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Review the latest news:

✔ Can SMT cause disc herniation?
✔ Conservative care is as effective as surgery for CTS
✔ Chiropractic patients use far fewer opioids
✔ 2 tests to predict LBP during pregnancy

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 two-dozen 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. A new (very large) European Spine Journal Study examined the risk of acute lumbar disc herniation requiring early surgery in patients who visited a chiropractor vs. those who visited a PCP:

The risk for acute LDH with early surgery associated with chiropractic visits was no higher than the risk associated with PCP visits. Both chiropractic and primary medical care were associated with an increased risk for acute LDH requiring ED visit and early surgery. Our analysis suggests that patients with prodromal back pain from a developing disc herniation likely seek healthcare from both chiropractors and PCPs before full clinical expression of acute LDH.”

P.S. Abundant research has revealed a similar conclusion for the relationship between cervical manipulation and stroke. Click here to download a helpful patient education handout regarding the safety of neck manipulation.

Hincapié, C.A., Tomlinson, G.A., Côté, P. et al. Eur Spine J (2018) 27: 1526.

2.A systematic review of carpal tunnel syndrome research comparing surgical vs. non-surgical outcomes found: “No significant differences at 3 or 12 months” in terms of functional status, symptom severity, and nerve conduction outcomes. Interestingly, the surgical patients experienced greater improvement at 6 months, but not before or after.

Qiyun S. et al. Comparison of the Short-term and Long-term Effects of Surgery and Nonsurgical Intervention in Treating Carpal Tunnel Syndrome: A Systematic Review and Meta-analysis. Hand. 2018 Jul 1:1558944718787892. [Epub ahead of print]

3.A study of more than 500 pregnant women found: “If both P4 and ASLR tests were positive mid-pregnancy, a persistent bothersome pelvic girdle pain of more than 5 days per week throughout the remainder of pregnancy could be predicted.”

Malmqvist S, Kjaermann I, Andersen K, et al Can a bothersome course of pelvic pain from mid-pregnancy to birth be predicted? A Norwegian prospective longitudinal SMS-Track study BMJ Open 2018;8:e021378. 

4. A systematic review found no correlation between LBP intensity and the degree of MODIC degenerative change in the lumbar spine.

Herlin C et al. Modic changes—Their associations with low back pain and activity limitation: A systematic literature review and meta-analysis. PLoS1 2018 Aug 1;13(8):e0200677. doi: 10.1371/journal.pone.0200677. eCollection 2018.

5. According to a systematic review with meta-analysis in the journal Physiotherapy: “There is very low evidence to support the use of trigger point dry needling (TDN) in the shoulder region for treating patients with upper extremity pain or dysfunction.”

Hall, Michelle Louise et al. Effects of dry needling trigger point therapy in the shoulder region on patients with upper extremity pain and dysfunction: a systematic review with meta-analysis. Physiotherapy , Volume 104 , Issue 2 , 167 – 177

6. A JMPT study of 82 cervicogenic headache patients found, “upper cervical spinal mobilization increased cervical range of motion and induced immediate headache relief.”

Malo-Urriés, Miguel et al. Immediate Effects of Upper Cervical Translatoric Mobilization on Cervical Mobility and Pressure Pain Threshold in Patients With Cervicogenic Headache: A Randomized Controlled Trial. Journal of Manipulative & Physiological Therapeutics, Volume 40 , Issue 9 , 649 – 658

7. A study of more than 6000 chiropractic patients revealed that few (5.4%) of the chiropractic patients used narcotics for their chronic pain, which is substantially lower than the 45% to 60% use typically found in chronic LBP populations. Additionally, if chiropractic care was no longer a covered insurance benefit, 30% of patients would continue as is, 61% would go less often, and only 7% would discontinue care.

Herman, Patricia M. et al.Characteristics of Chiropractic Patients Being Treated for Chronic Low Back and Neck Pain. JMPT 2018 Aug 15. [Epub ahead of print]

8. “Opioids are no more effective than non-opioid medications in the treatment of acute and chronic low back pain.”

Wertli, M.M. & Steurer, J. Pain medications for acute and chronic low back pain. Internist (2018). 2018 Aug 16. doi: 10.1007/s00108-018-0475-5. [Epub ahead of print]

9. A new article in the Journal of Family Practice endorsed a select group of therapies that show “good-quality patient-oriented evidence” for managing chronic low back pain. The journal advised physicians to:

  • “Recommend a trial of either acupuncture, mindfulness training, or spinal manipulation for patients with chronic LBP”
  • “Recommend tai chi as an exercise modality for patients with osteoarthritis.”

Lemmon R et al. Nonpharmacologic treatment of chronic pain: What works? J Fam Pract. 2018 Aug;67(8):474;477;480;483.

10. A recent spine Journal study was “the first to measure facet gapping during cervical manipulation on live humans. The results demonstrate that:

  • Target and adjacent motion segments undergo facet joint gapping (0.9 mm ± 0.4mm) during manipulation.
  • Intervertebral range of motion is increased (8-13 degrees) in all three planes of motion after manipulation.
  • Pain score improved from 3.7±1.2 before manipulation to 2.0±1.4 after manipulation. 

The results suggest that clinical and functional improvement after manipulation may occur as a result of small increases in intervertebral ROM across multiple motion segments.”

Anderst WJ et al. Intervertebral Kinematics of the Cervical Spine Before, During and After High Velocity Low Amplitude Manipulation. The Spine Journal Available online 22 August 2018

11. A study of 100 fibromyalgia (FM) patients found recurrent “electrodiagnostic features of polyneuropathy, muscle denervation, and chronic inflammatory demyelinating polyneuropathy (CIDP)”.

Caro XJ, Galbraith RG, Winter EF. Evidence of peripheral large nerve involvement in fibromyalgia: a retrospective review of EMG and nerve conduction findings in 55 FM subjects. Eur J Rheumatol 2018; 5: 104-10.

12. A study of 40 collegiate athletes found that application of elastic therapeutic tape over the gluteus medius “improved strength immediately after taping (and) it was maintained even on the third day.” Hip taping also generated short-term correction of dynamic knee valgus.

Rajasekar, Sannasi et al. Does Kinesio taping correct exaggerated dynamic knee valgus? A randomized double blinded sham-controlled trial. Journal of Bodywork and Movement Therapies , Volume 22 , Issue 3 , 727 – 732

 

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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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