Sept. '96


Abstracts from September 1996

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Table of Contents / Abstracts

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Each quarter, Chiropractic OnLine Today will present the Table of Contents and current Abstracts from Aspen Publications' Topics in Clinical Chiropractic.

The following list comprises TICC's Editorial advisory board:


Robert D. Mootz, DC, DABCO, FICC

Associate Editors:


Daniel T. Hansen, DC, DABCO, FICC

Kevin A. McCarthy, DC, DABCO

Howard Vernon, DC, FCCS

Continuing Education Editor:

Dorrie M. Talmage, DC, DABCO

Editorial Board

Alan H. Adams, DC

Alan Breen, DC

Bernard A. Coyle, PhD

Phillip S. Ebrall, BAppSC (Chiropractic)

Gary Greenstein, DC

Warren I. Hammer, DC, MS, DABCO

Karl C. Kranz, DC

Marion McGregor, Bsc, DC, FCCS (c)

Donna M. Mannello, DC

Paul J. Osterbauer, DC, MPH

Lindsay J. Rowe, MAppSc, MD, DACBR (USA), FCCR (CAN), FACCR (AUST), FICC

Olga Rutherford, BA, Msc, PhD

Tilden H. Sokoloff, DPM, MS, DC

Thomas A. Souza, DC, CCSP

Richard D. Stonebrink, BS, DC, ND, FACO, FICC

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Future Editions

Volume 4(3): Women’s Health - Manuscript Deadline: February 1, 1997
Contact: Linda J. Bowers, DC; Professor; Northwestern College of Chiropractic 2501 W. 84th Street; Bloomington , MN 55431

Volume 4(4): Pediatrics - Manuscript Deadline: May 1, 1997
Contact: Robert D. Mootz, DC Associate Medical Director; State of Washington Department of Labor and Industriews; PO Box 44321; Olympia, WA 98504-4321

Volume 5(1): Head and Face Pain - Manuscript Deadline: August 1, 1997
Contact: Howard T. Vernon, DC; Associate Dean of Research; Canadian Memorial Chiropractic College; 1900 Bayview Ave.; Toronto, Ontario, Canada M4G 3E6

Volume 5(2): Clinical Decision Making - Manuscript Deadline: October 1, 1997
Contact: Kevin a. McCarthy, DC; Dean of Clinicas; Palmer College of Chiropractic - West; 90 E. Tasman Drive; San Jose, CA 95134

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Table of Contents / Abstracts for September 1996

In this Issue: Low Back Pain and Chiropractic care of the Lumbar Spine: Are We There Yet?

  • Page Iv:
  • Letters to the Editor

  • Page vi:
  • Clinical Pearls

  • Page viii
  • Back to Basics: Clinical Pathoanatomy Related to Low Back Pain

  • Page 1: Gregory D. Cramer, DC, PhD, and Susan A. Darby, PhD
  • An Overview of Aquatic Rehabilitation Therapy

  • Page 9: Gordon E. Lawson, MSc, DC, DHN, DACBN, FCCSS( C )
  • Functional Capacity Evaluation and Chiropractic Case Management

  • Page 15: Steven G. Yeomans, DC, FACO, and Craig Liebenson, DC
  • Analysis of Low Back Pain Drawings: A Critique

  • Page 26: Peter Bryner, BAppSC (Chiropractic), Gdip (Human Services Research)
  • Imaging Modalities for the Lumbar Spine

  • Page 32: Sandra M. O’Connor, DC, DACBR, William S. W. Hsu, DC, DACBR, and Constance Columbus, DC
  • Distraction Chiropractic Adjusting: Clinical Application and Outcomes of 1,000 Cases

  • Page 45: James M. Cox, DC, DACBR, Jacquelyn Feller, PhD, and Julie Cox - Cid, BS
  • Spinal Stabilization

  • Page 60: Craig Liebenson, DC, Jerry Hyman, DC, Natalie Gluck, DC, and Donald, R. Murphy, DC
  • Appendixes: Algorithms, Forms and Other Clinical Aids Related to the Articles in this Issue

  • Page 75
  • Continuing Education Credit

  • Page 82

  • Back To Basics:

    Clinical Pathoanatomy Related to Low Back Pain
    Gregory D. Cramer, DC, PhD, and Susan A. Darby, PhD

    Purpose: An overview of anatomy and physiology of structures that may play a role in low back pain is provided. A discussion of the characteristics of low back pain, possible pain generators, and how pathologic processes may influence low back pain is offered. Pain transmission and regulation are examined. Method: Qualitative review of relevant literature and anatomic and physiologic concepts, with a synthesis of how the clinical phenomenon of low back pain is perceived. Summary: Low back pain is a complex physiologic process that may be affected by peripheral and central nervous system structures and activities as well as local anatomic structures in the low back. A discussion of contributing anatomic, physiologic, and pathologic elements provides a useful foundation to clinical management of patients with low back pain. Key words: anatomy, low back pain, lumbar vertebrae, neurons, nociceptors, pain, pain threshold, pathology.


    Gordon E. Lawson, MSc, DC, DHN, DACBN, FCCSS( C )

    Purpose: This article describes aquatic rehabilitation therapy (aquatherapy), which essentially provides a gravity-free method for performing active exercise. Benefits of this approach to exercise and rehabilitation are presented as well as specific phases of application including risks and contraindications. Method: The article is a qualitative literature review and descriptive clinical overview. Summary: Aquatherapy assists in increasing range of motion, provides a safe and comfortable way to approach progressive graded resistance exercise, helps promote early rehabilitation, and provides a useful and psychologically appealing approach to deeloping proprioceptive skills. Key words: exercise therapy, physical fitness, proprioception, rehabilitation, rehabilitation centers, water.


    Steven G. Yeomans, DC, FACO, and Craig Liebenson, DC

    Purpose: In an era when expensive tests have flourished, it is timely that efficient and economical functional tests satisfying fundamental criteria are developed in order to contain costs. An overview of functional capacity tests is provided, and a discussion of types and components is offered. Further, the validity of functional tests is addressed, especially their ability to predict either an individual’s performance in a target task or the development of future back pain/disability. Method: A qualitative review of relevant literature is integrated with the clinical experience of the authors. Summary: Functional capacity tests are designed for use when a patient has been in treatment for 1 month and care may extend beyond a reasonable expected natural history. Functional capacity testing provides baseline information from which objective improvement can be monitored. It can also help in establishing a rehabilitation prescription, determining return to work goals, and determining an end point of care. Key words: accidents (occupational), activities of daily living, disability evaluation, pain measurement, questionnaires, range of motion (articular), rehabilitation, work capacity evaluation.


    Peter Bryner, BAppSC (Chiropractic), Gdip (Human Services Research)

    Overview: Two alternative hypotheses have been proposed for unexplained low back pain: psychosocial contributing factors and musculoskeletal dysfunction (MSD). This article outlines how pain drawings have been analyzed, with commentary on usefulness in understanding MSD. In experimental settings selective provocation is used together with pain drawings to study how irritation results in pain being experienced at different locations. Method: Qualitative literature review. Summary: Pain drawing analysis (PDA) is one of many forms of assessment used in interpreting low back pain clinically. PDA can be grouped into three main methods: rating, area, and pattern. Rating drawings for the likelihood of underlying psychologic disorders (nonanatomic) has failed to be replicated for back pain sufferers. Its value in studying MSD is limited. Assessing drawings for area (or extent) provides descriptive data on location (site) and may indicate one component of severity as compared to intensity. PDA may be unresponsive to treatment because a small number of large anatomic regions may overestimate affected areas. Preliminary data with more accurate area assessment show significant time variation in drawing low back pain. Pattern analysis of pain drawings gained from a clinical setting may show correspondence with the pain drawings generated from selective provocation applied in an experimental setting. Key words: low back pain, musculoskeletal diseases, pain, pain measurement, reproducibility of results, somatoform disorders.


    Sandra M. O’Connor, DC, DACBR, William S. W. Hsu, DC, DACBR, and Constance Columbus, DC

    Purpose: Low back pain has many origins and can be difficult to diagnose due to its nonspecific nature. Appropriate diagnostic imaging can be helpful in establishing a diagnosis and in aiding the management of patients with low back pain. Methods: A qualitative review of commonly used imaging modalities is provided. This review is followed by an overview of nonmechanical disorders that may affect the lumbar spine and the role of diagnostic imaging in the assessment of these disorders. Summary: Plain film radiographs are the most commonly used imaging modality. They are low cost, widely available, and can rule out pathology. Nuclear imaging, computed tomography (CT), and magnetic resonance imaging (MRI) provide additional information that is not often visible on conventional radiographs. Overall, nuclear imaging and MRI are sensitive for detection of osseous pathology with MRI offering good soft tissue detail. CT is preferred for imaging osseous structures in spinal trauma or arthritic disorders. Key words: low back pain, musculoskeletal diseases, pain, pain measurement, reproducibility of results, somatoform disorders.


    James M. Cox, DC, DACBR, Jacquelyn Feller, PhD, and Julie Cox - Cid, BS

    Purpose: An overview of Cox distraction manipulation protocols is presentd including diagnosis and treatment decision making in low back and sciatica cases and proper utilization of flexion-distraction in treating lumbar spine and lower extremity pain. In addition, the outcome of 1,000 cases involving low back and/or leg pain treated with chiropractic adjusting (92% utilizing flexion-distraction) is presented. Methodology: A qualitative clinical and literature review provides the basis of the overview of diagnostic and treatment protocols. A descriptive case series design was used to collect outcome information on 1,000 patients with low back and/or leg pain; patients were pooled from two separate studies. Patients were treated by 30 different chiropractors, and a minimum of 20 cases were supplied by each physician. Results: A descriptive review of cases showed that less than 4% of patients with low back or leg pain were candidates for surgery. Less than 9% of patients reached the chronic stage of care. The average number of days to maximum improvement under care was 29, and the average number of treatments to maximum improvement was 12. Conclusion: The results of this study provide some evidence for the use of chiropractic management, particularly flexion-distraction manipulation, in the treatment of back pain problems due to a variety of mechanical causes. Key words: biomechanics, flexion-distraction, intervertebral disk displacement, low back pain, lumbar vertebrae, manipulation (orthopaedic), patient compliance, physical medicine, sciatica surgery (operative).


    Craig Liebenson, DC, Jerry Hyman, DC, Natalie Gluck, DC, and Donald, R. Murphy, DC

    Purpose: Spinal stabilization is a therapeutic approach to exercise that uses a progressive sequence of training in coordination and balance, endurance and strengthening. This article describes spinal stabilization and its usefulness. It provides the practicing chiropractor with a step-by-step overview of key spinal stabilization exercises how they might be integrated into chiropractic management strategies. Method: A qualitative review of relevant literature was undertaken to identify the value of spinal stabilization exercise. Based on relevant clinical literature and the authors’ practice-experience, a comprehensive practice strategy incorporating spinal stabilization is developed and presented. Summary: Spinal stabilization exercises are safe and have demonstrated effectiveness in patients with low back pain including those with nerve root compression. Spinal stabilization is a low technology approach to spinal rehabilitation that has been shown to outperform passive therapy and higher technology rehabilitation conditioning programs. These exercises can readily be included in chiropractic management approaches. Key words: exercise therapy, joint instability, lumbar vertebrae, movement, muscle fibers, muscles, posture, rehabilitation, spine.

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