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1.  RECORDING TECHNIQUES AND ANALYSIS OF THE ARTICULAR CRACK 
Objective: To review the available literature pertaining to the recording and analysis of the joint crack/cavitation sound produced as a result of spinal manipulative therapy. A critical appraisal of the recording and analysis techniques is presented.
Data Source: A broad based search of the English language literature was conducted utilising the databases Medline (1966-1996) and Chirolars (1800-1996), using the key words cavitation, noise, sound, audible release, crack/s/ing, vibration, sound recording, acoustic recording and accelerometers, coupled with the terms facet joint, spinal joint and apophyseal joint and chiropractic, osteopathic and spinal manipulation. A manual search was also conducted of non-indexed journals and text books relating to manual therapy of the library at RMIT University, Bundoora, Victoria.
Results: There appears to be a paucity of this research relating to spinal manipulative therapy. Research to date has focused on recording the joint crack sounds via microphones or piezoelectric accelerometers both of which appear to have limited applications.
Conclusion: Some worthwhile information may be gained by conducting further research into the joint crack phenomenon, particularly with respect to spectral analysis. However, before this research is undertaken a more reliable and accurate means of capturing and processing the joint crack signal needs to be established.
PMCID: PMC2050620  PMID: 17987144
Joint crack; cavitation; noise; sound; audible release; vibration; recording; spinal manipulative therapy.
2.  ESTABLISHMENT OF THE NATIONAL CENTRE FOR MULTIDISCIPLINARY STUDIES OF BACK PAIN 
Spinal pain of mechanical origin, with or without referred pain, is a serious health problem suffered by many Australians. In order to help patients with this ailment, and to investigate this costly and debilitating condition, the National Centre for Multidisciplinary Studies of Back Pain was established at Townsville General Hospital as a joint venture between James Cook University of North Queensland and the Northern Regional Health Authority.
The Centre has a multidisciplinary clinical team including a chiropractor. The Centre functions successfully, contributes to the public health of the community and shows that a multidisciplinary clinical team which includes a chiropractor can work harmoniously in an Australian hospital setting. The need for such a centre is demonstrated by an ever increasing demand for its professional services in Townsville as indicated by a review of the number of new patients and overall patient visits. The Centre could act as a model for the inclusion of chiropractic into the Australian hospital setting.
PMCID: PMC2050619  PMID: 17987142
Chiropractic; hospitals; medicine; clinical trial; history.
3.  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.
4.  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.
5.  THE MANIPULATIVE CRACK 
Objectives: This research was designed to analyse the frequency spectra of joint crack sounds produced during spinal manipulative therapy applied to the upper cervical spine of 50 volunteers and to determine if the spectra differed between the sexes and or for those with a history of previous neck trauma compared with those without a history of trauma.
Design: Randomised experimental study.
Setting: Macquarie University, Centre for Chiropractic, Summer Hill, New South Wales.
Subjects: Fifty asymptomatic subjects were recruited from the students and staff of the above college.
Intervention: Single, unilateral “diversified”, high velocity, low amplitude, rotatory thrust technique applied to the region of the C3/4 zygapophyseal joints.
Main Outcome Measures: Joint crack sound wave analysis of Digital Audio Tape (DAT) recordings, taken from two skin mounted microphones positioned on either side of the cervical spine and later analysed by the use of a computer equipped with professional quality frequency spectrum analysis software.
Results: All fifty manipulations resulted in at least one audible joint crack sound and in total the fifty subjects combined produced 123 individual joint cracks. Only 9 subjects (18%) produced a single joint crack, the majority of the subjects (82%) produced either two (22 subjects) or three (10 subjects) distinct joint crack signals, while seven subjects produced four and two subjects five separate joint crack signals. Frequency analysis was performed on a total of 122 individual wave forms. Peak frequencies for all analysed crack signals ranged from 1,830 Hz to 86 Hz with an mean of 333 Hz (95% C.I., 285-380 Hz), a mode of 215 Hz and a median of 215 Hz. Statistical analysis for recorded signals revealed 95% Confidence Interval for the mean of 285-380 Hz. No statistically significant differences were found for peak frequencies between the sexes or for a previous history of trauma and no trauma and for pre-manipulative and manipulative joint cracks.
PMCID: PMC2050616  PMID: 17987137
Chiropractic; zygapophyseal joints; cervical spine; joint crack; joint cavitation; manipulation; frequency analysis; spectra; sound recording.
6.  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.
7.  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.
8.  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.
9.  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.
10.  THE RELIABILITY OF CHIROPRACTIC METHODS USED FOR THE DETECTION OF SPINAL SUBLUXATION 
A Literature review was conducted to investigate the methods commonly used to detect chiropractic "subluxation". None were found to show irrefutable reliability and validity.
PMCID: PMC2050611  PMID: 17987135
Chiropractic; subluxation; literature review; diagnosis; reliability; validity.
11.  CONTINUING EDUCATION 
PMCID: PMC2050610  PMID: 17987133
Chiropractic; continuing education.
12.  THE LAW OF PATIENT CONSENT 
In 1992, the High Court of Australia handed down a decision on consent to medical treatment. The case had widespread media publicity, and caused consternation among many members of the medical profession. This article explains the law on consent to treatment by health practitioners and considers the relevance of the law for chiropractors and osteopaths.
PMCID: PMC2050609  PMID: 17987134
Informed consent; chiropractic; osteopathy; Australia.

Results 1-12 (12)