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This month’s research roundup is going head-to-toe! Check out what ChiroUp’s research team has pulled from the most up-to-date literature that impacts our profession & standard of care.

Review the latest news:

✔ Upper cervical restrictions linked to TMD
✔ Yergasons test is best
✔ Clinical prediction rule for lumbar traction
✔ One exercise that halves hamstring injuries
✔ When not to MRI a rotator cuff

Head & Neck

1. “Maladaptive postures can activate C1-C3 nociceptors. Convergence with trigeminal afferents at the trigeminocervical nucleus could explain spinal headache.”

Mingels S, Dankaerts W, Granitzer M. Is There Support for the Paradigm ‘Spinal Posture as a Trigger for Episodic Headache’? A Comprehensive Review. Curr Pain Headache Rep. 2019.

2. “Women with TMD, regardless of self-reported headaches, showed limited flexion/extension ROM, limited upper cervical spine (C1-C2) mobility, and poor deep cervical flexor performance.”

Ferreira MP et al. Mobility of the upper cervical spine and muscle performance of the deep flexors in women with temporomandibular disorders. J Oral Rehabil. 2019 Jul 10.


3. “The use of MRI before a trial of conservative management in patients with atraumatic shoulder pain, minimal to no strength deficits on physical examination, and suspected cuff tendinopathy other than full-thickness tears provides negative value

Cortes A et al. A value-based care analysis of magnetic resonance imaging in patients with suspected rotator cuff tendinopathy and the implicated role of conservative management. J Shoulder Elbow Surg. 2019 Jul 4. pii: S1058-2746(19)30247-2.

4. A systematic review of tests for proximal long head of the biceps tendon pathology concluded: “The accuracy of orthopedic tests varied greatly across studies. The only test of value was Yergason’s maneuver.”

Bélanger V et al. Accuracy of examination of the long head of the biceps tendon in the clinical setting: A systematic review. J Rehabil Med. 2019 Jul 8;51(7):479-491. doi: 10.2340/16501977-2563.

* Editor’s note: This data varies from prior research by Kibler et al. that found the most sensitive tests for biceps tendinopathy are the Bear Hug (0.79) and Upper Cut (0.73), and the most specific are Belly Press (0.85) and Speed’s (0.81).

Kibler BW, Sciascia AD, Hester P, Dome D, Jacobs C. Clinical utility of traditional and new tests in the diagnosis of biceps tendon injuries and superior labrum anterior and posterior lesions in the shoulder. Am J Sports Med. 2009 Sep;37(9):1840-7. 

Here are all five tests for your review:


5. “The effects of the lumbar belts on trunk postural control were small.” 

Shahvarpour A. et al. The effect of extensible and non-extensible lumbar belts on trunk postural balance in subjects with low back pain and healthy controls. Gait Posture. 2019 Jun 20;72:211-216.

6. Researchers tested five predictors for determining which disc herniation patients will benefit from lumbar traction:

  • limited lumbar extension range of motion
  • low-level fear-avoidance beliefs regarding work
  • no segmental hypomobility in the lumbar spine
  • short duration of symptoms
  • sudden onset of symptoms

“For the patients with at least three of the five predictors, the probability of their Oswestry Disability Index greatly improving increased from 23.3% to 48.7% when compared to patients without these (three) predictors.”

Hirayama K et al. Developing a clinical prediction rule to identify patients with lumbar disc herniation who demonstrate short-term improvement with mechanical lumbar traction. Phys Ther Res. 2019 Apr 20;22(1):9-16. doi: 10.1298/ptr.E9973. eCollection 2019.

7. “Active TENS applied while walking is no better than de-tuned TENS for improving walking ability in patients with degenerative lumbar spine stenosis and therefore should not be a recommended treatment in clinical practice.”

Ammendolia C et al. Effect of active TENS versus de-tuned TENS on walking capacity in patients with lumbar spinal stenosis: a randomized controlled trial. Chiropr Man Therap. 2019 Jun 19;27:24. doi: 10.1186/s12998-019-0245-z. eCollection 2019.

Hip & Knee

8. A systematic review of 15 studies including more than 8400 athletes concluded: “Programs that include the Nordic hamstring exercise reduce hamstring injuries by up to 51%.

van Dyk N, Behan FP, Whiteley R. Including the Nordic hamstring exercise in injury prevention programmes halves the rate of hamstring injuries: a systematic review and meta-analysis of 8459 athletes. British Journal of Sports Medicine Published Online First: 26 February 2019. 

9. “The addition of trunk stabilization exercise to a typical FAI hip rehabilitation protocol improves short-term clinical outcomes and may augment nonoperative and postoperative rehabilitation.”

Aoyama M et al. A Prospective, Randomized, Controlled Trial Comparing Conservative Treatment With Trunk Stabilization Exercise to Standard Hip Muscle Exercise for Treating Femoroacetabular Impingement: A Pilot Study. Clin J Sport Med. 2019 Jul;29(4):267-275.

Foot & Ankle

10. A systematic review of fifteen studies concluded: “Treatment with fluoroquinolones was associated with 2.5 times increased risk of Achilles tendon rupture, 3.95 times increased risk of Achilles tendinopathy. Older age and concomitant use of corticosteroids seem to be additional risk factors for tendinopathy.”  

Alves C et al. Fluoroquinolones and the risk of tendon injury: a systematic review and meta-analysis. Eur J Clin Pharmacol. 2019 Jul 4. doi: 10.1007/s00228-019-02713-1. [Epub ahead of print]


The top quote this month: “We’ve got your back.”

Bertelsman TJ,  Steele BC et al. ChiroUp Version 2.0 Online J of Appl Stuff  🙂 [Epub ahead of print]

ChiroUp has already incorporated this latest information into your favorite resource. In addition to a brand new V2 platform, here’s what we’ve enhanced for our subscribers this month:


  • Your TMD and cervicogenic headache protocols include exercises for maladaptive postures
  • The ChiroUp imaging recommendations for RC pathology are up-to-date
  • Your shoulder exam form & biceps tendinopathy assessment incorporates Yergason’s test
  • The new clinical prediction rule for lumbar traction is included in the description of that modality
  • Your hamstring protocol includes The Nordic hamstring exercise
  • Your FAI patient reports deliver the most potent trunk stabilization exercises

Does your exercise program do that each month? Stop settling for “good enough” and get on board with ChiroUp, the worldwide leading online platform for chiropractic clinical excellence.

Check out our plans & pricing today to get started.

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 past president of the executive board.

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