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Review the latest news:

✔ Simple Exercise for Patellar Tendinopathy
✔ Most specific & sensitive CTS test
✔ Surgical indications for disc herniation
✔ SMT increases subacromial space & ROM

Successful evidence-based chiropractors continually leverage new studies to improve their clinical decision-making. ChiroUp helps by scouring fresh literature to mine out useful best practice data. This month, we’ve summarized more than 40 studies and have already updated ChiroUp protocols with this information. We are showcasing a dozen articles here.

1. Top Test for CTS

A study of 512 carpal tunnel syndrome patients identified the most sensitive and specific tests:


  • The highest sensitivity was seen from the Durkan test (95.6%) and the lowest was from thenar atrophy (22.1%).
  • The highest specificity and positive predictive values were seen for thenar atrophy (100%) and the lowest were from the Tinel test (40.9% and 59.1%).
  • The highest negative predictive value was the Durkan test (94%) and thenar atrophy was the lowest (57.4%).

Durkan Test:

Examiner presses thumbs over carpal tunnel and holds pressure for 30 seconds. Onset of pain or paresthesia in the median nerve distribution within 30 seconds is a positive result of the test.

2. Surgical Indications for Thoracic Disc Herniation

International Orthopedics: “Symptomatic thoracic disc herniation is a rare condition predominantly localized between T8 and L1. Surgical indications include intractable back or radicular pain, neurological deficits, and myelopathy signs. “

Bouthors C et al. Surgical treatment of thoracic disc herniation: an overview. Int Orthop. 2018 Nov 8. doi: 10.1007/s00264-018-4224-0. [Epub ahead of print]

3. New Physical Activity Guidelines

The US Department of Health & Human Services has released the 2018 Physical Activity Guidelines. Download this handy patient summary for the latest recommendations.

4. Thoracic SMT Increases Subacromial Space & ROM

A new JMPT study found: “Active shoulder flexion and abduction mobility increase after manipulation of thoracic spine in patients who have undergone surgery for rotator cuff suture. Subacromial space increases significantly with shoulder in neutral and external rotation position after manipulation.”

Belón-Perez, Pedro et al. Immediate Effects of Thoracic Spine Manipulation Upon Shoulder Functionality in Patients With Sutured Rotator Cuff Repair: A Prospective Study Journal of Manipulative & Physiological Therapeutics , Volume 41 , Issue 7 , 589 – 595

5. Elastic therapeutic tape for CTS

“Kinesiotaping may provide a positive contribution to ultrasonographic and clinical outcomes in the treatment of mild or moderate carpal tunnel syndrome in the short term.”

Be sure to follow our Facebook page to see an upcoming post where Dr. Todd Riddle from FAKTR demonstrates dynamic taping for CTS.

Yildirim P. et al. Ultrasonographic and clinical evaluation of additional contribution of kinesiotaping to tendon and nerve gliding exercises in the treatment of carpal tunnel syndrome. Turk J Med Sci. 2018 Oct 31;48(5):925-932. doi: 10.3906/sag-1709-72.

6. Pregnancy LBP is Primarily SI… and Progressive

An International Journal of Gynecology & Obstetrics study of 1500 primigravidae pregnant women with pregnancy-induced LBP found that:

  • 7% were diagnosed with sacroiliac dysfunction
  • Pain and disability gradually worsened from the first toward the third trimester

Filipec M et al. Incidence, pain, and mobility assessment of pregnant women with sacroiliac dysfunction. Int J Gynaecol Obstet. 2018 Sep;142(3):283-287. doi: 10.1002/ijgo.12560. Epub 2018 Jun 25.

7. Lumbar Radiculopathies Affect Hip Abductor Strength

A new study in the Journal of Orthopedic Science found that patients with lumbar stenosis or disc lesions affecting L4/5 or L5/S1 show significantly diminished hip abductor strength on the affected side that normalizes following successful (surgical) management. 

Want to learn more?

Check out our Hip Abductor Weakness 15 minutes to Excellence webinar.


8. Walking Diminishes LBP Risk

A Spine Journal study found: “Walking for more than 3 days per week for over 30 min at a time significantly decreased the risk of developing low back pain (21-35%). The risk decreased further with increasing walking days and duration.”

Park SM et al. Walking more than 90 minutes/week was associated with a lower risk of self-reported low back pain in persons over 50 years of age: A cross-sectional study using the Korean National Health and Nutrition Examination Surveys. Spine J. 2018 Nov

9. Simple Relief for Patellar Tendinopathy?

The authors of a recent article have demonstrated that five 45-second isometric quadriceps contractions held at 70% of a maximum contraction provided almost complete relief of patellar tendon pain, immediately and for at least 45 minutes. Whereas isotonic exercise had only a small and transient effect on pain. This is the only study to date to assess the effect of isometric exercise on tendon pain. 

Sustained Quad Sets



11. Irreversible Damage in Adolescent Weight Lifters

A prospective 3-year cohort study of 12 child and adolescent weightlifters revealed: “abnormal lumbar findings in 11 of 12 participants at a high rate on MRI examination. Children and adolescents undergoing resistance training at the competition level could potentially have irreversible changes in the lumbar vertebra without symptoms.”

Shimozaki K, Nakase J, Yoshioka K, Takata Y, Asai K, Kitaoka K, et al. (2018) Incidence rates and characteristics of abnormal lumbar findings and low back pain in child and adolescent weightlifter: A prospective three-year cohort study. PLoS ONE 13(10): e0206125.

12. Why MD’s Don’t Refer

A Military Medicine study explored “barriers to the integration of on-base chiropractic services within the Canadian Forces Health Services (CFHS). Barriers to integrating chiropractic services included:

  • Lack of clarity about a chiropractor’s clinical knowledge and skills
  • CFHS team members’ negative prior experiences with chiropractors (e.g., inappropriate patient-focused communication, clinical management that was not evidence-based)
  • Suboptimal bi-directional communication between CFHS personnel and DCs across bases
  • Wide-ranging perspectives pertaining to duplication of services offered by PTs and DCs in managing MSK conditions.”

Listen to Dr. Bertelsman’s earlier Facebook live discussion of practical solutions for each of these four concerns.



Mior SA et al. Exploring Chiropractic Services in the Canadian Forces Health Services – Perceptions of Facilitators and Barriers Among Key Informants. Mil Med. 2018 Nov 21. doi: 10.1093/milmed/usy319. [Epub ahead of print]

Bonus: Patient Education- Short & Sweet Wins

A November RCT in JAMA regarding the effect of intensive patient education for LBP patients found that “adding two additional hours of patient education to simple advice and reassurance did not improve pain outcomes.” 

Want to see how you can deliver concise patient education in minutes? Click here to start your free ChiroUp trial and prescribe your first report in seconds!




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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