More and more people are catching onto to the benefits of chiropractic care. A new study found that chiropractors are the most commonly consulted complementary health physicians in Australia.
Out of 7,519 respondents, 15% of patients reported they had visited a chiropractor in the previous 12 months. Chiropractors were the fifth most common healthcare professional seen by respondents, following specialist doctors (47%), nurses (19%), hospital doctors (21%), and physiotherapists (21%).

Other research has suggested higher rates of chiropractic use among elderly and pregnant patients, with 37% and 16% reporting visiting a chiropractor, respectively. The percentage of people who had visited in a chiropractor in Australia was higher than in the US. A large study from the US National Health Survey showed that 9% of respondents had seen a chiropractor in the previous 12 months.

This latest study also revealed important characteristics about the chiropractic patients. People who had seen a chiropractor were:

• More likely to have seen at least one other complementary health provider
• No more or less likely to have seen a traditional doctor
• More economically advantaged (having had completed high-school education and were currently employed)
• 2.9 times more likely have back pain

Patients with back pain were:

• More likely to have a number of chronic conditions like arthritis, hypertension, chronic sinusitis, asthma, and dermatitis
• More likely to be a current smoker
• More likely to have depression, anxiety, and be taking antidepressants
• Not more or less likely to have a history of stroke, heart disease, diabetes, cancer, lipid disorder, or emphysema

"These findings have important implications for chiropractors," the authors wrote. "If a consumer seeks their care for a back problem then that consumer is more likely to have a number of other chronic health conditions... Chiropractors should be aware of this and ensure that these people are assessed and appropriately managed for these other health conditions."

This is precisely why many chiropractors are interested in holistic health and often assist patients in more than just pain relief through a number of natural therapies and coordination with other health providers.
 
Reference
French SD, et al. Who use Australian chiropractic services? Chiropractic & Manual Therapies 2013; 21 (31): doi:10.1186/2045-709X-21-31.

New research points to possible links among migraine, bruxism, and restless leg syndrome (RLS).  In a cohort study of patients being treated for RLS, more than half of patients were found to have symptoms qualifying them for diagnoses of migraine and bruxism. The authors of the study suggested the three conditions could share a common cause. The preliminary findings were presented at the annual meeting for the American Neurological Association, and were reported by Medpage Today.

Researchers conducted a survey of 470 patients with RLS who answered extensive health questionnaires. Sixty percent of patients reported grinding or clenching their teeth at night (bruxism), and 83% had previously been diagnosed with migraine. Fifty-two percent of patients showed signs of both conditions.

Restless leg syndrome is a neurological disorder causing extreme discomfort in the legs (and sometimes arms) such as pins and needles sensations, itching, and/or "creepy crawly" sensations that arise when sitting or lying down, especially in the evening. Patients experience an irresistible urge to move around in attempts to stop these symptoms, which can disrupt with their ability to sleep.

Lead author of the study, David Dickoff, MD, suggested that the co-occurrence of RLS, migraine, and bruxism in one patient may be explained by genes. Nearly half of RLS patients said they had family members who suffer from chronic headaches, 8% had at least one close family member with all three conditions, and 24% close relatives with two of the conditions.

Dickoff explained that bruxism could actually be considered restless jaw syndrome, and suggested the bruxism and RLS could potentially be the same disorder. In his study, 41% of RLS patients said they had arm symptoms corresponding to leg pain. Dickoff pointed out that RLS can often be confused with other pain conditions such as carpal tunnel syndrome and temporomandibular joint misalignment. In fact, 236 patients said they had previously undergone surgery for some type of chronic pain but only half of those patients were satisfied with the surgery outcome.

Earlier research has suggested that roughly three quarters of patients with both bruxism and RLS had a decrease in jaw symptoms after taking dopamine drugs for RLS. Although more research is needed to confirm these preliminary findings, it's possible that patients with RLS may benefit from treatments for migraine and bruxism.

Reference
Gever J, et al. Common cause for bruxism, restless legs, migraine. Medpage Today. October 17, 2013. 

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Perhaps you've always known you have a stiff shoulder, but suddenly, as you've grown older, that soreness is starting to interfere with your daily life and ability to sleep.

Frozen shoulder syndrome (FSS) is a common condition among middle-aged adults, especially women. The condition occurs when the capsule around the shoulder joint tightens and thickens, restricting the range of motion in the ligaments, bones, and tendons of the shoulder. This "freezing" develops gradually over time, and can cause significant pain and sleep disturbances.

Studies show that chiropractic spinal adjustments and exercise therapy can ease symptoms in patients with frozen shoulder syndrome. One recent study evaluated the effects of manipulation under anesthesia, combined with additional exercise therapy, in treating FSS.

Manipulation under anesthesia (MUA) is a non-invasive procedure involving spinal adjustments and soft-tissue therapies performed by a chiropractor or qualified physician. Like any type of chiropractic spinal adjustment, MUA is considered a safe, effective way to alleviate joint and spinal pain.

The study included 18 patients with FSS who received one session of MUA, along with additional exercise therapies. Researchers compared active range of motion and isometric maximal voluntary contraction of the muscles in the affected and unaffected shoulders. Range of motion was evaluated during shoulder flexion, adduction, and internal and external rotation. One month after treatment, the patients had a 27-37% improvement in active range of motion in all movements. Six months later, these improvements were sustained for adduction and internal rotation, but not for external rotation or flexion. Still, the patients had significant reductions in pain scores at both the one-month and six-month follow-ups.

Before MUA, patients average daytime pain score was 6.1 and nighttime pain score was 6.1. After MUA, the average pain score was 0.8 by day and 1.6 by night. Patients also had substantial improvements in isometric shoulder strength.

These findings add to earlier research demonstrating the safety and effectiveness of chiropractic treatments for frozen shoulder syndrome.

Reference
Sokk J, et al. Shoulder muscle isometric strength and active range of motion in patients with frozen shoulder after manipulation under anesthesia 2013; Clinical Investigations 2012; 48(7): 331-7. 

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New research showed that chiropractic led to significant improvements for 94% of neck-pain patients, but how do chiropractic techniques compare to other conservative treatments in the management of neck pain?

To answer that question, it's helpful to look back at an important study from 2003 published in the British Medical Journal. The study compared various conservative treatments and concluded that the type of manual therapy routinely used by chiropractors was the most cost-effective option for neck pain.

Researchers from the Netherlands were interested in evaluating not only the costs associated with manual therapy but how efficiently manual therapy delivered relief compared to other treatments.
They randomly assigned 183 patients with acute neck pain to receive care from manual therapists (MT), physiotherapists (PT), or general practitioners (GP). For the purposes of this study, manual therapy consisted of spinal mobilization applied to the neck without spinal adjustments.

Patients receiving manual therapy had the fastest recovery rate. After seven weeks of care, 68% of the MT group had recovered, compared to 51% of the PT group and 36% of the GP group. These differences in recovery rates were still statistically significant after 26 weeks but not after 52 weeks.

To calculate costs of treatments, the researchers considered direct costs such as visits to the healthcare provider and the costs of prescription drugs, in addition to indirect costs like work absenteeism and travel time. The manual therapy group had significantly lower costs, with patients spending only a third of the costs spent by patients in the PT and GP groups. On average manual therapy patients had approximately $611 in costs compared to $1773 in the physiotherapy group and $1885 in the general practitioner group (or €447, €1297, and €1379, respectively). Only nine patients in the MT group reported missed work due to neck pain, compared to 12 in the PT group and 15 in the GP group.

The reduced cost likely stemmed from the fact that MT patients were using significantly less prescription drugs and required fewer treatment interventions due to quicker recovery rates. The authors concluded that manual therapy, specifically spinal mobilization, is less costly and more effective for alleviating neck pain than physiotherapy or care from a general practitioner.

Reference
Korthals-de Bos IB, et al. Cost effectiveness of physiotherapy, manual therapy, and general practitioner. British Medical Journal 2003. doi: http://dx.doi.org/10.1136/bmj.326.7395.911. 

Researchers have discovered that patients with whiplash injuries may share certain characteristics of those with Achilles tendonosis, which may offer insight into potential new treatments for chronic whiplash pain. The study examined the tendons of patients with whiplash, and found signs of pathological neovascularization, or the development of blood vessels in abnormal tissues, similar to what has been found in patients with Achilles tendonosis.

"These findings promise that similar treatments that are now successful with Achilles tendonosis, may be effective in the [whiplash]-painful muscle insertions of the neck," wrote researchers from Umeå University in Sweden and Nova Southeastern College of Osteopathic Medicine in Florida.
Whiplash injuries occur when the body is subjected to shear forces which stretch, strain, and sometimes tear the ligaments, tendons, and structures of the neck, also called the cervical spine. This may create tiny microtears in the tendons of the neck, causing tendonosis. (Note tendonosis should not be confused with tendonitis which simply refers to the inflammation of tendons due to acute injury or repetitive strain injuries.)

Although many patients with whiplash are able to recover in a matter of weeks, a substantial number suffer from ongoing symptoms, and researchers sought to see whether studies of Achilles tendonosis could offer clues into the mechanisms behind this chronic pain.

Recent studies of chronic pain in the Achilles and patellar tendons have demonstrated the presence of high blood flow in the painful regions of the tendons, but not the non-painful regions of the tendons, using grey scale ultrasound (US) and color Doppler (CD) imaging techniques. Later biopsies revealed that these painful tendons showed signs of pathological neovascularization, or the growth of blood vessels in abnormal tissues. Injections of local anesthetics into these neovessels was found to provide temporary pain relief.

Umeå University researchers utilized the same imaging techniques used in the Achilles tendonosis studies to investigate changes in the tendons of patients with whiplash after auto collisions. Compared to healthy controls, whiplash patients had a more areas with high blood flow, and the blood flow was intensified at each region examined. Areas of high blood flow were apparent where the tendons entered into the bone (also called the enthesis) at the spinous process, and bilaterally juxtapositioned to the facet joints. Women with whiplash were more likely to have more areas of high blood flow then men, which may correspond to higher rates of whiplash injuries in women.
The authors suggested that this increased blood flow may be a sign of neovascularization, although more research is needed to confirm the results.

Seeking early treatment for whiplash injuries may assist in preventing chronic symptoms tied to tendonosis and muscle degeneration. Chiropractic adjustments, soft tissue therapies, and exercise rehabilitation can all help to heal the damaged tendons and ligaments of the neck after whiplash.
 
Reference
Kalawy H et al. New objective findings after whiplash injuries: High blood flow in painful cervical soft tissue: an ultrasound pilot studies. Scandinavian Journal of Pain 2013; 4(4): 173-179.