Chiropractic Scores Highest Among Professional Students in
Understanding Musculoskeletal Conditions
A report on the scientific literature
William J. Owens Jr DC DAAMLP
Mark Studin DC, FASBE(C), DAAPM, DAAMLP
According to Wikipedia: The musculoskeletal system (also known as the locomotor system) is an organ system that gives animals (including humans) the ability to move using the muscular and skeletal systems. The musculoskeletal system provides form, support, stability, and movement to the body. It is made up of the body's bones (the skeleton), muscles, cartilage, tendons, ligaments, joints, and other connective tissue that supports and binds tissues and organs together. The musculoskeletal system's primary functions include supporting the body, allowing motion, and protecting vital organs. The skeletal portion of the system serves as the main storage system for calcium and phosphorus and contains critical components of the hematopoietic system.
Musculoskeletal conditions range from neck, mid and low back pain to certain type of headaches and arm and leg pain. Most sports injuries are musculoskeletal in nature as well and most degenerative conditions (arthritis) that prevents the use of an limb over time. If it has to do with moving, lifting, sitting or carrying, it is usually a musculoskeletal condition responsible for the inability to perform that action, or have pain with completing the task related to movement.
In a recent article written by Humphreys, Sulkowski, McIntyre, Kasiban, and Patrick (2007), they stated, “In the United States, approximately 10% to 25% of all visits to primary care medical doctors are for MSK [musculoskeletal] complaints, making it one of the most common reasons for consulting a physician...Specifically, it has been estimated that less than 5% of the undergraduate and graduate medical curriculum in the United States and 2.26% in Canadian medical schools is devoted to MSK medicine” (p. 44).
Musculoskeletal complaints have a major impact on the healthcare system and although many patients believe that traditional providers are highly trained, recent publications relating to basic competency have shown otherwise. For example, the authors cited another study stating, “A study by Childs et al on the physical therapists’ knowledge in managing MSK conditions found that only 21% of students working on their master’s degree in physical therapy and 25% of students working on their doctorate degree in physical therapy achieved a passing mark on the BCE [Basic Competency Evaluation]” (Humphreys et al., 2007, p. 45).
The authors reported, “The objective of this study was to examine the cognitive (knowledge) competency of final-year chiropractic students in MSK [musculoskeletal] medicine" (Humphreys et al., 2007, p. 45). "The typical chiropractic curriculum consists of 4800 hours of education composed of courses in the biological sciences (ie, anatomy, embryology, histology, microbiology, pathology, laboratory diagnosis, biochemistry, nutrition, and psychology), chiropractic sciences, and clinical sciences (ie, clinical diagnosis, neurodiagnosis, orthorheumatology, radiology, and psychology). As the diagnosis, treatment, and management of MSK disorders are the primary focus of the undergraduate curriculum as well as future clinical practice, it seems logical that chiropractic graduates should possess competence in basic MSK medicine” (Humphreys et al., 2007, p. 45).
The following results were published in this paper for the Basic Competency Examination and various professions that are in the front line of the diagnosis and treatment of musculoskeletal conditions. In Table 2 on page 47, the following results were shown when the passing score was established at 73% or greater:
Recent medical graduates (18%), medical students, residents, and staff physicians (20.7%), osteopathic students (29.6%) physical therapy (MSc level, 21%), physical therapy (doctorate level, 26%), chiropractic students (51.5%).
In Table 2 on page 47, the following results were show when the passing score was established at 70% or greater.
Recent medical graduates (22%), medical students, residents, and staff physicians (NA), osteopathic students (33%) physical therapy (MSc level, NA), physical therapy (doctorate level, NA), chiropractic students (64.7%).
Although many professions offer significant training in musculoskeletal conditions, chiropractors, based upon their training and outcomes in comparative studies are shown to be highly competent in caring for musculoskeletal conditions. It is therefore in the public's best interest to consider chiropractic as a "first-line" treatment option or the primary care for "all things musculoskeletal."
Reference:
1. Human Musculoskeletal System, Retrieved from: http://en.wikipedia.org/wiki/Musculoskeletal_system
2. Humphreys, B. K., Sulkowski, A., McIntyre, K., Kasiban, M., & Patrick, A. N. (2007). An examination of musculoskeletal cognitive competency in chiropractic interns. Journal of Manipulative and Physiological Therapeutics, 30(1), 44-49.
Children with Tremors and Conversion Disorder
A Possible Chiropractic Solution
Reporting a Limited Case Study
A report on the scientific literature
by Mark Studin DC, FASBE(C), DAAPM, DAAMLP
Chiropractors and chiropractic has been treating children safely for over 110 years for a host of maladies. In December, 2008, the National Center for Complementary and Alternative Medicine (NCCAM), part of the National Institutes of Health, released findings on Americans and the use of complementary and alternative medicine (CAM). "The findings are from the 2007 National Health Interview Survey (NHIS), an annual in-person survey of Americans regarding their health- and illness-related experiences. The CAM section gathered information on 23,393 adults aged 18 years or older and 9,417 children aged 17 years and under" (National Center for Complementary and Alternative Medicine, 2008, http://nccam.nih.gov/news/camstats/ 2007/camsurvey_fs1.htm). They found that 11.8% of children in the United States have undergone CAM therapies, indicating that children aren’t obtaining the desired outcomes and their parents are looking for solutions.
CAM is a term applied to any healing discipline that does not fall into the category of traditional medicine or any health care that traditional medicine must govern over, such as nursing or physical therapy, rendering those as secondary health care providers and not allowing them to care for patients unless under the supervision of a medical doctor. Chiropractic is considered part of CAM simply because doctors of chiropractic are not medical doctors or secondary providers requiring supervision by a medical doctor.
Miller reported in 2010 on 2,645 children that were treated in the outpatient clinic of the Anglo-European College of Chiropractic from 2006-2010 for various maladies. Of these children, 87% were under the age of 5 and 13% were between 5 and 13. 34% were seen for musculoskeletal problems such as neck pain and postural issues, 30% were treated for infant colic/excessive crying, 16% for feeding disorders and the balance for various other issues. Every child had been seen by at least one medical practitioner and some by many medical providers. Of the 2,645 children referred to the chiropractic clinic, 83% were referred by their medical physicians.
Marchand (2012) reported that an extensive European study was performed revealing that 8.1% of chiropractic practices were children between the ages of 0-18 (this is lower than the 17.1% of pediatric case loads of American Chiropractors.) This was based upon 921 doctors of chiropractic participating and reporting 19,821 pediatric visits, thereby certifying a valid cross-section of patients to conclude results.
The pediatric related conditions that were reported to be cared for by chiropractors were the following:
Miller and Benfield (2008) conducted a study of children younger than 3 years old to determine the adverse effects of chiropractic care in that age group, arguably the most susceptible to injury based upon the fragility of that age group. The study was based upon 5,242 chiropractic adjustments and if the results were extrapolated to the wider infant/toddler population that receives chiropractic treatment, the adverse reaction rate is expected to be 1 out of every 1300 chiropractic adjustments. There was less than 1% of patients experiencing negative side effects and all of these adverse reactions to care were mild in nature; transient and required no medical care with serious complications. The typical reaction was transient crying.
The “Practical Application” reported by Miller and Benfield was that chiropractic adjustments were safe for young children and adolescents.
Conversion Disorder according to Heruti, Levy, Adunski and Ohry (2002) has been previously labeled Hysterical Neurosis, Somatisized Disorder, Anxiety Hysteria and Hysterical Personality. Today's proper accepted nomenclature has been the simple use of Hysterical Neurosis, where Conversion Disorder is lumped together with Dissociative Disorder. This disorder, according to the authors is "disability to a psychological mechanism in people with physical impairment secondary to trauma without evidence of organic etiology (deviation or disruption from any internal organ, part or system)" Page 327.
Alcantara and Adamek (2012) reported "that an 11 year old girl with presented with complaints of uncontrollable tremors of both arms and right leg. Conversion Disorder was diagnosed following negative examination findings of an organic etiology. Prior to institutionalization, her parents requested a second opinion from a clinical psychologist who referred her to a chiropractor. Care was provided using spinal manipulation to sites of spinal and cranial dysfunctions. With subsequent visits the patient's tremors improved. Following 12 chiropractic visits the patient's symptoms resolved. Long-term follow-up revealed continued resolution of the symptoms of tremors." (page 89)
Although this is one case as reported in a limited case study, it adds to the growing body of the results chiropractic care. It also adds to the growing list of conditions chiropractors care for. Over time, research will continue to render more outcome statistics on the efficacy of chiropractic care. However based upon the current statistical conclusions, chiropractic is being utilized to help an array of maladies worldwide in both the pediatric and adult population with minimal to no side effects.
References:
National Center for Complementary and Alternative Medicine. (2008, December). The use of complementary and alternative medicine in the United States. Retrieved from http://nccam.nih.gov/news/camstats/2007/camsurvey_fs1.htm\
2.Miller, J. (2010). Demographic survey of pediatric patients presenting to a chiropractic teaching clinic, Chiropractic & Osteopathy,18(33), Retrieved from http://www.chiroandosteo.com/content/pdf/1746-1340-18-33.pdf
3.Marchand, Aurelie (2012) Chiropractic Care of Children From Birth to Adolescence and Classification of reported Conditions: An Internet Cross-Sectional Survey of 956 European Chiropractors, Journal of Manipulative and Physiological Therapeutics, 35 (5) 372-380
4. Miller, J. E., & Benfield, K. (2008). Adverse effects of spinal manipulative therapy in children younger than 3 years: A retrospective study in a chiropractic teaching clinic. Journal of Manipulative and Physiological Therapeutics, 31(6), 419-423.
5.Heruti R., Levy, A., Adunski A. and Ohry A., (2002) Conversion Motor Paralysis: Overview and Rehabilitation Model, Spinal Cord, 40, 327-334
6. Alcantra J., Adamek R., (2012) The chiropractic care of a child with extremity tremors concomitant with a medical diagnosis of conversion disorder, Complementary Therapies in Clinical Practice, 18, 89-93
Children and Chiropractic Care:
Birth to 18 Years
Conditions cared for and side effects
2012 Report
A report on the scientific literature
By
Mark Studin DC, FASBE (C), DAAPM, DAAMLP
Chiropractic has been successfully caring for children for various conditions for over a century. The main issues are what conditions are cared for by chiropractors, what is the reported success rate and what is the incidence of side effects. Over time, research has started to catch up on what individual chiropractors have been realizing in their private practices and this article will outline the current state of the literature.
Marchand (2012) reported that an extensive European study was performed revealing that 8.1% of chiropractic practices were children between the ages of 0-18 (this is lower than the 17.1% of pediatric case loads of American Chiropractors.) This was based upon 921 doctors of chiropractic participating and reporting 19,821 pediatric visits, thereby certifying a valid cross-section of patients to conclude results.
The pediatric related conditions that were reported to be cared for by chiropractors were the following:
Miller and Benfield (2008) conducted a study of children younger than 3 years old to determine the adverse effects of chiropractic care in that age group, arguably the most susceptible to injury based upon the fragility of that age group. The study was based upon 5,242 chiropractic adjustments and if the results were extrapolated to the wider infant/toddler population that receives chiropractic treatment, the adverse reaction rate is expected to be 1 out of every 1300 chiropractic adjustments. There was less than 1% of patients experiencing negative side effects and all of these adverse reactions to care were mild in nature; transient and required no medical care with serious complications. The typical reaction was transient crying.
The “Practical Application” reported by Miller and Benfield was that chiropractic adjustments were safe for young children and adolescents.
Marchand (2012) also reported the negative side effects of chiropractic care in children to be less then 1% (0.23%,) which is consistent with what Miller and Benfield reported 4 years prior in an independent study. However, Marchand went further to categorize the negative side effects into mild, moderate and severe. In a 1 year study of 237,857 pediatric patients, there was a reported 534 mild side effects (0.2%) and 23 (0.009%) had moderate side effects with 0 (zero) reporting any severe side effects.
To render perspective on the safety of chiropractic care and children Le, Nguyen, Law and Hodding (2006) reported "The incidence of adverse drug reactions among hospitalized children in the United States has not been well studied. Because clinical trials involving neonates, infants, children, and adolescents are limited, the safety and tolerability of many pharmacologic agents are not well established. Often the pharmacologic actions of drugs in neonates, infants, and children are not similar to those identified for adults; therefore, information obtained from research with adults cannot be applied directly. On the basis of a meta-analysis of 17 prospective studies conducted in the United States and Europe, the incidence of adverse drug reactions among hospitalized children was 9.5%, with severe reactions accounting for 12% of the total (pg. 557.)
The above study indicates that side effects need more researched in many sects of health care, but comparatively speaking, chiropractic is a much safer choice than most alternative options.
Over time, research will continue to render more outcome statistics on the efficacy of chiropractic care. However based upon the current statistical conclusions, chiropractic is being utilized to help an array of maladies worldwide in the pediatric population with minimal to no side effects.
References: