Archive for year: 2015

Anoop Balachandran MSc (ex):

“Why should mechanical stress caused by “faulty movement patterns” always “lead to microtrauma & injury” as proposed by systems like FMS? Why can’t tissues just positively adapt and get stronger just like a normal biological tissue? IF indeed faulty movement patterns were the cause of injury, all those cerebral palsy patients, stroke victims, neurologic disorders and amputees (who run faster than most of us) should be in complete pain. Many double amputees have no particular pain. The compensations and asymmetries are 100% in these amputees and though we think they should be crying out loud in pain they continue to run around. Maybe that movement pattern is “ideal” for them and their tissues have simply adapted to it”. 

And on spinal stenosis and Degeneration (MRI diagnosis):

• Haig AJ et al. Spinal stenosis, back pain, or no symptom at all. Arch of PT med & rehab Jul;87 2006

• Brinjiki W et al. Systematic review of imaging features of spinal degeneration in asymptomatic populations. JNeuroradiol Apr;36(4) 2015

1. The radiologic and clinical assessment of 150 patients found NO correlation between patient evaluation and MRI findings. The impression obtained from an MRI scan does not determine whether stenosis is a cause of pain. Since MRI does in fact identify narrowing of the spinal canal, and this has been the whole basis of diagnosing stenosis with MRI, these results also strongly imply that a narrowed spinal canal does not (alone) cause the pain.
2. MRI findings of spine degeneration are present in high proportions of asymptomatic individuals, increasing with age. Many imaging-based degenerative features are likely part of normal aging and unassociated with pain.

About 50% of all adults have been to a Chiropractor.

14% have been in the last year, 12% in last (5) years.

65% of adults (18-34) have never been to a Chiropractor.

50% of adults have a positive view of Chiropractic.

50% “agree” or “somewhat agree” that DC’s are effective at treating neck or back pain.

25% of adults “agree” or “strongly agree” chiropractic is dangerous.

47% who have not been to a Chiropractor see it as dangerous.

Among the 51% who have never been to a Chiropractor uncertainly of COST, number of VISITS and EDUCATION represent barriers to use.

46% seeing a DC in the last 5 year said they would utilize it more often if it weren’t so expensive.

43% of Americans believe Chiropractic care is too expensive.

44% believe it requires too many visits.

50% do not know if their insurance covers the care.

Cameron’s book on physical agents for rehabilitation echo’s many of the tried & true clinical suggestions that I and others in the ‘decompression industry’ also recommend.  

“Optimal patient positioning: try to achieve a comfortable position allowing and muscle tension to relax, allowing separation of the vertebra. The relative degree of flexion or extension can determine which surfaces are most effectively separated. The flexion position can result in greater posterior separation, the extended in more anterior and the neutral in a centralized effect. Unilateral symptoms can be addressed with the force being offset more to one side”.

“For most application prone or supine is chosen. Though supine may be more common Prone positioning is most advantageous if flexion is a problem OR if the symptoms are helped or reduced by extension. Greater lumbar paraspinal muscle relaxation and less EMG activity have been reported with the Prone posture vs. supine. Clinically, symptoms of discal origin are also most reduced in the prone position”.

“The split-table reduces the amount of traction force lost to ’friction’. Initially the table should remain locked so it doesn’t move as the patient moves into ideal ‘treatment-position’. The sections should then be slowly unlocked to control the speed at which the subsequent force is applied”.

“Many MDs have relied heavily on the American Academy of Family Physicians for continuing medical education via the American Family Physician and the AAFP home study programs. The AAFP prides itself on its evidence-based approach to medicine. In general, it delivers. But the recent FP Essentials Number 432 on “Chronic Pain Management” fell short. It recommended treating chronic pain with acupuncture, chiropractic, touch therapy, and S-adenosyl methionine (SAM-e), presenting them in a way that misled readers into thinking that the recommendations were based on good scientific evidence. They were not”.

“With 6,500 peer reviewed journals and over two million papers published every year, it is easy to find a study to support pretty much any point of view. John Ioannidis taught us that most published research findings are false, with preliminary studies frequently being overturned by larger, better follow-up studies (see Cochran collaboration). When evaluating the evidence for a treatment, it is not enough to find one or two positive studies. It is essential to also look for negative studies and for systematic analyses that weigh all the published evidence, and to put all the available evidence into perspective. The authors failed to do that”.  Yepper!

Several studies conclude the odds of the SI joint being directly involved in cLBP is from 5-15%; its contribution in acute pain is nebulous. Orthopedic tests create an odds ratio of about 75% for SI involvement if several (4 of 5) of the assessment tests are positive. Conversely if 4 of 5 are negative an equal odds ratio exists. Recently a few studies now suggest the thigh thrust and sacral compression may be the most pertinent. Mcgill also describes an oscillation/rebound test created by the vertical fist placed under the sacral base being rapidly closed…thus creating a ‘bounce’ and a mild irritation to the structures.

The thigh thrust is designed as an SI assessment. The supine patients’ thigh and knee are bent to 90 degrees and the testers hand is positioned on the sacral base. A vertical transmission of force through the thigh via the clinicians body stresses the joint and tissues. Pain in the SI is a positive test. The torsion effect puts stress on the soft tissue structures of the SI. It is possible that reproduction of symptoms for the patient in areas commonly referred to by the SI joint may also indicate a positive result. The Thigh Thrust has shown specificity of up to 92% in 3 systematic reviews and sensitivity of 80-96%.