Chiropractic Management of Musculoskeletal Symptoms in a 14-Year-Old Hockey Player With Postconcussion Symptoms: A Case Report.

Objective: The purpose of this study is to describe the chiropractic management of a student athlete with postconcussion syndrome.

Clinical Features: A 14-year-old male hockey player presented to a chiropractic clinic with postconcussion symptoms 13 days after his initial injury. He experienced an occipital headache with a pain rating of 8/10, upset stomach, blurry vision, nausea, dizziness, balance problems, a "foggy feeling," difficulty with concentration, difficulty with memory, fatigue, confusion, drowsiness, and irritability.

One-Year Concussion Prevalence in Marion County, Florida High School Athletes.

Objective: The purpose of this study was to evaluate data on concussion prevalence in 1 geographic location and to identify which sports have a higher prevalence of concussion in the Marion County, Florida, school district.

Methods: High school athletic trainers in Marion County, Florida, are required to compile statistics related to number of participants and concussions sustained in the county school district during each season. They provided the data for the 2011-2012 school year to independent analysts with the permission of the athletic director.

The Physiological Role of Tumor Necrosis Factor in Human Immunity and Its Potential Implications in Spinal Manipulative Therapy: A Narrative Literature Review.

Objective: Although tumor necrosis factor (TNF) is a well-known inflammatory cytokine in the pathological development of various human diseases, its physiological roles are not widely understood nor appreciated. The molecular mechanisms underlying spinal manipulation therapy (SMT) remain elusive. The relationship between TNF and SMT is unclear.

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.

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.

Chiropractic Distraction Spinal Manipulation on Postsurgical Continued Low Back and Radicular Pain Patients: A Retrospective Case Series.

Purpose: The purpose of this case series is to report on changes in pain levels experienced by 69 postsurgical continued pain patients who received Cox Technic Flexion Distraction (CTFD).

Methods: Fifteen doctors of chiropractic collected retrospective data from the records of the postsurgical continued pain patients seen in their clinic from February to July 2012 who were treated with CTFD, which is a type of chiropractic distraction spinal manipulation. Informed consent was obtained from all patients who met the inclusion criteria for this study.

Novel Electromyographic Protocols Using Axial Rotation and Cervical Flexion-Relaxation for the Assessment of Subjects With Neck Pain: A Feasibility Study.

Objective: The purpose of this study is to examine the feasibility of novel variations to the way cervical flexion-relaxation phenomenon (FRP) studies are conducted and the feasibility of using cervical axial rotation as an alternative objective measure of cervical pain/dysfunction.

Methods: Electromyographic data were collected from cervical paraspinal muscles of 5 participants with neck pain and 5 asymptomatic controls. Cervical FRP was conducted as reported in the literature with the participants seated, except that they started with the head fully flexed instead of being erect.

Effect of Spinal Manipulation of Upper Cervical Vertebrae on Blood Pressure: Results of a Pilot Sham-Controlled Trial.

Objective: The purpose of this pilot sham-controlled clinical trial was to estimate the treatment effect and safety of toggle recoil spinal manipulation for blood pressure management.

Methods: Fifty-one participants with prehypertension or stage 1 hypertension (systolic blood pressure ranging from 135 to 159 mm Hg or diastolic blood pressure ranging from 85 to 99 mm Hg) were allocated by an adaptive design to 2 treatments: toggle recoil spinal manipulation or a sham procedure. Participants were seen by a doctor of chiropractic twice weekly for 6 weeks and remained on their antihypertensive medications, as prescribed, throughout the trial.

Renal Cell Carcinoma Presenting as Radiating Rib Pain: A 65-Year-Old Woman.

Objective: The purpose of this case report is to describe chiropractic management and referral of a patient with rib pain who was subsequently diagnosed with renal cell carcinoma.

Clinical Features: A 65-year-old woman presented with radiating rib pain to a chiropractic clinic. She was treated with a 2-week course of conservative care.

Clinical evaluation tools: a survey of doctors of chiropractic and students at one chiropractic college.

Introduction: The reliability and validity of many evaluation tools leading to clinical decision-making for spinal manipulation are varied. We surveyed senior students and DC employees at one chiropractic college regarding 1) which analysis tools should be used and 2) factors that influence their choices.

Methods: The survey queried which tools should be used on a routine patient encounter.

Cross-Sectional Analysis of Per Capita Supply of Doctors of Chiropractic and Opioid Use in Younger Medicare Beneficiaries.

Objective: The purpose of this study was to determine whether the per-capita supply of doctors of chiropractic (DCs) or Medicare spending on chiropractic care was associated with opioid use among younger, disabled Medicare beneficiaries.

Methods: Using 2011 data, at the hospital referral region level, we correlated the per-capita supply of DCs and spending on chiropractic manipulative therapy (CMT) with several measures of per-capita opioid use by younger, disabled Medicare beneficiaries.

Results: Per-capita supply of DCs and spending on CMT were strongly inversely correlated with the percentage of younger Medicare beneficiaries who had at least 1, as well as with 6 or more, opioid prescription fills.

Characteristics of US Adults Who Have Positive and Negative Perceptions of Doctors of Chiropractic and Chiropractic Care.

Objective: The purpose of this study was to compare characteristics, likelihood to use, and actual use of chiropractic care for US survey respondents with positive and negative perceptions of doctors of chiropractic (DCs) and chiropractic care.

Methods: From a 2015 nationally representative survey of 5422 adults (response rate, 29%), we used respondents' answers to identify those with positive and negative perceptions of DCs or chiropractic care. We used the χ(2) test to compare other survey responses for these groups.

The Association Between Use of Chiropractic Care and Costs of Care Among Older Medicare Patients With Chronic Low Back Pain and Multiple Comorbidities.

Objective: The purpose of this study was to determine whether use of chiropractic manipulative treatment (CMT) was associated with lower healthcare costs among multiply-comorbid Medicare beneficiaries with an episode of chronic low back pain (cLBP).

Methods: We conducted an observational, retrospective study of 2006 to 2012 Medicare fee-for-service reimbursements for 72326 multiply-comorbid patients aged 66 and older with cLBP episodes and 1 of 4 treatment exposures: chiropractic manipulative treatment (CMT) alone, CMT followed or preceded by conventional medical care, or conventional medical care alone. We used propensity score weighting to address selection bias.

Neural Responses to Physical Characteristics of a High-velocity, Low-amplitude Spinal Manipulation: Effect of Thrust Direction.

Study Design: Electrophysiological recordings were obtained from proprioceptors in deep lumbar paraspinal muscles of anesthetized cats during high-velocity low-amplitude spinal manipulation (HVLA-SM).

Objective: To determine how thrust direction of an HVLA-SM affects neural input from back musculature.

Summary Of Background Data: A clinician's ability to apply the thrust of an HVLA-SM in a specified direction is considered an important component of its optimal delivery.

Assessment of chiropractic treatment for active duty, U.S. military personnel with low back pain: study protocol for a randomized controlled trial.

Background: Low back pain is highly prevalent and one of the most common causes of disability in U.S. armed forces personnel.

The American Chiropractic Board of Sports Physicians Position Statement on Pre-Participation Examinations: An Expert Consensus.

Objective: The purpose of this paper is to present a position statement of best practices for the provision of a safe and high-quality pre-participation examination (PPE) and to provide recommendations on education requirements for doctors of chiropractic providing the PPE.

Methods: In 2014, the American Chiropractic Board of Sports Physicians (ACBSP) Board of Directors identified a need to review and update the ACBSP position statements and practice guidelines in order to be current with evolving best practices. Twelve ACBSP certificants, 10 Diplomates of the ACBSP, and 2 Certified Chiropractic Sports Physicians, met in April 2015 to author a pre-participation position statement using an expert consensus process.

Efficiency of muscle strength training on motor function in patients with coronary artery disease: a meta-analysis.

Background: Existing literature has shown that patients with coronary artery disease (CAD) can benefit greatly from the strength training; therefore, the strength training should play a more important role in cardiac rehabilitation. However, the medical community may still have conservation to apply the strength training owing to no comprehensive study so far to compare the effectiveness of the strength training to the other trainings, such as aerobic training.

Objective: To evaluate the effect of strength training on motor function in patients with CAD.

The McAndrews Leadership Lecture: February 2015, by Dr Scott Haldeman. Challenges of the Past, Challenges of the Present.

The McAndrews Leadership Lecture was developed by the American Chiropractic Association to honor the legacy of Jerome F. McAndrews, DC, and George P. McAndrews, JD, and their contributions to the chiropractic profession.

Antinociceptive Effects of Spinal Manipulative Therapy on Nociceptive Behavior of Adult Rats during the Formalin Test.

Optimizing pain relief resulting from spinal manipulative therapies, including low velocity variable amplitude spinal manipulation (LVVA-SM), requires determining their mechanisms. Pain models that incorporate simulated spinal manipulative therapy treatments are needed for these studies. The antinociceptive effects of a single LVVA-SM treatment on rat nociceptive behavior during the commonly used formalin test were investigated.

Integration of Chiropractic Services in Military and Veteran Health Care Facilities: A Systematic Review of the Literature.

This literature review examined studies that described practice, utilization, and policy of chiropractic services within military and veteran health care environments. A systematic search of Medline, CINAHL, and Index to Chiropractic Literature was performed from inception through April 2015. Thirty articles met inclusion criteria.

Similar Effects of Thrust and Nonthrust Spinal Manipulation Found in Adults With Subacute and Chronic Low Back Pain: A Controlled Trial With Adaptive Allocation.

Study Design: A three-arm controlled trial with adaptive allocation.

Objectives: The aim of this study was to compare short-term effects of a side-lying, thrust spinal manipulation (SM) procedure and a nonthrust, flexion-distraction SM procedure in adults with subacute or chronic low back pain (LBP) over 2 weeks.

Summary Of Background Data: SM has been recommended in recently published clinical guidelines for LBP management.

Comparing Propensity Score Methods for Creating Comparable Cohorts of Chiropractic Users and Nonusers in Older, Multiply Comorbid Medicare Patients With Chronic Low Back Pain.

Objective: Patients who use complementary and integrative health services like chiropractic manipulative treatment (CMT) often have different characteristics than do patients who do not, and these differences can confound attempts to compare outcomes across treatment groups, particularly in observational studies when selection bias may occur. The purposes of this study were to provide an overview on how propensity scoring methods can be used to address selection bias by balancing treatment groups on key variables and to use Medicare data to compare different methods for doing so.

Methods: We described 2 propensity score methods (matching and weighting).

What is the pain source? A case report of a patient with low back pain and bilateral hip osteonecrosis.

Background: Low back pain is a common symptom arising from many possible sources and includes the possibility of the contribution of remote pathology. This report describes a patient with bilateral osteonecrosis of the femoral heads presenting with a primary symptom of low back pain.

Case Presentation: A 37-year-old male presented for evaluation of dominant pain that existed for approximately 6-12 months and was located in the right low back.