Top Chiropractic Research from 2023 Q1 (January-March)
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Medline contains over 28 million references, with over one million new citations added yearly. Keeping up is tough, but the ChiroUp research team makes it easier by scouring and summarizing freshly published literature to mine out fresh chiropractic clinical pearls and chiropractic best practice data. The following up-to-date chiropractic research review offers ten new studies impacting our patients and practices.
1. WHO Research Recommends SMT
The World Health Organization commissioned an analysis to develop recommendations from high-quality clinical practice guidelines for patients with non-specific low back pain with and without radiculopathy:
“Recommended interventions included:
1) Education about recovery expectations, self-management strategies, and maintenance of usual activities.
2) Multimodal approaches incorporating education, exercise, and spinal manipulation.
3) NSAIDs combined with education in the acute stage.
4) Intensive interdisciplinary rehabilitation that includes exercise and cognitive/behavioral interventions for persistent pain.”
Deeper Dive: SMT is endorsed by multiple authoritative LBP clinical practice guidelines. Let’s spread the word with ChiroUp’s Natural Solution toolkit, including a potent video, newsletter, and infographic.
Zaina F, Côté P, Cancelliere C, Di Felice F, Donzelli S, Rauch A, Verville L, Negrini S, Nordin M. A systematic review of Clinical Practice Guidelines for persons with non-specific low back pain with and without radiculopathy: Identification of best evidence for rehabilitation to develop the WHO's Package of Interventions for Rehabilitation. Archives of Physical Medicine and Rehabilitation. 2023 Mar 23. Link
2. SMT-Related Adverse Events "Very Rare"
"This study examined the incidence and severity of adverse events (AEs) of patients receiving chiropractic spinal manipulative therapy (SMT). We identified patients with SMT-related AEs from January 2017 through August 2022 across 30 chiropractic clinics. AEs were independently graded 1–5 based on severity (1-mild, 2-moderate, 3-severe, 4-life-threatening, 5-death).
Among 960,140 SMT sessions for 54,846 patients, 39 AEs were identified, two were grade 3, both of which were rib fractures occurring in women age> 60 with osteoporosis, while none were grade 4, yielding an incidence of grade 3 AEs of 0.21 per 100,000 SMT sessions. There were no AEs related to stroke or cauda equina syndrome. In this study, severe SMT-related adverse events were reassuringly very rare."
Editors note: An unrelated study in March found: "spinal manipulations applied to the upper cervical spine in participants with chronic nonspecific neck pain did not appear to alter blood flow parameters of the vertebral artery and internal carotid arteries."
Deeper Dive: Use ChiroUp’s Safety of Manipulation infographic to educate patients and healthcare providers. And, if you’ve not already done so, register today for the ChiroUp SMT & Stroke webinar featuring Drs Tom Michaud and James Demetrious.
Chu EC, Trager RJ, Lee LY, Niazi IK. A retrospective analysis of the incidence of severe adverse events among recipients of chiropractic spinal manipulative therapy. Scientific Reports. 2023 Jan 23;13(1):1254. Link
3. Sciatica Systematic Reviews: SMT Validated, But PT is Not
A European Spine Journal systematic review of 18 trials with 2699 sciatica participants concluded:
"For disability [and pain,] there was no difference in the short, medium, or long term between physiotherapy and control interventions. Based on currently available... data, there is inadequate evidence to make clinical recommendations on the effectiveness of physiotherapy interventions for people with clinically diagnosed sciatica."
However, a 2015 Spine Journal systematic review concluded that five interventions were effective for sciatica: Manipulation, Acupuncture, Non-opioid analgesia, Epidural injections, and Disc surgery.
Deeper Dive: PCPs need to know that DCs are one of the few proven options for sciatica. Each month, ChiroUp Premium subscribers receive a PCP newsletter to relay the facts that change attitudes and referral patterns. If you’re not yet a Premium subscriber, upgrade your account today, or contact Becki@ChiroUp.com for more information or a sample newsletter.
Dove L, Jones G, Kelsey LA, Cairns MC, Schmid AB. How effective are physiotherapy interventions in treating people with sciatica? A systematic review and meta-analysis. European Spine Journal. 2022 Dec 29:1-7. Link
4. New Test For Lateral Epicondylopathy
"The [Free test] presented very good sensitivity and good accuracy in patients with lateral elbow tendinopathy with US diagnostic confirmation of intrasubstance tear. Overall, the Free test’s accuracy (0.79) was superior to the presence of nocturnal pain (0.72) and positive sign in the Cozen’s test (0.61).”
Deeper Dive: ChiropUp subscribers can review the new Free test in their Clinical Evaluations library.
Greene C, Droppelmann G, García N, Jorquera C, Verdugo A. A New Test for the Advanced Diagnosis of Lateral Elbow Tendinopathy with Concomitant Intrasubstance Tear: Failure to Resist Extension Effort (the Free Test). Orthopedic Research and Reviews. 2022 Dec 31:495-503. Link
5. Inversion Table Recommendations
"Inversion table therapy (ITT) is a form of spinal traction which is thought to have a role in relieving low back pain due to the gravity-facilitated traction of the spine which distracts the lumbar vertebrae. However, ITT is not without risk. According to the Food and Drug Administration (FDA) Medical Device Reporting Events Database, ITT has resulted in serious injuries including spinal cord injury, fractures, lacerations, and death."
Deeper Dive: Educate your patients using the updated ChiroUp Inversion Table infographic, which can be found in the forms library by searching “Inversion Tables”.
Kassay A, Soliman MA, Jhawar BS. Recommendations for inversion table therapy. Disability and Rehabilitation. 2022 Nov 28:1-4. Link
6. SNAG Beats SMT for Cervicogenic Headache
"The study [of 84 patients] concluded that [Mulligan’s sustained natural apophyseal glide (SNAG)] provided better outcomes in cervicogenic headache than those of spinal manipulation therapy and conventional massage therapy."
Editors note: All therapies, including spinal manipulation, in this small study, were provided by "licensed physical therapists with 15–20 years of clinical experience in manual and manipulation therapy."
Deeper Dive: Subscribers can review the SNAG exercise here or check out this ChiroUp SNAG blog.
Nambi G, Alghadier M, Ebrahim EE, Vellaiyan A, Tedla JS, Reddy RS, Kakaraparthi VN, Aldhafian OR, Alshahrani NN, Saleh AK. Comparative Effects of Mulligan’s Mobilization, Spinal Manipulation, and Conventional Massage Therapy in Cervicogenic Headache—A Prospective, Randomized, Controlled Trial. InHealthcare 2022 Dec 29 (Vol. 11, No. 1, p. 107). MDPI. Link
7. Patellofemoral Pain: Rehab The Hip
"The aim of this study was to compare the effect of exercises focusing on the proximal [hip] and distal [foot/ankle] joints to knee and knee local exercises on the Patellar location in athletes with patellofemoral pain ...The findings of the present study indicated further improvement in patellar location and knee pain in the proximal [hip] group. Accordingly, proximal group [hip] exercises can improve the pain and performance of athletes with Patellofemoral Pain by patellar relocation to the normal position."
Editors note: An unrelated study in December showed “... strong evidence suggests that hip strength is weaker in individuals with Patellofemoral Pain Syndrome”
Deeper Dive: Check out this ChiroUp Fifteen Minutes to Clinical Excellence Tutorial on Hip Abductor Weakness.
Hossein HS, Sara A, Hasan D. The effect of three types of exercise programs on the patella location in athletes with patellofemoral pain. The Knee. 2023 Mar 1;41:97-105. Link
8. Thoracic Manipulation Eases Neck Pain
A Journal of Pain research systematic review concluded:
“Thoracic spine manipulation was effective in reducing pain and neck disability in all adults with chronic mechanical neck pain compared to other interventions."
Tsegay GS, Gebregergs GB, Weleslassie GG, Hailemariam TT. Effectiveness of Thoracic Spine Manipulation on the Management of Neck Pain: A Systematic Review and Meta-Analysis of Randomized Control Trials. Journal of Pain Research. 2023 Dec 31:597-609. Link
9. Lateral Epicondylopathy: Manipulate the Wrist
“The evidence is convincing that wrist joint manipulations positively affect pain in the short term, compared to comparison groups in the management of lateral epicondylitis.”
Deeper Dive: We’re on it! ChiroUp is teaming up with our friends at MPI to create a wrist manipulation tutorial video related to this brand-new study. Watch for details in a blog later this month!
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In the interim, ChiroUp subscribers can review the current best-practice protocol for Lateral epicondylopathy or any of the other 115 diagnoses 24/7 from their Clinical Skills > Condition Reference tab.
Eapen C, Rosita R, Sohani MS, Patel VD. A systematic review of the effectiveness of wrist manipulative therapy in patients with lateral epicondylitis. Journal of Hand Therapy. 2023 Mar 12. Link
10. Exercise Eases Pregnancy-Related LBP & Sciatica
"The exercise group [of 93 pregnant women] increased 21.9 mm less [in] the VAS [for] low back pain and 12.9 mm less [in] the VAS sciatica score"
ChiroUp subscribers can deliver activity advice via the ChiroUp Exercise Recommendations for Pregnancy infographic, which can be found in the forms library by searching “Pregnancy”.
Aparicio VA, Marín‐Jiménez N, Flor‐Alemany M, Acosta‐Manzano P, Coll‐Risco I, Baena‐García L. Effects of a concurrent exercise training program on low back and sciatic pain and pain disability in late pregnancy. Scandinavian Journal of Medicine & Science in Sports. 2023 Mar 17. Link
Bonus - No S#!t study of the quarter: Home Exercise Improves MSK Outcomes
"Adherence to a HEP [home exercise program] was associated with superior functional outcomes compared to non-adherence.”
And an unrelated study in the World Neurosurgery Journal concluded, "YouTube videos were found to have low overall quality. Physicians should be cognizant about information sources readily available to patients as they may influence patient expectations and preconceptions."
Deeper dive: You need a trusted resource to educate patients and deliver exercises — we're it!
Himler P, Lee G, Rhon DI, Young JL, Cook CE, Rentmeester C. Understanding barriers to adherence to home exercise programs in patients with musculoskeletal neck pain. Musculoskeletal Science and Practice. 2023 Jan 21:102722. Link
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