Category: Research

ABSTRACT

Objective: To determine the effectiveness of chiropractic treatment on patients with back or neck pain as compared to traditional allopathic treatments, a systematic review of the literature.

Reporting Sources:  A search for randomized clinical trials (RCT’s) on chiropractic therapy was conducted using a Medline search (1980-2001), citation tracking and directed reference acquisition from relevant publications.

Data Extraction:  Studies examined for this review specifically compared chiropractic manipulative therapy with traditional “mainstream” medical treatment (i.e. physiotherapy, mobilization, massage, deep heat, bed rest, prescriptive drugs, back school, corset, T. E. N. S., traction and/or placebo).  Exclusion criteria covered a wide range of diseases and conditions such as spondylolysis, root compression, osteoarthritus, psychological disturbances, pregnancy and vertebral collapse.

Data Synthesis: Three meta-analysis studies examining 35 RCT’s met the inclusion criteria for this review.  They were Assendelft, et al. (1996); Abenheim, et al. (1992); Koes, et al. (1991).

Additionally, twelve individual studies comparing the effectiveness of chiropractic manipulation to medical interventions in the treatment of musculoskeletal pain, not examined in the above-mentioned meta-analysis, were included.

Methods:  A study was ascertained to be positive, if the RCT determined that chiropractic was more effective than allopathic methodologies and/or placebos (i.e., the difference being statistically significant at a level of P<0.05).  A study was deemed negative, if the RCT reported favorable results for the non-chiropractic treatment, and neutral, if there was no discernable difference between the treatment outcomes.

Both objective and subjective outcome measures were used in the RCT’s reviewed.  The following represent the most prevalent outcome measures:  recovery rate; the amount of time required for the patient to return to work or normal activities; reductive change in the threshold of pain; and the patients’ efficacy of treatment rating.

Conclusions:  There is an obvious research need for direct attention focused upon the methodologies of design, execution, reporting, randomization (to eliminate bias), control and manipulation in future RCT’s for chiropractic.  This also should entail the development of standardized uniform guidelines for varying types of chiropractic clinical studies.  Accomplishing the above will afford subsequent statistical pooling, which is not wholly viable now.

The above notwithstanding, this review presents 47 clinical trials and studies that have been analyzed from the standpoint of their empiric outcomes.   These data strongly suggest that chiropractic manipulation offers superior results when compared to traditional allopathic treatments for musculoskeletal pain.

INTRODUCTION

In the U.S., it is estimated that 85% of the population will be disabled by back pain at some point in their lives. Back pain is the most common cause of disability for people under the age of 45 in the U.S. Twelve million are considered to be back-pain impaired. Twenty percent of all military medical discharges from the U.S. armed forces are due to unresolved back pain. The costs associated with low back pain in the U.S. are estimated to be $60 billion annually. More than 30 million Americans will seek chiropractic care in 2006. Ninety percent of chiropractic users feel their treatment is effective. Chiropractic clearly is the most commonly utilized form of Complimentary Alternative Medicine (CAM) in the U.S.

Though long characterized as being a practice without scientific validation, few healthcare interventions have been assessed as extensively as spinal manipulation, both in terms of safety and effectiveness, over the last 40 years.

Yet, despite the high incidence and prevalence of back pain and the emergence of chiropractic to the forefront of CAM, its use and efficacy as a paradigm for back pain management remains controversial. A wide variety of therapeutic possibilities exist, both allopathically and in alternative healthcare, to treat back pain, thus, eliciting continuous debate regarding efficacy and safety.

STANDARDS AND VALIDITY

Meta-analysis reviewing RCT’s addressing the efficacy of chiropractic manipulation have tended to focus primarily on the methodological quality of the studies involved, ignoring patient outcomes.

METHODS: INTERVENTIONS AND TREATMENTS

Chiropractic treatments in the RCT’s reviewed involved typically similar chiropractic techniques consisting of short lever, high velocity, low amplitude thrusts, spinal manipulative therapy and full spine adjustments.  Control group treatments included:  physiotherapy, traction, exercises, back school, soft tissue massage, transcutaneous muscle stimulation, corset, sham manipulations and medical treatment including analgesics, injections, bed rest and/or physiotherapy.

Forty-seven clinical trials and studies were analyzed from the standpoint of their empiric outcomes. Chiropractic manipulation was deemed more effective than allopathic treatment in 70% of the 47 clinical studies examined spanning a 30-year period.

DISCUSSION

Based upon the conclusions of the three meta-analyses reviewed, it is obvious that future chiropractic RCT’s must become as methodologically precise as possible. Additionally, it is important that specific studies address the comparative effectiveness of various chiropractic adjusting techniques upon pragmatic outcomes in the treatment of musculoskeletal dysfunction.

However, this author strongly believes it is imprudent to summarily discount a myriad of studies of chiropractic manipulation strictly upon the basis of the above-mentioned criticisms.  Unlike most medical maladies, which can, for example, be quantified and specifically monitored via blood tests, biopsies and other highly objective means, spine related disorders can and often have multiple origins as well as on going problems.  With drugs, we know the half-lives, thresholds, doses and interactions.  This is not the case with chiropractic manipulation.  By way of example, a certain medical protocol may mandate 5 cc’s of a specific antibiotic given in regulated doses over a defined period.  This is extremely precise, the protocol does not vary and its result can be specifically quantified with blood work.

Comparatively, a chiropractic patient could be experiencing low back pain resulting from a posterior rotated ilium.  This could be addressed by a variety of chiropractic interventions:  Gonstead/Diversified side-posture adjustment; sacral occipital technique (SOT); Thompson drop table thrust or an activator procedure, etc.  While it would be highly beneficial to have individual data on the relative degree of effectiveness of each technique, all manipulations above described can realign the ilium, relieving the associated pain to the patient.  At this point, the issue is moot as to whether the adjustment was Thompson drop or Gonstead side-posture.  What is most relevant was the fact that the pain was alleviated and the patient benefited.

CONCLUSION

There is a need for revisions in the methodologies of design, execution, reporting, randomization, control and manipulation in future RCT’s of chiropractic care.  This should entail the development of standardized, uniform guidelines for varying types of chiropractic clinical studies.  Accomplishing this will afford subsequent statistical pooling which is not entirely viable at present.  Such methodological improvements might be useful when directly addressing and, perhaps, refuting future criticism of chiropractic research. Such methodological enhancement would more effectively assess pragmatic outcomes of chiropractic therapeutics.

Specific studies and comparisons of various chiropractic manipulation techniques (i.e. Gonstead vs. Diversified, etc.) with respect to various musculoskeletal disorders treated would be of tremendous benefit to both the practicing clinician and teaching/research institutions and could establish more effective treatment protocols.  Additionally, there is a need to evaluate the long-term results of chiropractic manipulation, both in alleviating musculoskeletal disorders as well as side effect profiles.

Fundamental criticisms of chiropractic are two-fold.  First, there is an argument that there is a paucity of data to validate the effectiveness of chiropractic adjustments in the treatment of muscular/skeletal pain and second, treatment standardization among chiropractic clinicians varies widely.

With respect to the first criticism, it should be noted that there is a greater number of scientific trials for chiropractic spinal manual manipulation and it’s effectiveness than numerous intricate allopathic procedures routinely performed in hospitals daily. Few health care interventions have been assessed as extensively as chiropractic manipulation.

With regard to treatment standardization, it is important to note that chiropractic protocols of manual therapies are somewhat different from certain allopathic approaches to medicine.  There are over 100 adjusting techniques in chiropractic to accomplish a manual manipulation to relieve nerve pressure. Most are effective in relieving pain.  Although the shear number of techniques makes standardization a monumental task, a long term study of treatment protocols with respect to different injuries and patient complaints would be of significant benefit.

In summary, this review presents 47 clinical trials and outcome studies that have been reviewed from the standpoint of their empiric results.  These data strongly suggest that chiropractic manipulation offers results that are equivalent or superior to specific or combined traditional allopathic treatments for musculoskeletal low back and neck pain.  Chiropractic manipulation was deemed more effective than allopathic treatment in 70% of the 47 clinical studies examined spanning a 30-year period.

As suggested by the end points and outcomes of the studies presented, various traditional treatment protocols, such as bed rest, traction, surgery, physical and pharmaceutical therapies, appeared to be less effective than spinal manipulation in returning the patient to function and/or significantly reducing pain.  Based upon the studies examined, it appears likely that, for uncomplicated neck and low back pain not caused by fracture, tumor, infection or the cauda equina syndrome, chiropractic spinal adjustment is an effective intervention that can occupy a significant role in an interactive approach to back pain.

Dr. Steve Perram is a recent graduate of Texas Chiropractic College. Raised in southern California, Dr. Perram spent 25 years in the business world owning 4 different companies & acting as a business consultant for major corporations from coast to coast.  In 2001, Dr. Perram decided on a career change & began his quest to become a chiropractor.  He has been featured in Success Magazine, TVRO Technology, Personal Selling Power, High-Tech Marketing & Satellite Retailer magazines.  His business & professional backround is included in Personalities of America, The American Biographical Institute, Men of Distinction & the International Biography, Cambridge, England.  281-413-1276.

References

1. Abenheim L, Bergeron AM: Twenty years of randomized clinical trials of manipulative therapy for back pain: a review.  Clin Invest Med.  1992 Dec; 15(6):527-35

2. Waddel G:  A new clinical model for the treatment of low back pain.  Spine.  1987; 12:632-44

3. Biggs SJ et al: Acute low back pain problems in adults.  U.S. Department of Health and Human Services, Agency for Health Care Policy and Research. 1994; No 95-0642

4. Shekelle PG et al:  Spinal manipulation for low back pain.  RAND Report.  Santa Monica, Ca.  Am Intern Med.  1992; 117:590-98

5. Manga P et al:  Cost effective chiropractic management of low back pain.  Richmond Hill, Canada:  Kenilworth.  1993:35-37

6. National Women’s Health Resource Center.  2000 Sept; 1-3

7. The Gallup Organization: Demographic characteristics of users of chiropractic services.  1991; Princeton, New Jersey

8. British Columbia Chiropractic Association:  1999-2000; 130-10100

9. Koes BW et al:  Spinal manipulation and mobilization for back and neck pain:  a blinded review:  BMJ.  1991 Nov 23; 303(6813):1298-303

10. Assendelft WJ et al:  The effectiveness of chiropractic for treatment of low back pain:  an update and an attempt at statistical pooling.  JMPT.  1996 Oct; 19(8); 499-507

11. The AV-MED Study: 1993

12. Painter FM:  The chiropractic research organization; chiropractic research.  2001

13. MacDonald MJ et al:  Chiropractic evaluation study task lll.  Report of the relevant literature:  MRI.  No 8533-D.  Department of Defense, O campus, Aurora, Co.  1986

14. Jarvis KB et al:  Cost per case comparison of back injury claims of chiropractic versus medical management for conditions with identical diagnostic codes.  Journal of Occupational Medicine.  33(8); 847-852

15. The Canadian Chiropractic Association; 1997

Soft-tissue Injuries of the Cervical Spine 15-year Follow-up

Reference:

Journal of Bone and Joint Surgery (British)
November 1996, Vol. 78-B, No. 6, pp. 955-7
B. Squires, M. F. Gargan, G. C. Bannister: From the University of Bristol, England

KEY POINTS FROM DAN MURPHY

1) At a mean of 15.5 years post whiplash trauma, 70% of whiplash-injured patients continued to complain of symptoms referable to the original accident.

2) Long-term symptoms from whiplash injury include neck pain, arm paraesthesia, back pain, headache, dizziness, and tinnitus.

3) Women and older patients have a worse outcome from whiplash injuries.

4) Radiating arm pain is more common in those with severe symptoms.

5) Between 10 and 15 years after the accident, 18% of the patients had improved, whereas 28% had deteriorated.

6) Soft-tissue injuries to the cervical spine may give persisting symptoms.

7) Most whiplash-injured patients reach their final state by two years after being injured, but this study shows ongoing symptom fluctuation between years 10 to 15.

8) At the 15-year follow-up, neck pain was present in 65% and low-back pain was present in 48%.

9) 80% of women and 50% of men continued to have symptoms at 15 years.

10) Back pain and tinnitus increased between years 10 and 15.

11) Symptoms remained static in 54%, improved in 18% and worsened in 28%.

12) Degenerative changes are associated with a worse prognosis for recovery.

13) 60% of symptomatic patients had not seen a doctor in the previous five years because the doctors were unable to help them.

14) 18% had taken early retirement due to health problems, which they related to the whiplash injury.

15) Whiplash symptoms do not improve after settlement of litigation.

16) Most radiating pain is referral from the facets, and not radicular.

17) Chronic whiplash symptoms will cause an abnormal psychological assessment after 3 months.

18) In this study, 100% of patients with severe ongoing problems had cervical spinal degeneration.

A 1978 graduate of Western States Chiropractic College, Dr. Dan Murphy is on the faculty of Life Chiropractic College West, and is the Vice President of the International Chiropractic Association. For more information, visit  www.danmurphydc.com.

Reference:

Pediatrics, Vol. 117, No. 1, January 2006, pp. 9-14
Lauren Daly, M.D., Michael J. Kallan, M.S., Kristy B. Arbogast, Ph.D. and Dennis R. Durbin, M.D., M.S.C.E.

FROM ABSTRACT:

OBJECTIVE.  The popularity of sport utility vehicles (SUV’s) is growing, and they are increasingly being used as family vehicles. Because of the large size of SUV’s, relative to passenger cars, parents may perceive that they are safer family vehicles.  The objective of this study was to determine the relative risk of injury to children involved in crashes in SUV’s, compared with those in passenger cars.

DESIGN.  These researchers looked at a sample of 3,922 child occupants, 0-to-15 years of age.

Injuries were defined as concussions and other brain injuries, spinal cord injuries, facial fractures and lacerations, internal organ injuries, extremity fractures, and scalp lacerations. [These injuries are not seen in our typical patients.]

Logistic regression modeling was used to compute the odds ratio (OR) of injury for children in SUV’s versus passenger cars, both unadjusted and adjusted, for several potential confounders, including differences in child seating position, restraint use, vehicle weight, exposure of the child to a passenger airbag, and whether the vehicle rolled over.

RESULTS.  Among all children in the study, those restrained appropriately were less likely to be injured (75% less) and those in the front seat were more likely to be injured (106% more).

In both vehicle types, children exposed to a passenger airbag were more likely to be injured than were those who were not (370% more).
Rollover crashes increased the risk of injury in both vehicle types (increased by 229%) and occurred more than twice as frequently with SUV’s compared with passenger cars.

After adjustment for all of the aforementioned factors, the risk of injury was not significantly different.

Especially detrimental for children in SUV’s was being unrestrained versus restrained in a rollover crash (2400% increased risk with a range between 568% to 9253%). [WOW! Look at these numbers. If you have an SUV, make sure your children are properly restrained.]

CONCLUSIONS. Despite the greater vehicle weight of SUV’s, the risk of injury for children in SUV’s is similar to that for children in passenger cars.
The potential advantage offered by heavier SUV’s seems to be offset by other factors, including an increased tendency to roll over.

Age-appropriate child restraint and rear seat positioning are important, particularly for children in SUV’s, given the very high risk of injury for children restrained inappropriately in rollover crashes.

KEY POINTS FROM DAN MURPHY

1) This study only looked at seriously injured children, including brain injuries, spinal cord injuries, facial fractures and lacerations, internal organ injuries, extremity fractures, and scalp lacerations. Consequently, most of the patients we would see in the clinical setting were not included.

2) Children who are properly restrained are 75% less likely to be [seriously] injured compared to unrestrained children.

3) Children in the front seat are 106% more likely to be [seriously] injured than children sitting in the back seat.

4) In any vehicle, children exposed to a deploying passenger airbag were 370% more likely to be [seriously] injured than were those who were not.

5) SUV’s are 4 times more likely to roll over in a crash than passenger cars.

6) Rollover crashes increased the risk of [serious] injury by 229%.

7) Risk of [serious] injury increased 2,400%, with a range between 568% to 9,253%, for unrestrained children in SUV rollover crashes. [If you have an SUV, make sure your children are properly restrained.]

8) Despite the greater vehicle weight of SUV’s, the risk of injury for children in SUVs is similar to that for children in passenger cars, primarily because of the increased tendency for the SUV to roll over.

9) “Any potential safety advantage of the SUVs’ increased size and weight is offset by their increased likelihood of rolling over in a crash, compared with passenger cars.”

10) In this study, children in SUV’s had a 62% elevated risk of [serious] injury compared to children in passenger cars.

11) In both SUV’s and passenger vehicles, children exposed to a passenger air bag were more (370%) likely to be [seriously] injured than were those who were not.

12) In rollover crashes involving SUV’s, the risk of injury was 25-fold greater for unrestrained versus appropriately restrained children. (Range was 7-fold to 94-fold increased risk.)

13) There is a 25-fold increased risk of injury to unrestrained child occupants in an SUV rollover crash.

14) In rollover crashes, 50% of unrestrained occupants are ejected from the vehicle, and 62% of those ejected will die.

15) Only 4% of restrained occupants are ejected in rollover crashes.

16) Because of the higher risk of rollover, there is strong importance for the use of age-appropriate restraint for all children who ride in SUV’s.

17) The increased risk of injury posed by deploying passenger air bags in any vehicle “reinforces the importance of continued education of parents to never place children less than 13-years-old in the front seat of a passenger air bag-equipped vehicle.”

A 1978 graduate of Western States Chiropractic College, Dr. Dan Murphy is on the faculty of Life Chiropractic College West, and is the Vice President of the International Chiropractic Association. For more information, visit
www.danmurphydc.com.

Reference:

Photobiological Principles of Therapeutic Applications of Laser Radiation
Biochemistry, Vol. 69, No. 1, January 2004, pp. 103-113
Yu. A. Vladimirov, A. N. Osipov, and G. I. Klebanov

KEY POINTS FROM DAN MURPHY:

1. Laser therapy is based on the stimulating and healing action of low-intensity lasers.

2. Too much or too strong of a laser can be deleterious to vital processes, and become a “hindrance to a successful application of laser therapy and a cause of disappointment.”

3. Low-intensity lasers are used to reduce pain, to treat edema, eczema, dermatitis, persisting ulcers, burns, diabetic foot, arthritis and sports rehabilitation.

4. A 632.8 nm laser increases the content of adenosine triphosphate (ATP) and causes morphological changes in the mitochondria.

5. Laser radiation of blood vessels causes immediate vasodilatation, resulting in the “improvement of microcirculation and blood supply in organs.”

6. The newest theory for the biological action of visible light laser radiation is a photoreactivation of Cu-Zn superoxide dismutase anti-oxidant enzyme.

7. The photoreactivation of cellular superoxide dismutase (Cu-Zn-SOD), with a 632.8 nm laser, results in accelerated wound healing.

8. Low-intensity laser radiation also increases the activity or production of the antioxidant enzyme catalase and glutathione peroxidase, which converts residual hydrogen peroxide into water and oxygen.

9. Laser radiation reactivates the activity of the antioxidant enzymes catalase and superoxide dismutase. Both superoxide dismutase and catalase enzymes absorb at the laser light wavelength of 633 nm.

10. Superoxide dismutase (SOD) requires copper (Cu) and zinc (Zn) to effectively detoxify the superoxide free radical.

11. The superoxide free radical is constantly formed during normal metabolism. The superoxide free radical is toxic for cells and tissues. The antioxidant enzyme superoxide dismutase (SOD) reduces the concentration of superoxide radical, converting it to hydrogen peroxide and oxygen. If superoxide dismutase levels are low, the cells are injured. Low-intensity laser increases levels of superoxide dismutase.

12. The hydrogen peroxide produced by the action of the antioxidant enzyme superoxide dismutase is also a free radical. But, it is a paradoxical free radical. It is a good free radical, because it is bactericidal, killing pathogens. However, too much hydrogen peroxide produces the dangerous hydroxyl free radical. Hydrogen peroxide is converted to water and oxygen by the enzymes catalase and glutathione peroxidase. Low intensity laser increases levels of these two important antioxidant enzymes.

13. Excess free radical hydrogen peroxide is converted into water and oxygen by the antioxidant enzymes catalase and glutathione peroxidase. [Glutathione requires the trace mineral selenium to effectively detoxify the free radical hydrogen peroxide.]

14. Other observed effects and mechanisms of low-intensity laser include:

A) Increased protein synthesis.
B) Increased bactericidal activity.
C) Activation of cell proliferation.
D) Accelerated and improved wound healing.
E) Improvement of blood microcirculation.
F) Regeneration of tissues.
G) Improved immunomodulation.
H) They are anti-inflammatory.

15. “Laser radiation at low doses makes a stimulating effect on cells, and, at high doses, a damaging one.” [Important]

COMMENTS FROM DAN MURPHY

This article presents evidence that low-level laser therapy works, in part, because they up regulate (increase the activity of) the genes that produce the three endogenous antioxidant enzymes, superoxide dismutase, glutathione peroxidase and catalase.

Equally important, the endogenous antioxidant enzymes require minerals to effectively neutralize destructive free radicals.

Superoxide dismutase requires zinc, copper, manganese.

Glutathione peroxidase requires Selenium.

The incredible effectiveness of low-level laser therapy is further enhanced by supplementing with a balance of zinc, copper, manganese, selenium, and riboflavin (which recharges depleted glutathione). Such a product has been developed by Nutri-West. It is called Laser-Min. Laser Minerals can also be topically applied to the skin with the Nutri-West product Laser Ice. Nutri-West’s phone number is (800) 443-3333.I primarily use the 635 nm line (not dot) laser from Erchonia. It has 8 laser beams, programmable to 100,000 frequencies, with enough power to get the job done without risking damage: (480) 633-3129 or (888) 242-0571.

A 1978 graduate of Western States Chiropractic College, Dr. Dan Murphy is on the faculty of Life Chiropractic College West, and is the Vice President of the International Chiropractic Association. For more information, visit
www.danmurphydc.com.

The biggest criticism leveled against chiropractic is that it is unscientific. Or, in the words of the now infamous Newsweek article on “Treating Back Pain” (April 26, 2004), it suffers from a “dearth of good research to prove efficacy.”

The statement is particularly surprising since the article dealt with chiropractic for back pain. Nearly all the research done to date on chiropractic has involved back pain and there are an impressive number of scientific research studies to validate our effectiveness in this area. Yet, still, we are considered unscientific.

Is it any wonder, then, that insurance companies consider chiropractic for children “experimental,” or that few people ever think of chiropractic for problems other than back pain?

When it comes to research, we have to ask ourselves, “How much is enough?” How many studies will we have to conduct in order to, once and for all, be considered scientifically based, to change the perception of chiropractic and to silence our critics?

Obviously, it won’t be enough to produce one or two studies on chiropractic’s broader applications. We already know, from our personal practice experience, that chiropractic has long-term benefits on health. But, to prove that to the wide audience, we’ll need to conduct research of “shock and awe” proportions. We’ll have to compile data from a huge number of people from vastly different geographic areas. And, since chiropractic, itself, is so diverse, our research will have to include nearly all techniques, rather than focus on one or two specific areas.

Even then, we won’t be able to stop. You’d think that once you conducted research showing that chiropractic can boost the immune system, for instance, we could move on to other matters. But that’s not the case. We have to keep “proving” the same thing over and over again.

Such research redundancy is the norm in medicine. How many research studies have been conducted to prove that obesity is a contributing factor in hypertension? A quick search of PubMed, the National Library of Medicine’s online index of research journals, came up with 11,269 citations between 2002 and 2005.

No matter what subject you choose, you’ll find hundreds of research articles in scientific journals, many duplicating previous ones or verifying hypotheses that are already considered proven “facts”. That’s what we have to do—produce an overwhelming amount of research on every aspect of chiropractic.

It’s exhausting just thinking about all this research. In the pharmaceutical and medical industries, research has become an incredibly large—and lucrative—business, in itself. Billions of dollars are pumped into research efforts and grants from drug companies, and government agencies are major sources of income for most medical schools. Chiropractic, unfortunately, doesn’t have that research infrastructure or income. We have to look for other incentives.

Actually, we don’t have to look far, since research has many very real and immediate benefits. As George McClelland, D.C., recently noted in the Foundation for Chiropractic Education and Research publication, Advance, “Many D.C.’s may not see the immediate relevance of chiropractic research on their practices; however, they should understand that chiropractic related research and research projects have played an invaluable role in promoting the expansion of chiropractic services in federal and private programs, as well as in public support and acceptance of chiropractic care. The overall impact is PRICELESS.”

Back in the 1970’s, women used to say, “Whatever women do, they must do twice as well as men to be thought half as good.” Well, the same is true for chiropractic. Whatever D.C.’s do, they must do twice as well as M.D.’s to be thought half as good. It’s not fair, but that’s the way things are—at least for now. In the future, the tide will turn and we’ll see other disciplines trying to catch up to chiropractic.

Dr. David A. Jackson is chief executive officer of Research and Clinical Science (RCS), a private sector research program exploring issues of subluxation correction and chiropractic care as they relate to health and wellness. Previously, he served as president of the Chiropractic Leadership Alliance and Creating Wellness Alliance and was owner/operator of several private practice offices in California and Idaho that specialized in high volume, family wellness based care. For a no-obligation information packet about chiropractic research and the work of RCS, call 800-909-1354 or 480-303-1694, or visit the RCS website at www.rcsprogram.com.

The use of flexion and extension MRI in the evaluation of cervical spine trauma: initial experience in 100 trauma patients compared with 100 normal subjects

Emergency Radiology
(October 2002)  9: 249–253
Vincenzo Giuliano, Concetta Giuliano, Fabio Pinto, Mariano Scaglione

Background information from Dan Murphy

1. Subacute whiplash patients have about half the range of motion when compared to normal control subjects.

2. In this study, the normal control subjects showed that 4 percent had hypolordosis and 2 percent had disk herniations.

3. In this study, the whiplash injured patients showed that 98 percent had hypolordosis and 28 percent had disk herniations.

4. These authors note that plain film lateral flexion and extension views to evaluate soft tissue and diskoli-gamentous injuries are poor, that videofluoroscopy is better, and that flexion and extension magnetic resonance imaging (MRI) is best. In this study, the flexion/extension MRI’s showed much pathology that was not seen with plain radiographs.

5. Flexion/extension MRI shows the “pattern of segmental motion.”

6. The “pattern of segmental motion” is normal in non-traumatic hypolordosis and non-traumatic disk herniation, but abnormal in post-traumatic hypo-lordosis.

7. In this study, 12–14 weeks after injury, the whiplash patients complained of neck pain, headache, arm pain and arm numbness. This is more evidence that not all patients recover in a period of 6-8 weeks.

8. Flexion and extension MRI optimizes the functional significance of disk herniations in symptomatic patients, offering a distinct advantage to conventional MRI examinations performed in the neutral position.

9. These authors recommend flexion and extension MRI’s in the clinical setting of subacute cervical spine trauma (more than 12 weeks following injury). The clinical indication includes persistent neurologic deficit and clinical evidence of instability despite normal radiographs.

10.[Recent studies are showing that weight-bearing flexion/extension MRI’s show more soft tissue pathology. Life Chiropractic College West now has an upright weight-bearing MRI unit: (510) 780-4500.]

A 1978 graduate of Western States Chiropractic College, Dr. Dan Murphy is on the faculty of Life Chiropractic College West, and is the Vice President of the International Chiropractic Association. For more information, visit www.danmurphydc.com.