Relationship between backpack load location, sex, anthropometric and body composition factors with postural sway in healthy young adults.

Objective: Evaluate the effect of backpack load location on postural sway and correlate sway path length (PL) to anthropometrics and body composition. Methods: Fifteen participants aged 18-25 stood on a force plate with backpack load located high (LH), low (LL) or without backpack (NL). Body composition and anthropometric variables were correlated to PL. Results: Load increased PL, 95% confidence ellipse, and mean velocity while it reduced mediolateral SampEn (p<0.05). Females had increased mean velocity and PL of sway (p<0.05). Larger phase angles correlated with reduced PL under NL. Taller individuals correlated with reduced PL under LL. Greater mass correlated with reduced PL under LH. Conclusions: Load carriage regardless of load location increased postural sway metrics except mediolateral SampEn. Females had greater PL and mean velocity compared to males. Select anthropometric and body composition variables correlated with postural sway under different load conditions.

Objectif: Évaluer l'effet de la position de la charge du sac à dos sur le balancement postural et corréler la longueur du chemin du balancement (PL) aux facteurs anthropométriques et à la composition corporelle. Méthodologie: Quinze participants âgés de 18 à 25 ans se sont tenus debout sur une plateforme biomécanique, la charge du sac à dos étant placée à un niveau élevé (LH), bas (LL) ou sans sac à dos (NL). La composition corporelle et les variables anthropométriques ont été corrélées à la PL. Résultats: La charge a augmenté la PL, l'ellipse de confiance à 95 % et la vitesse moyenne tout en réduisant la SampEn (entropie d'échantillon) médio-latérale (p<0,05). Les femmes avaient une vitesse moyenne et une PL de balancement plus élevées (p<0,05). Les angles de phase plus importants sont en corrélation avec une réduction de la PL sous NL. Les personnes plus grandes étaient en corrélation avec une réduction de la PL sous LL. Une masse plus importante est en corrélation avec une réduction de la PL sous LH. Conclusions: Le port de charge, quelle que soit la position de la charge, a augmenté les paramètres du balancement postural, à l'exception de la SampEn médio-latérale. Les femmes avaient une PL et une vitesse moyenne plus élevées que les hommes. Certaines variables anthropométriques et de composition corporelle sont en corrélation avec le balancement postural dans différentes conditions de charge.

Effects of simulated hypo-gravity on lower limb kinematic and electromyographic variables during anti-gravitational treadmill walking.

Introduction: This study investigated kinematic and EMG changes in gait across simulated gravitational unloading levels between 100% and 20% of normal body weight. This study sought to identify if each level of unloading elicited consistent changes-particular to that percentage of normal body weight-or if the changes seen with unloading could be influenced by the previous level(s) of unloading. Methods: 15 healthy adult participants (26.3 ± 2.5 years; 53% female) walked in an Alter-G anti-gravity treadmill unloading system (mean speed: 1.49 ±0.37 mph) for 1 min each at 100%, 80%, 60%, 40% and 20% of normal body weight, before loading back to 100% in reverse order. Lower-body kinematic data were captured by inertial measurement units, and EMG data were collected from the rectus femoris, biceps femoris, medial gastrocnemius, and anterior tibialis. Data were compared across like levels of load using repeated measures ANOVA and statistical parametric mapping. Difference waveforms for adjacent levels were created to examine the rate of change between different unloading levels. Results: This study found hip, knee, and ankle kinematics as well as activity in the rectus femoris, and medial gastrocnemius were significantly different at the same level of unloading, having arrived from a higher, or lower level of unloading. There were no significant changes in the kinematic difference waveforms, however the waveform representing the change in EMG between 100% and 80% load was significantly different from all other levels. Discussion: This study found that body weight unloading from 100% to 20% elicited distinct responses in the medial gastrocnemius, as well as partly in the rectus femoris. Hip, knee, and ankle kinematics were also affected differentially by loading and unloading, especially at 40% of normal body weight. These findings suggest the previous level of gravitational load is an important factor to consider in determining kinematic and EMG responses to the current level during loading and unloading below standard g. Similarly, the rate of change in kinematics from 100% to 20% appears to be linear, while the rate of change in EMG was non-linear. This is of particular interest, as it suggests that kinematic and EMG measures decouple with unloading and may react to unloading uniquely.

Immediate effect of lower extremity joint manipulation on a lower extremity somatosensory illusion: a randomized, controlled crossover clinical pilot study.

Objective: This study explored the influence of lower extremity manipulation on the postural after-effects of standing on an inclined surface. Methods: Eight healthy individuals (28.0 ± 4.1 years) were recruited for this open-label, crossover study. Participants stood on an incline board for 3 min to develop a known form of somatosensory illusion. After randomization to either a lower-extremity joint manipulation or no intervention, participants immediately stood on a force plate for 3 min with eyes closed. After a 24-h washout period, participants completed the remaining condition. Center of pressure (CoP) position data was measured by a force plate and evaluated using statistical parametric mapping. Pathlength, mean velocity, and RMS were calculated for significant time periods and compared with corrected paired t-tests. Results: Parametric maps revealed that CoP position of control and intervention conditions differed significantly for two time periods (70-86 s-control: 0.17 ± 1.86 cm/intervention: -1.36 ± 1.54 cm; 141-177 s-control: -0.35 ± 1.61 cm/intervention: -1.93 ± 1.48 cm). CoP pathlength was also significantly decreased for the second period (control: 6.11 ± 4.81 cm/intervention: 3.62 ± 1.92 cm). Conclusion: These findings suggest that extremity manipulation may be a useful intervention for populations where CoP stability is an issue. This study contributes to the growing body of evidence that manipulation of the extremities can drive global postural changes, as well as influence standing behavior. Further, it suggests these global changes may be driven by alterations in central integration. Clinical Trial Registration: ClinicalTrials.gov, NCT Number: NCT05226715.

The influence of flexion distraction spinal manipulation on patients with lumbar spinal stenosis: A prospective, open-label, single-arm, pilot study.

OBJECTIVE: Evaluate chiropractic care including flexion distraction spinal manipulation for improving function, symptoms and performance-based mobility in patients with lumbar spinal stenosis (LSS) using a pretest-posttest design. METHODS: Data were collected at baseline, midpoint and final visits prior to care on each visit. Objective data included Timed Up and Go, Five Times Sit to Stand, and balance (force plate). An additional balance assessment was also conducted after care on the baseline visit. Subjective data included: Activities-Specific Balance Confidence Scale, Zurich Claudication Questionnaire, and pain ratings. Balance data were securely transferred via iDrive; the others were collected via REDCap. RESULTS: Twelve patients (mean age = 83.5 years ± 5.71) completed the average midpoint visit at 9 visits and the final visit at 13.7 visits. Timed Up and Go and Five Times Sit to Stand Test decreased by 5.2 and 6.7 s at midpoint and 5.4 and 5.7 s at the final visit, respectively compared to the baseline visit (p < 0.05). Baseline visit pre-post reductions were found in anterior-posterior sample entropy and mean frequency of postural sway (p < 0.05). No balance change was found between baseline and mid or final visits. All subjective measures had statistically and clinically meaningful improvement. CONCLUSION: Significant improvement in objective and subjective outcomes were found after a pragmatic course of care including spinal manipulation in LSS patients.

Postural Control, Dual Task Performance and Executive Function Following an Ultramarathon.

As research into the postural and cognitive effects of ultramarathon running is sparse and still needed, we investigated the effect of ultramarathon running on runners' postural control, dual task postural control and a measure of executive function-the flanker test, expecting fatigue-related deterioration on each measure. We used a pre- and post-test research design with 14 runners who completed (a) postural assessment with eyes open and closed, on a flat surface and on foam during (b) a two-choice reaction time dual task postural assessment, and (c) an executive function modified flanker task. With regard to postural stability, we observed, after running, increased anterior-posterior (AP) path length and AP root mean square (RMS) and reductions in both mediolateral (ML) RMS and ML median frequency. Dual task analysis showed reduced ML RMS prior to the race, whereas the effect was absent afterwards. Reaction times were not significantly altered between pre-post or surface conditions assessments. There were no statistically significant differences in mean modified flanker scores before and after the race. These data demonstrated that, following an endurance run, there were plane specific movement adaptations in postural sway that may have resulted from neuroprotective changes under extreme fatigue.

Immediate impact of extremity manipulation on dual task performance: a randomized, crossover clinical trial.

BACKGROUND: Previous research demonstrated that manipulation of the extremities was associated with changes in multisegmental postural sway as well as improvement in a lower extremity balancing task. We were interested if these effects would extend to an upper extremity task. Our aim in this study was to investigate whether extremity manipulation could influence dual task performance where the explicit suprapostural task was balancing a water filled tube in the frontal plane. METHODS: Participants were healthy volunteers (aged 21-32 years). Upper- or lower-extremity manipulations were delivered in a participant and assessor blinded, randomized crossover, clinical trial. Postural (center of pressure) and suprapostural (tube motion) measurements in the frontal plane were made pre-post manipulation under eyes open and eyes closed conditions using a BTrackS™ force plate and a Shimmer inertial measurement unit, respectively. Pathlength, range, root mean square and sample entropy were calculated to describe each signal during the dual task performance. RESULTS: There was no main effect of manipulation or vision for the suprapostural task (tube motion). However, follow-up to interaction effects indicates that roll pathlength, range and root means square of tube motion all decreased (improvement) following lower extremity manipulation with eyes open. Regarding the postural task, there was a main effect of manipulation on mediolateral center of pressure such that pathlength reduced with both upper and lower extremity manipulation with larger decreases in pathlength values following upper extremity manipulation. CONCLUSION: Our findings show that manipulation of the extremities enhanced stability (e.g. tube stabilization and standing balance) on performance of a dual task. This furthers the argument that site-specific manipulations influence context specific motor behavior/coordination. However, as this study focused only on the immediate effects of extremity manipulation, caution is urged in generalizing these results to longer time frames until more work has been done examining the length of time these effects last. TRIAL REGISTRATION: Clinicaltrials.gov , NCT03877367 , Registered 15 March 2019. Data collection took place July 2019.

Impact of Extremity Manipulation on Postural Sway Characteristics: A Preliminary, Randomized Crossover Study.

OBJECTIVE: Evaluate multisegmental postural sway after upper- vs lower-extremity manipulation. METHODS: Participants were healthy volunteers (aged 21-40 years). Upper- or lower-extremity manipulations were delivered in a randomized crossover design. Postural assessments were made pre-post manipulation, in floor and rocker board conditions. Analysis included traditional balance measures of pathlength and range and sample entropy (SampEn) to examine the temporal structure of sway of the head, trunk, and surface. RESULTS: No statistical changes in pathlength or sway range on the ground surface condition were observed. No increases in the amount of sway occurred in any condition. Chiropractic manipulation of either upper or lower extremities led to reductions in traditional measures of postural control on the rocker board. In the anteroposterior direction (sagittal plane), lower-extremity manipulation led to increased trunk SampEn while on the ground, and conversely a decreased SampEn while on the rocker board. In the mediolateral rocker board condition (frontal plane), manipulation elicited a change in SampEn that differed according to site of manipulation; upper-extremity manipulation increased SampEn, whereas lower-extremity manipulation reduced SampEn. CONCLUSION: Both upper- and lower-extremity manipulation influenced several measures of postural sway on both the ground and the rocker board. Lower-extremity manipulation improved the organization of sway at the trunk (anteroposterior direction) and the board (mediolateral direction). Given the reduction and reorganization of sway metrics seen in this study, we propose extending this line of research to the elderly who are at greatest risk of increased sway and falls.

The effect of posture on neck proprioception and head/neck stabilization in asymptomatic participants.

OBJECTIVE: We sought to determine the effect of different body postures on neck proprioception and head/neck stabilization. METHODS: Twelve healthy college students completed a head repositioning task and a 'head still' task while wearing a headpiece (helmet) with laser fixed on top during standing, kneeling, sitting, and sitting with stabilization. Video data of the laser dot coordinates on a projection screen were obtained to examine the accuracy of the two tasks. RESULTS: There was a significant effect of both posture and vision for both vertical and horizontal head movements during the head still task. Standing and kneeling generated more variable head movement than sitting with or without stabilization. Posture did not significantly affect head repositioning accuracy. CONCLUSION: For healthy young adults, clinicians and researchers need to be concerned with postural influences on tasks that involve head/cervical spine stabilization, but not head repositioning accuracy.

OBJECTIF: Nous avons cherché à déterminer l'effet de différentes postures corporelles sur la proprioception du cou et la stabilisation tête/cou. MÉTHODES: Douze étudiants en bonne santé de niveau collégial ont accompli une tâche de repositionnement de la tête et une tâche d'immobilisation de la tête tout en portant un casque avec un laser fixé sur le dessus pendant qu'ils étaient debout, à genoux, assis et assis en état stable. Des données vidéo des coordonnées des points laser sur un écran de projection ont été obtenues pour examiner la précision des deux tâches. RÉSULTATS: On a observé un effet significatif de la posture et de la vision pour les mouvements verticaux et horizontaux de la tête pendant l'immobilisation de la tête. Le fait de se tenir debout et de s'agenouiller a généré un mouvement de la tête plus variable que le fait de s'asseoir en étant ou non stable. La posture n'a pas eu d'effet significatif sur la précision du repositionnement de la tête. CONCLUSION: Pour les jeunes adultes en santé, les cliniciens et les chercheurs doivent se préoccuper des influences posturales pour les tâches qui font appel à une stabilisation de la tête et de la colonne cervicale, mais non de la précision du repositionnement de la tête.

Effect of chiropractic manipulative therapy on reaction time in special operations forces military personnel: a randomized controlled trial.

BACKGROUND: Chiropractic manipulative therapy (CMT) has been shown to improve reaction time in some clinical studies. Slight changes in reaction time can be critical for military personnel, such as special operation forces (SOF). This trial was conducted to test whether CMT could lead to improved reaction and response time in combat-ready SOF-qualified personnel reporting little or no pain. METHODS: This prospective, randomized controlled trial was conducted at Blanchfield Army Community Hospital, Fort Campbell, KY, USA. Active-duty US military participants over the age of 19 years carrying an SOF designation were eligible. Participants were randomly allocated to CMT or wait-list control. One group received four CMT treatments while the other received no treatment within the 2-week trial period. Assessment included simple hand/foot reaction time, choice reaction time, and Fitts' Law and whole-body response time. On visits 1 and 5, the same five assessments were conducted immediately pre- and post-treatment for the CMT group and before and after a 10-min wait period for the wait-list group. Primary outcomes included between-group differences for the pre-CMT/wait-list period at visit 1 and visit 5 for each test. Secondary outcomes included between-group differences in immediate pre- and post-(within visit) changes. Analysis of covariance was used for all data analysis. RESULTS: One hundred and seventy-five SOF-qualified personnel were screened for eligibility; 120 participants were enrolled, with 60 randomly allocated to each group. Due to technical problems resulting in inconsistent data collection, data from 77 participants were analyzed for simple hand/foot reaction time. The mean ± standard deviation (SD) age was 33.0 ± 5.6 years and all participants were male. No between-group statistically significant differences were found for any of the five biomechanical tests, except immediate pre- and post-changes in favor of the CMT group in whole-body response time at both assessment visits. There were four adverse events, none related to trial participation. CONCLUSIONS: A single session of CMT was shown to have an immediate effect of reducing the time required for asymptomatic SOF qualified personnel to complete a complex whole-body motor response task. However, sustained reduction in reaction or response time from five tests compared with a wait-list control group was not observed following three sessions of CMT. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02168153 . Registered on 12 June 2014.

An acute bout of aerobic exercise reduces movement time in a Fitts' task.

Movement time (MT) is one of the most important variables influencing the way we control our movements. A few previous studies have generally found that MT reduces with reaction time testing during exercise. However, limited evidence exists concerning change in MT following an acute bout of exercise. Our purpose was to investigate the effect of an acute bout of aerobic exercise on movement time as assessed by a Fitts' Law task. We also sought to determine if exercise would further lower MT during the more difficult task conditions compared with rest. Nineteen (12 male, 7 female) volunteers (19-28 yrs) completed a computerized paired serial pointing task to measure movement time before and after rest (R) and an acute bout of moderate aerobic exercise (E) using a within subjects crossover design. Comparisons between exercise and rest conditions were made to determine if there were differences in movement time. Exercise significantly reduced MT compared with rest. Movement time was reduced by an average of 208 ms following exercise compared with 108 ms following rest. Exercise did not further lower MT during the more difficult task conditions. These results suggest that an acute bout of aerobic exercise reduces movement time which is an important component of motor control. Further studies are needed to determine the duration of the effect as well as the optimum duration and intensity of exercise.

The effect of chiropractic treatment on the reaction and response times of special operation forces military personnel: study protocol for a randomized controlled trial.

BACKGROUND: Chiropractic care is commonly used to treat musculoskeletal conditions and has been endorsed by clinical practice guidelines as being evidence-based and cost-effective for the treatment of patients with low back pain. Gaps in the literature exist regarding the physiological outcomes of chiropractic treatment. Previous pilot work has indicated the possibility of improvements in response time following the application of chiropractic treatment. However, it is unknown whether or not chiropractic treatment is able to improve reaction and response times in specific populations of interest. One such population is the U.S. military special operation forces' (SOF) personnel. METHODS: This study is a randomized controlled trial of 120 asymptomatic volunteer SOF personnel. All participants are examined by a study doctor of chiropractic (DC) for eligibility prior to randomization. The participants are randomly allocated to either a treatment group receiving four treatments of chiropractic manipulative therapy (CMT) over 2 weeks or to a wait-list control group. The wait-list group does not receive any treatment but has assessments at the same time interval as the treatment group. The outcome measures are simple reaction times for dominant hand and dominant foot, choice reaction time with prompts calling for either hand or either foot, response time using Fitts' law tasks for small movements involving eye-hand coordination, and brief whole body movements using the t-wall, a commercially available product. At the first visit, all five tests are completed so that participants can familiarize themselves with the equipment and protocol. Assessments at the second and the final visits are used for data analysis. DISCUSSION: SOF personnel are highly motivated and extremely physically fit individuals whose occupation requires reaction times that are as quick as possible during the course of their assigned duties. A goal of CMT is to maximize the functionality and integration of the neuromusculoskeletal systems. Therefore, chiropractic treatment may be able to optimize the capacity of the numerous components of those systems, resulting in improved reaction time. The objective of this study is to test the hypothesis that CMT improves reaction and response times in asymptomatic SOF personnel. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02168153 . Registered on 12 June 2014.

Relationship between body composition, leg strength, anaerobic power, and on-ice skating performance in division I men's hockey athletes.

The purpose of this study was to examine relationships between laboratory tests and on-ice skating performance in division I men's hockey athletes. Twenty-one men (age 20.7 +/- 1.6 years) were assessed for body composition, isokinetic force production in the quadriceps and hamstring muscles, and anaerobic muscle power via the Wingate 30-second cycle ergometer test. Air displacement plethysmography was used to determine % body fat (%FAT), fat-free mass (FFM), and fat mass. Peak torque and total work during 10 maximal effort repetitions at 120 degrees .s were measured during concentric muscle actions using an isokinetic dynamometer. Muscle power was measured using a Monark cycle ergometer with resistance set at 7.5% of body mass. On-ice skating performance was measured during 6 timed 89-m sprints with subjects wearing full hockey equipment. First length skate (FLS) was 54 m, and total length skate (TLS) was 89 m with fastest and average skating times used in the analysis. Correlation coefficients were used to determine relationships between laboratory testing and on-ice performance. Subjects had a body mass of 88.8 +/- 7.8 kg and %FAT of 11.9 +/- 4.6. First length skate-Average and TLS-Average skating times were moderately correlated to %FAT ([r = 0.53; p = 0.013] and [r = 0.57; p = 0.007]) such that a greater %FAT was related to slower skating speeds. First length skate-Fastest was correlated to Wingate percent fatigue index (r = -0.48; p = 0.027) and FLS-Average was correlated to Wingate peak power per kilogram body mass (r = -0.43; p = 0.05). Laboratory testing of select variables can predict skating performance in ice hockey athletes. This information can be used to develop targeted and effective strength and conditioning programs that will improve on-ice skating speed.

Running posture and step length changes immediately after chiropractic treatment in a patient with xeroderma pigmentosum.

OBJECTIVE: This case study reports on selected measures of locomotion (running) in a 5-year-old patient with xeroderma pigmentosum after chiropractic care. CLINICAL FEATURE: A 5-year-old female patient (16.4 kg, 99.1 cm) with xeroderma pigmentosum (type A) volunteered to participate in the experiment with the consent of her parents. The patient had well-documented signs of delayed fine motor (eg, difficulty with writing, coloring, cutting) and gross motor control (eg, balance and coordination dysfunction and falling while running), and delayed speech. INTERVENTION AND OUTCOMES: Trunk forward lean angles, step lengths, and hip horizontal translations were assessed by video as the participant ran as fast as possible down a laboratory runway. After chiropractic manipulation (adjustments), the patient reduced the trunk forward lean angle to become more vertical (P = .000). In addition, the patient experienced an increase in step length (P = .031). No significant change in lateral translation was observed after the intervention. CONCLUSION: For this patient with xeroderma pigmentosum, chiropractic manipulation (adjustments) resulted in immediate changes in running performance. Further investigation is needed to examine the effect of chiropractic on locomotion in both symptomatic and asymptomatic patients.

Chiropractic treatment of pregnancy-related low back pain: a systematic review of the evidence.

OBJECTIVE: This study systematically reviewed the published evidence regarding chiropractic care, including spinal manipulation, for pregnancy-related low back pain (LBP). METHODS: A multimodal search strategy was conducted, including multiple database searches along with reference and journal hand searching. Studies were limited to those published in English and in a peer-reviewed journal or conference proceeding between January 1982 and July 2007. All study designs were considered except single case reports, personal narratives, and qualitative designs. Retrieved articles that met the inclusion criteria were rated for quality by using a validated and reliable checklist. RESULTS: Six studies met the review's inclusion criteria in the form of 1 quasi-experimental single-group pretest-posttest design, 4 case series, and 1 cross-sectional case series study; their quality scores ranged from 5 to 14 of 27. All of the included studies reported positive results for chiropractic care of LBP during pregnancy. Outcome measure use between the studies was inconsistent as were descriptions of patients, treatments, and treatment schedules. CONCLUSIONS: Results from the 6 included studies showed that chiropractic care is associated with improved outcomes in pregnancy-related LBP. However, the low-to-moderate quality of evidence of the included studies preclude any definitive statement as to the efficacy of such care because all studies lacked both randomization and control groups. Given the relatively common use of chiropractic care during pregnancy, there is need for higher quality observational studies and controlled trials to determine efficacy.

The effect of chiropractic adjustments on movement time: a pilot study using Fitts Law.

OBJECTIVE: To investigate the effect of chiropractic adjustments on movement time using Fitts Law. METHODS: This was a prospective, randomized controlled trial. Ten patients from a private chiropractic practice participated. Participants in the treatment group received high-velocity, low-amplitude chiropractic adjustments to areas of joint dysfunction (chiropractic subluxation). A nonintervention group was used to control for improvement resulting from time and practice effects. Movement time was measured as participants moved a cursor onto a target appearing on a computer screen. A range of target widths and target distances were used to vary the index of difficulty. RESULTS: All participants in the experimental group had significantly improved movement times following spinal adjustments compared with only 1 participant in the control group. The average improvement in movement time for the experimental group was 183 ms, a 9.2% improvement, whereas the average improvement in movement time for the control group was 29 ms, a 1.7% improvement. The difference (improvement) scores after the intervention were significantly greater for the chiropractic group compared with the control group as measured by a 2-tailed independent samples t test (P < .05). CONCLUSION: The results of this study demonstrated a significant improvement in movement time with chiropractic care. These results suggest that spinal adjustments may influence motor behavior.

An online survey of chiropractors' opinions of Continuing Education.

BACKGROUND: Continuing Education (CE) for chiropractors is mandatory for licensure in most North American jurisdictions. Numerous chiropractic colleges have begun collaborating with universities to offer master's degree programs. Distance education master's degree programs may be desirable to allow full-time practicing doctors to further their post-graduate education. The present survey sought to answer three questions. First, what is the level of satisfaction of chiropractors with their continuing education? Second, what is the level of interest of chiropractors in online master's degree programs? Lastly, what is the response rate of chiropractors to an online survey? METHODS: An online survey consisting of 22 multiple choice questions was e-mailed to 1000 chiropractors randomly selected from the mailing list of an online chiropractic newsletter. Upon completion of the questionnaire, participants' answers were saved on a secure site. Data analysis included evaluation of the demographic characteristics of the respondents, their opinions of and patterns of taking CE including online education, preferred learning formats, and their interest in proposed online master's degree programs. A survey response rate was determined. RESULTS: Nearly 86% of respondents felt their previously completed CE courses were either somewhat or extremely satisfactory. Over ninety percent of respondents who had completed online or distance CE courses found them to be somewhat or extremely satisfactory. Almost half the respondents indicated that they most preferred online distance learning, while 34.08% most preferred face-to-face interaction. Fifty-three percent of respondents indicated an interest in starting a master's degree program; however 70.46% of respondents were interested in an online master's degree program that would offer CE credit. A response rate of 35.8% was obtained. CONCLUSION: Satisfaction among chiropractors with CE programs is high. The notion of completing a part-time online master's degree (or online combined with face-to-face interaction) appears to be popular among respondents, with a M.Sc. in Chiropractic Sciences being the most popular of those mentioned. Online surveys are a viable method of obtaining opinion in a cost and time efficient manner; there are some sources of bias involved in this type of research, and numerous steps need to be taken to obtain a suitable response rate.