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1.  Spinal Musculoskeletal Injuries Associated with Swimming 
Objectives: To review the biomechanics of the swimming stroke and examine common injuries which occur in swimming. A review of diagnosis and management strategies of these injuries is also performed.
Background: Most injuries and complaints encountered in swimming athletes occur because of repetitive microtrauma or overuse, with many injuries originating from faulty technique and poor swimming biomechanics. As a result, assessment of an injured athlete requires the practitioner to have an understanding of the four swimming strokes and hydrodynamics.
Methods: A Literature search of the MEDLINE and MANTIS databases was performed on all swimming related articles.
Results: Twenty seven journal articles and 7 text books were chosen that satisfied the search criteria and related to the aims of this review.
Discussion: The correct swimming technique is discussed and predisposing factors to injury in the stroke are identified. Specific injury sites are examined and pathologies to these areas are detailed.
Conclusion: The shoulder, neck and back are the injuries considered in this review. These regions are considered in the total training program of the athlete to identify other factors, such as weight training or other dry land programs that may be contributing to injury. However, whilst rest or reduced training may be necessary for recovery, every effort must be made to keep the swimmer “in the water” as cessation of training may lead to a rapid detraining effect and loss of competitive advantage.
PMCID: PMC2051327  PMID: 17987215
Swimming; analysis and movement; wounds and injuries; review literature; chiropractic
2.  Searching for the Evidence 
Background: Chiropractic and Osteopathy are categorised within the family of Complementary and Alternative Medicine (CAM) by most indexers and database managers. CAM therapies can be difficult to search because relevant resources are spread over a number of databases.
Objective: This paper aims to introduce basic searching skills for six databases which offer CAM literature.
Methods: Six readily available databases which can be used by a busy clinician to remain informed about best practice were chosen. The databases were searched and compared using two clinical scenarios as sample searches.
Discussion: Evidence-based practice demands that practitioners maintain their information gathering skills, but no one source provides all the answers. We are lured by the thought that everything is available on the web easily and speedily, but may sacrifice quality for ease and speed of retrieval.
PMCID: PMC2051324  PMID: 17987213
Databases; bibliographic; complementary therapies; information storage and retrieval
3.  A Clinical Model for the Diagnosis and Management of Patients with Cervical Spine Syndromes 
Background: Disorders of the cervical spine are common and often disabling. The etiology of these disorders is often multifactorial and a comprehensive approach to both diagnosis and management is essential to successful resolution.
Objective: This article provides an overview of a clinical model of the diagnosis and management of patients with disorders related to the cervical spine. This model is based in part on the scientific literature, clinical experience, and communication with other practitioners over the course of the past 20 years.
Discussion: The clinical model presented here involves taking a systematic approach to diagnosis, and management. The diagnostic process is one that asks three essential questions. The answers to these questions then guides the management process, allowing the physician to apply specific methods that address the many factors that can be involved in each individual patient. This clinical model allows the physician to individualize the management strategy while utilizing principles that can be applied to all patients. At times, the management strategy must be multidisciplinary, and cooperation with other physicians and therapists is often necessary for effective patient care.
This model is currently being used by the author in practice, as well as forming the basis upon which further research can be conducted to refine or, if necessary, abandon any of its aspects, as the evidence dictates.
It is the purpose of this paper to present this clinical model and the clinical and scientific evidence, or lack thereof, of its components.
PMCID: PMC2051323  PMID: 17987214
Cervical spine; chiropractic; conservative management; neck pain; headache; rehabilitation
4.  Spine Cancer 
Background: Spine pain is a common presenting complaint of patients who visit physicians and although spine cancer accounts for a very small percentage of cases of back pain, metastasis is a relatively common cause of spine pain in the elderly. The presentation of patients with spine cancers is highly variable, and in many cases the clinical findings of benign and cancerous causes of spine pain can be similar, often confounding the clinical picture. This can create difficulties in interpreting the clinical data available to the physician, particularly with a disease with such a devastating prognosis.
Objective: This manuscript discusses the more common causes of malignant lesions of the spine, including an overview of the incidence/prevalence data and clinical features of both primary and secondary malignancies. It also provides the reader with a clinical overview of patients with spine cancer.
Discussion: It is important to appreciate the myriad epidemiologic and clinical features of primary and secondary spine cancers. Patients with malignant skeletal lesions may be asymptomatic in the area of cancerous bone disease and, as a consequence, these lesions can be overlooked. This may result in dismal consequences for the patient, given the generally poor prognosis associated with spine cancers. Knowledge of the features discussed in this paper will assist the clinician in appropriately raising his/her index of suspicion for spine cancer in suitable clinical circumstances.
PMCID: PMC2051311  PMID: 17987205
Spine; pain; cancer; review
5.  Risk Management for Chiropractors and Osteopaths. Informed consent 
Obtaining the informed consent of a patient before undertaking chiropractic or osteopathic treatment is a common law requirement in Australia. This paper outlines the essential elements of informed consent and provides some practice tips on streamlining the process.
PMCID: PMC2051308  PMID: 17987206
Chiropractic; osteopathy; informed consent; risk management
6.  THE EFFECT OF TALO-CRURAL JOINT MANIPULATION ON RANGE OF MOTION AT THE ANKLE JOINT IN SUBJECTS WITH A HISTORY OF ANKLE INJURY 
Introduction: There is little research available on the effects of peripheral joint manipulation. Only a few studies have examined the effect of manipulation on ankle range of motion, with conflicting results. This study aimed to determine whether a single high-velocity, low-amplitude (HVLA) thrust manipulation to the talo-crural joint altered ankle range of motion in subjects with a history of lateral ligament sprain.
Methods: Male and female volunteers (N=52) with a history of lateral ligament sprain were randomly assigned into either an experimental group (n=26) or a control group (n=26). Those in the experimental group received a single HVLA thrust to the talo-crural joint, whilst those in the control group received no treatment intervention. Pre-test and post-test measurements of passive dorsiflexion range of motion were taken.
Results: No significant changes in dorsiflexion range of motion were detected between manipulated ankles and those of control subjects using dependent and independent t-tests. Ankles that cavitated displayed a greater mean DFR and large effect size (d=0.8) compared to those that did not gap and cavitate, but analysis with ANOVA revealed these differences to be not significant.
Conclusion: HVLA manipulation of the ankle did not increase dorsiflexion range of motion in subjects with a history of lateral ligament sprain.
PMCID: PMC2051316  PMID: 17987212
Ankle Joint; manipulation; dorsiflexion; range of motion; osteopathy
7.  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
8.  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
9.  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
10.  CLASSIFICATION OF LOW BACK PAIN 
PMCID: PMC2051084  PMID: 17987181
Low back pain
11.  VALIDITY AND RELIABILITY OF CLINICAL TESTS FOR THE SACROILIAC JOINT 
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.
PMCID: PMC2051080  PMID: 17987177
Sacroiliac joint; reliability; validity; clinical tests
12.  FIBROMYALGIA 
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.
PMCID: PMC2051079  PMID: 17987178
Fibromyalgia; diagnosis; management
13.  PATHOLOGICAL FRACTURES; A CONSIDERATION WITH METACHONDROMATOSIS AND DIFFERENTIAL DIAGNOSES 
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.
PMCID: PMC2051078  PMID: 17987186
Metachondromatosis; Osteochondromatosis; manual therapies; manipulation; chiropractic; contraindications; fractures; case report
14.  A USER’S GUIDE TO THE CHIROPRACTIC AND OSTEOPATHIC LITERATURE 
PMCID: PMC2051075  PMID: 17987180
Systematic review; chiropractic; osteopathy
15.  CLINICAL UPDATE 
PMCID: PMC2051073  PMID: 17987179
Shoulder pain; chiropractic; Scapulo-costal Syndrome
16.  Record keeping chart… 
PMCID: PMC2051067
Clinical procedures; chiropractic
17.  MULTISEGMENTAL STABILITY 
PMCID: PMC2051066  PMID: 17987173
Chiropractic; rehabilitation
18.  EVALUATING THE EFFECTIVENESS OF CARE IN NECK AND BACK PAIN 
Background: Objective outcome measures reflecting the level of effectiveness of care is a clinical imperative for practitioners dealing with neck and back pain. It is widely recognised that there is no relationship between physical pathology, pain and disability. Traditional measures of function such as range of motion and strength, on their own, are no longer sufficient when assessing treatment outcomes.
Objective: Five patient-based objective outcome tools for measuring pain and four for measuring disability are outlined with a view to encouraging their use when managing back and neck pain.
Discussion: All of the outcome measures presented in this review have a high clinical utility when managing patients with neck and back pain. That is, they have been shown to be valid and reliable as well as being easy to administer and score.
PMCID: PMC2051064  PMID: 17987170
Outcome measures; back pain; neck pain; disability
19.  LATERAL ANKLE INJURY 
Background: Injury to the ankle joint is the most common peripheral joint injury. The sports that most commonly produce high ankle injury rates in their participating athletes include: basketball, netball, and the various codes of football.
Objective: To provide an up to date understanding of manual therapy relevant to lateral ligament injury of the ankle. A discussion of the types of ligament injury and common complicating factors that present with lateral ankle pain is presented along with a review of relevant anatomy, assessment and treatment. Also included is a discussion of the efficacy of manual therapy in the treatment of ankle sprain.
Discussion: A detailed knowledge of the anatomy of the ankle as well as the early recognition of factors that may delay the rate of healing are important considerations when developing a management plan for inversion sprains of the ankle. This area appears to be under-researched however it was found that movement therapy and its various forms appear to be the most efficient and most effective method of treating uncomplicated ankle injury. Future investigations should involve a study to determine the effect chiropractic treatment (manipulation) may have on the injured ankle.
PMCID: PMC2051062  PMID: 17987171
Ankle; sport; injury; treatment; chiropractic
20.  MARKERS TO IDENTIFY A BACK PAIN PATIENT IN PROBABLE NEED OF SPINAL SURGERY 
PMCID: PMC2051060  PMID: 17987172
Spinal surgery; indications
21.  THE EFFECT OF FUNCTIONAL FASCIAL TAPING ON MORTON'S NEUROMA 
Objective and Background: Morton’s neuroma is essentially a benign tumor in the foot, which may cause extreme pain and disability. Both conservative and surgical modalities have been used, but as yet, neither has been successful in resolving the condition. This report introduces Functional Fascial Taping (FFT) developed by Alexander, as a new treatment regime and examines its effectiveness in the management of Morton’s neuroma.
Discussion: Functional Foot Index (FFI) was used to assess the effectiveness of this taping modality demonstrating both amelioration of pain and improvement in functionality. Although there is anecdotal evidence to support the benefits of Functional Facial Taping (FFT) in the treatment of Morton’s Neuroma, a more detailed study is warranted using larger numbers of participants to examine its long and short-term benefits.
PMCID: PMC2051058  PMID: 17987175
Morton’s neuroma; taping; disability; pain; foot
22.  IS MANUAL THERAPY A RATIONAL APPROACH TO IMPROVING HEALTH-RELATED QUALITY OF LIFE IN PEOPLE WITH ARTHRITIS? 
Background: People with arthritic disease are advised to participate in gentle exercise on a regular basis, and pursue long-term medication regimes. Alternative therapies are also used by people with arthritis, and may sometimes be recommended by rheumatologists and other medical personnel. Alternative therapies may be divided into two types: active therapies, in which the patient takes a driving role, and passive therapies, in which the therapy cannot proceed unless driven by a therapist.
Objective: To review the effectiveness of manual therapy in improving the health-related quality of life (HRQOL) of people with two common arthritis conditions: Osteoarthritis and rheumatoid arthritis.
Discussion: Massage, and other passive (practitioner-driven) manual therapies, have been anecdotally reported to improve health-related quality of life (HRQOL) in people with arthritis. Many manual therapists consult with patients who have arthritic diseases, receive referrals from rheumatologists, and consider the arthritic diseases to be within their field of practise. Although there is empirical evidence that manual therapy with some types of arthritis is beneficial, the level of effectiveness however is under-researched. Medical authorities are reluctant to endorse manual therapies for arthritis due to a lack of scientific evidence demonstrating efficacy, safety, and cost effectiveness.
PMCID: PMC2051057  PMID: 17987169
Health-related quality of life (HRQOL); osteoarthritis; rheumatoid arthritis; manual therapy
23.  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
24.  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
25.  IS THERE A ROLE FOR THE PRESCRIPTION OF MEDICATION BY CHIROPRACTORS? 
PMCID: PMC2051090  PMID: 17987193
Chiropractic; drugs; medicine

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