Editorial: The Challenge of Our Second Century
Mary Ann Chance and Rolf E. Peters
The Efficacy of Chiropractic Therapy on Premenstrual
Syndrome: A Case Series Study
MAX J. WALSH, SERA CHANDRARAJ and BARBARA I. POLUS
Anterior Shoulder Pain and the Infraspinatus Muscle:
A Case Report
ELHAM NIA
Case Report: Spinal Strain and Visual Perception
Deficit
R. FRANK GORMAN, ROBERT L. ANDERSON, DON BILTON, ROBERT J. FAVOLORO and
ANTHONY J. PITTORINO
Chiropractic referral by medical practitoners:
identifying referral criteria
JENNIFER R. JAMISON
Preliminary Report: The Thermal Characteristics of
Spinal Levels Identified as Having Differential Temperature by Contact
Thermocouple Measurement (Nerve Scope)
PHIILIP S. EBRALL, ANDREW IGGO, PETER HOBSON and GLENN FARRANT
The "Wet Specimen"
STANLEY P. BOLTON
Commentary - Lorenzo's Oil: Several Object Lessons for the
Chiropractic Profession
ABSTRACTS
The Efficacy of Chiropractic Therapy on
Premenstrual Syndrome: A Case Series Study
MAX J. WALSH, SERA CHANDRARAJ and BARBARA I. POLUS
Objective: To test a methodology for assessing the efficacy of
chiropractic treatment (CMT) on reducing the symptoms associated with
premenstrual syndrome (PMS).
Design: Eight women of reproductive age with diagnosed premenstrual
syndrome were given chiropractic treatment over a minimum of three
menstrual cycles in an uncontrolled prospective trial.
Setting: Teaching clinics of the School of Chiropractic and Osteopathy,
RMIT. All chiropractic examinations and treatment were performed by
qualified, experienced chiropractors.
Patients: Volunteers undertook a screening procedure consisting of a
medical examination and a premenstrual distress questionnaire. Exclusion
criteria included any history of gynaecological, liver, thyroid, or
psychiatric disorder, cancer or pregnancy. Eight subjects were accepted
into the treatment phase after being confirmed as having true PMS
following daily monitoring of their five major PMS symptoms for a
minimum of two cycles prior to treatment commencing. Interventions:
Standard chiropractic therapy was given to each subject over a minimum
of three menstrual cycles. The treatment was administered within the
ten-day period immediately prior to the commencement of menstruation.
Main Outcome Measure: The outcome measure used was the daily rating of
up to five major PMS symptoms. A PMT-Cater disc was used to record these
scores. The total of these scores for the premenstrual period during the
pre-treatment phase was compared with the total for a similar period
calculated during the treatment phase.
Results: The methodology used was found to be satisfactory for the study
of the efficacy of CMT on PMS. Due to the small numbers and the lack of
controls, no definitive conclusions can be drawn about the results,
however they did show a trend that supported anecdotal evidence and case
studies. Five of the eight subjects showed a statistically significant
reduction in PMS symptom scores during the treatment compared with the
pretreatment phase (p<0.05)
Conclusions: The results obtained in this study support available
anecdotal evidence and published case studies as to the possible
efficacy of CMT in alleviating PMS symptoms. They are suggestive that a
randomised clinical trial with placebo controls is warranted and that
the methodology used here would be suitable with appropriate
modifications to allow for a control group.
INDEX TERMS: (MeSH) CHIROPRACTIC; PREMENSTRUAL SYNDROME.
Chiropractic J Aust 1994 Dec;24(4):122-6
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Anterior Shoulder Pain and the Infraspinatus
Muscle: A Case Report
ELHAM NIA
Objective: To present a case of infraspinatus myofascial trigger
point in a patient complaining of anterior shoulder pain. Infraspinatus
myofascial trigger point is a relatively common but frequently
overlooked source of anterior shoulder pain.
Clinical Features: A 52-year-old female presented to a chiropractor
complaining of anterior right shoulder pain of three months' duration.
The patient reported the onset of pain as following an automobile
accident after which she had attended an emergency department as an
ambulatory patient; plain radiographs of the cervical spine and right
shoulder were taken and read as normal. She reported that a course of
anti-inflammatory medication was prescribed and she was discharged.
Examination of the patient at the chiropractic clinic revealed a
myofascial trigger point in the right infraspinatus muscle which, when
palpated, referred pain to the anterior shoulder.
Intervention and Outcome: The treatment selected in this case was
ischaemic compression and ultrasound on the trigger point, which
resulted in reduction of pain in the shoulder.
Conclusion: Infraspinatus trigger points (TrPs) are a common source of
referred pain and restricted range of movement in the shoulder and
should be included in the differential diagnosis of shoulder pain and
dysfunction. Chiropractors who manage patients with shoulder pain should
be competent in their examination and management of myofascialTrPs. This
requires familiarity with the TrP phenomenon and expertise in accurate
assessment and treatment of the TrPs.
INDEX TERMS: (MeSH) MYOFASCIAL PAIN SYNDROMES; ULTRASONIC THERAPY;
SHOULDER. (OTHER) INFRASPINATUS MUSCLE; MYOFASCIAL TRIGGER POINTS;
ISCHAEMIC COMPRESSION.
Chiropractic J Aust 1994 Dec;24(4):127-30
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Case Report: Spinal Strain and Visual
Perception Deficit
R. FRANK GORMAN, ROBERT L. ANDERSON, DON BILTON, ROBERT J. FAVOLORO
and ANTHONY J. PITTORINO
Objective: To raise the level of awareness that spinal injuries may
cause visual loss.
Clinical Features: This case history describes loss of vision after a
rear bumper motor vehicle accident; it suggests that the vision loss is
related to spinal derangement.
Intervention and Outcomes: The patient's cervical spine was manipulated
under anaesthetic, with immediate recovery of vision.
Conclusion: Greater significance should be given to spinal causes of
post traumatic syndromes, and in particular the role of spinal
manipulation in treating these syndromes.
INDEX TERMS: (MeSH) MIGRAINE VISUAL PERCEPTION MANIPULATION,
ORTHOPEDIC. (OTHER) POST TRAUMATIC VISUAL LOSS MANIPULATION, SPINAL;
CEREBRAL MICROVASCULAR SPASM.
Chiropractic J Aust 1994 Dec;24(4):131-4
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Chiropractic referral by medical
practitoners: identifying referral criteria.
JENNIFER R. JAMISON
Objective: This study aims to identify clinical conditions suitable
for chiropractic referral by medical practitioners. It also seeks to
achieve consensus on the referral criteria which chiropractic
specialists perceive as appropriate for use by medical practitioners.
Design: A Delphi study was undertaken in which the opinions of 20
leaders in the chiropractic profession were canvassed to ascertain those
conditions which they perceive may best be managed through chiropractic
care. Fifteen chiropractors participated in all three phases of the
study. The sample was selected from chiropractors with at least five
years of clinical experience who are recognised spokespersons for the
chiropractic profession in Australia. The consensus statement arising
from the survey was used as the basis of a second Delphi study. Six
chiropractors holding a specialist qualification in chiropractic science
were surveyed to delineate appropriate referral criteria for the listed
conditions.
Results: Conditions for which chiropractic intervention is perceived to
be demonstrably superior by a group of Australian chiropractors have
been listed. Chiropractic specialists have provided referral criteria
upon which medical practitioners may base their decisions when referring
patients with these conditions to chiropractors.
Conclusions: As medical practitioners are reported to be less confident
in managing certain musculoskeletal conditions than chiropractors, it
may be helpful to provide a template upon which medical practitioners
can base their chiropractic referrals. The template produced in this
study provides a minimal referral base and does not presume to include
all those conditions which may benefit from referral for chiropractic
intervention.
INDEX TERMS: (MeSH) REFERRAL AND CONSULTATION.
Chiropractic J Aust 1994 Dec;24(4):135-8
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Preliminary Report: The Thermal
Characteristics of Spinal Levels Identified as Having Differential
Temperature by Contact Thermocouple Measurement (Nerve
Scope)
PHIILIP S. EBRALL, ANDREW IGGO, PETER HOBSON and GLENN FARRANT
Objective: To use computer-assisted infra-red thermography in an
attempt to generate a description of the thermal characteristics of
spinal regions identified as having differential temperature by expert
users of the Nerve Scope, a contact thermocouple instrument used in
chiropractic clinical practice.
Design: Prospective recording of the infra-red thermographic images of
prepared, stabilised subjects and then alternate presentation by each
subject for blinded assessment by two expert users of the Nervo Scope
instrument to identify spinal levels where there was agreement of the
existence of a clinically relevant entity (known empirically as a
"break") as indicated by the instrument's response to differential
temperature, and then retrospective examination of those levels by
computer-assisted analysis of the infra-red thermographic images.
Setting: Four rooms within a controlled laboratory setting at The
Chiropractic Unit of RMIT University, Melbourne.
Subjects: Eighteen (18) male and 13 female (n = 31) humans with informed
consent as volunteers from a late adolescent/young adult student
population without any declared clinical symptomatology.
Intervention: Nil.
Main Observations: Five (5) subjects were identified where there was
agreement for appropriate evidence of spinal dysfunction at a particular
spinal level. Thermal analysis of the paraspinal region about the found
levels revealed a left/right difference of typically about 0.3"C and no
greater than 1.1"C, and a series range on any one side of the spine of
typically 1 .O"C and no greater than 1 .4"C. A particular characteristic
was found, namely that an asymmetrical thermal dynamic existed between
the paraspinal temperature gradients at these levels, meaning that the
skin temperature varied asymmetrically, with one side falling while the
other side increased.
Conclusions: The circular graphs (radar plots) of the data clearly
demonstrate the presence of an asymmetrical thermal dynamic which may,
if replicated in other laboratories, represent an objective dimension of
spinal dysfunction, or in more common terms, the subluxation
complex.
INDEX TERMS: (MESH): SKIN TEMPERATURE; DIAGNOSIS, COMPUTER-ASSISTED;
INSTRUMENTATION; THERMOGRAPHY; CHIROPRACTIC; AUSTRALIA.
Chiropractic J Aust 1994 Dec;24(4):139-46
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The "Wet Specimen"
STANLEY P. BOLTON
Research into chiropractic and chiropractic-related subjects is
neither an exclusive nor contemporary phenomenon. Developed sixty years
ago, the "wet specimen" is one example of research efforts of a former
generation of chiropractors and scientists.
INDEX TERMS: (MeSH) CERVICAL VERTEBRAE; CHIROPRACTIC; CHIROPRACTIC
HISTORY; (OTHER) SUBLUXATION; WET SPECIMEN.
Chiropractic J Aust 1994 Dec;24(4):147-50
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