Effects of Chiropractic Care on Strength, Balance, and Endurance in Active-Duty U.S. Military Personnel with Low Back Pain: A Randomized Controlled Trial

Vining, Robert D.; Long, Cynthia R.; Minkalis, Amy L.; Gudavalli, Maruti R.; Xia, Ting; Walter, Joan; Coulter, Ian D.; Goertz, Christine

doi:10.1089/acm.2020.0107

Cited by 29 publications

(41 citation statements)

References 45 publications

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“…Although we successfully programmed and used remote electronic data collection for previous clinical trials [ 9 , 66 , 67 ], this was our first time using REDCap. We had no issues using REDCap but recognize the necessity of strict reminder protocols and less assessment times and questionnaires.…”

Section: Discussionmentioning

confidence: 99%

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Care Outcomes for Chiropractic Outpatient Veterans (COCOV): a single-arm, pragmatic, pilot trial of multimodal chiropractic care for U.S. veterans with chronic low back pain

Long

Salsbury

Vining

et al. 2022

Pilot Feasibility Stud

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Background Over 25% of veterans seeking care at U.S. Veterans Health Administration facilities have chronic low back pain (LBP), with high rates of mental health comorbidities. The primary objective of this study was to assess the feasibility of participant recruitment, retention, and electronic data collection to prepare for the subsequent randomized trial of multimodal chiropractic care for pain management of veterans with chronic low back pain. The secondary objectives were to estimate effect sizes and variability of the primary outcome and choose secondary outcomes for the full-scale trial. Methods This single-arm pilot trial enrolled 40 veterans with chronic LBP at one Veterans Health Administration facility for a 10-week course of pragmatic multimodal chiropractic care. Recruitment was by (1) provider referral, (2) invitational letter from the electronic health record pre-screening, and (3) standard direct recruitment. We administered patient-reported outcome assessments through an email link to REDCap, an electronic data capture platform, at baseline and 5 additional timepoints. Retention was tracked through adherence to the treatment plan and completion rates of outcome assessments. Descriptive statistics were calculated for baseline characteristics and outcome variables. Results We screened 91 veterans over 6 months to enroll our goal of 40 participants. Seventy percent were recruited through provider referrals. Mean age (range) was 53 (22–79) years and 23% were female; 95% had mental health comorbidities. The mean number of chiropractic visits was 4.5 (1–7). Participants adhered to their treatment plan, with exception of 3 who attended only their first visit. All participants completed assessments at the in-person baseline visit and 80% at the week 10 final endpoint. We had no issues administering assessments via REDCap. We observed clinically important improvements on the Roland-Morris Disability Questionnaire [mean change (SD): 3.6 (6.1)] and on PROMIS® pain interference [mean change (SD): 3.6 (5.6)], which will be our primary and key secondary outcome, respectively, for the full-scale trial. Conclusions We demonstrated the feasibility of participant recruitment, retention, and electronic data collection for conducting a pragmatic clinical trial of chiropractic care in a Veterans Health Administration facility. Using the pilot data and lessons learned, we modified and refined a protocol for a full-scale, multisite, pragmatic, National Institutes of Health-funded randomized trial of multimodal chiropractic care for veterans with chronic LBP that began recruitment in February 2021. Trial registration ClinicalTrials.gov NCT03254719

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Section: Discussionmentioning

confidence: 99%

“…A limitation of a single-arm study is that the willingness of patients to be randomly allocated to a treatment group is not assessed. However, our success in conducting randomized clinical trials in complex clinical environments within military healthcare facilities reduces this limitation [ 9 , 66 , 67 ].…”

Section: Discussionmentioning

confidence: 99%

Care Outcomes for Chiropractic Outpatient Veterans (COCOV): a single-arm, pragmatic, pilot trial of multimodal chiropractic care for U.S. veterans with chronic low back pain

Long

Salsbury

Vining

et al. 2022

Pilot Feasibility Stud

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“…However, this study does indicate a change in neuromuscular function of the erector spinae muscles following the adjustment session (Keller and Colloca 2000 ). Interestingly, this study has been followed up with a recent RCT in active-duty military personnel with low back pain that found improved isometric pulling strength from a semi-squat position following 4 weeks of chiropractic care that included thoracolumbar and/or pelvic manipulation, education and self-management advice about daily activities that may benefit as compared to a wait-list control group (Vining et al 2020 ). This study did not specify whether or not the chiropractor applied their HVLA thrusts at dysfunctional spinal segments or not, but simply noted they provided manipulations at the lower back or other spinal regions or extremities as ‘clinically indicated’.…”

Section: Methodsmentioning

confidence: 99%

“…However, it may have less of a central neural effect compared to adjustments of CSMC problems. It is also possible that some of the publications that did not specify how they chose to direct their HVLA thrusts did direct them at CSMC problems, and this may be the reason for the induced central neural plastic changes (e.g., Vining et al ( 2020 )). The significant increases in force that occur after adjustments of CSMC problems have been shown in various muscle groups, such as upper limb muscles (Cleland et al 2004 ; Kingett et al 2019 ), lower limb muscles (Christiansen et al 2018 ; Holt et al 2019 ; Niazi et al 2015 , 2020 ), trunk muscles (Keller and Colloca 2000 ), and jaw clenching muscles (Haavik et al 2018a , b ).…”

Section: Methodsmentioning

confidence: 99%

“…The ability of spinal adjustments or spinal manipulation to alter corticomotor excitability is supported by multiple studies that have shown changes in force output or background muscle activity following single or repeated sessions of spinal adjustments or manipulations (see Table 1) (Christiansen et al 2018;Haavik et al 2016aHaavik et al , b, 2018aNiazi et al 2015Niazi et al , 2020Dunning and Rushton 2009;Cleland et al 2004;Holt et al 2019;Botelho and Andrade 2012;Hillermann et al 2006;Vining et al 2020;Keller and Colloca 2000;Humphries et al 2013;Grindstaff et al 2009;Fernandez-Carnero et al 2008;Galindez-Ibarbengoetxea et al 2017;Lo et al 2019). As mentioned earlier (and highlighted in Table 1) the various authors of these publications may or may not have used the terminology 'central segmental motor control (CSMC) problems' to describe any dysfunctional spinal segments.…”

Section: Direct Strength or Background Muscle Tone Changes Following Spinal Adjustment Or Manipulationmentioning

confidence: 99%

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The contemporary model of vertebral column joint dysfunction and impact of high-velocity, low-amplitude controlled vertebral thrusts on neuromuscular function

et al. 2021

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Purpose There is growing evidence that vertebral column function and dysfunction play a vital role in neuromuscular control. This invited review summarises the evidence about how vertebral column dysfunction, known as a central segmental motor control (CSMC) problem, alters neuromuscular function and how spinal adjustments (high-velocity, low-amplitude or HVLA thrusts directed at a CSMC problem) and spinal manipulation (HVLA thrusts directed at segments of the vertebral column that may not have clinical indicators of a CSMC problem) alters neuromuscular function. Methods The current review elucidates the peripheral mechanisms by which CSMC problems, the spinal adjustment or spinal manipulation alter the afferent input from the paravertebral tissues. It summarises the contemporary model that provides a biologically plausible explanation for CSMC problems, the manipulable spinal lesion. This review also summarises the contemporary, biologically plausible understanding about how spinal adjustments enable more efficient production of muscular force. The evidence showing how spinal dysfunction, spinal manipulation and spinal adjustments alter central multimodal integration and motor control centres will be covered in a second invited review. Results Many studies have shown spinal adjustments increase voluntary force and prevent fatigue, which mainly occurs due to altered supraspinal excitability and multimodal integration. The literature suggests physical injury, pain, inflammation, and acute or chronic physiological or psychological stress can alter the vertebral column’s central neural motor control, leading to a CSMC problem. The many gaps in the literature have been identified, along with suggestions for future studies. Conclusion Spinal adjustments of CSMC problems impact motor control in a variety of ways. These include increasing muscle force and preventing fatigue. These changes in neuromuscular function most likely occur due to changes in supraspinal excitability. The current contemporary model of the CSMC problem, and our understanding of the mechanisms of spinal adjustments, provide a biologically plausible explanation for how the vertebral column’s central neural motor control can dysfunction, can lead to a self-perpetuating central segmental motor control problem, and how HVLA spinal adjustments can improve neuromuscular function.

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Integrative Approaches for Cancer Pain Management

Martini,

Brown,

Singh

et al. 2024

Curr Oncol Rep

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Effects of Chiropractic Care on Strength, Balance, and Endurance in Active-Duty U.S. Military Personnel with Low Back Pain: A Randomized Controlled Trial

Cited by 29 publications

References 45 publications

Care Outcomes for Chiropractic Outpatient Veterans (COCOV): a single-arm, pragmatic, pilot trial of multimodal chiropractic care for U.S. veterans with chronic low back pain

Care Outcomes for Chiropractic Outpatient Veterans (COCOV): a single-arm, pragmatic, pilot trial of multimodal chiropractic care for U.S. veterans with chronic low back pain

The contemporary model of vertebral column joint dysfunction and impact of high-velocity, low-amplitude controlled vertebral thrusts on neuromuscular function

Integrative Approaches for Cancer Pain Management

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