treatment of LBP. In general, the rec- ommended indication for SMT/MOB is non-specifi c, mechanical CLBP. As such, the authors of this review could only rec- ommend that patients who do not have any of the contraindications listed below are potential candidates for SMT/MOB. Contraindications to SMT/MOB include: Red Flags: fever, unrelenting night pain or pain at rest, pain with below the knee numbness or weakness, leg weak- ness, loss of bowel/bladder control, pro- gressive neurological defi cit, history of cancer, unexplained weight loss; frac- ture; osteoporosis; trauma causing tissue disruption in the area being treated. The authors briefl y mentioned the emerging research on acute LBP (in the form of the LBP Clinical Prediction Rule from Delitto, Fritz, Childs et al.) that has identifi ed characteristics that can help distinguish patients who are more likely to respond favourably to SMT including: symptom duration less than 16 days no symptoms distal to the knee Fear Avoidance Beliefs Question- naire score less than 19 hypomobility of one or more seg- ments of the lumbar spine internal hip rotation greater than 35 degrees on one or both sides Please note, the Clinical Prediction • • • • • Rule has been summarized in a previous review that can be found on the Research Review Service. RESULTS OF LITERATURE REVIEW: Forty-two studies were identifi ed evalu- ating SMT/MOB for CLBP – eight more than the most recent large scale review on this topic; overall, the literature provides moderate to strong evidence in favour of SMT for mixed –but pre- dominantly chronic – LBP; in terms of patient-rated pain, SMT with strength- ening exercise is similar to prescription NSAIDs with exercise in the short and long term (moderate evidence); SMT/ MOB is superior to usual medical care and placebo for patient improvement (moderate evidence); high-dose SMT is superior to low-dose SMT for pain in the very short term, and similar in the short- term; fl exion-distraction MOB is superior to a combined exercise program for pain in the short term and superior/similar in the long term, and has a similar effect on disability as a combined exercise pro- gram; for mixed – mainly chronic – LBP, there is strong evidence that SMT is simi- lar to a combination of medical care and exercise in terms of short- and long-term patient-rated pain and disability; there is moderate evidence that SMT is superior to physical therapy and to home exercise in the long-term (bear in mind that many physical therapists do perform SMT). POTENTIAL HARMS OF LUMBAR SMT: SMT is generally a safe intervention PARKER SEMINARS MONTREAL – FORMIDABLE! The Hilton Montreal Bon- aventure hotel was the loca- tion of another successful Parker Seminars installment from May 15-17. Featuring some of the most power- ful lecturers in chiropractic – including speakers for chiropractic assistants – the weekend offered over 800 attendees extensive knowl- edge and information on the art, science and philosophy of chiropractic. Many thanks to all the event organizers and especially to Dr. Fabrizio Mancini, president of Parker College and our own Dr. Gilles Lamarche whose calm-and-cool guidance ensures, time and again, that the seminars are an enjoyable and powerful experience for all. Dr. Lamarche closed the weekend with a challenge for all to bring the message of chiropractic to the offi ce, the patients and the public. Next stop, Parker Seminars in Rimini, Italy, June 26-28, 2008 – fi re up your Vespa and come celebrate with Italian chiropractors, who just recently achieved professional recogni- tion in their country! 14 • CANADIAN CHIROPRACTOR | JUNE 2008 – most commonly associated with only benign, temporary side effects includ- ing local soreness which typically does not interfere with regular activity. Rare adverse events associated with lumbar SMT can include lumbar disc hernia- tion (LDH) and cauda equina syndrome (CES) – because of the low incidence, true risk estimates are tough to establish. The best available evidence, as summa- rized by these authors, places the risk of LDH or CES subsequent to lumbar SMT at approximately: one event in 3.72 mil- lion treatments CONCLUSIONS AND PRACTICAL APPLICATION: This paper provided a current synthesis of existing literature on the management of CLBP with SMT/MOB. The addition of newer evidence that has emerged since the last major review on this topic has strengthened the evidence regarding the effi cacy of SMT/MOB for CLBP. Future studies should focus on the treatment of well-defi ned groups of pa- tients, according to reliable and validated diagnostic classifi cation systems such as the LBP Clinical Prediction Rule (which also needs to be further studied and vali- dated). This will serve only to strengthen the quality of research in this area, and better guide clinical practice. • For article with references please visit www.canadianchiropractor.ca. VIBRA-PR THERAPY Vibra-Pro is th largest distrib of the newest tech- nology in vibr health. Man offi ces are no ing vibration fi patient treatm Recent resear has shown that WBV train- ing may be ef rehabilitation with spinal co dysfunction, blood circulation issues, and muscle- skeletal problems. Please contac Vibra-Pro for information. www.vibra-pro.com www.canadianchiropractor.ca news new product
Chiropractic + Naturopathic Doctor June 2008: Page 14
