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Review the latest news:

✔ Which braces and supports work best?
✔ Conservative care for SLAP lesions
✔ The best exercise for tennis elbow
✔ One third of young adults with chronic LBP may have an inflammatory arthropathy
✔ Tips for differentiating myofascial pain syndrome from fibromyalgia

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. Be sure to follow our Facebook page for regular synopses of all significant new chiropractic-related research.

1. American Family Physician recently published a synopsis on the effectiveness of various braces and supports:

  • The patellar tendon strap is effective in treating pain from patellar tendinopathy.
  • The patellar stabilizing brace helps maintain proper patellar alignment but has mixed results in treating patellofemoral pain syndrome.
  • Use of a functional ankle brace is more effective than immobilization or a compression wrap in terms of functional outcomes after an acute ankle sprain and prevention of future ankle sprains.
  • The thumb spica splint is effective for the treatment of thumb carpometacarpal osteoarthritis and de Quervain tenosynovitis, and may be used for patients with suspected scaphoid fractures.
  • A wrist splint has short-term effectiveness in treating symptoms of carpal tunnel syndrome but may not be more effective than other conservative therapies.

 

Sprouse RA et al. Braces and Splints for Common Musculoskeletal Conditions. Am Fam Physician. 2018 Nov 15;98(10):570-576.

2. A systematic review regarding the effects of corrective exercises on individuals with forward head posture (FHP) found that: “therapeutic exercises may result in large changes in (head position) and moderate improvement in neck pain.”

 

Rahman Sheikhhoseini et al. Effectiveness of Therapeutic Exercise on Forward Head Posture: A Systematic Review and Meta-analysis. JMPT Volume 41, Issue 6, Pages 530–539

 

Consider these 2 exercises for starters-

 

3.  For most throwers with SLAP lesions, a rehabilitation program focused on stretching the posterior capsule and correcting scapular posture is more successful than surgery.

 

Matthew CJ et al. Superior Labral Anterior to Posterior Tear Management in Athletes. Open Orthop J. 2018 Jul 31;12:303-313. doi: 10.2174/1874325001812010303. eCollection 2018.

 

4.  For most throwers with SLAP lesions, a rehabilitation program focused on stretching the posterior capsule and correcting scapular posture is more successful than surgery.

 

Matthew CJ et al. Superior Labral Anterior to Posterior Tear Management in Athletes. Open Orthop J. 2018 Jul 31;12:303-313. doi: 10.2174/1874325001812010303. eCollection 2018.

 

5. “Shockwave therapy significantly reduced the pain that accompanies tendinopathies and improves functionality and quality of life. It might be first choice (for treating tendinopathies) because of its effectiveness and safety.”

 

Dedes V et al. Effectiveness and Safety of Shockwave Therapy in Tendinopathies. Mater Sociomed. 2018 Jun;30(2):131-146. doi: 10.5455/msm.2018.30.141-146.

 

6. An expert panel for the Danish Health Authority performed a comprehensive review of published recommendations to establish National Clinical Guidelines for the treatment of neck pain (NP) and cervical radiculopathy (CR). The recommendations include:

 

  • combinations of exercise and manual therapy before medicine for neck pain
  • traction for cervical radiculopathy
  • acupuncture for neck pain but not cervical radiculopathy

 

Kjaer P et al. National clinical guidelines for non-surgical treatment of patients with recent onset neck pain or cervical radiculopathy. Eur Spine J. 2017 Sep;26(9):2242-2257. doi: 10.1007/s00586-017-5121-8. Epub 2017 May 18.

 

7. A study of 231 young adults (mean age 32) with LBP for greater than 3 months found that 39% “had axial-Spondyloarthropathy (axSpA) as per ASAS Criteria”

 

Rasool T et al. Axial Spondyloarthritis In Patients With Chronic Backache Using Assessment Of Spondyloarthritis International Society Criteria For Axial Spondyloarthritis. J Ayub Med Coll Abbottabad. 2018 Apr-Jun;30(2):253-257.

 

Check out this ChiroUp infographic for a quick summary of the most common inflammatory arthropathies.

 

8. A BMJ scoping review of 84 prior systematic reviews endorsed treatments with moderate/good quality evidence for the following conditions:

 

  • low back pain (yoga, acupuncture, spinal manipulation, osteopathy)
  • osteoarthritis (acupuncture, tai chi)
  • neck pain (acupuncture, manipulation/manual therapy)
  • myofascial trigger point pain (acupuncture)
  • depression (mindfulness-based stress reduction, meditation, tai chi, relaxation)
  • anxiety (meditation/MBSR, moving meditation, yoga)
  • sleep disorders (meditative/mind-body movement)
  • stress/distress (mindfulness)

 

Lorenc A, Feder G, MacPherson H, et al Scoping review of systematic reviews of complementary medicine for musculoskeletal and mental health conditions. BMJ Open 2018;8:e020222. doi: 10.1136/bmjopen-2017-020222

 

 

9. A study of 183 senior adults with back and neck related disability compared short-term treatment (12 weeks) versus long-term management (36 weeks) using spinal manipulative therapy combined with supervised rehabilitative exercises The authors conclusion: “For older adults with chronic back and neck disability, extending management from 12 to 36 weeks did not result in any additional important reduction in disability.”

 

Maiers M et al. Short or long-term treatment of spinal disability in older adults with manipulation and exercise. Arthritis Care Res (Hoboken). 2018 Oct 24. doi: 10.1002/acr.23798. [Epub ahead of print]

 

10. A study of nearly 70,000 adults found “a higher frequency of organic food consumption was associated with a reduced risk of cancer.”

 

Baudry J, Assmann KE, Touvier M, et al. Association of Frequency of Organic Food Consumption With Cancer RiskFindings From the NutriNet-Santé Prospective Cohort Study. JAMA Intern Med. Published online October 22, 2018. doi:10.1001/jamainternmed.2018.4357

 

11. European Spine Journal: “To evaluate the anatomical integrity of the cervical spine in adults with neck pain, we found preliminary evidence to support the use of:

  • extension-rotation test
  • neurological examination
  • Spurling’s
  • the upper limb neurodynamic tests

 

Lemeunier N. at al. Reliability and validity of clinical tests to assess the anatomical integrity of the cervical spine in adults with neck pain and its associated disorders: Part 1-A systematic review from the Cervical Assessment and Diagnosis Research. Eur Spine J (2017) 26: 2225. 

 

12. Differentiating myofascial pain syndrome from fibromyalgia

 

  • “In contrast to myofascial pain syndrome trigger points, fibromyalgia tender points do not present as overt palpable, nodular structures within the muscle. Other than their discrete tenderness, tender points are indistinguishable from the normal surrounding tissue.”
  • “Myofascial pain syndrome (MPS) is largely a regional pain condition which is often managed using conservative interventions including manual and physical therapy, along with exercise. Fibromyalgia (FM), on the other hand, is a more complex condition of widespread pain which, in addition to conservative measures above, often requires a multidisciplinary approach.”

Watch for ChiroUp’s newest best-practice synopsis on Fibromyalgia to be released shortly.

 

Bourgaize S, Newton G, Kumbhare D, Srbely J. A comparison of the clinical manifestation and pathophysiology of myofascial pain syndrome and fibromyalgia: implications for differential diagnosis and management. The Journal of the Canadian Chiropractic Association. 2018;62(1):26-41.

 

Want to learn more about current best practices? Register for the upcoming ACA webinar to hear Dr.’s Bertelsman & Steele summarize the current evidence-based management of LBP on Thursday November 15th at 1pm ET.

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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 President of the executive board.

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