Chiropractic Journal of Australia

A COMMENTARY ON THE 2019 SAFER CARE VICTORIA REVIEW

Genevieve Keating — 2023-02-13

In 2019, Safer Care Victoria (SCV) conducted a government-funded inquiry into the practice of spinal manipulation (SMT) of children under 12 years of age by chiropractors. SCV assembled an advisory panel, commissioned a Cochrane Collaboration Review, and invited submissions from consumers, health practitioners, insurers, education institutions, professional organizations, and interested stakeholders.
The report's principal findings were that while spinal manipulation of children results in very rare instances of harm, since evidence of the effectiveness of SMT is lacking, SMT cannot be recommended for children under 12 for a list of conditions or for general wellness.

IMPACT OF A SINGLE CERVICAL SPINAL MANIPULATION ON A HEALTHY POPULATION AS ASSESSED BY STATIC AND DYNAMIC BALANCE AND DUAL TASK PERFORMANCE

Shannan Behrens — 2023-05-22

Objective: The purpose of this study was to assess the feasibility of implementing a protocol evaluating the impact of chiropractic spinal manipulation on both static (one leg stance test) and dynamic (limits of stability test) balance assessments during regular and dual task (counting backwards by threes) conditions.
Methods: Thirty healthy participants were randomized into either a cervical spinal manipulation (n=15) or sham group (n=15). Participants completed balance assessments at pre, immediate post, and at a one-week follow-up. A survey assessing their experience was also administered at the one-week follow-up.
Results: All participants were compliant with protocols, including returning for the follow-up session. Group blinding and the sham procedure were not successful. Data for the balance assessments showed mixed changes in both groups, with some notable improvements in limits of stability variables following a single chiropractic cervical manipulation.
Conclusion: Further investigation into the impact of chiropractic spinal manipulation on both static and dynamic balance assessments during regular and dual task conditions appears feasible.

LESSONS LEARNED: HEART RATE VARIABILITY DEVICES AND STUDY PROCEDURES

Krista Ward — 2023-08-29

Abstract
Objective: This study aimed to compare heart rate variability metrics derived from four devices available at our Doctor of Chiropractic program educational institution.

Methods: Student and staff were recruited as study participants through campus electronic newsletters, flyers and in-course announcements. Eligibility requirements included non-smokers between the ages of 18-70 years with no known hypertension, chronic heart, or respiratory condition. Two electrocardiography and two photoplethysmography devices were used for data collection. Heart rate variability metrics derived from these devices included three time-domain and three frequency domain measures.

Results: Fifteen people responded to study recruitment efforts and met the eligibility requirements. However, data collection was only possible for three participants due to study interruption by the Covid-19 pandemic sheltering-in-place order. There was poor agreement for HRV metrics between the different devices. Variability was also noted within the same device/software system when two different investigators exported the Inter-Beat-Interval data and used different levels of artifact correction for the same volunteer participant.

Conclusion: This feasibility study identified several technical difficulties that can compromise heart rate variability measurements which should be considered for future research and by practitioners interested in the potential application of HRV within clinical and behavioral practice.

IT IS TIME TO UPDATE AUSTRALIAN CLINICAL CARE STANDARDS AND PRACTICE RECOMMENDATIONS FOR MANAGEMENT OF SPINAL PAIN: A COMMENTARY

Lyndon Amorin-Woods — 2023-08-31

The current Australian guidelines and standards for the management of spinal pain (low back and neck) need to be updated to reflect best available evidence and protect the public.

Opioids have been demonstrated to be clinically ineffective in the treatment of acute back and neck pain and have the potential to cause serious harm or even death. Despite this, current Australian guidelines still recommend their use. A recent randomised controlled trial that ran over six years (The OPAL study) found that opioids are less effective than placebo, with patients in the placebo group reporting significantly lower pain scores compared to the opioid group after one year. Additionally, the study revealed a higher risk of misuse among individuals who received opioids in the trial.

This paper argues for urgent action to update Australian standards and guidelines to explicitly prioritise non-pharmacological management of acute and chronic spinal pain, thus aligning with international guidelines and standards. The implications for chiropractors are discussed, emphasising their role in providing drug-free approaches to spinal pain management.

CORE STABILIZATION EXERCISES FOR MANAGING NON-SPECIFIC LOW BACK PAIN IN ADULTS

Joseph Comerford — 2023-03-08

Background: Non-specific low back pain affects people of all ages and is a leading contributor to disease burden worldwide. Estimates from the Australian Bureau of Statistics 2017–18 National Health estimate about 4.0 million Australians have back problems. The management of NSLBP has proven very challenging, as evidenced by its mounting socioeconomic burden. Core stability treatment procedures aim to improve pain and disability by increasing spinal stability in the lumbar spine. The purpose of this review is to examine the effect enhancing core stability through targeted core stabilisation exercises has on reducing the symptoms of NSLBP in combination with or independent of general exercise programs and/or conservative treatments.

Methods: A structured search of relevant articles was performed using the PubMed, Elsevier, and Cochrane databases. The search provided a total of 608 articles. Twenty-two articles met the inclusion criteria, and 586 articles were excluded.

Results: Core stability provides excellent therapeutic effects in NSLBP patients by reducing pain intensity and functional disability. Evidence suggests that core stability is more effective than rest or no/minimal intervention and, when used in combination with other types of exercise for NSLBP, can have even greater efficacy.

Conclusion: Core stability exercises should be used as part of a comprehensive treatment approach for non-specific low back pain (NSLBP), combined with other modalities such as therapeutic exercise and allied health conservative treatment plans. When used in conjunction with other modalities in a multidisciplinary approach, these treatments have demonstrated significant improvements in both pain levels and functional status, as compared to a placebo.