Subclinical neck pain and the effects of cervical manipulation on elbow joint position sense.
J Manipulative Physiol Ther. 2011 Feb ;34(2):88-97. PMID: 21334540
Heidi Haavik, Bernadette Murphy
OBJECTIVE: The objectives of this study were to investigate whether elbow joint position sense (JPS) accuracy differs between participants with a history of subclinical neck pain (SCNP) and those with no neck complaints and to determine whether adjusting dysfunctional cervical segments in the SCNP group improves their JPS accuracy.
METHOD: Twenty-five SCNP participants and 18 control participants took part in this pre-post experimental study. Elbow JPS was measured using an electrogoniometer (MLTS700, ADInstruments, New Zealand). Participants reproduced a previously presented angle of the elbow joint with their neck in 4 positions: neutral, flexion, rotation, and combined flexion/rotation. The experimental intervention was high-velocity, low-amplitude cervical adjustments, and the control intervention was a 5-minute rest period. Group JPS data were compared, and it was assessed pre and post interventions using 3 parameters: absolute, constant, and variable errors.
RESULTS: At baseline, the control group was significantly better at reproducing the elbow target angle. The SCNP group's absolute error significantly improved after the cervical adjustments when the participants' heads were in the neutral and left-rotation positions. They displayed a significant overall decrease in variable error after the cervical adjustments. The control group participants' JPS accuracy was worse after the control intervention, with a significant overall effect in absolute and variable errors. No other significant effects were detected.
CONCLUSION: These results suggest that asymptomatic people with a history of SCNP have reduced elbow JPS accuracy compared to those with no history of any neck complaints. Furthermore, the results suggest that adjusting dysfunctional cervical segments in people with SCNP can improve their upper limb JPS accuracy.
Article Published Date : Feb 01, 2011
Integration of Doctors of Chiropractic Into Private Sector Health Care Facilities in the United States: A Descriptive Survey.
J Manipulative Physiol Ther. 2018 Jan 04;:
Authors: Salsbury SA, Goertz CM, Twist EJ, Lisi AJ
OBJECTIVE: The purpose of this study was to describe the demographic, facility, and practice characteristics of doctors of chiropractic (DCs) working in private sector health care settings in the United States.
METHODS: We conducted an online, cross-sectional survey using a purposive sample of DCs (n = 50) working in integrated health care facilities. The 36-item survey collected demographic, facility, chiropractic, and interdisciplinary practice characteristics, which were analyzed with descriptive statistics.
RESULTS: The response rate was 76% (n = 38). Most respondents were men and mid-career professionals with a mean 21 years of experience in chiropractic. Doctors of chiropractic reported working in hospitals (40%), multispecialty offices (21%), ambulatory clinics (16%), or other (21%) health care settings. Most (68%) were employees and received salary compensation (59%). The median number of DCs per setting was 2 (range 1-8). Most DCs used the same health record as medical staff and worked in the same clinical setting. More than 60% reported co-management of patients with medical professionals. Integrated DCs most often received and made referrals to primary care, physical medicine, pain medicine, orthopedics, and physical or occupational therapy. Although in many facilities the DCs were exclusive providers of spinal manipulation (43%), in most, manipulative therapies also were delivered by physical therapists and osteopathic or medical physicians. Informal face-to-face consultations and shared health records were the most common communication methods.
CONCLUSIONS: Doctors of chiropractic are working in diverse medical settings within the private sector, in close proximity and collaboration with many provider types, suggesting a diverse role for chiropractors within conventional health care facilities.
PMID: 29307457 [PubMed - as supplied by publisher]
Annals Understanding Clinical Research: Implications of Missing Data Due to Dropout.
Ann Intern Med. 2017 Apr 18;166(8):596-598
Authors: Liao JM, Stack CB
PMID: 28241264 [PubMed - indexed for MEDLINE]
Diagnostics and Treatment of Infants Suspected with Kinematic Imbalance Due to Suboccipital Strain (KISS)
Book. 2009 06 Authors: Brurberg KG, Myrhaug HT, Reinar LM
KISS is an acronym for Kinematic Imbalance due to Suboccipital Strain, and a term being used to describe a possible causal relation between imbalance in the upper neck joints in infants and symptoms like postural asymmetry, development of asymmetric motion patterns, hip problems, sleeping and eating disorders. Several academic disciplines (e.g. manual therapist, chiropractors and osteopaths) are currently offering treatment to infants suspected to have KISS, a treatment typically consisting of spinal manipulation of the upper neck joints, relaxing- and mobilisation exercises. Treatment is often followed up by paediatric physiotherapists who stimulate development of a symmetric motion patterns and build muscular strength. To make this report, several databases have been systematically searched to reveal research literature evaluating the effectiveness of different techniques used to treat infants with KISS. Databases were also searched for evidence of adverse effects and studies examining the accuracy (validity) of various diagnostic tests. At the present there is no gold standard or standardized ways to diagnose infants suspected for KISS, but some commenced projects may provide valuable results in the future. We identified one randomized controlled trial showing that osteopathy can potentially reduce the degree of postural asymmetry among infants, but the study did not reveal any changes in vegetative parameters following treatment. It has to be emphasized that these conclusions are based solely on one small study, suggesting that the strength of the evidence is too low to make reliable conclusions about treatment effects. We did not find evidence suggesting that the use of manual therapeutic, osteopathic or chiropractic treatment strategies in infants is associated with risk of injuries or harmful side effects, but the level of evidence is very low.