Management of knee and hip osteoarthritis: an opportunity for the Canadian chiropractic profession

Knee and hip osteoarthritis (OA) place a significant burden on the Canadian health system and are a major public health challenge. This brief commentary discusses the recently published Osteoarthritis Research Society International guideline and the American College of Rheumatology guideline for the management of OA. Special attention has been given to the role of manual therapy, exercise, and patient education for the treatment of knee and hip OA. This article also reviews the Good Life with osteoArthritis in Denmark (GLA:D^®) treatment program for knee and hip OA and the implementation of this program in Canada. Lastly, the authors discuss the opportunity for the Canadian chiropractic profession to embrace treatment programs like GLA:D^® and take an active role in the strengthening of the Canadian health system from a musculoskeletal perspective.     

整脊推拿结合化痰祛瘀方治疗颈源性眩晕伴颈动脉斑块43例

目的:观察整脊推拿结合中药化痰祛瘀方治疗颈源性眩晕伴颈动脉斑块的的效果及安全性。方法:伴有颈动脉斑块的颈源性眩晕患者按随机数字表法分为两组,对照组45例采用基础治疗联合中药化痰祛瘀方,观察组43例在对照组基础上结合整脊推拿干预,治疗后统计比较两组眩晕指征和血脂改善情况。结果:治疗后两组患者眩晕、耳鸣、恶心欲呕、头痛、视力障碍、猝倒发作、颈项不适、反应迟钝等症状的恢复率比较,差异有统计学意义(P<0.01);治疗结束后观察组的总有效率为95.35%,明显优于对照组的77.78%,差异有统计学意义(P<0.05);疗程结束后两组患者血脂均较治疗前有所改善(P<0.05),观察组中的总胆固醇(TC)、低密度脂蛋白(LDL)明显低于对照组,高密度脂蛋白(HDL)明显高于对照组,差异均有统计学意义(P<0.05),但三酰甘油(TG)和对照组比较差异无统计学意义(P> 0.05)。结论:整脊推拿结合化痰祛瘀方治疗颈源性眩晕伴颈动脉斑块,在改善眩晕相关指征和血脂方面疗效较好。     

Whiplash evokes descending muscle recruitment and sympathetic responses characteristic of startle

Whiplash injuries are the most common injuries following rear-end collisions. During a rear-end collision, the human muscle response consists of both a postural and a startle response that may exacerbate injury. However, most previous studies only assessed the presence of startle using data collected from the neck muscles and head/neck kinematics. The startle response also evokes a descending pattern of muscle recruitment and changes in autonomic activity. Here we examined the recruitment of axial and appendicular muscles along with autonomic responses to confirm whether these other features of a startle response were present during the first exposure to a whiplash perturbation. Ten subjects experienced a single whiplash perturbation while recording electromyography, electrocardiogram, and electrodermal responses. All subjects exhibited a descending pattern of muscle recruitment, and increasing heart rate and electrodermal responses following the collision. Our results provide further support that the startle response is a component of the response to whiplash collisions.     

Chiropractic management of postpartum pubic symphysis diastasis: A case report

This case report describes the chiropractic management of a 30-year-old female patient with severe postpartum pelvic pain secondary to pubic symphysis diastasis. No literature was found on the chiropractic management of postpartum symphysis pubis diastasis. The existing literature concerning chiropractic care for symphysis pubis dysfunction during pregnancy is limited and indicates a potential benefit. Separation of the pubic symphysis may include ligamentous injury to the sacroiliac joints and may lead to chronic pain. Pubic symphysis separation of 17 millimeters was present on digital radiograph. Management consisted of chiropractic adjustments, trigger point release, electrical stimulation, moist heat, sacroiliac belt, and specific stabilizing exercises. The patient’s pain improved immediately following treatment on the initial visit. Pain was reduced from 8/10 VAS at the first visit to 2/10 at the fourth visit. She was able to resume normal activities and reached a final pain level of 1/10. The diastasis was reduced by 7 millimeters at 14-weeks post radiograph for a final separation of just under 10 millimeters. Collaboration between obstetricians, midwives and chiropractors may be warranted.     

Is “fear of passive movement” a distinctive component of the Fear-Avoidance Model in whiplash?

Objectives:Modify the Tampa Scale for Kinesiophobia (TSK) for ‘fear of passive motion’ beliefs.Methods:With permission, a 14-item modification, the TSK-PM (passive movement), was created. Test-retest reliability was tested first. Construct validity was tested in chronic whiplash patients by comparing the TSK-PM with the TSK, the Neck Disability Index (NDI) and cervical ranges of motion.Results:The TSK-PM showed high test-retest reliability (r = 0.83) and high correlation with the original TSK (r = 0.84). Low, non-significant correlations were found with other variables. NDI scores were strongly correlated with ranges of motion.Conclusions:While having high test-retest reliability and a single factor structure, the TSK-PM failed to demonstrate distinctive construct validity vs the original TSK. The original TSK is likely to be sufficient to assess fear of being moved in neck pain patients in a clinical setting. Modifications to the current version of the TSK-PM might improve its construct validity in future studies.     

R + C Factors and Sacro Occipital Technique Orthopedic Blocking: a pilot study using pre and post VAS assessment

Introduction:

The concept of a systematic or predictive relationship between distant vertebral levels distinct from accumulative functional compensatory mechanisms, such as in scoliosis, has been perpetuated within chiropractic technique systems based on clinical observation and experience. This study seeks to investigate this relationship between the cervical and lumbar vertebrae.

Methods:

Patients (experimental group n=26 and control group n=12) were selected from the patient base of one office, and were limited to patients that had sensitivity at specific cervical reflex points. Using a pre and post outcome measurement and sacro occipital technique R + C protocols, the related lumbar vertebra was adjusted in the direction indicated by the cervical vertebral sensitivity.

Results:

Statistical analysis revealed there was a statistically significant difference between pre- and post-VAS measurements and found that the notable difference in mean change in VAS scores were statistically significantly different between the experimental and control groups (p < .001).

Conclusion:

The findings of this study suggest that further research into cervical and lumbar vertebra interrelationships, and the efficacy of orthopedic block treatment, may be warranted. Further studies are needed to confirm whether a causal relationship exists between lumbar manipulation and decreased cervical spine sensitivity.     

Improvement in clinical outcomes after dry needling in a patient with occipital neuralgia

The primary purpose of this case report is to outline the diagnosis, intervention and clinical outcome of a patient presenting with occipital neuralgia. Upon initial presentation, the patient described a four-year history of stabbing neck pain and headaches. After providing informed consent, the patient underwent a total of four dry needling (DN) sessions over a two-week duration. During each of the treatment sessions, needles were inserted into the trapezii and suboccipital muscles. Post-intervention, the patient reported a 32-point change in her neck disability index score along with a 28-point change in her headache disability index score. Thus, it appears that subsequent four sessions of DN over two weeks, our patient experienced meaningful improvement in her neck pain and headaches. To the best of our knowledge, this is the first case report describing DN to successfully improve clinical outcomes in a patient diagnosed with occipital neuralgia.     

A posterior ring apophyseal fracture and disc herniation in a 21-year-old competitive basketball player: a case report

Objective:

To describe the diagnosis and management of a competitive male basketball player with discogenic low back pain and presence of an old posterior ring apophyseal fracture (PRAF). This case will highlight the importance of early recognition and considerations regarding patient management for this differential of radiating low back pain.

Clinical Features:

A 21-year-old provincial basketball player presented with recurrent radiating low back pain into the left groin and lower limb. After several weeks of persistent symptoms including pain, muscle weakness, and changes in the Achilles deep tendon reflex, imaging was obtained that revealed a large disc extrusion with an old posterior ring apophyseal fracture. In collaboration with a spine surgeon and family physician, the patient was treated using a conservative, multimodal approach. Treatment consisted of graded mobilizations, spinal manipulative therapy, interferential current, and soft tissue therapy to the lumbar spine. Rehabilitation exercises focused on centralizing symptoms and improving strength, proprioception and function of the lower limb. After a period of 8 weeks, the patient was able to complete all activities of daily living without pain in addition to returning to basketball practice.

Summary:

PRAF is a unique condition in the immature spine and recent evidence suggests that those involved in sports requiring repetitive motion of the lumbar spine may be at increased risk. The astute clinician must consider this differential in young populations presenting with discogenic low back pain, as a timely diagnosis and necessary referral may allow for effective conservative management to reduce symptoms. Equally as important, one must be aware of the complications from PRAF as a contributing source of low back pain and dysfunction into adulthood. Knowing when to refer for advanced imaging and/or a surgical consult given the variable clinical presentation and prognosis is an essential component to care.     

Attitudes toward vaccination: A cross-sectional survey of students at the Canadian Memorial Chiropractic College

Introduction:

The purpose of this study was to conduct an online survey of chiropractic students in the 2011/12 academic year at CMCC in order to determine their attitudes toward vaccination, their history of vaccination and their opinions towards their level of preparedness and confidence to discuss vaccination with patients.

Method:

All students enrolled in the program at CMCC were eligible to participate in this anonymous survey modeled after a similar survey administered in 1999/2000.

Results:

The response rate was 43%. Over 90% of all students reported they had been vaccinated. Roughly half of students felt they were well prepared to discuss vaccination with their patients and two-thirds felt they were confident to do so. Between 83.9% and 90% of students in various years of the program expressed a positive attitude toward vaccination.

Discussion:

Separate Welsh t-test for each year of study indicated statistically significant differences between our survey and the survey published in 1999/2000, with students in our study expressing a more positive attitude toward vaccination.

Conclusion:

Students enrolled in the chiropractic program at CMCC in the 2011/12 expressed a positive attitude toward vaccination.