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The research is out! Our ChiroUp data collection team reviewed more than a thousand abstracts last month to mine out the essential, best practices that will impact your practice today. 

Review the latest news:

✔ Manipulation Helps Migraines
✔ Coronary Artery Disease Linked to CTS
✔ Therapeutic Tape Reduces LBP & Disability
✔ What’s the Best Position for Shoulder Exercise?
✔ Gyroscope Exercise for Upper Extremity Rehab
✔ Skipping Breakfast Increases Diabetes Risk

Check out the top 21 summaries and clinical pearls that will enhance your assessment and management.

 

First, Let’s Celebrate the Effectiveness of Our Primary Tool

1. Researchers from Harvard Medical School, Brigham & Women’s Hospital, and Palmer College of Chiropractic performed a systematic review of the effectiveness of SMT for migraine and concluded that: “Spinal manipulation may be an effective therapeutic technique to reduce migraine days and pain/intensity…We observed that spinal manipulation reduced migraine days as well as migraine pain/intensity.”

Rist PM et al. The Impact of Spinal Manipulation on Migraine Pain and Disability: A Systematic Review and Meta-Analysis. Headache. 2019 Apr;59(4):532-542.

2. A systematic review of 47 randomized trials found that cervical manipulation is safe and effective:

  • An effect in favor of thrust manipulation plus exercise compared to an exercise regimen alone for a reduction in pain and disability.
  • Of the 25 studies (that evaluated adverse events), either no or minor events occurred.
  • According to the published trials reviewed, manipulation and mobilization appear safe.  

Coulter ID et al. Manipulation and Mobilization for Treating Chronic Nonspecific Neck Pain: A Systematic Review and Meta-Analysis for an Appropriateness Panel. Pain Physician. 2019 Mar;22(2):E55-E70.

3. Researchers have found that SMT may be a natural drug: “The mechanical stimuli provided through a cervical spinal manipulation may modify neuropeptide expression by immediately increasing the serum concentration of nociception-related (inhibiting) biomarkers.”

Lohman EB et al. The immediate effects of cervical spine manipulation on pain and biochemical markers in females with acute non-specific mechanical neck pain: a randomized clinical trial. J Man Manip Ther. 2018 Dec 11:1-11.

4. “In patients with cervical radiculopathy, one session of thoracic manipulation may result in improvements in pain disability, cervical ROM, and deep neck flexor endurance.”

Young IA et al. Immediate and Short-term Effects of Thoracic Spine Manipulation in Patients With Cervical Radiculopathy: A Randomized Controlled Trial. J Orthop Sports Phys Ther. 2019 May;49(5):299-309.

5. “Patients with acute and chronic back pain reported statistically significant improvements in patient-reported outcomes four weeks after initiating chiropractic care.” 

Gedin F et al. Patient-reported improvements of pain, disability, and health-related quality of life following chiropractic care for back pain – A national observational study in Sweden. J Bodyw Mov Ther. 2019 Apr;23(2):241-246.

Now, Let’s Hone the Other Aspects of Our Care

 

History

6. “Patients presenting with nonspecific ear fullness may have TMD.”

Lee SY et al. Clinical implications of magnetic resonance imaging in temporomandibular disorders patients presenting ear fullness. Laryngoscope. 2018 Jul;128(7):1692-1698.

7. A 14-year study of 70,622 patients with coronary artery disease (CAD) and 70,622 patients  without CAD found: “A significant positive correlation was observed between CAD and a previous diagnosis of carpal tunnel syndrome.”

Editor’s note- no surprise since CTS also results from ischemia (via nerve compression or tension)

Chang YC, Chiang JH, Lay IS, Lee YC. Increased Risk of Coronary Artery Disease in People with a Previous Diagnosis of Carpal Tunnel Syndrome: A Nationwide Retrospective Population-Based Case-Control Study. Biomed Res Int. 2019;2019:3171925. Published 2019 Mar 3.

Assessment

8. “The cervicothoracic differentiation test (CTDT) is a specific test with significant diagnostic utility to identify individuals who will experience immediate pain relief following thoracic manipulation. The CTDT should be considered during the clinical decision-making process when treating individuals with neck pain.”

Want to learn more about the cervicothoracic differentiation test? Check out Dr. Steele’s recent video blog.

Swanson BT et al. Reliability and diagnostic accuracy of cervicothoracic differentiation testing and regional unloading for identifying improvement after thoracic manipulation in individuals with neck pain. Musculoskelet Sci Pract. 2019 Feb;39:80-90.

9. “Results showed that a Kamath and Stothard carpal tunnel questionnaire (CTQ) score:

  • < 3:  correlated 100% to negative nerve conduction study
  • 5+:  90% of patients had a positive nerve conduction study
  • 3-4:  the nerve conduction study could not be reliably predicted

“These findings suggest that the Kamath and Stothard CTQ is a useful tool in determining which patients may require negative nerve conduction study. We suggest that only patients with a CTQ score of 3 or 4 and with equivocal signs and symptoms should undergo negative nerve conduction study.”

Sangram BS et al. Can we accurately predict nerve conduction study outcome using a carpal tunnel syndrome questionnaire? Surgeon. 2019 Mar 29. pii: S1479-666X(19)30031-9.

10. Neurosurgical Focus Journal: “The Timed Up and Go (TUG) test is a quick and easily applicable tool that reliably measures objective functional impairment in patients with lumbar spine stenosis.”

TUG Test: Patients wear their regular footwear and can use a walking aid if needed. Begin by having the patient sit back in a standard armchair and identify a line 3 meters, or 10 feet away, on the floor. When I say “Go,” I want you to:

  1. Stand up from the chair.
  2. Walk to the line on the floor at your normal pace.
  3. Turn.
  4. Walk back to the chair at your normal pace.
  5. Sit down again.

On the word “Go,” begin timing. Stop timing after patient sits back down. Record time.

Stand by the patient for safety.

Stienen MN et al. Objective functional assessment using the “Timed Up and Go” test in patients with lumbar spinal stenosis. Neurosurg Focus. 2019 May 1;46(5):E4. doi: 10.3171/2019.2.FOCUS18618.

11. “Posterior interosseous nerve syndrome is a compressive neuropathy of the posterior interosseous nerve which innervates the extensor compartment of the forearm. It usually has an insidious onset, often presenting with weakness in finger and thumb extension. However, there should be preservation in wrist extension due to the radial nerve innervated extensor carpi radialis longus.  It is often self-limiting and resolves with conservative measures.”

Here are 3 tests to help identify Posterior Interosseous/ Radial nerve irritation:

Wheeler R et al. Posterior Interosseous Nerve Syndrome. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Apr 19.

12. Who moved L4? A new study has shown greater accuracy in spinal enumeration when the spinal level at the landmark of the iliac crests was identified as L3 (or L3/4), as opposed to the conventional landmark rule that the spinal level of the palpated iliac crests is L4.

Cooperstein R et al. Would adopting a revised landmark rule for the spinal level of the iliac crests improve the accuracy of lumbar level identification?  Can Chiropr Assoc. 2019 Apr;63(1):26-35.

Treatment

13. In a cumulative review of more than 1 million acupuncture treatments, the risk of a serious adverse event with acupuncture was estimated to be 0.05 per 10,000 treatments. Most common side effects were bleeding at the needle site and localized needling pain. Similar findings were also reported in 229,230 patients with more than 2 million visits.

Mao JJ et al. Acupuncture for Chronic Low Back Pain: Recommendations to Medicare/Medicaid from the Society for Acupuncture Research. J Altern Complement Med. 2019 Mar 30.

14. “In patients with LBP, KinesioTape (KT) with or without tension reduces pain three days after its application. Additionally, when applied with tension, it improves disability.”

KT was positioned in the form of “I” over the erector spinae muscles bilaterally. The tape was applied with the participants seated, with the spine in anatomical position for the application of the anchor, which was positioned in the sacral region without tension. The participants were then asked to perform trunk flexion and rotation to the opposite side to the application of the tape with a slight stretch of approximately 10 to 15%, which was then repeated on the opposite side. The tape was fixed with tension from the posterior superior iliac spine to T12 with a final anchor point fixed directly above T12.

15. “Friction massage of the pronator teres muscle helps restore ROM of the forearm supination and immediately increases supinator muscle strength. This technique can be used as an intervention method to improve muscle strength in patients with limited supination ROM. 

Check out this related video demonstrating STM of the pronator teres. Friction massage would be performed near the tendon’s origin on the medial epicondyle.

16. “In patients with chronic low back pain, adding connective tissue manipulation to standard care shows superiority… for improving pain, increasing spinal mobility, and well-being.”

Celenay ST et al. Adding connective tissue manipulation to physiotherapy for chronic low back pain improves pain, mobility, and well-being: a randomized controlled trial. J Exerc Rehabil. 2019 Apr 26;15(2):308-315.

Exercise

17. Tennis elbow and golfer’s elbow are associated with decreased eccentric peak torque of shoulder external rotators and abductors compared with those of healthy athletes. This tends to decrease the external stability of the shoulder joint and put high stress on the distal joints of the upper kinetic chain.

Nabil BA et al. The Impact of Tennis and Golfer’s Elbow on Shoulder External Rotators and Abductors Peak Torque. J Sport Rehabil. 2019 Apr 29:1-24. 

18. “Due to the significant effects of the “gyroscopic device” mediated exercise on grip strength, wrist and shoulder strength and proprioception, and performance of the upper extremity, use of the exercise (three sessions per week over 8 weeks) can be recommended for subjects with impingement syndrome or tennis elbow impairment in measured variables.”

19. Researchers sought to determine the most appropriate posture for early infraspinatus strengthening. “The activity of the infraspinatus can be increased gradually during rehabilitation by beginning in the supine position, which assures low activity of the upper trapezius and biceps brachii. Exercise with the shoulder adducted in the supine position can strengthen the infraspinatus gradually and avoid compensatory mobility.”

Sasaki Set al. Electromyographic analysis of infraspinatus and scapular muscles during external shoulder rotation with different weight loads and positions. J Orthop Sci. 2019 Jan;24(1):75-80.

ADL’s

20. JAMA weighs in on the benefits of a low-carb diet such as Atkins and keto: “In the short-term, if a person (is significantly overweight), almost anything that would cause weight loss would be beneficial,” “In the long-term, it’s a different story. Virtually anyone who wants to lower their risk of a variety of ailments, including cardiovascular disease and multiple types of cancer should consume more, not fewer, carbs, as long as they’re good carbs, i.e., fiber-rich whole grains, legumes, fruits, and vegetables.”

Rubin R. High-Fiber Diet Might Protect Against Range of Conditions. JAMA. Published online April 17, 2019.

21. A large review of nearly 100,000 people found that skipping breakfast led to higher rates of type II diabetes:

  • Skipping breakfast once per week led to a 33% increased risk
  • Skipping breakfast 4-5 times per week led to a 55% increased risk 

Ballon A et al. Breakfast Skipping Is Associated with Increased Risk of Type 2 Diabetes among Adults: A Systematic Review and Meta-Analysis of Prospective Cohort Studies. J Nutr. 2019 Jan 1;149(1):106-113.

We all understand that skipping any form of nourishment leads to problems… and that includes not staying up-to-date with the latest research. That’s why ChiroUp feeds you a steady diet of continually evolving best practices; improving the health of your personal skillset, your practice, and your patients.

Ready to put this research into action? ChiroUp makes it easy! Our top-rated clinical resource both improves patient outcomes & increases your practice income. It’s everything your practice needs in one easy-to-use system. See for yourself and try us out free for 14 days – no credit card required.

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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 past president of the executive board.

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