Patient-centered outcomes of high-velocity, low-amplitude spinal manipulation for low back pain: a systematic review.

Low back pain (LBP) is a well-recognized public health problem with no clear gold standard medical approach to treatment. Thus, those with LBP frequently turn to treatments such as spinal manipulation (SM). Many clinical trials have been conducted to evaluate the efficacy or effectiveness of SM for LBP. The primary objective of this paper was to describe the current literature on patient-centered outcomes following a specific type of commonly used SM, high-velocity low-amplitude (HVLA), in patients with LBP. A systematic search strategy was used to capture all LBP clinical trials of HVLA using our predefined patient-centered outcomes: visual analogue scale, numerical pain rating scale, Roland-Morris Disability Questionnaire, and the Oswestry Low Back Pain Disability Index. Of the 1294 articles identified by our search, 38 met our eligibility criteria. Like previous SM for LBP systematic reviews, this review shows a small but consistent treatment effect at least as large as that seen in other conservative methods of care. The heterogeneity and inconsistency in reporting within the studies reviewed makes it difficult to draw definitive conclusions. Future SM studies for LBP would benefit if some of these issues were addressed by the scientific community before further research in this area is conducted.

The efficacy of adjusting the ankle in the treatment of subacute and chronic grade I and grade II ankle inversion sprains.

OBJECTIVE: The purpose of this study was to determine the efficacy of adjusting the ankle in the treatment of subacute and chronic grade I and grade II ankle inversion sprains. DESIGN: A single-blind, comparative, controlled pilot study. SETTING: Technikon Natal Chiropractic Day Clinic. PARTICIPANTS: Thirty patients with subacute and chronic grade I and grade II ankle inversion sprains. Patients were recruited from the public; they responded to advertisements placed in newspapers and on notice boards around the campus and local sports clubs. INTERVENTION: Each of the 15 patients in the treatment group received the ankle mortise separation adjustment. Each of the 15 patients in the placebo group received 5 minutes of detuned ultrasound treatment. Each participant received a maximum of 8 treatment sessions spread over a period of 4 weeks. MAIN OUTCOME MEASURE: Patients were evaluated at the first treatment, at the final treatment, and at a 1-month follow-up consultation. Subjective scores were obtained by means of the short-form McGill Pain Questionnaire and the Numerical Pain Rating Scale 101. Objective measurements were obtained from goniometer readings measuring ankle dorsiflexion range of motion and algometer readings measuring pain threshold over the ankle lateral ligaments. A functional evaluation of ankle function was also used. RESULTS: Although both groups showed improvement, statistically significant differences in favor of the adjustment group were noted with respect to reduction in pain, increased ankle range of motion, and ankle function. CONCLUSIONS: This study appears to indicate that the mortise separation adjustment may be superior to detuned ultrasound therapy in the management of subacute and chronic grade I and grade II inversion ankle sprains.

From Africa to Africa.

Chiropractic, an American-born profession, has grown and developed internationally, especially within the last decade. In reality, however, this growth started long ago in other countries. This article explores the development of the profession in South Africa by examining the life of an American-trained, South African-born, chiropractor. During this time, the international chiropractic community was a small group with close ties to America. This was, in part, due to the fact that chiropractic education was only available in the United States and one was not considered "legitimate" unless he or she was American trained. The struggles of the profession are not unique to America; they have also occurred elsewhere. Chiropractic evolution in South Africa is examined as well as the development of registration (licensing) and tertiary education.

Morton's neuroma.

Morton's "neuroma" is a perineurofibrosis of an interdigital nerve. The authors describe various factors that may be responsible for the development of this lesion and relate this information to two case histories. In these cases, treatment with manipulation, various physical therapy modalities, and/or foot orthotics, resulted in the successful resolution of symptoms.

A critical look at the subluxation hypothesis.

Historically, manipulation has been applied to manage spinal and extremity joint lesions that produce pain. The cause of this local or referred joint pain often has been attributed to subluxation or partial dislocation. This paper looks at the historical roots of the subluxation hypothesis, and reviews the literature to see if any valid research exists supporting the hypothesis that slight subluxations correlate with local or referred pain or is a cause of fixation. Also examined is whether proof exists that manipulation reduces subluxation. Associations between subluxation and the manipulable lesion are outlined, and suggestions for use of the word subluxation are addressed. The term somatic dysfunction is forwarded as an appropriate descriptive diagnosis of the manipulable lesion.