Colic and sleep outcomes of nonpharmacological intervention in infants with infantile colic: systematic review and metaanalysis

SUMMARY OBJECTIVE: The aim of this study was to systematically review the colic and sleep outcomes of nonpharmacological intervention in infants with infantile colic and perform a meta-analysis of the available evidence. METHODS: The literature review for this systematic review was conducted between December 2022 and January 2023 using five electronic databases, namely PubMed, CINAHL, Scopus, Web of Science, and ULAKBİM. Published articles were scanned using MeSH-based keywords. Only randomized controlled trials conducted in the past 5 years were included. The data were analyzed using the Review Manager computer program. RESULTS: This meta-analysis included three studies involving a total of 386 infantile colic infants. After nonpharmacological treatment, it was found that infants with infantile colic reduced crying time (standardized mean difference: 0.61; 95%CI 0.29-0.92; Z=3.79; p=0.00002), improved sleep duration (standardized mean difference: 0.22; 95%CI −0.04 to 0.48; Z=1.64; p=0.10), and decreased crying intensity (mean difference: −17.24; 95%CI −20.11 to 14.37; Z=11.77; p<0.000001). CONCLUSION: According to the meta-analysis findings, it was determined that the risk of bias was low in the studies included and that nonpharmacological chiropractic, craniosacral, and acupuncture treatments applied to infantile colic infants in the three included studies reduced crying time and intensity and increased sleep duration.

Absence of Neuroplastic Changes in the Bilateral H-Reflex Amplitude following Spinal Manipulation with Activator IV.

Background and Objectives: Chiropractic spinal manipulation is an alternative medical procedure for treating various spinal dysfunctions. Great interest exists in investigating its neuroplastic effects on the central nervous system. Previous studies have found contradictory results in relation to the neuroplastic changes in the H-reflex amplitude as a response to manual spinal manipulation. The discrepancies could be partly due to differences in the unilateral nature of these recordings and/or the variable force exerted in manual techniques applied by distinct chiropractors. Concerning the latter point, the variability in the performance of manual interventions may bias the determination of the significance of changes in H-reflex responses derived from spinal manipulation. To investigate such responses, a chiropractic device can be used to provide more precise and reproducible results. The current contribution aimed to examine whether spinal manipulation with an Activator IV instrument generates neuroplastic effects on the bilateral H-reflex amplitude in dancers and non-dancers. Materials and Methods: A radiograph verified spinal dysfunction in both groups of participants. Since there were significant differences between groups in the mean Hmax values of the H-reflex amplitude before spinal intervention, an assessment was made of the possible dependence of the effects of spinal manipulation with Activator IV on the basal conditions. Results: Ten sessions of spinal manipulation with Activator IV did not cause statistically significant changes in the bilateral H-reflex amplitude (measured as the Hmax/Mmax ratio) in either group. Furthermore, no significant difference was detected in the effects of spinal manipulation between groups, despite their distinct basal H-reflex amplitude. Conclusions: Regarding the therapeutic benefits of a chiropractic adjustment, herein carried out with Activator IV, the present findings suggest that the mechanism of action is not on the monosynaptic H-reflex pathway. Further research is needed to understand the mechanisms involved.

Overview of conditions seen on a Canadian Memorial Chiropractic College outreach to the Dominican Republic.

OBJECTIVE: This study aims to gather information on conditions seen, treatments rendered, and referrals made during a Canadian Memorial Chiropractic College outreach to the Dominican Republic serving those in need. METHODS: Data was extracted from templated patient files retrospectively. RESULTS: Spinal, extremity and other/whole body chief complaints accounted for 71.79%, 24.64% and 3.57% respectively in patients ranging in age from 1.5 to 106 years whose data was collected. Mechanical pain accounted for 95.07% of all cervical, 96.81% of thoracic and 91.27% of lumbar spine diagnoses. Various non-mechanical conditions were also encountered.Manual therapy was performed in 96.10% of cases. Twenty referrals were made to urgent care, six to a World Spine Care clinic and 46 for further investigation, including local medical doctors or surgery. CONCLUSION: This study reports empirical data collected from an 11-day outreach to the Dominican Republic that provided otherwise unattainable chiropractic care for musculoskeletal complaints.

OBJECTIF: Cette étude vise à recueillir des données sur les conditions observées, les traitements administrés et les renvois effectués pendant la mission d'un établissement d'enseignement de la chiropratique en République dominicaine, au service des personnes dans le besoin. MÉTHODOLOGIE: Les données ont été extraites de dossiers de patients. RÉSULTATS: Les principaux symptômes des patients étaient des douleurs à la colonne vertébrale, aux extrémités et à toutes les parties du corps; elles étaient apparues respectivement chez 71,79 %, 24,64 % et 3,57 % des patients âgés de 1,5 à 106 ans. La douleur mécanique comptait pour 95,07 % de tous les symptômes cervicaux, 96,81 % des douleurs thoraciques et 91,27 % des douleurs lombaires. Divers troubles non mécaniques étaient aussi observés.Des thérapies manuelles ont été pratiquées dans 96,1 % des cas. Vingt patients ont été orientés vers des établissements de soins d'urgence; 6 vers une clinique World Spine Care et 46 vers des médecins de la région pour subir d'autres examens, ou une intervention chirurgicale. CONCLUSION: Cette étude rend compte des données empiriques recueillies au cours d'une mission de 11 jours en République dominicaine au cours de laquelle des soins chiropratiques ont été offerts à des patients qui autrement n'auraient pas pu en bénéficier.

Active Visceral Manipulation Associated With Conventional Physiotherapy in People With Chronic Low Back Pain and Visceral Dysfunction: A Preliminary, Randomized, Controlled, Double-Blind Clinical Trial.

OBJECTIVE: The purpose of this study was to generate data for conduction of a power analysis to investigate short-term effects of visceral manipulation associated with conventional physical therapy on pain intensity, lumbar mobility, and functionality of people with chronic low back pain and visceral dysfunctions. METHODS: This was a double-blinded, randomized, controlled, clinical trial preliminary study. A blinded evaluation was conducted involving 20 people with chronic low back pain with visceral dysfunction. Pain perception, lumbar mobility, and functionality were assessed in 3 moments: evaluation 1 (1 week before the intervention), evaluation 2 (immediately after the last intervention), and evaluation 3 (1 week after the last intervention). The protocol consisted of 50-minute session of conventional physical therapy and visceral manipulation. The participants were randomly allocated to 2 groups: 10 for the experimental group (conventional physical therapy and visceral manipulation) and 10 for the control group (conventional physical therapy and placebo visceral manipulation). RESULTS: Significant reductions were found in the experimental group for lumbar mobility and specific functionality in comparison with the control group (P < .05). There were no significant differences for pain perception and global functionality. CONCLUSION: The combination of visceral manipulation and conventional physical therapy program demonstrated significant between-groups differences over time for lumbar spine mobility and specific functionality. These gains occurred after 5 sessions, once a week, and were maintained 1 week after the end of the treatment. This study generated data for conduction of a power analysis to inform the design for future clinical research in this line of inquiry.

Síndrome de Cola de Caballo asociado a tratamiento quiropráctico: Reporte de 3 casos y revisión de la literatura / Horsetail syndrome associated with chiropractic treatment: Report of 3 cases and review of the literature

El síndrome de cola de caballo (SCC) es una urgencia quirúrgica poco frecuente con una incidencia estimada de hasta 1,8 casos por millón de habitantes, producida por la compresión de las raíces nerviosas en el extremo inferior del canal espinal. La manipulación espinal puede desempeñar un papel etiogénico, provocando la movilización y extrusión del disco. El diagnóstico temprano y el tratamiento oportuno son cruciales, ya que el pronóstico suele ser desfavorable si el tratamiento quirúrgico se retrasa produciendo un daño neurológico permanente. El objetivo de este trabajo es identificar los potenciales factores de riesgo para la manipulación espinal y optimizar esta práctica, evitando así posibles complicaciones derivadas del tratamiento quiropráctico. Presentamos 3 casos de SCC, observados y tratados en nuestro centro, en los que se sugiere una estrecha relación entre la manipulación espinal quiropráctica y la aparición de dicho síndrome. Tras realizarles una RM en la que se observó una hernia discal L5-S1 causante del SCC, los 3 pacientes fueron tratados quirúrgicamente de forma urgente. Los casos presentados demostraron la existencia de una asociación patogénica entre la manipulación espinal y el desarrollo del SCC, al producirse dicho síndrome en las horas siguientes a la manipulación debida a la protusión abrupta de un disco demostrado por RM.

Introduction: Cauda equine syndrome (CES) is a rare surgical emergency with an estimated incidence of up to 1.8 cases per million. It is caused by compression of the nerve roots at the lowest point of the spinal canal. Spinal manipulation can play a pathogenic role, resulting in mobilization and extrusion of the disc. Early diagnosis and timely treatment are crucial, since the prognosis is usually unfavorable and permanent neurological damage likely if surgical treatment is delayed. Objective: The aim of this study was to identify potential risk factors associated with spinal manipulation and, thereby, optimize this practice to reduce the risk of complications from chiropractic treatment. Methods: We present three cases of CES, observed and treated at our center, in which a close relationship between chiropractic spinal manipulation and the appearance of CES was apparent. Results: After magnetic resonance imaging (MRI) revealed an L5-S1 herniated disc causing the SCC, all three patients underwent urgent surgical treatment. Conclusion: The three presented cases demonstrate a strong pathogenic relationship between spinal manipulation and the development of CES, when this syndrome occurs within hours of spinal manipulation, secondary to MRI-documented acute disc protrusion.

Quiropraxia no Brasil: cenário político e ético-profissional / Chiropractic in Brazil: political and ethical-professional scenario

Esta pesquisa objetivou desvelar as percepções dos entrevistados profissionais da Fisioterapia, Fisioterapia Quiropráxica e os graduados em Quiropraxia em relação ao atual cenário político e ético-profissional da Quiropraxia no Brasil. A Quiropraxia é reconhecida como uma Especialização da profissão Fisioterapia. Porém, existem duas instituições de ensino superior que ofertam graduação em Quiropraxia no Brasil. Com o objetivo de regulamentar a profissão de Quiropraxia, tramitam no Senado Federal os Projetos de Lei n°. 4.199/2001, n°. 1436/2011, n°. 114/2015 e o Projeto de Lei do Senado n°. 599/2011. Trata-se de uma pesquisa exploratória e descritiva com abordagem qualitativa. Os sujeitos foram os profissionais da Fisioterapia, e indivíduos graduados em Quiropraxia. Para a coleta de dados utilizou-se de gravação de uma entrevista de voz a partir de um questionário semiestruturado. As entrevistas foram realizadas nos meses de novembro de 2017 até dezembro de 2017, respeitando os aspectos éticos. Na interpretação dos dados, empregou-se a análise de conteúdo proposta por Bardin (2009). As categorias identificadas foram: "O Atual cenário da Quiropraxia no Brasil", "Quem está com a razão?" e "Uma convivência pacífica". Com base nas categorizações foi possível refletir sobre novos pontos que emergiram como: os novos desafios e avanços das práticas de Quiropraxia no Brasil, Quiropraxia e Saúde Pública no Brasil. Esse trabalho conseguiu desenhar a percepção dos entrevistados sobre o atual cenário político e ético-profissional da Quiropraxia no Brasil, como uma nova ferramenta de debate, para transformar ideias enraizadas, na busca do desenvolvimento de novas reflexões entre profissionais Fisioterapeutas e graduados em Quiropraxia, promovendo um debate absolutamente importante, a fim de proporcionar a sociedade um profissional mais completo e preparado para a prática de atenção e preservação da saúde, livre das amarras de reserva de mercado.

This paper aims to show perceptions of Physiotherapy, Chiropractic Physiotherapy professionals and also Physiotherapy undergraduates concerning the current political and ethical-professional scene of Chiropractic in Brazil. Chiropractic is recognized as a specialization from Physiotherapy. However, there are two universities that offer this graduation in Brazil. In order to regulate the Chiropractic Professional is under evaluation in the Federal Senate through the law projects n° 4.199/2001, n° 1436/2011, n° 114/2015 and the law project n° 599/2011. It is a descriptive and exploratory research with qualitative approach. The interviewees were Physiotherapy professionals and graduated people in Chiropractic. To the data collection was used the recording of a voice interview from a semi- structured questionnaire. The interviews were conducted from November 2017 until December 2017, with respect of all the ethics aspects. In interpretation of data, was used the content analysis suggested by Bardin (2009). The categories identified were: " The current scenario of Chiropractic in Brazil", "Who has the reason?" and "A peaceful living". On the basis of the classification it was possible to reflect about new issues such as: the new challenges and the Chiropractic practices advances in Brazil, Chiropractic and Public Health in Brazil. This paper was able to show the interviewees' perception about the current political and ethical-professional scene of Chiropractic in Brazil, as a new debate tool to change old ideas in the search of new developments and new reflections among phisiotherapists and chiropractors encouraged an absolutely and important debate in order to show the society a complete and prepared professional with attention experience, preserve health and free from the bonds of the market.

The Quality of Life of Children Under Chiropractic Care Using PROMIS-25: Results from a Practice-Based Research Network.

OBJECTIVES: To characterize pediatric chiropractic and assess pediatric quality of life (QoL). DESIGN: A prospective cohort. Setting/Locations: Individual offices within a practice-based research network located throughout the United States. SUBJECTS: A convenience sample of children (8-17 years) under chiropractic care and their parents. EXPOSURE: Chiropractic spinal adjustments and adjunctive therapies. OUTCOME MEASURES: Survey instrument measuring sociodemographic information and correlates from the clinical encounter along with the Patient Reported Outcomes Measurement Information System (PROMIS)-25 to measure QoL (i.e., depression, anxiety, and pain interference). Sociodemographic and clinical correlates were analyzed using descriptive statistics (i.e., frequencies/percentages, means, and standard deviations). The PROMIS-25 data were analyzed using scoring manuals, converting raw scores to T score metric (mean = 50; SD = 10). A generalized linear mixed model was utilized to examine covariates (i.e., sex, number of visits, and motivation for care) that may have played an important role on the PROMIS outcome. RESULTS: The original data set consisted of 915 parent-child dyads. After data cleaning, a total of 881 parents (747 females, 134 males; mean age = 42.03 years) and 881 children (467 females and 414 males; mean age = 12.49 years) comprised this study population. The parents were highly educated and presented their child for mainly wellness care. The mean number of days and patient visits from baseline to comparative QoL measures was 38.12 days and 2.74 (SD = 2.61), respectively. After controlling for the effects of motivation for care, patient visits, duration of complaint, sex, and pain rating, significant differences were observed in the probability of experiencing problems (vs. no reported problems) across all QoL domains (Wald = 82.897, df = 4, p < 0.05). Post hoc comparisons demonstrated the children were less likely to report any symptoms of depression (Wald = 6.1474, df = 1, p < 0.05), anxiety (Wald = 20.603, df = 1, p < 0.05), fatigue (Wald = 22.191, df = 1, p < 0.05), and pain interference (Wald = 47.422, df = 1, p < 0.05) after a trial of chiropractic care. CONCLUSIONS: The QoL of children improved with chiropractic care as measured by PROMIS.

The Use of the Patient Reported Outcomes Measurement Information System and the RAND VSQ9 to Measure the Quality of Life and Visit-Specific Satisfaction of Pregnant Patients Under Chiropractic Care Utilizing the Webster Technique.

OBJECTIVE: To quantify the quality of life (QoL) and visit-specific satisfaction of pregnant women. DESIGN: A prospective cohort within a practice-based research network (PBRN). Setting/Locations: Individual chiropractic offices. SUBJECTS: Pregnant women (age ≥18 years) attending chiropractic care. INTERVENTION(S): Chiropractic care (i.e., The Webster Technique, spinal adjustments, and adjunctive therapies). MAIN OUTCOME MEASURES: The RAND VSQ9 to measure visit-specific satisfaction and the Patient Reported Outcomes Measurement Information System (PROMIS®)-29 to measure QoL. RESULTS: A convenience sample of 343 pregnant patients (average age = 30.96 years) comprised their study population. They were highly educated with 75% attaining a 2-year associate's degree or higher. The pregnant patients presented for chiropractic care with a mean week of gestation of 25.67 weeks (median = 28 weeks; range = 0-42 weeks) and parity (i.e., the number of live births) of 0.92 live births (median = 1; range = 0-6). From baseline (i.e., at study entrance with minimum first visit) and comparative (i.e., following a course of chiropractic care), the VSQ9 measurements revealed increasingly high satisfaction on the part of the subjects (i.e., the mean difference of baseline minus comparative measures = -0.7322; p < 0.005). The median number of visits (i.e., visits attended) at baseline and comparative measures was 1.00 (standard deviation [SD] = 22.69) and 3.30 (SD = 22.71), respectively. Across outcomes, QoL improved from baseline to comparative measurement after holding constant for visit number and time lapse, trimester of pregnancy, and care provider type. There was a reduction in mean T scores associated with fatigue (p < 0.05), pain interference (p < 0.05), sleep disturbance (p < 0.05), and an improvement in satisfaction with social roles (p < 0.05). A significant decrease was also found with pain interference (p < 0.05). No evidence was found that anxiety (p = 0.1404) or depression (p = 0.8785) changed. CONCLUSION: A PBRN study was successfully implemented among chiropractors to find pregnant patients highly satisfied and their QoL scores improving with care beyond chance.

Association of Venous Leg Ulcers With Ankle Range of Motion in People Attending Chiropractic Mobile Clinics in the Dominican Republic.

OBJECTIVE: The goal of the study was to determine if there was an association between chronic venous disorders (CVDs), particularly venous leg ulcers, and ankle range of motion (ROM) in the Dominican Republic. METHODS: Chronic venous disorders were classified using the clinical manifestations portion (C) of the CEAP (clinical manifestations, etiology, anatomy, pathophysiology) method. The legs of participants attending mobile chiropractic clinics in rural, low-income areas in the Dominican Republic were assessed for clinical signs of CVD and venous ulcers. Ankle ROM was then measured, and photographs of the legs were taken. The 6 clinical stages of CVD were divided into 3 groups: normal legs (normal), no ulcer CVD, and ulcer CVD (healed and active). Multiple linear regression of ankle ROM against CVD grouping was used to test the association. RESULTS: Eight of the 837 patients for whom CVD classification was obtained had venous ulcers (healed or active) on at least 1 leg. About 30% relative reduction in ROM (ankle dorsiflexion plus plantar flexion) was observed between the ulcer group and the normal group. Regression analysis comparing legs with ulcers to healthy legs (normal), adjusted for age, gender, indicator for obesity, and previous leg trauma, revealed a significant decrease of approximately 14° (P = .0007) in ankle ROM. Age was also found to be strongly significant in the regression analysis, 1 year of aging was associated with a decrease of 0.16° (P < .0001) in ankle ROM (approximately 1.6° in 10 years). CONCLUSION: A significant decrease was observed in ankle ROM for participants with active and healed leg venous ulcers compared with those without ulcers. There appeared to be an association between venous leg ulcers and ankle ROM in this sample.

Effectiveness of chiropractic adjustment in lumbar pain in crossfit practitioners / Eficácia do ajuste quiroprático nas dores lombares em praticantes de crossfit / Eficacia del ajuste quiropráctico en los dolores lumbares en practicantes de crossfit

ABSTRACT Objective: To evaluate the efficacy of acute chiropractic adjustment in individuals who practice CrossFit with regard to complaints of low back pain and the joint range of motion in this region. Methods: A randomized clinical trial comprised of CrossFit practitioners from a box in Novo Hamburgo-RS, of both sexes and aged 18 to 40 years who had low back pain at the time of the study. The following tools were used: Semi-structured Anamnesis Questionnaire, Visual Analog Scale, McGill Pain Questionnaire, and SF-36 Quality of Life Questionnaire. Individuals in the control group answered the questionnaires before and after CrossFit training. The chiropractic group performed the same procedure, plus pre-training chiropractic adjustment and joint range of motion (ROM) before and after lumbar adjustment. Results: There was a significant increase in pain in the control group, and a significant decrease in pain in the chiropractic group, including one day after the chiropractic adjustment. In the chiropractic group, the joint ranges of motion had a significant increase in flexion and extension of the lumbar spine after chiropractic adjustment. Conclusion: The chiropractic group achieved a significant improvement in pain level and joint range of motion, suggesting that acute chiropractic adjustment was effective in reducing low back pain.

RESUMO Objetivo: Avaliar a eficácia do ajuste quiroprático agudo em indivíduos praticantes de CrossFit com relação às queixas de dores lombares e à amplitude de movimento articular nessa região. Métodos: Estudo clínico randomizado, composto por praticantes de CrossFit de um box de Novo Hamburgo/RS, de ambos os sexos e com idades de 18 a 40 anos que tinham dor lombar na ocasião da pesquisa. Foram usados os instrumentos Ficha de Anamnese Semiestruturada, Escala Visual Analógica, Questionário de dor McGill e Questionário de Qualidade de Vida SF-36. Os indivíduos do grupo controle responderam os questionários antes e depois do treino de CrossFit. O grupo quiropraxia realizou o mesmo procedimento, acrescido do ajuste quiroprático pré-treino e da medição da amplitude de movimento (ADM) articular antes e depois de ajuste lombar. Resultados: Observaram-se aumento significativo de dor no grupo controle e diminuição significativa de dor no grupo quiropraxia, inclusive um dia após o ajuste quiroprático. No grupo quiropraxia, as amplitudes de movimento articular tiveram aumento significativo na flexão e na extensão da coluna lombar após o ajuste quiroprático. Conclusão: O grupo quiropraxia obteve uma melhora significativa no nível de dor e na amplitude de movimento articular, sugerindo que o ajuste quiroprático agudo foi eficaz na redução da dor lombar.

RESUMEN Objetivo: Evaluar la eficacia del ajuste quiropráctico agudo en individuos que practican CrossFit con relación a las quejas de dolores lumbares y el rango de movimiento articular en esa región. Método: Ensayo clínico aleatorizado compuesto por practicantes de CrossFit de un box de Novo Hamburgo-RS, de ambos sexos y con edades de 18 a 40 años que tenían dolor lumbar en ocasión de la investigación. Se utilizaron los cuestionarios Ficha de Semi-estructurada de Anamnesis, Escala visual analógica, cuestionario de McGill y el Cuestionario de Calidad de vida SF -36. Los individuos del grupo control respondieron los cuestionarios antes y después del entrenamiento de CrossFit. El grupo quiropráctico realizó el mismo procedimiento, incrementado de ajuste quiropráctico pre-entrenamiento y de la medición del rango de movimiento (RM) articular antes y después de ajuste lumbar. Resultados: Se observó un aumento significativo de dolor en el grupo control y disminución significativa del dolor en el grupo quiropráctico, incluso un día después del ajuste quiropráctico. En el grupo quiropráctico, los rangos de movimiento articular tuvieron un aumento significativo en la flexión y extensión de la columna lumbar después del ajuste quiropráctico. Conclusión: El ajuste quiropráctico agudo logró una mejora significativa en el nivel de dolor lumbar y en el rango de movimiento articular, sugiriendo que el ajuste quiropráctico agudo fue eficaz en la reducción del dolor lumbar.

Functional disability in patients with low back pain: the mediator role of suffering and beliefs about pain control in patients receiving physical and chiropractic treatment.

BACKGROUND: Low back pain is the leading cause of disability worldwide. There is evidence that depression, anxiety, and external locus of control are negative predictors of functional disability in low back patients. METHODS: This study focused on the mediator role of suffering and beliefs about pain control in the relationship between psychological morbidity and functional disability in patients receiving physical therapy and chiropractic treatment for chronic low back pain. The sample included 213 patients receiving chiropractic treatment and 125 receiving physical therapy, who answered the following instruments: Beliefs about Pain Control Questionnaire; Inventory of Subjective Experiences of Suffering in Illness; Oswestry Low Back Pain Disability Questionnaire; and the Hospital Anxiety and Depression Scales. RESULTS: Suffering was a mediator in the relationship between depression and functional disability in both treatment groups. Only beliefs related to external chance events mediated the relationship between depression and functional disability in the physical therapy group, but not in the chiropratic teratment group. CONCLUSION: Intervention should focus on suffering regardless of the type of treatment and target beliefs about pain control, in patients receiving physical therapy treatment since they seem to play a key role in functional disability in patients with low back pain.

High-velocity low-amplitude manipulation (thrust) and athletic performance: a systematic review / Manipulação em alta velocidade/baixa amplitude e desempenho atlético: uma revisão sistemática

Abstract Introduction: The high demand level in sports has encouraged the search for strategies to increase the yield. In this context, manual therapy through high-velocity low-amplitude (thrust) has been employed in many sports. Despite the adhesion of manual therapists in clinical practice, there were no systematic reviews on this topic. Objective: To evaluate the effects of thrust on the performance of athletes in relation to the outcomes hand-grip strength, jump height and running speed. Methods: The databases used in the search were MEDLINE / PUBMED, LILACS, CINAHL, PEDro, WEB OF SCIENCE, CENTRAL and SCOPUS, and Randomized controlled trials were included, whose participants were professionals or recreational athletes and had thrust as intervention. The methodological quality of the studies was assessed using the PEDro scale of 10 points. Intervention effects were determined by the mean difference and confidence interval. The data analysis was done in the descriptive form due to the heterogeneity found among studies. Results: Five trials were included with a total of 95 individuals. The methodological quality of studies was low, with an average value of 5.6 on the PEDro scale. It was found two articles for each outcome, but in none of them was presented differences between the experimental and control groups considering the confidence interval. Conclusion: The current evidence is insufficient to determine the use or nonuse the MAVBA in sports in order to improve performance.

Resumo Introdução: O elevado nível de exigência no meio esportivo tem incentivado a busca por estratégias para aumentar o rendimento. Nesse contexto, a terapia manual através da Manipulação em Alta e Velocidade e Baixa Amplitude (MAVBA) tem sido empregada em vários esportes. Apesar da adesão dos terapeutas manuais na prática clínica, não foram encontradas revisões sistemáticas acerca do tema. Objetivo: Avaliar os efeitos da manipulação de alta velocidade e baixa amplitude sobre o desempenho de atletas. Métodos: As bases de dados utilizadas na busca foram MEDLINE/PUBMED, LILACS, CINAHL, PEDro, WEB OF SCIENCE, CENTRAL e SCOPUS. Foram incluídos Ensaios Randomizados e Controlados, cujos participantes eram atletas profissionais ou recreacionais, que aplicaram a MAVBA como intervenção. A qualidade metodológica dos estudos foi avaliada por meio da Escala PEDro. Os efeitos da intervenção foram determinados através da diferença de média e do respectivo intervalo de confiança (IC). A análise dos dados foi realizada de maneira descritiva, em virtude da heterogeneidade encontrada entre os estudos. Resultados: Cinco ensaios foram incluídos com um total de 95 indivíduos. A qualidade metodológica dos estudos foi baixa, com uma média de 5.6 na Escala de PEDro. Foram encontrados dois artigos para cada desfecho, e em nenhum deles foi detectada diferença entre o grupo experimental e controle quando levado em consideração o IC. Conclusão: A evidência atual é insuficiente para determinar o uso ou o não uso da MAVBA em com objetivo de melhorar o desempenho esportivo.

Spine Care as a Framework for the Chiropractic Identity.

OBJECTIVE: The purpose of this commentary is to provide an argument for the role and identity of chiropractors as spine care providers within the context of the greater health care system. DISCUSSION: Surveys of the general public and chiropractors indicate that the majority of patients seek chiropractic services for back and neck pain. Insurance company utilization data confirm these findings. Regulatory and legal language found in chiropractic practice acts reveals that most jurisdictions define the chiropractic scope of practice as based on a foundation of spine care. Educational accrediting and testing organizations have been shaped around a chiropractic education that produces graduates who focus on the diagnosis and treatment of spine and musculoskeletal disorders. Spine care is thus the common denominator and theme throughout all aspects of chiropractic practice, legislation, and education globally. CONCLUSION: Although the chiropractic profession may debate internally about its professional identity, the chiropractic identity seems to have already been established by society, practice, legislation, and education as a profession of health care providers whose area of expertise is spine care.

Methods of Muscle Activation Onset Timing Recorded During Spinal Manipulation.

OBJECTIVE: The purpose of this study was to determine electromyographic threshold parameters that most reliably characterize the muscular response to spinal manipulation and compare 2 methods that detect muscle activity onset delay: the double-threshold method and cross-correlation method. METHODS: Surface and indwelling electromyography were recorded during lumbar side-lying manipulations in 17 asymptomatic participants. Muscle activity onset delays in relation to the thrusting force were compared across methods and muscles using a generalized linear model. RESULTS: The threshold combinations that resulted in the lowest Detection Failures were the "8 SD-0 milliseconds" threshold (Detection Failures = 8) and the "8 SD-10 milliseconds" threshold (Detection Failures = 9). The average muscle activity onset delay for the double-threshold method across all participants was 149 ± 152 milliseconds for the multifidus and 252 ± 204 milliseconds for the erector spinae. The average onset delay for the cross-correlation method was 26 ± 101 for the multifidus and 67 ± 116 for the erector spinae. There were no statistical interactions, and a main effect of method demonstrated that the delays were higher when using the double-threshold method compared with cross-correlation. CONCLUSIONS: The threshold parameters that best characterized activity onset delays were an 8-SD amplitude and a 10-millisecond duration threshold. The double-threshold method correlated well with visual supervision of muscle activity. The cross-correlation method provides several advantages in signal processing; however, supervision was required for some results, negating this advantage. These results help standardize methods when recording neuromuscular responses of spinal manipulation and improve comparisons within and across investigations.

The Neuromuscular Response to Spinal Manipulation in the Presence of Pain.

OBJECTIVE: The purpose of this study was to evaluate differences in muscle activity in participants with and without low back pain during a side-lying lumbar diversified spinal manipulation. METHODS: Surface and indwelling electromyography at eight muscle locations were recorded during lumbar side-lying manipulations in 20 asymptomatic participants and 20 participants with low back pain. The number of muscle responses and muscle activity onset delays in relation to the manipulation impulse were compared in the 2 pain groups using mixed linear regressions. Effect sizes for all comparisons were calculated using Cohen's d. RESULTS: Muscle responses occurred in 61.6% ± 23.6% of the EMG locations in the asymptomatic group and 52.8% ± 26.3% of the symptomatic group. The difference was not statistically significant but there was a small effect of pain (d = 0.350). Muscle activity onset delays were longer for the symptomatic group at every EMG location except the right side indwelling L5 electrode, and a small effect of pain was present at the left L2, quadratus lumborum and trapezius surface electrodes (d = 0.311, 0.278, and 0.265) respectively. The indwelling electrodes demonstrated greater muscle responses (P ≤ .01) and shorter muscle activity onset delays (P < .01) than the surface electrodes. CONCLUSIONS: The results revealed trends that indicate participants with low back pain have less muscle responses, and when muscle responses are present they occur with longer onset delays following the onset of a manipulation impulse.

Efeitos do tratamento quiroprático na concentração sérica de proteína C-reativa e nos sintomas de indivíduos com cervicalgia / Effects of chiropractic treatment on serum C-reactive protein and in the symptoms of individuals with neck disorders

Introdução: cervicalgia é a segunda queixa principal mais prevalente relatada pelos pacientes que procuram tratamento quiroprático, e acomete 55% da população (KNOPLICH, 2003; LEAVER et al., 2007). A manipulação vertebral altera a entrada dos sinais sensórios dos tecidos paraespinhais de maneira a melhorar a função fisiológica 3. A função da proteína C-reativa (PCR) in vivo não está bem definida e os resultados de estudos com animais experimentais têm produzido resultados contraditórios. Métodos: em um estudo quase experimental, a concentração sérica de proteína C-reativa após tratamento quiroprático foi determinada em 12 pacientes, sendo seis sintomáticos à cervicalgia e seis assintomáticos. Foram realizadas coletas sanguíneas. A partir das amostras foi dosada a concentração plasmática de proteína C-reativa. Resultados: os resultados sugerem que a manipulação quiroprática estimula a produção de interleucinas que, por sua vez, aumenta a produção da PCR para combater a inflamação. Dessa forma, a melhora do processo inflamatório provocada pelo procedimento quiroprático pode reduzir a descarga dos aferentes nociceptivos e, desta forma, reduzir a sensação de dor. Conclusão: existe uma tendência ao aumento da concentração da PCR, e a diminuição da dor, o que sugere efeitos benéficos da manipulação articular vertebral sobre eventos inflamatórios e nociceptivos. (AU)

Introduction: Neck pain is the second most prevalent chief complaint reported by patients who seek chiropractic care, and affects 55% of the population (KNOPLICH, 2003; LEAVER et al., 2007). The spinal manipulation, in theory, change the entry of sensory signals from paraspinal tissues in order to improve the function physiological 3. The role of C-reactive protein (CRP) in vivo is not well defined and the results of experimental animal studies have produced contradictory results. Methods: A quasiexperimental study, the serum C-reactive protein after chiropractic treatment was determined in 12 patients, 6 with symptomatic and 6 asymptomatic neck. Blood were collected. From the samples was measured plasma concentration of C-reactive protein. Results: The results suggest that chiropractic manipulation stimulates the production of interleukins that in turn, increases the production of CRP to fight inflammation. Thus, the improvement of the inflammatory process caused by the chiropractic procedure can reduce the discharge of nociceptive afferents and thereby reduce the sensation of pain. Conclusion: There is a tendency to increased concentration of CRP and reduction of pain, suggesting beneficial effects of joint manipulation on spinal nociceptive and inflammatory events. (AU)

Vertical ground reaction force analysis during gait with unstable shoes / Análise da força vertical de reação do solo durante a marcha com calçado instável

AbstractIntroduction Footwear is no longer just an accessory but also a protection for the musculoskeletal system, and its most important characteristic is comfort.Objectives This study aims to identify and to analyze the vertical ground reaction force in barefoot women and women with unstable shoes.Methodology Five women aged 25 ± 4 years old and mass of 50 ± 7 kg participated in this study. An AMTI force plate was used for data acquisition. The 10 trials for each situation were considered valid where the subject approached the platform with the right foot and at the speed of 4 km/h ± 5%. The instable shoe of this study is used in the practice of physical activity.Results The results showed that the first peak force was higher for the footwear situation, about 5% and significant differences between the barefoot and footwear situation. This significant difference was in the first and second peaks force and in the time of the second peak.Conclusion The values showed that the footwear absorbs approximately 45% of the impact during gait.

ResumoIntrodução O calçado deixou de ser acessório e tornou-se uma proteção para o sistema musculoesquelético, tendo como principal objetivo o conforto.Objetivo O presente estudo tem como objetivo verificar e analisar a componente vertical de reação do solo em mulheres descalço e com calçado instável.Metodologia Participaram deste estudo cinco mulheres com idade de 25 ± 4 anos e massa de 50 ± 7 kg. Para a aquisição dos dados foi utilizado plataforma AMTI. Foram consideradas válidas 10 tentativas de o sujeito abordar a plataforma com o pé direito e na velocidade de 4 km/h ± 5%. O calçado instável deste estudo foi utilizado na prática de atividade física.Resultados Os resultados apresentaram que o primeiro pico de força foi maior para a situação calçado, cerca de 5%, e diferenças significativas entre a situação descalço e com calçado para o primeiro pico de força, segundo pico de força e tempo do segundo pico de força.Conclusão Verificou-se que o calçado absorve aproximadamente 45% do impacto durante a marcha.

Effect of Spinal Manipulative Therapy on the Singing Voice.

OBJECTIVE: This study investigated the effect of spinal manipulative therapy (SMT) on the singing voice of male individuals. STUDY DESIGN: Randomized, controlled, case-crossover trial. METHODS: Twenty-nine subjects were selected among male members of the Heralds of the Gospel. This association was chosen because it is a group of persons with similar singing activities. Participants were randomly assigned to two groups: (A) chiropractic SMT procedure and (B) nontherapeutic transcutaneous electrical nerve stimulation (TENS) procedure. Recordings of the singing voice of each participant were taken immediately before and after the procedures. After a 14-day period, procedures were switched between groups: participants who underwent SMT on the first day were subjected to TENS and vice versa. Recordings were subjected to perceptual audio and acoustic evaluations. The same recording segment of each participant was selected. Perceptual audio evaluation was performed by a specialist panel (SP). Recordings of each participant were randomly presented thus making the SP blind to intervention type and recording session (before/after intervention). Recordings compiled in a randomized order were also subjected to acoustic evaluation. RESULTS: No differences in the quality of the singing on perceptual audio evaluation were observed between TENS and SMT. CONCLUSIONS: No differences in the quality of the singing voice of asymptomatic male singers were observed on perceptual audio evaluation or acoustic evaluation after a single spinal manipulative intervention of the thoracic and cervical spine.

Clinical competency evaluation of Brazilian chiropractic interns.

OBJECTIVE: This study compares the results of an objective structured clinical examination (OSCE) between 2 groups of students before an internship and after 6 months of clinical practice in an internship. METHODS: Seventy-two students participated, with 36 students in each cohort. The OSCEs were performed in the simulation laboratory before the participants' clinical practice internship and after 6 months of the internship. Students were tested in 9 stations for clinical skills and knowledge. The same procedures were repeated for both cohorts. The t test was used for unpaired parametric samples and Fisher's exact test was used for comparison of proportions. RESULTS: There was no difference in the mean final score between the 2 groups (p = .34 for test 1; p = .08 for test 2). The performance of the students in group 1 was not significantly different when performed before and after 6 months of clinical practice, but in group 2 there was a significant decrease in the average score after 6 months of clinical practice. CONCLUSIONS: There was no difference in the cumulative average score for the 2 groups before and after 6 months of clinical practice in the internship. There were differences within the cohorts, however, with a significant decrease in the average score in group 2. Issues pertaining to test standardization and student motivation for test 2 may have influenced the scores.

Peripheral oxidative stress blood markers in patients with chronic back or neck pain treated with high-velocity, low-amplitude manipulation.

OBJECTIVE: The purpose of this study was to investigate oxidative-stress parameters in individuals with chronic neck or back pain after 5 weeks of treatment with high-velocity, low-amplitude (HVLA) spinal manipulation. METHODS: Twenty-three individuals aged 38.2 ± 11.7 years with nonspecific chronic neck or back pain verified by the Brazilian Portuguese version of the Chronic Pain Grade, with a sedentary lifestyle, no comorbidities, and not in adjuvant therapy, underwent treatment with HVLA chiropractic manipulation twice weekly for 5 weeks. Therapeutic procedures were carried out by an experienced chiropractor. Blood samples were assessed before and after treatment to determine the activities of the antioxidant enzymes superoxide dismutase (SOD), catalase and glutathione peroxidase (GPx), and the levels of nitric oxide metabolites and lipid hydroperoxides. These blood markers were analyzed by paired Student t test. Differences were considered statistically significant, when P was <.05. RESULTS: There was no change in catalase but an increase in SOD (0.35 ± 0.03 U SOD per milligram of protein vs 0.44 ± 0.04 U SOD per milligram of protein; P < .05) and GPx (7.91 ± 0.61 nmol/min per milligram of protein vs 14.07 ± 1.07 nmol/min per milligram of protein; P < .001) activities after the treatment. The nitric oxide metabolites and the lipid hydroperoxides did not change after treatment. CONCLUSION: High-velocity, low-amplitude spinal manipulation twice weekly for 5 weeks increases the SOD and GPx activities. Previous studies have shown a relationship between pain and oxidative and nitrosative parameters; thus, it is possible that changes in these enzymes might be related to the analgesic effect of HVLA spinal manipulation.