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RESEARCH ARTICLES

 

General Spine Care Related Articles
Click on link for full article

 

1) Low Back Pain Of Mechanical Origin: Randomized Comparison Of Chiropractic And Hospital Outpatient Treatment, 1990, BMJ (Full Article)

Conclusions: “For patients with low back pain in whom manipulation is not contraindicated chiropractic almost certainly confers worthwhile, long term benefit in comparison with hospital outpatient management. The benefit is seen mainly in those with chronic or severe pain. Introducing chiropractic into NHS practice should be considered.”

2) Randomized Comparison Of Chiropractic And Hospital Outpatient Management For Low Back Pain: Results From An Extended Follow-up, 1995, BMJ (Full Article)

Conclusions: “At three years the results confirm the findings of an earlier report that when chiropractic or hospital therapists treat patients with low back pain as they would in day to day practice those treated by chiropractic derive more benefit and long term satisfaction than those treated by hospitals.”

3) Outcome Of Low Back Pain In General Practice: A Prospective Study, 1998, BMJ (Full Article)

Conclusions: “The results are consistent with the interpretation that 90% of patients with low back pain in primary care will have stopped consulting with symptoms within three months. However, most will still be experiencing low back pain and related disabilty one year after consultation.”

4) Effects Of Unilateral Spinal Adjustments On Goinometrically-Assessed Cervical Lateral-Bending End-Range Asymmetry In Otherwise Asymptomatic Subjects, 1989, JMPT (Full Article)

This study confirms that an appropriate spinal adjustment can predictably normalize abnormal cervical spine motions.

5) An Evaluation Of Medical And Chiropractic Provider Utilization And Costs: Treating Injured Workers In North Carolina , 2004, JMPT (Full Article)

Conclusions: “These data, with the acknowledged limitations of an insurance database, indicated lower treatment costs, less workdays lost, lower compensation payments, and lower utilization of ancillary medical services for patients treated by DCs. Despite the lower cost of chiropractic management, the use of chiropractic services in North Carolina appear very low.”

6) Efficacy Of Spinal Manipulation And Mobilization For Low Back Pain And Neck Pain: A Systematic Review And Best Evidence Synthesis, 2003, The Spine Journal (Full Article)

Results: “….. There is limited to moderate evidence that SMT is better than physical therapy and home back exercise in both the long and short term…..”

7) Long-Term Follow-up Of A Randomized Clinical Trial Assessing The Efficacy Of Medication, Acupuncture, And Spinal Manipulation For Chronic Mechanical Spinal Pain Syndromes, 2005, JMPT (Full Article)

Conclusions: “In patients with chronic spinal pain syndromes, spinal manipulation, if not contraindicated, may be the only treatment modality of the assessed regimens that provides broad and significant long-term benefit.”

8) Efficacy Of Preventive Spinal Manipulation For Chronic Low-Back Pain And Related Disabilities: A Preliminary Study, 2004 JMPT (Full Article)

Conclusions: “Intensive spinal manipulation is effective for the treatment of chronic low back pain. This experiment suggests that maintenance spinal manipulations after intensive manipulative care may be beneficial to patients to maintain subjective postintensive treatment disability levels. Further studies, however, are needed to confirm the finding in a larger group of patients with chronic low-back pain.”

9) Chiropractic Effects On Athletic Ability, 1991, JCR (Full Article)

Athletic ability was increased with chiropractic care as compared to a control group.

10) Objective Physiologic Changes And Associated Health Benefits Of Chiropractic Adjustments In Asymptomatic Subjects: A Review Of The Literature, 2004 JVSR (Full Article)

Conclusions: “The data reviewed lend support to the contention that chiropractic adjustments, often for the purpose of correcting vertebral subluxation, confer measurable health benefits to people regardless of the presence of absence of symptoms. …..”

11) Spinal Manipulation In The Treatment Of Low-Back Pain, 1985, Can Fam Physician (Full Article)

“Over the past decade, there has been an escalation of clinical and basic science research on manipulative therapy, which has shown that there is a scientific basis for the treatment of back pain by manipulation. Most family practitioners have neither the time nor inclination to master the art of manipulation and will wish to refer their patients to a skilled practitioner of this therapy. Results of spinal manipulation with 283 patients with low back pain are presented.”

 

Manipulation Under Anesthesia/Fibrosis Release Procedures
Click on link for full article

 

1) Manipulation Under Anesthesia: A Report Of Four Cases, JMPT, 9.2005 (Full Article)

Four patients that had not improved adequately to numerous months of in-office chiropractic management improved substantially after MUA/FRP procedures. This study also reports a 70% success rate found during a Quality Assurance review of the surgery center where MUA cases are performed. 70% of patients interviewed after MUA procedures reported that they were “very satisfied” with the improvement that they obtained from the procedure. This recent MUA study confirms the findings of other researchers that reported similar results.

2) Frank Kohlbeck , DC and Scott Haldeman, DC, MD, PhD, published a literature review of MUA ( 49 published articles) in THE SPINE JOURNAL in (2002) Medication Assisted Spinal Manipulation and concluded the following: (Full Article)

“Medicine-assisted spinal manipulation therapies have a relatively long history of clinical use and have been reported in the literature for over 70 years.” Page 288

“Recent advances in highly titratable and reversible intravenous anesthesia have significantly reduced risks associated with manipulation under anesthesia (MUA), analgesia and sedation, which can now be performed in outpatient surgical centers.” Page 289

“There are case reports and case series describing the successful use of MUA and other medically assisted manual therapies in patients …” Page 289

“The rationale for the use of MUA is that anesthesia and analgesia help to eliminate or reduce pain and muscle spasm that hinder the effective use of traditional manipulation … to break up joint adhesions and reduce segmental dysfunction to a greater extent than if anesthesia had not been employed.” Page 289

“The earliest MUA study … was published in 1930 by The Lancet … overall 75 percent of patients improved.” Page 290

“In a first study by Siehl ad Bradford published in 1952, 33 percent of the patients … demonstrated good (symptom-free) results.” Page 294

“Siehl’s followup study … 96 percent reported successful (good or fair) outcomes.”

Mesner’s study included 205 patients … 51 percent of the patients reported satisfactory results.” Page 294

“In Chrisman’s study 83 percent of the subjects reported good or excellent result after a 3-year follow-up.” Page 294

“In Morey’s 1973 review … treating physician reported excellent or good results in 85 percent of the cases.” Page 294

“In a study published in 1986 by Krumhansel and Nowacek … outcomes were reported as 25 percent ‘cured’, 50 percent ‘much improved’, and 20 percent ‘better, but’. Page 294

“In a 1990 article by Mennell … 30 percent with symptoms cured, 35 percent with marked improvement, 29 percent with moderate improvement…” Page 294

“In a recent case series by West et al … VAS scores improved 4.6 points for cervical pain and 4.31 points for lumbar pain. Decrease in time off work and less use of prescription pain medication were also reported.” Page 294 (This is the ONLY article reviewed by ACOEM and somehow led to their conclusion of “not recommended”)

“Current procedures more commonly use specific, short-lever, high velocity low amplitude thrusts characteristic of chiropractic and modern osteopathic adjustive techniques in addition to mobilization.” Page 294

“A typical MUA procedure involves placing the patient in a twilight anesthesia by a board-certified anesthesiologist while the clinician with the aid of a skilled assistant provides specific mobilization and manipulation techniques to the affected joints and spinal regions.” Page 294

“Current guidelines recommend the presence of a primary physician and assisting physician who have both undergone adequate training in MUA procedures. An assistant is necessary to position the patient and stabilize the sedated patient.” Page 295

“We have been unable to find any report of complications using more modern osteopathic and chiropractic techniques or as a result of the use of anesthesia.” Page 297

“If a clinician recommends MUA it would be difficult to deny the use of medication-assisted manipulation or fail to reimburse for it.”

“The literature (a PubMed search from 1966) consists primarily of case reports and case series with two randomized controlled trials and one cohort study.”

3) Supplemental Care With Medication-Assisted Manipulation Versus Spinal Manipulation Therapy Alone For Patients With Chronic Low Back Pain, 2005 JMPT (Full Article)

“Medication-assisted manipulation appears to offer patients increased improvement in low back pain and disability when compared to usual chiropractic care.” Page 258

“The relative odds of experiencing a 10-point improvement in pain and disability favored the medication-assisted manipulation group at 3 months and one year.” Page 258

4) Daniel West et al reported in a JMPT 1999;22(5) study titled “Effective Management of Spinal Pain in 177 Patients Evaluated for MUA” (Full Article)

“VAS ratings improved by 62.2 percent in those patients with cervical pain problems and 60.1 percent in those patients with lumbar pain problems. There was a near-complete reversal (68 percent) in patients out of work before MUA, and those returning to unrestricted activities at 6 months after MUA totaled 64.1 percent. There was a 58.4 percent reduction in the percentage of patients requiring prescription pain medication from the pre-MUA period to 6 months after MUA. Additionally, 24 percent of the treatment group required no medication at 6 months after MUA.” Page 299

“The addition of anesthetic allows for the benefits of manipulation to be shared with those patients who cannot tolerate manual techniques because of pain response, spasm, muscle contractures, and guarding.” Page 300

“MUA has been used successfully in treating those patients unresponsive to acute and chronic musculoskeletal conditions for years.” Page 300

“Only highly skilled, graduate practitioners who have been trained in structural diagnosis and manipulative treatments should be performing these procedures.” Page 300

“All patients with diagnosed spinal conditions received treatment in the area of primary diagnosis, as well as the areas superior and inferior. This is due to the anatomy of the ligamentous, tendinous, and muscular origins and insertions (i.e. if the lumbar spine is the primary site of injury, the treatment areas were thoracic, lumbar, and pelvic).” Page 303

“Performance of the MUA procedure requires a certified MUA first assistant for stabilization and patient positioning, as well as direct ancillary treatment.” Page 304

“We believe we have shown that this treatment program is safe and efficacious in comparison with other treatment options.” Page 307

5) Palmieri et al , October 2002. Chronic LBP: A study of the effects of MUA. JMPT Oct 2002;25(8):E8] (Full Article)

Demonstratedclinical efficacy of MUA performed in a series of three consecutive procedures. The average Numeric Pain Scale scores in the MUA group decreased by 50 percent, and the Roland-Morris Questionnaire scores decreased by 51 percent compared to a controlled group.

“Existing methods for managing nonpathologic chronic back pain include patient education, back schools, spinal injections, medications, physical therapy, exercise and rehabilitation, acupuncture, spinal mobilization and manipulation, behavioral modification, and work and lifestyle activity modification. The MUA procedure is typically performed on patients who have received some or all of these treatments without favorable results.” Page 2

6) Siehl D. Manipulation of the Spine under General Anesthesia. J Am Osteopath Assoc. June 1963;62:35-41. (Full Article)

“… the reposition under anesthesia is harmless and presents absolutely an acknowledged and trustworthy procedure in treatment.” Page 36

“However, I believe that manipulation under anesthesia might well be the ideal treatment in many cases of acute low back and neck problems.” Page 37

“Of the patients having merely myofibrositis or a similar pathologic state, 96.3 percent were improved (good to fair results), making manipulation (under anesthesia) worth while.” Page 38

“It becomes evident from the review of these cases that manipulation of the spine under general anesthesia is a valuable procedure, but the cases must be specifically selected.” Page 39

“The steady spasm and the consequent postural defects combine with local pain, tetalgia, disturbances of the sympathetic nervous system, insomnia, and fatigue to form a vicious circle which magnifies the disability. Therefore, in an attempt to break up this vicious circle, manipulation of various types is carried out through the spinal areas. This can be applied more effectively in many cases with the patient under general anesthesia.” Page 39

“A high percentage of good results can be obtained with careful evaluation and selection of cases.” Page 39

7) Davis CG, DC. Fernando CA, MD. Do Motta MA, DC. Manipulation of the Low Back Under General Anesthesia: Case Studies and Discussion. J of Neuromusculoskeletal System. Fall 1993;1(3):126-134. (Full Article)

“Following this course of treatments, there was marked improvement in pain, with improvement in the orthopedic and neurologic exam. Medication use was decreased and functional capacity increased.” Page 126

“Failed back surgery syndrome is a common indication for MUA.” Page 126

“MUA was presented to the patient as an option for attempting to improve pain control and functioning. The procedure resulted in marked symptomatic improvement immediately after the MUA. Additionally, functional ability improved in these patients for whom physicians had expressed little hope of recovery of normal function.” Page 129

“The cross-links bind collagen fibers so that movement is restricted. When subjected to a high-velocity thrust, these cross-links may be disrupted without a resultant inflammatory reaction that would occur if the collagen fibers were torn.” Page 132

“The two patients in this case report had prolonged symptoms, and each had a number of back surgeries with radiographically identified postoperative scarring.” Page 132

“The MUA procedure in these cases have had longer lasting results than previous surgeries, nerve blocks, or medications.” Page 132

“Reports of manipulation under anesthesia have gone back as far as 1930 when
Riches reported successful treatment of 87 percent of his patients with chronic sciatica, and 92 percent with chronic sacroiliac strain with manipulation under anesthesia.” Page 132.

Many of the techniques require at least two operators, since control of the weight of the patient’s body and of the extremities rest entirely with the operators when the patient is under general anesthesia. This is particularly important with treatment directed at the lumbar spine and pelvis.” Page 133

“The assistant operator is needed for the positioning and stabilization of the patient and to assist in manipulations.” Page 133

“Care must be taken not to manipulate too vigorously under anesthesia. Instead of trying to achieve full range of motion in one manipulation, it is often better to manipulate more gently on two or more occasions.” Page 133

“Mennell has stated than it is no more irrational to use anesthesia to provide relaxation and to avoid pain in joint manipulation than it is to use anesthesia for the reduction of fractures and dislocation or extracting a tooth.” Page 133

“Both patients also regarded their functional capacity as being much improved.” Page 133

“With patients who have undergone surgery only to have the pain return due to scar tissue and fibrosis, MUA may be beneficial.” Page 134

8) Mennell J MCM , MD. The Validation of the Diagnosis “Joint Dysfunction” in the Synovial Joints of the Cervical Spine. JMPT Jan 1990;13(1):7-12. (Full Article)

“I use it (MUA) to obtain pure relaxation, for pain relief and sometimes for expedience – never so that I may use more force or any different technique.” Page 11

“My manipulative techniques are exactly the same with the patient awake or asleep. It is interesting that when asleep the patient’s restricted joint movement (amount of loss of function) is exactly the same as when they are awake.” Page 11

“When a patient is anesthetized, the therapeutic techniques used are exactly the same, though they are performed even more gently.” Page 11

9) Greenman PE, DO. Manipulation with the patient under anesthesia. JAOA Sept 1992;92(9):1159-1170. (Full Article)

“Safety and effectiveness are favored by appropriate selection of patients, knowledge of indications and contraindications, suitable anesthetic, and services of a qualified physician trained in structural diagnosis and manipulative technique.” Page 1159

“The patient was symptom-free for the succeeding 18 months, …” Page 1160

“The patient’s condition was greatly improved 24 hours after undergoing manipulation under anesthesia, and she was symptom-free within 10 days. No subsequent sequelae occurred for 18 months. Minor recurrence then responded quickly to more usual forms of manual medicine.” Page 1160

“The purpose of the anesthesia is to obliterate the pain and muscle spasm that has prevented other forms of conservative manual medicine care from being effective.” Page 1167

“Additionally, an experienced team can accomplish the procedure more quickly and save anesthesia time. Many of the techniques recommended … require a minimum of two operators.” Page 1167

10) Herzog J, DC. Use of Cervical Spine Manipulation Under Anesthesia for Management of Cervical Disk Herniation, Cervical Radiculopathy, and Associated Cervicogenic Headache Syndrome. JMPT Mar/Apr 1999;22(3):166-70. (Full Article)

“The patient had immediate relief after the first procedure. Her neck and arm pain were reported to be 50 percent better after the first trial, and her headaches were better by 80 percent after the third trial. Four months after the last procedure the patient reported a 95 percent improvement in her overall condition.” Page 166

“The generally accepted rationale for how MUA works is based on solid scientific data relating to muscle and joint physiology.” Page 166

“Siehl and Claybourne have documented the validity of MUA as a procedure useful in treating musculoskeletal disorders when restriction of the joint, joint capsule, and surrounding musculature has taken place as a result of the formation of fibrous adhesions.” Page 166

“She returned to work and maintained the improvement three months later.” Page 168

“The post-MUA therapy continues for a total of 6 to 8 weeks. At that time the patient will have achieved a maximum therapeutic benefit and be discharged. Rehabilitation and strengthening of the supporting tissues will help maintain the effects of the alteration of the fibrous adhesions that have occurred with the MUA.” Page 169

“Regardless, it seems to appear that MUA has a positive effect on certain types of conditions that have been unresponsive to traditional therapeutic approaches.” Page 169

“Significant increase in overall muscle flexibility and spinal range of motion was realized after each treatment. The rationale for MUA use is to control and alter the fibrous adhesions that are a result of the inflammatory cycle.” Page 170

“MUA has been shown to be of benefit in a case of cervical disk herniation with cervical radiculopathy and cervicogenic headache syndrome.” Page 170

11) Rumney IC, DO. Manipulation of the Spine and Appendages under Anesthesia: An evaluation. JOAO. Nov. 1968;68:75-85. (Full Article)

“Tospon reports that, in treating over 200 cases of ligamentous strain of the neck due to auto accident, early manipulation under anesthesia (second or third week after the accident) lessened the morbidity and hastened the recovery.” Page 76

“In 1955 Mensor reported good results in 64 percent of private practice patients and 45 percent of patients whose disability was caused by industrial accidents. After 20 years’ experience and treatment of more than 600 patients with manipulation of the back under anesthesia he has had sufficiently satisfactory results to continue with this procedure.” Page 76

“When the condition advances to fibrosis one is faced with a prolonged program, and it is at this point that manipulative therapy under anesthesia is most frequently indicated.” Page 77

“Even after the manipulative procedures break up the fibrosis, one must institute an adequate program of physical therapy and exercise. If one does not prevent, or lessen, the formation of fibrous tissue, the patient’s original problem will recur.” Page 77

“I believe there is a definite place for MUA. The procedure would definitely obviate the need for back surgery in many cases.” Page 85

“Only physicians who are well trained in the art of manipulative therapy should employ anesthesia for such procedures.” Page 85.

12) Samuel Turek , MD , orthopedic surgeon, reports in his textbook, Principles and Applications of Orthopedics.

“ good to excellent results” can be expected in 50 percent of patients with acute herniated nucleus pulposis with MUA.

13) Thomas Dorman , MD , Orthopedist, Diagnosis Techniques in Orthopedic Medicine.

“MUA is recommended when the patient has failed at conservative in-office care.”

14) Robert Mensor , MD , orthopedic surgeon. Lumbar Vertebral Disc Syndrome. (Full Article)

Conducted a large clinical trial of over 600 patients with EMG verified radiculopathy and found that 83 percent responded well to MUA.

15) Christman OD , MD. et al. A Study of the Results Following Rotatory Manipulation in the Lumbar IVD Syndrome. J Bone and Joint Surgery. 1964 Apr;46-A(3) (Full Article)

reported that 51 percent of patients with unrelieved symptoms after conservative care had good to excellent results even three years after MUA.

 

Extracorporeal Shockwave Therapy - Summaries Only. Please email Dr. Richard K. Skala for specific abstracts or articles.

 

Plantar Fascitis

  • “High level of efficacy and patient satisfaction.” [Wilner JM, Clin Podiatr Med Surg. 2004 Jul;21(3):441-7, viii]
  • “An effective form of treatment for proximal insertional plantar fascitis.” [Strash WW, Clin Podiatr Med Surg. 2002 Oct;19(4):467-76]
  • “A prospective randomized placebo-controlled double-blind multicenter trial shows efficiency and safety of ESWT. A single shock wave application can improve the condition significantly compared with placebo treatment (p = 0.0149). The Roles and Maudsley score also showed a significant improvement between the groups, with 61.6% good or excellent results in the verum group and 39.7% in the placebo group (p = 0.0128). Therapy-related side effects (local swelling, petechia) are rare. The data presented in this study led to FDA approval in January 2002.” [Buch M, Orthopade. 2002 Jul;31(7):637-44]
  • “Six months after ESWT pain decreased by 64% to 88% on the visual analog scale (VAS) and the comfortable walking time had increased significantly in both groups.” [Hammer DS, Foot Ankle Int. 2002 Apr;23(4):309-13]
  • ”These eight published studies involved 840 patients, with success rates of as much as 88%. 12 studies had methodological variables or lack of appropriate follow-up data that would limit their validity, although the success rates were comparable to the A to C studies. This meta-analysis shows that the directed application of shockwaves to the enthesis of the plantar fascia at the inferior calcareous is a safe and effective nonsurgical method for treating chronic, recalcitrant heel pain syndrome that has been refractory to other commonly used nonoperative therapies. The results suggest that this therapeutic procedure should be considered before any surgical intervention, and may be preferable prior to cortisone injection, which has a recognized risk of rupture of the plantar fascia and a frequent recurrence of symptoms.” [ Ogden JA, Foot Ankle Int. 2002 Apr;23(4):301-8]
  • “The effect of shockwave therapy was investigated in 79 patients (85 heels) with plantar fascitis with one-year follow-up. The overall results were 75.3% complaint-free, 18.8% significantly better, 5.9% slightly better and none unchanged or worse. The effect of shockwave therapy seemed cumulative and was time-dependent. The recurrence rate was 5%. There were no device-related problems, systemic or local complications. Shockwave therapy is a safe and effective modality in the treatment of patients with plantar fascitis.” [Wang CJ, Foot Ankle Int. 2002 Mar;23(3):204-7] 
  • ”Fifty patients with recalcitrant heel pain and a plantar calcaneal spur on the X-ray received in a controlled, prospective and randomized study. The follow-up after 12 months showed clear improvement and relief of pain in both groups on manual pressure and while walking and an increase of the pain-free walking ability from 10 minutes before the treatment to 2 and 3 hours respectively after 12 months. We saw significantly better results after the treatment with 3 x 500 impulses. The extracorporal shock-wave therapy is an effective treatment in refractory heel pain. An amount of at least 3 x 500 impulses in the low energetic treatment is useful.” [Krischek O, Z Orthop Ihre Grenzgeb. 1998 Mar-Apr;136(2):169-74]

ESWT, High Energy (in general)

  • “Its effects are not well understood. Theorized that neovascularization is responsible for improvement in symptoms. Noninvasiveness and minimal complication rate are its primary advantages. The effects of shock wave therapy seem to be time dependent.” [Strash WW, Clin Podiatr Med Surg. 2002 Oct;19(4):467-76]
  • ”Excellent results in clinical application and research led to widespread use of this noninvasive procedure. Until now the actual mode of action and biochemical pathways remain unknown. A tissue thickness of 15 mm significantly influenced focus characteristics. We found distinct spreading and slight lateral deviation of the focus. In the same way, the peak positive pressure was significantly reduced after the shock waves had passed the musculocutaneous model. The clinical application of extracorporeal shock waves should be modified in intensity and number of shock waves depending on individual anatomic conditions, indication, and location.” [Gerdesmeyer L, Orthopade. 2002 Jul;31(7):618-22]
  • “An ultrasound controlled treatment was applied in the low and middle energy range, using energy densities of 0.09 to 0.36 mJ/mm2. 65/409 persons in the study were competitive sportsmen. The performed examination exhibits that for conservatively treated tendinoses of the competitive sportsmen, similarly good therapy results concerning the application of ESWT can be reached compared with the classical orthopaedic shockwave therapy. Therefore, for the treatment of a tendinosis, a shock wave therapy should always be taken into account to avoid long exercise and competition breaks due to operative interventions.” [Steinacker T, Sportverletz Sportschaden. 2001 Jun;15(2):45-9]
  • ”After 5 months 85 patients for all three indications a significant improvement of the pain situation could be reached. Patients with plantar fascitis demonstrated the highest decrease of pain, followed by tendinosis calcarea and epicondylitis radialis.” [Maier M, Z Orthop Ihre Grenzgeb. 2000 Jan-Feb;138(1):34-8]
  • “105 papers referring to ESWT of the locomotor system are rated. Validation was performed for each paper according to the international accepted system of the American Association of Spine Surgery in Type A-E. 4825 cases from 55 publications and abstracts that underwent ESWT were evaluated. 24 papers with 1585 cases (33%) live up to the standards of a scientific investigation. No serious complications were observed. The advantages of ESWT are non-invasiveness and low rate of complications.” [Heller KD, Z Orthop Ihre Grenzgeb. 1998 Sep-Oct;136(5):390-401]
  • ”On the basis of the results achieved, it may be concluded that, for specific indications, extracorporeal shock wave therapy may now be taken out of the clinical testing stage and introduced into routine practice.” [Rompe JD, Fortschr Med. 1997 Jun 30;115(18):26, 29-33]
  • ”The results show the benefit of ESWA in the treatment of chronic soft-tissue disorders without severe side effects. Some patients showed small subcutaneous hematomas and erosion of the skin when energies about 20 mJ were used. Forty-seven of 84 of the patients obtained complete relief; 24 patients showed a marked reduction in their complaints. In only 13 of 84 cases was the treatment unsuccessful.” [Boxberg W, Chirurg. 1996 Nov;67(11):1174-8]

Chronic Calcific Tendinitis of the Shoulder

  • “4-year outcome was determined in a prospective study of 115 patients. By 4 years after shockwave therapy, 20% of the entire patient population had undergone surgery on the involved shoulder. Subjectively, 78% of patients in group A and 87% in group B thought the shockwave treatment had been successful. Radiologic changes were found in 93% of patients in each group. The failure rate after ESWT is high, but for 70% of the patients in this study, the treatment was successful and no long-term complications were seen.” [Daecke W, J Shoulder Elbow Surg. 2002 Sep-Oct;11(5):476-80]
  • “The aim of the study was to verify the hypothesis that either high-dose or low-dose ESWT could be effective if the total amount of applied energy was similar. METHOD: Fifty patients were assigned at random to 2 groups. The treatment consisted of 3 x 5000 low-dose impulses without anesthesia (group 1) and 1 x 5000 high-dose impulses with intravenous analgesia (group 2). Extracorporeal shock wave therapy may be an alternative treatment of calcifying tendinitis of the shoulder. Both treatment protocols gave equivalent results.” [Seil R, Z Orthop Ihre Grenzgeb. 1999 Jul-Aug;137(4):310-5]
  • “In part A 80 patients with chronic symptoms were randomly assigned to a control and three subgroups which had different treatment by low-energy and high-energy shock waves. In part B 115 patients had either one or two high-energy sessions. The results after six months showed energy-dependent success, with relief of pain ranging from 5% in our control group up to 58% after two high-energy sessions. Shockwave therapy should be considered for chronic pain due to calcific tendinitis which is resistant to conservative treatment.” [Loew M, J Bone Joint Surg Br. 1999 Sep;81(5):863-7]
  • ”After 12 weeks 14/20 patients showed a marked improvement of symptoms. The x-rays of 7/20 patients showed a complete resorption of the calcifications, in 5/20 cases partial disintegration of the calcium deposits was seen. The overall morbidity was low with 14/20 patients developing transient hematomas; MRI imaging showed no severe damages of bone and soft tissue.” [Loew M, Urologe A. 1995 Jan;34(1):49-53]
  • “In a pilot group of 5 patients the deposits were localized by sonography. Immediately after treatment 1 patient felt complete release of pain, the calcium deposit had disappeared on the x-ray control one day after treatment. In 3 cases pain release and elimination of the calcification appeared during 6 weeks after treatment. One patient showed only radiological disintegration of the calcification with no release of pain.” [Loew M, Z Orthop Ihre Grenzgeb. 1993 Sep-Oct;131(5):470-3]

Lateral Epicondylitis (LE)

  • ”Complications such as small hematomas were only found in four patients. After a mean follow-up of 30.7 months, 78 patients could be evaluated with the Roles and Maudsley score. Of these 30.8% had an excellent and 42.3% a good result, while 11.5% had a fair and 15.4% a distinctly poor outcome. Sixty-two patients declared their satisfaction with the ESWT and would agree to have the therapy repeated.” [Decker T, Orthopade. 2002 Jul;31(7):633-6]
  • ”Clinically examined before and after repetitive low-energy ESWT. After a follow-up of 18.6 months clinical evaluation showed a significantly better mean clinical performance than before treatment. Interestingly, male patients showed a significantly better mean clinical performance than female patients, and male and female patients differed significantly in the signal intensity of the common extension tendon cross-section and tendon thickening on MRI. This study reports the first indication of predictability of positive clinical outcome of the treatment of chronic lateral tennis elbow by ESWT using imaging prior to treatment.” [Maier M, Arch Orthop Trauma Surg. 2001 Jul;121(7):379-84]
  • ” Follow-ups were performed at 3, 6, 12, 24 weeks. Statistical analysis showed significant improvement both of subjective and objective criteria. 41/75 patients became painfree. Only 7 patients decided to have an operation after the 24-weeks-follow-up. Ambulatory shock wave therapy is a considerable alternative before surgical intervention in chronic tennis elbow.” [ Rompe JD, Z Orthop Ihre Grenzgeb. 1996 Jan-Feb;134(1):63-6]

Supraspinatus Tendon Syndrome

  • ”No statistically significant differences were proven between ESWT and radiotherapy. “ESWT appears to be at least equivalent to radiotherapy in treating chronic supraspinatus tendinitis syndrome and can avoid a dose of radiation for patients and staff.” [Haake M, Z Orthop Ihre Grenzgeb. 2001 Sep-Oct;139(5):397-402]
  • ”We found functional improvement and pain reduction in both groups 12 weeks after treatment. For the treatment of calcific tendinitis affecting the supraspinatus, we recommend accurate fluoroscopy-controlled focusing of ESWT on the calcification. Focusing on the calcification rather than on the insertion of the supraspinatus tendon is significantly more effective. On the basis of our results, ESWT requires the use of suitable shockwave generators that permit accurate focusing.” [Haake M, Biomed Tech (Berl). 2001 Mar;46(3):69-74]

 

Partial List Of Dr. Richard K. Skala’s Publications

 

1) Effects Of Unilateral Spinal Adjustments On Goinometrically-Assessed Cervical Lateral-Bending End-Range Asymmetry In Otherwise Asymptomatic Subjects, 1989, JMPT

This study confirms that an appropriate spinal adjustment can predictably normalize abnormal cervical spine motions (Full Article)

2) Effects Of Cervical Adjustments On Lateral-Flexion Passive End-Range Asymmetry And On Blood Pressure, Heart Rate, And Plasma Catecholamine Levels, 1991, JMPT (Full Article)

This study confirms that when cervical adjustments are performed and provide robust mechanical normalizing effects, they do this without affecting blood pressure, heart rate, or catecholamine levels.

3) Time Course Considerations For The Effects of Unilateral Lower Cervical Adjustments With Respect To The Amelioration Of Cervical Lateral-Flexion Passive End-Range Asymmetry, 1990, JMPT (Full Article)

Timelines for the stability of normalized motions after a spinal adjustment vary depending on numerous variables, including prior history of symptoms and prior cervical spine injuries.

4) Manipulation Under Anesthesia: A Report Of Four Cases, JMPT, 9.2005 (Full Article)

Four patients that had not improved adequately to numerous months of in-office chiropractic management improved substantially after MUA/FRP procedures. This study also reports a 70% success rate found during a Quality Assurance review of the surgery center where MUA cases are performed. 70% of patients interviewed after MUA procedures reported that they were “very satisfied” with the improvement that they obtained from the procedure. This recent MUA study confirms the findings of other researchers that reported similar results.

5) A Retrospective Consecutive Case Analyses Of Pretreatment And Comparative Static Radiological Parameters Following Chiropractic Adjustments, 12.1990, JMPT (Full Article)

Following an average of eight chiropractic (Gonstead-type) adjustments to the low back vertebra that showed retrolisthesis (posteriority) on a weight-bearing lateral radiograph, a reduction of the retrolisthesis of approximately 1/3 was seen. This may explain one mechanism of how these adjustments often improve low back and leg pain.


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