Greg Kawchuk

• BSc, DC, MSc, PhD
• Professor at University of Alberta

Although the number of publications focusing on low back pain in older adults (LBP-O) and working-age adults (LBP-W) has been growing for decades, comparative research trends in these two populations, which may help to guide future investigation, have not been rigorously explored. This analysis aimed to describe publication patterns and trends of r...

The Chiropractic Academy for Research Leadership (CARL) was formed in 2016 in response to a need for a global network of early career researchers and leaders in the chiropractic profession. Thirteen fellows were accepted competitively and have since worked together at residentials and virtually on many research and leadership projects. In 2020, the...

Spinal manipulative therapy (SMT) is a common nonpharmacological treatment for low back pain (LBP). Although generally supported by systematic reviews and practice guidelines, clinical trials evaluating SMT have been characterized by small effect sizes. This study adopts a Multiphase Optimization Strategy framework to examine individual components...

Magnetic resonance imaging findings often do not distinguish those with and without low back pain. However, there are still a large number of people who undergo magnetic resonance imaging to help determine the aetiology of their back pain. Texture analysis shows promise for classification of tissues that look similar, and machine learning can minim...

Introduction: In individuals having low back pain, the application of spinal manipulative therapy (SMT) has been shown to reduce spinal stiffness in those who report improvements in post-SMT disability. The underlying mechanism for this rapid change in stiffness is not understood presently. As clinicians and patients may benefit from a better unde...

Background: In the midst of the coronavirus pandemic, the International Chiropractors Association (ICA) posted reports claiming that chiropractic care can impact the immune system. These claims clash with recommendations from the World Health Organization and World Federation of Chiropractic. We discuss the scientific validity of the claims made i...

Background: Internet analytics are increasingly being integrated into public health regulation. One specific application is to monitor compliance of website and social media activity with respect to jurisdictional regulations. These data may then identify breaches of compliance and inform disciplinary actions. Our study aimed to evaluate the novel...

Background: Social media has become an increasingly important tool in monitoring the onset and spread of infectious diseases globally as well monitoring the spread of information about those diseases. This includes the spread of misinformation, which has been documented within the context of the emerging COVID-19 crisis. Understanding the creation...

Background Spinal manipulative therapy (SMT) is among the nonpharmacologic interventions that has been recommended in clinical guidelines for patients with low back pain, however, some patients appear to benefit substantially more from SMT than others. Several investigations have examined potential factors to modify patients’ responses prior to SMT...

Background Device-based measurement of lumbar spinal stiffness has the potential to identify patients with low back pain who are more likely to improve with spinal manipulative therapy. This study evaluates how voluntary contraction of spine muscles may impact stiffness measures. Objective To determine how the contraction of different spinal muscl...

Background: Approximately 50% of patients who receive spinal manipulative therapy (SMT) experience some kind of adverse event (AE), typically benign and transient in nature. Regardless of their severity, mitigating benign AEs is important to improve patient experience and quality of care. The aim of this study was to identify beliefs, perceptions...

The mechanisms underlying pain relief following spinal manipulative therapy (SMT) are not understood fully although biomechanical and neurophysiological processes have been proposed. As such, we designed this randomized trial to elucidate the contributions of biomechanical and neurophysiological processes. A total of 132 participants with low back...

Vaccine hesitancy–the reluctance to receive recommended vaccination because of concerns and doubts about vaccines–is recognized as a significant threat to the success of vaccination programs and has been associated with recent major outbreaks of vaccine-preventable diseases. Moreover, the association between complementary and alternative medicine (...

PurposeArtificial intelligence algorithms can now identify hidden data patterns within the scientific literature. In 2019, these algorithms identified a thermoelectric material within the pre-2009 chemistry literature; years before its discovery in 2012. This approach inspired us to apply this algorithm to the back pain literature as the cause of b...

Background Approximately 50% of patients who receive spinal manipulative therapy (SMT) experience some kind of adverse event (AE), typically benign and transient in nature. Regardless of their severity, mitigating benign AEs is important to improve patient experience and quality of care. The aim of this study was to identify beliefs, perceptions an...

Background: Approximately 50% of patients who receive spinal manipulative therapy (SMT) experience some kind of adverse event (AE), typically benign and transient in nature. Regardless of their severity, mitigating benign AEs is important to improve patient experience and quality of care. The aim of this study was to identify beliefs, perceptions a...

This rapid review considers materials the WFC is aware have been cited in support of claims of effectiveness for spinal adjustment / manipulation in conferring or enhancing immunity.

Introduction Building and implementing a robust evidence-base which is informed by high quality research is the challenge facing contemporary healthcare professions. In doing so, it can be valuable for healthcare professions to establish a strategic research agenda in order to enhance the professions public health priorities within healthcare and a...

Objective: The purpose of this study was to conduct a systematic review of studies to determine whether sitting time measured objectively (by laboratory controlled time trial, direct observation, or wearable sensor) is associated with the immediate increase in low back pain (LBP) (determined by pain scale rating) in people >18 years of age. Metho...

Objective: The objective of this review is to identify and map current literature describing the center of rotation locations and migration paths during lumbar spine movements. Introduction: The importance of lumbar spine kinematics has been described and altered kinematics has been associated with pain and injury. Intervertebral segments' cente...

Synopsis: Individuals with back pain are often diagnosed with spine instability, even though it is unclear whether the spine is susceptible to unstable behavior. The spine is a complex system with many elements that cannot be directly observed, which makes the study of spine function and direct assessment of spine instability difficult. What is kn...

Background: Few, if any, patient reported symptoms have been shown to be related to objective measures ofspine function. Recently, patient-reported measures of disability following spinal manipulative therapy have beenassociated with an immediate decrease in spinal stiffness obtained by instrumented L3 indentation. Given thisnovel relation, we anti...

Objective: The purpose of this study was to quantify the threshold at which clinicians can detect a difference in spinal stiffness of the thoracic and lumbar spine via palpation and then determine if this detection threshold would affect a clinician's ability to identify changes in spinal stiffness as measured by an objective instrument. Methods:...

Background The chiropractic profession has a long history of internal conflict. Today, the division is between the ‘evidence-friendly’ faction that focuses on musculoskeletal problems based on a contemporary and evidence-based paradigm, and the ‘traditional’ group that subscribes to concepts such as ‘subluxation’ and the spine as the centre of good...

Objective Since the discovery of ionizing radiation, clinicians have evaluated X-ray images separately from the patient. The objective of this study was to investigate the accuracy and repeatability of a new technology which seeks to resolve this historic limitation by projecting anatomically correct X-ray images on to a person’s skin. Methods A t...

Purpose Our prior study revealed that people with non-specific low back pain (LBP) who self-reported a > 30% improvement in disability after SMT demonstrated significant post-treatment improvements in spinal stiffness, dynamic muscle thickness and disc diffusion, while those not having self-reported improvement did not have these objective changes....

letter to the editor; no abstract

Objectives: To: 1) develop/adapt and validate an instrument to measure patient safety attitudes and opinions of community-based spinal manipulative therapy (SMT) providers; 2) implement the instrument; and 3) compare results among healthcare professions. Methods: A review of the literature and content validation were used for the survey developm...

The tremendous cost, pain and disability associated with degenerative disc disease (DDD) makes the development of a biological agent that can mitigate the course of DDD, a critical unmet need. We have identified and reported that a single injection of a combination of recombinant human (rh) Transforming growth factor beta 1 (TGF-β1) and Connective...

BACKGROUND CONTEXT Clinicians of all disciplines learn to visualize internal anatomy to enhance diagnostic accuracy and reduce iatrogenic injury. Unfortunately, the performance of this skill is poor. To address this issue, our team developed technology that superimposes diagnostic images on to a patient's skin while minimizing distortion caused by...

BACKGROUND CONTEXT Degenerative disc disease (DDD) contributes significantly to the genesis of spinal pain. DDD-related spinal pain is an enormously expensive malady and a major cause of disability worldwide and no contemporary surgical treatments promote repair. Thus, there exists a need for the identification of effective, minimally invasive, reg...

Ultrafast ultrasound imaging is used to capture driven spinal vibrations as a new method for non-invasive spinal testing in living subjects. Previously, it has been shown that accelerometer-based vibration testing in cadaveric models can reveal the presence, location and magnitude of spinal pathology. However, this process remains an invasive proce...

Synopsis: Motor control exercise has been shown to be effective in the management of low back pain (LBP). However, the effect sizes for motor control exercise are modest, possibly because studies have used a one-size-fits-all approach, while the literature suggests that patients may differ in presence or type of motor control issues. In this comme...

Synopsis: Compared to healthy individuals, patients with low back pain demonstrate differences in all aspects of trunk motor control that are most often studied as differences in muscle activity and kinematics. However, differences in these aspects of motor control are largely inconsistent. We propose that this may reflect the existence of 2 pheno...

Background: Low back pain is a common and costly condition. Spinal manipulative therapy (SMT) is a treatment supported in some guidelines, although most clinical trials examining SMT report small effect sizes. Enhancing the effects of SMT requires an understanding of underlying mechanisms and a systematic approach to leverage understanding of mech...

Objective: Spinal stiffness assessments are commonly used by manual therapists. Although devices have been developed to objectively measure spinal stiffness, individual characteristics (i.e., sex, age, weight, height) may affect the measurement results. Therefore, this study aimed to describe the correlations between individual characteristics and...

Objective: To evaluate Australian and New Zealand chiropractic students' opinions regarding the identity, role setting, and future of chiropractic practice. Methods: An online, cross-sectional survey was administered to chiropractic students in all chiropractic programs in Australia and New Zealand. The survey explored student viewpoints about t...

In an evidence-based health care environment, healthcare professions require a sustainable research culture to remain relevant. At present however, there is not a mature research culture across the chiropractic profession largely due to deficiencies in research capacity and leadership, which may be caused by a lack of chiropractic teaching programs...

Background context: Previous studies found that the intervertebral disc (IVD) experiences the greatest loads during spinal manipulation therapy (SMT). Purpose: Based on that, this study aimed to determine if loads experienced by spinal tissues are significantly altered when the application site of SMT is changed. Study design: A biomechanical...

Abstract Background The measurement of Posterior-Anterior (P-A) spinal stiffness is a common component of the physical examination of patients presenting with spinal disorders. The aim of this assessment is to provoke pain and/or to determine the degree of resistance or compliance of these structures and the associated soft-tissues to loading. This...

We present the movement control approach as part of the treatment-based classification system. This approach proposes a movement control schema that clarifies that movement control is a product of the interplay among multiple biopsychosocial components. The schema illustrates that for movement to occur in a dynamically controlled fashion, the lumba...

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. This article is an edited and truncated version of the McAndrews Leadership Lecture given by Dr Greg Kawchuk on February 27, 2016...

Background Research funds are limited and a healthcare profession that supports research activity should establish research priority areas. The study objective was to identify research priority areas for the Canadian chiropractic profession, and for stakeholders in the chiropractic profession to rank these in order of importance. Methods We conduc...

Objective: To better understand the research resources and environment within the Canadian chiropractic profession. Methods: All members of the Canadian Chiropractic Association (n=7200) were invited to access an electronic survey on research capacity, activity, and resources. Canadian chiropractic stakeholder organizations received an invitatio...

Our research group recently published a Delphi study that identified Canadian chiropractic profession research priority areas. At the same time, the Canadian Chiropractic Research Foundation (CCRF) was developing their own research priority areas. In this commentary, we discuss the results of the Delphi study, compare and contrast these results to...

The internal anatomy of a patient can be difficult for clinicians and other patients to visualize and analyzed in context. The ability to project medical images (CT and MRI scans) directly onto a patient's body helps those viewing these images to recover missing anatomical context for more accurate interpretation. This paper proposes such a system....

Does feeling back stiffness actually reflect having a stiff back? This research interrogates the long-held question of what informs our subjective experiences of bodily state. We propose a new hypothesis: feelings of back stiffness are a protective perceptual construct, rather than reflecting biomechanical properties of the back. This has far-reach...

We present the movement control approach as part of the treatment-based classification system. This approach proposes a movement control schema that clarifies that movement control is a product of the interplay among multiple biopsychosocial components. The schema illustrates that for movement to occur in a dynamically controlled fashion, the lumba...

Objective: In order to define the relation between spinal manipulative therapy (SMT) input parameters and the distribution of load within spinal tissues, the aim of this study was to determine the influence of force magnitude and application site when SMT is applied to cadaveric spines. Methods: In 10 porcine cadavers, a servo-controlled linear...

Background Spinal manipulation (SM) is used commonly for treating low back pain (LBP). Spinal stiffness is routinely assessed by clinicians performing SM. Flexion-relaxation ratio (FRR) was shown to distinguish between LBP and healthy populations. The primary objective of this study was to examine the association of these two physiological variable...

Objectives: This investigation compared indirect 3-dimensional angular kinematics (position, velocity, and acceleration) of the lumbar spine for 2 different high-velocity, low-amplitude (HVLA) spinal manipulation procedures (lumbar spinous pull or push), and altered initial patient lower limb posture. Methods: Twenty-four participants underwent...

Study design: Comparative study using robotic replication of SMT vertebral kinematics together with serial dissection. Objective: To quantify loads created in cadaveric spinal tissues arising from three different forms of SMT application. Summary of background data: There exist many distinct methods by which to apply spinal manipulative therap...

Abnormal spinal segmental motion/stiffness is purported to be a cause, or an effect of, low back pain. Therefore, the assessment of posteroanterior segmental spinal stiffness is a common practice in clinical and research settings. In clinical settings, manipulative practitioners routinely assess spinal stiffness manually to guide clinical decision-...

Spinal manipulative therapy (SMT) creates health benefits for some while for others, no benefit or even adverse events. Understanding these differential responses is important to optimize patient care and safety. Toward this, characterizing how loads created by SMT relate to those created by typical motions is fundamental. Using robotic testing, it...

O1 The functional properties of paraspinal muscles in adolescents with idiopathic scoliosis (AIS): A systematic review of the literature Eric Parent, Alan Richter O2 The importance of the lateral profile in the treatment of idiopathic scoliosis Angelo Gabriele Aulisa, Vincenzo Guzzanti, Paolo Pizzetti, Andrea Poscia, Lorenzo Aulisa O3 Radiological...

Study Design An in vivo biomechanical study. Objective The aim of the present study was to quantify and compare the reaction loads for two spinal manipulation therapy (SMT) procedures commonly used for low back pain using a biomechanical computer model. Summary of Background Data Contemporary computer-driven rigid linked-segment models (LSMs) hav...

Objectives: The purpose of this study was to determine the accuracy of locating lumbar vertebrae using palpation vs ultrasonography. Methods: In this study, ultrasonic imaging was used by 2 experienced clinicians to identify the third lumbar spinous process (target) of a female participant. The target was then located by 16 undergraduate chiropr...

Background: While some patients with low back pain demonstrate increased spinal stiffness that decreases as pain subsides, this observation is inconsistent. Currently, the relation between spinal stiffness and low back pain remains unclear. This study aimed to investigate the effects of experimental low back pain on temporal changes in posteroante...

Structural health monitoring (SHM) is an engineering technique used to identify mechanical abnormalities not readily apparent through other means. Recently, SHM has been adapted for use in biological systems, but its invasive nature limits its clinical application. As such, the purpose of this project was to determine if a non-invasive form of SHM...

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...

Introduction: In the present study, we sought to quantify and contrast the secretome and biomechanical properties of the non-chondrodystrophic (NCD) and chondrodystrophic (CD) canine intervertebral disc (IVD) nucleus pulposus (NP). Methods: We used iTRAQ proteomic methods to quantify the secretome of both CD and NCD NP. Differential levels of pr...

Sequential dissection is a technique used to investigate loads experienced by articular tissues. When the joint of interest is tested in an unconstrained manner, its kinematics change with each tissue removal. To address this limitation, sufficiently rigid robots are used to constrain joint kinematics. While this approach can quantify loads experie...

While previous studies suggest braces/corsets can reduce acute pain, no prior study has assessed back function following bracing with both self-reported and objective measures. Use of both self-reported and objective measures of spine function together may be important given evidence they assess unique aspects of function. To assess both self-repor...

Non-randomized controlled studyObjective. To determine if low back pain (LBP) patients who respond to spinal manipulative therapy (SMT) differ biomechanically from non-responders and untreated asymptomatic controls. Some, but not all LBP patients report improvement in function after SMT. When compared to non-responders, studies suggest that SMT-res...

Cracking sounds emitted from human synovial joints have been attributed historically to the sudden collapse of a cavitation bubble formed as articular surfaces are separated. Unfortunately, bubble collapse as the source of joint cracking is inconsistent with many physical phenomena that define the joint cracking phenomenon. Here we present direct e...

Systematic investigations are needed identifying how variability in the biomechanical characteristics of spinal manipulation affects physiological responses. Such knowledge may inform future clinical practice and research study design. To determine how contact site for high velocity, low amplitude spinal manipulation (HVLA-SM) affects sensory input...

The authors have found that some of the data contained in this manuscript are categorized inappropriately. Many of the cases included from two case-control studies (Rothwell et al. and Stevinson et al.) should be omitted from the paper’s calculations as they were reported originally as cervical artery dissection cases in general, but not cervical a...

The spinal load sharing and mechanical stresses developed in the spine segments due to mechanical loads are dependent on the unique spinal anatomy (geometry and posture). Variation in spinal curvature alters the load sharing of the lumbar spine as well as the stiffness and stability of the passive tissues. In this paper, effects of lumbar spine cur...

Background Low back pain (LBP) is a major health issue due to its high prevalence rate and socioeconomic cost. While spinal manipulation (SM) is recommended for LBP treatment by recently published clinical guidelines, the underlying therapeutic mechanisms remain unclear. Spinal stiffness is routinely examined and used in clinical decisions for SM d...

Introduction A team of interdisciplinary research leaders have taken a novel approach to support a patient safety culture for spinal manipulation therapy (SMT) providers. The aim was to devise a team-based approach to identify modifiable and non-modifiable patient and provider risk factors. Methods SafetyNET has four main areas of inquiry, led by...

Abstract Assessment of spinal stiffness is widely used by manual therapy practitioners as a part of clinical diagnosis and treatment selection. Although studies have commonly found poor reliability of such procedures, conflicting evidence suggests that assessment of spinal stiffness may help predict response to specific treatments. The current stu...

The purpose of this study was to determine how the preload that precedes a high-velocity, low-amplitude spinal manipulation (HVLA-SM) affects muscle spindle input from lumbar paraspinal muscles both during and after the HVLA-SM. Primary afferent activity from muscle spindles in lumbar paraspinal muscles were recorded from the L6 dorsal root in anes...

Background / Purpose: Some conservative treatments are thought to improve clinical outcomes in persons with low back pain (LBP) by improving the activity of transversus abdominis and lumbar multifidus muscles. This systematic review aims to summarize evidence regarding which post-treatment characteristics of these muscles may predict clinical imp...

Unlabelled: Previous research describes an inconsistent relation between temporal changes in transversus abdominis or lumbar multifidus and temporal changes in clinical outcomes. Unfortunately, a relevant systematic review is unavailable. As a result, this systematic review was designed to summarize evidence regarding the association between tempo...

Like other factors that can influence treatment efficacy (eg, dosage, frequency, time of day), the site of treatment application is known to affect various physical interventions such as topical anesthetics and cardiopulmonary resuscitation. Like these examples, spinal manipulative therapy (SMT) is a physical intervention that may exhibit maximal b...

Although individual reports suggest that baseline morphometry or activity of transversus abdominis or lumbar multifidus predict clinical outcome of low back pain (LBP), a related systematic review is unavailable. Therefore, this review summarized evidence regarding the predictive value of these muscular characteristics. Candidate publications were...