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Results for “Manipulation, Spinal”

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At least 649 records · Page 36Linked to original sources

PubMed1992

Lumbar motion trends and correlation with low back pain. Part II. A roentgenological evaluation of quantitative segmental motion in lateral bending.

OBJECTIVE: A radiographic study was undertaken to describe the relationship between the magnitude of coupled lumbar motion in lateral bending and the presence of low back pain: correlation between pain and motion, relationship between motion category and motion and symmetry of lumbar motion. DESIGN: Survey. SETTING: Chiropractic college student health center and private chiropractic clinic. PARTICIPANTS: 249 subjects: 114 with low back pain, 29 asymptomatic with no history and 106 asymptomatic with history. Of these, 194 were freshman volunteers and 55 were new private clinic low back pain patients. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Net lumbar segmental tilt and rotation in lateral bending: corrected and uncorrected for segmental malposition with the patient standing in the upright neutral position. RESULTS: Statistical analysis demonstrated no significant relationship between coupled lumbar motion and low back pain (p greater than .01). The presence of type II motion could account for, on average, less than 5% loss of segmental tilt in the lumbar spine. Asymmetries between left and right side motion averaged 45 to 100% of unilateral range of motion. CONCLUSIONS: This study suggests that back pain is not an indication for the routine use of lateral bending films for the identification of alterations in the magnitude of lumbar segmental motion in lateral bending. It further indicates that type II motion cannot be ruled out as a normal variant. The paucity of symmetrical lumbar motion suggests that segmental tilt or coupled rotation asymmetry, in and of itself, should not be considered an indication for spinal manipulation.

Adolescent↗

PubMed1992

Family physicians, chiropractors, and back pain.

In this article, major aspects of back care provided to patients by family physicians and chiropractors are reviewed, and the recent guidelines on spinal manipulation therapy are discussed. These guidelines should be useful for family physicians wishing to refer patients to chiropractors.

Attitude of Health Personnel↗

PubMedDate not supplied

Visit time as a framework for reimbursement: time spent with chiropractors and acupuncturists.

CONTEXT: Visit length is an important component of physician payment systems. As use and insurance coverage of complementary and alternative medicine (CAM) increases, equitable reimbursement strategies for CAM providers will be needed. Little information is available about the time CAM providers spend with patients. OBJECTIVE: To describe the length of visit and determinants of visit time to chiropractors and acupuncturists. DESIGN: Survey of CAM practitioners that collected information on providers (e.g., socio-demographics, practice patterns, training) and professional visit encounters (e.g., patient demographics, payment source, problem acuity, visit length, procedures performed). SUBJECTS: Random sample of 130 licensed chiropractors and 133 licensed acupuncturists surveyed in 1998-1999, each from one Western and one Northeastern US state. MEASURES: Patient, provider, and visit factors associated with visit duration were analyzed using weighted linear regression. RESULTS: Data were available on 2550 chiropractic and 2561 acupuncture visits. Mean chiropractic visit length was 21.5 minutes (SE = 0.8). Mean acupuncture visit length was 56.6 minutes (SE = 0.7) In both professions, new patient visits took longer, while visits for wellness or chronic problems were shorter. Preventive counseling by the chiropractor increased visit time, as did use of manual (vs. instrument) spinal manipulation, soft tissue techniques and physiotherapeutics. Acupuncture visits were shorter when specialized needling techniques (e.g. auricular or scalp acupuncture) were used, and longer with other adjunctive Asian therapies (e.g., cupping or magnets). Self-paid acupuncture visits were longer, as were visits with acupuncturists who had less practice experience or fewer years of training. CONCLUSIONS: For both chiropractic and acupuncture, certain visit factors, provider characteristics, and procedures increase visit length, many of which parallel those observed in conventional medical settings. Thus, a similar time-based payment scheme may be a reasonable starting point for developing methods for reimbursing CAM providers.

Acupuncture Therapy↗

PubMed2004

The unique role of osteopathic physicians in treating patients with low back pain.

Low back pain is a common and costly condition in industrialized nations. Consequently, a variety of treatment modalities and providers are available. A widely recognized clinical practice guideline states that spinal manipulation, as potentially provided by various types of practitioners, can be helpful for patients with acute low back problems without radiculopathy when used within the first month of symptoms. The underlying principles of osteopathic manipulative treatment (OMT) suggest the potential utility of OMT in both acute and chronic low back pain. The author summarizes the methodologic characteristics and results of the three major clinical trials of OMT for low back pain conducted in the United States and discusses their implications for osteopathic medicine.

Humans↗

PubMed2005

[Systematic review of the effects of therapy in infants with the KISS-syndrome (kinetic imbalance due to suboccipital strain)].

OBJECTIVE: To establish the effects of manual therapy, chiropractic, or osteopathic treatment of the KISS-syndrome (kinetic imbalance due to suboccipital strain) in infants with positional preference, plagiocephaly, and colic. DESIGN: Systematic review of the literature. METHOD: PubMed, Embase and the Cochrane Library were searched for articles on the effects of manual therapy, chiropractic and osteopathy on the KISS-syndrome. Experts in the field of manual medicine and osteopathy were asked to provide relevant articles. The bibliography in a textbook of manual therapy for children was hand-searched for additional references to the KISS-syndrome. RESULTS: No clinical trials were found that evaluated the effects of manual therapy or osteopathy on either the KISS-syndrome or its symptoms. Pooled analysis of two randomised clinical trials on the effects of chiropractic in infantile colic showed no statistically significant difference between active and control treatments. In addition, we found that 22% of infants showed short episodes of apnoea during manual therapy of the spine, and that one case has been described in which such apnoea resulted in death. CONCLUSION: Given the absence of evidence of beneficial effects of spinal manipulation in infants and in view of its potential risks, manual therapy, chiropractic and osteopathy should not be used in infants with the KISS-syndrome, except within the context of randomised double-blind controlled trials.

Apnea↗

PubMed2001

Thoracic spine spasms secondary to hemorrhagic intestinal ulcer.

A case of thoracic spine spasms secondary to a bleeding duodenal ulcer is presented. A 41-year-old male with 14-week history of thoracic spine spasm was treated with bed rest, spinal manipulation, physical therapy, medication, and a thoracolumbar brace. Subsequently, a provocative thoracic discogram performed at T9-T10 created periscapular pain and also reproduced the presenting thoracic spasms. Intradiscal electrothermal annuloplasty (IDET) was performed at the T9-T10 level, but without sustained relief. The patient presented to a spine center for evaluation. The diagnosis of thoracic discogenic disease was suspected. A second provocative thoracic discogram was performed and failed to reproduce his thoracic spasms. Three weeks after being referred to a chronic pain management physician, the patient presented to a local emergency room with hema-temesis. An endoscopic evaluation revealed a bleeding duodenal ulcer. Following medical treatment of the duodenal ulcer with a proton pump inhibitor the patient had complete resolution of his thoracic spasms. This represents the first reported case of thoracic spine spasms as an initial presenting symptom of a bleeding peptic ulcer.

Journal Article↗

PubMed1991

Statistical methodology for reliability studies.

Although a considerable number of reliability studies have appeared in the chiropractic literature in the last 10 yr, there is still no consensus on the definition of reliability, appropriate statistics for reliability testing or interpretation of results. This paper offers suggestions for the standardization of experimental design, analysis and evaluation for reliability studies. The primary focus is on appropriate concordance statistics, i.e., Kappa and intraclass correlation. These are presented in detail, together with a discussion of their limitations. Less suitable, but often used indices such as Pearson's r are also discussed. A measure of precision, the interexaminer measurement error, is introduced and a methodology for evaluating precision is presented. Clinical issues which must be considered in reliability studies are discussed; specifically, those issues relevant to studies of diagnostic indicators for spinal manipulation.

Analysis of Variance↗

PubMed1990

Bronchogenic carcinoma presenting as neuromusculoskeletal pain.

A case of bronchogenic carcinoma manifesting Pancoast's syndrome is presented. A 48-year-old female patient suffered from pain in the neck, axilla, anterior lower ribs and subscapular regions, with thoracic paraspinal muscle spasm, and paresthesia in the right upper extremity. An anteroposterior lower cervical radiograph demonstrated a homogenous mass lesion in the apex of the right lung. The patient was referred for medical diagnosis and treatment. A significant reduction in the pain experienced by the patient was achieved with spinal manipulative therapy while the patient was undergoing medical therapy for the malignancy.

Carcinoma, Bronchogenic↗

PubMed1989

Infantile colic treated by chiropractors: a prospective study of 316 cases.

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.

Child Behavior↗

PubMed1989

Patient evaluations of low back pain care from family physicians and chiropractors.

We compare health maintenance organization enrollees' evaluations of the care they received from family physicians and chiropractors for low back pain. Patients of chiropractors were three times as likely as patients of family physicians to report that they were very satisfied with the care they received for low back pain (66% versus 22%, respectively). Compared with patients of family physicians, patients of chiropractors were much more likely to have been satisfied with the amount of information they were given, to have perceived that their provider was concerned about them, and to have felt that their provider was comfortable and confident dealing with their problem. Although the more positive evaluations of chiropractors may be related to differences in the patient populations served by the two providers or to benefits of spinal manipulation, it is suggested that a potentially more potent force--the therapeutic effect of the patient and provider interaction itself--may explain the observed differences.

Adolescent↗

PubMed1986

An algorithm for the management of scoliosis.

Scoliosis is a lateral and rotary deformity of the spine that is often found in children. Treatment of this deformity is based on the principle of early recognition and prevention, although surgical correction may be warranted in the case of progressive curves. There is no scientific evidence that spinal manipulative therapy (SMT) has any effect on curve progression in patients with idiopathic scoliosis; however, there is clinical evidence that SMT is a useful treatment for those patients who have an associated mechanical backache. This paper reviews the classification, natural history, pathogenesis, and clinical and radiological assessment of scoliosis. An algorithm for the management of scoliosis by chiropractors is presented, and illustrative cases from a scoliosis clinic in a university hospital are used to reinforce important clinical principles.

Adolescent↗

PubMed1988

Need for multiple diagnosis in the presence of spondylolisthesis.

A case of sacroiliac syndrome and lumbar facet capsulitis coexisting with an asymptomatic grade II spondylolisthesis is presented. Spinal manipulative therapy is not contraindicated in the presence of spondylolisthesis if specific to the site of joint hypomobility and if the underlying spondylolisthesis is stable. Manipulation may prove to be diagnostic as well as therapeutic. The need to clinically assess whether the spondylolisthesis is symptomatic is discussed.

Back Pain↗

PubMed1988

Managing low back pain--a comparison of the beliefs and behaviors of family physicians and chiropractors.

Random samples of 605 family physicians and 299 chiropractors in Washington were surveyed to determine their beliefs about back pain and how they would respond to three hypothetic patients with back pain. With 79% of the family physicians and 70% of the chiropractors responding, family physicians and chiropractors differed greatly not only in their technical approaches to back pain--such as drug therapy versus spinal manipulation--but also in their underlying beliefs and attitudes. Family physicians think that most back pain is caused by muscle strain, that lumbosacral radiographs are rarely useful, that appropriate therapy does not depend on a precise diagnosis, and that back pain will usually resolve within a few weeks without professional help. Family physicians were more likely than chiropractors to feel frustrated by patients with back pain, less likely to think they can help patients prevent future episodes of back pain, and less confident that their patients are satisfied with their care. Studies are needed to determine whether the different perspectives of family physicians and chiropractors are associated with differences in the costs and outcomes of care.

Adult↗

PubMed1988

Cortical evoked potential monitoring during spinal surgery: sensitivity, specificity, reliability, and criteria for alarm.

Cortical somatosensory evoked potentials (EP) were used for intraoperative monitoring of spinal cord integrity during 158 consecutive cases involving surgical correction of spinal deformities. Using a monitoring technique designed to optimize recording, 88% of patients had stable EP results at the time of spinal manipulation. However, five of six patients with preexistent neurological deficits did not have stable EPs. A persistent EP amplitude attenuation of greater than or equal to 40% was a sensitive and specific criterion for alarm. Seven patients had transient attenuations of greater than or equal to 40% after distraction that recovered, so that the distraction instrumentation could be left in place. Overall, this particular cortical somatosensory EP recording technique appears to be appropriate for clinical monitoring. Other recording techniques may be necessary for patients with preexisting neurological deficits.

Adolescent↗

PubMed1988

Chondromalacia patellae.

Chondromalacia patellae is a relatively common condition affecting adolescents or young adults, involving the articular cartilage of the patella and opposing femoral condyles. Etiological factors, clinical features and radiographic signs of this condition are discussed. A conservative treatment approach is put forth emphasizing rehabilitative exercise, bracing and spinal manipulation.

Adult↗

PubMed1987

Patient monitoring in the conservative management of cervical radiculopathy.

With increasing frequency, concern is being raised by nonmanipulating health professionals over the use of manual procedures in the cervical spine. With respect to treatment of radicular syndromes secondary to discogenic spondylosis, the potential for occasional iatrogenic complications must be an "a priori" consideration. Illustrated with the data from case presentation, conservative therapeutic management utilizing electrodiagnostic monitoring in questionable cases is discussed. Anecdotal improvement in median nerve F-wave function following conservative treatment including spinal manipulation is presented.

Cervical Vertebrae↗

PubMed1987

Exacerbation of a case of myasthenia gravis during therapeutic electric stimulation.

In patients with myasthenia gravis, vigorous exercise and electric stimulation produce weakness that is usually reversed by rest. We describe a case of persistent weakness in a 31-year-old woman with myasthenia gravis following therapeutic electric stimulation. She was injured in an automobile accident, with cervical and lumbar muscle strain diagnosed by a local emergency room physician. She consulted a chiropractor two days later because her symptoms had not abated. The chiropractic treatment of short-wave diathermy, high-voltage electric stimulation and spinal manipulation continued thrice weekly for six weeks. She then presented to her neurologist, complaining of persistent fatigue, weakness, increased diplopia, cervical and occipital pain, and disrupted sleep. Neck weakness had developed since her last visit. She was admitted to the hospital for evaluation. Neurologic exam showed no other abnormality of strength, sensation, or reflexes. The exacerbation of myasthenia responded to prednisone and increased pyridostigmine. After two months she required only her preinjury dose of pyridostigmine (60 mg q.d. p.r.n.) to prevent diplopia or fatigue, and her strength was normal. Repeated electrically induced muscle contraction is suspected of causing this exacerbation of myasthenia gravis.

Adult↗

PubMed1983

Chiropractic management of back pain.

The vast majority of those with back pain respond extremely well to chiropractic spinal manipulation. There are several hundred procedures available to a well trained chiropractor, including high velocity manipulation, mobilisation, soft tissue techniques and pressure point therapy, which may be used to eliminate the need for manipulation under anaesthesia or surgery.

Back Pain↗