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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.
July 18, 2022Knees, Spines and the Bayesian Brain - Part 3Is it possible to 'reset' a brain that is experiencing chronic pain? What is the difference between a 'top-down' approach and a 'bottom-up' approach?
December 4, 2021Knees, Spines and the Bayesian Brain - Part 2How does the brain use stored memories to decide when something is 'wrong' with the body? Can we do anything to help when pain persists?
October 16, 2021Knees, Spines and the Bayesian Brain - Part 1Pain is a complex phenomenon that is not directly related to tissue damage. But how does the brain predict when things should hurt?
July 31, 2019The Antibiotic-Stroke ConnectionCervical artery dissection is a rare but important cause of stroke. But who poses the greatest risk? Could an everyday antibiotic make some people more susceptible?
June 25, 2019It's the Whole PackageMeasuring the effects of spinal manipulation in a research setting is very difficult. Just how important is the context to the outcome? And how do the patient's beliefs influence your results?
January 19, 2019Migraine and Stroke - What's the Connection?Migraine sufferers are complex. But it's not just their headaches that you need to understand - they also have a greater risk of stroke and arterial dissection.
July 27, 2017Sensing Your RealityHow 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?
May 13, 2017Yes 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?
February 28, 2017Input 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?
February 23, 2017The Quality of Your Life is the Quality of Your InhibitionWhat makes patients with fibromyalgia, migraine, anxiety and irritable bowel syndrome so sensitive? More importantly, can you do anything about it?
October 21, 2016Make Yourself UsefulChiropractors 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?
September 4, 2016Calcium 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?
August 23, 2016You Need to Know ThingsAs 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'?
August 18, 2016The Murky World of Modic ChangesWe 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?
June 11, 2016Will That Disc Herniation Get Better? IIAnnular 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?
May 28, 2016Is 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?
April 17, 2016Uncertainty Sets You FreeHumans 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?
March 5, 2016The Brain, Balance & Bone DensityOsteoporosis seems to depend upon genetics, biochemistry and the environment. But what role does the brain play in regulating bone turnover, particularly the balance system?
January 5, 2016Responders Are DifferentWhy 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?
September 8, 2015Pain Beyond the FacetWhen 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?
September 5, 2015Complexity and CommunicationThe chiropractic profession has always placed an emphasis upon function. But how easy is it to explain 'function' to medical practitioners, versus a tissue diagnosis?
August 25, 2015Letting Go is Never EasyScience 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?
August 7, 2015What 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?
April 4, 2015Adjusting Our UnderstandingSpinal 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?
December 23, 2014Keeping an Open MindModern 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?
November 23, 2014Why 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?
October 11, 2014The Stroke PerspectiveThe 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?
May 24, 2014When 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?
May 3, 2014Will 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?
March 30, 2014Right, 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?
December 29, 2013Many Shades of GreyYou 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.
September 3, 2013The Diagnostic ImperativeSince 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?
July 23, 2013Proprioception, the Brain and PainAs 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.
June 23, 2013The Migraine-Melatonin ConnectionMigraine 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?
February 26, 2013Migraine Changes EverythingChronic 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?
October 12, 2012Exercises, 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?
May 12, 2012Everything is Unreliable - Get Used to itClinical 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?
March 13, 2012Migraine, Colic and ComplexityMigraine 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.
December 7, 2011Expectation and PainPlacebo 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.
July 30, 2011Scoliosis, 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.
May 5, 2011What 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.
March 24, 2011Knuckle Cracking and ArthritisOne 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?
March 22, 2011Tell Me Where it Hurts IIThe 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?
March 5, 2011Tell Me Where it HurtsOne 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".
February 13, 2011Distance 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.
December 16, 2010Adhesions RevisitedAdhesions 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?
October 26, 2010Facet 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?
August 14, 2010Expectation and OutcomeWhile 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.
August 3, 2010Does 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?
June 20, 2010Adjusting 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?
June 3, 2010Are 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?
May 22, 2010Proprioception Part IIProprioceptive 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?
May 11, 2010Proprioception - Key to ChiropracticConnective 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?
April 29, 2010Vagaries of the Clinical ExamIt 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...
April 27, 2010The Nerve Root Sedimentation SignOne 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?
April 26, 2010Albert Was RightMany 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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