Journal of the Canadian Chiropractic Association最新文献

Objective: To describe clinical outcomes and return-to-play following multimodal chiropractic management of an elite speed skater with acute L5-S1 disc protrusion and S1 radiculopathy.

Clinical features: A 20-year-old male elite speed skater presented with sudden-onset severe lumbosacral pain and S1 dermatomal symptoms during ice training. Assessment revealed positive straight leg raise at 40 degrees, diminished reflexes, and motor weakness consistent with S1 radiculopathy. Day 3 MRI confirmed mild L5-S1 disc protrusion with S1 nerve root impingement.

Intervention: McKenzie-based directional preference exercises with lumbar extension movements demonstrating centralization phenomenon. Treatment included progressive loading rehabilitation with sport-specific movement patterns through structured phases, McKenzie exercises performed 3-4 times daily (3-5 sets of 10-12 repetitions), and coordinated multidisciplinary care with physiotherapy, massage therapy, and strength coaching.

Outcome: Complete return to competitive speed skating within 4.8 months with sustained participation without symptom recurrence at 12-month follow-up. Notable 5-second personal best improvement in week 9 of rehabilitation.

Conclusion: Conservative chiropractic management utilizing McKenzie-based protocols within a coordinated multidisciplinary framework achieved excellent outcomes in this elite athlete with lumbar disc herniation and radiculopathy, including successful return to competitive performance with enhanced outcomes.

Objective: To highlight the rehabilitation exercises of a football player following surgical reconstruction of a multi-ligament knee injury (MLKI) with vascular compromise.

Case presentation: A 17-year-old male high school football player sustained a traumatic MLKI requiring immediate limb saving surgery and subsequent tissue repair. Post-operatively, he engaged in an interdisciplinary phased and structured rehabilitation program with an emphasis on progressive loading, neuromuscular control and return-to-sport (RTS) readiness. At eight months post-op the athlete returned to a United States prepatory school where he transitioned to an external strength and conditioning program.

Summary: This case report illustrates the complexities and value of an interdisciplinary and individualized rehabilitation program in the early stages of MLKI recovery. Outcomes were positive through eight months, but there were limitations related to the continuity of care that prevented long-term follow up.

Objective: Present a unique case of non-operative management of a partial ulnar collateral ligament (UCL) tear where the athlete was able to return to performance-based training in a brief six-week period.

Case presentation: A 29-year-old male running back presented to a sports specialist chiropractor for post-injection management of a grade 2 partial tear of the right UCL treated with ultrasound-guided platelet-rich plasma (PRP) and stem cell injections. Physical exam testing found limitations in elbow range of motion (ROM) as well as positive orthopedic tests confirming a UCL injury including the milking maneuver, and dynamic valgus stress test.

Summary: Management consisted of multimodal chiropractic care including active release therapy (ART), electroacupuncture and rehabilitation exercises. This patient's improved strength and function without surgical intervention highlights the possible role of biologic injections as a form of non-operative management when combined with multimodal care to accelerate recovery from UCL injuries in elite athletes.

Background: Indigenous communities in northern Manitoba face a high burden of musculoskeletal (MSK) conditions and limited access to care. In October 2023, a new chiropractic service was launched in Cross Lake, Manitoba, aiming to improve MSK care access. This study explored: (1) the nature of MSK-related care provided at the Cross Lake Nursing Station, and (2) changes in clinical management during the first 10 months post-implementation.

Methods: We conducted a retrospective chart review (standardized 14-item form) for two periods: December 2021-2022 (pre-implementation) and October 2023-August 2024 (post-implementation). Data on presentations, imaging, treatments, and referrals were analyzed descriptively.

Results: Post-implementation, imaging use declined (63.4% to 44.9%), as did prescription of NSAIDs (80.5% to 53.1%), acetaminophen (63.4% to 32.7%), and opioids (21.9% to 8.2%). Muscle relaxant prescriptions increased, while pregabalin/gabapentin remained stable.

Conclusion: The new chiropractic service may be associated with reduced use of imaging and common medications for MSK conditions.

Background: Soft tissue masses in the extremities of athletes present commonly in clinical practice. Clinicians focusing on musculoskeletal care will be familiar with common causes such as myofascial trigger points, hematomas and even lipomas, but may overlook less common causes such as benign or metastatic tumours. This paper describes a case of a schwannoma, a benign nerve tumour.

Case presentation: A 28-year-old recreational athlete presented with a five-year history of progressive calf pain and a palpable nodule unresponsive to conservative care. Imaging revealed a well-circumscribed intramuscular mass with vascular features. Surgical excision and histopathology confirmed a schwannoma. Postoperatively, the patient returned to full activity with resolution of pain.

Summary: This case underscores the necessity of maintaining a broad differential and reinforces the importance of reevaluating diagnoses when conservative interventions fail. Early recognition and referral for imaging are critical to avoid prolonged mismanagement.

Background: Chiropractors face workplace stressors that affect well-being, burnout and job satisfaction. The well-being of chiropractors and students in Australia is yet to be examined.

Methods: From September 2024 to January 2025, Australian chiropractors and students completed a well-being survey. Measures included burnout, anxiety, depression, job satisfaction, substance use, suicidal ideation and job demands/resources. Multivariable regression models assessed factors associated with burnout and job satisfaction.

Results: Of 200 respondents, 38% reported burnout and nearly 80% reported job satisfaction. Early-career chiropractors reported lower job satisfaction and higher burnout. Higher depression (β=0.26 [0.15-0.36]) and anxiety (β=0.03 [0.00-0.06]) scores were associated with burnout. Job satisfaction was associated with lower depression (OR=.60 [0.39-0.93]), more resources (OR=2.98 [1.39-6.39]) and greater workload control (OR=2.03 [1.14-3.62]).

Conclusion: Preliminary results suggest the need for well-being screening and interventions for at-risk groups, including students, early career chiropractors and those experiencing elevated anxiety and depression.

Objective: To outline a successful return to cycling protocol in a patient recovering from chronic coccydynia.

Case presentation: A 34-year-old female recreational cyclist suffered chronic coccydynia for one year. She received a cortisone shot that provided relief until she had a hysterectomy, which then intensified the pain. She was referred to a pelvic floor physiotherapist where she was discharged after one visit due to no pelvic abnormalities. She then sought chiropractic care where she went through a return to cycling protocol based around coccydynia rehabilitation and pain management. The patient was able to return to cycling after 22 weeks of chiropractic care.

Summary: Coccydynia is a painful condition that has no universally accepted treatment or guidelines for management. As such, there are no return-to-sport protocols for individuals who have developed coccydynia in sports. Here we present an evidence-based protocol that can assist practitioners in the management of chronic coccydynia.