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Editorial: Gradus ad Parnassum - p41 A Single Mechanical
Impulse to the Neck: Does It Influence Autonomic Regulation of
Cardiovascular Function? - p42 The Use of Hip Manipulation in
the Management of Acetabular Labrum Injury - p49 Commentary: Are We
Teaching the Right Courses? - p57 From Competency to Capability:
An Essential Development for Chiropractic Education - p61 Chiropractor, Surgeon and
Independent Thinker: John C. Hubbard, DC, MD, DPH, FICC - p68 In Memoriam: Frank Leonhard Wyss - p78 Letters - p 77 Book Review - p80 ABSTRACTS A Single Mechanical Impulse to the Neck: Does It Influence Autonomic Regulation of Cardiovascular Function? NOBUHIRO WATANABE and BARBARA I. POLUS Objective: This study aims to examine the effects of a simulated cervical manipulation in the absence of any head movement on autonomic regulation of cardiovascular function in young healthy adults. Design: A pre- post-test study design. Setting: An acute laboratory-based study that examined the effect of application of a brief mechanical stimulus (simulating a chiropractic adjustment using an Activator® Instrument) to the neck on cardiac autonomic nervous and cardiovascular function. Participants: Eleven (11) young healthy adults completed this study. Intervention: A single mechanical impulse (“sham” or “authentic” manipulation procedure) was applied to the neck. Main Outcome Measures: Heart rate (HR), heart rate variability (HRV) and non-invasive beat-to-beat blood pressure (BP) were measured. Results: There were significant reductions in BP after application of the mechanical stimulus in the supine posture (p < .05). Particularly, the reductions peaked at 20 sec post-stimulation. Changes in HR and HRV parameters, however, were not significant in either supine or sitting posture (p > .05). Also there were no significant differences in responses between authentic and sham manipulation procedures. Conclusion: Our results showed that a mechanical stimulus applied to the upper cervical region is capable of acutely influencing cardiovascular function in young adults. The sham spinal manipulative procedure chosen for this study appeared to be contaminated with unspecified factors that had interventional effects, or the response might be due to an arousal reaction. This issue is being addressed in further investigations. INDEX TERMS: (MeSH): CHIROPRACTIC; AUTONOMIC NERVOUS SYSTEM; HEART RATE; BLOOD PRESSURE; MANIPULATION, CHIROPRACTIC. Chiropr J Aust 2007; 37:42-48 The Use of Hip Manipulation in the Management of Acetabular Labrum Injury HENRY P. POLLARD, WAYNE T. HOSKINS and MATTHEW SCHMERL Objective: To discuss the conservative management of two presenting cases of acetabular labral tears using hip manipulation. Clinical Features: Case 1: a 46-year-old female cleaner presented with chronic low back, groin and gluteal pain. A painless click was also present in the hip. She had no recall of hip rotation injury but had chronic ongoing problems and a family history of hip abnormalities and replacements. Slump, Bonnet’s, Patrick Fabere, Scour and hip flexion with internal rotation reproduced the pain on the right. MRI revealed an antero-superior labral tear. Case 2: a 15-year-old female individual medley swimmer noticed sharp anterior right hip pain that was aggravated by rotation movements, with pain referral to the medial knee. A painful click was also present in the hip. There were no lower back or posterior hip symptoms. Orthopaedic tests compressing the anterior hip capsule were positive as was psoas muscle testing. Previous history included a gymnastics career and several rotation falls with injury and hip pain following. A diagnosis of anterior-superior acetabular labral tear was made. Intervention and Outcome: The first patient was managed with lumbopelvic and hip manipulation and mobilisation, soft tissue therapy to the hip and active therapy that incorporated a progressive stretching and strengthening program. Hip and lumbar pain subsided with short-term treatment, but a painless clicking hip remained. The second patient was managed with a similar protocol. In addition, breaststroke swimming was removed from her training schedule for 3 months. The hip pain resolved in the absence of the frog-leg kick associated with breaststroke swimming. Conclusion: The acetabular labrum is increasingly being recognised as a source of hip pain, particularly in athletes. Research is required in the form of clinical trials to determine efficacy of hip manipulation or mobilisation for treatment of this injury. INDEX TERMS: (MeSH): ACETABULUM; HIP; MANIPULATION, CHIROPRACTIC; ATHLETIC INJURIES. (Other): ACETABULAR LABRUM; SPORTS INJURIES. Chiropr J Aust 2007; 37: 49-56 From Competency to Capability: An Essential Development for Chiropractic Education PHILLIP EBRALL Objective: To demonstrate, using contemporary theories of learning and teaching, that the competencies as included within the standards for first professional chiropractic programs published by the Council on Chiropractic Education Australasia are weak measures of the preferred educational outcomes of educational programs in the chiropractic discipline. It is argued that competencies must immediately be replaced by higher level graduate capabilities. Discussion: Reference is made to a hierarchy of knowledge described by Biggs, and competencies are shown to lie at the lower levels of this hierarchy, namely about the level of declarative and procedural knowledge. In contrast, graduate capabilities are shown to be about place and time and the measures of how and where learned skills apply. As such they graduate up the knowledge hierarchy and represent conditional and functioning knowledge and provide a more realistic mechanism for the student to make the transition from university to professional knowledge. Conclusion: Contemporary chiropractic educators hold a primary responsibility to their graduates and the things that will affect their practice in whatever global environment they find themselves. It is imperative that capability-based curricular items replace those based solely on competencies to ensure chiropractic programs produce graduates that retain a high degree of relevance in the rapidly changing field of health care. INDEX TERMS: (MeSH): COMPETENCY-BASED EDUCATION; CHIROPRACTIC EDUCATION; CLINICAL COMPETENCE. (ICL): COMPETENCY-BASED EDUCATION; EDUCATION, CHIROPRACTIC; EDUCATION, CHIROPRACTIC/AUSTRALIA; EDUCATION, CHIROPRACTIC/STANDARDS; EDUCATION. CHIROPRACTIC/TRENDS. Chiropr J Aust 2007; 37: 61-67. Chiropractor, Surgeon and Independent Thinker: John C. Hubbard, DC, MD, DPH, FICC JOSEPH C. KEATING, LAWRENCE SIORDIA, D. PATRICK MONTGOMERY All but forgotten in the early and middle years of chiropractic is the saga of John C. Hubbard, a virtuoso whose talents spanned many fields of human endeavour. Following a career in theatre, he studied at the Carver Chiropractic College and fought for his new profession in the legislative halls of several states in the second decade of the 20th century. He next studied medicine, served his country in uniform in the Panama Canal Zone as a quarantine officer and medical director of a leper colony, and returned to Oklahoma City to establish his private practice of general medicine and surgery. Ostracised by the local allopathic establishment, Hubbard opened his own hospital where he served his patients for three decades while editing the Eclectic Medical Journal. Recalled to duty during World War II, in 1946 he returned to civilian life and practised with his three physician sons for the remainder of his life. Dr Hubbard maintained his contact with the chiropractic profession through membership in the National Chiropractic Association and through guest lectures at his chiropractic alma mater. In many respects his story epitomises the pioneer spirit and determination of early chiropractors. INDEX TERMS: (MeSH): CHIROPRACTIC, HISTORICAL ARTICLE; HISTORY OF MEDICINE, 20TH CENTURY. Chiropr J Aust 2007; 37:68-76. |
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