Check out this very well written post on the present understanding of Chiropractic neck adjustments and strokes. Thanks for posting this information Dr Cole.
A couple of weeks ago I started to feel ill. I had a cough and stuffy nose. I caught a cold. This put a damper on my training. I took a couple days off from my workouts and on the third day I tried to exercise but with little success. I felt short of breath. The next day a full blown fever hit me and I couldn’t train at all that day. Not long after that I received an email from Tribesports.com to contribute to their website and they asked me to write a post on training for sport while sick. Interesting coincidence.
So should you exercise when you are sick?
Generally speaking if your symptoms are above your neck then moderate training/activity is acceptable during the course of the cold.
Light to moderate walking during the common cold does not negatively effect the severity or symptoms of sports performance. Check out http://europepmc.org/abstract/MED/9140895 &
http://europepmc.org/abstract/MED/9813869. If you have a runny nose and sore throat without a fever or general body aches and pains then intensive exercise training may be safely resumed a few days after the resolution of symptoms.
If symptoms are below the neck then don’t train and get to bed!
If you have a flu symptoms, fever, extreme tiredness, muscle aches, dizziness, light-headedness, diarrhea, vomiting, and/or swollen lymph glands, then don’t exercise. Once the symptoms are gone take 2 to 4 weeks to build up to your previous intense training.
Words of Caution
If you are using a decongestant an increase in heart rate will result in addition to the increase from the workout. This may lead to shortness of breath and difficulty breathing. This is why I stopped working out during one of my workouts during my cold.
For those with asthma exercise with cold may worsen your asthma symptoms. Diabetics may also have problems when they are sick. Being sick results in an increase in blood sugar at rest as well as a decrease in blood sugar during activity. Monitoring your blood sugar more closely is recommended for diabetics who are sick.
Listen to your body before you decide to train.
When you see the word, Chiropractor, there are a number images that people conjure up; both positive and negative. One of the most common images is the image of back pain. Back pain is one of the most common ailments that people come in to see me at my chiropractic office. Spinal manipulation is often used in my treatments, in addition to Active Release Techniques, acupuncture and corrective exercises.
This blog is a continuation of a blog post seeking out the evidence of the above image. Though I have not found the specific statements in the research regarding the effectiveness of manipulation on lower back pain here is what the evidence says in the literature.
I would like to comment on some of the findings you will read in this post. When a conclusion is made that says that there is no evidence that the treatment is superior to other forms of treatment this doesn’t mean that it is not effective. What it does mean is that it is equally as effective as those treatments. That’s a good thing. It means it is a viable option for care for back pain.
Check out some of the research. Read the highlights, read the entire abstract or seek out the full paper. If you have questions seek out further information or just ask and I’ll try and find that information for you.
Lower Back Pain
In 2007 guidelines, the American College of Physicians and the American Pain Society included spinal manipulation as one of several treatment options for practitioners to consider when low-back pain does not improve with self-care. More recently, a 2010 Agency for Healthcare Research and Quality (AHRQ) report noted that complementary health therapies, including spinal manipulation, offer additional options to conventional treatments, which often have limited benefit in managing back and neck pain. The AHRQ analysis also found that spinal manipulation was more effective than placebo and as effective as medication in reducing low-back pain intensity. However, the researchers noted inconsistent results when they compared spinal manipulation with massage or physical therapy to reduce low-back pain intensity or disability.
Researchers continue to study spinal manipulation for low-back pain.
Researchers are investigating whether the effects of spinal manipulation depend on the length and frequency of treatment. In one study funded by NCCAM that examined long-term effects in more than 600 people with low-back pain, results suggested that chiropractic care involving spinal manipulation was at least as effective as conventional medical care for up to 18 months. However, less than 20 percent of participants in this study were pain free at 18 months, regardless of the type of treatment used.
Researchers are also exploring how spinal manipulation affects the body. In an NCCAM-funded study of a small group of people with low-back pain, spinal manipulation affected pain perception in specific ways that other therapies (stationary bicycle and low-back extension exercises) did not.
Cochrane systematic review of randomized controlled trials.
To determine the effects of combined chiropractic interventions on pain, disability, back-related function, overall improvement, and patient satisfaction in adults with low-back pain (LBP).
SUMMARY OF BACKGROUND DATA:
Chiropractors commonly use a combination of interventions to treat people with LBP, but little is known about the effects of this care.
We used a comprehensive search strategy. All randomized trials comparing combined chiropractic interventions (rather than spinal manipulation alone) with no treatment or other therapies were included. At least two authors selected studies, assessed bias risk, and extracted data. Descriptive synthesis and meta-analyses were performed.
We included 12 studies involving 2887 LBP participants. Three studies had low risk of bias. Included studies evaluated a range of chiropractic procedures in a variety of subpopulations with LBP. For acute and subacute LBP, chiropractic interventions improved short- and medium-term pain (standardized mean difference [SMD] -0.25 [95% CI: -0.46 to -0.04] and MD -0.89 [95%CI: -1.60 to -0.18]) compared with other treatments, but there was no significant difference in long-term pain (MD -0.46 [95% CI -1.18 to 0.26]). Short-term improvement in disability was greater in the chiropractic group compared to other therapies (SMD -0.36 [95% CI: -0.70 to -0.02]). However, the effect was small and studies contributing to these results had high risk of bias. There was no difference in medium- and long-term disability. No difference was demonstrated for combined chiropractic interventions for chronic LBP and studies that had a mixed population of LBP.
Combined chiropractic interventions slightly improved pain and disability in the short term and pain in the medium term for acute/subacute LBP. However, there is currently no evidence that supports or refutes that these interventions provide a clinically meaningful difference for pain or disability in people with LBP when compared to other interventions.
Do you have tennis elbow or carpal tunnel? Have you been trying other forms of care without success? Chiropractic manipulation is one of the tools that I use to successfully treat these ailments.
This blog is a continuation of a blog post seeking out the evidence of the above image. Though I have not found the specific statements in the research regarding the effectiveness of manipulation on tennis elbow and carpal tunnel here is what the evidence says in the literature.
Manipulation of the Wrist for Management of Lateral Epicondylitis: A Randomized Pilot Study
Background and Purpose. Lateral epicondylitis (“tennis elbow”) is a common entity. Several nonoperative interventions, with varying success rates, have been described. The aim of this study was to compare the effectiveness of 2 protocols for the management of lateral epicondylitis: (1) manipulation of the wrist and (2) ultrasound, friction massage, and muscle stretching and strengthening exercises.
Subjects and Methods. Thirty-one subjects with a history and examination results consistent with lateral epicondylitis participated in the study. The subjects were randomly assigned to either a group that received manipulation of the wrist (group 1) or a group that received ultrasound, friction massage, and muscle stretching and strengthening exercises (group 2). Three subjects were lost to follow-up, leaving 28 subjects for analysis. Follow-up was at 3 and 6 weeks. The primary outcome measure was a global measure of improvement, as assessed on a 6-point scale. Analysis was performed using independent t tests, Mann-Whitney U tests, and Fisher exact tests.
Results. Differences were found for 2 outcome measures: success rate at 3 weeks and decrease in pain at 6 weeks. Both findings indicated manipulation was more effective than the other protocol. After 3 weeks of intervention, the success rate in group 1 was 62%, as compared with 20% in group 2. After 6 weeks of intervention, improvement in pain as measured on an 11-point numeric scale was 5.2 (SD=2.4) in group 1, as compared with 3.2 (SD=2.1) in group 2.
Discussion and Conclusion. Manipulation of the wrist appeared to be more effective than ultrasound, friction massage, and muscle stretching and strengthening exercises for the management of lateral epicondylitis when there was a short-term follow-up. However, replication of our results is needed in a large-scale randomized clinical trial with a control group and a longer-term follow-up.
Specific manipulative therapy treatment for chronic lateral epicondylalgia produces uniquely characteristic hypoalgesia
Carpal Tunnel Syndrome
An investigation to compare the effectiveness of carpal bone mobilisation and neurodynamic mobilisation as methods of treatment for carpal tunnel syndrome.
Carpal tunnel syndrome is the most common peripheral entrapment neuropathy. There is little literature available that addresses the management of this condition, which may partly explain why physiotherapy is often overlooked as a treatment approach in its management. This study investigated the effects of two manual therapy techniques in the treatment of patients experiencing carpal tunnel syndrome. An experimental different subject design compared three groups of subjects in three different conditions (two treatment interventions and one control group). Each group consisted of seven patients. The objectives of the study were: (1) to investigate differences between treated and untreated groups; (2) to investigate differences in the effectiveness of treatment I (median nerve mobilization) compared with treatment II (carpal bone mobilization). Measurements were taken applying several measurement tools, including active range of wrist movement (ROM flexion and extension), upper limb tension test with a median nerve bias (ULTT2a), three different scales to evaluate pain perception and function, and lastly numbers of patients continuing to surgery in each group were compared. In visual terms a clear trend was demonstrated between subjects who received treatment compared to those who were not treated, in particular the descriptive analysis of results for ULTT2a and numbers of patients continuing to surgery. When analysed statistically, less could be concluded. Only scores on a Pain Relief Scale (P<0.01) demonstrated highly significant differences between the three groups when analyzed using Kruskal-Wallis Test. In exploring the results of the two intervention groups, no statistically significant difference in effectiveness of treatment was demonstrated between carpal bone mobilization and median nerve mobilization.
Comparative efficacy of conservative medical and chiropractic treatments for carpal tunnel syndrome: a randomized clinical trail.
OBJECTIVE: To compare the efficacy of conservative medical care with chiropractic care in the treatment of carpal tunnel syndrome.
DESIGN: Two-group, randomized, single-blind trial with 9 wk of treatment and a 1-month follow-up interview.
SETTING: Wolfe-Harris Center for Clinical Studies at Northwestern College of Chiropractic in Bloomington, Minnesota.
PATIENTS: Ninety-one of 96 eligible subjects who reported symptoms that were confirmed by clinical exam and nerve conduction studies.
INTERVENTIONS: Interventions included ibuprofen (800 mg 3 times a day for 1 wk, 800 mg twice a day for 1 wk and 800 mg as needed to a maximum daily dose of 2400 mg for 7 wk) and nocturnal wrist supports for medical treatment. Chiropractic treatment included manipulation of the soft tissues and bony joints of the upper extremities and spine (three treatments/week for 2 wk, two treatments/week for 3 wk and one treatment/week for 4 wk), ultrasound over the carpal tunnel and nocturnal wrist supports.
MAIN OUTCOME MEASURES: Outcome measures were pre- and postassessments of self-reported physical and mental distress, nerve conduction studies and vibrometry.
RESULTS: There was significant improvement in perceived comfort and function, nerve conduction and finger sensation overall, but no significant differences between groups in the efficacy of either treatment.
CONCLUSIONS: Carpal tunnel syndrome associated with median nerve demyelination but not axonal degeneration may be treated with commonly used components of conservative medical or chiropractic care.
OBJECTIVE: To determine if chiropractic manipulation could relieve carpal tunnel syndrome (CTS).
CLINICAL FEATURES: A 42-yr-old female suffered from pain, tingling and numbness in the right wrist. Paresthesia along the C6 dermatome, a positive Phalen’s test and Tinel’s sign was present. EMG testing confirmed the clinical diagnosis of CTS.
INTERVENTION AND OUTCOME: Chiropractic manipulations were rendered 3 times per week for 4 wk, to the subject’s cervical spine, right elbow and wrist using a low amplitude, short lever, low force, high velocity thrust. Significant increase in grip strength and normalization of motor and sensory latencies were noted. Orthopedic tests were negative. Symptoms dissipated.
CONCLUSION: In this case study, chiropractic made a demonstrable difference through objective and subjective outcomes. Further investigations using double-blind, cross-over designs with larger samples are warranted.
I hope you found this interesting.
I found this image on Facebook and I thought it was worth sharing with all of you. What I liked about the image is that it shows many of the conditions I find to be successfully treated in my Chiropractic/Athletic Therapy practise. What I was curious about, when viewing this picture, was if these were actual quotes in the research. There are no references on the picture but I did find a website that gave some references. The problems with these references is that either I couldn’t find the article in an internet search or I couldn’t read more than the abstract and if I could read it I did not find the statistical quotes. If anyone finds them please send them to me.
I decided to search for some evidence of these stated benefits even if I couldn’t find the direct quote. This post will be the first of several blog posts on the above statements.
1. Chronic Neck Pain: “Nearly 80% of chronic neck pain patients improve significantly with chiropractic care”.
Take a look at some of the literature. You will see that spinal manipulation is of benefit for chronic neck pain especially if a neck exercise program is also performed.
Study Design. A randomized, prospective clinical study was conducted that included 119 patients with chronic neck pain of greater than 3 months’ duration.
Objectives. To compare the relative effectiveness of intensive training of the cervical musculature, a physiotherapy treatment regimen, and chiropractic treatment on this patient group.
Summary of Background Data. There are only a few studies involving chronic neck pain patients representative of those seeking care in primary health care centers. Mobilization techniques and intensive training have been shown to be useful, but cervical manipulation has not been assessed. Clinical results involving these commonly used therapies have not been compared.
Methods. A total of 167 consecutive patients were screened. One hundred nineteen patients were admitted to the study and were randomized according to Taves’ minimization principles. Primary outcome measures included self-reported pain, disability, medication use, patients’ perceived effect, and physician’s global assessment. Patients were assessed at enrollment and at completion of the study. Postal questionnaires were used to carry out 4- and 12-month follow-up assessments. Secondary outcome measures included active range of motion of the cervical spine as well as strength and endurance measurements of the cervical musculature. These measurements were carried out at enrollment and completion of the study.
Results. A total of 88% of the patients completed the study. Of these, 97% completed the 4-month questionnaire and 93% the 12-month questionnaire. Patients from all three groups demonstrated significant improvements regarding self-reported pain and disability on completion of the study. Improvements were maintained throughout the follow-up period. Medication use was also significantly reduced in all groups. There was, however, no significant difference between groups at any assessment period. Physician’s and patients’ assessments were also positive, and again group scores were essentially equal. Patients who underwent intensive training demonstrated significantly greater endurance levels at the completion of treatment.
Conclusions. There was no clinical difference between the three treatments. All three treatment interventions demonstrated meaningful improvement in all primary effect parameters. Improvements were maintained at 4- and 12-month follow-up. However, whether this was a result of the treatments or simply a result of time is unknown. Future studies will be necessary to delineate ideal treatment strategies.
Study Design. A randomized, parallel-group, single-blinded clinical trial was performed. After a 1-week baseline period, patients were randomized to 11 weeks of therapy, with posttreatment follow-up assessment 3, 6, and 12 months later.
Objectives. To compare the relative efficacy of rehabilitative neck exercise and spinal manipulation for the management of patients with chronic neck pain.
Summary of Background Data. Mechanical neck pain is a common condition associated with substantial morbidity and cost. Relatively little is known about the efficacy of spinal manipulation and exercise for chronic neck pain. Also, the combination of both therapies has yet to be explored.
Methods. Altogether, 191 patients with chronic mechanical neck pain were randomized to receive 20 sessions of spinal manipulation combined with rehabilitative neck exercise (spinal manipulation with exercise), MedX rehabilitative neck exercise, or spinal manipulation alone. The main outcome measures were patient-rated neck pain, neck disability, functional health status (as measured by Short Form-36 [SF-36]), global improvement, satisfaction with care, and medication use. Range of motion, muscle strength, and muscle endurance were assessed by examiners blinded to patients’ treatment assignment.
Results. Clinical and demographic characteristics were similar among groups at baseline. A total of 93% of the patients completed the intervention phase. The response rate for the 12-month follow-up period was 84%. Except for patient satisfaction, where spinal manipulative therapy and exercise were superior to spinal manipulation with (P = 0.03), the group differences in patient-rated outcomes after 11 weeks of treatment were not statistically significant (P = 0.13). However, the spinal manipulative therapy and exercise group showed greater gains in all measures of strength, endurance, and range of motion than the spinal manipulation group (P < 0.05). The spinal manipulation with exercise group also demonstrated more improvement in flexion endurance and in flexion and rotation strength than the MedX group (P < 0.03). The MedX exercise group had larger gains in extension strength and flexion–extension range of motion than the spinal manipulation group (P < 0.05). During the follow-up year, a greater improvement in patient-rated outcomes were observed for spinal manipulation with exercise and for MedX exercise than for spinal manipulation alone (P = 0.01). Both exercise groups showed very similar levels of improvement in patient-rated outcomes, although the spinal manipulation and exercise group reported greater satisfaction with care (P < 0.01).
Conclusions. For chronic neck pain, the use of strengthening exercise, whether in combination with spinal manipulation or in the form of a high-technology MedX program, appears to be more beneficial to patients with chronic neck pain than the use of spinal manipulation alone. The effect of low-technology exercise or spinal manipulative therapy alone, as compared with no treatment or placebo, and the optimal dose and relative cost effectiveness of these therapies, need to be evaluated in future studies.
Purpose: To determine whether spinal manipulation as an isolated intervention has any effect on proprioception-dependent performance of subjects with chronic neck pain, compared with effects achieved through stretching exercises.
Design: Matched, nonrandomized, controlled trial.
Setting: Private chiropractic clinic.
Participants: Twenty subjects with chronic (daily, > or = 4 months) neck pain. Volunteers were recruited from a pool of patients visiting the clinic or from those referred by informed clinicians.
Intervention: Half of the subjects received six sessions of high-velocity, low-amplitude manipulation to the cervical and upper thoracic regions during a 3-4 wk period. The other half were instructed in stretching exercises for the cervicothoracic muscles, to be performed in two unsupervised sessions daily over the same time period.
Main Outcome Measurements: Pain levels were assessed at baseline and at each of six follow-up sessions using a 100-mm visual analogue scale. The abilities of the blindfolded subjects to reproduce a neutral head position after moving the head and neck through various planes of motion was the method used to estimate proprioceptive acuity. This was done with the use of a laser pointer affixed to the top of an adjustable cap. Points were marked and measured on a target before and after head movement and repositioning.
Results: Subjects receiving manipulation demonstrated a mean reduction in visual analogue scores of 44%, along with a 41% improvement in mean scores for the head repositioning skill. In comparison, a 9% mean reduction in visual analogue scores and a 12% improvement in head repositioning scores was observed for the stretching group. The difference in the outcomes of the head repositioning skill scores was significant (p < or = .05).
Conclusion: The results suggest a possible effect of manipulation on proprioception in subjects with chronic neck pain. The small sample size, lack of true randomization and lack of blinding of the examiner are factors that weaken these findings. Larger, more controlled studies are needed to determine what specific effects manipulation may have on the function of proprioception.
Two-Year Follow-up of a Randomized Clinical Trial of Spinal Manipulation and Two Types of Exercise for Patients with Chronic Neck Pain
Objectives. To compare the effects of spinal manipulation combined with low-tech rehabilitative exercise, MedX rehabilitative exercise, or spinal manipulation alone in patient self-reported outcomes over a two-year follow-up period.
Summary of Background Data. There have been few randomized clinical trials of spinal manipulation and rehabilitative exercise for patients with neck pain, and most have only reported short-term outcomes.
Methods. One hundred ninety-one patients with chronic neck pain were randomized to 11 weeks of one of the three treatments. Patient self-report questionnaires measuring pain, disability, general health status, improvement, satisfaction, and OTC medication use were collected after 5 and 11 weeks of treatment and 3, 6, 12, and 24 months after treatment. Data were analyzed taking into account all time points using repeated measures analyses.
Results. Ninety-three percent (178) of randomized patients completed the 11-week intervention phase, and 76% (145) provided data at all evaluation time points over the two-year follow-up period. A difference in patient-rated pain with no group-time interaction was observed in favor of the two exercise groups [F(2141) = 3.2;P = 0.04]. There was also a group difference in satisfaction with care [F(2143) = 7.7;P = 0.001], with spinal manipulation combined with low-tech rehabilitative exercise superior to MedX rehabilitative exercise (P = 0.02) and spinal manipulation alone (P < 0.001). No significant group differences were found for neck disability, general health status, improvement, and OTC medication use, although the trend over time was in favor of the two exercise groups.
Conclusion. The results of this study demonstrate an advantage of spinal manipulation combined with low-tech rehabilitative exercise and MedX rehabilitative exercise versus spinal manipulation alone over two years and are similar in magnitude to those observed after one-year follow-up. These results suggest that treatments including supervised rehabilitative exercise should be considered for chronic neck pain sufferers. Further studies are needed to examine the cost effectiveness of these therapies and how spinal manipulation compares to no treatment or minimal intervention.
I hope you found this interesting