Developing a standardized curriculum for teaching chiropractic technique.

Objective: This is a report of the results of 4 facilitated workshops aimed at developing a standardized chiropractic technique curriculum.

Methods: Workshops were held at research conferences during 2014, 2016, 2018, and 2019. Participants were tasked with developing recommendations for diagnostic and therapeutic procedures appropriate for chiropractic technique programs.

Would adopting a revised landmark rule for the spinal level of the iliac crests improve the accuracy of lumbar level identification?

This is a secondary analysis of two previous systematic reviews demonstrating cephalad bias in using palpation to enumerate lumbopelvic levels, based on the conventional landmark rule that the spinal level of the palpated iliac crests=L4. Our study included 7 articles which enumerated lumbopelvic levels based on this rule, and furthermore reported data such that the direction and magnitude of errors could be abstracted from the article. The primary goal was to determine if enumeration accuracy would have improved had examiners known that the spinal level of palpated crests was closer to the L3-4 or L3 spinal level, as shown in our previous review.

Interexaminer Reliability of Seated Motion Palpation for the Stiffest Spinal Site.

Objectives: The purpose of this study was to assess the interexaminer reliability of palpation for stiffness in the cervical, thoracic, and lumbar spinal regions.

Methods: In this secondary data analysis, data from 70 patients from a chiropractic college outpatient clinic were analyzed. Two doctors of chiropractic palpated for the stiffest site within each spinal region.

Does the Gillet test assess sacroiliac motion or asymmetric one-legged stance strategies?

Objective: The purpose of this study was to quantify the extent to which apparent movements of the posterior superior iliac spine and sacral base areas Gillet sacroiliac motion testing were related to (a) degree of hip flexion and (b) the examiner's palpatory pressure.

Methods: A preliminary exploratory study quantified relative PSIS/S2 displacements in 10 sacroiliac joints among 5 asymptomatic subjects at 10° increments of hip flexion from 0-90°. A comprehensive follow-up asymptomatic study quantified PSIS/S2 displacements at 0° vs.

Systematic review and meta-analyses of the difference between the spinal level of the palpated and imaged iliac crests.

Objective: The purpose of this study was to undertake a systematic review of the literature to determine and compare, for patient sub-groups, the spinal level of the iliac crests as commonly measured through manual palpation and radiographic imaging procedures.

Methods: Relevant citations were retrieved by searching the PubMed, ICL, CINAHL, AMED, Osteopathic Research Web, OstMed, and MANTIS biomedical databases, and included articles were rated for quality. Search terms included Tuffier*, intercristal line, intercrestal line, Jacoby's line, lumbar spine, lumbar landmark, pelvic landmark, palpation, and TL (Tuffier's Line).

Comparison of Supine and Prone Methods of Leg Length Inequality Assessment.

Objective: The primary objective of the current study was to determine the reliability between methods of supine and prone leg length inequality (LLI) assessment. The secondary objective was to determine if the degree of examiner confidence affected the degree of intermethod agreement.

Methods: Two experienced doctors of chiropractic assessed 43 participants for LLI, one using a prone and the other a supine method.

The reliability of spinal motion palpation determination of the location of the stiffest spinal site is influenced by confidence ratings: a secondary analysis of three studies.

Background: This is a secondary analysis of three previous studies on the cervical, thoracic, and lumbar spines. It uses continuous analysis of the stiffest spinal site rather than more typical level-by-level analysis to assess interexaminer reliability, and the impacts of examiner confidence and spinal region. The primary goal was secondary analysis of the combined data; secondary goal was de novo analysis of combined data emphasizing absolute indices of examiner agreement; and tertiary goal was analysis of actual vs.

The reliability of lumbar motion palpation using continuous analysis and confidence ratings: choosing a relevant index of agreement.

Introduction: Most studies show motion palpation unreliable. This study's primary objective was assessing its reliability using a continuous measure methods, most-fixated level paradigm, stratified by examiners' confidence; and the secondary objective was comparing various indices of examiner agreement.

Methods: Thirty-four minimally symptomatic participants were palpated in side posture by two experienced examiners.

The reliability of palpating the posterior superior iliac spine: a systematic review.

Introduction: Among pelvic landmarks routinely palpated by manual therapists, the posterior superior iliac spines (PSISs) are particularly important. In addition to serving as landmarks for identifying possible pelvic torsion, contacting the PSISs is integral to many other static and dynamic pelvic palpatory procedures. The primary study goal was to systematically review the literature on the intra- and interexaminer reliability of PSIS palpation.

Assessment of Consistency Between the Arm-Fossa Test and Gillet Test: A Pilot Study.

Objective: The purpose of this pilot study was to test methods needed to conduct a study with adequate power to investigate consistency between the arm-fossa test (AFT) and the Gillet test.

Methods: A convenience sample of chiropractic college students enrolled in a weekend Sacro-Occipital Technique seminar participated. Each was tested with AFT and sacroiliac orthopedic tests, including the Gillet test.

Validity of palpation of the C1 transverse process: comparison with a radiographic reference standard.

Objectives: Primary goal: to determine the validity of C1 transverse process (TVP) palpation compared to an imaging reference standard.

Methods: Radiopaque markers were affixed to the skin at the putative location of the C1 TVPs in 21 participants receiving APOM radiographs. The radiographic vertical distances from the marker to the C1 TVP, mastoid process, and C2 TVP were evaluated to determine palpatory accuracy.

The location of the inferior angle of the scapula in relation to the spine in the upright position: a systematic review of the literature and meta-analysis.

Practitioners in several of the health care professions use anatomical landmarks to identify spinal levels, both in order to enhance diagnostic accuracy and to specifically target the site of intervention. Authoritative sources usually state the upright inferior scapular angle (IAS) aligns with the spinous process (SP) of T7, but some specify the T7-8 interspace or the T8 SP. The primary goals of this study were to systematically review the relevant literature; and conduct a meta-analysis of the pooled data from retrieved studies to increase their statistical power.

Chiropractic management of pubic symphysis shear dysfunction in a patient with overactive bladder.

Objective: The purpose of this case report is to describe chiropractic management of a patient with overactive bladder (OAB) and to describe an hypothetical anatomical basis for a somato-vesical reflex and possible clinical link between pelvic and symphysis pubis dysfunction to OAB.

Clinical Features: A 24-year-old nulliparous female with idiopathic OAB, with a primary complaint of nocturia presented for chiropractic care. Her sleep was limited to 2 consecutive hours due to bladder urgency.

Mapping intended spinal site of care from the upright to prone position: an interexaminer reliability study.

Background: Upright examination procedures like radiology, thermography, manual muscle testing, and spinal motion palpation may lead to spinal interventions with the patient prone. The reliability and accuracy of mapping upright examination findings to the prone position is unknown. This study had 2 primary goals: (1) investigate how erroneous spine-scapular landmark associations may lead to errors in treating and charting spine levels; and (2) study the interexaminer reliability of a novel method for mapping upright spinal sites to the prone position.

Review of methods used by chiropractors to determine the site for applying manipulation.

Background: With the development of increasing evidence for the use of manipulation in the management of musculoskeletal conditions, there is growing interest in identifying the appropriate indications for care. Recently, attempts have been made to develop clinical prediction rules, however the validity of these clinical prediction rules remains unclear and their impact on care delivery has yet to be established. The current study was designed to evaluate the literature on the validity and reliability of the more common methods used by doctors of chiropractic to inform the choice of the site at which to apply spinal manipulation.

Interexaminer reliability of cervical motion palpation using continuous measures and rater confidence levels.

Introduction: Motion palpators usually rate the movement of each spinal level palpated, and their reliability is assessed based upon discrete paired observations. We hypothesized that asking motion palpators to identify the most fixated cervical spinal level to allow calculating reliability at the group level might be a useful alternative approach.

Methods: Three examiners palpated 29 asymptomatic supine participants for cervical joint hypomobility.

Interexaminer reliability of the Johnston and Friedman percussion scan of the thoracic spine: secondary data analysis using modified methods.

Objective: The purpose of this study is to perform a secondary analysis using modified methods of previously reported data to analyze the amount of examiner concordance in the Johnston and Friedman percussion scan of the most fixated spinal level.

Method: A 2001 study evaluated interexaminer reliability of the percussive method of Johnston and Friedman for detecting altered segmental mobility (somatic dysfunction, spinal/segmental dysfunction, or chiropractic subluxation) in the thoracic spine. The original reported level of agreement using the κ statistic for discrete measures was only 0.

Heuristic exploration of how leg checking procedures may lead to inappropriate sacroiliac clinical interventions.

Several primary studies have shown that an anatomical short leg predicts anterior rotation of the ipsilateral ilium, whereas anatomical long leg predicts posterior rotation of the ilium on the long leg side. At the same time, in chiropractic and other manual therapy professions, it is widely believed that the leg check finding of a short leg is associated with posterior ilium rotation, and a long leg with anterior ilium rotation. The purpose of this commentary is to explore the consequences of this paradox for the manual therapy professions, insofar as leg checking procedures are commonly used to derive appropriate vectors for chiropractic manipulation/adjustive procedures.

Interexaminer reliability of thoracic motion palpation using confidence ratings and continuous analysis.

Objective: Motion palpation is integral to most chiropractic techniques and can be found in curricula of most every chiropractic college. Paradoxically, most studies do not show strong reliability for motion palpation. The purpose of this study was to determine if allowing motion palpators to rate their confidence in their findings, as well using a continuous data analytic method, would influence the level of concordance.

Chiropractic care for patients with acute neck pain: results of a pragmatic practice-based feasibility study.

Objective: The purpose of this study was to determine the feasibility of a chiropractic practice-based research network to investigate the treatment of acute neck pain (ANP) and to report resulting findings.

Methods: Participating chiropractors recruited sequentially presenting ANP patients on their initial visit to the office. Patients were treated by the chiropractors using their usual methods.

The relationship between pelvic torsion and anatomical leg length inequality: a review of the literature.

Objective: Although it is common to find assertions relating functional leg length inequality (LLI) to pelvic torsion and other states of subluxation, comments and/or data concerning anatomical LLI in this same context are uncommon. This review of the literature synthesizes the evidence on pelvic torsion in relation to anatomical LLI.

Methods: The literature was searched using the PubMed; Manual, Alternative, and Natural Therapy Index System; Allied and Complementary Medicine Database; Cumulative Index to Nursing and Allied Health Literature; and Index to Chiropractic Literature databases for primary studies that related LLI, either artificially created or naturally occurring, to pelvic torsion.

The location of the inferior angle of the scapula in relation to the spinal level of prone patients.

Background: In two previous studies we established the mean location of the upright inferior angle of the scapula (IAS) to be near the spinous process of T8. The current study investigates the common belief that the prone IAS lines up with the T6 SP.

Methods: The location of the IAS in relation to the spine of 20 mostly asymptomatic subjects was assessed on a Hi-Lo table in 7 different postures, 2 upright and 5 prone.

An annotated bibliography of spinal motion palpation reliability studies.

Background: Several literature reviews have addressed the reliability of spinal and sacroiliac (SI) motion palpation (MP), finding that, in general, interexaminer reliability is slight and intraexaminer reliability is moderate.

Methods: We performed a literature search of four biomedical databases to locate articles that dealt with MP of the spine or SI joints. The abstracts of the retrieved citations were independently screened for inclusion by two of the authors.

Spinal motion palpation: a comparison of studies that assessed intersegmental end feel vs excursion.

Objective: Spinal motion palpation (MP) is a procedure used to detect intersegmental hypomobility/hypermobility. Different means of assessing intersegmental mobility are described, assessing either excursion of the segments (quantity of movement) or end feel (quality of motion when stressed against the paraphysiological space). The objective of this review was to classify and compare studies based on method of MP used, considering that some studies may have used both methods.