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chiropractic research update

Evidence-based chiropractors know they must employ and continually refine “best practices” to obtain great outcomes. Chiropractic innovators thrive upon new outcome-based studies to advance clinical knowledge and patient education. Peer reviewed literature is the foundation of evidence-based learning; unfortunately transferring that literature into daily clinical practice poses a greater challenge.

ChiroUp automates the delivery of new tests, treatments, exercises, and concepts to you and your patients. Pertinent data from the following 15 new 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.

1. Two-thirds (66.66%) of all lumbar disc herniations will spontaneously reabsorb via conservative care. The authors concluded: “according to our results, conservative treatment may become the first choice of treatment for LDH.”

Ming Zhong, MD, Jin Tao Liu, MD, Hong Jiang, MD, PhD, Wen Mo, PhD, Peng-Fei Yu, MD, Xiao Chun Li, MD, and Rui Rui Xue, MD Incidence of Spontaneous Resorption of Lumbar Disc Herniation: A Meta-Analysis. Pain Physician 2017; 20:E45-E52

Note: If you would like to see what nuclear material looks like in vivo, check out this earlier video of a disc dissection:

2. Vertebral endplate defects (Schmorl’s nodes) inhibit transport of metabolites into the IVD and have a proportionate association to disc degeneration.

Zehra, Uruj et al. Defects of the vertebral end plate: implications for disc degeneration depend on size. The Spine Journal , Volume 17 , Issue 5 , 727 – 737

3. A study of 1271 LBP patients determined that patients with related leg pain and signs of nerve root involvement are considered to have a worse prognosis than patients with LBP alone. Chiropractic clinical outcomes after two weeks varied based upon the characteristics of pain:

Local LBP alone (77% of patients improved)

LBP + pain above the knee (72 %)

LBP + pain below the knee (61%)

LBP + positive nerve tension test (SLR) or abnormal neuro findings (40%)

Similar differences were reported at 3 & 12 months. Average outcomes for chiropractic patients, regardless of pain location, were significantly better that those of GP’s at 2 weeks (74% vs 36%), 3 months (82% vs. 60%), and 12 months (73% vs. 54%).

Hartvigsen L. et al. Leg pain location and neurological signs relate to outcomes in primary care patients with low back pain. BMC Musculoskeletal Disorders 2017, 18:133 DOI: 10.1186/s12891-017-1495-3

4. A systematic review determined “a significant association between early opioid prescription and prolonged work disability” in workers with musculoskeletal disorders.

Carnide N. et al. Early Prescription Opioid Use for Musculoskeletal Disorders and Work Outcomes: A Systematic Review of the Literature. Clin J Pain 2017 Jul;33(7):647-658.

5. A histological investigation performed on 10 cadaveric specimens confirmed “the existence of a connective tissue link between the rectus capitis posterior minor and the dura mater. The biomechanical testing suggests that this tissue link complex can reduce the bulging of the dura mater into the spinal canal, caused during hyperextension, by 53.4%.” 

Venne G. et al. Rectus Capitis Posterior Minor: Histological and Biomechanical Links to the Spinal Dura Mater. Spine 2017 Apr 15;42(8):E466-E473. doi: 10.1097/BRS.0000000000001867.

Note: For more information about myodural bridges and their associated treatment, check out this earlier ChiroUp video on Suboccipital Nerve Flossing:

6. A systematic review on the biochemical effects of SMT concluded: “Various biochemical markers such as substance-P, neurotensin, interleukins, and cortisol modulate pain and inflammation. Spinal manipulation increases substance-P, neurotensin, oxytocin and can alter various biochemical markers. Spinal manipulation therefore may play an important role in pain and or inflammatory disorders.”

Kovanur-Sampath K. et al. Changes in biochemical markers following spinal manipulation-a systematic review and meta-analysis, Musculoskeletal Science and Practice, Volume 29, 2017, Pages 120-131 

7. A survey of more that 34,000 US adults found: “Lifetime and 12-month prevalence of chiropractic use were 24.0% and 8.4%, respectively. There is a growing trend of chiropractic use amongst US adults from 2002 to 2012. Back pain (63.0%) and neck pain (30.2%) were the most prevalent health problems for chiropractic consultations and the majority of users reported chiropractic helping a great deal with their health problem and improving overall health or well-being.”

Adams J. et al. The prevalence, patterns, and predictors of chiropractic use among US adults: Results from the 2012 National Health Interview Survey. Spine Apr 28. doi: 10.1097/BRS.0000000000002218.

8. A systematic review of 12 articles and more than 5400 LBP participants identified three factors that significantly increased risk of developing LBP:

  • restriction in lumbar lateral flexion
  • limited hamstring range of motion
  • diminished lumbar lordosis

Sadler SG, Spink MJ, Ho A, De Jonge XJ, Chuter VH. Restriction in lateral bending range of motion, lumbar lordosis, and hamstring flexibility predicts the development of low back pain: a systematic review of prospective cohort studies. BMC Musculoskeletal Disorders. 2017;18:179. doi:10.1186/s12891-017-1534-0.

9. The scientific journal Systematic Reviews performed an overview of the studies regarding the safety of SMT. The journal found differing outcomes- 54 published systematic reviews concluded SMT was a “safe” treatment and 15 found SMT potentially “harmful”. Not surprisingly, the authors concluded that: “Reviews with good internal validity had a higher chance of expressing that SMT is safe.”

Nielsen SM, Tarp S, Christensen R, Bliddal H, Klokker L, Henriksen M. The risk associated with spinal manipulation: an overview of reviews. Syst Rev. 2017 Mar 24;6(1):64.

10. A systematic review concerning pain during therapeutic exercise determined:

“Protocols using painful exercises offer a small but significant benefit over pain-free exercises in the short term.” This does not imply that clinicians should seek to generate unnecessary pain, rather the implementation of appropriate painful exercises, i.e. eccentric loading for tendinopathy, may be acceptable.

Smith BE. et al. Should exercises be painful in the management of chronic musculoskeletal pain? A systematic review and meta-analysis. Br J Sports Med. 2017 Jun 8. pii: bjsports-2016-097383. doi: 10.1136/bjsports-2016-097383. [Epub ahead of print]

11. Manual therapy, exercise, and low-level laser are appropriate interventions for shoulder pain arising from impingement, rotator cuff pathology, and adhesive capsulitis.

Hawk C. Systematic Review of Nondrug, Nonsurgical Treatment of Shoulder Conditions. J Manipulative Physiol Ther  2017 Jun ;40(5):293-319

12. “The tear size of symptomatic rotator cuff tears progressed in 47% of the shoulders during a mean of 19 months, and the speed of progression was 3.8 mm/year in length and 2.0 mm/year in width. The risk factors for tear progression were:

  • a medium-sized tear
  • a full-thickness tear
  • smoking”

Yamamoto N. et al. Risk Factors for Tear Progression in Symptomatic Rotator Cuff Tears: A Prospective Study of 174 Shoulders. The American Journal of Sports Medicine. June-13-2017.

13. Dehydration is common in competitive athletes and has the ability to significantly impact performance. Dehydrated college golfers required, on average, 4 additional strokes to complete a round vs. their well-hydrated counterparts.

Magee PJ. et al. High Prevalence of Dehydration and Inadequate Nutritional Knowledge Among University and Club Level Athletes. International Journal of Sport Nutrition and Exercise Metabolism 2017 27:2, 158-168 

14. A randomized clinical trial comparing outcomes for neck pain patients treated with manual joint mobilization vs. physical therapy demonstrated similar outcomes for both groups. However, the manual therapy group required significantly fewer treatment sessions (6.1 vs. 10.0 treatments at 52 weeks).

Groeneweg R, van Assen L, Kropman H, et al. Manual therapy compared with physical therapy in patients with non-specific neck pain: a randomized controlled trial. Chiropractic & Manual Therapies. 2017;25:12. doi:10.1186/s12998-017-0141-3.

15. Breaking news! Adults who read nutrition labels have a lower risk of developing diabetes.

Kollannoor SG et al. Nutrition label use is associated with lower longer-term diabetes risk in US adults. Am J Clin Nutr 2017 105: 5 1079-1085. doi: 10.3945/ajcn.116.145359. Epub 2017 Mar 29.

Bonus: Another no-brainer: Clinicians who read ChiroUp reviews & use the associated protocols achieve better clinical results. It doesn’t require a systematic review to determine that regardless of the game, those who take time to invest in their future achieve better outcomes. And outcomes will soon become the primary determinant of our practice incomes. Taking your hands off of the wheel results in undesired consequences regardless if the situation involves your health, your relationships, or your clinical skills. Chiropractic college was only the start of our education. Data changes rapidly and so must our beliefs and clinical protocols. Providers who keep their hands on the wheel and stay on top of their clinical A-game will be rewarded. ChiroUp is proud to be your partner in chiropractic clinical excellence and practice success.

About the Author

Dr. Tim Bertelsman

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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