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1.  Chiropractic spinal manipulative treatment of migraine headache of 40-year duration using Gonstead method: a case study 
Journal of Chiropractic Medicine  2011;10(3):189-193.
Objective
The purpose of this article is to present a case study of chiropractic spinal manipulative treatment (CSMT) using the Gonstead method for a patient with migraines.
Clinical Features
The patient was a 52-year-old married woman with a long-term history of chronic migraines, which included nausea, vomiting, and photophobia. The patient had endometriosis, but did not relate the migraines to her menstrual cycles. She also reported not using medication for her migraines due to previous drug-related issues. The average frequency of episodes before treatment was 1 per month, and her migraines often included an aura. The pain was moderate, was located on the right side, was pulsating, and lasted for approximately 15 hours. The numeric pain scale for an average episode was 8 out of a possible 10. The aura involved nausea, photophobia, and visual disturbances including black dots in the visual field lasting for approximately 10 minutes.
Intervention and Outcome
The patient reported all episodes being eliminated following CSMT. At 6-month follow-up, the patient had not had a single migraine episode in this period. The patient was certain that there had been no other lifestyle changes that could have contributed to her improvement.
Conclusion
This case adds to previous research suggesting that some migraine patients may respond favorably to CSMT. The case also provides information on the Gonstead method. A case study does not represent significant scientific evidence in context with other studies conducted; this study suggests that a trial of CSMT using the Gonstead methods could be considered for chronic, nonresponsive migraines.
doi:10.1016/j.jcm.2011.02.002
PMCID: PMC3259914  PMID: 22014909
Migraine disorders; Chiropractic; Manipulation, spinal
2.  Chiropractic spinal manipulative treatment of cervicogenic dizziness using Gonstead method: a case study 
Journal of Chiropractic Medicine  2011;10(3):194-198.
Objective
The purpose of this case report is to present the response of a patient with chronic nonresponsive cervicogenic dizziness to chiropractic care.
Case report
A 29-year-old man had a 10-year history of progressive cervicogenic dizziness with symptoms including a sensation of excessive motion, imbalance, and spinning associated with neck pain and stiffness. After treatment, he reported a reduction in pain and dizziness and an improved quality of life following Gonstead method of chiropractic spinal manipulative therapy.
Conclusion
This case study suggests that a patient with nonresponsive cervicogenic dizziness might respond to chiropractic spinal manipulative therapy approach using Gonstead method.
doi:10.1016/j.jcm.2011.06.001
PMCID: PMC3259942  PMID: 22014910
Chiropractic; Manipulation, spinal; Dizziness; Vertigo
3.  A review of the literature on chiropractic and insomnia 
Journal of Chiropractic Medicine  2010;9(3):121-126.
Objective
The purpose of this literature review is to critically review the evidence for chiropractic as a treatment of primary insomnia.
Methods
A search of the following databases up to October 2006 was conducted: PubMed, PEDro, MANTIS, CINAHL, and the specialized register of the Cochrane review group. We also performed hand searching of relevant journals. Randomized clinical trials, clinical trials, and case studies of chiropractic treatment of insomnia were included. It was required that each study used at least one form of standard patient outcome measure. Treatment strategies included manual therapy such as spinal manipulative therapy or muscle relaxation techniques. The review focused on articles published in indexed, peer-reviewed journals.
Results
Fifteen studies met the selection criteria. There were no randomized clinical trials specific to chiropractic and insomnia. One study was a survey of opinion for treatment regimens for insomnia, which had low methodological scores. Another study assessed osteopathic cranial manipulation for insomnia, which appeared to have positive effects. Four studies identified physiotherapy treatment and manual therapy. A further 9 studies related to mind-body medical therapies and impaired health status, sleep disorders, and pain in the craniomandibular and cervical spinal regions.
Conclusion
Some studies have noted improvement in insomnia following manual therapy; however, based on clinical trials, there is minimal evidence of support for chiropractic in insomnia. Further studies with high methodological scores need to be conducted.
doi:10.1016/j.jcm.2010.03.003
PMCID: PMC3188343  PMID: 22027034
Chiropractic; Insomnia; Neck pain
4.  Manual therapies for migraine: a systematic review 
The Journal of Headache and Pain  2011;12(2):127-133.
Migraine occurs in about 15% of the general population. Migraine is usually managed by medication, but some patients do not tolerate migraine medication due to side effects or prefer to avoid medication for other reasons. Non-pharmacological management is an alternative treatment option. We systematically reviewed randomized clinical trials (RCTs) on manual therapies for migraine. The RCTs suggest that massage therapy, physiotherapy, relaxation and chiropractic spinal manipulative therapy might be equally effective as propranolol and topiramate in the prophylactic management of migraine. However, the evaluated RCTs had many methodological shortcomings. Therefore, any firm conclusion will require future, well-conducted RCTs on manual therapies for migraine.
doi:10.1007/s10194-011-0296-6
PMCID: PMC3072494  PMID: 21298314
Manual therapies; Massage; Physiotherapy; Chiropractic; Migraine; Treatment
5.  Manual therapies for migraine: a systematic review 
The Journal of Headache and Pain  2011;12(2):127-133.
Migraine occurs in about 15% of the general population. Migraine is usually managed by medication, but some patients do not tolerate migraine medication due to side effects or prefer to avoid medication for other reasons. Non-pharmacological management is an alternative treatment option. We systematically reviewed randomized clinical trials (RCTs) on manual therapies for migraine. The RCTs suggest that massage therapy, physiotherapy, relaxation and chiropractic spinal manipulative therapy might be equally effective as propranolol and topiramate in the prophylactic management of migraine. However, the evaluated RCTs had many methodological shortcomings. Therefore, any firm conclusion will require future, well-conducted RCTs on manual therapies for migraine.
doi:10.1007/s10194-011-0296-6
PMCID: PMC3072494  PMID: 21298314
Manual therapies; Massage; Physiotherapy; Chiropractic; Migraine; Treatment
6.  A case of chronic migraine remission after chiropractic care 
Abstract
Objective
To present a case study of migraine sufferer who had a dramatic improvement after chiropractic spinal manipulative therapy (CSMT).
Clinical features
The case presented is a 72-year–old woman with a 60-year history of migraine headaches, which included nausea, vomiting, photophobia, and phonophobia.
Intervention and outcome
The average frequency of migraine episodes before treatment was 1 to 2 per week, including nausea, vomiting, photophobia, and phonophobia; and the average duration of each episode was 1 to 3 days. The patient was treated with CSMT. She reported all episodes being eliminated after CSMT. The patient was certain there had been no other lifestyle changes that could have contributed to her improvement. She also noted that the use of her medication was reduced by 100%. A 7-year follow-up revealed that the person had still not had a single migraine episode in this period.
Conclusion
This case highlights that a subgroup of migraine patients may respond favorably to CSMT. While a case study does not represent significant scientific evidence, in context with other studies conducted, this study suggests that a trial of CSMT should be considered for chronic, nonresponsive migraine headache, especially if migraine patients are nonresponsive to pharmaceuticals or prefer to use other treatment methods.
doi:10.1016/j.jcme.2008.02.001
PMCID: PMC2682939  PMID: 19674722
Migraine; Chiropractic; Spinal manipulative therapy
7.  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
8.  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
9.  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
10.  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
11.  THE DESIGN AND PRESENTATION OF A CASE STUDY 
PMCID: PMC2051088  PMID: 17987187
Case study; design
12.  THE EFFECT OF CHIROPRACTIC SPINAL MANIPULATIVE THERAPY ON SALIVARY CORTISOL LEVELS 
Objective: This study examines the effect of chiropractic spinal manipulative therapy on salivary cortisol levels.
Design: Prospective case series over six weeks duration. The trial consisted of establishment of each individual’s baseline cortisol level, a two week treatment period (4 treatments), and a two week post treatment period.
Setting: Macquarie University Chiropractic Research Centre.
Participants: Nine subjects (six male, three female), employed in a large corporation, volunteered to the trial of spinal manipulative therapy.
Main Outcome Measures: Saliva samples were analysed using an Amerlex Radioimmunoassay Kit to determine the cortisol concentrations present.
Results: Statistical interpretation, after exclusion of an apparent outlying subject, revealed results of statistical significance (p<0.001) for reduction of salivary cortisol over the complete five week study. In addition, there was no apparent alteration in salivary cortisol levels immediately preceding and 15 minutes after spinal manipulative therapy.
Conclusion: The initial evidence is inconclusive, however, the potential relationship demands further investigation. Additional research is necessary in measuring the physiological effects of Chiropractic spinal manipulative therapy. This method is currently being used in a larger randomised controlled trial.
PMCID: PMC2050804  PMID: 17987159
Salivary cortisol; chiropractic; spinal manipulation
13.  SPINAL CARE EDUCATION AS A PREVENTATIVE STRATEGY FOR OCCUPATIONAL HEALTH & SAFETY 
Objective: To evaluate the cost effectiveness of a spinal care lecture (conducted by a chiropractor) in reducing the number of spinal injuries and their associated costs in the workplace.
Method: A lecture was designed to increase employees awareness of spinal injury and how it might be prevented. The lecture was designed following a work-place inspection, to assess the most likely risk factors for injury. The lecture also included advice on posture, normal biomechanics and alternative strategies to improve spinal health.
Subjects: Volunteer subjects, all from the same company, were randomly assigned to a study group (n = 34) and a control group (n = 27). The remaining employees (n = 60) formed a non intervention (baseline) comparison group.
Main Outcome Measures: The number and severity of injuries for all groups was monitored over a six month period prior to and following the lecture. In addition, Oswestry pain and disability questionnaires were collected prior to the lecture and at the six month follow up period.
Results: The average cost of injuries went from $451 in the six months prior to training down to $194 in the first three months and then to $269 at six months after training. In comparison, the corresponding control group figures were $396, $409 and $382, respectively.
Discussion: The cost of reported back injuries decreased by 57% in the first three months for the educated group when compared to pre-intervention levels. At the six month follow up the cost of back injuries remained 40% lower than previous levels.
Conclusion: The results from our study demonstrated a statistically significant reduction (p< .05) in the cost of back injuries and Oswestry pain scores, following an employee training program conducted by a chiropractor.
PMCID: PMC2050638  PMID: 17989760
Back injuries; chiropractic; prevention; education
14.  A CASE SERIES OF MIGRAINE CHANGES FOLLOWING A MANIPULATIVE THERAPY TRIAL 
Objective: To present the characteristics of four cases of migraine, who were included as participants in a prospective trial on chiropractic spinal manipulative therapy for migraine.
Method: Participants in a migraine research trial, were reviewed for the symptoms or clinical features and their response to manual therapy.
Results: The four selected cases of migraine responded dramatically to SMT, with numerous self reported symptoms being either eliminated or substantially reduced. Average frequency of episodes was reduced on average by 90%, duration of each episode by 38%, and use of medication was reduced by 94%. In addition, several associated symptoms were substantially reduced, including nausea, vomiting, photophobia and phonophobia.
Discussion: The various cases are presented to assist practitioners making a more informed prognosis.
PMCID: PMC2050634  PMID: 17987154
Migraine; diagnosis; manual therapy
15.  THE EFFICACY OF CHIROPRACTIC SPINAL MANIPULATIVE THERAPY (SMT) IN THE TREATMENT OF MIGRAINE 
Objective: To test the efficacy of Chiropractic spinal manipulative therapy (SMT) in the treatment of migraine, using an uncontrolled clinical trial.
Design: A clinical trial of six months duration. The trial consisted of 3 stages: two months of pre-treatment, two months of treatment, and two months post treatment. Comparison was made to initial baseline episodes of migraine preceding commencement of SMT.
Setting: Chiropractic Research Centre of Macquarie University.
Participants: Thirty two volunteers, between the ages of 23 to 60 were recruited through media advertising. The diagnosis of migraine based on a detailed questionnaire, regarding self reported symptoms or signs, with minimum of one migraine with aura per month.
Interventions: Two months of SMT provided by an experienced chiropractor at a university clinic.
Main Outcome Measures: Participants completed diaries during the entire trial noting the frequency, intensity, duration, disability, associated symptoms and use of medication for each migraine episode. In addition, clinic records were compared to their diary entries of migraine episodes.
Results: A total of fifty nine participants responded to the advertising, with twenty five being excluded or deciding not to continue in the trial. Two participants (5.9%) withdrew during the trial, one due to alteration in work situation and one following soreness after SMT. The Chiropractic SMT group showed statistically significant improvement (p < 0.05) in migraine frequency and duration, when compared to initial baseline levels. Only one participant (3.1%) reported that the migraine episodes were worse after the two months of SMT, and this was not sustained at the two month post treatment follow up period.
Conclusion: The results of this study suggest that Chiropractic SMT is an effective treatment for migraine with aura. However, due to the cyclical nature of migraine with aura, and the finding that episodes usually reduce following any intervention, further research is required. A prospective randomised controlled trial utilising detuned EPT (interferential), a sham manipulation group and an SMT group is nearing conclusion. It is anticipated this trial will provide further information of the efficacy of Chiropractic SMT in the treatment of migraine with aura.
PMCID: PMC2050630  PMID: 17987148
Migraine; chiropractic; spinal manipulation; clinical trial
16.  REQUIREMENTS FOR CHIROPRACTORS INVOLVED AS OCCUPATIONAL HEALTH AND SAFETY CONSULTANTS IN AUSTRALIA 
A literature review was conducted to determine significant factors for chiropractors progressing towards classification as an Occupational Health & Safety (OHS) consultant in Australia.
A number of priority areas for investigation were identified as significant for OHS consultants. These included: work site assessment, risk control and prevention, spinal care awareness and injury prevention, OHS committee, training procedures and induction manuals, ergonomic improvements, stress management, first aid, forklift safety, accident records, job rotation and supervisor training.
Several issues are important considerations where chiropractor's knowledge may be deficient. Lack of awareness of the issues may leave the chiropractor liable for prosecution due to misrepresentation as an OHS consultant.
PMCID: PMC2050625  PMID: 17987146
Chiropractic; OHS; ergonomics
17.  CORRELATION OF CERVICAL LORDOSIS MEASUREMENT WITH INCIDENCE OF MOTOR VEHICLE ACCIDENTS 
A retrospective analysis of 500 patient radiographs was conducted to measure the clinical correlation of cervical lordosis measurements and incidence of motor vehicle accident (MVA). Five hundred lateral cervical radiographs were selected at random from the practice of one of the authors (DLM). The C1-7 angle of the cervical curve was then measured by two blinded examiners. Inter-examiner reliability had a confidence interval of 95%. Eighty-two percent of patients who have had a MVA had an abnormal lordosis. The mean lordosis of patients who had been involved in a MVA was 26.1 degrees (SD 11.4), compared with 36.4 (SD 8.4) for those who had not been involved in a MVA. The results suggest a correlation of reduced cervical lordosis measurements following motor vehicle accident (MVA).
PMCID: PMC2050618  PMID: 17987143
Cervical; lordosis; motor vehicle accident (MVA); neck pain.
18.  CLASSIC MIGRAINE OR NOT CLASSIC MIGRAINE 
Objective: To identify the main characteristics of classic migraine, with specific regard to diagnostic criteria for manual therapy practitioners, including chiropractors and osteopaths.
Method: Ten case studies on migraine were reviewed for the symptoms and clinical features.
Results: The majority of cases reviewed as classic migraines were in reality not correct diagnoses in accordance with standard classification systems. Some cases had classic signs which may have been missinterpreted, whilst other cases had possible inconsistent symptoms making diagnosis difficult.
Discussion: The various classification systems are presented with guidelines for diagnosis to assist practitioners making the accurate diagnosis.
PMCID: PMC2050617  PMID: 17987141
Migraine; diagnosis; manual therapy.
19.  A CASE STUDY OF CHRONIC HEADACHES 
The following paper is a case study of a patient with a history of chronic headaches (originally diagnosed as migraine without aura) who was being treaded at the Macquarie University Chiropractic Outpatients Clinic for cervical spine dysfunction. The treatments successfully reduced the upper neck and thoracic pain that the patient was experiencing and for which they had initially presented at the clinic. During the treatments, the patient also showed a significant subjective reduction in prevalence and intensity of headaches over a four month period. Analysis of the outcome is complicated by the fact that it is not clear whether the patient’s headaches were initially misdiagnosed as common migraine when in fact, they were cervicogenic. There may be some overlap between the two conditions, and a possible causative relationship between cervical spine dysfunction and common migraine. Furthermore, this case study discusses the validity of chiropractic treatment of organic disorders such as chronic headache or migraine.
PMCID: PMC2050613  PMID: 17987139
Chiropractic; headache.
20.  INTEREXAMINER RELIABILITY OF CHIROPRACTIC EVALUATION FOR CERVICAL SPINE PROBLEMS—A Pilot Study 
Objective: A pilot study was conducted to determine whether untrained examiners could agree on palpatory findings in the cervical spine.
Design: Fifty-three university students, (most of whom were chiropractic students), had their cervical spines examined by seven different chiropractors using their own clinical methods, of which motion palpation was a common, but not standard component.
Setting: Chiropractic Centre in Macquarie University.
Participants: Volunteer university students.
Main Outcome Measures: Individual clinical methods, which included static and/or motion palpation, vertebral springing, range of motion and applied kinesiology.
Results: Statistically, for the total group, there was poor interexaminer reliability. Of eight examiners, four did not disagree significantly, the next two examiners disagreed with each other but only at a single level and the remaining two examiners disagreed with most of the other examiners and each other.
Conclusion: In the cervical spine, it appears that C6 is the level of highest contention, followed by C1 and C5. Essentially the results suggest that combinations of examiners show reasonable consistency at identifying the same entity while using their own typical examination techniques. The nature of these palpable findings, leading to a diagnosis of subluxation or vertebral dysfunction is ill defined. Several issues were considered as important: expectations of examiners, research design, subject compliance, role of asymptomatic subjects and what the examiners were actually detecting.
PMCID: PMC2050612  PMID: 17987136
Chiropractic; cervical spine; reliability; neck pain; manual medicine; musculoskeletal diagnosis.
21.  "What About the Next 100 Years" 
COMSIG review  1995;4(3):57-60.
There is no abstract available for this article.
PMCID: PMC2050382  PMID: 17989753
Chiropractic
22.  Book Review: GUIDES TO THE EVALUATION OF PERMANENT DISABILITY 
COMSIG review  1995;4(2):47.
PMCID: PMC2050378
Book review; disability

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