Featured Blogs

Effectiveness of Postsurgical Rehabilitation Following Lumbar Disc Herniation Surgery

Lumbar disc herniation (LDH) with radiculopathy is a common condition we encounter in clinical practice, with an annual prevalence of about 2% in the general population. Normally, the prognosis is good for these patients, but as with most conditions, a small proportion of patients go on to experience more non-responsive, [...]

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Influence of Active, Passive & Manual Therapy Interventions for Low Back Pain on Opioid Prescription and Health Care Utilization

Should we combine active and passive interventions for low back pain? Is spinal manipulation an active or passive therapy, or both? A variety of treatments offered by chiropractors and physical therapists are commonly recommended in clinical practice guidelines (CPGs) as a first line of treatment for patients with LBP. However, [...]

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Chiropractic care reduces tramadol prescriptions for radicular low back pain!

A growing body of evidence suggests seeing a chiropractor can help keep radicular back pain patients off prescription drugs like benzodiazepines, gabapentin, opioids in general and now, tramadol (a synthetic opioid) specifically! Tramadol is an atypical, synthetic opioid that is often prescribed for low back pain. Previous studies have found [...]

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Individualized Walking & Education Program for Preventing Recurrence of Low Back Pain

A simple moral to this week’s research story…get your low back pain patients moving, and it can be as simple as walking! Low back pain (LBP) is highly prevalent and disabling. It is also pervasive for many, as we know that approximately 70% of individuals experience a recurrence of back [...]

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Adjusting cadavers in the name of science!

Have you ever adjusted a cadaver? These researchers have, all in the name of good science! We are all aware of the possible relationship between cSMT and cervical artery strokes (including those affecting the internal carotid artery, but most often in relation to the vertebral artery). The best epidemiological research [...]

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Managing Back Pain in Pediatric Patients

It is well known that back pain is very common in adults, but children and adolescents also experience this problem. A prior systematic review reported the annual incidence of low back pain in those 18 years of age and under to be 33.6%. Other evidence regarding thoracic pain reveals a [...]

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Cost of Chiropractic vs. Medical Management of Spine-Related Musculoskeletal Pain

This is a very positive study for our profession, supporting the idea that patients with spinal pain should see a chiropractor first! Spine-related musculoskeletal pain is the leading cause of disability globally and associated healthcare costs have been rising relentlessly, with spinal pain being the costliest medical condition in the [...]

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Reducing Mechanical Hyperalgesia & Pain Catastrophizing Via Spinal Manipulation for Low Back Pain

Musculoskeletal pain is generally classified based on three main descriptors: nociceptive, neuropathic, and nociplastic. Compared to a specific musculoskeletal tissue pathology, altered nociceptive processing in chronic low back pain is thought to contribute to nociplastic pain. Further, central sensitization likely enhances the degree of nociceptive transmission in chronic low back [...]

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All Blogs

Effectiveness of Postsurgical Rehabilitation Following Lumbar Disc Herniation Surgery

Lumbar disc herniation (LDH) with radiculopathy is a common condition we encounter in clinical practice, with an annual prevalence of about 2% in the general population. Normally, the prognosis is good for these patients, but as with most conditions, a small proportion of patients go on to experience more non-responsive, [...]

Read more
Influence of Active, Passive & Manual Therapy Interventions for Low Back Pain on Opioid Prescription and Health Care Utilization

Should we combine active and passive interventions for low back pain? Is spinal manipulation an active or passive therapy, or both? A variety of treatments offered by chiropractors and physical therapists are commonly recommended in clinical practice guidelines (CPGs) as a first line of treatment for patients with LBP. However, [...]

Read more
Chiropractic care reduces tramadol prescriptions for radicular low back pain!

A growing body of evidence suggests seeing a chiropractor can help keep radicular back pain patients off prescription drugs like benzodiazepines, gabapentin, opioids in general and now, tramadol (a synthetic opioid) specifically! Tramadol is an atypical, synthetic opioid that is often prescribed for low back pain. Previous studies have found [...]

Read more
Individualized Walking & Education Program for Preventing Recurrence of Low Back Pain

A simple moral to this week’s research story…get your low back pain patients moving, and it can be as simple as walking! Low back pain (LBP) is highly prevalent and disabling. It is also pervasive for many, as we know that approximately 70% of individuals experience a recurrence of back [...]

Read more
Adjusting cadavers in the name of science!

Have you ever adjusted a cadaver? These researchers have, all in the name of good science! We are all aware of the possible relationship between cSMT and cervical artery strokes (including those affecting the internal carotid artery, but most often in relation to the vertebral artery). The best epidemiological research [...]

Read more
Managing Back Pain in Pediatric Patients

It is well known that back pain is very common in adults, but children and adolescents also experience this problem. A prior systematic review reported the annual incidence of low back pain in those 18 years of age and under to be 33.6%. Other evidence regarding thoracic pain reveals a [...]

Read more
Cost of Chiropractic vs. Medical Management of Spine-Related Musculoskeletal Pain

This is a very positive study for our profession, supporting the idea that patients with spinal pain should see a chiropractor first! Spine-related musculoskeletal pain is the leading cause of disability globally and associated healthcare costs have been rising relentlessly, with spinal pain being the costliest medical condition in the [...]

Read more
Reducing Mechanical Hyperalgesia & Pain Catastrophizing Via Spinal Manipulation for Low Back Pain

Musculoskeletal pain is generally classified based on three main descriptors: nociceptive, neuropathic, and nociplastic. Compared to a specific musculoskeletal tissue pathology, altered nociceptive processing in chronic low back pain is thought to contribute to nociplastic pain. Further, central sensitization likely enhances the degree of nociceptive transmission in chronic low back [...]

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Location of Pregnancy-Related & Postpartum Back Pain & Limitations of Daily Activities & Work Participation

This week’s Research Review is from my friend Dr. Carol Ann Weis an her colleagues, who present a fresh take on the location of back pain during pregnancy and what that might mean to us as clinicians… Back pain is a common issue during pregnancy and has been associated with [...]

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Concussion in Sport – 2022 Amsterdam Consensus Statement

Sport-related concussion is an evolving topic with emerging clinical science and Monday morning realities sometimes sidetracked by the politics of diagnosis for those of us who see these patients. I’ve always thought chiropractors, with some additional training, are optimally positioned to manage concussion patients and supervise their safe return to [...]

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Association between Chiropractic Spinal Manipulation & Cauda Equina Syndrome in Adults with Low Back Pain

Cauda equina syndrome (CES) occurs when the nerve roots that arise directly from the spinal cord at the level of the upper lumbar spine become compressed, typically by disc herniation. Signs and symptoms of CES may include: CES becomes a medical emergency when neurological deficits are present, and prompt corrective [...]

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Patient-Reported Outcomes for Low Back Pain Patients After Structured Education & Exercise Program (GLA:D Back)

Lumbar spinal stenosis (LSS) is a common condition experienced by older adults, and often seen in primary care settings. Like non-specific low back pain (NS-LBP), most people with LSS can be managed with interventions including patient education and exercise. Although they may not have received a definitive diagnosis of LSS, [...]

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SMT & Electrical Dry Needling for Lumbar Spinal Stenosis

Lumbar spinal stenosis can be a progressive, debilitating condition, but is often amenable to chiropractic care and other conservative treatments…this week, a randomized trial looking at the addition of SMT and electrical dry-needling to conventional physical therapy in a randomized trial. Lumbar spinal stenosis (LSS) is a narrowing of the [...]

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A contemporary approach to the biopsychosocial model for chiropractors…a fireside chat with Dr. Thistle & colleagues

This week, I will be at the CCA’s National Convention & Tradeshow in Toronto – I hope to see some of you there! Instead of a Research Review, today I wanted to share a fireside chat we filmed as we wrapped shooting for the filming of “Mastering the Biopsychosocial Approach: [...]

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Management of Chronic Pain Secondary to Temporomandibular Disorders

Jaw issues and TMJ pain are common, and can be a primary driver of chronic pain, or a comorbidity for many patients with other painful conditions. Temporomandibular disorders (TMD) comprise a group of more than 30 painful conditions that affect the muscles of mastication, the temporomandibular joint (TMJ), and associated [...]

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Understanding the Clinical Course of Low Back Pain

Something we discuss with chiropractic patients every day! Low back pain is a leading cause of disability worldwide with the most common type being ‘nonspecific’. The pillars regarding the management of low back pain are education and reassurance, nonpharmacological treatments and analgesic medications to reduce pain and disability. The literature [...]

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Chiropractic Management of Pediatric Patients – Best Practices Guideline

Chiropractic care is the most common complementary and integrative medicine practice used by children in the USA and is used commonly by children worldwide, most often for the treatment of musculoskeletal (MSK) conditions. Chiropractic undergraduate education includes the study of the unique anatomy and physiology of children as well as [...]

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HINTS Examination for Diagnosing Central Causes of Acute Vestibular Syndrome

Dizziness and vertigo are common reasons for people to present for medical care and they often present in our chiropractic offices as well. When this symptomatology is acute and severe, do you know what to do? A specific cause of dizziness and vertigo is called acute vestibular syndrome, which consists [...]

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Preventing costly ‘treatment escalation’ with chiropractic care!

Treatment escalation for low back pain (LBP) is costing our healthcare system a ton of money, despite the fact that most of these expensive interventions and imaging modalities do not improve patient outcomes. So, for us as chiropractors, a relevant question is: how much treatment is needed to avoid unnecessary [...]

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Risk Factors for Low Back Pain with Prolonged Standing

We normally ask our low back pain patients about pain with prolonged sitting, but do you ask them about pain with long periods of standing? Low back pain (LBP) will impact 70-85% of adults throughout their lives, exacting significant social and economic costs. Those experiencing acute LBP will have a [...]

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Manage cervicogenic headache with spinal manipulation + dry needling, says new systematic review…

We see patients with cervicogenic headaches all the time and generally, chiropractic care is very helpful for these patients. The literature however, has taken some time to catch up to our clinical observations, partly because headache is generally difficult to study (lots of variability!). Previous systematic reviews have reported that [...]

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Adverse childhood experiences linked to chronic pain in adulthood…

As chiropractors, we need to explore psycho-emotional factors with some patients. This week we summarize a new paper linking childhood adversity with chronic pain in adulthood… Adverse childhood experiences (ACEs) are defined as traumatic experiences occurring before the age of 18, and include a variable combination of physical, emotional, and [...]

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The Role of Back Muscle Dysfunction in Chronic Low Back Pain

Low back pain (LBP) is one of the leading causes of disability worldwide, affecting about 80% of the population at some point in their lifetime. Episodes of LBP generally resolve in a few weeks, however, up to 2/3 of patients experience a flare up within one year and about 15% [...]

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Do psychosocial factors mediate recovery in chronic low back pain patients?

The Fear Avoidance Model of Pain (FAM) posits that the interpretation of pain, rather than the pain itself, is chiefly related to the risk of chronicity. The model suggests that pain that is perceived as non-threatening is less likely to significantly disrupt daily activities and encourage more swift recovery. In [...]

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Nociplastic pain and central sensitization: Terminology update

Our understanding of chronic pain phenotypes and related mechanisms continues to evolve… Suffering from acute pain after an injury is beneficial to us as humans because it ensures that we protect damaged (or potentially damaged) tissue during healing. However, once time has elapsed and pain is in the chronic state [...]

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Impact of neck pain on gait health…

How does neck pain relate to gait? Providing effective care for older patients is something our profession can excel at. This topic is certainly an interesting aspect of healthy aging… Gait is a complex function that requires coordination of almost every physiologic system in the body, and the quality of [...]

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Untangling the relationship between migraine and neck pain…

How does neck pain relate to migraine? Why does neck treatment not many, but not ALL migraine patients? Neck pain affects about 3.5% of the general population globally, although its prevalence increases to over 70% among persons with migraine. Neck pain has been shown to bring on migraine attacks which [...]

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Pathophysiology of Discogenic Back Pain

Chronic back pain is one of the most common causes of disability worldwide. Low back pain can result from many etiologies including disc herniations, spinal canal stenosis, facet joint osteoarthritis, myofascial or spontaneous causes, and discogenic causes. In particular, discogenic back pain arises from degeneration to the intervertebral disc and [...]

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Impact of Initial Provider Specialty on Longitudinal Care Patterns for New-Onset Neck Pain

Neck pain is common cause of pain and a leading cause of disability worldwide and can lead to substantial limitations to daily activities. Low back pain research has found that the initial care provider seen by a patient can significantly influence subsequent care patterns and costs. Research has started assessing [...]

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Thoracic manipulation for chronic neck pain: What does the evidence say?

We’ve all had patients who don’t want their neck adjusted, which is (of course) their choice. So, what do we do in these cases? Do you recommend thoracic SMT instead? This week’s Review updates us on the evidence for thoracic SMT for chronic neck pain. The most common type of [...]

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Clinical Signs for Diagnosing Degenerative Cervical Myelopathy

In the last few years, what we used to refer to as cervical spondylotic myelopathy (CSM) has been renamed to degenerative cervical myelopathy (DCM). DCM is a progressive spine condition which can present with subtle, non-specific symptoms in the upper and lower extremities, making diagnosis difficult. Existing evidence shows us [...]

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Adding Spinal Manipulation to Pharmacologic Management of Fibromyalgia

Fibromyalgia (FM) is a chronic condition that is characterized by widespread pain, decreased pain threshold, fatigue, sleep disturbances, cognitive dysfunction, and other somatic symptoms. FM patients are typically provided a combination of pharmacological and nonpharmacological treatments, including analgesics, antiepileptics, antidepressants, exercise, cognitive behavioral therapy, physical therapies, relaxation techniques, and patient [...]

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Should we combine manual therapy and exercise for neck pain?

Low back and neck pain, when combined, account for much of the individual disability and tremendous healthcare expenditure globally. It is therefore necessary to continually evaluate the effective management and treatment of patients with nonspecific spinal pain conditions. Nonspecific neck pain typically develops gradually and may be caused by a variety [...]

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Association Between Chiropractic Spinal Manipulation & Gabapentin Prescriptions for Radicular Low Back Pain…Conservative care first!

Radicular low back pain is type of neuropathic pain, characterized by a nerve root lesion leading to radiating ipsilateral lower extremity symptoms. Gabapentin is an anticonvulsant and anti-epileptic medication which may work to alleviate neuropathic pain by binding to a subunit of voltage gated calcium channels, subsequently inhibiting ectopic nerve [...]

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Physical Activity, Sedentary Behaviour & Low Back Pain Trajectory…Get your patients moving!

Low back pain (LBP) is a common condition which affects approximately 40% of people worldwide at some time during their lives. LBP often results in physical disability and contributes to the number of years lived with disability (YLDs) more than any other condition. There are huge costs to society resulting [...]

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Cervical Spine Involvement in Tension Type Headaches…from evidence to practice

Tension type headache (TTH) is a primary headache characterized by a bilateral pattern, with pain reported as pressing or tightening in quality, of mild to moderate intensity, and lasting minutes to days. TTH does not worsen with routine physical activity and has no association with nausea, however, phonophobia or photophobia [...]

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Chiropractic reduces Benzodiazepine prescriptions for radicular low back pain! New evidence…

Benzodiazepines are a class of psychoactive medications that are increasingly prescribed for patients with low back pain and commonly used in patients with radicular low back pain. However, because of insufficient evidence supporting the efficacy of these medications for low back pain and the risk of serious adverse events, clinical [...]

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Antibiotic Treatment for Chronic Low Back Pain…what does the evidence say?

Low back pain remains one of the most disabling conditions worldwide, with substantial socioeconomic consequences.  A major consideration in treating low back pain is the use of pharmacological interventions such as opioids, which is especially pertinent in the treatment of chronic low back pain (CLBP).  Given the increasingly common use [...]

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Targeting a Specific Vertebral Level with SMT for Back Pain…does it matter?

Spinal manipulative therapy (SMT) is a cost effective and safe treatment, and as a result it is included in almost all clinical practice guidelines and practice recommendations for low back pain. The two most common types of SMT are joint mobilization and manipulation, with the main difference between the two [...]

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Prehabilitation for Spine Surgery – what works?

Spinal disorders are one of the most disabling and costly health issues and sometimes, surgery is necessary. A growing body of research suggests that physical and psychological factors are associated with important clinical and economic outcomes following spine surgery. In fact, when predicting clinical outcomes following lumbar spinal stenosis surgery, [...]

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Cervical Artery Dissection and Neck Manipulation (new big data study!)

Cervical artery dissection (CeAD) is the most serious safety concern related to the provision of high-velocity, low-amplitude cervical spinal manipulation (SMT) and can involve the carotid or vertebral arteries. The pathology of concern is dissection, which occurs when the arterial lining deteriorates, allowing blood to penetrate the artery wall. This [...]

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Phenotyping Nociceptive, Neuropathic & Nociplastic Pain

There is a clear global shift towards precision medicine in treating various conditions. The International Association for the Study of Pain (IASP) has thus outlined terms and decision criteria for distinct pain descriptors, known as pain phenotypes. This article elucidates the relevance of pain phenotyping and its utility in specific [...]

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Cervical Disc Degeneration – Clinical Considerations

Cervical disc degeneration (CDD) is an age-related condition occurring commonly in patients greater than 45 years of age and is characterized by its progressive nature and radicular symptoms.  Like lumbar disc degeneration, CDD can be identified on radiographs in asymptomatic patients although, in contrast to lumbar degeneration, radiographic findings in [...]

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Exercise vs. NSAIDs/Tylenol for Hip or Knee Osteoarthritis

Osteoarthritis (OA) is the most common form of joint disease and the leading cause of pain in older adults.  Oral non-steroidal anti-inflammatory drugs (NSAIDs) and paracetamol (or acetaminophen/Tylenol) are the most frequently prescribed analgesics in this population, with 10-35% of patients with OA reporting oral NSAID use. It is important [...]

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Association Between Clinical Findings and Lumbar Spine Osteoarthritis Imaging Features

Association Between Clinical Findings and Lumbar Spine Osteoarthritis Imaging Features Low back pain is frequently labelled as ‘nonspecific’ in nature, which is diagnosed by the exclusion of specific underlying causes through a history and physical examination. However, among patients with nonspecific low back pain, there may be subgroups of individuals [...]

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Rehabilitation After Anterior Cruciate Ligament Reconstruction

Rehabilitation After Anterior Cruciate Ligament Reconstruction Successful recovery following anterior cruciate ligament reconstruction (ACLR) hinges largely on the rehabilitation program.  Given that most ACL injuries are sports-related, the goal of rehabilitation is normally to return to sport as quickly as possible.  While up to 80% of ACLR patients return to some [...]

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Neural Mobilization in Low Back & Radicular Pain

Neural Mobilization in Low Back & Radicular Pain Low Back and Radicular Pain (LBRP) is a common type of low back pain which is caused by compression, irritation, or other pathology of one or more lumbosacral nerve roots. Lumbar disc herniation is thought to be the most common cause of [...]

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Manual Therapy Dosing & Outcomes in Hip Osteoarthritis

Manual Therapy Dosing & Outcomes in Hip Osteoarthritis Hip osteoarthritis (OA) is often managed by conservative treatments, one of the most important being manual therapy (MT), which aims to relieve symptoms by improving mobility and general tissue extensibility. Clinical guidelines currently recommend thrust, non-thrust and soft tissue mobilization for those [...]

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Peripheral Neuropathy Bedside Examination – Clinical Challenges

Peripheral Neuropathy Bedside Examination – Clinical Challenges The bedside neurological examination is an important clinical tool to assist in the diagnosis of suspected peripheral neuropathies such as radiculopathy, carpal tunnel syndrome or diabetic neuropathy. The main goal of the neurological examination is to identify a loss of action potential conductivity, [...]

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Management of Cervicogenic Dizziness

Management of Cervicogenic Dizziness Cervicogenic Dizziness has a lifetime prevalence of 15-35% in the general population and has many causes, including vestibular, cardiorespiratory, neurological, mental/psychiatric, and cervical/musculoskeletal. Cervical-related dizziness can be caused by altered blood flow in the cervical arterial blood vessels due to compression or disruption or altered functioning [...]

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Prolonged Slumped Sitting Causes Neck Pain & Increased Axioscapular Muscle Activity in Healthy Subjects

Prolonged Slumped Sitting Causes Neck Pain & Increased Axioscapular Muscle Activity in Healthy Subjects I’m sure you’ve seen a 3-year (!) spike in the number of your patients slumped over a laptop working from home? In many ways, the pandemic exacerbated a problem that was already nearly ubiquitous in office [...]

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Can seeing a chiropractor reduce the need for lumbar discectomy?

Can seeing a chiropractor reduce the need for lumbar discectomy? Lumbar disc herniations (LDH) are relatively common and certainly something you will encounter in practice. These patients require a comprehensive clinical workup, with careful consideration to the best plan of management. LDH involves a focal displacement of intervertebral disc material [...]

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Diagnostic Accuracy of the Ottawa Ankle Rules to Exclude Fractures in Acute Ankle Injuries in Adults

Diagnostic Accuracy of the Ottawa Ankle Rules to Exclude Fractures in Acute Ankle Injuries in Adults Ankle trauma is a common reason for individuals to visit the emergency department or a family physician, chiropractor or physiotherapist. Currently, radiographic assessment is routinely used in ankle trauma, despite evidence suggesting that it [...]

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Patient Characteristics Associated with Non-Serious Adverse Events After Cervical Manual Therapy

Patient Characteristics Associated with Non-Serious Adverse Events After Cervical Manual Therapy Cervical spine manipulation and mobilization are commonly used for the treatment of patients with neck pain, with 6% to 12% of neck pain patients utilizing cervical spine manipulation annually. Manual therapy (MT), comprising high velocity thrust (HVT) manipulation and/or [...]

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Diagnosing Low Back Pain of Disc, Sacroiliac Joint or Facet Joint Origin

Diagnosing Low Back Pain of Disc, Sacroiliac Joint or Facet Joint Origin Most clinical practice guidelines recommend general treatment approaches for low back pain, including exercise, medication or manual therapy. When studied, these interventions typically demonstrate small effect sizes and there is little to no information on how to individualize [...]

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Tensile Force in the Vertebral Arteries During Cervical Spine Manipulation Applied to Human Cadavers

Tensile Force in the Vertebral Arteries During Cervical Spine Manipulation Applied to Human Cadavers This week, we discuss an update to ground breaking cadaveric research conducted nearly 20 years ago by Drs. Walter Herzog, Bruce Symons and colleagues investigating cervical artery strains and forces experienced during neck manipulation. This new [...]

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Relationship Between Physical Activity & Pain in American Adults

Relationship Between Physical Activity & Pain in American Adults “Motion is lotion, rest is rust” As chiropractors, one of our primary roles should be to promote and facilitate physical activity in our patients. As discussed in this week’s Review, how active our patients are can relate directly to how much [...]

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Clinical Instrument to Identify Appropriate Patients for Low Back Pain Maintenance Care

Clinical Instrument to Identify Appropriate Patients for Low Back Pain Maintenance Care Low back pain (LBP) affects a large portion of the adult population worldwide. In about 80-85% of individuals, LBP episodes are often short lived but recurrent throughout one’s life. As a result, research has looked at strategies of [...]

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Prognosis of a New Episode of Low Back Pain in a Community Inception Cohort

Prognosis of a New Episode of Low Back Pain in a Community Inception Cohort Previous studies have shown that the natural course of low back pain is typically favorable, with most episodes substantially improving within 6 weeks. Within these studies, the majority have assessed the prognosis of acute low back [...]

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Shoulder Injury Prevention, Rehabilitation & Return to Sport

Shoulder Injury Prevention, Rehabilitation & Return to Sport Shoulder injuries commonly impact athletes at amateur and professional levels and can impact performance, training and activities of daily living. Despite the prevalence and impact of shoulder injuries, there is a lack of high-quality evidence to guid clinicians, athletes and coaches in [...]

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Lumbar Spinal Stenosis Treatment Algorithm – Delphi Consensus

Lumbar Spinal Stenosis Treatment Algorithm – Delphi Consensus Lumbar spinal stenosis (LSS) is a common condition affecting older adults, which is treated with a variety of non-surgical and surgical interventions. Despite up to 35% of patients having poor satisfaction with surgical outcomes at one-year follow-up and the lack of sustained [...]

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Dry Needling & Upper Cervical Manipulation for Temporomandibular Disorder – RCT

Dry Needling & Upper Cervical Manipulation for Temporomandibular Disorder – RCT Temporomandibular disorder (TMD) is a very common condition which affects 16% to 59% of the global population and has been shown to be the third most prominent pain condition world-wide. TMD is associated with a variety of factors, such [...]

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Manual Therapy with Rehabilitation of Cervical Sensorimotor Control for Neck Pain

Manual Therapy with Rehabilitation of Cervical Sensorimotor Control for Neck Pain Between 50% and 85% of persons with neck pain do not attain complete resolution of their symptoms, possibly due to altered afferent/sensory input from cervical proprioceptors. Research has shown that such altered afferentation can result in impaired joint proprioception, [...]

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Effect of Diagnostic Labelling on Patients’ Perceived Need for Imaging for Low Back Pain

Effect of Diagnostic Labelling on Patients’ Perceived Need for Imaging for Low Back Pain Within many chiropractic offices and existing clinical guidelines, non-specific low back pain (NS-LBP) is diagnosed when no specific structural cause can be identified. However, there is some controversy regarding the use of this term, as opponents [...]

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Psychosocial Factors Related to Severe Pain & Functional Limitation in LBP

Psychosocial Factors Related to Severe Pain & Functional Limitation in LBP Low back pain is the leading cause of disability worldwide. Psychosocial factors are known to negatively influence clinical outcomes in patients with LBP by contributing to pain development, pain aggravation and chronification. It is also established that patients with [...]

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Surgery vs. Rehabilitation for Anterior Cruciate Ligament Injuries

Surgery vs. Rehabilitation for Anterior Cruciate Ligament Injuries Anterior cruciate ligament (ACL) injuries are one of the most common and serious knee injuries. There is an ongoing clinical and scientific debate that certainly matters to our patients – whether the management of these injuries should primarily consist of surgery or [...]

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Inguinal-Related Groin Pain in Athletes

Inguinal-Related Groin Pain in Athletes Athletes with groin pain in the inguinal canal region with no palpable hernia present a challenge for clinicians. Pain within this region can be a result of several conditions, many of which are musculoskeletal in nature and form the focus of this editorial. When it [...]

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Clinical Relevance of Pressure Pain Thresholds in Real‑World Chiropractic Practice

Clinical Relevance of Pressure Pain Thresholds in Real‑World Chiropractic Practice This Research Review contains a guest commentary from the study’s lead author and one of our professions rising research stars – Dr. Casper Glissmann Nim! Pressure pain threshold (PPT) is a concept within manual therapies that is proffered as a [...]

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Association Between Cervical Artery Dissection & Spinal Manipulation in Older Patients

Association Between Cervical Artery Dissection & Spinal Manipulation in Older Patients Patients with cervical artery dissection (CeAD) involving the carotid or vertebral arteries may be asymptomatic, although they frequently experience neck pain and/or headache (therefore they may seek chiropractic care!). A recent case-control study involving 165 patients < 50 years-of-age [...]

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Identifying Peripheral Arterial Diseases or Flow Limitations of the Lower Limb

Identifying Peripheral Arterial Diseases or Flow Limitations of the Lower Limb Pain into the lower limbs can be caused by many conditions including peripheral arterial disease (PAD), which is a common and potentially serious condition of the lower limb. Despite its frequency in the population, the diagnosis of this condition [...]

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Rehabilitation After Anterior Cruciate Ligament & Meniscal Injuries

Rehabilitation After Anterior Cruciate Ligament & Meniscal Injuries The paper we Reviewed for you this week is one of several systematic reviews contributing to the development of evidence-based consensus recommendations for rehabilitation to optimize musculoskeletal health and prevent post-traumatic osteoarthritis (OA) following knee trauma (OPTIKNEE). Anterior cruciate ligament (ACL) and [...]

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Chiropractic Care Reduces Opioid Prescriptions, AGAIN!

Chiropractic Care Reduces Opioid Prescriptions, AGAIN! Many recent studies have shown that seeing a chiropractor can reduce one’s risk of being prescribed opioid medications for spinal pain. This week, we summarize a recent paper from one of our newest DC/PhD colleagues in Canada – Dr Peter Emary, who graciously contributed [...]

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Reducing Sitting Time in the Workplace – Cluster Randomized Trial

Reducing Sitting Time in the Workplace – Cluster Randomized Trial Many adults (and younger people!) spend a large portion of their day sedentary. In particular, office-based workers have been found to spend 73% of their workday and 66% of their waking day sitting! The emergence of recent evidence linking a [...]

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Hypermobility & Related Disorders – Masterclass Review Paper

Hypermobility & Related Disorders – Masterclass Review Paper Joint hypermobility refers to the ability of a joint to move beyond a “normal” range of motion after considering age, gender and ethnicity. For some people, joint hypermobility may cause increased risk of injury and may be associated with other systemic conditions [...]

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Effectiveness of Manual Therapy for Cervicogenic Headache

Effectiveness of Manual Therapy for Cervicogenic Headache Patients often consult chiropractors with headaches and in many cases, a reasonable trial of chiropractic care is warranted once red flags have been ruled out and a diagnosis has been reached. Cervicogenic headaches are relatively common, but in my experience can overlap with [...]

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SMT effective for older adults with chronic LBP – new, supportive high-level evidence!

SMT effective for older adults with chronic LBP – new, supportive high-level evidence! Spinal manipulation is an effective option for older patients with low back pain! Combine SMT with patient-centred care including reassurance and exercise/movement/rehabilitation and we really have the capacity to make a difference for this growing patient population! [...]

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Exercise Therapy vs. NSAIDs or Opioids for Knee Osteoarthritis Pain

Exercise Therapy vs. NSAIDs or Opioids for Knee Osteoarthritis Pain Exercise for the win, again! Opioids are commonly used in the management of chronic musculoskeletal (MSK) conditions, however, the appropriateness of treating conditions such as osteoarthritis (OA) with opioids is widely debated due to the risk of adverse events (AE) [...]

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How do we define ‘growing pains’?

How do we define ‘growing pains’? “Doc, my 5 year old wakes up sometimes with really sore legs, what’s happening?” This is a question we often hear in practice (or something we experience with our own children), and the answer we normally provide is “growing pains”. But, do we know [...]

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Does the popping sound with SMT matter for pain outcomes?

Does the popping sound with SMT matter for pain outcomes? When you adjust a patient, do you think the popping sound is necessary to achieve a desired clinical outcome regarding pain? This week’s Review looks at the evidence in this space… Spinal pain is very common worldwide and can have [...]

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The Science of MD Referrals

The Science of MD Referrals Why do MD’s refer (or not refer) patients to chiropractors. This week, a study on chiropractor characteristics that can drive referrals…there are some important lessons in this paper! An emphasis on interprofessional practices and education has been growing worldwide, in part because it has been [...]

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