1 / 36

Clinical Management

Clinical Management. An Introduction to Chiropractic. Jeffrey McKinley, DC, CCSP. 2700 B.C. 1500 B.C. Ancient Chinese and Greek writings mention spinal manipulation and the maneuvering of the lower extremities to ease low back pain. Hippocrates 460 to 357 B.C.

hswilley
Télécharger la présentation

Clinical Management

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Clinical Management An Introduction to Chiropractic Jeffrey McKinley, DC, CCSP

  2. 2700 B.C. 1500B.C. Ancient Chinese and Greek writings mention spinal manipulation and the maneuvering of the lower extremities to ease low back pain.

  3. Hippocrates 460 to 357 B.C. “Get knowledge of the spine, for this is the requisite for many diseases.”

  4. D.D. Palmer 1895 – Beginning date of modern day chiropractic history

  5. David Robertson, M.D.Professor, Departments of Medicine, Pharmacology and NeurologyMember, Division of Clinical PharmacologyDirector, Clinical Research CenterDirector, Medical Scientist Training Program

  6. Profile: This laboratory aims to identify mechanisms of autonomic neurodegenerative disease processes and develop improved treatments for them. Over the years, we have explored how the brain exerts control over the nervous system and how abnormalities in this regulation can lead to disease. These studies resulted in the identification of the previously unrecognized disorders, dopamine-ß-hydroxylase deficiency and baroreflex failure

  7. Biomechanics • Structure • Function

  8. Vertebral Subluxation Complex

  9. Doctors of Chiropractic Assess and Manage Patients Patient history Physical examination – orthopedic & neurological Diagnostic testing – x-ray, CT, MRI, lab Diagnosis Treatment plan – manipulative therapy, physical therapy, counsel lifestyle changes, nutrition

  10. Current Education • Three years of pre-chiropractic • 4.5 years of professional education • 16 USDE accredited schools in US

  11. Primary Healthcare Provider Licensed in all 50 states Post Graduate Education Family Practice Clinical Neurology Sports Chiropractic Nutrition Industrial Consulting Applied Chiro Sciences Orthopedics Pediatrics Rehabilitation Radiology

  12. Government Inquiries • Similar inquiries with similar findings • Sweden – 1987 • Measures to improve cooperation between chiropractors, MDs, and PTs are vital to the interest of the public • Canada - 1993 • United Kingdom – 2 reports in the last 10 years

  13. Government Inquiries • Australia – Medicare Benefits Review • 1984 • Review by committee – less weight • Recommended full funding in hospitals and other health institutions

  14. Government Inquiries • New Zealand – by judicial hearing • 1978-1979 • Glowing report on chiropractic care • Highly cost effective treatment for spine related conditions • Procedures very safe • Deficiencies were caused by medical boycott

  15. Conditions Treated • Spine pain – neck, mid back and low back • Musculoskeletal pain – fibromyalgia, chronic fatigue • Headache – migraine and tension • Peripheral joint pain • Sports injuries

  16. Back Pain • Uses manipulation to improve function of spinal segments • Therapy to reduce spasm and swelling • Exercises to improve movement patterns • Postural and nutritional counseling

  17. Manipulation • Improves spinal function • Reduces intradiscal pressure • Reduces nerve root pressure • Reduces spasticity of paraspinal muscles • Has CNS and peripheral nerve effects

  18. Lower Back Pain • Most common condition treated by D.C.s • Spinal manipulation is the most researched treatment for LBP

  19. Effectiveness of SMT for LBP Assendelft WJ, Morton SC, Yu EI, Suttorp MJ, Shekelle PG. Spinal manipulative therapy for low back pain. A meta-analysis of effectiveness relative to other therapies. Ann Intern Med 2003;138(11):871-81.

  20. Assendelft et al – Meta-analysis • “Conclusion: There is no evidence that spinal manipulative therapy is superior to other standard treatments for patients with acute or chronic low back pain” • Other standard treatments: • General practitioner care • Analgesics • Physical therapy • Exercises • Back school

  21. Assendelft et al – Meta-analysis • Conclusion is valid • However, a biased statement • Actual finding SMT = other treatments • Thus, SMT an effective alternative for patient’s who desire CAM

  22. Why People Choose CAM • “Largely because they find these health care alternatives to be more congruent with their own values, beliefs, and philosophical orientations toward health and life.” • Astin JA. Why patients use alternative medicine: Results of a national study. JAMA 1998;279(19):1548-53.

  23. Nyiendo, Joanne, Mitchell Haas, and Peter Goodwin. 2000, “Patient Characteristics, Practice Activities, and one-month Out Comes for Chronic, Recurrent Low-Back Pain Treated by Chiropractors and Family Medicine Physicians: A Practice-based Feasibility Study.” Journal of Manipulative and Physiological Therapeutics 23, no. 4: 239-245. • … the chiropractic patients showed a five times greater improvement than that of the medical patients on the Visual Analogue Scale, with the chiropractic patients also reporting better results in diminished pain. Likewise, 90% of the chiropractic patients claimed satisfaction with their care, while only 52% of the medical patients reported the same.

  24. Giles, Lynton G. F. and Reinhold Muller. 2003, “Chronic Spinal Pain: A Randomized Clinical Trial Comparing Medication, Acupuncture, and Spinal Manipulation.” Spine 28, no. 14: 1490-1502. • …manipulation patients experienced the greatest short-term benefits, in spite of the fact that they had the longest pre-treatment duration of pain (8.3 years ave), yet 27% recovered in a nine-week period or less. Overall results of the study showed that 47% of chiropractic patients improved, while only 18% and 15% improved in the medication and acupuncture groups respectively.

  25. Niemisto, L., T. Lahtinen-Suopanki, P. Rissanen, K. A. Lindgren, S. Sarna, and H, Hurri. 2003, “A randomized Trial of Combines Manipulation, Stabilizing Exercises, and Physician Consultation Compared to Physician Consultation Alone for Chronic Low Back Pain.” Spine 28, no. 19;2185-2191 • … manipulative therapy is superior to consultation alone and that short, specific treatments may change the course of chronic low-back pain.

  26. Haas, M., B. Goldberg, M. Aickin, B. Ganger, and M. Attwood. 2004. “A Practice-Based Study of Patients with Acute and Chronic Low Back Pain Attending Primary Care and Chiropractic Physicians: Two-week to 48-month Follow-up.” Journal of Manipulative and Physiological Therapeutics 23,no. 4; 225-230 • The study demonstrated that VAS were lower for chronic low-back pain chiropractic patients than for medical patients. Results were even greater for patients with concurrent leg pain. Thus, the authors concluded that chiropractic patients with chronic and acute low-back pain experienced greater relief up to one year following treatment, and those with chronic LBP showed a clinically important advantage in the short term.

  27. Conditions Treated • Spine pain – neck, mid back and low back • Musculoskeletal pain – fibromyalgia, chronic fatigue • Headache – migraine and tension • Peripheral joint pain • Sports injuries

  28. Nelson, Craig F., Gert Bronfort, Roni Evans, Pat Boline, CharlieGoldsmith, and A.V. Anderson. 1998. “The Eddicacy of Spinal Manipultion, Amitriptyline and the Combination of Both Therapies for the Prophylaxis of Migraine Headache. Journal of Manipulative and Physiological Therapeutics 21,no. 8: 511-519. • Spinal manipulation seemed to be as effective as a well-established and efficacious treatment (amitriptyline), and on the basis of a benign side effects profile, should be considered a treatment option for patients with frequent migraine headaches.

  29. McCrory, Douglas C., Donald B. Penzien, Vic Hasselblad, and Rebecca N. Gray. 2001. Behavioral and Physical Treatments for Tension-type and Cervicogenic Headache.” Duke University Evidence-based Practice Center. • … SMT resulted in a 40% decrease in headache severity compared to no change in rest period groups. Also, when compared to soft-tissue therapy, SMT reduced headache frequency by 69% and severity by 36% compared to the repective soft-tissue reductions of 37% and 17%. SMT also showed better results than did the commonly practice amitriptyline. … 82% of amitriptyline patients reported adverse effects from the drug, while only 4% of SMT patients reported adverse effects.

  30. CHIROPRACTIC RESEARCH CHALLENGE? “Remember, Ginger Rogers did everything Fred Astaire did, but she did it back- wards and in high heels.” -Faith Whittlesey

More Related