March 2010 Newsletter from Malik Slosberg, DC, MS

Bronfort G, DC, PhD, Haas M, DC, Evans,R, Leiniger B, Triano J, DC, PhD. Effectiveness of manual therapies: the UK evidence report.  Chiropractic & Osteopathy 2010, 18:3. 

Lee CD, Sui X, Blair SN. Combined effects of cardiorespiratory fitness, not smoking, and normal waist girth on morbidity and mortality in men. Arch Intern Med 2009;169:2096-101. 


Bronfort G, DC, PhD, Haas M, DC, Evans,R, Leiniger B, Triano J, DC, PhD. Effectiveness of manual therapies: the UK evidence report.  Chiropractic & Osteopathy 2010, 18:3. 

This authoratative and extensive review just published by five influential authors, all trained as doctors of chiropractic but who are now full time professional researchers, is a comprehensive summary of the scientific evidence to date regarding the effectiveness of manual therapies for the management of a variety of musculoskeletal and non-musculoskeletal conditions. It is a 113 page document and can be read or downloaded in its entirety from the website www.chiroandosteo.com 

The paper is based on a review of: 
1. The results of 49 systematic reviews of randomized clinical trials (RCTs). 
2. Sixteen widely accepted evidence-based clinical guidelines primarily from the United Kingdom and the United States.
3. The results of all 46 RCTs not yet included in the first three categories.
The strength & quality of the evidence regarding effectiveness is based on a version of the grading system developed by the US Preventive Services Task Force and a study risk of bias assessment tool for the recent RCTs not yet included in the systematic reviews and evidence-based guidelines. By September 2009, 26 categories of conditions were located containing RCT evidence for the use of manual therapy: 13 musculoskeletal conditions, 4 types of chronic headache & 9 non-musculoskeletal conditions. 
The conditions reviewed are: 
• Non-specific Low Back Pain, 
• Non-specific mid-back pain, 
• Mechanical neck pain, 
• Coccydynia, 
• Shoulder Pain,
• Lateral Epicondylitis, 
• Carpal tunnel syndrome, 
• Hip Pain, Ankle & Foot Conditions, 
• Temporalmandibular Joint Pain, 
• Cervicogenic headache (HA), 
• Migraine HA, 
• Tension-type HA, 
• Miscellaneous HA, 
• Asthma, 
• Pneumonia,
• Vertigo,
• Infantile Colic, 
• Nocturnal Enuresis, 
• Otitis Media, 
• Hypertension,
• Dysmenorrhea, 
• Premenstral SyndromeN

Conclusions: Spinal manipulation(SM) and/or mobilization (MO) are effective in adults for: acute, subacute, & CLBP; migraine & cervicogenic HA; cervicogenic dizziness. SM/MO is effective for several extremity joint conditions: shoulder girdle pain/dysfunction, adhesive capsulitis, lateral epicondylitis, hiposteoarthritis, knee osteoarthritis, patellofemoral pain syndrome, plantfascitis. Thoracic SM/MO is effective for acute/subacute neck pain. Evidence is inconclusive for cervical SM/MO alone for neck pain of any duration, and for SM/MO for mid-BP, sciatica, tension-type HA, coccydynia, TMJ disorders, fibromyalgia, PMS, & pneumonia in older adults. SM is not effective for asthma & dysmenorrhea vs sham SM, or for Stage 1 hypertension when added to an antihypertensive diet. 

Massage is effective in adults for CLBP & CNP. Evidence is inconclusive for knee OA, fibromyalgia, myofascial pain, migraine HA, & PMS. In children, evidence is inconclusive for otitis media & enuresis, & it is not effective for infantile colic & asthma vs sham SM. In children, evidence is inconclusive for asthma & infantile colic.

Commentary: This is a very impressive and thorough document based on all of evidence available over the past decade. Some of the findings are consistent with what chiropractors have observed in their clinical practice, others are disappointing: evidence is inconclusive for cervical SM/MO alone for neck pain of any duration, and for SM/MO for mid-BP, sciatica, tension-type HA, coccydynia,  TMJ disorders, fibromyalgia, PMS, & pneumonia in older adults. Nevertheless, this paper succinctly offers the profession a clear window into the current state of the clinical science of chiropractic and defines where we must put our resources in order to document the effectiveness of clinical practice which need further support and clarification. Once again, you can view the document for free, including good summary tables on chiroandosteo.com. 



Lee CD, Sui X, Blair SN. Combined effects of cardiorespiratory fitness, not smoking, and normal waist girth on morbidity and mortality in men. Arch Intern Med 2009;169:2096-101. 

Physical inactivity, cigarette smoking, and abdominal obesity are key modifiable risk factors for coronary heart disease (CHD). We investigated the combined effects of not having these risk factors on CHD events and cardiovascular disease (CVD) and all-cause mortality in men. We followed 23,657 men, (30-79 yrs), who had a medical exam including a maximal treadmill exercise test and self-reported health habits over an average of 14.7 yrs. 

A low-risk profile was defined as not smoking, moderate or high fitness, and normal waist girth. There were 482 CHD events (nonfatal myocardial infarction or fatal CHD) and 1034 deaths (306 CVD, 387 cancers, and 341 others) over follow-up. 

Results: After adjustment for multiple baseline risk factors, there was an inverse association between a greater number of low-risk factors and CHD events, CVD and all-cause mortality in men. Men with a normal waist girth, were physically fit and not smoking had: a 59% lower risk of CHD events; a 77% lower risk of CVD mortality; a 69% lower risk of all-cause mortality compared to men w none of these low-risk factors. Men with 0 versus 3 low-risk factors had a shorter life expectancy by 14.2 years. 

Conclusion: Being physically fit, not smoking, and maintaining a normal waist girth is associated with lower risk of CHD events, CVD and all-cause mortality in men.Our major finding was that menwho were physically fit, not smoking, and with a normal waist girth had: 
• a 59% lower risk of CHD events,
• a 77% lower risk of CVD mortality, 
• 69% lower risk of all-cause mortality
over 15 years, compared with men with none of these low-risk factors. The magnitude of having the 3 low-risk factors is impressive for both population attributable risk and for longevity and indicates the clinical and public health importance of these characteristics. 
• Our findings indicate that men with 3 low-risk factors had a 14.2-year longer life expectancy (all-cause mortality) compared with men with none of these low-risk factors. 
 
Commentary: This is an enormous longitudinal general population survey of 23,657 men for an average follow-up of 14.7 years. An amazing amount of data was collected with strikingly clear results: men who smoke, are not physically fit, and have a large waist girth have a shorter life expectancy than men who don't smoke, have moderate to high fitness, and a normal waist girth. Our findings indicate that men with 3 low-risk factors had a 14.2-year longer life expectancy (all-cause mortality) compared with men with none of these low-risk factors! It pays to be healthy for ourselves and as a role model for our patients. This is all part of the natural, wellness lifestyle that chiropractic promotes. Teach and Live it.