Journal of manipulative and physiological therapeutics
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J Manipulative Physiol Ther · Feb 1999
ReviewLow back pain and the lumbar intervertebral disk: clinical considerations for the doctor of chiropractic.
Low back pain exists in epidemic proportions in the United States. Studies that demonstrate innervation to the intervertebral disk provide evidence that may account for instances of discogenic low back pain encountered in general medical and chiropractic practice. Many patients and health care practitioners believe that intervertebral disk lesions require surgery as the only method of treatment that will result in satisfactory outcome. Surgery rates vary widely across geographic regions. Only one randomized prospective study exists that compares surgical and nonsurgical treatment; it demonstrated essentially equal outcomes in the long run. ⋯ Patients should be screened for "red flags" to determine whether they are candidates for conservative treatment. Magnetic resonance imaging is perhaps the most practical imaging study for evaluation of lumbar disk lesions because it involves no use of ionizing radiation and because magnetic resonance imaging has other advantages over computed tomographic scanning such as excellent delineation of soft tissue structures, direct multiplanar imaging, and excellent characterization of medullary bone. Provocation computed tomography-diskography is an invasive procedure and should be reserved for patients with normal magnetic resonance imaging findings and continuing severe pain who have not been helped by conservative treatment attempts and for whom surgical intervention is contemplated. Both conservative and surgical interventions have been shown to be effective in the treatment of discogenic and radicular pain syndromes.
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J Manipulative Physiol Ther · Jan 1999
Comparative StudyIncidence of ponticulus posterior of the atlas in migraine and cervicogenic headache.
The clinical significance of the ponticulus posticus is far from clear. It has been associated with headaches, Barré-Lieou syndrome, photophobia, and migraine. However, little epidemiologic evidence for this exists. ⋯ In a chiropractic patient population that required cervical x-ray examinations, a significant association was found between ponticulus posticus and migraine without aura, with an odds ratio of 2.19:1 in favor of this complaint being present with the osseous anomaly. The mechanism for this remains obscure but may be related to ischemic compression of the vertebral artery or by dural tension at the craniocervical junction.
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J Manipulative Physiol Ther · Jan 1999
Case ReportsChiropractic rehabilitation of a patient with S1 radiculopathy associated with a large lumbar disk herniation.
To describe the nonsurgical treatment of acute S1 radiculopathy from a large (12 x 12 x 13 mm) L5-S1 disk herniation. ⋯ This case demonstrates the potential benefit of a chiropractic rehabilitation strategy by use of multimodal therapy for lumbar radiculopathy associated with disk herniation.
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J Manipulative Physiol Ther · Oct 1998
Randomized Controlled Trial Clinical TrialThe efficacy of spinal manipulation, amitriptyline and the combination of both therapies for the prophylaxis of migraine headache.
Migraine headache affects approximately 11 million adults in the United States. Spinal manipulation is a common alternative therapy for headaches, but its efficacy compared with standard medical therapies is unknown. ⋯ There was no advantage to combining amitriptyline and spinal manipulation for the treatment of migraine headache. Spinal manipulation seemed to be as effective as a well-established and efficacious treatment (amitriptyline), and on the basis of a benign side effects profile, it should be considered a treatment option for patients with frequent migraine headaches.
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J Manipulative Physiol Ther · Oct 1998
The Copenhagen Neck Functional Disability Scale: a study of reliability and validity.
To determine whether a newly developed disability scale for patients with neck pain demonstrated acceptable reliability and validity. ⋯ The disability scale demonstrated excellent practicality and reliability. The scale accurately reflects patient perceptions regarding functional status and pain as well as doctor's global assessment and is responsive to change over long periods of time. We feel that this scale can be a valuable tool for the assessment of patients in future clinical trials and quality of care studies.