Our annual review of the published research for 2021 produced a large number of studies of interest to chiropractors! While it was difficult to choose, here are 21+ clinically relevant papers published in 2021. Happy reading!
SPINAL MANIPULATION (SMT) EFFECTS
1. Colicky babies show clinical evidence of underlying vestibular dysregulation. Gentle treatment aimed at correcting upper-cervical muscular tightness by means of vibratory proprioceptive stimulation may be effective in decreasing vestibular hyperactivity, signifying an improvement of brainstem regulation.
Hoeve, J. (2021). Clinical Evidence of Vestibular Dysregulation in Colicky Babies Before and After Chiropractic Treatment vs. Non-colicky Babies. Frontiers in Pediatrics, 9. https://doi.org/10.3389/fped.2021.668457
2. This is a good review of several neurophysiological mechanisms of chiropractic spinal manipulation for spine pain. Spinal manipulation inhibits back and neck pain partly through spinal segmental mechanisms and potentially through peripheral mechanisms regulating inflammatory responses.
Gevers‐Montoro, C., Provencher, B., Descarreaux, M., Ortega de Mues, A., & Piché, M. (2021). Neurophysiological mechanisms of chiropractic spinal manipulation for spine pain. European Journal of Pain. https://doi.org/10.1002/ejp.1773
3. Spinal manipulation added to standard physiotherapy produced better results over a period of 3 months for patients with subacute or chronic lumbar radiculopathy.
Ghasabmahaleh, S. H., Rezasoltani, Z., Dadarkhah, A., Hamidipanah, S., Mofrad, R. K., & Najafi, S. (2021). Spinal Manipulation for Subacute and Chronic Lumbar Radiculopathy: A Randomized Controlled Trial. The American Journal of Medicine, 134(1), 135–141. https://doi.org/10.1016/j.amjmed.2020.08.005
4. A review of the literature shows that there is basic science evidence that HVLA controlled vertebral thrusts can modulate immune mediators, such as neurotensin, oxytocin, substance-P, and interleukin levels in healthy asymptomatic individuals in the short-term. In addition, they may influence cortisol levels in symptomatic and asymptomatic individuals. It’s not known yet how relevant these effects are.
Haavik, H.; Niazi, I.K.; Kumari, N.; Amjad, I.; Duehr, J.; Holt, K. The Potential Mechanisms of High-Velocity, Low-Amplitude, Controlled Vertebral Thrusts on Neuroimmune Function: A Narrative Review. Medicina 2021, 57, 536. https://doi.org/10.3390/medicina57060536
5. An in-depth meta-analysis found that SMT is a good option for the treatment of chronic low back pain. While most of us in practice know this, this article adds strong support in the scientific literature.
de Zoete, A., Rubinstein, S. M., de Boer, M. R., Ostelo, R., Underwood, M., Hayden, J. A., Buffart, L. M., van Tulder, M. W., Bronfort, G., Foster, N. E., Maher, C. G., Hartvigsen, J., Balthazard, P., Cecchi, F., Ferreira, M. L., Gudavalli, M. R., Haas, M., Hidalgo, B., Hondras, M. A., & Hsieh, C. Y. (2021). The effect of spinal manipulative therapy on pain relief and function in patients with chronic low back pain: an individual participant data meta-analysis. Physiotherapy, 112, 121–134. https://doi.org/10.1016/j.physio.2021.03.006
6. Improvements in motor function were observed when chiropractic care was added to 4 weeks of physical therapy care in people with subacute or chronic stroke.
Holt, K.; Niazi, I.K.; Amjad, I.; Kumari, N.; Rashid, U.; Duehr, J.; Navid, M.S.; Shafique, M.; Haavik, H. The Effects of 4 Weeks of Chiropractic Spinal Adjustments on Motor Function in People with Stroke: A Randomized Controlled Trial. Brain Sci. 2021, 11, 676. https://doi.org/10.3390/brainsci11060676
7. A systematic review and meta-analysis of randomized controlled trials of Spinal Manipulative Therapy for acute neck pain found SMT alone or in combination with other modalities was effective for patients with acute neck pain.
Chaibi, A., Stavem, K., & Russell, M. B. (2021). Spinal Manipulative Therapy for Acute Neck Pain: A Systematic Review and Meta-Analysis of Randomised Controlled Trials. Journal of Clinical Medicine, 10(21), 5011. https://doi.org/10.3390/jcm10215011
8. SMT doesn’t have to be specific to a “clinically relevant” joint or clinician-determined “correct” vertebral level to improve a patient’s spinal pain or disability. Non-specific SMT is effective.
Nim, C.G., Downie, A., O’Neill, S. et al. The importance of selecting the correct site to apply spinal manipulation when treating spinal pain: Myth or reality? A systematic review. Sci Rep 11, 23415 (2021). https://doi.org/10.1038/s41598-021-02882-z
9. This review explored how neuromuscular function is altered by both vertebral column dysfunction, known as central segmental motor control (CSMC) problems, and spinal adjustments/spinal manipulation.
Haavik H, Kumari N, Holt K, et al. The contemporary model of vertebral column joint dysfunction and impact of high-velocity, low-amplitude controlled vertebral thrusts on neuromuscular function. Eur J Appl Physiol. 2021;121(10):2675-2720. doi:10.1007/s00421-021-04727-z
10. For patients with chronic cervical radiculopathy, vertebral mobilization of the cervical spine is effective in short-term improvement of pain intensity, neck function, and neck ROM as well as localized mechanical pressure hypersensitivity.
Alshami, A. M., & Bamhair, D. A. (2021). Effect of manual therapy with exercise in patients with chronic cervical radiculopathy: a randomized clinical trial. Trials, 22(1). https://doi.org/10.1186/s13063-021-05690-y
11. In people with Achilles tendinopathy, thoracic spinal manipulation resulted in immediate increase in the total oxygenation index in the calf muscle followed by an increase in the testosterone/cortisol (T/C) ratio 6 hours’ post-intervention.
Kovanur Sampath, K., Mani, R., Katare, R., Neale, J., Cotter, J., & Tumilty, S. (2021). Thoracic Spinal Manipulation Effect on Neuroendocrine Response in People With Achilles Tendinopathy: A Randomized Crossover Trial. Journal of Manipulative and Physiological Therapeutics, 44(5), 420–431. https://doi.org/10.1016/j.jmpt.2021.06.001
12. Extrapolating Beyond the Data in a Systematic Review of Spinal Manipulation for Nonmusculoskeletal Disorders: A Fall From the Summit. A controversial topic in 2021.
Goertz, C. M., Hurwitz, E. L., Murphy, B. A., & Coulter, I. D. (2021). Extrapolating Beyond the Data in a Systematic Review of Spinal Manipulation for Nonmusculoskeletal Disorders: A Fall From the Summit. Journal of Manipulative and Physiological Therapeutics, 44(4), 271–279. https://doi.org/10.1016/j.jmpt.2021.02.003
13. SMT is a safer first choice for patients with back pain. With controlling for patient characteristics, health status, and propensity score, the adjusted rate of adverse drug events was more than 42 times higher for initial choice of Opioid Analgesic Therapy versus initial choice of SMT. DCs deliver nearly 97% of SMT in the U.S.
Whedon, James M. DC, MSa; Kizhakkeveettil, Anupama BAMS, (Ayurveda), MAOM, LAc, PhD; Toler, Andrew WJ MS; MacKenzie, Todd A. PhD; Lurie, Jon D. MD, MS; Hurwitz, Eric L. DC, MS, PhDa; Bezdjian, Serena PhD; Bangash, Maria BS; Uptmor, Sarah DC; Rossi, Daniel BS; Haldeman, Scott DC, MD, PhD. Initial Choice of Spinal Manipulative Therapy for Treatment of Chronic Low Back Pain Leads to Reduced Long-term Risk of Adverse Drug Events Among Older Medicare Beneficiaries, SPINE: December 15, 2021 – Volume 46 – Issue 24 – p 1714-1720
14. Using insurance claim data, the estimated risk of treatment escalation was 2.38 times higher in those who received care other than those who received spinal manipulation. In the United States, over 90% of spinal manipulation is provided by doctors of chiropractic.
Anderson, B. R., McClellan, W. S., & Long, C. R. (2021). Risk of Treatment Escalation in Recipients vs Nonrecipients of Spinal Manipulation for Musculoskeletal Cervical Spine Disorders: An Analysis of Insurance Claims. Journal of Manipulative and Physiological Therapeutics, 44(5), 372–377. https://doi.org/10.1016/j.jmpt.2021.03.001
CLINICAL CARE:
15. An expert panel convened to develop the first best-practice consensus document on chiropractic care for pregnant and postpartum patients with low back pain (LBP), pelvic girdle pain (PGP), or a combination.
Weis, C. A., Pohlman, K., Barrett, J., Clinton, S., da Silva-Oolup, S., Draper, C., Lee, J., Kumar, R., O’Beirne, M., Stuber, K., & Hawk, C. (2021). Best-practice recommendations for chiropractic care for pregnant and postpartum patients: Results of a consensus process. Journal of Manipulative and Physiological Therapeutics
16. Cervicogenic symptoms are prevalent in the acute and chronic stages following concussion, which if not diagnosed appropriately increase the likelihood of persistent post-concussive symptoms (PPCS).
Cheever, K., McDevitt, J., Phillips, J., & Kawata, K. (2021). The Role of Cervical Symptoms in Post-concussion Management: A Systematic Review. Sports Medicine, 51(9), 1875–1891. https://doi.org/10.1007/s40279-021-01469-y
17. Young low back pain patients, approximately age 20, were followed up by MRI for 30 years and found that early degeneration in lumbar discs predicts progressive degenerative changes in the respective discs, but not pain, disability, or clinical symptoms.
Sääksjärvi S, Kerttula L, Luoma K, Paajanen H, Waris E. Disc Degeneration of Young Low Back Pain Patients: A Prospective 30-year Follow-up MRI Study. Spine (Phila Pa 1976). 2020 Oct 1;45(19):1341-1347. https://doi.org/10.1097/brs.0000000000003548
18. This study found there was no evidence to support an association between a higher number of lumbar segments with radiographic degenerative changes (K-L grade, osteophytes, and disc space narrowing) and more severe back pain-related disability cross-sectionally or over time in middle-aged women.
Chen, L., Perera, R. S., Radojcic, M. R., Beckenkamp, P. R., Ferreira, P. H., Hart, D. J., Spector, T. D., Arden, N. K., & Ferreira, M. L. (2021). Association of Lumbar Spine Radiographic Changes With Severity of Back Pain–Related Disability Among Middle-aged, Community-Dwelling Women. JAMA Network Open, 4(5), e2110715. https://doi.org/10.1001/jamanetworkopen.2021.10715
19. Ordering an MRI in the first 4-6 weeks of care is associated with increased length of disability in patients with acute LBP without red flags.
hraim BA, Shraim MA, Ibrahim AR, Elgamal ME, Al-Omari B, Shraim M. The association between early MRI and length of disability in acute lower back pain: a systematic review and narrative synthesis. BMC Musculoskelet Disord. 2021 Nov 24;22(1):983. https://doi.org/10.1186/s12891-021-04863-9
20. A diagnosis-based clinical decision guide consisting of 3 questions can effectively distinguish patients with LBP and better specify treatment plans. The questions are: Are the symptoms with which the patient is presenting reflective of a visceral disorder or a serious or potentially life-threatening disease? From where is the patient’s pain arising? What has gone wrong with this person as a whole that would cause the pain experience to develop and persist?
Murphy, D.R., Hurwitz, E.L. Application of a diagnosis-based clinical decision guide in patients with low back pain. Chiropr Man Therap 19, 26 (2011). https://doi.org/10.1186/2045-709X-19-26
21. The modified cervical and shoulder retraction exercise program was shown to improve cervical lordosis and neck pain in patients with loss of cervical lordosis. The two step exercise: raise head up and push the chin backward simultaneously within the pain free range, and keep upright and try to pull back the shoulder and head within the pain free range.
Lee, M. Y., Jeon, H., Choi, J. S., Park, Y., & Ryu, J. S. (2020). Efficacy of Modified Cervical and Shoulder Retraction Exercise in Patients With Loss of Cervical Lordosis and Neck Pain. Annals of Rehabilitation Medicine, 44(3), 210–217. https://doi.org/10.5535/arm.19117
BONUS! Here are a few more that are impactful.
22. This is a excellent review of COVID-19’s effects and MSK conditions.
Hasan LK, Deadwiler B, Haratian A, Bolia IK, Weber AE, Petrigliano FA. Effects of COVID-19 on the Musculoskeletal System: Clinician’s Guide. Orthop Res Rev. 2021;13:141-150. Published 2021 Sep 21. doi:10.2147/ORR.S321884
23. Type 2 diabetes was found to be a predisposing factor for lumbar spine disorders. Type 2 diabetes was significantly associated with lumbar spine degenerative intervertebral disc disorders, lumbar Spondylotic radiculopathy, spondylolisthesis and spinal stenosis.
Park, CH., Min, KB., Min, JY. et al. Strong association of type 2 diabetes with degenerative lumbar spine disorders. Sci Rep 11, 16472 (2021). https://doi.org/10.1038/s41598-021-95626-y
24. Vitamin D deficiency is associated with lumbar disc degeneration and LBP in postmenopausal women. Specifically, a serum vitamin D concentration < 10 ng/mL is a marker of severe LDD and LBP. Smoking, severe vitamin D deficiency, lack of vitamin D supplementation, high body mass index, and osteoporosis are associated with a higher prevalence of moderate-to-severe pain.
Xu HW, Yi YY, Zhang SB, Hu T, Wang SJ, Zhao WD, Wu DS. Does vitamin D status influence lumbar disc degeneration and low back pain in postmenopausal women? A retrospective single-center study. Menopause. 2020 May;27(5):586-592. https://pubmed.ncbi.nlm.nih.gov/32049928/
About the Author: Dr. David Graber is a nationally known presenter on chiropractic technique.
ChiroExcellence
Our annual review of the published research for 2021 produced a large number of studies of interest to chiropractors! While it was difficult to choose, here are 21+ clinically relevant papers published in 2021. Happy reading!
SPINAL MANIPULATION (SMT) EFFECTS
1. Colicky babies show clinical evidence of underlying vestibular dysregulation. Gentle treatment aimed at correcting upper-cervical muscular tightness by means of vibratory proprioceptive stimulation may be effective in decreasing vestibular hyperactivity, signifying an improvement of brainstem regulation.
Hoeve, J. (2021). Clinical Evidence of Vestibular Dysregulation in Colicky Babies Before and After Chiropractic Treatment vs. Non-colicky Babies. Frontiers in Pediatrics, 9. https://doi.org/10.3389/fped.2021.668457
2. This is a good review of several neurophysiological mechanisms of chiropractic spinal manipulation for spine pain. Spinal manipulation inhibits back and neck pain partly through spinal segmental mechanisms and potentially through peripheral mechanisms regulating inflammatory responses.
Gevers‐Montoro, C., Provencher, B., Descarreaux, M., Ortega de Mues, A., & Piché, M. (2021). Neurophysiological mechanisms of chiropractic spinal manipulation for spine pain. European Journal of Pain. https://doi.org/10.1002/ejp.1773
3. Spinal manipulation added to standard physiotherapy produced better results over a period of 3 months for patients with subacute or chronic lumbar radiculopathy.
Ghasabmahaleh, S. H., Rezasoltani, Z., Dadarkhah, A., Hamidipanah, S., Mofrad, R. K., & Najafi, S. (2021). Spinal Manipulation for Subacute and Chronic Lumbar Radiculopathy: A Randomized Controlled Trial. The American Journal of Medicine, 134(1), 135–141. https://doi.org/10.1016/j.amjmed.2020.08.005
4. A review of the literature shows that there is basic science evidence that HVLA controlled vertebral thrusts can modulate immune mediators, such as neurotensin, oxytocin, substance-P, and interleukin levels in healthy asymptomatic individuals in the short-term. In addition, they may influence cortisol levels in symptomatic and asymptomatic individuals. It’s not known yet how relevant these effects are.
Haavik, H.; Niazi, I.K.; Kumari, N.; Amjad, I.; Duehr, J.; Holt, K. The Potential Mechanisms of High-Velocity, Low-Amplitude, Controlled Vertebral Thrusts on Neuroimmune Function: A Narrative Review. Medicina 2021, 57, 536. https://doi.org/10.3390/medicina57060536
5. An in-depth meta-analysis found that SMT is a good option for the treatment of chronic low back pain. While most of us in practice know this, this article adds strong support in the scientific literature.
de Zoete, A., Rubinstein, S. M., de Boer, M. R., Ostelo, R., Underwood, M., Hayden, J. A., Buffart, L. M., van Tulder, M. W., Bronfort, G., Foster, N. E., Maher, C. G., Hartvigsen, J., Balthazard, P., Cecchi, F., Ferreira, M. L., Gudavalli, M. R., Haas, M., Hidalgo, B., Hondras, M. A., & Hsieh, C. Y. (2021). The effect of spinal manipulative therapy on pain relief and function in patients with chronic low back pain: an individual participant data meta-analysis. Physiotherapy, 112, 121–134. https://doi.org/10.1016/j.physio.2021.03.006
6. Improvements in motor function were observed when chiropractic care was added to 4 weeks of physical therapy care in people with subacute or chronic stroke.
Holt, K.; Niazi, I.K.; Amjad, I.; Kumari, N.; Rashid, U.; Duehr, J.; Navid, M.S.; Shafique, M.; Haavik, H. The Effects of 4 Weeks of Chiropractic Spinal Adjustments on Motor Function in People with Stroke: A Randomized Controlled Trial. Brain Sci. 2021, 11, 676. https://doi.org/10.3390/brainsci11060676
7. A systematic review and meta-analysis of randomized controlled trials of Spinal Manipulative Therapy for acute neck pain found SMT alone or in combination with other modalities was effective for patients with acute neck pain.
Chaibi, A., Stavem, K., & Russell, M. B. (2021). Spinal Manipulative Therapy for Acute Neck Pain: A Systematic Review and Meta-Analysis of Randomised Controlled Trials. Journal of Clinical Medicine, 10(21), 5011. https://doi.org/10.3390/jcm10215011
8. SMT doesn’t have to be specific to a “clinically relevant” joint or clinician-determined “correct” vertebral level to improve a patient’s spinal pain or disability. Non-specific SMT is effective.
Nim, C.G., Downie, A., O’Neill, S. et al. The importance of selecting the correct site to apply spinal manipulation when treating spinal pain: Myth or reality? A systematic review. Sci Rep 11, 23415 (2021). https://doi.org/10.1038/s41598-021-02882-z
9. This review explored how neuromuscular function is altered by both vertebral column dysfunction, known as central segmental motor control (CSMC) problems, and spinal adjustments/spinal manipulation.
Haavik H, Kumari N, Holt K, et al. The contemporary model of vertebral column joint dysfunction and impact of high-velocity, low-amplitude controlled vertebral thrusts on neuromuscular function. Eur J Appl Physiol. 2021;121(10):2675-2720. doi:10.1007/s00421-021-04727-z
10. For patients with chronic cervical radiculopathy, vertebral mobilization of the cervical spine is effective in short-term improvement of pain intensity, neck function, and neck ROM as well as localized mechanical pressure hypersensitivity.
Alshami, A. M., & Bamhair, D. A. (2021). Effect of manual therapy with exercise in patients with chronic cervical radiculopathy: a randomized clinical trial. Trials, 22(1). https://doi.org/10.1186/s13063-021-05690-y
11. In people with Achilles tendinopathy, thoracic spinal manipulation resulted in immediate increase in the total oxygenation index in the calf muscle followed by an increase in the testosterone/cortisol (T/C) ratio 6 hours’ post-intervention.
Kovanur Sampath, K., Mani, R., Katare, R., Neale, J., Cotter, J., & Tumilty, S. (2021). Thoracic Spinal Manipulation Effect on Neuroendocrine Response in People With Achilles Tendinopathy: A Randomized Crossover Trial. Journal of Manipulative and Physiological Therapeutics, 44(5), 420–431. https://doi.org/10.1016/j.jmpt.2021.06.001
12. Extrapolating Beyond the Data in a Systematic Review of Spinal Manipulation for Nonmusculoskeletal Disorders: A Fall From the Summit. A controversial topic in 2021.
Goertz, C. M., Hurwitz, E. L., Murphy, B. A., & Coulter, I. D. (2021). Extrapolating Beyond the Data in a Systematic Review of Spinal Manipulation for Nonmusculoskeletal Disorders: A Fall From the Summit. Journal of Manipulative and Physiological Therapeutics, 44(4), 271–279. https://doi.org/10.1016/j.jmpt.2021.02.003
13. SMT is a safer first choice for patients with back pain. With controlling for patient characteristics, health status, and propensity score, the adjusted rate of adverse drug events was more than 42 times higher for initial choice of Opioid Analgesic Therapy versus initial choice of SMT. DCs deliver nearly 97% of SMT in the U.S.
Whedon, James M. DC, MSa; Kizhakkeveettil, Anupama BAMS, (Ayurveda), MAOM, LAc, PhD; Toler, Andrew WJ MS; MacKenzie, Todd A. PhD; Lurie, Jon D. MD, MS; Hurwitz, Eric L. DC, MS, PhDa; Bezdjian, Serena PhD; Bangash, Maria BS; Uptmor, Sarah DC; Rossi, Daniel BS; Haldeman, Scott DC, MD, PhD. Initial Choice of Spinal Manipulative Therapy for Treatment of Chronic Low Back Pain Leads to Reduced Long-term Risk of Adverse Drug Events Among Older Medicare Beneficiaries, SPINE: December 15, 2021 – Volume 46 – Issue 24 – p 1714-1720
14. Using insurance claim data, the estimated risk of treatment escalation was 2.38 times higher in those who received care other than those who received spinal manipulation. In the United States, over 90% of spinal manipulation is provided by doctors of chiropractic.
Anderson, B. R., McClellan, W. S., & Long, C. R. (2021). Risk of Treatment Escalation in Recipients vs Nonrecipients of Spinal Manipulation for Musculoskeletal Cervical Spine Disorders: An Analysis of Insurance Claims. Journal of Manipulative and Physiological Therapeutics, 44(5), 372–377. https://doi.org/10.1016/j.jmpt.2021.03.001
CLINICAL CARE:
15. An expert panel convened to develop the first best-practice consensus document on chiropractic care for pregnant and postpartum patients with low back pain (LBP), pelvic girdle pain (PGP), or a combination.
Weis, C. A., Pohlman, K., Barrett, J., Clinton, S., da Silva-Oolup, S., Draper, C., Lee, J., Kumar, R., O’Beirne, M., Stuber, K., & Hawk, C. (2021). Best-practice recommendations for chiropractic care for pregnant and postpartum patients: Results of a consensus process. Journal of Manipulative and Physiological Therapeutics
16. Cervicogenic symptoms are prevalent in the acute and chronic stages following concussion, which if not diagnosed appropriately increase the likelihood of persistent post-concussive symptoms (PPCS).
Cheever, K., McDevitt, J., Phillips, J., & Kawata, K. (2021). The Role of Cervical Symptoms in Post-concussion Management: A Systematic Review. Sports Medicine, 51(9), 1875–1891. https://doi.org/10.1007/s40279-021-01469-y
17. Young low back pain patients, approximately age 20, were followed up by MRI for 30 years and found that early degeneration in lumbar discs predicts progressive degenerative changes in the respective discs, but not pain, disability, or clinical symptoms.
Sääksjärvi S, Kerttula L, Luoma K, Paajanen H, Waris E. Disc Degeneration of Young Low Back Pain Patients: A Prospective 30-year Follow-up MRI Study. Spine (Phila Pa 1976). 2020 Oct 1;45(19):1341-1347. https://doi.org/10.1097/brs.0000000000003548
18. This study found there was no evidence to support an association between a higher number of lumbar segments with radiographic degenerative changes (K-L grade, osteophytes, and disc space narrowing) and more severe back pain-related disability cross-sectionally or over time in middle-aged women.
Chen, L., Perera, R. S., Radojcic, M. R., Beckenkamp, P. R., Ferreira, P. H., Hart, D. J., Spector, T. D., Arden, N. K., & Ferreira, M. L. (2021). Association of Lumbar Spine Radiographic Changes With Severity of Back Pain–Related Disability Among Middle-aged, Community-Dwelling Women. JAMA Network Open, 4(5), e2110715. https://doi.org/10.1001/jamanetworkopen.2021.10715
19. Ordering an MRI in the first 4-6 weeks of care is associated with increased length of disability in patients with acute LBP without red flags.
hraim BA, Shraim MA, Ibrahim AR, Elgamal ME, Al-Omari B, Shraim M. The association between early MRI and length of disability in acute lower back pain: a systematic review and narrative synthesis. BMC Musculoskelet Disord. 2021 Nov 24;22(1):983. https://doi.org/10.1186/s12891-021-04863-9
20. A diagnosis-based clinical decision guide consisting of 3 questions can effectively distinguish patients with LBP and better specify treatment plans. The questions are: Are the symptoms with which the patient is presenting reflective of a visceral disorder or a serious or potentially life-threatening disease? From where is the patient’s pain arising? What has gone wrong with this person as a whole that would cause the pain experience to develop and persist?
Murphy, D.R., Hurwitz, E.L. Application of a diagnosis-based clinical decision guide in patients with low back pain. Chiropr Man Therap 19, 26 (2011). https://doi.org/10.1186/2045-709X-19-26
21. The modified cervical and shoulder retraction exercise program was shown to improve cervical lordosis and neck pain in patients with loss of cervical lordosis. The two step exercise: raise head up and push the chin backward simultaneously within the pain free range, and keep upright and try to pull back the shoulder and head within the pain free range.
Lee, M. Y., Jeon, H., Choi, J. S., Park, Y., & Ryu, J. S. (2020). Efficacy of Modified Cervical and Shoulder Retraction Exercise in Patients With Loss of Cervical Lordosis and Neck Pain. Annals of Rehabilitation Medicine, 44(3), 210–217. https://doi.org/10.5535/arm.19117
BONUS! Here are a few more that are impactful.
22. This is a excellent review of COVID-19’s effects and MSK conditions.
Hasan LK, Deadwiler B, Haratian A, Bolia IK, Weber AE, Petrigliano FA. Effects of COVID-19 on the Musculoskeletal System: Clinician’s Guide. Orthop Res Rev. 2021;13:141-150. Published 2021 Sep 21. doi:10.2147/ORR.S321884
23. Type 2 diabetes was found to be a predisposing factor for lumbar spine disorders. Type 2 diabetes was significantly associated with lumbar spine degenerative intervertebral disc disorders, lumbar Spondylotic radiculopathy, spondylolisthesis and spinal stenosis.
Park, CH., Min, KB., Min, JY. et al. Strong association of type 2 diabetes with degenerative lumbar spine disorders. Sci Rep 11, 16472 (2021). https://doi.org/10.1038/s41598-021-95626-y
24. Vitamin D deficiency is associated with lumbar disc degeneration and LBP in postmenopausal women. Specifically, a serum vitamin D concentration < 10 ng/mL is a marker of severe LDD and LBP. Smoking, severe vitamin D deficiency, lack of vitamin D supplementation, high body mass index, and osteoporosis are associated with a higher prevalence of moderate-to-severe pain.
Xu HW, Yi YY, Zhang SB, Hu T, Wang SJ, Zhao WD, Wu DS. Does vitamin D status influence lumbar disc degeneration and low back pain in postmenopausal women? A retrospective single-center study. Menopause. 2020 May;27(5):586-592. https://pubmed.ncbi.nlm.nih.gov/32049928/
About the Author: Dr. David Graber is a nationally known presenter on chiropractic technique.
ChiroExcellence 