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chiropractic research update

 

Successful evidence-based chiropractors continually leverage new studies to improve their clinical decision making. ChiroUp helps by scouring fresh literature to mine out practical best practice data. We hope that you will enjoy reviewing nineteen of the most relevant new studies – plus a bonus.

 

1. Researchers determined that low pain intensity predicted poor outcomes in chronic LBP presentations. The study also verified that fear of movement, advancing age, and depression are predictive factors for lingering complaints in LBP patients.

Adnan, Rahmat et al. Determining Predictive Outcome Factors for a Multimodal Treatment Program in Low Back Pain Patients: A Retrospective Cohort Study, JMPT Volume 40 , Issue 9 , 659 – 667

2.The Spine Journal reviewed the diagnostic value of 5 different tests for cervical radiculopathy.

 

Test Sensitivity     (Neg rules out) Specificity (Pos rules in)
4 Nerve Tension Tests 0.97 0.69
Arm Squeeze 0.97 0.97
Spurlings 0.67 0.96
Cervical Distraction 0.33 0.97
Shoulder Abduction 0.47 0.85

 

“Clinicians may use a combination of Spurling’s, axial traction, and an Arm Squeeze test to increase the likelihood of a cervical radiculopathy, whereas a combined results of four negative neurodynamics tests and an Arm Squeeze test could be used to rule out the disorder.”

*ChiroUp Subscribers- all four nerve tension test video demonstrations are available in your Sharpen My Clinical Skills tab.

Thoomes, Erik J. et al. Value of physical tests in diagnosing cervical radiculopathy: a systematic review. The Spine Journal , Volume 18 , Issue 1 , 179 – 189

3. A study of 573 office workers found that “one hour weekly of strength training reduced headache frequency and intensity.” Timing and spacing of session times did not affect the positive outcome, but participants whose training was supervised used fewer analgesics.

Andersen, CH et al. Effect of resistance training on headache symptoms in adults: Secondary analysis of a RCT. Musculoskeletal Science and Practice, Volume 32, 2017, Pages 38-43

4. A study in the European Spine Journal attested that neck and back pain are common in children; with increasing prevalence to 25% by late adolescence. Work and sports activity increased the odds of back pain.

Scarabottolo, C.C. Back and neck pain prevalence and their association with physical inactivity domains in adolescents Eur Spine J (2017) 26: 2274.

 

5.LBP patients demonstrate elevated chemotactic cytokine levels that diminish significantly following SMT; correlating with improvements in VAS and Oswestry Disability Index scores

Teodorczyk-Injeyan JA et al. Elevated Production of Nociceptive CC Chemokines and sE-Selectin in Patients With Low Back Pain and the Effects of Spinal Manipulation: A Nonrandomized Clinical Trial. The Clinical Journal of Pain. 34(1):68–75, JAN 2018

 

6. A systematic review of 51 studies concluded: “There is moderate-quality evidence that manipulation and mobilization are likely to reduce pain and improve function for patients with chronic low back pain; manipulation appears to produce a larger effect than mobilization. Both therapies appear safe.” “Subgroup analyses showed that manipulation significantly reduced pain and disability, compared with other active comparators including exercise and physical therapy.”

Coulter ID. et al. Manipulation and mobilization for treating chronic low back pain: a systematic review and meta-analysis. 2018 Jan 31. pii: S1529-9430(18)30016-0.  Spine Journal. doi: 10.1016/j.spinee.2018.01.013. [Epub ahead of print]

 

7. A systematic review of 25 studies concluded that having larger deep core muscle bulk (multifidus) provided protection against LBP. The benefit of greater superficial muscle bulk (erector spinae & QL) was inconclusive.

Ranger, Tom A. et al. Are the size and composition of the paraspinal muscles associated with low back pain? A systematic review. The Spine Journal , Volume 17 , Issue 11 , 1729 – 1748

 

8. A small study comparing motor control exercise plans vs general exercise plans concluded that both produce similar significant reductions in non-specific back pain and disability.

Shamsi, MohammadBagher et al. Shamsi, MohammadBagher et al. Comparison of spinal stability following motor control and general exercises in nonspecific chronic low back pain patients. Clinical Biomechanics , Volume 48 , 42 – 48

 

9. A systematic review examining the effectiveness of manual therapy interventions on pain and disability in older persons with chronic low back pain found “moderate evidence supporting the use of manual therapy to reduce pain levels and alleviate disability.”

de Luca, Katie E. et al. The Effectiveness and Safety of Manual Therapy on Pain and Disability in Older Persons With Chronic Low Back Pain: A Systematic Review. JMPT Volume 40 , Issue 7 , 527 – 534

 

10. A BMJ systematic review of 19 studies regarding the utility of manual therapy for infantile colic found “moderate strength evidence for the effectiveness of manual therapy on reduction in crying time ( −1.27 less hours per day)” and that “manual therapy appears relatively safe”

Carnes D, Plunkett A, Ellwood J, et al Manual therapy for unsettled, distressed and excessively crying infants: a systematic review and meta-analyses. BMJ Open 2018;8:e019040.

 

11. A systematic review of over 14,000 articles found the 12-month utilization of chiropractic services was 9.1% and 57% of chiropractic patients were female.

The most common reported reasons for seeking chiropractic care:

  • low back pain (49.7%)
  • neck pain (22.5%)
  • extremity problems (10.0%)

The most common treatments provided by chiropractors included:

  • spinal manipulation (79.3%)
  • soft-tissue therapy (35.1%)
  • formal patient education (31.3%)

Beliveau PJH, Wong JJ, Sutton DA, et al. The chiropractic profession: a scoping review of utilization rates, reasons for seeking care, patient profiles, and care provided. Chiropractic & Manual Therapies. 2017;25:35. doi:10.1186/s12998-017-0165-8.

 

12. A systematic review of 102 studies found moderate-quality evidence suggesting (osteopathic) manipulation had a significant effect on decreasing pain and increasing functional status in pregnant and post-partum women with LBP.

Franke, Helge et al. Osteopathic manipulative treatment for low back and pelvic girdle pain during and after pregnancy: A systematic review and meta-analysis

Journal of Bodywork and Movement Therapies , Volume 21 , Issue 4 , 752 – 762

 

13. The addition of (Schroth) scoliosis-specific exercises provided a large benefit in terms of reduced scoliosis progression risk when compared to observation or bracing alone.

Schreiber S, et al.  Schroth physiotherapeutic scoliosis-specific exercises for adolescent idiopathic scoliosis: how many patients require treatment to prevent one deterioration? – results from a randomized controlled trial – “SOSORT 2017 Award Winner.” Scoliosis and Spinal Disorders. 2017;12:26.

 

14. “Cross-sectional data from the 2012 National Health Interview Survey (n = 34,525) were analyzed.

 

 

  • Lifetime and 12-month prevalence of chiropractic use were 24.0% and 8.4%, respectively.
  • There is a growing trend of chiropractic use among US adults from 2002 to 2012.
  • Back pain (63.0%) and neck pain (30.2%) were the most prevalent health problems for chiropractic consultations.
  • The majority of users reported chiropractic helping a great deal with their health problem and improving overall health or well-being.
  • A substantial number of chiropractic users had received prescription (23.0%) and/or over-the-counter medications (35.0%) for the same health problem for which chiropractic was sought.
  • 8% reported chiropractic care combined with medical treatment as helpful.

Adams J. et al. The Prevalence, Patterns, and Predictors of Chiropractic Use Among US Adults: Results From the 2012 National Health Interview Survey. SPINE. 42(23):1810–1816, Dec 2017

 

15. A study in the American Journal of Public Health found “Approximately 1 in 12 US physicians received a payment involving an opioid during the 29-month study. 375,266 non-research opioid-related payments were made to 68,177 physicians, totaling $46,158 ,388. The top 1% of physicians received 82.5% of total payments in dollars. Most payments were for speaking fees, honoraria, food and beverage. Physicians specializing in anesthesiology received the most in total annual payments.”

Hadland S. et al. Industry Payments to Physicians for Opioid Products, 2013–2015, American Journal of Public Health 107, no. 9 (September 1, 2017): pp. 1493-1495.

 

16. Approximately 50% of US military treatment facilities currently offer chiropractic care.

Herman Patricia M., Sorbero Melony E., and Sims-Columbia Ann C.. The Journal of Alternative and Complementary Medicine. November 2017, 23(11): 837-843

 

17. A study comparing the effect of exercise vs. dietary intervention for fat loss found that dietary intervention alone triggered more fat loss than exercise alone. However, the greatest fat loss came from combining diet and exercise. Resistance training produced the added benefit of increased lean muscle mass.

Miller T et al. Resistance Training Combined With Diet Decreases Body Fat While Preserving Lean Mass Independent of Resting Metabolic Rate: A Randomized Trial. International Journal of Sport Nutrition & Exercise Metabolism, 2018, vol. 28, issue 1, p 46,

 

18 A meta-analysis of 37 studies demonstrated that PRP injections “may reduce pain associated with lateral epicondylitis and rotator cuff injuries.”

Chen X. et al. The Efficacy of Platelet-Rich Plasma on Tendon and Ligament Healing: A Systematic Review and Meta-analysis With Bias Assessment. The American Journal of Sports Medicine, December 21, 2017

 

19. A study comparing the effectiveness of active release technique (ART) and muscle energy technique (MET) on latent trigger points in the upper trapezius muscle concluded: “Both manual techniques of ART and MET reduced the symptoms in the upper trapezius in the two groups equally, neither technique being superior to the other.”

Sadria, Golnaz et al. A comparison of the effect of the active release and muscle energy techniques on the latent trigger points of the upper trapezius. Journal of Bodywork and Movement Therapies , Volume 21 , Issue 4 , 920 – 925

 

Bonus.

Clinicians who read ChiroUp reviews & use the associated protocols achieve better clinical results. It doesn’t require a systematic review to determine that regardless of the game, those who take time to invest in their future achieve better outcomes. And outcomes will soon become the primary determinant of our practice incomes. Taking your hands off of the wheel results in undesired consequences regardless if the situation involves your health, your relationships, or your clinical skills. Chiropractic college was only the start of our education. Data changes rapidly and so must our beliefs and clinical protocols. Providers who keep their hands on the wheel and stay on top of their clinical A-game will be rewarded. ChiroUp is proud to be your partner in chiropractic clinical excellence and practice success. If you’re not yet a subscriber, click here to start today!

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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