Research Review Corner Continued from Page 44 • It varies in density, layering patterns and biomechanical properties. • It is responsible for regional force distribution and likely global movement patterns (via the conceptual fascial “trains”). • Muscles don’t just “pull”; they expand or flatten to help modulate the moment arm for their enveloping fascia. • Fascia and other connective tissue cell membranes contain receptors that respond to stretch, mechanical loads, defor- mation, shear stress, etc. • The effect of common clinical interventions such as exercise, manipulation and acupuncture on fascia are not completely understood, but studies are underway in many of these areas. EVIDENCE FOR ALTERED CENTRAL PROCESSING – DR. bERNADETTE MURPHY • “Neural plasticity” equals any lasting modulation to the function of the central nervous system (CNS) and: o can include changes to synaptic connections or changes in “circuitry” o can be adaptive or maladaptive (for example, altered sensory processing from a repetitive strain injury). • Joint dysfunction may play a role in afferent functions, sen- sorimotor integration and motor control problems – these concepts are currently under study. • A variety of neurophysiological measurements are current- ly being used to study the effects of spinal manipulation on the central nervous system – somatosensory evoked potentials, EMG, transcranial magnetic stimulation, feed forward activation. DIFFERENTIATING PAIN: SPINAL-SOMATIC REFERRAL MECHANISMS – DR.HOWARD VERNON • Pain research has typically focused on cutaneous pain, or pain stimuli in peripheral tissues. • Recently, there is increasing work in delineating the unique characteristics of deep pain mechanisms, both somatic and visceral – spinal pain is of special interest. • Spinal pain of mechanical origin demonstrates important differences from peripheral tissue mechanisms: o primary afferents display prominent divergence when they enter the grey matter of the spinal cord (cranial and caudal secondary zones – multisegmental innervation) o lumbar dorsal horn neurons receive input from affer- ents throughout the lumbar spine, including somatic and visceral inputs o deep spinal inputs display more pronounced laminar termination in the spinal cord. • In summary, back pain is more like visceral pain than extremity pain. • Our understanding is increasing but further research is required. SOMATIC PAIN FROM INTERNAL DISORDERS – DR. bRIAN bUDGELL • Dr. Budgell discussed some common theories that are used to explain visceral referred pain. 62 • Canadian ChiropraCtor | dECEMBEr 2009 • There are several good hypotheses that are incomplete at this time. • Central projection of noxious stimuli involves numerous spinal cord tracts, including: spinothalamic, spinoreticular and spinomesencephalic. • A general theory is that afferent input beyond a certain threshold creates dysfunction in sensory processing. • No single current theory can account for various factors surrounding referred pain, including: o the delayed onset of referred pain o topographical evolution of referred pain o non-segmental referred pain. IDENTIFYING SUbGROUPS OF PATIENTS WITH LOW bACk PAIN – DR. JEFFREY HEbERT • Dr. Hebert discussed the evolution and development of the Clinical Prediction Rule for low back pain (LPB) assess- ment and management. • LBP is not a homogenous condition, yet it is often stud- ied as such, leading to inconclusive results on a variety of treatment interventions. • Treating all LBP with one intervention is analogous to treating all causes of chest pain with a drug meant only for acid reflux. • It is now apparent that subgroups of LBP patients exist that will respond differently to various treatment interventions. • The specific subgroups that have been identified based on historical and physical examination findings include: o manipulation o stabilization exercise o specific exercise o traction. CHIROPRACTIC FOR NON-MUSCULOSkELETAL CONDITIONS – DR. CHERYL HAWk Dr. Hawk summarized a study that reviewed the literature on chiropractic care for non-musculoskeletal conditions. 17 RCTs were included on manual procedures (not just chi- ropractic) for the following conditions: asthma, hypertension, vertigo, infantile colic, otitis media, dysmenorrhea, nocturnal enuresis, pneumonia, phobia, jet lag. (The results of this study were reviewed in Research Review Corner in the May 2008 – Volume 13, No. 3 – of Canadian Chiropractor magazine.) In addition to these presentations, Dr. Michael Schneider added an interesting case study presentation and review of oc- cult upper cervical instability, while Dr. Carlo Amendolia pre- sented the key note speech during dinner, updating attendees on the state of the literature and the clinical approach to two conditions: ankylosing spondylitis and lumbar spinal stenosis. As you can see, the Saturday session was packed with use- ful information and an attempt at reviewing it all can merely scratch the surface – for this reason, I encourage all of you to attend future research symposia at CMCC. Chiropractors who pursue research dedicate their lives to our discipline through their work, and their passion for knowledge and improving patient outcomes is exemplary. Their research will ensure our continuing success and improve our profession. They truly de- serve our admiration and gratitude. The present and future of chiropractic research is very bright! • www.canadianchiropractor.ca
Chiropractic + Naturopathic Doctor December 2009: Page 62
