Top 10 Chiropractic Studies of 2013

From: http://www.chironexus.net/2013/12/top-10-chiropractic-studies-2013/

1.  Chiropractic Adjustments Produce Immediate Results Visible on MRI

New research helps to explain why chiropractic is so effective for low-back pain. Using MRI scans, researchers were able to document the immediate benefits of chiropractic adjustments.

Patients with low-back pain have restricted mobility in the lumbar spine that results in degenerative changes and fibrous adhesions within the joints of the vertebrae.

Researchers hypothesized that chiropractic adjustments increase gapping between the joints of the vertebrae, which breaks up adhesions and allows the joints to move freely.

In a new study, 112 patients with low-back pain were randomly assigned to receive either chiropractic adjustments, side-posture positioning, or two control treatments.

Immediately after the treatment, they received an MRI scan that allowed researchers to analyze spinal gapping.

The chiropractic patients had the most substantial spinal gapping, and patients treated with a combination of chiropractic adjustments and side-posture positioning had the greatest reduction in pain.

This study shows how chiropractic can restore spinal health to decrease disability and pain.

Reference

Cramer GD, et al. Magnetic resonance imaging zygaphosphyseal joint space changes (gapping) in low back pain patients following spinal manipulation and side-posture positioning: a randomized controlled mechanisms trial with blinding. Journal of Manipulative and Physiological Therapeutics 2013; pii: S0161-4754(13)00055-9. doi: 10.1016/j.jmpt.2013.04.003.

2.  AMA Recommends Chiropractic & PT Before Resorting to Surgery

In an article written to educate the public about back pain, the Journal of the American Medical Association (JAMA) has suggested that patients seek chiropractic and other conservative back-pain treatment before taking more invasive measures.Image not available.

The article says that surgery is not usually needed for treating back pain and should only be considered when other conservative methods fail.

This recommendation reinforces what the American Chiropractic Association (ACA) teaches patients, as well. Chiropractic should be the first line of defense against musculoskeletal pain.

The article has been published online on the JAMA patient page titled “Low Back Pain,” and discusses the causes, symptoms, diagnosis, treatment options, and prevention of low-back pain. The doctors who wrote the article go on to explain that the back is comprised of bones, nerves, muscles, and soft tissues like ligaments and tendons. Back pain can be a result of problems with any of these structures.

Because chiropractors are neuro-musculoskeletal experts, they are well equipped to manage and prevent low-back pain.

In an interview about the JAMA article, ACA President Keith Overland, DC, said that he and his colleagues at ACA were encouraged to see chiropractic suggested for back-pain treatment. He confirmed that in many cases, back pain can be alleviated without the use of drugs or surgery, “so it makes sense to exhaust conservative options first.”

And chiropractic makes sense for reducing health-care costs as well. Dr. Overland went on to say, “Research confirms that the services provided by chiropractic physicians are not only clinically effective but also cost-effective, so taking a more conservative approach at the onset of low back pain can also potentially save both patients and the health care system money down the line.”

If you have low-back pain, follow the advice of these reputable medical communities. See a chiropractor first.

References

American Chiropractic Association. JAMA suggests chiropractic for low back pain. Businesswire May 8, 2013. businesswire.com.

JAMA Back Pain PDF

Goodman D, Burke A, Livingston E. Low back pain. JAMA Patient Page April 24, 2013; 309(16): 1738. doi:10.1001/jama.2013.3046.

3.  Chiropractic Beats Epidural Injections for Disc Herniations

Chiropractic adjustments were just as effective as epidural injections for patients with back pain in a new study — without the risks and at lower cost.

The findings show that chiropractic can significantly reduce pain in patients with lumbar disc herniation, and is less expensive than medical treatment.

Lumbar epidural injections are frequently used for back pain and sciatica in patients with lumbar disc herniation, failed back surgery syndrome, and spinal stenosis. During the procedure, a physician injects a high dose of pain medication, and sometimes steroids, into the area of the lumbar spine around the damaged nerve. This temporarily reduces inflammation and pain.

Although the injections are widely used, controversy lingers due to the lack of a studies with placebo controls, and questions about the effects of steroids versus anesthetic alone. Side effects of steroids include a weakening of muscles and spinal bones around the affected nerve and a disruption of the body’s natural hormone balance. It’s also unclear whether epidural injections are more effective than other conservative treatments for lumbar disc herniation.

While a number of studies have established the efficacy of chiropractic for low-back pain, fewer have tested its comparative effectiveness with other treatments for lumbar disc herniation.

In a new study from the Journal of Manual and Physiological Therapeutics, researchers from Switzerland compared the effects of chiropractic spinal manipulative therapy (SMT) and epidural nerve root injections (NRI). The study included 102 with symptomatic, MRI-confirmed lumbar disc herniation who were treated with either SMT or NRI.

After one month of treatment, both groups experienced significant improvements. Of the patients under chiropractic care, 76.5% said they were “much better” or “better” compared to 62.7% of NRI patients. Sixty percent of chiropractic patients had a significant reduction in pain compared to 53% of NRI patients. These slight differences were not statistically significant.

While none of the chiropractic patients received surgery, three of the NRI patients eventually opted for an operation.

Since the treatments were considered equally effective, the cost analysis became even more important for comparing both treatments, the researchers pointed out. On average, one month of chiropractic adjustments was less expensive than NRI ($558 vs. $729). Their analysis included only the “minimum cost” of NRIs, and did not take into account other costs that are frequently tacked on like additional consultations with clinicians, multiple injections, or possible surgery. Additionally, treatment cost for chiropractic patients may have been slightly higher than normal since they were required to receive an MRI to be in the study. Many chiropractic patients do not receive MRI because imaging guidelines do not recommend MRIs for patients with lumbar disc herniation in most cases. In contrast, MRIs are typically performed before injections or other more invasive procedures.

Although randomized trials are needed to confirm these results, the authors concluded that, “There were no significant differences in outcomes between the more universally accepted treatment procedure of NRI compared to SMT.”

This study suggest that patients can experience substantial relief from chiropractic care without worrying about the side effects of steroids or drugs. It may even save them money, since research suggests that chiropractic patients have lower annual medical costs compared to patients under traditional care.

Reference

Peterson, CK, et al. Symptomatic Magnetic Resonance Imaging-confirmed lumbar disk herniation patients: a comparative effectiveness prospective observational study of 2 age- and sex-matched cohorts treated with either high-velocity, low-amplitude spinal manipulative therapy or imaging-guided lumbar nerve root injections. Journal of Manipulative and Physiological Therapeutics 2013; doi: 10.1016/j.jmpt.2013.04.005.

4.  Chiropractic May Lower Blood PressureChiropractic May Lower Blood Pressure

Nearly a third of Americans have high blood pressure, putting them at risk for heart disease, stroke, and number of health conditions. While medication is the primary treatment for hypertension, there are several non-pharmaceutical ways to manage high blood pressure including, stress reduction, weight loss, and diet changes. Now, a growing body of research suggests that chiropractic care could help.

Researchers from Sherman College of Chiropractic have found preliminary evidence that regular chiropractic care reduced blood pressure in middle-aged African Americans. Earlier research has suggested that chiropractic adjustments can decrease blood pressure in patients with cervical spine dysfunction or anxiety. However there have been no age and racial-specific studies on the effects of chiropractic on blood pressure.

Researches conducted a non-randomized, non-controlled pragmatic study to evaluate the feasibility of a future clinical trial. The results are still considered preliminary, but since they support earlier findings, they are highly suggestive as to the potential effects chiropractic can have on blood pressure.

The study included 58 hypertensive patients of African American descent who were over the age of 40. Patients received one year of chiropractic care for various spinal conditions, and their blood pressure was taken three times throughout the course of the study.

The researchers discovered that in patients with a BMI lower than 50, diastolic blood pressure significantly decreased over the course of treatment. Patients with a BMI higher than 50 (considered severely obese), did not experience the same drops in blood pressure. This lead researchers to suggest that obese patients may be “more resistant” to blood pressure reductions when it came to chiropractic care.

Chiropractic care isn’t the only hands-on therapy that may help with hypertension. A study published earlier this year showed that massage decreased blood pressure in pre-hypertensive women.

Primary reference:

McMasters KL, et al. Blood pressure changes in African American patients receiving chiropractic care in a teaching clinic: a preliminary study. Journal of Chiropractic Medicine 2013; 12(2): 55-59.

Additional references:

Yates R.G., Lamping D.L., Abram N.L., Wright C. Effects of chiropractic treatment on blood pressure and anxiety: a randomized, controlled trial. Journal of  Manipulative and Physiological Therapy 1988;11(6):484–488. [PubMed]

McKnightM.E., DeBoer K.F. Preliminary study of blood pressure changes in normotensive subjects undergoing chiropractic care. Journal of  Manipulative and Physiological Therapy 1988;11(4):261–266. [PubMed]

Knutson G.A. Significant changes in systolic blood pressure post vectored upper cervical adjustment vs resting control groups: a possible effect of the cervicosympathetic and/or pressor reflex. Journal of  Manipulative and Physiological Therapy 2001;24(2):101–109. [PubMed]

Bakris G., Dickholtz M., Meyer P.M. Atlas vertebra realignment and achievement of arterial pressure goal in hypertensive patients: a pilot study. Journal of Human Hypertension 2007:1–6. [PubMed]

5.  Chiropractic Best Option for Sacroiliac Joint PainChiropractic Best Option for Treating Sacroiliac Joint

Dysfunction in the sacroiliac joint (SIJ), located in the pelvis, is thought to be a possible cause of sciatica, resulting in back pain that radiates down the leg and below the knee.

Scientists have questioned what the best treatment option is for patients with SIJ-related leg pain. In a recent study, researchers compared three treatment options: physical therapy, chiropractic manual therapy, and intra-articular injections of corticosteroids. Patients included 51 adults with leg pain associated with the sacroiliac joint. Researchers analyzed the effectiveness of each method after 6 weeks of selected treatments, and again after 12 weeks. The results for each patient was categorized as either a success or failure, based on relief or worsening of symptoms and average pain scores.

The study’s findings revealed that manual therapy is the superior choice for treating leg pain associated with the SIJ. The success rate for chiropractic manual therapy was 72%, compared to just 20% for physiotherapy and 50% for corticosteroid injections. Researchers also found that neither physical therapy nor injections resulted in significant pain relief, whereas manual therapy resulted in a significant improvement on pain scores.

Due to the success rate and pain reduction of manual therapy, the study authors concluded that chiropractic should be the first treatment of choice in patients with SIJ-related leg pain. They hoped that their findings would be confirmed by further research with a larger sample size.

Additionalresearch has highlighted the efficacy of chiropractic for sciatica, even after surgery has failed.

Reference

Visser L, Woudenberg N, et al. Treatment of the sacroiliac joint in patients with leg pain: a randomized-controlled trial. European Spine Journal 2013 [online]. doi: 10.1007/s00586-013-2833-2.

6.  Neck Adjustments Immediately Improve Joint Position Sense

New research shows that spinal adjustments can result in immediate improvements in cervical joint function. A new study from Korea Nazarene University shows that cervical manipulation, also called neck adjustments, can significantly improve joint position sense, which may improve neck mobility in patients with neck pain or whiplash.

Joint position sense is a major component of proprioception, or the body’s awareness and ability to control your limbs without looking at them. Patients with neck pain and whiplash injuries have been found to have impaired joint position sense in their neck and upper limbs. This may limit the ability of the joint to move fluidly with speed and accuracy. Poor joint position sense in neck pain patients has also been tied to symptoms of dizziness. Earlier research has shown that neck adjustments, commonly used by chiropractors, can improve elbow joint position sense. However, there have been no studies on the effects of neck adjustments on healthy individuals without neck pain.

Korean researchers examined the effects of neck adjustments on the joint position sense in a group of 30 healthy volunteers. Half the volunteers were treated with neck adjustments and light massage while the other half was treated exclusively with massage. Joint position sense was determined by measuring joint position error before and after the interventions using a digital dual clinometer. The participants were shown twice how to position their necks at six different angles (such as 35 degrees flexion and a 35 degree extension) and then were asked to recreate that angle on their own. The difference in the position measured and the correct angle was calculated as the joint position error.

All participants showed improvements in joint position sense after treatment. However, participants who received a neck adjustment had significantly better improvements in two of the angles measured (left lateral flexion and left rotation) compared to the massage-only group. The researchers suggested that massage had the capacity to improve joint position sense, but that the combined treatment of neck adjustments and massage was the most effective for increasing range of motion. They concluded by recommending that cervical joint manipulation and massage by used in combination when treating patients with reduced joint position sense due to decrease range of motion, neck pain, or whiplash.

The findings suggest that chiropractic neck adjustments could immediately improve cervical range of motion, which may help to explain why patients may experience reduced neck pain after a single session of chiropractic care.

Reference

Gong, Wontae. Effects of cervical joint manipulation on joint position sense of normal adults. Journal of Physical Therapy Science 2013; 25:721–723.

Haavik H, and Murphy B. Subclinical neck pain and the effects of cervical manipulation on elbow joint position sense. Journal of Manipulative and Physiological Therapeutics 2011; 34(2):88-97. doi: 10.1016/j.jmpt.2010.12.009.

7.  Chiropractic Better Than Medical Care Care Alone for Back Pain

People with back pain who are treated by a chiropractor experience more relief than patients treated with standard care alone, according to new research.

A new study from the journal Spine tested the effects of combining chiropractic with standard medical care in 91 military personnel with low-back pain. While all service members received standard medical care, half were also treated with chiropractic spinal adjustments.

Chiropractic made a major difference: 73% of chiropractic patients had moderate to substantial pain relief, compared to just 17% of standard care patients. Chiropractic patients also had significantly lower disability scores.

This study shows that there’s a significant advantage in incorporating chiropractic into the standard care of back pain.

Reference

Goertz C, et al. Adding chiropractic manipulative therapy to standard medical care for patients with acute low back pain: Results from a pragmatic randomized comparative effectiveness study. Spine 2013; 38 (8): 627–634. doi: 10.1097/BRS.0b013e31827733e7.

8. Spinal Adjustments Relieve Muscle Pain Instantly

Chiropractic adjustments can provide immediate relief for people with chronic muscle pain, according to new research.

Chronic muscle pain, also known as myofascial pain syndrome, affects an estimated 25% of the general population, and 85% of middle-aged people. Myofascial pain can be caused by an injury to muscle fibers, repetitive motions, or a lack of activity. Frequently patients have specific trigger points, or hyperirritable spots of pain.

In a new study, 36 patients with myofascial pain were treated with either chiropractic spinal adjustments or a sham treatment. The researchers measured patients’ pressure pain threshold, or their ability to withstand pain at trigger points. Having a lower pressure pain threshold indicates more pain sensitivity and tenderness.

Immediately after receiving spinal adjustments, chiropractic patients had significantly improved pressure pain thresholds and reduced sensitivity compared to the control group.

This adds to earlier research showing that chiropractic is a safe, effective way to reduce chronic pain. If you suffer from ongoing muscle pain, chiropractic can help.

Reference

Srbely J, Vernon H, Lee D, Polgar M. Immediate effects of spinal manipulative therapy on regional antinociceptive effects in myofascial tissues in healthy young adults. Journal of Manipulative and Physiological Therapeutics 2013. dOI: 10.1016/j.jmpt.2013.01.005.

9. Cervical Disc Herniation Eased by Chiropractic

New research shows the chiropractic can produce clinically significant reductions in pain for patients with cervical disc herniation.

Often patients with neck pain experience tingling, numbness, and pain emanating from their neck down the arm. These symptoms are characteristic of cervical radiculopathy or radicular pain. Cervical radiculopathy results from compression of the nerve root in the cervical spine (the part of the spine in your neck), and can cause pain to travel down the nerve pathway in the arm.

Disc herniation is the second most common causes of cervical radiculopathy. Unfortunately, few medical studies have analyzed the effectiveness of conservative treatments for cervical disc herniation. A team of Swiss researchers sought to fill that gap in knowledge by observing the effects of chiropractic care on patients with disc herniation in a new study.

The study included 50 patients with cervical disc herniation confirmed on MRI scans and orthopedic tests. The patients were treated by chiropractors who used spinal adjustments applied directly to the affected area observed on the MRI scans. After two weeks of treatment more than half of patients had significantly improved. By the three month mark, 85.7% of patients had significant improvements in pain and disability. Additionally, none of the patients experienced adverse effects as result of treatment.

Patients with acute pain at the start of the study (with symptoms lasting under 4 weeks) had a greater chance of recovery compared to patients with subacute/chronic pain. However, the majority of patients with of subacute/chronic pain patients (76.5%) still experienced significant improvements.

“This is clinically important as the chronic patients are the ones who are usually the most costly in terms of health care cause and quality-of-life disruption,” the researchers wrote.

These findings add to earlier research demonstrating the efficacy of chiropractic care for lumbar disc herniation and radiculopathy.

Reference

Peterson CK, et al. Outcomes from magnetic resonance imaging–confirmed symptomatic cervical disk herniation patients treated with high-velocity, low-amplitude spinal manipulative therapy.: a prospective cohort study with 3-month follow-up. Journal of Manipulative and Physiological Therapeutics 2013; doi 10.1016/j.jmpt.2013.07.002).

10. Chiropractic Thaws Frozen Shoulder Syndrome

Many patients with shoulder pain are told have surgery, get steroid shots, or take anti-inflammatory drugs to relieve the pain. Unfortunately, these treatments do not always work to reliably reduce symptoms, particularly in patients with frozen shoulder syndrome.

Frozen shoulder syndrome is characterized by night pain and painful restriction of shoulder movement during rotation and abduction. Only 2-5% of the general population has FSS, but rates are higher among people with Parkinson’s disease, cardiovascular disease, thyroid disease, and stroke; in fact, up to 40% of patients with diabetes suffer from FSS.

Finding an effective way to relieve FSS remains a challenge since many patients say they still experience symptoms for several years after their initial medical treatment. A recent study suggests that chiropractic treatment may provide better relief for persistent FSS.

The study included 50 patients with FSS between the ages of 40-70 years old. Patients were treated with a high-velocity, low-amplitude thrust that seeks to correct dysfunction of occipitoatlantal articulation (C0-C1 chiropractic subluxation).

After an average treatment time of 28 days, the majority of patients had substantial improvements in shoulder adduction and pain. The median average patient had their pain score drop from a nine out of ten to a two out of ten, resulting in a median 78% improvement in pain. Additionally, researchers evaluated the patients’ shoulder function by measuring their degree of shoulder adduction. Sixteen patients had regained completely normal shoulder adduction; 25 patients had 75-90% improvement in shoulder adduction; and eight showed a 50-75% improvement.

“The results of this case series are encouraging in that many of these patients’ complaints seemed to improve or resolve within 1 month of presentation, whereas, in general, it is thought that FSS symptoms can persist for 2 years or more,” the researchers wrote.

Although large-scale studies are needed to test these results, the findings suggest that chiropractic adjustment can provide effective relief of FSS.

Reference

Murphy F. Chiropractic management of frozen shoulder syndrome using a novel technique: a retrospective case series of 50 patients. Journal of Chiropractic 2012; 11: 267-72.

 

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