahwah, NJ).

RESULTS:

Before treatment (t(-0.5)), the TRP(8) CT was significantly different between the ipsilateral and the contralateral sides for all subgroups. At 10 minutes (t(10)) after intervention, CT increased significantly (P < .05) for the treatment group but not for the sham and control groups. In contrast, there were no significant differences in the TRP(30) CT before treatment between the ipsilateral and the contralateral sides; but at t(10), CT was significantly (P < .05) greater for all 3 subgroups compared with preintervention CT.

CONCLUSION:

Contacting the skin with the instrument with (treatment group TRP(30)) or without (sham group TRP(30)) a thrust with a sustained pressure stronger than the loading principle taught in the Activator Methods Chiropractic Technique protocol or a thrust respecting the standard loading principle (treatment group TRP(8)) of the instrument produced a CT cooling immediately after the adjustment. Furthermore, we observed that when contacting the skin with the instrument with a thrust respecting the standard loading principle (treatment group TRP(8)) of the instrument, it produced a secondary cooling at t(5) followed by a rewarming at t(10). Finally, contacting the skin with the instrument without a thrust and respecting the standard loading principle (sham TRP(8)) of the instrument did not produce a CT change.


J Manipulative Physiol Ther. 2008 Mar;31(3):230-6. [PMID:18394501]

Author information: Roy RA, Boucher JP, Comtois AS. Private Practice, LaSalle, Québec, Canada.

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Abstract

OBJECTIVE:

The purpose of this study was to perform an interexaminer reliability evaluation of the prone leg length analysis procedure.

METHODS:

Two chiropractors each examined a series of 45 patients with a history of low back pain. Patients were in the prone position, with the knees in both extended and flexed positions, and with the head rotated right and left. The clinicians were asked to determine the side of the short leg with knees extended and if a change in leg length occurred with head rotation or when the knees were flexed. They were also asked to visually judge the amount of leg length differential by categorizing the difference as either less than 0.25, 0.25 to 0.5, 0.5 to 0.75, or more than 0.75 in. The head rotation portion of the test was performed only with patients (n = 22) in whom the leg length differential was determined to be less than 0.25 in.

RESULTS:

kappa statistics and frequency distributions were calculated for each of the respective observations. Reliability of determining the side of the short leg with knees extended was good at 82% agreement (kappa = 0.65) but fair for determining the amount of leg length difference at 67% agreement (kappa = 0.28). Reliability of the head rotation testing procedure was extremely poor, with only 50% and 45% agreement about the observed change in leg length with the head rotated left and right, respectively (kappa = 0.04, kappa = -0.195). There was no significant correlation found between the side of reported pain by the patient and the side of the short leg as noted by either clinician (chi2 = 0.55, P = .91, and chi2 = 1.55, P = .67). All of the patients (100%) were judged to have a leg length difference by both clinicians. When the knees were flexed, there was 93% agreement that the short leg became longer (43/45 cases), with no reported cases of the short leg getting shorter. Calculation of kappa statistics was confounded for these last 2 observations because of extremely high prevalence bias.

CONCLUSIONS:

The results indicate that 2 clinicians show good reliability in determining the side of the short leg in the prone position with knees extended but show poor reliability when determining the precise amount of that leg length difference. The head rotation test for assessing changes in leg length was unreliable in this sample of patients. There does not appear to be any correlation between the side of pain noted by the patient and the side of the short leg as observed by the clinicians; all 45 patients in this sample were found to have a short leg by both clinicians.


J Manipulative Physiol Ther. 2007 Sep;30(7):514-21. [PMID:17870420]

Author information: Schneider M, Homonai R, Moreland B, Delitto A. Spine and Pain Care Center, Pittsburgh, Pa, USA.

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