Objective:The purpose of this study was to identify the point and lifetime prevalence of low back pain (LBP) among dressage riders and identify riding-related variables that may precipitate LBP. Methods:A cross-sectional, exploratory, quantitative study was conducted using an online questionnaire. One hundred dressage riders competing at preliminary and higher levels were recruited at the South African Equestrian Federation's registered shows. Frequencies and descriptive statistics were performed on each question in addition to cross-tabulations for associations between variables or differences between riding practices and experiences. Results:Participants were between the ages of 18 and 66 years. The questionnaire identified that 71% of participants reported point prevalence of LBP and 56% reported lifetime prevalence of LBP. Spearman ρ correlations showed positive correlations between how often participants believed their LBP was horse riding-related and how often they experienced LBP while competing/riding (r[75] = 0.46, P = .00) and how often their pain got worse with competing/riding (r[75] = 0.49, P = .00) and negative correlations with the number of hours spent in sitting trot and an increase in LBP (r[75] = -0.13, P = .28) and the number of hours spent cantering and an increase in LBP (r[75] = -0.19, P = .94). Conclusion:This study reports point and lifetime prevalence of LBP among competitive dressage riders in South Africa. Training/riding-specific horse gaits were associated with LBP in dressage riders.
Objective The purpose of this study was to examine the musculoskeletal (MSK) cognitive competency among 1st and 2nd-year Master of Health Science (MHSc) chiropractic students at the University of Johannesburg. Methods This cross-sectional, quantitative, and exploratory study used an adapted Freedman and Bernstein Basic Competency Examination (BCE) assessment distributed anonymously and online to the MHSc (n = 50) students at University of Johannesburg between 6 December 2022 to 17 March 2023. Statistical analyses included frequencies, descriptive statistics, and cross-tabulations to identify patterns or interrelationships. Results The survey achieved a 90% response rate (n = 45) from the 2022 MHSc students: 46.7% (n = 21) were 1st-year students and 53.3% (n = 24) were 2nd-year students. The participants of this study achieved a mean score of 79.58% (95% confidence interval, 75.9%-83.7%) for the 20-item Freedman and Bernstein BCE. The minimum score achieved by the participants was 11.50 (57.50%) and the maximum score achieved was 20.00 (100.00%). Statistically significant differences were observed between the 1st- and 2nd-year cohorts on the Freedman and Bernstein BCE, particularly in content and clinically based areas. Conclusion This study showed that this group of MHSc chiropractic students at the University of Johannesburg demonstrated strong cognitive competency in the MSK system using an adapted standardized assessment, highlighting adequate chiropractic training and student preparedness in managing MSK conditions.
Objective This study aimed to assess the validity of visual assessment in diagnosing lower extremity impairments during level walking. Methods Twenty-eight subjects (17 women, 11 men) with tibiofemoral rotation syndrome (TFRS) were examined using visual assessment as the index test and 3-dimensional (3D) motion analysis as the reference test. Both knee joint movements and the index and reference tests were evaluated simultaneously. Results The sensitivity and specificity of visual assessment for detecting movement impairments were Se: 98% and Sp: 16.7%, respectively. The positive and negative predictive values were PPV: 81.5% and NPV: 50%, respectively. The positive and negative likelihood ratios were PLR: 1.18 and NLR: 0.12. Conclusion The results demonstrate excellent validity of visual assessment for identifying movement impairments in subjects with TFRS during level walking. However, this test's validity for detecting the absence of movement impairments in subjects without TFRS was poor.
Objectives The objective of this study was to assess chiropractors’ and chiropractic students’ acceptability of a sensing glove system for measuring Spinal manipulative therapy (SMT) force-time characteristics and to compare the effectiveness of 2 interventions in improving their acceptability and perceived usability. Methods Sixteen participants were recruited and initially rated their agreement with 12 statements about the acceptability of the sensing glove system. They then underwent 2 interventions designed to improve their acceptability of the system in a random order: a 7-minute informational video and a 20-minute supervised practice session. After each intervention, participants reassessed their agreement with the acceptability statements and provided feedback on the system’s usability through 10 additional statements. Data analysis used McNemar and Cochran’s Q tests to assess the interventions’ effectiveness. Results The practice session led to a significantly higher number of participants agreeing with 4 more acceptability statements than at baseline, and with 1 more statement than after the video intervention. Conversely, the video intervention showed an increased proportion of agreement for only 1 statement compared to the baseline. Furthermore, the practice session resulted in a higher proportion of participants agreeing with 2 usability statements compared to the video intervention. Conclusions The study highlights the importance of supervised hands-on practice in enhancing the acceptability and willingness of chiropractors and chiropractic students to adopt a force-sensing system in their clinical practice.
Objectives The purpose of this study was to explore the use of remote consultations (RCs) by chiropractors in the United Kingdom. Methods All registered practicing UK chiropractors were invited to participate in an online survey during part of the first UK national lockdown period of the COVID-19 pandemic (May 2020 to June 2020). This survey collected information on 1) chiropractor demographics, 2) use of RCs by chiropractors, and 3) chiropractors’ views of RCs. Descriptive and inferential statistics (chi-squared and Spearman’s Rho) were used to analyze the data. Results The response rate was 17.1% (534/3131). A third of respondents (32.5%) had been using RCs (telephone) prior to the pandemic. Two-thirds (67.2%) used RCs during the first lockdown period and included uptake of video consultations (6.6%), phone consultations (30%), or a combination of video and phone (30.7%). A majority (58.6%) responded that they planned to continue RCs after practice restrictions were lifted. Under half (47.8%) gave their opinion that RCs would not be as effective as face-to-face care, a similar proportion (50.1%) stated they were engaging their patients with active care more than typical. Only around a half of the respondents (52.5%) were confident in carrying out RCs. Conclusions This survey provides preliminary data on RCs delivered by UK chiropractors - a traditionally ‘hands-on’ profession. Both telephone and video RCs increased during the first UK national lockdown but confidence in carrying out RCs and impressions of their effectiveness was mixed.
Objective The purpose of this case series is to describe the outcomes of chiropractic therapy using Cox technic flexion distraction decompression spinal manipulation for patients with cervical and lumbar failed back surgery syndrome (FBSS) who were experiencing pain in the areas where they had previously undergone surgery. Methods This case series includes clinical outcome measures from 61 patients with FBSS treated by 21 certified Cox Doctors of Chiropractic from multiple clinic locations. Primary outcomes were pain severity and function, assessed using Patient-Reported Outcomes Measurement System-29 v1.0, Neck Disability Index, and Numerical Pain Rating Scale (NPRS) questionnaires. Data were analyzed with SPSS software (version 28, IBM Corp). Demographic data were summarized with descriptive statistics. NPRS for neck pain was analyzed using the Friedman test. Repeated measures ANOVA was used to compare initial visit data with data at 3 and 12 months after the onset of care. Results The cohort received a mean (SD) of 12.9 (8.0) treatments over 56.3 (35.2) days. Pain relief reported by doctors was 67.2% (28.5%) and by patients was 65.9% (29.3%). Neck Disability Index scores had reduced by 6.4 (SD 6.9) and 2.67 (5.1) at 3 and 12 months, respectively. NPRS showed reduced pain for cervical and lumbar patients at 3 and 12 months. Patient-Reported Outcomes Measurement System-29 v1.0 scores improved in physical function, anxiety, depression, fatigue, pain interference, average pain, spine pain, leg and arm pain, sleep disturbance, and social roles. Conclusion Patients with FBSS who received specialized chiropractic flexion distraction spinal manipulation in this study experienced relief of pain and disability.
Objective The purpose of this case report is to describe chiropractic management of a patient with neck pain, cervical kyphosis, cervical radiculopathy, and resting tremors of the left arm. Clinical Features A 58-year-old White male presented with an insidious onset of severe neck pain and burning pain down the left arm with accompanying involuntary resting tremors of the left arm. The pain and tremors limited his ability to sit, walk, work, drive, sleep, and perform household chores, with driving and sleeping reportedly being the most substantial activities affected. Clinical testing revealed left cervical radiculopathy with severe myospasm in the scalene and levator scapulae muscles. Radiographs revealed reversed cervical curvature and degenerative spondylosis with neural foraminal encroachment at C4-C5, C5-C6, and C6-C7. Intervention and Outcome The patient was initially managed with soft tissue therapy to the upper trapezius and levator scapulae, and gentle manual cervical traction for 4 visits over the course of 1 week. This was followed by incorporation of cervical spinal manipulation using low force adjustments, manual cervical traction, and thoracic spinal manipulation using diversified technique 3 times a week for 3 additional weeks. After active treatment, a monthly maintenance plan was prescribed. At the start of treatment, the Numeric Pain Rating (NPR) was recorded at 8/10, and the Neck Disability Index (NDI) Score was 26%. At 1- and 2-year follow-ups, NPR was recorded as 0/10 and 0/10, respectively, and NDI Score was 4% and 0%, respectively. Conclusion Neck and arm pain and debilitating tremors resolved in a patient who received chiropractic care. These improvements were maintained 2 years after the start of treatment.
Objective This study aimed to examine the effect of the psoas myofascial release (MFR), along with physiotherapy (PT) on pain and disability index in treating people with nonspecific chronic low back pain (NCLBP). Methods Forty subjects with NCLBP (>3 months) were randomly allocated into 2 groups (n = 20) of the MFR+ PT and PT alone groups. Each group received 8 sessions of PT. The MFR+ PT group received the psoas MFR in 4 sessions in addition to PT. The Numeric Pain Rating Scale was used for pain assessment, while the Roland Morris Questionnaire (RMQ) for disability index was employed to evaluate the effect of psoas MFR and PT. Assessments were performed at baseline, end of the treatment, and 4 weeks of follow-up. Results The statistical analysis revealed a significant reduction in pain and disability index in both groups at the end of the treatment (P < .001). A significant decline in disability index was observed in the MFR+ PT group (P < .05). There were no significant differences in pain between the 2 groups post-intervention (P > .05). Conclusion The findings of this study indicate that the psoas MFR may have an effect on the disability index in people with NCLBP. However, psoas MFR was not more effective in reducing pain.
Objective The purpose of this case report is to describe the management of chronic low back pain in a Veteran with advanced testicular cancer. Clinical Features A 34-year-old with testicular cancer, status post orchiectomy, was referred to the chiropractor for his chronic thoracolumbar pain at a VA medical center. Intervention and Outcomes Palliative treatment included lifestyle counseling, exercise, soft-tissue therapy, spinal mobilization, and low-force drop manipulation. A total of 13 visits occurred over 14 months. Pain intensity temporarily reduced from 5/10 to 3/10 for about 2 to 4 weeks following treatments. Despite persistent urging from multiple healthcare providers, the patient delayed follow-up on a concerning pelvic lesion. Metastatic spread to the lumbar spine was identified 14 months after his referral, and 5 months later he experienced a pathologic L3 vertebral fracture. Nine months after this fracture, widespread metastasis combined with a COVID-19 infection led to his death. Conclusions In this case, chiropractic care was provided as palliative care in the context of testicular cancer. His back pain temporarily improved after chiropractic treatment.
Objective The purpose of this report is to describe a patient with progressive neurological signs during a trial of chiropractic care for lumbar radicular pain. Clinical Features A 72-year-old male US Veteran presented for chiropractic care with left lower extremity pain and numbness and tingling in both hands and feet. The patient’s comorbidities included stage IV b-cell lymphocytic leukemia currently in remission, scleroderma, diabetes mellitus with previously diagnosed peripheral neuropathy, hemolytic anemia, and osteoporosis from long-term corticosteroid use. Initial evaluation was unremarkable for neurological findings, a re-evaluation revealed new signs suggestive of myelopathy including brisk patellar reflexes and a unilateral Hoffman’s sign. Lumbar spine radiographs were requested and demonstrated moderate, diffuse spine-related degenerative changes. Intervention and Outcome After 5 sessions of chiropractic flexion-distraction manipulation to the lumbar spine, soft-tissue therapy, and sciatic nerve mobilization exercises, the patient improved. However, at re-evaluation progressive neurological findings warranted primary care coordination for the request of advanced imaging due to suspicion of cervical myelopathy. A cervical MRI revealed severe cervical spinal stenosis with impingement upon the cervical cord at C3-C4. A neurosurgical consult was placed by the requesting physician for surgical consideration. Conclusion This case highlights the challenges associated with early signs of degenerative cervical myelopathy and its variable presentation. It highlights the importance of performing routine re-evaluations when managing multimorbid neuromusculoskeletal conditions and how signs of chronic conditions, such as degenerative cervical myelopathy, may rapidly manifest.
Objective The purpose of this study was to determine the relationship between pain, disability, and lumbar multifidus activity in people with chronic low back pain while standing. Methods This cross-sectional study included baseline analysis of a randomized controlled trial of 150 patients with chronic low back pain. Pain intensity during standing, disability, and lumbar multifidus activity was assessed using a visual analog scale, the Oswestry Disability Index questionnaire, and surface electromyography, respectively. Multiple linear regression was used to analyze the association between lumbar multifidus activity, pain during standing, and disability. Results Lumbar multifidus (LM) activity on the right side did not significantly correlate with pain intensity during standing, except for the left-side percent maximum voluntary contraction of the LM, which showed a significant positive correlation with pain intensity (r = 0.328, P < .001). There was a positive correlation of functional disability with right-side LM activity (r = 0.180, p < .05) and left-side LM activity (r = 0.351, p < .001). Conclusion An increase in lumbar multifidus activity is correlated with increased pain during standing and disability.
Objective This study aimed to measure muscle activity during seated trunk strength training using resistance-wheeled training equipment at different resistance levels. Methods The participants were 19 healthy males. Resistance-wheeled training equipment, such as the small vehicle used in this study, had a mechanical braking function that locked the wheels and unlocked the brakes while only pressing downward with a constant force. The subjects moved the equipment forward and backward on a desk with an unlocked brake status. The participants performed under 3 conditions; (1) unlocked with no force, (2) unlocked with low force, and (3) unlocked with high force. Results Muscle activity increased significantly with increasing locked strength in the deltoid posterior, internal and external oblique, rectus abdominis, erector spinae thorax, and lumbar muscles. Some muscles reached over 50% of the maximum voluntary contraction when unlocked with a high force. Conclusion The muscle activity measured during trunk training that exceeded 50% of the maximum voluntary activation level corresponds to be sufficiently high for strength training and the activity level required for muscle hypertrophy. We believe that this research equipment may be a useful seated trunk strength training device.
Objective The study aimed to assess the endurance of core muscles, shoulder range of motion (ROM), strength, and disability in subjects with and without shoulder pain. A secondary aim was to determine a possible connection between core muscle endurance and shoulder pain, along with related variables. Methods This cross-sectional study evaluated 50 subjects with shoulder pain (54.60 ± 12.17 years) and 50 without shoulder pain (53.86 ± 12.08 years). Core muscle endurance was assessed using the flexor endurance test and the prone bridge. Shoulder ROM, strength, scapula strength, and SPADI were evaluated. Results The mean duration of shoulder pain was 13.77 months. Subjects with shoulder pain had significantly reduced core muscle endurance (P < .001), shoulder strength (P < .001), scapula elevator and depressor muscle strength (P < .05), and passive ROM (P < .05). Correlation was found between core muscle endurance and shoulder muscle strength (r = 0.50; P < .05). Conclusion Reduced core muscle endurance was strongly linked to shoulder muscle strength in individuals experiencing shoulder pain. This underscores the necessity of addressing core stability along with shoulder and scapula strength assessment.
Objective The purpose of this study was to compare the effects of 4 weeks of conventional abdominal training and training combined with whole-body vibration (WBV) on erector spinae (ES) stiffness, assessed using ultrasound shear wave elastography. Methods Twenty-four healthy university students were randomly assigned to either a WBV or non-WBV group and performed the same exercise on the floor. The participants held a sit-up position for training, 3 times per week for 4 weeks. The primary outcome was ES stiffness measured using shear wave elastography. Secondary outcomes included pressure pain threshold of the ES, lumbar proprioception, and maximum lumbar flexion angle. Split-plot ANOVA was used to analyze the data. Results There was no significant group × period interaction for ES stiffness. However, the WBV group showed a significant reduction in ES stiffness and an improvement in lumbar proprioception after the intervention. In contrast, the non-WBV group showed a decrease in ES pressure pain threshold. Conclusion Abdominal training with WBV reduced ES stiffness and enhanced lumbar proprioception in asymptomatic adults. These findings suggest that WBV may improve trunk muscle properties and sensorimotor function.
Objective This study evaluated the effects of transfer energy capacitive and resistive (TECAR) therapy on primary shoulder adhesive capsulitis by assessing the Shoulder Pain and Disability Index (SPADI) and shoulder passive range of flexion, abduction, and external rotation. Methods Thirty subjects with shoulder adhesive capsulitis, having a minimum 3 months history of shoulder pain, aged 41 to 72 years, were randomized to receive either physiotherapy (PT) or PT plus TECAR therapy (TT). Both groups received 8 sessions of PT treatment, including modalities and exercises, and the TT group received an additional 10 minutes of TECAR treatment in the resistive mode. SPADI and shoulder passive range of motion were evaluated before treatment, 1 day after the 8th session, and after 1 month. Results Significant changes in all variables were observed in both groups (P < .001), except the passive external rotation range and disability subscale of SPADI, which were significant only in the TT group. Changes in all variables (except the disability subscale of SPADI and total SPADI scores) did not have any relationship with the membership of patients in the groups, means there was no interaction between time and type of intervention. There were no significant between-group differences (P > .05). Conclusion In this preliminary study, TT and PT treatment both showed improvements in shoulder passive ROM, pain, and disability. There were no significant differences between the groups.
Objective:This study explored the link between hip abductor function, assessed through the Trendelenburg test (TT), and pelvic drop during walking and running across various terrains and speeds. Methods:A sample of 19 healthy adults (11 females, 8 males; average age 24.4 years, height 1.74 meters, weight 72.5 kilograms) participated. The TT was conducted on both sides of each participant's body, followed by walking at three speeds (self-selected, slow, fast) on 3 slopes (-10%, level, 10%) and running at 2 speeds (8 and 10 km/h) on the same slopes, using a motorized treadmill. Pelvic motion was captured with a 3D system to analyze maximum and minimum pelvic motion (P MAX, P MIN) and range of angular motion (P ROM). Participants were divided into "positive" and "negative" groups based on TT results. Independent and paired t tests (with Bonferroni corrections), along with Pearson's correlations, were used to analyze data. Results:Significant differences in P MAX and P MIN were observed between the groups, with the "positive" group showing 5.3° and 5.9° less movement, respectively, than the "negative" group. However, no significant differences were found in P ROM data between the groups across all gait tasks, and no correlation was identified between TT P ROM data and P ROM gait data in different walking conditions. Conclusion:This study showed no association between the effects of hip abductor weakness (as identified by the TT) and pelvic mobility during walking and running gait in a healthy, young population. While the TT may serve as a valuable tool for identifying hip abductor weakness in a clinical setting, its direct applicability to predicting dynamic pelvic motion during walking and running remains limited.
Objective The purpose of this case study is to describe the clinical presentation and imaging evaluation of an acute type II dens fracture that failed to unite with immobilization. Subsequent management aimed at optimizing the patient’s quality of life is discussed. Clinical Presentation An 84-year-old male presented to a chiropractic clinic 4 days after a ground-level fall onto his face. He demonstrated facial bruising, severe pain of the neck and severely limited cervical rotation. Based on the clinical findings and history, the attending chiropractor suspected a cervical spine fracture. Intervention and outcome The chiropractor proceeded to take cervical spine radiographs which showed a type II dens fracture and anterior translation of C1. The patient was then transported to the hospital by ambulance, where computed tomography (CT) confirmed the presence of a type II odontoid fracture. Following immobilization, initially with a hard collar and later a soft collar, the dens fracture healed but with non-union. A magnetic resonance imaging scan with flexion and extension showed translation of the dens, however no spinal cord compromise was demonstrated. Surgery was not advised due to the patient’s age and lack of cord compromise. The chiropractor resumed management after medical clearance, focusing on fall prevention strategies, neck strengthening exercises and gentle soft tissue work. Conclusion Upright magnetic resonance imaging with flexion and extension was helpful for evaluation and further management of a non-united mobile type II dens fracture. Patients who experience non-union of type II odontoid fracture may benefit from conservative measures aimed at falls prevention, such as balance exercises, bone and heart health evaluation, muscle strengthening, cataract evaluation and scrutiny for hazards in the home.
Objective: The purpose of this study was to investigate iron deficiency anemia (IDA), its associated factors, and intake of iron/folate supplements among pregnant women in the antenatal care facility of Aminu Kano Teaching Hospital, Kano, Nigeria. Methods: The study was longitudinally designed, and 112 pregnant women in the second trimester were recruited and followed up through the third trimester. Sociodemographic characteristics, medical/obstetrical history, consumption pattern, and iron indices were assessed using standard methods. Results: This study showed that 58.0% of the pregnant women investigated have attained a tertiary level of education, and 50.0% were full-time housewives. Among the pregnant women, 56.4% were iron/folate supplement-compliant, and 83.0% and 67.8% were multigravida and multipara, respectively. The study reported that approximately 24.8% of the pregnant women consumed heme iron food sources at least 1 to 3 times daily, while approximately 64.8% did not have a daily intake of at least 1 nonheme iron-rich food source. Iron deficiency anemia prevalence in the second trimester was 10.7%, increasing to 16.5% in the third trimester (P < .05). Similarly, all-cause anemia increased from 37.5% to 65.9% and iron deficiency from 14.3% to 23.5% (P < .05 for both). Conclusion: Progression from the second to third trimesters was associated with an increased risk of anemia, iron deficiency, and IDA among pregnant women. Pregnant women taking iron/folate supplements had higher iron indices than the noncompliant pregnant women. Consumption of iron-rich foods among pregnant women was low and had little effect on the iron indices estimated, while supplement intake and birth spacing had a significant negative association with anemia, iron deficiency, and IDA.
Objective:The main aim of this study was to assess the effects of adding MT to a Respiratory Rehabilitation (RR) program in patients with Respiratory Disorders (RD). Methods:A systematic search was carried out in PubMed, EMBASE, CINAHL, PEDro and Google Scholar (February 1st 2023). The outcome measures were pulmonary function parameters (FEV1 and FVC); and exercise capacity, through the 6-minute walk test (6-MWT). Standardized mean differences (SMDs) and 95% confidence intervals were calculated and were pooled in a meta-analysis with a random effects model. Results:In total, 6 studies were included. Regarding the pulmonary function parameters, no significant effects were found in favor of adding MT to a RR program. However, the meta-analysis showed a significant improvement of 6-MWT when MT were added to a RR with a small clinical effect (n = 6, SMD = -0.55 (-1.01 to -0.09)). Lastly, the meta-regression analysis revealed that the intervention time of MT was not significantly correlated with the improvement of FEV1 (R2 = 52.49%, P = .16), FVC (R2=4.22%, P = .70), or 6-MWT (R2=9.95%, P = .62). Conclusions:There is low-quality evidence that adding MT to an RR program can improve the exercise capacity in patients with RD. However, MT plus RR showed no effect on pulmonary function parameters, also with low-quality evidence.
Objective The purpose of this report is to describe changes in the cellular lipid profile of participants following 120 days of omega-3 fatty acid supplementation. Methods Six participants received a non-gastric acid-resistant omega-3 fatty acid supplement, with dosages personalized based on preintervention red blood cell (RBC) omega-6 to omega-3 ratios. Blood samples were analyzed pre- and postintervention to determine changes in RBC lipid profiles. Results Six participants who were either fully or partially compliant with the supplementation showed a mean reduction of 41.2% in their RBC omega-6 to omega-3 ratio, with 2 participants achieving a ratio of 4:1 or lower. Conclusion Several of the compliant participants with Omega-3 fatty acid supplementation recorded a reduction in the omega-6 to omega-3 ratio in RBC lipid profiles.
