CJA Vol.23 Issue 2Editorial: Science, Sanity and Spizzerinctum. Rotary Subluxation of the Atlas: An Exploration of
the Diagnostic Potential of the CT Scan. Premenstrual Syndrome: A Clinical Update for the
Chiropractor. Residual Disability from Delayed Manipulative
Treatment for Mechanical Low-Back Pain: A Case Review. Use of Provocational Tests by Clinicians to Predict
Vulnerability of Patients to Vertebrobasilar Insufficiency. Olfactory Whiplash: A Case Study. Chiropractic in Australia: A Delphi Study of the
Primary Contact Practice Paradigm. ABSTRACTS Rotary Subluxation of the Atlas: An Exploration of the Diagnostic Potential of the CT Scan PHILLIP S. EBRALL and THOMAS P. MOLYNEUX Chiropractors treat spinal dysfunction, identified variously as fixation or subluxation. Some chiropractors rely on the graphic marking of plain radiographs to determine the probable levels of spinal dysfunction amenable to manipulation. A method of measuring rotation about the y axis by upper cervical spine segments as shown on a CT scan in the transverse plane is presented. A study group of 12 subjects was assessed by the method, and the findings are presented. It is concluded that the CT scan is an appropriate diagnostic tool for assessment of the intersegmental relationships of the upper cervical region, and that there is a paucity of research on the chiropractic application of this type of assessment. It remains to be seen whether diagnostic utility of CT scanning can be demonstrated with respect to the biomechanical considerations of upper cervical spine dysfunction. INDEX TERMS: (MeSH): tomography, x-ray computed; radiography; chiropractic; spine; manipulation, chiropractic; atlanto-axial joint;cervical vertebrae Chiropractic J Aust 1993 Jun;23(2):42-7 Premenstrual Syndrome: A Clinical Update for the Chiropractor. MAXWELL J. WALSH Anecdotal evidence of the effectiveness of chiropractic manipulative therapy (CMT) in reducing the symptoms associated with premenstrual syndrome (PMS) has existed for some time. Recent case studies support this, but no clinical trials have been performed. This article reviews the current definition and diagnosis of PMS. Common non-chiropractic therapies are critically reviewed and, in general, are found to be ineffective or to have undesireable side-effects. Chiropractic management of PMS is discussed, and some theoretical models are proposed. A wholistic chiropractic management regime offers the possibility of a safe, effective method of reducing many of the symptoms of PMS, however, there is a need for placebo-controlled clinical trials to explore the role of chiropractic in the treatment of this complex disorder. INDEX TERMS: MeSH); chiropractic; premenstrual syndrome Chiropractic J Aust 1993 Mar;23(2):48-53 Residual Disability from Delayed Manipulative Treatment for Mechanical Low-Back Pain: A Case Review PHILLIP S. EBRALL The objective of this study was to document the empirical observation that delayed manipulative intervention may produce residual disability in workers with mechanical low-back pain (MLBP), through a review of three case studies by catamnesis and follow-up telephone call. The setting was an outer suburban chiropractic clinic with the cases originating between July 1990 and October 1991. Three previously healthy, physically fit, employed adult males with no prior disability were identified, each reporting an initial episode of debilitating low-back pain. The subjects respectively were treated by (i)manipulation commencing three days after injury, (ii) initial medical management, then manipulation commencing three weeks after injury, and (iii)extensive initial medical management, then manipulation commencing four months after injury. The observation is made that residual disability appears to be related to delayed manipulative intervention for MLBP. It is proposed that a prospective study of patients with work-related MLBP be undertaken to adequately test the hypothesis that early manipulative intervention by chiropractors produces less residual disability than do other contemporary protocols. The outcomes to assess would include subject recovery time, ability to return to work, and residual disability. Such a study may provide further evidence in support of removing governmental restriction of access to chiropractors by workers with low-back injury, through documenting the degree, cost, and legal implications of any residual disability in those injured workers who do not receive the most appropriate treatment promptly. INDEX TERMS: (MeSH); chiropractic;backache; accidents, occupational;intervertebral disc; workmen's compensation;(other): occupational health;industrial back sprain. Chiropractic J Aust 1993 Mar;23(2):54-8 JOHN J. IVANCIC, DEBORAH BRYCE and PHILIP S. BOLTON The aim of this study was to determine the proportion of chiropractors, osteopaths, physiotherapists and medical practitioners that use provocational tests reported to identify vertebrobasilar insufficiency (VBI). A survey was undertaken of practitioners from each of the professional groups. The practitioners surveyed were selected at random from the Yellow Pages telephone directories for the state of New South Wales. Data from the respondents (n=135) suggest that those practitioners who manipulate (adjust) the cervical vertebral column of their patients are aware that vascular incidents and accidents may occur subsequent to manipulation of the neck. Most chiropractors and many osteopaths surveyed "often" adjust the neck (8 in 10 patients) whereas physiotherapists and medical patients "rarely" (1 in 10 patients) manipulated the neck. We also found that chiropractors, osteopaths and those physiotherapists with specialty training in manipulative therapy use VBI provocational tests prior to the administration of manipulative procedures to the neck. Most of the practitioners who use the provocational tests were able to identify signs and symptoms associated with VBI. The sensitivity and specificity of the provocational tests used to determine the patient at risk of cerebral ischemia from VBI have yet to be determined and therefore their clinical usefulness remains to be determined. However, our survey suggests that VBI provocational tests are commonly used by chiropractors and osteopaths to identify patients who may present with positional VBI. INDEX TERMS: (MeSH); manipulation, chiropractic; manipulation, orthopedic; manipulation, adverse effects; cervical vertebrae; ischemia; vertebrobasilar insufficiency. Chiropractic J Aust 1993 Mar;23(2):59-63 Olfactory Whiplash: A Case Study W. BRUCE ELLIS A unique cause of cervical "whiplash" injury is presented with discussion on evaluating a patient's verbal history, and the mechanism of injury. A new syndrome is suggested with ideas on minimising possible repeat injuries. INDEX TERMS; (MeSH): chiropractic; wit and humour. Chiropractic J Aust 1993 Mar;23(2):64 Chiropractic in Australia: A Delphi Study of the Primary Contact Practice Paradigm JENNIFER R. JAMISON A Delphi study was used to canvass expert chiropractic opinion with regard to the primary practice model of chiropractic in the Australian health care system. Respondents strongly supported the notion of direct patient access to chiropractic care and perceived chiropractors as diagnostically competent practitioners with expertise in biomechanical health care. Also emphasised was the educational role of practitioners and the empathic nature of patient interaction. Identification of the perceived practice paradigm of chiropractors proved more problematic than characterisation of primary chiropractic practice. Elements of both the mechanistic and holistic paradigms appear consistent with chiropractic practice. Based upon the responses of the experts canvassed, it would appear that there is a lack of consensus amongst chiropractors as to their current practice paradigm. It does, however, appear that a trend towards conventional holism is anticipated. INDEX TERMS: (MeSH); chiropractic; holistic health; (other): paradigm. Chiropractic J Aust 1993 Mar;23(2):66-70 |
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