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1. Hare-Mortensen L, Lauridsen H, Grunnet-Nilsson N. Relative
responsiveness of 3 different types of clinical outcome measures
on chiropractic patients with low back pain. J Manipulative
Physiol Ther 2006;29:95-9.
In Reply:
The article is based on a master’s thesis that has been
reduced to an article, and in that process, some information
will inevitably have to be left out—which we agree
is unfortunate.
Originally, on day 1, 220 patients filled out the
questionnaires, and on follow-up on day 21, only 182 pa-
tients responded. The nonresponders were left in the
database as missing values, which give rise to the differing
numbers. However, in the thesis, there was an analysis of
the baseline data (demographics, pain score, etc) of the
nonresponders, and it was shown that there were no
significant differences between responders and nonrespond-
ers on any variables.
Therefore, leaving them in should not in any way affect
the conclusions, which is the important thing. Another
explanation for the differing numbers also is that not all
respondents at the second round answered all the questions.
Nevertheless, we agree that they ideally should have
been taken out of the database in the final analysis.
Niels Grunnet-Nilsson
University of Southern Denmark
0161-4754/$32.00 Copyright D2007 by National University of Health Sciences
doi: 10.1016/j.jmpt.2006.11.019
To the Editor:
The purpose of this letter is to bring to light a central
issue that comprises the underpinnings of current clinical
practice: x-ray listings. Weinert
revisited and improved
upon the 1981 study by Shram et al.
He concluded that by
Gonstead line drawing analysis dartificial listingsTmay be
produced from subtle pelvic rotations as projected onto
2-dimensional, AP lumbopelvic radiographs.
Although only hinted upon, the implications of these
findings bear directly on the central belief of the traditional
chiropractic notion that the sacroiliac joint (SIJ) can be
dadjustedTback into a normal position from that of a
dsubluxatedTone. This tenet has 3 dependent criteria: (a)
subluxated SIJ is causing/related to pain/health problems;
(b) SIJ dlistingTidentifies means of dcorrectionTas deter-
mined by x-ray; (c)dadjustmentTto SIJ in opposite of
determined listing repositions joint to normal position and
function with amelioration of pain/restored health.
Regarding (a), it has been elucidated that the SIJ
can be a pain generator as it is richly, neurologically
In consideration of (b), there is direct evi-
dence by Shram et al.,
and now replicated by Weinert,
that the x-ray analysis procedures of the Gonstead and
spin-off systems (ie, Palmer-Gonstead) are invalid. Weinert
states, bA few degrees of y-axis rotation placement error
could produce an artificial listing beyond accepted motion
limits of the sacroiliac joint.QIn consideration of (c), there
is good evidence that SIJ dadjustment/manipulationT
provides effective and even immediate symptomatic
The crux of the current issue is this: because A leads to
C, does not mean that A + B = C. Thus, outdated and invalid
procedures determining methods of thrust delivery may not
determine a successful outcome in as much as if a thrust is
given at all. There is growing evidence suggesting a thrust
to a spinal joint or specifically in this case, the SIJ is by no
means specific in nature
despite the best intentions of the
thrusters and their analysis systems.
The time is now to address traditional ideologies of chi-
ropractic. I applaud Dr. Weinert for his individual effort in
this avenue; we should all listen carefully to the words of
Stuart McGill, PhD, bFailing to accept the implications of
new data, whether they support or refute traditional ideas,
and to develop a common code of practice based on sound
experiment, will form a major impediment to further
Weinert’s findings mirroring those of Shram et al.
almost a quarter century ago highlight that new data do not
readily permeate traditional technique protocols as taught
in our colleges. Perhaps the real challenge will not be
the conduction of thoughtful investigation but rather
in disseminating this information throughout the profession
as a whole.
Paul Oakley, DC, MSc
Innovative Chiropractic Centre
Newmarket, Ontario, Canada
0161-4754/$32.00 Copyright D2007 by National University of Health Sciences
1. Weinert DJ. Influence of axial rotation on chiropractic pelvic
analysis. J Manipulative Physiol Ther 2005;28:117-21.
78 Journal of Manipulative and Physiological TherapeuticsLetters to the Editor
January 2007
2. Shram S, Hosek R, Silverman H. Spinographic positioning errors
in Gonstead pelvic x-ray analysis. J Manipulative Physiol Ther
3. Vilensky JA, O’Connor BL, Fortin JD, Merkel GJ, Jimenez BA,
Scofield BA, et al. Histologic analysis of neural elements in the
human sacroiliac joint. Spine 2002;24:1202-7.
4. Herzog W, Conway PJW, Willcox BJ. Effects of different
treatment modalities on gait symmetry and clinical measures for
sacroiliac joint patients. J Manipulative Physiol Ther
5. Ruch WJ. Atlas of common subluxations of the human spine
and pelvis. New York: CRC Press; 1997.
6. Hessel BW, Herzog W, Conway PJW, McEwen MC.
Experimental measurement of the force exerted during spinal
manipulation using the Thompson technique. J Manipulative
Physiol Ther 1990;13:448-53.
7. Schneider MJ. Soft tissue effects of sacroiliac and lumbosacral
joint manipulation. Chiropr Tech 1992;4:136- 42.
8. Profile: Stuart M, McGill, PhD. J Can Chiropr Assoc 1999;
Letters to the EditorJournal of Manipulative and Physiological Therapeutics
Volume 30, Number 1 79
... For example, Ruch's Atlas 15 was cited in only 4 chiropractic journals and 4 nonchiropractic journals, according to Google Scholar. [229][230][231][232][233][234][235] Epstein's works are rarely cited in the literature. 3, 168 Kent's 1996 review, 9 which proposed the dysafferentation approach to CVS, was followed by a paper by Seaman and Winterstein, titled "Dysafferentation: A Novel Term to Describe the Neuropathophysiological Effects of Joint Complex Dysfunction." ...
Objective: The purpose of this paper is to review and discuss the history of chiropractic vertebral subluxation (CVS) during 1996 and 1997. The literature during this period offered critical and integrative models emphasized by a need for research into operational and functional definitions. Discussion: Several integrative approaches emerged, from Rome's 296 synonyms to Bergman's Pain/Tenderness, Asymmetry/Alignment, Range of Motion Abnormality, Tissue Tone, Texture, Temperature Abnormality, and Special Tests (PARTS) analysis adopted by the profession in the United States. Other noteworthy contributions included Ruch's Atlas of Common Subluxations, Epstein's introduction of network spinal analysis, and Kent's review of CVS models. Boone's introduction of the Journal of Vertebral Subluxation Research was accompanied by his 3-part model with Dobson. These years also included the paradigm statement of the Association of Chiropractic Colleges, which was adopted by the American Chiropractic Association, International Chiropractors Association, and World Federation of Chiropractic. Two other papers included Nelson's critique of the CVS paradigm and Keating's 1996 "Hunt for the Subluxation." Conclusion: The CVS reached a new stage of complexity and critique and offered new directions for research, integration, and development.
Full-text available
Fears over radiation have created irrational pressures to dissuade radiography use within chiropractic. Recently, the regulatory body for chiropractors practicing in British Columbia, Canada, the College of Chiropractors of British Columbia (CCBC), contracted Pierre Côté to review the clinical use of X-rays within the chiropractic profession. A "rapid review" was performed and published quickly and included only 9 papers, the most recent dating from 2005; they concluded, "Given the inherent risks of radiation, we recommend that chiropractors do not use radiographs for the routine and repeat evaluation of the structure and function of the spine." The CCBC then launched an immediate review of the use of X-rays by chiropractors in their jurisdiction. Member and public opinion were gathered but not presented to their members. On February 4, 2021, the College announced amendments to their Professional Conduct Handbook that revoked X-ray rights for routine/repeat assessment and management of patients with spine disorders. Here, we highlight current and historical evidence that substantiates that X-rays are not a public health threat. We also point out critical and insurmountable flaws in the single paper used to support irrational and unscientific policy that discriminates against chiropractors who practice certain forms of evidence-based X-ray-guided methods.
Full-text available
The posterior ligament of the human sacroiliac joint was examined for nerves and nerve endings using histologic and immunohistochemical techniques. To identify nerve fibers and mechanoreceptors in the posterior ligament. According to the findings of previous studies, the human sacroiliac joint receives myelinated and unmyelinated axons that presumably conduct pain and proprioceptive impulses derived from mechanoreceptors and free nerve endings in the human sacroiliac joint. Tissue obtained from six patients was stained with gold chloride and that obtained from six additional patients was stained using antibodies specific for substance P and protein gene product 9.5. The staining of joint tissue using the gold chloride technique showed myelinated and unmyelinated nerve fibers, two morphotypes of paciniform encapsulated mechanoreceptors, and a single nonpaciniform mechanoreceptor. Analysis using immunohistochemical staining for protein gene product 9.5 did not unequivocally show axons, nerve fascicles, or mechanoreceptors. Similarly, analysis based on immunohistochemical staining for substance P, one of several neurotransmitters known to signal pain from the periphery, showed reactive elements that may have been nerves, but because of background staining, could not be positively identified as such. The presence of nerve fibers and mechanoreceptors in the sacroiliac ligament demonstrates that the central nervous system receives information, certainly proprioceptive, and possibly pain from the sacroiliac joint. Although it is not known how the central nervous system uses such information, it seems reasonable to speculate that the proprioceptive information is used to optimize upper body balance at this joint. In addition, because the staining techniques used generally to show nerves and nerve elements in periarticular connective tissue are nonspecific, the distinction between neural and nonneural should be made on the basis of both morphologic and staining characteristics.
The purpose of this study was to assess the effects of two different treatment modalities on the rehabilitation process of chronic sacroiliac joint patients. The treatment modalities included spinal manipulative therapy given by a chiropractor and a program of back school therapy given by a physiotherapist. The rehabilitation process was assessed using clinical and biomechanical measures. It was found that back school therapy was a better treatment modality than the spinal manipulative therapy, according to the clinical measures of rehabilitation. Precisely the opposite result was found for the biomechanical measures.
The purpose for conducting this study was to quantify the forces exerted by a chiropractor on a patient during spinal manipulative therapy. Six patients received three treatments each from two chiropractors for a sacroiliac joint fixation. The Thompson technique was used to treat the patients. The force characteristics of the spinal manipulation were analyzed with respect to the following five points: preloading force, peak force, duration of manipulation, impulse of manipulation and point of application of the peak force. The results obtained indicated that all treatments have certain common characteristics; for example, a preload force is always followed by a large thrusting force. The values for the preload force, peak force, duration and impulse were found to have large standard deviations for a given adjuster and between patients. The location of the point of application of the peak force relative to a low back reference system appeared to be very consistent. However, it was not on the posterior superior iliac spines (PSIS) as expected, but always slightly medial to this point. This is the first study to report force results which were measured directly during spinal manipulative therapy in a clinical situation. In further studies, the results of this investigation will be compared to results obtained from a large population of patients and chiropractic adjusters. Differences in the force characteristics between chiropractors will be compared to clinical and objective measures of the rehabilitation process of the patients in order to find an "optimal" way of performing spinal manipulative therapies.
The aim of the study is to explore associations between axial (y-axis) rotation of the pelvis and pelvic radiographic measurements. Descriptive film statistics of an incrementally rotated pelvis and linear regression analysis were performed. A phantom pelvic model was incrementally imaged (1 degrees increments) at 40-in source-to-image distance through 10 degrees of axial rotation. Chiropractic line drawing analysis was performed. The chiropractic examiner was blinded to the degree of rotation during the film analysis. Regression analysis was performed between axial rotation and pubic symphysis deviation, sacral width, and innominate and femur head heights. Each measurement corresponds to a chiropractic listing within the Gonstead system. Regression analysis revealed a strong association between the degree of axial rotation and each response variable: pubic symphysis deviation, sacral width, innominate height, and femur head height. The strongest relationship existed between y-axis rotation and pubic symphysis deviation. Chiropractic pelvic listings are strongly influenced by positioning of the subject. A few degrees of axial rotation may create apparent misalignments of several millimeters.
Atlas of common subluxations of the human spine and pelvis
  • W J Ruch
Ruch WJ. Atlas of common subluxations of the human spine and pelvis. New York: CRC Press; 1997.
Soft tissue effects of sacroiliac and lumbosacral joint manipulation
  • Schneider
Schneider MJ. Soft tissue effects of sacroiliac and lumbosacral joint manipulation. Chiropr Tech 1992;4:136 -42.
Spinographic positioning errors in Gonstead pelvic x-ray analysis
  • S Shram
  • R Hosek
  • H Silverman
Shram S, Hosek R, Silverman H. Spinographic positioning errors in Gonstead pelvic x-ray analysis. J Manipulative Physiol Ther 1981;4:179-81.
  • Profile
  • M Stuart
  • Phd Mcgill
Profile: Stuart M, McGill, PhD. J Can Chiropr Assoc 1999; 43:71.
Spinographic positioning errors in Gonstead pelvic x-ray analysis
  • Shram