Can Chiropractic help increase or decrease reproduction?
Evidence-Based Chiropractic Assignment
(For my assignment write about: I wanted to see if chiropractic care prior to sports related activities will reduce/prevent injuries compared to athletes that do not see the chiropractor annualy)
Chiropractic care can be beneficial to everyone. It is even more critical for athletes. In competitive sports, the difference between winning is sometimes measured in seconds. Athletes must gain every bit of stre.and speed they possibly can. However, when injuries happen, they turn to chiropractic care in place of other invasive options for pain relief. An area chiropractic care has been used for athletes is during stress reactions or fractures. However, some Universities sports medicine departments do not have chiropractors on staff for their athletes. Therefore, having credible research to enforce the claim that chiropractors can indeed be a benefit for an athlete would be substantial. However, I wanted to see if chiropractors could help diagnosis and healing process of stress fractures in athletes. Therefore, I performed a literature search on chiropractic care frequency of adding in the diagnosis and healing process in athletes. My hypothesis is as follows: chiropractic care can aid in the diagnosis and recovery process of stress fractures.
(for my paper my search term method was, “Chiropractic injury prevention)
For my literature search I utilized EBSCOhost SPORTS Discus, CINAHL, and PubMed. My search term was “chiropractic AND stress fractures.” I did not want to use the term athlete in place of stress fracture due to a wide variety of items that would be available for chiropractic and athletes. When researching I found that CINAHL had ten articles, SPORTS Discus had eight articles, and lastly PubMed had 16. When examining the articles in CINAHL, five of the ten articles pertained to my hypothesis. Diving further into each database I found that for EBSCOhost SPORTS Discus only two were relevant to my hypothesis. Furthermore, of the 16 available for PubMed three were significant for my hypothesis. Next, I changed the search using “chiropractic AND fracture.” With the change CINAHL had a total of 153 results with again five being important for my hypothesis. For SPORTS Discus a total of 74, 14 of the studies had information to add to my hypothesis. PubMed had 118 results and four were significant. Overall, with changing my search term it did not help. There were more results however the focus had become much larger. The references from my three databases EBSCOhost SPORTS Discus, CINAHL, and PubMed using “Chiropractic AND stress fracture” and “Chiropractic AND fracture” are listed below:
Avrahami DJ, Paiaczkowski JA. Femoral neck stress fracture in a female athlete: a case report. Journal of Chiropractic Medicine. 2012; 11(4):273-279
Battaglia PJ, Kaeser MA, Kettner NW. Diagnosis and serial sonography of a proximal fifth metatarsal stress fracture. Journal of Chiropractic Medicine. 2013; 12(2):196-200.
Castlereagh F, Pollard H. Traumatic spondylolysis in a heptathlete: a case history and review. Journal of Chiropractic Medicine. 2005; 4(2):89-96
Hubka, MJ, Cassidy JD, Dust W. Femoral neck stress fracture presenting as low back pain. Journal of Canadian Chiropractic Association. 1992; 36(4):217.
Lapp JM. Pelvic stress fracture: assessment and risk factors. Journal of Manipulative & Physiological Therapeutics. 2000; 23(1):52-55.
Lemire JJ, O’Connor SM. Femoral neck stress fracture a potentially disable condition: a case study. Journal of the Canadian Chiropractic Association. 1993; 37(2): 85.
McVey MJ, Kettner NW. Pathologic fracture of metacarpal enchondroma: case study and differential diagnosis. Journal of Manipulative & Physiological Therapeutics. 2002; 25(5); 340-344.
Mussmann SE, Poirier JN. Snowboarder’s fracture caused by a wakeboarding injury: a case report. Journal of Chiropractic Medicine. 2010; 9(4):174-178.
Plezbert JA, Oestreich AT. Fracture of a lamina in the cervical spine. Journal of Manipulative & Physiological Therapeutics.1994; 17(8):552-7.
Uhrenholt L. Serious Bicycle crash injury in chiropractic practice- a case report of delayed diagnosis. Journal of Manipulative & Physiological Therapeutics. 2016; 1; 24-40.
Those articles above have information that was significant for my research. If I used other key words or even the ones I presented above, there are many articles that will be displayed which have irrelevant information. While combing through each article, I found information which was not helpful as I mentioned. Determining if information was supportive of my hypothesis was done through numerous avenues. First, some of the article only had chiropractic in the journal title, the article did not discuss using a chiropractor in the diagnosis phase or during recovery. Another issue was that I was focusing on athletes, many articles had fractures occur from falling or other methods. I realized, I could have added the search term athlete, however, in my experience doing my thesis and research on Division I athletes is that when reading an article on stress fractures the authors will cite articles about athletes. This will allow you to further investigate articles which will include athletes and stress fractures. Therefore, I deemed my search terms relevant to identify the information I was looking for. Lastly, articles appeared which only included part of the search term about case studies.
(study 1)While diving deeper into each article I found that Avrahami et al. (2012) examined a 41-year-old personal trainer who competed in mountain biking and cross-country skiing. A sports physician diagnosed the patient had a stress fracture in the right femur. At one week she was referred to a chiropractor who assisted in the rehabilitation through non-weight bearing strengthening exercises, myofascial release, and motion palpation testing of the lumbar and sacroiliac joints. After eight weeks the patient reported 0/10 for pain on the numeric rating scale. This article really aided in the question does chiropractic care help in the recovery process of stress fractures.
(study 2)The next study which was also a case study is a bit different, Battaglia et al. examined a case where the patient went to a chiropractor with a chief complain of foot pain. Three days after the patient ended up in an urgent care due to the pain where they diagnosed as a stress fracture. The reason I included this was because the first place the patient went was a chiropractor. The study did not go into detail about the care the chiropractor administered, however she did end up in an urgent care, therefore, one can assume the chiropractor did not take x-rays. This study did not aid in my questions, yet it did help clarify the information I wanted to understand: can a chiropractor diagnose a stress fracture early or at first onset of a pain, as well as can they then aid in the recovery process.
(study 3) A study conducted by Hubka et al. (1992) examined a female aerobics instructor who had low back pain when she woke up. She waited six weeks to go to a family physician referred the patient for chiropractic evaluation for possible lower back nerve root entrapment and sacroiliac join syndrome. The diagnosis was mechanical lower back pain with left sacroiliac join syndrome. She was treated daily for one and a half weeks however there were no improvements. The patient was sent back to the family physician for a follow up, the imaging found that she had a sub capital stress fracture of the left femur. This study was interesting, first, it was great to read about the doctors working closely together on a patient. I also found it interesting that the there was no mention of imaging at the chiropractic care office. Therefore, this does not fully answer my question to if a chiropractor can diagnose a stress fracture and aid in the recovery process.
(research conducted study,case,treatment)) Following that study is the research conducted by Castlereagh et al. (2005). The case study was conducted on a 21-year-old heptathlete who had experienced low back pain after the second day of an event during the javelin. She visited a chiropractor who diagnosed stress fracture of the pars interarticularis. After 9 months of recovery she became to have manipulation of the L4/g which provided relief to the pain she was experiencing after sitting for long periods of time. This study was useful in answer my initial question can chiropractor’s diagnosis stress fractures. Also, the chiropractor aided in the recovery process.
(another study)Another study with similar methodology included a patient who had hip pain after running. She was diagnosed with an inferior pubic ramus stress fracture. The part of this study that was especially interesting was that the intervention included low-amplitude chiropractic manipulation, along with stretching of the psoas and piriformis. This study did not answer the question of if chiropractors can diagnosis the stress fracture, due to the fact that the study did not mention where the films were taken. However, it did explain that chiropractic care can be beneficial to the recovery of a stress fracture, specifically in this case the patient felt significant pain reduction after eight weeks.
(another patient study)Lemire et al. (1993) examined a patient at a chiropractic clinic who had a three-day history of left groin pain after running. The patient was diagnosed with a femoral neck stress fracture. This answers the first part of my hypothesis of which I wanted to know if chiropractors could indicate a stress fracture in a patient. The article explained that the patient did a number of different rehabilitation exercises which she felt worse after, none of the interventions were chiropractic techniques. This makes me question the idea of if chiropractic techniques were used would her pain have decreased. Therefore, I cannot conclude if chiropractic care would have made a difference.
(ANother study) A study conducted by McVey et al. (2002) found that in a 25-year-old male who had an athletic trauma had a fracture in the first metacarpal with a resultant anterior angulation of the distal fragment. An interesting aspect is the patient with the trauma was a chiropractic student. Therefore, they did not go into detail about who did the x-rays or the intervention. This study is hard to use for my hypothesis due to the fact that details were not given.
(STUDY with evidence supporting claim of yes chiropractic care helps prevent or not)
Yet another study which gives evidence to chiropractor’s diagnosis fractures is conducted by Mussmann et al. (2010). A wakeboarder presented an ankle injury to the chiropractic clinic where they diagnosed his injury was a lateral talar process fracture. Then he was referred to a local orthopedic for assistant. In conclusion this study answered my question on if chiropractors can diagnose fractures, however, there was no indication that the chiropractor did any treatment for recovery.
(STUDY)In a study conducted by Plezbert et al. (1994) a man had mild neck pain and stiffness due to a car accident. Therefore, this study does not refer to athlete, yet the methodology can still be useful in other studies. At the emergency room he had x-rays indicating a fracture adjacent to the anterior superior end plate of C6/ and a cervical lamina fracture of C5. For intervention he had soft tissue, gentle manual cervical traction and pain and stiffness was cleared by his six weeks follow up. Therefore, even though this injury was not athletic related chiropractors were utilized during the recovery to enable care.
Ultimately, I found some citations on chiropractic care being the first place many people went when they had a pain, and from there the chiropractor diagnosed a stress fracture or fracture, however, some chiropractors missed the fracture which I associated to lack of imaging. I would consider this review semi-successful. I imaged I would have found more information on the care throughout the stress fracture using Pulsed Electromagnetic Field therapy or other modalities, along with continuing adjustments to ensure the body can properly heal itself. One reason for the lack of results could be due to the limited research on this topic. Further research should be explored to enhance the healing process for elite athletes. I found CINAHL and PubMed to have the most results, yet SPORTS Discus had the majority of the significant journal articles for my topic. In conclusion, with the information I found through this literature review I do believe chiropractors are a first line of communication when having a potential stress fracture. This is important due to the fact that having a stress fracture would change the treatment plan for a patient. However, it is difficult to make a conclusion if chiropractic care can be beneficial in the treatment of stress fractures due to limited research. Furthermore, research should be completed in this area to give athletes as well as anyone with a stress fracture the best possible recovery.