We recently completed a feasibility study on patellofemoral pain syndrome.

A feasibility study is one in which you are determining whether a larger trial makes sense to pursue, whether you’re properly set up for it, that sort of thing.

Yes. Specifically, it compares two chiropractic protocols for patellofemoral pain syndrome. We did this with intramural funding, using a combination of doctors and highly trained interns. Although it was a feasibility study, in fact it had every component of a randomized controlled trial. The two groups were randomized by computer. We had blind assessors. This was done with minimal intramural funding; we did not pay patients anything to defray travel, time, effort or expense as well-funded studies generally do. Despite that, I am very pleased with how it turned out. The outcomes appear encouraging and this feasibility study suggests that a larger trial is justified.¹³

So you are hoping to expand from that feasibility study into something larger?

That’s now a real possibility down the line if funding can be secured (always the question). Right now, we’ve turned to a couple of other areas. I am highly interested in finishing a study on hip osteoarthritis. I wanted to do a study based on the work of Hoeksma, a PT, who used high-velocity, low-amplitude axial elongation hip traction thrusts with pre and post stretching. Hoeksma has already demonstrated this approach to be superior to general medical care.^{9, 14}

In our study, we’re going to have one group protocol very similar to the Hoeksma protocol, while the other group will receive that same protocol plus additional work on the full kinetic chain. This will include not only hip adjustment but also assessment of the knee, the ankle, and the lumbosacral spine, and adjustment of these areas as indicated by the evaluation.

Regarding the knee, we will be keeping in mind some things we’ve learned from studies by Deyle et al, Fish et al, and Tucker et al regarding knee osteoarthritis such as avoiding any early forced flexion of the knee.^{6, 9, 15} Of course, I can’t make any claims at this point, but we’re pleased with how this trial is going. We’ve got one paper submitted on a prospective, single group pre-test post-test design generated from this trial and we hope to shortly submit a similar but larger study to a particular medical journal. The RCT, or trial itself will be completed in a little over a year and we believe we will reach or get close to full sample size, which is 60 per group. I am optimistic about this trial.

It sounds like you are, step-by-step, putting together a body of research on chiropractic care for extremity conditions which can be very important to the future of the profession. I understand that you now have, at various stages of development, research projects studying chiropractic care for shoulder impingement syndrome and lateral epicondylitis (tennis elbow), as well as inversion strain and a few other extremity conditions. This appears to be more than a small niche; it’s a key area that hasn’t been well explored in chiropractic research yet. Do you see it that way?

Absolutely. For the hip osteoarthritis study, we got a $100,000 grant from Unihealth Foundation*. CCCLA and I are very grateful for that grant, which has made an incredible difference. We are also planning other extremity studies and are about to submit a grant proposal to NIH. One group will get full kinetic chain adjustive therapy and rehab (including exercise and soft tissue treatment). This will be compared to “standard care,” or rehabilitation only, consisting of methods (strengthening and stretching exercises) that have already been demonstrated superior to placebo. I think this has the potential to be a very important study. We are hopeful that it will demonstrate the efficacy of chiropractic care.

Is there anything else that you’d like to add?

Yes, I am very grateful to have had, and to have the opportunity to be helpful to our patients and the profession in doing research at CCCLA and previously at these other fine schools, to help improve patient care and outcomes.

* UniHealth Foundation is a nonprofit philanthropic organization whose mission is to support and facilitate activities that significantly improve the health and well being of individuals and communities within its service area.