The research is out! Be sure to check out #'s 1,2,4,5,9,15 and 19!!
1. Annals of Medicine: “Manual therapy does not result in an increased risk of cervical artery dissection” Chaibi A et al. A risk-benefit assessment strategy to exclude cervical artery dissection in spinal manual-therapy: A comprehensive review. Ann Med. 2019 Mar 19:1-27.
2. “Cervical rotary manipulation does not cause adverse effects on hemodynamics…and appears to be a relatively safe technique.” Guan T et al. Effects of Cervical Rotatory Manipulation on Internal Carotid Artery in Hemodynamics Using an Animal Model of Carotid Atherosclerosis: A Safety Study. Med Sci Monit 2019; 25:2344-2351
3. “The current evidence is insufficient to support or dismiss the use of TENS for acute LBP.” Binny J et al. Transcutaneous electric nerve stimulation (TENS) for acute low back pain: systematic review. Scand J Pain. 2019 Mar 9. pii: /j/sjpain.ahead-of-print/sjpain-2018-0124/sjpain-2018-0124.xml.
4. “Acupuncture therapy is an effective and safe treatment for patients with fibromyalgia” Zhang XC, Chen H, Xu WT, Song YY, Gu YH, Ni GX. Acupuncture therapy for fibromyalgia: a systematic review and meta-analysis of randomized controlled trials. J Pain Res. 2019;12:527-542. Published 2019 Jan 30. doi:10.2147/JPR.S186227
5. “The use of chiropractors increased from 9.1% in 2012 to 10.3% in 2017. Women were more likely than men to see a chiropractor (11.1% versus 9.4%).” Clarke TC et al. Use of Yoga, Meditation, and Chiropractors Among U.S. Adults Aged 18 and Over. NCHS Data Brief. 2018 Nov;(325):1-8.
6. For patients with lateral epicondylopathy, “The counterforce brace provides significant reduction in the frequency and severity of pain in the short term (2-12 weeks), as well as overall elbow function at 26 weeks.” Kroslak M et al. Counterforce bracing of lateral epicondylitis: a prospective, randomized, double-blinded, placebo-controlled clinical trial. J Shoulder Elbow Surg. 2019 Feb;28(2):288-295. doi: 10.1016/j.jse.2018.10.002.
7. “Diagnostic ultrasound is a sensitive and specific method in diagnosing ulnar neuropathy at the elbow (cubital tunnel syndrome).” Rayegani SM et al. Diagnostic value of ultrasonography versus electrodiagnosis in ulnar neuropathy. Med Devices (Auckl). 2019 Feb 22;12:81-88. doi: 10.2147/MDER.S196106. eCollection 2019.
8. “Surface irregularities of the greater trochanter are not reliable radiographic indicators for the diagnosis of greater trochanteric pain syndrome.” Barrett MC et al. Trochanteric spurs and surface irregularities on plain radiography are not predictive of greater trochanteric pain syndrome. Hip Int. 2019 Mar 11:1120700019835641. doi: 10.1177/1120700019835641. [Epub ahead of print]
9. American Family Physician: “The use of anticonvulsants like gabapentin (Neurontin) for painful conditions has increased greatly in recent years. These drugs are not an effective treatment for low back pain with or without radiculopathy, and are associated with an increased risk of adverse events.” Ebell MH.Gabapentin and Pregabalin Not Effective for Low Back Pain with or Without Radiculopathy. Am Fam Physician. 2019 Mar 15;99(6):Online.
10. “Myofascial pain syndrome (primarily involving the gluteus medius) is present in the majority of patients with LBP (73%) , sciatica (50%), and LBP with sciatica (85%).” Kameda M, Tanimae H. Effectiveness of active soft tissue release and trigger point block for the diagnosis and treatment of low back and leg pain of predominantly gluteus medius origin: a report of 115 cases. J Phys Ther Sci. 2019;31(2):141-148.
11. “In the treatment of lumbar disc herniation, spinal manipulation presented with a higher effective rate than acupuncture and lumbar traction.” Mo, Zhuomao et al. Comparison Between Oblique Pulling Spinal Manipulation and Other Treatments for Lumbar Disc Herniation: A Systematic Review and Meta-Analysis. Journal of Manipulative & Physiological Therapeutics , Volume 41 , Issue 9 , 771 – 779
12. “Substance P-positive nerve fibers were obviously increased in number and deeply ingrown into the inner anulus fibrosus and even into the nucleus pulposus in the degenerative cervical discs of patients with severe neck pain” Wu B et al. Ingrowth of Nociceptive Receptors into Diseased Cervical Intervertebral Disc Is Associated with Discogenic Neck Pain. Pain Med. 2019 Mar 8. pii: pnz013. doi: 10.1093/pm/pnz013. [Epub ahead of print]
13. “Dry needling seems to be a reliable procedure for treating plantar fasciitis, with better outcomes than corticosteroid injection.” Uygur E et al. Preliminary Report on the Role of Dry Needling Versus Corticosteroid Injection, an Effective Treatment Method for Plantar Fasciitis: A Randomized Controlled Trial. J Foot Ankle Surg. 2019 Mar;58(2):301-305. doi: 10.1053/j.jfas.2018.08.058.
14. “Extracorporeal shockwave therapy (ESW) was found to be more effective than cortisone injections for plantar fasciitis.” Mishra BN et al. Effectiveness of extra-corporeal shock wave therapy (ESWT) vs methylprednisolone injections in plantar fasciitis. J Clin Orthop Trauma. 2019 Mar-Apr;10(2):401-405. doi: 10.1016/j.jcot.2018.02.011. Epub 2018 Feb 23.
15. “Smokers with fibromyalgia were more likely to report increased severity of fibromyalgia symptoms, worse quality of life, more sleep problems, and increased anxiety compared with nonsmokers with fibromyalgia.” Ge L et al. Tobacco Use in Fibromyalgia Is Associated With Cognitive Dysfunction: A Prospective Questionnaire Study. Mayo Clin Proc Innov Qual Outcomes. 2019 Feb 26;3(1):78-85. doi: 10.1016/j.mayocpiqo.2018.12.002. eCollection 2019 Mar.
16. In 80 NFL players with Achilles tendon rupture, “The overall return to play rate was 61.3%.” Yang J, Hodax JD, Machan JT, et al. Factors Affecting Return to Play After Primary Achilles Tendon Tear: A Cohort of NFL Players. Orthop J Sports Med. 2019;7(3):2325967119830139. Published 2019 Mar 12. doi:10.1177/2325967119830139
17. “Achilles tendinopathy is associated with large deficits in plantar flexor torque and endurance. The deficits are bilateral in nature and appear to be explained by a greater loss of soleus force rather than the gastrocnemius.” O’Neill S et al. Plantarflexor strength and endurance deficits associated with mid-portion Achilles tendinopathy: The role of soleus. Phys Ther Sport. 2019 Mar 9;37:69-76. doi: 10.1016/j.ptsp.2019.03.002. [Epub ahead of print]
18. Regarding carpal tunnel syndrome, “The Nerve Conduction Study (NCS) demonstrated the highest estimated sensitivity of 97%, and the Wainner Clinical Prediction Rule had the highest estimated specificity of 97%.” Wang WL et al. A Comparison of 6 Diagnostic Tests for Carpal Tunnel Syndrome Using Latent Class Analysis. Hand (N Y). 2019 Mar 10:1558944719833709. doi: 10.1177/1558944719833709. [Epub ahead of print]
19. “Care must be taken when performing yoga positions with extreme spinal flexion and extension. Patients with osteopenia or osteoporosis may have higher risk of compression fractures or deformities and would benefit from avoiding extreme spinal flexion.” Lee M et al. Soft Tissue and Bony Injuries Attributed to the Practice of Yoga: A Biomechanical Analysis and Implications for Management. Mayo Clin Proc. 2019 Mar;94(3):424-431. doi: 10.1016/j.mayocp.2018.09.024. Epub 2019 Feb 18.
20. “Soft tissue calcification is likely iatrogenic complication of steroid injection for lateral epicondylitis patients.” Park HB et al. Association of steroid injection with soft-tissue calcification in lateral epicondylitis. J Shoulder Elbow Surg. 2019 Feb;28(2):304-309. doi: 10.1016/j.jse.2018.10.009.
21. A study of nearly 400,000 patients demonstrated “a causal relationship between short stature and higher risk of carpal tunnel syndrome” Wiberg A, Ng M, Schmid AB, et al. A genome-wide association analysis identifies 16 novel susceptibility loci for carpal tunnel syndrome. Nat Commun. 2019;10(1):1030. Published 2019 Mar 4. doi:10.1038/s41467-019-08993-6
Review the latest news:
Magnesium relieves migraines
Exercise vs. manipulation for SI dysfunction
Cupping carpal tunnel syndrome
Glucosamine & chondroitin for TMD
Exercise rivals shoulder surgery
1. An umbrella review of 2048 papers found strong evidence that magnesium supplementation(400-600 mg/ day) reduced the intensity and frequency of migraine. Veronese N et al. Magnesium and health outcomes: an umbrella review of systematic reviews and meta-analyses of observational and intervention studies. Eur J Nutr. 2019 Jan 25. doi: 10.1007/s00394-019-01905-w. [Epub ahead of print]
2. “Upper limb nerve tension (ULNT) tests are useful for ruling out cervical radiculopathy. The combined use of all four tests shows a sensitivity of 0.97. “Koulidis K et al. Diagnostic accuracy of upper limb neurodynamic tests for the assessment of peripheral neuropathic pain: A systematic review. Musculoskelet Sci Pract. 2019 Jan 12;40:21-33. doi: 10.1016/j.msksp.2019.01.001. [Epub ahead of print]
3. A double-blind trial of 44 patients found that for treating cervical radiculopathy, both active (self-flossing) and passive (in-office) neural mobilization are equally effective. Ayub A et al. Effects of active versus passive upper extremity neural mobilization combined with mechanical traction and mobilization in females with cervical radiculopathy: A randomized controlled trial. J Back Musculoskelet Rehabil. 2019 Jan 11. doi: 10
4. A study of patients with chronic lateral epicondylalgia found that scapular muscle strengthening improves pain, pain-free grip strength, functional outcome, muscle strength, scapular position, and muscle activity. Sethi K et al. Scapular muscles strengthening on pain, functional outcome and muscle activity in chronic lateral epicondylalgia. J Orthop Sci. 2018 Sep;23(5):777-782. doi: 10.1016/j.jos.2018.05.003. Epub 2018 Jun 28.
5. “Exercise and manipulation therapy appear to be effective in reducing pain and disability in patients with sacroiliac joint dysfunction (with manipulation showing earlier results). However, the combination of these 2 therapies does not seem to bring about significantly better therapeutic results than either approach implemented separately.” Nejati P, Safarcherati A, Karimi F. Effectiveness of Exercise Therapy and Manipulation on Sacroiliac Joint Dysfunction: A Randomized Controlled Trial. Pain Physician. 2019 Jan;22(1):53-61.
6. Twenty minutes of daily “early subthreshold aerobic exercise appears to be an effective treatment for adolescents after sport-related concussion.” Leddy JJ, Haider MN, Ellis MJ, et al. Early Subthreshold Aerobic Exercise for Sport-Related Concussion: A Randomized Clinical Trial. JAMA Pediatr. Published online February 04, 2019. doi:10.1001/jamapediatrics.2018.4397
7. A study of 56 hands with CTS found: “Incorporation of cupping can reduce the severity of symptoms and improve the distal sensory disturbance of the median nerve.” Mohammadi S et al. The effects of cupping therapy as a new approach in the physiotherapeutic management of carpal tunnel syndrome. Physiother Res Int. 2019 Jan 29:e1770. doi: 10.1002/pri.1770. [Epub ahead of print]
8. “Open-chain hip abduction and single-limb support exercises appear to be effective options for recruiting the individual gluteus medius segments.” Here are a couple of very useful open-chain gluteus medius exercises: Advanced Clam and Side Plank with Abduction. Moore D et al. Rehabilitation Exercises for the Gluteus Medius Muscle Segments – An Electromyography Study. J Sport Rehabil. 2019 Feb 12:1-14. [Epub ahead of print]
9. Glucosamine and chondroitin sulfate are effective in treating TMJ disorders. (The typical dose is 1500mg Glucosamine and 1200mg Chondroitin/ day) Ganti S, Shriram P, Ansari AS, Kapadia JM, Azad A, Dubey A. Evaluation of Effect of Glucosamine-Chondroitin Sulfate, Tramadol, and Sodium Hyaluronic Acid on Expression of Cytokine Levels in Internal Derangement of Temporomandibular Joint. J Contemp Dent Pract. 2018 Dec 1;19(12):1501-1505. PubMed PMID: 30713180.
10. Despite being one of the most common orthopedic surgeries performed, subacromial decompression is notsignificantly better than exercise therapy to treat patients with pain and limited function caused by shoulder impingement. Shaughnessy AF. Decompression Surgery No More Effective Than Exercise for Shoulder Impingement Syndrome. Am Fam Physician. 2019 Feb 1;99(3):190.
11. HVLA Beats Exercise for Chronic Neck Pain: “Although both interventions were associated with immediately improved ROM and pain after treatment, HVLA manipulation was more effective than craniocervical flexion exercise in improving ROM and VAS (for chronic neck pain patients)”. Galindez-Ibarbengoetxea X, Setuain I, Ramírez-Velez R, Andersen LL, González-Izal M, Jauregi A, Izquierdo M. Immediate Effects of Osteopathic Treatment Versus Therapeutic Exercise on Patients With Chronic Cervical Pain. Altern Ther Health Med. 2018 May;24(3):24-32.
The objective of this study was to estimate the incidence of serious and fatal adverse drug reactions (ADR) in hospital patients. Serious ADRs were defined as those that required hospitalization, were permanently disabling, or resulted in death. The authors performed a meta‐analysis of 39 prospective studies done in the United States over a period of 32 years on the incidences of Adverse Drug Reactions (ADRs). The goal of this study was to “estimate injuries incurred by drugs that were properly prescribed and administered.” If the event was determined to be a “Possible ADRs” it was excluded from this study. The authors noted:
“We estimated that in 1994 overall 2,216,000 (1,721,000‐2,711,000) hospitalized patients had serious ADRs and 106,000 (76,000‐137,000) had fatal ADRs, making these reactions between the fourth and sixth leading cause of death.”
“We have found that serious ADRs are frequent and more so than generally recognized. Fatal ADRs appear to be between the fourth and sixth leading cause of death. Their incidence has remained stable over the last 30 years.”
“It is important to note that we have taken a conservative approach, and this keeps the ADR estimates low by excluding errors in administration, overdose, drug abuse, therapeutic failures, and possible ADRs. Hence, we are probably not overestimating the incidence of ADRs.”
This study on ADRs excluded medication errors “to show that there are a large number of serious ADRs even when the drugs are properly prescribed and administered.”
“The incidence of serious and fatal ADRs in US hospitals was found to be extremely high.”
The incidence of hospital adverse drug reactions detailed in the Lazarou and colleague’s study is stunning:
•106,000 yearly deaths; these deaths rank between the 4th and the 6th leading causes of death yearly.
•2,216,000 yearly events that required hospitalization to recover or resulted in a lifelong disability.
Importantly, these numbers require additional discussion. These statistics pertain only to hospitalized patients; they did not assess similar such events occurring outside of the hospital setting, in locations such as nursing homes, extended care facilities, at home, etc.
Additionally, and more startling, these deaths and serious adverse events occurred as a consequence of taking the correct drug for the correct diagnosis in the correct dosage. As such, these deaths and serious adverse events are not considered to be as a consequence of error. Rather, they are considered to be “fallout” of a health care delivery discipline that is heavily dependent upon pharmacology.
The primary reason people seek chiropractic care is for pain. Chiropractic is considered an alternative therapy for pain management, and especially for spinal pain (5, 6). An important study looking at some of the risks associated with the chronic use of nonsteroidal anti‐inflammatory drugs (NSAIDs) for pain was published by M. Michael Wolfe, MD, and colleagues, from Stanford’s Medical School and Boston University School of Medicine, and published in the New England Journal of Medicine in 1999. The article was titled (7):
Gastrointestinal Toxicity of Nonsteroidal Anti‐inflammatory Drugs
The authors make the following points:
“It has been estimated conservatively that 16,500 NSAID‐ related deaths occur among patients with rheumatoid arthritis or osteoarthritis every year in the United States.”
“If deaths from gastrointestinal toxic effects of NSAIDs were tabulated separately in the National Vital Statistics reports, these effects would constitute the 15th most common cause of death in the United States.”
“Yet these toxic effects remain largely a ‘silent epidemic,’ with many physicians and most patients unaware of the magnitude of the problem.”
“Furthermore, the mortality statistics do not include deaths ascribed to the use of over‐the‐counter NSAIDs.”
The authors note that Cox‐2 inhibitors (a prescription form of NSAID) have been available in the US since February 1999, in the hope that they will have a reduced capacity to cause injury to the gastroduodenal mucosa. However, Cox‐2 inhibitors are also known to cause defects in renal function, alter the regulation of bone resorption, impair female reproductive physiology, and increase the rate of thrombotic events in patients with increased risk of cardiovascular disease.
In 2003, researchers from the University of Queensland, Australia, published a study in the Journal Spine, titled (8):
Chronic Spinal Pain:
A Randomized Clinical Trial Comparing Medication, Acupuncture, and Spinal Manipulation
In this study, the spinal manipulation was performed by licensed chiropractors (two visits per week). The medications used were Celebrex or Vioxx, both prescription NSAIDs. The acupuncture (also two visits per week) was performed by an experienced acupuncturist. The study evaluated 115 chronic neck and back pain patients. The treatment interventions extended over a 9‐week period. These authors made the following observations and statements:
“Adverse reactions to nonsteroidal antiinflammatory (NSAID) medication have been well documented.”
“Gastrointestinal toxicity induced by NSAIDs is one of the most common serious adverse drug events in the industrialized world.”
“The newer COX‐2‐selective NSAIDs are less than perfect, so it is imperative that contraindications be respected.”
"There is “insufficient evidence for the use of NSAIDs to manage chronic low back pain.”
“The highest proportion of early (asymptomatic status) recovery was found for manipulation (27.3%), followed by acupuncture (9.4%) and medication (5%).”
“Manipulation yielded the best results over all the main outcome measures.”
“The consistency of the results provides evidence that in patients with chronic spinal pain, manipulation, if not contraindicated, results in greater short‐term improvement than acupuncture or medication.”
“The results of this efficacy study suggest that spinal manipulation, if not contraindicated, may be superior to needle acupuncture or medication for the successful treatment of patients with chronic spinal pain syndrome.”
“Medication apparently did not achieve a marked improvement in chronic spinal pain and caused adverse reactions in 6.1% of the patients.”
“In summary, the significance of the study is that for chronic spinal pain syndromes, it appears that spinal manipulation provided the best overall short‐term results, despite the fact that the spinal manipulation group had experienced the longest pre-treatment duration of pain.”
Highlights of this study show that chiropractic spinal manipulation is five times more effective than prescription NSAIDs in the treatment of chronic low back and neck pain, and the results from spinal manipulation were accomplished without any reported adverse events. In contrast, for the patients taking the drugs, more experienced an adverse event (6.1%) than those who became asymptotic (5%) over the nine‐week clinical trial.
Importantly, when this study was published in 2003, Vioxx had been on the market since 1999, four years. The following year, 2004, Vioxx was pulled off the market due to an unacceptable incidence of fatal heart attacks and strokes (9, 10). It has since been established that in the five years that Vioxx was on the market it caused more US deaths (about 60,000) than the Viet Nam war did in 10 years (about 58,000).
Review the latest news:
Top undiagnosed causes of hip pain
High false positive carpal tunnel rate for NCV’s
Therapeutic tape for tennis elbow and shoulder dysfunction
Low vitamin D may contribute to scoliosis
Surprise: ultrasound works for ______ but not _______
Head & Spine
1. A small study of 31 patients with forward head posture found “The combination of upper cervical and upper thoracic spine mobilization indicated better overall short-term outcomes in craniovertebral angle, numeric pain rating scale, and respiratory function, compared with deep cervical flexion exercises.” Cho J et al. Upper cervical and upper thoracic spine mobilization versus deep cervical flexors exercise in individuals with forward head posture: A randomized clinical trial investigating their effectiveness. J Back Musculoskelet Rehabil. 2018 Dec 10. doi
2. Manual Therapy Wins Again!
A new JAMA randomized clinical trial of 259 lumbar spine stenosis (LSS) patients compared the effectiveness of three non-surgical options and concluded ”Manual therapy/individualized exercise had a greater proportion of responders in symptoms and physical function (20%) and walking capacity (65.3%) at 2 months compared with medical care (7.6% and 48.7%, respectively) or group exercise (3.0% and 46.2%, respectively). Although LSS is a chronic degenerative condition, patients with LSS can show improvement in walking capacity with nonsurgical approaches.”Schneider MJ, Ammendolia C, Murphy DR, et al. Comparative Clinical Effectiveness of Nonsurgical Treatment Methods in Patients With Lumbar Spinal Stenosis: A Randomized Clinical Trial. JAMA Netw Open.2019;2(1):e186828. doi:10.1001/jamanetworkopen.2018.6828
3. Short-term rigid and Kinesio taping may help improve scapular dyskinesis and pectoralis minor length in overhead athletes.” Ozer, S. T., Karabay, D., & Yesilyaprak, S. S. (2018). Taping to Improve Scapular Dyskinesis, Scapular Upward Rotation, and Pectoralis Minor Length in Overhead Athletes. Journal of Athletic Training (Allen Press), 53(11), 1063–1070.
4. Another study of 30 overhead athletes confirmed positive effects of therapeutic taping on scapular joint position sense and movement control. Shih, Y.-F., Lee, Y.-F., & Chen, W.-Y. (2018). Effects of Kinesiology Taping on Scapular Reposition Accuracy, Kinematics, and Muscle Activity in Athletes With Shoulder Impingement Syndrome: A Randomized Controlled Study. Journal of Sport Rehabilitation, 27(6), 560–569.
5. A study of 23 minor league baseball players found: “Stretching the contralateral SI joint improved Glenohumeral Rotation Deficits (GIRD) more than the sleeper’s stretch.”
Left SI stretch for Right-sided GIRD – While lying supine, grab your left knee with your right hand and forcefully pull your knee toward your right shoulder while fully abducting your left arm and shoulder in the opposite direction. Hold this position for 30 seconds and repeat three times. Romano V, Romano J, Gilbert GE. Sacroiliac Stretching Improves Glenohumeral Internal Rotation Deficit of the Opposite Shoulder in Baseball Players in a Randomized Control Trial. J Am Acad Orthop Surg Glob Res Rev. 2018;2(10):e060. Published 2018 Oct 8. do
6. A study of 46 participants with shoulder impingement concluded: “The effect of high-intensity laser therapy plus exercise is not higher than exercise alone to reduce pain and improve functionality in patients with subacromial syndrome.” Aceituno-Gómez J, Avendaño-Coy J, Gómez-Soriano J, García-Madero VM, Ávila-Martín G, Serrano-Muñoz D, González-González J, Criado-Álvarez JJ. Efficacy of high-intensity laser therapy in subacromial impingement syndrome: a three-month follow-up controlled clinical trial. Clin Rehabil. 2019 Jan 23.
7. A study of 30 lateral epicondylopathy patients found: “Therapeutic taping in addition to exercises is more effective than sham taping and exercises only in improving pain in daily activities and arm disability.” Giray E, Bingul DK, Akyuz G. The effectiveness of kinesiotaping, sham taping or exercises only in treatment of lateral epicondylitis: A randomized controlled study. PM R. 2019 Jan 4.
8. In patients with acute tennis elbow symptoms: “A counterforce brace provides significant reduction in the frequency and severity of pain in the short term as well as overall elbow function.” Kroslak M, Pirapakaran K, Murrell Gac. Counterforce Bracing Of Lateral Epicondylitis: A Prospective, Randomized, Double-Blinded, Placebo-Controlled Clinical Trial. J Shoulder Elbow Surg. 2019 Feb;28(2):288-295. Doi: 10.1016/J.Jse.2018.10.002.
Did you know that radial tunnel syndrome mimics lateral epicondylopathy?
While a counterforce brace may help LE, it will likely aggravate RTS. Take our 7-question quiz to test your ability to differentiate.
9. A study of 50 patients found that “extracorporeal shock wave therapy (ESWT) and therapeutic ultrasound are equally effective in the treatment of lateral epicondylosis.” Yalvaç B, Mesci N, Geler Külcü D, Volkan Yurdakul O. Comparison of ultrasound and extracorporeal shock wave therapy in lateral epicondylosis. Acta Orthop Traumatol Turc. 2018;52(5):357-362.
10. A study of 40 asymptomatic hands found that nerve conduction studies had a high false positive rate (43%) for carpal tunnel syndrome; while the false positive rate for diagnostic ultrasound was lower (23%).
Fowler JR et al. False-Positive Rates for Nerve Conduction Studies and Ultrasound in Patients Without Clinical Signs and Symptoms of Carpal Tunnel Syndrome. J Hand Surg Am. 2019 Jan 8. pii: S0363-5023(18)30599-9. doi: 10.1016/j.jhsa.2018.11.010. [Epub ahe
11. In patients with mild carpal tunnel syndrome, use of a splint is an appropriate and sufficient treatment.
Hesami O, Haghighatzadeh M, Lima BS, Emadi N, Salehi S. The effectiveness of gabapentin and exercises in the treatment of carpal tunnel syndrome: a randomized clinical trial. J Exerc Rehabil. 2018;14(6):1067-1073. Published 2018 Dec 27. doi:10.12965/jer.1
SI & Hip
12. In patients younger than 50, greater than 85% of hip pain that is undiagnosed or misdiagnosed by primary physicians falls into one of the four following diagnoses:
13. The A study of 36 patients with patellofemoral pain found “altered gluteus medius, vastus medialis oblique (VMO), and vastus lateralis (VL) muscle activity during single leg stance and single leg squat compared to healthy subjects.”
Mirzaie GH et al. Electromyographic activity of the hip and knee muscles during functional tasks in males with and without patellofemoral pain. J Bodyw Mov Ther. 2019 Jan;23(1):54-58. doi: 10.1016/j.jbmt.2018.11.001. Epub 2018 Nov 9.
Hip Abductor Weakness & Knee PainTo learn more about hip abductor weakness and knee pain, check out this ChiroUp 15 minutes to excellence webinar.
14. “The addition of therapeutic ultrasound did not improve the efficacy of conservative treatment for plantar fasciitis. Therefore, the authors recommend excluding therapeutic ultrasound from the treatment of plantar fasciitis and agree with results of previous studies that stretching may be an effective treatment for healing plantar fasciitis.”
Wagner, Eric R.; Solberg, Muriel J.; Higgins, Laurence D. The Utilization Of Formal Physical Therapy After Shoulder Arthroplasty. Journal Of Orthopaedic & Sports Physical Therapy Nov2018, Vol. 48 Issue 11, P856
15. A systematic review found that “low-level laser therapy (LLLT) in patients with plantar fasciitis significantly relieves the heel pain and the excellent efficacy lasts for 3 months after treatment.”
Wang W et al. Clinical efficacy of low-level laser therapy in plantar fasciitis: A systematic review and meta-analysis. Medicine (Baltimore). 2019 Jan;98(3):e14088. doi: 10.1097/MD.0000000000014088.
16. Consider testing scoliosis patients for vitamin D deficiency: “We postulate that vitamin D deficiency and/or insufficiency (negatively) affects Adolescent Idiopathic Scoliosis development by its effect on the regulation of fibrosis, postural control, and bone mineral density.”
Ng SY, Bettany-Saltikov J, Cheung IYK, Chan KKY. The Role of Vitamin D in the Pathogenesis of Adolescent Idiopathic Scoliosis. Asian Spine J. 2018;12(6):1127-1145.
17. A systematic review of 22 studies found: “strength training is beneficial and can be used to treat fibromyalgia. The main results included reduction in pain, fatigue, number of tender points, depression, and anxiety, with increased functional capacity and quality of life.”
Andrade A et al. A systematic review of the effects of strength training in patients with fibromyalgia: clinical outcomes and design considerations. Adv Rheumatol. 2018 Oct 22;58(1):36. doi: 10.1186/s42358-018-0033-9.
18. “A single session of chiropractic manipulative therapy was shown to have an immediate effect of reducing the time required for asymptomatic special operations forces personnel to complete a complex whole-body motor response task.”
DeVocht JW et al. Effect of chiropractic manipulative therapy on reaction time in special operations forces military personnel: a randomized controlled trial. Trials. 2019 Jan 3;20(1):5. doi: 10.1186/s13063-018-3133-2.
Review the latest news:
*Avoiding surgery for rotator cuff tears
*Transverse friction massage is superior for lateral epicondylopathy
*Muscle energy tops mobilization for restoring shoulder ROM
*Chiropractic care excels for lumbar stenosis
*Ultrasound and TENS may not work for….
5 Treatments That Work
1. Journal of Shoulder & Elbow Surgery: “Nonoperative treatment is an effective and lasting option for many patients with a chronic, full-thickness rotator cuff tear. The operative and nonoperative outcomes at 5-year follow-up were not significantly different. 75% of patients remained successfully treated with nonoperative treatment at 5 years.” Boorman RS, More KD, Hollinshead RM, et al. What happens to patients when we do not repair their cuff tears? Five-year rotator cuff quality-of-life index outcomes following nonoperative treatment of patients with full-thickness rotator cuff tears. J Shoulder Elbow Surg. 2018;27(3):444-448.
2. A study comparing the effectiveness of three common strategies for lateral epicondylitis (splinting/ stretching, cortisone injection, and transverse friction massage) concluded: “At 6-month follow-up, only patients in the deep friction massage group demonstrated a significant improvement in all outcome measures, including VAS pain score, DASH score, and grip strength.” Yi R, Bratchenko WW, Tan V. Deep Friction Massage Versus Steroid Injection in the Treatment of Lateral Epicondylitis. Hand (N Y). 2018 Jan;13(1):56-59. doi: 10.1177/1558944717692088. Epub 2017 Feb 1.
3. JMPT: “Patients with mild to moderate carpal tunnel syndrome benefit from manual therapy including neurodynamic techniques.” Wolny T et al. The Effect of Manual Therapy Including Neurodynamic Techniques on the Overall Health Status of People With Carpal Tunnel Syndrome: A Randomized Controlled Trial. J Manipulative Physiol Ther. 2018 Dec 26. pii: S0161-4754(18)30334-8. doi: 10.
4. “Posterior shoulder tightness, defined as limited glenohumeral horizontal adduction and internal rotation motion, is a common occurrence in overhead athletes. (This study found) the application of muscle energy techniques to the horizontal abductors provides acute improvements to glenohumeral horizontal adduction, while joint mobilizations provide no improvements.” Reed, ML et al. Acute effects of muscle energy technique and joint mobilization on shoulder tightness in youth throwing athletes: a randomized controlled trial. Int J Sports Phys Ther. 2018 Dec; 13(6): 1024–1031.
5. A JAMA randomized clinical trial of 259 lumbar spine stenosis patients compared the effectiveness of three non-surgical options:
The results: “manual therapy/individualized exercise had greater improvement of symptoms and physical function compared with medical care or group exercise.” Schneider MJ, Ammendolia C, Murphy DR, et al. Comparative Clinical Effectiveness of Nonsurgical Treatment Methods in Patients With Lumbar Spinal Stenosis: A Randomized Clinical Trial. JAMA Netw Open.2019;2(1):e186828. doi:10.1001/jamanetworkopen.2018.6828
5 Less Promising Interventions
6. A Cochrane Database systematic review concluded: “Acupuncture and laser acupuncture may have little or no effect in the short term on symptoms of carpal tunnel syndrome in comparison with placebo or sham acupuncture.” Choi GH. Et al. Acupuncture and related interventions for the treatment of symptoms associated with carpal tunnel syndrome. Cochrane Database Syst Rev. 2018 Dec 2;12:CD011215. doi: 10.1002/14651858.CD011215.pub2. [Epub ahead of print]
7. A study of 54 patients concluded “the addition of therapeutic ultrasound did not improve the efficacy of conservative treatment for plantar fasciitis.” Yigal Katzap, Michael Haidukov, Olivier M. Berland, Ron Ben Itzhak, and Leonid Kalichman. Additive Effect of Therapeutic Ultrasound in the Treatment of Plantar Fasciitis: A Randomized Controlled Trial. Journal of Orthopaedic & Sports Physical Therapy 2018
8. A clinical trial of 97 patients: “This study does not support the use of TENS in the treatment of patients with chronic LBP.” Garaud T. et al. Randomized study of the impact of a therapeutic education program on patients suffering from chronic low-back pain who are treated with transcutaneous electrical nerve stimulation. Medicine (Baltimore). 2018 Dec;97(52):e13782. doi: 10.109
9. An RCT of 61 TMD patients concluded: “The efficacy of manipulation seems to be limited, in contrast to our expectations. The advantage of manipulation was observed only during the first treatment session.” Nagata K et al. Efficacy of mandibular manipulation technique for temporomandibular disorders patients with mouth opening limitation: a randomized controlled trial for comparison with improved multimodal therapy. J Prosthodont Res. 2018 Dec 15. pii: S1883
10. “Imaging is overused in the management of low back pain (LBP). Interventions designed to decrease non-indicated imaging have predominantly targeted practitioner education alone; however, these are typically ineffective.” Jenkins HJ, Moloney NA, French SD, et al. Using behaviour change theory and preliminary testing to develop an implementation intervention to reduce imaging for low back pain. BMC Health Serv Res. 2018;18(1):734. Published 2018 Sep 24. doi:10.1186/s12913-0
5 Thought-Provoking Studies
11. The fascial system includes solid and liquid fascia, closely inter-linked, without interruption. Each cell communicates with neighboring cells by sending and receiving signals. Therapeutic touch at the skin triggers cell deformation which sends electromagnetic and mechanometabolic messages throughout the entire body–like electricity in water. This concept is known as quantum entanglement. Bordoni B, Simonelli M. The Awareness of the Fascial System. Cureus. 2018;10(10):e3397. Published 2018 Oct 1. doi:10.7759/cureus.3397
*Our friend and mentor Dr. Tom Hyde commented on this research and reminded us of the incredible “Strolling under the skin” video from Dr. Jean-Claude Guimberteau that provides a fascinating look into the fascial system. You can check out the full 28 minute version or this brief clip.
12. A new study mapped carpal tunnel pain vs. paresthesia: “Painful symptoms were clearly centered over the carpal tunnel and were reported much less frequently in the digits. Non-painful sensory disturbances (e.g. numbness, paresthesias) were found to have a much more peripheral and lateral distribution.” Nelson JT et al. Patient Reported Symptom-Mapping in Carpal Tunnel Syndrome. Muscle Nerve. 2018 Dec 14. doi: 10.1002/mus.26398. [Epub ahead of print]
13. Following ankle sprain, the supporting muscle (peroneus longus) undergoes fatty degeneration with resultant loss of strength. This process “increases with increasing frequency of ankle sprain” – with obvious implications for chronic ankle instability. Sakai S et al. Quantity and quality of the peroneus longus assessed using ultrasonography in leg with chronic ankle instability. J Phys Ther Sci. 2018 Dec;30(12):1396-1400. doi: 10.1589/jpts.30.1396. Epub 2018 Nov 21.
14. Q: How thick is an average healthy disc?
A: Generally less than 9mm
An imaging analysis of 240 healthy spines measured the height of the intervertebral disc and compared those measurements against age and gender: “Variation in disc height is determined much more by sex rather than age. The maximum height of the interbody space in the adult lumbar spine was at the L4/5 level (8.9±1.7 mm males, 8.6±1.8 mm females).” Bach K et al. Morphometric Analysis of Lumbar Intervertebral Disc Height: An Imaging Study. World Neurosurg. 2018 Dec 19. pii: S1878-8750(18)32836-5. doi: 10.1016/j.wneu.2018.12.014. [Epub ahead of print]
15. A new JAMA article discussed the link between dementia and chronic pain: “compared with pain-free controls, those with chronic pain showed a more rapid decline in memory and increased probability of dementia.” (Whitlock et al) “These findings are especially relevant for patients with low back pain given that current pharmacotherapy has the potential to cause central nervous system depression and further compromise cognition.“ (Bailey et al) Whitlock EL, Diaz-Ramirez LG, Glymour MM, Boscardin WJ, Covinsky KE, Smith AK. Association Between Persistent Pain and Memory Decline and Dementia in a Longitudinal Cohort of Elders. JAMA Intern Med. 2017;177(8):1146-1153. Bailey DM et al. Low Back pain. Lancet. Volume 392, Issue 10164, P2548, December 15, 2018
Review the latest news: Which braces and supports work best?
Conservative care for SLAP lesions
The best exercise for tennis elbow
One third of young adults with chronic LBP may have an inflammatory arthropathy
Tips for differentiating myofascial pain syndrome from fibromyalgia
Successful evidence-based chiropractors continually leverage new studies to improve their clinical decision-making. This month, we’ve summarized more than 40 studies and have already updated our protocols with this information. We are showcasing a dozen articles here.
1. American Family Physician recently published a synopsis on the effectiveness of various braces and supports:
2. A systematic review regarding the effects of corrective exercises on individuals with forward head posture (FHP) found that: “therapeutic exercises may result in large changes in (head position) and moderate improvement in neck pain.”
Rahman Sheikhhoseini et al. Effectiveness of Therapeutic Exercise on Forward Head Posture: A Systematic Review and Meta-analysis. JMPT Volume 41, Issue 6, Pages 530–539
Consider these 2 exercises for starters-Cervical Retractions
Deep Neck Flexion
3. For most throwers with SLAP lesions, a rehabilitation program focused on stretching the posterior capsule and correcting scapular posture is more successful than surgery.
Matthew CJ et al. Superior Labral Anterior to Posterior Tear Management in Athletes. Open Orthop J. 2018 Jul 31;12:303-313. doi: 10.2174/1874325001812010303. eCollection 2018.
4. For most throwers with SLAP lesions, a rehabilitation program focused on stretching the posterior capsule and correcting scapular posture is more successful than surgery.
Matthew CJ et al. Superior Labral Anterior to Posterior Tear Management in Athletes. Open Orthop J. 2018 Jul 31;12:303-313. doi: 10.2174/1874325001812010303. eCollection 2018.
5. “Shockwave therapy significantly reduced the pain that accompanies tendinopathies and improves functionality and quality of life. It might be first choice (for treating tendinopathies) because of its effectiveness and safety.”
Dedes V et al. Effectiveness and Safety of Shockwave Therapy in Tendinopathies. Mater Sociomed. 2018 Jun;30(2):131-146. doi: 10.5455/msm.2018.30.141-146.
6. An expert panel for the Danish Health Authority performed a comprehensive review of published recommendations to establish National Clinical Guidelines for the treatment of neck pain (NP) and cervical radiculopathy (CR). The recommendations include:
7. A study of 231 young adults (mean age 32) with LBP for greater than 3 months found that 39% “had axial-Spondyloarthropathy (axSpA) as per ASAS Criteria”
Rasool T et al. Axial Spondyloarthritis In Patients With Chronic Backache Using Assessment Of Spondyloarthritis International Society Criteria For Axial Spondyloarthritis. J Ayub Med Coll Abbottabad. 2018 Apr-Jun;30(2):253-257.
8. A BMJ scoping review of 84 prior systematic reviews endorsed treatments with moderate/good quality evidence for the following conditions:
9. A study of 183 senior adults with back and neck related disability compared short-term treatment (12 weeks) versus long-term management (36 weeks) using spinal manipulative therapy combined with supervised rehabilitative exercises The authors conclusion: “For older adults with chronic back and neck disability, extending management from 12 to 36 weeks did not result in any additional important reduction in disability.”
Maiers M et al. Short or long-term treatment of spinal disability in older adults with manipulation and exercise. Arthritis Care Res (Hoboken). 2018 Oct 24. doi: 10.1002/acr.23798. [Epub ahead of print]
10. A study of nearly 70,000 adults found “a higher frequency of organic food consumption was associated with a reduced risk of cancer.”
Baudry J, Assmann KE, Touvier M, et al. Association of Frequency of Organic Food Consumption With Cancer RiskFindings From the NutriNet-Santé Prospective Cohort Study. JAMA Intern Med. Published online October 22, 2018. doi:10.1001/jamainternmed.2018.4357
11. European Spine Journal: “To evaluate the anatomical integrity of the cervical spine in adults with neck pain, we found preliminary evidence to support the use of:
12. Differentiating myofascial pain syndrome from fibromyalgia
Successful evidence-based chiropractors continually leverage new studies to improve their clinical decision-making. ChiroUp helps me by scouring fresh literature to mine out useful best practice data. This month, we’ve summarized more than a dozen studies for your review.
1. A new (very large) European Spine Journal Study examined the risk of acute lumbar disc herniation requiring early surgery in patients who visited a chiropractor vs. those who visited a PCP:
“The risk for acute LDH with early surgery associated with chiropractic visits was no higher than the risk associated with PCP visits. Both chiropractic and primary medical care were associated with an increased risk for acute LDH requiring ED visit and early surgery. Our analysis suggests that patients with prodromal back pain from a developing disc herniation likely seek healthcare from both chiropractors and PCPs before full clinical expression of acute LDH.”
P.S. Abundant research has revealed a similar conclusion for the relationship between cervical manipulation and stroke. Click here to download a helpful patient education handout regarding the safety of neck manipulation.
Hincapié, C.A., Tomlinson, G.A., Côté, P. et al. Eur Spine J (2018) 27: 1526.
2.A systematic review of carpal tunnel syndrome research comparing surgical vs. non-surgical outcomes found: “No significant differences at 3 or 12 months” in terms of functional status, symptom severity, and nerve conduction outcomes. Interestingly, the surgical patients experienced greater improvement at 6 months, but not before or after.
Qiyun S. et al. Comparison of the Short-term and Long-term Effects of Surgery and Nonsurgical Intervention in Treating Carpal Tunnel Syndrome: A Systematic Review and Meta-analysis. Hand. 2018 Jul 1:1558944718787892. [Epub ahead of print]
3.A study of more than 500 pregnant women found: “If both P4 and ASLR tests were positive mid-pregnancy, a persistent bothersome pelvic girdle pain of more than 5 days per week throughout the remainder of pregnancy could be predicted.”
Malmqvist S, Kjaermann I, Andersen K, et al Can a bothersome course of pelvic pain from mid-pregnancy to birth be predicted? A Norwegian prospective longitudinal SMS-Track study BMJ Open 2018;8:e021378.
4. A systematic review found no correlation between LBP intensity and the degree of MODIC degenerative change in the lumbar spine.
Herlin C et al. Modic changes—Their associations with low back pain and activity limitation: A systematic literature review and meta-analysis. PLoS1 2018 Aug 1;13(8):e0200677. doi: 10.1371/journal.pone.0200677. eCollection 2018.
5. According to a systematic review with meta-analysis in the journal Physiotherapy: “There is very low evidence to support the use of trigger point dry needling (TDN) in the shoulder region for treating patients with upper extremity pain or dysfunction.”
Hall, Michelle Louise et al. Effects of dry needling trigger point therapy in the shoulder region on patients with upper extremity pain and dysfunction: a systematic review with meta-analysis. Physiotherapy , Volume 104 , Issue 2 , 167 – 177
6. A JMPT study of 82 cervicogenic headache patients found, “upper cervical spinal mobilization increased cervical range of motion and induced immediate headache relief.”
Malo-Urriés, Miguel et al. Immediate Effects of Upper Cervical Translatoric Mobilization on Cervical Mobility and Pressure Pain Threshold in Patients With Cervicogenic Headache: A Randomized Controlled Trial. Journal of Manipulative & Physiological Therapeutics, Volume 40 , Issue 9 , 649 – 658
7. A study of more than 6000 chiropractic patients revealed that few (5.4%) of the chiropractic patients used narcotics for their chronic pain, which is substantially lower than the 45% to 60% use typically found in chronic LBP populations. Additionally, if chiropractic care was no longer a covered insurance benefit, 30% of patients would continue as is, 61% would go less often, and only 7% would discontinue care.
Herman, Patricia M. et al.Characteristics of Chiropractic Patients Being Treated for Chronic Low Back and Neck Pain. JMPT 2018 Aug 15. [Epub ahead of print]
8. “Opioids are no more effective than non-opioid medications in the treatment of acute and chronic low back pain.”
Wertli, M.M. & Steurer, J. Pain medications for acute and chronic low back pain. Internist (2018). 2018 Aug 16. doi: 10.1007/s00108-018-0475-5. [Epub ahead of print]
9. A new article in the Journal of Family Practice endorsed a select group of therapies that show “good-quality patient-oriented evidence” for managing chronic low back pain. The journal advised physicians to:
10. A recent spine Journal study was “the first to measure facet gapping during cervical manipulation on live humans. The results demonstrate that:
Anderst WJ et al. Intervertebral Kinematics of the Cervical Spine Before, During and After High Velocity Low Amplitude Manipulation. The Spine Journal Available online 22 August 2018
11. A study of 100 fibromyalgia (FM) patients found recurrent “electrodiagnostic features of polyneuropathy, muscle denervation, and chronic inflammatory demyelinating polyneuropathy (CIDP)”.
Caro XJ, Galbraith RG, Winter EF. Evidence of peripheral large nerve involvement in fibromyalgia: a retrospective review of EMG and nerve conduction findings in 55 FM subjects. Eur J Rheumatol 2018; 5: 104-10.
12. A study of 40 collegiate athletes found that application of elastic therapeutic tape over the gluteus medius “improved strength immediately after taping (and) it was maintained even on the third day.” Hip taping also generated short-term correction of dynamic knee valgus.
Rajasekar, Sannasi et al. Does Kinesio taping correct exaggerated dynamic knee valgus? A randomized double blinded sham-controlled trial. Journal of Bodywork and Movement Therapies , Volume 22 , Issue 3 , 727 – 732
Review the latest news: Manipulation for headaches and lateral elbow pain
KinesioTape for carpal tunnel syndrome
Epidural steroid injections increase the risk of fracture
How common are rotator cuff tears?
1. A Spine Journal study found that in patients suffering from cervicogenic headache, spinal manipulation cuts the number of symptomatic days in half:
“256 adults with chronic cervicogenic headache (CGH) were randomized to four dose levels of chiropractic SMT: 0, 6, 12, or 18 sessions. Participants were treated three times per week for 6 weeks and received a focused light-massage control at sessions when SMT was not assigned. A linear dose-response was observed for all follow-ups, a reduction of approximately 1 CGH day/month for each additional 6 SMT visits. Cervicogenic headache days/month were reduced from about 16 to 8 for the highest and most effective dose of 18 SMT visits. Cervicogenic headache intensity showed no important improvement nor differed by dose.”
Incidentally, SMT proved to be more effective than massage for CGH.
Haas M. et al. Dose-response and efficacy of spinal manipulation for care of cervicogenic headache: a dual-center randomized controlled trial. Spine J. 2018 Feb 23. [Epub ahead of print]
2. Archive of Physical Medicine & Rehabilitation: “For patients with neurogenic claudication due to lumbar spine stenosis, a comprehensive conservative program demonstrated superior, large and sustained improvements in walking ability and can be a safe non-surgical treatment option.”
Ammendolia C, et al. Comprehensive non-surgical treatment versus self-directed care to improve walking ability in lumbar spinal stenosis: A randomized trial. Arch Phys Med Rehabil. 2018.
3. As many as 96% of persons over age 50 years may have shoulder abnormalities involving the rotator cuff. Many of these individuals remain asymptomatic. Now a new study has found the incidence and prevalence of subclinical supraspinatus pathology in young subjects may be significantly greater than expected:
“Forty-six subjects, having no shoulder pain or known functional impairment were assessed using physical screening and musculoskeletal sonography. Results showed that 24% of these asymptomatic shoulders demonstrated degenerative changes.”
Guffey JS, et al. Degenerative Changes in Asymptomatic Subjects: A Descriptive Study Examining the Using Musculoskeletal Sonography in a Young Population. J Allied Health. 2018.
4. A study in Spine Journal found that sheep that underwent L3/4 spinal fusion experienced significant degenerative changes:
“(In fused specimens) The MRI and histologic analysis demonstrated significant disc degeneration. The mechanical environment set up by immobilization alone is capable of inducing lumbar disc degeneration.”
Wang T et. al. A novel in vivo large animal model of lumbar spinal joint degeneration. Spine J. 2018 May 22. [Epub ahead of print]
5. A study in the Journal of Bone & Joint Surgery found that lumbar epidural steroid injections increase the risk of osteoporotic vertebral compression fracture by 21%, per injection:
“Each successive injection increased the risk of fracture by a factor of 1.21. The findings suggest that Lumbar epidural steroid injections, like other forms of exogenous steroid administration, may lead to increased bone fragility.”
Mandel S. et al. A Retrospective Analysis of Vertebral Body Fractures Following Epidural Steroid Injections. The Journal of Bone & Joint Surgery. 95(11):961–964, JUN 2013
6. A study of over 32,000 people found that overweight people have a 21% increased risk of LBP, while obesity increases one’s risk by 55%.
Peng, Trent et al. The Association Among Overweight, Obesity, and Low Back Pain in U.S. Adults: A Cross-Sectional Study of the 2015 National Health Interview Survey. Journal of Manipulative & Physiological Therapeutics , Volume 41 , Issue 4 , 294 – 303
7. Individuals who received mobilization and expressed a positive perception of effect exhibited significantly greater changes in neurodynamic mobility than those without a positive perception.
Hartstein, Aaron J. et al. Immediate Effects of Thoracic Spine Thrust Manipulation on Neurodynamic Mobility. Journal of Manipulative & Physiological Therapeutics , Volume 41 , Issue 4 , 332 – 341
8. A systematic review in the Journal of Hand Therapy has shown “compelling evidence” that joint mobilization and manipulation improve pain, grip strength, and functional outcomes in patients with tennis elbow.
Lucado AM. et. al. Do joint mobilizations assist in the recovery of lateral elbow tendinopathy? A systematic review and meta-analysis. J. Hand Therapy 2018 Apr 25. [Epub ahead of print]
9. A randomized clinical trial compared the effectiveness of a splint vs. KinesioTape (KT) for the management of carpal tunnel syndrome:
“A significant improvement was observed in the KT group compared to the splint group in terms of electrophysiological changes, provocative test responses, symptom severity, and functional status scores. KT may help prevent the disease from progressing further in mild and moderate idiopathic CTS when applied in time using the appropriate technique and be a good alternative to neutral splinting in terms of patient compliance.”
Akturk S. et. al. Comparison of splinting and Kinesio taping in the treatment of carpal tunnel syndrome: a prospective randomized study.Clin Rheumatol. 2018 Jun 15. [Epub ahead of print]
10. NEJM: “A staggering 36,000 randomized controlled trials (RCTs) are published each year, on average, and it typically takes about 17 years for findings to reach clinical practice.”
Kanter MH et. al. A Model for Implementing Evidence-Based Practices More Quickly. NEJM Catalyst. February 5, 2017
Evidence-based chiropractors explain the disconnect between symptoms and imaging findings.
Recently, Daimon K et al. (2018) published a landmark study for EVERY evidence-based chiropractor. It highlights the notion that degenerative changes are merely age-related and do not necessarily correlate with symptoms. This study assimilates two decades of sequential imaging to prove that there little association between degeneration and clinical symptoms:
“results of our statistical analysis and the different rates of disc degeneration versus clinical symptoms reported here and elsewhere, the degenerative findings on cervical MRI do not appear to be generally associated with the development of clinical symptoms.” (1)
Structural findings take months or years to progress. Acute symptoms usually occur within moments to days after a trauma, or change in activity, movement, hobby, or habit. Structural abnormalities can complicate tissue failure, but are not directly correlated with symptoms. It is essential that we focus on what is correctable and what is not. There is no treatment to eliminate the degenerative changes in the spine; however evidence-based chiropractic care can effectively and efficiently resolve symptoms.
Arthritic and degenerative changes are a fact of life. It is important not to focus on what shows up on imaging but rather focus on what we can do with the cards that were dealt.
“the rate of degenerative progression at one intervertebral disc level on MRI over the 20-year period was 95.3%, whereas the rate of the development of clinical symptoms was 66.9%. Statistical analysis of the relationship between the progression of the 5 degenerative findings in the cervical spine and the occurrence of clinical symptoms only detected a significant association between foraminal stenosis and upper limb pain.”
When a patient presents with a one-week onset of neck pain; is it from their stenosis? NO! The cervical narrowing has been there for years. Is it a complicating factor? YES. We treat the patient’s symptoms by focusing on the functional reasons the pain started. Once the pain is gone, the stenosis will still be there. Our office educates the patient to not blame their arthritis for every malady affecting their life. We focus on their habits, hobbies, and postures to eliminate the stressors on their body that are exacerbating their spinal condition. This same paradigm works for disc pathology, or chronic meniscus injuries, or SLAP lesions, or…(name your chronic structural lesion)
“A study of clinical symptoms and cervical MRI findings by Siivola et al. showed that neck and shoulder pain in young adults was not associated with disc degeneration, an annular tear, or disc protrusion on MRI.”(2)
Cliff Atwell, B.S., D.C.