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research update

Medline contains more than 24 million articles, with almost one million new citations added each year. Keeping up is tough, but ChiroUp makes it easier for you to stay on top of the musculoskeletal literature. Each week our team mines the most relevant chiropractic best practice research to keep you up to date.

Here’s a sampling of 13 studies that we used to update protocols this week. Some studies describe new concepts, while others simply reinforce our current understanding and provide additional support for evidence-based chiropractic practice.


  1. A two year cohort study of 208 patients to determine the diagnostic accuracy of 15 different diagnostic tests for rotator cuff tear concluded: the Jobe test (88% sensitivity, 62% specificity) and Full can test (70% specificity, 81% sensitivity) had high diagnostic utility for supraspinatus tears, and Hornblower sign (96% specificity) performed well for infraspinatus tears. The external rotation lag sign performed at 0 degrees of shoulder abduction demonstrated 98% specificity for infraspinatus tear. Prior research suggested that the external rotation lag sign performed at 20 degrees of shoulder abduction demonstrated high sensitivity and specificity for supraspinatus involvement.

Jain NB, et al. The Diagnostic Accuracy of Special Tests for Rotator Cuff Tear: The ROW Cohort Study. Am J Phys Med Rehabil 96 (3), 176-183. 3 2017. 

  1. In a randomized clinical trial of shoulder impingement syndrome patients, adding cervicothoracic manipulation to exercise therapy led to greater improvements in pain and range of motion compared to performing home exercise alone. 

Vinuesa-Montoya, Sergio et al. A Preliminary Randomized Clinical Trial on the Effect of Cervicothoracic Manipulation Plus Supervised Exercises vs a Home Exercise Program for the Treatment of Shoulder Impingement. Journal of Chiropractic Medicine , June 2107, Volume 16 , Issue 2 , 85 – 93

  1. “Running does not appear to be detrimental to the knees. There is no increased risk of symptomatic knee OA among self-selected runners compared with non-runners in a cohort recruited from the community.” 

Lo GH, et al Is There an Association Between a History of Running and Symptomatic Knee Osteoarthritis? A Cross-Sectional Study From the Osteoarthritis Initiative. Arthritis Care Research 2017 Feb;69(2):183-191.

  1. In patients with tension-type headache, the combination of neural mobilization and soft tissue techniques induces significant improvement of pain and function. (Check out this prior blog video demonstration) 

Ferragut-Garcías, Alejandro et al. Effectiveness of a Treatment Involving Soft Tissue Techniques and/or Neural Mobilization Techniques in the Management of Tension-Type Headache. Archives of Physical Medicine and Rehabilitation , Volume 98 , Issue 2 , 211 – 219.e2

  1. Migraine patients harbor trigger points in the SCM, upper trapezius, and/or splenius capitis that, when activated, can reproduce migraine headache. 

Lidiane L. Florencio; Gabriela N. Ferracini, et al. Active Trigger Points in the Cervical Musculature Determine the Altered Activation of Superficial Neck and Extensor Muscles in Women With Migraine. The Clinical Journal of Pain. 33(3):238–245, MAR 2017 

  1. A systematic review on the incidence of serious adverse events following lumbopelvic spinal manipulative therapy found; “…only anecdotal cases, so causation cannot be inferred. Similar risks of adverse events occur with exercise compared with manual therapy; risk is lower comparing manual therapy with drugs.”

Hebert, JJ, Stomski, NJ, French, SD, and Rubinstein, SM. Serious adverse events and spinal manipulative therapy of the low back region: a systematic review of cases. J Manipulative Physiol Ther. 2015; 38: 677–691

  1. A systematic review: Best Practices for Chiropractic Care for Older Adults, produced several clinical pearls:
  • Advanced age alone is not necessarily a clinical indication for diagnostic imaging.
  • Conventional radiographs may be indicated in cases of clinically suspected trauma-induced injury, such as fracture or dislocation, and in cases of suspected compression fracture (even in absence of significant trauma), as in patients with spinal pain that is not related to posture or position. Radiographs should also be considered in patients who fail to respond to an initial brief trial of chiropractic care.
  • Older adults often have significant musculoskeletal degeneration with chronic symptoms which may benefit from supportive management in the form of periodic evaluation and interventions that enable the older adult to maintain functional activities.
  • Regarding safety: The data indicated that a higher incidence of adverse events is not associated with SMT as compared with other techniques or sham interventions.
  • The consensus identified a useful list of Red Flags for geriatric patients.

Hawk, Cheryl et al. Best Practices for Chiropractic Care for Older Adults: A Systematic Review and Consensus Update. Journal of Manipulative & Physiological Therapeutics , Volume 40 , Issue 4 , 217 – 229

  1. Obese women who exercise during pregnancy experience significantly shorter labor than non-exercisers. This effect is more pronounced in multiparous women. 

Tinius, Rachel A., Alison G. Cahill, and W. Todd Cade. “Impact of Physical Activity during Pregnancy on Obstetric Outcomes in Obese Women.” The Journal of sports medicine and physical fitness 57.5 (2017): 652–659. PMC. Web. 24 May 2017. 

  1. “Manual therapy and surgery had similar effectiveness for improving self-reported function, symptom severity, and pinch-grip force on the symptomatic hand in women with Carpal Tunnel Syndrome.”

Fernández-de-Las-Peñas C, Cleland J, Palacios-Ceña M, Fuensalida-Novo S, Pareja JA, Alonso-Blanco C. The Effectiveness of Manual Therapy Versus Surgery on Self-reported Function, Cervical Range of Motion, and Pinch Grip Force in Carpal Tunnel Syndrome: A Randomized Clinical Trial. Journal of Orthopaedic & Sports Physical Therapy, 2017 Volume:47 Issue:3 Pages:151–161

  1. A meta-analysis concluded that a single, ultrasound-guided, leukocyte rich platelet-rich plasma (LR-PRP) intra-tendinous injection offers benefit for tendinopathy patients.

Fitzpatrick J, et al. The Effectiveness of Platelet-Rich Plasma in the Treatment of Tendinopathy: A Meta-analysis of Randomized Controlled Clinical Trials. The American Journal of Sports Medicine Vol 45, Issue 1, pp. 226 – 233

  1. “There is a distinct correlation between chronic neck pain and functional pulmonary impairments” (i.e., lower maximum inspiratory and expiratory pressures, lower respiratory volumes). 

Amir Hossein Kahlaee; Leila Ghamkhar, et al.  The Association Between Neck Pain and Pulmonary Function: A Systematic Review. American Journal of Physical Medicine & Rehabilitation. 96(3):203–210, MAR 2017

  1. In a related matter, a small pilot study of 12 participants concluded: “A single application of soft tissue manual therapy appears to have the potential to produce immediate clinically meaningful improvements in lung function in patients with severe and very severe COPD.”

Cruz-Montecinos, Carlos et al. “The Immediate Effect of Soft Tissue Manual Therapy Intervention on Lung Function in Severe Chronic Obstructive Pulmonary Disease.” International Journal of Chronic Obstructive Pulmonary Disease 12 (2017): 691–696. PMC. Web. 24 May 2017.

  1. A functional study of biceps activation determined that progressive loading of the biceps brachii is accomplished as follows:

Low load, < 20% MVC (maximum voluntary contraction):

  • arm shake with an Xco-trainer
  • lateral pull-down in pronation
  • chest shake with an Xco-trainer
  • lateral pull-down in supination

Moderate load, 20-50% MVC:

  • pull-up in pronation with Redcord
  • air punch
  • forward flexion in supination
  • pull-up in supination with Redcord
  • inclined biceps curl 

High load, >50% MVC:

  • throwing forward flexion
  • reverse punch

Borms D, et al. Biceps Disorder Rehabilitation for the Athlete: A Continuum of Moderate- to High-Load Exercises. The American Journal of Sports Medicine. Vol 45, Issue 3, pp. 642 – 650


“Best Practice” knowledge is the foundation of our profession’s future success. Together, by practicing evidence-based chiropractic, we can make our profession the undeniable best choice for patients and payors alike. We welcome your suggestions to help improve our knowledge base.

About the Author

Dr. Tim Bertelsman

Dr. Tim Bertelsman


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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