Hamstrings; cervical spine; isometric; contract-relax; passive knee extension; clinical challenge
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.
Clinical audit; pain and disability measurement; chiropractic; osteopathic
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.
Chiropractic; stroke; manipulation
Clinical audit; pain and disability measurement; chiropractic; osteopathic; clinical challenge
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.
Hamstrings; cervical spine; isometric; contract-relax; passive knee extension
Low back pain
Sacroiliac joint; reliability; validity; clinical tests; clinical challenge
Background: The sacroiliac joint (SIJ) can be a source of low back pain. The complexity of the system involving the SIJ and the varied SIJ pain referral pattern makes it difficult to clinically assess SIJ dysfunction. Despite the emergence of detail of the SIJ complex, the basis of the clinical tests has not been thoroughly investigated.
Objective: To review the literature from the last decade dealing with the validity and reliability of clinical tests for SIJ dysfunction in order to determine which tests are reliable and valid.
Discussion: For clinical tests with multiple studies, there was agreement on reliability for Gaenslens, Thigh Thrust test, Finger Point test and SIJ Pain Mapping and agreement on validity for Thigh Thrust test. However, Gillets Test, Patrick’s FABER and Sacral Thrust/Compression were considered invalid and unreliable, although these results may have been influenced by methodological shortcomings. Examination of the entire SIJ complex may mean that a series of tests are required.
Sacroiliac joint; reliability; validity; clinical tests
Background: Fibromyalgia is a common chronic musculoskeletal pain syndrome, however its characteristics, diagnosis and management have not always been well understood. There is now increasing understanding of the pathophysiological mechanisms of fibromyalgia and development of more effective management strategies.
Objective: To explain the characteristics and diagnostic features of fibromyalgia. A discussion of current management strategies is included.
Discussion: Fibromyalgia patients have a central pain system problem that results in widespread musculoskeletal pain, and many other disabling features in the absence of tissue damage. The ability to exclude other pathology and recognize the disorder is important, as there are very real management options available. Management is most effective as a multidisciplinary, layered approach. It is important to involve the patient in their own treatment program, to enhance its success.
Fibromyalgia; diagnosis; management
Background: Metachondromatosis is a condition that causes gross conical metaphyseal expansion (sometimes irregular), cortical thinning, exostoses. Metachondromatous lesions occur mainly in the extremities and are roughly symmetrical. The lesions can involve the bones of the hand and all long bones in the arms and legs. The distribution in this case additionally involved the acromion process and ischia. The bone changes, although dramatic, can be confused with other types of metaphyseal dysplasia such as Gaucher disease and multiple exostoses.
Objective: This paper will review the literature with regard to Metachondromatosis, Gaucher disease and Osteochondromatosis due to their similarities. The case study serves as an example of these findings and documents a history of fractures secondary to the obvious bone changes.
Discussion: Clinical manifestations of these conditions and how they may present to the manual therapist are discussed. With respect to Metachondromatosis, the manual therapist needs to be mindful of pathological fractures that can occur with little trauma. Manual therapists are cautioned against using long bones as levers for spinal manipulation in these patients.
Metachondromatosis; Osteochondromatosis; manual therapies; manipulation; chiropractic; contraindications; fractures; case report
Systematic review; chiropractic; osteopathy
Shoulder pain; chiropractic; Scapulo-costal Syndrome
Fibromyalgia; diagnosis; management; clinical challenge
Clinical challenge; systematic review