Journal of the Canadian Chiropractic Association最新文献

Spinal manipulation learning requires intensive practice, which can cause injuries in students. Motor imagery (MI) paired with physical practice (PP) appears to be a suitable means to reduce the number of physical repetitions without decreasing skill outcomes. This study examines whether a session of MI paired with PP leads to a similar improvement in the ability to precisely produce peak forces during a thoracic manipulation as PP alone. Chiropractic students participated in a thoracic manipulation training program for five weeks. They were randomised in two groups: the MI+PP group performed sessions combining physical and mental repetitions with 1/3 fewer PP sessions, while the PP group performed only PP. Thoracic manipulation performance was assessed in pre and post-tests, consisting of thoracic manipulations at three different strength targets. Absolute error (AE), corresponding to the difference between the force required and the force applied by the student, was recorded for each trial. The main result revealed that AE was significantly lower in post-test than in pre-test for both groups. Despite fewer physical repetitions, the MI+PP participants showed as much improvement as the PP participants. This result supports the use of MI combined with PP to optimise the benefits of physical repetitions on thoracic manipulation learning.

This is the third of three papers in our series of articles on the use of mixed methods in chiropractic research. In this commentary, we discuss the mixed methods experimental (or intervention) design. This design is a complex mixed methods research design in which qualitative research is integrated with randomized controlled trials. We provide a brief overview of this study design as well as a case example from the literature to illustrate how this approach can be applied to research within the chiropractic profession.

Background: Lhermitte's sign is a nonspecific historical and exam finding that carries with it a differential diagnosis of cervical myelopathy, multiple sclerosis, intradural tumors, or other central nervous system pathology. Regardless of the suspected diagnosis, further diagnostic investigation is indicated to determine etiology of symptoms.

Case presentation: In this case, a 67-year-old male Veteran presents to a Veterans Affairs (VA) outpatient chiropractic clinic with an insidious 6-month onset of neck pain with historical description of a positive Lhermitte's sign, a single episode of bladder incontinence, and mild changes in upper extremity manual dexterity. These subtle historical findings prompted referral for a brain and cervical spine MRI, revealing an ependymoma in the cervical spine. Urgent neurosurgical referral was made, and the patient underwent C3-C7 laminectomy, C3-T2 fusion, and tumor resection.

Summary: This case represents an example of clinical reasoning in a VA chiropractic clinic when presented with subtle neurologic findings, and discusses the differential diagnoses and decision-making process to pursue imaging that resulted in appropriate neurosurgical management.

Background: Axillary-subclavian venous thrombosis (ASVT) is a type of upper extremity deep vein thrombosis (UEDVT). UEDVTs are classified as either primary or secondary depending on their etiology. Although uncommon, clinicians should be aware of the clinical presentation of UEDVT as timely diagnosis and early treatment is critical in preventing possible post-thrombotic complications.

Case presentation: We report a rare case of axillary-subclavian and internal jugular vein thrombosis in the absence of clear risk factors in a 78-year-old male weightlifter who presented to the office with two-week duration of left upper extremity pain and swelling following strenuous exercise at the gym.

Summary: The combination of unusual thrombi location, in addition to the unusual absence of existing thoracic-outlet compression or indwelling medical hardware, makes our case of UEDVT especially uncommon. Clinicians should be aware of this rare disease due to the debilitating effects both in the short and long term.

Although most cases of Achilles tendinitis are caused by some form of biomechanical stress, other factors may play a role in its etiology. Fluoroquinolone use is a well-known contributing factor to Achilles tendon pathology. This report describes a case of fluoroquinolone-induced Achilles tendinitis in a 77-year-old woman. Eight weeks after she presented to our office, the patient reported significant improvements after a course of care that included low level laser therapy (LLLT), activity modification and graduated exercises. Management can include many of the treatment tools used for biomechanically induced tendinopathy, with particular consideration given to delaying more advanced weight-bearing rehabilitative exercise due to the increased risk of rupture.

Objectives: To investigate the research capacity and productivity of Canadian sports chiropractors.

Methods: A cross-sectional survey (phase one) and scoping review (phase two) investigated the research capacity and productivity (from 2015-2020) of the Canadian sports chiropractic field.

Results: Most respondents (72%) reported obtaining research training from fellowship and master's programs, with only 2 (1%) PhD qualifications identified. Approximately, 30% reported active involvement in research, with 28% being part-time clinician researchers. Access to human and technological research resources were limited. We identified 67 publications and 16 conference presentations within a five-year period, with clinical, population health, and basic science research as the areas most studied.

Conclusion: The research effort of Canadian sports chiropractors is primarily conducted by clinicians involved in research on a part-time basis. Its research outputs predominantly reflect the research requirements of the RCCSS(C) Sports Sciences Residency Program, highlighting its contribution in developing capacity and producing research for the Canadian sports chiropractic field.

Objective: To identify, appraise and synthesize the evidence of autonomic nervous system (ANS) dysfunction following sport-related concussion in pediatric populations.

Methods: A literature search was conducted using MEDLINE (Ovid), SportDiscus (EBSCO), CINAHL (EBSCO), EMBASE (Ovid) and PsycINFO (Ovid). Studies were selected and appraised using the Joanna Briggs Institute (JBI) critical appraisal tools. Data was extracted from the included studies and qualitatively synthesized.

Results: Eleven studies were included in the synthesis. There was variability in the methods used to measure ANS function between studies, and sample populations and time to assessment following concussion varied considerably. There was also variability in the direction of change of ANS function between some studies.

Conclusion: This systematic review identifies that concussion is associated with dysregulation of ANS function in pediatric athletes. We identified some weaknesses in the extant literature which may be due to existing logistical and financial barriers to implementing valid ANS measurements in clinical and sports settings.

Objective: To present a unique case of pulmonary embolism (PE) in an elite-Ironman triathlete and review athlete-specific risk factors associated with venous thromboembolism (VTE).

Case presentation: A 57-year-old male triathlete presented for chiropractic care of midback pain and dyspnea one day before competition. During competition, he was removed and unable to complete the event with dyspnea, chest, and midback pain. Vitals revealed prolonged elevated resting heart rate. He was triaged to the hospital with a high index of suspicion for PE. He was diagnosed with multiple PE in both lungs.

Summary: VTE is not normally considered in athletes. A combination of athlete-specific risk factors may predispose athletes to a higher propensity of VTE. Due to life-threatening consequences, it is important to include a differential diagnosis of VTE in patients presenting with midback pain and dyspnea.

Distal radius fractures are a common sports injury, often managed with reduction, immobilization, and rehabilitation. However, structured sport specific return to play protocols have yet to be developed, specifically within hockey. This case report reviews the various factors to consider when managing an athlete's recovery from a radius fracture, and objective measures to aid with return to play decision making when managing a hockey player.