Objective:The primary aim of this study was to report the distribution of prognostic subgroups, as determined by The Keele (STarT) Back Screening Tool (SBT) in Veterans with low back pain presenting for consultation at a chiropractic clinic within the Veterans Health Administration (VHA). Methods:A chart review was conducted on all Veterans completing an initial consultation at a single VHA chiropractic clinic between April 15th, 2021 and January 31st, 2023. STarT Back Screening Tool scores and PROs were collected from the medical record corresponding to the date of consultation available in the VHA's electronic healthcare record (EHR) system. The proportion of each SBT subgroup (i.e., "low-risk", "medium-risk", and "high-risk") was calculated and subgroup differences across patient reported outcomes (PROs) were assessed. Results:Of 458 completed consultations, 386 (84.3%) sought care for low back pain and 251 (54.8%) had SBT data collected; 51 (20.3%) scored low-risk, 107 (42.6%) medium-risk, and 93 (37.1%) high-risk for persistent disability. As expected, the subgroups differed across baseline PRO. Conclusions:In this chiropractic clinic, the percentage of Veterans with a favorable prognosis suggested by SBT was low.
The author reflects on experiences over a half-century of engagement in chiropractic education. Both positive and negative aspects of the profession's evolution are highlighted, including such areas as clinical education, diversity within chiropractic education, the importance of research, and the importance of gaining public trust through evidence-based practices. The paper concludes with a repeated call to action for the profession to be a major player in the solution to the global challenge of low back pain, which can be supported by integration with the healthcare-system-at-large as a trusted and valued team member.
Objective:This quantitative pilot study with a qualitative adjunct aimed to characterize patients at two U.S.-based chiropractic teaching clinics using the novel MAINTAIN instrument, and to assess clinicians' and interns' initial clinical impressions based on patients' MAINTAIN scores. Methods:Between February and September 2022, 597 spinal pain patients were screened. Eligible patients (n=91) completed demographic and health questionnaires, including the MAINTAIN instrument. Clinicians and interns completed surveys to assess treatment plans and expectations for recovery. A qualitative analysis assessed clinicians' and interns' initial impressions based on patients' MAINTAIN scores. Results:The mean MAINTAIN score was 15.06 (SD: 9.03, range -7 to 32), with 39.6% of participants identified as potential candidates for maintenance care. Qualitative analysis identified several themes and subthemes which describe how clinicians and interns used patients' MAINTAIN scores. Conclusions:Despite limitations, these findings highlight the value of integrating the MAINTAIN instrument in chiropractic teaching clinics to enhance clinical decision-making and patient management.
Chiropractic specialization in Canada has evolved into a nationally coordinated, competency-based framework guided by the Federation of Canadian Chiropractic (FCC) and regulated through the Competency Profile for Chiropractic Specialists in Canada (2023) and emerging accreditation standards. Although specialists represent only 3% of Canadian chiropractors, they contribute disproportionately to education, research, and professional leadership. A 2025 survey on the value proposition of chiropractic specialty confirmed broad consensus that specialization enhances professional quality and public protection, yet revealed persistent barriers including inconsistent provincial recognition, limited visibility, and uneven geographic access. Framed within an advanced-practice paradigm, this commentary proposes three strategic priorities-harmonized recognition across provinces, equitable access through innovation, and enhanced visibility and evidence-to position chiropractic specialists as valued contributors to Canada's healthcare system. Implementation will strengthen quality assurance, expand interprofessional collaboration, and advance evidence-informed neuromusculoskeletal care.
We present the case of a 43-year-old male with progressive thoracic spine pain and bilateral intercostal referral who was ultimately diagnosed with spondylodiscitis. Despite red flag features such as night pain, functional decline, and significant unintentional weight loss, the patient lacked traditional risk factors for spinal infection. He had previously received acupuncture for lumbar radiculopathy, which had since resolved. Magnetic resonance imaging revealed vertebral body involvement and disc space destruction at the T8-T9 level, consistent with spondylodiscitis. The patient underwent surgical decompression, washout, and fusion, followed by a course of intravenous and oral antibiotics. He achieved full symptomatic resolution at follow-up. This case underscores the importance of early imaging and diagnostic suspicion in patients with spinal pain and red flags, even in the absence of conventional risk factors, and highlights the potential infectious risks of acupuncture performed outside clinical settings.
Objective:To describe the use of Mechanical Diagnosis and Therapy in evaluating and treating a patient with chronic postpartum isolated coccygeal pain. Clinical features:A 30-year-old female presented with isolated coccygeal pain that began after a vaginal birth 4 months prior. Aggravating factors included sitting and standing upright. She also expressed fear of transitioning from sitting to standing. Intervention/outcome:A directional preference for lumbar extension with right lateral flexion was identified, leading to a diagnosis of lumbar derangement and initiation of reductive forces. At follow-up, she maintained reduction and reported periods of being pain free with less fear of movement. Subsequently, force progressions were implemented. By visit 6, she was discharged with symptom resolution and functional improvement. Summary:This case demonstrates the utility of applying the principles of Mechanical Diagnosis and Therapy in the evaluation and treatment of a patient with chronic postpartum isolated coccygeal pain who failed previous treatments.
Background:Canadian chiropractic specialties have evolved over five decades with varied provincial recognition. This study assesses how regulators, specialists, and chiropractors perceive the value and future development of chiropractic specialties. Methods:We conducted a bilingual, cross-sectional online survey. Respondents rated agreement with 12 value propositions (5-point Likert), and open-ended comments were analyzed thematically. Results:248 respondents completed our survey (response rate of 5%): 12 regulators from 9 provinces, 58 specialists from 7 provinces, and 178 chiropractors from Ontario and Quebec. Agreement was consistently high (58.5-91.1%), with no significant differences between groups (F=1.85, p=0.160). Top future priorities: Paediatrics and Neurology (71%), Chronic Pain Management (65%), Geriatrics (56%). Qualitative analysis identified barriers (limited recognition, restricted scope, underutilization) alongside strong support for specialization. Conclusion:Despite reported consensus on specialization's value among respondents, structural barriers appear to limit integration within the healthcare system. Proposed solutions for advancing chiropractic specialties included national accreditation standards for postgraduate specialty programs, harmonized provincial recognition, and strengthened visibility.
Background:This systematic review evaluated the efficacy of SMT for chronic spinal conditions in adults aged 55 years and older. Methods:We searched multiple databases for randomized controlled trials (RCTs) on SMT for older adults with chronic spinal conditions (≥ 12 weeks) published from February 2016 through October 2024. Additionally, studies from the prior article being updated were included as appropriate. Eligible studies compared SMT to active or inert comparators, measuring pain, function, or quality of life. Results:Nine reports were included, evaluating SMT for chronic low back pain (5 RCTs, n=544), chronic neck pain (2 RCTs, n=241), lumbar spinal stenosis (1 RCT, n=259), and combined neck/back disability (1 RCT, n=182). Conclusion:SMT may offer comparable or modestly greater benefit than other treatments for chronic spinal conditions in older adults, particularly for neck pain and LSS. Evidence certainty remains very low to moderate. Registration:PROSPERO (CDR42024615084).
Objectives:To describe utilization of sports chiropractic treatment and injury statistics provided by Federation Internationale de Chiropratique du Sport (FICS) delegation at the International Workers and Amateurs in Sports Confederation 6th World Sport Games 2019 in Catalunya, Spain. Methods:This historical case-series study analysed clinical encounters of participants seeking sports chiropractic services during the 2019 WSG event. Descriptive statistical data included: participant demographics, utilization rate (proportion of accredited participants who sought chiropractic treatment), frequency (number of treatment sessions per individual), conditions per sport, treatment provided, and Numerical Rating Scale (NRS) for pain intensity (0-10 scale) before/after treatment provided by the FICS Chiropractic delegation. Results:Of a total of 2566 participants, 406 adults (accredited athletes and non-athletes over 18 years who provided informed consent) sought treatment from FICS; the overall utilization rate was 15.8%. We collected 623 forms; 602 met the inclusion criteria (complete treatment records from consenting adults). The FICS delegation provided services at centralized locations servicing 9 of 30 available sports. Primary body regions treated were shoulder (13.9%), neck (13.6%), knee (10.7%), thoracic spine (10.1%), and lumbar spine (10.1%), representing 58.4% of all treatments. The remaining 41.6% included ribs, sacroiliac joint, extremities, and other regions. Treatment modalities included: myotherapy (38.8%), manipulation (34.3%), taping (15.6%), and mobilization (8.2%). Participants receiving chiropractic treatment reported statistically significant pain reduction (average decrease of 2.8 NRS points, p < 0.001, 95% CI: 2.6-3.0), though the contribution of natural healing processes and concurrent interventions cannot be excluded. Volleyball (49.6%), beach volleyball (49.4%), and tennis (49.1%) showed the highest utilization rates. Conclusion:Participants receiving sports chiropractic treatment reported clinically significant pain reduction, with 90% experiencing immediate improvement. However, the single-arm observational design precludes definitive attribution to chiropractic intervention alone. The utilization rates varied by sport with volleyball, beach volleyball, and tennis showing the highest rates among sports with access to treatment centres. These findings provide valuable insights for future integration of sports chiropractic services at international sporting events.
Objectives:To describe the force-time characteristics of HVLA hip manipulation (HVLA-HM) with (DP) and without (NDP) a drop-piece. Methods:Twenty asymptomatic participants (22-28 years; 60% female) received 3 whip HVLA-HM (DP) on one hip and 3 whip HVLA-HM (NDP) on the other. Force-time characteristics were collected using Force-Sensing Table Technology (FSTT®) and analyzed descriptively. Results:On average, HVLA-HM (DP) had a 1st peak force initiation of 40N (±19), peak force of 637N (±218), time to 1st peak of 62ms (±26), loading rate of 10763N/s (±5042) and 2nd peak force of 197N (±85). HVLA-HM (NDP) had a 1st peak force initiation of 36N (±23), peak force of 567N (±290), time to 1st peak of 63ms (±22), loading rate of 9465N/s (±5966) and 2nd peak force of 197N (±82). Conclusion:Forces during these techniques present with slightly higher peak forces and loading rates during HVLA-HM (DP) at the patient-table interface.
Objective:Present a unique case of non-operative management of a partial ulnar collateral ligament (UCL) tear where the athlete was able to return to performance-based training in a brief six-week period. Case Presentation:A 29-year-old male running back presented to a sports specialist chiropractor for post-injection management of a grade 2 partial tear of the right UCL treated with ultrasound-guided platelet-rich plasma (PRP) and stem cell injections. Physical exam testing found limitations in elbow range of motion (ROM) as well as positive orthopedic tests confirming a UCL injury including the milking maneuver, and dynamic valgus stress test. Summary:Management consisted of multimodal chiropractic care including active release therapy (ART), electroacupuncture and rehabilitation exercises. This patient's improved strength and function without surgical intervention highlights the possible role of biologic injections as a form of non-operative management when combined with multimodal care to accelerate recovery from UCL injuries in elite athletes.
Objective:To outline a successful return to cycling protocol in a patient recovering from chronic coccydynia. Case Presentation:A 34-year-old female recreational cyclist suffered chronic coccydynia for one year. She received a cortisone shot that provided relief until she had a hysterectomy, which then intensified the pain. She was referred to a pelvic floor physiotherapist where she was discharged after one visit due to no pelvic abnormalities. She then sought chiropractic care where she went through a return to cycling protocol based around coccydynia rehabilitation and pain management. The patient was able to return to cycling after 22 weeks of chiropractic care. Summary:Coccydynia is a painful condition that has no universally accepted treatment or guidelines for management. As such, there are no return-to-sport protocols for individuals who have developed coccydynia in sports. Here we present an evidence-based protocol that can assist practitioners in the management of chronic coccydynia.
Objective:To describe clinical outcomes and return-to-play following multimodal chiropractic management of an elite speed skater with acute L5-S1 disc protrusion and S1 radiculopathy. Clinical Features:A 20-year-old male elite speed skater presented with sudden-onset severe lumbosacral pain and S1 dermatomal symptoms during ice training. Assessment revealed positive straight leg raise at 40 degrees, diminished reflexes, and motor weakness consistent with S1 radiculopathy. Day 3 MRI confirmed mild L5-S1 disc protrusion with S1 nerve root impingement. Intervention:McKenzie-based directional preference exercises with lumbar extension movements demonstrating centralization phenomenon. Treatment included progressive loading rehabilitation with sport-specific movement patterns through structured phases, McKenzie exercises performed 3-4 times daily (3-5 sets of 10-12 repetitions), and coordinated multidisciplinary care with physiotherapy, massage therapy, and strength coaching. Outcome:Complete return to competitive speed skating within 4.8 months with sustained participation without symptom recurrence at 12-month follow-up. Notable 5-second personal best improvement in week 9 of rehabilitation. Conclusion:Conservative chiropractic management utilizing McKenzie-based protocols within a coordinated multidisciplinary framework achieved excellent outcomes in this elite athlete with lumbar disc herniation and radiculopathy, including successful return to competitive performance with enhanced outcomes.
Background:Indigenous communities in northern Manitoba face a high burden of musculoskeletal (MSK) conditions and limited access to care. In October 2023, a new chiropractic service was launched in Cross Lake, Manitoba, aiming to improve MSK care access. This study explored: (1) the nature of MSK-related care provided at the Cross Lake Nursing Station, and (2) changes in clinical management during the first 10 months post-implementation. Methods:We conducted a retrospective chart review (standardized 14-item form) for two periods: December 2021-2022 (pre-implementation) and October 2023-August 2024 (post-implementation). Data on presentations, imaging, treatments, and referrals were analyzed descriptively. Results:Post-implementation, imaging use declined (63.4% to 44.9%), as did prescription of NSAIDs (80.5% to 53.1%), acetaminophen (63.4% to 32.7%), and opioids (21.9% to 8.2%). Muscle relaxant prescriptions increased, while pregabalin/gabapentin remained stable. Conclusion:The new chiropractic service may be associated with reduced use of imaging and common medications for MSK conditions.
Objective:To highlight the rehabilitation exercises of a football player following surgical reconstruction of a multi-ligament knee injury (MLKI) with vascular compromise. Case Presentation:A 17-year-old male high school football player sustained a traumatic MLKI requiring immediate limb saving surgery and subsequent tissue repair. Post-operatively, he engaged in an interdisciplinary phased and structured rehabilitation program with an emphasis on progressive loading, neuromuscular control and return-to-sport (RTS) readiness. At eight months post-op the athlete returned to a United States prepatory school where he transitioned to an external strength and conditioning program. Summary:This case report illustrates the complexities and value of an interdisciplinary and individualized rehabilitation program in the early stages of MLKI recovery. Outcomes were positive through eight months, but there were limitations related to the continuity of care that prevented long-term follow up.
Background:Chiropractors face workplace stressors that affect well-being, burnout and job satisfaction. The well-being of chiropractors and students in Australia is yet to be examined. Methods:From September 2024 to January 2025, Australian chiropractors and students completed a well-being survey. Measures included burnout, anxiety, depression, job satisfaction, substance use, suicidal ideation and job demands/resources. Multivariable regression models assessed factors associated with burnout and job satisfaction. Results:Of 200 respondents, 38% reported burnout and nearly 80% reported job satisfaction. Early-career chiropractors reported lower job satisfaction and higher burnout. Higher depression (β=0.26 [0.15-0.36]) and anxiety (β=0.03 [0.00-0.06]) scores were associated with burnout. Job satisfaction was associated with lower depression (OR=.60 [0.39-0.93]), more resources (OR=2.98 [1.39-6.39]) and greater workload control (OR=2.03 [1.14-3.62]). Conclusion:Preliminary results suggest the need for well-being screening and interventions for at-risk groups, including students, early career chiropractors and those experiencing elevated anxiety and depression.
Background:Soft tissue masses in the extremities of athletes present commonly in clinical practice. Clinicians focusing on musculoskeletal care will be familiar with common causes such as myofascial trigger points, hematomas and even lipomas, but may overlook less common causes such as benign or metastatic tumours. This paper describes a case of a schwannoma, a benign nerve tumour. Case Presentation:A 28-year-old recreational athlete presented with a five-year history of progressive calf pain and a palpable nodule unresponsive to conservative care. Imaging revealed a well-circumscribed intramuscular mass with vascular features. Surgical excision and histopathology confirmed a schwannoma. Postoperatively, the patient returned to full activity with resolution of pain. Summary:This case underscores the necessity of maintaining a broad differential and reinforces the importance of reevaluating diagnoses when conservative interventions fail. Early recognition and referral for imaging are critical to avoid prolonged mismanagement.
