Top 10 Game-Changing Clinical Pearls From 2020

Each month, your ChiroUp research team scours hundreds of musculoskeletal and chiropractic research articles for new studies, techniques, and news that will enhance your evidence-based chiropractic practice. While it’s hard to pick favorites, check out this short webinar of our top 10 game-changing topics from 2020.

Now it’s time to let this knowledge empower your practice! And ChiroUp knows a thing or two about that. Check out the accompanying ChiroUp Resource to implement each of 2020’s most significant game-changing research topics into your daily practice:

10. Rotator Cuff Assessment & Non-Surgical Management

Journal of Shoulder and Elbow Surgery 

"We found no significant differences in clinical outcomes between (rotator) cuff repair and nonoperative treatment at 12-month follow-up." (2)

Journal of Shoulder and Elbow Surgery

"[surgery] may provide little or no clinically important benefits with respect to pain, function, overall quality of life or participant-rated global assessment of treatment success when compared with non-operative treatment." (3)

Cochrane Database Review

What this research powers:

• DIME test tutorial in the ChiroUp Assessment Library

9. Tendinopathy Etiology & Management

“Obesity is associated with a higher risk of tendinopathy, tendon tear and rupture, and complications after tendon surgery than non-obesity.” (4)

The Association of Bone and Joint Surgeons

“When treating tendinopathy regardless of location, eccentric exercises were the best treatment option to improve tendinopathy related pain and improve self-reported function." (5)

Scandinavian Journal of Medicine & Science in Sports

What this research powers:

• Prescribing exercise plans for any tendinopathy automatically incorporates the appropriate ADLs and eccentric exercises.

8. Carpal Tunnel Assessment & Management 

"A total of 174 extremities in 146 (CTS) patients were included in the study. Pronator syndrome was diagnosed in 22 extremities (12%)." (6)

The Journal of Hand Surgery

"In the long term, manual therapy including desensitization maneuvers of the central nervous system resulted in similar outcomes and similar surgery rates compared to surgery in women with CTS. Both interventions were combined with a tendon/nerve gliding exercise program at home." (7)

Physical Therapy Journal

"Myofascial stretching of the carpal ligament showed statistically significant symptom improvement in persons with CTS." (8)

Journal of Hand Therapy

What this research powers:

• Median nerve self-floss and Carpal ligament stretch from the exercise library

• Median Nerve Glide from the treatment technique library

• Updated best practice protocols for Carpal tunnel syndrome and Pronator Teres syndrome

7. Tennis Elbow Assessment and Management

"Mobilization with movement plus exercise and cold therapy is a safe and effective alternative with positive effects on elbow pain, functional capacity, and pain-free, maximum grip strength." (9)

Journal of Back and Musculoskeletal Rehabilitation

"A treatment program using eccentric strengthening of adequate intensity and duration seemed to be most effective for treating lateral elbow tendinopathy." (10)

Journal of Hand Therapy

"Conventional therapy combined with shoulder and scapula muscle training could be more effective in improving the pain and functional abilities of patients with lateral epicondylopathy compared with conventional therapy only" (11)

Physiotherapy Theory and Practice

What this research powers:

• Mobilization with movement tutorial from the treatment library

• The updated best practice protocol for Lateral Epicondylopathy employs eccentric exercises.

• Visit the Scapular Dyskinesis protocol or review our scapular dyskinesis webinar.

6. 97% of Lumbar Disc Herniations Respond to Conservative Care

"Our results suggest that the majority of  lumbar disc herniation patients (97%) are successfully managed non-operatively.” (12) - Global Spine Journal 

What this research powers:

• See how you compare. Confidentially review your clinical outcomes and patient satisfaction for each of the top 100 diagnoses in your Clinical Profile page.

5. Lumbar Instability Tests

The Apprehension Sign“showed the highest specificity (92.60%) and the second-highest positive likelihood ratio (LR+ = 2.35) but a very low sensitivity of 17.40%.”

The Painful Catch Sign“was the most accurate test overall, having the second-highest sensitivity (72.80%), the highest LR+ (2.38), and the lowest negative likelihood ratio (LR- = 0.39).”

The Prone Instability Test“was the most sensitive test, with the highest LR- (0.39).” (13) Musculoskeletal Science and Practice

What this research powers:

• Review the updated Lumbar Instability tests in the assessment library

• Review the updated condition protocol for Spinal Instability

• Prescribe stability exercises in your home care advice

4. Two Most Important LBP Messages

"Experts considered that the most important messages for patients are (1) remain active and (2) reassurance that back pain is a normal experience and not necessarily related to serious harm." (14)

Pain Journal

What this research powers:

• Incorporate the new ADL for Chronic pain into any condition report or exercise plan.

• Share the new lay infographics: Key insights for managing back pain  or LBP Myths and facts

3. Chiropractic Care Lowers Opioid Use

“Patients with spinal pain who saw a chiropractor had half the risk of filling an opioid prescription.” (15)

Pain Medicine

“Offering (chiropractic) services in primary care may help to address pain and disability, and hopefully limit external referrals, advanced imaging, and opioid prescriptions.” (16)

Journal of Primary Care & Community Health

"Compared to patients with neck pain who saw a primary health care provider, patients with neck pain who initially saw a conservative therapist were 72%-91% less likely to fill an opioid prescription” (17)

What this research powers:

• Share the Opioid Key Facts infographic with legislators, healthcare decision-makers, and patients on social media

2. Communicating the effectiveness of SMT

On average, adding SMT to usual medical care led to approximately two (1.9) less migraine days per month. (18)

Cephalalgia Journal

"These results show that a single upper cervical HVLA manipulation produces an improvement in standing postural control and increases the rotational range of motion (ROM) in the upper cervical spine in patients with chronic, non-specific neck pain." (19)

Journal of Clinical Medicine

"A single session of lumbopelvic manipulation immediately improved balance control, knee joint position sense, and pain in patients diagnosed with patellofemoral pain." (20)

Journal of Bodywork and Movement Therapies

"Our previous study showed that in experimental osteoporosis, chiropractic manipulation (CM) exerts protective effects on bone. Our (new) results suggest that chiropractic manipulation may mitigate OA progression by improving subchondral bone as well as cartilage and synovial membrane status." (21)

Scientific Reports

"[patients] receiving chiropractic care exhibited improved strength and endurance, as well as reduced LBP intensity and disability, compared with a wait-list control." (22)

The Journal of Alternative and Complementary Medicine

“The results of the research show that HVLA techniques, on subjects with musculoskeletal disorders, are able to influence pain modulation, mobility and strength both in the treated area and at a distance. Cervical manipulations are effective in management of cervicalgia, epicondylalgia, temporomandibular joint disorders and shoulder pain.” (23) - Archives of Physical Medicine and Rehabilitation

What this research powers:

• Send MD initial report and MD release report summaries on every patient

• Implement the proven step-by-step MD marketing campaign

Visit the forms library and download our newest infographics:

• Benefits of SMT

• MD/DC Collaboration

• Indications for Referral

• Athletes for Chiropractic

1. The COVID Pandemic

“Over half of (chiropractor) respondents reported moderate levels of stress, and just over 30% reported severe levels due to a variety of reasons related to both personal and professional circumstances. The primary stressors were financial and business concerns. The highest stress levels were among employers responsible for others.” (24) - Research Square

What this research powers:

• Take full advantage of your ChiroUp subscription. Check out the Boost Metrics tab in the main menu for dozens of step-by-step, proven practice-building strategies.

And speaking of game plans...have you started your’s for the New Year yet? We hope you’ll use these findings & the associated resources to help inspire your 2021 practice goals. 

Real talk...we’ve been through a lot this year - it’s forced us all to do things differently, adapt to change, and get creative. With ChiroUp, you don’t have to do this alone. 

Subscribers can use ChiroUp’s entire platform of resources to help take your clinical outcomes and practice viability to the next level in 2021. Let’s make 2021 your best year ever!

• References

  1. Abraham PF, Nazal MR, Varady NH, Gillinov SM, Quinlan NJ, Alpaugh K, Martin SD. The New Dynamic Isokinetic Manipulation Examination (DIME) is a Highly-Sensitive Secondary Screening Tool for Supraspinatus Full-Thickness Tears. Journal of Shoulder and Elbow Surgery. 2020 Jul 7.

  2. Ranebo MC, Hallgren HC, Holmgren T, Adolfsson LE. Surgery and physiotherapy were both successful in the treatment of small, acute, traumatic rotator cuff tears: a prospective randomized trial. Journal of shoulder and elbow surgery. 2020 Mar 1;29(3):459-70. Link

  3. Karjalainen TV, Jain NB, Heikkinen J, Johnston RV, Page CM, Buchbinder R. Surgery for rotator cuff tears. Cochrane Database of Systematic Reviews. 2019(12). Link

  4. Macchi M, Spezia M, Elli S, Schiaffini G, Chisari E. Obesity Increases the Risk of Tendinopathy, Tendon Tear and Rupture, and Postoperative Complications: A Systematic Review of Clinical Studies. A Publication of The Association of Bone and Joint Surgeons®| CORR®. 2020 Apr 14. Link

  5. Irby A, Gutierrez J, Chamberlin C, Thomas SJ, Rosen AB. Clinical Management of Tendinopathy: A Systematic Review of Systematic Reviews Evaluating the Effectiveness of Tendinopathy Treatments. Scandinavian Journal of Medicine & Science in Sports. 2020 Jun 2. Link

  6. Özdemir A, Acar MA, Güleç A, Durgut F, Cebeci H. Clinical, Radiological, and Electrodiagnostic Diagnosis of Pronator Syndrome Concurrent With Carpal Tunnel Syndrome. The Journal of Hand Surgery. 2020 Jul 22. Link

  7. Fernández-de-Las-Peñas C, Arias-Buría JL, Cleland JA, Pareja JA, Plaza-Manzano G, Ortega-Santiago R. Manual Therapy Versus Surgery for Carpal Tunnel Syndrome: 4-Year Follow-up From a Randomized Controlled Trial. 2020 Aug 6. Link

  8. Shem K, Wong J, Dirlikov B. Effective self-stretching of carpal ligament for the treatment of carpal tunnel syndrome: A double-blinded randomized controlled study. Journal of Hand Therapy. 2020 May 1. Link

  9. Reyhan AC, Sindel D, Dereli EE. The effects of Mulligan’s mobilization with movement technique in patients with lateral epicondylitis. Journal of Back and Musculoskeletal Rehabilitation. 2020 Jan 1(Preprint):1-9. Link

  10. Chen Z, Baker NA. Effectiveness of eccentric strengthening in the treatment of lateral elbow tendinopathy: A systematic review with meta-analysis. Journal of Hand Therapy. 2020 Apr 11. Link

  11. Mostafaee N, Divandari A, Negahban H, Kachooei AR, Moradi A, Ebrahimzadeh MH, Tabesh H, Daghiani M. Shoulder and scapula muscle training plus conventional physiotherapy versus conventional physiotherapy only: a randomized controlled trial of patients with lateral elbow tendinopathy. Physiotherapy Theory and Practice. 2020 Sep 26:1-2. Link

  12. Lilly DT, Davison MA, Eldridge CM, Singh R, Montgomery EY, Bagley C, Adogwa O. An Assessment of Nonoperative Management Strategies in a Herniated Lumbar Disc Population: Successes Versus Failures. Global Spine Journal. 2020 Jul 7:2192568220936217. Link

  13. Areeudomwong P, Jirarattanaphochai K, Ruanjai T, Buttagat V. Clinical utility of a cluster of tests as a diagnostic support tool for clinical lumbar instability. Musculoskeletal Science and Practice. 2020 Jul 24:102224. Link

  14. French SD, Nielsen M, Hall L, Nicolson PJ, van Tulder M, Bennell KL, Hinman RS, Maher CG, Jull G, Hodges PW. Essential key messages about diagnosis, imaging, and self-care for people with low back pain: a modified Delphi study of consumer and expert opinions. Pain. 2019 Dec 1;160(12):2787-97. Link

  15. Whedon JM, Toler AW, Kazal LA, Bezdjian S, Goehl JM, Greenstein J. Impact of Chiropractic Care on Use of Prescription Opioids in Patients with Spinal Pain. Pain Medicine. 2020 Mar 6. Link

  16. Prater C, Tepe M, Battaglia P. Integrating a Multidisciplinary Pain Team and Chiropractic Care in a Community Health Center: An Observational Study of Managing Chronic Spinal Pain. J Prim Care Community Health. 2020;11:2150132720953680. doi:10.1177/2150132720953680 Link

  17. Louis CJ, Herrera CN, Garrity BM, McDonough CM, Cabral H, Saper RB, Kazis LE. The association of initial provider type on opioid fills for individuals with neck pain. Archives of Physical Medicine and Rehabilitation. 2020 May 11. Link

  18. Rist PM, Bernstein C, Kowalski M, Osypiuk K, Connor JP, Vining R, Long CR, Macklin EA, Wayne PM. Multimodal chiropractic care for migraine: A pilot randomized controlled trial. Cephalalgia. 2020 Oct 13:0333102420963844. Link

  19. Gómez F, Escribá P, Oliva-Pascual-Vaca J, Méndez-Sánchez R, Puente-González AS. Immediate and Short-Term Effects of Upper Cervical High-Velocity, Low-Amplitude Manipulation on Standing Postural Control and Cervical Mobility in Chronic Nonspecific Neck Pain: A Randomized Controlled Trial. Journal of Clinical Medicine. 2020 Aug;9(8):2580. Link

  20. Motealleh A, Barzegar A, Abbasi L. The immediate effect of lumbopelvic manipulation on knee pain, knee position sense and balance in patients with patellofemoral pain: a randomized controlled trial. Journal of Bodywork and Movement Therapies. 2020 Feb 6. Link

  21. Conesa-Buendía FM, Mediero A, Fujikawa R, Esbrit P, Mulero F, Mahillo-Fernández I, Ortega-De Mues A. Beneficial effects of manually assisted chiropractic adjusting instrument in a rabbit model of osteoarthritis. Scientific Reports. 2020 Aug 6;10(1):1-5. Link

  22. Vining R, Long CR, Minkalis A, Gudavalli MR, Xia T, Walter J, Coulter I, Goertz CM. Effects of Chiropractic Care on Strength, Balance, and Endurance in Active-Duty US Military Personnel with Low Back Pain: A Randomized Controlled Trial. The Journal of Alternative and Complementary Medicine. 2020 Jun 12. Link

  23. Giacalone A, Febbi M, Magnifica F, Ruberti E. The Effect of High Velocity Low Amplitude Cervical Manipulations on the Musculoskeletal System: Literature Review. Cureus. 2020 Apr;12(4). Link

  24. Neff SM, Deyo RL, Auley AL, Lawrence DJ. The impact of COVID-19 on the chiropractic profession: a cross-sectional survey on opinions, professional changes, and personal hardships of US chiropractors. Research Square; 2020. Link