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4.  RISK MANAGEMENT FOR CHIROPRACTORS AND OSTEOPATHS 
This article is the second in a series of articles dealing with risk management in the practise of chiropractic and osteopathy, prepared by the COCA Risk Management Subcommittee.
Background: Radiographic examination carries risks that must be weighed against the possible benefits when determining patient care.
Objective: The objective of this article is to propose guidelines for the use of imaging in chiropractic and osteopathic practice.
Discussion: Plain film radiography, CT scan, magnetic resonance imaging (MRI) and other forms of imaging are available for use in chiropractic and osteopathic practice in Australia. The astute practitioner utilises these imaging procedures for clinical decision making in order to make an accurate diagnosis that will determine a patient’s management. This article attempts to guide the practitioner in the proper use of these imaging procedures for different regions of the body.
PMCID: PMC2051318  PMID: 17987210
Chiropractic; risk management; osteopathy
5.  INJURIES IN AUSTRALIAN RULES FOOTBALL 
Background: Australian Rules Football is one of the most popular sports in Australia. Successful injury prevention relies on injury surveillance to establish the extent of injuries, to monitor injury patterns and to evaluate prevention strategies. Despite the popularity of participation at the community level, few injury surveillance studies have been published, so a detailed review of the literature is vital. There is limited information available outside of the elite level. Injury statistics for any professional sport may not necessarily be translatable to community sport level.
Objective: To document the most prevalent injuries at the elite, junior elite, amateur and junior level and determine if incidences differ across levels of play. Aetiology and significant risk factors for injuries are emphasized and prevention and treatment discussed.
Discussion: Injuries on average are more common at the elite level compared with other levels of participation. The type of injury varies slightly, with non contact injuries, particularly muscle strains, being the most common. Of these, the hamstring strain is the most common. Aetiology and risk factors vary between levels of play due to a time basis, physical development, speed of play and skill level. Recurrence rates are a concern for clubs and players, although rates are decreasing at the elite level, indicating better treatment and conservative management of injured players.
PMCID: PMC2051317  PMID: 17987211
Australian Rules Football; AFL; injuries
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
11.  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
12.  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
13.  Lessons from Laurie Jean Mathiason 
PMCID: PMC2051302  PMID: 17987200
Chiropractic; stroke
14.  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
15.  Can we believe… 
PMCID: PMC2051300  PMID: 17987198
Evidence
16.  CLINICAL ACTIVITIES AUDIT 
PMCID: PMC2051298  PMID: 17987204
Clinical audit; pain and disability measurement; chiropractic; osteopathic; clinical challenge
17.  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

Results 1-17 (17)