Science is hard; good science is more difficult.

When I entered this profession in the late 1970s my naive belief was that since chiropractors were obviously getting people better, all we needed for our ac-ceptance to skyrocket was research showing that chiropractic works.

Flash forward to today. Despite many practice challenges, chiropractic is now far better accepted socially, as well as by other healthcare professionals. It’s been quite a while since I've been called a quack. Last week I went to dinner with six DCs and six MDs- neurosurgeons, neurologists and other NMS docs. The topic of mutual referral underlies many of the conversations, but these collaborations would never have occurred 20 years ago. Plus demand is up, as there’s been a tremendous increase in the problem back pain during the 21st century – a good thing for those treating back pain.

But are chiropractors’ social popularity and success skyrocketing?

Insurance companies continue to tighten the economics of practice as we enter the grand PPACA healthcare system experiment, better known as ObamaCare. Time will tell whether it was bold or foolish, but no one is claiming it is going to fix the growing problem of back pain in an aging, slumped over society.

It seems as though just as physicians and other providers accept us more, the individual practitioner has less ability to steer patients to DCs, because now the MD has become an employee. Medical Homes and other entities with acronyms like ACOs and PCMHs are ascendant, with protocols written by committees of administrators and accountants (as well as some clinicians) who look at the ―scientific evidence.”

And research does show the value of spinal manipulation, but often in less glowing terms than myself and our researchers hoped.

The problem of quantifying back pain

The problem—science is hard. My friends who are scientists continually repeat that the plural of anecdote is not data. They require the use of dimly recalled things from Statistics 101 like chi-square and T tests to determine “statistical significance.” To scientifically and statistically prove something requires showing there is less than one chance in 20 that whatever you are studying happened by chance. Also known as P= <.05, reaching this probability means controlling for all other possible variables.

For back pain, there’s an amazing variance of flavors of patients and their com-plaints. Patient history and the specifics of the problem onset and character is one. Does the pain radiate into the SI joint in the low back only, both SI joints, or going into the buttocks? A really important but often neglected factor is bio-psycho-social, where intertwining of the person's psychological involvement with their pain creates psychological and personal benefits (think more attention or a bigger settlement) and creates a spiral of negative behavior.

The multifactorial nature of back pain is probably the one thing on which all the low back pain research agrees. Regarding spinal manipulation, unfortunately the 200 plus studies currently in the journals don’t fully agree, but new exciting studies are coming out which demonstrate the effectiveness of chiropractic, as well as pointing to a role for the DC in the health delivery system.

Meta-studies draw improved conclusions

A big trend in science is doing a study to look at a number of other studies in a meta-study, which is essentially pooling data to see what works best.

A 2013 study published in SPINE by Goertz looked at eight of these systematic reviews and reported that, indeed, chiropractic manipulative therapy can moderately reduce low back pain and disability.

The study: “Adding chiropractic manipulative therapy to standard medical care for patients with acute low back pain: Results of a pragmatic randomized comparative effectiveness study.”

The results: “Chiropractic manipulative therapy in conjunction with standard medical care offers a significant advantage for decreasing pain and improving physical functioning when compared with only standard care, for men and women between 18 and 35 years of age with acute LBP” care.¹

In other words, chiropractic makes medical care better.

A possible suggestion for these researchers’ next study: Compare chiropractic plus medical care to chiropractic care alone. Another even more exciting study was just published in the Annals of Internal Medicine. “Spinal Manipulation and Home Exercise With Advice for Subacute and Chronic Back-Related Leg Pain” looked at what happens when you add chiroprac-tic to an exercise and posture advice program already shown to improve low back pain.

Bradford’s team at Northwestern University of Health Science Advice taught ge-neric awareness such as, “Patients were also instructed in methods for developing spine posture awareness related to their activities of daily living, such as lifting, pushing and pulling, sitting, and getting out of bed.”

The study’s result: Adding chiropractic gave even better results than the exercise and advice alone.² In both of these studies, researchers controlled for a multifactorial problem by adding chiropractic to something whose effectiveness was already measured. Both studies’ results counter the arguments that back pain is psychological, or that some improvements occur when you teach people exercises and give them postural advice. In other words, posture training helps and placebo effects may be real…but so are the positive changes seen with chiropractic manipulative therapy.

Chiropractic really does help back pain, as does exercise, as does postural advice. And, when it’s all combined, patients do even better!

But practice is not a research environment. In Bronfort’s study, home exercise and advice were delivered in four 1-hour, one-on-one visits during a 12-week intervention. The main program goals were to provide patients with the tools to “manage existing pain, prevent pain recurrences, and facilitate engagement in daily activities.” And while research is fantastic, in the real world chiropractic practice economics defines what can be done. Especially in these days of third party reimbursements, it’s smart to effectively fit programs into sequenced 8-15 minute encounters, program care to be systematically individualized and progressive, and be able to have different staff reliably and reproducibly teach the exercises and posture awareness.

This is why the StrongPosture® exercise protocols and PostureZone® framework is a great way to systematically teach exercise and also communicate with patients, the public and other professionals.

The PosturePractice Model

By first engaging people with a picture from an app (see above image), and then communicating concepts of PostureZone© biomechanics, the message can apply to spine care, as well as people with other neuromuscular skeletal issues including extremity concerns, hip to foot and shoulder to hand. Plus, Baby Boomers concerned about hunching over and athletes seeking performance also value posture. And while not clinical, for many a significant appeal of the PostureZone© framework is vanity’s appeal— people who stand tall with strong posture simply look better.

Once people are interested and engaged with posture awareness, the StrongPosture® exercises use the PostureZone© cueing in an actionable framework to systematically strengthen functional postural balance, alignment and motion in a daily posture exercise habit, individualized to for the patient and applicable to multiple demographics.

These posture concepts are receiving increasing coverage in national and local media. Dynamic Chiropractic’s October 1st front page article covered how posture is the DC-MD bridge, and on the general public side the November 2014 issues of SHAPE as well as RealSimple magazines talked about the benefits of improving posture.

Through the trends of both clinical research and media, it has become clear that people are interested in chiropractic care and how our services can help them to live longer, healthier lives. As we venture into a new era of healthcare practices, it makes sense to position the chiropractic profession into a place of value, both in the eyes of other wellness profes-sionals as well as those of the consumer.

About the Author

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1—Goertz, C. M., Long, C. R., Hondras, M. A., Petri, R., Delgado, R., Lawrence, D. J., . . . Meeker, W. C. (2013). Adding chiropractic manipulative therapy to standard medical care for patients with acute low back pain: Results of a pragmatic randomized comparative effectiveness study. Spine, 38(8), 627-34. doi:10.1097/BRS.0b013e31827733e

2—Bronfort, G., Hondras, M. A., Schulz, C. A., Evans, R. L., Long, C. R., & Grimm, R. (2014). Spinal manipulation and home exercise with advice for subacute and chronic back-related leg pain: A trial with adaptive allocation. Annals of Internal Medicine, 161(6), 381-91. doi:10.7326/M14-000

Dr. Terence Murphy, a chiropractor in Westchester, is running for the NY State Senate. His election would be very significant for the chiropractic profession as a voice in the NYS Senate. Please consider giving him your support.

You can get more information at www.VoteforMurphy.com

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About Dr. Murphy

Dr. Terrence Murphy’s family originally moved to Yorktown 52 years ago when Yorktown’s mascot, the Cornhusker, was still a common and public sight. Growing up next to Wilken’s Fruit Farm, Terrence enjoyed an incredible childhood which included apple picking and skating on Mill Pond. As the youngest of six children, Dr. Murphy learned at a young age how to stick up for himself. His father Jack, a blue-collar, union man and labor advocate who worked for Con Edison for over fifty years taught him the importance of hard work, dedication, and commitment to community.

Remembering his father’s teachings of the importance of community Dr. Murphy was always willing to help others in need. It was of little surprise to his family when he decided to study chiropractic following his graduation from Yorktown High School in 1984. Terrence’s time away from Yorktown was a blessing in disguise. It allowed him to become an independent individual, traveling the world as a member of a world class rugby team, while reinforcing his love and passion for his home town.

In 1999, Dr. Murphy made his first official mark on Yorktown by opening the Yorktown Health and Wellness Center on Commerce Street. Standing in the same storefront today as then Dr. Murphy has exhibited his father’s lessons of hard work, dedication, and commitment to his community.

Following the passing of his father, Dr. Murphy, opened Murphy’s Restaurant in Yorktown in 2006, with his Mom Deneyse, and older siblings, Colleen, Erin, Sean, Denis, and Pat. As a tribute to their father, Murphy’s stands as one of Yorktown’s largest and most successful businesses and has been recognized twice for providing employment opportunities for the mentally challenged.

Dr. Murphy’s commitment to the Yorktown community does not stop there. For fifteen years he volunteered for the Yorktown High School Athletic Department caring for our young athletes as an on-field medical professional. Terrence served for nearly ten years as a New York State certified EMT and started the watchdog organization Keeping Westchester Safe.

Today, Dr. Murphy continues his chiropractic practice while assist in managing his family’s restaurant. Always keeping family first, Dr. Murphy’s favorite time spent is with this wife Caroline, and children McKayla, Jack, and Kian.

It is with great pleasure that I announce the publication of my book Ending Back Pain.

Many of you know me as a Spinal Neurosurgeon but this book is not about surgery. I wrote Ending Back Pain to inform the public about the need to advocate for themselves in a medical system that is ill equipped to deal with this major health issue. My goal is to help the reader establish a correct diagnosis and thereby the appropriate treatment options. I review those options and wherever possible quote the pertinent medical literature that supports the treatment.

I am a former member of the Board of Trustees of the New York Chiropractic College and longtime member of the Office of Professions of the NY State Board of Regents in Chiropractic and I have seen firsthand the benefits of Chiropractic.

I hope you will consider buying the book and recommending it to your patients.

I enclose a link to a podcast from the book’s website: https://soundcloud.com/dr-jack-stern/dr-jack-stern-md-on-chiropractic-care-for-back-pain

Best Wishes,

Jack Stern, MD, PhD

Arlington, Va.—The American Chiropractic Association (ACA), in a letter to U.S. House and Senate conferees regarding legislation addressing recent health care issues uncovered at the U.S. Department of Veterans Affairs (VA), urges lawmakers to further integrate the essential services provided by doctors of chiropractic (DCs) in the VA health care system.

The letter, addressed to Chairman Jeff Miller (R-Fla.) and Ranking Member Mike Michaud (D-Maine) of the House Committee on Veterans Affairs and Chairman Bernie Sanders (I-Vt.) and Ranking Member Richard Burr (R-N.C.) of the Senate Committee on Veterans Affairs, reminds legislators that chiropractic physicians deliver conservative care for neuromusculoskeletal conditions necessary for America’s veterans.

ACA believes improved access to chiropractic services for the veteran population will result in decreasing its overuse and abuse of prescription pain medications. This can be accomplished by transitioning to a conservative-care-first model, which focuses on using conservative treatments, providing care in out-patient settings and incorporating health promotion and wellness counseling. Veterans should be afforded the opportunity to choose and have access to services provided by chiropractic physicians prior to prescription medication and surgical procedures. The need for change in the VA is urgent. Recent statistics from a Center for Investigative Reporting special report found that prescriptions in the VA for four highly addictive painkillers have surged by 270 percent since the war in Afghanistan began, far outpacing the increase in patients. Additional VA research shows that the fatal overdose rate among veteran patients is nearly double the national average.

“VA currently provides access to a DC at more than 45 major treatment facilities within the U.S. However, the overwhelming majority of eligible veterans continue to be denied access to chiropractic services because VA has failed to take any significant action to provide access at around 100 other VA facilities,” said ACA President Anthony Hamm, DC. “Action is needed to ensure that all the brave men and women who have put their lives on the line for our country have access to as much health care as they need when they get back home, regardless of the provider they wish to see.”

ACA’s letter urges conferees to integrate language from pending legislation in the U.S. House and Senate into the coming House-Senate conference report, as further integration of chiropractic physicians within VA can significantly reduce costs without compromising excellent clinical outcomes or high patient satisfaction.

The full text of the letter can be found on ACA’s website.

The American Chiropractic Association (ACA), based in Arlington, Va., is the largest professional association in the United States advocating for more than 130,000 doctors of chiropractic (DCs), chiropractic assistants (CAs) and chiropractic doctoral students. ACA promotes the highest standards of ethics and patient care, contributing to the health and well-being of millions of chiropractic patients. Visit us at www.acatoday.org.

The NYSCA would like to express our deepest gratitude to the American Chiropractic Association and New York Chiropractic College for their support and advocacy regarding a proposal from the New York State Workers' Compensation Board to limit DCs' workers' compensation reimbursement.

In their recent letter, the ACA urged the Board to reconsider their proposal. Citing numerous cost effectiveness studies related to the services provided by DCs, ACA stated that such a proposal "detracts from the aims of New York's workers' compensation reforms, which include patient-centered, evidence informed and cost-effective care." ACA opposes the establishment of any system which unfairly limits one profession compared to other authorized providers and vows to voice this view strongly whenever and wherever necessary.

As always, the NYSCA and Council, through the Joint Legislative Task Force, continue to work for protecting practice rights and the services provided under New York State Workers’ Compensation. We will also keep you, our membership, informed as updates occur.

Abstract (provisional)

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Background

Low back pain is among the most common and costly chronic health care conditions. Recent research has highlighted the common occurrence of non-specific low back pain in adolescents, with prevalence estimates similar to adults. While multiple clinical trials have examined the effectiveness of commonly used therapies for the management of low back pain in adults, few trials have addressed the condition in adolescents. The purpose of this paper is to describe the methodology of a randomized clinical trial examining the effectiveness of exercise with and without spinal manipulative therapy for chronic or recurrent low back pain in adolescents.

Methods

This study is a randomized controlled trial comparing twelve weeks of exercise therapy combined with spinal manipulation to exercise therapy alone. Beginning in March 2010, a total of 184 participants, ages 12 to 18, with chronic or recurrent low back pain are enrolled across two sites. The primary outcome is self-reported low back pain intensity. Other outcomes include disability, quality of life, improvement, satisfaction, activity level, low back strength, endurance, and motion. Qualitative interviews are conducted to evaluate participants' perceptions of treatment.

Discussion

This is the first randomized clinical trial assessing the effectiveness of combining spinal manipulative therapy with exercise for adolescents with low back pain. The results of this study will provide important evidence on the role of these conservative treatments for the management of low back pain in adolescents.

Abstract (provisional)

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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.

Methods

Experiment 1 was a thought experiment exploring the consequences of depending on the erroneous landmark association of the inferior scapular tip with the T7 spinous process upright and T6 spinous process prone (relatively recent studies suggest these levels are T8 and T9, respectively). This allowed deduction of targeting and charting errors. In experiment 2, 10 examiners (2 experienced, 8 novice) used an index finger to maintain contact with a mid-thoracic spinous process as each of 2 participants slowly moved from the upright to the prone position. Interexaminer reliability was assessed by computing Intraclass Correlation Coefficient, standard error of the mean, root mean squared error, and the absolute value of the mean difference for each examiner from the 10 examiner mean for each of the 2 participants.

Results

The thought experiment suggesting that using the (inaccurate) scapular tip landmark rule would result in a 3 level targeting and charting error when radiological findings are mapped to the prone position. Physical upright exam procedures like motion palpation would result in a 2 level targeting error for intervention, and a 3 level error for charting. The reliability experiment showed examiners accurately maintained contact with the same thoracic spinous process as the participant went from upright to prone, ICC (2,1) = 0.83.

Conclusions

As manual therapists, the authors have emphasized how targeting errors may impact upon manual care of the spine. Practitioners in other fields that need to accurately locate spinal levels, such as acupuncture and anesthesiology, would also be expected to draw important conclusions from these findings.

Abstract (provisional)

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Background

Lumbar spinal stenosis is the most common reason for spinal surgery in older adults. Previous studies have shown that surgery is effective for severe cases of stenosis, but many patients with mild to moderate symptoms are not surgical candidates. These patients and their providers are seeking effective non-surgical treatment methods to manage their symptoms; yet there is a paucity of comparative effectiveness research in this area. This knowledge gap has hindered the development of clinical practice guidelines for non-surgical treatment approaches for lumbar spinal stenosis.

Methods

This study is a prospective randomized controlled clinical trial that will be conducted from November 2013 through October 2016. The sample will consist of 180 older adults (>60 years) who have both an anatomic diagnosis of stenosis confirmed by diagnostic imaging, and signs/symptoms consistent with a clinical diagnosis of lumbar spinal stenosis confirmed by clinical examination. Eligible subjects will be randomized into one of three pragmatic treatment groups: 1) usual medical care; 2) individualized manual therapy and rehabilitative exercise; or 3) community-based group exercise. All subjects will be treated for a 6-week course of care. The primary subjective outcome is the Swiss Spinal Stenosis Questionnaire, a self-reported measure of pain/function. The primary objective outcome is the Self-Paced Walking Test, a measure of walking capacity. The secondary objective outcome will be a measurement of physical activity during activities of daily living, using the SenseWear Armband, a portable device to be worn on the upper arm for one week. The primary analysis will use linear mixed models to compare the main effects of each treatment group on the changes in each outcome measure. Secondary analyses will include a responder analysis by group and an exploratory analysis of potential baseline predictors of treatment outcome.

Discussion

Our study should provide evidence that helps to inform patients and providers about the clinical benefits of three non-surgical approaches to the management of lumbar spinal stenosis symptoms.

Trial registration: ClinicalTrials.gov identifier: NCT01943435

Abstract (provisional)

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Background

Several studies showed the effect of osteopathic manipulative treatment on neonatal care in reducing length of stay in hospital, gastrointestinal problems, clubfoot complications and improving cranial asymmetry of infants affected by plagiocephaly. Despite several results obtained, there is still a lack of standardized osteopathic evaluation and treatment procedures for newborns recovered in neonatal intensive care unit (NICU). The aim of this paper is to suggest a protocol on osteopathic approach (NE-O model) in treating hospitalized newborns.

Methods

The NE-O model is composed by specific evaluation tests and treatments to tailor osteopathic method according to preterm and term infants' needs, NICU environment, medical and paramedical assistance. This model was developed to maximize the effectiveness and the clinical use of osteopathy into NICU.

Results

The NE-O model was adopted in 2006 to evaluate the efficacy of OMT in neonatology. Results from research showed the effectiveness of this osteopathic model in reducing preterms' length of stay and hospital costs. Additionally the present model was demonstrated to be safe.

Conclusion

The present paper defines the key steps for a rigorous and effective osteopathic approach into NICU setting, providing a scientific and methodological example of integrated medicine and complex intervention.

To the Editor:

Doctors of chiropractic (DCs) were troubled after reading the latest ill-informed attack on the chiropractic profession by Steven Salzberg, PhD. His latest Forbes blog post “New Medicare Data Reveal Startling $496 Million Wasted On Chiropractors” is sensationalism at its finest, as chiropractic has historically made up less than 1% of all Medicare claims.

It’s evident to anyone who is truly interested in fixing the problems facing the U.S. health care system that chiropractic physicians, with their conservative approach to pain relief and health promotion, are an important part of the solution. DCs are the highest rated healthcare practitioners for low-back pain treatments—treating nearly 27 million Americans annually—above physical therapists, specialist physicians/MDs (i.e., neurosurgeons, neurologists, orthopedic surgeons) and primary care physicians/MDs (i.e., family or internal medicine). This is not surprising when you consider that injured workers are 28 times less likely to undergo spinal surgery if their first point of contact is a DC rather than a surgeon (MD), and that treatment for low back pain initiated by a chiropractic physician costs up to 20% less than treatment started by a MD.

If the blog contributor were truly interested in facts, he would have mentioned that chiropractic consistently outperforms all other back pain treatments, including prescription medication, deep-tissue massage, yoga, Pilates, and over-the-counter medication therapies according to a leading consumer survey. He also might have mentioned that unnecessary spinal fusion surgery (a procedure that has seen a 500% increase in the last decade) has resulted in an estimated $200 million in improper billing to Medicare in 2011 alone. It is noteworthy that Medicare deemed the surgeries medically unnecessary because more conservative treatment hadn’t been tried first.

What makes this viewpoint so short-sighted is also that the need for providers who offer a conservative approach to pain management has never been greater. The Centers for Disease Control and Prevention recently classified prescription drug abuse in the United States as epidemic. The U.S. is home to six percent of the world’s population, yet consumes 80% of its pain medication.

DCs are designated as physician-level providers in the vast majority of states and the federal Medicare program. The services provided by DCs are also available in federal health delivery systems, including those administered by Medicaid, the U.S. Departments of Veterans Affairs and Defense, Federal Employees Health Benefits Program, Federal Workers' Compensation, and all state workers' compensation programs. DCs complete nationally accredited, four-year doctoral graduate school programs with a curriculum that includes a minimum of 4,200 hours of classroom, laboratory and clinical internship, with the average DC program equivalent in classroom hours to medical and osteopathic schools.

Chiropractic services are one of the safest and most effective treatments for back pain, neck pain and headaches, and can help patients avoid riskier treatments, more expensive care and get well sooner. If Forbes.com is interested in presenting more balanced information on improving patient care and cutting excessive health care spending, DCs would encourage the editors to choose articles without the steeped misinformation and blatant personal bias shown in this commentary.

Thank you,
Anthony W. Hamm, DC
President, American Chiropractic Association

Create a campaign and show people how to take their annual posture picture

From text-neck to the computer slump, people know their posture is a problem. It‟s up to you to help them do something about it and create an action plan towards improvement that includes regular chiropractic care. A Posture Month campaign is a great way to build awareness with education and annual posture pictures. Plus, engaged patients will often share their awareness by taking pictures of their friends‟ posture, building your authority as the Posture Expert.

The first step in improving posture is seeing and benchmarking what someone‟s posture looks like. A camera and a regular background create digital documentation so you can make an objective assessment. Hold the camera level with the ground and photograph the subject from the front, back and side. (NOTE: A posture picture is protected health information under HIPAA, so keep pictures digitally secure with a dedicated camera or just download pictures to their EHR).

Grids are great for more precise measurement, but a standard six panel door or anything showing a vertical reference works as a benchmark to compare future images. Have them stand a few inches from the wall or door with what feels like “standing tall good posture.” If they stand rigidly "at attention," tell them to relax (and notice how many people are actually a bit uncertain of what standing tall actually feels like).

People are usually amazed to see their first Posture Picture, which helps them take the first step in becoming Posture Conscious. This awareness and the intentionality of taking a posture picture is the key to teaching patients to take pictures of others. When you review the clinical correlation of their posture and problem, suggest they can take a similar photo of others. Having them download a free posture assessment app (whether or not it‟s the one you use) can be helpful to encourage them to do so, but is not necessary to engage patients to take pictures of those they care about.

A cell phone camera or tablet is an essential tool for any neuro-musculo-skeletal professional. Back pain isn't going away, Boomers are getting older, and posture is an acknowledged marker of general health¹. It's not just kids with backpacks or cane-carrying seniors – studies show poor posture is a major cause of back and neck pain for all ages, and over time often contributes to digestive and cardio-pulmonary problems. The good news: there are easy things people can do to strengthen posture, including care to restore spinal health with an adjustment.

Repositioning the pain patient towards an awareness of their postural and motion deficits provides a logical and intuitively true bio-mechanical link between perceived pain and observable motion dysfunction. Restoring lost segmental motion is among the most agreed upon benefits of an adjustment, and often correlates with pain relief. Chiropractors can then empower patients for pain management, rehab and wellness as well as align with the cultural and scientific perceived value of strengthening core stabilizing muscles by adding posture, balance and alignment exercises to their protocols.

In addition to training healthy joints to move in full-range symmetry, strengthening posture can have potential positive effects on psychological and/or emotional issues by improving posture and body consciousness. Also, posture pictures taken during an initial exam set the stage to build posture awareness and support the benefits of care when patients see tangible posture improvements after treatment.

A posture practice can target the opportunity today by building real relationships, regardless of insurance, to help people with the problem they present with, and then build value. The patient's desire to move well, optimize health and avoid a recurrence of their initial complaint becomes the center of a practice model with three elements: Posture Consciousness, Concepts and Control. In other words, build a cycle: connect their problem with posture, create awareness with a digital posture picture and then empower them with StrongPosture® exercises². Be aware of the benefits of standing taller and moving well.

Dr. Weiniger literally wrote the book on improving posture, Stand Taller ~ Live Longer: An Anti-Aging Strategy, and is managing partner of BodyZone. He's trained thousands of DCs to help their patients move well with the StrongPosture® exercise protocols and promote posture awareness with the free PostureZone iPhone app and online referral directories. Dr Weiniger work on posture has been featured in mainstream media including ABC, NBC and FOX News, Oprah‟s Oxygen network, Scripps, Natural Health, Prevention, Bottom Line and Golf Digest. For professionals his team hosts PostureZone.com for practice tools and PosturePractice.com for training as a CPEP(Certified Posture Exercise Professional).

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¹ McEvoy MP, Grimmer K. Reliability of upright posture measurements in primary school children. BMC Musculoske-let Disord 2005;29:6-35
² Stand Taller~Live Longer: An Anti- Aging Strategy, S. Weiniger, BodyZone Press, 2008

Abstract

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Objective

The purpose of this study was to compare the effect of dual tasking on postural and cognitive performance between participants with and without nonspecific chronic low back pain.

Methods

In this 3-factor mixed-design study, dynamic postural stability was assessed in 15 patients with chronic nonspecific low back pain and 15 age-, sex-, and size-matched asymptomatic participants. Bilateral stance on a Biodex Balance System was investigated at 3 levels of postural task difficulty (different platform stabilities levels with eyes open and closed) and 2 levels of cognitive task difficulty (with or without auditory Stroop test). We measured anterior-posterior, medial-lateral, and overall indices for postural performance. Average reaction time and error ratio of a modified auditory Stroop test were calculated as measures of the cognitive task performance.

Results

Mixed-design 3-way analyses of variance revealed significant interactions. Post hoc 2-way analyses of variance showed significant group by cognitive task difficulty for anterior-posterior (P < .001), medial-lateral (P = .003), and overall stability indices (P < .001) on a stiffness level of 5 with eyes closed. At this level, there were significant differences between single- and dual-task conditions for anterior-posterior (P < .001), medial-lateral (P = .02), and overall stability indices (P < .001) only in the chronic low back pain group. Also, at the most difficult postural conditions, participants with chronic low back pain increased their error ratio (P = .002), whereas matched asymptomatic individuals increased their reaction time (P < .01) of the auditory Stroop test.

Conclusion

Postural task performance is attenuated by cognitive loading at a moderate level of postural task difficulty. Therefore, to observe the effect of attentional demands of postural control, task difficulty should be considered.

Abstract

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Objective

The purpose of this study was to establish the frequency of burnout among doctors of chiropractic in the United States.

Methods

Using a nonprobability convenience sampling methodology, we e-mailed the Maslach Burnout Inventory–Human Services Survey and a sociodemographic questionnaire to a randomized sample of licensed doctors of chiropractic (n = 8000).

Results

The survey return rate was 16.06%. Twenty-one percent of the participants had high emotional exhaustion (EE), 8% had low personal accomplishment, and 8% had high depersonalization.

Discussion

Significant differences (P < .001) were found in the level of EE, depersonalization, and personal accomplishment as a function of sex, time dedicated to clinical care and administrative duties, source of reimbursement, the type of practice setting, the nature of practitioners' therapeutic focus, the location of chiropractic college, self-perception of burnout, the effect of suffering from a work-related injury, the varying chiropractic philosophical perspectives, and the public's opinion of chiropractic.

Conclusion

Although doctors of chiropractic in the United States who responded to the survey had a relatively low frequency of burnout, higher levels of EE remain workplace issues for this professional group.

Abstract

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Objective

The purpose of this study was to evaluate the test-retest reliability of handgrip strength measurement using a hydraulic hand dynamometer in patients with cervical radiculopathy (CR).

Methods

A convenience sample of 19 participants (14 men and 5 women; mean ± SD age, 50.5 ± 12 years) with CR was measured using a Jamar hydraulic hand dynamometer by the same rater on 2 different testing sessions with an interval of 7 days between sessions. Data collection procedures followed standardized grip strength testing guidelines established by the American Society of Hand Therapists. During the repeated measures, patients were advised to rest their upper limb in the standardized arm position and encouraged to exert 3 maximum gripping efforts. The mean value of the 3 efforts (measured in kilogram force [Kgf]) was used for data analysis. The intraclass correlation coefficient, SEM, and the Bland-Altman plot were used to estimate test-retest reliability and measurement precision.

Results

Grip strength measurement in CR demonstrated an intraclass correlation coefficient of 0.976, suggesting excellent test-retest reliability. The small SEM in both testing sessions (SEM1, 2.41 Kgf; SEM2, 2.51 Kgf) as well as the narrow width of the 95% limits of agreements (95% limits of agreement, −4.9 to 4.4 Kgf) in the Bland-Altman plot reflected precise measurements of grip strength in both occasions.

Conclusions

Excellent test-retest reliability for grip strength measurement was measured in patients with CR, demonstrating that a hydraulic hand dynamometer could be used as an outcome measure for these patients.

Abstract

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Objective

The purpose of this study was to evaluate the efficacy of manipulative and manual therapy treatments with regard to pain perception and neck mobility in patients with tension-type headache.

Methods

A randomized clinical trial was conducted on 84 adults diagnosed with tension-type headache. Eighty-four subjects were enrolled in this study: 68 women and 16 men. Mean age was 39.76 years, ranging from 18 to 65 years. A total of 57.1% were diagnosed with chronic tension-type headache and 42.9% with tension-type headache. Participants were divided into 3 treatment groups (manual therapy, manipulative therapy, a combination of manual and manipulative therapy) and a control group. Four treatment sessions were administered during 4 weeks, with posttreatment assessment and follow-up at 1 month. Cervical ranges of motion pain perception, and frequency and intensity of headaches were assessed.

Results

All 3 treatment groups showed significant improvements in the different dimensions of pain perception. Manual therapy and manipulative treatment improved some cervical ranges of motion. Headache frequency was reduced with manipulative treatment (P < .008). Combined treatment reported improvement after the treatment (P < .000) and at follow-up (P < .002). Pain intensity improved after the treatment and at follow-up with manipulative therapy (P < .01) and combined treatment (P < .01).

Conclusions

Both treatments, administered both separately and combined together, showed efficacy for patients with tension-type headache with regard to pain perception. As for cervical ranges of motion, treatments produced greater effect when separately administered.

Abstract

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Objective

The purpose of this case series is to report the effects of manipulation under anesthesia (MUA) for patients with lumbopelvic (lumbar spine, sacroiliac and/or pelvic, hip) pain in an outpatient ambulatory/hospital-based setting.

Methods

A retrospective chart review of cases treated at an outpatient ambulatory surgical center in New York and a general hospital in New York was performed. Patients with pre- and postintervention Oswestry Low Back Pain Disability Index (ODI) scores and lumbopelvic and hip complaints were included (N = 18). No intervention other than MUA was administered between the initial and follow-up ODI scoring. Scores on the ODI were assessed within 1 week prior to MUA and again within 2 weeks postprocedure.

Results

Patients underwent 2 to 4 chiropractic MUA procedures over the course of 7 to 8 days as per National Academy of Manipulation Under Anesthesia physicians' protocols. Preprocedure ODI scores ranged from 38 to 76, with an average score of 53.4. Postprocedure scores ranged from 0 to 66, with an average score of 32.8. For each patient, ODI scores were lower after MUA, with an average decrease of 20.6. Sixteen of 18 patients experienced a clinically meaningful improvement in ODI score. No adverse reactions were reported.

Conclusions

For 16 of the 18 patients with chronic lumbopelvic pain reported in this study, MUA showed clinically meaningful reduction in low back pain disability.