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chiropractic research

Did That Go?

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Before I jump into my post today, I’d first like to apologize for not posting for so long. It seems that I have taken to being a Comox Valley resident quite nicely, which means less work and more play. Too much time spent on the mountain, on the trails or in the ocean and not enough in front of the computer. Well, at least not enough to manage to blog.

Today, I’d like to discuss something that has significant bearing on all chiropractic practices – the crack! The cracking noise associated with adjustments (or cavitation, as it is properly termed) is something that is  perceived as a required outcome for most patients. People regularly ask “Did that go?” or “Did that work?” if they don’t hear a cavitation following and adjustment.

A new study in JMPT found that an audible cavitation was not necessary in order to experience the benefits of the adjustment. The authors measured 2 different variables associated with pain relief, and found that the adjustment reduced pain equally regardless of whether there was an audible cavitation or not.

So, it is the actual mechanism of the adjustment, the high velocity low amplitude thrust, that results in pain relief. Whether or not it creates an audible cavitation means nothing.



Dr. Debbie Wright is a practicing Courtenay Chiropractor.

Chiropractic Care as Pain Management for Mesothelioma Patients

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Chiropractic care is often sought as a form of alternative medicine and complementary care to coincide with traditional medical treatments. Many cancer patients even elect to visit a chiropractor as part of their treatment regimen.

According to the Canadian Chiropractic Association, chiropractic doctors have a deep respect for the human body’s ability to heal itself without the use of surgery or medication. These doctors devote careful attention to the biomechanics, structure and function of the spine, its effects on the musculoskeletal and neurological systems, and the role played by the proper function of these systems in the preservation and restoration of health. A doctor of chiropractic is one who is involved in the treatment and prevention of disease, as well as the promotion of public health, and a wellness approach to patient care.

Cancer patients have included chiropractic care in their course of treatment to help control pain and alleviate headaches, tension and stress. Patients interested in alternative treatment, who strongly believe in the body’s ability to heal itself, may find chiropractic care particularly appealing. Alleviating severe headaches and movement pains during cancer treatment may make the treatment process more comfortable for cancer patients, including those battling mesothelioma.

Mesothelioma is a rare and aggressive type of cancer that develops in the mesothelial cells that make up the lining of the lungs, heart and abdomen. The primary cause of meosthelioma is exposure to a naturally occurring mineral known as asbestos. Mesothelioma is often difficult to treat as it is typically not diagnosed until it has reached later stages.

A study published in the Journal of Manipulative and Physiological Therapeutics examined the case of a 54-year-old man diagnosed with lung cancer (a cancer often related to asbestos exposure). He began seeing a chiropractor after experiencing very little pain relief one year after he underwent surgery to fight his cancer. The man experienced pain relief immediately after beginning chiropractic care and discontinued use of all pain medications after two visits to his chiropractor.

This case study provides a perfect example of how all types of health care practitioners can work together to ensure the best outcome for the patient – the main goal of any health care system.

Dr. Debbie Wright is a practicing Courtenay Chiropractor.

Knee Pain? Look to the Hip!

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Anytime someone comes into my Comox Valley Chiropractic office with knee pain, I always will look at their hips and pelvis for dysfunction. It is a logical step that most chiropractors will take.

Now, new research is emerging which is showing that a measurable relationship does exist between patellofemoral joint (kneecap) pain and altered hip mechanics.

This study published in the Journal of Orthopaedic & Sports Physical Therapy found a link between women with kneecap pain, increased internal hip rotation and weakness with hip extension. These subjects consistently showed weaker single leg squatting and jumping abilities, and had improper hip mechanics when running.

A comprehensive treatment strategy would involve normalizing the hip and pelvic function with chiropractic adjustments, working on the muscular tension with soft tissue therapy, and addressing the hip weakness with a gluteus medius and maximus rehab program.

The incidence of knee pain is very high in our society, especially in younger women. There are ways to help this condition, and it is not necessarily something you have to live with!

Dr. Debbie Wright is a practicing Courtenay Chiropractor.

Exercises For Spine Stabilization

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Over the years, research has clearly shown that exercise and stabilization of the lower back are key to making a full recovery from back pain. Stu McGill, a leader in this field of research has consistently guided our thinking in terms of specific exercises that optimally stabilize the spine, while minimizing the amount of stress and strain on its structures (disc, joint, ligament etc.).

An article published in the Archives of Physical Medicine and Rehabilitation further clarifies our knowledge when it comes to stabilizing exercises for the low back. This study focuses on the three main exercises recommended for back stabilization, and aims to help guide clinicians in determining how to progress patients through these exercises.

Curl UpCurl Up: This classic curl-up involves keeping one leg straight, one leg bent, both hands under the back and curling the shoulder blades up off the ground. Progressions can involve pre-bracing, adding in arm movements (dead-bugs), and deep breathing during the exercise.

Side Bridge

Side Bridge: This involves lying on your side with our elbow and knee on the floor, while lifting the hips up off the ground and holding. Progressions can involve using feet instead of knees as lower balance point and moving arm positions.

Bird DogBird Dog: This involves starting on all fours with hips and shoulders at a 90 degree angle. Progressions can involve raising one arm, one leg, opposite arm and leg together, and movements of the limbs while elevated.

These three simple exercises are easy for clinician’s to prescribe, and can be done safely by a patient with little or no supervision. Its important for us to take the time to teach these exercises properly, so patients can attain the improvements they need with minimal stress on their spine.

Dr. Debbie Wright is a practicing Comox Valley Chiropractor.

Chiropractic Success in Hospitals

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A great article (which can be found here) recently appeared in the Toronto Star talking about academic research and collaborative practice amongst Chiropractic doctors. With new Chiropractic research chairs being added each year (University of British Columbia, University of Alberta, McMaster University to name a few), more and more people are realizing that Chiropractors have a valuable contribution to make to understanding the spine and its problems.

One such contribution came in the form of a pilot project at St. Michael’s Hospital in Toronto, Ontario. This program saw chiropractors added as staff to treat patients in a collaborative way with other departments (such as the family medicine department). The project has been a huge success.

For those of us who see the results of chiropractic care first hand, it makes perfect sense to have chiropractors on staff in a hospital. The few times I’ve been to the ER with a bad sprain or broken finger, I can’t believe how many people I see waiting 8 hours with back pain. Most of those people will simply be given an X-ray, pain medication and discharged in the same state in which they came in.

I know that if they had come to my office instead, I could have at the very least made them feel better than when they arrived. More importantly, chiropractors are educated in differential diagnosis, which means we can determine when someone should go to the ER instead of being in our office. On two different cases this year I sent someone back to the ER or their family doctor only to find out that the diagnosis was ureter cancer and a tumor of the nerve sheath.

Including chiropractors in a hospital setting is a great way to ensure patients get quick and effective relief from their pain, and also to save time and money on needless diagnostic tests or harmful medications.

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Dr. Debbie Wright is a practicing Comox Valley Chiropractor (soon).

Chiropractic Care for Neck Pain – Is it Safe?

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A current study published in Spine set out to determine the relationship between benign adverse events (reactions to treatment) and outcomes (neck pain and disability, perceived improvement) in a group of people who received chiropractic care for their neck pain.

529 patients participated in the study. 56% of the participants reported an adverse event during the first 3 treatments, and only 13% graded it as “intense”. Muscle or joint pain events were the most common types reported, and none of the events were considered serious.

The researchers found that if someone reported an “intense” adverse event during any one of the first 3 visits, they were less likely to report recovery on the fourth visit. What is interesting about this is that they didn’t have significantly more neck pain or disability than those who didn’t experience an adverse event.

At a follow-up 3 months later, those who had “intense” adverse events experienced the same recovery and pain reduction as those who didn’t have any adverse events.

The bottom line here is that even if someone reports an adverse event or reaction after treatment, it did not negatively affect their outcomes or recovery at 3 months. Moreover, it was only those who had an “intense” adverse events that reported less recovery in the short term (13% of participants).

It is also important to note that out of 4,891 treatments, no serious adverse events occurred. This adds validity to the current view that “the benefits of chiropractic care for neck pain seem to outweigh the potential risks.”

Dr. Debbie Wright is a practicing Comox Valley Chiropractor.

Easing Chronic Muscle Pain – What works?

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Myofascial Pain Syndrome can be defined as chronic muscle pain. This pain originates around certain points of pain and sensitivity in your muscles called trigger points. A recent study was published in the Journal of Manipulative and Physiological Therapeutics that sought to identify and review the most common treatments for myofascial pain syndrome.

This study identified many different types of treatment used, and some of them are as follows:

  • Spray and Stretch – vapo-coolant spray followed by muscle stretch
  • Soft Tissue Massage
  • Ischemic Compression – compressing the trigger point in the muscle
  • Occipital Release Exercises – a form of massage and mobilization for the occiput (base of skull)
  • Strain/Counter-strain – stretching a muscle and then having the patient contract that muscle
  • Myofascial Release – compressing and tensioning the trigger point while stretching the muscle through its full range
  • Chiropractic Spinal Adjustments

Immediate (after treatment) benefits were demonstrated with the chiropractic adjustments, spray and stretch, compression, massage and strain/counter-strain. The authors therefore concluded that there is moderately strong evidence to support the use of these manual therapies for the treatment of trigger point pain. These treatments, however, didn’t show as strong benefits as long term solutions.

Recommendations for other types of treatment for trigger points and myofascial pain syndrome can be drawn from this review.  They are as follows:

  • There is strong evidence that laser therapy is effective.
  • There is moderately strong evidence that electrical therapy is effective on a short term basis.
  • There is moderately strong evidence that acupuncture is effective for up to 3 months after treatment.
  • There is limited evidence for modalities such as muscle stimulation, interferential current, an other such stims.

Dr. Debbie Wright is a practicing Comox Valley Chiropractor.

Routine X-rays Not Needed

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Following up on my previous post about the necessity of X-rays, I came across a review of the literature for low back imaging.

In 1994, the AHPR began recommending against imaging of the low back in the early stages of acute low back pain. This study was undertaken to investigate the relationship between the use of immediate X-rays for the low back and the clinical outcome of the case.

479 articles were identified and reviewed. The authors found no differences in long term and short term outcomes between those who were X-rayed immediately and those who simply received treatment.

They concluded that for patients who present with simple uncomplicated low back pain (no red flags present), X-raying their back did not lead to any greater improvements. Since there is no benefit to imaging the back, but there are draw backs (radiation exposure, cost), routine imaging should be avoided.

Ultimately, every clinician has to rationalize their decisions when it comes to the assessment and treatment of their patients. I will often explain my decision not to X-ray with the fact that the X-ray result will not change my clinical management of their case. We know already from previous studies that many things are seen on X-ray and MRI that don’t have clinical relevance and may actually confuse the issue.

If you would like to read the original article, it can be found here.

Dr. Debbie Wright is a practicing Comox Valley Chiropractor.

The Evidence Supports Chiropractic Care

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Myth #3: There is no evidence to support that chiropractic works.

I don’t even know where to start with this one. The fact is that there is are so many studies done on spinal manipulation that a Medline search would be overwhelming. Instead of going through the many systematic reviews and meta-analyses that exist, I think the evidence is well summed up by an review exploring international low back pain guidelines. The review can be accessed here.

Over the last 10 years, 12 countries have done critical reviews of the scientific literature concerning low back pain. The international consensus is that the balance of the evidence shows that chiropractic spinal manipulation is effective in managing low back pain, and therefore is included in the recommendations. Here is a summary of their findings:

Clinical practice guidelines for the treatment of acute lower back pain

  • Reassurance of the favourable natural history
  • Advice to stay active
  • Discourage bed rest
  • Acetaminophen, p.r.n.
  • Chiropractic spinal manipulative therapy
  • Advice against passive physiotherapy modalities, prolonged bed rest or specific back exercises.

Essentially the investigators found that following these treatment guidelines (including chiropractic spinal manipulation) led to better outcomes than usual medical care. It is important to note that the guidelines don’t recommend chiropractic as a stand alone treatment, but as one component of a continuum of care.

One of the authors of the study then went on to launch the 2-part C.H.I.R.O study (Chiropractic Hospital-Based Interventions Research Outcome study). The first part pitted chiropractic care (along with the above guideline recommendations) versus usual medical care. The people who received chiropractic care showed better functional and quality of life improvements. The results of this study have been presented at Canadian Spine Society Meeting, the International Society for the Study of the Lumbar Spine, and the North American Spine Society and will be published in an upcoming edition of Spine. A summary of the results can be found here.

In the opinion of this Comox Valley Chiropractor, we are so far past establishing that there is evidence supporting chiropractic care. We are now heading in the direction of trying to establish how to best use this tool in the management of patients, or whether certain subsets of patients will respond more favourably. In the past 5 years, Chiropractic Research Chairs have been established at many universities across Canada in order to further chiropractic research.

Dr. Debbie Wright is a practicing Comox Valley Chiropractor.

Chiropractic Care Better Than “Usual Care”

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A recent article in Lippincott’s Bone and Joint Newsletter caught this Comox Valley Chiropractor‘s eye concerning the effectiveness of chiropractic care when compared to “usual care” given by family doctors. The main author of the study is Dr. Paul Bishop, DC, PhD, MD, a professor of orthopedics at the University of British Columbia.

The study was presented at the International Society for the Study of the Lumbar Spine in Hong Kong. The results indicated that following the existing clinical practice guidelines (which include chiropractic spinal manipulation) produces better outcomes than family doctor-directed care for acute low back pain patients.

The guideline based care involved avoiding passive treatment, acetaminophen to control pain, reassurance and four weeks of spinal manipulation performed by chiropractic doctors at a frequency of two times per week. All patients returned to work within eight weeks.

Using pain and disability questionnaires, the chiropractic treatment group was found to have a significantly greater improvement than those who received “usual care” from their family physicians.

It was also stated that,

“Typically, the family physician-based care involved excessive use of passive therapies such as massage and passive physical therapy, excessive bed rest, and excessive use of narcotic analgesics, Bishop added.”

The evidence continues to mount that chiropractic care is an effective form of treatment for low back pain, and should be used as a first line of treatment for uncomplicated cases.