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Medline contains more than 24 million articles, with almost one million new citations added each year. Keeping up is tough, but ChiroUp make it easier for you to stay on top of the literature. Each week our team mines the most relevant “best practice” data to update our protocols and keep you current.

Here’s a sampling of the protocol updates that we added this week. Some studies describe new concepts, while others simply reinforce our current understanding and provide additional support for the care we deliver.

The lumbopelvic bony architecture may have a predictive effect on the level of lumbar disc herniation- in that patients with long L5 transverse processes and/or high intercrestal lines (horizontal line drawn between the tops of the iliac crests) have a significantly higher incidence of L4/5 disk herniation, whereas low intercrestal lines and lumbarization are associated with L5/S1 disk herniation.

Dang L Chen Z, Liu X, et al. Lumbar Disk Herniation in Children and Adolescents: The Significance of Configurations of the Lumbar Spine. Neurosurgery. 2015 Dec;77(6):954-9; discussion 959.

Patients with lumbar disc herniation who undergo SMT to the level of involvement demonstrate a significant decrease in radicular symptoms.

Ehrler M, Peterson C Leemann S et al. Symptomatic, MRI Confirmed, Lumbar Disc Herniations: A Comparison of Outcomes Depending on the Type and Anatomical Axial Location of the Hernia in Patients Treated With High-Velocity, Low-Amplitude Spinal Manipulation. JMPT Mar-April 2016, Volume 39, Issue 3, Pages 192–199

Exercise programs that focus on strength/resistance and coordination/stabilization are appropriate for the treatment of chronic LBP.

Searle A, Spink M, et al. Exercise interventions for the treatment of chronic low back pain: a systematic review and meta-analysis of randomised controlled trials. Clin Rehab. 2015 Dec;29(12):1155-67.

LBP that arises from SI joint dysfunction demonstrates a clinically recognizable altered pattern of SI/ innominate movement when compared to LBP of non-SI origin.

Adhia DB, et al. Innominate movement patterns, rotation trends and range of motion in individuals with low back pain of sacroiliac joint origin. Man. Ther. 2016 Feb;21:100-8.

In patients with cervicogenic headache, “6-8 sessions of upper cervical and upper thoracic manipulation were shown to be more effective than mobilization and exercise, and the effects were maintained at 3 months.”

Dunning JR, et al. Upper cervical and upper thoracic manipulation versus mobilization and exercise in patients with cervicogenic headache: a multi-center randomized clinical trial. BMC Musculoskelet Disord. 2016 Feb 6;17(1):64

The best treatment outcomes for plantar fasciitis are achieved by combining multiple techniques- particularly mobilization and exercise.

Sutton, Deborah A. et al. The Effectiveness of Multimodal Care for Soft Tissue Injuries of the Lower Extremity: A Systematic Review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration Journal of Manipulative & Physiological Therapeutics , Volume 39 , Issue 2 , 95 – 109.e2

A study of 104 MRI-confirmed cervical disc herniations demonstrated that patients treated with SMT were significantly more likely to report relevant “improvement” compared to those treated with cervical nerve root injection blocks.

Peterson, Cynthia K. et al. Symptomatic, Magnetic Resonance Imaging–Confirmed Cervical Disk Herniation Patients: A Comparative-Effectiveness Prospective Observational Study of 2 Age- and Sex-Matched Cohorts Treated With Either Imaging-Guided Indirect Cervical Nerve Root Injections or Spinal Manipulative Therapy. Journal of Manipulative & Physiological Therapeutics , Volume 39 , Issue 3 , 210 – 217

Researchers have shown that asymptomatic rotator cuff defects are present in 10% of those under the age of twenty, 50% of people over 70 years of age, and 62-80% of people over 80 years of age. Not all tears are the source of the patient’s symptoms.

Teunis, Teun et al. A systematic review and pooled analysis of the prevalence of rotator cuff disease with increasing age. Journal of Shoulder and Elbow Surgery , Volume 23 , Issue 12 , 1913 – 1921
Milgrom C, Schaffler M, Gilbert S, van Holsbeeck M. Rotator-cuff changes in asymptomatic adults: the effect of age, hand dominance and gender. J Bone Joint Surg Br 1995;77:296-8

Older patients who use Chiropractic Manipulative Treatment (CMT) either alone or in combination with conventional medical care during their chronic LBP episodes have lower overall costs of care, shorter episodes, and lower cost of care per episode day than patients using standard medical care. These findings support initial CMT use in the treatment of, and possibly broader chiropractic management of, older chronic LBP patients.

Weeks, William B et al. The Association Between Use of Chiropractic Care and Costs of Care Among Older Medicare Patients With Chronic Low Back Pain and Multiple Comorbidities. Journal of Manipulative & Physiological Therapeutics , Volume 39 , Issue 2 , 63 – 75.e2

And finally, a few consensus suggestions from the ChiroUp advisory board peer-review of our recent SLAP lesion protocol:

  • The presence of a SLAP lesion does not automatically necessitate surgical intervention. Most clinicians view this structural abnormality with the same skepticism as “disc lesion”, “meniscus tear”, or “rotator cuff tear”- wherein the imaged defect is not necessarily the primary contributor to the patient’s complaint.
  • Myofascial release and stretching should target the subscapularis and infraspinatus. Strengthening exercises should focus on re-balancing strength between anterior (pec, upper traps) and posterior muscle groups (lower traps, serratus anterior, rhomboid). Rehabilitation must restore serratus anterior strength and proper scapular function.
  • Diagnostic ultrasound is a useful modality for imaging SLAP tears with an added benefit of receiving patient feedback while evaluating their injury.

“Best Practice” knowledge is the foundation of our profession’s future success. Together we can make chiropractic 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

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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