Issue Category: Volume 29

How does a clinician objectively assess a patient who complains of low back pain that is chronic? Oftentimes, the condition is primarily subjective, with little objective clinical findings that would validate the complaint. Whether it is chronic low back pain or any number of similar complaints, the conundrum presents itself to the doctor as a challenge to seek and determine any positive physical, orthopedic or neurological signs that would corroborate the complaint, and lead to a direction for appropriate treatment.

We have the benefit of input from doctors Joel Carmichael, Brian Bond, Susan St. Claire and Lisa Killinger to help the clinician to better assess and determine possible cause(es) (mechanical, neurologic, psychological, vascular, infectious, neoplastic), and form an effective treatment plan. Some modalities and other treatment approaches are discussed, some of which may be outside the scope of practice of the average chiropractic physician (e.g., opioids). But, just because we cannot utilize a specific approach, does not mean we are not responsible to be aware of what is available to the clinician and patient for effective management of the condition, as well as the downsides of some of these other approaches. With respect to opioids, Dr. Bond provides a helpful overview of availability, utilization, effects and dangers associated with their use.

It is interesting how both experience and ongoing study eventually redirect the enthusiastic new practitioner into the realistic view that each case is not always an opportunity to affect a cure, but is a challenge to effectively manage with sound clinical judgment and well- developed skills.

Respectfully,

Vincent P. Lucido, DC, DACBO
Editor-in-Chief

Dr. Brett Martin’s lecture on the efficacy of cold laser therapy for the treatment of tendinopathies is a comprehensive insight into how this modality can be effectively utilized in various musculoskeletal conditions affecting the tendons. He discusses the different types of laser with respect to their power, penetration, wavelengths, and physiologic effects. He also discusses the comparison of cold laser therapy with other interventions and their therapeutic efficacy. Additionally, he cautions about certain contraindications and safety measures that should be observed when using cold laser therapy. There were five studies comparing the effects of NSAID therapy to laser therapy. The efficacy of both forms of treatment were virtually synonymous for pain reduction. However, the laser therapy group also potentiated tissue healing and repair.

Dr. Brynne Stainsby’s lecture on the clinical effects of vibration therapy provides the clinician with information on the various components of vibration therapy, the mechanism of its mechanical and physiologic effects on the nervous and musculoskeletal system. She covers the benefits in different populations and conditions that benefit from vibration therapy, and some of the contraindications and safety concerns.

Dr. Carlo Guadagno is our feature article author. He deals with a subject that is of critical importance to any clinician that has the occasion to treat an athlete whose sport involves forceful physical contact, or anyone who may have accidentally suffered head trauma. He covers the incidence, epidemiology, and symptoms associated with head trauma that may result in concussion, with particular attention to football injuries. He raises the caveat to never minimize a blow to the head, and the importance of striving to minimize occurrences leading to concussion. In order to accomplish the latter, he lists preventative measures that will facilitate this goal. His feature article also contains several therapeutic approaches in management of concussion injuries, and various methods of retraining the injured athlete.

Dr. Lisa Killinger follows up with several salient abstracts and commentaries on adjunctive therapies in neurogenic claudication, whiplash associated disorders, neck pain, and carpal tunnel syndrome. The outcomes vary from improved outcome with the approaches to the neurogenic claudication, to limited effectiveness with respect to nerve gliding in carpal tunnel syndrome, and no effectiveness for neck pain when using heat, cold, diathermy, hydrotherapy, and ultrasound.

Respectfully,
Vincent P. Lucido, DC, DACBO
Editor-in-Chief