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Evidence-based chiropractors know that they must employ and continually refine “best practices” to obtain great clinical outcomes. ChiroUp regularly scours freshly published literature to mine out new clinical pearls and “best practice” data. The following up-to-date chiropractic research review offers a dozen new studies that impact our patients and practices.

The first two citations pertain to a complaint that generates more than four million doctor visits each year- shoulder pain. See what the latest studies reveal and as a bonus, download the popular guidebook Mastering the Rotator Cuff.

1. A study of over 300 patients with subacromial shoulder pain demonstrated that arthroscopic surgery, with or without decompression, delivered no clinically significant outcome improvement when compared to no treatment.

Beard DJ, Rees JL, et. al. Arthroscopic subacromial decompression for subacromial shoulder pain (CSAW): a multicentre, pragmatic, parallel group, placebo-controlled, three-group, randomised surgical trial. Lancet 2017 Nov 20. pii: S0140-6736(17)32457-1. [Epub ahead of print]


2. A systematic review published in the British Journal of Sports Medicine found: “Athletes with scapular dyskinesis have 43% greater risk of developing shoulder pain than those without scapular dyskinesis.”

Hickey D, Solvig V, Cavalheri V, et al Scapular dyskinesis increases the risk of future shoulder pain by 43% in asymptomatic athletes: a systematic review and meta-analysis Br J Sports Med 2018;52:102-110.

For the latest information concerning the diagnosis and management of shoulder pain, Download the valuable guidebook “Mastering the Rotator Cuff”. This illustrated guide describes the most sensitive tests, most effective treatments, and best exercises for resolving shoulder complaints.




3. Cervical spine mobilization improves range of motion and induces “immediate headache relief” in patients with cervicogenic headache.

Malo-Urriés, Miguel et al. Immediate Effects of Upper Cervical Translatoric Mobilization on Cervical Mobility and Pressure Pain Threshold in Patients With Cervicogenic Headache: A Randomized Controlled Trial. JMPT, Volume 40, Issue 9 , 649 – 658


4. A new study in the European Spine Journal found that chiropractic treatment of acute LBP carries no excess risk of lumbar disc herniation vs. traditional medical care by a PCP: “Both chiropractic and primary medical care were associated with an increased risk for acute LDH requiring ED visit and early surgery. Our analysis suggests that patients with prodromal back pain from a developing disc herniation likely seek healthcare from both chiropractors and PCPs before full clinical expression of acute LDH. We found no evidence of excess risk for acute LDH with early surgery associated with chiropractic compared with primary medical care.”

Hincapié, C.A., Tomlinson, G.A., Côté, P. et al. Eur Spine J (2017).


5. A JMPT study identified several LBP outcome predictors: “Specifically, kinesiophobia is predictive of poor treatment outcome in acute LBP. In chronic LBP, older age, low LBP intensity, and higher degrees of depression and LBP-related disability are predictive of poor treatment outcome.”

Adnan, Rahmat et al. Determining Predictive Outcome Factors for a Multimodal Treatment Program in Low Back Pain Patients: A Retrospective Cohort Study JMPT, Volume 40, Issue 9, 659 – 667


6. “Insufficient strength of the deep core musculature may increase a runner’s risk of developing LBP.” This Journal of Biomechanics study demonstrated deep core muscle weakness increases anterior shear loading increased and compressive spinal loading on the lumbar vertebrae. Muscular compensations compounded by the repetition of running may increase risk of muscular fatigue or damage to spinal structures.

Raabe, Margaret E. et al. Biomechanical consequences of running with deep core muscle weakness. Journal of Biomechanics , Available online 6 December 2017:


7. Disc lesions often inhibit a spinal nerve’s ability to move during SLR maneuvers.

Rade M et al. Reduced Spinal Cord Movement With the Straight Leg Raise Test in Patients With Lumbar Intervertebral Disc Herniation. Spine 2017 Aug 1;42(15):1117-1124.


8. A European study demonstrated that a single session of spinal manipulation increased muscle strength (MVC) and corticospinal excitability in elite athletes. “Following manipulation, the increased MVC force lasted for 30 min and the corticospinal excitability increase persisted for at least 60 min.”

Christiansen, T.L., Niazi, I.K., Holt, K. et al. Eur J Appl Physiol (2018).


9. An analysis of 5511 workers compensation cases highlights the value of chiropractic care but raises concerns regarding the role of physiotherapists as gatekeepers. The study found: “those (injured workers) who first saw a chiropractor experienced shorter first episodes of compensation, and the workers who first saw a physiotherapist experienced a longer episode of compensation.” Additionally, “the odds of having a second episode of financial compensation were higher among the workers who first consulted a physiotherapist.”

Blanchette, MA., Rivard, M., Dionne, C.E. et al. J Occup Rehabil (2017) 27: 382.


10. An analysis of the 2012 National Health Interview Survey showed that among the 8.5% of US adults who reported receiving manipulation, most were under age 65 (83.7%), female (56.6%), and white (85.1%).

Forte, Mary L. et al. Functional Limitations in Adults Who Utilize Chiropractic or Osteopathic Manipulation in the United States: Analysis of the 2012 National Health Interview Survey

JMPT, Volume 40, Issue 9 , 668 – 675


11. Patients exhibiting a forward-head posture have impaired cervical muscular function: “Semispinalis capitis had less thickness changes during maximal voluntary isometric contraction of neck extensors in individuals with forward head posture compared with those with normal head posture. This indirectly implies lower activity of this muscle in forward head posture.”

Goodarzi, Fereshte et al. The Effects of Forward Head Posture on Neck Extensor Muscle Thickness: An Ultrasonographic Study. Journal of Manipulative & Physiological Therapeutics , Volume 41 , Issue 1 , 34 – 41


12. Spinal cavitation is “significantly more likely to occur unilaterally, and on the side contralateral to the short-lever applicator contact, during cervicothoracic HVLA thrust manipulation.”

Dunning J, Mourad F, Zingoni A, et al. CAVITATION SOUNDS DURING CERVICOTHORACIC SPINAL MANIPULATION. International Journal of Sports Physical Therapy. 2017;12(4):642-654.


This concurs with three prior studies:

  • Bolton A Moran R Standen C. An investigation into the side of joint cavitation associated with cervical spine manipulation. International journal of osteopathic medicine. 2007;10:88-96.
  • Reggars JW Pollard HP. Analysis of zygapophyseal joint cracking during chiropractic manipulation. J Manipulative Physiol Ther. 1995;18(2):65-71
  • Dunning J Mourad F Barbero M, et al. Bilateral and multiple cavitation sounds during upper cervical thrust manipulation. BMC Musculoskelet Disord. 2013;14:24.


Bonus. The Dunning et. al. study also pointed out: “the cavitation sound is traditionally considered to be an important indicator for the successful technical delivery of an HVLA thrust manipulation. However, four previous studies have suggested that the “audible pop” following HVLA thrust manipulation is not related to the clinical outcomes of pain and/or disability.” 


  • Bialosky JE Bishop MD Robinson ME George SZ. The relationship of the audible pop to hypoalgesia associated with high-velocity, low-amplitude thrust manipulation: a secondary analysis of an experimental study in pain-free participants. J Manipulative Physiol Ther. 2010;33:117-124. 
  • Cleland JA Flynn T Childs JD Eberhart SL. The audible pop from thoracic spine thrust manipulation and its relation to short-term outcomes in patients with neck pain. Journal of Manual and Manipulative Therapy. 2007;15:143-154. 
  • Flynn TW Childs JD Fritz JM. The audible pop from high-velocity thrust manipulation and outcome in individuals with low back pain. J Manipulative Physiol Ther. 2006;29(1):40-45. 
  • Flynn TW Fritz JM Wainner RS Whitman JM. The audible pop is not necessary for successful spinal high-velocity thrust manipulation in individuals with low back pain. Arch Phys Med Rehabil.2003;84:1057-1060. 


ChiroUp automates the delivery of new research and other “best practices” to you and your patients. Pertinent data from the preceding articles have already been incorporated into ChiroUp condition references, lay condition reports, and chiropractic marketing samples. You can practice with confidence knowing that your management tools are consistent with the latest research. If you’re not yet a subscriber, we would love to have you join our team of evidence-based, like-minded providers! Click here to start your free trial today.

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