Journal of Chiropractic Medicine RSS feed: Articles in Press. The Journal of Chiropractic Medicine is a peer-reviewed journal devoted to providing a forum for the chiropractic profession to disseminate information dedicated to the developing primary care emphasis within the profession. The journal focuses on providing practical and applicable information for the practicing doctor of chiropractic. http://www.journalchiromed.com//inpress?rss=yesElsevier Inc.en © 2012 National University of Health Sciences. Published by Elsevier Inc. All rights reserved. Journal of Chiropractic Medicine1556-37072012-03-09 © 2012 National University of Health Sciences. Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.journalchiromed.com/article/PIIS1556370712000119/abstract?rss=yesAbstract: Objective: Spondylolisthesis is a pathological condition characterized by the slipping of a vertebral body, compared with the underlying one, following structural and/or degenerative changes of the spine. The purpose of this case series is to describe clinical presentations and the conservative physiotherapy management of 4 patients with low back pain and lumbar isthmic spondylolisthesis.Clinical Features: Four patients aged 25, 43, 36, and 50 years presented with low back pain of various duration. Radiographs confirmed the presence of lumbar isthmic spondylolisthesis. Outcome measures included numerical rating scale, disability outcome measure (Oswestry Disability Index), spinal instability tests (Prone Instability Test, Passive Lumbar Extension test), and muscle function tests (Aberrant Movement Patterns, Active Straight Leg Raising, Prone and Supine Bridge Tests).Intervention and Outcomes: Treatment consisted of postural reeducation, stretching, and strengthening exercises. Over the course of individualized treatment, ranging from 8 to 10 treatment visits, outcomes improved for all 4 patients.Conclusion: This report describes varying clinical presentations and treatment of 4 patients with isthmic spondylolisthesis, suggesting that different pain generators could be managed by different conservative approaches.Clinical presentation and physiotherapy treatment of 4 patients with low back pain and isthmic spondylolisthesis - Corrected ProofSilvano Ferrari, Carla Vanti, Caroline O'Reilly10.1016/j.jcm.2011.11.001Journal of Chiropractic Medicine (2012)2012-03-09Journal of Chiropractic Medicine2012-03-09http://www.journalchiromed.com/article/PIIS1556370712000053/abstract?rss=yesAbstract: Objective: The purpose of this case report is to describe the evaluation and conservative management of an isolated posterior cruciate ligament (PCL) tear.Clinical Features: A 32-year-old man with a traumatic right knee injury after tripping was initially diagnosed with medial patellar retinaculum tear at a multidisciplinary clinic. The patient received physiotherapy but reinjured the knee after returning to the sports field 3 weeks later. Subsequent clinical testing and magnetic resonance imaging confirmed a grade II isolated PCL tear.Intervention and Outcome: Following the PCL tear diagnosis, a multimodal treatment approach over the course of 8 weeks consisting of chiropractic lumbopelvic manipulation, physiotherapy, and an exercise program emphasizing eccentric muscle action was implemented. Lunges, 1-leg squats, and trunk stabilization exercises were extensively used. Three months postinjury, the patient successfully returned to sports activity with no further complications.Conclusion: The patient in this case report demonstrated successful return to preinjury functional status. This case highlights a multidisciplinary approach through the utilization of chiropractic, physiotherapy, and exercise therapies.Multimodal and interdisciplinary management of an isolated partial tear of the posterior cruciate ligament: a case report - Corrected ProofMatthew Fernandez, David Pugh10.1016/j.jcm.2011.10.005Journal of Chiropractic Medicine (2012)2012-03-07Journal of Chiropractic Medicine2012-03-07http://www.journalchiromed.com/article/PIIS1556370712000065/abstract?rss=yesAbstract: Objective: The purpose of this case report is to describe the chiropractic management of a 39-year-old woman with essential tremors and migraine headaches.Clinical Features: A 39-year-old woman presented with essential tremors and migraine headaches, which occurred 2 to 3 times per week. The essential tremor was diagnosed in 2000, and migraine headaches with aura were diagnosed when she was 10. Both diagnoses were made by her general medical practitioner. Previous treatments for migraine included propranolol, isometheptene, dichloralphenazone, acetaminophen, sumatriptan, and over-the-counter pain relievers.Intervention and Outcome: The patient received high-velocity, low-amplitude chiropractic spinal manipulation to her upper cervical spine using the Blair Upper Cervical chiropractic technique protocol. There was improvement in her tremors and migraine headaches following her initial chiropractic treatment, with a sustained improvement after 4 months of care.Conclusion: This case study demonstrated improvement in a woman with essential tremors and migraine headaches. This suggests the need for more research to examine how upper cervical specific chiropractic care may help mitigate tremors and migraine headaches.Chiropractic management of essential tremor and migraine: a case report - Corrected ProofTodd A. Hubbard, Janice D. Kane10.1016/j.jcm.2011.10.006Journal of Chiropractic Medicine (2012)2012-03-07Journal of Chiropractic Medicine2012-03-07http://www.journalchiromed.com/article/PIIS1556370712000077/abstract?rss=yesAbstract: Introduction: The purpose of this case report is to describe the clinical presentation, examination findings, and management decisions of a patient with thoracic myelopathy who presented to a chiropractic clinic.Case Report/Methods: After receiving a diagnosis of a diffuse arthritic condition and kidney stones based on lumbar radiograph interpretation at a local urgent care facility, a 45-year-old woman presented to an outpatient chiropractic clinic with primary complaints of generalized low back pain, bilateral lower extremity paresthesias, and difficulty walking. An abnormal neurological examination result led to an initial working diagnosis of myelopathy of unknown cause. The patient was referred for a neurological consult.Results: Computed tomography revealed severe multilevel degenerative spondylosis with diffuse ligamentous calcification, facet joint hypertrophy, and disk protrusion at T9-10 resulting in midthoracic cord compression. The patient underwent multilevel spinal decompressive surgery. Following surgical intervention, the patient reported symptom improvement.Conclusion: It is important to include a neurologic examination on all patients presenting with musculoskeletal complaints, regardless of prior medical attention. The ability to recognize myelopathy and localize the lesion to a specific spinal region by clinical examination may help prioritize diagnostic imaging decisions as well as facilitate diagnosis and treatment.Clinical presentation of a patient with thoracic myelopathy at a chiropractic clinic - Corrected ProofCharles W. Gay, Mark D. Bishop, Jacqueline L. Beres10.1016/j.jcm.2011.10.007Journal of Chiropractic Medicine (2012)2012-03-07Journal of Chiropractic Medicine2012-03-07http://www.journalchiromed.com/article/PIIS1556370712000089/abstract?rss=yesAbstract: Objective: Traction apophysitis is a common condition in physically active and skeletally immature adolescents. This case study describes the clinical presentation and plain film imaging of traction apophysitis of the acromion process of the scapula.Clinical Features: A physically active 13-year-old adolescent boy presented to a chiropractic physician with an acute onset of moderate shoulder pain. Plain film radiographs of the shoulder were performed that revealed fragmentation, sclerosis, and irregularity of the left acromial apophysis.Intervention and Outcome: The patient was treated with conservative therapy for 10 weeks, with complete resolution of symptoms. Follow-up radiographs 9 weeks later revealed no radiographic change in the appearance of the apophysis; however, clinical symptoms were absent. The apophyseal growth cartilage is the most vulnerable site in the muscle-tendon unit in the skeletally immature patient and is more susceptible to very small avulsion fractures. Repetitive microtrauma following chronic overuse at a tendon insertion site in a skeletally immature patient may result in traction apophysitis.Conclusions: Acromial apophysitis should be included in the differential diagnosis when presented with a young active patient with shoulder pain. Early treatment with restriction of activities is important in the prevention of permanent injury to the acromial cartilaginous growth plate. This case demonstrates that a prompt diagnosis can be made with a careful history, physical examination, and conventional imaging.Acromial apophysitis in a 13-year-old adolescent boy: a common condition in an uncommon location - Corrected ProofErin Quinlan, William C. Bogar10.1016/j.jcm.2011.10.008Journal of Chiropractic Medicine (2012)2012-03-07Journal of Chiropractic Medicine2012-03-07http://www.journalchiromed.com/article/PIIS1556370712000107/abstract?rss=yesAbstract: Objective: Lumbosacral transitional vertebrae (LSTV) are relatively common skeletal anomalies with a debated role in low back pain. There are few documented cases of conservative care being used to address LSTV-associated symptomatology. The current report discusses chiropractic management of 2 patients with unilateral sacralization.Clinical Features: Two patients with LSTV involving unilateral sacralization of L5, a Castellvi type IIIa variant, presented with back pain to a chiropractic clinic. Each case presented with symptomatology similar to piriformis syndrome.Intervention and Outcome: Manual therapy, including spinal manipulation soft tissue therapies and exercise/stretching, was used to address the presenting symptoms. Approximately 2 weeks after initial treatment, the first patient subjectively reported a 70% improvement in symptoms, with lumbar extension increased to full in active range of motion at the lumbar spine but with continued tenderness and hypertonicity at the left piriformis and gluteus medius. After 4 weeks of treatment, the second patient reported improvement in pain and perceived mobility, although prolonged standing remained an aggravating factor. Although both showed improvement, neither case resulted in complete resolution of symptoms.Conclusion: The presenting cases demonstrated partial resolution of symptoms after chiropractic management. It is proposed that sacralization is a possible cause of back pain in these cases.Partial lumbosacral transitional vertebrae: 2 cases of unilateral sacralization - Corrected ProofJeffrey M. Muir10.1016/j.jcm.2011.12.002Journal of Chiropractic Medicine (2012)2012-03-07Journal of Chiropractic Medicine2012-03-07