Evidence-based chiropractors know that they must employ and continually refine “best practices” to obtain great outcomes. ChiroUp continually scours freshly published literature to mine out new clinical pearls and “best practice” data. The following up-to-date chiropractic research review offers 10 new studies that impact our patients and practices.
1.“While NSAIDs are commonly used in the treatment of muscle strains and are generally effective in treating the pain associated with these injuries, numerous studies have shown that blocking the COX enzymes after muscle injury generally inhibits biological processes associated with muscle regeneration, leading to long-term deficits in muscle function.”
2. The American Journal of Radiology published a best practice guideline for imaging chronic shoulder pain. The following plain film views are recommended for the majority of chronic shoulder presentations:
- AP (performed with shoulder internal rotation)
- Grashey, aka Neer AP or True AP (performed with shoulder external rotation)
- Lateral axillary
- Arch/ Rockwood- if evaluation of the acromion is desired for impingement
3. The same AJR guidelines identified the most appropriate advanced imaging when plain films are insufficient. For patients with a suspected rotator cuff tear or biceps tendinopathy, diagnostic ultrasound performed by a skilled technologist has sensitivity and specificity equivalent to that of MRI and may be the preferred advanced imaging modality.
MR arthrography is also very helpful for assessing the glenoid labrum. The addition of abducted and externally rotated images can further improve identification of labral tears over standard images. MR arthrography is not routinely recommended for diagnosing rotator cuff tears as it has marginal benefit over plain MRI or Ultrasound.
4. In patients with suspected lumbar spinal segmental instability, i.e. lumbar degenerative spondylolisthesis, etc, a lateral slump sitting dynamic radiograph has equal ability to identify displacement and superior ability to identify angular ROM when compared to conventional flexion views.
The slump sitting view is performed by first adjusting a chair so that the patient can sit with their hips and knees bent to 90 degrees. The patient sits laterally, adjacent to the bucky and is then asked to slump forward and place their palms under their distal thighs. The collimation includes the entire lumbar spine with the central ray directed at L3. The source image distance (SID) is 40 inches.
Hey, Hwee Weng Dennis et al. Slump sitting X-ray of the lumbar spine is superior to the conventional flexion view in assessing lumbar spine instability. The Spine Journal , Volume 17 , Issue 3 , 360 – 368
5. Spine published an interesting study on the effect of age and gender on cervical spine lordosis:
“The total cervical lordosis of males and females was similar. Males had smaller upper cervical lordosis (FM-C3) and higher lower cervical lordosis (C3-C7) than females. The sum of vertebral body wedging of males and females is kyphotic (anterior height smaller than posterior height). Males had more lordotic intervertebral discs than females. Half of the adults (51%) had lordotic cervical spine, 41% had straight spine, and less than 10% had double curve or kyphotic spine. Children had similar total cervical lordosis (FM-C7) to adults. The sum of vertebral body wedging for children was more kyphotic-by 7°-than that of adults, whereas the sum of intervertebral disc wedging in children was more lordotic-by11°-than that of adults. Seventy-one percent of the children had lordotic cervical spine, 23% had straight spine, and less than 6% had double curve spine. Gender differences are already apparent in children as girls had higher upper cervical lordosis (FM-C3; C1-C3) than boys do.”
6. A sample of 8820 workers showed that those utilizing CAM practitioners experienced significantly fewer lost workdays and improved health.
7.In patients with Patellofemoral Pain Syndrome, combining manual therapy with physical therapy “reduces pain and improves function, especially when applied on the full kinetic chain and when strengthening hip and knee muscles.”
Espí-López, Gemma Victoria et al. Effectiveness of Manual Therapy Combined With Physical Therapy in Treatment of Patellofemoral Pain Syndrome: Systematic Review Journal of Chiropractic Medicine , Volume 16 , Issue 2 , 139 – 146
To learn more about the functional assessment for the lower chain, check out this Exceptional Outcomes video on Hip Abductor Weakness.
8. In patients with chronic low back pain, four 40-minute sessions of myofascial release produced “significant improvement in both pain and disability”.
9. An April 2017 paper defines the relationship of scapular dyskinesis to shoulder pathology: “Patients with shoulder impingement syndrome and shoulder instability had an increased protraction, lesser upward rotation and increased internal rotation during scapular plane elevation.” These patients also “had greater scapular posterior tilt and external rotation during shoulder abduction.”
Keshavarz, Roshanak et al. The role of scapular kinematics in patients with different shoulder musculoskeletal disorders: A systematic review approach. Journal of Bodywork and Movement Therapies , Volume 21 , Issue 2 , 386 – 400
Check out this 15 minutes to clinical excellence tutorial for more information about scapular dyskinesis.
10. Following formal in-office rehab, neck pain patients scores for pain and disability correlated to their adherence to a home exercise program and those who participated in a home-based telemedicine program were more likely to perform their home exercises (87% vs 65%).
Providers who use tools for patient compliance achieve better outcomes! ChiroUp automates the delivery of exercises and other “best practices” to you and your patients. Pertinent data from the preceding articles has already been incorporated into ChiroUp condition references, lay condition reports, and your chiropractic marketing samples. You can practice with confidence knowing that your management tools are consistent with the latest research.
About the Author
Dr. Tim Bertelsman
DC, CCSP, DACO
Dr. Tim Bertelsman graduated with honors from Logan College of Chiropractic and has been practicing in Belleville, IL since 1992. He has lectured nationally on various clinical and business topics and has been published extensively. He has served in several leadership positions within the Illinois Chiropractic Society and currently serves as President of the executive board.
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