The effects of orthotic intervention and 9 holes of simulated golf on gait in experienced golfers.

BACKGROUND: This investigation evaluated the effects of orthotic intervention on gait patterns and fatigue associated with 9 holes of simulated golf among a group of experienced golfers. SETTING: Northwestern Health Sciences University, Bloomington, Minn. PARTICIPANTS: Twelve experienced golfers. METHOD: By means of video freeze-frame analysis, gait was assessed in each subject before and after 9 holes of simulated golf. Subjects wore custom-made, flexible orthotics daily for 6 weeks, and gait was then reassessed through use of the same objective measurement parameters. Fatigue was introduced by having participants complete 9-hole rounds of simulated golf before and after wearing custom-made, flexible orthotics for 6 weeks. MAIN OUTCOME MEASURE: Parameters associated with gait (ie, stride length and pelvic rotation) were measured in all subjects before and after they used custom-fit, flexible orthotics for 6 weeks and before and after they completed 9 holes of simulated golf. RESULTS: The data indicate that for experienced golfers, wearing the custom-fit, flexible orthotics used in this study for 6 weeks influenced the parameters associated with gait and reduced the effects of fatigue associated with 9 holes of simulated golf. CONCLUSION: The use of custom-fit, flexible orthotics in this study had a significant influence on the elements of gait measured in the investigation-specifically, pelvic rotation and stride length. There was an average increase in pelvic rotation of between 29% and 36%, and there were concomitant changes in stride length after subjects had used the orthotics for 6 weeks. In addition, use of these custom orthoses reduced the effects of fatigue associated with playing 9 holes of simulated golf; they could thus improve the likelihood of more consistent performance, possibly as a result of a more efficient gait pattern.

Effects of orthotic intervention and nine holes of simulated golf on club-head velocity in experienced golfers.

OBJECTIVE: This study was an initial investigation evaluating the effects of orthotic intervention on club-head velocity (CHV) among a group of experienced golfers before and after 9 holes of simulated golf. SETTING: Northwestern College of Chiropractic, Bloomington, Minnesota. PARTICIPANTS: Twelve experienced golfers were included in the study. METHOD: CHV was measured with a device used by many Professional Golf Association and Ladies Professional Golf Association teaching professionals before and after wearing orthotics and before and after completing 9 holes of simulated golf. Subjects wore custom-made, flexible orthotics daily for 6 weeks and then were retested with the same objective measurement parameters. OUTCOME MEASURE: CHV (swing speed in miles per hour) was measured in all subjects before and after wearing custom-fit, flexible orthotics for 6 weeks and before and after completing 9 holes of simulated golf. RESULTS: There was an approximate increase in CHV of between 3 and 5 mph, or a relative increase in CHV by up to 7%, after subjects had worn custom-made, weight-bearing, flexible orthotics daily for 6 weeks. A 5-mph increase in CHV is equivalent to an approximate increase in golf ball travel distance of 15 yards, a significant increase for the tour player for whom small increases in performance can reflect large position changes on the roster board. In addition, the use of these custom of those eliminated the effects of fatigue associated with playing 9 holes of golf (relative to CHV) and therefore may improve the likelihood for more consistent golf performance. CONCLUSION: The use of the custom-fit, flexible orthotics in this study had a positive influence on CHV in experienced golfers.

A conservative approach for a patient with traumatically induced urinary incontinence.

OBJECTIVE: To consider a conservative management plan for a patient suffering from diurnal enuresis. CLINICAL FEATURES: A 12-yr-old girl complained of left flank pain and involuntary urine loss that apparently began a short time after she fell backwards and landed on her coccyx. She had to wear a sanitary pad prophylactically throughout each day for more than a year because of unpredictable urinary incontinence. INTERVENTION: Manual adjusting procedures and soft tissue therapy were applied initially. Procedures were modified later to include an intrarectal technique. The quantity of urine loss decreased slowly with the initial treatment approach but never resolved completely. The flank pain also decreased somewhat but never ceased altogether. After the introduction of the intrarectal technique, additional progress was reported and both the flank pain and urinary incontinence resolved completely. A 4-yr follow-up confirmed complete resolution. CONCLUSION: Conservative care helped an adolescent girl suffering from traumatically induced urinary incontinence.

Effects of nine holes of simulated golf and orthotic intervention on balance and proprioception in experienced golfers.

OBJECTIVE: To investigate effects of orthotic intervention on balance and proprioception among a group of experienced golfers. SETTING: Northwestern College of Chiropractic. PARTICIPANTS: Twelve experienced golfers were included in the study. METHOD: Balance and proprioception were measured before and after nine holes of simulated golf using piezo-electric film sensor platforms. Subjects wore custom-made, flexible orthotics daily for 6 wk and were then retested using the same objective measurement parameters. OUTCOME MEASURE: Primary outcome measures included stabilization index and stabilization time. RESULTS: Statistical trends suggest that the custom-made, flexible orthotics used in this study were effective in enhancing balance and proprioception and may have reduced the relative effects of fatigue associated with nine holes of simulated golf. CONCLUSION: Although individual differences were anticipated, data trends suggest that nine holes of simulated golf promotes changes in standing balance and proprioception and that 6 wk of wearing these custom-made, flexible orthotics has a positive influence in promoting balance and proprioceptive symmetry.

A holistic approach to severe headache symptoms in a patient unresponsive to regional manual therapy.

OBJECTIVE: To discuss the case of a patient suffering from severe headache complaints who was previously unresponsive to regional cervical spine care. CLINICAL FEATURES: A prodrome was described. In addition to headache itself, associated symptoms included light sensitivity, blurred vision and nausea. A visit to a hospital emergency room was often necessary to reduce pain intensity. INTERVENTION AND OUTCOMES: Manual chiropractic spinal adjustment were performed as the only treatment intervention. After a course of treatment, the patient reported no visits to the emergency room, even after a 1-yr follow-up, and the average visual analogue pain scores decreased. CONCLUSION: This patient seemed to respond favorably to conservative care that included regions of spine not traditionally associated with headache pain. This suggests that some individuals may require a more comprehensive evaluation if regional care fails to promote a positive response within a few weeks. Controlled, randomized trials will assist in comparing effectiveness of various treatment interventions.

Inter- and intraexaminer reliability of a single, digital inclinometric range of motion measurement technique in the assessment of lumbar range of motion.

OBJECTIVE: The between and within examiner reliability of a range of motion digital inclinometer was evaluated for lumbar flexion, extension and right and left lateral flexion. DESIGN: Blinded, lumbar range of motion instrumentation reliability. SETTING: Private college research and ambulatory patient care facility. PARTICIPANTS: Twenty-eight asymptomatic persons recruited from a private college. This included students, staff and faculty that ranged from 23-36 yr, with no history of back pain or surgery or back injury 6 wk prior to entry into the study. INTERVENTION: Lumbar range of motion examination, twice by each examiner, or four times in all per subject. MAIN OUTCOME MEASURE: Lumbar range of motion, measured in degrees. RESULTS: Intraclass correlation (ICC) revealed lack of reliability for this device except flexion, but intrinsic limitations of the instrument suggests that flexion as well may not be reliable. The p value of .05 was used for statistical significance and Burdock's recommended value of .75 represented the minimum R value for reliability. CONCLUSION: Most of the reliability values did not meet Burdock's recommended minimum R value, and the R values for flexion may have met minimum criteria due to intrinsic limitations of the instrument itself. Due to the findings of this study, we conclude that the Orthoranger II digital inclinometer is not reliable, between and/or within examiners, for measuring lumbar flexion, extension or lateral flexion. Because there was evidence to suggest other variables which were not accounted for, and which could have affected final results, the development of a streamlined protocol may result in more consistent findings. Further research is needed to either support or dispute these results before this instrument can be recommended as an assessment tool in clinical practice or in clinical trials.

Clinical presentation of a patient with multiple sclerosis and response to manual chiropractic adjustive therapies.

OBJECTIVE: To present a clinical case presentation of a patient with multiple sclerosis (MS). Diagnostic criteria are presented, including advanced imaging; and, for the first time, a potential relationship between chiropractic manual adjustive therapies and the symptoms associated with MS is presented. CLINICAL FEATURES: A 32-yr-old male presented with numbness from the lower trunk to the distal lower extremities, anteriorly and posteriorly, bilaterally equal. There was a family history suggestive of MS, reflexes were hyperactive, and hypoesthesia was present with the neurological pinwheel exam. There was evidence to suggest biomechanical vertebral segmental dysfunction. A second-opinion medical neurological evaluation and multifocal demyelination lesions confirmed with magnetic resonance imaging reinforced the working impression. Laboratory screening was conducted but was non-revealing. INTERVENTION AND OUTCOME: Conservative chiropractic manual adjustive therapies were provided to address spinal segmental dysfunction and the patient reported complete absence of symptoms following the first treatment intervention. It was at this time, in order to rule out other possibilities and to confirm the working impression of MS, that a second opinion with a medical neurologist was recommended. CONCLUSION: Manual adjustive therapies appear to be responsible for the dramatic symptomatic relief provided for a patient diagnosed with MS. The relative risk-to-benefit ratio suggests that this approach may be appropriate as an alternative symptom management approach for MS patients, and future research efforts can and should direct the comprehensive management approach to the treatment of this disorder.

Dysfunctional uterine bleeding with concomitant low back and lower extremity pain.

In this case presentation, a temporal relationship between conservative chiropractic care and dysfunctional uterine bleeding (DUB) in a patient with mild low back and primary leg pain is described. Criteria are discussed to establish protocol that will be useful in the formulation of a diagnosis for DUB secondary to lower sacral nerve root compression and lumbar mechanical dysfunction. There have been investigations recently published that suggest a positive relationship between chiropractic lumbar, closed reduction distractive decompression (CRDD) and patients with pelvic pain and organic dysfunction. This case study presents the treatment response of one patient with one form of somatovisceral dysfunction, namely, dysfunctional uterine bleeding, in the absence of pelvic pain. Conservative chiropractic care may be an effective, noninvasive method for treating some individuals with dysfunctional uterine bleeding, caused secondarily from biomechanical and/or neurological insult. Further research in this area is encouraged.

The management of symptoms associated with premenstrual syndrome.

Criteria for the accurate diagnosis of premenstrual syndrome are described and a methodology for monitoring patient response to treatment is presented. The PMT-Cator, a recently developed device, affords a procedure for converting the patient's subjective symptoms into an objective menstrual cycle interval score, thereby providing a means for statistical analysis in larger, controlled clinical trials. Most investigators agree that there are somatic phenomena which are causally related to the symptoms associated with premenstrual syndrome. Furthermore, the chiropractic profession purports a primary relationship between anatomical structure and physiologic function. This case presentation examines a potential relationship between chiropractic spinal adjusting procedures and the management of premenstrual symptoms. Protocols from this isolated case study are presented as a template for suggested future research.