Points to consider when writing to the CARE Guidelines for Case Reports
Abstract: Case Reports have high evidential value. The greatest evidence is where reports are written in accord with these CARE Guidelines. This paper sets out the guidelines to follow.
Indexing Terms: Case reports, CARE Guidelines, chiropractic, evidence
Cite: Doyle M. Points to consider when writing to the CARE Guidelines for Case Reports. Asia-Pac Chiropr J. 2021;1.3:Online only. URL www.apcj.net/doyle-care-checklist-for-case-reports/
Chiropractic care of paediatric non-musculoskeletal conditions: A retrospective patient survey.
Abstract: This paper attempts to facilitate a glimpse into a chiropractic clinical practitioner’s office where non-musculoskeletal conditions are routinely being treated.
Methods: As standard practice of this office an active group of paediatric patients (2000-07) were (n=127) sent a questionnaire via the mail. For the purposes of this retrospective patient survey children treated for non-musculoskeletal symptoms (n=37) out of those who responded to the questionnaire were used for this survey. All paediatric patients were treated by the same clinician utilising sacro occipital technique and cranial paediatric treatments.
Results: 65/127 parents responded from our standard follow up outreach and 37/65 were treated for non-musculoskeletal presentations. Of the 37 (17?, 20?) non-musculoskeletal paediatric patients, five were treated for immune dysfunction, seven for developmental delays/dysfunction, nine for birth trauma, one for seizure activity, four for learning problems, three for endocrine problems, three for migraines, two gastrointestinal issues, two for fussiness/agitated/anxiety, and one for enuresis.
Discussion: Developing a paediatric chiropractic evidence base for practicing doctors should start with expanding the doctor’s knowledge of paediatric diagnosis and treatment options.
Conclusion: To build a representative evidence base it is essential that research into chiropractic treatment of non-musculoskeletal conditions incorporates successful chiropractic clinical practices treating this subset of paediatric patient.
Indexing Terms: Paediatric care, chiropractic, sacro-occipital technique, cranial technique, non-musculoskeletal conditions.
Cite: Rosen MG, Blum C. Chiropractic Care of paediatric non-musculoskeletal conditions: A retrospective patient survey. Asia-Pac Chiropr J. 2021;1.3:Online only. URL www.apcj.net/rosen-and-blum-paediatric-non-msk-conditions/
The fixation element of the articular subluxation: More than a vertebral dysfunction. Part 1 of a series.
Abstract: This narrative review examines the limited and varied interpretation of what constitutes evidence in evidence based chiropractic practice. The authors report a bias towards only one of the three evidential The majority of spinal motion studies appear to focus on the anterior vertebral motor unit. This paper discusses the vertebral subluxation (VS) element of segmental dysfunction within a facet’s centrode in relation to mechanical articular fixation along the path of instantaneous axes of motion. In effect, there would be three segmental axes of motion, one through the vertebral body, and two within each zygapophyseal joint. Discussion is offered here on the loss of facet joint motion identified as a vertebral fixation as being but one of a complex of factors comprising a vertebral subluxation (VS). It is appreciated that a change in segmental motion such as a vertebral fixation would affect all axes. It is generally accepted that mechanically, a vertebra may be fully fixated (locking), partially fixated, or subject to aberrant (erratic) motion. There is also a classification of a hypermobile subluxation – a condition not addressed in this dissertation. In essence, a VS may comprise varying degrees of dysfunction, displacement and somatosensory activation. It is seen here as a more complex consideration than just a minor mechanical disturbance. Lineal displacement and rotation may vary considerably depending on the spinal region. Somato-autonomic stimulation may be initiated by activated somatosensory sensations such as nociceptors, mechanoreceptors and proprioceptors. As noted by the World Health Organisation (WHO) definition, there are three main elements in the chiropractic model of a vertebral subluxation. This discussion is presented to explore the pathophysiological fixation element of the dysfunction in the segmental subluxation. It may be regarded as a relatively common form of dysfunction attended by chiropractors and others. The fixation has been adopted elsewhere under such synonyms as blockage, dysfunction, locking and blockade. Theories regarding the biological mechanism of a fixation are discussed and our preferred hypothesis of negative pressure (suction or adhesiveness) resulting in contraction of the articulating surfaces.
Indexing terms: Vertebral subluxation, Facet fixation, Segmental fixation, Vertebral subluxation complex (VSC).
Cite: Rome P. Waterhouse JD. The fixation element of the articular subluxation: More than a vertebral dysfunction. Part 1 of a series. Asia-Pacific Chiropr J. 2021;1.3. URL www.apcj.net/rome-and-waterhou...
Investigating the idea that spinal manipulative therapy can affect the patient beyond muscle and joint pain: A systematic narrative review.
Abstract: Chiropractors are primary care providers for spinal and musculoskeletal conditions. Current literature recognises the evidence for benefits of common musculoskeletal complaints including back and neck pain, a minority of patient visits are non-musculoskeletal in nature. The hypothesis that spinal manipulative therapy does have an effect on the patient beyond muscle and joint pain is a claim that has been scrutinised inside and outside the profession possibly due to the absence of high level evidence to support those claims. Electronic databases were searched using Mesh terms and selection criteria was met. The search yielded 23 papers, the literature was evaluated using selective critical appraisal tools. Of those, ten were randomised controlled trials, nine were systematic reviews, one was a cohort study and three were surveys. Four papers were evaluated as no evidence, 14 were evaluated as inconclusive, four papers had conclusive evidence and there was a moderate to low range of bias across all papers. The claim that SMT can affect the patient beyond muscle and joint pain cannot be substantiated due to the methodological bias and inconclusive evidence of the current literature. Improvements for future evidence quality may increase with better objective outcome measures, specified topics of research, double-blinding in randomised controlled trials and more controlled cohort studies to improve reproducibility.
Indexing Terms: Spinal manipulative therapy, non-musculoskeletal, evidence, chiropractic
Cite: McDowall C-A. Evidence that may support the claim that spinal manipulative therapy can affect the patient beyond muscle and joint pain: A systematic narrative review. Asia-Pac Chiropr J. 2021;1.3.URL apcj.net/mcdowall-review/
Differentiating chiropractic articular adjustments from manipulation: Part 2 of a series.
Abstract: Without greater differentiation, the authors contend that it is misleading to consider that all forms of manual therapy should be categorised under the one single term of manipulation. This paper seeks to clarify differences in the forms of manipulation, in particular, the intricacy, erudition and complex considerations of the vertebral adjustment. The extent of concentrated undergraduate training and depth of physiological recognition of the adjustment is portrayed in order to acknowledge that adjustments are more complex by involving integrated elements of somatosensory and somato-autonomic implications rather than just physical- mechanical procedures.
Indexing terms: Articular adjustment, Vertebral adjustment, Manipulation, Spinal manipulation, Technique.
Cite: Rome P. Waterhouse JD. Differentiating chiropractic articular adjustments from manipulation: Part 2 of a series. Asia-Pacific Chiropr J. 2021;1.3. URL www.apcj.net/rome-and-waterhouse-differentiating-the-adjustment/
The Baby Jesus Rule (You can't always get what you want)
If you still get no satisfaction,
Harken the Rolling Stones who carol their advice:
‘You can't always get what you want,
But if you try
Sometimes you find
You get what you need.’
So, if the King of Kings
was content with just three,
that’s all you need
under your Christmas tree.
Cite: Smith JC. The Baby Jesus rule [Column]. Asia-Pac Chiropr J. 2021;1.3. URL www.apcj.net/jc-smith-the-baby-jesus-rule/
A review of considerations regarding audible articular cavitation: Part 3 of a series.
Abstract: The biomechanical release of the articular fixation element of a vertebral subluxation is often signified by an audible cavitation. While some minor cavitation may occur with non-specific forms of finger manipulation, it has been shown that a manual adjustment results in audible cavitation which can activate sensory and autonomic reflexes. However, more recent research indicates that the audible cracking sound is not related to the collapse of intra-articular gas bubble. This review discusses aspects of the articular audible cavitation of the previously researched metacarpophalangeal (MCP) joints under distraction, as compared to cavitation of a vertebral facet fixation noted during a segmental adjustment. It is suggested that these procedures may be quite different mechanisms. The mechanism of the origin of audible cavitation has been the subject of a range of theories over the years. Its timing in relation to a gas cavitation and separation of facet joint surfaces is still subject to clarification following recent research. Due to technological constraints, the speed of the audible release and the cavity formation, the specific timing has yet to be conclusively demonstrated. Future research may focus on suction separation of the facet interface, and particularly of vertebral facets in preference to research done with metacarpophalangeal articulations.
Indexing terms: Cavitation, Audible cavitation, Articular release.
Cite: Rome P. Waterhouse JD. A review of considerations regarding audible articular cavitation: Part 3 of a series. Asia-Pacific Chiropr J. 2021;1.3. URL www.apcj.net/rome-and-waterhouse-cavitation-considerations/
Mind, trauma & muscle inhibition Part II: When muscle inhibition is not ignored. Evidence of effectiveness from the NBA
Abstract: Part I of this series experimentally validated a hypothesis that muscle inhibition (the ongoing weakness of individual muscles clinically revealed through manual muscle testing) is sustained by trauma-induced maladaptive learning; a muscular form of PTSD (mPTSD). It demonstrated that about 90% of inhibited muscles would immediately strengthen, and 80% would remain strong over a period of weeks, when treated only with side-to-side eye movements, a part of EMDR, an accepted intervention for PTSD. This therapy has been theorised to gain its effects by interrupting reconsolidation (re-storage) of activated (recalled) and therefore destabilised memories.
Currently, muscle inhibition is ignored and considered untreatable in most musculoskeletal specialties. The chiropractic subspecialty of Applied Kinesiology however, has been reversing muscle weakness for over 50 years, but because of a dearth of reporting and studies of the treatment, it has gone unnoticed in most muscle inhibition literature. A 20 plus-year ‘demonstration’ of correction of muscle inhibition in the NBA has left statistical and other evidence suggesting what is possible when the condition is routinely treated. Particularly striking is the finding that when treated immediately, mild to moderate sprain-strain injuries can recover in minutes, not weeks, putting into question universal assumptions we hold about the nature of tissue damage in injuries.
Indexing Terms: Muscle inhibition, PTSD, chiropractic, theory, NBA, Applied Kinesiology.
Cite: Weissfeld R. Mind, trauma & muscle inhibition Part II: When muscle inhibition is not ignored. Evidence of effectiveness from the NBA. Asia-Pac Chiropr J. 2021;1.3. URL www.apcj.net/weissfeld-hypothesis-mptsd-part-2/