21 for 2021

21 Research Studies in 2020 That Every Chiropractor Should Know and Share with Their Patients

To say that 2020 is a year that we’ll never forget is an understatement. While it seems rather mundane to talk about research in such an explosive, disruptive, and life-changing year, there were dozens of studies and reviews that came out that are directly related to a practicing chiropractor’s practice.

Here are summaries of 21 studies published in 2020 that I’ve vetted for your attention. They are listed in no particular order of importance.

1. Chiropractic maintenance care is most effective for pain management in chronic non-specific low back pain patients if they have more emotional distress and pain-avoidance behaviors. (Eklund, A., Hagberg, J., Jensen, I. et al. The Nordic maintenance care program: maintenance care reduces the number of days with pain in acute episodes and increases the length of pain free periods for dysfunctional patients with recurrent and persistent low back pain – a secondary analysis of a pragmatic randomized controlled trial. Chiropr Man Therap 28, 19 (2020). https://doi.org/10.1186/s12998-020-00309-6)

2. An updated evidence-based guideline for the most common musculoskeletal conditions in chiropractic practice was published: Best Practices for Chiropractic Management of Patients with Chronic Musculoskeletal Pain: A Clinical Practice Guideline.  (Cheryl Hawk, Wayne Whalen, Ronald J. Farabaugh, Clinton J. Daniels, Amy L. Minkalis, David N. Taylor, Derek Anderson, Kristian Anderson, Louis S. Crivelli, Morgan Cark, Elizabeth Barlow, David Paris, Richard Sarnat, and John Weeks.The Journal of Alternative and Complementary Medicine.Oct 2020.884-901. http://doi.org/10.1089/acm.2020.0181)

3. Active-duty military personnel receiving chiropractic care exhibited improved strength and endurance, as well as reduced LBP intensity and disability, compared with a wait-list control. (ining R, Long CR, Minkalis A, Gudavalli MR, Xia T, Walter J, Coulter I, Goertz CM. Effects of Chiropractic Care on Strength, Balance, and Endurance in Active-Duty U.S. Military Personnel with Low Back Pain: A Randomized Controlled Trial. J Altern Complement Med. 2020 Jul;26(7):592-601. doi: 10.1089/acm.2020.0107. Epub 2020 Jun 12. PMID: 32543211.)

4. In patients with low back pain, spinal manipulation affects the central nervous system and changes the brain metabolites. Consequently, pain and functional disability are reduced. (Didehdar D, Kamali F, Yoosefinejad AK, Lotfi M. The effect of spinal manipulation on brain neurometabolites in chronic nonspecific low back pain patients: a randomized clinical trial. Ir J Med Sci. 2020 May;189(2):543-550. doi: 10.1007/s11845-019-02140-2. Epub 2019 Nov 26. PMID: 31773541.)

5. Spinal manipulations and mobilizations may result in significant decrease of systolic as well as diastolic blood pressure.  (Gera C, Malik M, kaur J, Saini M. A systematic review and meta-analysis on effect of spinal mobilization and manipulation on cardiovascular responses. Hong Kong Physiother J. 2020;40(2):75-87. doi:10.1142/S1013702520500122)

6. Chiropractic care reduces opiod use. Patients with spinal pain who saw a chiropractor had half the risk of filling an opioid prescription. Among those who saw a chiropractor within 30 days of diagnosis, the reduction in risk was greater as compared with those with their first visit after the acute phase. ( James M Whedon, DC, MS, Andrew W J Toler, MS, Louis A Kazal, MD, Serena Bezdjian, PhD, Justin M Goehl, DC, MS, Jay Greenstein, DC, Impact of Chiropractic Care on Use of Prescription Opioids in Patients with Spinal Pain, Pain Medicine, , pnaa014, https://doi.org/10.1093/pm/pnaa014)

7. In chronic stroke survivors, a single session of chiropractic spinal manipulation was found to increase the cortical activity related to the somatosensory evoked N30 potential, which may alter the early sensorimotor functionality. (Navid, M. S., Niazi, I. K., Lelic, D., Nedergaard, R. B., Holt, K., Amjad, I., … & Haavik, H. (2020). Investigating the Effects of Chiropractic Spinal Manipulation on EEG in Stroke Patients. Brain Sciences, 10(5), 253.)

8. Positive changes in the Cobb angle on x-rays was found in 10 patients with adolescent idiopathic scoliosis after a trial of chiropractic manipulation was observed in a study. An average of 10.3 months of treatment produced an overall average correction of 21.2%. (Pu Chu, E. C., Chakkaravarthy, D. M., Huang, K. H. K., Ho, V. W. K., Lo, F.-S., & Bhaumik, A. (2020). Changes in radiographic parameters following chiropractic treatment in 10 patients with adolescent idiopathic scoliosis: A retrospective chart review. Clinics and Practice, 10(3). https://doi.org/10.4081/cp.2020.1258)

9. An RCT found that spinal manipulation improves the results, compared to a control group of physiotherapy, over a period of 3 months for patients with subacute or chronic lumbar radiculopathy. Both subjective and physical exam measures improved more in the manipulation group.  (Ghasabmahaleh SH, Rezasoltani Z, Dadarkhah A, Hamidipanah S, Mofrad RK, Najafi S. Spinal manipulation for subacute and chronic lumbar radiculopathy: a randomized controlled trial. Am J Med. 2020 Sep 12:S0002-9343(20)30777-4. doi: 10.1016/j.amjmed.2020.08.005. ).

 10. Patients with chronic non-specific low back pain can be predicted to have more long-term disability if they sought medical care prior to seeking further care from a chiropractor or physiotherapist. (Petrozzi, M.J., Rubinstein, S.M., Ferreira, P.H. et al. Predictors of low back disability in chiropractic and physical therapy settings. Chiropr Man Therap 28, 41 (2020). https://doi.org/10.1186/s12998-020-00328-3)

 11. In a 4 year follow-up study of women with Carpal Tunnel Syndrome, manual therapy, including nerve glides and slides, and combined with a tendon/nerve gliding exercise program at home resulted in similar outcomes those who had surgery. (César Fernández-de-las-Peñas, José L Arias-Buría, Joshua A Cleland, Juan A Pareja, Gustavo Plaza-Manzano, Ricardo Ortega-Santiago, Manual Therapy Versus Surgery for Carpal Tunnel Syndrome: 4-Year Follow-up From a Randomized Controlled Trial, Physical Therapy, , pzaa150, https://doi.org/10.1093/ptj/pzaa150)

 12. A study demonstrated that there is a direct relationship between the position of atlas, unilateral restriction in Atlanto-Axial rotation, and the presence of cervicogenic headaches. The proposed mechanism was of dural tension. (Rob Sillevis, Eric Shamus, Karen Wyss et al. Cervicogenic Headache and the Relationship Between the Position and Movement of the Upper Cervical Spine and Dura, 28 May 2020, PREPRINT (Version 1) available at Research Square https://www.researchsquare.com/article/rs-31086/v1

13. Cervical spine manipulation was found to be effective in treating people with degenerative cervical radiculopathy, and superior to traction. ( Zhu L, Wei X, Wang S. Does cervical spine manipulation reduce pain in people with degenerative cervical radiculopathy? A systematic review of the evidence, and a meta-analysis. (Clin Rehabil. 2016 Feb;30(2):145-55. doi: 10.1177/0269215515570382. Epub 2015 Feb 13. PMID: 25681406.)

14. Most adverse events of SMT in children under 10 are mild (e.g., increased crying, soreness) and uncommon. It is unclear if SMT increases the risk of adverse events in children. (Corso, M., Cancelliere, C., Mior, S. et al. The safety of spinal manipulative therapy in children under 10 years: a rapid review. Chiropr Man Therap 28, 12 (2020). https://doi.org/10.1186/s12998-020-0299-y)

15. A study showed an association between self-reported spinal morning stiffness, especially lasting >30 minutes, and symptomatic lumbar disc degeneration. The association was stronger when the severity of spinal morning stiffness increased. (van den Berg, R., Chiarotto, A., Enthoven, W. T., de Schepper, E., Oei, E. H., Koes, B. W., & Bierma-Zeinstra, S. M. (2020). Clinical and radiographic features of spinal osteoarthritis predict long-term persistence and severity of back pain in older adults. Annals of Physical and Rehabilitation Medicine.)

16. 7 themes were identified with respect to potential mechanisms to explain changes in spinal stiffness following SMT: 1) change in muscle activity; 2) increase in mobility; 3) decrease in pain; 4) increase in pressure pain threshold; 5) change in spinal tissue behavior; 6) change in the central nervous system or reflex pathways; and 7) correction of a vertebral dysfunction. (Jun, P., Pagé, I., Vette, A. et al. Potential mechanisms for lumbar spinal stiffness change following spinal manipulative therapy: a scoping review. Chiropr Man Therap 28, 15 (2020). https://doi.org/10.1186/s12998-020-00304-x)

17. People with forward head posture exhibited abnormal sensorimotor control and autonomic nervous system dysfunction compared to those with normal head alignment. (Moustafa IM, Youssef A, Ahbouch A, Tamim M, Harrison DE. Is forward head posture relevant to autonomic nervous system function and cervical sensorimotor control? Cross sectional study. Gait & Posture. 2020 Mar;77:29-35. DOI: 10.1016/j.gaitpost.2020.01.004.)

18.  18 factors in patients were found that could predict instantaneous relief from spinal manipulation for non-specific low back pain. The highest ranked factor was, “a history that included a good response to previous spinal manipulation”. (Innes, S., Beynon, A., Hodgetts, C. et al. Predictors of instantaneous relief from spinal manipulation for non-specific low back pain: a delphi study. Chiropr Man Therap 28, 39 (2020). https://doi.org/10.1186/s12998-020-00324-7)

19.  A literature review on the effects of cervical manipulation found that HVLA techniques, on subjects with musculoskeletal disorders, are able to influence pain modulation, mobility and strength both in the treated area and at a distance. Cervical manipulations are effective in management of cervicalgia, epicondylalgia, temporomandibular joint disorders and shoulder pain.  (Giacalone A, Febbi M, Magnifica F, Ruberti E. The Effect of High Velocity Low Amplitude Cervical Manipulations on the Musculoskeletal System: Literature Review. Cureus. 2020 Apr 15;12(4):e7682. doi: 10.7759/cureus.7682. PMID: 32426194; PMCID: PMC7228797.)

 20. An observational study attempted to show predictors of visit frequency for patients using ongoing chiropractic care for chronic low back (CLBP) and chronic neck pain (CNP). Findings included:  Patients with either CLBP or CNP and worse function had significantly higher visit frequency. Having some insurance coverage increases visit frequency by 0.44 visits per month for patients with CLBP but has little to no effect for CNP. Visit frequency was significantly higher for patients of chiropractors who reported treating more patients per day and was significantly lower for patients of chiropractors who have been in practice for 20–30 years. Women with CLBP have fewer chiropractic visits per month than men. Newer patients, seeing the DC for less than 30 days, had more frequent visits. Herman, P.M., Edgington, S.E., Hurwitz, E.L. et al. Predictors of visit frequency for patients using ongoing chiropractic care for chronic low back and chronic neck pain; analysis of observational data. BMC Musculoskelet Disord 21, 298 (2020). https://doi.org/10.1186/s12891-020-03330-1

21.  More plant-based diets might have pain-relieving effects on chronic musculoskeletal pain. A proposed mechanism stems from the anti-inflammatory characteristics of the plant-based diet.  Pain severity is positively associated with fat and sugar intake in chronic osteoarthritis pain, and pain threshold is positively associated with protein intake.  (Elma, Ö., Yilmaz, S. T., Deliens, T., Coppieters, I., Clarys, P., Nijs, J., & Malfliet, A. (2020). Do nutritional factors interact with chronic musculoskeletal pain? A systematic review. Journal of clinical medicine, 9(3), 702.)

Dr. David Graber is a Diplomate of the American Chiropractic Board of Sports Physicians, and an ANJC board member. He practices in Parsippany, New Jersey. He teaches nationally courses in spinal and extremity manipulation, hands-on care, and evidence-informed practice. He was the ANJC’s 2012 Chiropractor of the Year. He can be reached at drdavidgraber@gmail.com.