Further consideration for Stabilization & consistent ATM2 training?

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The Effects of Low-Load Motor Control Exercises and a High-Load Lifting Exercise on Lumbar Multifidus Thickness-A Randomized Controlled Trial.

Spine (Phila Pa 1976). 2016 Nov 18.

Berglund L1, Aasa B, Michaelson P, Aasa U.

STUDY DESIGN:

The aim of this study was to compare the effects of low-load motor control exercises and a high-load lifting exercise, on lumbar multifidus (LM) thickness on either side of the spine and whether the effects are affected by mechanical LBP.

SUMMARY:

There is evidence that patients with low back pain may have a decreased size of the (LM) muscles with an asymmetry between sides in the lower back. It has also been shown that low-load motor control training can affect this asymmetry. It is, however, not known whether a high-load exercise has the same effect.

CONCLUSIONS:

There was a difference in thickness of the LM muscles between sides. It seems that exercises focusing on spinal alignment may increase the thickness of the LM muscles on the small side, irrespective of exercise load. The increase in LM thickness does not appear to be mediated by either current pain intensity or the magnitude of change in pain intensity.

Risk of Carotid Stroke after Chiropractic Care: A Population-Based Case-Crossover Study.

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 J Stroke Cerebrovasc Dis. 2016 Nov 21. pii: S1052-3057(16)30434-7. doi: 10.1016/j.jstrokecerebrovasdis.2016.10.031.

Cassidy JD1, Boyle E2, Côté P3, Hogg-Johnson S4, Bondy SJ5, Haldeman S6.

BACKGROUND:

Chiropractic manipulation is a popular treatment for neck pain and headache, but may increase the risk of cervical artery dissection and stroke. Patients with carotid artery dissection can present with neck pain and/or headache before experiencing a stroke. These are common symptoms seen by both chiropractors and primary care physicians (PCPs). We aimed to assess the risk of carotid artery stroke after chiropractic care by comparing association between chiropractic and PCP visits and subsequent stroke.

METHODS: 

A population-based, case-crossover study was undertaken in Ontario, Canada. All incident cases of carotid artery stroke admitted to hospitals over a 9-year period were identified. Cases served as their own controls. Exposures to chiropractic and PCP services were determined from health billing records.

RESULTS: 

We compared 15,523 cases to 62,092 control periods using exposure windows of 1, 3, 7, and 14 days prior to the stroke. Positive associations were found for both chiropractic and PCP visits and subsequent stroke in patients less than 45 years of age. These associations tended to increase when analyses were limited to visits for neck pain and headache-related diagnoses. There was no significant difference between chiropractic and PCP risk estimates. We found no association between chiropractic visits and stroke in those 45 years of age or older.

CONCLUSIONS:

We found no excess risk of carotid artery stroke after chiropractic care. Associations between chiropractic and PCP visits and stroke were similar and likely due to patients with early dissection-related symptoms seeking care prior to developing their strokes.

ATI’s and non-celiac gluten sensitivity

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The study investigated a relationship between the presence of chronic health conditions outside the bowel and the contribution of a family of protiens found in wheat called amylase-trypsin inhibitors(ATI’s). ATI’s make up about 4% of wheat protiens.
Past studies focused on Gluten and its effects on digestive health this research casts a light on the effects ATIs may play in chronic health conditions such as RS, MS, asthma and others.
The type of “gut inflammation” seen in non-celiac chronic gluten sensitivity differs from that of celiac disease and they don’t believe its triggered by gluten protiens. “We demonstrated that ATI’s from wheat, that are also contaminating commercial gluten, activate specific types of immune cells in the gut and other tissues, potentially worsening the symptoms of pre-existing inflammatory illnesses”.

Maybe there is something to the sedulous chatter regarding: “I feel so much better not eating wheat…but my doctor tells me its all in my head because I don’t have celiac disease”…..

Relationship between Active Trigger Points and head/neck posture and migraine.

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Ferracini GN et al Am J Phys Med Rehab. Nov;95 2016.

The study investigated a relationship between the presence of active trigger points (TrPs) craniocervical posture and clinical features in patients with migraine. Patient postural assessments and radiographs were analyzed for head and neck posture. The results showed patients with migraine had active or latent TrPs in all muscles. The suboccipital, upper trapezius, SCM and temporalis muscles are the most affected. There is a relationship between the number of active TrPs and x-ray assessment particularly loss of cervical lordosis. This study also demonstrated no association between the number of active TrPs and the clinical features of migraine. However there appears to be an association with reduced lordosis and head extension.

Lumbar disc herniation and cauda equine syndrome following spinal manipulative therapy.

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Boucher P, Robidoux S. J Forensic Legal Med. Feb. 2014.

This interesting review of (6) Canadian court cases where Chiropractors were sued for allegedly causing a lumbar disc herniation after spinal manipulation. The highlights of the cases were:
1. Informed consent is an ongoing process and can’t be entirely delegated to office personnel.
2. When patient history reveals risk factors for lumbar herniation the DC has a duty to rule out disc pathology as an etiology for the symptoms before beginning anything but palliative treatments.
3. Lumbar disc herniation may be triggered by spinal manipulation on vertebral segments distant from the involved disc…such as the thoracic spine.

Diagnosiing discogenic LBP associated with DDD using a medical interview.

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Tonosu J et al PLoS One Nov. 2016.

This research project sought to find the specificity and sensitivity of a series of (5) clinician questions associated with disc-related back pain whose responses may indicate a likelihood of discogenic pain.
These constitute a support-tool from which clinicians can better assess the target-area generating the patients’ symptoms:
1. Experience pain after prolonged sitting?
2. Pain standing-after-sitting?
3. Squirming in a chair after sitting too long?
4. Pain ‘washing one’s face’ while standing over a sink?
5. Pain standing in sustained flexion?
The researchers found these questions pertinent to determine discogenic pain compared to a control group. The sensitivity reached 100% with specificity at 72%. Their conclusion was these (5) questions were a useful support tool for diagnosis discogenic LBP. As with our classification-analysis (which includes most of these questions) enough research has been performed to draw reasonable assumptions as to disc-related pain vs, “other”.

The effects of strength exercise & walking on lumbar function, pain-level & body-composition in cLBP.

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Jung-Seok, L et al. J Exerc Rehab Oct. 2016.

The benefits of strength exercise plus walking was found to be more effective for overweight cLBP patients vs. just strength training. The exercise was performed twice a week, 50 mins per session for 12 weeks. All variables were improved but the fat-loss and pain levels were more improved by the addition of strength-training plus walking.
This study further supports the suggestion that if we are using rehab in our clinics, 2-4 months of 2-3x per week sessions is both reasonable and clinically expedient for all of the variables which constitute successful outcomes.