-17
Gert Bronfort, D.C., Ph.D.
Northwestern College of Chiropractic
A Randomized Trial of Conservative Therapies for Sciatica: A Feasibility Study
$78,828
This investigation is an essential pilot and feasibility study to precede a full-scale randomized clinical trial
to evaluate the effectiveness of three common conservative treatments for sciatica: chiropractic care,
medical care, and epidural injections. In the pilot study, a total of 24 patients experiencing sciatica from
2-12 weeks will be randomized into the following groups: Chiropractic care: an established protocol of
spinal manipulation with light soft tissue massage and/or traction, activity modification and bedrest
prescribed as needed, plus 2 sessions of self-care instruction using the McKenzie approach. Medical
care: prescription NSAIDs, acetaminophen, mild narcotic medicaton, activity modification and bedrest
prescribed as needed, plus 2 sessions of self-care using the McKenzie method. Epidural steroid
injection: up to 3 epidural steroid injections over 12 weeks, activity modification and bedrest prescribed
as needed, plus 2 sessions of self-care using the McKenzie method.
Patients will receive up to 12 weeks of treatment with the number of visits and schedule to be
determined by each provider. Self-reported outcome measures [modified Roland-Morris questionnaire;
anchored pain scale; and improvement, general health status, disability, satisfaction, depression, and
nonprescription medication use questionaires] will be collected at baseline and 3 and 12 weeks after the
start of treatment; objective outcome measures [lumbar ROM, straight leg raise, functional capacity]
will be assessed by blinded examiners at baseline and 12 weeks.
2. 97-10-18
Charles Henderson, D.C., Ph.D.
Gregory Cramer, D.C., Ph.D.
Development and Evaluation of a Reversible Small Animal Model of Chiropractic
Subluxation
Palmer Center for Chiropractic Research / National College of Chiropractic
$232,774
This proposal presents a comprehensive investigation of a small animal model of spinal subluxation
consisting of percutaneously attached pins into the spinous process of two adjacent vertebrae. These
pins will then be experimentally manipulated, allowing the full external, nontraumatic and reversible
control of two key features of the subluxation hypothesis: fixation and
malposition. This experimental
system, the Rat Transcutaneous Spinous Fixation Model [RTSFM] will be replicated by investigative
teams at both Palmer and National Colleges of Chiropractic to assure the practicality of the model in
terms of reproducibility, economy and ease of construction.
Both the fixation and malposition elements of the RTSFM will be evaluated by visual inspection
[radiographically and at surgery and autopsy] and by instrument-assisted biomechanical analysis both in
vivo and in vitro. Preliminary data to assess the putative anatomical, biochemical, and
electrophysiological consequences of the subluxation will also be obtained. Examples of the types of
data to be extracted are histological changes of the zygapophyseal [Z] joints, changs in receptor
populations on afferent neurons associated with the immobilzed Z joints, nerve conduction velocity
changes in dorsal roots near sites of fixation or malposition, and alterations in neuromodulators to pain.
The clinical relevance of the RTSFM model is demonstrated by its ability to provide data relating to the
following questions: [i] Is there an optimum time window for applying spinal manipulation; [ii] What are
the effects of changing biomechanical features [simulating different chiropractic techniques]; [iii] What is
the effect of repeated manipulation under different states of the subject; and [iv] can chiropractic
subluxations alter visceral function?
3. 98-03-01
Gary Hack, D.D.S.
A Three-Dimensional Model of the Myo-Dural Connection
University of Maryland Dental School
$4,250
Dr. Hack's recent postulation of a muscle-dural connection responsible for producing headaches,
already the subject of a landmark publication in the 1998 Medical and Health Annual of the
Encyclopedia Britannica, is to be further developed by the construction of a three-dimensional model in
consultation with an engineering company. This model will incorporate the use of 3-D glasses in order
to visualize the myo-dural connection that will be created from the Visible Human Project data sets
recently made available from the National Institutes of Health. In addition to forming the centerpiece of
a poster to be presented to the Association of Neurological Surgeons, this model should help to further
develop a functional biomechanical model with particular attention to the effects of chiropractic
adjustments. Dr. Hack's work provides an excellent example how the health care professions may
successfully collaborate, as recent surgical findings have shown that scar tissue forming between
cervical muscles and the dura produces an increse in headache. Models and observations such as these
have had considerable impact in promoting understanding from the medical community as to how
cervical manipulation may be effective in the management of headache. With such undertanding comes
ultimate acceptance.
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