A Brief Review of Chiropractic Educational Programs and Recommendations for Celebrating Education on Chiropractic Day.

Objective: The purpose of this article is to provide an overview of the growth of chiropractic education globally and a chronological list of current training programs. Another purpose is to provide exemplars of enduring programs and offer suggestions for how chiropractic practitioners may celebrate education on Chiropractic Day, which is September 18. Discussion: Chiropractic education has transformed considerably over the past 125 years, and there are now 52 programs globally. We consider the 5 longest-existing chiropractic programs and propose hypotheses for what may have contributed to their durability. In addition, we offer ideas and opportunities for how chiropractic practitioners may focus on chiropractic education when celebrating the founding of the profession. Conclusion: Since its inception, chiropractic education has expanded around the world and continues to develop. Recognized accreditation agencies and testing organizations are ensuring that standards of education are established and maintained internationally. With innovation, international collaboration, and a commitment to continuous professional development, the future of chiropractic education is bright. We urge chiropractic practitioners from all over the world to celebrate these accomplishments on Chiropractic Day.

Clinical Practice Guideline: Chiropractic Care for Low Back Pain.

OBJECTIVE: The purpose of this article is to provide an update of a previously published evidence-based practice guideline on chiropractic management of low back pain. METHODS: This project updated and combined 3 previous guidelines. A systematic review of articles published between October 2009 through February 2014 was conducted to update the literature published since the previous Council on Chiropractic Guidelines and Practice Parameters (CCGPP) guideline was developed. Articles with new relevant information were summarized and provided to the Delphi panel as background information along with the previous CCGPP guidelines. Delphi panelists who served on previous consensus projects and represented a broad sampling of jurisdictions and practice experience related to low back pain management were invited to participate. Thirty-seven panelists participated; 33 were doctors of chiropractic (DCs). In addition, public comment was sought by posting the consensus statements on the CCGPP Web site. The RAND-UCLA methodology was used to reach formal consensus. RESULTS: Consensus was reached after 1 round of revisions, with an additional round conducted to reach consensus on the changes that resulted from the public comment period. Most recommendations made in the original guidelines were unchanged after going through the consensus process. CONCLUSIONS: The evidence supports that doctors of chiropractic are well suited to diagnose, treat, co-manage, and manage the treatment of patients with low back pain disorders.

Community-based free clinics: opportunities for interprofessional collaboration, health promotion, and complex care management.

OBJECTIVE: Free or outreach clinics offer students the opportunity to work with diverse patient populations. The objective of this study was to describe the demographics and clinical characteristics of a sample of chiropractic patients at a free community-based clinic to assess clinical and educational opportunities for students to work with diverse populations, collaborate with other professions and practice health promotion through patient education. METHODS: This was a prospective, descriptive cross-sectional study conducted over 2 months. Data on demographics, health status, and health risks were collected from patients and their interns. RESULTS: Of the 158 patients, 50.6% were women and 50.6% African-American, while only 20.9% were employed full-time. Of the 24.7% tobacco users, 48.7% expressed interest in cessation. Of 80.0% overweight or obese patients, 48.8% expressed interest in weight loss. By self-report, 16.5% were diabetic, 10.1% took hypertension medication, 36.7% used prescription pain medication (9.4% opiate use), 33.5% used nonprescription pain medication, and 9.4% were under the care of a mental health professional. CONCLUSION: This patient population is demographically diverse. A high proportion of patients who used tobacco, or were overweight or obese expressed interest in information on those topics. A substantial proportion reported being under care with a mental health professional. This clinic provides opportunities for students to work with diverse populations, collaborate with other professions, and practice health promotion.

Patient characteristics upon initial presentation to chiropractic teaching clinics: A descriptive study conducted at one university.

Objective : The purpose of this study was to compare demographics and chief complaints of the new patient population at our institution's fee-for-service clinics to the patient population of practicing chiropractors in the United States. We also compared the prevalence of obesity and hypertension to reference standards for the adult population. Methods : Patient data were obtained from the electronic health records. All records identified as new patients during October 2013 were included. Variables of interest were clinic site, patient demographics, blood pressure, body mass index (BMI), chief complaint, and ICD-9 codes. Descriptive statistics were computed and compared to reference standards from previous reports. Results : During October 2013, there were 224 new patients that entered the clinics. The average patient was a 31- to 50-year-old white male. Our clinic patients differed from those seen by US chiropractors in the distribution of all demographic variables. For adult patients, 31.4% were overweight, 29% were obese, and 8% stage 1 or 2 hypertension. Conclusion : New patients in the fee-for-service teaching clinics appear to be dissimilar to those of US practicing chiropractors in several important demographics, characteristics, and types of complaints. The new patients had lower levels of overweight, obesity, and hypertension compared to US reference standards.

Ultrasonography and radiography to identify early post traumatic myosistis ossificans in an 18-year-old male: a case report.

OBJECTIVE: The purpose of this case report is to describe a patient with post traumatic myositis ossificans (PTMO) of the anterior thigh following blunt trauma and discuss the incidence, clinical presentation, management, and imaging findings. CLINICAL FEATURES: An 18-year-old male presented to a chiropractic clinic with a chief complaint of left knee pain and reduced range of motion after an impact injury to his left anterior thigh during hurdling 6 weeks earlier. Immediately after the injury, he presented to the emergency department where radiography of the left knee was negative and he was diagnosed with a muscle sprain. Follow-up radiography and ultrasonography of the left knee in a chiropractic radiology department revealed ossification consistent with PTMO within his vastus intermedius. INTERVENTION AND OUTCOME: The patient underwent a course of rehabilitation for 2 months including ice, class IV cold laser and vibration applied to his anterior thigh, and myofascial release of his quadriceps musculature with targeted and progressive rehabilitative exercises. His left knee pain resolved within 2 weeks of care. He resumed sports participation (American football) pain-free, while wearing protective padding over the affected thigh, 1 month after presentation, which was approximately 2 1/2 months following his injury. CONCLUSION: This case demonstrates that ultrasonography may have the capability to detect early phases of PTMO approximately 2 weeks prior to radiographic evidence and to monitor progression throughout its course.

Feasibility of using a standardized patient encounter for training chiropractic students in tobacco cessation counseling.

Objective : Although tobacco cessation training is included in many health profession programs, it is not yet routinely incorporated into chiropractic education. The purpose of this study was to assess the feasibility of incorporating a problem-based learning tobacco cessation activity into a lecture course for chiropractic students. Methods : Seventy-two students were assigned to participate in two 1-hour lectures on health promotion counseling and tobacco cessation followed by an experiential student-driven lab session using standardized patients at various stages of dependency and willingness to quit. The intervention was based on the transtheoretic model and the "5 A's" of counseling (ask, advise, assess, assist, arrange). Outcomes were assessed via (1) questionnaires completed by the standardized patients regarding the students' use of the 5A's, and (2) questionnaires completed by the students using a 5-point Likert scale of "strongly disagree" to "strongly agree" on the acceptability of this method of learning. Descriptive statistics were computed. Results : Sixty-eight students (94%) completed the activity, spending a median of 2.5 minutes with patients. Over 90% addressed 4 of the 5A's: 99% asked patients if they were smokers; 97% advised them to quit; 90% assessed if they were willing to quit; and 99% offered assistance in quitting. Only 79% arranged a follow-up visit. Overall, students expressed a positive response to the experience; 81% said it increased their confidence in being able to advise patients, and 77% felt it would be valuable for use in their future practice. Conclusion : This active learning exercise appeared to be a feasible way to introduce tobacco counseling into the curriculum.

Diagnosis and serial sonography of a proximal fifth metatarsal stress fracture.

OBJECTIVE: The purpose of this report is to describe a fifth metatarsal stress fracture that was not detectable using conventional radiographs and was identified with diagnostic ultrasonography (US), confirmed with computed tomography, and followed through symptom resolution with US. CLINICAL FEATURES: A 68-year-old woman presented to a chiropractic teaching clinic for evaluation of right foot pain. Diagnostic US examination using an 8- to 15-MHz linear array transducer showed increased vascularity, periosteal elevation, and cortical disruption of the proximal diaphysis of the fifth metatarsal suggestive of a stress fracture. The patient was referred to an orthopedic specialist for comanagement. INTERVENTION AND OUTCOME: The patient was treated by an orthopedist who confirmed a stress fracture using computed tomography, and she was fit with a short-leg walking boot. Serial US images were obtained to document fracture healing and exclude complications. After 6 months, the patient was asymptomatic and had resumed all of her daily activities. CONCLUSION: We report a case of a proximal fifth metatarsal stress fracture that was visualized with US and followed through symptom resolution by serial examinations.

Tuberculous spondylitis presenting as severe chest pain.

This case report describes a 32-year-old male who presented to an emergency department with severe chest pain and a history of cough, fever, night sweats, loss of appetite and weight. Chest radiography revealed a left upper lobe consolidation and multiple compression deformities in the thoracic spine. Magnetic resonance imaging demonstrated significant kyphosis and vertebral plana at two thoracic levels. Anterior compression of the spinal cord and adjacent soft tissue masses were also noted.

Tumefactive multiple sclerosis: an uncommon diagnostic challenge.

OBJECTIVE: This case report describes a rare presentation of multiple sclerosis (MS) that was initially diagnosed as a peripheral nerve lesion in the emergency department. CLINICAL FEATURES: A 30-year-old woman presented to a chiropractic teaching clinic with a complaint of a sudden right foot drop. Magnetic resonance imaging of the brain revealed a large mass in the left parietal lobe with additional white matter lesions. The mass and smaller lesions were consistent with a rare presentation of demyelinating disease, tumefactive MS. INTERVENTION AND OUTCOME: The patient was referred to a neurologist for further evaluation and treatment. Her short-term clinical course was punctuated by recurrent myospasms and neurologic deficits. CONCLUSION: Tumefactive MS may mimic the clinical and magnetic resonance imaging characteristics of glioma or a cerebral abscess. The clinical presentation, pathophysiology, differential diagnosis, role of diagnostic imaging, and treatment options of MS are described. This case report illustrates that the timely diagnosis and optimal treatment of MS require recognition of its varied, sometimes atypical, and often nonspecific clinical and imaging manifestations.

A calcific pelvic mass in a woman with chronic spinal pain: a case of mature cystic teratoma.

OBJECTIVE: The purpose of this case is to describe findings of a mature cystic teratoma and to further provide differential diagnoses for ovarian pelvic masses and calcifications. CLINICAL FEATURES: A 27-year-old woman presented to a chiropractic teaching clinic with a chief complaint of chronic multilevel spinal pain. During a full spine radiographic examination, radiopaque densities were incidentally identified in the pelvic bowl visualized through a gonad shield. Follow-up pelvic radiography revealed several radiopacities of uniform density localized in the pelvic bowl. INTERVENTION/OUTCOMES: Medical (gynecological) consultation led to ultrasonography of the pelvis that revealed a mature cystic teratoma. The patient underwent complete excision of the mass through a laparotomy procedure. The patient continued to receive chiropractic treatment of her original cervical and lumbar spine complaints, further suggesting that the pelvic mass was not a source of her musculoskeletal complaints. CONCLUSION: This case demonstrates the detection and proper referral of a patient with a calcific mass. The presence of a pelvic mass, suspected of arising from the ovary, requires additional diagnostic imaging and careful clinical correlation.

A case report of an intermuscular lipoma: presentation, pathophysiology, differential diagnosis.

OBJECTIVE: The purpose of this report is to present the case of a 54-year-old female patient with a pathologically confirmed diagnosis of soft tissue lipoma. The clinical presentation, pathophysiology, differential diagnosis, and treatment options for lipoma are described. CLINICAL FEATURES: The patient presented to a chiropractic clinic with painful swelling in the right anterior thigh. Physical examination revealed a palpable mobile mass with minimal tenderness. INTERVENTION AND OUTCOME: The initial consultation was with the primary care physician, and it resulted in a sonographic examination as the initial imaging modality to rule out deep venous thrombosis. The result of this examination was negative. Following a delay by additional incorrect diagnoses and treatments, a diagnosis of an intermuscular lipoma was established by magnetic resonance imaging and confirmed on biopsy as a soft tissue lipoma. The patient underwent complete excision of the mass. CONCLUSION: Lipomas are common benign soft tissue masses and should be considered in the differential diagnosis of a thigh mass. Magnetic resonance imaging with contrast depicts the lipomatous mass as having a characteristic high-intensity fat signal without enhancement. It is important for clinicians to have an increased awareness in recognizing the clinical and imaging manifestations of a soft tissue lipoma to optimize an initial diagnosis and treatment.