| So if a practitioner specializes strictly on certain areas of the musculoskeletal system—just the leg or just the spine—they might in some cases fail to address all of the causal factors underlying the patient’s pain or other problems.
Absolutely. Researchers have correlated restricted ankle dorsiflexion with knee pain. From a biomechanical point of view, it’s pretty simple and straightforward. If you’ve got a hip problem and also a knee problem, addressing the hip problem but failing to address the knee problem (for example, pain plus loss of knee range of motion) is probably not going to bring as high a level of relief as addressing both of them, and the spine as well. The physical therapists appear to have accepted this concept. Deyle et al’s (2005) large study on knee osteoarthritis is one that used full kinetic chain adjusting to manage knee OA.6 This included manipulative therapy of the knee but also the ankle, foot, hip or lumbosacral spine.6 There has also been research correlating restricted hip pain and lumbosacral pain and it appears that restricted hip motion may be an indicator for adjusting the lumbosacral spine.7 Of course, you want to address the hip directly, as well.
What can you tell us about studies that you personally have undertaken regarding chiropractic adjusting for lower extremity disorders?
In 1996, I was hired by Durban University of Technology in South Africa to work in the clinic and to supervise masters of science degree students. I was helping students run all sorts of small trials. They asked me for research ideas and I mentioned a variety of areas that had not previously been studied.
This sounds like a researcher’s dream, having all of your potential studies pursued by enthusiastic grad students.
Every student there was required to do a research project. For example, Justin Pellow did a small trial on adjusting the ankle for inversion sprain. We published it in the Journal of Manipulative and Physiological Therapeutics in 2001, the first randomized controlled trial of adjusting the ankle for inversion sprain in the history of chiropractic.8
What did he find?
That adjusting was superior to placebo. It was well done but a pilot study (with weaknesses inherent in a small intramurally or minimally funded study) so you can’t overly generalize.
But it’s a necessary first step.
Yes, it’s a beginning. Also, you have to remember that these studies were done for around the equivalent of $1000 U.S. Virtually nothing.
That sounds quite cost effective.
There are strengths and also weaknesses in these small studies, but they are a very important starting point. I think it would be very helpful to have a portion of chiropractic research funds targeted at small studies like these and donations directly to the Department of Research at CCCLA would allow for a variety of small pilot prospective case series and studies to collect data and determine feasibility which could lead to attempts by CCCLA to obtain significant funding (such as NIH or NCCAM grants) and the conducting of large definitive trials. However, although chiropractic extremity research is growing, much more of the research in extremity disorders is now coming from the physical therapists.9 Immediately after the ankle inversion study I mentioned, a PT named Green did a study on manipulation for acute ankle inversion sprain and found that adding manipulation to a RICE (rest, ice, compression and elevation) protocol was more effective than RICE alone for decreasing pain and increasing dorsiflexion. We’ve done some other foot studies since that time, as have the PTs and the osteopaths.10
Also at Durban, students did the first two studies published in the peer reviewed literature, on chiropractic care for the treatment of patellofemoral pain syndrome. 9 At CCCLA and DUT, the first two chiropractic RCTs for the treatment of shoulder impingement syndrome and rotator cuff tendinopathy were completed, underwent peer review and were published.11, 12 Another shoulder study from the University of Surrey in Guildford, England was also been recently jointly published with CCCLA. We have another bunion study from the University of Johannesburg, a joint CCCLA–UJ project, that we hope to submit and have published fairly soon.
I began work on my PhD and later received a doctorate in clinical research from the University of Surrey in 2005, finishing the final work on that dissertation and degree while at Cleveland Chiropractic College–Los Angeles. Dr. Gary Globe was very helpful in giving me the extra time I needed to work on it. |
