Chiropractic Spinal Adjustments Have Positive Sleep Outcomes
By Mark Studin, DC, FPSC, FASBE(C), DAAPM
Seven hours of sleep is recommended by the American Academy of Sleep Medicine and the Sleep Research Society,[i] and over 25% of the population in the United States (85,000,000 people) does not meet these guidelines.[ii] Good sleep includes taking less time falling asleep and staying asleep.[iii] Considering a 30-day snapshot in 2020, the Centers for Disease Control (CDC), in a National Health Interview Survey, defined trouble falling asleep or staying asleep most days, and found that 14.5% of the population falls under that category.[iv]
In the same study, the CDC also found that the percentage of adults who had trouble falling asleep decreased with increasing age from 15.5% among adults ages 18-44 to 12.1% among those aged 65 and over. Women (17.1%) were more likely to have trouble falling asleep than men (11.7%). Non-Hispanic white adults (15.1%) were most affected by sleep issues, followed by non-Hispanic black adults (14.3%) and non-Hispanic Asian adults (8.1%). They also reported that difficulties falling asleep increased as places of residence became more rural, from 12.7% in large central metropolitan areas to 171% in non-metropolitan areas.
According to Stanford University “While there's no precise number for the exact number of people addicted to sleep drugs, it's estimated that nearly 5 million people over 12 misused prescription sedatives like Ambien in 2022, with approximately 144,000 beginning this misuse for the first time, according to the National Survey on Drug Use and Health. Additionally, about 2.4 million people had a prescription sedative use disorder or tranquilizer use disorder, according to the same survey. About 6% of the U.S. population (20,400,000 people) has abused sedative-hypnotics.”[v]
The problem with sleep drugs is that they create a negative interconnecting cycle that deepens the problem. According to Valentino and Volkow (2020), “The neurobiology of sleep and substance abuse interconnects, such that alterations in one process have consequences for the other. Acute exposure to drugs of abuse disrupts sleep by affecting sleep latency, duration, and quality. With chronic administration, sleep disruption becomes more severe, and during abstinence, insomnia with a negative effect prevails, which drives drug craving and contributes to impulsivity and relapse. Sleep impairments associated with drug abuse also contribute to cognitive dysfunction in addicted individuals. Further, because sleep is important in memory consolidation and the process of extinction, sleep dysfunction might interfere with the learning of non-reinforced drug associations needed for recovery. Notably, current medication therapies for opioid, alcohol, or nicotine addiction do not reverse sleep dysfunctions, and this may be an obstacle to recovery. Whereas exposure to drugs of abuse is causal to sleep dysfunctions that further promote chronic use, sleep disorders in turn are risk factors for substance abuse, and their severity can predict the prognosis of substance use disorders.[vi]
When studying the neurophysiology of a chiropractic spinal adjustment (CSA) and it’s relationship to sleep, mechanisms are critical. Therefore, one cannot be interchange a CSA with a physical therapy manipulation or mobilization, as the mechanism and neurobiochemical processes are different and render different results. The arbiter and ultimate test between the CSA and spinal manipulation is the central segmental motor control (CSMC) changes that occur as sequela to that treatment. The CSMC changes have been evidenced (a topic for another discussion) and are easily defined as central nervous system changes that affect the motor and other functions of the brain afferently. The core of the difference is where the thrust is directed. Haavik et al. (2021) reported, “It is possible to direct a thrust at any spinal segment, regardless of whether it is dysfunctional or not. Therefore, for the purposes of this review, if a thrust is directed at a spinal segment that has not been examined and identified as having clinical indicators of dysfunction, it will be referred to as spinal manipulation. In contrast, a thrust directed at a dysfunctional vertebral motion segment will be referred to as a spinal adjustment. This distinction is important, as adjustments are likely to have different physiological consequences compared to thrusting at or manipulating a vertebral segment that has no signs of motor control dysfunction.”[vii]
The key is determining the dysfunctional segments that make neuroplastic changes based on outcomes. In those dysfunctional segments, the high-velocity, low-amplitude thrust, or chiropractic spinal adjustment (CSA/HVLA) must be directed, or you will be manipulating and not realize the best outcomes. In determining outcomes, a CSA/HVLA thrust in deep abdominal muscular activation was 38.4% better than manipulation. Six months later, 19% of that additional muscular activation was retained. A CSA/HVLA thrust increased the H-Reflex and V-Wave (neurological feed to the central nervous system) by 16% without muscular fatigue. That control and manipulation group had no changes in amplitude, and the muscle fatigued much earlier. Maximum voluntary contractions of the jaw increased by 55% to 60% with CSA/HVLA thrusts only after one adjustment. Maximum voluntary contractions increased by 64.2% in chronic stroke survivors, with/HVLA only after one adjustment. A CSA/HVLA spinal adjustment increases motor evoked potentials by 54.5% in the upper limb and 44.6% in the lower limb muscles. A CSA/HVLA had a 16.76% change in the neurophysiological change in the 30N SEP (brain impulses). It changed brain functioning.[viii],[ix],[x], [xi]
Haavik et. al (2024) performed neurophysiological assessments post-chiropractic spinal adjustments, which revealed, based on Electroencephalogram (EEG) and Somatosensory Evoked Potentials (SEPs), that Theta, Alpha, and Beta bands in the brain increased significantly, while Delta bands significantly decreased. They found this persisted when retested after 4 weeks. The control groups showed no changes.[xii]
Physiologically, Theta, Alpha, and Beta bands, among other things, promote sleep and deep relaxation, while Delta brainwaves, the slowest and deepest, are crucial for restorative sleep because they are associated with deep, dreamless sleep and the release of growth hormones. As sleep progresses, delta waves become less dominant, and faster brain waves (like theta and alpha) become more prominent.This equates to sleep better.
Haavik also reported that it has long been known that a chiropractic spinal adjustment creates neuroplasticity (the brain's ability to change and adapt) in the primary somatosensory cortex, primary motor cortex, prefrontal cortex, and the cerebellum. All of these cortical regions directly affect the Default Mode Network, a system of interconnected brain areas that become more active when a person is not focused on external stimuli or engaged in a specific task, and is directly related to sleep.
Considering the side effects and negative neurological cascade of drugs used for sleeping by over 20,000,000 people in the United States, a chiropractic spinal adjustment can help many of those get to sleep and stay asleep.
[i] Consensus Conference Panel, Watson NF, Badr MS, Belenky G, Bliwise DL, Buxton OM, et al. Recommended amount of sleep for a healthy adult: A joint consensus statement of the American Academy of Sleep Medicine and Sleep Research Society. J Clin Sleep Med 11(6):591–2. 2015.
[ii] Adjaye-Gbewonyo D, Ng AE, Black LI. QuickStats: Percentage of adults aged ≥ 18 years who sleep < 7 hours on average in a 24-hour period, by sex and age group—National Health Interview Survey, United States, 2020. MMWR Morb Mortal Wkly Rep 71(10):393. 2022.
[iii] Ohayon M, Wickwire EM, Hirshkowitz M, Albert SM, Avidan A, Daly FJ, et al. National Sleep Foundation’s sleep quality recommendations: First report. Sleep Health 3(1):6–19. 2017.
[iv]Adjaye-Gbewonyo, Dzifa, Amanda E. Ng, and Lindsey I. Black. "Sleep difficulties in adults: United States, 2020." (2022).
[v] Waking up to sleeping pill risks (2020), Retrieved from: https://bewell.stanford.edu/waking-up-to-sleeping-pill-risks/
[vi]Valentino, Rita J., and Nora D. Volkow. "Drugs, sleep, and the addicted brain." Neuropsychopharmacology 45.1 (2020): 3-5.
[vii] Haavik, Heidi, et al. "The contemporary model of vertebral column joint dysfunction and impact of high-velocity, low-amplitude controlled vertebral thrusts on neuromuscular function." European Journal of Applied Physiology 121.10 (2021): 2675-2720.
[viii] Haavik-Taylor H, Murphy B (2007b) Transient modulation of intracortical inhibition following spinal manipulation. Chiropractic J Australia 37:106
[ix] Haavik H, Niazi I, Jochumsen M, Sherwin D, Flavel S, Turker K (2017)Impact of spinal manipulation on cortical drive to upper and lower limb muscles. Brain Sci 7:2
[x] Marshall P, Murphy B (2006) The effect of sacroiliac joint manipulation on feed-forward activation times of the deep abdominal musculature. J Manipulative Physiol Ther 29:196–202
[xi] Haavik, Heidi, et al. "The contemporary model of vertebral column joint dysfunction and impact of high-velocity, low-amplitude controlled vertebral thrusts on neuromuscular function." European Journal of Applied Physiology 121.10 (2021): 2675-2720.
[xii] Haavik, Heidi, et al. "Neuroplastic Responses to Chiropractic Care: Broad Impacts on Pain, Mood, Sleep, and Quality of Life." Brain Sciences 14.11 (2024): 1124.
Pharmacological Treatment of Low Back Pain Increased Overdose-Related Hospitalizations by 300% Compared to Chiropractic (Non-Pharmacological Treatment) circa 2025.
BY: Mark Studin, DC, FPSC, FASBE(C), DAAPM
Low back pain (LBP) is one of the most prevalent and disabling chronic conditions worldwide. It is estimated that upwards of 80% of adults experience low back pain at some point in their lives.[i] Furthermore, LBP incidents continue to rise worldwide, making it the leading cause of disability globally, and approximately 20% of acute cases become chronic, where these individuals bear a disproportional rate of LBP issues.[ii] Additionally, LBP sufferers are a prime reason for opioid use.[iii]
Treating low back pain is 1 area most chiropractors have in common globally. No matter the focus of a chiropractic practice, neck and low back pain, based on my independent research, is one of the most common maladies treated in chiropractic. When considering outcomes for LBP care paths, patient satisfaction, increased drug use, and overdose hospitalizations are prime areas of consideration.
Bronfort et. al. (2022) reported, “While the ‘biopsychosocial model’ for LBP has been promoted for decades, it is still incompletely and inadequately applied in research and clinical practice. Indeed, the majority of back pain cases remain poorly treated with a heavy emphasis on symptom management using a ‘one size fits all’ approach that fails to address sufferers’ unique needs. This has resulted in the persistent use of marginally effective and potentially harmful unimodal therapies (injections, drug therapies, etc.) with a primarily physical focus. Further, current back pain management practices often contradict clinical guideline recommendations by failing to offer treatment options with scientific support, including complementary approaches.”
Although LBP remains an epidemic worldwide,[iv] and the cost of managing back pain is increasing substantially[v], with consistently poor outcomes, medicine has dogmatically held onto the label of "non-specific low back pain." Non-specific low back pain is defined as low back pain not attributable to a recognizable, known specific pathology (e.g., infection, tumor, osteoporosis, fracture, structural deformity, an inflammatory disorder, radicular syndrome (discs), or cauda equina syndrome). It represents approximately 95% of all back pain and is persistently labeled non-specific because medicine cannot define a specific diagnosis.[vi]
Ntedan (2020), in a 4-year study and a cohort of 8,023,162, reported that 96% of chiropractic recipients were satisfied with their outcomes, including LBP and other spinal maladies.[vii] As medicine is highly trained in anatomical pathology, its education lacks chiropractic’s forte, training in diagnosing and treating spinal biomechanical pathology with non-pharmacologic care.
Despite the overwhelming evidence, the Mayo Clinic, one of the world's prominent medical institutions, lists chiropractic in the last section under "Alternative Medicine" and states it "might ease symptoms" after checking with their doctor [MD]. Chiropractic is listed last after physical therapy, drugs (including antidepressants and narcotics), surgery, implanted nerve stimulators, radiofrequency ablation (surgery), steroid injections, and most of all, doing nothing. [viii]
Physical therapy (PT) is still considered the “first-line treatment” for non-specific back pain, even with the evidence pointing otherwise. Farrokhi et. al (2023) reported that opioid use increased by 80% in 89.9% of cases with any combination of PT modalities was used for LBP. If only a PT manipulation was performed, there was no reduction in opioid use, and if any combination of PT therapy was performed, there was a 52% increase in opioid use.[ix] Conversely, Whedon et al (2018) reported that chiropractic care reduced opioid use by 55% in the general population, by 56% in the senior population, and decreased opioid costs by 74%.
The utilization of pharmacological (opioid and benzodiazepine (Gabapentinoids) management of LBP revealed that the incidence of drug-related overdose hospitalization was 200% less for both drug users and non-pharmacological treatment that included non-pharmacological treatments. For those using only non-pharmacological treatments, there was a 300% reduction in the incidence of drug-related overdose hospitalization.[x] This study “lumps together” chiropractic and physical therapy; however, based on the above studies, it has been found that physical therapy alone using mixed modalities increases opioid use in 89.9% of the patients, whereas chiropractic has been found to reduce opioid use by 55%.
Conclusion
A Google Scholar search for "low back pain" yields approximately 4.56 million results, showcasing a vast array of opinions and approaches on how to manage this widespread condition. Despite the overwhelming number of treatment options discussed, chiropractic care consistently emerges as one of the most effective first-line options in many of these studies. Yet, many healthcare providers cling to outdated and ineffective care models that rely heavily on pharmacological intervention.
This persistent reliance on failed treatment paths not only delays patient recovery but also contributes significantly to the rise in drug-related overdose hospitalizations and escalating healthcare costs. The core issue lies in attempting to solve a mechanical problem, such as spinal dysfunction or joint misalignment, with a pharmacological approach, which inherently cannot address the root cause of the pain. Medications may temporarily mask symptoms, but do not correct the underlying biomechanical issues.
Chiropractic care, by contrast, addresses the mechanical nature of low back pain directly and effectively. Research shows that it independently reduces drug-related overdose hospitalizations by an astonishing 300%, further supporting its role as a superior first-line treatment. This growing body of evidence makes a compelling case for rethinking our standard care pathways and placing chiropractic at the forefront of conservative, non-drug interventions for low back pain.
[i] Hoy D, Bain C, Williams G, March L, Brooks P, Blyth F, Woolf A, Vos T, Buchbinder R. A systematic review of the global prevalence of low back pain. Arthritis Rheum. 2012;64(6):2028–37.
[ii] Bronfort, G., Maiers, M., Schulz, C. et al. Multidisciplinary integrative care versus chiropractic care for low back pain: a rando clinical trial. Chiropr Man Therap 30, 10 (2022).
[iii] Moshfegh J, George SZ, Sun E. Risk and risk factors for chronic opioid use among opioid-naive patients with newly diagnosed musculoskeletal pain in the neck, shoulder, knee, or low back. Ann Intern Med. 2019;170(7):504–5.
[iv] Balagué, Federico, et al. "Non-specific low back pain." The Lancet 379.9814 (2012): 482-491
[v] Government Accountability Office. Medicare Part B imaging services: rapid spending growth and shift to physician offices indicate the need for CMA to consider additional management practices. Washington, DC: Government Accountability, 2008
[vi] Oliveira, Crystian B., et al. "Clinical practice guidelines for the management of non-specific low back pain in primary care: an updated overview." European Spine Journal 27.11 (2018): 2791-2803
[vii] Ndetan, H., et al. "Chiropractic Care for Spine Conditions: Analysis of National Health Interview Survey." Journal of Health Care and Research 2020.2 (2020): 105
[viii] Back Pain (2021)Mayo Clinic, retrieved from https://www.mayoclinic.org/diseases-conditions/back-pain/diagnosis-treatment/drc-20369911
[ix] Farrokhi, S., Bechard, L., Gorczynski, S., Patterson, C., Kakyomya, J., Hendershot, B.D., Condon, C.R., Perkins, L.M., Rhon, D.I., Delitto, A., and Schneider, M., 2023. The Influence of Active, Passive, and Manual Therapy Interventions for Low Back Pain on Opioid Prescription and Health Care Utilization. Physical therapy, p.pzad173
[x]Dow, Patience M., et al. "Association of Pharmacologic and Nonpharmacologic Management of Acute Low Back Pain with Overdose Hospitalizations: A Nested Case-Control Study." Journal of Integrative and Complementary Medicine (2025).
Chiropractic Outcomes and Patient Satisfaction Have Persistently Outperformed Medicine and Physical Therapy
By: Mark Studin DC, FPSC, FASBE(C), DAAPM
Chiropractic care is often misunderstood within healthcare for several reasons despite its growing recognition and substantial evidence in the scientific arena. Historical stereotypes lead to skepticism due to chiropractic’s origins in the late 19th century when its methods were less grounded in scientific principles. Early chiropractic was seen as alternative or even pseudoscientific, creating a stigma that lingers despite significant advancements. While many chiropractors adhere to evidence-based practices, some may still follow outdated or unscientific methods, reinforcing negative perceptions magnified with complications. The resultant medical intervention to those complications missed or created by those few within chiropractic magnifies the misconception of chiropractic created by the few but assigned to an entire profession.
Chiropractors typically address musculoskeletal issues like back and neck pain, which overlap with treatments offered by physical therapists, orthopedic doctors, and pain management specialists. This competition has historically led to resistance and false information from other medical fields. While a growing body of evidence supports chiropractic interventions, such as spinal adjustments for lower back pain, some critics falsely point to a lack of large-scale, high-quality studies in chiropractic care. This misrepresentation in media and anecdotal experiences often skew public understanding of chiropractic. Negative stories about rare adverse effects or unqualified practitioners too frequently overshadow positive patient outcomes.
The problem in chiropractic is two-fold: too many practitioners work in isolation, limiting opportunities for collaboration and mutual understanding with other healthcare professionals. Secondly, too many chiropractors still “cut corners” in documentation, with many still using paper records, rendering a non-professional perception and hurting the reputation of an entire profession. For an unknown reason, others who use electronic records still avoid vitals and systems reviews. 100% of doctors of chiropractic are taught this in our basic training. Still, when these corners are cut, it renders the perception that we are not “real doctors” trained to protect the public, again rendering a non-professional perception and hurting the reputation of an entire profession. Worse, underlying conditions go unrecognized and could have an adverse health outcome.
Chiropractic is one of the safest treatments currently available in healthcare, and when there is a treatment where the potential for benefits far outweighs any risk, it deserves serious consideration. Whedon et al. (2015) reported that their study was based on 6,669,603 subjects after the unqualified subjects had been removed, accounting for 24,068,808 office visits. They concluded, “No mechanism by which SM [spinal manipulation or a chiropractic spinal adjustment] induces injury into normal healthy tissues has been identified. Chu et al. (2023), studying 960,140 spinal manipulative therapy (chiropractic spinal adjustments), revealed 39 adverse events, with the majority having underlying osteoporosis. The incidence is 0.21 per 100,000 visits, and none reported severe health incidents. There were no stroke or cauda equina-related incidences.
Newell and Holmes (2024) reported:
“Generally, chiropractic patients are very satisfied with their care with high proportions generating consistently high satisfaction scores. This includes patient groups receiving care in both the independent and public sectors. Studies recruiting patients presenting with conditions commonly seen by chiropractors reported high to very high satisfaction/experience scores with care. This is also true of parental satisfaction with pediatric care where scores range from around 75% to 95% satisfaction.” (pg. 2)
Newell and Holmes (2024) also reported that patient satisfaction for chronic care utilizing chiropractic was 86.4%, medical care for the same conditions was 71%, and acute patients reported 90% satisfaction with chiropractic care vs. 76% for medical care. The common determinant was changes in positive changes in pain outcomes. Upwards of 97% reported very good or excellent on all outcome questions, including the evaluation experience.
In a study exploring the relationship between chiropractors, medical doctors, and their patients, chiropractic scored higher in trust between the patient and their chiropractor. The perceived support and trust in the doctor-patient relationship for their condition was superior with chiropractic care.
Ntedan et al. (2020), with a cohort of 8,023,162, reported that 96% of chiropractic patients were satisfied with chiropractic care. Conversely, Chiarotto and Koes (2022) reported that 99.1% of acute patients did not have serious spinal conditions or non-specific back pain (the title of their published article in the New England Journal of Medicine). In contrast, for those who did not have identifiable causes, they identified the interaction of biological, psychological, and social factors accounting for upwards of 90% of the cases. Statistically, this makes no sense as they first account for 0.9% identified with an anatomical cause (fracture, tumor, infection, herniation) but then assign 90% to psychological or psychosocial issues, leaving a 9.1% gap. Regardless, medicine cannot identify the cause of 99.1% of non-anatomical spinal-related pain. In comparison, chiropractic reports a satisfaction rate of 96% with the above-reported cohort of 8,032,162 participants in a 4-year study.
Farrokhi et al. (2023) reported that opioid use increases in 89.9% of patients with physical therapy, spinal injections increase by 53%, and MD specialty care increases by 50% with two or more modalities, as are typical physical therapy protocols. Conversely, Whedon et al. (2020) reported that opioid use decreased with chiropractic care by 55%, and opioid-related costs decreased by 74% with chiropractic care.
Despite some chiropractors' poor practice and documentation protocols, which hurts the entire profession, the adage “it’s always about the money” seems to overshadow much of the overall issue. According to Farabaugh et al. (2024), the cost of low back pain in the United States alone is $134.5 billion, and they concluded:
“Patients with spine-related musculoskeletal pain who consulted a chiropractor as their initial provider incurred substantially decreased downstream healthcare services and associated costs, resulting in lower overall healthcare costs compared with medical management.” (pg. 1)
With so much money at stake and most in organized medicine (hospitals, private, local, state, and federal programs) preventing the inclusion of chiropractic, it keeps most of the money inside the medical system despite poorer outcomes. Increased collaboration, when clinically indicated, coupled with advanced chiropractic credentials using medical academia in conjunction with chiropractic academia, has already broken many “glass ceilings,” resulting in additional millions of referrals to chiropractic offices globally.
Integrating evidence into decision-making involves aligning scientific findings with ethical, social, and financial incentives. While the transition might face resistance, persistence in presenting robust data and advocating for change can help evidence prevail over purely financial motivations.
References
Sophia Huang MSIV, Frank Mascaro MD, Randall Loftus MD, Joanna Garvey DC, Carol Jackson-Gibson MD, Samantha Wilfong DC, Gary Smith DC, David Marcarian MA, John Strom DC, Mark Studin DC, Joseph Serghany MD, Jennifer Sperrazza DC, Geoffrey Gerow DC. “LUMBAR DISC HERNIATION, RADICULOPATHY AND FCE”. Medpix: National Institute of Health/National Library of Medicine. Published March 12, 2025.
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Jared Gurba MSIV, Frank Mascaro MD, Randall Loftus MD, Joanna Garvey DC, Carol Jackson-Gibson MD, Samantha Wilfong DC, Gary Smith DC, David Marcarian MA, John Strom DC, Mark Studin DC, Joseph Serghany MD, Jennifer Sperrazza DC, Geoffrey Gerow DC. “CERVICAL CORD INJURY, DISC INJURY AND MOTOR AFFECT”. Medpix: National Institute of Health/National Library of Medicine. Published March 12, 2025.
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Jeffrey Garofalo DC, Mark Studin DC, Randall Loftus MD, John Strom DC, Geoffrey Gerow DC. “COMPLETE RESOLUTION OF SUBJECTIVE AND OBJECTIVE FINDINGS WITH CHIROPRACTIC CARE AND IDD THERAPY IN A PATIENT WITH DISC EXTRUSION AND RADICULUAR SYMPTOMS” Medpix: National Institute of Health/National Library of Medicine. Published February 9, 2025.
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Scott Anderson MSIV, Frank Mascaro MD, Randall Loftus MD, Joanna Garvey DC, Carol Jackson-Gibson MD, Samantha Wilfong DC, Gary Smith DC, David Marcarian MA, John Strom DC, Mark Studin DC, Joseph Serghany MD, Jennifer Sperrazza DC, Geoffrey Gerow DC. “POST TRAUMATIC SUBDURAL HEMMORHAGE AND MENINGIOMA”. Medpix: National Institute of Health/National Library of Medicine. Published February 10, 2025.
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Scott Anderson MSIV, Frank Mascaro MD, Randall Loftus MD, Joanna Garvey DC, Carol Jackson-Gibson MD, Samantha Wilfong DC, Gary Smith DC, David Marcarian MA, John Strom DC, Mark Studin DC, Joseph Serghany MD, Jennifer Sperrazza DC, Geoffrey Gerow DC. “POST TRAUMATIC SUBDURAL HEMMORHAGE AND MENINGIOMA”. Medpix: National Institute of Health/National Library of Medicine. Published February 10, 2025.
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Jiminez A, Mascaro F, Loftus R., Garvey J., Jackson-Gibson C., Wilfong S. Smith G., Marcarian D. Strom J. Studin M., Serghany J., Sperazza J., Gerow J., “POST TRAUMATIC MVC UMBILICAL HERNIA AND MULTILEVEL LUMBAR DISC PATHOLOGY” Medpix: National Institute of Health/National Library of Medicine.
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Josh Johnston DC, Mark Studin DC, Randall Loftus MD, John Strom DC, Geoffrey Gerow DC. “CASE STUDY: 2 level Cervical Disc Herniations and Segmental Ligament Sprain with AOMSI, Previously Non-responsive to Conservative therapy” Medpix: National Institute of Health/National Library of Medicine. Published January 13, 2025.
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