Effectiveness of Chiropractic Care
Certified for:
1. Low Back Pain: Chronic, severe, moderate & non-specific
2. Neck Pain: Severe and moderate
3. Migraine Headaches
4. Headaches: Cervicogenic
5. Dizziness: Cervicogenic
6. Hip Pain: From Arthritis
A report on the scientific literature
By
Mark Studin DC, FASBE (C), DAAPM, DAAMLP
In order to understand the vast importance of this study, it is critical to understand the context of the work. These conclusions were based on randomized clinical trials and evidenced based results. The studies which the conclusions were based upon come from the input of hundreds of sources.
Randomized Clinical Trials
According to the National Cancer Institute (2004), "Randomization is a process that assigns research participants by chance, rather than by choice, to either the investigational group or the control group of all phase III (and some phase II) clinical trials...Each study participant has a fair and equal chance of receiving either the new intervention being studied (by being placed in the investigational group), or of receiving the existing or 'control' intervention (by being placed in the control group)" (http://www.cancer.gov/clinicaltrials/learning/what-is-randomization).
"The goal of randomization is to produce comparable groups in terms of general participant characteristics, such as age or gender, and other key factors that affect the probable course the disease would take. In this way, the two groups are as similar as possible at the start of the study. At the end of the study, if one group has a better outcome than the other, the investigators will be able to conclude with some confidence that one intervention is better than the other. A randomized, controlled trial is considered the most reliable and impartial method of determining what medical interventions work the best" (National Cancer Institute, 2004, http://www.cancer.gov/clinicaltrials/learning/what-is-randomization).
Evidenced Based Healthcare/Practice
According to Schardt and Mayer (2010), "[Evidenced based practice] is the integration of clinical expertise, patient values, and the best research evidence into the decision making process for patient care. Clinical expertise refers to the clinician's cumulated experience, education and clinical skills. The patient brings to the encounter his or her own personal and unique concerns, expectations, and values. The best evidence is usually found in clinically relevant research that has been conducted using sound methodology" (http://www.hsl.unc.edu/Services/Tutorials/EBM/whatis.htm).
"The evidence, by itself, does not make a decision for you, but it can help support the patient care process. The full integration of these three components into clinical decisions enhances the opportunity for optimal clinical outcomes and quality of life. The practice of EBP is usually triggered by patient encounters which generate questions about the effects of therapy, the utility of diagnostic tests, the prognosis of diseases, or the etiology of disorders. Evidence-Based Practice requires new skills of the clinician, including efficient literature searching, and the application of formal rules of evidence in evaluating the clinical literature" (Schardt & Mayer, 2010, http://www.hsl.unc.edu/Services/Tutorials/EBM/whatis.htm).
Conclusion
In a 2010 study by Bronfort, Haas, Evans, Leininger and Triano, the researchers both randomized clinical trials and studied evidenced based practice results utilizing guidelines found in scientific literature. In each case, they compared the results of manipulation (chiropractic spinal adjustments or extremity adjusting) to "sham" treatment and concluded that manipulation was effective for:
1. Low back pain, soreness or tension
2. Neck pain
3. Hip pain from arthritis
4. Migraine
5. Headache localized in the neck or back of the head
6. Dizziness emanating from the neck
The following entities were included in the above study to help conclude the results of this research: The American College of Physicians/American Pain Society, The Journal of the AMA, the World Health Organization, Journal of Manipulative Physiological Therapeutics, New Zealand Journal of Medicine and many others. Some clarified what was not yet conclusive while others certified chiropractic as a viable choice for care. The arguments as to whether chiropractic works or not has been long silenced. The only question that now arises is when will the more scientific literature be published?
Asthma is one area is that is lacking in research. As the author of this article and a chiropractic practitioner for 30 years, there has not been one asthma patient that didn’t respond to chiropractic care ranging from the acute to the chronic patient where most discarded their drugs and inhalers (as a result of the advice of their medical practitioners) because they didn’t need them anymore. During most of my career, there was no literature, it just worked. Today, we do not have to go simply on faith as there is much literature in the scientific community confirming the benefits of chiropractic.
This study along with many others concludes that a drug-free approach of chiropractic care is one of the best solutions for many problems and returning to a normal life. To find a qualified doctor of chiropractic near you go to the US Chiropractic Directory at www.USChiroDirectory.com and search your state.
References
1. National Cancer Institute. (2004, August 3).What is randomization? Retrieved from http://www.cancer.gov/clinicaltrials/learning/what-is-randomization
2. Schardt, C., & Mayer , J. (2010, July). What is evidence-based practice. Retrieved from http://www.hsl.unc.edu/Services/Tutorials/EBM/whatis.htm
3. Bronfort, G., Haas M., Evans R., Leininger, B., &Triano, J. (2010). Effectiveness of manual therapies: The UK evidence report. Chiropractic and Osteopathy, 18(3). Retrieved from http://www.chiroandosteo.com/content/18/1/3
Prediction of Outcomes with Chiropractic Care and Cervical Pain
A report on the scientific literature
By
Mark Studin DC, FASBE (C), DAAPM, DAAMLP
William J. Owens DC, DAAMLP
updated 12-4-2013
Pain located in the neck is a very common condition. Neck pain can come from a number of activities, disorders and diseases in the neck, such as degenerative disc disease, neck strain, whiplash, a herniated disc, or a pinched nerve. It can also come from overuse, sports injuries, and everyday home and work related activities. Usually, there is an underlying instability or problem in the neck that is a precursor to the pain. Neck pain is also referred to as cervical pain.
"Neck pain is commonly associated with dull aching. Sometimes pain in the neck is worsened with movement of the neck. Other symptoms associated with some forms of neck pain include numbness, tingling, tenderness, sharp shooting pain, fullness, difficulty swallowing, pulsations, swishing sounds in the head, dizziness or lightheadedness, and gland swelling" (MedicineNet.com, 2008, http://www.medicinenet. com/neck_pain/article.htm).
"There are seven vertebrae that are the bony building blocks of the spine in the neck (the cervical vertebrae) that surround the spinal cord and canal. Between these vertebrae are discs, and nearby pass the nerves of the neck" (MedicineNet.com, 2008, http://www.medicinenet.com/neck_pain/article.htm).
"Incredibly, the cervical spine supports the full weight of your head, which is on average about 12 pounds. While the cervical spine can move your head in nearly every direction, this flexibility makes the neck very susceptible to pain and injury" (American Chiropractic Association, n.d., http://www.acatoday.or/ content_css.cfm?CID=2430).
"The neck’s susceptibility to injury is due in part to biomechanics. Activities and events that affect cervical biomechanics include extended sitting, repetitive movement, accidents, falls and blows to the body or head, normal aging, and everyday wear and tear" (American Chiropractic Association, n.d., http://www.acatoday. or/content_css.cfm?CID=2430).
Further detailed explanations of some of the causes of neck pain are:
"Injury and Accidents: A sudden forced movement of the head or neck in any direction and the resulting "rebound" in the opposite direction is known as whiplash. The sudden "whipping" motion injures the surrounding and supporting tissues of the neck and head. Muscles react by tightening and contracting, creating muscle fatigue, which can result in pain and stiffness. Severe whiplash can also be associated with injury to the intervertebral joints, discs, ligaments, muscles, and nerve roots. Car accidents are the most common cause of whiplash" (American Chiropractic Association, n.d., http://www.acatoday.or/ content_css.cfm?CID=2430).
"Growing Older: Degenerative disorders such as osteoarthritis, spinal stenosis, and degenerative disc disease directly affect the spine.
- Osteoarthritis, a common joint disorder, causes progressive deterioration of cartilage. The body reacts by forming bone spurs that affect joint motion.
- Spinal stenosis causes the small nerve passageways in the vertebrae to narrow, compressing and trapping nerve roots. Stenosis may cause neck, shoulder, and arm pain, as well as numbness, when these nerves are unable to function normally.
- Degenerative disc disease can cause reduction in the elasticity and height of intervertebral discs. Herniated discs are NOT an effect of growing older and are a direct effect of trauma, but can also cause similar reduction in elasticity and height of the intervertebral disc, but have the potential to cause more serious problems.
"Daily Life: Poor posture, obesity, and weak abdominal muscles often disrupt spinal balance, causing the neck to bend forward to compensate. Stress and emotional tension can cause muscles to tighten and contract, resulting in pain and stiffness. Postural stress can contribute to chronic neck pain with symptoms extending into the upper back and the arms" (American Chiropractic Association, n.d., http://www.acatoday. or/content_css.cfm?CID=2430).
When considering solutions for neck pain, you must look at what will help you and how long it will take to get better. Like with any malady, the progression of treatment should be drugless first, involve drugs second and have surgery as a final option. A significant factor must be the scientific evidence that predicts the outcome of any treatment. A cancer patient or a heart disease patient, prior to undergoing chemotherapy or open heart surgery, will ask the doctor what the percentage of success is for the treatment. The same question should be asked of every doctor for every treatment and chiropractic is no different.
In 2008, Thiel and Bolton studied 19,722 patients that were treated for a variety of symptoms, most of which were pain or stiffness in the neck, shoulder or arm region. The purpose of the study was to determine the outcome of chiropractic care in patients with nonspecific musculoskeletal disorders, including mechanical neck disorders. The results revealed that 71.6% of females and 67.9 % of males had immediate improvement. This shouldn’t be confused with the overall satisfaction rate of 94% of patients treated with acute neck pain as reported by Haneline (2006), asThiel and Bolton (2008) examined immediate improvement, not improvement over time as Haneline did.
Since statistics can be manipulated in many different ways, let’s examine those patients who experienced immediate worsening. The Thiel and Bolton (2008) study revealed that 95.2% of females and 96.2% of males reported no immediate worsening, rendering an overwhelming predictor of a successful outcome. Predictable outcomes are critical in guiding both the public and the doctor in realizing a successful treatment plan.
These studies, along with many others, conclude that a drug-free approach of chiropractic care is one of the best solutions to treat neck pain. To find a qualified doctor of chiropractic near you, go to the US Chiropractic Directory at www.USChiroDirectory.com and search your state.
References:
1. MedicineNet.com. (2008, January). Neck pain. Retrieved from http://www.medicinenet.com/neck_pain/article.htm
2. American Chiropractic Association. (n.d.). Chiropractic and neck pain: Conservative care of cervical pain, injury. Retrieved from http://www.acatoday.org/content_css.cfm?CID=2430
3. Thiel, H. W., & Bolton, J. E. (2008). Predictors for immediate and global responses to chiropractic manipulation of the cervical spine. Journal of Manipulative and Physicological Therapeutics, 31(3), 172-183.
Acute Neck Pain (Torticollis), Disability
and Chiropractic:
Patient Satisfaction Results
The overall patient satisfaction rate was 94%
A report on the scientific literature
By
Mark Studin DC, FASBE (C), DAAPM, DAAMLP
William J. Owens DC, DAAMLP
"Acute neck pain means immediate neck pain. Neck pain that just started. This type of pain comes on suddenly and affects the ability to properly move your head in its proper range of motion. One serious type of acute neck pain is whiplash - the sudden jarring motion of your head going backwards and forward. This often occurs with a rear end collision. Acute neck pain can also be the result of a fall, sleeping awkwardly, a trauma or even a fall.. Often times when someone has just strained or irritated their neck in some way the pain is most severe. There is usually inflammation, immobility, and muscle tenderness. Often with acute neck pain, the muscles or ligaments are involved" (The Neck Pain Relief Shop, n.d., http://www.neckpainreliefkit.com/acuteneckpain).
The “real life” issue for the patient who either wakes up with this debilitating pain or is in an accident that causes it, is that taking drugs without narcotics is insufficient for relieving the pain. With the narcotics, one can be severely hampered and may not be able to go about his/her life. It is often a double-edged sword; take strong drugs and compromise your life or don't take drugs, receive no chiropractic care and suffer.
A 2006 study examined "...the extent to which a group of patients with acute neck pain managed with chiropractic [adjustments]...and the degree to which they were subsequently satisfied...A total of 115 patients were contacted, of whom 94 became study participants, resulting in 60 women (64%) and 34 men. The mean age was 39.6 years...The mean number of visits was 24.5...Pain levels improved significantly from a mean of 7.6...before treatment to 1.9...after treatment...The overall patient satisfaction rate was 94%" (Haneline, 2006, p. 288).
"There were reductions in disability recorded during the study that were statistically significant. Approximately 84% of the patients related that their activities were restricted before chiropractic treatment because of their neck pain, whereas only 25% still had activity restrictions at the time of the interview. Furthermore, 57% of those with physical restrictions described their disabilities as moderately severe or greater before treatment, whereas at the time of the interview, just 12% did (Haneline, 2006, p. 294).
"When comparing trauma with no-trauma cases, Trauma cases received more than 3 times as many visits. This difference may be related to tissue damage that often accompanies trauma, which, many times, heals imperfectly. In addition, patients with this type of problem may have ensuing long-term pain and physical impairment, which further shows that trauma complicates the recovery of acute neck pain (Haneline, 2006, p. 294).
This study along with many others concludes that a drug-free approach of chiropractic care is one of the best solutions to acute neck pain and returning to a normal life. To find a qualified doctor of chiropractic near you go to the US Chiropractic Directory at www.USChiroDirectory.com and search your state.
References
1. The Neck Pain Relief Shop. (n.d.). Acute neck pain.Retrieved from http://www.neckpainreliefkit.com/acuteneckpain
2. Haneline, M. T. (2006). Symptomatic outcomes and perceived satisfaction levels of chiropractic patients with a primary diagnosis involving acute neck pain. Journal of Manipulative and Physiological Therapeutics, 29(4), 288-296.
Chronic Neck Pain and Chiropractic:
A Comparative Study with Massage Therapy
A report on the scientific literature
By
Mark Studin DC, FASBE (C), DAAPM, DAAMLP
William J. Owens DC, DAAMLP
Neck pain is a very common problem, second only to low back pain in its frequency in the general population and in doctors' offices treating musculoskeletal injuries. "The musculoskeletal system is an organ system that gives [humans] the ability to move using their muscular and skeletal systems" (Wikipedia, ,2010, http://en.wikipedia.org/wiki/Musculoskeletal). "Estimates of the prevalence of chronic neck pain vary. In a Swedish population 18.5% of females and 13.2% of males had neck pain for longer than 6 months; however, when continuous chronicity was rated, these figures were reduced to 10% and 7%, respectively. A Finnish study reported chronic neck pain in 13.5% of females and 9.5% of males. A Norwegian studyreported an overall rate of 13.8% for neck pain greater than 6 months duration; however, for subgroups with age greater than 43, the rate rose above 20%. It would appear that approximately 15% of females and 10% of men have chronic neck pain at any one time. Chronic neck pain produces a high level of morbidity by affecting occupational and avocational activities of daily living and by affecting quality of life" (Vernon, Humphreys & Hagino, 2007, p. 215).
"Manual therapy [chiropractic adjusting] is a generic therapeutic category that is composed of a variety of procedures directed at the musculoskeletal structures in the treatment of mechanical pain. Two major subcategories exist that divide these therapies into those which produce joint motion and those which do not. The first subcategory includes manipulation, mobilization, and manual traction. The second subcategory involves both generalized soft tissue therapies, such as the many types of massage, and focal soft tissue therapy, such as trigger point therapy, shiatsu, and acupressure. For this review, we used the separate therapy categories of manipulation, mobilization, manual traction, massage, and pressure techniques" (Vernon, Humphreys & Hagino, 2007, pp. 215-216).
There are numerous systematic reviews of the treatment of neck pain by manual therapy. With few exceptions, they have included studies of manual therapies for acute, subacute, and chronic neck pain. They have also included studies of subjects with neck pain due to whiplash-type injury as well as those in which whiplash-associated disorder (WAD) was not involved. These reviews have also included studies of subjects with or without concomitant headaches and/or arm pain...Finally, these reviews have included studies where manual therapies have been combined with other therapies such as exercises, relaxation therapy, etc (so-called 'multimodal therapy'). The most recent reviews by Gross et al, Bronfort et al and the Canadian Chiropractic Association Clinical Practice Guideline have brought the evidence base up to date but are similarly broad in scope" (Vernon, Humphreys & Hagino, 2007, p. 216).
The results of these research studies included studies that provided information of long-term outcomes, meaning they continued their study up to at least 52 weeks, with one going as high as 104 weeks (2 years) in order to determine the validity over a long period of time confirming the non-recurrence of the pain. The results of one long-term study that examined the effects of chiropractic treatment on the recovery of clinical trial patients found that approximately 70% of the patients showed full recovery. However,100% of the patients in five studies that varied in length had positive changes. It was also reported that 0%, or none of the massage therapy patients had positive outcomes at the 6 week period.
This study along with many others conclude that a drug-free approach of chiropractic care is one of the best solutions to neck pain. To find a qualified doctor of chiropractic near you go to the US Chiropractic Directory at www.USChiroDirectory.comand search your state.
References
1. Wikipedia, The Free Encyclopedia. (2010, July). Human musculoskeletal system. Retrieved from http://en.wikipedia.org/wiki/Musculoskeletal
Whiplash Disorders and Neck Pain
A report on the scientific literature
By
Mark Studin DC, FASBE (C), DAAPM, DAAMLP
In car accidents and other trauma related causes, whiplash, formally known as WAD (Whiplash Associated Disorders), has the potential to create significant problems to the neck area or cervical spine. The treatment of these disorders ranges from rest or no care to non-invasive care such as chiropractic, acupuncture or physical therapy to invasive care starting with drugs and leading to surgery. Every one of these treatment modalities is indicated based upon the individual diagnosis of the condition and requires the care from a doctor who is experienced and credentialed in trauma related care.
The problem with whiplash is that it affects the ligamentous attachments that connect the bones to one another and creates hypermobility (too much movement or laxity). It often results in compression of the nerves causing pain and resultant premature degeneration. The biggest problem is that ligaments, as reported in a 2006 study, never heal or wound repair.1 They stay impaired for a lifetime, which affects different people in different ways.
Symptoms from whiplash include:2
When analyzing and comparing non-invasive modalities for care, interventions involving mobilization (chiropractic) were more effective than usual care. Multimodal treatment including manual therapy, which included relaxation therapy, led to a quicker return to work and increased satisfaction with recovery.3
With whiplash and resultant damage to ligaments, one the solutions is quick intervention where the joints are mobilized or put back in their normal position with a chiropractic adjustment before adhesions (internal scar tissue) can create a chronic (long term) problem. By getting the area “adjusted” after a conclusive diagnosis is one of the best approaches to treat whiplash disorders.
These studies along with many others conclude that a drug-free approach of chiropractic care is one of the best solutions for pregnant patients with back pain. To find a qualified doctor of chiropractic near you go to the US Chiropractic Directory at www.uschirodirectory.comand search your state.
References:
1. Tozer, S., & Duprez, D. (2005). Tendon and ligament; Repair and disease. Birth Defects Research (Part C) 75, 226-236.
Shoulder Pain, Neck Pain and Chiropractic
A report on the scientific literature
By
William J. Owens DC, DAAMLP
Mark Studin DC, FASBE (C), DAAPM, DAAMLP
Many people experience pain in the upper back area between the bottom of the neck and the shoulders. There is a very large muscle there called the trapezius muscle. Doctors of chiropractic have long understood the relationship between the nervous system and the rest of the body. In this area, the part of the nervous system that controls the trapezius is actually found in the neck. A research paper was presented that sought to determine whether a chiropractic adjustment to the neck at specific levels of the spine would result in reduced sensitivity to pain in the shoulders. What they found was VERY interesting.
The authors stated, “Our results suggest that a cervical spine manipulation [chiropractic adjustment] directed at the C3 through C4 segment induced changes in pain sensitivity...in the upper trapezius muscle” (Ruiz-Sáez, Fenández-de-las-Peñas, Blanco, Martínez-Segura, & García-Léon, 2007, p. 578). What this means is that stimulation and/or correction of the nervous system in the neck can effect the shoulders! This is important because many of the things that we do on a daily basis increase the demand on the vertebral column found in the neck. This in turn can create problems in the shoulders. While helping to reduce symptoms is important, only doctors of chiropractic are specifically trained to look to the CAUSE of the problem, essentially to find the SOURCE of your pain.
More and more research is coming out on a daily basis that shows what chiropractic patients have known for years; CHIROPRACTIC WORKS. If you are suffering from pain in the shoulders, especially the type that increases throughout the day, speak with a doctor of chiropractic today. According to this research article, you will be happy you did!
References:
1. Ruiz-Sáez, M., Fenández-de-las-Peñas, C., Blanco, C. R., Martínez-Segura, R., & García-Léon, R. (2007). Changes in pressure pain sensitivity in latent myofascial trigger points in the upper trapezius muscle after a cervical spine manipulation in pain-free subjects. Journal of Manipulative and Physiological Therapeutics, 30(8), 578-583.
Neck Pain and Chiropractic
A report on the scientific literature
By
William J. Owens DC, DAAMLP
Mark Studin DC, FASBE (C), DAAPM, DAAMLP
A recent study examined the effect a chiropractic adjustment has on the pain levels of muscle spasm in the neck. When only a part of a muscle goes into spasm it is called a trigger point (knot). These hypersensitive areas are a common cause of pain in the neck and a major reason patients present for treatment. They can occur slowly over time (from things like computer work or video games) or can be the result of an acute trauma such as a car accident or a fall. In a recent study, the authors stated, "A clinical relationship between MTrPs [trigger points] and joint impairments has been suggested by some authors" (Ruiz-Sáez, Fernández-de-las-Peñas, Blanco, Martı´nez-Segura, & Garcı´a-León, 2007, p. 579). In other words, there is a problem with the bones of the spine [subluxation] that contributes to these painful conditions. In most cases, there are multiple areas on the body that have subluxations and in turn, have trigger points. These points were first reported in 1942 and can result in severe pain. Many patients may be on pain medications (even narcotic medication) and be unable to continue with their daily activities.
The another study also related to these issues, the author’s state, “The purpose of this study was to review the most commonly used treatment procedures in chiropractic for MPS [myofascial pain syndrome] and MTrPs” (Vernon &Schneider, 2009, p. 14). Manipulation (chiropractic adjustment) was shown to be effective in reducing the sensitivity to pain in the neck and the middle back which are very common areas to have trigger points. The authors indicate, “There is moderately strong evidence to support the use of some manual therapies in providing immediate pain relief at TrPs”(Vernon & Schneider, 2009, p.189). The key to treatment is having a doctor that can find the CAUSE of the problem, helping to ultimately eliminate the symptoms.
Remember, trigger points are a “symptom” of an improperly functioning muscle and nerve systems. Only a doctor of chiropractic is specifically trained to diagnose and treat subluxations that lead to myofascial trigger points.
References:
1. Ruiz-Sáez, M., Fernández-de-las-Peñas, C., Blanco, C. R., Martı´nez-Segura, R., & Garcı´a-León, R. (2007). Changes in pressure pain sensitivity in latent myofascial trigger points in the upper trapezius muscle after a cervical spine manipulations in pain-free subjects. Journal of Manipulative and Physiological Therapeutics, 30(8), 578-583.
2. Vernon, H. & Schneider, M. (2009). Chiropractic management of myofascial trigger points and myofascial pain syndrome: A systemic review of the literature. Journal of Manipulative and Physiological Therapeutics, 32(1),14-24.
A report on the scientific literature
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