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Chiropractic Treatment vs. Self-Management in Patients With Acute Chest Pain
Mette J. Stochkendahl, DC, PhD, et al.
Objective: The musculoskeletal system is a common but often overlooked cause of chest pain. The purpose of the present study is to evaluate the relative effectiveness of two treatment approaches for acute musculoskeletal chest pain: (1) chiropractic treatment that included spinal manipulation; and (2) self-management as an example of minimal intervention.
Methods: In a nonblinded, randomized, controlled trial set at an emergency cardiology department and four outpatient chiropractic clinics, 115 consecutive patients with acute chest pain and no clear medical diagnosis at initial presentation were included. After a baseline evaluation, patients with musculoskeletal chest pain were randomized to four weeks of chiropractic treatment or self-management, with posttreatment questionnaire follow-up four and 12 weeks later. Primary outcome measures were numeric change in pain intensity (11-point box numerical rating scale) and self-perceived change in pain (seven-point ordinal scale).
Results: Both groups experienced decreases in pain, self-perceived positive changes, and increases in Medical Outcomes Study Short Form 36-Item Health Survey scores. Observed between-group significant differences were in favor of chiropractic treatment at four weeks regarding the primary outcome of self-perceived change in chest pain and at 12 weeks with respect to the primary outcome of numeric change in pain intensity.
Conclusions: To the best of our knowledge, this is the first randomized trial assessing chiropractic treatment vs. minimal intervention in patients without acute coronary syndrome, but with musculoskeletal chest pain. Results suggest that chiropractic treatment might be useful, but further research in relation to patient selection, standardization of interventions, and identification of potentially active ingredients is needed.
Intraoral Myofascial Therapy for Chronic Myogenous TMD
Allan Kalamir, BSc, MChiro, et al.
Objective: Studies investigating the efficacy of intraoral myofascial therapies (IMTs) for chronic temporomandibular disorder (TMD) are rare. The present study was an expansion of a previously published pilot study that investigated whether chiropractic IMT and the addition of education and self-care were superior to no-treatment or IMT alone for five outcome measures – interincisal opening range, jaw pain at rest, jaw pain upon opening, jaw pain upon clenching, and global reporting of change – over the course of one year.
Methods: Ninety-three participants with myogenous TMD between the ages of 18 and 50 years experiencing chronic jaw pain of longer than three months in duration were recruited for the study. Successful applicants were randomized into one of three groups: (1) IMT consisting of two treatment interventions per week for five weeks; (2) IMT plus education and “self-care” exercises (IMTESC); and (3) wait-list control. The main outcome measures were used. Range-of-motion findings were measured by vernier callipers in millimeters, and pain scores were quantified using an 11-point self-reported graded chronic pain scale. Global reporting of change was a seven-point self-reported scale, balanced positively and negatively around a zero midpoint.
Results: There were statistically significant differences in resting, opening and clenching pain, opening scores, and global reporting of change (P < .05) in both treatment groups compared with the controls at six months and one year. There were also significant differences between the two treatment groups at one year.
Conclusions: The study suggests that both chiropractic IMT and IMTESC were superior to no treatment of chronic myogenous TMD over the course of one year, with IMTESC also being superior to IMT at one year.
Effect of Cervical Spine Manipulative Therapy on Judo Athletes' Grip Strength
Marcelo Botelho, DC, et al.
Objective: The objective of this study was to perform an investigation evaluating if cervical spinal manipulative therapy (SMT) can increase grip strength on judo athletes in a top 10 nationally ranked team.
Methods: A single-blinded, prospective, comparative, pilot, randomized, clinical trial was performed with 18 athletes of both sexes from a judo team currently competing on a national level. The athletes were randomly assigned to two groups: chiropractic SMT and sham. Three interventions were performed on each of the athletes at different time points. Force measurements were obtained by a hydraulic dynamometer immediately before and after each intervention at the same period before training up to three weeks with at least 36 hours between interventions.
Results: Analysis of grip strength data revealed a statistically significant increase in strength within the treatment group after the first intervention (6.95% right, 12.61% left) as compared with the second (11.53% right, 17.02% left) and the third interventions (10.53% right, 16.81% left). No statistically significant differences were found in grip strength comparison within the sham group. Overall differences in strength were consistently significant between the study groups (P = .0025).
Conclusion: The present study suggests that the grip strength of national-level judo athletes receiving chiropractic SMT improved compared to those receiving sham.
Manual Therapy for Craniofacial Pain in Patients With Chronic Rhinosinusitis
Roberto Méndez-Sánchez, PT, MSc, et al.
Objective: Chronic rhinosinusitis (CRS) is thought to develop through an inadequate drainage of nasal and sinus secretions, and perpetuated by local mechanical and autonomic nervous system factors. Manual therapy may have an effect on these factors, providing symptomatic relief of CRS symptoms. The purpose of this prospective case series was to report the results of manual therapy on a set of patients with craniofacial pain and a diagnosis of CRS.
Methods: Fourteen consecutive patients presenting with a primary report of craniofacial pain and a diagnosis of CRS completed self-report questionnaires including the Sinonasal Assessment Questionnaire, Rhinosinusitis Task Force, visual analog scale for craniofacial pain, and pressure pain threshold over four sinus points on the face. Patients were seen once a week for seven consecutive weeks, and completed all outcome measures at baseline and subsequent weekly sessions. They received manual therapy interventions only on the second, third, and fifth weekly sessions.
Results: No significant changes in outcome measures were observed from baseline to one week, when no intervention was applied. Significant improvements were observed on all outcome measures (Ps ≤ .015) for pre– and post–first treatment session, as well as from baseline to seven weeks (Ps ≤ .001). All patients exhibited a significant decrease in craniofacial pain and increased pressure pain thresholds and reported less severity of their symptoms.
Conclusion: Patients with craniofacial pain and CRS who were treated with manual therapy demonstrated improvements in all outcome measures only after each treatment session. Our results suggest that manual therapy treatment could be considered as an appropriate alternative treatment of CRS.
Evaluation of Mechanical Allodynia in an Animal Immobilization Model
Jaqueline Trierweiler, BS, et al.
Objective: The purpose of this study was to evaluate the mechanical allodynia in animals after immobilization and chiropractic manipulation using the Activator instrument through the Von Frey test in an animal model that had its hind limb immobilized as a form to induce mechanical allodynia.
Method: Eighteen adult male Wistar rats were used and divided into three groups: control group (C) (n = 6) that was not immobilized; immobilized group (I) (n = 6) that had its right hind limb immobilized; immobilized and adjusted group (IAA) (n = 6) that had its right hind limb immobilized and received chiropractic manipulation after. The mechanical allodynia was induced through the right hind limb immobilization. At the end of the immobilization period, the first Von Frey test was performed, and after that, six chiropractic manipulations on the tibial tubercle were made using the Activator instrument. After the manipulation period, Von Frey test was performed again.
Results: It was observed that after the immobilization period, groups I and IAA had an exacerbation of mechanical allodynia when compared with group C (P < .001) and that after the manipulation, group IAA had a reversion of these values (P < .001), whereas group I kept a low pain threshold when compared with group C (P < .001).
Conclusion: This study demonstrates that immobilization during four weeks was sufficient to promote mechanical allodynia. Considering the chiropractic manipulation using the Activator instrument, it was observed that group IAA had decreased levels of mechanical allodynia, obtaining similar values to group C.
Immediate Effect of Nimmo Technique on Subjects with Chronic LBP
Terry Koo, PhD, et al.
Objective: Objectives of this study were to (1) quantify the immediate effect of Nimmo technique on muscle elasticity, pain perception, and disability; and (2) evaluate comparative effectiveness of treating all primary and secondary trigger points (TrPs) vs. primary TrP only.
Methods: Fourteen chronic low back pain subjects recruited from a chiropractic college were tested in this within-day repeated-measures design study. Gluteus medius containing a prominent TrP was indented for four sessions using a mechanoacoustic indentor system. A finite element optimization method extracted hyperelastic material constants of the gluteus medius. Load-deformation response on a standardized block was simulated. Area under the load-deformation curve from 0% to 25% deformation (AFE) and force at 25% deformation (FFE) were determined. No treatment was applied between the first and second sessions. Only the primary TrP in the gluteus medius was treated between the second and third sessions. Full Nimmo treatment was used between the third and fourth sessions, requiring treatment of all primary and secondary TrPs. The AFE, FFE, tissue thickness, subjective pain, and Oswestry Disability Index were compared between sessions.
Results: After full Nimmo treatment, AFE and FFE were significantly smaller than baseline (P = .021 and .027, respectively) and focal TrP treatment only (P = .003 and .001, respectively). The changes accompanied concomitant improvement in subjective pain and disability. It appears that focal TrP treatment resolves TrP, but full Nimmo treatment further reduces electrogenic spasm.
Conclusions: Immediate effect of a single full Nimmo treatment appears to be reduced muscle tone, subjective pain, and disability, and is more beneficial than focal TrP treatment.
JMPT abstracts appear in DC with permission from the journal. Due to space restrictions, we cannot always print all abstracts from a given issue. Visit www.journals.elsevierhealth.com/periodicals/ymmt for access to the complete January 2012 issue of JMPT.
