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Chiropractic: A Critical Evaluation
Abstract
Chiropractic was defined by D.D. Palmer as "a science of healing without drugs." About 60,000 chiropractors currently practice in North America, and, worldwide, billions are spent each year for their services. This article attempts to critically evaluate chiropractic. The specific topics include the history of chiropractic; the internal conflicts within the profession; the concepts of chiropractic, particularly those of subluxation and spinal manipulation; chiropractic practice and research; and the efficacy, safety, and cost of chiropractic. A narrative review of selected articles from the published chiropractic literature was performed. For the assessment of efficacy, safety, and cost, the evaluation relied on previously published systematic reviews. Chiropractic is rooted in mystical concepts. This led to an internal conflict within the chiropractic profession, which continues today. Currently, there are two types of chiropractors: those religiously adhering to the gospel of its founding fathers and those open to change. The core concepts of chiropractic, subluxation and spinal manipulation, are not based on sound science. Back and neck pain are the domains of chiropractic but many chiropractors treat conditions other than musculoskeletal problems. With the possible exception of back pain, chiropractic spinal manipulation has not been shown to be effective for any medical condition. Manipulation is associated with frequent mild adverse effects and with serious complications of unknown incidence. Its cost-effectiveness has not been demonstrated beyond reasonable doubt. The concepts of chiropractic are not based on solid science and its therapeutic value has not been demonstrated beyond reasonable doubt.
... 68 Unique chiropractic terminology and concepts are points of attack for some detractors of chiropractic, who generalize by claiming that all chiropractors are antiscientific or cultists. [69][70][71][72][73][74] This has been used to question the validity of complementary medicine altogether. 69 The presence of an alternative paradigm to the biomedical or orthodox medical understanding of health and disease may be divisive between some groups within chiropractic. ...
... 78 Separate language that supports a paradigm of health alternative to that of mainstream biomedicine may reduce referrals from other health care professionals 9 and may be a source of conflict within the profession. 70 For example, one study found that Australian general medical practitioners had an unfavorable opinion of both osteopaths and chiropractors, although it is not clear whether terminology was the cause. 79 Students at different educational institutions within the same country may use different terminology. ...
Objective
The purpose of this study was to compare the prevalence of 5 chiropractic-specific terms on UK chiropractic websites to findings in a previous study in Australia and to provide an argument against the use of these terms.
Methods
We searched websites belonging to chiropractors registered with the General Chiropractic Council for 5 terms: subluxation, vital(-ism/-istic), wellness, adjust(-ing/-ment), and Innate (Intelligence). Of 3239 websites, 326 were sampled. Each page was searched, and terms were counted only if used in a chiropractic-specific context. Term occurrence and frequency were recorded. The data were analyzed using a single-sample χ² goodness-of-fit test for unequal proportions. The results were compared to those of our prior Australian study, using the χ² test of homogeneity to determine the differences between samples.
Results
At least 1 of the 5 chiropractic-specific terms was found on 245 (75%) of UK websites. Adjust(-ing/-ment) was found on 222 (68%) of UK websites compared to 283 (77%) in Australia; wellness on 67 (5%) of UK sites compared to 199 (33%) in Australia; vital(-ism/-istic) on 30 (9%) of UK sites compared to 71 (19%) in Australia; subluxation on 17 (5%) of UK sites compared to 104 (28%) in Australia; and Innate on 10 (3%) of UK sites compared to 39 (11%) in Australia. A χ² test found that the terms were not equally distributed in the two samples, χ42 = 404.080, P < .001. In the discussion, we explain why we feel that chiropractic-specific terms should be abandoned and standard biomedical terms used.
Conclusion
In the sample of websites we evaluated in this study, the majority in the United Kingdom used the 5 chiropractic-specific terms that we searched for. The terms were used less frequently than on websites in Australia but were in a similar order of prevalence.
... Chiropractors are healthcare professionals who offer services in diagnosis, treatment, prevention of neuromuscular skeletal system disorders and their effect on public health, focus on dysfunctions, and use manual therapies such as joint adjustment and manipulation. [3][4][5]. The building blocks of chiropracty consist of the interaction between the structure composed of the spine and the musculoskeletal system and functions of the nervous system. ...
... The building blocks of chiropracty consist of the interaction between the structure composed of the spine and the musculoskeletal system and functions of the nervous system. And the fundamental philosophy of chiropracty is to protect health and resolve health problems [3]. ...
T h e J o u r n a l of O r t h o p a e d i c s T r auma S u r g e r y a n d Relat e d R e s e a r c h © J ORTHOP TRAUMA SURG REL RES Abstract Introduction: The aim of this study is to investigate the immediate effects of chiropractic thoracic manipulations on the autonomic nervous system through heart rate variability data. The study includes 30 healthy individuals and thoracic spine physical examinations were performed before the application of the chiropractic thoracic manipulations. The 30 participants were randomly divided into two groups: an experimental group and a placebo group. Thoracic manipulations were applied after 5 minute Heart Rate Variability (HRV) measurement of each 15 individuals in the experimental group via the eMotion Faros device. The 15 participants in the placebo group were also subjected to the same measurements and analyses before sham manipulations. The measurements were then repeated after the manipulations for the two groups. Consequently, the data obtained by these measurements was evaluated by the Kubios HRV analysis software.
... The use of unique terms also allows detractors to generalise these concepts to all chiropractors [76,[79][80][81]. It has even been shown to prompt people to question the validity of complementary medicine altogether [79]. ...
... Similarly, lack of moral authority because of traditional beliefs persistent in homeopathy have threatened public funding and perceptions of legitimacy in that profession [84,85]. Diversity in chiropractic care has been found to deter referrals from other professions to chiropractors and to be a source of internal conflict [10,80]. Student populations at different educational institution have been found to use different lexicons, either more scientific or more traditional, depending on the institution, so tolerance for diversity in education seems to contribute to division as well [86]. ...
Background:
Chiropractors use words and phrases in unique ways to express traditional, chiropractic-specific theories. This lexicon represents concepts that reinforce the separation of chiropractic from other health care professions. It may impact referrals both to and from chiropractors, lead to public confusion about health care issues, and reduce cross-disciplinary research. Therefore, it is important to understand how prevalent chiropractic-specific terms are in publicly available media.
Methods:
Five chiropractic terms were selected: subluxation, adjustment, vital (-ism/-istic), wellness, and Innate (Intelligence). States and territories in Australia were proportionately sampled according to population of chiropractors using a Google search for chiropractors' private practice websites. The top results were recorded. Websites were word-searched on every publicly available page for the five terms. Context was checked to count only terms that were used to support a chiropractic-specific concepts. The number of occurrences of each term was recorded, tallied nationally and by state/territory. Descriptive statistics were applied to determine prevalence.
Results:
Three hundred sixty-nine websites were sampled, based on an estimate of 5500 chiropractors practising in Australia. Nationally, 85% of chiropractors used one or more terms. The term adjust (-ing/-ment) occurred most frequently, being found on 283 websites (77%) with a total of 2249 occurrences. Wellness was found on 199 websites (54%) with 872 occurrences; subluxation was found on 104 websites (28%), 489 occurrences; vital (-ism/-istic) on 71 websites (19%) with 158 occurrences; and Innate was least used, being found on 39 websites (11%) with 137 occurrences.
Conclusion:
A majority of the Australian chiropractors sampled used one or more chiropractic-specific terms on their websites. Future research should explore the effects of chiropractic language on the public, policy-makers, and other health care professionals.
... Massage therapy involves manipulating the muscles and other soft tissues of the body. In the United States, massage therapy is sometimes seen as a part of conventional medicine [7]. ...
Chronic pain is a debilitating condition that affects many individuals throughout their daily lives. While it is common to treat chronic pain with pharmaceutical treatments, an approach that has also shown great benefits is the use of integrative medicine, such as massage therapy, osteopathic and spinal manipulation, acupuncture, and yoga. The keywords "integrative medicine," "pain," "chronic pain," and "pain management" with the use of the Boolean operators "AND," "OR," and "NOT" were used to identify relevant studies discussing the effectiveness of alternative medicine in the treatment of chronic pain. Massage therapy uses different forms of pressing, rubbing, and moving of muscles and other soft tissues, and has shown short-term benefits for chronic pain relief. Osteopathic and spinal manipulation is mainly used in treating muscles, tendons, and bone pain due to worn-out joints, torn ligaments, and more. Acupuncture involves penetrating the skin with thin needles which are activated through gentle and specific movements. According to our review, acupuncture and massage therapy are effective for short-term treatment, lasting three to five months for chronic pain. Yoga involves various physical, mental, and spiritual practices or disciplines that have shown beneficial results in the treatment of chronic pain. Combining yoga with physical therapy has shown significant benefits. This review aims to describe the benefits and uses of integrative medicine in the treatment of chronic pain.
... Lemon grass (Cymbopogon citrates) was used in traditional medicine. It belongs to the Poaceae family, and a native to warm temperate and tropical regions (Ernst, 2008). In recent years, the number of scientific papers concerning pomegranate (Punica granatum L.) and its health properties has increased greatly. ...
... Lack of solid scientific concept at the basis of this method 35 , except for back pain. Massage Therapy Small effects on short-term observed in case of low-back pain 22 . ...
Osteoarticular pain is a common condition in the adult population. It is a nociceptive pain modulated by different factors, and it is one of the major symptoms that force patients to seek medical advice. Since osteoarticular pain has a complex pathophysiology and it is not a linear condition, we propose in this paper an original approach to osteoarticular pain by paradigms, where a paradigm refers to a framework of concepts, results, and procedures within which subsequent work is structured. The paradigm presented is a conceptual tool that could help clinicians to choose the correct therapy considering both pain characteristics and clinical features.
... • мануални манипулации на гръбначен стълб; • мануални мобилизации на периферни стави; • мускулно-инхибиращи техники; • физикални фактори; • масажни техники; • препоръки свързани с начина на живот (7). Днес хиропрактиката е лицензирана и регулирана професия в много страни, където се практикува съгласно националното законодателство (5,13). ...
... GETAT Uygulamaları Yönetmeliği'nin (17) 2014 yılında yürürlüğe girmesiyle birlikte uygulanabilecek 15 farklı yöntemin genel hatları belirlenmiş, bilimselliğin hakim olduğu bir konu olarak sağlık sistemine dahil edilmiştir (18). Bu yöntemler içerisinde cildin belirli yerlerine özel olarak üretilmiş iğneler yerleştirilerek çeşitli rahatsızlıkların iyileştirmesini sağlayan akupunktur (19), arı ve arı ürünlerinin kullanıldığı apiterapi (20), geleneksel şekilde bitkisel ürün ve ilaçların kullanıldığı fitoterapi (21), uyaran ve dikkat azaltılmasını sağlayan farklı telkin metotlarının kullanıldığı hipnoz (22), bölgesel antikoagülan etki sağlamak için steril sülük (23), hastalık belirtilerinin sağlıklı bir kişide meydana gelmesini sağlayabilecek ürün veya maddelerin hastaya çok düşük dozlarda verilmesi prensibine dayanan homeopati (24), kas iskelet sistemine elle uygulamaların yapıldığı kayropraktik (25), esnetme ve masaj şeklinde yapılan osteopati (26), cilde yüzeyel kesikler yapılarak uygulanan kupa tedavisi (27), ölü dokuları uzaklaştırmada kullanılan steril larva (17), çeşitli deri hastalıklarının tedavisinde kullanılan mezoterapi (28) yer almaktadır. Bunların dışında ligament ve tendonlarda yeni hücre gelişimini sağlayan proloterapi (29), hastadan alınan kanın vücut dışında ozonla etkileşime maruz kaldıktan sonra hastaya geri verilmesi şeklinde uygulanan ozon terapi (30), vücudun her bölgesinin temsili bir yerin olduğu fikrinden yola çıkan refleksoloji (31), seçilmiş ve kaydedilmiş müzikler ile rahatsızlıkların iyileştirilmesine çalışan müzik terapi (32) GETAT kapsamında uygulanmaktadır (33). ...
Amaç: Bu çalışma ile kronik hastalığı olan 65 yaş ve üstü bireylerin, akılcı ilaç kullanımı ve geleneksel tıbba yönelik tutumlarının incelenmesi amaçlanmıştır. Gereç-Yöntem: Araştırma bir özel hastane polikliniklerine başvuran 65 yaş ve üstü kronik hastalığa
sahip bireylerle Aralık 2021- Ocak 2022 tarihleri arasında gerçekleştirilmiştir. Çalışmaya 152 hasta katılmıştır. Araştırmada veri toplama aracı olarak sosyo-demografik özellikler formu, akılcı ilaç kullanımı ölçeği ve geleneksel ve tamamlayıcı tıbba karşı tutum
ölçeğinden yararlanılmıştır. Bulgular: Çalışmaya katılan bireylerin hastalık tanıları incelendiğinde kalp hastalığı (%31,6) ve romatizmal hastalıklar (%27,0) ilk sıradadır. En sık uygulanan GETAT yöntemi ise %34,9 ile bitkisel ürün/ilaçtır. Katılımcıların Akılcı İlaç Kullanımı Ölçeği puan ortalaması (33,55±3,16) bulunmuş olup düşük düzeydedir.
Geleneksel ve tamamlayıcı tıbba karşı tutum ölçeği puan ortalaması (29,01±6,06) bulunmuş ve olumlu tutuma sahip oldukları tespit edilmiştir. Akılcı ilaç kullanımı ile GETAT’a yönelik tutum arasında istatistiksel olarak anlamlı farklılık bulunmamıştır (r=-0,06; p=0,45). Sonuç: Kronik hastalığa sahip 65 yaş üstü bireylerin GETAT yöntemleri
hakkında olumlu tutuma sahip oldukları saptanmışken akılcı ilaç kullanımı ile GETAT tutumu arasında istatistiksel olarak anlamlı farklılık bulunmamıştır.
... This disorder was also observed in chiropractic (a derivation of osteopathy) and acupuncture (which originated in ancient Asian medicine) [33,34]. These alternative therapies continue to be the subject of controversy because their original concepts predate modern medicine, and even today there is a divide between those who practice them strictly following the original empirical principles and those who are trying to adapt them to the scientific method [35,36]. Despite being controversial, many patients with chronic pain opt for alternative therapies because they do not find relief with conventional treatment. ...
Musculoskeletal pain involving a region of the spine with radiation to the head, trunk, or extremities is relatively common in daily medical practice, such as upper�neck pain with headache, lower-neck pain and discomfort in the shoulders and arms, or low-back pain with sciatica. The instability of a vertebral segment produces a
persistent barrage of nociceptive impulses that trigger peripheral and central sensitization phenomena, affecting the metamere innervated by the corresponding nerve
root. This process produces clinical manifestations of hyperalgesia and/or allodynia in dermatomes, myotomes, and sclerotomes with a typical regional distribution
known as spinal segmental sensitization (SSS). The activation of new peripheral nociceptive foci within the affected metamere can further aggravate the clinical
picture. This disorder is usually classified as non-specific for being a somatosensory nervous system dysfunction without evident structural damage, which can lead
to confusion since the magnitude of pain and disability reported by the patient appear to be disproportionate to the findings of auxiliary tests. In the absence of a
timely diagnosis and adequate treatment, patients may resort to alternative therapies, which often do not solve the problem. The use of a standardized set of diagnostic
criteria will help clinicians identify SSS and help researchers conduct studies in homogeneous populations. This review of its pathophysiology provides a foundation
for rationally and systematically establishing the best treatment schemes and thus will benefit the many patients who suffer from this syndrome, which represents a
challenge for medicine today.
... There is evidence that chiropractic medicine may help back pain to some degree (Walker, et al., 2010). Other claims for the key chiropractic spinal manipulation method are not well supported by high quality scientific evidence (Ernst, 2008). There do not seem to have been any chiropractic bibliometrics papers, other those focusing on article types (e.g., Pohlman et al., 2009). ...
Some complementary and alternative medicines (CAM) are frequently criticised for being based on faith rather than scientific evidence. Despite this, researchers, academic departments, and institutes teach and investigate them. This article assesses whether the scholarship produced by four CAMs is valued by the academic community in terms of citations, and whether the level of citations received might be detrimental to academic authors’ careers. Based on an analysis of acupuncture, chiropractic, homeopathy, and osteopathy journal articles indexed in Scopus 1996–2020, the results show that the prevalence of the four areas vary substantially internationally, with acupuncture eclipsing the others in East Asia but homeopathy being more common in India and Brazil. The main broad fields publishing these specialties are Medicine, Nursing, Health Professions, Veterinary Science, and Neuroscience. Whilst the research tends to be cited at a below average rate in most broad fields (n = 27) and years (1996–2017), acupuncture, chiropractic, and homeopathy are exceptions in some broad fields, including some core areas. Thus, studying these alternative medicines may not always lead to research that tends to be ignored in academia, even if many scientists disparage it. As a corollary, citation analysis cannot be relied on to give low scores to widely disparaged areas of scholarship.
... The purpose of chiropractice is to identify biomechanical dysfunctions, mainly in the vertebral column, and re-establish them by means of precise manipulations. Although it is described as a safe practice which doesn't make use of drugs, usually associated with transient adverse effects -including local or radiating pain, headache and tiredness, severe vascular accidents, such as cervical arterial dissection and stroke, have been described due to manipulations of the upper spine (9). In light of this, as well as other healthcare practitioners, also chiropractors can be involved in cases of professional liability (10)(11)(12)(13). ...
Introduction:
Water intoxication is a well-recognized cause of symptomatic hyponatremia, whose often fatal consequences are de-scribed in a wide variety of conditions such as psychiatric disorders, metabolic dysfunctions, child abuse, drug abuse and several medical procedures.
The case:
We here report a rare case of a 67-year-old woman with severe acute hyponatremia due to an excessive voluntary water intake - 14 litres in two days - following a chiropractic prescription. The patient developed sudden severe symptoms, including water retention, sensory alteration, altered mental status and tonic-clonic seizures. She was thus admitted to the Intensive Care Unit with a diagnosis of coma due to electrolyte alterations following water intoxication.
Conclusion:
The evaluation, in the present case, of the medico-legal implications related to malpractice involving a practitioner of Complementary and Alternative Medicine, led to the admission of a professional liability of the chiropractor.
... Cymbopogon citratus of the Poaceae family is a tall, monocotyledonous aromatic perennial plant with slender sharp-edge green leaves and pointed apex. Lemongrass, Cymbopogon citratus is one of the important leaves among the species of grasses, and has various applications in traditional medicine (Ernst, 2008). In Nigeria, the Edos call it: eti, Efik: Ikon eti, Hausa call it: tsauri, Ibibio: myobaka makara, Igbo (Owerri) call it: achara ehi and Yoruba call it: kooko oba (Ahmad and Beg, 2001). ...
The indiscriminate use of drugs, medication and non-adherence are one of the factors that has led to the emergence of multi-drug resistant Salmonella typhi. This study was conducted to assess the incidence of typhoid fever among out-patients in some selected Specialist Hospitals in Ilorin Metropolis and to determine the susceptibility of the causative agent to antibiotics and plant extract of Cymbopogon citratus. A cross-sectional survey was completed over a five-month surveillance period in these four locations namely: The Children Specialist Hospital Centre Igboro; Cottage Hospital; Adewole Specialist Hospital Alagbado; and Civil Service Hospital with a total of about 400 blood samples from out-patients across ages. Antibiogram profiling of the isolates to standard gram-negative antibiotics and antibacterial activity of Cymbopogon citratus extracts were determined using disc diffusion method. A total of Eight (8) Salmonella typhi isolates were recovered collectively from the patients. All the isolates were multi-drug resistant with a notable resistance to chloramphenicol, ampicillin and co-trimoxazole. Molecular confirmation of the isolates showed DNA size of 500 base pairs. The ethanolic extract of Cymbopogon citratus was more potent with MIC of 12.5mg/ml and MBC 25mg/ml while the phytochemical screening of the plants revealed the presence of alkaloids, flavonoids, phenols, tannins, saponins, steroids and glycosides. The promising outcome of the plant extract against Salmonella typhi posits its possible application in treatment against the infectious agent.
... The problems with this ideology have been discussed elsewhere [9][10][11][12]. Suffice it say that at best chiropractic vertebral subluxation (VS) as a cause of disease is a potentially testable hypothesis, at worst it is a dogmatically retained anachronism that does not have any role in the twenty-first century health care system. ...
Background
The COVID-19 pandemic has seen the emergence of unsubstantiated claims by vertebral subluxation-based chiropractors that spinal manipulative therapy has a role to play in prevention by enhancing the body’s immune function. We contend that these claims are unprofessional and demonstrate a disturbing lack of insight into the doctrine of informed consent. As such it is timely to review how informed consent has evolved and continues to do so and also to discuss the attendant implications for contemporary health practitioner practice.
We review the origins of informed consent and trace the duty of disclosure and materiality through landmark medical consent cases in four common law (case law) jurisdictions. The duty of disclosure has evolved from a patriarchal exercise to one in which patient autonomy in clinical decision making is paramount. Passing time has seen the duty of disclosure evolve to include non-medical aspects that may influence the delivery of care. We argue that a patient cannot provide valid informed consent for the removal of vertebral subluxation. Further, vertebral subluxation care cannot meet code of conduct standards because it lacks an evidence base and is practitioner-centered.
The uptake of the expanded duty of disclosure has been slow and incomplete by practitioners and regulators. The expanded duty of disclosure has implications, both educative and punitive for regulators, chiropractic educators and professional associations. We discuss how practitioners and regulators can be informed by other sources such as consumer law. For regulators, reviewing and updating informed consent requirements is required. For practitioners it may necessitate disclosure of health status, conflict of interest when recommending “inhouse” products, recency of training after attending continuing professional development, practice patterns, personal interests and disciplinary findings.
Conclusion
Ultimately such matters are informed by the deliberations of the courts. It is our opinion that the duty of a mature profession to critically self-evaluate and respond in the best interests of the patient before these matters arrive in court.
... Most chiropractors provide multimodal treatment of musculoskeletal conditions that includes, manipulation of the spine and extremities, various soft tissue therapies as well as exercise prescription amongst other lifestyle advice [33][34][35]. However, the profession of chiropractic is frequently referred to as a monotherapy [36] particularly by medicine and other allied health professions [37,38]. This has resulted in a perception that most if not all chiropractic treatment involves manipulation of the spine [sometimes referred to as an adjustment) [39]. ...
Background
This paper presents a case of an evolving unusual thunderclap headache that presented to a chiropractor.
Case presentation
The intense “migraine-like” headache was aggravated by standing up and relieved substantially when lying down. This low pressure, orthostatic headache was diagnosed as a spontaneous intracranial hypotension (SIH) secondary to a spontaneous tear of the dura. It was referred to the local hospital for management with autogolous blood injection to form an epidural blood patch of the defect. It resolved substantially within 3 days.
Conclusions
The significance of key features in the history and examination and how if not recognised and subsequently treated with manual therapy, the dural tear could be attributed to the treatment of the chiropractor, a treatment that would typically involve cervical manipulation. Discussion is provided of the implications of a missed diagnosis and possible subsequent chiropractic management with the evolving SIH being attributed to the chiropractic intervention rather than its true “spontaneous” nature.
... This is remarkable, as the term 'subluxation' does not represent a reproducible clinically diagnosable entity [54]. Currently 'subluxation' remains a theoretical concept without evidence for its existence or ability to impact on the wellbeing of patients [55][56][57] and the intra and inter-reliability of students' or practitioners' ability to detect 'subluxations' is little better than chance [58][59][60]. ...
Background:
Chiropractors see themselves as well positioned to provide safe, effective and economical care for the on-going financial burden that spinal pain imposes. However, in many places of the world, the chiropractic profession continues to find itself struggling to gain acceptance as a mainstream allied health care provider. There is evidence of the existence of undesirable chiropractic practice patterns and it is in part due to some of the world's accredited chiropractic programs. This indicated a need for scrutiny of international chiropractic educational accreditation standards, which are the responsibility of Councils on Chiropractic Education (CCEs). To this end we reviewed an emerging body of evidence about the chiropractic educational system in order to identify issues and make recommendations that may enhance professional acceptance through improved graduate outcomes and hopefully the quality of patient care. This commentary summarises the findings of that research.
Main text:
We reviewed recent relevant studies, including our own, into the role and function of CCEs and found that there is sufficient evidence to identify areas of concern that could be addressed, at least in part, by improvements to CCEs' educational standards and processes. Areas included a lack of definitions for key terms such as, 'chiropractic', 'diagnosis', and 'competency', without which there can be no common understanding at a detailed level to inform graduate competencies and standards for a matching scope of practice. Further, there is some evidence to suggest that in some cases this level of detail is avoided in order to enable a "big tent" approach that allows for a diversity of approaches to clinical care to co-exist. This combined with the held view that chiropractic is "unique", highly valued, and best understood by other chiropractors, explains how students and practitioners can cling to 'traditional' thinking. This has implications for public safety and patient quality of care.
Conclusion:
If chiropractic care is to gain mainstream acceptance worldwide then it needs to adopt, through revitalised CCE accreditation standards and processes, those of other allied healthcare professions and wholeheartedly embrace science, evidence-based practice and patient centred care.
... Most of the current clinical practice and manual techniques used by the majority of practitioners defined as "experts in manipulative treatments," are based on biomechanical assumptions at the root of the patient's symptoms, with palpatorily identifiable dysfunctions, that can be treated by means of specific techniques aimed at joint tissue [3][4][5], myofascial tissue [6][7][8], or nervous tissue [9]. ...
Manual Therapy is one of the most widely used therapeutic solutions in the treatment of pain and musculoskeletal disorders. Its evolution began several centuries ago and culminated in the modern reference methods in the field of physiotherapy, osteopathy, and chiropractic, which mainly address the treatment of joint and myofascial tissues. The advent of evidence-based medicine and the ever-growing literature available in the field of Manual Therapy has led this therapeutic approach to be heavily criticized on the basis of studies that have shown its limitations with regard to manual and palpatory assessment techniques, the poor biomechanical validity of therapeutic methods, and the poor long-term results in the treatment of patients with musculoskeletal pain. A better understanding of the mechanisms underlying the effectiveness of Manual Therapy, as well as of the mediators of the medium- and long-term effectiveness of musculoskeletal rehabilitation processes, has made it possible to reconsider the role of Manual Therapy and the healthcare professionals specializing in manipulative therapy within the framework of the biopsychosocial model, which focuses on the patient and their functionality.
... Also, Adegbite (2003) indicate that C. odorata extracts inhibited egghatch in M. incognita. Cymbopogon citrates, family Poaceae is a tall monocotyledonous perennial plant cultivated in Africa and Central and South America and other tropical countries (Ernst, 2008). C. citratus is consumed in various forms because of its high antioxidant levels. ...
Studies were conducted on the nematicidal properties of Jatropha curcas, Cymbopogon citratus and Chromolaena odorata and Carbofuran 5G. Consequently, hot water extracts of the plants and the nematicide at 20, 35 and 50 % concentrations were applied to 5-week old stem cuttings of T. triangulare in 5 kg of sterilized soil and inoculated with 5,000 eggs and second stage juveniles of M. javanica. The control had no nematode, plant extracts and cabofuran, thereafter uninoculated-untreated (Uit) and another had nematode suspension, but no extracts and nematicide [inoculated-untreated (Ut)]. The experiment was a factorial in a completely randomized design, with four replications. Data on the number of leaves, seeds and flowers, nematode population in the soil and root of T. triangulare including root galling index were obtained and subjected to Analysis of Variance. Results show that number of leaves was significantly (P≤0.05) higher in Uit (25.75) and carbofuran at 20% concentration (21.0) than in the Ut (11.25). There were no significant differences in the number of flowers and seeds, although visual observations show that number of seeds was higher in Uit (13.5). Nematode populations in the root and soil were significantly lower in J. curcas at 50% concentration (30.0 and 9.0) respectively, compared to others at the same concentration except in carbofuran for nematode in the soil. Also, gall index was lowest in J. curcas extract at 50% concentration. Thus, J. curcas extract was more effective in managing root-knot nematode in waterleaf than cabofuran.
... In our opinion, this middle ground is becoming increa singly harder to reconcile and thus difficult to hold, as the marital difficulties inevitably play out more openly, because of the increasing general public interest in chiropractic [51][52][53][54]. Therefore, we contend that members of the middle group will eventually have to choose sides between adhering to a scope of evidence-friendly practice relating to musculoskeletal problems or to a traditional approach aiming at treating a multitude of conditions through spinal manipulation. ...
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 health. This difference is becoming increasingly obvious and problematic from both within and outside of the profession in light of the general acceptance of evidence-based practice as the basis for health care.
Because this is an issue with many factors to consider, we decided to illustrate it with an analogy. We aimed to examine the chiropractic profession from the perspective of an unhappy marriage by defining key elements in happy and unhappy marriages and by identifying factors that may determine why couples stay together or spilt up.
Main body
We argue here that the situation within the chiropractic profession corresponds very much to that of an unhappy couple that stays together for reasons that are unconnected with love or even mutual respect. We also contend that the profession could be conceptualised as existing on a spectrum with the ‘evidence-friendly’ and the ‘traditional’ groups inhabiting the end points, with the majority of chiropractors in the middle. This middle group does not appear to be greatly concerned with either faction and seems comfortable taking an approach of ‘you never know who and what will respond to spinal manipulation’. We believe that this ‘silent majority’ makes it possible for groups of chiropractors to practice outside the logical framework of today’s scientific concepts.
Conclusion
There is a need to pause and consider if the many reasons for disharmony within the chiropractic profession are, in fact, irreconcilable. It is time to openly debate the issue of a professional split by engaging in formal and courageous discussions. This item should be prioritised on the agendas of national associations, conferences, teaching institutions, and licensing/registration as well as accreditation bodies. However, for this to happen, the middle group of chiropractors will have to become engaged and consider the benefits and risks of respectively staying together or breaking up.
... However, many questions remain about the safety of the use of CAM for headache or migraine during pregnancy. For example, commentators stated safety issues in relation to some manual therapies which have not been sufficiently defined or reported, 27 and the efficacy of many CAM products for headache or migraine has not been adequately determined during pregnancy. 28 Detailed investigation into the use of CAM by women with headache or migraine during pregnancy is essential to understand the characteristics of this use and to ensure that CAM is being used effectively and safely. ...
Objectives
Little is known about women’s use of health services affected by headache or migraine during pregnancy. This paper directly addresses the research gap reporting on the healthcare utilization among Australian pregnant women experiencing headache or migraine.
Design and setting
In this retrospective observational study, data on 1,835 Australian pregnant women were obtained from the nationally-representative Australian Longitudinal Study on Women’s Health. Information on quality of life and health seeking behaviors regarding conventional medicine and complementary and alternative medicine providers was identified among these participants. Factors associated with healthcare use were analyzed using regression analyses.
Results
A total of 16% of the pregnant women surveyed experienced headache or migraine, and over 20% sought help from more than two types of healthcare practitioners for their headache or migraine. General practitioners (37.8%) were the most commonly consulted providers of pregnant women for their headache or migraine. Women with headache or migraine during pregnancy had worse health-related quality of life than those without. Education level and private health insurance status of pregnant women are the predictors of the use of healthcare practitioners for their management of headache or migraine (both p < 0.05).
Conclusions
Headache or migraine during pregnancy significantly impacts upon pregnant women’s quality of life. The use of multiple healthcare practitioners, including conventional medicine and complementary and alternative medicine practitioners, highlights the need for further research investigating health services utilization of pregnant women with headache or migraine in different severity and frequency to help inform effective and safe treatment.
... Many studies have evaluated the effectiveness of chiropractic treatments in treating various disorders, but with contradictory results. The treatment of back pain is the only proven benefit of chiropractic treatments (5). Chiropractic is widely established in USA, Canada and Australia, while in Europe it is far less. ...
Objectives
To determine the usefulness of manual treatment in reducing or eliminating pregnancy symptoms during first and second trimester.
Methods
Manual treatment of the cervical and thoracic spine was performed in a group of 115 pregnant women who developed pregnancy symptoms during normal pregnancy. A rotational traction of the cervical spine was applied. Patients in whom the treatment was unsuccessful underwent second round of treatment after a pause of a minimum 3 days. Patients for whom the treatment was initially successful but later relapsed also repeated whole procedure. Pregnancy symptoms analyzed in this study were heartburn, nausea, vomiting, dizziness, headache, insomnia, neck pain, hyperosmia and hypersalivating.
Results
Manual treatment successfully treated pregnancy symptoms in 91 (79.1%) patients, it was partially successful for 22 (19.1%), and unsuccessful for 2 patients (1.7%) after the first treatment. After the second treatment, out of a total 56 patients, the treatment was completely successful in 40 (71.4%), partially successful in 14 (25%), and unsuccessful in 2 (3.6%) patients. The highest success rate was in eliminating headache (97.3%), vomiting (95.9%), dizziness (94.5%), nausea (92.9%), neck pain (92.9%), insomnia (91.9%), heartburn (88.8%), hyperosmia (78.5%) and hyper salivating (78%).
Conclusion
Manual therapy in pregnancy is a drugless, etiological, usually highly effective therapy. It is a low cost, rapid, safe, and well tolerated treatment for pregnancy symptoms which frequently has an immediate effect, thus making it an optimal treatment for pregnancy symptoms.
... As discussed in previous sections, this positionwhich appears to have arisen due to stubborn adherence to vitalistic ideologyhas limited acceptance, hindered interprofessional cooperation within health care and brought ridicule from both the academic and scientific communities [86]. Perhaps worst of all, it has perpetuated a subculture of unethical practice, negatively impacting cultural authority [7,72] and limiting utilisation. ...
Since its inception, the chiropractic profession has been divided along ideological fault lines. These divisions have led to a profession wide schism, which has limited mainstream acceptance, utilisation, social authority and integration.
The authors explore the historical origins of this schism, taking time to consider historical context, religiosity, perpetuating factors, logical fallacies and siege mentality.
Evidence is then provided for a way forward, based on the positioning of chiropractors as mainstream partners in health care.
... In some parts of the world chiropractors are highly integrated in insurance or government funded healthcare programs and educated in government funded universities, whereas in other parts chiropractors are educated in private schools and practice as complementary and alternative practitioners completely outside of mainstream healthcare. Further, some academic authorities outside of chiropractic dismiss chiropractic as a legitimate health care profession [4], whereas others publically endorse the role of chiropractors in the management of specific health problems [5], adding to the confusion about the role the chiropractic profession plays. ...
While in some jurisdictions chiropractic is fully integrated in public and insurance funded health care systems, in others it is outside and considered as complementary or alternative health care. There is a paucity of data and rigorous scientific studies regarding most aspects of chiropractic practice although research activity has been increasing in recent years. We call for papers for a thematic series in Chiropractic and Manual Therapies that can help define chiropractic better to stakeholders inside and outside the profession under the theme What is Chiropractic?
... Worse yet, from an epidemiological perspective (strength of association, specificity, temporality, dose response, experimental evidence, biological plausibility, coherence and analogy), the subluxation is found to be wanting [83] as is adherence to subluxation theory as a mode of practice [70,[84][85][86][87][88][89]. ...
Aim
This paper examines appeal to fear in general: its perceived positive aspects, its negative characteristics, its appropriate as well as its fallacious use.
Background
Appeal to fear is a commonly used marketing method that attempts to change behaviour by creating anxiety in those receiving a fearful message. It is regularly used in public health initiatives such as anti-smoking, anti-drunk driving campaigns as well as in hypertension awareness campaigns. Some chiropractors appear to use appeal to fear to promote subluxation awareness and thereby encourage the use of chiropractic treatment.
Research supporting its use is equivocal; nevertheless, when used judiciously, appeal to fear probably has sufficient strengths to warrant its continued conditional use. When used to promote care for which there is no supporting evidence, its use is fallacious.
Discussion
Appeal to fear has been used in health promotion campaigns for sixty years or more with the intent of modifying behaviours. While there is evidence to suggest that appeal to fear may motivate some individuals to modify offending behaviour or adopt recommended behaviour there is growing resistance to the use of appeal to fear on ethical and psychological grounds. Using appeal to fear as a tool of persuasion can be valid or fallacious depending on the truth of the premises within the argument.
When used to raise awareness about genuine health concerns such as smoking, drunk driving and hypertension appeal to fear is considered to be a valid approach with certain caveats. However, when appeal to fear, not based on evidence or reason, is used as motivator to get others to accept unnecessary interventions for unproven disorders, the use of appeal to fear is fallacious.
Conclusion
In spite of the evidence against its use, it seems likely that appeal to fear will continue to be used in conjunction with other public awareness initiatives to modify recognized detrimental behaviours such as smoking and drunk driving as well as silent killers such as hypertension. However, when used to promote a treatment that has no evidentiary basis such as subluxation based practice in chiropractic the appeal to fear is a fallacy and must be stopped.
... This failure to respond, he argued, was due to a loss of tone in an organ or body system which, when restored or recovered, would build health and empower a person to reach their 'destiny'. Palmer used the analogy of musical tone to describe a cause-and-effect model of health and disease for chiropractic, which was at odds with causeand-effect models of other health professionals [12]. Since then, the profession has evolved and basic concepts such as tone are being questioned [47]. ...
Study design:
Concept analysis.
Introduction:
This paper is a report on the analysis of the concept of tone in chiropractic.
Purpose:
The purpose of this paper is to clarify the concept of tone as originally understood by Daniel David Palmer from 1895 to 1914 and to monitor its evolution over time.
Methods:
Data was sourced from Palmer's original work, published between 1895 and 1914. A literature search from 1980 to 2016 was also performed on the online databases CINHAL, PubMed and Scopus with key terms including 'tone', 'chiropractic', 'Palmer', 'vitalism', 'health', 'homeostasis', 'holism' and 'wellness'. Finally hand-searches were conducted through chiropractic books and professional literature from 1906 to 1980 for any references to 'tone'. Rodgers' evolutionary method of analysis was used to categorise the data in relation to the surrogates, attributes, references, antecedents and consequences of tone.
Results:
A total of 49 references were found: five from publications by Palmer; three from the database searches, and; the remaining 41 from professional books, trade journals and websites.
Major conclusions:
There is no clear interpretation of tone in the contemporary chiropractic literature. Tone is closely aligned with functional neurology and can be understood as an interface between the metaphysical and the biomedical. Using the concept of tone as a foundation for practice could strengthen the identity of the chiropractic profession.
... Após o ajuste da coluna, os membros serão examinados, procurando se há áreas de tensão muscular, áreas mais frias ou mais quentes e checando se a mobilidade das articulações. (ERNST, 2008; ASBACO, 2008; RENALVET,2008). ...
... Those in the "against chiro" group, in attempting to convince other commenters-and seemingly a wider audience-about issues surrounding chiropractic, rely predominantly on the argument that chiropractic is lacking evidence and is not science-based. This argument is a common one that can be found in academic discourse critiquing the treatment, (Ernst, 2008;Mirtz, Morgan, Wyatt, & Greene, 2009;Shelley et al., 2015) and is part of a long history of discourse addressing what constitutes and what goes against science-based practices in medicine or health care (Derkatch, 2016;Sackett, 1997;Sackett, Rosenberg, Gray, Haynes, & Richardson, 1996). Furthermore, the "against chiro" commenters on YouTube raise issues of health risks associated with the treatment and suggest that chiropractors make false claims regarding their practices (five or 36% of the discussions). ...
Numerous studies have examined health-related YouTube videos, but very few studies have also investigated the health-related discussions taking place in YouTube comment sections. Taking up the topic of chiropractic, a popular form of “alternative medicine”, this study first sought to determine if debates or controversies surrounding chiropractic were present in the comments on popular YouTube chiropractic videos. If debates were present, the goal was then to use iterative coding methods to map out how debates were unfolding by describing the general characteristics of the discussions as well as the arguments used by opposing groups. Lastly, the objective was to determine levels of hostility in the debates. Our results demonstrate that there are debates taking place over the efficacy and legitimacy of chiropractic. Furthermore, while our study maps out a wide variety of arguments and debate characteristics, key findings show that those arguing “for chiropractic” rely primarily on personal anecdotes...
... The grass is used in food or as culinary used i.e. it is eatable and also it can be used as cosmetic cream and even as herb. The linear leaves can grow up to 90 cm in height and 5m in width [6]. ...
The purpose of this chapter is to provide information about some health care therapies that are typically not considered mainstream. Different forms of complementary medicine are described, so clinical practitioners will be familiar with what they involve.
Numerous alternative treatments are physical by nature. They often require a hands-on approach of an alternative practitioner. In this chapter, I discuss treatments that fall into this category.
Oleoresin is a mixture of volatile and nonvolatile components available in whole extract of natural herb or spice. It principally comprises essential oils and resin. Lemongrass oleoresins come from the Cymbopogon species, which grow in the tropical and subtropical regions of the world. Oleoresin of lemongrass is a dark green-colored viscous liquid having a characteristic lemon aroma and flavor and is mostly used as a flavoring ingredient. The lemon prefix in the lemongrass specifies the characteristic lemon-like odor, which is due to the availability of citral content (mixture of two isomeric aldehydes, geranial and neral). It has been utilized in synthesizing flavors, perfumes, cosmetics, detergents, and in the food and pharmaceutical industries. Different methods are used to extract the lemongrass essential oil, but steam distillation is the most suitable method as it doesn’t alter the quality of the obtained oil. The chemical composition of lemongrass oil varies depending on its extraction methods, genetic differences, harvest period, photoperiod, plant age, farming practices, and geographical origin. Lemongrass essential oil has shown several biological activities, including antimicrobial, antifungal, antiprotozoan, antioxidant, antidiarrheal, antimutagenic, antiinflammatory, antimalarial, antinociceptive, antihepatotoxic activities, etc. Lemongrass oil is a potent food preservative because of its extraordinary antifungal and antibacterial activities.
Chapter of the Springer Textbook "Family Medicine: Principles and Practice, 8th edition", not available for sharing
Akupressur ist die Stimulation spezifischer Punkte, auf der Körperoberfläche durch Druck zu therapeutischen Zwecken. Der erforderliche Druck kann manuell oder mit einer Reihe von Instrumenten ausgeübt werden.
Complementary and alternative medicine can be defined as diagnosis, treatment, and/or prevention which complements mainstream medicine by contributing to a common whole, by satisfying a demand not met by orthodoxy, or by diversifying the conceptual frameworks of medicine. It is popular; hence doctors should know about it. The term covers a vast array of treatments and diagnostic techniques which have little in common except that they are not part of mainstream medicine. The most important modalities are acupuncture, phytotherapy, homeopathy, and spinal manipulation. In industrialized countries, typical users of complementary and alternative medicine are middle-aged, female, well-educated members of a high socioeconomic class. Indications range from chronic benign conditions where mainstream medicine does not offer a cure (e.g. back pain) to life-threatening diseases like cancer and AIDS.
Son yıllarda dünyada ve ülkemizde “Geleneksel
ve Tamamlayıcı Tıp” (GETAT) uygulamalarında ve ürünlerinin kullanımında artış
izlenmektedir. Hekimler GETAT uygulama ve ürünlerinin gerekliliği, yararı
konusunda ikiye bölünmüş durumdadır. Bir görüş bu uygulamaların medikal
tedavide yeri olduğunu savunmaktayken, diğer görüş kullanımının ve kullanımına
bağlı sonuçların hekimin sorumluluğunda olmadığını savunmaktadır. Bu çalışmada
Zonguldak Bülent Ecevit Üniversitesi Tıp Fakültesi’nde görevli öğretim üyesi ve
araştırma görevlisi hekimlerin GETAT uygulamaları konusundaki bilgi ve
görüşlerini değerlendirmek amaçlanmıştır. Araştırma kesitsel tiptedir. Şubat
2017- Mayıs 2018 tarihlerinde görevli 327 hekimin tümüne ulaşılması
hedeflenmiştir, 262’sine (%80,1) ulaşılmıştır. Verilerin toplanmasında anket
kullanılmıştır. Hekimlerin %66,4’ünün kendi görüşlerine göre GETAT yöntemleri
konusunda bilgi düzeyleri düşüktür, %43,1’i eğitim almak istemektedir, %2,3’ü
GETAT kurs/sertifika programına katılmıştır. Hekimlerin %45,0’ı hastalarının
GETAT kullanma durumunu bilmektedir, bilenlerin %41,5’i hastalarının GETAT
yöntemi kullandığını, en fazla akupunktur (%63,2) ve kupa (%40,8)
kullandıklarını belirtmiştir. Hekimlerin %48,5’i GETAT’ın faydalı olduğunu
düşünmektedir. Hekimlerin hastalarına bir GETAT yöntemi önerme oranı %16,0,
uygulama oranı %4,9’dur. Hekimlerin %15,2’sinin kendisi, %24,4’ünün ailesindeki
bireyler bir GETAT yöntemi kullanmıştır. Öneren hekimlerin en fazla önerdikleri
(%57,1), kullanan hekimlerin en fazla kullandıkları (%45,0) yöntem
akupunkturdur. Hekimlerin GETAT yöntemlerini önerme durumu; kendi görüşlerine
göre GETAT bilgi düzeylerine, kurs/sertifika programına katılma durumlarına,
faydasına dair görüşlerine, hekimin ve ailesinin GETAT kullanma durumuna göre
farklı bulunmuştur. Hekimlerin GETAT eğitimi almak isteme durumu; yaşa,
akademik ünvana, bölüme, faydasına dair görüşlerine göre farklılık
göstermiştir. Hekimlerin yarısından fazlası, GETAT ile ilgili yeterli bilgisi
bulunmadığını belirtmiştir ve hastalarının yöntemleri kullanma durumuyla ilgili
bilgi sahibi değildir. Meslekte geçirdikleri süre daha kısa olan genç hekimler
ve dahili bilimlerde çalışan hekimler daha fazla GETAT eğitimi almak
istemektedirler. Hekimler, tedavileri ile etkileşimleri bakımından hastalarının
GETAT yöntemi kullanma durumunu sorgulamalı, toplumda sık kullanılan yöntemler
konusunda yapılan bilimsel araştırmaları takip etmelidirler. Bununla birlikte
hekimler, GETAT yöntemlerini ancak bilimsel yöntem izlenerek yapılan araştırmalar
sonucunda ulaşılacak bilgiler ışığında tedavi seçeneği olarak düşünebilirler.
Background and aim:
Alternative medicine is a broad term used to encompass different therapies, including chiropractic. Chiropractic was called "a science of healing without drugs" by its founder, David Daniel Palmer. It is based on the idea that the body has a powerful self-healing ability and that there is a relationship between body structure and function that affects health. In particular, chiropractic assumes that the nervous system controls the human body through nerves branching from the vertebral column and spinal cord. Researchers do not fully understand how chiropractic therapies affect pain, but chiropractic is widely used today to treat chronic pain, such as back pain. Different studies with animal models have demonstrated that chiropractic therapies mediate neuroplasticity, specifically through modulation of neurotrophins. No studies have yet been published on interaction between neurotrophin gene polymorphisms and chiropractic treatment.
Methods:
We searched PubMed with the following keywords: chiropractic, neuroplasticity, neurotrophin gene polymorphism for a panorama of on the molecular mechanisms of chiropractic therapy.
Results:
From the material collected, we identified a set of genes and some functional polymorphisms that could be correlated with better response to chiropractic therapy.
Conclusions:
Further association studies will be necessary to confirm hypotheses of a correlation between single nucleotide polymorphisms in specific genes and better response to chiropractic therapy.
Key words: C.citratus, P. undulata, MTZ, anti-giardiasis, medicinal plants Background: Metronidazole (MTZ) is the drug of choice for treatment of giardiasis, but it has many drawbacks and there is a need to find out medicinal plants having anti-giardiasis efficacy to be alternative to MTZ. Objectives: This work aimed to study the in vitro and in vivo anti-giardial effectiveness of the aqueous extracts of two plants; Cymbopogon(C.)citratus and Pulicaria (P.)undulata in comparison with MTZ. Methodology: For in vitro study, one mL from different concentrations of plant extracts and MTZ were added to one mL of Giardia cysts suspension for 5, 15, 30 and 60 min. The viability was distinguished by 0.1 % eosin. Also, morphological alterations of Giardia cysts were examined by scanning electron microscope (SEM). For in vivo study, 50 male Albino mice were divided into: Group I: non-infected control; Group II: infected-untreated (IU); Group III: infected-treated with 15 mg/kg of MTZ; Group IV: infected treated with 500 mg/kg of C. citratus extract and Group V: infected-treated with 200 mg/kg of P. undulata extract. The effectiveness of the extracts was evaluated by cyst count per gram of feces, histopathological and transmission electron microscopic (TEM) examination of the small intestine. Results: in vitro mortality percentages of Giardia cysts showed a significant dose and time dependent effect regarding each extract. The aqueous extract of C. citratus extract at 500 ug/mL revealed the highest significant mortality percentages. P.undulata at 400ug/mL, MTZ and C. citratus at 250 µg/mL showed high mortality percentages with significant differences on comparison with C. citratus at 500 µg/mL. The ultrastructure morphological alternations of G. lamblia cysts were observed mainly with C.citratus. In the in vivo study, C. citratus revealed significant early complete absence of the parasite from fecal samples at 5 th days post treatment, while P. undulata and MTZ achieved complete cure at 10 th days post treatment. Progressive improvement of intestinal mucosa pathological changes and the mucosal ultrastructure were observed in the treated mice. Conclusion: C.citratus and P. undulata aqueous extracts were effective against G. lamblia both in vitro and in vivo and they could be natural therapeutic alternative agents to MTZ.
Key words: C.citratus, P. undulata, MTZ, anti-giardiasis, medicinal plants Background: Metronidazole (MTZ) is the drug of choice for treatment of giardiasis, but it has many drawbacks and there is a need to find out medicinal plants having anti-giardiasis efficacy to be alternative to MTZ. Objectives: This work aimed to study the in vitro and in vivo anti-giardial effectiveness of the aqueous extracts of two plants; Cymbopogon(C.)citratus and Pulicaria (P.)undulata in comparison with MTZ. Methodology: For in vitro study, one mL from different concentrations of plant extracts and MTZ were added to one mL of Giardia cysts suspension for 5, 15, 30 and 60 min. The viability was distinguished by 0.1 % eosin. Also, morphological alterations of Giardia cysts were examined by scanning electron microscope (SEM). For in vivo study, 50 male Albino mice were divided into: Group I: non-infected control; Group II: infected-untreated (IU); Group III: infected-treated with 15 mg/kg of MTZ; Group IV: infected treated with 500 mg/kg of C. citratus extract and Group V: infected-treated with 200 mg/kg of P. undulata extract. The effectiveness of the extracts was evaluated by cyst count per gram of feces, histopathological and transmission electron microscopic (TEM) examination of the small intestine. Results: in vitro mortality percentages of Giardia cysts showed a significant dose and time dependent effect regarding each extract. The aqueous extract of C. citratus extract at 500 ug/mL revealed the highest significant mortality percentages. P.undulata at 400ug/mL, MTZ and C. citratus at 250 µg/mL showed high mortality percentages with significant differences on comparison with C. citratus at 500 µg/mL. The ultrastructure morphological alternations of G. lamblia cysts were observed mainly with C.citratus. In the in vivo study, C. citratus revealed significant early complete absence of the parasite from fecal samples at 5 th days post treatment, while P. undulata and MTZ achieved complete cure at 10 th days post treatment. Progressive improvement of intestinal mucosa pathological changes and the mucosal ultrastructure were observed in the treated mice. Conclusion: C.citratus and P. undulata aqueous extracts were effective against G. lamblia both in vitro and in vivo and they could be natural therapeutic alternative agents to MTZ.
Acupressure is the stimulation of specific points, called acupoints, on the body surface by pressure for therapeutic purposes. The required pressure can be applied manually of by a range of devices. Acupressure is based on the same tradition and assumptions as acupuncture. Like acupuncture, it is often promoted as a panacea, a ‘cure all’.
Women are over-represented within alternative medicine, both as consumers and as service providers. In this paper, I show that the appeal of alternative medicine to women relates to the neglect of women’s health needs within scientific medicine. This is concerning because alternative medicine is severely limited in its therapeutic effects; therefore, those who choose alternative therapies are liable to experience inadequate healthcare. I argue that while many patients seek greater autonomy in alternative medicine, the absence of an evidence base and plausible mechanisms of action leaves patients unable to realize meaningful autonomy. This seems morally troubling, especially given that the neglect of women’s needs within scientific medicine seems to contribute to preferences for alternative medicine. I conclude that the liberatory credentials of alternative medicine should be questioned and make recommendations to render scientific medicine better able to meet the needs of typical alternative medicine consumers.
As frustration with conventional medicine deepens, people are seeking novel approaches to health care for themselves and their pets. Not only are many alternative therapies comparatively inexpensive and readily available, they offer owners an opportunity to actively contribute to their pets’ health. Hope surrounding alternative veterinary medicine is understandable, but for most modalities there is little evidence to support efficacy, and some pose significant risks to both humans and companion animals. Although there is little scientific research to report, this paper aims to inform on the safety and efficacy of select alternative modalities, with a focus on feline medicine.
In this study we present the Pseudoscientific Belief Scale (PSEUDO; α = 0.90). The conceptual foundations of the scale include: (1) a philosophically grounded and functional demarcation criterion between science and pseudoscience; (2) an analysis of the pseudoscientific status of science denialism, which is integrated into the scale; and (3), a bibliographic justification to back up the inclusion of each item. The validation process is carried out based on two studies. Study 1 (N = 3416) uses both exploratory factor analysis and cluster analysis: conceptually congruent factors are not reported. Study 2 (N = 292) includes a total of 21 sociodemographic, personality and cognitive independent variables, as well as the two thematic subscales of PSEUDO as dependent variables, in order to analyse the psychological profile of both sets of believers. Results show high similarity between both groups, confirming construct validity.
Purpose
Though there is abundant literature on cervicogenic dizziness with at least half a dozen of review articles, the condition remains to be enigmatic for clinicians dealing with the dizzy patients. However, most of these studies have studied the cervicogenic dizziness in general without separating the constitute conditions. Since the aetiopathological mechanism of dizziness varies between these cervicogenic causes, one cannot rely on the universal conclusions of these studies unless the constitute conditions of cervicogenic dizziness are separated and contrasted against each other.
Methods
This narrative review of recent literature revisits the pathophysiology and the management guidelines of various conditions causing the cervicogenic dizziness, with an objective to formulate a practical algorithm that could be of clinical utility. The structured discussion on each of the causes of the cervicogenic dizziness not only enhances the readers’ understanding of the topic in depth but also enables further research by identifying the potential areas of interest and the missing links.
Results
Certain peculiar features of each condition have been discussed with an emphasis on the recent experimental and clinical studies. A simple aetiopathological classification and a sensible management algorithm have been proposed by the author, to enable the identification of the most appropriate underlying cause for the cervicogenic dizziness in any given case. However, further clinical studies are required to validate this algorithm.
Conclusions
So far, no single clinical study, either epidemiological or interventional, has incorporated and isolated all the constitute conditions of cervicogenic dizziness. There is a need for such studies in the future to validate either the reliability of a clinical test or the efficacy of an intervention in cervicogenic dizziness.
Background
The subluxation construct generates debate within and outside the profession. The International Chiropractic Education Collaboration, comprised of 10 chiropractic programs outside of North America, stated they will only teach subluxation in a historical context. This research sought to determine how many chiropractic institutions worldwide still use the term in their curricula and to expand upon the previous work of Mirtz & and Perle.
Methods
Forty-six chiropractic programs, 18 United States (US) and 28 non-US, were identified from the World Federation of Chiropractic Educational Institutions list. Websites were searched by multiple researchers for curricular information September 2016–September 2017. Some data were not available on line, so email requests were made for additional information. Two institutions provided additional information. The total number of mentions of subluxation in course titles, technique course (Tech) descriptions, principles and practice (PP) descriptions, and other course descriptions were reported separately for US and non-US institutions. Means for each category were calculated. The number of course titles and descriptions using subluxation was divided by the total number of courses for each institution and reported as percentages.
Results
Means for use of subluxation by US institutions were: Total course titles = .44; Tech = 3.83; PP = 1.50; other = 1.16. For non-US institutions, means were: Total course titles = .07; Tech = .27; PP = .44; other = 0. The mean total number of mentions was 6.94 in US vs. 0.83 in non-US institutions. Similarly, the mean course descriptions was 6.50 in US vs. 0.72 in non-US institutions.
Conclusions
The term subluxation was found in all but two US course catalogues. The use of subluxation in US courses rose from a mean of 5.53 in 2011 to 6.50 in 2017. US institutions use the term significantly more frequently than non-US. Possible reasons for this were discussed. Unscientific terms and concepts should have no place in modern education, except perhaps in historical context. Unless these outdated concepts are rejected, the chiropractic profession and individual chiropractors will likely continue to face difficulties integrating with established health care systems and attaining cultural authority as experts in conservative neuro-musculoskeletal health care.
High quality education is essential for the development of competent practitioners in all medical and medically related fields. Healthcare education entails the provision of knowledge in the sciences relevant to medicine and clinical practice, coupled with appropriate practical instruction. The basic education of healthcare professionals must be designed and delivered to ensure that newly qualified practitioners are competent to both practice in their field and be able to properly comprehend and respond to future developments within and intersecting their discipline. Beyond the initial phase of inculcating basic competence, education should be a continuing process that healthcare professionals engage with throughout their professional career.
This article, adopting a historical point of view, aims to shed light and provide some insights into the long-lasting, tortuous process that led to a full recognition of the legitimacy of physiotherapists’ professional role in the United States as we presently know it. To achieve this purpose, the paper singles out which were the most relevant components that contributed to shape physiotherapists’ identity, who, during the twentieth century, shifted from the role of mere practitioners to that one of autonomous professionals. If it is uncontested that a clear distinction was soon traced between physiotherapists and osteopaths, and a second one, although more contrasted, with chiropractors, the essay advocates that physiotherapy evolved from a various, heterogeneous set of body manipulators (namely, from ‘bonesetters’, fitness trainers, masseurs/masseuses, and general nurses), and that it would be simplistic to reduce the profession forerunners to the over-cited WWI ‘reconstruction aides’. The article furthermore argues that physiotherapists had to struggle with the solid medical dominance to achieve recognition as autonomous practitioners, and that two fundamental positive factors toward this goal were the foundation and growth of a nationwide professional organization, and the implementation of a standardized, accredited college education.
Purveyors of ‘snake oil’ that was claimed to cure everything from baldness to impotence were familiar in the nineteenth century. In the twenty-first century, snake oil purveyors have been replaced by advocates of a variety of alternative therapies from homeopathy to reflexology and from acupuncture to chiropractic treatment, with their exaggerated claims about the effectiveness of their proposed treatment being largely based on flawed clinical trial results. Where well-designed and performed randomized clinical trials have been performed, the claimed effectiveness of the majority of alternative treatments has most often been shown to be a myth.
Summary of Background Data and Objectives. Alternative health care was used by an estimated 42% of the U.S. population in 1997, and chiropractors accounted for 31% of the total estimated number of visits. Despite this high level of use, there is little empirical information about who uses chiropractic care or why. Methods. The authors surveyed randomly sampled chiropractors (n = 131) at six study sites and systematically sampled chiropractic patients seeking care from participating chiropractors on 1 day (n = 1275). Surveys collected data about the patient’s reason for seeking chiropractic care, health status, health attitude and beliefs, and satisfaction. In addition to descriptive statistics, the authors compared data between patients and chiropractors, and between patients and previously published data on health status from other populations, corrected for the clustering of patients within chiropractors. Results. More than 70% of patients specified back and neck problems as their health problem for which they sought chiropractic care. Chiropractic patients had significantly worse health status on all SF-36 scales than an age- and gender-matched general population sample. Compared with medical back pain patients, chiropractic back pain patients had significantly worse mental health (6–8 point decrement). Roland-Morris scores for chiropractic back pain patients were similar to values reported for medical back pain patients. The health attitudes and beliefs of chiropractors and their patients were similar. Patients were very satisfied with their care. Conclusion. These data support the theory that patients seek chiropractic care almost exclusively for musculoskeletal symptoms and that chiropractors and their patients share a similar belief system.
Study Design. A systematic review of randomized controlled trials. Objectives. To assess the effectiveness of the most common conservative types of treatment for patients with acute and chronic nonspecific low back pain. Summary of Background Data. Many treatment options for acute and chronic low back pain are available, but little is known about the optimal treatment strategy. Methods. A rating system was used to assess the strength of the evidence, based on the methodologic quality of the randomized controlled trials, the relevance of the outcome measures, and the consistency of the results. Results. The number of randomized controlled trials identified varied widely with regard to the interventions involved. The scores ranged from 20 to 79 points for acute low back pain and from 19 to 79 points for chronic low back pain on a 100‐point scale, indicating the overall poor quality of the trials. Overall, only 28 (35%) randomized controlled trials on acute low back pain and 20 (25%) on chronic low back pain had a methodologic score of 50 or more points, and were considered to be of high quality. Various methodologic flaws were identified. Strong evidence was found for the effectiveness of muscle relaxants and nonsteroidal anti‐inflammatory drugs and the ineffectiveness of exercise therapy for acute low back pain; strong evidence also was found for the effectiveness of manipulation, back schools, and exercise therapy for chronic low back pain, especially for short‐term effects. Conclusions. The quality of the design, execution, and reporting of randomized controlled trials should be improved, to establish strong evidence for the effectiveness of the various therapeutic interventions for acute and chronic low back pain.
Objective
To identify adverse effects of spinal manipulation.
Design
Systematic review of papers published since 2001.
Setting
Six electronic databases.
Main outcome measures
Reports of adverse effects published between January 2001 and June 2006. There were no restrictions according to language of publication or research design of the reports.
Results
The searches identified 32 case reports, four case series, two prospective series, three case-control studies and three surveys. In case reports or case series, more than 200 patients were suspected to have been seriously harmed. The most common serious adverse effects were due to vertebral artery dissections. The two prospective reports suggested that relatively mild adverse effects occur in 30% to 61 % of all patients. The case-control studies suggested a causal relationship between spinal manipulation and the adverse effect. The survey data indicated that even serious adverse effects are rarely reported in the medical literature.
Conclusions
Spinal manipulation, particularly when performed on the upper spine, is frequently associated with mild to moderate adverse effects. It can also result in serious complications such as vertebral artery dissection followed by stroke. Currently, the incidence of such events is not known. In the interest of patient safety we should reconsider our policy towards the routine use of spinal manipulation.
To obtain preliminary data on neurological complications of spinal manipulation in the UK all members of the Association of British Neurologists were asked to report cases referred to them of neurological complications occurring within 24 hours of cervical spine manipulation over a 12-month period. The response rate was 74%. 24 respondents reported at least one case each, contributing to a total of about 35 cases. These included 7 cases of stroke in brainstem territory (4 with confirmation of vertebral artery dissection), 2 cases of stroke in carotid territory and 1 case of acute subdural haematoma. There were 3 cases of myelopathy and 3 of cervical radiculopathy. Concern about neurological complications following cervical spine manipulation appears to be justified. A large long-term prospective study is required to determine the scale of the hazard.
Objective: To provide a brief overview of the current state of evidence for chiropractic care, specifically in the management of asthma and to a lesser extent allergy. Data Sources: A search of MEDLINE for English-language articles published between January 1966 and July 2002 was conducted using the keywords asthma, allergy, manual therapy, physical therapy techniques, chiropractic, physical therapy (specialty), physiotherapy, massage, and massage therapy. A hand search of the primary chiropractic and osteopathic literature on the treatment of asthma was performed, and proceedings from a recent research symposium on spinal manipulation were included. Study Selection: Clinical controlled studies and systematic reviews on spinal manipulative therapy (SMT) and asthma were selected. There were no primary clinical trials on SMT and allergy found. Results: Many of the claims of chiropractic success in asthma have been primarily based on anecdotal evidence or uncontrolled case studies. Three recently reported randomized controlled studies showed benefit in subjective measures, such as quality of life, symptoms, and bronchodilator use; however, the differences were not statistically significant between controls and treated groups. There were no significant changes in any objective lung function measures. The clinical issues emanating from these trials are discussed. Conclusions: There is currently no evidence to support the use of chiropractic SMT as a primary treatment for asthma or allergy. Based on reported subjective improvement in patients receiving chiropractic care, certain clinical circumstances may warrant a therapeutic trial in patients with asthma. Further property designed, collaborative research is needed to determine if there is a role for chiropractic SMT in the care of asthma or allergy.
Chiropractic is a system of healing based on the belief that health is maintained when the spinal column is in its proper position and the nervous system is not impinged. This healing art is often misunderstood by patients and other health care providers. This article gives a brief history of chiropractic, describes the education of doctors of chiropractic, outlines their practice guidelines, and describes their interaction with the clinical laboratory.
In this chapter, we present an overview of animal models that have been used to study the chiropractic subluxation, or in the case of osteopathy, the osteopathic lesion. Of course, not all basic research into subluxation and joint manipulation must involve animals. A number of valuable basic science studies have been performed in humans. However, as illustrated by Vernon's eight reasons for using animal models in research, animal research provides research opportunities that cannot be accomplished in human studies. In addition to reviewing animal research used to study the chiropractic subluxation and joint manipulation within the period 1964 - 2004, animal model characteristics, and ethical issues involving the use of animal models are discussed.
Objective: The aim of this review is to systematically summarise and assess all available economic evaluations of complementary and alternative therapies. Methods: Systematic literature searches were performed in seven electronic databases and the reference lists located were checked for further relevant publications. All articles in which original, prospectively collected data from any form of standard economic analysis of complementary and alternative therapies administered for any medical condition to groups of patients was presented were included. No language restrictions were imposed. Study selection, data extraction and quality assessment were performed independently with any disagreements being settled by discussion. Results: Twenty-eight articles were identified relating to the economic evaluation of manipulative therapy, relaxation, acupuncture, hypnosis, plant-based preparations, traditional Chinese medicine, homeopathy and neuroreflexotherapy. Cost effectiveness analyses were included in 27 of the articles; two of which also incorporated a cost-utility analysis. One paper described a cost-minimisation analysis. Studies were of medium to good quality with scores ranging from 0.63 to 1.0. Preliminary evidence exists to suggest that some therapies may be superior to the comparative treatment, in terms of cost-effectiveness, in the setting of the clinical trials discussed. The addition of some complementary therapies to standard care may also be associated with additional cost with no further clinical benefit. Conclusions: There is a paucity of data from rigorous economic evaluations of complementary and alternative therapies. Rigorous economic evaluation of complementary therapies with demonstrated effectiveness is needed before conclusions as to the relative cost effectiveness can be drawn.
A questionnaire was sent to all 13 consultant neurologists listed in the Irish Medical Directory 1996-97; 11(85%) responded. In the previous live years they had seen a total of 16 patients with neurological complications following manipulation of the cervical spine by chiropractors, osteopaths or medical practitioners. Cerebrovascular injury in both the vertebral and carotid territories accounted for the majority, and two patients had cervical cord damage. Thirteen (81%) had persistent neurological deficit, described as major in three. Such problems are more frequent than reported or previously estimated.
Background:
Dysmenorrhoea refers to the occurrence of painful menstrual cramps of uterine origin and is a common gynaecological condition. One possible treatment is spinal manipulation therapy. One hypothesis is that mechanical dysfunction in certain vertebrae causes decreased spinal mobility. This could affect the sympathetic nerve supply to the blood vessels supplying the pelvic viscera, leading to dysmenorrhoea as a result of vasoconstriction. Manipulation of these vertebrae increases spinal mobility and may improve pelvic blood supply. Another hypothesis is that dysmenorrhoea is referred pain arising from musculoskeletal structures that share the same pelvic nerve pathways. The character of pain from musculoskeletal dysfunction can be very similar to gynaecological pain and can present as cyclic pain as it can also be altered by hormonal influences associated with menstruation.
Objectives:
To determine the safety and efficacy of spinal manipulative interventions for the treatment of primary or secondary dysmenorrhoea when compared to each other, placebo, no treatment, or other medical treatment.
Search strategy:
We searched the Cochrane Menstrual Disorders and Subfertility Group trials register (searched 18 March 2004), CENTRAL (The Cochrane Library Issue 1, 2004), MEDLINE (1966 to March 2004), EMBASE (1980 to March 2004), CINAHL (1982 to March 2004), AMED (1985 to March 2004), Biological Abstracts (1969 to Dec 2003), PsycINFO (1872 to March 2004) and SPORTDiscus (1830 to March 2004). The Cochrane Complementary Medicine Field's Register of controlled trials (CISCOM) was also searched. Attempts were also made to identify trials from the metaRegister of Controlled Trials and the citation lists of review articles and included trials. In most cases, the first or corresponding author of each included trial was contacted for additional information.
Selection criteria:
Any randomised controlled trials (RCTs) including spinal manipulative interventions (e.g. chiropractic, osteopathy or manipulative physiotherapy) vs each other, placebo, no treatment, or other medical treatment were considered. Exclusion criteria were: mild or infrequent dysmenorrhoea or dysmenorrhoea from an IUD.
Data collection and analysis:
Four trials of high velocity, low amplitude manipulation (HVLA), and one of the Toftness manipulation technique were included. Quality assessment and data extraction were performed independently by two reviewers. Meta analysis was performed using odds ratios for dichotomous outcomes and weighted mean differences for continuous outcomes. Data unsuitable for meta-analysis were reported as descriptive data and were also included for discussion. The outcome measures were pain relief or pain intensity (dichotomous, visual analogue scales, descriptive) and adverse effects.
Main results:
Results from the four trials of high velocity, low amplitude manipulation suggest that the technique was no more effective than sham manipulation for the treatment of dysmenorrhoea, although it was possibly more effective than no treatment. Three of the smaller trials indicated a difference in favour of HVLA, however the one trial with an adequate sample size found no difference between HVLA and sham treatment. There was no difference in adverse effects experienced by participants in the HVLA or sham treatment. The Toftness technique was shown to be more effective than sham treatment by one small trial, but no strong conclusions could be made due to the small size of the trial and other methodological considerations.
Reviewers' conclusions:
Overall there is no evidence to suggest that spinal manipulation is effective in the treatment of primary and secondary dysmenorrhoea. There is no greater risk of adverse effects with spinal manipulation than there is with sham manipulation.
Study Design. A systematic review within the Cochrane Collaboration Back Review Group. Objectives. To assess the effectiveness of back schools for patients with nonspecific low back pain (LBP). Summary of Background Data. Since the introduction of the Swedish back school in 1969, back schools have frequently been used for treating patients with LBP. However, the content of back schools has changed and appears to vary widely today. Methods. We searched the MEDLINE and EMBASE databases and the Cochrane Central Register of Controlled Trials to November 2004 for relevant trials reported in English, Dutch, French, or German. We also screened references from relevant reviews and included trials. Randomized controlled trials that reported on any type of back school for nonspecific LBP were included. Four reviewers, blinded to authors, institution, and journal, independently extracted the data and assessed the quality of the trials. We set the high-quality level, a priori, at a trial meeting six or more of 11 internal validity criteria. Because data were clinically and statistically too heterogeneous to perform a meta-analysis, we used a qualitative review (best evidence synthesis) to summarize the results. The evidence was classified into four levels (strong, moderate, limited, or no evidence), taking into account the methodologic quality of the studies. We also evaluated the clinical relevance of the studies. Results. Nineteen randomized controlled trials (3,584 patients) were included in this updated review. Overall, the methodologic quality was low, with only six trials considered to be high-quality. It was not possible to perform relevant subgroup analyses for LBP with radiation versus LBP without radiation. The results indicate that there is moderate evidence suggesting that back schools have better short- and intermediate-term effects on pain and functional status than other treatments for patients with recurrent and chronic LBP. There is moderate evidence suggesting that back schools for chronic LBP in an occupational setting are more effective than other treatments and placebo or waiting list controls on pain, functional status, and return to work during short- and intermediate-term follow-up. In general, the clinical relevance of the studies was rated as insufficient. Conclusion. There is moderate evidence suggesting that back schools, in an occupational setting, reduce pain and improve function and return-to-work status, in the short- and intermediate-term, compared with exercises, manipulation, myofascial therapy, advice, placebo, or waiting list controls, for patients with chronic and recurrent LBP. However, future trials should improve methodologic quality and clinical relevance and evaluate the cost-effectiveness of back schools.
This book upholds that underlying all unorthodox medical systems is a characteristically American strain of religious thought which states that spiritual, physical and economic well-being flow from the individual's connection with the cosmos. After a survey of the earliest nineteenth-century health reforms, including hydropathy, homeopathy and Thomsonianism (which held that all disease was caused by cold and could be cured by heat), Fuller turns to mesmerism and Swedenborgianism. These two movements he argues were key representatives of an extraordinary metaphysical flowering that took place in America between the 1830s and the Civil War. He then goes on to demonstrate that virtually all subsequent health care enthusiasms can be shown to relate to or stem from seminal movements. The final chapter raises the question of whether it is the religious element in these groups that makes them effective healing forces. Fuller's conclusion is that such groups and practices supply a perception of "sacred reality" and contact with a higher power in a way that organized religions have failed to do.
Chiropractic is an important component of the US health care system and the largest alternative medical profession. In this overview of chiropractic, we examine its history, theory, and development; its scientific evidence; and its approach to the art of medicine. Chiropractic's position in society is contradictory, and we reveal a complex dynamic of conflict and diversity. Internally, chiropractic has a dramatic legacy of strife and factionalism. Externally, it has defended itself from vigorous opposition by conventional medicine. Despite such tensions, chiropractors have maintained a unified profession with an uninterrupted commitment to clinical care. While the core chiropractic belief that the correction of spinal abnormality is a critical health care intervention is open to debate, chiropractic's most important contribution may have to do with the patient-physician relationship.
Radiographic terminology basic imaging principles radiation protection positioning principles chest upper limbs lower limbs head procedures spine and bone thorax GI series GB and urinary system. (Part contents)
Seit dem Konsensusworkshop von Bingen 1994 ist der Zusammenhang zwischen zervikalen Manipulationen und Läsionen der Zervikalarterien in den Fokus des Interesses gerückt. Anhand evidenzbasierter Daten, die im Rahmen einer Metaanalyse der vorhandenen Literatur erhoben wurden, muss ein solcher Zusammenhang eindeutig verneint werden. Unter anderem basiert der in Frankfurt im Juli 2003 gefundene Konsens des QM-Workshops auch auf diesen Fakten. Als wichtigstes Ergebnis wurde festgehalten, dass eine Läsion einer Zervikalarterie keine typische Komplikation einer lege artis durchgeführten HWS-Manipulation sei. Die vorwiegend von einigen Neurologen geübte Praxis, unbegründet wegen einer zeitlichen Koinzidenz einen Kausalzusammenhang anzunehmen, hat aufgrund der vorhandenen Datenlage eine besondere haftungsrechtliche und berufspolitische Brisanz, da Gutachter für Mängel ihrer Gutachten seit dem 1.7.2002 haften. Gutachter haben nach den Anforderungen der Auftraggeber den aktuellen Stand der Wissenschaft zu berücksichtigen und Abweichungen kenntlich zu machen.
Randomized clinical trial.
To document the types and frequencies of adverse reactions associated with the most common chiropractic treatments for neck pain, and to identify possible clinical predictors of adverse reactions to chiropractic treatment.
Chiropractic care is frequently sought by patients for relief from neck pain; however, adverse reactions related to its primary modes of treatment have not been well examined.
A total of 336 patients with neck pain presenting to 4 southern California health care clinics were randomized in a balanced 2 x 2 x 2 factorial design to manipulation with or without heat, and with or without electrical muscle stimulation (EMS); and mobilization with or without heat and with or without EMS. Discomfort or unpleasant reactions from chiropractic care were self-assessed at 2 weeks after the randomization/baseline visit.
Of the 280 participants (83%) who responded, 85 (30.4%) had 212 adverse symptoms as a result of chiropractic care. Increased neck pain or stiffness was the most common symptom, reported by 25% of the participants. Less common were headache and radiating pain. Patients randomized to manipulation were more likely than those randomized to mobilization to have an adverse symptom occurring within 24 hours of treatment (adjusted odds ratio [OR] = 1.44, 95% confidence interval [CI] = 0.83, 2.49). Heat and EMS were only weakly associated with adverse symptoms (heat: OR = 0.94, 95% CI = 0.54, 1.62; EMS: OR = 1.09, 95% CI = 0.63, 1.89). Moderate-to-severe neck disability at baseline was strongly associated with adverse neurologic symptoms (OR = 5.70, 95% CI = 1.49, 21.80).
Our results suggest that adverse reactions to chiropractic care for neck pain are common and that despite somewhat imprecise estimation, adverse reactions appear more likely to follow cervical spine manipulation than mobilization. Given the possible higher risk of adverse reactions and lack of demonstrated effectiveness of manipulation over mobilization, chiropractors should consider a conservative approach for applying manipulation to their patients, especially those with severe neck pain.
A 31-year-old woman suffered a brainstem infarction
secondary to chiropractic neck manipulation. A dissection of
both vertebral arteries could be demonstrated by MR tomography.
This case report should alert therapists to be aware of
vertebrobasilar complications after spinal manipulations.
Introduction. – The use of spinal manipulation (SM) is widespread, particularly in English-speaking countries, where many studies are published showing its popularity. However, no study exists of the demography and activity of the French medical profession. Our objective was to investigate the use of SM by French doctors in their daily practice.Materials and methods. – We questionned 234 doctors, general practitioners and specialists who obtained the Inter-Academy of Manual Medicine and Osteopathy Diploma from Strasbourg University between 1985 and 2002.Results. – We obtained a response from140 physicians: 110 (79%) practiced SM in their daily practice. They considered the technique efficient and used it as a first intention. Approximately one quarter of cases resulted in adverse effects on the back. Most of the doctors (77%) continued their education during their career.Conclusion. – This first assessment of the practice of physicians trained in a university in manual medicine allows for confirming the respect of good medical practice with regular actualization of knowledge and reasonable outpatient care.
Introduction. – Recent studies have emphasized the incidence and the general underestimation in literature of spinal manipulation (SM) linked accident. The aim of this study was to estimate the frequency and the incidence of strokes, myelopathies, radiculopathies or osteoarticular accidents in a major French area.Material and method. – We made a survey among 240 neurologists, neurosurgeons, rhumatologists and physicians concerning the number of accidents observed during the preceding two years.Results. – We obtained a response from 133 physicians and 93 cases of complication were reported. Most of these complications were radiculopathies (69%). Approximatively 50% occured at the cervical level, less than 24 hours after SM with or without sligth aftereffects in 68%. The incidence of vertebro-basilar accidents was 30 times higher than in published series.Conclusion. – Spinal manipulations should remain under very strict medical control.Physicians who practice SM should be able to choose the manual treatment and perform it themselves in order to minimize risks of complications, especially at the cervical level.
We present 3 cases of stroke due to arterial dissection following chiropractic manipulation: (1) a 31-year-old woman with left vertebral dissection developed a large cerebellar infarct, (2) a 64-year-old man developed a left parietal infarct due to left carotid dissection and (3) a 51-year-old man developed right Horner’s syndrome, fluctuating dysarthria, left facial droop, and left arm weakness due to right carotid dissection. Imaging studies and the literature are reviewed.
This article examines the drive for legitimation on the part of osteopathy and chiropractic in Australia. A brief history is presented of the development of these two manual medical systems down under, their respective drives for statutory registration and public funding of their training institutions (all of which are embedded in public universities), and their respective niches within the context of the Australian dominative medical system. Ironically, although osteopathy is politically strong in both the United States, where it has evolved in osteopathic medicine and a parallel medical system to biomedicine, and in Britain, where it remains primarily a manual medical system, chiropractic over time became politically stronger than osteopathy in Australia. The author argues that although chiropractic and osteopathy remain distinct and related systems in Australia, from the perspective of the Australian state, they essentially are one and the same.
Objectives: To review the scientific evidence for both manipulation and mobilization therapies for the cervical spine. This report presents the results from a review of the medical, chiropractic, osteopathic, physical therapy, and dental literature on the efficacy, complications, and indications for manipulation and mobilization of the cervical spine, and the appropriateness ratings of indications for manipulation and mobilization. Methods: Articles were identified through searches of computerized databases [MEDLINE [Index Medicus], CHIROLARS [Chiropractic Literature Analysis and Retrieval System] etc.], review of article's bibliographies, and advice from experts. This yielded 362 primary articles on cervical spine manual therapy and 145 articles on complications. Priority was given to research that used randomized, controlled trial [RCT] designs. Second priority was given to non-experimental studies including cohort, case-control, and cross sectional studies. Case series and case reports were given lowes...
To the Editor:
I read with interest the commentary by Ernst1 regarding life-threatening complications of spinal manipulation. Recently, I reported2,3 3 cases of stroke that occurred after chiropractic manipulation, 2 involving carotid dissection and 1 involving vertebral dissection. Ernst cites 1 literature case of carotid dissection.4 There is a fourth case his research did not uncover.5 I wish to add an unusual case of intracranial hypotension due to presumed dural tear, a heretofore unreported complication of cervical chiropractic manipulation.
A 34-year-old man suffered a whiplash injury in a motor vehicle accident. He consulted a chiropractor for nonradiating neck pain and improved somewhat. Approximately 1 month after the initial injury, …
This paper examines the arguments presented at the Royal Commission of Inquiry into chiropractic, which took place in New Zealand in 1978. Drawing on the work of Potter, it suggests that the protagonists in the debate, the medical profession and its allies on one side and the chiropractic profession on the other, developed rhetorical strategies to counter competing versions of the world. An unusual feature of this debate was that it took place before ‘impartial’ judges. The paper demonstrates the delicate process of negotiation performed by chiropractic groups when confronting medicine in an open forum. The paper concludes that in order to resolve the competing rhetorics, the Commissioners sought for a compromise, which at once embedded chiropractic within the public health service in New Zealand and ‘de-radicalised’ its claims.
A 26-year-old woman presented with acute headache and hand-motion vision in both eyes. One day prior to presentation she went to her chiropractor for cervical manipulation. The patient had received 20 chiropractic manipulations over the previous two years. CT scan and MRI showed bilateral, symmetric occipital-parietal hemorrhagic infarctions. Angiography revealed severe focal stenosis in the distal vertebral arteries bilaterally at the superior C1 level possibly representing dissections. There was also a pseudoaneurysm of the left vertebral artery at the C1 level. Risk factors included chiropractic manipulation, recent fever, and therapies for polycystic ovarian disease. The patient showed slow, steady improvement in her vision. Twenty days following admission, vision was 20/20 OU. The improvement in her vision most likely reflects the reduction in swelling and absorption of blood at the site of the strokes.
Objective: To estimate the effect of adding exercise classes, spinal manipulation delivered in NHS or private premises, or manipulation followed by exercise to "best care" in general practice for patients consulting with back pain.
Design: Pragmatic randomised trial with factorial design.
Setting: 181 general practices in Medical Research Council General Practice Research Framework; 63 community settings around 14 centres across the United Kingdom.
Participants: 1334 patients consulting their general practices about low back pain.
Main outcome measures: Scores on the Roland Morris disability questionnaire at three and 12 months, adjusted for centre and baseline scores.
Results: All groups improved over time. Exercise improved mean disability questionnaire scores at three months by 1.4 (95% confidence interval 0.6 to 2.1) more than "best care." For manipulation the additional improvement was 1.6 (0.8 to 2.3) at three months and 1.0 (0.2 to 1.8) at 12 months. For manipulation followed by exercise the additional improvement was 1.9 (1.2 to 2.6) at three months and 1.3 (0.5 to 2.1) at 12 months. No significant differences in outcome occurred between manipulation in NHS premises and in private premises. No serious adverse events occurred.
Conclusions: Relative to "best care" in general practice, manipulation followed by exercise achieved a moderate benefit at three months and a small benefit at 12 months; spinal manipulation achieved a small to moderate benefit at three months and a small benefit at 12 months; and exercise achieved a small benefit at three months but not 12 months.
Objective: To assess the cost effectiveness of adding spinal
manipulation, exercise classes, or manipulation followed by exercise
("combined treatment") to "best care in general practice for patients
consulting with low back pain.
Design: Stochastic cost utility analysis alongside pragmatic randomised
trial with factorial design.
Setting: 181 general practices and 63 community settings for physical
treatments around 14 centres across the United Kingdom.
Participants:
1287 (96%) of 1334 trial participants.
Main outcome measures: Healthcare costs, quality adjusted life years
(QALYs), and cost per QALY over 12 months.
Results Over one year, mean treatment costs relative to "best care"
were 1195 ($360; (sic)279; 95% credibility interval pound85 to
pound308) for manipulation, pound140 (pound3 to pound278) for exercise,
and pound125 (pound21 to pound228) for combined treatment. All three
active treatments increased participants' average QALYs compared with
best care alone. Each extra QALY that combined treatment yielded
relative to best care cost pound3800; in economic terms it had an
"incremental cost effectiveness ratio" of pound3800. Manipulation alone
had a ratio of 5:8700 relative to combined treatment If the NHS was
prepared to pay at least pound10 000 for each extra QALY (lower than
previous recommendations in the United Kingdom), manipulation alone
would probably be the best strategy. If manipulation was not available,
exercise would have an incremental cost effectiveness ratio of
pound8300 relative to best care.
Conclusions: Spinal manipulation is a cost effective addition to "best
care" for back pain in general practice. Manipulation alone probably
gives better value for money than manipulation followed by exercise.
The development of effective implementation strategies for chiropractic clinical practice guidelines (CPGs) presumes knowledge about the attitudes of the Canadian chiropractic profession. The purpose of this study was to explore the attitudes of Canadian chiropractors to philosophy and scope of practice. We hypothesized that given most Canadian chiropractors are trained at one school, the Canadian Memorial Chiropractic College (CMCC) in Toronto, there would be a reasonable degree of consensus about the practice of chiropractic in Canada, and therefore, effective implementation strategies could be developed.
This study focused on the attributes of all new patients (N = 15,174) treated at CMCC clinics from 1986 to 1990. The average age of patients (33 years) was similar to that of other teaching clinics (36.5 years) but lower than private practice patients (46 years). The average number of treatments (6.6) was similar to some other chiropractic college teaching clinic settings but lower than private practice patients in Ontario (9.8) and the United States (16.6). The cervical spine was the most common site (32.4%) of chief complaint followed by lumbar (24.4%), nonspinal (18.8%), thoracic (11.2%), sacroiliac (10.0%) and other (3.2%). Radiographs were taken on 34.4% of the patients, similar to other chiropractic college teaching clinics but lower than for private practice patients (73%). Complaints persisted for at least 6 months prior to treatment in 47.5% of the CMCC patients whereas other studies indicated that 81.4% of complaints treated by private chiropractic practitioners were of 6 months or greater duration. In general, as duration of complaint lengthened, the number of treatments required to reach resolution also increased. More than 70% of CMCC’s patients obtained complete or substantial relief from symptoms which compared well with other teaching clinics and private chiropractic practice. Recommendations for the development of new data gathering instruments, and involvement of private practitioners in this type of clinical research are made.
This review surveys the literature regarding reliability studies of lumbar motion palpation.
Using the indexing terms motion palpation lumbar spine and palpation, the following English language databases were surveyed: a) Medline, including back file; b) Embase; c) Cinahl; and d) Epic. Additionally, a manual search of the Chiropractic Research Archives Collection and JMPT was performed and researchers at Western States Chiropractic College were consulted. Pertinent references cited in bibliographies of retrieved papers were included if contributory.
Studies pertaining to intra- and interexaminer reliability of lumbar motion palpation were reviewed.
Statistical analysis, subject selection, method of palpation and sources of error are discussed.
Multiple variations were noted in type of palpation, subjects examined, statistical analysis and experience of examiners.
To date, most studies have demonstrated marginal to poor interexaminer reliability, while good to moderate intrarater reliability has generally been reported.
In this article, major aspects of back care provided to patients by family physicians and chiropractors are reviewed, and the recent guidelines on spinal manipulation therapy are discussed. These guidelines should be useful for family physicians wishing to refer patients to chiropractors.
A radiographic study was undertaken to determine the relationship between static vertebral malalignment and segmental lumbar motion in lateral bending.
Survey.
Chiropractic college student health center and private chiropractic clinic.
249 subjects: 114 with low back pain, 29 asymptomatic with no history and 106 asymptomatic with history. Of these, 194 were freshman volunteers and 55 were new private clinic low back pain patients.
None.
Net lumbar segmental tilt and rotation in lateral bending: corrected and uncorrected for segmental malposition with the patient standing in the upright neutral position.
There was moderate to good negative correlation of malalignment with segmental tilt motion and segmental motion asymmetry (r = -.42 to -.89, p less than .001). Correlation of malalignment with motion from the ideal neutral segmental position of perfect alignment was modest (r = .16-.42). A large variation in segmental motion was found for all segmental malalignments.
This study suggests that malalignment is associated with segmental tilt motion in lateral bending, although large subject variability greatly compromises predictability on an individual basis. This study also indicates that segmental malposition may complicate the palpation of active range of motion. This is because the malalignment itself may facilitate a greater arc of segmental motion in the direction of comparative restriction in movement from the ideal neutral position to the extreme of lateral flexion.
From its discovery in 1895 to its current status, in which the World Federation of Chiropractic Meeting may be considered a prestigious international scientific conference, the evaluation of chiropractic can be viewed as a compression of the phases which medical and scientific evolution have followed over a much longer period. Chiropractic theory started primarily as a vitalistic philosophy justifying its treatment while the medical scientific community was rejecting vitalism. Both chiropractic and medical spine specialists went through a period of speculative theory in the first half of this century based upon either perceived neurological or pathological observations. There was a period of single-theory preoccupation by chiropractors (the subluxation) and medical specialists (disc herniation) which brought these professions into conflict. The past decade has led to greater scientific exploration by both professions, with more national scientific discussion of the causes and treatment of spinal problems. The next decade, however, appears likely to require greater emphasis on social research into clinical effectiveness of treatments, prevention of back pain, patient satisfaction and quality assurance. This evolution should be considered the normal maturation of a health care profession.
The publications of philosophically conservative chiropractors document their allegiance to a posture of hostile opposition to health prevention based upon immunization procedures. The challenge to medical anthropology is to make sense of what seems scientifically senseless. This paper attempts to come to an understanding of this position by tracing professional attitudes which are derived from a history of political and economic conflict with the American medical establishment, which emanate from an explanatory model of disease causation that preserves a nineteenth century monocausal theory, and which reflect a process of cultural schizmogenesis. In preserving these heretical medical beliefs, conservative chiropractors, who are trained in the basic medical sciences, defend themselves by basing their opposition to immunization upon imperfections in vaccines that relate to the efficacy, safety and necessity of immunizations. Further, they persist in a belief that chiropractic spinal manipulation provides an alternative method for achieving immune status. This belief has not been subjected to testing in clinical trials or laboratory experiments, and thus becomes a matter of belief rather than of scientific verity. A refusal to advocate or submit to vaccines serves conservative chiropractors as an understandable cultural symbol, but it is a symbol with sinister health costs to those who translate it into non-immune status in a world otherwise still hostage to disease-producing organisms.
Sixty student volunteers were assessed for fixation in the lumbar spine using a passive motion palpation protocol. Subjects were examined in random order by two experienced chiropractors. Every subject was evaluated twice by each examiner. Fixations were judged present or absent for each of five lumbar motion segments. Moderate test-retest agreement beyond chance was noted at L1/2, minimal reliability at L4/5, and no significant agreement within examiners was detected for mid-lumbar segments. Interexaminer agreement beyond chance was poor for all segments assessed. When segments were grouped regionally and re-evaluated, some increase in intrarater agreement was evident, especially at L4/5/S, but interrater agreement was still absent.