Changes in Vertebral Artery Blood Flow Following Various Head Positions and Cervical Spine Manipulation

Objective

The objective of the study was to investigate the cerebrovascular hemodynamic response of cervical spine positions including rotation and cervical spine manipulation in vivo using magnetic resonance imaging technology on the vertebral artery (VA).

Methods

This pilot study was conducted as a blinded examiner cohort with 4 randomized clinical tasks. Ten healthy male participants aged 24 to 30 years (mean, 26.8 years) volunteered to participate in the study. None of the participants had a history of disabling neck, arm, or headache pain within the last 6 months. They did not have any current or history of neurologic symptoms. In a neutral head position, physiologic measures of VA blood flow and velocity at the C1-2 spinal level were obtained using phase-contrast magnetic resonance imaging after 3 different head positions and a chiropractic upper cervical spinal manipulation. A total of 30 flow-encoded phase-contrast images were collected over the cardiac cycle, in each of the 4 conditions, and were used to provide a blood flow profile for one complete cardiac cycle. Differences between flow (in milliliters per second) and velocity (in centimeters per second) variables were evaluated using repeated-measures analysis of variance.

Results

The side-to-side difference between ipsilateral and contralateral VA velocities was not significant for either velocities (P = .14) or flows (P = .19) throughout the conditions. There were no other interactions or trends toward a difference for any of the other blood flow or velocity variables.

Conclusions

There were no significant changes in blood flow or velocity in the vertebral arteries of healthy young male adults after various head positions and cervical spine manipulations.     

Consumer Characteristics and Perceptions of Chiropractic and Chiropractic Services in Australia: Results From a Cross-Sectional Survey

Objective

The purpose of this study was to describe patient characteristics and summarize their perceptions of chiropractic in Australia.

Methods

This study is part of a broader study aiming to extend the knowledge of the role of chiropractic within the current health care environment. A 33-item, paper-based, cross-sectional survey of a sample of patients from 100 systematically sampled chiropractic clinics from all the states and territories of Australia was conducted. The survey focused on patient demographics, socioeconomic status, perceived health status, and perceptions of chiropractic and chiropractic services.

Results

A total of 486 responses were received (24.3% response rate). Respondents were predominantly female patients (67.1%) of the 45- to 64-year age group. Approximately half of the respondents reported a pretax annual income exceeding $40 000. Most patients sought chiropractic services because of musculoskeletal disorders (68.7%) and for general health (21.2%), and personal beliefs motivated most respondents (70.2%) to visit a chiropractor. Most respondents would seek the chiropractic services again (97.5%) and were satisfied with the service received.

Conclusions

The results of this study show that the typical chiropractic patient in Australia is a middle-aged woman with a moderate to high income. Although only a small proportion of the Australian population sees a chiropractor, this group seems to be satisfied with the service.     

The Role of Preload Forces in Spinal Manipulation: Experimental Investigation of Kinematic and Electromyographic Responses in Healthy Adults

Objectives

Previous studies have identified preload forces and an important feature of skillful execution of spinal manipulative therapy (SMT) as performed by manual therapists (eg, doctors of chiropractic and osteopathy). It has been suggested that applying a gradual force before the thrust increases the spinal unit stiffness, minimizing displacement during the thrust. Therefore, the main objective of this study was to assess the vertebral unit biomechanical and neuromuscular responses to a graded increase of preload forces.

Methods

Twenty-three participants underwent 4 different SMT force-time profiles delivered by a servo-controlled linear actuator motor and varying in their preload forces, respectively, set to 5, 50, 95, and 140 N in 1 experimental session. Kinematic markers were place on T6, T7, and T8 and electromyographic electrodes were applied over paraspinal muscles on both sides of the spine.

Results

Increasing preload forces led to an increase in neuromuscular responses of thoracic paraspinal muscles and vertebral segmental displacements during the preload phase of SMT. Increasing the preload force also yielded a significant decrease in sagittal vertebral displacement and paraspinal muscle activity during and immediately after the thrust phase of spinal manipulation. Changes observed during the SMT thrust phase could be explained by the proportional increase in preload force or the related changes in rate of force application. Although only healthy participants were tested in this study, preload forces may be an important parameter underlying SMT mechanism of action. Future studies should investigate the clinical implications of varying SMT dosages.

Conclusion

The present results suggest that neuromuscular and biomechanical responses to SMT may be modulated by preload through changes in the rate of force application. Overall, the present results suggest that preload and rate of force application may be important parameters underlying SMT mechanism of action.     

The Chiropractic Scope of Practice in the United States: A Cross-Sectional Survey

Objective

The purpose of this study was to assess the current status of chiropractic practice laws in the United States. This survey is an update and expansion of 3 original surveys conducted in 1987, 1992, and 1998.

Methods

A cross-sectional survey of licensure officials from the Federation of Chiropractic Licensing Boards e-mail list was conducted in 2011 requesting information about chiropractic practice laws and 97 diagnostic, evaluation, and management procedures. To evaluate content validity, the survey was distributed in draft form at the fall 2010 Federation of Chiropractic Licensing Boards regional meeting to regulatory board members and feedback was requested. Comments were reviewed and incorporated into the final survey. A duplicate question was imbedded in the survey to test reliability.

Results

Partial or complete responses were received from 96% (n = 51) of the jurisdictions in the United States. The states with the highest number of services that could be performed were Missouri (n = 92), New Mexico (n = 91), Kansas (n = 89), Utah (n = 89), Oklahoma (n = 88), Illinois (n = 87), and Alabama (n = 86). The states with the highest number of services that cannot be performed are New Hampshire (n = 49), Hawaii (n = 47), Michigan (n = 42), New Jersey (n = 39), Mississippi (n = 39), and Texas (n = 30).

Conclusion

The scope of chiropractic practice in the United States has a high degree of variability. Scope of practice is dynamic, and gray areas are subject to interpretation by ever-changing board members. Although statutes may not address specific procedures, upon challenge, there may be a possibility of sanctions depending on interpretation.     

Effect of Chiropractic Manipulation on Vertical Jump Height in Young Female Athletes with Talocrural Joint Dysfunction: A Single-Blind Randomized Clinical Pilot Trial

Objective

The main objective of this pilot study was to explore the effect of chiropractic high-velocity, low-amplitude (HVLA) manipulation on vertical jump height in young female athletes with talocrural joint dysfunction.

Methods

This was a randomized assessor-blind clinical pilot trial. Twenty-two female handball players with talocrural joint dysfunction were randomized to receive either HVLA manipulation (n = 11) or sham treatment (n = 11) once a week during a 3-week period. The main outcome was change in vertical jump height from baseline to follow-up within and between groups after 3 weeks.

Results

Nineteen athletes completed the study. After 3 weeks, the group receiving HVLA manipulation (n = 11) had a statistically significant mean (SD) improvement in vertical jump height of 1.07 (1.23) cm (P = .017). The sham treatment group (n = 8) improved their vertical jump height by 0.59 (2.03) cm (P = .436). The between groups' change was 0.47 cm (95% confidence interval, − 1.31 to 2.26; P = .571) in favor of the group receiving HVLA manipulation. Blinding and sham procedures were feasible, and there were no reported adverse events.

Conclusion

The results of this pilot study show that a larger-scale study is feasible. Preliminary results suggest that chiropractic HVLA manipulation may increase vertical jump height in young female athletes with talocrural joint dysfunction. However, the clinical result in favor of HVLA manipulation compared with sham treatment needs statistical confirmation in a larger randomized clinical trial.     

The Comparative Effect of Episodes of Chiropractic and Medical Treatment on the Health of Older Adults

Objectives

The comparative effect of chiropractic vs medical care on health, as used in everyday practice settings by older adults, is not well understood. The purpose of this study is to examine how chiropractic compares to medical treatment in episodes of care for uncomplicated back conditions. Episodes of care patterns between treatment groups are described, and effects on health outcomes among an older group of Medicare beneficiaries over a 2-year period are estimated.

Methods

Survey data from the nationally representative Survey on Assets and Health Dynamics among the Oldest Old were linked to participants' Medicare Part B claims under a restricted Data Use Agreement with the Centers for Medicare and Medicaid Services. Logistic regression was used to model the effect of chiropractic use in an episode of care relative to medical treatment on declines in function and well-being among a clinically homogenous older adult population. Two analytic approaches were used, the first assumed no selection bias and the second using propensity score analyses to adjust for selection effects in the outcome models.

Results

Episodes of care between treatment groups varied in duration and provider visit pattern. Among the unadjusted models, there was no significant difference between chiropractic and medical episodes of care. The propensity score results indicate a significant protective effect of chiropractic against declines in activities of daily living (ADLs), instrumental ADLs, and self-rated health (adjusted odds ratio [AOR], 0.49; AOR, 0.62; and AOR, 0.59, respectively). There was no difference between treatment types on declines in lower body function or depressive symptoms.

Conclusion

The findings from this study suggest that chiropractic use in episodes of care for uncomplicated back conditions has protective effects against declines in ADLs, instrumental ADLs, and self-rated health for older Medicare beneficiaries over a 2-year period.     

Stress and burnout in chiropractic students of European chiropractic colleges:: A cross-sectional study

ObjectiveHigh levels of stress and burnout are known to negatively impact academic success, quality of life, and well-being of students. The purpose of this study was to investigate the degrees of stress and burnout levels of students from several European chiropractic colleges.MethodsStress and burnout were assessed using the Perceived Stress Scale (PSS-10) and the Maslach Burnout Inventory–Student Survey (MBI-SS). Surveys were delivered electronically in November 2017 to chiropractic students from 4 different chiropractic colleges. Data were analyzed using t test and 1-way ANOVA to determine differences between demographic data. Scores in perceived stress and burnout subscales were compared to the general, chiropractic, and medical student populations.ResultsBoth the MBI-SS and PSS had similar response rates (30%–34%) and demonstrated statistically significant differences between institutions, with C-3 demonstrating the highest levels of exhaustion (p < .001) and the highest levels of perceived stress (p = .012). MBI-SS results show that in the general chiropractic student population, 26.4% presented high emotional exhaustion, 18.2% high cynicism, and 43.8% low academic efficacy. Meanwhile, the PSS score indicated “moderate” levels of stress.ConclusionsEuropean chiropractic students experience higher levels of perceived stress than the general population and they may suffer levels of burnout similar to those of medical students. These results suggest that colleges should monitor stress and burnout levels in their students. This may help to establish student support systems in order to improve students'' quality of life and academic performance, as well as help new graduates transition to their professional lives.     

Active learning strategies,such as analogical models,aid in student learning of spinal anatomy and biomechanics

ObjectiveThis study aimed to examine the effect of active learning strategies using analogical models versus didactic lectures on student learning of spinal anatomy and biomechanics.MethodsStudents enrolled into year 1 of a chiropractic program in 2014 and 2015 were eligible to participate. The 2014 cohort received didactic lectures. Active learning approaches using analogical models were incorporated into the 2015 cohort. Both groups received an identical written assessment at the end of the 3rd lecture. Between-group differences in age and written assessment percentages were analyzed using independent t tests.ResultsFifty-nine students from the 2014 cohort and 62 students from the 2015 cohort took part. There were no significant differences in age or gender between the cohorts. The differences in the mean of the written assessment percentages between the didactic group and the analogical models group were significant (p = .00), with a mean difference of 22.6% (95% CI, 17.4–27.9). The didactic group mean percentage was 37.9% (SD 15.8) and was within a fail percentage bracket. The analogical models group mean percentage was 60.6% (SD 13.1) and within a pass percentage bracket.ConclusionThe analogical models group performed significantly better than the didactic lecture group, particularly with regard to content delivered using literal or surface analogies.     

A case of central retinal artery occlusion after chiropractic manipulation of the neck

Here we report a case of central retinal artery occlusion after chiropractic manipulation on the neck. A 49-year old man presented at the hospital because of sudden visual loss in his right eye after chiropractic neck manipulation. He had received chiropractic manipulation of the neck by a chiropractor eight days prior. When he first visited us, his best corrected visual acuity in his right eye was hand motion. A full ophthalmic examination was performed. There was cherry-red spot in the macula in his right eye. We performed a fluorescein angiogram and cervical color Doppler. The arterio-venous transit time in the fluorescein angiogram was delayed, and we detected stenosis of the right internal carotid artery with diffuse atherosclerotic plaques in the right common carotid artery. We prescribed ginko biloba extract (Tanamin). Three years after his first visit, the best corrected visual acuity of his right eye was 20 / 200.     

Dose-response and efficacy of spinal manipulation for care of cervicogenic headache: a dual-center randomized controlled trial

Background Context

The optimal number of visits for the care of cervicogenic headache (CGH) with spinal manipulative therapy (SMT) is unknown.