Effectiveness

Koes, BW, Van Tulder MW, Thomas S. Diagnosis and Treatment of Low back Pain. British Medical Journal. 2006. 332:1430-1434. Spinal manipulation is recommendedfor both acute and chronic low back pain.

 

Santilli V, Beghi E, Finucci SA. Chiropractic Manipulation in the Treatment of Acute Back Pain and Sciatica with Disc Protrusion: A Randomized Double blind Clinical Trial of Active and Simulated Spinal Manipulations. The Spine Journal. 2006; 6:131-137. 102 patients were randomly assigned to group who received rotational adjustment versus sham adjustment. Patients were given chiropractic adjustments up to 5 days per week and up to a maximum of 20 treatment sessions during a 30 day period. Very positive results for chiropractic. At the end of follow up, 180 days or 150 days since end of treatment phase, 55% of patients in the treatment group were free from radiating pain, versus 20% in the control group. 28% were free from local back pain versus 6% in the control group.

 

HanelineMT.Symptomatic Outcomes and Perceived Satisfaction Levels of Chiropractic Patients with a Primary Diagnosis Involving Acute Neck Pain.

 

J Manipulative Physiol Therapeutics. 2006. 29:288-92. This was a multi centered retrospective survey of patients from chiropractic practices. It reports good results in a population of 115 patients in terms of reduced pain and disability and strong levels of patient satisfaction.

 

Murphy DR, Hurwitz EL, Gregory AA. Manipulation in the Presence of Cervical Spinal Cord Compression: A Case Series. J Manipulative Physiol Therapeutics. 2006; 29:236-244. Compression of the spinal cord in the cervical spine, confirmed by MRI will be a contraindication to manipulative treatment in some circumstances, but in others skillful assessment and treatment may lead to excellent results and avoidance of surgery that presents much higher risks. This is a case series of 27 patients with neck and or arm pain with clear findings of cervical spinal cord encroachment on MRI. Patients received an average of 12 treatments with 18 receiving joint manipulation, 8 receiving low velocity muscle energy techniques and 1 receiving both. Patient rate of improvement averaged 70% for pain and disability. There were no new neurological symptoms or signs

 

Hurwitz, EL, Morgenstern H et al (2006). A Randomized Trial of Chiropractic and Medical Care for Patients with Low back Pain: Eighteen Month Follow-Up Outcomes from the UCLA Low back Pain Study; Spine. 31(6):611-621). Overall this RCT and its results support the now conventional wisdom that more frequent care and monitoring than found in usual medical practice, and the active interventions of manual care and exercise, produce higher satisfaction and better results than traditional medical advice and medication. Chiropractic scored particularly well in the areas of safety and patient satisfaction.

 

Martinez-Segura R., Fernandez-de-las-Penas C, Ruiz-Saez M, Lopez-Jimeniz C, Rodriquez-Blanco C. Immediate effects on neck pain and active range of motion after a single cervical high velocity low amplitude manipulation in subjects presenting with mechanical neck pain: a randomized controlled trial. Journal of Manip Physiol Ther. 2006 Sep; 29(7):511-7. CONCLUSIONS: Results suggest that a single cervical HVLA manipulation was more effective in reducing neck pain at rest and in increasing active cervical range of motion than a control mobilization procedure in subjects suffering from mechanical neck pain.

 

 

United Kingdom Back Pain Exercise and Manipulation (UK Beam) Randomized Trial: Effectiveness of Physical Treatments for Back Pain in Primary Care, British Medical Journal Online First, November 19, 2004:1-8. British Medical Journal December 11; 329(7479):1381.OBJECTIVE: To assess the cost effectiveness of adding spinal manipulation, exercise classes, or manipulation followed by exercise ("combined treatment") to "best care" in general practice for patients consulting with low back pain. CONCLUSIONS: Spinal manipulation is a cost effective addition to "best care" for back pain in general practice. Manipulation alone probably gives better value for money than manipulation followed by exercise. “This is the first study to show convincingly that both manipulation alone and manipulation followed by exercise provide cost effective additions to best care (for low back pain patients) in general practice.” UK BEAM Trial.

 

 

Bronfort G, Haas M, Evans RL, Bouter LM. Efficacy of spinal manipulation and mobilization for low back pain and neck pain: a systematic review and best evidence synthesis. Spine Journal, May-June, 2004, 4(3): 335-56.  Data synthesis suggests that recommendations can be made with some confidence regarding the use of SMT and/or MOB as a viable option for the treatment of both low back pain and NP. There have been few high-quality trials distinguishing between acute and chronic patients, and most are limited to shorter-term follow-up. Future trials should examine well-defined subgroups of patients, further address the value of SMT and MOB for acute patients, establish optimal number of treatment visits and consider the cost-effectiveness of care.

 

 

Korthals-de Bos IB, Hoving JL, van Tulder MW, et al.  Cost effectiveness of physiotherapy, and general practitioner care for neck pain: economic evaluation alongside a randomized controlled trial.  British Medical Journal, April 26, 2003: 326.  Manual therapy was more effective than physiotherapy and general practitioner, 68%-51%-36% respectively.  Manual therapy also proved significantly more effective at one year.  Manual therapy consisted of muscular mobilization, specific articular mobilization, coordination or stabilization. 

 

Giles LGF, Muller R. Chronic spinal pain-a randomized clinical trial comparing medication, acupuncture, and spinal manipulation. Spine 2003; 28: 1490-1503.  Chiropractic manipulation was superior to both drugs and acupuncture in the treatment of chronic spinal pain (pain greater than 13 weeks).  Medication utilized were Celebrex, Vioxx, paracetamol.  Recovered patients for the manipulation group, acupuncture and medication groups were 9, 3,  and 2 respectively.  Superiority for manipulation was expressed by patients in all testing except for VAS for neck pain.  One of the most remarkable findings was that patients in the manipulation group reported a 47 percent improvement on the SF-36 questionnaire, compared to 15 for acupuncture and 18 for medication.  The test gives perception of overall health.  The spinal manipulation group also had experienced the longest pretreatment duration of pain.  

 

Aure OF, et al.Manual Therapy and Exercise Therapy in Patients With Chronic Low Back Pain: A Randomized, Controlled Trial With 1-Year follow-up.  Spine. March 15, 2003; Vol. 28, No. 6, pp. 525-531. Improvements were found in both intervention groups, but manual therapy showed significantly greater improvement than exercise therapy in patients with chronic low back pain. The effects were reflected on all outcome measures, both on short and long-term follow-up.

Evans R, Bronfort G, et al.  Two year follow up of a randomized clinical trial of spinal manipulation and two types of exercise for patient with chronic neck pain.  Spine 2002: 27(21), pp. 2383-2389.  This study suggests that spinal manipulation and rehabilitative exercises together are more advantageous than manipulation alone or machine based exercise for treating neck pain. 

 

January 2002: President Bush signs into law direct access to chiropractic doctors for all U.S. veterans under the U.S. military health care system.

 

March 2001: A new literature review from DukeUniversity regarding effectiveness of treatments for common headaches has been published.  The authors at Duke conclude that spinal manipulation (adjustment) is one of the only effective treatments for the most common headaches such as cervicogenic (CGH) and muscle tension headache (TTH).  20-30% of the adult population suffers from TTH once a month and 3% have them 15 days or more.  As the Duke Evidence Report states medication is given primarily to control symptoms whereas behavioral and physical interventions like manipulation are primarily aimed at the prevention of headaches.

 

2/12/2001: For approximately 2 years Blue Cross Blue Shield of Illinois, that states largest managed care plan, has given their more than 700,000 members an option of choosing a chiropractor as their primary care physician.  The goal is to evaluate a true prevention-based health care system as opposed to an after-the-fact disease care system.  The results of this program as supplied by BC/BS of Illinois, compared to similar managed care plans employing medical doctors as PCP’s is the following.  Hospitalizations reduced by approximately 60%.  Outpatient surgery reduced by approximately 85%.  Usage of pharmaceuticals reduced by approximately 56%.  Reduction of Cesarean sections by over 22 percent.  Higher patient satisfaction rates.

 

10/31/2000: President Clinton signs into law direct access to chiropractic doctors for all active military personnel.

 

3/20/2000: The Department of Defense recently completed a congressionally mandated, multi-year pilot program to determine the feasibility and advisability of including chiropractic care in the DOD health care system.  Results were:

·        Military personnel who used chiropractic care for the treatment of common neuromusculoskeletal conditions experienced superior outcomes compared to patients who received traditional care and physical therapy. 

 

·        A higher proportion of chiropractic patients reported that they felt better, had less pain, and had fewer restrictions/physical limitations than patients receiving traditional care. 

 

·        More combat readiness

 

·        199,000 less lost work days

 

·        An assessment was made that implementing chiropractic care within the military would save the Department of Defense over 25 million dollars per year. 

 

 

Bigos S, M.D., Bowyer O, et al.  Acute Low Back Problems in Adults.  Clinical Practice Guideline, No. 14, Rockville Maryland: U.S. Department of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research, AHCPR Pub, No. 95-0642, December 1994.  A multidisciplinary panel, divorced from politics, analyzed the scientific literature and found there are two recommended treatments for acute low back pain.  Spinal manipulation and over the counter non-steroidal anti inflammatories.

 

Haldeman, D.C., Ph.D., M.D.  Backletter 1994; 9(11): 125.  Tremendous outcomes research effort combined with an impressive level of organization on the part of doctors of chiropractic has transformed the reputation of manipulation over a 2 decade span.  Outcome research has led to the legitimization of a treatment that was regarded medically as quackery 20 years ago.  No other back pain prescription has been subjected to such examination.  The evolution of this treatment from the fringes of health care to one of primary consideration is a triumph of science and research over dogma and opinion.  When all 54 trials are considered together, the evidence in favor of manipulation as a treatment for back pain is overwhelming.

 

The Wilk et al., vs. American Medial Association et al, anti-trust case (1987) established that the chiropractic profession’s complaint against organized medicine, that there was long term, AMA led, illegal conspiracy, and unfair portrayal of the chiropractic profession as ‘cultist’ and ‘unscientific’, was a legitimate complaint.  A federal court ruled there was such an illegal conspiracy, and imposed orders that opened the door for much greater cooperation between chiropractors and medical doctors in practice, education and research.

 

Triano, D.C., Spine 1995; 20(8): 948-955.  Randomized trial for patients with untreated low back pain lasting greater than 7 weeks.  Groups were treated with 1) spinal manipulation, 2) sham manipulation, 3) back education program.  170 patients completed the study with a mean of 10.5 visits.  Greater improvement was noted in pain and activity tolerance in spinal manipulation group.  Immediate benefit from pain relief continued to accrue after spinal manipulation even after the last treatment at the end of the 2-week interval.

 

Spitzer.  Quebec Task Force in Whiplash-associated Disorders (WAD).  1995; 20(8S): 73S. The task force consensus stated that use of short-term manipulation and mobilization by trained persons, NSAIDS (i.e. Ibuprofen, Tylenol), analgesics, and active exercises are useful in Grade II and III WAD.

 

Boline.  Journal of Manipulative and Physiological Therapeutics.  1995; 18(3): 148-155.  Spinal manipulation group showed a 32% reduction in headache intensity, 42% reduction in frequency, 30% reduction in over the counter medication usage and improvement of 16% in functional health status.  The amitriptyline group showed no improvement or a slight worsening from baseline values in the same major 4 measures.  There was also a sustained benefit for the spinal manipulation group and none for amitriptyline.

 

Morton PT, M Hth Sc.  Manipulation in the treatment of acute low back pain.  JMPT 1999; 7(4): 182-189.  Prospective study of 29 patients with acute low back pain.  Two groups, one who received stabilization exercises only and other stabilization exercises and manipulation.  Conclusions: patients who receive spinal manipulation + exercise for ALBP will improve more and faster than patients who receive exercises alone. The difference between the groups appears early. 

 

BronfortDC, Ph.D. et al.  A randomized clinical trial of exercise and spinal manipulation for patients with chronic neck pain.  Spine, 2001; 26: 788-99.  Patients with chronic mechanical neck pain were compared for the efficacy of 20 sessions of spinal manipulation (SM) alone, SM with low-tech exercise, or high tech exercise.  Results after 11 weeks.  All 3 groups improved.  No significant difference between the groups in terms of pain, neck disability, general health, improvement, except for satisfaction with care which was significantly higher for SM plus exercise group than for SM alone.  In terms of neck performance at least twice as much improvement in SM/exercise group than for SM alone was including ROM.  SM/exercise group showed greater improvement in flexion endurance and flexion strength than MedX.  SM/exercise group satisfaction was superior to both MedX and SM groups.  The respective benefits were evident for months after treatment ceased. 

 

Shekelle PG, M.D., Adams A, et al.  The Appropriateness of Spinal Manipulation for Low Back Pain: Indications and Ratings by a Multidisciplinary Expert Panel, RAND Corporation, Santa Monica, California, 1991.  A chiropractic doctor performs 94% of all spinal manipulation done in the United States.

 

Hillyer, D.C.  A 1995 survey titled: Manipulation in the curricula of Chiropractic, Osteopathic, Physical Therapy, and MedicalSchools, showed that doctors of chiropractic have the most extensive education in joint manipulation compared to all other health care professionals.  During their formal education, chiropractic doctors receive an average of 563 total hours with regards to manipulation.  This compares to 146 hours for osteopaths and no hours of education and training for medical doctors or physical therapists during their formal training.

 

The North American Spine Society.  Spine, 1991, Vol. 16, No. 10, pages 1161-1167.  Chiropractic given their highest rating: Procedure Category 1: Generally accepted, well established, widely used.  Recommended for up to 3-4 months, with a 1-month optimum.  Reinstitution is warranted if there is a flare up.

 

Shekelle, M.D., Ph.D..  The Backletter 1994; 9(6): 61, 62, 68.  The evidence on spinal manipulation is much better than for most other back treatments.  I think of the treatments that have been tested for acute low back pain, spinal manipulation has probably done best.  There are new treatments that need to be tested and they need it against spinal manipulation to see if they perform better.  Spinal manipulation, based on its performance in studies today, deserves a prominent role in future research on back pain treatment.

 

Curtis P, Carey TS, Evans P, Rowane MP, Garrett JM, Jackman A. Training primary care physicians to give limited manual therapy for low back pain.  Spine 2000; 25: 2954-2961.  The study was designed to determine whether training primary care physicians in techniques of limited manual therapy would result in improve outcomes for their patients with acute low back pain.  Perhaps the most interesting aspect of the study is the effect it had on the MD’s: Two years after training, most physicians in the study reported continued use of manual therapy.  They reported that they had changed their management by performing more complete examinations, more touching, less use of narcotics, reduced referrals to specialists, and increased referrals to chiropractors.  The referral rate to chiropractors increased from 17% before training to roughly 50% at one year follow up.  The authors warn that “the physicians were not experts in manual therapy” and that these results “should therefore not be generalized to the effectiveness of manual therapy performed by expert practitioners”.

 

Whittingham, D.C., Ph.D. Nilsson, D.C. M.C., Ph.D.  Active range of motion in the cervical spine increases after spinal manipulation JMPT 2001; 24(9): 552-5.  Blinded RCT of the changes in active cervical ROM after cervical spinal manipulation in 105 patients with cervicogenic headache.  Results: after receiving manipulation active cervical ROM increased significantly between the groups. 

 

Drezner, MD, Herring, MD.  Managing LBP.  Steps to optimize function and hasten return to activity.  Physical and Sports Medicine 2001; 29(8).  SM should always be used with other appropriate rehab components.  Protracted passive treatment places that patient in a dependant role and becomes counter productive to establishing functional independence.  The high recurrence rate and functional changes that occur in CLBP warrant attempts to maximize rehab.  The overall goal is to restore normal function and promote safe and independent return to activity.  Implementing a long-term maintenance program is important in preventing recurrence.  Thus rehab should continue beyond the resolution of symptoms and return to sport. 

 

Dr. Scott Donkin’s BACKSAFE and SITTING SAFE employee training programs for the prevention of neck and back injuries are now in wide use with major corporations because of impressive results such as:

1)      United Airlines, after training 20,000 flight attendants in 10 countries with the Backsafe program led by chiropractors as trainer, saw a 63% decrease in neck and back injuries.

2)      Boeing reduced back injuries by 41%

3)      Citicorp in Beverly Hills experienced a 50% reduction in back injuries after employees received this training.

4)      Results similar to those of Citicorp were realized by Chevron and Merrill Lynch.

 

Wiesel, M.D.  Backletter.  1997; 12(6): 63.  Carey examined the impact, over 12 months, of a 2-day intensive training on manual therapy skills on a group of 30 family physicians and internists.  Confidence in the ability to treat back pain increased substantially.  15% of M.D.’s felt well prepared to treat LBP prior to the course and 67% at 1 year.  90% felt comfortable explaining the rationale of spinal manipulation to their patients.  The M.D.’s didn’t perform many spinal manipulations as a result of the course.  The program seemed to build bridges between M.D.’s and D.C.’s.  Prior to training 17% of M.D.’s said they frequently or occasionally suggested referral to D.C.’s.  47% did so at 1 year after training.

 

Nilsson, DC, MD. et al.  Journal of Manipulative and Physiological Therapeutics.  1997; 20(5):  326-330.  Study of the effect of spinal manipulation (SM) on cervicogenic headache (HA) in a prospective, random controlled trial in 53 patients with frequent HA criteria for cervicogenic  HA.  All subjects were age 20 to 60; had >/= 5 days per months of HA for at least 3 months with no prior SM of cervical spine; no effect with migraine medications, occipital HA location; patients could identify neck movements or postures that precipitate or aggravate HA; patients exhibited decrease passive range of motion; patient kept a HA diary for 1 week before treatment.  28 patients received SM 2 times per week for 3 weeks.  Results:  1) Use of analgesics decreased by 36% in the SM group but was unchanged in the soft tissue group.  2) Number of HA hours / day decreased by 69% in the SM group compared with 37% in the SM group vs. 17% in the soft tissue group.  Conclusion:  Spinal manipulation has a significant positive effect in cases of cervicogenic headache.

 

Waddell, M.D.  Chiropractic Report.  1993; July: 1-6.  Failure to restore function means any pain relief will be temporary and reinforces chronic pain.  In the management of occupational back pain, the chiropractic profession is leading the way.  The problem is weakness and loss of function not disease.

 

Taylor, JAM, et al.  Spine, Vol. 20, No. 10, 1995.  pgs. 1147-1154.  A controlled comparison of radiographic interpretive performance based on training and experience was carried out.  The test compared students, clinicians, radiology residents, and radiologists in medicine and chiropractic.  Contrary to what is often heard about the superiority of medical training, “the test results of chiropractic radiologists, chiropractic radiology residents, and chiropractic students was significantly higher than that of the corresponding medical categories (general medical radiologists, medical radiology residents and medical students, respectively.)”

 

Back Pain:  Report of a CSAG Committee on Back Pain.  Clinical Standards Advisory Group, National Health Services, London, England, May 1994.  This study states that spinal manipulation / adjustment should be included in treatment to avoid long lasting back pain.

 

Koes, Ph.D., Journal of Manipulative and Physiological Therapeutics 1992; 15(1):  16-23. 

256 individuals with back or neck pain of at least 6 weeks, randomly assigned to 1) physiotherapy (PT), 2) manual therapy, 3) medical treatment (general practitioner), 4) placebo.  Manual treatment had the fastest and largest improvement.  Number of treatments was only 5.4 versus 14.7 for PT, which had the second best results.

Koes, Ph.D.  Journal of Manipulative and Physiological Therapeutics 1993; 16(4):  211-219.

At 12 month follow up, better results were noted for manual treatment than other groups, especially in chronic patients (symptoms > 1 year) and in-patients younger than 40 years old.

 

British Back Pain Guidelines, developed by the Clinical Standards Advisory Group, published as Back Pain, and Epidemiology and Cost of Back Pain.  These guidelines recommend that patients should be seen earlier in the community by chiropractors, osteopaths, and physiotherapists skilled in manipulation.

 

 

Manga P, Angus D, et al.  The Effectiveness and Cost Effectiveness of Chiropractic Management of Low Back Pain.  The Ontario Ministry of Health, Ottawa, Ontario, Canada, August 1993.  This study showed that based on the most scientific studies that spinal

manipulation performed by chiropractors is shown to be more effective than other

treatments (including medical) for low back pain.

 

Shekelle PG, M.D., Adams A, et al.  The Appropriateness of Spinal Manipulation for Low Back Pain: Indications and Ratings by a Multidisciplinary Expert Panel.  RAND Corporation, Santa Monica, California, 1991.  This was the first time that medical doctors have gone on record stating that spinal manipulation/adjustment was beneficial for treating certain pains in the low back.

 

Meade TW, Dyer S, et al.  “Low Back Pain of Mechanical Origin:  Randomized Comparison of Chiropractic and Hospital Outpatient Treatment.”  British Medical Journal, Volume 300, Number 6737, June 2, 1990, Pages 1431-1437.  This study found that chiropractic adjustments / manipulation kept people more pain free than standard hospital outpatient treatment for low back pain.

 

Meade TW, Dyer S, et al.  “Randomized Comparison of Chiropractic and Hospital Outpatient Management for Low Back Pain: Results from Extended Follow Up.”  British Medical Journal, Volume 311, Number 7001, August 5, 1995, Pages 349-351.  This study also showed that chiropractic treatment was better than treatment by hospital therapists for low back pain.

 

Koes BW, Bouter LM, et al.  “Randomized Clinical Trial of Manipulative Therapy andPhysiotherapy for Persistent Back and Neck Complaints:  Results of One-Year Follow Up.”  British Medical Journal, Volume 304, Number 6827, March 7, 1992, Pages 601-605.  This study found that adjustment / manipulation was better than physical therapy

and treatment by a family medical doctor for neck and back pain.

 

Lauro, D.C.  Journal of Chiropractic Research and Clinical Investigation, 1991; 6(4): 84-87.  Evaluated the effect of spinal manipulation on athletic ability in a group of 50 completely asymptomatic athletes.  Result:  In randomized trial, the control group improved overall 4.5% at 6 weeks.  8 of 11 test scores improved, 3 declined.  Significant improvement occurred in only 2 of 11 tests.  In the spinal manipulation group all 11 tests scores improved, none declined.  At 6 weeks overall improvement was 10.57% or 2.35 times better than control group.  20 of 24 athletes received spinal manipulation an additional 6 weeks and were 16.7% better than at baseline at that point.  Chiropractic quantitatively improved agility, balance, speed reaction time, kinesthetic perception, and power.  How?  I.  Identify and correct altered biomechanical patterns of activity which if not corrected leads to a) decreased mechanical efficiency, b) increased energy expenditure, c) decreased performance, d) altered load distribution, e) increased risk of injury, f) altered proprioception and fine motor tuning.

 

Petersen.  Dynamic Chiropractic.  1997; 15(4) Feb. 10: 1, 8.  The World Health Organization establishes official relations with Chiropractic profession.  In Jan. 1997 meeting in Switzerland, the WHO granted official status to the World Federation of Chiropractic.  The recognition resulted from strong support of non-governmental organizations such as the International Council of Nurses, World Federation of Neurology and World Federation of Health Associations.

 

Verhoef, Ph.D. et al.  Journal of Manipulative and Physiological Therapeutics.  1997; 20(4), May 235-240.  The Chiropractic Outcome Study.  Study of 278 patients with back and/or neck pain from 13 chiropractic practices in Canada evaluating the changes from baseline to 6 week follow-up in terms of 1) Pain, 2) Functional ability, 3) Patient satisfaction as measured by the Visual Analog Scale, Oswestry, and Neck Disability Index.  Results:  Pain relief and changes in functional ability were greatest among patients with initial moderate or severe pain or disability, patients with acute conditions and those who saw no other provider than the DC during treatment.  Satisfaction questionnaire indicated high levels of satisfaction with care.

 

Waddell, M.D., et al.  Clinical guidelines for the Management of Acute Low Back Pain.  RoyalCollege of General Practitioners.  1996; 26.  There are 36 random controlled trials of spinal manipulation for LBP.  19 report positive results and 5 more positive results in subgroups.  Within the first 6 weeks of acute or recurrent LBP, spinal manipulation provides better short-term improvement in pain activity levels and higher patient satisfaction that other treatments with which it has been compared.  Risks of spinal manipulation for LBP are very low if carried out by a trained practitioner.  Recommendation:  Consider spinal manipulation within the first 6 weeks for patients who need additional help with pain relief or who are failing to return to normal activities.  Based on the evidence it is doubtful that specific back exercises produce clinically significant improvement in acute low back pain but theoretical arguments for exercises are strong.

 

Wiesel, M.D.  Chiropractic continues to grow.  Backletter 1997; 12(5): 60.  The chiropractic profession continues to grow in popularity worldwide.  It is now the third largest primary health care profession in the western world after medicine and dentistry.

 

Petersen.  Dynamic Chiropractic.  1997; 15(11); May 19: 1, 11.  Maine Bill Guarantees Direct Access to Chiropractic under Managed Care.  In April 1997, the governor Maine signed a bill requiring HMO’s to provide enrollees direct access to the services of D.C.’s by self-referral for acute care without prior approval from a primary care physician / gatekeeper.  D.C.’s can treat enrollees up to 12 times in a 3 week period for acute care and up to 36 times per year without approval from a primary care provider.  The governor vetoed this bill at first but he was overruled for the first time in his 8 years in office.

 

Coulter, Ph.D. et al.  Chiropractic and Care for the Elderly.  Topics in Clinical Chiropractic.  1996; 3(2): 46-55.  A study of 414 elderly adults (average of 80 years), 23 use chiropractic care.  At baseline DC patients were similar to the general sample except they were an average of 2 years younger.  DC users were more likely to do strenuous exercise, less likely to report their health status as fair or poor, rated their health as good to excellent, less likely to have arthritis, nursing home visits, hospitalizations, and doctor visits.

 

Marteletti, MD, Journal of Neuromusculoskeletal System.  1995; 3(4): 182-187.  Criteria for Cervicogenic Headache.  36 patients were treated spinal manipulation(SM) at 3 times per week for 4 weeks using Diversified technique.  Patients were allowed to take analgesics.  Pain intensity was recorded in daily headache diary, duration of headache in hours and amounts of analgesics or anti-inflammatories.  Results:  There was a progressive decrease in total pain index (TPI) as well as drug consumption index (DCI).  The declines of both began immediately after the start of SM and remained significantly lower even during 4 week follow up.

 

Baker, B.  Family Practice News 1996; June 1: 14.   Spinal Manipulation (SM) vs. Acetaminophen (Tylenol) for Chronic Neck Pain.  Study at University of Colorado of patients with chronic neck pain of minimum of 12 weeks and an average of 10 years.  35 patients in SM group saw a doctor of chiropractic (DC) for 12 visits over 6 weeks.  34 patients in medicated group got Acetaminophen 4 times daily and saw a nurse for 12 visits over 6 weeks for personal attention.  Both groups were told to exercise and use a heating pad.  At the end of 6 weeks patients in SM group reported significant improvement in neck pain and function, and showed trends toward better range of motion and strength.  Patients in medication group showed no real change.  Long-term follow up is underway.

 

Winters, et al.  British Medical Journal.  1997; 314, May 3: 1320-1325.  Compares efficacy of physical therapy, manipulation and corticosteroid injection for treatment of patients with shoulder complaints in a randomized single blind study in the Netherlands.  172 divided into 2 diagnostic groups: 1) synovial group (n=114) and 2) shoulder girdle group (n=58).  Patients in shoulder girdle group were randomized to manipulation or physical therapy.  Patients in synovial group were randomized to corticosteroid injection, manipulation, and physical therapy.  Main outcomes were duration of shoulder complaints.  Results:  In shoulder girdle group duration of complaints was significantly shorter after manipulation than physical therapy.  The number of patients reporting failure was less with manipulation.  In synovial group duration of complaints was shortest after corticosteroid injections.

 

Vicenzino, B et al.  Pain 1996; 68: 69-74.  Effects of cervical Spinal Manipulation (SM) on the pain and dysfunction of lateral epicondylitis.  15 patients with lateral epicondylitis (LE) and elbow pain for a mean of 8 months had a reduction of 53.4% in the neurodynamic test; 35.3% in pain free grip strength, 43.1% in pressure pain threshold at baseline as compared to their unaffected side.  The patients had a high prevalence of hypo mobility in the lower cervical spine.  Each of the patients received one of the 3 interventions per day (SM, placebo or control) and all 3 in a randomized sequence over 3 days.  Both patients and assessors were blinded.  Outcome measures were determined immediately before and after the intervention.  Pain (VAS)was also assessed at 24 hours.  Patients and assessors were blinded as to which group the patients were in.  Results:  A significant effect was found for upper limb tension test, pain free grip and pressure pain threshold and 24 hour pain scores.  The study demonstrates a clear and immediate hypoalgesic effect of SM in-patients with tennis elbow at a site removed from the site of treatment application.