CCE “Cartel” is at it Again

PRE PRESS-RELEASE ARTICLE

Dr. Joe Betz, B.S., D.C

ICA Board Member,

PCCRP Board Member

Private Practice Boise, ID

Idaho Chiropractic Association Board Member

CBP Instructor

INTRODUCTION

Few organizations dictate the direction of the Chiropractic profession more than the Council on Chiropractic Education (CCE). CCE is the agency recognized by the U.S. Department of Education for accrediting schools offering the “doctor of chiropractic” degree. The CCE along with the National Board of Chiropractic Examiners (NBCE) really dictate what will be taught at a chiropractic college. However, to say that certain actions by CCE have been controversial over the years is an understatement. Furthermore, to insinuate that CCE acts as an impartial entity not biased in any one direction is ridiculous.

As an example, CCE viciously attacked Life University’s accreditation, several years ago now, leading to a hearing on June 6, 2006 where CCE and the incestuous nature of the organization (and affiliates) were referred to as having “cartel” control over the profession. Dr. Denardis, as one of the individuals hearing the case for the National Advisory Committee on Institutional Quality and Integrity stated,

“Battles over turf, battles over philosophy, maybe battles over personal ambition, but divisions of every kind. And some of this, maybe most of it, is a consequence of, at least as I see it, a monopoly control of a profession which has led to the establishment of a virtual cartel…”

The essence of the above quote pretty well sums up our profession. The cartel control of the profession breeds the bitter battle mentality that we deal with on a regular basis. It is the minority at the top (‘cartel’) demanding it be their way or the highway that breeds the internal problems in our profession. The majority (the rest of us in the Chiropractic Profession) is obviously sick of it; suggested by the fact that most of the profession will not join a national association.

CURRENT PROBLEM

Now the CCE is at it again. The CCE has “Standards” which are used to determine if a Chiropractic school can obtain accreditation. These Standards are a necessity to have guidelines for judging whether students are being prepared to practice responsibly. It so happens that the CCE Standards are being re-written and have been available for review and comment until September 24, 2010; though most of the profession has not been made aware of this?

There are 4 basic components of the proposed Standards that have brought on the ire of much of the profession:

1. A proposal to expand the degree programs accredited by the CCE beyond the D.C. degree to “equivalent” degree offerings

CCE has taken an unprecedented step by declaring that they can offer accreditation for degree programs other than the DC degree. To top it off, these “other degree equivalents” are determined by CCE! This has long been a goal of the “Chiropractor as Primary Care Physician” camp. National University already uses the phrase “Doctor of Chiropractic Medicine” (DCM) on its website and in describing its program within CCE materials. Again this is the next step to push for tiering of the profession. And now the CCE seems to be conspiring in this goal.

1. The elimination of any and all references to the concept of subluxation, vertebral subluxation or vertebral subluxation complex

One would think that identifying subluxation and correcting subluxation would be an important part of a chiropractic education program. Apparently CCE doesn’t agree. All references to subluxation have been removed from the proposed Standards. A school no longer needs to teach its students to take an X-ray, learn about subluxation or even how to adjust a patient!

1. The elimination of the section addressing the “Purpose of Chiropractic Education” which includes the references to the profession being oriented toward health care “without the use of drugs and surgery.”

Should chiropractic colleges teach that chiropractic is a drug free healing profession? CCE no longer thinks so. This and other very important “identity” elements have been removed from the requirements under one of the most important sections of the current Standards describing the “Purpose of Chiropractic Education”. Apparently the CCE wants the profession to get in on the pharmaceutical game. Could this be driven by monetary incentives or future prospects of the $$$$ to come our way by dishing out the internal organ destructive candies of our era? I’ll let the reader decide.

1. The modification of the term and definition of “Chiropractic primary care physician”

The proposed Standards have shifted the image of a DC from a “primary care Chiropractic physician” meaning portal of entry, able to diagnose doctor to “chiropractic primary care physician” meaning primary care physician in the traditional medical sense referring to MD’s and DO’s. This theme is obvious throughout the changes in the Standards.

DISCUSSION

The four changes presented above amount to an unprecedented attack on Chiropractic as a drugless healing profession focused on adjusting a patient’s spine. CCE appears to be pushing for a segregated profession where some colleges can teach pharmacology (with the intent of prescribing), surgical procedures, etc. all under the guise of a fabricated “Doctor of Chiropractic Medicine” (DCM) program. Then these DCM’s can go practice (and be certified by the state) as an “advanced” chiropractic physician in New Mexico.

The assault on our profession from within has reached unprecedented levels. If the silent majority does not speak up and do so very quickly, the chiropractic profession as we know it will cease to exist. You can no longer go into your practice and just adjust your patients and go home. You need to work to protect what we have inherited. It is our responsibility.

CALL TO ACTION

First, please join your state association, ask what you can do to help them, and request that they oppose this cartel’s actions. Second, join a national association that represents your interests and request that they respond to this cartel’s actions.

We’ve heard this so many times, but now it rings louder, clearer, and with more certainty than ever: A divided profession topples over at the slightest push, but a united profession can resist most all forces and stand the test of time. If the majority of the Chiropractic profession belonged to one of its associations, said association could speak with strength, power and certainty and have the where-with-all to back it up.

References of Interest

1. Click here to view the full text of the latest version of the proposed CCE Standards online:
   http://www.cce-usa.org/uploads/Draft__2_Standards_Combined.pdf
2. ICA and CBP Researchers have developed model comments on the CCE new proposed Standards. Please click here to view these model comments:
   http://members.chiropractic.org/asset/docs/MODELCCECOMMENTS.doc
3. Dr. Gerry Clum (President of Life Chiropractic College West) has succinctly summarized the CCE proposal in the following clipping from his positional paper found at http://www.lifewest.edu/ccerevisions.shtml

CCGPP Council on Chiropractic Guidelines and Practice Parameters, Chiropractic BioPhysics, Council on Chiropractic Education (CCE)

URGENT ACTION REQUIRED! CCE Attempting to Re-Invent the Standards for Chiropractic Institutions & Doctors

Dear Colleagues, Chiropractors, Friends:

Please read, I know its long but you need to know-----

The Council on Chiropractic Education (CCE) is attempting to dramatically revise the profession by creating new standards for chiropractic institutions; these will fundamentally alter the focus of chiropractic education by the proposed removal of virtually every chiropractic-specific definition and requirement. While there are many issues that concern us, there are four key changes we strongly believe must be reversed.  Those are:

1.       A proposal to expand the degree programs accredited by the CCE beyond the D.C. degree to “equivalent” degree offerings.

2.       The elimination of any and all references to the concept of subluxation, vertebral subluxation or vertebral subluxation complex.

3.       The elimination of the section addressing the “Purpose of Chiropractic Education” which includes the references to the profession being oriented toward health care “without the use of drugs and surgery.”

4.       The modification of the term and definition of “Chiropractic primary care physician.”

If these new CCE proposed standards, which are scheduled to take effect in 2012, are adopted without alteration, an objective observer without foreknowledge that these are the standards of a “chiropractic” accreditation body, would not be able to distinguish what profession the standards are for. Nowhere do the proposed Standards define chiropractic. They could be for nursing, dental, physical therapy or even medical education. This would represent a major step backwards for the chiropractic profession and open the door for a dramatic re-direction of chiropractic in a medical direction.

Furthermore, Dr. Gerry Clum (President of Life Chiropractic College West) has succinctly summarized the CCE proposal in the following clipping from his positional paper found at http://www.lifewest.edu/ccerevisions.shtml
“The items in the new CCE revision indicate an attempt to move the Chiropractic profession:
a. Toward the Doctor of Chiropractic Medicine perspective
b. Away from the use of the term subluxation
c. Toward the inclusion of drug therapy
d. Away from being a drugless discipline
e. Toward a generalized common definition of primary care as used in primary medicine.
f. Away from any definition of chiropractic and what a chiropractor does.”

Click here to view the full text of the latest version of the proposed CCE Standards online:
http://www.cce-usa.org/uploads/Draft__2_Standards_Combined.pdf

 CCE is accepting comments from the field and you have a personal opportunity to make your voice heard on these critical changes.  CCE has provided a format through which to submit your comments via fax. 

Click here to print out a faxable comment form:

http://www.cce-usa.org/uploads/COUNCIL_Form_16_-_Proposed_Revision_to_Standards_FILL-IN_FORM.pdf

ICA and CBP will be submitting formal comments according to the procedures established by CCE. ICA has also encouraged other national, state and local chiropractic organizations as well individual DCs, students and concerned individuals to carefully consider the potential negative consequences of the proposed changes and to express their feelings and concerns through those same channels.

 It is vitally important that you carefully follow the instructions for comments provided by CCE in order to make certain that your thoughts and concerns are received and taken into consideration. Once you have completed your comments form, again following the exact instructions, forward it to CCE by fax:

The Council on Chiropractic Education
Attn: CCE President

 8049 N. 85thWay
Scottsdale, AZ 85258
Fax: (480) 483-7333 or Email: cce@cce-usa.org

 The deadline for receiving your comments is close of business September 24th.

ICA and CBP Researchers have developed model comments you may review for ideas and concepts on which to build your personal comments.  Please click here to view these model comments:

http://members.chiropractic.org/asset/docs/MODELCCECOMMENTS.doc

 Then use the faxable comment form to submit you feedback to CCE.---See bottom of this message below my name to see an easy example of how to fill out this form:

http://www.cce-usa.org/uploads/COUNCIL_Form_16_-_Proposed_Revision_to_Standards_FILL-IN_FORM.pdf

The four key issues ICA and CBP has identified in its model comments, when viewed as a group in context and in light of the circumstances of the profession in 2010, become more important than each item when considered individually. They represent an erosion of the core contributions to health care that the profession provides and they serve to promote a loss of professional identity and emphasis critical to our future and that of the students being educated. There is a lot at stake in these proposed changes and responsible action to defend the vital center of the chiropractic educational process is ICA’s and CBP’s top priority. We know it is the right thing to do. Remember, the deadline for submitting your comments is September 24, 2010 so ACT TODAY!

Yours in Chiropractic,

Deed E. Harrison, DC

 President CBP Technique and Seminars

On Behalf of:

Gary L. Walsemann, DC, FICA
ICA President

Joe Betz, DC

ICA Board Member

Here is the easiest way to fill out the attached CCE form

Field 1)  Please indicate you are a FIELD PRACTITIONER (DC)
Field 2)  You can LEAVE BLANK
Field 3)  Add your own general comments (see points a-f from Dr. Clum's clip above)...be specific and clear
Field 4) You can LEAVE BLANK
Field 5)  Add your personal information

SAMPLE  Text for Field 3:
“I oppose the changes to the Standards For Doctor of Chiropractic programs as it attempts to move the profession: 1) Toward the Doctor of Chiropractic Medicine perspective; 2) Away from the any use of the term subluxation; 3) Toward the inclusion of drug therapy; 4) Away from a drugless discipline; 5) Towards a generalized common definition of primary care as used in primary care medicine; 6) Away from any definition of chiropractic or what a chiropractor does.”

Sincerely,

Dr. John Jones
 

BioPhysics Insights: Determining the Appropriate Home Traction for Abnormalities of the Cervical Lordosis

Deed E. Harrison, DC

President CBP Seminars, Inc.

Vice President CBP Non-Profit, Inc.

Chair PCCRP Guidelines

Editor—AJCC

INTRODUCTION

Recently in this journal, I’ve been discussing the evidence for the use of home corrective orthotic (cervical curve traction) devices as a supplementation to in office CBP treatment programs aimed at rehabilitation of abnormal cervical curvatures. In this article I will continue the discussion of home corrective orthotic devices by presenting appropriate indications and contra-indications for the use of these devices. Just like the CBP in office traction rehabilitation equipment (Compression-extension chair,¹ Pope 2-way,² Compression-extension 2-way,³ etc.), there is no such thing as a “one size fits all” for at home orthotics. Specifically, I will discuss two primary types of cervical corrective orthotic devices for at home use: 1) The TruCurve compression-extension orthotic, and 2) The Denneroll cervical orthotic device.

Figure 1. The TruCurv Compression extension spinal corrective orthotic device for at home use. The patient lies over a wedge shaped fulcrum with the upper thoracic region (T4) at the apex of the wedge. The compression force is applied to the forehead by way of a strap; straightening the legs increases the compression-extension loading.

Compression Extension Corrective Loading

The Compression-extension at home cervical orthotic device has been around a number of years and is modeled after the in office device Compression-extension traction chair (‘Regainer’) designed by Dr. Dwight DeGeorge of Promote Chiropractic in the late 1980’s. In corrective chiropractic practices around the world, this is the most commonly recommended home device for restoration of the cervical lordosis. In Figure 1, the TruCurv compression extension orthotic device is shown; this is device that CBP recommends and distributes to doctors. Although the compression-extension orthotic is a very effective device, in my opinion it is one of the most miss-used cervical orthotics on the market. Allow me to explain my position by discussing the Contra-indications and Indications of this orthotic.

There are a number of patient conditions and spinal configurations compression-extension loading would likely exacerbate; these conditions would be considered Contra-indications to compression-extension loading. Like-wise, there should be a unique set of patient conditions and spinal configurations that compression-extension loading would likely improve.

Contra-indications to compression-extension loading:

· A significant retrolisthesis in the cervical spine; especially one that is unstable on extension loading. Under combined loads of compression-extension the segments of the cervical spine are subjected to posterior shear loads.⁴

· A normal thoracic kyphosis without posterior translation of the thoracic cage relative to the pelvis. Due to the fact that the patient is lying on a wedge in the mid-thoracic spine, the ribcage will be translated anteriorly. It is a known biomechanical fact that anterior thoracic translation causes straightening of the thoracic kyphosis.⁵Furthermore, the compression extension force acting on the skull creates an extension bending moment at the upper thoracic region where it contacts the apex of the traction wedge. This scenario causes a flattening of the upper thoracic curve--take an X-ray of a patient to confirm this if you doubt it!

· Hyper-extension of the upper cervical spine. See Figure 2A. A combined compression-extension force would create even more hyper-extension in the upper cervical region.

· Significant anterior head translation where the lower cervical spine flexes (C4-T1) and the upper cervical spine extends (C0-C4). See Figure 2B. In this case, the cervical spine is behaving as it should for an anterior head posture.⁶ In other words, the forward head posture is the cause of the alteration in the cervical curvature. Compression-extension loading of the head/neck region is an inappropriate force to correct forward head posture.

· Canal stenosis or canal diameter less then or equal to 11 mm is a contra-indication for compression-extension loading. While this can be a case specific contra-indication, many patients with canal stenosis will experience exacerbation of symptoms (radicular or long-tract signs) with an applied compression-extension load. It is simply better pursue a different type of corrective force.

Figure 2. Cervical Curve Contraindications to Compression Extension forces. In A, there is excessive upper cervical extension and a retro-listhesis at C3-C4. While B, is the typical spinal coupling pattern for an anterior head translation posture. Compression Extension force application would likely cause injury to the upper-cervical region in these cases.

Indications for compression-extension loading:

• Antero-listhesis with loss of lordosis and anterior head translation.
• No absolute canal stenosis or canal diameter ≥ 11 mm.
• No hyper-extension of the upper neck.
• Significant Anterior translation of the head with the following three features:

a) Hypo-lordosis of the cervical spine and,

b) Posterior thoracic translation and,

c) Mild-to moderate hyper thoracic kyphosis in the upper thoracic region (T1-T4).

• In general, compression-extension loading to restore the cervical lordosis is used when a patient has anterior head translation and posterior thoracic translation with a loss of the cervical lordosis where the majority of the posterior vertebral body margins are in front of the ideal spinal model (shown as a red-circular segment in most of the figures). See Figure 3.

Figure 3. Abnormal cervical curvatures that are INDICATED for the TruCurv Extension Compression corrective force application. These curves are hypo-lordotic with significant forward displacement of the head and the posterior body margins relative to the CBP ideal cervical model.¹ Note that the patient must also have:

• Posterior thoracic translation and;
• A mild-to moderate increase of the mid-upper thoracic kyphosis.

The Denneroll

The Denneroll cervical orthotic device (Figure 4-6) overcomes the specific case contra-indications that are inappropriate for the compression extension home device. The Denneroll is a passive 3-point bending force that is generally well tolerated by patient and is most consistent with the Pope-2-way type of in office corrective traction force. The Denneroll currently comes in 2 sizes (adult large and adult small) and can be used when the TruCurv compression-extension device is contraindicated. There are three primary placements of the Denneroll cervical orthotic device shown in Figures 4-6. The Denneroll placement should be consistent with both the shape of the cervical curve and the amount/type of sagittal head translation correction that is desired.

Indications for the Denneroll:

· Upper thoracic/lower cervical placement. This placement of the Denneroll will cause significant posterior head translation, it will increase the upper thoracic curve, and increase the overall cervical lordosis. Specifically, this placement should be used for straightened or kyphotic lower cervical segments with loss of upper thoracic kyphosis and anterior head translation of ≤ 40mm. See Figure 4.

Figure 4. Abnormal cervical curvatures that fit the inclusion criteria for the application of the Denneroll corrective orthotic in the lower cervical region. These spines must have:

· Normal or a mild loss of the upper thoracic kyphosis;

· Loss of the lower cervical curve (with or without kyphosis);

· Anterior head translation of approximately ≤ 40mm.

· Mid-low cervical placement. This placement of the Denneroll will cause slight posterior head translation; however if the larger Denneroll device is used on a small statured individual then it will create some anterior head translation. The cervical spine should have straightened or kyphotic mid cervical regions (apex of the curve). See Figure 5. In cases with significant posterior head translation, as in Figure 5A, the large Denneroll orthotic should be used and a towel can be placed under the Denneroll to increase the height if needed.

Figure 5. Abnormal cervical curvatures that fit the inclusion criteria for the application of the Denneroll corrective orthotic in the middle cervical region. These spines must have:

· Normal or a loss of the upper thoracic kyphosis;

· Straightening or apex at the mid-cervical curve;

· Slight anterior head translation of approximately ≤ 15mm;

· In B with Posterior head translation the LARGE Denneroll should be used with a small towel under it to increase height.

· Upper to mid cervical placement. This placement of the Denneroll is used for posterior head translation with straightened or kyphotic mid-upper cervical curves. This position allows extension bending of the upper cervical segments while causing slight anterior head translation. See Figure 6. In cases like Figure 6A with significant posterior head translation, where the posterior vertebral bodies are behind the ideal red curved line,⁷ the large Denneroll orthotic should be used. While in Figure 6B, the small Denneroll should be used.

Figure 6. Abnormal cervical curvatures that fit the inclusion criteria for the application of the Denneroll corrective orthotic in the upper cervical region. These spines must have:

· Close to normal lower cervical curvature;

· Straightening or apex at the C2-C4-cervical segments;

· In B, normal head translation of approximately ≤ 15mm. Here the SMALL Denneroll is used to not create anterior head posture;

· In A with Posterior head translation the LARGE Denneroll should be used to create anterior head translation.

Contra-indications for the Denneroll:

Quite simply put, the Contra-Indications for the Denneroll orthotic device would be the same indications for the TruCurve compression-extension orthotic.

SUMMARY

All home cervical corrective orthotic devices have indications and contra-indications. Simply put, the two devices discussed herein (TruCurve and Denneroll) should be used in opposite patient cases. The cervical corrective orthotic should be fit to the following patient presenting conditions: 1) their symptomatology and severity of spinal arthritis/disc disease, 2) their ability to perform specific movements, 3) their presenting posture of the head and thoracic region, 4) their configuration of the cervical curvature, and 5) their configuration of the mid-upper thoracic kyphosis. I hope this presentation assists in your delivery of effective patient intervention in the office and at supplementation of at home devices.

References

1. Harrison DD, et al. J Manipulative Physiol Ther 1994;17(7):454-464.
2. Harrison DE, et al. Arch Phys Med Rehab 2002; 83(4): 447-453.
3. Harrison DE, et al. J Manipulative Physiol Ther 2003; 26(3): 139-151.
4. Harrison DE, Harrison DD, et al. J Manipulative Physiol Ther 1998; 21(3): 177-86.
5. Harrison DE, Cailliet R, Harrison DD, Janik TJ. Eur Spine J 2002; 11(3): 287-293.
6. Harrison DE, Harrison DD, Haas JW. CBP Structural Rehabilitation of the Cervical Spine. Chapters 2 & 6. CBP Seminars, 2002; pgs:147-151. ISBN 0-9721314-0-X.
7. Harrison DD, et al. Spine 2004; 29:2485-2492.

cervical lordosis, Chiropractic BioPhysics, Compression Extension Traction, Home Traction, Traction

Why Instrument Adjusting?

Christopher J. Colloca, D.C. CEO and Founder Neuromechanical Innovations


From their benefits of ease of use to providing added safety to a patient encounter, adjusting instruments have provided a new dimension to chiropractic practice. Why all the buzz about Instrument adjusting? Here are the top ten most popular reasons why you should incorporate Instrument adjusting into your practice.

#10. A Mechanical Advantage
From the outset, adjusting instruments were developed to provide the clinician with a mechanical advantage for more efficient chiropractic adjustments.
F = ma
Newton’s Second Law is force equals mass times acceleration. Adjusting instruments take advantage of the acceleration part of the equation in providing large accelerations with a substantially smaller mass. Faster thrusts are associated with the elicitation of neuromuscular reflexes thought to be related to the mechanisms underlying successful treatments (1-3). Instrument adjustment speed also allows you to deliver the thrust faster than the patient’s natural tendency to tighten up and resist the adjustment.
σ = f/a
Stress is another consideration among the mechanical advantages of instrument adjusting. In continuum mechanics, stress is a measure of the average amount of force exerted per unit area, where stress equals force divided by area. Adjusting instruments can achieve an appreciable stress to the spine, while keeping the forces relatively low due to their small contact area with the patient. Appreciating these physics concepts helps to explain how similar amounts of intersegmental bone movement can be achieved with instrument adjusting as manual techniques (4-5).

#9. Safety
Chiropractic adjustments are extremely safe. Still, there are instances where you may have a concern of manually adjusting a particular patient. For instance, you may not want to provide higher forces of manual adjustments to an elderly patient with osteoporosis. Likewise, you may not impart rotatory cervical spine adjustments to a patient with dizziness or signs of cerebrovascular disease. Instrument adjusting enables you to administer care with peace of mind in some situations that you may feel uncomfortable applying manual techniques.



#8. Easy Incorporation Into Your Existing Technique
Instrument adjusting can be easily incorporated into your existing technique repertoire. You may want to adjust the upper cervical spine and TMJ of a headache patient with an instrument, yet perform manual methods on their thoracic and lumbar spine. Alternatively, you may want to adjust the shoulder in a rotator cuff syndrome patient with an instrument instead of using a drop piece.

#7. Evidence-Based Care
A number of studies have investigated instrument adjusting for its effectiveness and have found it to be equivocal to manual adjusting techniques (6). In a number of clinical trials instrument adjusting fared just as well as manual adjusting techniques in reducing pain and improving function (7-11). Ongoing research into the basic science and clinical study of instrument has quantified vertebral motions, and neurophysiological responses associated with instrument adjusting (12-13). Providing evidence-based care is important for your own self-confidence, as well as the confidence of your patients.

#6. Increase The Range of Patients You Care For
Instrument adjusting allows you to care for a broader range of patients. The low force setting of the Impulse Adjusting Instrument® makes adjustments easier for pediatric adjusting and managing children. Instrument adjusting also enables you to care for patients in their senior years. With the aging of the baby-boomer population, more and more seniors will be seeking care, and using a technique that is well suited for them is important in the growth and sustainability of your practice.




#5. Expand The Range of Services You Provide
Perhaps you currently don’t adjust the feet of patients with plantar fasciitis. Maybe you have been concentrating on the spine and don’t do much with extremity adjusting, or patients with anterior rib pain, TMJ dysfunction, shoulder problems, and the list goes on. Incorporating instrument adjusting into your practice allows you to care for a broader range of conditions and will create a buzz among your patients and in your community.



#4. Adding Technology to Your Practice
It’s a technological age, and adding instrument adjusting into your practice gives a feeling of technology in the practice. Explain to your patients that the adjusting instrument that you are about to use is much faster than you can adjust them manually with your hands and that you can target just the right areas specifically with the tip of the stylus. Your patients will be impressed with your choice to stay current with the times by adding technology to help them heal.

#3. Easier on the Patient
Because of the extreme speed and lower forces generated with instrument adjusting, the adjustments are easier on the patient. This equates with less side-effects, such as muscle soreness, and increased pain during the adjustment or afterwards. Adjustments which are easier on the patient increase patient satisfaction, compliance and patients’ willingness to refer others.

#2. Speed up Your Adjusting Time
Many times I’m asked what I think about a particular soft-tissue technique that takes 20-30 minutes to administer. My response is, “I think it’s great, but you had better be charging $150 a visit for your time.” With instrument adjusting you can achieve the same, if not better, clinical results while speeding up the time it takes for you to provide care.

#1. Easier on You
The number one benefit of instrument adjusting just may be prolonging your practice career. Chiropractors come to us who have hurt their own backs, wrists and shoulders from years of manual adjusting. Others have had carpal tunnel problems and even surgery themselves from pulling a spring-loaded adjusting instrument for years. Decrease the risk of injuring yourself and prolong your practice career with instrument adjusting.

*References and more information on Instrument Adjusting can be found at www.neuromechanical.com

Impulse Adjusting Instrument

New RCT Shows Improved Pain, Motion & Nerve Function with Lordosis Correction

Ibrahim Moustafa Moustafa Abu Amer, PT Basic Science Department, Faculty of Physical Therapy, Cairo University, Egypt	Deed E. Harrison, DC President CBP Seminars, Inc. Vice President CBP Non-Profit, Inc. Chair PCCRP Guidelines Editor—AJCC

We’re excited to announce that a new randomized control trial (RCT) has been performed and completed using 3-point bending cervical extension traction (Pope 2-way) to improve the cervical lordosis. Approximately 2 years, ago, I was contacted by Ibrahim Moustafa from the University of Cairo. He was working on a research investigation for part of his graduation requirements. Ibrahim was interested in investigating the usage of 2-way traction in a population of patients suffering from cervical spondylotic radiculopathy with concomitant reduction of the cervical lordosis. I was asked to be an advisor on this graduate project. In May of this year, Ibrahim sent me the completed draft of his study. Currently this project has been edited and the study has been submitted for review and hopeful publication in a spine related journal.

STUDY ABSTRACT

TITLE: The Efficacy of Cervical Lordosis Rehabilitation for Nerve Root Function, Pain, and Segmental Motion in Cervical Spondylotic Radiculopathy: A Randomized Control Trial.

AUTHORS: Ibrahim Moustafa Abu Amer, PT, Aliaa Attiah Mohamed Diaab PT, Deed E. Harrison DC,

Background: There is a general agreement about the relevance of conservative treatment for cervical spondylotic radiculopathy (CSR); however the precise treatment protocol for this disorder in specific patient groups remains unanswered.

The purpose: This study was conducted to test the hypothesis that improvement of cervical lordosis in CSR, using 3-point bending extension traction, will improve the clinical features in a sample population of patients suffering from CSR with defined cervical hypo-lordosis.

Subjects: Thirty patients with lower CSR and with a cervical lordosis less than 25° as measured using posterior body tangent lines from C2-C7 - were included in the study. The patients were assigned randomly into two groups of equal number, study and control groups respectively.

Methods: Both groups received stretching exercises and infrared radiation; additionally the study group received 3 point bending cervical traction. Treatments were applied 3 x per week for 10 weeks after which a 12 week follow up was performed. The peak to peak amplitude of dermatomal somatosensory evoked potentials (DSSEPS), absolute rotation angle (ARA C2-C7), cervical flexion-extension kinematics analysis, and visual analogue scale (VAS) were measured for all patients at three intervals (initial, after 10 weeks of treatment, and at follow up of 3 months).

Results: In the study group, an increase in cervical lordosis (ARA C2-C7) was found (p< 0.0001, F=49.81) and maintained at follow up. No statistically significant improvement in lordosis was found for the control group.

A Significant reduction in VAS for study group after 10 weeks of treatment and at 12 weeks follow up was found. In contrast, there was a less significant decrease in post treatment VAS and the follow up measures revealed a significant increase in the VAS score towards initial baseline values. An inverse linear correlation between increased lordosis and VAS was found (r=-.49; p=0.0059) for both groups initially and maintained in the study group post treatment (r=-.6; p=0.0138).

At 10-week follow up, we found statistically significant improvements in DSSEPS for both groups (one way ANNOV, p< 0.0001). However, at 12 week post treatment follow up, only the study group showed statistically significant improvement compared to initial (p < 0.006) whereas the control group values returned to baseline measurement (p<0.153). We identified a linear correlation between initial DSSEPs and ARA for both groups (r=.65; p<0.0001), where as this relationship was only maintained in the study group at final follow-up (r=.55; p=0.033).

Conclusions: Improved lordosis in the study group was associated with significant improvements in nerve root function, VAS rating, and translational and rotational motions of the lower cervical spine. Only in the study group were the results maintained at long-term follow up. Appropriate physical rehabilitation for CSR should include sagittal cervical correction, as it may to lead greater and longer lasting improved function.

cervical lordosis, Chiropractic BioPhysics, traction, Nerve Root Function