Evidence is fairly strong when it comes to the effectiveness of joint manipulation for the treatment of acute and chronic neck and back pain. When people think of a Chiropractor they think of someone who is good at treating back and neck problems. When it comes to injuries to the shoulders, elbows, wrists, hips, knees, ankles and feet an Athletic Therapist or other health care provider may be considered first.
From my experience Chiropractic care, along with soft tissue release (ie. Active Release Techniques) and corrective exercises can be effective for a number of injuries to the extremities. My questions this week are, “What does the evidence say abut the effectiveness of joint manipulation for various extremity problems?””Would seeing a Chiropractor for these conditions be a good idea?” I found a research paper that reviewed a number of extremity conditions, along with other spinal conditions, and ranked them based on quality of the evidence. Here is a quick summary of their findings.
High Quality Evidence
Evidence is considered high if there are consistent results from well designed and well conducted studies. There has to be at least two randomized trials.
None of the conditions the researchers had studied exhibited high quality evidence . If there was high quality then an evidence informed doctor would be able to say that this form of care is effective for the condition.
Moderate Quality Evidence
Evidence was considered moderate if there is sufficient data leading to that conclusion but their confidence is less due to the number, size or quality of each study, inconsistency of findings between the studies or lack of coherence in the chain of evidence.
The researchers found that manipulation/mobilization was positively effective for pain between the shoulder blades or scapular dysfunction and hip osteoarthritis. High grade mobilization is positively effective for adhesive capsulitis/frozen shoulder. The use of manipulation/mobilization along with exercise is positively effective for knee osteoarthritis, patellofemoral pain syndrome, tennis elbow and plantar fasciitis.
Based on these findings an evidence informed doctor would say these are effective treatments for the conditions listed.
Low Quality Evidence
Evidence quality is low due to several factors. There may be a limited number or power of studies. There may be important flaws in the design or methods of the study. There may be unexplained inconsistency between higher quality trials or their may be gaps in the chain of evidence.
Rotator cuff pain, carpal tunnel syndrome, ankle sprains, morton’s neuroma hallux limitus all have favourable outcome using manipulation or mobilization, in the research, but the quality of the evidence is low.
Based on this information use of manipulation/mobilization would be an effective alternative in the absence of an effective alternative.
I hope you found this interesting and that if you are suffering from any of these conditions
Dr Chris Notley
Winnipeg Athletic Therapist/Chiropractor since 2000
P.S. A great response to the paper I read was from a very well respected Chiropractor, Dr Scott Haldemann. He describes how he uses evidence informed care with his patients. This is a great way to treat my patients. You can read that response here.