Disparities in chiropractic utilization by race, ethnicity and socioeconomic status: A scoping review of the literature / 中西医结合学报

BACKGROUND@#Chiropractic is the largest complementary and alternative medicine profession in the United States, with increasing global growth. A preliminary literature review suggests a lack of widespread diversity of chiropractic patient profiles.@*OBJECTIVE@#There have been no prior studies to comprehensively integrate the literature on chiropractic utilization rates by race, ethnicity, and socioeconomic status. The purpose of this scoping review is to identify and describe the current state of knowledge of chiropractic utilization by race, ethnicity, education level, employment status, and income and poverty level.@*SEARCH STRATEGY@#Systematic searches were conducted in PubMed, Ovid MEDLINE, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Cochrane Database of Systematic Reviews, and Index to Chiropractic Literature from inception to May 2021.@*INCLUSION CRITERIA@#Articles that reported race or ethnicity, education level, employment status, income or poverty level variables and chiropractic utilization rates for adults (≥18 years of age) were eligible for this review.@*DATA EXTRACTION AND ANALYSIS@#Data extracted from articles were citation information, patient characteristics, race and ethnicity, education level, employment status, income and poverty level, and chiropractic utilization rate. A descriptive numerical summary of included studies is provided. This study provides a qualitative thematic narrative of chiropractic utilization with attention to race and ethnicity, education level, income and poverty level, and employment status.@*RESULTS@#A total of 69 articles were eligible for review. Most articles were published since 2003 and reported data from study populations in the United States. Of the race, ethnicity and socioeconomic categories that were most commonly reported, chiropractic utilization was the highest for individuals identifying as European American/White/non-Hispanic White/Caucasian (median 20.00%; interquartile range 2.70%-64.60%), those with employment as a main income source (median utilization 78.50%; interquartile range 77.90%-79.10%), individuals with an individual or household/family annual income between $40,001 and $60,000 (median utilization 29.40%; interquartile range 25.15%-33.65%), and individuals with less than or equal to (12 years) high school diploma/general educational development certificate completion (median utilization 30.70%; interquartile range 15.10%-37.00%).@*CONCLUSION@#This comprehensive review of the literature on chiropractic utilization by race, ethnicity and socioeconomic status indicates differences in chiropractic utilization across diverse racial and ethnic and socioeconomic populations. Heterogeneity existed among definitions of key variables, including race, ethnicity, education level, employment status, and income and poverty level in the included studies, reducing clarity in rates of chiropractic utilization for these populations. Please cite this article as: Gliedt JA, Spector AL, Schneider MJ, Williams J, Young S. Disparities in chiropractic utilization by race, ethnicity and socioeconomic status: A scoping review of the literature. J Integr Med. 2023; 21(2): 159-167.

Chiropractic plus plum-blossom needling combined with flexibility training on attention deficit in mentally-retarded adolescents / 中国针灸

OBJECTIVE@#To observe the clinical efficacy of chiropractic plus plum-blossom needling combined with flexibility training for attention deficit in mentally-retarded adolescents.@*METHODS@#Thirty adolescents with mild mental retardation were randomly divided into a medical rehabilitation plus flexibility training group (10 cases, 2 cases dropped off), a flexibility training group (10 cases, 1 case dropped off) and a control group (10 cases). The patients in the flexibility training group received flexibility training, once every other day, 3 times a week for 12 weeks. The patients in the medical rehabilitation plus flexibility training group received chiropractic and plum-blossom needling at Baihui (GV 20) and Sishencong (EX-HN 1) on the basis of the treatment in the flexibility training group, once every other day, 3 times a week for 12 weeks. The patients in the control group did not receive any targeted physical training and medical rehabilitation. Tobii Pro Spectrum eye movement instrument was used to test the attention concentration (T), attention span (M), attention transfer (γ%) and attention distribution (η).@*RESULTS@#Compared before treatment, T and M in the medical rehabilitation plus flexibility training group and the flexibility training group were increased after treatment (P<0.01, P<0.05), and γ% in the medical rehabilitation plus flexibility training group was increased after treatment (P<0.05). The increasing range of T, M and γ% in the medical rehabilitation plus flexibility training group and the flexibility training group was greater than that in the control group (P<0.01), and the increasing range of T and γ% in the medical rehabilitation plus flexibility training group was greater than that in the flexibility training group (P<0.05).@*CONCLUSION@#The chiropractic plus plum blossom needling combined with flexibility training can improve the attention deficit in mentally-retarded adolescents.

Efeito da mobilização neural no tratamento da dor em indivíduos com cervicobraquialgia: uma revisão sistemática / Effect of neural mobilization on the treatment of pain in individuals with cervicobrachialgia: a systematic review

: A cervicobraquialgia (CB) é caracterizada por uma dor com origem em diferentes níveis estruturais da coluna cervical baixa (C3- C7), com irradiação bilateral ou unilateral para o membro superior. Considerando as causas e consequências advindas da CB, novas modalidades de tratamento têm sido propostas na tentativa de promover intervenções efetivas. Entre os procedimentos fisioterapêuticos encontram-se as técnicas de terapia manual como liberação miofascial, quiropraxia, mobilização articular, estabilização segmentar e a mobilização neural (MN) que procura restabelecer a função do tecido neural, sua condução elétrica, elasticidade, movimento e fluxo axoplasmático. Sendo assim, o objetivo do estudo foi avaliar sistematicamente as evidências sobre o efeito da MN no tratamento da dor em indivíduos com CB. A busca bibliográfica foi realizada no período entre Novembro de 2018 a Junho de 2019, sem limite de ano de publicação, nas bases de dados: PEDro, PubMed, Biblioteca Virtual em Saúde (Lilacs, Scielo e Medline) e Cochrane Library. A análise foi restrita aos ensaios clínicos randomizados. Para a análise etodológica dos artigos aptos a inclusão, foi utilizada a escala PEDro. Foi encontrado um total de 38 artigos. Após remoção de duplicatas, 14 artigos foram elegidos por resumo, 8 artigos foram recuperados para leitura completa e analisados quanto a sua adequação, dos quais 3 foram excluídos por não cumprirem os critérios de elegibilidade, ao fim 5 artigos foram incluídos na revisão. Houve redução significativa da dor, em pacientes tratados com MN. Considerando os resultados obtidos nesta revisão, foi possível concluir que a MN demonstra ser eficaz na redução da dor presente na CB. Embora os estudos mostrem que os resultados da MN como tratamento da CB são significativamente inferiores ao efeito do Ibuprofeno, deve-se ter em consideração as consequências a longo prazo para a saúde sobre a utilização de anti- inflamatórios orais.(AU)

Cervicobrachialgia (CB) is characterized by pain originating from different structural levels of the lower cervical spine (C3-C7), w ith bilateral or unilateral irradiation to the upper limb. Considering the causes and consequences of CB, new treatment modalities have been proposed in an attempt to promote effective interventions. Among the physical therapy procedures are manual therapy techniques such as myofascial release, chiropractic, joint mobilization, segmental stabilization and neural mobilization (NM) that seeks to restore the function of neural tissue, its electrical conduction, elasticity, movement and ax oplasmic flow . Thus, the objective of the study w as to evaluate systematically evaluate the evidence on the effect of NM on pain management in individuals w ith CB. The bibliographic search w as performed from November 2018 to June 2019, w ithout limit of year of publication, in the databases: PEDro, PubMed, Virtual Health Library (Lilacs, Scielo and Medline) and Cochrane Library. The analysis w as restricted to randomized controlled trials. For the methodological analysis of the articles eligible for inc lusion, the PEDro scale w as used. A total of 38 articles w ere found. After removal of duplicates, 14 articles w ere elected by abstract, 8 articles w ere retrieved for full reading and analyzed for suitability, of w hich 3 w ere excluded for not meeting eligibility c riteria, at the end 5 articles w ere included in the review . There was a significant pain reduction in patients treated w ith NM. Considering the results obtained in this review , it w as concluded that NM demonstrates to be effective in reducing pain present in CB. Although studies show that the results of NM as a treatment for CB are significantly low er than the effect of ibuprofen, consideration should be given to the long-term health consequences about the utilization of oral anti-inflammatory drugs.(AU)

Manual therapy interventions in the treatment of plantar fasciitis: a comparison of three approaches

Background: Plantar fasciitis is one of the common causes of heel pain and a common musculoskeletal problem often observed by clinicians. Numerous options are available in treating plantar fasciitis conservatively, but no previous studies have compared combined conservative management protocols. Aim: The aim of this study was to compare manipulation of the foot and ankle and cross friction massage of the plantar fascia; cross friction massage of the plantar fascia and gastrocsoleus complex stretching; and a combination of the aforementioned protocols in the treatment of plantar fasciitis. Setting: This study was conducted at the University of Johannesburg, Chiropractic Day Clinic, and included participants that complied with relevant inclusion criteria. Methods: Forty-five participants between the ages of 18 and 50 years with heel pain for more than 3 months were divided into three groups and received one of the proposed treatment interventions. The data collected were range of motion (ROM) of the ankle (using a goniometer) and pain perception using the McGill Pain Questionnaire and Functional foot index and algometer. Results: The results of this study indicate that cross friction massage of the plantar fascia and stretching of the gastrocsoleus complex showed the greatest overall improvement in terms of reducing the pain and disability and ankle dorsiflexion ROM, whereas the combination group showed the greatest increase in plantar flexion. Conclusion: The results demonstrated that all three protocols had a positive effect on the ROM and pain perception to patients with plantar fasciitis

Torticollis and Atlantoaxial Rotatory Subluxation after Chiropractic Therapy

Torticollis is an abnormal, asymmetric head or neck position which usually caused by imbalance of paracervical muscles. The traumatic torticollis can be caused by following events; atlantoaxial rotatory subluxation, atlantoaxial dislocation, cervical vertebral fractures, and injury to the cervical musculature. Especially, acute traumatic atlantoaxial rotatory subluxation usually presents limitation of cervical range of motion without pain or neurologic deficit. We report a case of a 58 year-old man who developed the acute atlantoaxial rotatory subluxation right after the chiropractic therapy, which induced the limitation of cervical range of motion to 52.5% of normal range. The magnetic resonance image revealed the facture of the odontoid process and the partial injury in transverse ligaments of the atlas. He underwent intramuscular botulinum toxin injection and 10 days of continuous cervical traction 15 hours a day using a 5 kg weight. The range of the cervical motion restored up to 90.2% of normal range.

Letter to the Editor: A Case of Posterior Inferior Cerebellar Artery Infarction after Cervical Chiropractic Manipulation (Korean J Neurotrauma 2018;14:159–163) / 대한신경손상학회지

No abstract available.

Authors' Reply to Letter to the Editor: A Case of Posterior Inferior Cerebellar Artery Infarction after Cervical Chiropractic Manipulation (Korean J Neurotrauma 2018;14:159–163) / 대한신경손상학회지

No abstract available.

Síndrome de Cola de Caballo asociado a tratamiento quiropráctico: Reporte de 3 casos y revisión de la literatura / Horsetail syndrome associated with chiropractic treatment: Report of 3 cases and review of the literature

El síndrome de cola de caballo (SCC) es una urgencia quirúrgica poco frecuente con una incidencia estimada de hasta 1,8 casos por millón de habitantes, producida por la compresión de las raíces nerviosas en el extremo inferior del canal espinal. La manipulación espinal puede desempeñar un papel etiogénico, provocando la movilización y extrusión del disco. El diagnóstico temprano y el tratamiento oportuno son cruciales, ya que el pronóstico suele ser desfavorable si el tratamiento quirúrgico se retrasa produciendo un daño neurológico permanente. El objetivo de este trabajo es identificar los potenciales factores de riesgo para la manipulación espinal y optimizar esta práctica, evitando así posibles complicaciones derivadas del tratamiento quiropráctico. Presentamos 3 casos de SCC, observados y tratados en nuestro centro, en los que se sugiere una estrecha relación entre la manipulación espinal quiropráctica y la aparición de dicho síndrome. Tras realizarles una RM en la que se observó una hernia discal L5-S1 causante del SCC, los 3 pacientes fueron tratados quirúrgicamente de forma urgente. Los casos presentados demostraron la existencia de una asociación patogénica entre la manipulación espinal y el desarrollo del SCC, al producirse dicho síndrome en las horas siguientes a la manipulación debida a la protusión abrupta de un disco demostrado por RM.

Introduction: Cauda equine syndrome (CES) is a rare surgical emergency with an estimated incidence of up to 1.8 cases per million. It is caused by compression of the nerve roots at the lowest point of the spinal canal. Spinal manipulation can play a pathogenic role, resulting in mobilization and extrusion of the disc. Early diagnosis and timely treatment are crucial, since the prognosis is usually unfavorable and permanent neurological damage likely if surgical treatment is delayed. Objective: The aim of this study was to identify potential risk factors associated with spinal manipulation and, thereby, optimize this practice to reduce the risk of complications from chiropractic treatment. Methods: We present three cases of CES, observed and treated at our center, in which a close relationship between chiropractic spinal manipulation and the appearance of CES was apparent. Results: After magnetic resonance imaging (MRI) revealed an L5-S1 herniated disc causing the SCC, all three patients underwent urgent surgical treatment. Conclusion: The three presented cases demonstrate a strong pathogenic relationship between spinal manipulation and the development of CES, when this syndrome occurs within hours of spinal manipulation, secondary to MRI-documented acute disc protrusion.

A Case of Posterior Inferior Cerebellar Artery Infarction after Cervical Chiropractic Manipulation / 대한신경손상학회지

We describe the case of a patient who had infarction of the posterior inferior cerebellar artery (PICA) after a chiropractic cervical manipulation. A 39-year-old man visited the emergency room with signs of cerebellar dysfunction, presenting with a 6-hour history of vertigo and imbalance. Two weeks ago, he was treated by a chiropractor for intermittent neck pain. At the time of admission, brain computed tomography, magnetic resonance imaging, and angiography revealed an acute infarction in the left PICA territory and occlusion of the extracranial vertebral artery (VA; V1/2 junction) as a result of the dissection of the VA. Angiography revealed complete occlusion of the left PICA and arterial dissection was shown in the extracranial portion of the VA. He was treated with antiplatelet therapy. Three weeks later, he was discharged without any sequelae. The possibility of VA dissection should be considered at least once in patients presenting with cerebellar dysfunctions with a recent history of chiropractic cervical manipulation.

"Sacando el frío": imágenes del ejercicio de la sobandería en el pueblo Nasa / "Taking out the cold": images of the practice of bonesettering (sobandería) in Nasa People

Objetivo: Describir la práctica de la "sobandería" en el pueblo indígena Nasa. Metodología: El autor participó en "Circulos de Palabra" y realizó entrevistas etnográficas con diversos miembros del pueblo indígena Nasa. La información así obtenida fueron consignadas como notas de diario de campo, para su posterior análisis de contenido temático. Las imágenes fotográficas fueron capturadas por el autor durante el ejercicio práctico de la "sobandería". Resultados: Se presentan de manera textual y visual aspectos generales de la "cosmovisión", el sistema de cuidado de la salud tradicional, y el ejercicio de la "sobadería" en el pueblo indígena Nasa. Conclusiones: La "sobandería" es una práctica terapéutica anclada en la "cosmovisión" del pueblo indígena Nasa. Su contextualización es necesaria en cualquier ejercicio de complementariedad terapéutica en un claro escenario de pluralismo médico.

Objective: To describe the "bonesettering" (sobandería) practices in Nasa People. Methodology: the author participate in "Word Circles" and realize ethnographic interviews to Nasa People. The data was stored as fieldnotes in a field diary, and was analyzed by content analysis technique. The photographs were captured during a bonesettering practice. Results: describe of bonesettering practices of Nasa People using textual and visual media. This practices is contextualized in "cosmovision" and traditional healthcare system. Conclusion: Bonesettering practice is a therapeutic practice culturally inmersed in "cosmovision" of Nasa People. This is relevant in the exercise of therapeutic complementarity in a context of medical pluralism.

Ejercicio de la quiropráctica y su consideración como objetivo normativo en la legislación peruana / Exercise of chiropractic and its consideration as a normative objective in Peruvian legislation

En la presente investigación se aborda un problema relacionado con la necesidad de normar, regular y fiscalizar tanto el desempeño de la actividad quiropráctica en el Perú como la formación profesional en dicha disciplina; pero de interés mayúsculo es la primera, para tal efecto, se tomó como caso referencial a los centros quiroprácticos que al año 2016 vienen brindando sus servicios en Lima metropolitana. Como el vacío de regulación es a nivel nacional, Lima metropolitana es una muestra fehaciente de todo lo que sucede en todas las regiones de nuestro país. Todos los quiroprácticos del Perú, ejercen esta actividad de manera informal, debido a que no hay ningún mecanismo de control legal, no existen universidades, institutos ni otras instituciones que formen académicamente a profesionales en quiropráctica, por ende no puede existir un Colegio de Quiroprácticos del Perú, solo existe la ley general de salud, LEY N°26842, que por ser general causa vacíos regulatorios y por lo tanto muchos empíricos quiroprácticos ejercen la misma labor con toda confianza porque saben que no existe ninguna Ley especifica que los fiscalice. La OMS, (organización mundial de la salud), considera a la quiropráctica como una profesión sanitaria, pero la mayoría de países del mundo la consideran como una medicina complementaria, y otros como medicina alternativa, en nuestro país es prácticamente nuevo, muchos no le dan una clasificación por distintas razones, razón principal el desconocimiento, y otros profesionales de la salud lo consideran como medicina alternativa, dándole un rango menor como la de acupuntura, reflexología, homeopatía, etc.

The use of complementary and alternative medicine in children with common neurologic diseases / 소아과

Complementary and alternative medicine (CAM) is a phrase used to describe additional health care methods such as mind/body practices and natural products not regarded as treatments by conventional medicine. The use of CAM in children with common neurologic diseases is more frequent than its use in healthy children (24%–78% vs. 12%). However, less than half of patients report such use to their physicians. The preferred modalities of CAM vary in different countries due to their different cultures and traditions. The most common factor significantly associated with the use of CAM is parental CAM use in most studies. The frequency of the use of CAM in children and adults with neurologic diseases is similar, and both rates are higher than the rates in those without these conditions. The preferred modalities of CAM in adults are diverse, and megavitamins and mind/body therapy (prayer and chiropractic care) are included. The most common factor significantly associated with the use of CAM in adults with neurologic diseases is high educational level. Physicians need to be concerned with patients' use of CAM and provide correct information about CAM so that patients may make the right decisions. Further study is needed to determine the evidence-based efficacy of CAM use in children with common neurologic diseases.

The implementation of problem-based learning in collaborative groups in a chiropractic program in Malaysia / 보건의료교육평가

PURPOSE: Problem-based learning (PBL) is usually conducted in small-group learning sessions with approximately eight students per facilitator. In this study, we implemented a modified version of PBL involving collaborative groups in an undergraduate chiropractic program and assessed its pedagogical effectiveness. METHODS: This study was conducted at the International Medical University, Kuala Lumpur, Malaysia, and involved the 2012 chiropractic student cohort. Six PBL cases were provided to chiropractic students, consisting of three PBL cases for which learning resources were provided and another three PBL cases for which learning resources were not provided. Group discussions were not continuously supervised, since only one facilitator was present. The students' perceptions of PBL in collaborative groups were assessed with a questionnaire that was divided into three domains: motivation, cognitive skills, and perceived pressure to work. RESULTS: Thirty of the 31 students (97%) participated in the study. PBL in collaborative groups was significantly associated with positive responses regarding students' motivation, cognitive skills, and perceived pressure to work (P<0.05). The students felt that PBL with learning resources increased motivation and cognitive skills (P<0.001). CONCLUSION: The new PBL implementation described in this study does not require additional instructors or any additional funding. When implemented in a classroom setting, it has pedagogical benefits equivalent to those of small-group sessions. Our findings also suggest that students rely significantly on available learning resources.

Page kidney after botulinum toxin injection during chiropractic care / 영남의대학술지

Page kidney refers to the phenomenon of hypertension secondary to long-standing compression of renal parenchyma caused by renal subcapsular collection. The most common cause of renal subcapsular collection is a hematoma which usually occurs after a history of blunt trauma. A 42-year-old female patient who received botulinum toxin injection in her back during chiropractic care was admitted to the emergency room with sudden bilateral flank pain and hypertension. The computed tomography (CT) images demonstrated the presence of bilateral subcapsular renal hematoma. The patient was treated conservatively and recovered well. The follow up CT images showed markedly resolved bilateral hematoma.

Prevalência de subluxações cervicais e torácicas com relação ao membro dominante superior em atletas amadores de voleibol / Prevalence of cervical and thoracic subluxations in relation to the dominant upper limb in amateur volleyball players

O voleibol exige um ótimo condicionamento físico, força, velocidade, agilidade e flexibilidade de seus participantes. Nele, a repetição de determinados tipos de movimentos e a sobrecarga de treinamento exigida produz um processo de adaptação orgânica do corpo que resulta, muitas vezes, em desequilíbrio muscular. Somado a isso, os gestos específicos e os erros na técnica de execução dos movimentos podem aumentar a prevalência de alterações posturais influenciando o aumento de possibilidades de lesões (JUNIOR, 2004). As alterações posturais, por sua vez, podem ocasionar distúrbios que afetam a coluna vertebral. Objetivo: o propósito do estudo foi detectar as principais subluxações - vertebrais cervicais e torácicas - por meio da análise das rotações do processo espinhoso de cada vértebra e lateralidade do atlas com o membro dominante superior, relacionando com as categorias e com a posição em quadra de atletas de Voleibol. Método: para tanto, realizou-se uma pesquisa descritiva com 145 atletas de categorias de base e adulta que treinam mais de dois dias por semana. Os atletas foram submetidos a uma avaliação quiroprática. Resultados e Discussão: verificou-se que as subluxações mais prevalentes foram das vértebras C1, C7, T4, T8 e T12. Observou-se que a musculatura e a articulação do ombro estão diretamente interligadas com as subluxações encontradas. Atletas ambidestros apresentaram menor percentagem de subluxações e maior equilíbrio rotacional dos processos espinhosos e da lateralidade do atlas. Os demais atletas apresentaram a lateralidade do atlas e as rotações do processo espinhoso das regiões cervical e torácica para o lado direito...

Volleyball requires a great physical fitness, strength, speed, agility and flexibility of its players. In it, the repetition of certain types of movements and the overload of training required may produces an organic process of adaptation of the body that often results in muscle imbalance. Added to this, the specific gestures and errors in technique of the movements may increase the prevalence of postural changes influencing the increased possibilities of injuries. Postural changes, inturn, can lead to disorders affecting the spine. Objective: the purpose of the study was to identify the main subluxations - cervical and thoracic - through the analysis of rotations of the spinous process of each vertebra and laterality of the atlas with the dominant upper limb, in what respect the categories and the position in court of volleyball athletes. Method: it was carried out a descriptive study of 145 athletes from youth teams and adult training more than two days per week. The athletes underwent a chiropractic evaluation. Results and Discussion: it was found that the most prevalent vertebral subluxation are C1, C7, T4, T8 and T12. It was noted that the muscles and the shoulder joint are directly interconnected with the subluxations found. Ambidextrous athletes showed lower percentage of subluxations and higher rotational equilibrium of the spinous processes and the laterality of the atlas. The other athletes showed the laterality of the atlas and the rotations of the spinous process of the cervical and thoracic regions to the right side...

Quiropraxia / Chiropractic

Este artigo de revisão apresenta a quiropraxia, uma profissão na área da saúde que se ocupa do diagnóstico, tratamento e prevenção de condições neuromusculoesqueléticas, em especial algias vertebrais e sintomas associados. São abordadas inicialmente a definição e área da atuação, seguindo-se uma revisão da história da profissão no Brasil e no mundo. A formção profissional, que consiste de cursos superiores com quatro anos de duração é discutida. São apresentados os dois cursos superiores de Quiropraxia em atividade no Brasil, sua história e importância para a implantação da profissão no país. A avaliação biomecânica realizada por quiropraxistas é descrita, em especial técnicas de palpação articular, bem como os métodos terapêuticos utilizados por quiropraxistas, em especial a utilização de técnicas de terapia manual. A terapia de manipulação articular e seus efeitos fisiológicos são detalhados. Contra indicações e complicações são discutidos. Por fim, é feita uma breve revisão da literatura relativa a estudos clínicos sobre a eficácia do tratamento com quiropraxia.

This is a review about Chiropractic, a health care profession concerned with the diagnosis, treatment and prevention of disorders of the neuromusculoskeletal system, with a special emphasis on the treatment of vertebral pain and associated symptoms. The profession is initially defined and an overview of the history of chiropractic in the world as well as in Brazil is presented. Professional education, consisting of four years of university-level graduation programs is described. The two chiropractic programs in activity in Brazil are presented and their importance to the establishment of the profession in this country is discussed. The biomechanical evaluation performed by chiropractors is explained, with special emphasis on techniques of joint palpation. Treatment procedures used by chiropractors are summarized, particularly techniques of manual therapy. Spinal manipulation therapy and its physiological effects are then detailed. Contra-indications and complications are discussed. Finally, a brief review of the medical literature with respect to clinical trials on the efficacy of chiropractic therapy for the treatment of specific conditions is outlined.

Efeitos da quiropraxia em pacientes com cervicalgia: revisão sistemática / Effects of chiropractic care in patients with cervical pain: a systematic review

JUSTIFICATIVA E OBJETIVOS: A dor cervical é ocasionada na maioria das vezes por alterações mecânicos-posturais. Dentre diferentes técnicas terapêuticas realizadas por fisioterapeutas a quiropraxia têm se tornado comum no Brasil. O objetivo deste estudo foi rever na literatura, com fontes secundárias e terciárias, utilizando-se as bases de dados Pubmed/Medline e PEdro. CONTEÚDO: Foram encontrados apenas 6 ensaios clínicos controlados e aleatórios, investigando os efeitos da quiropraxia na dor cervical. Na maioria dos estudos as técnicas de manipulação promoveram o alívio de dor de maneira mais rápida e mais prolongada nos pacientes. A dor foi avaliada por meio do Índice Funcional de Oswestry, do Questionário de Dor McGill e da Escala Analógica Visual da Dor. CONCLUSÃO: É necessária a realização de maior número de ensaios clínicos controlados e aleatórios envolvendo a quiropraxia, bem como a utilização de métodos de avaliação mais fidedignos, a fim de comprovar os seus reais efeitos no tratamento da cervicalgia.

BACKGROUND AND OBJECTIVES: Cervical pain is mostly caused by mechanical-postural changes. Among different therapeutic techniques used by physical therapists, chiropractic care is becoming common in Brazil. This study aimed at reviewing the literature, with secondary and tertiary sources, using Pubmed, Medline and PEdro databases. CONTENTS: Just 6 controlled randomized clinical trials investigating the effects of chiropractic care on cervical pain were found. In most studies, manipulation techniques have promoted pain relief in a faster and more prolonged way and pain was evaluated by Oswestry's Functional Index, by McGill Pain Questionnaire and by Pain Visual Analog Scale. CONCLUSION: A larger number of controlled randomized clinical trials involving chiropractic care is needed, as well as the use of more dependable evaluation methods, to prove its real effects in the treatment of cervical pain.

What does integrative medicine mean to the physician and the ministry of health and welfare?

Our aging society, rapid growth of diseases resulting from unhealty habits, frequent occurrences of sickness, and variations in the awareness of health by patients, the worldwide need for integrative medicine, which means the incorporation and integration of complementary and alternative medicine (CAM) into conventional medical systems, is growing rapidly. The most widely available forms of CAM in the treatment of diseases in the U.S. and Europe are acupuncture, chiropractic, phytomedicine (western herbal medicine), mind-body therapies, and nutrition therapy. The well-known hospitals in the U.S. and in Europe (e.g., Harvard, Memorial Sloan-Kettering Cancer Center, Duke, Maryland, Essen, and Humboldt) are offering integrative medicine. The clinical practices as well as the education on CAM of medical schools is becoming more widespread in Korea. It is critical for us as physicians to be aware that the role of CAM is to support and complement conventional medicine, not to substitute for it. To manage chronic diseases effectively, it is imperative for physicians to incorporate and integrate Korean oriental medicine as well as CAM into the conventional medical systems. It is the duty of the medical universities and hospitals to integrate care delivery proven by CAM therapies into the conventional medicine and to develop the standard curriculum for integrative medicine at the undergraduate and graduate levels. To globalize Korean oriental medicine and to scientifically prove the efficiency of CAM, the role of integrative medicine is critical. One of the most important roles of the Ministry of Health and Welfare is to support the hospitals in which integrative medicine is systematically practiced and financially supported. In order to successfully accomplish integrative medicine in Korea, it is important to not only establish an integrative medicine center, but to also develop the contents and clinical pathway along with legal systems regarding integrative medicine with the support of the specialists in the field of integrative medicine.

Enlightenment by chiropractic's developing mode / 中国骨伤

Traditional Chinese spinal manipulative therapy (TCSMT) and Chiropractic are similar in treating related with spinal disease, but they keep different characteristics of themselves. Although Chiropractic's "Subluxation" and TCSMT's "Jin Chu Cao and Gu Cuo Feng" theory have not be widely recognized, yet Chiropractic has already have official cooperation with WHO,and has launched "WHO Basis of Chiropractic Training and Security Guide" which would promote the project further research. Comparatively, TCSMT has mature theoretical system and satisfactory clinical effectiveness, but it's hard to global spreading formally and legally. By means of cogitation of the TCSMT'S basic theories and clinical applications, this paper aims to analyze the inadequacy aspects of it, and hope to borrow some Chiropractic's advantage to TCSMT's global spreading. And I wish this paper could be helpful for relative doctors and researchers.