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1.  Treatment of Frozen Shoulder Using Distension Arthrography (Hydrodilatation) 
Frozen shoulder (adhesive capsulitis) is a common, painful and disabling condition which is typically slow to resolve. Patients with this condition will be seen in every musculoskeletal practitioner’s clinic on a regular basis. There is a wide variety of treatment modalities available, some more effective than others. This article reviews the literature on the aetiology and natural history of the condition, and the common treatments provided. The literature on hydraulic arthrographic capsular distension (hydrodilatation) is reviewed and six cases referred for this treatment from a chiropractic clinic are presented.
PMCID: PMC2051310  PMID: 17987207
Frozen shoulder; hydrodilatation; case series
2.  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
3.  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
4.  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
5.  A CASE OF LEPTOMENINGEAL DISEASE PRESENTING AS A LUMBAR NERVE ROOT RADICULOPATHY 
Objective: To discuss a case of leptomenigeal disease mimicking a lower lumbar disc lesion and accompanying neurological deficit.
Clinical Features: A 62 year old male presented with a 3-4 day history of left low back and left posterior thigh pain. The patient had a previous history of non-specific low back pain for approximately 10-25 years, which was relieved in the past by manual therapy. He was also currently being treated by a medical oncologist with chemotherapy for low grade non-Hodgkin's lymphoma, which was considered stable.
Intervention and Outcome: After a favourable initial response to therapy, the patient developed a noticeable left-sided limp. Computed tomography scanning of the lumbar spine and pelvis was then performed, which revealed a mild posterior annular bulging of the intervertebral disc at the L4/5 level. The patient was then treated with axial lumbar spine traction but on review two days later had also developed a left sided facial droop, consistent with a Bell's palsy. A subsequent magnetic resonance imaging scan of the brain and lumbar spine revealed sites of abnormal enhancement of multiple cranial nerves, the cauda equina and the vertebral bodies L1 and L5. The findings were consistent with widespread leptomeningeal disease or leptomenigeal carcinomatosis and unfortunately the patient died as a direct consequence of the disease approximately three weeks after diagnosis.
Conclusion: Although relatively rare, leptomenigeal disease must considered as a differential diagnosis in a patient with a history of carcinoma who presents with low back pain and/or any neurological signs and symptoms.
PMCID: PMC2050809  PMID: 17987161
Non-Hodgkin's lymphoma; leptomeningeal disease/carcinomatosis; radiculopathy; lumbar disc herniation; chiropractic; spinal manipulative therapy
6.  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
7.  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
8.  MANAGEMENT OF ACHILLES TENDON DISORDERS 
A case of heel pain is presented. The clinical presentation implicates the pathological processes of acute retrocalcaneal bursitis, Achilles tendinosis, partial rupture of the tendon possibly as a result of repetitive corticosteroid injection, and subsequent calf atrophy and functional disability. Finally, aspects of predisposing factors, biomechanics, pathology, and clinical management of Achilles tendon disorders are reviewed in the discussion.
PMCID: PMC2050628  PMID: 17987151
Achilles tendon; pain; management
9.  SPONDYLOLYSIS IN A PROFESSIONAL FAST BOWLER 
Spondylolysis is a common nemesis of the professional cricket fast bowler. This case study demonstrates a series of clinical presentations beginning with spondylolysis in the same professional fast bowler over a one year period. The initial presentation of the injury received chiropractic evaluation and successful management. The second presentation of the patient eight months later was an aggravation of the first injury, but the second presentation did not respond to chiropractic management. Highlighted is the subsequent clinical presentation of the fast bowler two hours prior to sustaining a fracture of the opposite pedicle (left) and the presentation one hour post fracture. The goals of appropriate conservative management are discussed. The role of aberrant intersegmental spinal and sacroiliac joint mobility in the aetiology of spondylolysis is also discussed.
PMCID: PMC2050621  PMID: 17987145
Spondylolysis; spondylolisthesis; sacroiliac joint; chiropractic; manipulation; cricket; biomechanics
10.  SOMETIMES THEY MAY BE ZEBRAS: HERPES ZOSTER OF THE L2 SPINAL NERVE 
This case report describes a relatively uncommon presentation of herpes zoster affecting the cutaneous distribution of the L2 spinal nerve. The coexistence of a previous history of leg pain, cortical thickening of the femoral shaft on plain film x-ray examination, and the absence, at the time of examination, of the tell tale rash of herpes zoster provided the clinician with a diagnostic challenge. Furthermore, this case stresses the importance of a thorough neurological and orthopaedic examination as well as careful visual inspection of the painful region.
PMCID: PMC2050615  PMID: 17987138
Herpes zoster; spinal nerves; chiropractic; spinal manipulative therapy.
11.  PATIENT SATISFACTION 
Patient satisfaction is a pre-requisite to successful clinical practice. While an efficacious treatment is an important consideration, other variables are recognized to contribute to clinical satisfaction. This case study of a South African teaching clinic identifies and compares variables perceived as essential, important and unnecessary by chiropractic students and their patients.
Method: A case study of the chiropractic student clinic at Technikon Natal was undertaken. A non-random sample of chiropractic patients and student clinicians were requested to respond to a questionnaire. Participants were requested to select 12 from a total of 27 closed questions and allocate 4 items to each of the three listed categories.
Results: Forty-three(43) patients and 17 student clinicians completed the questionnaire. Behavoiurs considered essential to chiropractic practice largely focused on listening carefully to the patient’s description of their problem and explaining how the problem could be avoided in the future. Patients and student clinicians were also agreed about the relative importance of the duration of the clinical consultation, the necessity for patients to choose how they wish to be treated and the desirability of a narrow/broad focus on the patient’s problem.
Conclusions: The importance of providing an understandable and comprehensive clinical discussion about the patient’s problem emerged in both this and a similar Australian Study. It is suggested that competence in communication skills be considered as an integral component of the undergraduate chiropractic curriculum.
PMCID: PMC2050614  PMID: 17987140
Communication; chiropractic; clinical satisfaction.
12.  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.

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