October 2018

Chiropractic Maintenance Care More Effective Than Symptom Treatment, Study Says

A peer-reviewed study was published by PLOS ONE on September 12, 2018, documenting that chiropractic maintenance care was more effective for reducing the total number of episodes of non-specific lower back pain (LBP) over a 52 week period than chiropractic symptom-guided treatment.

When it comes to chiropractic adjustments, patients have usually taken one of two approaches. One approach is known as corrective or symptom care. In this approach, the patient begins care with the purpose of decreasing or eliminating pain. Once the pain has been corrected, the care is discontinued until another episode of pain occurs and the patient seeks chiropractic care again.

The second approach involves the patient remaining under chiropractic care after the alleviation of pain. This approach is usually known as either wellness or maintenance care. Most chiropractors promote the continuation of care after symptoms have gone to either help prevent future episodes of pain, or to promote overall wellness.

This study specifically looked at the comparison of what researchers called "symptom-guided treatment" verses chiropractic maintenance care. The narrow criterion chosen for this comparison was to see if patients with "recurrent or persistent non-specific low back pain" had less future episode of their problem if they continued chiropractic care beyond the correction of their symptoms while under chiropractic care for their initial episode of lower back pain.

This study was a randomized controlled trial which included 328 patients between the ages of 18 and 65 who sought chiropractic for non-specific lower back pain and had a favorable response to the initial chiropractic care. The study was conducted between the years 2012 and 2016 from the offices of 40 participating Swedish chiropractors with clinics across Sweden.

After the initial chiropractic care, the patients were randomly selected be in one of two groups. One group would continue to receive chiropractic care on a maintenance basis, while the second group, known as the control group, would not receive any additional chiropractic care. 

Each week for one year after the initial chiropractic care was completed, the patients in both the maintenance chiropractic group and the control group would send text messages to researchers about any "bothersome days" of lower back pain they may have experienced.  The results of the study showed that the patients who continued to receive chiropractic care on a maintenance basis experienced statistically fewer days of bothersome lower back pain over the next year than did the patients in the control group. As expected and reported by the researchers, those patients under chiropractic maintenance care received more chiropractic visits than those in the control group.

In their conclusion the researchers reported, "MC (maintenance care) was more effective than symptom-guided treatment in reducing the total number of days over 52 weeks with bothersome non-specific LBP but it resulted in a higher number of treatments. For selected patients with recurrent or persistent non-specific LBP who respond well to an initial course of chiropractic care, MC should be considered an option for tertiary prevention."


After Auto Accident Teenage Boy's Neck Pain and Neck Curvature Helped by Chiropractic

The Journal of Pediatric, Maternal & Family Health published a case study on September 10, 2018, documenting chiropractic helping a teenage boy with neck pain following a car accident. The study was also able to show improvement in the boy's neck curvature.

The study authors begin by noting that the most common diagnosis from U.S. hospital emergency departments given to people involved in a motor vehicle accident (MVA) is neck sprain/strain. These types of injuries are often painful, progressive and permanent if not corrected. One common finding in lateral x-rays of patients involved in MVA is a loss or reversal of the normal forward neck curvature. Neck curvature may not be directly from the MVA, but having an abnormal curve seems to be associated with a poor outcome. The study also reported that there is a higher incidence of forward head position in patients who have had a MVA as compared to those who have not.

Typical medical care of either medications or a "wait and see" approach have been shown to help in acute situations, but do not do as well for chronic pain, and do nothing to address the aberrant neck curvature or forward head position.

In this case, a 14-year-old boy who was involved in a MVA a year earlier was brought to a chiropractor by his parents. The boy was suffering with chronic headaches and neck pain that he and his parents related to the MVA a year earlier. The boy had no history of his neck pain or headaches prior to the accident. The accident occurred when the boy was riding in the front passenger seat of a minivan which was then rear-ended by a full sized pickup truck.

Within the first three months after the accident, the boy did receive some chiropractic care which had given him some relief. However, care was not continued until a year after the MVA when specific forms of chiropractic were utilized after an examination and additional x-rays. The neck x-rays specifically showed a loss of the neck curvature and a forward head position.

Prior to the specific chiropractic care, the boy's pain level was reported to be  7 out of 10, with 10 being the worst. After 11 weeks of specific chiropractic care, his pain had been reduced to 0 out of 10. Additionally, the reversal of the neck curve that was seen on the initial x-rays had began to show a curvature in the proper direction according to the follow-up neck x-rays.


Toe Walking and Feeding Difficulties Resolved Following Chiropractic

A case study published on September 13, 2018, in the Journal of Pediatric, Maternal & Family Health documents the improvement of a 15-month-old child who was suffering with toe-walking and feeding problems. Toe walking is not considered a medical issue by itself under the age of two years. However, above the age of two, toe walking is considered abnormal.

According to the American Academy of Orthopedic Surgeons, "Toe walking is a pattern of walking in which a child walks on balls of his or her feet, with no contact between the heels and ground. Toe walking is common in children who are learning to walk. After the age of 2, however, most children outgrow toe walking and begin to walk with a normal heel-to-toe pattern."

Toe walking has been associated with disorders such as cerebral palsy, congenital contracture of the Achilles tendon or paralytic muscular disorders and some developmental disorders such as autism or myopathic and neuropathic disorders. It is estimated that 2-5% of children at age 5.5 years still have toe walking. Among children with a neuropsychiatric diagnosis or developmental delays, the percentage of toe walking is much higher at 41%. If other conditions are ruled out, toe walking by itself can be referred to as idiopathic toe walking.

In this case, a 15-month-old girl was brought to the chiropractor by her mother. The girl's problems included toe walking and a reported difficulty in eating. Her mother reported that her daughter has been toe walking since she started walking at 12 to 13 months of age. Since that point, the girl has never walked normally. It was reported that the girl would take a few steps with flat feet and then start walking on her toes by the fourth or fifth step.

In addition to the toe walking, the girl has also had eating problems since she was 3-months-old. Her mother reported that her daughter refused to nurse or bottle-feed, so her mother was forced to spent hours each day spoon-feeding her pumped breast milk. Once eating solid food the girl would only eat if distracted and food was placed into her mouth. The girl did not suffer from any neurodevelopmental disorders or from other disorders associated with toe walking.

A chiropractic examination was performed which found some positive findings from palpation, a posture analysis and reflex tests.  It was determined that subluxations were present. With the mother's consent, specific pediatric chiropractic care was started.

On the fifth visit, the girl's mother stated that her daughter was no longer toe walking, and was walking normally. Her mother also reported that her daughter was demonstrating an increased interest in food and eating, and appeared to be physically more comfortable while eating. During a three-month follow-up visit, it was reported that the girl was still free from toe walking.

In the study discussion and conclusion the authors wrote, "The infant presented in this case report presented with both difficulty eating and toe walking. The focus of this case report was her toe walking but we acknowledge the impact of chiropractic care in improving the infant’s feeding mechanics and feeding habits." They continued, "This case report provides supporting evidence on the benefits of chiropractic care in a child with toe-walking."


Earaches Helped, Hearing Improved, and Tubes Avoided Due to Chiropractic Care

On September 24, 2018, the  Journal of Pediatric, Maternal & Family Health published a case study documenting the improvement of earaches and hearing in a boy who was scheduled to have ear tube surgery. Earaches, clinically known as Otitis Media (OM), is any inflammation of the middle ear and is typically caused by a bacteria or virus.

The study points out that Otitis Media is the most common reason to visit a medical physician for children under the age of 15 years. It is a very common problem affecting about 2/3rds of children under age two, and generating approximately 20 million visits to physicians each year. This problem is estimated to cost more than $3.8 billion dollars each year in the U.S. alone. Otitis Media is considered to be chronic if the condition lasts more than three weeks.

In this case, a 9˝-year-old boy was brought to the chiropractor by his mother. The boy had been suffering with recurrent ear infections. The history had revealed that he had been suffering with ear infections since he was 2 years of age. His medical history reports that in the 7 years prior to him being brought to the chiropractor, the boy had been treated medically for multiple bilateral ear infections with antibiotics, removal of his adenoids as well as three sets of butterfly tube implants. Each of the three attempts with ear implant tubes resulted in rejection. Just prior to the time of his visit to the chiropractor, he had been scheduled for a 4th attempt at ear tube implants.

His pain level was 7 out of 10, on a scale of 0 to 10 with 10 being the worst. The boy was experiencing a fever and was losing sleep due to the problem. Because of the ear infections, the boy was missing school and having difficulty concentrating when he was in attendance. His mother stated that nothing was relieving her son's symptoms.

A chiropractic examination was performed. It was observed that at that time, an active ear infection was present. A postural analysis showed an anterior head position and restricted ranges of motion in areas of the boy's neck. Palpation of the spine and musculature was also performed and a determination of the presence of subluxations was made. Chiropractic care was then started.

The study records that as chiropractic care progressed, the boy's pain level decreased from 7 out of 10 to between a 2 and 4 out of 10. A follow-up visit to his medical doctor confirmed that the ear fluid was decreasing. His improvement led to the canceling of his ear tube surgery. His rate of ear infections and fluid in his ear continued to decrease over time. It was also reported that he was missing less school, his hearing had improved and he was sleeping better.

In the conclusion the authors stated, "The purpose of this case study was to show in detail a patient with recurrent otitis media managed with chiropractic care after failed allopathic treatments. The report describes the care of a 9˝-year-old male. In this case there were a marked improvements in frequency of episodes, ear pain, hearing loss, difficulty sleeping, fevers, increased absences from school, and difficulty engaging in social interactions. Chiropractic positively impacted the quality of the patient and parent’s lives."


Opiate Usage Lower for Veterans Receiving Chiropractic Care

A study published in Oxford Academic Pain Medicine on September 7, 2018, showed that U.S. military veterans of operations Enduring Freedom, Iraqi Freedom, and New Dawn used less opioid medication if they also received chiropractic care at a VA facility.

This study specifically looked at veterans who were involved in operations Iraqi Enduring Freedom, Iraqi Freedom, and New Dawn. The veterans in this study made at least one visit to a Veterans Affairs (VA) chiropractic clinic between the years 2004 and 2014. For the purposes of this study, opioid usage was described as a prescription given to a veteran somewhere between 90 days before a chiropractic VA visit, as well as up to 90 days after a chiropractic VA clinic visit.

The study found that veterans were more likely to be prescribed opioids if they had moderate to severe pain, or  if they had PTSD or depression. The study did show that those veterans who received chiropractic care had a significantly lower usage of opiates after receiving chiropractic care as compared to those veterans who did not receive any chiropractic care at all.

In the study conclusion, the authors state, "Nearly one-third of (Operations Enduring Freedom, Iraqi Freedom, and New Dawn) veterans receiving VA chiropractic services also received an opioid prescription, yet the frequency of opioid prescriptions was lower after the index chiropractic visit than before. Further study is warranted to assess the relationship between opioid use and chiropractic care."

In explaining the results the authors wrote, "The percentage of veterans receiving opioid prescriptions was lower in each of the three 30-day time frames assessed after the index chiropractic visit than before. Our work did not attempt to assess causation or otherwise explain this observation. Veterans may have been referred to chiropractic care as part of an opioid taper plan, or those who agreed to chiropractic care may have been inherently less likely to seek opioid prescriptions. However, it is also possible that the delivery of chiropractic care may have been a substitute for opioid use in our sample, which raises interesting research, policy, and practice considerations as the VA continues to expand chiropractic services. This is particularly relevant in light of other work that has shown a negative correlation between chiropractic use and opioid use in private sector populations."

Another study published in October 2018 showed that the duration of prescription opioid drugs is a risk factor for non-medical usage of prescription opioids among veterans receiving medical care. Therefore, it makes sense that anything that reduces the use of opioids by veterans reduces the inherent risks of opioid usage both medically and non-medically. Chiropractic has been shown to be a key factor in reducing the usage of opioids.


Chiropractic Helps Dog Suffering from Weakness, Constipation, and Extreme Thirst

An unusual study was published in the September 3, 2018, issue of the Annals of Vertebral Subluxation Research that documented that case of a dog suffering with weakness, constipation and extreme thirst being helped by chiropractic.

In the United States, laws vary from state to state as to how animals can receive chiropractic. In some states there is no legal basis for animals to receive chiropractic. In other states chiropractic can only be administered by a chiropractor in conjunction, and with the approval of a licensed veterinarian.  Chiropractors have been caring for animals for many decades based upon their own expertise and from training from other chiropractors who cared for animals before them. In 1986, the American Veterinary Chiropractic Association (AVCA) was formed by chiropractors and veterinarians. This organization has been offering certification courses for both professions.

On a section of the AVCA website, they describe the process of chiropractic with four points. They say.  "How Chiropractic Works; 1) The bones of the spine and joints are maintained in a specific alignment. 2) The nerves which surround each joint and vertebral articulation are in constant communication with the central nervous system, brain and all organs. 3) When even a subtle change in the alignment occurs, it is called a subluxation. 4) Subluxations affect the nervous system, local muscles, joints and even distant organs, glands and body functions." 

In this case, a 14-year-old female Boston terrier mix was brought to the chiropractor.  She was suffering for the past six days with constipation. Additionally, she also had a severe unquenchable thirst, and was significantly weak. A week earlier, the dog had been to the veterinarian due to being lame in the right front limb. After a series of tests and medication, the dog was no longer using her bowels and was getting worse daily. After a week, the dog was hospitalized. Additional more invasive testing was recommended but the dog owner decided to see if chiropractic would be of benefit.

When the dog arrived at the chiropractic office, she was unable to walk. A chiropractic evaluation was performed and noted limb weakness, as well as areas of muscle tenderness along the spine. Motion and static palpation revealed the presence of subluxations in the dog's spine. Based upon these findings, a chiropractic adjustment was given to the dog.

Immediately after her first adjustment, the dog was taken outside to evaluate her gait and strength. She was able to walk on her own without assistance. Immediately thereafter, the dog had a bowel movement of what the clinician described as being a significant volume. The dog was seen a week later for a second chiropractic adjustment and continued to gain strength and return toward total health.

In the discussion of this case, the author's point out, "Animal chiropractic is currently practiced by both licensed veterinarians and chiropractors in the United States, and animal chiropractic training has been incorporated into chiropractic and veterinary programs internationally. Scope of practice is determined by state licensing boards, but most states require chiropractors to obtain referral from a licensed veterinarian or work under the direct supervision of a licensed veterinarian."