Dry Creek Chiropractic

Previous research suggests that spinal manipulative therapy (SMT) may be helpful for various types of chronic headaches, including cervicogenic headache (CGH), which is associated with neck pain and dysfunction. In a recent randomized controlled trial, NCCAM-funded researchers from Western States Chiropractic College and other institutions evaluated the dose (number of treatments) and relative efficacy of SMT in a group of 80 patients with chronic CGH.

The study participants were assigned to an SMT group or a control group, which received light massage. Participants in both groups received treatments from chiropractors in 10-minute sessions either once or twice a week for 8 weeks, for a total of 8 or 16 treatments. Participants who were treated only once a week also had weekly examination visits, which included a discussion of the patient’s condition followed by a manual examination, as a control for provider contact/attention. Researchers used pain and disability scales to evaluate the participants’ response to treatment once every 4 weeks for 24 weeks. They also asked subjects about the number of headaches experienced.

Compared with massage, participants receiving SMT had greater improvements in CGH-related pain and disability, lasting to 24 weeks. These differences were clinically important and statistically significant. The dose effects of SMT treatments (i.e., differences between 8 and 16 treatments) were small but significant. The mean number of headaches reported by SMT subjects decreased by more than half during the study.

The researchers concluded that their findings support SMT as a viable option for treating CGH, but also point out that these findings should be considered preliminary. They suggest additional research to determine whether SMT results for patients with CGH are affected by treatment intensity and duration, use of other therapies, lifestyle changes, and an integrative care approach.

Reference:

Care was provided for 4 weeks, followed by assessment of improvement. The outcome measures included: (1) Oswestry Back Pain Disability Index, (2) Neck Disability Index, and (3) three visual analogue scales of local pain intensity. After the period of 30 days, the spinal manipulation group was the only intervention that achieved statistically significant improvements.

The second trial, published in 2003 in SPINE involved 115 patients randomized to the 3 treatment groups. Outcome assessment was gathered at baseline, and at 2, 5, and 9 weeks after the beginning of treatment. [2] Spinal adjusting again yielded the highest proportion of early (asymptomatic status) recovery, and the best overall improvements at 9 weeks. The results again demonstrated that patients with chronic spinal pain, manipulation, if not contraindicated, resulted in greater short-term improvement than acupuncture or medication.

The third study, published in 2005 involved follow-up of the same cohort of patients from the 2nd study, with a remarkable 90% retention rate. [3] Using the same outcome instruments they found that, of the 3 randomized treatments, only spinal manipulation had provided broad-based beneficial short-term and long-term benefits from care.

The article stated:   “This is, to the authors’ knowledge, this is the first report on long-term efficacy of 3 distinct and standardized treatment regimens for patients with chronic spinal pain syndromes using a “fastidious” approach; that is, the only type of study from which potentially valid inferences of cause and effect can directly be drawn.”

He went on to state that:   “Chronic mechanical spinal pain syndromes are prevalent conditions that tend to create a cluster of related problems reaching from withdrawal from social activity to a compromised immune function. The associated resulting direct and indirect costs in industrialized communities are vast.”

This concludes our series of Editorials about Kaisers decision to stop paying for chiropractic cervical adjusting. It should be obvious that their choice to reduce coverage was based upon financial incentives rather than any evidence that cervical spinal manipulation lacks benefit or safety.

The Chiropractic and Chronic Neck Pain page contains many other valid studies demonstrating the vast superiority of chiropractic care over standard medical approaches for managing chronic spinal pain syndromes. If you are aware of any other studies we failed to include on this page, please notify me at Frankp@chiro.org so we can correct that oversight.

REFERENCES:

1. Chronic Spinal Pain Syndromes: A Clinical Pilot Trial Comparing Acupuncture, A Nonsteroidal Anti-inflammatory Drug, and Spinal Manipulation
J Manipulative Physiol Ther 1999 (Jul); 22 (6): 376–381
www.chiro.org/research/ABSTRACTS/Medication_Acupuncture_and_Spinal_Manipulation_Pilot.shtml

2. Chronic Spinal Pain: A Randomized Clinical Trial Comparing Medication, Acupuncture, and Spinal Manipulation
Spine 2003 (Jul 15); 28 (14): 1490–1502
www.chiro.org/research/ABSTRACTS/Medication_Acupuncture_and_Spinal_Manipulation.shtml

“The Benefits Outweigh the Risks for Patients Undergoing Chiropractic Care for Neck Pain”

This study was a prospective, multicenter, observational cohort study. Patients with neck pain of any duration, who fulfilled the inclusion criteria, were recruited in a practice-based study. Data were collected on the patients and from the chiropractors at baseline, the first 3 visits, and at 3 and 12 months. Clinical outcome measures included (1) neck pain in the 24 hours preceding the visit, (2) neck disability, (3) treatment satisfaction, (4) global assessment, and (5) adverse events.

529 subjects were involved in the trial, under the care of 79 different chiropractors. Follow-up was possible for 90% and 92%, respectively, at 3 and 12 months. It should be noted that most patients in this study had chronic, recurrent complaints; mild to moderate disability of the neck; and a mild amount of pain at baseline.

Approximately half of these patients reported they were recovered by their 4th visit, and approximately two thirds of them reported sustained benefit during followup at 3 and at 12 months.

The researchers found that although some patients report mild and brief adverse responses after the first few visits, that a large percentage of the patients report recovery, particularly in the long term.

“Is Patient Advice Adequate for the Management of Neck Pain?”

The first article we will discuss is a Cochrane Database review [1] to assess whether patient education strategies, either alone or in combination with other treatments, are of benefit for pain, function, global perceived effect, quality of life, or patient satisfaction, in adults with neck pain with and without radiculopathy.

Researchers at McMaster University reviewed 10 high quality trials and found that “advice to activate, advice on stress coping skills, and neck schools” provided no additional benefits for patients suffering from acute or chronic neck pain, with or without radiculopathy. A more in-depth review of these studies was just published in the 8-26-2010 edition of Dynamic Chiropractic by the esteemed author Arthur Croft, DC, MS, MPH, FACO. [2]

Meanwhile, researchers at McMaster University reviewed 88 randomized clinical trials on neck pain, and concluded that “exercise combined with mobilization/manipulation, exercise alone, and intramuscular lidocaine for chronic mechanical neck disorders; intravenous glucocorticoid for acute whiplash associated disorders; and low-level laser therapy demonstrated either intermediate or longterm benefits.” [3]

That’s a far cry from Kaiser’s contention that cervical adjusting (manipulation) provides no benefit.

REFERENCES:

1. Patient education for neck pain with or without radiculopathy
Cochrane Database Syst Rev. 2009 (Jan 21); (1): CD005106
www.ncbi.nlm.nih.gov/pubmed/19160247

2. Is Advice Alone Adequate for the Management of Neck Pain?
Dynamic Chiropractic ~ August 26, 2010

During this same time period, the inclusion of a chiropractic benefit within a large managed care program (observed over a 4-year period) resulted in significant savings, as well as a reduction in the rates of surgery, and unnecessary use of advanced imaging, inpatient care, and plain-film radiographs.

These 2 studies, along with many similar findings, make it apparent that chiropractic should be the FIRST choice of management for people experiencing musculoskeletal complaints. If you doubt that, then please review this editorial, titled: End the Medical Mis-Management of Musculoskeletal Complaints

The Chiropractic and Chronic Neck Pain page contains numerous articles about the etiology of neck pain, as well as gathering many clinical trials, which have demonstrated the power of chiropractic management for neck pain.

The first study I’d like to draw your attention to is a paper published in the Archives of Physical Medicine & Rehabilitation (2005). Although this study is not specific to neck pain per-se, the results, published by several M.D.s and a Ph.D. from the Department of Rehabilitation Medicine at the University of Washington School of Medicine is still most interesting.

Questionnaires were given to several hundred recruited patients who experienced severe neuromusculoskeletal (NMS) pain. The researchers used a broad selection of assessment tools, including Pain presence or absence, pain severity, pain quality (Neuropathic Pain Scale), pain interference (Brief Pain Inventory), pain site, quality of life (Medical Outcomes Study 36-Item Short-Form Health Survey [SF-36]), and the form of pain treatment used by the patient.

The following table tabulates the type of treatment each patient used, followed by the average pain relief they experienced from that treatment. It’s rated on a classical 1-10 scale, with 1 meaning little or no relief, and 10 suggesting complete pain relief. The results are quite staggering:

It may be hard for organized medicine to swallow, but this study revealed that chiropractic care was more effective for pain relief than nerve blocks, opioid analgesics , muscle relaxants, physical therapy, or acetaminophen (in that order). That’s pretty powerful stuff, isn’t it?

I have great respect for these authors because, even though the results were not very complementary to standard medical treatment (pain pills, muscle relaxants and physical therapy), they published the article anyway. Who’s to say how many other similar studies may never have made it to publication because they contained comparable findings?

The Supplements Section contains 38 sub-sections covering nutrients from Acidophilus Pre/Probiotics to all the vitamins and minerals. If you happen to be using any prescription drugs then the Nutrient Depletion Charts will show you which nutrients a particular drug depletes from your body.

The Opinion Section reviews the benefits of organic produce, fad diets and answers the question “Are Supplements Worth the Money?”

The Helpful Tools section provides links to the FDA, NIH, our bookstore, and our Women’s Health Page.

The Nutrition Links section links to nutrition journals and other sites of interest.

Best of all, we have our own Nutrition Search Tool to help you find what you want more easily.

We also provide access to several chapters on soft-tissue injury and cervical spine trauma from the profession’s most-published author, Richard C. Schafer, D.C., FICC. All these materials are found in the Primary Resources section.

The next section, titled Whiplash Articles contains hundreds of peer-reviewed abstracts relating to all aspects of whiplash research.

The Low Speed Rear End Impact Collisions (LOSRIC) contains articles that clarify why low-speed accidents generate the symptoms we encounter in our office.

And last, the Chronic Neck Pain page contains many studies demonstrating the effectiveness of chiropractic care for chronic neck pain.

I hope you will find the Whiplash Page to be a helpful resource.

According to Kapandji (Physiology of the Joints, Volume III), for every inch your head moves forwards, it gains 10 pounds in weight, as far as the muscles in your upper back and neck are concerned. That’s because because they have to work that much harder to keep the head (chin) from crashing onto your chest. This abnormal positioning also forces the suboccipital muscles (the ones that raise the chin) to remain in constant contraction, putting pressure on the 3 suboccipital nerves.

The following is Chapter 3 from RC’s best-selling book:
“Clinical Biomechanics: Musculoskeletal Actions and Reactions”

The following materials are provided as a service to our profession. There is no charge for individuals to copy and file these materials. However, they cannot be sold or used in any group or commercial venture without written permission from ACAPress.

Chapter 3:   Basic Factors of Biodynamics and Joint Stability

The techniques used for analyzing static positions of the body are only approximate inasmuch as forces accompanying movement incorporate such dynamic factors as acceleration, momentum, friction, the changing positions of rotational axes, and the resistance and support offered by tissues other than muscles. This chapter discusses the basic concepts and terms of biodynamics, biomechanical stress, and the biomechanical aspects of articular cartilage pertinent to the clinical setting.

Structural Motion

The study of dynamics is concerned with loads and the motions of bodies (kinematics) and the action of forces in producing or changing their motion (kinetics). Kinematics lets us describe the characteristics of motion position, acceleration, and velocity such as in gait or scoliotic displacements. Here we are concerned with the position of the center of mass of the body and its segments, the segmental range of motion, and the velocity and direction of their movements. In kinetics, we become concerned with the forces that cause or restrict motion such as muscle contraction, gravity, and friction. A complete biomechanical analysis of human motion or motion of a part would include both kinematic and kinetic data.

Motion can be defined as an object’s relative change of place or position in space within a time frame and with respect to some other object in space. Thus, motion may be determined and illustrated by knowing and showing its position before and after an interval of time. While linear motion is readily demonstrated in the body as a whole as it moves in a straight line, most joint motions are combinations of translatory and angular movements that are more often than not diagonal rather than parallel to the cardinal planes. In addition to muscle force, joint motion is governed by factors of movement freedom, axes of movement, and range of motion.

Degrees of Freedom

JOINT AXES

As previously discussed, the body is composed of numerous uniaxial, biaxial, and multiaxial joints. Joints with one axis have one degree of freedom to move in one plane such as pivot and hinge joints, joints with two axes have two degrees of freedom to move in two different planes, and joints with three axes have three degrees of freedom to move in all three planes, eg, the ball-and-socket joints. Thus, that motion in which an object may translate to and fro along a straight course or rotate one way or another about a particular axis equals one degree of freedom.

In Chapter 1, joint classification was given under the major divisions of synarthrodial, amphiarthrodial, and diarthrodial joints. This is the classic anatomic classification. However, from a purely biomechanical viewpoint, joint motion can be reduced to just two types: (1) ovoid, which permits motion in one plane, X; and (2) sellar, which permits motion in two planes, Y and Z (Fig. 3.1).

Search engines do not count shortened URLs as real traffic to our site, because their software does not track them to the final destinations. All you do is raise the Stats for Tiny or Bit.

The following is Chapter 7 from RC’s best-selling book:
“Clinical Biomechanics: Musculoskeletal Actions and Reactions”

The following materials are provided as a service to our profession. There is no charge for individuals to copy and file these materials. However, they cannot be sold or used in any group or commercial venture without written permission from ACAPress.

Chapter 7:   CLINICAL BIOMECHANICS OF THE CERVICAL SPINE

This chapter considers those factors that are of biomechanical and related clinical interest imperative to the satisfactory evaluation of common or not infrequent cervical syndromes. The discussion assumes that the physician is skilled in taking a thorough clinical history and performing the basic physical, orthopedic, neurologic, and roentgenographic examination procedures. The kinesiology and kinematics of the neck, the effects and mechanisms of cervical trauma, and a number of clinical problems are discussed that are pertinent to the diagnosis and management of musculoskeletal cervical disorders.

Background

The viscera of the neck serve as a channel for vital vessels and nerves, the trachea, esophagus, spinal cord, and as a site for lymph and endocrine glands. The cervical spine provides musculoskeletal stability and support for the cranium, and a flexible and protective column for movement, balance adaptation, and housing of the spinal cord and vertebral artery. When the head is in balance, a line drawn through the nasal spine and the superior border of the external auditory meatus will be perpendicular to the ground.

Cervical subluxations may be reflected in total body habitus, and insults can manifest themselves throughout the motor, sensory, and autonomic nervous systems. Many peripheral nerve symptoms in the shoulder, arm, and hand will find their origin in the cervical spine. Nowhere in the spine is the relationship between the osseous structures and the surrounding neurologic and vascular beds as intimate or subject to disturbance as it is in the cervical region.

Many of the skeletal landmarks readily observed in the thin individual are frequently obscured in the obese (Fig. 7.1). Except for the manatee and some sloths, all mammals have seven cervical vertebrae.

Kinesiology of the Neck

The cervical spine is a miracle in design and structure as it moves in various planes. It must support the head, and it must move the eyes and the ears for various sensory orientations.

Mechanically, the head teeters on the atlanto-occipital joints, shaped like cupped palms tipped slightly medially. Because the line of gravity falls anterior to these articulations, a force must be constantly provided in the upright posture by the posterior neck muscles to hold the head erect. Added to this gravitational stress is the action of the anterior muscles of the neck, essentially the masticatory, suprahyoid, and infrahyoid groups, which as a chain join the anterior cranium to the shoulder girdle.

Flexion, extension, rotation, lateral flexion, and circumduction are the basic movements of the cervical region. Movements of the head on the neck are generally confined to the occiput-atlas-axis complex and can be described separately from movements of the neck on the trunk. The prime movers and accessories involved in neck motion are listed in Table 7.1.

Table 7.1. Neck Motion