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Balmoral Spine Clinic

Chiropractic Research Belfast 2017

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Here’s a sampling of 14 studies that we used to update protocols this week. Some studies describe new concepts, while others simply reinforce our current understanding and provide additional support for evidence-based chiropractic practice.

1. A systematic review of 26 studies strongly supports the existence of a soft tissue connection between the upper cervical muscles (rectus capitis posterior minor, the rectus capitis posterior major, and the obliquus capitis inferior) and the spinal cord dura. This connection has pathophysiological and therapeutic implications that may help explain the beneficial effect of manual therapy on craniocervical disorders, i.e. cervicogenic headache, cervicogenic vertigo, etc.

PalomequeDel-Cerro L, et al. A systematic review of the soft-tissue connections between neck muscles and dura mater: The myodural bridge. Spine (Phila Pa 1976).2017 Jan 1;42(1):49-54.

2. “Mobilization, (cervical & thoracic) manipulation, and clinical massage are effective interventions for the management of neck pain. Electroacupuncture, strain-counterstrain, relaxation massage, and some passive physical modalities (heat, cold, diathermy, hydrotherapy, and ultrasound) are not effective.”

Wong JJ, et al. Are manual therapies, passive physical modalities, or acupuncture effective for the management of patients with whiplashassociated disorders or neck pain and associated disorders? An update of the Bone and Joint Decade Task Force on Neck Pain and Its Associated Disorders by the OPTIMa collaboration. Spine J. 2016 Dec;16(12):1598-1630

3. In older adults with chronic neck pain, incorporating spinal manipulation decreases overall societal costs 5% and results in greater improvements in pain and disability when compared to a home exercise program alone. Furthermore, adding spinal manipulation to a home exercise program resulted in 47% lower costs compared to supervised rehabilitation.

Leininger B, et al. Cost-effectiveness of spinal manipulative therapy, supervised exercise, and home exercise for older adults with chronic neck pain. Spine J. 2016 Nov;16(11):1292-1304.

4. Regarding patients with myofascial neck and shoulder pain, a randomized clinical trial found that 4 sessions of either dry needling or manual pressure resulted in significant short and long-term improvements in pain and stiffness. Dry needling was not shown to be more effective than manual pressure in the treatment of myofascial neck and shoulder pain.

Meulemeester KE, et al. Comparing Trigger point dry needling and manual pressure technique for the management of myofascial neck/shoulder pain: A randomized clinical trial. De J Manipulative Physiol Ther. 2017 Jan;40(1):11-20.

5. In patients with cervical radiculopathy, cervical manipulation provides immediate pain relief.

Thoomes EJ. Effectiveness of manual therapy for cervical radiculopathy, a review. Chiropr Man Therap. 2016 Dec 9;24:45.

6. Spinal manipulation leads to changes in cortical excitability and motor control of both upper and lower limb muscles. This is particularly encouraging for providers treating athletic populations or muscle degrading dyfunctions (i.e. stroke).

Haavik H, et al. Impact of spinal manipulation on cortical drive to upper and lower limb muscles. 2016 Dec 23;7(1).

7. In a group of 104 migraine patients, cervical spine manipulation resulted in significantly decreased headache intensity and duration with no significant adverse effects. Patients undergoing SMT also noted a reduction in frequency, however not significantly different as compared to participants in prescription medication and placebo control groups.

Chaibi A, Benth JŠ, Tuchin PJ, Russell MB. Chiropractic spinal manipulative therapy for migraine: a three-armed, single-blinded, placebo, randomized controlled trial. Eur J Neurol. 2017 Jan;24(1):143-153.

8. Patients with Shoulder Anterior Impingement Syndrome show positive outcomes to upper thoracic manipulation.

Kardouni JR, Shaffer SW, Pidcoe PE, Finucane SD, Cheatham SA, Michener LA. Immediate changes in pressure pain sensitivity after thoracic spinal manipulative therapy in patients with subacromial impingement syndrome: a randomized controlled study. Man Ther. 2015;20:540–46.View ArticlePubMedGoogle Scholar

9. Obese patients are less likely to show improvement from LBP treatment regardless of the care they receive.

Ewald SC, Hurwitz EL, Kizhakkeveettil A. The effect of obesity on treatment outcomes for low back pain. Chiropr Man Therap. 2016 Dec 12;24:48.

10. An analysis of over 5000 LBP workers compensation clams showed that patients who chose a chiropractor over an MD or PT as their first healthcare provider typically had:
o a mixed-manual job (i.e. skilled or semi-skilled occupation)
o longer employment tenure
o higher income
o a smaller residential community (<500,000)

Blanchette MA, Rivard M, Dionne CE, Hogg-Johnson S, Steenstra I. Workers’ characteristics associated with the type of healthcare provider first seen for occupational back pain. BMC Musculoskelet Disord. 2016 Oct 18;17(1):428.

11. Patients with LBP have impaired lumbar proprioception compared to controls.

Tong MH, et al. Is there a relationship between lumbar proprioception and low back pain? A systematic review with meta-analysis. Arch Phys Med Rehabil. 2017 Jan;98(1):120-136.e2.

12. A systematic review showed no significant long-term effect for surgery compared to physical activity based interventions for leg and back pain from lumbar disc herniation. The same study found that surgery provided long-term benefit for local and radicular complaints in appropriate stenosis and spondlyolisthesis patients.

Fernandez M, et al. Surgery or physical activity in the management of sciatica: a systematic review and meta-analysis. Eur Spine J. 2016 Nov;25(11):3495-3512.

13. A systematic review concluded that manual therapy and exercise therapy are beneficial for people with hip osteoarthritis in terms of reduced pain, improved physical function and improved quality of life. In particular, exercise therapy provided short-term as well as long-term benefits.

Sampath KK, Mani R, Miyamori T, Tumilty S. The effects of manual therapy or exercise therapy or both in people with hip osteoarthritis: a systematic review and metaanalysis.. Clin Rehabil. 2016 Dec;30(12):1141-1155.

14. A randomized clinical trial found that in patients with knee osteoarthritis, Kinesio taping resulted in improvements in pain, ambulation, and ROM.

Kaya Mutlu E, Mustafaoglu R, Birinci T, Razak Ozdincler A. Does kinesio taping of the knee improve pain and functionality in patients with knee osteoarthritis?: A randomized controlled clinical trial. Am J Phys Med Rehabil. 2017 Jan;96(1):25-33.

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