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CJA Vol.35 Issue 1 Editorial: A Significant Year for Chiropractic in Australia -
p1 In Memoriam: Keith Michael Phillips - p2 The Chiropractic Adjustment: The Patients’
Perception - p4 Cranial and Other Chiropractic Adjustments in the
Conservative Treatment of Trigeminal Neuralgia: A Case Report -
p9 Technique Review: Derifield-Thompson Leg Length
Analysis and Adjusting Protocol - p16 Thirty Years of Chiropractic Education at RMIT
University: The Establishment Period: 1975 to 1978 - p29 Letters to the Editor - p39 ABSTRACTS The Chiropractic Adjustment: The Patients' Perception JENNIFER R. JAMISON A number of variables are responsible for the efficacy of chiropractic care. The relative contribution each wellness trigger makes to the clinical outcome is unknown. This study seeks to identify which elements of the consultation patients regard as contributing most to the benefit they derive from chiropractic care. Research Method: A case study to identify which elements in the chiropractic consultation patients perceived as most beneficial was undertaken. The study involved purposive sampling of chiropractic clinics and convenience sampling of patients. Six chiropractic clinics in Queensland and Western Australia and 146 patients participated. Data was collected using a semi-structured interview. Results: The major benefit of chiropractic care reported by over 71% of patients was pain relief. One in 3 patients believed the chiropractic adjustment was entirely responsible for the beneficial outcome of their care; 85% felt the adjustment accounted for more than half of their clinical benefit. Discussion: Patients perceive the adjustment as the most potent contributor to the benefit they derive from chiropractic care, however the mechanism whereby the adjustment achieves its clinical effect remains obscure; the technique most likely to achieve the optimal outcome in a particular case remains unknown, as does apportionment of the benefit attributable to the specific and placebo overlay of the chiropractic adjustment. Conclusions: The shift to evidence-based care provides chiropractic with an opportunity to achieve scientific credibility. Research leading to a deeper understanding of the chiropractic adjustment is urgently needed. INDEX TERMS: MeSH: CHIROPRACTIC. Other: ADJUSTMENT; PATIENT PERCEPTION. Chiropr J Aust 2005; 35:4-8. FRANK O. PEDERICK Trigeminal neuralgia, sometimes called tic douloureux, is characterised by episodes of electric-shock-like pain in areas of the face where branches of the trigeminal nerve are distributed. Medical treatment includes pharmaceuticals, analgesics, surgery, radiosurgery, low-powered lasers, TENS, acupuncture and biofeedback. Manipulative approaches have been used successfully in a medical centre in China, and reports of successful treatment with chiropractic techniques have been published. The patient in this report had a history of right-sided facial pain, diagnosed as trigeminal neuralgia, over a 6-year period with remissions after dental or medical treatment and exacerbations, the most recent of 2 months duration. Prior to cranial and other chiropractic adjustments, the patient had continuous pain that she rated at 9.5 on the visual analogue scale, and after 4 consultations over an 11-day period, pain had reduced to 0.5. Spinal and cranial adjusting potentially affects a wide range of causes of trigeminal neuralgia and offers a conservative, low-cost, low-technology initial approach which, if ineffective, will not greatly delay or inhibit other treatment. Occasional maintenance care may be required in some instances to reduce occurrences. INDEX TERMS: MeSH: CHIROPRACTIC; TRIGEMINAL NEURALGIA. Other: CRANIAL ADJUSTING, SPINAL ADJUSTING; CRANIAL MANIPULATIVE THERAPY; SPINAL MANIPULATIVE THERAPY; SOFT TISSUE THERAPY. Chiropr J Aust 2005; 35:9-15. Technique Review: Derifield-Thompson Leg Length Analysis and Adjusting Protocol DENNIS M.J. HOMACK Many doctors of chiropractic have relied on the Derifield leg length protocol as a method of determining pelvic and spinal dysfunction in patients. In most cases, practitioners do not use the Derifield technique in its entirely; rather, parts of it are used to supplement other analysis strategies, often as part of an amalgam of several methods, put together by the individual examiner. This has introduced and proliferated a number of misconceptions and inconsistencies that may lead to a widespread decrease in the reliability and accuracy of results and interpretation. The premise of the apparent presence of the short leg is predicated on the fact that the neurological basis for balance and posture is found in the reticular system of the brain stem. Theoretically, a neurological imbalance, such as might be initiated by spinal or pelvic subluxation or muscle spindle misinformation, will affect the musculature of the legs, resulting in the appearance of various leg-length discrepancies. For the Derifield-Thompson technique, these patterns have been arranged into 5 general categories, each with an associated clinical presentation and recommended treatment protocol. Although there has been material published on this subject, confusion continues to permeate the profession. Presented here is an attempt to organise the steps of the procedure and offer some rationale behind why the findings predicted occur, as well as adjustive recommendations found in the Derifield-Thompson protocol. Included is an algorithm that serves as a quick reference guide to the analytic procedures outlined. INDEX TERMS: MeSH: CHIROPRACTIC. Other: DERIFIELD-THOMPSON LEG LENGTH CHECK Chiropr J Aust 2005; 16-20. JOHN DULHUNTY Objective: To investigate the validity of the methods and mechanical principles employed in the Gonstead method to analyse the positional integrity of the sacroiliac joints on erect pelvic radiographs. The results were used to assess the need and basis for formulating an alternative method of analysis that maximises the projection and mechanical factors identified. Method: Radiographs were taken of a surrogate right innominate bone fixed in 3 specified positions representing the AS, PI and normal alignment of the ilium as suggested by Gonstead. Radiographic graphical and geometrical assessment was made to determine the validity of radiographic pelvic analytical methods employed by practitioners using the Gonstead method. Results: Measurements or calculations were made with the ilium in the normal, rotated +5o and –5o around the x-axis direction and with the tube in the standard erect AP lumbo-pelvic position as well as a sacral base view. This resulted in 6 sets of numbers. The measured difference in height on the Gonstead views was 2 mm, while for the sacral base views the difference ranged from 19-29 mm. Conclusion: The calculations and measurements derived from 3 investigation methods support the contention that the analytical methods currently taught and used in clinical chiropractic practice as part of the Gonstead method of pelvic x-ray analysis do not involve optimisation of projection and mechanical principles when measuring the theorised misalignment of one or both ilia relative to the adjacent sacrum. The Gonstead method of pelvic radiographic analysis can be shown to be inappropriate for the type and amount of misalignment anticipated. The alternate method presented would meet the requirements outlined without compromising the theoretical basis of the Gonstead analysis method. INDEX TERMS: MeSH: BIOMECHANICS; CHIROPRACTIC; RADIOGRAPHY. Other: PELVIC MISALIGNMENT; SACROILIAC SUBLUXATION; GONSTEAD METHOD Chiropr J Aust 2005; 35:21-8. Thirty Years of Chiropractic Education at RMIT University: The Establishment Period 1975 to 1978 PHILLIP EBRALL and TOM MOLYNEUX The chiropractic program now at RMIT University is celebrating its thirtieth anniversary during 2005. It was the first chiropractic program in Australia designed to be of international standard and was introduced into Melbourne by the International College of Chiropractic (ICC). Prior to 1975 Australians who wanted to become chiropractors had two choices: travel overseas to study chiropractic in North America, Canada (from 1945) or England (from 1965) or remain in Australia and complete a local training program at a private college that typically offered dual qualifications in chiropractic and osteopathy. In 1959 Frederick George Roberts established the Chiropractic and Osteopathic College of Australasia. It was later to become the Chiropractic College of Australasia and eventually merge into a new college founded in Melbourne in 1975 by the ICC. This paper documents a number of events surrounding the establishment of the program by the ICC and pays tribute to the colourful characters that succeeded in their fight to establish a program of international standard in Australia. This paper provides an account of what we have termed the Establishment Period 1975 to 1978. A second paper will explore what the authors have termed the Consolidation Period (1979 to 1999) and a third, the Reformation Period (2000 to the present). INDEX TERMS: MeSH: CHIROPRACTIC; HEALTH EDUCATION; HISTORY; AUSTRALIA; EDUCATION. Chiropr J Aust 2005; 35:29-38. |
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