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29.  THE EFFECT OF CERVICAL SPINE ISOMETRIC CONTRACT-RELAX TECHNIQUE ON HAMSTRING EXTENSIBILITY 
PMCID: PMC2051304  PMID: 17987203
Hamstrings; cervical spine; isometric; contract-relax; passive knee extension; clinical challenge
30.  CLINICAL ACTIVITIES AUDIT 
Introduction: Continuing professional education activities such as professional conferences and passive dissemination of literature appear to have no little or no impact on changing clinicians’ practice. A clinical activities audit was carried out with a group (44) of chiropractors and osteopaths as part of the Chiropractic and Osteopathic College of Australasia’s continuing professional development program to determine whether it was likely to generate improvement in practice.
Methods: The participants gathered data relating to six audit criteria on ten patient records in round 1 and ten in round 2 (six months later). Each participant received a learning guide relating to useful clinical tools for pain and disability measurement immediately after completing the first round. The audit criteria relate to: methods used to assess the site and severity of pain, methods used to assess disability, other investigations performed or ordered, referrals made and outcome measures used for pain and disability. The data were analysed to determine whether the participants increased their use of objective pain and disability and outcome measures over the course of the audit.
Results: Results of the first round of audit were compared with those of the second round. Practitioners’ use of objective measures of pain and disability and outcome measures was significantly higher in the second round of audit.
Conclusion: This indicates that this clinical activities audit is a useful tool for improving practice.
PMCID: PMC2051303  PMID: 17987202
Clinical audit; pain and disability measurement; chiropractic; osteopathic
31.  Lessons from Laurie Jean Mathiason 
PMCID: PMC2051302  PMID: 17987200
Chiropractic; stroke
32.  RISK MANAGEMENT FOR CHIROPRACTORS AND OSTEOPATHS 
Although rare, vertebrobasilar stroke is the best known of the possible side effects of cervical manipulation. Due to the serious sequelae that may result from cervical manipulation, chiropractors and osteopaths must take the appropriate steps to ensure the risk is minimised. This article outlines how the astute practitioner can minimise this risk. Practitioners must decide on the options for treatment of a patient with neck problems. Practitioners must also advise the patient of these options as part of an appropriate informed consent.
PMCID: PMC2051301  PMID: 17987199
Chiropractic; stroke; manipulation
33.  Can we believe… 
PMCID: PMC2051300  PMID: 17987198
Evidence
34.  CLINICAL ACTIVITIES AUDIT 
PMCID: PMC2051298  PMID: 17987204
Clinical audit; pain and disability measurement; chiropractic; osteopathic; clinical challenge
35.  THE EFFECT OF CERVICAL SPINE ISOMETRIC CONTRACT-RELAX TECHNIQUE ON HAMSTRING EXTENSIBILITY 
Objectives: To re-investigate the effect of a cervical isometric contract-relax technique on hamstring extensibility and examine the duration of any treatment effect.
Methods: Forty asymptomatic participants were randomly assigned equally to either an experimental or control group. Both groups underwent pre and post hamstring extensibility measurements using passive knee extension with the thigh maintained at 90° of hip flexion, with the examiner blinded to treatment allocation of the participants. Torque was measured with a hand held dynamometer to maintain consistent force in pre and post measurements. The experimental group received an upper cervical isometric contract-relax treatment. A digital camera recorded the knee extension angles and the images were computer analysed to determine hamstring extensibility.
Results: A split plot ANOVA (SPANOVA) revealed no significant hamstring extensibility differences between or within the groups, immediately or at 30 minutes.
Conclusion: The cervical isometric contract-relax treatment produced no significant effect to the extensibility of the hamstring. This study does not support the use of cervical techniques to alter hamstring extensibility.
PMCID: PMC2051297  PMID: 17987201
Hamstrings; cervical spine; isometric; contract-relax; passive knee extension
36.  INTEGRATIVE FASCIAL RELEASE & FUNCTIONAL TESTING 
Soft tissue techniques, including Integrative Myofascial Release (IFR) can be more effective if the area of treatment can be determined by functional testing. The patient’s source of pain may not necessarily be located at the area of complaint and functional testing helps in pinpointing the source. Post-treatment functional testing will provide feedback to both the patient and the doctor as to whether the technique was effective. This paper will describe some typical functional tests and treatment using IFR of the posterior cervical/thoracolumbar fascia.
PMCID: PMC2050814  PMID: 17987166
Soft tissue; chiropractic
37.  A CASE OF A PATHOGENIC ACTIVE SCAR 
Soft tissues follow every movement of bones and joints. Their free movement is essential for normal functioning of the motor system. Scars form mainly in the soft tissues, and if abnormal, or ‘active’, can interfere with the function of the motor system as well. For diagnosis and treatment the barrier phenomenon is a most useful concept: a pathological barrier restricts movement and does not spring when engaged. After engaging the barrier and waiting, release, relief and normal mobility are obtained. An illustrative case with an active appendectomy scar is presented, with both low back and abdominal pain. Extensive and costly examination were all negative. After diagnosis and treatment of the active scar symptoms were promptly relieved. Diagnosis and treatment of active scars should become part of the physical therapist’s approach to the patient’s problems.
PMCID: PMC2050813  PMID: 17987167
Soft tissue; chiropractic
38.  SPECIFIC SEQUENTIAL MYOFASCIAL TRIGGER POINT THERAPY IN THE TREATMENT OF A PATIENT WITH MYOFASCIAL PAIN SYNDROME ASSOCIATED WITH REFLEX SYMPATHETIC DYSTROPHY 
A patient with traumatic rotator cuff tear of the left shoulder developed severe myofascial pain syndrome with reflex sympathetic dystrophy (RSD) involving the left upper extremity. He was unable to tolerate any type of manual therapy or needle treatment due to severe allodynia in the whole left upper limb. This patient presented for treatment approximately 6 months after the onset of trauma. Treatment consisting of specific myofascial trigger point (MTrP) therapy, beginning with desensitization and gentle massage on the MTrP of the first dorsal interosseous muscle, followed by treatment of MTrPs of the wrist-finger extensors and anterior deltoid muscles was commenced. Allodynia was remarkably reduced and further physical therapy with modalities was administered. After 2 weeks of daily MTrP therapy, he received local steroid injection to the left shoulder and continued MTrP therapy 2-3 times per week. Approximately 2 months after the injection the patient was almost pain free with nearly full range of motion in his left shoulder. The mechanism of MTrPs and their association with RSD is discussed in this paper.
PMCID: PMC2050812  PMID: 17987165
Manual therapy; muscle pain; Myofascial Trigger Points; Reflex Sympathetic Dystrophy
39.  SOFT TISSUE & ANCILLARY TECHNIQUES 
PMCID: PMC2050811
Soft tissue techniques; chiropractic
40.  SHOULDER PAIN IN ELITE SWIMMERS 
Much research has investigated shoulder pain which inhibits the performance of elite swimmers. An ever increasing understanding of the epidemiology and aetiology of what has been termed 'swimmer's shoulder' has enabled better treatment, rehabilitation and prevention programs to be implemented. This paper reviews the current research relevant to 'swimmer's shoulder' and the methods of treatment being employed to treat the problem.
PMCID: PMC2051095  PMID: 17987196
Shoulder; pain; elite swimmer; chiropractic
41.  CHIROPRACTIC MANAGEMENT OF MIGRAINE WITHOUT AURA 
Objective: To assess the response of a patient with chronic migraines to a short program of chiropractic care (diversified technique).
Method: The study was run over a 13 week period with chiropractic spinal manipulative therapy (CSMT) on a once weekly schedule for 5 weeks, followed by an 8 week re-evaluation.
Outcome Measures: To measure the effect of treatment, a previously reported diary system was used which noted the intensity of a range of symptoms that are recorded following each migraine episode.
Results: The results attained showed there was a marked improvement in the migraine symptoms following the chiropractic care. The patient reported an improvement in frequency, intensity, duration and use of medication. These findings appear to also confirm other evidence which documented similar changes following a large randomised controlled trial of chiropractic treatment of migraine.
Discussion: The case is presented as further support for CSMT in the treatment of migraine. The outcome of this case is also discussed in relation to recent research that concludes that CSMT is a very effective treatment for some people with non-neuromusculoskeletal conditions.
Conclusion: It now appears clear that chiropractic care may be used to assist patients with migraine. Research is currently being undertaken to investigate the potential mechanisms of chiropractic in the treatment of migraine. This research should also assess what (if any) prognostic signs can be identified to assist practitioners making a more informed decision on the treatment of choice for migraine.
PMCID: PMC2051094  PMID: 17987195
Classic Migraine; chiropractic; manipulation; spinal; case report
42.  TREATMENT OF ACUTE ATOPIC ECZEMA BY CHIROPRACTIC CARE 
Objective: To investigate a patient with atopic eczema and assess how they responded to chiropractic care.
Method: The study was run over a 7 week period with chiropractic treatments (diversified technique) on a once weekly schedule.
Outcome Measures: To measure the effect of treatment, a rating system was developed and the intensity of a range of symptoms was recorded (through a questionnaire) on a twice weekly basis.
Results: The results attained showed there was a marked improvement in the eczema symptoms following the chiropractic care. The patient reported an improvement in eczematous symptoms of excoriation, pruritus, oedema and general psychological ease. These findings were also confirmed by photographic evidence which documented the change in the lesions.
Discussion: The case is presented to assist practitioners making a more informed decision on the treatment of choice for eczema. The outcome of this case is also discussed in relation to recent research that concludes that chiropractic spinal manipulative therapy has a role in the treatment for some people with non-neuromusculoskeletal conditions.
Conclusion: It appears that chiropractic care may have assisted this patient with eczema. However, more research is required to investigate the role that chiropractic has in the treatment of patients with eczema, and the potential mechanisms that could explain the improvement.
PMCID: PMC2051093  PMID: 17987197
Eczema; dermatitis; atopic; chiropractic; case report
43.  THE ROLE OF THE CHIROPRACTOR 
Chiropractors in Australia face some challenges that are unique in their history. The value of their primary treatment modality is now widely recognised. The process of professionalisation of this occupation is well advanced. Yet the integration of chiropractic services within the mainstream Australian health care system remains problematic. It is contended in this paper that chiropractors' integration will be facilitated by two genuine and strategic moves by the medically minded segment of, or the entire, profession. One is to abandon metaphysical notions as part of the 'philosophy of chiropractic' and the other is to pursue limited prescription rights allowing chiropractors to play fully the role of the primary contact practitioners of neuromusculoskeletal medicine. This development is deemed to be beneficial and appropriate for the profession as well as the patients served by this profession.
PMCID: PMC2051092  PMID: 17987192
Chiropractic; prescription rights; neuromusculoskeletal; scope of practice
44.  A TWELVE MONTH CLINICAL TRIAL OF CHIROPRACTIC SPINAL MANIPULATIVE THERAPY FOR MIGRAINE 
Objective: To assess the efficacy of Chiropractic spinal manipulative therapy (SMT) in the treatment of migraine.
Design: A prospective clinical trial of twelve months duration. The trial consisted of 3 stages: two month pre-treatment, two month treatment, and two months post treatment. Comparison of outcomes to the initial baseline factors was made and also 6 months after the cessation of the study.
Setting: Chiropractic Research Centre of Macquarie University.
Participants: Thirty two volunteers, between the ages of 20 to 65 were recruited through media advertising. The diagnosis of migraine was based on a self reported detailed questionnaire, with minimum of one migraine per month.
Interventions: Two months of chiropractic SMT at vertebral fixations determined by the practitioner, through orthopedic and chiropractic testing.
Main Outcome Measures: Participants completed diaries during the entire trial noting the frequency, intensity (visual analogue score), duration, disability, associated symptoms and use of medication for each migraine episode.
Results: The initial 32 participants showed statistically significant (p < 0.05) improvement in migraine frequency, VAS, disability, and medication use, when compared to initial baseline levels. A further assessment of outcomes after a six month follow up (based on 24 participants), continued to show statistically significant improvement in migraine frequency (p < 0.005), VAS (p < 0.01), disability (p < 0.05), and medication use (p < 0.01), when compared to initial baseline levels.
In addition, information was collected regarding any changes in neck pain following chiropractic SMT. The results indicated that 14 participants (58%) reported no increase in neck pain as a consequence of the two months of SMT. Five participants (21%) reported a slight increase, three participants (13%) reported mild pain, and two participants (8%) reported moderate pain.
Conclusion: The results of this study support the hypothesis that Chiropractic SMT is an effective treatment for migraine, in some people. However, a larger controlled study is required.
PMCID: PMC2051091  PMID: 17987194
Migraine; chiropractic; spinal manipulation; prospective trial; neck
45.  IS THERE A ROLE FOR THE PRESCRIPTION OF MEDICATION BY CHIROPRACTORS? 
PMCID: PMC2051090  PMID: 17987193
Chiropractic; drugs; medicine
46.  BACTERIAL ARTHRITIS 
Acute pain in peripheral joints is not a common presenting symptom for chiropractors or osteopaths. However, chiropractors or osteopaths may be asked to assess peripheral joints when patients present with other conditions such as back pain.
This paper reviews the literature on bacterial arthritis as a specific type of infectious arthritis. Information was obtained from Medline and internet search using the keyword: “bacterial arthritis”. The most common presenting symptoms are described, with specific reference for chiropractors and osteopaths in clinical presentation of patients' with this condition.
PMCID: PMC2051089  PMID: 17987191
Bacterial arthritis; chiropractic
47.  THE DESIGN AND PRESENTATION OF A CASE STUDY 
PMCID: PMC2051088  PMID: 17987187
Case study; design
48.  MULTIPLE CHANNEL RECORDING OF THE ARTICULAR CRACK ASSOCIATED WITH MANIPULATION OF THE METACARPOPHALANGEAL JOINT 
Background: The audible release or cracking sound associated with spinal manipulation is familiar to practitioners of spinal manipulative therapy. Furthermore, some authors believe the articular crack to be at least in part responsible for the therapeutic benefits derived from spinal manipulative therapy. Although some research has been directed towards the investigation of some aspects of this phenomenon, little research has be conducted in order to establish from which side and vertebral level the audible release occurs during the manipulative process.
Objective: To assess the reliability and accuracy of multiple surface mounted microphones to detect the audible release of the target joint during manipulation of the third metacarpophalangeal joint.
Design: Observational study.
Setting: Private practice of chiropractic, Ringwood, Victoria, Australia.
Participants: Twenty volunteers recruited from staff and patients of the private practice of chiropractic.
Method: Eight omnidirectional microphones were affixed to the palmar surface of the hand. Microphone No.1 was positioned directly over the third metacarpophalangeal joint while the remaining microphones were arranged in a uniform pattern over the palmar surface of the hand. Manipulation in the form of long axis traction was then applied to the third metacarpophalangeal joint. Where an audible release was associated with the manipulation the resultant signals were captured via computer and stored for later analysis.
Main Outcome Measure: A difference of greater than one volt in peak amplitude between the microphone positioned over the target joint and the other microphones. The student's t-test was then applied to the data in order to determine if the mean output of the target joint microphone was statistically different to the mean output of the other microphones.
Results: A total of eighteen manipulations resulted in nineteen audible release signals. The mean voltage of channel 1 was consistently greater than all the other channels in this group of subjects. This difference was statistically significant for all the channels.
Conclusion: This research suggests that multiple surface mounted microphones are capable of consistently detecting the audible release from the target joint, with manipulation directed to the third MCP joint. It is hoped that this method will be able to be applied to the audible release associated with spinal manipulative therapy and a better understanding of the manipulative process will ensue.
PMCID: PMC2051087  PMID: 17987189
Joint crack; cavitation; noise; sound; audible release; vibration; recording; manipulation; metacarpophalangeal joint; spine
49.  CHIROPRACTIC AND OSTEOPATHIC EDUCATION AT ROYAL MELBOURNE INSTITUTE TECHNOLOGY 
Objective: To assess the attitudes of undergraduate chiropractic and osteopathic students at Royal Melbourne Institute of Technology (RMIT) in 1992 on the education they are receiving and on the effectiveness of chiropractic and osteopathic care.
Design: Cross-sectional descriptive survey.
Participants: Undergraduate chiropractic and osteopathic students enrolled at RMIT School of Chiropractic and Osteopathy in 1992.
Results: This study surveyed 272 students, 196 who were chiropractic students and 76 who were osteopathic students from RMIT School of Chiropractic and Osteopathy in Melbourne, Australia. The students that responded represented 73.4% of chiropractic students and 85.4% of osteopathic students currently enrolled in their respective courses. Chiropractic and osteopathic students entered their respective courses from non-chiropractic/non-osteopathic families. More chiropractic students than osteopathic students (1.3:1.0) had their respective course as their first choice when applying for tertiary education. A majority (95.8 chiropractic students and 94.8% osteopathic students) of both groups surveyed were pleased with their choice of course. Students from both disciplines held considerable respect for each other in the care of certain conditions, but did not see the other profession’s care as effective as their own. A greater percentage of osteopathic students believed there was sufficient difference between chiropractic and osteopathy to justify two separate professions (57.6% compared to 97.2%).
Discussion: High quality education is a major aim in our schools and colleges. For this standard to be maintained it requires continual re-evaluation and assessment. Surveys such as this should be performed regularly as a method of evaluating student attitude and how these attitudes change during the course. This would also allow administrators to determine whether they are achieving their academic intentions. An immediate follow up survey asking the same questions is suggested to ascertain whether the same attitudes exist today.
PMCID: PMC2051086  PMID: 17987188
Chiropractic; osteopathic medicine; education; students; attitude
50.  THE AMA AND CHIROPRACTIC 
PMCID: PMC2051085  PMID: 17987190
News; chiropractic; AMA

Results 26-50 (118)