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Chiropractic Research
Back Pack Safety
According to the American Chiropractic Association…
- Back packs should weigh no more than 5-10% of the child's body weight, and never more than 25 lbs.
- The pack should be no lower than 4 inches below the waistline. It increases the weight on the shoulders and causes more deformation of the posture.
- Wide padded straps are important for better weight distribution.
- Be sure to wear both straps so the weight is proportionate, in order to avoid muscle spasms and low back pain.
- Bigger may not be better. To large of a pack will just allow it to be filled, and become too heavy.
- Messenger bags are much more taxing on the body than backpacks.
- The typical backpack design requires 10% more energy than a saddlebag style, which distributes the weight more evenly across the body.
- When possible try to store un-necessary items in a locker.
- Keep different bags for different activities to be more efficient.
Resource: American Chiropractic Association
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Neck Pain: Manipulation Plus Exercise Better Than Either Alone
Neck pain afflicts roughly 70% of adults at some point in their lives; for nearly 14%, the pain is chronic. This randomized clinical trial studied the effectiveness of spinal manipulation alone compared to the combination of spinal manipulation plus rehabilitative exercises and to a high-tech rehabilitative exercise program for treating neck pain. The study involved 20- to 65-year-old subjects with mechanical neck pain of at least 12 weeks duration. All patients completed 20 one-hour appointments over an 11-week period. The 191 patients were randomized into three groups, as follows:
- Spinal Manipulation Therapy (SMT) Alone: Spinal manipulation and light soft-tissue massage from experienced chiropractic clinicians.
- Manipulation Plus Rehabilitative Exercise: Spinal manipulation as described above, plus rehabilitative exercise from trained exercise therapists. Sessions included warm-up, stretching and dynamic neck exercises consisting of extension, flexion and rotation movements while wearing headgear with 1.25- to 10-pound weight attachments.
- MedX Rehabilitative Exercise: Warm-up stretching exercise and neck exercises using a variable resistance, cervical extension and rotation machine, designed by the MedX Corporation of Ocala, Fla.
Subjects were evaluated by self-report questionnaires, neck range of motion, neck strength and neck muscle endurance at baseline and five and 11 weeks after beginning treatment. At three, six, 12 and 24 months following treatment, subjects completed self-report questionnaires, such as the Neck Disability Index and the SF-36 D form, on pain, satisfaction with care and disability. Satisfaction was determined on a seven-point scale, ranging from "completely satisfied" to "completely dissatisfied."
Patient-rated pain differed between groups, in favor of the two exercise groups. SMT plus exercise provided greater satisfaction than SMT alone or MedX exercises, however. The advantage of both SMT/exercise and MedX over manipulation alone continued over the two-year follow-up period. Overall, the exercise groups benefited more regarding pain, disability, improvement and health status
The researchers admit that the pain results fall slightly short of clinical significance, yet note that clinically significant differences favoring SMT plus exercise over both other treatments were seen for patient satisfaction.
Resource: Evans R, Bronfort G, et al. Two-year follow-up of a randomized clinical trial of spinal manipulation and two types of
exercise for patients with chronic neck pain. Spine 2002:27(21), pp. 2383-2389. www.spinejournal.com
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Chiropractic for Non-musculoskeletal Conditions?
Since the dawn of chiropractic, a great deal has been written pertaining to spinal manipulative therapy (SMT) and somato-visceral conditions. However, scientific evidence supporting a rationale for this proposed connection remains lacking.
The goal of this study was to "find out how frequently patients report non-musculoskeletal symptomatic improvements and to find out more about the types of such reactions that patients believe to be associated with chiropractic treatment." Twenty consecutive patients from each of 87 Swedish chiropractors answered questionnaires on return visits within two weeks of previous treatment, with a total of 1,504 questionnaires completed and returned.
Results: Patients reported numerous positive improvements in non-musculoskeletal symptoms, including:
- easier to breathe (98 patients);
- improved digestive function (92 patients);
- clearer/better/sharper vision (49 patients);
- improved circulation (34 patients);
- less ringing in the ears (10 patients);
- acne/eczema better (8 patients);
- dysmenorrhoea better (7 patients);
- asthma/allergies better (6 patients).
The number of spinal areas treated was also related to the number of reactions: 15% reported experiencing positive reactions having a single area adjusted, as compared to 35% of patients having four areas adjusted. Overall, 23% of chiropractic patients reported experiencing changes in symptoms that were not musculoskeletal in nature.
Take Note: The authors are quick to note that these findings do not assert any sort of causal relation between treatment and reaction. However, they conclude that a minority of chiropractic patients do report having positive non-musculoskeletal reactions following SMT, and that "such reports cluster predominantly around specific symptoms."
Resource: Leboeuf-Yde C, Axen I, Ahlefeldt G, et al. The types and frequencies of improved nonmusculoskeletal symptoms reported after chiropractic spinal manipulative therapy. Journal of Manipulative and Physiological Therapeutics, Nov./Dec. 1999:22(9), pp559-64
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Chiropractic Management of Dyspepsia
Dyspepsia is a common affliction: Up to 50% of Americans and Europeans suffer from the condition, which is characterized by pain, heartburn, excessive belching, and general abdominal discomfort. The majority of patients who experience such symptoms do so without the presence of any identifiable disease, and are considered to have "functional,” (non-ulcerous) dyspepsia.
In this study, the authors sought to determine whether dyspepsia is commonly encountered in the chiropractic setting; the chiropractic procedures used by DCs to address the condition; and if DCs perceived that their care was effective in treating the condition. Researchers sent an electronic survey and explanatory note to 621 members of the Chiropractors' Association of Australia.
Participants were asked to estimate how often patients with dyspepsia were seen in their clinics; to specify which techniques they used most frequently for dyspepsia patients (including specific vertebral levels adjusted); and to rate their perceived effectiveness in the management of dyspepsia. The chiropractors were given 10 days to complete and return the questionnaire.
Results: Data drawn from the 66 surveys received (11.8% of those originally e-mailed) showed that the most common method of dyspepsia management was adjustment of the thoracic spine (91%), followed by nutritional advice (74%), cervical adjustment (68%), visceral manipulation (55%) and soft tissue work/mobilization (52%). Recommendation of herbal/homeopathic remedies, pelvic adjustments and lumbar adjustments were all used less than 50% of the time.
More than 30 "brand name" techniques were employed by chiropractors in the management of dyspeptic patients. The most commonly used techniques were Sacro-Occipital Technique (41%), Activator Methods (36%), applied kinesiology (32%), relaxation techniques (30%), and cranial techniques and Terminal Point Technique (27% each). Overall, chiropractors considered their methods effective in the management of dyspepsia. Ninety-five percent of the respondents rated chiropractic management "very effective" or "moderately effective." Only 5% considered chiropractic management "mildly effective."
The researchers concluded that their findings, particularly those related to the effectiveness of chiropractic in the treatment, provide grounds for "further investigation in the form of randomized, controlled clinical trials." They added, "Further research into the efficacy of individual methods used, as well as details of those specified only in broad terms, would be interesting."
While this study illuminates some interesting associations between dyspepsia and chiropractic care, readers should be aware that a response rate of 60% or more is generally accepted as the standard for a survey to provide valid data.
Resource: Love Z, Bull P. Management of dyspepsia: a chiropractic perspective. Chiropractic Journal of Australia June 2003:3(2), pp57-63.
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Exercise Aids in Common Cold Prevention
As people get older, their ability to fight off infection and other health problems diminishes. The immune system does not function as well in older adults as it does in younger people, even when fighting something as simple as a cold. Aside from eating right and taking the recommended daily vitamins, seniors - particularly postmenopausal women - may now have another way to keep their immune system in shape - exercise. A recent study, supported by the National Cancer Institute, attempted to show this correlation.
Although studies on the relationship between exercise and upper-respiratory infections have been performed, they were both short-term and included a small number of participants. The group of participants for the study, which was published in the November 2006 issue of The American Journal of Medicine, included 115 overweight and obese, sedentary, postmenopausal women from the Seattle area. Women were randomly assigned to either a moderate-intensity exercise group or to a control group that did not exercise. The exercises consisted of 45-minute sessions, five days per week for 12 months. The control group attended weekly 45-minute stretching sessions.
Participants completed a self-administered questionnaire, first at baseline, and then at three-, six-, nine- and 12-month intervals, that recorded the number of times they had a cold or the flu, including when they visited a doctor. Before the women were assigned to groups, they were taught how to monitor the occurrence of upper respiratory tract infections.
Results: The number of colds in the intervention group was lower in the first three months of the study and was approximately three times lower than the stretching group at the end of the 12-month study. The authors concluded that one year of moderate-intensity exercise reduced the incidence of colds in postmenopausal women, adding: "These findings are of public health relevance and add a new facet to the growing literature on the health benefits of moderate exercise."
Resource: Chubak J, McTiernan A, Soresen B, et al. Moderate-intensity exercise reduces the incidence of colds among
postmenopausal women. American Journal of Medicine 2006;119(11):937-942.
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Manipulation Plus Exercise Superior to Exercise Alone for Chronic LBP
Recent studies have shown exercise therapy to be effective for treating chronic low-back pain (LBP). Many studies on the efficacy of manipulation for LBP focus on acute pain, and results of randomized, controlled trials evaluating this therapy for chronic LBP have brought inconsistent results.
Forty-nine patients with chronic low-back or radicular leg pain who had been sick-listed for between eight weeks and six months were randomized to receive exercise therapy or manual therapy. The patients, ages 20-60, were administered 16, 45-minute treatments over eight weeks; outcomes (pain intensity, functional disability, general health and return-to-work status) were
measured before and after treatment and at four weeks, six months and one year after treatment. Spinal range of motion was recorded only before and immediately after treatment.
Subjects in the manual-therapy group received mobilization or HVLA manipulation from trained physiotherapists. Manual procedures were limited to traction thrust to the thoracic-lumbar unction; side-posture rotation-lateral flexion manipulation to segments between T10-L5; and/or sacroiliac manipulation. These subjects also performed 11 specific exercises to improve strength, flexibility and coordination of the torso, spine and legs. Exercise-group patients trained under the supervision of a physiotherapist for 45 minutes per session, with a 35-minute focus on the trunk and legs that followed 10 minutes of warm-up on an exercise bicycle.
Results: Both groups showed improvements; however, the manual-therapy group experienced greater improvements than the exercise group in all outcome measures at every point in follow-up. For example, mean reduction in pain on a visual analog scale (VAS) was doubled for manual-therapy patients compared to exercise patients (33 mm vs. 17 mm). Also, immediately following the treatment period, the manual-therapy group was significantly more likely to have returned to work (67% vs. 27% for the exercise group). At one-year follow-up, exercise-therapy patients were over three times more likely to still be sick-listed (59%) than manual-therapy patients (19%).
Resource: Aure OF, Nilsen JH, Vasseljen O. Manual therapy and exercise therapy in patients with chronic low back pain: A randomized, controlled trial with 1-year follow-up. Spine 2003:28(6), pp. 525-532. www.spinejournal.com
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Options for Tennis Elbow
Tennis elbow or lateral epicondylitis is a common condition that affects the outer part of the elbow; commonly, it is a result of a specific strain, overuse, or directly hitting the area. The area becomes painful and tender, and sometimes no specific cause is found. Researchers from Australia are looking for alternative therapies for tennis elbow that don't involve regular injections.
In a study designed to evaluate the differences between a wait-and-see approach, physiotherapy and corticosteroid injections, 198 men and women between the ages of 18 and 65, and who had not received any other active treatment by a health care practitioner in the previous six months, were split into three groups: wait and see, eight sessions of physiotherapy, or up to two corticosteroid injections within the first six weeks. Participants were measured for global improvement, grip force, and assessor's rating of severity at baseline, six weeks and 52 weeks.
Corticosteroid injection effectively relieved symptoms at six weeks, but there were high recurrence rates thereafter (47 of the 65 patients regressed). There were significantly inferior outcomes in the long term compared with physiotherapy. The physiotherapy sessions were superior to the wait-and-see approach in the short term, but no difference was seen at 52 weeks, when most participants in both groups reported a successful outcome. Patients in the physiotherapy group required less additional treatment, such as non-steroidal anti-inflammatory drugs, than the other two groups.
Results: The combination of elbow manipulation and exercise had a superior advantage to wait and see in the first six weeks and to corticosteroid injections after six weeks. The researchers suggest this might be a reasonable alternative to injections, since the short-term benefits of corticosteroid injection were reversed after the initial six weeks.
Resource: Bisset L, Beller E, Jull G, et al. Mobilisation with movement and exercise, corticosteroid injection, or wait and see
for tennis elbow: randomised trial. BMJ (online first), Sept. 29, 2006. (doi:10.1136/bmj.38961.584653.AE)
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Stretching vs. Manipulation for Hamstring
For athletes, as well as the amateur sports enthusiast, stretching before and after a game, run or
swim can aid in performance and protect the body from injury. One of the more commonly trained
muscles in the body is the hamstring. In a recent clinical study, researchers compared the effects of both stretching and sacroiliac joint manipulation on the hamstring muscle.
As part of the three-week trial, 15 volunteers who passed the initial criteria and had a passive straight leg raise (SLR) less than or equal to 70 degrees were randomly divided into either the
stretching or stretching/manipulation group. Both groups participated in a stretching exercise two
times a day and were tested twice a week using the passive SLR and back saver sit and reach
(BSSR) tests. During the testing portions, the manipulation group also received bilateral sacroiliac
joint manipulations. A final test was performed one week after the trial ended.
In the end, although members of both groups saw positive results, the manipulation group saw a
greater benefit, as shown by both test results. The participants who received both treatments saw a mean change of almost 11 degrees in the left leg and close to 9 degrees in the right leg in the SLR test over the stretching group. The BSSR test results only showed a little over 1cm change for the right leg and less than 0.5cm improvement for the left leg over the stretching group. Although the results showed a greater improvement for the group that combined stretching and manipulation, the researchers feel more testing must be conducted to confirm that manipulation has a greater effect.
Resource: Fox M. Effect on hamstring flexibility of hamstring stretching compared to hamstring stretching and
sacroiliac joint manipulation. Clinical Chiropractic 2006;9:21-32
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Wait-and-See approach to Earaches
For many MDs, the first response to childhood acute otitis media (AOM) is a signed prescription for any one of the many antibiotics currently available. The frequency of past infections or the urgency of the current one do not seem to go into their decision. This automatic response has
spurred some researchers to explore alternatives to the "take this every six hours" treatment. A recent study by the American Medical Association shows that the wait-and-see prescription (WASP) approach could create a reduction in the over-prescription of antibiotics.
The year-long trial was conducted on 283 children between the ages 6 and 12 who were randomly selected for either the WASP group or the control group at the Yale- New Haven Hospital in New Haven, Conn. After the diagnosis of AOM was made, the children in the control group were given a standard prescription for an antibiotic that would expire in three days. The parents of children in the WASP group were also given similar prescriptions, but were told not to fill them unless their child did not show improvement within 48 hours.
In the WASP group, 62 percent of the parents did not fill the prescriptions, compared to only 13 percent in the control group. The researchers concluded that the WASP approach could substantially reduce the unnecessary use of antibiotics in children.
Spiro D, Tay K, Arnold D, et al. Wait-and-see prescription for the treatment of acute otitis media: a randomized controlled trial. Journal of the American Medical Association 2006;296(10):1235-1241
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Dr. Razvan Ilie
Chiropractor
4611 Freeport Blvd. Suite 3
Sacramento, CA 95822
(916)-451-7655
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