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Infantile Colic
A case study of a 3 month old female suffering from colic with sleep interruption and appetite decrease is presented. Favorable outcome was realized with adjustment of the child's spine. The results were obtained from direct observation and involvement of both parents and from interviews at each treatment. Specific Adjustments to T7 and the upper cervical area relieved symptoms of infantile colic in a relatively short period of time. The patient received three adjustments with approximately a two week period of time in between adjustments.
Pluhar GR; Schobert PD; Vertebral Subluxation and Colic: A Case Study. J Chiro Research and Clin Invest 1991; 7(3):75-6
In a retrospective uncontrolled questionnaire study of 132 infants colic, 91% of the parents reported an improvement, which occured after an average of two to three manipulations, and one week after the treatment started.
Nilsson N; Infant Colic And Chiropractic. Eur J Chiropr 1985; 33(4): 264-265.
A prospective, uncontrolled study of 316 infants suffering from infantile colic and selected according to well-defined criteria shows a satisfactory result of spinal manipulative therapy in 94% of the cases. The median age of the infants was 5.7 wk at the beginning of the treatment. The results were evaluated by analysis of a diary continuously kept by the mother and an assessment file comprised by interview. The study was carried out as a multicenter study lasting 3 months and involving 73 chiropractors in 50 clinics. The results occurred within 2 wk and after an average of three treatments.
Klougart N, Nilsson N, Jacobsen J. Infantile colic treated by chiropractors: a prospective study of 316 cases. J Manipulative Physiol Ther 12 (4): 281-288 (Aug 1989)
Manipulation Effective In Reducing Neck Pain and Headaches
STUDY DESIGN: Cervical spine manipulation and mobilization were reviewed in an analysis of the literature from 1966 to the present.
OBJECTIVES: To assess the evidence for the efficacy and complications of cervical spine manipulation and mobilization for the treatment of neck pain and headache.
SUMMARY OF BACKGROUND DATA: Although recent research has demonstrated the efficacy of spinal manipulation for some patients with low back pain, little is known about its efficacy for neck pain and headache.
METHODS: A structured search of four computerized bibliographic data bases was performed to identify articles on the efficacy and complications of cervical spine manual therapy. Data were summarized, and randomized controlled trials were critically appraised for study quality. The confidence profile method of meta-analysis was used to estimate the effect of spinal anipulation on patients' pain status.
RESULTS: Two of three randomized controlled trials showed a short-term benefit for cervical mobilization for acute neck pain. The combination of three of the randomized controlled trials comparing spinal manipulation with other therapies for patients with subacute or chronic neck pain showed an improvement on a 100-mm visual analogue scale of pain at 3 weeks of 12.6 mm (95% confidence interval, -0.15, 25.5) for manipulation compared with muscle relaxants or usual medical care. The highest quality randomized controlled trial demonstrated that spinal manipulation provided short-term relief for patients with tension-type headache. The complication rate for cervical spine manipulation is estimated to be between 5 and 10 per 10 million manipulations.
CONCLUSIONS: Cervical spine manipulation and mobilization probably provide at least short-term benefits for some patients with neck pain and headaches. Although the complication rate of manipulation is small, the potential for adverse outcomes must be considered because of the possibility of permanent impairment or death.
Hurwitz EL, Aker PD, Adams AH, Meeker WC, Shekelle PG. Manipulation and mobilization of the cervical spine. A systematic review of the literature. Spine 21 (15): 1746-1759 (Aug 1 1996)
Manipulation Effective for Headaches
OBJECTIVE: To discuss the case of a patient suffering from severe headache complaints who was previously unresponsive to regional cervical spine care.
CLINICAL FEATURES: A prodrome was described. In addition to headache itself, associated symptoms included light sensitivity, blurred vision and nausea. A visit to a hospital emergency room was often necessary to reduce pain intensity.
INTERVENTION AND OUTCOMES: Manual chiropractic spinal adjustment were performed as the only treatment intervention. After a course of treatment, the patient reported no visits to the emergency room, even after a 1-yr follow-up, and the average visual analogue pain scores decreased.
CONCLUSION: This patient seemed to respond favorably to conservative care that included regions of spine not traditionally associated with headache pain. This suggests that some individuals may require a more comprehensive evaluation if regional care fails to promote a positive response within a few weeks. Controlled, randomized trials will assist in comparing effectiveness of various treatment interventions.
Stude DE, Sweere JJ. A holistic approach to severe headache symptoms in a patient unresponsive to regional manual therapy. J Manipulative Physiol Ther 19 (3): 202-207 (Mar 1996)
Manipulation Effective for Neck Pain and Safer than NSAIDS
OBJECTIVE: We reviewed the literature to evaluate the risk of serious injury or death resulting from cervical manipulation and to assess the evidence that cervical manipulation is an effective treatment for mechanical neck pain. We also reviewed the literature to assess the risks and effectiveness of nonsteroidal anti-inflammatory drugs (NSAIDs), which are often used as the "conventional" first-line treatment for similar musculoskeletal conditions.
DATA SOURCES: A series of Medicine literature searches were performed, and materials were reviewed from 1966-1994. Key words included: Chiropractic or Orthopedic Manipulation; Non-Steroidal Anti-Inflammatory Agents; Neck or Back Pain; Randomized Controlled Trials; Adverse Effects.
STUDY SELECTION: Studies and literature reviews that provided a numerical estimate of the risk of serious adverse effects or death from cervical manipulation or NSAID use were selected. Also, randomized, controlled studies that evaluated the effectiveness of manipulation or NSAID use for neck pain were included.
DATA SYNTHESIS: Although there are a small number of well-performed trials of cervical manipulation for neck pain, we were unable to locate even a single randomized, controlled trial examining NSAID use specifically for neck pain. As for comparative safety, the best available evidence indicates that NSAID use poses a significantly greater risk of serious complications and death than the use of cervical manipulation for comparable conditions.
CONCLUSION: The best evidence indicates that cervical manipulation for neck pain is much safer than the use of NSAIDs, by as much as a factor of several hundred times. There is no evidence that indicates NSAID use is any more effective than cervical manipulation for neck pain.
Dabbs V, Lauretti WJ. A risk assessment of cervical manipulation vs NSAIDs for the treatment of neck pain. J Manipulative Physiol Ther 1996; 18 (8) 530-6.
Manipulation Effective for Tension-Type Headaches
OBJECTIVE: To review the literature on outcome studies of chiropractic/manipulation for tension-type and migraine headaches.
DESIGN: Qualitative literature review.
RESULTS: Of nine studies of manipulation for tension-type headaches that reported quantitative outcomes, four were randomized clinical trials and five were case series designs. These studies reported on 729 subjects, 613 of whom received manipulation. Outcomes ranged from good to excellent. Manipulation seems to be better than no treatment, some types of mobilization and ice, and it seems to be equivalent to amitriptyline but with greater durability of effect than this medication. Of three studies on migraine, only one was a randomized clinical trial. These studies reported on 202 subjects, 156 of whom received manipulation. The outcomes ranged from fair to very good.
CONCLUSION: A modest body of clinical studies exists dealing with the effect of manipulation and headache. The overall results are encouraging, even if not quite supportive in the case of tension-type headache. Further studies in this area are definitely warranted, particularly well-controlled studies in migraine.
Vernon HT. The effectiveness of chiropractic manipulation in the treatment of headache: an exploration in the literature. J Manipulative Physiol Ther 18 (9): 611-617 (Nov 1995)
Spinal Manipulation Effective in Low Back Pain
OBJECTIVE:To compare chiropractic and hospital outpatient treatment for managing low back pain of mechanical origin.
DESIGN:Randomised controlled trial. Allocation to chiropractic or hospital management by minimisation to establish groups for analysis of results according to initial referral clinic, length of current episode, history, and severity of back pain. Patients were followed up for up two years.
SETTING:Chiropractic and hospital outpatient clinics in 11 centres.
PATIENTS:741 Patients aged 18-65 who had no contraindications to manipulation and who had not been treated within the past month.
INTERVENTIONS:Treatment at the discretion of the chiropractors, who used chiropractic manipulation in most patients, or of the hospital staff, who most commonly used Maitland mobilisation or manipulation, or both.
MAIN OUTCOME MEASURES:Changes in the score on the Oswestry pain disability questionnaire and in the results of tests of straight leg raising and lumbar flexion.
RESULTS:Chiropractic treatment was more effective than hospital outpatient management, mainly for patients with chronic or severe back pain. A benefit of about 7% points on the Oswestry scale was seen at two years. The benefit of chiropractic treatment became more evident throughout the follow up period. Secondary outcome measures also showed that chiropractic was more beneficial.
CONCLUSIONS:For patients with low back pain in whom manipulation is not contraindicated chiropractic almost certainly confers worthwhile, long term benefit in comparison with hospital outpatient management. The benefit is seen mainly in those with chronic or severe pain. Introducing chiropractic into NHS practice should be considered.
Meade TW, Dyer S, Browne W, Townsend J, Frank AO. Low back pain of mechanical origin: randomised comparison of chiropractic and hospital outpatient treatment. BMJ 300 (6737): 1431-1437 (Jun 2 1990)
Three Year Follow Up Shows Spinal Manipulation Effective for Low Back Pain
OBJECTIVE:To compare the effectiveness over three years of chiropractic and hospital outpatient management for low back pain.
DESIGN:Randomised allocation of patients to chiropractic or hospital outpatient management.
SETTING:Chiropractic clinics and hospital outpatient departments within reasonable travelling distance of each other in 11 centres.
SUBJECTS:741 men and women aged 18-64 years with low back pain in whom manipulation was not contraindicated.
OUTCOME MEASURES:Change in total Oswestry questionnaire score and in score for pain and patient satisfaction with allocated treatment.
RESULTS:According to total Oswestry scores improvement in all patients at three years was about 29% more in those treated by chiropractors than in those treated by the hospitals. The beneficial effect of chiropractic on pain was particularly clear. Those treated by chiropractors had more further treatments for back pain after the completion of trial treatment. Among both those initially referred from chiropractors and from hospitals more rated chiropractic helpful at three years than hospital management.
CONCLUSIONS:At three years the results confirm the findings of an earlier report that when chiropractic or hospital therapists treat patients with low back pain as they would in day to day practice those treated by chiropractic derive more benefit and long term satisfaction than those treated by hospitals.
Meade TW, Dyer S, Browne W, Frank AO. Randomised comparison of chiropractic and hospital outpatient management for low back pain: results from extended follow up. BMJ 311 (7001): 349-351 (Aug 5 1995)
Spinal Manipulation Highly Effective in Low Back Pain
STUDY DESIGN: A randomized trial was conducted on a representative sample of patients with untreated low back pain lasting 7 weeks or longer, or having more than 6 episodes in 12 months.
OBJECTIVES: To contrast the effectiveness of manipulation, a manipulation mimic, and a back education program. Methodologic criticisms of earlier studies were addressed.
SUMMARY OF BACKGROUND DATA: Published meta-analyses suggest clinical benefit from manipulation for acute patients. Data are inconclusive for patients having symptoms for longer than 1 month.
METHODS: A total of 1267 consecutive patients were screened. Block randomization was used to assign 209 qualifying patients to treatment groups. Self-reported pain and activity tolerance served as primary outcome measures. Patients were assessed at enrollment, after 2 weeks of treatment, and again after 2 weeks without treatment. Multiple teams conducted recruitment, randomization, assessment, treatment, and data analysis independently without sharing information. Treatments were carefully described, monitored, and balanced for physician attention and physical contact effects.
RESULTS: A total of 81.3% of subjects completed the study. Confounding factors and missing data were identified in approximately 20% of those completing the final follow-up. Analysis of the remaining data was carried out. A strong time effect under treatment was observed. Greater improvement was noted in pain and activity tolerance in the manipulation group. Immediate benefit from pain relief continued to accrue after manipulation, even for the last encounter at the end of the 2-week treatment interval.
CONCLUSION: Time is a strong ally of the low back pain patient. In human terms, however, there appears to be clinical value to treatment according to a defined plan using manipulation even in low back pain exceeding 7 weeks' duration.
Triano JJ, McGregor M, Hondras MA, Brennan PC. Manipulative therapy versus education programs in chronic low back pain. Spine 20 (8): 948-955 (Apr 15 1995)
Manipulation Resolves Enuresis
OBJECTIVE: To discuss a patient with primary nocturnal enuresis whose symptoms resolved following manipulation.
CLINICAL FEATURES: An 8-yr-old boy with a history of primary functional nocturnal enuresis was under care at this office. The patient's clinical examination was benign. He had several areas of lumbar segmental dysfunction. The patient's medical history was unremarkable except for childhood asthma.
INTERVENTION AND OUTCOME: The patient's lumbar spine was manipulated once, and at a 1 month follow-up there was complete resolution of enuresis. The patient had several recurrences of bed-wetting, all of which were associated with minor injury to the lower back. The patient responded positively to subsequent manipulation.
CONCLUSION: This patient's enuresis resolved with the use of manipulation. This happened in a manner that could not be attributed to time or placebo effect.
Blomerth PR. Functional nocturnal enuresis. J Manipulative Physiol Ther 17 (5): 335-338 (1994)
Chiropractic Treatment of Primary Nocturnal Enuresis is Effective
OBJECTIVE: To evaluate chiropractic management of primary nocturnal enuresis in children.
DESIGN: A controlled clinical trial for 10 wk preceded by and followed by a 2-wk nontreatment period.
SETTING: Chiropractic clinic of the Palmer Institute of Graduate Studies and Research.
PARTICIPANTS: Forty-six nocturnal enuretic children (31 treatment and 15 control group), from a group of 57 children initially included in the study, participated in the trial.
INTERVENTION: High velocity, short lever adjustments of the spine consistent with the Palmer Package Techniques; or a sham adjustment using an Activator at a nontension setting administered to the examiner's underlying contact point. Two 5th-year chiropractic students under the supervision of two clinic faculty performed the adjustments.
MAIN OUTCOME MEASURES: Frequency of wet nights.
RESULTS: The post-treatment mean wet night frequency of 7.6 nights/2 wk for the treatment group was significantly less than its baseline mean wet night frequency of 9.1 nights/2 wk (p = 0.05). For the control group, there was practically no change (12.1 to 12.2 nights/2 wk) in the mean wet night frequency from the baseline to the post-treatment. The mean pre- to post-treatment change in the wet night frequency for the treatment group compared with the control group did not reach statistical significance (p = 0.067). Twenty-five percent of the treatment-group children had 50% or more reduction in the wet night frequency from baseline to post-treatment while none among the control group had such reduction.
CONCLUSIONS: Results of the present study strongly suggest the effectiveness of chiropractic treatment for primary nocturnal enuresis. A larger study of longer duration with a 6-month follow-up is therefore warranted.
Reed WR; Beavers S; Reddy SK; Kern G; Chiropractic management of primary nocturnal enuresis J Manipulative Physiol Ther 1994; 17(9): 596-600
Spinal Manipulattion Effective in Treating Primary Nocturnal Enuresis
OBJECTIVE: A comprehensive review of the literature concerning the etiology, diagnosis, and the natural history of primary nocturnal enuresis is presented. Contemporary treatment options are discussed in light of the documented annual remission rate of this disorder.
DATA SOURCE: Articles reviewed were obtained by conducting a computer-aided search of papers indexed in Medline and the Index to Chiropractic Literature from 1989 to 1993. In addition, the Chiropractic Research Abstracts Collection and bibliographies from pertinent articles were manually searched.
DATA SYNTHESIS: Primary nocturnal enuresis affects some 200,000 children and their families throughout Canada. Twenty percent of children wet the bed at age 5, 10% at age 10, and only about 1% at age 15. The documented natural history of the disorder reveals that for those affected, 10% to 20% exhibit spontaneous resolution per year. Contemporary treatment options center on three factors that play primary roles in the etiology of this condition: functional bladder capacity, patient conditioning and the circadian rhythm of nocturnal ADH secretion.
CONCLUSIONS: The success of each therapeutic option must, in part, be attributed to the natural history of enuresis, as well as any educational or placebo aspects of treatment. Conditioning therapy utilizing the urine pad alarm may be the most reasonable initial mode of intervention. Spinal manipulative therapy has been shown to possess an efficacy comparable to the natural history.
Kreitz BG, Aker PD. Nocturnal enuresis: treatment implications for the chiropractor. J Manipulative Physiol Ther 1994 Sep;17(7):465-473
Spinal Manipulation Reduces Frequency of Wet Nights
A controlled clinical trial of 46 primary enuretic children was over a period of 14 weeks to assist in evaluating the influence of chiropractic care. Subjects were between five and 13 years of age. There were 31 in the treatment group which received a spinal evaluation and/or adjustment at a minimum of every ten days. The remaining 15 subjects were control which came in with the same frequency but received a "sham" adjustment over an equal period of time. Chiropractic care was rendered for ten weeks, preceded and followed by a 14-day non-treatment baseline. The mean post-treatment frequency of wet nights for the treatment group was significantly less than its pre-treatment frequency; while there was practically no difference between mean pre- and post-frequency for the control group. Subjects receiving chiropractic care averaged a 17.9% reduction in wet nights for the control over the same period of time.
Reed WR; Beavers S; Reddy SK; Kern G; Chiropractic management of primary nocturnal enuretic children. Proceedings Of The National Conference On Chiropractic & Pediatrics. 1993 Oct. pp 64-82.
Spinal Manipulation Reduces Frequency of Wet Nights
In 171 children suffering with enuresis, The average number of bed wettings per week was 7, while at the end of the study the average number of bed wettings per week was reduced to 4. Additionally, 1% of patients were considered "dry" at the beginning of the study, while 15.5% were considered "dry" at the end of the study.
Functional nocturnal enuresis is a common problem which causes a great deal of stress to the suffering children and their families. Some chiropractors advocate chiropractic care as a mode of therapy for this complaint. One hundred and seventy-one enuretic children, aged 4 to 15, were treated with chiropractic adjustments, and their number of wet nights was monitored by their parents. The median number of wet nights per week was 7.0 at the onset of the study. After 2 wk without any therapy, the number of wet nights had decreased to 5.6 (p = .01) and by the end of the treatment this figure was 4.0 (p less than .0001). Following the course of treatment, 15.5% of subjects wet a maximum of 2 nights per fortnight, or, where data for the last 2 wk of therapy were unavailable, a maximum of 1 night/wk. This result is less favorable than the therapeutic success of other common types of therapy, which have reported "cure" rates well above 50%. The only variable which predicted treatment outcome was the initial estimate of bed-wetting; the more severe the condition at the onset, the less likely was the child to improve by the end of the study. In the absence of a control group there appears to be no validity in the claim that chiropractic is a treatment of choice for functional nocturnal enuresis.
Leboeuf C; Brown P; Herman A; Leembruggen K; Walton D; Crisp TC; Chiropractic Care of Children With Nocturnal Enuresis: A Prospective Outcome Study. J Manipulative Physiol Ther 1991; 14(2):110-5
Manipulation Relieves Sacroiliac Subluxation Associated With Pregnancy
A retrospective review of 100 consecutive pregnancies, involving 94 women receiving prenatal care at a rural western New York family practice, was conducted. Back pain was spontaneously reported to the physician by 23 women in 23 pregnancies. Eleven of the 23 women met diagnostic criteria for sacroiliac subluxation. These criteria include absence of lumbar spine and hip pathology, pain in the sacral region, a positive Piedallu's sign (asymmetrical movement of the posterior superior iliac spines upon forward flexion), a positive pelvic compression test and asymmetry of the anterior superior iliac spines. A cohort of 11 women meeting criteria for sacroiliac subluxation was treated with rotational manipulation of the sacroiliac joints. After manipulative therapy, 10 of the 11 women (91%) had relief of pain and no longer exhibited signs of sacroiliac subluxation.
Daly JM, Frame PS, Rapoza PA. Sacroiliac subluxation: a common treatable casue of low back pain in pregnancy. Fam Prac Res J 1991;11(2):149-159.
· Fligg, Bruce. Biomechanical and treatment considerations for the pregnant patient. Journal of the CCA, Vol 30, No. 3, Sept 1986; 145-147.
· Penna, Mariangela. Pregnancy and Chiropractic Care. ACA Journal of Chiropractic, Nov 1989; 31-33.
· Fallon, Joan. Chiropractic and Pregnancy. A Partnership for the future. ICA Internation review of chiropractic, Nov 1990; 39-42.
· Chalker, Harold. Spinal compensations of Pregnancy. The American Chiropractor, May/June 1993; 23-26.
· Howe, Claudia Anrig. Scientific Ramifications for providing pre-natal and neonate chiropracticcare. The American Chiropractor, May/June 1993; 20-24(?).
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Nociceptive Reflexes And Somatic Dysfunction
A model of somatic dysfunction is developed in which restriction in mobility and autonomic, visceral, and immunologic changes are produced by pain-related sensory neurons and their reflexes. Nociceptors are known to produce muscular guarding reactions, as well as autonomic activation, when musculoskeletal or visceral tissue is stressed or damaged. This guarding causes abnormal musculoskeletal position and range of motion. Local inflammatory responses and autonomic reflexes further reinforce nociceptor activity, maintaining restriction. Nociceptive autonomic reflexes also evoke changes in visceral and immunologic function. Finally, maintenance of muscles, joints, and related tissues in an abnormal guarding position causes changes in the connective tissues, solidifying the abnormal position. Stretching these tissues into a normal range of motion will restimulate the nociceptor, reflexly reinforcing the somatic dysfunction. This model has evolved from Korr's neurologic model but emphasizes the nociceptor and its reflexes as a source of the connective tissue, circulatory, visceral, and immunologic changes seen in the somatic dysfunction.
Van Buskirk RL. Nociceptive reflexes and the somatic dysfunction: a model. J Am Osteopath Assoc 1990 Sep;90(9):792-794
Pupillary Diameter Affected By Somatovisceral Reflex
The relationship between a cervical chiropractic adjustment, in subluxated vs. unsubluxated subjects, and autonomic response monitored as change in pupillary diameter was evaluated in 15 subjects. The results indicate that: a) a successful adjustment elicits either a parasympathetic or sympathetic response; b) the vertebral level at which the adjustment is administered has undetectable specificity for the parasympathetic or sympathetic input to the pupil; c) unsubluxated subjects generally exhibit no change in pupillary diameter following a sham adjustment and d) subluxated subjects exhibit variable preadjustment pupillary diameters, with significant pupillary diameter changes in response to an adjustment. These data suggest that autonomic input to the pupil may be influenced by subluxation, as well as the magnitude and direction of force exerted during the chiropractic adjustment. An anatomical pathway through which the observed responses may occur is proposed.
Briggs L, Boone WR. Effects of a chiropractic adjustment on changes in pupillary diameter: a model for evaluating somatovisceral response. J Manipulative Physiol Ther 1988 Jun;11(3):181-189
Manipulation Aids in Healing of Otitis Media
OBJECTIVE: The aims of this study were to determine (a) if the patients improved while under chiropractic care; (b) how many treatments were needed to reach improvement; and (c) which factors were associated with early improvement.
DESIGN: Cohort, nonrandomized retrospective study.
SETTING: Private chiropractic practice in a Minneapolis suburb.
PARTICIPANTS: Forty-six children aged 5 yr and under.
INTERVENTION: All treatments were done by a single chiropractor, who adjusted the subluxations found and paid particular attention to the cervical vertebrae and occiput. Sacral Occipital Technique-style pelvic blocking and the doctor's own modified applied kinesiology were also used. Typical treatment regimen was three treatments per week for 1 wk, then two treatments per week for 1 wk, then one treatment per week. However, treatment regimen was terminated when there was improvement.
OUTCOME MEASURE: Improvement was based on parental decision (they stated that the child had no fever, no signs of ear pain, and was totally asymptomatic), and/or the child seemed to be asymptomatic to the treating DC and/or the parent stated that the child's MD judged the child to be improved. A data abstraction form was used to determine number of treatments used and presence of factors possibly associated with early improvement.
RESULTS: 93% of all episodes improved, 75% in 10 days or fewer and 43% with only one or two treatments. Young age, no history on antibiotic use, initial episode (vs. recurrent) and designation of an episode as discomfort rather than ear infection were factors associated with improvement with the fewest treatments.
CONCLUSION: Although there were several limitations to this study (mostly because of its retrospection but also, significantly, because very little data was found regarding the natural course of ear infections), this study's data indicate that limitation of medical intervention and the addition of chiropractic care may decrease the symptoms of ear infection in young children.
Froehle RM. Ear infection: a retrospective study examining improvement from chiropractic care and analyzing for influencing factors. J Manipulative Physiol Ther 19 (3): 169-177 (Mar 1996)
Chiropractic Care Effective at Treating Otitis Media
Objective: The purpose of this article is to present a case series of five children with chronic recurrent otitis media presenting to a chiropractic clinic. The various medical treatment options presently available for children with this condition are discussed, together with options for chiropractic management. This article also discusses a hypothetical pathophysiological mechanism for the resolution of otitis media, observed in patients undergoing chiropractic management.
Design: A case series.
Setting: Private practice. Patients: Selection of patients (n=5) was determined by age (0 to 5 years), and an existing diagnosis of chronic recurrent otitis media. Selected patients must also have been under the regular care of their medical pediatrician for this condition, for at least 6 months, without resolution.
Outcome Measures: Resolution of the condition was determined by normal otoscopic examination findings, including pneumatic otoscopy and reduction of fever.
Results: For each case, the clinical results of a short series of chiropractic spinal adjustments are presented. Each of the 5 children selected for this study responded favorably to the treatment provided. Response time for each case was recorded as 4 days, 3 days, 8 days, 8 weeks and 3 weeks, respectively. None of the cases required more than 5 treatment sessions. No complications were noted and no tympanostomy procedures were performed.
Conclusion: The author has presented a case series of five patients with chronic recurrent otitis media who underwent a program of chiropractic case management, including specific spinal adjustments. All patients had excellent outcomes with no residual morbidity or complications. Hypothetical mechanisms for the putative effects of spinal adjustments at areas exhibiting signs of subluxation, in patients with otitis media, are presented. The relative effectiveness of the various treatments used in case management, including adjustments and lymphatic massage, was not addressed in this case series. More formalized experimental designs, including randomized controlled trials, are needed to fully address the scientific issues, in order to determine if the clinical results seen in this case series can be generalized to other patients. The associated morbidity of current medical and surgical options for OME, coupled with a lack of rigorous experimental designs in some reports, further necessitates the exploration of alternative approaches to case management.
FYSH, PN Chronic Recurrent Otitis Media: Case Series of Five Patients With Recommendations for Case Management. JOURNAL OF CLINICAL CHIROPRACTIC PEDIATRICS. 1996 . 1(2). pp 66
Manipulation Relieves Indigestion
OBJECTIVE: To determine the prevalence of indigestion and mid-back pain in persons seeking chiropractic care.
DESIGN: A cross-sectional survey using a self-report questionnaire.
SETTING: Three primary care private chiropractic practices in metropolitan Perth, Australia.
SUBJECTS: Persons seeking chiropractic care during a 1-month period.
INTERVENTION: None.
OUTCOME MEASURES: Six-month prevalence of indigestion and mid-back pain, rate of association between indigestion and mid-back pain, and distribution of thoracic dysfunction and manipulation. Proportion who report relief from manipulation.
OBSERVATIONS: Of 1567 persons who consulted 8 chiropractors on 2974 occasions during November 1994, 1494 responses were obtained. There were 119 first-time consultations. The mean age of respondents was 41 yr (range 10-94); 57% were women. Fifty-seven percent reported indigestion infrequently or more and 71% reported mid-back pain during the previous 6 months. Forty-six percent experienced both symptoms during this time. Of these, 36% reported the symptoms together at some time. Twenty-two percent of those with indigestion reported some relief after chiropractic care. Compared with those reporting no relief, mid-back pain was more common among those reporting indigestion. The level at which the manipulation was given was unrelated to relief. No major differences were noted between the three clinics in patient demographics or the main outcome measures.
CONCLUSIONS: Indigestion and mid-back pain are commonly experienced in this population. A person with indigestion is more likely to report mid-back pain. Relief of indigestion by manipulation is more common among those who report mid-back pain. Further research is needed to understand differences between subgroups and differences compared with other studies.
Bryner P, Staerker PG. Indigestion and heartburn: a descriptive study of prevalence in persons seeking care from chiropractors.J Manipulative Physiol Ther 19 (5): 317-323 (Jun 1996)
Manipulation Relieves Pain Associated with PMS
OBJECTIVE: The primary objectives of this study were to compare the effect of spinal manipulation vs. sham manipulation on
a) circulating plasma levels of the prostaglandin F2a metabolite, 15-keto-13,14-dihydroprostaglandin (KDPGF2a),
b) perceived abdominal and back pain and c) perceived menstrual distress in women with primary dysmenorrhea.
DESIGN: This randomized clinical pilot study investigated the outcome measures before and after either a spinal manipulation treatment (SMT) or a sham manipulation.
SETTING: All subjects were treated at the National College Chiropractic clinic, a private chiropractic clinic in the suburban Chicago area.
PARTICIPANTS: Forty-five women with a history of primary dysmenorrhea were recruited from the local community. The volunteers ranged in age from 20-49 (mean age = 30.3 yr), and were entered into the study between April 1990 and January 1991. Twenty-four were randomly assigned to the spinal manipulation group and 21 were assigned to the sham group.
INTERVENTIONS: Subjects treated with spinal manipulation were placed in a side-lying position with the bottom leg straight and the top leg flexed at the knee and hip. They received a high-velocity, short lever, low-amplitude thrust to all clinically relevant vertebral levels within T10 and L5-S1 and the sacroiliac joints. In the sham manipulation, subjects were placed in a side-lying position with both hips and knees flexed. Their manipulation consisted of a similar thrust administered to the midline base of the sacrum.
OUTCOME MEASURES: Perceived abdominal and back pain were measured with a visual analog scale, and menstrual distress was measured with the Menstrual Distress Questionnaire. Both were administered 15 min before and 60 min after treatment. Blood samples were collected by venipuncture for the determination of plasma levels of KDPGF2a at the same times. The plasma was then assayed for KDPGF2a by radioimmunoassay.
RESULTS: Analysis of covariance and paired Student's t tests were used for the statistical evaluation. Immediately after treatment, the perception of pain and the level of menstrual distress were significantly reduced by SMT. This reduction was associated with a significant reduction in plasma levels of KDGPF2a in the SMT group. A significant and similar reduction in plasma KDPGF2a also occurred in the sham group, indicating that a placebo effect was associated with a single sham intervention.
CONCLUSIONS: This randomized pilot study suggests that SMT may be an effective and safe nonpharmacological alternative for relieving the pain and distress of primary dysmenorrhea. However, the large change in KDPGF2a observed in both treatment groups clearly indicates that further studies with more subjects, studied over a longer time frame, are needed to resolve the question of a placebo effect.
Kokjohn K, Schmid DM, Triano JJ, Brennan PC. The effect of spinal manipulation on pain and prostaglandin levels in women with primary dysmenorrhea. J Manipulative Physiol Ther 15 (5): 279-285 (Jun 1992)
Torticollis
OBJECTIVE: To present a case of congenital muscular torticollis and discuss the clinical manifestations and chiropractic treatment.
CLINICAL FEATURES: A 7-month-old male infant with significant head tilt since birth was brought to a chiropractic physician for evaluation. The infant's history included ear infections, facial asymmetry and regurgitation. Significant spasm of the left sternocleidomastoid and trapezius muscles, a left lateral atlas and suboccipital joint dysfunctions were present upon examination. A diagnosis of congenital muscular torticollis was made.
INTERVENTION AND OUTCOME: Treatments included chiropractic manipulation, trigger point therapy, specific stretches, pillow positioning and exercises. Excellent results were obtained.
CONCLUSION: Suggests that chiropractic intervention is a viable treatment option for congenital muscular torticollis. Further studies should be performed to compare the effectiveness of other treatment options.
Toto BJ. Chiropractic correction of congenital muscular torticollis.J Manipulative Physiol Ther 16 (8): 556-559 (Oct 1993)
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