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Cam-type deformities of the proximal femur have long been associated with femoroacetabular impingement (FAI); an orthopedic condition recognized in the etiology of early osteoarthritis (OA) in the non-dysplastic adult hip. However, the optimal clinical management (including the long-term prognosis) of patients with cam-type deformities with or without FAI symptoms remains uncertain. In this imaging case review (ICR), we present the 10-year follow-up of a retired chiropractor with bilateral cam-type femoral deformities who initially underwent total right hip joint arthroplasty for advanced hip joint OA, and subsequently developed advanced hip joint OA on the contralateral side. [ABSTRACT FROM AUTHOR]

This case study documents the case of a 27-year-old female who presented with a complaint of left anterolateral thigh numbness, initially diagnosed as meralgia paresthetica with a differential diagnosis of lumbar radiculopathy. Over a span of two weeks, the patient endured emotional trauma and subsequently developed lesions in the area of complaint. The patient was diagnosed at a medical clinic with herpes zoster and was prescribed anti-viral medication which resulted in complete resolution. This case highlights the importance of considering herpes zoster as a differential diagnosis for nerve-related symptoms. Features of lumbar radiculopathy, meralgia paresthetica, varicella zoster and herpes zoster are discussed, as well as the defining characteristics and treatment options. Practitioners must remain vigilant in suspicion of viral infections such as herpes zoster even with lower incidence due to approved vaccines. [ABSTRACT FROM AUTHOR]

Objective: Technique description and verification of L5 pars interarticularis (L5PI) using diagnostic ultrasound (DUS). Methods: Asymptomatic 10-year-old male subject was scanned with diagnostic ultrasound applying a linear array transducer (8-13 MHz) over L5/S1 facets; longaxis slide cephalad to capture both superior (SAP) and inferior articulating process (IAP) of L5. Contiguous hyperechoic cortex with deep acoustic shadowing between the SAP and IAP was assumed to be L5PI. To confirm in vivo technique representing L5PI, two spine models (plastic, human spine) were scanned to verify authors' assumption. Metallic paperclip was placed over L5PI then DUS image captured. Lastly, a subject with known spondylolysis was imaged and sonographic appearance of L5PI compared. Results: The structures localized with the metal paperclip on L5PI models were equivalent to the in vivo DUS image. Spondylolysis demonstrates an abrupt stepoff defect at L5PI. Conclusion: We report the first technique description and verification of the L5PI using DUS. [ABSTRACT FROM AUTHOR]

Background: Clinicians make clinical decisions using the dual process theory. The dual process theory comprises two approaches, System 1, based on heuristics, and System 2, involving an analytical and effortful thought process. However, there are inherent limitations to the dual process theory, such as relying on inaccurate memory or misinterpreting cues leading to inappropriate clinical management. As a result, clinicians may utilize mental shortcuts, termed heuristics, and be susceptible to clinical errors and biases that may lead to flawed decision making and diagnosis. Methods: This case series describes four clinical cases whereby the clinicians use distinct strategies to assess and manage complex clinical presentations. Discussion: Through the use of self-reflection and acknowledging diagnostic uncertainty, the clinicians were able to reduce common cognitive biases and provide effective and timely patient care. We discuss strategies that clinicians can implement in their daily practice to improve clinical decision-making processes and deliver quality care. [ABSTRACT FROM AUTHOR]

Objectives: This sequential explanatory mixed-method study aimed to explore chiropractic students' attitudes toward incorporating maintenance care (MC) focused evidence. Methods: Attitudes towards using an evidence-based clinical protocol for maintenance care (MC), the MAINTAIN instrument, were assessed via surveys, monologue responses, dialogues, and qualitative feedback. Participants from a single chiropractic educational institution completed questionnaires evaluating their perspectives on patient-centeredness, chronic pain, and evidence incorporation. Descriptive statistics summarized quantitative data, while content analysis was used for qualitative data. Results: 74.4% (n=419) of students participated, mostly male (57.5%), with an average GPA of 3.15 (out of a maximum of 4.0). Qualitative analysis identified the need to clarify MC terminology and factors motivating students to adopt new evidence, such as quality and alignment with healthcare beliefs. Conclusions: This study's findings emphasize the importance of refining healthcare training strategies, including defining terminology and addressing motivators for evidence incorporation, as evidence for MC for low back pain evolves. [ABSTRACT FROM AUTHOR]

Concussions are increasingly recognized as a public health concern. This paper evaluates Canadian concussion care guidelines, advocating for the inclusion of a broader range of healthcare professionals (HCPs) in concussion assessment, diagnosis, and management. It emphasizes the role of chiropractors, in addition to medical doctors (MDs) and nurse practitioners (NPs), highlighting their extensive training in musculoskeletal and neurological disorders. Chiropractors are adept at managing symptoms like headache, neck pain, and dizziness, and employing evidence-based, comprehensive interventions including patient education, exercise therapy, manual therapy, cervicovestibular rehabilitation, and return-to-sport (RTS) protocols. The paper also addresses regional variations in chiropractors' roles, focusing on Ontario's "Rowan's Law," and argues that limiting aspects of concussion care (assessment, diagnosis, RTS clearance) to MDs and NPs may result in healthcare inefficiencies and inequities. The findings are significant for policymakers and healthcare leaders, indicating a need for updated concussion care guidelines that integrate and utilize diverse HCPs. This could lead to improved patient outcomes, healthcare efficiency, and equity in concussion management across Canada. [ABSTRACT FROM AUTHOR]

Background: Lhermitte's sign is a nonspecific historical and exam finding that carries with it a differential diagnosis of cervical myelopathy, multiple sclerosis, intradural tumors, or other central nervous system pathology. Regardless of the suspected diagnosis, further diagnostic investigation is indicated to determine etiology of symptoms. Case presentation: In this case, a 67-year-old male Veteran presents to a Veterans Affairs (VA) outpatient chiropractic clinic with an insidious 6-month onset of neck pain with historical description of a positive Lhermitte's sign, a single episode of bladder incontinence, and mild changes in upper extremity manual dexterity. These subtle historical findings prompted referral for a brain and cervical spine MRI, revealing an ependymoma in the cervical spine. Urgent neurosurgical referral was made, and the patient underwent C3-C7 laminectomy, C3-T2 fusion, and tumor resection. Summary: This case represents an example of clinical reasoning in a VA chiropractic clinic when presented with subtle neurologic findings, and discusses the differential diagnoses and decision-making process to pursue imaging that resulted in appropriate neurosurgical management. [ABSTRACT FROM AUTHOR]

Background: Axillary-subclavian venous thrombosis (ASVT) is a type of upper extremity deep vein thrombosis (UEDVT). UEDVTs are classified as either primary or secondary depending on their etiology. Although uncommon, clinicians should be aware of the clinical presentation of UEDVT as timely diagnosis and early treatment is critical in preventing possible postthrombotic complications. Case presentation: We report a rare case of axillarysubclavian and internal jugular vein thrombosis in the absence of clear risk factors in a 78-year-old male weightlifter who presented to the office with two-week duration of left upper extremity pain and swelling following strenuous exercise at the gym. Summary: The combination of unusual thrombi location, in addition to the unusual absence of existing thoracic-outlet compression or indwelling medical hardware, makes our case of UEDVT especially uncommon. Clinicians should be aware of this rare disease due to the debilitating effects both in the short and long term. [ABSTRACT FROM AUTHOR]

Although most cases of Achilles tendinitis are caused by some form of biomechanical stress, other factors may play a role in its etiology. Fluoroquinolone use is a wellknown contributing factor to Achilles tendon pathology. This report describes a case of fluoroquinolone-induced Achilles tendinitis in a 77-year-old woman. Eight weeks after she presented to our office, the patient reported significant improvements after a course of care that included low level laser therapy (LLLT), activity modification and graduated exercises. Management can include many of the treatment tools used for biomechanically induced tendinopathy, with particular consideration given to delaying more advanced weightbearing rehabilitative exercise due to the increased risk of rupture. [ABSTRACT FROM AUTHOR]

This is the third of three papers in our series of articles on the use of mixed methods in chiropractic research. In this commentary, we discuss the mixed methods experimental (or intervention) design. This design is a complex mixed methods research design in which qualitative research is integrated with randomized controlled trials. We provide a brief overview of this study design as well as a case example from the literature to illustrate how this approach can be applied to research within the chiropractic profession. [ABSTRACT FROM AUTHOR]

Background: Spinal epidural lipomatosis (SEL) is a rare contributor of low back pain (LBP) that can present with or without radicular symptoms. Case Presentation: A 51-year-old and 65-yearold male presented with chronic LBP to the Veterans Affairs chiropractic clinic for a trial of care. One had a moderate degree of lumbar spinal stenosis with known SEL and the other had severe. The patient with moderate grade stenosis responded favorably with weeks of transient benefit after visits and the patient with severe grade did not find benefit with care. Summary: SEL is a condition that conservative care providers should be aware of as a potential cause of central canal stenosis or neuroforaminal narrowing. Chiropractic management of SEL has been scarcely reflected in the published literature, but may be a viable option for transient symptom management. [ABSTRACT FROM AUTHOR]

Background: Spinal Manipulative Therapy (SMT) benefits LBP patients, but its mechanism is not well documented. One hypothesis indicates that SMT restores interspinal movements. Ultrasound measurement (UM) of spinous process separation (SPS) assesses the intersegmental movements. Methods: We used the test-retest reliability of UM between the L3, L4, L5, and S1 spinous processes on fifteen asymptomatic volunteers while lying prone on a chiropractic table. The participants then walked around for over 5 minutes, and ultrasound images were reperformed prone. UM identified the tips of the spinous processes and distances between L3-L4, L4-L5, and L5-S1. Reliability was assessed using intra-class correlation coefficient (ICC). Results: ICC values of SPS measurements were 0.982 for L3-L4, 0.992 for L4-L5, and 0.997 for L5-S1. Rootmean square difference between the two measures were 0.35mm for L5-S1, 0.36mm for L4-L5, and 0.57mm for L3-L4. Conclusions: This study found UM to be reliable in measuring interspinous distance. [ABSTRACT FROM AUTHOR]

We recently each completed doctoral programs where the major focus of our work was in mixed methods research. In the first part of this three-part commentary, we present an overview of mixed methods research. In the second part, we present a summary of our primary and secondary research findings from our doctoral work involving mixed methods. In a third paper, we will discuss integrating qualitative research with randomized controlled trials and how this mixed methods study design can be applied to research within the chiropractic profession. Our aim with these papers is to increase awareness amongst the chiropractic community of the value (and challenges) of using this unique methodology. We also make recommendations for improving the quality of reporting and conduct of future chiropractic mixed methods studies. Further dissemination of this work will occur through online webinars and conference presentations. [ABSTRACT FROM AUTHOR]

In part 1 of this commentary, we presented an overview of mixed methods research and the rationales for using this methodology with examples from the chiropractic literature. We also introduced readers to the three core mixed methods study designs, as well as the advantages and challenges of employing a mixed methods approach. In part 2 of this series, we provide a summary of the primary and secondary findings from our doctoral work involving mixed methods research and make recommendations for improving the reporting and conduct of future chiropractic mixed methods studies. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the research capacity and productivity of Canadian sports chiropractors. Methods: A cross-sectional survey (phase one) and scoping review (phase two) investigated the research capacity and productivity (from 2015-2020) of the Canadian sports chiropractic field. Results: Most respondents (72%) reported obtaining research training from fellowship and master's programs, with only 2 (1%) PhD qualifications identified. Approximately, 30% reported active involvement in research, with 28% being part-time clinician researchers. Access to human and technological research resources were limited. We identified 67 publications and 16 conference presentations within a five-year period, with clinical, population health, and basic science research as the areas most studied. Conclusion: The research effort of Canadian sports chiropractors is primarily conducted by clinicians involved in research on a part-time basis. Its research outputs predominantly reflect the research requirements of the RCCSS(C) Sports Sciences Residency Program, highlighting its contribution in developing capacity and producing research for the Canadian sports chiropractic field. [ABSTRACT FROM AUTHOR]

Distal radius fractures are a common sports injury, often managed with reduction, immobilization, and rehabilitation. However, structured sport specific return to play protocols have yet to be developed, specifically within hockey. This case report reviews the various factors to consider when managing an athlete's recovery from a radius fracture, and objective measures to aid with return to play decision making when managing a hockey player. [ABSTRACT FROM AUTHOR]

Objective: To present a unique case of pulmonary embolism (PE) in an elite-Ironman triathlete and review athlete-specific risk factors associated with venous thromboembolism (VTE). Case presentation: A 57-year-old male triathlete presented for chiropractic care of midback pain and dyspnea one day before competition. During competition, he was removed and unable to complete the event with dyspnea, chest, and midback pain. Vitals revealed prolonged elevated resting heart rate. He was triaged to the hospital with a high index of suspicion for PE. He was diagnosed with multiple PE in both lungs. Summary: VTE is not normally considered in athletes. A combination of athlete-specific risk factors may predispose athletes to a higher propensity of Due to life-threatening consequences, it is important include a differential diagnosis of VTE in patients presenting with midback pain and dyspnea. [ABSTRACT FROM AUTHOR]

Objective: To understand Canada-based sports chiropractors' attitudes, beliefs, and practical application of sport psychology in the sports injury rehabilitation process. Methods: A cross-sectional, mixed-methods study design was employed. A questionnaire was emailed to 144 eligible participants including Fellows and Residents of the Royal College of Chiropractic Sports Sciences (Canada) (RCCSS(C)). Fifty-two surveys were returned fully completed. Fifteen respondents completed semi-structured interviews to further examine attitudes and beliefs in sport psychology training, delivery, and referrals. Results: Approximately two-thirds of Canada-based sports chiropractors felt that athletes were affected psychologically 100% of the time when injured. Sports chiropractors reported using some basic psychological techniques during the sports injury rehab process and expressed interest in having more training in more advanced techniques and practical application of these skills, as well as developing a referral network with sport psychology professionals in Canada. Conclusions: Sports chiropractors in Canada reported receiving entry level training in sports psychology and understood the importance of addressing the psychological aspects of sports injury. Further research is warranted to explore the effectiveness of current and future sports psychology education interventions for sports chiropractors. [ABSTRACT FROM AUTHOR]

Background: Physical activity and exercise (PAE) counselling and exercise prescriptions increase patient physical activity. However, the perceptions/practices of chiropractors are poorly understood. Methods: We surveyed the practices among chiropractors working in Canada (n=50) and Internationally (n=37). Chiropractors completed self-reflection questionnaires regarding their current practices and perceptions towards providing PAE counselling to patients. Chiropractor responses were obtained via Canadian provincial survey and educational workshops. Results: Chiropractor respondents included PAE content and exercise prescriptions in most patient appointments (67±27% and 59±35%, respectively), but the largest barriers (2.5/4.0) and least confidence were in their patients to follow through (52±21%). Canadian respondents reported higher knowledge (~0.4/4.0 higher), greater self-confidence (10-20% higher), and provided more PAE recommendations (8%) and prescriptions (16%) than International respondents. Chiropractor respondents were least comfortable advising patients with cancer. Conclusion: Chiropractor respondents may serve as health promotors to address patient inactivity, and the challenges identified should be addressed through educational training. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this review was to identify existing prevention strategies for recreational windsurfing-related acute injuries and provide clinicians with a practical overview of current evidence supporting proposed potential prevention strategies. Methods: A literature search was conducted through March 8, 2023, using relevant keywords with Boolean operators, such as "windsurfing" AND "injury prevention" and "windsurfing" AND "exercise interventions," from the PubMed and Google Scholar databases. Only peer-reviewed English-articles were included. Results: Existing prevention strategies, right-of-way rules, a new proposed set of eight potential primary to tertiary prevention strategies for windsurfing-related acute injuries, and proposed definitions of injury prevention levels equivalent to Haddon's matrix were identified and tabled. Conclusions: The proposed potential prevention strategies may facilitate clinicians in preventing recreational windsurfing-related acute injuries. Injury prevention for recreational windsurfing is underresearched. Future studies should focus on large prospective clinical trials evaluating the efficacy of prevention strategies for recreational windsurfingrelated injuries. [ABSTRACT FROM AUTHOR]

A case of anteromedial leg pain diagnosed and treated for 10 years as "shin splints" (medial tibial stress syndrome) is described. A history and examination was performed focused on anatomy, biomechanics, and peripheral nerves. Detailed sensory testing was performed in the painful area, and imaging was obtained to confirm the diagnosis. The clinical investigation was consistent with dynamic stenosis of the left L4-5 intervertebral foramen, causing a mixed partial mononeuropathy of the L4 spinal nerve that presented as pain and hypersensitivity in the anteromedial shin. Manual therapy maneuvers intended to open the intervertebral foramen led to resolution of the pain and sensory deficits. After three additional treatments performed within a month, resolution was maintained for >3 years. This case highlights how concepts from preclinical studies, coupled with basic anatomical, neurological, and biomechanical investigations, can be critical for accurate diagnosis and treatment for a case previously considered unresponsive to care. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this report is to describe the course of chiropractic care for an adult male experiencing persistent anterolateral thigh pain due to bilateral meralgia paresthetica. Clinical features: A 40-year-old male U.S. Veteran was referred to chiropractic care for a two-year history of bilateral anterolateral thigh pain and paresthesia that worsened with inguinal pressure and hip extension activities. Intervention and outcomes: A total of six chiropractic visits, including a combination of telehealth and inperson appointments, took place over a period of 10 weeks. Treatments included patient education, soft-tissue therapy, therapeutic exercise prescription, and spinal manipulation directed toward the lumbar spine. The patient's pain was reduced from a 6/10 rating to a 0/10, he was able to reengage in recreational activities without discomfort, and sustained improvement was reported. Summary: In this case, a trial of chiropractic care was associated with a resolution of the patient's bilateral meralgia paresthetica symptoms. [ABSTRACT FROM AUTHOR]

Objectives: Previous studies have investigated the role of clinical attire in establishing patient-held perceptions of professionalism and knowledgeability across various healthcare settings. This study aimed to understand patients' preferences for chiropractic student attire. Methods: Three hundred and twenty patients were recruited from a university chiropractic clinic and asked to complete an online questionnaire. The patients' preferences for five different attires were rated and calculated as the composite score of five domains (knowledgeable, trustworthy, caring, professional, and comfortable). Results: While 71.9% of participants indicated that how students dress was important to them, most (63.4%) disagreed that wearing a white coat was essential for chiropractic student clinicians. The most preferred form of attire was the current clinic shirt. Conclusion: The attire worn by chiropractic student clinicians at a single institution was found to be an influential attribute. Student chiropractic clinicians should dress professionally to make a good first impression. This study provided some guidance with the ongoing debate around students' dress code. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this review was to identify the epidemiology of, and develop standardized injury definitions for, acute injuries among recreational windsurfers. Methods: A literature search was conducted from the PubMed and Google Scholar databases through February 28, 2023, using relevant keywords with Boolean operators, such as "windsurfing" AND "epidemiology" AND "risk factors." Only peerreviewed, relevant windsurfing-related injury articles were included. Results: A wide range of acute injuries, from minor, moderate, severe, to catastrophic, were reported. Injury rates, frequency of anatomical distributions, existing and potential risk factors, the proposed standardization definitions of behaviour types, skill levels, general windsurfing-related injuries, and injury severity classifications and levels for windsurfing epidemiology were identified and tabled. Conclusions: There is inconsistency in the epidemiological methods and definitions of windsurfing research. The injury rates remain difficult to compare among the identified studies. Future in-depth windsurfing-related injury studies should focus on prospective designs using standardized injury definitions. [ABSTRACT FROM AUTHOR]

Objective: To describe the differential diagnosis, diagnosis, and chiropractic management of a case of chronic upper extremity paresthesia. Clinical features: A 24-year-old woman presented with recent neck stiffness, along with a primary complaint of chronic upper extremity paresthesia and hand weakness of insidious onset. Intervention and outcome: Results of previous electro-diagnostic and advanced imaging studies were combined with clinical assessment to diagnose thoracic outlet syndrome (TOS). Discontinuing after five weeks of chiropractic management, the patient reported significant improvement of paresthesia but less improvement of her hand weakness. Summary: Several etiologies can give rise to symptoms in common with TOS. It is imperative to rule out mimicking conditions. A battery of clinical orthopedic tests has been proposed in the literature for the diagnosis of TOS but with reported questionable validity. As a result, TOS is mostly a diagnosis of exclusion. Chiropractic treatment shows potential for effective management of TOS, but research is required. [ABSTRACT FROM AUTHOR]

Nerve entrapments in the lower extremity are rare and can be difficult to diagnose. Here we describe a Canadian Armed Forces veteran with left posteriorlateral calf pain. The patient's condition was previously misdiagnosed as a left-sided mid-substance Achilles tendinosis, which subsequently led to mismanagement, persistent pain and severe functional limitations. After performing a thorough evaluation, we diagnosed the patient with chronic left-sided sural neuropathy secondary to entrapment within the gastrocnemius fascia. The patient's physical symptoms abated completely with chiropractic care, while overall disability improved substantially after taking part in an interdisciplinary pain program. The objectives of this case report are to describe a challenging differential diagnosis of sural neuropathy, and present conservative whole-person management options according to the patient's needs and goals. [ABSTRACT FROM AUTHOR]

Background: Distal bimelic amyotrophy (DBMA) also known as Hirayama disease, is a rare, self-limiting motor neuron disease manifesting as atrophy of C7-T1 innervated muscles. We present a case report describing the chiropractic management of neck and thoracic pain in a patient with known DBMA. Case presentation: A 30 year-old black male U.S. veteran with DBMA presented with myofascial pain of the neck, shoulder, and back. A trial of chiropractic care was undertaken involving spinal manipulation of the thoracic spine and cervicothoracic region, manual and instrument-assisted soft tissue mobilization, and home exercise prescription. The patient reported modest improvement in pain intensity and did not experience any adverse events. Summary: This case presents the first documentation of chiropractic services in musculoskeletal pain management of a patient with concurrent DBMA. At this time there is no guidance in the existing body of literature for the safety and effectiveness of manual therapy in this population. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to determine the practicality of using a teleconferencing platform to assess the effect of hype on clinicians' evaluations of reports of clinical trials in spinal care. Methods: Twelve chiropractic clinicians were interviewed via a videoconferencing application. Interviews were recorded and timed. Participant behaviour was monitored for compliance with the protocol. Differences between participants numerical ratings of hyped and non-hyped abstracts based on four measures of quality were analysed using pairwise comparisons (Wilcoxon signed rank test for independent samples). In addition, a linear mixed effects model was fitted with condition (i.e. hype vs. no hype) as a fixed effect and participant and abstract as random effects. Results: The interviews and data analysis were conducted without significant technical difficulty. Participant compliance was high, and no harms were reported. There were no statistically significant differences in the quality rankings of hyped versus nonhyped abstracts. Conclusion: The use of a videoconferencing platform to measure the effects of hype on clinicians' evaluations of abstracts of clinical trials is practical and an adequately powered study is justified. Lack of statistically significant results may well be due to low participant numbers. [ABSTRACT FROM AUTHOR]

Objective: To review and summarize the recent literature, increase awareness and provide guidance for chiropractic physicians regarding the diagnosis of spinal gout. Methods: A search of PubMed was undertaken for recent case reports, reviews and trials relating to spinal gout. Results: Our analysis of 38 cases of spinal gout revealed that 94% of spinal gout patients presented with back or neck pain, 86% displayed neurological symptoms, 72% had a history of gout, and 80% had raised serum uric acid levels. Seventy-six percent of cases proceeded to surgery. A combination of clinical findings, laboratory tests and appropriate utilization of Dual Energy Computed Tomography (DECT) has the potential to improve early diagnosis. Conclusion: Gout is an uncommon cause of spine pain; however, it must be considered in the differential diagnosis as outlined in this paper. Increased awareness of the signs of spinal gout and earlier detection and treatment has the potential to improve the quality of life of patients and reduce the need for surgery. [ABSTRACT FROM AUTHOR]

Objectives: To conduct a narrative review of the literature pertaining to strategies employed by health professional programs to teach social determinants of health (SDOH) and use the results to describe pathways for integrating SDOH education into Doctor of Chiropractic programs (DCPs). Methods: A narrative review of peer-reviewed literature describing SDOH education in health professional programs within the United States was performed. The results were used to inform potential pathways of integrating SDOH education into all aspects of DCPs. Results: Twenty-eight papers demonstrated health professional programs' incorporation of SDOH education and assessment into didactic and experiential learning opportunities. Educational interventions resulted in positive changes in knowledge and attitudes toward SDOH. Conclusion: This review demonstrates existing methods for integrating SDOH in health professional programs. Methods may be adopted and assimilated into an existing DCP. Further research is needed to understand barriers and facilitators to the implementation of SDOH education into DCPs. [ABSTRACT FROM AUTHOR]

Low back pain accounts for the most years lost to disability of any malady worldwide but most cases of disc herniation (DH) and degenerative disc disease (DDD) resolve with conservative methods. Numerous tissue sources of pain affecting the degenerative/ herniated disc have been identified, with changes secondary to the influence of inflammation figuring prominently among them. Due to the proven linkage of inflammation to the pain and progression of disc degeneration, anti-inflammatory/anti-catabolic and pro-anabolic repair strategies are gaining prominence for novel therapeutic approaches. Current treatments include conservative therapies such as modified rest, exercise, anti-inflammatory treatments, and analgesics. There is no accepted proposed mechanism of action to support the direct role of spinal manipulation for the treatment of the degenerative and/or herniated disc. However, there are published accounts of very serious adverse events accompanying such treatments leading to the question; 'should a patient with suspected painful IVD be treated with manipulation? [ABSTRACT FROM AUTHOR]

Objective: To highlight a case of an athlete with a symptomatic pretibial cyst 4-years post-ACL reconstruction surgery. Case presentation: A 23-year-old female soccer athlete presented with right-sided knee pain, locking and catching, and diminished sensation along the anteroinferior knee. She had a history of an ipsilateral ACL hamstring autograft four years prior. Physical evaluation revealed a visible and palpable swelling medial to the patellar tendon, limited and painful range, and hypoesthesia within the infrapatellar branch of the saphenous nerve. MRI revealed a tubular ganglion cyst along the anterior aspect of the tibial tunnel, medial to the patellar tendon, and anterior to the ACL graft. Summary: Post-surgical ganglion cyst formation in the reconstructed ACL is a rare complication that can present years following ACL surgery. This case aims to bring awareness to this condition as a potential long-term complication in the ACL-reconstructed athlete. [ABSTRACT FROM AUTHOR]

Objective: Following sports injury, a timely and accurate diagnosis is important, so as to initiate appropriate care as soon as possible. This is perhaps even more paramount in pediatric athletic trauma, particularly during the pre-puberty through adolescent years of rapid skeletal growth. This paper presents the diagnosis and management of osteochondritis dissecans in its third most common location, the elbow, a presentation of which chiropractors should be aware, including the importance of timely diagnosis and appropriate treatment. Clinical features: A 9-year-old elite gymnast presented at a chiropractic clinic with elbow pain and restricted range of motion after a fall during training. Following multidisciplinary involvement, the diagnosis was eventually made as osteochondritis dissecans. Intervention and outcomes: The patient underwent successful arthroscopic surgery in order to remove the osteochondral fragment, followed by a specific regimen of rehabilitation exercises, which helped to enhance and accelerate optimal healing for her return to athletic activity. Summary: This case reminds the practicing chiropractor of the valuable role he/she can play in a multidisciplinary management of pediatric sports trauma, particularly in diagnosis and post-surgical care. A literature review presents a synopsis of the reported clinical presentations, diagnostic assessment and therapeutic options for capitellar osteochondritis dissecans. [ABSTRACT FROM AUTHOR]

This case series presents four cases of scapholunate interosseous ligament (SLIL) injury. We discuss the process of early recognition and highlight difficulties encountered in current diagnostic and conservative management strategies. The cases profile interdisciplinary management of four scapholunate (SL) injuries that have different clinical presentations and injury mechanisms. Three sport-related SL injuries were managed conservatively by a sport specialist chiropractor and one sport-related case was self-managed. Management strategies included early wrist immobilization, soft tissue manual therapy, low-level laser therapy, proprioceptive and strengthening exercises, and early orthopedic referral. This case series highlights: (1) the spectrum of SL injuries (2) the importance of early specialty referral, (3) the paucity of literature with respect to conservative management of these injuries and (4) the role of manual therapy and rehabilitation professionals as part of the healthcare team in detecting and helping manage these wrist injuries. [ABSTRACT FROM AUTHOR]

Objectives: To identify and prioritize research to inform research agenda development for Canadian chiropractors working in sport. Methods: Clinicians, researchers and leaders from the Canadian sports chiropractic field were invited to participate in 1) a survey to refine a list of research priorities, 2) a Delphi procedure to determine consensus on these priorities, and 3) a prioritization survey. Results: The top three research priorities were 1) effects of interventions on athletic outcomes, 2) research about sports healthcare teams, and 3) clinical research related to spinal manipulative and mobilization therapy. The three highest ranked conditions to research were 1) low back pain, 2) neck pain, and 3) concussion. Collaborations with sports physicians and universities/colleges were rated as important research collaborations to pursue. Conclusions: These results represent the Canadian sports chiropractic perspective to research priority setting and will be used alongside stakeholder input to set the first research agenda for the Canadian sports chiropractic field. [ABSTRACT FROM AUTHOR]

Background: Non-pharmacologic treatment, including chiropractic care, is now recommended instead of opioid prescriptions as the initial management of chronic spine pain by clinical practice guidelines. Chiropractic care, commonly including spinal manipulation, has been temporally associated with reduced opioid prescription in veterans with spine pain. Purpose: To determine if chiropractic management including spinal manipulation was associated with decreased pain or opioid usage in financially disadvantaged individuals utilizing opioid medications and diagnosed with musculoskeletal conditions. Methods: A retrospective analysis of quality assurance data from a publicly funded healthcare facility was conducted. Measures included numeric pain scores of spine and extremity regions across three time points, opioid utilization, demographics, and care modalities. Results: Pain and opioid use significantly decreased concomitant with a course of chiropractic care. Conclusions: A publicly funded course of chiropractic care temporally coincided with statistically and clinically significant decreases in pain and opioid usage in a financially disadvantaged inner-city population. [ABSTRACT FROM AUTHOR]

Introduction: The objectives of this study was to conduct an updated comparative audit involving a larger and more representative group of accredited chiropractic programs in order to determine if (i) if there has been any changes in the delivery of JEB curricula since the first audit was conducted in 2010, and (ii) provide recommendations that could lead toward a standardized or model JEB curriculum worldwide. Methods: This study was approved by the ERB of the University of South Wales. Twenty-one chiropractic programs agreed to provide JEB course outlines for review. Results: A total of 88 different course outlines, which listed 83 different topics pertaining to JEB course content, were submitted for review. Conclusion: The results of this comparative audit revealed there has been an increase in the variability of JEB course content taught to students over time. Recommendations are provided for the next steps that could lead toward a standardized or model JEB curriculum curricula. [ABSTRACT FROM AUTHOR]

Objective: We set out to create a Family Medicine EHR (electronic health record) embedded exercise application. This was done to evaluate the utility of the exercise app for providers and to understand the usefulness of the exercise app from the perspective of patients. Methods: This exercise application was developed through an iterative process with repeated pre-testing and feedback from an interprofessional team and embedded into the EHR at an academic family medicine clinic. Anecdotal feedback from patients was used to inform pre-testing adaptations. Results: The application required six iterations prior to clinical utility. It had several features that clinicians and patients felt were beneficial. These features involved a customizable exercise directory with pre-made templated plans which could be further modified. To overcome accessibility barriers, the application was developed to include digital and printable copies with an integrated direct email option for ease of remote sharing with patients. Conclusion: A customizable, open-source exercise application was developed to facilitate provider exercise prescription and support patient self-management. This project may be useful for other providers interested in developing similar programs to address musculoskeletal conditions in their patients. Next steps are to undertake pilot testing of the app with broader provider and patient feedback. [ABSTRACT FROM AUTHOR]

The Chiropractic Academy for Research Leadership (CARL) is an innovative program that provides mentorship, training, and leadership opportunities to the next generation of chiropractic researchers through an open application process. The first CARLoquium was launched by in 2021 by the CARL Fellows as a means to meet and disseminate research findings from the chiropractic community during the COVID-19 pandemic with the second CARLoquium held virtually in March 2022. To date, the conference has featured numerous keynote speakers, hundreds of abstracts and continues to provide a cost-effective avenue for our researcher community to gather. [ABSTRACT FROM AUTHOR]

Background: Injuries to the meniscus are particularly prevalent in soccer players, with an incidence of 0.448 injuries per 1000 hours of playing. However, in the adolescent soccer player population, it has been reported that up to 63% of asymptomatic knees may demonstrate horizontal or oblique tears on MRI. These results may negatively influence clinical decision-making and plan of management for adolescent soccer players with knee problems. Case presentation: A case of a 15-year-old soccer player is presented after having been diagnosed by his family physician with a left lateral meniscus tear as per MRI, following a 10-week period of anterior knee pain. He presented to a chiropractor for a second opinion before consulting with the orthopedic surgeon. Management and outcome: Recommendations for progressive rehabilitation owing to the lack of clinical evidence for meniscal abnormality were made. A primary diagnosis of left patellar tendinopathy was determined and after a 6-week comprehensive rehabilitation program, the patient made a complete recovery. Summary: A thorough history, physical examination, and understanding of the patient's injury mechanism are suggested before confirming/refuting suspicions of meniscal abnormalities via MRI. This will help to inform better clinical decision-making as well as decrease the occurrence of unnecessary imaging. [ABSTRACT FROM AUTHOR]

Cervical spondylotic myelopathy (CSM) is the leading cause of acquired spinal cord dysfunction worldwide and may be expected to increase in prevalence due to an aging global population. Clinical features of CSM are highly variable, and chiropractors frequently manage patients with common signs and symptoms of CSM such as neck pain, extremity weakness, and gait imbalances. Early recognition of signs consistent with myelopathy may mitigate future disability and improve quality of life. Key predictors of patient outcome are the age of initial presentation, baseline CSM severity (as measured by mJOA score), and the presence of gait disturbances. This report describes three cases of CSM presenting to a chiropractic clinic. Each case illustrates a unique manifestation of CSM, including myelopathy, myeloradiculopathy, and distal neuropathic pain (funicular referral). In addition, a review of CSM terminology, epidemiology, pathobiology, clinical features, imaging, and management is provided. [ABSTRACT FROM AUTHOR]

Patient-provider communication can lead to unhelpful ideas and beliefs about a patient's condition, negatively impacting their clinical outcome. A 34-year-old male Veteran presented for an evaluation of high impact chronic low back pain. Previous interactions with various healthcare providers resulted in the Veteran viewing his condition as ominous and in need of intervention, however clinical findings did not support these beliefs. Our Veteran underwent six visits in the chiropractic clinic with treatment consisting of pain education, utilization of cognitive behavioral principles, active home care exercises and spinal manipulation, resulting in improvements in functional and objective outcome measures. This case report highlights the impact of misalignment between an early contact healthcare provider and patient misunderstanding of their condition on long term outcomes. It serves as an example of how physicians utilizing pathoanatomic explanations to describe a patient's chronic low back pain diagnosis can alter the patient's beliefs about their condition. [ABSTRACT FROM AUTHOR]

There is limited research regarding management of temporomandibular disorders (TMD) in adolescents with imaging signs of juvenile idiopathic arthritis (JIA). An 11-year-old girl presented to a hospital-based chiropractor for evaluation of a 1.5-year history of unilateral temporomandibular joint (TMJ) pain and trismus. Previously, pediatric rheumatologists diagnosed JIA after contrast-enhanced magnetic resonance imaging revealed edema, effusion, and bilateral anterior disc displacement, and recommended methotrexate, corticosteroid injection, and arthrocentesis. The chiropractor questioned the JIA diagnosis, instead relating symptoms to a mechanical TMD/disc origin. Manual therapy, TMJ exercises, and acupuncture improved TMJ pain and opening. Invasive medical JIA interventions were avoided without long-term recurrence, further questioning the preceding JIA diagnosis. The success of this case suggests that stepped care, beginning with conservative treatment, has value for adolescents with TMD suspect for JIA. Integration of chiropractors and acupuncturists into healthcare institutions may facilitate this care model by affording nonpharmacologic interventions earlier in patient care. [ABSTRACT FROM AUTHOR]

Objective: We aimed to determine the feasibility of conducting a cross-sectional study to estimate the one-week prevalence of overuse-related shoulder pain and activity limitation in competitive tennis players. Methods: Eligible for the study were competitive adult tennis players who reside in Toronto. Using a convenience sample, the Oslo Sports Trauma Research Centre Overuse Shoulder Injury Questionnaire (OSIQ) was administered online to provide preliminary estimates of the prevalence of shoulder pain and activity limitation, injury severity and pain intensity. Feasibility outcomes included evaluating participation rate and missing data in the questionnaire. Results: Forty-three tennis players were included in the questionnaire (68.3% participation rate, 100% completion rate). There was no missing data. The oneweek proportion of those with shoulder pain and activity limitation was 41.9% with a mean injury severity of 33/100. Mean pain intensity was 1.9/10. Conclusion: Our study demonstrates that it is feasible to conduct a cross-sectional study to measure the oneweek prevalence of shoulder pain and activity limitation in tennis players. [ABSTRACT FROM AUTHOR]

Objective: To examine the risk of bias in chiropractic mixed methods research. Methods: We performed a secondary analysis of a meta-epidemiological review of chiropractic mixed methods studies. We assessed risk of bias with the Mixed Methods Appraisal Tool (MMAT) and used generalized estimating equations to explore factors associated with risk of bias. Results: Among 55 eligible studies, a mean of 62% (6.8 [2.3]/11) of MMAT items were fulfilled. In our adjusted analysis, studies published since 2010 versus pre-2010 (adjusted odds ratio [aOR] = 2.26; 95% confidence interval [CI], 1.39 to 3.68) and those published in journals with an impact factor versus no impact factor (aOR = 2.21; 95% CI, 1.33 to 3.68) were associated with lower risk of bias. Conclusion: Our findings suggest opportunities for improvement in the quality of conduct among published chiropractic mixed methods studies. Author compliance with the MMAT criteria may reduce methodological bias in future mixed methods research. [ABSTRACT FROM AUTHOR]

Objective: We set out to identify factors associated with recording of exercise minutes per week in electronic patient files at chiropractic teaching clinics to better understand whether this important health determinant -- exercise vital sign (EVS) -- is captured or not. Methods: Patient files (4018) from 23 clinicians eligible for inclusion underwent multilevel logistic regression modeling to explore the association between a recorded EVS and the following: patients' age, sex, comorbidities and interns nested within clinicians. Results: EVS discussion was documented in 81.2% of patient files, whereas 44.9% had exercise minutes recorded numerically. Clinicians and interns explained 1.7% and 25.5% of the variance in the EVS outcome. Conclusion: To enhance EVS recording, clinic directors and clinicians should better educate the interns on the importance of exercise is medicine and appropriate record keeping, as they explained the largest portion of variability in recording exercise in minutes per week. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study is to describe the attitude of Université du Québec à Trois-Rivières (UQTR) chiropractic students toward the International Clinical and Professional Chiropractic Education Position Statement and evidence-based practice (EBP) beliefs. Methods: A cross-sectional survey was administered to all the UQTR chiropractic students. Using a five-point Likert scale, students were asked to rate their level of agreement with the position statement (10 items), EBP (2 items), interprofessional collaboration (2 items) and vitalistic philosophy (2 items). Results: Survey response rate was 71%. Students most frequently reported strong agreement with the position statement, EBP and interprofessional collaboration. They also most frequently disagreed with vitalistic philosophy. The attitude toward the position statement was positively correlated with the year of study in the program (r=0.10, p=0.019), EBP (r=0.56, p<0.001) and interprofessional collaboration (r=0.45, p <0.001). Conclusions: UQTR chiropractic students demonstrate high levels of agreement with EBP and the Education Position Statement. [ABSTRACT FROM AUTHOR]

Introduction: Distal clavicular osteolysis (DCO) is a musculoskeletal pathology characterized by shoulder pain. Given the high prevalence of shoulder pain due to rotator cuff and subacromial injuries, DCO is often overlooked. Conservative therapy is indicated prior to surgical intervention. However, no literature has described conservative management of DCO in detail. This report will outline conservative management details for DCO to guide future research and clinicians. Case presentation: A 24-year-old female hockey player presented with trauma-induced injury, where she was diagnosed with type II acromio-clavicular joint separation. She presented 5-months later with residual pain and limitations in ranges of motion (ROM). Radiographic images revealed DCO. Management and outcome: Management entailed strict rest from overhead activities followed by rehabilitation and manual therapy. 6-months later the patient reported resolution of symptoms, improved ROMs, and activities of daily living. Summary: DCO can be difficult to diagnose given its limited etiological understanding, low incidence, and poor radiographic sensitivity. DCO diagnosis should be considered in cases with unresolving shoulder pain. [ABSTRACT FROM AUTHOR]

Background: Vertebral osteomyelitis (OM) is an infectious condition of bone caused by an infecting organism, most commonly Staphylococcus aureus (S. aureus). Though rare in adolescents, it is important to remember that this population has vascularized intervertebral discs prior to skeletal maturity and, therefore, is more susceptible to an osteodiscitis infection. Purpose: To determine the possible factors that lead to a delayed diagnosis of osteodiscitis compared to an early diagnosis in an adolescent athlete. Summary: This case provides a unique example of osteodiscitis in an adolescent rowing athlete where an infected heel blister was the only indication toward a diagnosis. Early diagnosis and successful management of osteodiscitis are dependent on recognizing constitutional and non-constitutional signs and symptoms of infection. Clinical relevance: In sport, when skin barriers may be compromised more readily, the risk of infection should be considered in the differential diagnosis of unprovoked back pain. [ABSTRACT FROM AUTHOR]

Objective: This study describes the radiographic diagnosis and nonoperative chiropractic management for a case of a chronic calcaneonavicular coalition in an adult patient. Background: Calcaneonavicular coalition is a congenital/acquired condition of the tarsal bones often diagnosed in individuals 8-12 years old. Considering its rare presentation (less than 1% of the population), there remains little literature on the conservative management of this condition. Case presentation: Chronic calcaneonavicular coalition in a 35-year-old recreational athlete is presented. Management/outcome: Following radiographic diagnosis, the patient was placed in a walking boot for four-weeks. After removal of the boot, the patient was managed nonoperatively. They reported a full resolution of symptoms with noted return to all pre-injury activities. Summary: Presentation of calcaneonavicular coalition may be dependent on many factors, including age, medical history, and chronicity of the condition. Previous medical background may include recurrent inversion ankle sprains, aggravated with activity, and alleviated with rest. Nonoperative management of calcaneonavicular coalition may be considered as a viable intervention. [ABSTRACT FROM AUTHOR]