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PubMed1998

The origin and relief of common pain.

Where pain of the musculoskeletal system is present, commonly, this pain is without objective evidence of disease, trauma, or disorder. Absence of an apparent cause for common pain prompts the consideration of mechanical stress as a contributing factor. The principal stress of the musculoskeletal system is postural. By posture it is usually meant the distribution of body mass with respect to gravity. Past efforts to predict chronic pain by postural analysis or to reduce such pain by strengthening, conscious control or splinting of posture has had marginal success. Past failure to relate posture to pain is attributable to (1) ubiquity of sub-optimal posture that precludes clinical comparison to those with optimal posture; (2) presupposition that the causal relation between posture and pain is of the observational class of causality rather than the manipulable kind; (3) a definition of posture that is too narrow to complete the picture; and (4) inadequate methods for reduction of postural asymmetry to an extent that is sufficient to elicit a significant and enduring effect on sub-optimal posture and related pain. Posture can be defined more broadly as the stance of the body performing within the boundaries of posture and which is mediated by the Postural Control System towards greatest stability (Fx. 1). The stance of the body is the arrangement of the body with respect to gravity and other accelerative forces. The postural boundaries are the set of forces that resist acceleration and thereby provide the limits within which one functions stably, and this resistance is currently approximated by six principal sources of resistance to acceleration: viscous, elastic, neuromuscular, rigid, viscoelastic, and inertial. The Postural Control System is located in the brainstem and modulates body stance to more economically and stably effect and resist acceleration. The rigid boundaries can be so with respect to compressive, tractive, or tensile qualities that permits three kinds of motion: translation, rotation and oscillation. An example of postural boundaries that are rigid with respect to compression and tensile character are the bones that bear weight. In contrast, ligaments provide a tractive rigidity and musculotendons a relatively elastic boundary. Joint surfaces are considered boundaries that are rigid but not perfectly so. Of fundamental importance are those joints that arc lowermost in a column of the musculoskeletal system namely: (1) the feet and ankles that support the entirety of the musculoskeletal system and; (2) the base of the sacrum that supports the vertebral spine. This broadened definition of posture leads to a greatly enhanced manipulability of posture in the upright stance and alleviation of more than two-thirds of common pain by the coherent combination of (1) manual manipulation to reduce somatic dysfunction; (2) foot orthotics to optimize the amplitude of the arches of the feet and vertically align the ankle; (3) a heel lift to level the sacral base; (4) and a group of therapeutic postures configured to minimize restriction of peripheral soft tissue reflective of the earlier posture, all aimed to optimize posture. Mediated by the postural control system, manipulation of postural boundaries accordingly modifies the structure and function of the entire musculoskeletal system. Typically, this relief is maintained by foot orthotic and heel lift alone without maintenance by manual manipulation, medication, or exercise.

Back Pain↗
PubMed2003

Manipulation of the cervical spine.

In New Zealand, a new approach to manual therapy of the cervical spine has integrated physiotherapy and osteopathy techniques. The combination of the philosophies of these two professions has added a new dimension to the management of cervical spine pain. Emphasis is placed on issues of safety, such as the degree of cervical rotation and comfort for both the patient and the therapist. This is combined with biomechanical considerations, which have made the teaching and learning of these manipulative techniques less complicated and easily progressed from palpation to mobilization and onto manipulation. Appropriate patient screening and selection identified through thorough subjective and objective assessments are important aspects of this approach and reflective interpretation of all clinical findings is essential. The refinement of cervical joint positioning and an increased anatomical awareness have led to the utilization of new upper cervical high-velocity thrust techniques. Consequently, it is envisaged that an increase in the safety and specificity of cervical manipulative techniques is achieved.

Cervical Vertebrae↗
PubMed2000

Cervical spine manipulation and the precautionary principle.

Cervical manipulations can cause severe neurologic complications, which are both exceedingly rare and generally unpredictable. To meet the requirements of the principles of prevention and precaution, we believe the number of cervical manipulations should be reduced. To this end, we suggest that five recommendations developed by consensus be followed: unwanted effects, however minor, of previous manipulation should be looked for routinely and taken as absolute contraindications to further manipulation; a thorough physical examination, including a neurological evaluation, should be performed prior to manipulation; all known contraindications and indications should be followed; manipulation should be performed only by physicians experienced in this technique; and special caution should be exercised when performing first-line cervical manipulation.

Cervical Vertebrae↗
PubMed2001

Decline in structural examination compliance in the hospital medical record with advancing level of training.

A retrospective review of 115 randomly pulled hospital charts of patients admitted to the care of osteopathic physicians at an American Osteopathic Association-accredited primary care hospital revealed a significant decline in the frequency of structural examinations in history and physical examinations during a merger and relocation, as well as with increasing level of training of the examiner (chi 2 test, P < .001). Attending physicians completed fewer structural examinations (45% of their history and physical examinations) compared to house staff (70%) and students (92%). A follow-up anonymous survey of 100 osteopathic physicians and students (response rate, 58%) revealed that the low overall frequency of structural examination completion (60%) was due primarily to attending physicians who considered this examination less relevant or impractical for their hospitalized patients. These results indicate that education on relevance of structural examination and manipulative treatment for acutely ill patients needs to be directed not only to house staff and students but also to attending physicians to preserve and improve the use of osteopathic principles at osteopathic hospitals.

Attitude of Health Personnel↗
PubMed2004

Chiropractic care in asthma and allergy.

OBJECTIVE: To provide a brief overview of the current state of evidence for chiropractic care, specifically in the management of asthma and to a lesser extent allergy. DATA SOURCES: A search of MEDLINE for English-language articles published between January 1966 and July 2002 was conducted using the keywords asthma, allergy, manual therapy, physical therapy techniques, chiropractic, physical therapy (specialty), physiotherapy, massage, and massage therapy. A hand search of the primary chiropractic and osteopathic literature on the treatment of asthma was performed, and proceedings from a recent research symposium on spinal manipulation were included. STUDY SELECTION: Clinical controlled studies and systematic reviews on spinal manipulative therapy (SMT) and asthma were selected. There were no primary clinical trials on SMT and allergy found. RESULTS: Many of the claims of chiropractic success in asthma have been primarily based on anecdotal evidence or uncontrolled case studies. Three recently reported randomized controlled studies showed benefit in subjective measures, such as quality of life, symptoms, and bronchodilator use; however, the differences were not statistically significant between controls and treated groups. There were no significant changes in any objective lung function measures. The clinical issues emanating from these trials are discussed. CONCLUSIONS: There is currently no evidence to support the use of chiropractic SMT as a primary treatment for asthma or allergy. Based on reported subjective improvement in patients receiving chiropractic care, certain clinical circumstances may warrant a therapeutic trial in patients with asthma. Further properly designed, collaborative research is needed to determine if there is a role for chiropractic SMT in the care of asthma or allergy.

Asthma↗
PubMed2006

General practitioners' attitudes toward (and use of) complementary and alternative medicine: a New Zealand nationwide survey.

AIMS: This study aimed to update our understanding of how general practitioners view and use complementary and alternative medicine (CAM). METHOD: A nationwide cross-sectional postal questionnaire sent to 500 randomly selected general practitioners (GPs) of the 2358 who met the inclusion criteria of the study in December 2005. RESULTS: 300 completed questionnaires were returned thus giving a response rate of 60%. Twenty percent of the GP respondents practiced (and 95% referred patients to) one or more forms of complementary and alternative medicine. The most common CAM therapy practiced by GPs was acupuncture, and chiropractic manipulation was the most common GP-referred therapy for patients. Thirty-two percent of respondents had formal training and 29% had self education in one or more CAM therapies. Sixty-seven percent felt that an overview of CAM should be included in conventional medical education. CONCLUSIONS: The number of GPs practising CAM therapies has decreased over the past 15 years, although the number referring patients to CAM has increased. The finding 'that GPs feel information about CAM should be included in medical education' is consistent with earlier research and should be taken into account when developing the medical curriculum.

Acupuncture Therapy↗