Donald R Murphy

• DC, FRCC
• Professor (Assistant) at Brown University

Objectives Low back pain (LBP) is the number one cause of disability world-wide. It is also the most expensive area in healthcare. Patient-centered innovations are needed. This paper uses medical storytelling to illustrate the common problems that often lead to unnecessary suffering for patients, and costs to society. We present innovative solution...

Background In an article published in 2011, we discussed the need for a new role in health care systems, referred to as the Primary Spine Practitioner (PSP). The PSP model was proposed to help bring order to the chaotic nature of spine care. Over the past decade, several efforts have applied the concepts presented in that article. The purpose of th...

Objective: This abbreviated version of the American College of Occupational and Environmental Medicine's Low Back Disorders guideline reviews the evidence and recommendations developed for invasive treatments used to manage low back disorders. Methods: Comprehensive systematic literature reviews were accomplished with article abstraction, critiq...

Objective: The aim of this study was to summarize evidence-based diagnostic guidelines for low back disorders. Methods: A comprehensive literature review was conducted. A total of 101 articles of high or moderate quality addressing low back disorders diagnostic evaluation met the inclusion criteria. Evidence-based recommendations were developed...

Importance Lumbar spinal stenosis (LSS) is the most common reason for spine surgery in older US adults. There is an evidence gap about nonsurgical LSS treatment options. Objective To explore the comparative clinical effectiveness of 3 nonsurgical interventions for patients with LSS. Design, Setting, and Participants Three-arm randomized clinical...

eAppendix. Trial baseline adaptive randomization methodology

Background The purported relationship between cervical manipulative therapy (CMT) and stroke related to vertebral artery dissection (VAD) has been debated for several decades. A large number of publications, from case reports to case–control studies, have investigated this relationship. A recent article suggested that case misclassification in the...

Objective The purpose of this commentary is to provide an argument for the role and identity of chiropractors as spine care providers within the context of the greater health care system. Discussion Surveys of the general public and chiropractors indicate that the majority of patients seek chiropractic services for back and neck pain. Insurance co...

Objective: The purpose of this study was to explore potential baseline physical examination and demographic predictors of clinical outcomes in patients with lumbar spinal stenosis. Methods: This was a secondary analysis of data obtained from a pilot randomized controlled trial. Primary and secondary outcome measures were the Swiss Spinal Stenosi...

A 30-year-old woman presented to an emergency department with sudden onset of transient loss of left peripheral vision. Owing to a history of migraine headaches, she was released with a diagnosis of ocular migraine. Two days later, she sought chiropractic care for the chief symptom of severe neck pain. The chiropractor suspected the possibility of...

Efforts are underway to reform our health care system to improve efficiency, outcomes, patient satisfaction and costs. In no field is this more critical than that of spine- related disorders, where escalating costs combined with decreasing clinical benefits for patients has reached a breaking point. Traditionally, practitioners have grouped togethe...

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 m...

Accurate measurement of functional improvement in clinical practice is becoming increasingly recognized as essential in demonstrating whether patients are deriving meaningful benefit from care. Several simple questionnaires have been developed for this purpose. The majority of these have been developed in English. In North America, there is a growi...

The purposes of this study were to investigate whether a screening procedure could capture important psychologic factors with minimum burden to the patient and to investigate whether correlations exist among the various psychologic factors. A screening procedure consisting of the 11-item Tampa Scale for Kinesiophobia, a 2-question coping strategies...

ABSTRACT: Low back pain (LBP) is common and costly. Development of accurate and efficacious methods of diagnosis and treatment has been identified as a research priority. A diagnosis-based clinical decision guide (DBCDG; previously referred to as a diagnosis-based clinical decision rule) has been proposed which attempts to provide the clinician wit...

The objective of the current study was to investigate whether any differences exist in the activity of the cervical erector spinae and upper trapezius (TRA) muscles between asymptomatic participants who show "normal" and "abnormal" lumbar spine motion patterns during the prone hip extension (PHE) test. Twenty-six asymptomatic participants recruited...

Standardized form on which the answers to the three questions of diagnosis were documented.

Neck pain (NP) is a common cause of disability. Accurate and efficacious methods of diagnosis and treatment have been elusive. A diagnosis-based clinical decision guide (DBCDG; previously referred to as a diagnosis-based clinical decision rule) has been proposed which attempts to provide the clinician with a systematic, evidence-based guide in appl...

It is widely recognized that the dramatic increase in health care costs in the United States has not led to a corresponding improvement in the health care experience of patients or the clinical outcomes of medical care. In no area of medicine is this more true than in the area of spine related disorders (SRDs). Costs of medical care for SRDs have s...

To report and discuss four cases of ear pain which were treated successfully with manual therapy. Report of four cases. Four patients with ear pain were referred for chiropractic consult. They were all treated with a combination of manual therapy and exercise with resolution of their ear symptoms. The mechanism of idiopathic ear pain that may be am...

The purpose of this study is to provide preliminary information regarding the factor-structure, group- and individual-level reliability, and criterion-referenced validity of measures obtained from the MedRisk Instrument for Measuring Patient Satisfaction with Chiropractic Care. Three hundred twenty-three subjects who had completed a course of chiro...

Case report. To present the case of a patient with low back and lower extremity pain suspected to result from lumbar radiculopathy but who was discovered to have symptomatic uterine fibroid (UF). UFs are usually asymptomatic but at times can produce symptoms such as excessive menstrual bleeding, intermenstrual bleeding, dysmenorrhea, pelvic pain, p...

The understanding of the relationship between cervical manipulative therapy (CMT) and vertebral artery dissection and stroke (VADS) has evolved considerably over the years. In the beginning the relationship was seen as simple cause-effect, in which CMT was seen to cause VADS in certain susceptible individuals. This was perceived as extremely rare b...

This report describes the process, participation, and recommendations of a set of consensus conferences on strategy for professional growth that emphasized elements of public trust and alignment between the chiropractic profession and its stakeholders. In February and August 2006, an invitational group of leaders in the chiropractic profession conv...

The relationship between cervical manipulative therapy (CMT) and vertebral artery dissection and stroke (VADS) has been a source of great controversy for many years. A great deal has been written about this topic, from emotionally charged commentaries to high quality science. The evolution of our knowledge about the relationship between CMT and VAD...

This study presents the outcomes of patients with lumbar radiculopathy secondary to disk herniation treated after a diagnosis-based clinical decision rule. A prospective observational cohort study was conducted at a multidisciplinary, integrated clinic that includes chiropractic and physical therapy health care services. Data on 49 consecutive pati...

The purpose of this study was to describe the clinical outcomes of patients with pregnancy-related lumbopelvic pain (PRLP) treated according to a diagnosis-based clinical decision rule. This was a prospective observational cohort of consecutive patients with PRLP. Data on 115 patients were collected at baseline and on 78 patients at the end of the...

It has been stated that individuals who have spondylotic encroachment on the cervical spinal cord without myelopathy are at increased risk of spinal cord injury if they experience minor trauma. Preventive decompression surgery has been recommended for these individuals. The purpose of this paper is to provide the non-surgical spine specialist with...

It is commonly stated that nerve root pain should be expected to follow a specific dermatome and that this information is useful to make the diagnosis of radiculopathy. There is little evidence in the literature that confirms or denies this statement. The purpose of this study is to describe and discuss the diagnostic utility of the distribution of...

Clinical practice guideline. To develop evidence-based recommendations on use of interventional diagnostic tests and therapies, surgeries, and interdisciplinary rehabilitation for low back pain of any duration, with or without leg pain. Management of patients with persistent and disabling low back pain remains a clinical challenge. A number of inte...

Cases have been reported in which radiculopathy or myelopathy secondary to herniated disk has occurred after cervical manipulation. In each case, it is not possible to determine whether the neurologic symptoms and signs were directly caused by the manipulation or whether they developed as part of the natural history of the disorder. The purpose of...

Spinal pain is a common and often disabling problem. The research on various treatments for spinal pain has, for the most part, suggested that while several interventions have demonstrated mild to moderate short-term benefit, no single treatment has a major impact on either pain or disability. There is great need for more accurate diagnosis in pati...

The chiropractic profession has succeeded to remain in existence for over 110 years despite the fact that many other professions which had their start at around the same time as chiropractic have disappeared. Despite chiropractic's longevity, the profession has not succeeded in establishing cultural authority and respect within mainstream society,...

Table 3. Findings from studies related to question 2.

Table 2. Number of studies identified that address factors related to question number 3.

Table 4. Findings from studies related to question 3.

This case reports on a patient with an unusual presentation of a rare tumor: urethral transitional cell carcinoma (TCC). Urethral TCC occurs in approximately 0.7% to 4.0% of patients who have had primary bladder cancer. The initial symptoms usually involve hematuria, with approximately a third of patients reporting flank area pain. Buttock pain and...

Background contextAlthough manual therapists believe that they can diagnose symptomatic joints in the neck by manual examination, that conviction is based on only one study. That study claimed that manual examination of the neck had 100% sensitivity and 100% specificity for diagnosing painful zygapophyseal joints. However, the study indicated that...

Spinal pain is a common problem, and disability related to spinal pain has great consequence in terms of human suffering, medical costs and costs to society. The traditional approach to the non-surgical management of patients with spinal pain, as well as to research in spinal pain, has been such that the type of treatment any given patient receives...

The aim of the study was to discuss a case of cervical epidural abscess and present the clinical features and diagnosis of this disorder. A 52-year-old man had severe neck pain for 1 week. He had a long history of chronic recurrent neck pain, including 2 previous neck surgeries. He was afebrile on each visit, but developed rapid onset of motor loss...

Spinal manipulation applied to the cervical spine is a relatively safe and effective treatment for neck pain and headache. However, complications of this form of treatment have been reported and these can at times be disabling and on rare occasions can be devastating. A postmanipulation complication being treated with a different form of manipulati...

The hip extension test may be a clinical sign of impaired motor control in the lumbar spine, which may have a negative impact on spine stability. The purpose of this study is to evaluate the interexaminer reliability of the hip extension test for suspected dynamic instability of the lumbar spine in patients with chronic low back pain. Forty-two pat...

Little is specifically written regarding the details of clinical interventions with workers with chronic spinal pain. Specifically, the individual thought process behind the management of an injured worker is not often discussed except in clinical conferences or discussions with other clinicians. It is well known that once an injured worker is disa...

The objective of this study was to describe the clinical outcomes of patients with cervical radiculopathy (CR) treated nonsurgically after a diagnosis-based decision rule. A prospective observational cohort study on consecutive patients with CR was performed. Data on 35 consecutive patients were collected at baseline, at the end of the active treat...

The purpose of this study is to present information from a series of patients with imaging findings of encroachment on the cervical spinal cord who were treated with chiropractic cervical manipulation. There were 27 patients (18 females, 9 males; age range, 23-65, mean age, 44.3 years) with neck and/or arm pain with findings of cervical spinal cord...

While it is widely held that non-surgical management should be the first line of approach in patients with lumbar spinal stenosis (LSS), little is known about the efficacy of non-surgical treatments for this condition. Data are needed to determine the most efficacious and safe non-surgical treatment options for patients with LSS. The purpose of thi...

The chiropractic educational system in North America is currently in a state of flux. The attempted conversion of some chiropractic schools into "universities" and the want of university affiliation for chiropractic schools suggests that we are searching for a better alternative to the present system. In the early 20th century, the Flexner Report h...

Disorders of the cervical spine are common and often disabling. The etiology of these disorders is often multifactorial and a comprehensive approach to both diagnosis and management is essential to successful resolution. This article provides an overview of a clinical model of the diagnosis and management of patients with disorders related to the c...

Objective: To describe the chiropractic management of a patient with whiplash-associated disorder and a covert, concomitant dissecting aneurysm of the thoracic aorta caused by Marfan syndrome or a related variant. Clinical Features: A 25-year-old man was referred by his family physician for chiropractic assessment and treatment of neck injuries rec...

Rehabilitation has been a part of chiropractic almost since the beginning of the profession. Yet today, relatively few chiropractors provide rehabilitation in any systematic way in their practices. The modern era of health care calls for all spine specialists to emphasize exercise in their management strategies, and the chiropractic profession has...

This article presents two patients with post-traumatic syringomyelia (PTS) who were treated successfully and without complication for mechanical spine pain with high-velocity, low-amplitude (HVLA) manipulation. These cases provide evidence that PTS should not, in and of itself, be considered a contraindication to HVLA manipulation in the area of th...

SPINAL EPIDURAL ABSCESS is a relatively rare condition that often presents initially with low back pain. Early diagnosis is imperative with this infectious process, as it frequently leads to rapid progression of neurologic deficit, with death often following shortly after. A case is presented of a patient with chronic, recurrent low back pain in wh...

Alternative medicine is one of the most visible and fastest growing areas of health care. It is well documented that patients are actively seeking and using a wide variety of alternative medicine therapies. 1 At the same time, many primary care providers remain unaware of and often extremely resistant to the burgeoning information from these discip...

To present the diagnosis and differential diagnosis of diabetic polyneuropathy and report a case in which a patient with this disorder was successfully managed utilizing chiropractic procedures. An 80-year-old man with a history of diabetes mellitus complained of low back pain along with burning pains in the lower extremities and poor balance. Dist...

To present two cases in which patients with Type I Arnold-Chiari malformation (ACM) were treated with adjustments to the cervical spine for conditions unrelated to the anomaly. The ACM is an anomaly of central nervous system development in which structures from the posterior fossa descend below the level of the foramen magnum. The patients reported...