Archive for category: KDT Blog

Gianola S et al Phys Ther 2016

An interesting and imperative study especially pertinent to those who ‘study studies’ regularly. The authors note that less than 1/5th of studies on rehabilitation of LBP would be “replicable clinically”.
The percent of studies providing full essential information on interventions was 14% thru 1980 and only 20% thru 2010.
Their conclusion:
“Despite remarkable energy spent producing RCTs in LBP rehab the majority failed to report sufficient information allowing the intervention to be replicated in clinical practice”.

Comment: for years we have echoed this finding that “physical interventions” are often only tacitly defined and modalities either distinct manufacturers (thus “suggesting” like results may require this equipment) or description of vague protocols.
This bias was replete in the development of spinal decompression thru the early 2000’s. Vax D famously though unconvincingly suggested “their research was only applicable to their device”.

Does IV range-of-motion increase after spinal manipulation? A prospective cohort study. 

Branney J et al Chiropractic and Manual therapies 2014

Conclusions: “The study found NO differences in cervical IV-ROM between non-specific neck pain patients and matched controls. There was a modest dose-response relationship between the number of manipulations given and number of levels increasing IV-RoM, suggesting manipulation may have a mechanical effect at segmental levels. However patient-reported outcomes were NOT related to this”.

Discussion: The prevalence of both hypo-mobile and paradoxical segments was also subject to considerable intra-subject variation. 4 of 22 hypo-mobile segments remained so at follow-up with 8 new hypo-mobile segments detected. Only 8 out of 25 paradoxical segments remained so at follow-up with 4 new levels detected.

Hypo-mobility is commonly considered an indication for manipulation. Due to the changing nature of these motion-features….hypo-mobility or paradoxical motion in response to manipulation may not be possible or meaningful.

Crazy traumatic cervical injury….asymptomatic (excepting mild stiffness & torticollis) without neurological signs or symptoms. Surgery WAS done but entrance findings were minimal without clear indicators of “what lies beneath“.

Not sure what it means….but radiographs after trauma may not be a frivolous idea.

Chiroprac Man Ther May 2016.

This Australian study with 140+ patients was based on determining whether manipulation or Graston technique had a discernible benefit vs. placebo (nothing) in a randomized controlled setting. The conclusions not surprisingly showed no benefit at “any time point” vs placebo for thoracic spine pain. It was noted this was the first RCT of its kind comparing manipulation and Graston for TSP.

There were no differences noted at 1-3-6 or 12 months however ALL groups tended to improve over time (natural regression) including placebo-control group.

Studies which are well-controlled to reduce bias suggest manipulation has limited effects (long term) on pain or underlying pain generating mechanisms. A recent Cochrane systematic review of over 200 studies concluded: “spinal manipulation offered no benefit beyond that of any other standard treatment or no particular treatment. Further, given the common minor adverse side effects and potential for random catastrophic outcomes spinal manipulation cannot be recommended for treatment of any known condition”.

Fortunately these reviews, though seen by insurers and researches tend not to be accessed by the general public and their impact appears to be mitigated by the overall acceptance and enthusiasm manipulation enjoys. 

It should however make every DC aware that, though we tell ourselves otherwise, much of what we do is not proven or based in substantial scientific outcome-evidence.

Having a strong working knowledge of rehab (e.g. McGill etc) is a necessity when competing with PTs and evidenced-based medical rehab centers.

Man  Ther  Jun; 2016

This interesting study (secondary analysis of a RCT) assessed whether DP guided management (10 sessions with a PT) and advice was more effective than advice alone (2 sessions) in a group of patients with back & leg pain.
The conclusion suggests those with reducible disc lesions are helped more thru 10-weeks of DP exercise than with advice alone. 

These results however were not sustained and though pain-relief was noted thru 10weeks there were no differences in ‘activity limitations’ or between groups when assessed at long-term follow up. So it was effective in giving rapid, albeit brief pain-relief…..when compared to nothing!
Studies of this type (comparing relatively ‘elaborate’ interventions to extremely minimal ones) always beg the question: shouldn’t the “response” be monumentally better vs only marginally better (and not just short-term) IF in fact the treatments were truly effective?
Ostensibly 10 PT sessions would likely be 10 times the cost of 2 and the benefit of short term pain reduction with NO difference in activity limitations or long-term improvement is troublesome. This especially considering DP is proffered as not only a pain-modifying activity (requiring very intense and elaborate training for the practitioner and efficient compliance from the patient) but also, as the name implies: a ‘reducible’ disc treatment.
Of course natural attrition of pain and self-healing are constant activities of living organisms but we’d like to imagine our interventions make greater differences than to just be “coincidental passengers” with innate.
Comparisons of Chiropractic and exercise to Mackenzie DP have yet to establish superiority….or even dramatic advantages over ‘standard-of-care’ but it certainly warrants inclusion in our treatment arsenal and assessing for a DP is better done than not in most cases.