Mario Pribicevic

Manipulative Therapy for Lower Extremity Conditions: Update of a Literature Review

OBJECTIVE The purpose of this study is to update a systematic review on manipulative therapy (MT) for lower extremity conditions. METHODS A review of literature was conducted using MEDLINE, MANTIS, Science Direct, Index to Chiropractic Literature, and PEDro from March 2008 to May 2011. Inclusion criteria required peripheral diagnosis and MT with or without adjunctive care. Clinical trials were assessed for quality using a modified Scottish Intercollegiate Guidelines Network (SIGN) ranking system. RESULTS In addition to the citations used in a 2009 systematic review, an additional 399 new citations were accessed: 175 citations in Medline, 30 citations in MANTIS, 98 through Science Direct, 54 from Index to Chiropractic Literature, and 42 from the PEDro database. Forty-eight clinical trials were assessed for quality. CONCLUSIONS Regarding MT for common lower extremity disorders, there is a level of B (fair evidence) for short-term and C (limited evidence) for long-term treatment of hip osteoarthritis. There is a level of B for short-term and C for long-term treatment of knee osteoarthritis, patellofemoral pain syndrome, and ankle inversion sprain. There is a level of B for short-term treatment of plantar fasciitis but C for short-term treatment of metatarsalgia and hallux limitus/rigidus and for loss of foot and/or ankle proprioception and balance. Finally, there is a level of I (insufficient evidence) for treatment of hallux abducto valgus. Further research is needed on MT as a treatment of lower extremity conditions, specifically larger trials with improved methodology.

An Epidemiologic Survey of Shoulder Pain in Chiropractic Practice in Australia

OBJECTIVE This survey investigated the demographic characteristics of the responding practitioners, the prevalence of shoulder pain symptoms seen in weekly chiropractic practice, the sources of shoulder pain, the chiropractor-diagnosed prevalence of shoulder clinical syndromes, and the management strategies for Australian chiropractors. METHODS A survey was created by the authors consisting of questions seeking demographic information from the respondents, shoulder syndrome, and shoulder management information. The survey was mailed to every chiropractic practitioner based in the Australian state of New South Wales (general population 6.8 million in 2005). Contact details were derived from Yellow Pages online listings. RESULTS One thousand thirty-seven surveys were mailed to New South Wales-based chiropractors, with 192 (21%) returning a completed survey. The prevalence of shoulder pain symptoms as reported by the practitioners was 12% of the total weekly patients, with the major cause of symptoms related to overuse (32%). The most prevalent working diagnosis of shoulder pain was shoulder impingement syndrome (13%), followed by impingement syndrome with rotator cuff tendinosis (17%), impingement syndrome without rotator cuff tendinosis (14%), and chiropractic shoulder subluxation (12%). Shoulder pain is managed with a combination of manipulation, mainly diversified technique (81%), peripheral joint manipulation (82%), and various soft tissue strategies used by 92% of practitioners. Rehabilitation strategies were also used by 89% of practitioners with a main emphasis placed on rotator cuff strengthening. CONCLUSION The results suggest a moderate prevalence of shoulder pain in clinical practice with the most prevalent structure involved being the rotator cuff tendon. Most practitioners use a multimodal therapeutic treatment approach in managing disorders of the shoulder.

A Systematic Review of Manipulative Therapy for the Treatment of Shoulder Pain

OBJECTIVE The purpose of this systematic review is to discuss the evidence for manipulative methods of management of shoulder pain and chiropractic management techniques used within the literature. METHODS A literature search of MEDLINE, CINAHL, MANTIS, the Cochrane Musculoskeletal Group trials register and the Cochrane Controlled Trials Register was conducted. Search terms included chiropractic or manipulative therapy and shoulder pain, impingement, rotator cuff, shoulder instability, shoulder joint, treatment or rehabilitation exercises. Publications were included if they contained shoulder pain or contained a specific clinical diagnosis of a shoulder pain syndrome in the title; a detailed description of the treatment intervention which was typical of the profession; treatment performed by a registered practitioner and outcome measures were included in the studies. Exclusion criteria included the diagnosis of adhesive capsultis or referred/pathological pain. The articles were reviewed and clinical trials ranked on the Physiotherapy Evidence Database scale. RESULTS From a total of 913 retrieved publications, 22 case reports, 4 case series and 4 randomized, controlled trials met the inclusion and exclusion criteria for this review. CONCLUSIONS The literature contains 2 articles of reasonably sound methodology. The evidence for chiropractic management of shoulder pain is limited to low level evidence in the form of case reports and case series and 1 small controlled trial. There is a need for more well-designed, trials investigating multi-modal chiropractic management for shoulder pain.

A multi-modal treatment approach for the shoulder: A 4 patient case series

BackgroundThis paper describes the clinical management of four cases of shoulder impingement syndrome using a conservative multimodal treatment approach.Clinical FeaturesFour patients presented to a chiropractic clinic with chronic shoulder pain, tenderness in the shoulder region and a limited range of motion with pain and catching. After physical and orthopaedic examination a clinical diagnosis of shoulder impingement syndrome was reached. The four patients were admitted to a multi-modal treatment protocol including soft tissue therapy (ischaemic pressure and cross-friction massage), 7 minutes of phonophoresis (driving of medication into tissue with ultrasound) with 1% cortisone cream, diversified spinal and peripheral joint manipulation and rotator cuff and shoulder girdle muscle exercises. The outcome measures for the study were subjective/objective visual analogue pain scales (VAS), range of motion (goniometer) and return to normal daily, work and sporting activities. All four subjects at the end of the treatment protocol were symptom free with all outcome measures being normal. At 1 month follow up all patients continued to be symptom free with full range of motion and complete return to normal daily activities.ConclusionThis case series demonstrates the potential benefit of a multimodal chiropractic protocol in resolving symptoms associated with a suspected clinical diagnosis of shoulder impingement syndrome.

Erratum to: Quality of reporting of randomised controlled trials in chiropractic using the CONSORT checklist

[This corrects the article DOI: 10.1186/s12998-016-0099-6.].

Revisión sistemática del tratamiento manipulativo para el hombro doloroso

Resumen Objetivo El objetivo de esta revision sistematica es describir la evidencia para los metodos manipulativos de tratamiento del hombro doloroso y las tecnicas de tratamiento quiropractico usadas en los estudios medicos publicados. Metodo Se efectuo una busqueda de la bibliografia medica en las bases de datos MEDLINE, CINAHL, MANTIS, Cochrane Musculoskeletal Group Trials Register y Cochrane Controlled Trials Register. Los terminos de busqueda incluyeron chiropractic or manipulative therapy (tratamiento quiropractico o manipulativo) y shoulder pain (hombro doloroso), impingement (pinzamiento/atrapamiento), rotator cuff (manguito de los rotadores), shoulder instability (inestabilidad del hombro), shoulder joint (articulacion del hombro), treatment or rehabilitation exercises (tratamiento o ejercicios de rehabilitacion). Se incluyeron las publicaciones si en el titulo contenian hombro doloroso o un diagnostico clinico especifico de sindrome del hombro doloroso, proporcionaban una descripcion detallada de la intervencion terapeutica caracteristica de la profesion, tratamiento instaurado por un medico e incluyeron un analisis de las variables. Los criterios de exclusion incluyeron un diagnostico de capsulitis adhesiva o dolor referido/patologico. Se revisaron los articulos y los ensayos clinicos se categorizaron a partir de la escala Evidence Database. Resultados De un total de 913 publicaciones recuperadas, cumplian los criterios de inclusion y exclusion para la presente revision 22 casos clinicos, 4 series de casos y 4 ensayos aleatorizados, controlados. Conclusiones Los estudios publicados contienen 2 articulos cuya metodologia es razonablemente solida. La evidencia para el tratamiento quiropractico se limita a una de bajo nivel en forma de casos clinicos y series de casos y un ensayo controlado a pequena escala. Se necesita un mayor numero de ensayos, bien disenados, que investiguen el tratamiento quiropractico multimodal del hombro doloroso.