Self-Administered Traction as an Adjunct in the Chiropractic Treatment of Low Back Pain: A Case Report.

Objective: The purpose of this case report is to describe self-administered lumbar traction as a component of the treatment of a patient with low back pain (LBP).

Clinical Features: A 41-year-old male chiropractic student presented with an exacerbation of intermittent LBP of approximately 2 years duration. Pain intensity was 4 to 8/10 on a verbal pain scale the day after exertion and 10 on the Patient Reported Outcomes Measurement Information System (PROMIS) 3a.

Comparison of online to face-to-face instruction for anatomy review in a third-year clinical course.

Objective: This project compared student learning and satisfaction of an anatomy review delivered by a face-to-face lecture (F2FL) and an online learning module (OLM) for third-year doctor of chiropractic students.

Methods: This cohort study compared student learning and satisfaction of a pediatric spinal anatomy review delivered via F2FL (cohort 1, n = 23) and OLM (cohort 2, n = 18) in 2 successive 2019 (pre-COVID) course offerings. Previously validated pre- and post-tests were given.

A Novel and Accurate Palpation Method for Identification of the L4 Spinous Process: A Preliminary Study of Accuracy.

Objective: The purpose of this study was to assess a novel method of lumbar spinous process (SP) palpation by using magnetic resonance imaging (MRI) high-signal marker reference standards for verification.

Methods: Clinicians (doctors of chiropractic) in this study used either: (1) the standard/traditional method of identifying the L4 SP using the supracristal plane (n = 14) or (2) a novel method that manually induced sacral motion to identify the L5 and then the L4 SP (n = 54). The clinicians, blinded to the results of each other, used a grease pencil to mark the location identified as the L4 SP.

Reliability of Human Lumbar Facet Joint Degeneration Severity Assessed by Magnetic Resonance Imaging.

Objective: The purpose of this study was to determine the reliability of the assessment of lumbar facet joint degeneration severity by analyzing degeneration subscales using magnetic resonance imaging (MRI) in human participants.

Methods: The reliability of articular cartilage degeneration, subchondral bone sclerosis, and osteophyte formation subscales of lumbar facet joint degeneration severity was assessed in MRI images from n = 10 human participants. Each scale was applied to n = 20 lumbar facet joints (L4/5 level).

A Feasibility Study to Assess Vibration and Sound From Zygapophyseal Joints During Motion Before and After Spinal Manipulation.

Objective: This feasibility study used novel accelerometry (vibration) and microphone (sound) methods to assess crepitus originating from the lumbar spine before and after side-posture spinal manipulative therapy (SMT).

Methods: This study included 5 healthy and 5 low back pain (LBP) participants. Nine accelerometers and 1 specialized directional microphone were applied to the lumbar region, allowing assessment of crepitus.

The effectiveness and feasibility of an online educational program for improving evidence-based practice literacy: an exploratory randomized study of US chiropractors.

Background: Online education programs are becoming a popular means to disseminate knowledge about evidence-based practice (EBP) among healthcare practitioners. This mode of delivery also offers a viable and potentially sustainable solution for teaching consistent EBP content to learners over time and across multiple geographical locations. We conducted a study with 3 main aims: 1) develop an online distance-learning program about the principles of evidence-based practice (EBP) for chiropractic providers; 2) test the effectiveness of the online program on the attitudes, skills, and use of EBP in a sample of chiropractors; and 3) determine the feasibility of expanding the program for broader-scale implementation.

Grading Osteoarthritic Changes of the Zygapophyseal Joints from Radiographs: A Reliability Study.

Objective: This study tested the reliability of a 5-point ordinal scale used to grade the severity of degenerative changes of zygapophyseal (Z) joints on standard radiographs.

Methods: Modifications were made to a Kellgren grading system to improve agreement for grading the severity of osteoarthritic changes in lumbar Z joints. These included adding 1 grade of no degeneration, multiple radiographic views, and structured examiner training.

US chiropractors' attitudes, skills and use of evidence-based practice: A cross-sectional national survey.

Background: Evidence based practice (EBP) is being increasingly utilized by health care professionals as a means of improving the quality of health care. The introduction of EBP principles into the chiropractic profession is a relatively recent phenomenon. There is currently a lack of information about the EBP literacy level of US chiropractors and the barriers/facilitators to the use of EBP in the chiropractic profession.

A pilot randomized controlled trial of flexion-distraction dosage for chiropractic treatment of lumbar spinal stenosis.

Objective: The purpose of this pilot clinical trial was to assess the feasibility of recruiting older adults with lumbar spinal stenosis (LSS) into a clinical trial that used different dosages of flexion-distraction manipulation.

Methods: This randomized controlled trial used a 4-group design. Three groups consisted of chiropractic flexion-distraction manipulation applied at different dosages (8, 12, or 18 treatments).

Development of a student-mentored research program between a complementary and alternative medicine university and a traditional, research-intensive university.

The global need to develop clinician-scientists capable of using research in clinical practice, translating research knowledge into practice, and carrying out research that affects the quality, efficacy, and efficiency of health care is well documented. The complementary and alternative medicine (CAM) professions embrace the call to develop physician-researchers to carry out translational and applied research for CAM modalities. CAM universities face unique challenges when implementing research training compared with traditional, research-intensive (TRI) universities and medical centers where the majority of medical research is carried out.

Magnetic resonance imaging zygapophyseal joint space changes (gapping) in low back pain patients following spinal manipulation and side-posture positioning: a randomized controlled mechanisms trial with blinding.

Objective: The purpose of this study was to quantify lumbar zygapophyseal (Z) joint space separation (gapping) in low back pain (LBP) subjects after spinal manipulative therapy (SMT) or side-posture positioning (SPP).

Methods: This was a controlled mechanisms trial with randomization and blinding. Acute LBP subjects (N = 112; four n = 28 magnetic resonance imaging [MRI] protocol groups) had 2 MRI appointments (initial enrollment and after 2 weeks of chiropractic treatment, receiving 2 MRI scans of the L4/L5 and L5/S1 Z joints at each MRI appointment.

Quantification of cavitation and gapping of lumbar zygapophyseal joints during spinal manipulative therapy.

Objectives: The purpose of this study was to use previously validated methods to quantify and relate 2 phenomena associated with chiropractic spinal manipulative therapy (SMT): (1) cavitation and (2) the simultaneous gapping (separation) of the lumbar zygapophyseal (Z) joint spaces.

Methods: This was a randomized, controlled, mechanistic clinical trial with blinding. Forty healthy participants (18-30 years old) without a history of low-back pain participated.

Distribution of cavitations as identified with accelerometry during lumbar spinal manipulation.

Objective: This project determined the location and distribution of cavitations (producing vibrations and audible sounds) in the lumbar zygapophyseal (Z) joints that were targeted by spinal manipulative therapy (SMT).

Methods: This randomized, controlled, clinical study assessed 40 healthy subjects (20 men, 20 women) 18 to 30 years of age who were block randomized into SMT (group 1, n = 30) or side-posture positioning only (group 2; control, n = 10) groups. Nine accelerometers were placed on each patient (7 on spinous processes/sacral tubercles of L1-S2 and 2 placed 3 cm left and right lateral to the L4/L5 interspinous space).

Evaluating the relationship among cavitation, zygapophyseal joint gapping, and spinal manipulation: an exploratory case series.

Objective: This project determined the feasibility of conducting larger studies assessing the relationship between cavitation and zygapophyseal (Z) joint gapping following spinal manipulative therapy (SMT).

Methods: Five healthy volunteers (average age, 25.4 years) were screened and examined against inclusion and exclusion criteria.

Zygapophyseal joint adhesions after induced hypomobility.

Objective: Adhesions (ADH) have been previously identified in many hypomobile joints, but not in the zygapophyseal (Z) joints of the spine. The objective of this study was to determine if connective tissue ADH developed in lumbar Z joints after induced intervertebral hypomobility (segmental fixation).

Methods: Using an established rat model, 3 contiguous segments (L4, L5, L6) were fixed with specially engineered, surgically implanted, vertebral fixation devices.

Reliability of zygapophysial joint space measurements made from magnetic resonance imaging scans of acute low back pain subjects: comparison of 2 statistical methods.

Objective: This purpose of this study was to assess the reliability of measurements made of the zygapophysial (Z) joint space from the magnetic resonance imaging scans of subjects with acute low back pain using new equipment and 2 different methods of statistical analysis. If found to be reliable, the methods of Z joint measurement can be applied to scans taken before and after spinal manipulation in a larger study of acute low back pain subjects.

Methods: Three observers measured the central anterior-to-posterior distance of the left and right L4/L5 and L5/S1 Z joint space from 5 subject scans (20 digitizer measurements, rounded to 0.

Recruitment methods and costs for a randomized, placebo-controlled trial of chiropractic care for lumbar spinal stenosis: a single-site pilot study.

Objective: The purpose of this article is to describe the methods for recruitment in a clinical trial on chiropractic care for lumbar spinal stenosis.

Methods: This randomized, placebo-controlled pilot study investigated the efficacy of different amounts of total treatment dosage over 6 weeks in 60 volunteer subjects with lumbar spinal stenosis. Subjects were recruited for this study through several media venues, focusing on successful and cost-effective strategies.

Introducing the external link model for studying spine fixation and misalignment: current procedures, costs, and failure rates.

Objective: This is the last article in a series of 3 articles introducing a new animal model, the external link model (ELM), that permits reversible, nontraumatic control of the cardinal biomechanical features of the subluxation: fixation and misalignment. A detailed description of current ELM procedures is presented and practical issues are reviewed such as expense (dollars and time) and construct failure rates during and after the surgical implant procedure.

Method: Descriptive report of current ELM procedures, refinements to the spinous attachment units (SAUs), and tabulation of costs and failure rates drawn from recent studies.

Preliminary morphological evidence that vertebral hypomobility induces synaptic plasticity in the spinal cord.

Objective: A widely accepted theoretical model suggests that vertebral hypomobility can cause pain and abnormal spinal mechanics because of changes in sensory input from spinal and paraspinal tissues. The purpose of this pilot study was 3-fold: (1) to make a preliminary determination if chronic vertebral hypomobility at L4 through L6 in the rat would affect synaptic density and/or morphology in the superficial dorsal horn of the L2 spinal cord level, (2) to identify relevant outcome variables for future studies, and (3) to obtain preliminary data that would permit estimating an appropriate sample size for future studies.

Methods: Using an established rat model, we fixed 3 contiguous lumbar segments (L4-L6) for 8 weeks with a specially engineered vertebral fixation device.

Introducing the external link model for studying spine fixation and misalignment: part 2, Biomechanical features.

Objectives: The purpose of this study was to characterize intervertebral stiffness and alignment changes in the external link model and evaluate it as an experimental mimic for studying the chiropractic subluxation.

Method: A controlled test-retest design was used to evaluate rats with spine segments linked in 3 alignment configurations and controls that were never linked. Dorsal-to-ventral spine stiffness was measured with a load platform, and flexion/extension misalignment was assessed on lateral radiographs obtained with a spine extension jig.