Author: Superadmin

Chiropractors comprise an essential part of the American healthcare system. With more than 70,000 practitioners, chiropractors¹ form the third largest primary healthcare profession and the largest non-allopathic healthcare profession.² Chiropractors practice an integrative system of medicine that incorporates the diagnosis and manipulation of misaligned joints, particularly in the spine, which often negatively affect the rest of the body.³ Traditionally, this involves performing adjustments – specific, controlled forces applied to misaligned joints – to restore proper function and mobility.  

Chiropractic, however, adopts a holistic lens to treat musculoskeletal concerns. As primary care providers, chiropractors participate in the diagnosis, treatment, and prevention of general health issues too, particularly as they relate to musculoskeletal disorders.⁴ Therefore, chiropractors also perform soft-tissue therapies, provide lifestyle advice, prescribe exercise regimens, and nutritionally counsel their patients.³  

Nutrition, specifically, serves as a cornerstone of general health and preventative medicine. As holistic health professionals, chiropractors hold a unique position to implement nutritional changes.⁵ Further, chiropractors treat various conditions and disorders that often benefit from dietary recommendations.¹ For example, substantial research suggests that certain dietary changes may reduce systemic inflammation. These diets, therefore, may alleviate pain in inflammatory conditions like rheumatoid arthritis, osteoarthritis, and scoliosis, all of which chiropractors often treat.⁷ Similarly, research suggests that tryptophan and vitamin C deficiencies are correlated with the development of scoliosis, and that vitamin B₆ may aid in scoliosis prevention.^8–10   

In 2009, the National Board of Chiropractic Examiners reported that approximately 94% of chiropractors in the United States provide nutritional or dietary services for their patients.¹¹ Similarly, in a 2001 study, most chiropractors incorporated nutrition counseling into their practice; yet only half of this sample felt they received adequate nutrition education from their chiropractic college.² Chiropractors appear split on this issue – 44% and 42% of this 2001 sample disagreed and agreed with, respectively, the following statement: “Chiropractors are able to address all nutritional concerns and do not require the service of a dietitian or nutritional specialist.”² Unsurprisingly, the average chiropractor in this same sample received eighty-four hours of postgraduate nutrition instruction to supplement their initial education.² 65% of chiropractors in a 2007 study also felt their chiropractic education did not prepare them adequately to counsel their patients on nutrition in-depth.⁵ Most chiropractic colleges offer two nutrition courses – give or take – in their core curricula.^12,2  

Practitioners use various methods to assess their patients’ nutritional wellbeing. At the initial patient examination, a 2018 study reported that chiropractors frequently appraised patients’ nutritional wellbeing through questions about medications, nutritional supplements, smoking, alcohol, self-perception of health, and physical appearance.⁶ Chiropractors used dietary assessment, waist-to-hip ratio, and laboratory measures less frequently to evaluate nutritional wellbeing.⁶ Research suggests that chiropractors most often provide nutritional guidance via the prescription of vitamins or nutritional supplements to their patients.^2,5,6,15 Chiropractors also typically discuss healthy nutrition choices, offer recipe suggestions, and recommend sources of nutrition information.⁶ These resources include general health books and magazines, nutrition brochures, practice newsletters, and scientific or professional journals and newsletters.⁶  

Time and education constraints likely contribute to the type of nutritional guidance chiropractors offer. Many chiropractors wish for more nutrition education during their chiropractic college and postgraduate education.⁵ Furthermore, busy practices also lend themselves to nutritional guidance that requires less time per patient, such as the dissemination of nutritional information and supplements.⁵ In addition, the reimbursement policies of health insurance and managed care plans potentially affect the time that chiropractors devote to nutrition counseling.¹¹ 

References

1. Key Facts. American Chiropractic Association https://www.acatoday.org/News-Publications/Newsroom/Key-Facts. 
2. Smith, D. L. & Spillman, D. M. A survey of chiropractors’ use of nutrition in private practice. J. Chiropr. Humanit. 10, 93–98 (2001). 
3. What is Chiropractic? https://www.palmer.edu/about-us/what-is-chiropractic/. 
4. Goncalves, G., Le Scanff, C. & Leboeuf-Yde, C. Primary prevention in chiropractic practice: a systematic review. Chiropr. Man. Ther. 25, (2017). 
5. Holtzman, D. & Burke, J. Nutritional counseling in the chiropractic practice: a survey of New York practitioners. J. Chiropr. Med. 6, 27–31 (2007). 
6. Lee, M. K., Amorin-Woods, L., Cascioli, V. & Adams, J. The use of nutritional guidance within chiropractic patient management: a survey of 333 chiropractors from the ACORN practice-based research network. Chiropr. Man. Ther. 26, (2018). 
7. Seaman, D. R. The diet-induced proinflammatory state: a cause of chronic pain and other degenerative diseases? J. Manipulative Physiol. Ther. 25, 168–179 (2002). 
8. Silverstone, A. M. & Hammell, L. Spinal deformities in farmed Atlantic salmon. Can. Vet. J. 43, 782–784 (2002). 
9. Worthington, V. & Shambaugh, P. Nutrition as an environmental factor in the etiology of idiopathic scoliosis. J. Manipulative Physiol. Ther. 16, 169–173 (1993). 
10. Pompeiano, O., Manzoni, D. & Miele, F. Pineal gland hormone and idiopathic scoliosis: possible effect of melatonin on sleep-related postural mechanisms. Arch. Ital. Biol. 140, 129–158 (2002). 
11. Christensen, M., Kollasch, M. & Hyland, J. Chapter 9: Professional Functions and Treatment Procedures. in Practice Analysis of Chiropractic 2010 (National Board of Chiropractic Examiners, 2009). 
12. Christensen, M. G. et al. Job analysis of chiropractic. 18 (2005). 
13. Chiropractic Curriculum Organization and Design for Life University. Life University. A World Leader in Holistic Health and Chiropractic Education. https://www.life.edu/academic-pages/chiropractic-program/chiropractic-curriculum/. 
14. Doctor of Chiropractic degree program course curriculum. Parker University. https://www.parker.edu/doctor-of-chiropractic-curriculum/. 
15. Stuber, K., Bruno, P., Kristmanson, K. & Ali, Z. Dietary supplement recommendations by Saskatchewan chiropractors: results of an online survey. Chiropr. Man. Ther. 21, 11 (2013). 

High velocity, low-amplitude (HVLA) spinal mobilization is one of the most popular chiropractic methods for addressing both lower and middle back pain. An evidence report compiled in 2010 by Bronfot et al. noted that spinal mobilization was also effective in adults for migraine, cervicogenic dizziness, and neck pain.^[1]There are three schools of technique of HVLA spinal mobilization, as described below:

1. Diversified technique: The most common of the three HVLA methodologies, a diversified technique is generally used to restore full range of motion to restricted joints. One short, high-velocity thrust is applied to the joint of interest to create an unlocking effect. Multiple adjustments can be made in a single appointment if more than one joint is restricted. Manipulation of patient body positioning may be necessary to allow for the ideal angle and leverage for diversified HVLA. 
2. Palmer-Gonstead adjustment: The Palmer-Gonstead adjustment is similar to the diversified technique in both duration and magnitude of force, but places greater emphasis on isolating an exact spinal location for ideal joint adjustment. Location can be determined through palpation (both with motion and static), visualization, instrumentation, and X-ray analysis. A wide variety of specially-designed tables, chairs, and other equipment are employed to alter body configuration and create optimal angles for spinal adjustment. 
3. Drop technique: Also known as the Thompson Terminal Point technique, the drop technique focuses specifically on facilitating the movement of the restricted joint during HVLA mobilization. Patients are placed on specialized tables that have the ability to drop a short distance during the physician’s or chiropractor’s thrust. Occasionally, the drop of the table along is sufficient to free the restricted joint. The drop technique is often used as a complement to the diversified technique.

Little research has been done to compare the relative efficacy of these techniques to each other; however, preliminary findings suggest they may perform similarly.^[2] Regardless, it has been found that overall, successful HVLA spinal mobilization results in significantly superior patient outcomes as compared to placebos,^[3] and should be considered a useful method for treating a variety of back-related issues.

References

^[1] Bronfort G, Haas M, Evans R, Leininger B, Triano J. Effectiveness of manual therapies: the UK evidence report. Chiropr Osteopat. 2010 Feb 25;18:3. doi:10.1186/1746-1340-18-3. PMID: 20184717; PMCID: PMC2841070.

^[2] Cao DY, Reed WR, Long CR, Kawchuk GN, Pickar JG. Effects of thrust amplitude and duration of high-velocity, low-amplitude spinal manipulation on lumbar muscle spindle responses to vertebral position and movement. J Manipulative Physiol Ther. 2013;36(2):68-77. doi:10.1016/j.jmpt.2013.01.004.

^[3] von Heymann WJ, Schloemer P, Timm J, Muehlbauer B. Spinal high-velocity low amplitude manipulation in acute nonspecific low back pain: a double-blinded randomized controlled trial in comparison with diclofenac and placebo. Spine (Phila Pa 1976). 2013 Apr 1;38(7):540-8. doi:10.1097/BRS.0b013e318275d09c. PMID: 23026869.

Low back pain is one of the most prevalent chronic conditions world-wide, affecting adults as young as 18, and worsens with age [4]. Typical interventions for alleviating low back pain involve adjustments in life-style factors such as workload, social support, and physical therapy, with very rare cases requiring admission to an emergency room [2]. However, severe back pain can also be a symptom of a lesser known or misdiagnosed condition [3][4]. For instance, Cauda Equina Syndrome (CES) is a rare condition that typically requires immediate surgical treatment in order to avoid serious excretory complications (incontinence) and permanent nerve damage [5][7]. 

The cauda equina, Latin for “horse’s tail”, is a bundle of spinal nerve roots originating near the distal end of the spinal cord that send and receive nerve impulses to pelvic organs and lower limbs [3][4][7]. Damage to the cauda equina can result in sudden and severe symptoms that disrupt motor and sensory functions of the lower extremities, bladder and bowels [3][5]. Typically, this damage arises from compression and inflammation of the nerve roots, caused by a herniated disc in the lumbar region [3][7]. Common causes of a lumbar disc herniation include excessive pressure from loading or strain from sudden twisting movements [6]. Other causes include but are not limited to spinal infections and inflammation, lumbar spine trauma, spinal lesions and tumors, lumbar spinal stenosis, and spinal hemorrhages [5][7]. 

The severity of symptoms varies depending on the degree of compression and number of nerves injured [5][6]. For some patients, the onset of cauda equina symptoms can develop within 24 hours (acute onset) or over weeks and months (gradual onset) [5]. Typical symptomatic indicators of CES include severe low back pain, weakness, tingling, or sharp, hot pain in one or both legs and/or “saddle region” (groin, buttocks, genitals, upper thighs), recent onset of bladder and bowel dysfunction and/or incontinence, and loss of reflexes in the lower extremities [3-7]. Patients are typically classified into two categories: CES-R (urinary retention) and CES-I (an incomplete syndrome) [4]. In addition to a diagnostic screening with an MRI, Gardner et al. suggests implementation of a trigone sensitivity test in order to discern “genuine” neurological deficits of bladder retention [4].

As mentioned above, CES usually requires immediate hospitalization and prompt decompression surgery in order to reduce the symptoms of neurological dysfunction and avoid incontinence and permanent paralysis [3][4]. As with most neurological conditions, the sooner the diagnosis and subsequent treatment, the better the chance of recovery with minimal lasting neurological damage [1][4][5]. Ideally, CES is treated early within 24 to 48 hours for the best chance of complete sensory recovery [1][4]. However, surgery does not necessarily eradicate the possibility of irreversible outcomes [6]. It is important to note that the rarity and variability of CES contributes to misdiagnosis and delay of treatment, contributing to its “prominent position in the medico-legal field” [4]. While attention of CES has increased in the medical field, it is crucial for patients and doctors to be informed and aware of this rare syndrome.

References

1. Bečulić, H., Skomorac, R., Jusić, A., Alić, F., Imamović, M., Mekić-Abazović, A., Efendić, A., Brkić, H., & Denjalić, A. (2016). Impact of timing on surgical outcome in patients with cauda equina syndrome caused by lumbar disc herniation. Medicinski Glasnik : official publication of the Medical Association of Zenica-Doboj Canton, Bosnia and Herzegovina, 13(2), 136–141. https://doi.org/10.17392/861-16

2. Buruck, G., Tomaschek, A., Wendsche, J., Ochsmann, E., & Dörfel, D. (2019). Psychosocial areas of work life and chronic low back pain: a systematic review and meta-analysis. BMC musculoskeletal disorders, 20(1), 480. https://doi.org/10.1186/s12891-019-2826-3

3. Cauda Equina Syndrome. American Association of Neurological Surgeons.https://www.aans.org/en/Patients/Neurosurgical-Conditions-and-Treatments/Cauda-Equina-Syndrome

4. Gardner, A., Gardner, E., & Morley, T. (2011). Cauda equina syndrome: a review of the current clinical and medico-legal position. European Spine Journal: official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 20(5), 690–697. https://doi.org/10.1007/s00586-010-1668-3

5. Hoy, D., Bain, C., Williams, G., March, L., Brooks, P., Blyth, F., Woolf, A., Vos, T., & Buchbinder, R. (2012). A systematic review of the global prevalence of low back pain. Arthritis and Rheumatism, 64(6), 2028–2037. https://doi.org/10.1002/art.34347

6. Kapetanakis, S., Chaniotakis, C., Kazakos, C., & Papathanasiou, J. V. (2017). Cauda Equina Syndrome Due to Lumbar Disc Herniation: a Review of Literature. Folia Medica, 59(4), 377–386. https://doi.org/10.1515/folmed-2017-0038

7. Villavicencio, A. Cauda Equina Syndrome (2016). Cauda Equina Syndrome. Spine-Health. https://www.spine-health.com/conditions/lower-back-pain/cauda-equina-syndrome

Osteoarthritis (OA) is the most common form of arthritis and the most common joint disorder in the United States, affecting approximately 1 in 7 adults [1]. OA is a disease that is caused and worsened by the continual inflammation of joint cartilage along with the surrounding bone and synovium [2] [3]. OA is caused primarily by joint injury and overuse, as these occurrences trigger the production of inflammatory mediators—such as cytokines and chemokines—in the synovium and chondrocytes (cartilage cells). During later stages of OA, cartilage fragments can fall into the synovium, exacerbating the process. Those who are older, obese, and work more physically demanding jobs are more likely to develop OA, as these factors all increase the use of or stress on joints. OA also disproportionately affects women; of those over the age of 60, women are almost twice as likely to develop the condition (18.0% of women over 60 versus 9.6% of men) [4]. OA can develop in any joint, but most commonly occurs in the knees, hips, hands, and spine.

Common symptoms of OA include joint pain, stiffness, swelling, decreased range of motion, and fatigue. This often results in intense discomfort during use, and can inhibit function of the joint, leading to an inability to walk if OA is present in the hip, knee, or foot. However, an individual’s level of pain or discomfort does not translate to the structural deterioration of the joint—thus, OA is often difficult to diagnose symptomatically, especially when pain is less present in its early stages [5]. OA has no cure; its end-stage involves the irreversible damage of joint cartilage, necessitating surgical joint replacement. As such, early diagnosis of OA—through an analysis of symptoms and X-ray or MRI screenings—is imperative for preventive treatment [6]. The presence of developing osteophytes (bone outgrowths), along with narrowing of joint space and deformity are indications of OA. 

Management of OA is largely dependent on the patient and severity. Mild OA can be managed through simple exercises that do not stress the joints, such as aerobics and light muscle-strengthening exercises [1] [7] [8]. Patients with obesity are often given weight loss suggestions, and almost all patients are suggested to attend self-management education courses, which are designed to instruct patients to adopt practices to mitigate daily pain and discomfort. These practices range from identifying unhealthy exercise habits to stress management techniques to improving sleep schedules and diet. Most of all, these courses aim to support patients with the emotional toll of OA, as deteriorating joint function often leads to frustration and depression [1] [4]. Simple analgesics assist patients with day-to-day activities and if needed, topical or oral NSAIDs (non-steroidal anti-inflammatory drugs) can also be prescribed [9]. Physiotherapy is also often recommended. In severe cases, supportive devices like crutches and canes or intra-articular corticosteroid injections may become necessary for function and, as previously stated, end-stage OA requires joint replacement. Although not empirically proven, alternative medicine methods—like acupuncture—have also been reported to improve OA symptoms. 

Hence, it is vital that those who are high-risk of developing OA consult medical professionals in a timely manner to catch symptoms before the OA develops and causes irreversible damage. Individuals who attribute mild joint pain or stiffness solely to the aging process may mistakenly overlook a developing case of OA. When diagnosed early, OA can be alleviated through proper self-management and exercise practices, leading to a superior quality of life. 

References

1. Centers for Disease Control and Prevention (CDC). (2020). A National Public Health Agenda for Osteoarthritis: 2020 Update. https://www.cdc.gov/arthritis/docs/oaagenda2020.pdf
2. Berenbaum, F. (2013). Osteoarthritis as an inflammatory disease (osteoarthritis is not osteoarthrosis!). Osteoarthritis and cartilage, 21(1), 16-21.
3. Goldring, M. B., & Otero, M. (2011). Inflammation in osteoarthritis. Current opinion in rheumatology, 23(5), 471.
4. Arthritis Foundation. (2019). Arthritis by the Numbers: Book of Trusted Facts & Figures.https://www.arthritis.org/getmedia/e1256607-fa87-4593-aa8a-8db4f291072a/2019-abtn-final-march-2019.pdf
5. Glyn-Jones, S., Palmer, A. J. R., Agricola, R., Price, A. J., Vincent, T. L., Weinans, H., & Carr, A. J. (2015). Osteoarthritis. The Lancet, 386(9991), 376-387.
6. Zhang, Y., & Jordan, J. M. (2010). Epidemiology of osteoarthritis. Clinics in geriatric medicine, 26(3), 355-369.
7. Fransen, M., McConnell, S., Harmer, A. R., Van der Esch, M., Simic, M., & Bennell, K. L. (2015). Exercise for osteoarthritis of the knee. Cochrane database of systematic reviews, (1).
8. Fransen, M., McConnell, S., Hernandez‐Molina, G., & Reichenbach, S. (2014). Exercise for osteoarthritis of the hip. Cochrane Database of Systematic Reviews, (4).
9. Dieppe, P. A., & Lohmander, L. S. (2005). Pathogenesis and management of pain in osteoarthritis. The Lancet, 365(9463), 965-973.

Chiropractic has a long history of serving the public by healing people through the use of natural methods.⁶ Founded by David Daniel Palmer in September 1985, chiropractic has become one of the most commonly used complementary and alternative medicine therapies in the world.² Currently, chiropractors practice in over 100 countries, in which 90 have established national chiropractic associations.² Worldwide, billions are spent each year for their services.¹ In the United States alone, there are over 60,000 licensed chiropractors, making chiropractic a major stakeholder in the healthcare expenditures of the nation.² Knowing the foundations of chiropractic will assist in the understanding of this growing profession. 

Originating from an ancient Greek phrase meaning “done by hand,” chiropractic was viewed by Palmer as an integration of science, art, and philosophy.³ Early chiropractic displayed many aspects of a religion, declaring that there existed an “innate intelligence” that enabled the body to heal itself.¹ The “innate” regulated all body functions, but was hindered by “vertebral subluxations.”^1,5 People were well when the “innate” had unobstructed freedom to act throughout the body.⁵ Diseases were caused by a lack of normal transmission of the “innate.”⁵ The role of chiropractors was to correct subluxations through manual adjustments of the spine and, therefore, restore the flow of the “innate.”^1,5 Early chiropractic was advertised as a cure for many ailments like insanity, sexual dysfunction, measles, and influenza.¹ Chiropractic soon became known as “a science of healing without drugs.”¹ 

Today, chiropractic is defined by the World Health Organization as a health care profession concerned with the diagnosis, treatment, and prevention of disorders of the neuromusculoskeletal system, with an emphasis on manual corrections of misalignments of the vertebrae.⁴ Modern chiropractic philosophy views health as an expression of biological, psychological, social, and spiritual factors.⁷ At the very center of chiropractic is the belief that the body is self-regulating and capable of healing itself.⁶ This perspective represents a holistic biopsychosocial philosophy of health, in contrast to the biomedical one typically shared by medical doctors.⁷ Chiropractic embraces three main principles.¹ First, there is a symbiotic relationship between the spine and health.¹ Second, subluxations negatively affect health.¹ Third, correction of subluxations by spinal manipulation improves health.¹ 

Chiropractors address patients’ health and wellness by using conservative and natural methods, as opposed to prescription drugs and surgery.⁶ They are mainly focused on the relationship between structure, primarily the spine and musculoskeletal system, and function, as directed by the nervous system.⁷ Chiropractors propose that neurological disturbances in the spine and other areas can cause dysfunction to appear in remote organs and tissues.⁶ Since the nervous system has an influence on all bodily functions, chiropractors argue that corrections of dysfunctional areas of the spine and other parts of the body improves health.⁶ They utilize chiropractic manipulations, also known as adjustments, to bring relief to patients most commonly suffering from back and neck pain, headache, sports injuries, and neuromusculoskeletal disorders.⁶ Chiropractic manipulations involve applying specific and controlled movements to various joints in the body to help restore normal structure and function.⁶ In addition to providing adjustments to patients, chiropractors may also provide patients with rehabilitation exercises and counsel patients on healthy lifestyle and nutritional habits.⁷ 

It is important for healthcare professionals to understand the fundamentals of chiropractic. Patient visit to chiropractors are becoming increasingly popular, accounting for 30% of all visits made to complementary and alternative practitioners.⁶ As the percentage of patients receiving chiropractic care each year continues to grow, healthcare professionals should be knowledgeable about the profession and be prepared to answer questions patients may have.⁶ 

References 

1. Ernst, Edzard. 2008. “Chiropractic: A Critical Evaluation”. Journal of Pain and Symptom Management 35 (5): 544-562. doi:10.1016/j.jpainsymman.2007.07.004. 

2. Beliveau, Peter J. H., Jessica J. Wong, Deborah A. Sutton, Nir Ben Simon, André E. Bussières, Silvano A. Mior, and Simon D. French. 2017. “The Chiropractic Profession: A Scoping Review of Utilization Rates, Reasons for Seeking Care, Patient Profiles, And Care Provided”. Chiropractic & Manual Therapies 25 (1). doi:10.1186/s12998-017-0165-8. 

3. Senzon, Simon. 2018. “An Integral Approach to Unifying the Philosophy of Chiropractic”. Journal of Conscious Evolution 2 (2). 

4. Glucina, Tanja T., Christian U. Krägeloh, Panteá Farvid, and Kelly Holt. 2020. “Moving Towards A Contemporary Chiropractic Professional Identity”. Complementary Therapies in Clinical Practice 39: 101105. doi:10.1016/j.ctcp.2020.101105. 

5. Palmer, B. J. 1920. The Science of Chiropractic. Davenport, Iowa: Palmer School of Chiropractic. 

6. Hawk, Cheryl. 2017. The Praeger Handbook of Chiropractic Health Care. Santa Barbara: ABC-CLIO, LLC. 

7. Hawk, Cheryl, and John Weeks. 2017. Careers in Chiropractic Health Care: Exploring A Growing Field. Santa Barbara: ABC-CLIO, LLC. 

When athletes experience an anterior cruciate ligament (ACL) injury, physical activity becomes highly restricted1. Following an ACL surgery, there are many factors that medical professionals have to consider when allowing athletes or other patients with ACL injuries to begin resuming physical activity1. If incorrect recommendations are made for resuming full activity, the patient can experience additional injuries by adding pressure to the injured ACL, which can be even more dangerous1. As such, figuring out when a patient can resume full activity after an ACL surgery is an incredibly difficult task for many medical professionals.

Zaffagnini et al. (2015) outlines the various intrinsic and extrinsic factors that physicians often consider when making the decision to allow patients to return to a full range of physical activity1. The intrinsic factors include genetics, which is how a patient biologically responds to an ACL surgery, as well as the type of ACL injury and the patient’s motivation or psychological attitude towards resuming full activity1. The extrinsic factors are often the ones that the physician is able to better control. These factors include the technique used during an ACL reconstruction surgery, the type of graft used, and the rehabilitation support that is provided1. Clearly, there are several variables involved in a physician’s decision to allow a patient to resume full activity after an ACL surgery. This creates a challenge for the medical professional as there is no one solution that can be applied to all patients.

To see these factors in play, McCullough et al. (2014) carried out a retrospective cohort study with football players that had experienced an ACL injury2. Looking at both high school and collegiate players, the researchers found that approximately 50% of students did not return to resuming full activity of their sport after their injury2. Some of the factors that influenced players’ ability to resume full activity include the aforementioned extrinsic factors such as the type of graft; however, it seems that a majority of the decision to resume full activity relied on the intrinsic factors2. Interestingly, psychological attitude and motivation were two factors that played a large role, but literature on this matter and how these factors can be used to increase the percentage of players resuming full activity is quite scant2.

Ardern et al. (2014) is just one of the small handful of studies that investigates how psychological factors can influence a player’s return to full activity following an ACL injury3. Using a cross-sectional study design, the researchers looked at factors such as self-efficacy, psychological readiness, and fear of reinjury to assess how a patient’s psychological attitude might have influenced their recovery3. The results revealed that athletes who had completely resumed full activity after surgery were those who

initially had more positive attitudes indicating higher psychological readiness3. For players who had not resumed full activity, the researchers found that players often had a fear of reinjury or a lack of trust in their own body’s abilities3. Ardern et al. (2014) provides rather interesting insights as information on the effect of psychological factors can help physicians then create better interventions and programs for patients to resume full activity.

These studies are critical as a medical professional’s decision to allow their patient to resume full activity after an ACL surgery relies on a large variety of variables. More research similar to Ardern et al. (2014) exploring different factors in greater detail are needed in order for physicians to develop more successful rehabilitation plans for their patients.

References:

(1) Zaffagnini S, Grassi A, Serra M, Marcacci M. Return to sport after ACL reconstruction: how, when and why? A narrative review of current evidence. Joints. 2015;3(1):25‐30. Published 2015 Jun 8.

(2) McCullough KA, Phelps KD, Spindler KP, et al. Return to high school- and college-level football after anterior cruciate ligament reconstruction: a Multicenter Orthopaedic Outcomes Network (MOON) cohort study. Am J Sports Med. 2012;40(11):2523‐2529. doi:10.1177/0363546512456836

(3) Ardern CL, Österberg A, Tagesson S, Gauffin H, Webster KE, Kvist J. The impact of psychological readiness to return to sport and recreational activities after anterior cruciate ligament reconstruction. Br J Sports Med. 2014;48(22):1613‐1619. doi:10.1136/bjsports-2014-093842

Fibromyalgia syndrome (FMS) refers to a chronic condition causing pain, tenderness, and stiffness in the muscles, joints, and tendons. This pain is typically widespread, affecting the neck, buttocks, shoulders, arms, upper back, and chest on both sides of the body. Patients also report having “tender points”, which refer to localized areas of the body that cause widespread pain and muscle spasms when touched.¹ FMS is also characterized by restlessness, tiredness, fatigue, anxiety, depression, and impaired bowel function.² Despite experiencing severe pain, patients do not develop tissue damage or deformities because there is no inflammation associated with FMS, which makes it difficult to elucidate the mechanisms of this condition.³ FMS commonly arises in young and middle-aged females in the form of persistent pain, fatigue, stiffness, cognitive difficulties, anxiety, depression, and functional impairment. Furthermore, the prevalence in the United States is 6% to 15%, with women being five times as likely as men to develop FMS.⁴

While the mechanistic underpinnings remain unclear, there is a characteristic pathophysiology associated with FMS. Namely, patients commonly experience changes in their sleep patterns and neuroendocrine transmitters – such as serotonin, substance P, growth hormone, and cortisol – which indicates that regulation of the autonomic and neuroendocrine systems serves as the biological basis of the condition.⁵ Although FMS is not life-threatening, it is characterized by debilitating, chronic pain that may result from a variety of interconnected mechanisms. More specifically, patients with FMS may experience aberrant pain processing due to central sensitization; this refers to the blunting of inhibitory pain pathways and associated changes in neurotransmitter levels. Due to aberrant neurochemical processing of sensory signals, the threshold of pain is significantly lowered in patients with FMS.⁶ Therefore, many of the symptoms associated with FMS may be explained by alterations in the autonomic, neuroendocrine, and pain processing systems.

Management of FMS is often patient-centered and can involve a variety of therapeutic approaches. Pain medications used to treat FMS include paracetamol, nonsteroidal anti-inflammatory drugs (NSAIDs), and acetaminophen. In addition to analgesics, other drugs such as antidepressants, anticonvulsants, dopamine agonists, and growth hormones, can be useful in the management of FMS.⁷ A combination of tricyclic antidepressants and selective serotonin reuptake inhibitors (SSRIs) can produce mild to moderate improvement in symptoms of FMS. In addition, duloxetine, a serotonin and norepinephrine reuptake inhibitor, has shown promise in patients with FMS.

Lifestyle modifications are a powerful method to alleviate the symptoms of FMS. For example, patients can practice stress management to avoid increased levels of stress and feelings of depression, anxiety, and frustration. Cognitive behavioral therapy, relaxation training, group therapy, and biofeedback are all effective treatment options that can help patients reduce their stress levels.⁸ Exercise such as walking, jogging, or sports, is another lifestyle change that can help alleviate symptoms by further reducing stress. Additionally, there are several alternative therapies for FMS, such as Chinese herbal medications, Chinese herbal tea, acupuncture, and Tai-chi.⁸

In summary, FMS is a common condition characterized by widespread pain and stiffness, sleep disturbances, anxiety, and depression, among other symptoms. Although there are many theories of etiology, the biological underpinnings of FMS are not fully understood. With the proper treatment from a skilled chiropractor who can assist in developing an effective exercise plan and implementing appropriate lifestyle changes, patients with FMS can alleviate pain and improve their quality of life.

References

1. Mease PJ, Clauw DJ, Arnold LM, Goldenberg DL, Witter J, Williams DA, et al. Fibromyalgia syndrome. J Rheumatol 2005. Nov;32(11):2270-2277.
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