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Colorectal and uterine movement and tension of the
inferior hypogastric plexus in cadavers
Background:
Hypotheses on somatovisceral dysfunction often assume interference by stretch orcompression of the nerve supply to visceral structures. The purpose of this study is toexamine the potential of pelvic visceral movement to create tension of the loose connectivetissue that contains the fine branches of the inferior hypogastric nerve plexus.
Methods:
Twenty eight embalmed human cadavers were examined. Pelvic visceral structures weredisplaced by 5 N unidirectional tension and the associated movement of the endopelvic fasciacontaining the inferior hypogastric plexus that this caused was measured.
Results:
Most movement of the fascia containing the inferior hypogastric plexus was obtained bypulling the rectosigmoid junction or broad ligament of the uterus. The plexus did not crossany vertebral joints and the fascia containing it did not move on pulling the hypogastricnerve.
Conclusions:
Uterine and rectosigmoid displacement produce most movement of the fascia containing thehypogastric nerve plexus, potentially resulting in nerve tension. In the living this might occuras a consequence of menstruation, pregnancy or constipation. This may be relevant tosomatovisceral reflex theories of the effects of manual therapy on visceral conditions.
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Trunk muscle fatigue during a lateral isometric hold
test: what are we evaluating?
Background:
Side bridge endurance protocols have been suggested to evaluate lateral trunk flexor and/orspine stabilizer muscles. To date, no study has investigated muscle recruitment andfatigability during these protocols. Therefore the purpose of our study was to quantify fatigueparameters in various trunk muscles during a modified side bridge endurance task (i.e. alateral isometric hold test on a 45degrees roman chair apparatus) and determine which primary trunkmuscles get fatigued during this task. It was hypothesized that the ipsilateral external obliqueand lumbar erector spinae muscles will exhibit the highest fatigue indices.
Methods:
Twenty-two healthy subjects participated in this study. The experimental session included leftand right lateral isometric hold tasks preceded and followed by 3 maximal voluntarycontractions in the same position. Surface electromyography (EMG) recordings wereobtained bilaterally from the external oblique, rectus abdominis, and L2 and L5 erectorspinae. Statistical analysis were conducted to compare the right and left maximal voluntarycontractions (MVC), surface EMG activities, right vs. left holding times and decay rate of themedian frequency as the percent change from the initial value (NMFslope).
Results:
No significant left and right lateral isometric hold tests differences were observed neither forholding times (97.2 +/- 21.5 sec and 96.7 +/- 24.9 sec respectively) nor for pre and post fatigueroot mean square during MVCs. However, participants showed significant decreases ofMVCs between pre and post fatigue measurements for both the left and right lateral isometrichold tests. Statistical analysis showed that a significantly NMFslope of the ipsilateral externaloblique during both conditions, and a NMFslope of the contralateral L5 erector spinae duringthe left lateral isometric hold test were steeper than those of the other side's respectivemuscles. Although some participants presented positive NMFslope for some muscles, eachmuscle presented a mean negative NMFslope significantly different from 0.
Conclusions:
Although the fatigue indices suggest that the ipsilateral external oblique and contralateral L5erector spinae show signs of muscle fatigue, this task seems to recruit a large group of trunkmuscles. Clinicians should not view this task as evaluating specifically lateral trunk flexors,but rather as providing an indication of the general endurance and stabilisation capacity of thetrunk.
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Pain in the three spinal regions: the same disorder? data from a population-based sample of 34,902 Danish adults
Background:
Studies of back pain are typically based on the assumption that symptoms from different parts of the spine are distinctive entities. Recently, however, the assumption that back pain is a site-specific disorder has been challenged, suggesting that localized back pain should be seen as part of a general musculoskeletal syndrome.ObjectivesTo describe and compare the patterns of reporting of pain and consequences of pain in the three spinal regions.
Methods:
In all, 34,902 (74%) twin individuals representative of the general Danish population, aged 20 to 71, participated in a cross-sectional nation-wide survey. Identical questions from the Standardised Nordic Questionnaire for each of the three spinal regions were used for lumbar, mid-back and neck pain respectively: Pain past year, pain ever, radiating pain, and consequences of back pain (care-seeking, reduced physical activities, sick-leave, change of work/work duties and disability pension). The relative prevalence estimates of these variables were compared for the three spinal regions.
Results:
The relative proportions of individuals with pain ever, who also reported to have had pain in the past year varied between 75% and 80%, for the three spinal regions. The proportions of individuals with pain in the past year and for various pain durations were also very similar. Regardless if pain was reported in the lumbar, thoracic or cervical regions, the proportions of individuals reporting radiating pain were equally large. The relative number of consequences was the same across the spinal regions, as were the relative proportions of each these consequences. However, low back pain resulted more often in some kind of consequence compared to the consequences of pain in the neck and mid back.
Conclusions:
Back pain and its consequences share many characteristics and may, at least in a general population, be regarded as the same condition regardless of where the pain happens to manifest itself. However, because some exceptions were noted for the lumbar spine, separate entities for a smaller group of individuals with back pain cannot be ruled out.
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A descriptive study of chiropractors' opinions and practices regarding office-based health product sales
Background:
Although the sale of non-prescription health products is ubiquitous, the views of health professionals, such as chiropractors, regarding the sale of such products are not well known. Practitioner opinion is important to understand and inform professional practice. The purpose of this study was to describe chiropractors' perspectives and practices on the sale of health care products from practitioners' offices.
Methods:
Chiropractors were invited to provide written comments about health product sales at the end of a fixed choice, mailed survey. Respondents' comments were analyzed using qualitative description. Ethics approval was received from the Conjoint Health Research Ethics Board at the University of Calgary.
Results:
One hundred seven of the 265 respondents (response rate of 51%) provided written comments. Approximately 30 pages of double-spaced, typed text were gathered. Respondents did not consistently endorse or condemn health product sales, and engaged in the practice to greater and lesser extents. While some were opposed to health products sales, some accepted the practice with a degree of ambivalence whereas others clearly embraced it. Some respondents acknowledged a professional conflict of interest in such sales and marketing, and described strategies used to mitigate it. Others provided a range of justifications for the practice. Personal integrity and professional standards were discussed and a need for monitoring identified.
Conclusions:
A wide range of opinions and practices were described and this is consistent with resulting variation in practice. In light of this, standards that facilitate consistency in practice may benefit professionals and the public alike.
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Absence of low back pain in patients followed weekly over one year with automated text messages
Background:
In order to define the onset of a new episode of low back pain (LBP), the definition of a "non-episode" must be clear. De Vet et al reviewed the scientific literature but found no evidence-based definitions of episodes or non-episodes of LBP. However, they suggested that pain-based episodes should be preceded and followed by a period of at least one month without LBP. As LBP is an episodic disease, it is not clear whether a sufficient number of patients with LBP will be LBP-free for at least one month ("non-episode") to justify the use of this duration in the definition of pain free episode.ObjectivesTwo clinical populations were followed weekly over one year making it possible 1) to determine the maximum numbers in a row of weeks without LBP, 2) to determine the prevalence of non-episodes throughout a one-year period, and 3) to find the prevalence of patients who reported to be in a non-episode of LBP at the end of the study.
Methods:
Secondary data were used from two recent clinical studies, in which weekly automated text messages (SMSes) had been collected on the number of days with LBP in the preceding week for one year. Weeks with 0 days of LBP were defined as "zero-weeks" and four zero-weeks in a row were defined as a period without LBP (a"non-episode") according to de Vet et al's suggestion. The study participants, all from the secondary care sector, consisted of: study 1) patients with LBP and Magnetic Resonance Imaging-identified Modic changes and study 2) patients without obvious acute disc problems, Modic changes or other pathologies, who therefore were assumed to have non-specific LBP. Both studies were two-armed intervention studies without a significant difference in outcome between intervention groups. The number of zero-weeks was identified in each participant. Thereafter the numbers of participants who reported at least one non-episode during the study period were identified. Finally, the numbers of participants who had a non-episode at the end of the study were counted. Estimates are reported with their 95% confidence intervals.
Results:
The numbers of participants included in the analyses were 80 and 209. Most commonly, no zero weeks were reported, by 65% (95% CI:55-75) and 56% (95% CI:49-63) of patients, respectively. The percentages of study participants with at least one non-episode at some time during the course of the study were 20% (95% CI:11-29) and 18% (95% CI: 15-21). The percentages of participants who were identified as being in a non-episode at the time of the last week of the study were 5% (95% CI: 0-10) and 4% (95% CI: 1-7) respectively.
Conclusions:
The vast majority of these secondary care sector patients had a profile of more or less constant LBP. The estimates for non-episodes during the study period and at the end of the study were very similar for participants with LBP who also had Modic changes and those with non-specific LBP. It is possible that a definition of pain-free periods is pointless in patients seeking care in the secondary care sector.
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Adverse events from spinal manipulation in the pregnant and postpartum periods: a critical review of the literature
Background:
The safety of spinal manipulation during pregnancy and the postpartum periods has been a matter of debate among manual therapists. Spinal manipulative therapy during these periods is a commonly performed intervention as musculoskeletal pain is common in these patients. To date there has not been an evaluation of the literature on this topic exclusively.
Methods:
A literature search was conducted on PubMed, CINAHL and the Index to Chiropractic Literature along with reference searching for articles published in English and French in the peer-reviewed literature that documented adverse effects of spinal manipulation during either pregnancy or postpartum. Case reports, case series, and any other clinical study designs were deemed acceptable for inclusion, as were systematic reviews. The appropriate Scottish Intercollegiate Guidelines Network (SIGN) tools were used to rate included articles for quality when applicable.
Results:
Five articles identifying adverse events in seven subjects following spinal manipulation were included in this review, along with two systematic reviews. The articles were published between 1978 and 2009. Two articles describing adverse effects from spinal manipulation on two postpartum patients were included, while the remaining three articles on five patients with adverse effects following spinal manipulation were on pregnant patients. Injury severity ranged from minor injury such as increasing pain after treatment that resolved within a few days to more severe injuries including fracture, stroke, and epidural hematoma. SIGN scores of the prospective observational cohort study and systematic reviews indicated acceptable quality.
Conclusions:
There are only a few reported cases of adverse events following spinal manipulation during pregnancy and the postpartum period identified in the literature. While improved reporting of such events is required in the future, it may be that such injuries are relatively rare.
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A randomized, placebo-controlled double-blinded comparative clinical study of five over-the-counter non-pharmacological topical analgesics for myofascial pain: single session findings
ObjectivesTo investigate the effects of topical agents for the treatment of Myofascial Pain Syndrome (MPS) and Myofascial Trigger Point (MTRP).
Methods:
Subjects with an identifiable trigger point in the trapezius muscle, age 18-80 were recruited for a single-session randomized, placebo-blinded clinical study. Baseline measurements of trapezius muscle pressure pain threshold (PPT: by pressure algometer) along with right and left cervical lateral flexion (rangiometer) were obtained by a blinded examiner. An assessor blinded to the outcomes assessments applied one of 6 topical formulations which had been placed in identical plastic containers. Five of these topicals were proposed active formulations; the control group was given a non-active formulation (PLA). Five minutes after the application of the formula the outcome measures were re-tested. Data were analyzed with a 5-way ANOVA and Holms-adjusted t-tests with an alpha level of 0.05.
Results:
120 subjects were entered into the study (63 females; ages 16-82); 20 subjects randomly allocated into each group. The pre- and post-treatment results for pressure threshold did show significant intra-group increases for the Ben-Gay Ultra Strength Muscle Pain Ointment (BG), the Professional Therapy MuscleCare Roll-on (PTMC roll-on) and Motion Medicine Cream (MM) with an increased threshold of 0.5 kg/cm2 (+/-0.15), 0.72 kg/cm2 (+/-0.17) and 0.47 Kg/cm2 (+/-0.19) respectively. With respect to the inter-group comparisons, PTMC roll-on showed significant increases in pressure threshold compared with Placebo (PLA) (p = 0.002) and Icy Hot Extra Strength Cream (IH) (p = 0.006). In addition, BG demonstrated significant increases in pressure threshold compared with PLA (p = 0.0003).
Conclusions:
With regards to pressure threshold, PTMC roll-on, BG and MM showed significant increases in pain threshold tolerance after a short-term application on a trigger points located in the trapezius muscle. PTMC roll-on and BG were both shown to be superior vs placebo while PTMC was also shown to be superior to IH in patients with trigger points located in the trapezius muscle on a single application.CMCC Research Ethics Board Approval # 1012X01, 2011
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Clinical decision-making to facilitate appropriate patient management in chiropractic practice: 'the 3-questions model'
Background:
A definitive diagnosis in chiropractic clinical practice is frequently elusive, yet decisions around management are still necessary. Often, a clinical impression is made after the exclusion of serious illness or injury, and care provided within the context of diagnostic uncertainty. Rather than focussing on labelling the condition, the clinician may choose to develop a defendable management plan since the response to treatment often clarifies the diagnosis.DiscussionThis paper explores the concept and elements of defensive problem-solving practice, with a view to developing a model of agile, pragmatic decision-making amenable to real-world application. A theoretical framework that reflects the elements of this approach will be offered in order to validate the potential of a so called '3-Questions Model';SummaryClinical decision-making is considered to be a key characteristic of any modern healthcare practitioner. It is, thus, prudent for chiropractors to re-visit the concept of defensible practice with a view to facilitate capable clinical decision-making and competent patient examination skills. In turn, the perception of competence and trustworthiness of chiropractors within the wider healthcare community helps integration of chiropractic services into broader healthcare settings.
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Pain originating from the sacroiliac joint is a common non-traumatic musculoskeletal complaint in elite inline-speedskaters - an observational study
Study designObservational studyObjectivesTo investigate common non-traumatic musculoskeletal complaints of the low back in elite inline-speedskaters of the German national team.Summary of background dataTraumatic injuries associated with falls or collisions are well documented in speedskaters but so far no studies have investigated non-traumatic low back pain. Previously, the sacroiliac joint was suspected as a frequent origin of complaint, we aimed to investigate this assumption.
Methods:
Two chiropractors examined elite inline-speedskaters of the German national team during three sports events between summer 2010 and 2011. A test cluster of five provocative tests for the sacroiliac joint was selected based on reliability and validity.
Results:
A total of 37 examinations were conducted on 34 athletes with low back pain during the three sport events. The reported pain intensities ranged from mild to moderate pain (VAS 23.4 ± 13.4 to 35.1 ± 19.2). About 90% of cases showed involvement of the SI joint of which again 90% presented with left sided symptoms.
Conclusions:
Non-traumatic complaints of the low back originating from the left sacroiliac joint frequently occur in competitive inline speedskaters.
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Burnout among chiropractic practitioners: real or imagined. An exploratory study protocol.
Burnout is a psychological syndrome of emotional exhaustion, depersonalization and reduced personal accomplishment that has been found to exist in a significant number of healthcare and helping professionals. It imposes a significant societal burden by shortened practitioner lifespan, decreased efficiency, negative health outcomes and poorer levels of patient care. Theoretical models suggest that it appears to be the result of a complex interaction between job resources and job demands. It may be reasonable to conclude that Chiropractic professionals experience similar vocational demands and thus experience significant levels of occupational stress and subsequent burnout. However the data on burnout within the chiropractic profession is limited. It is possible that this results in significant negative outcomes on chiropractors and their patients. Therefore, the objective of this paper is to demonstrate the need to explore burnout in chiropractic practice and offer a research protocol for a potential study.
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[R-DO.org]
