Henrik W. Christensen, DC, MD, Niels Nilsson, DC, MD.
Objective: To describe the natural variation of the active and passive cervical range of motion (ROM) over three weeks in asymptomatic subjects.
Study Design: One way repeated measures of active and passive cervical ROM.
Setting: Institute of Medical Biology (Center of Biomechanics) at Odense University. Participants: 40 asymptomatic students from the University of Odense, male/female ratio: 20/20, mean age 23.9 years (range 20-30 years).
Intervention: Measurements of the active and passive cervical ROM using the electrogoniometer CA-6000 Spine Motion Analyzer. Each subjects was measured six times during a three week period. The measurements were performed on the same time of the day. The device gives the maximum end range of motion for the motion plane examined.
Results: The natural variation in active and passive ROM was found to be in the order of x + 12o for lateral flexion and x + 14o for rotation.
Conclusion: In asymptomatic subjects the individual natural variation is quite large for active and passive cervical flexion/extension, lateral flexion and rotation. When measuring individual patients one should allow for a natural variation of 12-20o.
Key Indexing Terms: cervical range of motion; natural variation.
Strong and weak measures of efficacy: A comparison of chiropractic with biomedicine in the management of back pain
Robert Anderson, MD, PhD, DC.
A holistic, biocultural model for identifying efficacy in the management of back pain by chiropractic and medical doctors is proposed here based upon adopting the concepts of vertical reasoning and dual-level control. Utilizing this approach, four different ways in which efficacy can be measured are identified: 1) anatomic-physiologic (curing of disease); 2) body/mind (healing of illness); 3) sociocultural (termination of sickness); and 4) political-economic (ending no access to care). These four are conceptualized as relating to levels in a hierarchy of structures of increasing size and complexity ranging from atoms and molecules to societies and nations. In measuring efficacy at each level, it is important to distinguish weak from strong measures. Strong measures conform to a Guttman scale model in the sense that each higher measure of efficacy also demonstrates efficacy at all levels lower than itself. Weak measures fail to conform to a Guttman-like scale, and are of therefore of questionable value when used to support decisions relating to health care policy
Key Indexing Terms: low back pain; chiropractic; health care policy: medical anthropology.
Chiropractic radiologists: A survey of demographics, abilities, educational attitudes, and practice trends.
Dennis Marchiori, DC, MS, DACBR, Cheryl Hawk, DC, PhD, and Joseph Howe, DC, DACBR.
Objective: To assess the education, abilities, practices, and opinions of chiropractic radiologists.
Design: Eight page survey with two mailings.
Participants: One-hundred and seventy five diplomats of the American Chiropractic Board of Radiology (DACBR) listed with the American Chiropractic College of Radiology office.
Results: One-hundred and eleven surveys were returned from the 175 individuals listed with the ACCR office. Following exclusion for deceased and those with a self-reported retired status, the response rate was calculated as 66%. Respondents were 81% males, 96% white, and reported a mean age of 46.4 (SD = 11.2) years. Most were residents of California, followed by Canada and Illinois. Thirty-six percent teach at chiropractic colleges. They feel most confident to interpret plain film studies of the musculoskeletal system. Many have undergone advanced training in specialized imaging. They feel topics related patient positioning, plain film physics, arthritides, trauma, avascular necrosis and tumors are most important to a chiropractic curriculum. Most respondents feel the use of plain film radiology is most appropriate where the clinical presentation of the patient suggests strong possibility of underlying disease.
Conclusions: Radiology is an important topic to the education of students and the practice of chiropractic. The results of this survey will assist future decisions regarding student education and clinical use of radiology.
Key Indexing Terms: radiology; survey; education; chiropractic.
Chiropractic management of a patient with low-back pain and epileptic seizures.
Joel Alcantara, DC, Roger Heschong DC, Gregory Plaugher, DC, and Joey Alcantara.
Objective: To describe the chiropractic management of a patient presenting with complaints of low back pain and epileptic seizures. The discussion also addresses epilepsy and the current concepts of this disorder, such as its multifactorial nature, classification schemes; we propose possible mechanisms for the neurological effects of the chiropractic adjustment and its therapeutic implications.
Clinical Features: A 21-year-old female suffering from low-back pain reported that she had fainted during the night and had hit her head. She had been diagnosed since childhood as having grand mal (tonic clonic) seizures as well as petit mal seizures. At the time of chiropractic evaluation, the frequency of her seizures was reported at three-hour intervals, with a duration between 10 seconds to 30 minutes for each episode. Examination indicated signs of dysfunction/subluxation at the L5-S1, C6-C7 and C3-C4 spinal levels. There was no evidence of cranial nerve involvement or any upper motor neuron lesion. Radiographic analysis revealed retrolisthesis of L5, hypolordosis of the cervical spine and hyperextension of the C6-C7 motion segment.
Intervention and Outcome: Chiropractic adjustments utilizing a specific contact, short lever arm, high-velocity, low-amplitude maneuver were applied to the subluxation findings at the cervical, thoracic and lumbopelvic region. The patient's reported low-back pain and neck complaints improved and her seizure frequency decreased. At one and one-half year follow-up, the patient reported her low-back complaints had resolved and her seizures had decreased to where the period between seizures had been as great as two months.
Conclusion: The chiropractic management of a patient reporting low-back pain and epileptic seizures is reported. Results encourage further investigation of possible neurologic sequalae, such as epileptic seizures, from spinal dysfunction identified as vertebral subluxation complexes by chiropractors and treated by specific spinal adjustment.
Key Indexing Terms: low-back pain; epilepsy; chiropractic.
The relationship between posture and curvature of the cervical spine.
Corine Visscher, Wim de Boer, PhD, and Machiel Naeije, PhD.
Objective: To study the relationship between posture and curvature of the cervical spine in healthy subjects.
Subjects: The study comprised of 54 healthy students, aged 20 to 31 years with a mean age of 24.7 years (25 men and 29 women).
Methods: Lateral radiographs of the head and cervical spine of the subjects, while standing in a neutral position, were taken. Cervical spine posture was quantified by the angle of a reference line, composed of reference points of the upper six cervical vertebrae, with the horizontal axis. The curvature of the cervical spine was classified visually as lordotic, straight or reversed.
Results: A relationship was found between posture and curvature of the cervical spine (p=0.006); a more forward posture of the cervical spine was related to a partly reversed curvature, a more upright posture to a lordotic curvature. Moreover, men more often showed a straight curvature and women more often a partly reversed curvature.
Conclusion: The curvature of the cervical spine is related to its posture and to gender.
Key Indexing Terms: cervical spine; posture; gender.
Spina bifida occulta mimicking a destructive lesion.
Vince DeBono, RT, DC, Dennis Marchiori, DC, MS, DACBR.
Objective: To discuss an unusual presentation of spina bifida occulta mimicking an aggressive lesion of bone
Clinical Features: A 59 year-old male suffered from intermittent neck pain. The plain film radiographs revealed rarefaction of the C6 spinous process which mimicked an aggression lesion of bone. Computed tomography and past radiographs of the region confirmed a spina bifida occulta defect of the C6 level.
Intervention and Outcome: Supportive therapy was applied to patient for his presenting neck complaint. Chiropractic manipulative treatment was not applied to the lower cervical spine until the possibility of an aggressive bone lesion was excluded.
Conclusion: An unusual presentation of spina bifida occulta is presented. This case demonstrates the usefulness of specialized imaging to further delineate questionable anatomical presentations, which at times mimic destruction lesions of bone.
Key Indexing Terms: spina bifida; low-back pain; chiropractic.
Spinal manipulation in China.
Li Yi-kai, PhD, Zhong Shi-zhen, PhD.
Objective: To discuss the history and status of Chinese spinal manipulation.
Discussion: The history, status, publication record, education, clinical application and basic studies about spinal manipulation in China are described.
Conclusion: The article discusses the general status of spinal manipulation in China and of its spinal manipulation specialists.
Key Indexing Terms: manipulation; basic research; traditional Chinese medicine; spine.
Dynamic Chiropractic editorial staff members research, investigate and write articles for the publication on an ongoing basis. To contact the Editorial Department or submit an article of your own for consideration, email
.