Two Chiropractic Techniques Outperform Conventional
Medicine for Low Back Pain in Older Adults

In the first randomized controlled trial of chiropractic care for older adults, and one of the first to compare different methods of chiropractic adjustment to each other and to standard medical care, researchers evaluated the effects of these three approaches for 240 people with subacute and chronic low back pain. High-velocity and low-velocity chiropractic techniques resulted in similar levels of improvement, with both chiropractic methods outperforming the medical care group.

Subjects were assessed with the 24-item Roland Morris Disability questionnaire at 3, 6, 12, and 24 weeks. Participants were randomly allocated to 6 weeks of care including 12 visits of either high-velocity, low-amplitude (HVLA)-SM, low-velocity, variable-amplitude (LVVA)-SM, or 3 visits of MCMC. Adjusted mean Roland Morris Disability change scores from baseline to the end of active care were 2.9 (2.2, 3.6) and 2.7 (2.0, 3.3) in the LVVA-SM and HVLA-SM groups, respectively, and 1.6 (0.5, 2.8) in the MCMC group. There were no significant differences between LVVA-SM and HVLA-SM at any of the end points. The LVVA-SM group had significant improvements in mean functional status ranging from 1.3 to 2.2 points over the MCMC group. There were no serious adverse events associated with any of the interventions.

The investigators concluded that “from an evidence-based care perspective, patient preference and clinical experience should drive how clinicians and patients make the SM procedure decision for this patient population.”

Hondras MA, Long CR, Cao Y, Rowell RM, Meeker WC. A randomized controlled trial comparing 2 types of spinal manipulation and minimal conservative medical care for adults 55 years and older with subacute or chronic low back pain. J Manipulative Physiol Ther. Jun 2009;32(5):330-343.

Veterans with Posttraumatic Stress Less
Responsive to Chiropractic Care

At a time when the wars in Iraq and Afghanistan have brought thousands of veterans with posttraumatic stress disorder (PTSD) into the Veterans Administration Healthcare System, both medical and chiropractic practitioners in the VA need to understand the special needs of these veterans. In a study published in Military Medicine, chiropractors at a VA facility in New York State compared baseline and discharge scores for the neck and low back regions in patients with and without PTSD. Patients with PTSD (n = 21) experienced significantly lower levels of score improvement than those without PTSD (n = 119) on self-reported outcome measures of neck and low back disability. These findings, coupled with the theorized relationships between PTSD and chronic pain, suggest that the success of conservative forms of management for veteran patients with musculoskeletal disorders may be limited by the presence of PTSD. Further research is warranted to examine the potential contributions of PTSD on chiropractic clinical outcomes with this unique patient population.

Dunn AS, Passmore SR, Burke J, Chicoine D. A cross-sectional analysis of clinical outcomes following chiropractic care in veterans with and without post-traumatic stress disorder. Mil Med. Jun 2009;174(6):578-583.