Journal of the Canadian Chiropractic Association最新文献

Patient-provider communication can lead to unhelpful ideas and beliefs about a patient's condition, negatively impacting their clinical outcome. A 34-year-old male Veteran presented for an evaluation of high impact chronic low back pain. Previous interactions with various healthcare providers resulted in the Veteran viewing his condition as ominous and in need of intervention, however clinical findings did not support these beliefs. Our Veteran underwent six visits in the chiropractic clinic with treatment consisting of pain education, utilization of cognitive behavioral principles, active home care exercises and spinal manipulation, resulting in improvements in functional and objective outcome measures. This case report highlights the impact of misalignment between an early contact healthcare provider and patient misunderstanding of their condition on long term outcomes. It serves as an example of how physicians utilizing pathoanatomic explanations to describe a patient's chronic low back pain diagnosis can alter the patient's beliefs about their condition.

Objective: We aimed to determine the feasibility of conducting a cross-sectional study to estimate the one-week prevalence of overuse-related shoulder pain and activity limitation in competitive tennis players.

Methods: Eligible for the study were competitive adult tennis players who reside in Toronto. Using a convenience sample, the Oslo Sports Trauma Research Centre Overuse Shoulder Injury Questionnaire (OSIQ) was administered online to provide preliminary estimates of the prevalence of shoulder pain and activity limitation, injury severity and pain intensity. Feasibility outcomes included evaluating participation rate and missing data in the questionnaire.

Results: Forty-three tennis players were included in the questionnaire (68.3% participation rate, 100% completion rate). There was no missing data. The one-week proportion of those with shoulder pain and activity limitation was 41.9% with a mean injury severity of 33/100. Mean pain intensity was 1.9/10.

Conclusion: Our study demonstrates that it is feasible to conduct a cross-sectional study to measure the one-week prevalence of shoulder pain and activity limitation in tennis players.

Introduction: Distal clavicular osteolysis (DCO) is a musculoskeletal pathology characterized by shoulder pain. Given the high prevalence of shoulder pain due to rotator cuff and subacromial injuries, DCO is often overlooked. Conservative therapy is indicated prior to surgical intervention. However, no literature has described conservative management of DCO in detail. This report will outline conservative management details for DCO to guide future research and clinicians.

Case presentation: A 24-year-old female hockey player presented with trauma-induced injury, where she was diagnosed with type II acromio-clavicular joint separation. She presented 5-months later with residual pain and limitations in ranges of motion (ROM). Radiographic images revealed DCO.

Management and outcome: Management entailed strict rest from overhead activities followed by rehabilitation and manual therapy. 6-months later the patient reported resolution of symptoms, improved ROMs, and activities of daily living.

Summary: DCO can be difficult to diagnose given its limited etiological understanding, low incidence, and poor radiographic sensitivity. DCO diagnosis should be considered in cases with unresolving shoulder pain.

Objectives: To determine the influence of induced fatigue on dynamic balance in healthy athletes.

Design: Systematic review.

Data sources: PUBMED, MEDLINE, CINAHL, Sports Discus, and the Cochrane library from onset to May 28, 2019.

Eligibility criteria: Eligible studies included any study examining the effects of induced-fatigue on dynamic balance, as measured by the SEBT/YBT, in healthy athletic populations. Studies with a low risk of bias were considered scientifically admissible for a best evidence synthesis.

Results: Fifteen studies with low risk of bias were included - seven investigated recreational athletes while eight focused on competitive athletes. In the recreational population, five of the studies found significant decrease in dynamic balance following the fatiguing intervention. However, the remaining two concluded with insignificant changes. As for the competitive population, three studies showed significant effects of induced fatigue on dynamic balance, while five showed no effects.

Conclusion: There are conflicting results regarding the effects of induced fatigue on dynamic balance. The majority of studies focused on competitive athletes found that fatigue did not alter their dynamic balance. Per contra, the majority of studies focused on recreational athletes concluded the opposite - fatigue did indeed affect dynamic balance.

Objectives: This study aims to determine whether manipulative therapy of the hip joint can increase range of motion (ROM) and/or decrease pain in individuals experiencing symptomatic hip pain.

Methods: Non-disabled young adults were recruited on campus of a chiropractic college for this randomized crossover study. Subjects' hip active and passive ROM and pain perception were measured. Subjects then received a drop-piece hip manipulation (DPHM) or an alternative treatment, followed by measurement of active and passive ROM and pain.

Results: Eight males and 12 females (n=20) between the ages of 21-32 years completed the study. Statistically significant improvements in numeric pain scale (NRS) and passive abduction were observed for the manipulation group when compared to the alternative treatment. No significant change was observed for all other hip ranges.

Conclusions: DPHM of the symptomatic hip joint in a small sample of young adults resulted in statistically significant improvements in pain and passive abduction when compared to sham manipulation. Due to low sample size, further research is recommended.

Objectives: To investigate the degree of knowledge North American chiropractors have in regards to concussion diagnosis and management.

Methods: A Concussion Knowledge Assessment Tool (CKAT) survey was administered to North American chiropractors through SurveyMonkey.com. This survey was sent to all practicing members of the American Chiropractic Association (ACA) and Canadian Chiropractic Association (CCA).

Results: 1321 surveys were completed and analyzed (response rate of 3.3%). The average score of the CKAT amongst North American Chiropractors was 4.82 out of 9. Using our modified scoring method, chiropractors scored 39.44 out of 48.

Conclusions: North American chiropractors who participated in this study demonstrated concussion knowledge and management using the CKAT tool. Further investigation is recommended in order to address learning gaps and updating the CKAT based on current literature and guidelines.

Objectives: To identify sports-focused research priorities to inform the development of a research agenda for sports chiropractors.

Methods: A qualitative description study was conducted using semi-structured interviews with 20 sports chiropractic researchers from 8 different countries and focus group interviews with 12 sports chiropractic leaders from Canada.

Results: 150 research priorities were identified, and three main themes emerged: area of research, research actions, and research methodology. Six areas of research were identified: basic science and mechanism research, clinical research, health services research, population health, specific conditions and topics in sport, and chiropractic research in sport. Collaboration in research and contributing to the broader sports research effort were two subthemes identified as research actions, and the remaining codes were related to research methodology.

Conclusions: The research priorities identified can be utilized to plan future research prioritization studies to inform a research agenda for the sports chiropractic field.

Objective: To present the diagnostic, clinical, and radiological features of pigmented villonodular synovitis (PVNS), create awareness of this rare condition, and provide guidance for conservative healthcare practitioners for further referral and appropriate management.

Case presentation: We present the case of a 41-year-old recreational runner who presented to the clinic with anterior hip pain of one year duration. Following a clinical history and examination, the patient was diagnosed with clinical femoroacetabular impingement. Radiographs taken at that time displayed mild degenerative joint disease of the left hip joint with coxa profunda. After four weeks of conservative care, the patient reported no improvement in symptoms. The patient was then referred for an MRI, while conservative care continued. Ten weeks later, the patient's symptoms and functional abilities had worsened. The MRI was obtained and the diagnosis of PVNS was made.

Summary: PVNS is a rare disease that can mimic mechanical hip pain. A high index of suspicion should be utilized when symptoms worsen despite conservative care. Referral for advanced imaging is critical for appropriate diagnosis of PVNS.

Objective: This study describes the radiographic diagnosis and nonoperative chiropractic management for a case of a chronic calcaneonavicular coalition in an adult patient.

Background: Calcaneonavicular coalition is a congenital/acquired condition of the tarsal bones often diagnosed in individuals 8-12 years old. Considering its rare presentation (less than 1% of the population), there remains little literature on the conservative management of this condition.

Case presentation: Chronic calcaneonavicular coalition in a 35-year-old recreational athlete is presented.

Management/outcome: Following radiographic diagnosis, the patient was placed in a walking boot for four-weeks. After removal of the boot, the patient was managed nonoperatively. They reported a full resolution of symptoms with noted return to all pre-injury activities.

Summary: Presentation of calcaneonavicular coalition may be dependent on many factors, including age, medical history, and chronicity of the condition. Previous medical background may include recurrent inversion ankle sprains, aggravated with activity, and alleviated with rest. Nonoperative management of calcaneonavicular coalition may be considered as a viable intervention.