THE CLINICAL CLARITY BLOG

| idea | This is a place for thinking about new evidence and new ideas. The Clinical Clarity Blog looks at the latest research and puts it into perspective for chiropractors. So come back here often to challenge your thinking, improve your decision-making and to grow your clinical certainty.

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    July 27, 2017
    Sensing Your Reality
    How does the brain use our sensory system to build a 'model' of our world, and what happens if the brain is deprived of this important data? What can a chiropractic adjustment do to improve this?
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    May 13, 2017
    Yes Chiropractic is Neurological, But What Does That Actually Mean?
    When chiropractors are asked how manipulation works, they usually answer that the effect is 'neurological'. But what does this actually mean?
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    February 28, 2017
    Input or Output?
    Spinal manipulation is often described as a tool for removing neurological interference - to facilitate improved motor output. But is this correct? Or is it really a novel type of sensory input?
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    February 23, 2017
    The Quality of Your Life is the Quality of Your Inhibition
    What makes patients with fibromyalgia, migraine, anxiety and irritable bowel syndrome so sensitive? More importantly, can you do anything about it?
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    October 21, 2016
    Make Yourself Useful
    Chiropractors occupy an unusual, and undervalued, position within the healthcare community. But where exactly does our rightful place lie? How do we become relevant to our medical peers?
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    September 4, 2016
    Calcium Supplements, Friend or Foe?
    The use of calcium supplements to prevent or manage osteoporosis is common, and the logic seems unassailable. But are they actually doing more harm than good?
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    August 23, 2016
    You Need to Know Things
    As chiropractors, we have a strong association with the spine. But how much do we really know about it, particularly when it hurts? Just how much do we need to know to claim to be 'experts'?
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    August 18, 2016
    The Murky World of Modic Changes
    We don't tend to think about bacteria as a cause of lower back pain. But might some of our patients actually have an infection within their spine? How would you know?
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    June 11, 2016
    Will That Disc Herniation Get Better? II
    Annular tears are an accepted cause of lower back pain. But how can you tell whether your patient will get better, or perhaps require surgery? Can an MRI help you to decide?
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    May 28, 2016
    Is Walking Enough?
    The use of exercises in managing spinal disorders seems well founded. But have we made it all too complex? Is walking actually enough for most people? Does specificity matter?
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    April 17, 2016
    Uncertainty Sets You Free
    Humans are hard-wired to see patterns when often none exist, and this includes our clinical examination. So how reliable are the things that we all do everyday - such as palpation?
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    March 5, 2016
    The Brain, Balance & Bone Density
    Osteoporosis seems to depend upon genetics, biochemistry and the environment. But what role does the brain play in regulating bone turnover, particularly the balance system?
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    January 5, 2016
    Responders Are Different
    Why do some patients with spinal pain respond well to manipulation, but others do not? Is the difference actually physiological, or just psychological? Or could it all be due to genetics?
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    September 8, 2015
    Pain Beyond the Facet
    When a patient has sciatica it is tempting to immediately suspect a disc protrusion. After all, what other structures could possibly compress the nerve roots? But is nerve compression really necessary?
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    September 5, 2015
    Complexity and Communication
    The chiropractic profession has always placed an emphasis upon function. But how easy is it to explain 'function' to medical practitioners, versus a tissue diagnosis?
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    August 25, 2015
    Letting Go is Never Easy
    Science continues to bring us new ideas and challenge existing ones. But what happens when science says that something we do every day doesn't work? Do we ignore it, or do we change?
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    August 7, 2015
    What is Our Story?
    After more than 100 years of existence, the chiropractic profession still has trouble defining itself and communicating its uniqueness. Just what is our story, and how important is it?
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    April 4, 2015
    Adjusting Our Understanding
    Spinal adjustment is the defining feature of the chiropractic profession. But what actually changes after manipulation, and how does it improve someone's quality of life?
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    December 23, 2014
    Keeping an Open Mind
    Modern clinicians are constantly being exposed to new ideas that challenge our entrenched beliefs and practices. So how important is it for us to keep a truly open mind?
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    November 23, 2014
    Why Do We Have Brains?
    Most people presume that we have evolved brains to think with. But some neuroscientists believe that we only have them to allow purposeful movement. What are the implications for chiropractors?
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    October 11, 2014
    The Stroke Perspective
    The topic of chiropractic, neck manipulation and stroke just won't go away. While science has given us confidence to understand the issue, the perception of danger still lingers. Why?
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    May 24, 2014
    When Can I Start Exercising?
    Exercises are often seen as an important part of an 'evidence-based' approach to spine care. But is it ever too early to begin exercises? Is there actually a right time to start, and what form should they take?
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    May 3, 2014
    Will That Disc Herniation Get Better?
    Large disc herniations are often a cause for concern, but many will actually resorb over time. How can you tell whether the herniated material will ever shrink back? Could the MRI give us a clue?
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    March 30, 2014
    Right, Wrong or Incomplete?
    Research has had a difficult time determining the usefulness of spinal manipulation for chronic low back pain. Maybe the science of acupuncture might help us understand?
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    December 29, 2013
    Many Shades of Grey
    You would think that a patient requiring a hip replacement looks very different to someone with sciatica. After reading this, you might think quite differently next time you see someone with leg pain.
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    September 3, 2013
    The Diagnostic Imperative
    Since its inception the chiropractic profession has had an uneasy relationship the word 'diagnosis'. But what are the implications of using this word? What is our role in the health care system?
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    July 23, 2013
    Proprioception, the Brain and Pain
    As science uncovers more about the underlying mechanisms of spinal pain we are increasingly drawn to the central changes occurring within the brains of our patients.
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    June 23, 2013
    The Migraine-Melatonin Connection
    Migraine has always been a problem of chemistry. Interestingly, one of the most common triggering agents is sleep. But how does this relate to migraine? Could melatonin play a role in this disease?
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    February 26, 2013
    Migraine Changes Everything
    Chronic back pain can be due to abnormal brain function, not just simple mechanics. What about migraineurs, who already have compromised neural circuitry? How do they compare?
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    October 12, 2012
    Exercises, What's the Use?
    A frequent criticism of chiropractic care is that it seems largely passive and that exercises don't feature strongly in overall management. But do tailored exercises lead to better outcomes?
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    May 12, 2012
    Everything is Unreliable - Get Used to it
    Clinical examination is often seen as 'unreliable', and there's a tendency to seek high-tech solutions to the problem of uncertainty. But what about MRI scans? Do they ever 'miss' things?
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    March 13, 2012
    Migraine, Colic and Complexity
    Migraine is a genetic neurological disease that is often misunderstood. It now appears that the neuronal instability of the migraineur's brain may manifest in infants as colicky behaviour.
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    December 7, 2011
    Expectation and Pain
    Placebo is part of health care. But recent studies have shown that a patient's expectation of treatment success influences their nociceptive system all the way from the cortex to the spinal cord.
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    July 30, 2011
    Scoliosis, Mechanical or Neurological?
    Scoliosis is a condition that chiropractors are often asked to manage. But is it a mechanical problem? Recently there has been a shift in research towards brain-based models of scoliosis development.
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    May 5, 2011
    What Does an Adjustment Do?
    What does a spinal adjustment actually do? The research literature is gradually building a body of evidence as to the mechanics of manual treatment and how it is transduced into neurological effects.
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    March 24, 2011
    Knuckle Cracking and Arthritis
    One of the most common questions that a chiropractor is asked is, "Does joint cracking cause arthritis?" You may have no difficulty refuting the suggestion, but do you actually have any evidence?
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    March 22, 2011
    Tell Me Where it Hurts II
    The possibility of osteoporotic fracture is usually raised in post-menopausal women suffering from thoracic pain. But is the pain typically felt in the midline, or even over the spine at all?
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    March 5, 2011
    Tell Me Where it Hurts
    One of the great challenges of clinical practice is determining the origin of pain. But can we accurately identify a tissue source using our clinical examination? The answer seems to be "Yes".
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    February 13, 2011
    Distance Running - Are We Born to it?
    Scientists look to anthropology for clues as to why human beings are so good at running. The author Christopher McDougall, who wrote the best-selling book “Born to Run”, also has some ideas.
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    December 16, 2010
    Adhesions Revisited
    Adhesions have been implicated in both joint stiffness and degeneration. But where else might adhesions have their influence upon the spinal pain patient? Can they be the reason for chronic sciatica?
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    October 26, 2010
    Facet Joints - What's Going On There?
    There's no single explanation for facet joint pain. Terms such as 'synovitis' and 'adhesions' are often used, but how common are these entities, and what causes them? What's really happening?
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    August 14, 2010
    Expectation and Outcome
    While we might not like to think it, research suggests that a patient's expectation about the outcome of treatment is possibly the largest determinant of success, particularly when it comes to pain.
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    August 3, 2010
    Does Distance Running Harm You?
    A 'truth' that is often stated without interrogation is that long distance running causes osteoarthritis of the knees, hips and spine. But is there any data to support this assertion?
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    June 20, 2010
    Adjusting Discs - What Are We Doing?
    Managing patients with intervertebral disc damage is an everyday occurrence for chiropractors. But how does manipulation help someone who has torn the connective tissue of a disc?
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    June 3, 2010
    Are You Adjusting a Hypo or Hyper?
    Most definitions of joint dysfunction state that stiffness is a cardinal sign. But could it actually be the hypermobile joints that benefit most from the neurological effects of an adjustment?
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    May 22, 2010
    Proprioception Part II
    Proprioceptive difficulties are common in back pain patients. But could the problem be in the brain itself? Could a disruption in the way the cortex represents a painful back underpin the condition?
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    May 11, 2010
    Proprioception - Key to Chiropractic
    Connective tissue damage in the spine is frequently the symptom of a greater deficit. But what might precede a spinal injury? And how would we know it was present if our patients are asymptomatic?
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    April 29, 2010
    Vagaries of the Clinical Exam
    It is unfortunate that the art of clinical diagnosis is exactly that - an art. Sometimes our most cherished practices are not as reliable as we'd like - such as the humble palpatory examination...
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    April 27, 2010
    The Nerve Root Sedimentation Sign
    One of the great challenges facing clinicians is to decide whether a radiological finding is relevant. How can we tell whether stenosis on a lumbar MRI is causing symptoms?
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    April 26, 2010
    Albert Was Right
    Many of the difficulties facing chiropractors arise out of a single, treatable problem - a lack of clinical certainty. As the saying goes, “You can't sell what you don't own”. But where does certainty come from?
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