23 From 2023

Once again, here is our annual review of some of the most practical research articles for chiropractic physicians published in the year. Here are 23 from 2023 to help you better care for and educate your patients!

Cervical Spine:

A study of cervical spine MRI findings found that cervical disc degeneration and disc contour changes were associated with neck pain, and vertebral endplate signal changes was associated with neck disability. None of the MRI findings were associated with headache.[1]

2. For patients with degenerative Cervical Myelopathy, the most sensitive clinical diagnostic tests were the Tromner and hyperreflexia, whereas the most specific tests were the Babinski, Tromner, clonus and inverted supinator sign. [2]

3. Having a long duration of current neck pain was found to be the only clinical indicator to predict if continued care was recommended to the patient by the chiropractors studied. Continued care past 4 weeks was often recommended when all 3 of these clinical indicators were present: previous pain episodes, a long pain duration and improvement after initial treatment. [3]

4. Cervical SM was demonstrated to not stretch the vertebral arteries. During cervical SM, using cervical spine extension and rotation, vertebral arterial length changes remained below that slack length. This suggests that the vertebral arteries are elongated but were not stretched during the manipulation.[4]

5. Cervical spinal manipulation (SM) is safe. 2 large studies, using private health claims and Medicare data, both again strongly suggest that cervical SM and does not cause cervical artery dissection in all age groups. [5] [6]

Lumbar Spine:

6. One study’s findings suggest that US adults receiving chiropractic SM for newly diagnosed radicular low back pain have significantly reduced odds of receiving a gabapentin prescription over 1-year follow-up compared with those receiving usual medical care.[7]

7. An excellent review on intervertebral disc degeneration and how it leads to low back pain can be found here: JOR Spine, 6(1), e1231. https://doi.org/10.1002/jsp2.1231. [8]

8. Non-specific SM is effective. 2 related studies both found that non-specific SM is as effective for pain relief and reducing patient-reported disability as SM targeted to a specific segment in patients with non-specific low back pain. [9] [10]

9. With Lumbar MRI findings, type I Modic changes, disc degeneration, endplate defects, disc herniation, spinal canal stenosis, nerve compression, and muscle fat infiltration have the highest probability to be related to low back pain.[11]

10. In the presence of caudal foraminal stenosis and a positive SLR test, 6 weeks of conservative treatments (oral meloxicam and dexamethasone, corset, back extension exercise, physiotherapy, and manual therapy) were more likely to fail in patients with lumbar disc herniation.[12]

11. Patients with low back or neck pain were found to have the lowest total health care usage, fewer invasive interventions, and lower total costs if they first sought care with chiropractic care or physical therapy.[13] [14]

12. Performing remote myofascial release of the lower limbs on patients with chronic low back pain reduced the pain and increased the elasticity of the lumbar fascia. [15]

13. Chronic low back patients were found to have a significantly lower diet quality, higher inflammatory scores, and a lower intake of total protein, total fat, dietary fiber, omega-3 fatty acids, vitamin B6, vitamin A, beta-carotene, vitamin E, and magnesium. Pain sensitivity mainly showed a negative correlation with nutritional intakes known for anti-inflammatory properties. [16]

14. SMT has again been recognized as frontline treatment for patients with back pain. The World Health Organization launched their first ever guideline for management of low back pain in adults, and gave strong recommendations for SMT as a top physical intervention. [17]

Thoracic spine:

15. Thoracic manipulation provides immediate and short-term effecst to improve pain and neck disability among patients with chronic mechanical neck pain.[18]

16. An immediate improvement in the range of motion and pain after thoracic thrust manipulation was found in patients with shoulder impingement.[19]

17. Patients with hyper-thoracic kyphosis exhibited abnormal sensorimotor control and autonomic nervous system dysfunction compared to those with normal thoracic kyphosis.[20]

18. A biomechanically designed exercise protocol can help straighten the scoliotic curve through curve specific corrective exercises and stabilized the curve by “Breathing with core”. [21]

Spinal Manipulation:

19. A literature review listed some clear neurophysiological changes following spinal manipulation, which include neural plastic changes, alteration in motor neuron excitability, increase in cortical drive and many more.[22]

20. Severe SMT-related adverse events were found to be reassuringly very rare, approximately 1 per 480,000 SMT sessions according to a study of 960,140 SMT sessions for 54,846 patients.[23]

General Health:

21. Higher leisure-time sitting (>4 h/day) may be associated with greater risk for radiographic knee OA incidence/progression over 2 years. Furthermore, this association was intensified among adults who also reported frequent work time sitting.[24]

22. A one question spinal outcome assessment was shown to be as accurate as validated tools such as the Oswestry Disability Index. Patients were asked to answer the following question, “What percentage is the function of your spine if the normal function of a healthy spine is 100%?[25]

23. If you have pediatric patients, several international peer-reviewed chiropractic pediatric history and examination forms for the infant, child, and adolescent are available here: https://jccponline.com/Weber22-01.html [26]

References are available by emailing: DrDavidGraber@gmail.com or going to: https://chiro-excellence.com/

[1] Jensen, R.K., Dissing, K.B., Jensen, T.S. et al. The association between cervical degenerative MRI findings and self-reported neck pain, disability and headache: a cross-sectional exploratory study. Chiropr Man Therap 31, 45 (2023). https://doi.org/10.1186/s12998-023-00517-w

[2] Jiang Z, Davies B, Zipser C, et al. The value of Clinical signs in the diagnosis of Degenerative Cervical Myelopathy – A Systematic review and Meta-analysis. Global Spine Journal. 2023;0(0). doi:10.1177/21925682231209869

[3] Myhrvold, B.L., Vøllestad, N.K., Irgens, P. et al. Clinical indicators for recommending continued care to patients with neck pain in chiropractic practice: a cohort study. Chiropr Man Therap 31, 33 (2023). https://doi.org/10.1186/s12998-023-00507-y

[4] Gorrell LM, Sawatsky A, Edwards WB, Herzog W. Vertebral arteries do not experience tensile force during manual cervical spine manipulation applied to human cadavers. J Man Manip Ther. 2023 Aug;31(4):261-269. doi: 10.1080/10669817.2022.2148048. Epub 2022 Nov 15. PMID: 36382347; PMCID: PMC10324446.

[5] Whedon JM, Petersen CL, Schoellkopf WJ, Haldeman S, MacKenzie TA, Lurie JD. The association between cervical artery dissection and spinal manipulation among US adults. Eur Spine J. 2023 Oct;32(10):3497-3504. doi: 10.1007/s00586-023-07844-9. Epub 2023 Jul 8. PMID: 37422607; PMCID: PMC10591258.

[6] Whedon, J.M., Petersen, C.L., Li, Z. et al. Association between cervical artery dissection and spinal manipulative therapy –a medicare claims analysis. BMC Geriatr 22, 917 (2022). https://doi.org/10.1186/s12877-022-03495-5

[7] Trager RJ, Cupler ZA, Srinivasan R, et alAssociation between chiropractic spinal manipulation and gabapentin prescription in adults with radicular low back pain: retrospective cohort study using US dataBMJ Open 2023;13:e073258. doi: 10.1136/bmjopen-2023-073258

[8] Diwan, A. D., & Melrose, J. (2023). Intervertebral disc degeneration and how it leads to low back pain. JOR Spine, 6(1), e1231. https://doi.org/10.1002/jsp2.1231

[9] 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

[10] Spinal Manipulative Therapy for Nonspecific Low Back Pain: Does Targeting a Specific Vertebral Level Make a Difference?: A Systematic Review With Meta-analysis Peter Westlund Sørensen, Casper Glissmann Nim, Erik Poulsen, and Carsten Bogh Juhl

Journal of Orthopaedic & Sports Physical Therapy 2023 53:9, 529-539

[11] van der Graaf JW, Kroeze RJ, Buckens CFM, Lessmann N, van Hooff ML. MRI image features with an evident relation to low back pain: a narrative review. Eur Spine J. 2023 May;32(5):1830-1841. doi: 10.1007/s00586-023-07602-x. Epub 2023 Mar 9. PMID: 36892719.

[12] Ding S, Du X, Fu C, Zhao X, Ge Y, Wang Y. Conservative Treatments for Lumbar Disc Herniation at L3-4 or L4-5 Were More Likely to Fail When Ipsilateral Foraminal Stenosis Was Present at the Caudally Adjacent Segment. World Neurosurg. 2023 Feb;170:e577-e583. doi: 10.1016/j.wneu.2022.11.070. Epub 2022 Nov 18. PMID: 36403932.

[13] Bise CG, Schneider M, Freburger J, Fitzgerald GK, Switzer G, Smyda G, Peele P, Delitto A. First Provider Seen for an Acute Episode of Low Back Pain Influences Subsequent Health Care Utilization. Phys Ther. 2023 Sep 1;103(9):pzad067. doi: 10.1093/ptj/pzad067. PMID: 37379349.

[14] Fenton JJ, Fang SY, Ray M, Kennedy J, Padilla K, Amundson R, Elton D, Haldeman S, Lisi AJ, Sico J, Wayne PM, Romano PS. Longitudinal Care Patterns and Utilization Among Patients With New-Onset Neck Pain by Initial Provider Specialty. Spine (Phila Pa 1976). 2023 Oct 15;48(20):1409-1418. doi: 10.1097/BRS.0000000000004781. Epub 2023 Aug 1. PMID: 37526092.

[15] Hassan Tamartash, Farid Bahrpeyma, Manijhe Mokhtari Dizaj. Effect of Remote Myofascial Release on Lumbar Elasticity and Pain in Patients With Chronic Nonspecific Low Back Pain: A Randomized Clinical Trial. Journal of Chiropractic Medicine,Volume 22, Issue 1,2023,Pages 52-59,https://doi.org/10.1016/j.jcm.2022.04.002.

[16] Ömer Elma, Sevilay Tümkaya Yılmaz, Jo Nijs, Peter Clarys, Iris Coppieters, Evelien Mertens, Tom Deliens, Anneleen Malflie. Proinflammatory Dietary Intake Relates to Pain Sensitivity in Chronic Nonspecific Low Back Pain: A Case-Control Study,The Journal of Pain,2023. https://doi.org/10.1016/j.jpain.2023.08.015.

[17]https://www.who.int/publications/i/item/9789240081789?fbclid=IwAR2Lzes8or2oa1aPcE24L3NN4iKJIsUP3rYWWyoGD9uzgr8u6OZN3_RKjsc

[18] Tsegay GS, Gebregergs GB, Weleslassie GG, Hailemariam TT. Effectiveness of Thoracic Spine Manipulation on the Management of Neck Pain: A Systematic Review and Meta-Analysis of Randomized Control Trials. J Pain Res. 2023 Feb 27;16:597-609. doi: 10.2147/JPR.S368910. PMID: 36875686; PMCID: PMC9983435.

[19] Bukhari B, Ahmad A, Fatima A, Ali S. Effects of thoracic spinal thrust manipulation for the management of shoulder impingement syndrome: Systematic review. J Pak Med Assoc. 2023 Feb;73(2):338-345. doi: 10.47391/JPMA.5151. PMID: 36800722.

[20] Moustafa IM, Shousha T, Arumugam A, Harrison DE. Is Thoracic Kyphosis Relevant to Pain, Autonomic Nervous System Function, Disability, and Cervical Sensorimotor Control in Patients with Chronic Nonspecific Neck Pain? J Clin Med. 2023 May 27;12(11):3707. doi: 10.3390/jcm12113707. PMID: 37297903; PMCID: PMC10253448.

[21] Maharathi Sujata, Iyengar Raju, Chandrasekhar Patnala. Biomechanically designed Curve Specific Corrective Exercise for Adolescent Idiopathic Scoliosis gives significant outcomes in an Adult: A case report . Frontiers in Rehabilitation Sciences, VOLUME=4,2023. https://www.frontiersin.org/articles/10.3389/fresc.2023.1127222  

[22] Giles Gyer, Jimmy Michael, James Inklebarger, Jaya Shanker Tedla. Spinal manipulation therapy: Is it all about the brain? A current review of the neurophysiological effects of manipulation. Journal of Integrative Medicine, Volume 17, Issue 5, 2019, Pages 328-337, https://doi.org/10.1016/j.joim.2019.05.004.

[23] Chu EC, Trager RJ, Lee LY, Niazi IK. A retrospective analysis of the incidence of severe adverse events among recipients of chiropractic spinal manipulative therapy. Sci Rep. 2023 Jan 23;13(1):1254. doi: 10.1038/s41598-023-28520-4. PMID: 36690712; PMCID: PMC9870863.

[23] Voinier, D., Neogi, T., Master, H., Thoma, L. M., Brunette, M., Jakiela, J., Stefanik, J. J., & White, D. K. (2023). Sitting may increase risk for radiographic incidence and progression of knee osteoarthritis over 2 years: Data from a large cohort study. Musculoskeletal Care, 21(4), 1075–1084. https://doi.org/10.1002/msc.1786

[23] Takeuchi K, Nakamura M, Konrad A, Mizuno T. Long-term static stretching can decrease muscle stiffness: A systematic review and meta-analysis. Scand J Med Sci Sports. 2023; 33: 1294-1306. doi:10.1111/sms.14402

[23] Leopold, V.J., Warminski, N., Löchel, J. et al. Validation of the Subjective Spine Value: A new single item score for the assessment of spine-specific function. Arch Orthop Trauma Surg 143, 6497–6501 (2023). https://doi.org/10.1007/s00402-023-04941-8

[24] Voinier, D., Neogi, T., Master, H., Thoma, L. M., Brunette, M., Jakiela, J., Stefanik, J. J., & White, D. K. (2023). Sitting may increase risk for radiographic incidence and progression of knee osteoarthritis over 2 years: Data from a large cohort study. Musculoskeletal Care, 21(4), 1075–1084. https://doi.org/10.1002/msc.1786

[25] Leopold, V.J., Warminski, N., Löchel, J. et al. Validation of the Subjective Spine Value: A new single item score for the assessment of spine-specific function. Arch Orthop Trauma Surg 143, 6497–6501 (2023). https://doi.org/10.1007/s00402-023-04941-8

[26] https://jccponline.com/Weber22-01.html

About the Author:

Dr. David Graber is nationally known presenter on chiropractic technique and is a member of the ANJC board of directors. He maintains a private practice in Parsippany, NJ. He blogs on chiropractic and clinical topics at: drgraber.wordpress.com. He can be reached at: DrDavidGraber@gmail.com.

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