Biological Basis of Musculoskeletal Injury and Manual Therapies
Clinical and Health Sciences Research
Knowledge Translation and Health Policy
According to Health Canada, eight out of 10 Canadians will suffer from back pain at some point in their lives. In Ontario alone, low back pain costs an estimated $1.2 billion annually and is a leading cause of long-term disability.
CMCC created the McMorland Family Research Chair in Mechanobiology to investigate spine instability, degeneration and joint dysfunction/subluxation and the impact of everyday activities on spine health.
Director of the Human Performance Laboratories Dr. Samuel Howarth, holds the Chair position and has set an overarching agenda for the labs to study movement, both high performance and those used in day to day tasks.
Although chiropractic care is an accepted form of treatment for low back pain, there are significant questions regarding its underlying mechanisms and relatively little is known about its biomechanical impact. This study plans to identify the possible biomechanical effects that chiropractic care, including spinal manipulation, has on acute and chronic low back sufferers. Subjects were recruited and tested through the Faculty of the Daniel Felix Ritchie School of Engineering and Computer Science at the University of Denver in Denver, Colorado, USA. There are 60 total subjects (n = 60); 20 asymptomatic, 20 acute low back pain, 20 chronic low back pain. Kinematics of the thorax and pelvis were measured as the subjects participated in the sit-to-stand test (STS) both prior to and after receiving chiropractic treatment to the low back. The collected raw data from these trials will be sent from Denver to the Canadian Memorial Chiropractic College human performance lab for biomechanical and statistical analysis. The outcomes of interest are the pelvis-thorax joint angles and velocities in all 3 planes.
Recent lab-based findings suggest acute neurophysiological benefits following high-velocity low-amplitude (HVLA) manipulation. Anecdotal claims of enhanced athletic performance following HVLA manipulation by coaches and athletes have yet to be explored. The proposed study investigates the effect of instrument-assisted extremity HVLA manipulation applied to the midfoot on performance of the unilateral horizontal drop-jump (U-HDJ) test in a population of elite sprinters. The U-HDJ test has been suggested as a low threshold realistic clinical representation of sprinting performance.
Static imaging of the spine at the end ranges of motion is commonly performed for people with low back pain; however, this type of imaging is limited in its relationship to low back pain and is unable to capture dynamic characteristics of movement between the spine’s vertebrae throughout the range of motion. Quantitative fluoroscopy continuously images the spine throughout its range of motion. Quantitative fluoroscopy has been used to examine motion sharing between segmental levels of the lower back, which can distinguish healthy people from those with low back pain. This study will establish reliability for these motion sharing properties.
Healthcare workers, such as chiropractors, utilizing manual therapeutic procedures are subjected to considerable physical loads. Research suggests chiropractors sustain musculoskeletal disorders (MSDs) from their clinical practice. However, such research is dated and fails to adequately contextualize the etiology and severity. This study aims to determine prevalence, bodily distribution, duration, and severity of MSDs in practicing Ontario chiropractors through a customdesigned online survey tool. Additional information will be obtained regarding biomechanical and/or practice modifications made by chiropractors with work-related MSDs. These data will be critical in facilitating the development of safer manual therapeutic procedures for chiropractors and other healthcare workers.
Neck pain is a common condition frequently treated with forces that are manually applied to the spine such as spinal manipulation (SMT). Currently, it is not known if the SMT characteristics (force, duration, etc.) is related to patient outcomes. This study will initiate the investigation of the potential influence SMT characteristics might have on pain and stiffness in people with neck pain receiving a mid-back SMT.
Spinal pain such as low back and neck pain is responsible for a large proportion of pain and disability in the Canadian Armed Forces (CAF). We aim to develop a practice-based research network (PBRN) of chiropractors to deliver an evidence-based care pathway to CAF personnel with spinal pain. This may help to improve patient outcomes, maintain operational readiness of CAF personnel, reduce interprofessional collaboration barriers for chiropractors, and reduce healthcare costs of spinal pain. Successful implementation of a PBRN model could provide guidance for a national PBRN and support further CAF-related research.
The chiropractic profession is more than 120 years old and it is unclear if the state of the profession is better, stable or worse now than it was in the past. Our primary aim is to develop a list of indicators for assessing the status of the chiropractic profession in Canada using a modified Delphi technique to reach national scientific consensus. This study will be a first step toward a more rigorous and consensus-based evaluation of the status of the chiropractic profession in Canada. We believe that a rigorous and credible assessment of the profession is essential to promote evidence-based use of the profession’s resources and sustainable growth. The use of such an evaluation could facilitate decision-making processes toward strategic professional status improvement.
Knowledge about the utilization of chiropractors in the general population and a minority of sport settings has been documented, however the use of chiropractors by Canadian national team athletes has not been previously reported. The objective of this study is to determine the knowledge and utilization of chiropractors by Canadian national team athletes. Data will be analyzed from previously collected data from surveys completed by members of AthletesCAN, the association of Canada’s national team athletes. This study will help elucidate the role that chiropractors play in the Canadian sporting domain and can inform practitioners where chiropractic utilization may be under represented.
The literature shows that up to 90% of pregnant women experience low back pain (LBP), pelvic girdle pain (PGP), or a combination of both pains. This pain can lead to a decreased quality of life affecting activities of daily living. Unfortunately, many allopathic practitioners do not offer treatment recommendations as it is thought that pregnancy-related back pain is normal and self-limiting. Pregnant women have used different treatment approaches to relieve their pain. There has been increasing use of kinesiotape for musculoskeletal injuries; however, there is limited evidence to date to support its effectiveness. This study aims to assess the effectiveness of kinesiotape in the pregnant population.
Concussion is a common injury in ice hockey and is clouded with numerous misconceptions among players. Effective educational interventions need to be developed in order to better address these misconceptions, improve the management of concussion in ice hockey, and potentially reduce the incidence of concussion-related ailments. To date, the knowledge and attitudes regarding concussions among elite hockey players is largely unknown. The purpose of this study is to assess the knowledge about and attitude towards concussions amongst elite junior level male ice hockey players in Canada.
It is estimated that 50% of Canadians have received spinal manipulation therapy (SMT), most commonly for back and neck pain. Despite its popularity, it is estimated that about 50% of patients who receive SMT will experience some kind of adverse response, mostly benign and transient. Regardless of their severity, adverse responses still interfere with patient’s well-being and quality of life. This study will initiate a series of studies focusing on mitigation strategies for benign adverse responses following SMT. By assessing CMCC’s clinicians and patients’ preferences and practice regarding strategies to mitigate benign adverse response following SMT, further investigations can be conducted using the preferred strategies so that the number of benign adverse responses following SMT can be reduced.
The growing use of technology is challenging the traditional methods of knowledge sharing in health care. However, there are few practical ways for healthcare professionals to access relevant, evidence-based information, making their ability to stay current difficult and unrealistic. In fact, the use of research evidence in clinical practice is sub-optimal. This is the case for many areas of healthcare, including chiropractic. Using technology-based learning tools that incorporate pedagogical methods may improve health care professionals’ ability to stay current. This study will help inform future developments of technology-based learning tools designed to improve knowledge of evidence-based guidelines for health professionals.
The purpose of this work is to gain a better understanding for the use of force sensing technology when performing extremity manipulations. Research of this type is a necessary first step in order to establish the ground work for future studies and ultimately incorporating this technology into the curriculum of extremity manipulations at Chiropractic schools around the world. The findings of this research will provide valuable information on the types of adjustments this technology works well with and the feasibility of using a hand held load cell for teaching and practice purposes.
Evidence-based chiropractic practice is continuously changing with new, emerging research. As such, there is a need to also implement the most recent evidence into the curriculum at the Canadian Memorial Chiropractic College (CMCC). This study is aimed at describing and evaluating the types of educational resources that were listed in the course syllabi and supplemental reading lists of all courses offered at CMCC during the 2017-2018 academic year.
There is an increased prevalence of low back pain in pregnancy, and prenatal treatment options are limited, as pain medication use while pregnant is not recommended. Alternative forms of therapy, such as chiropractic care, may provide relief. As the evidence is lacking, manual therapists may be unsure of the most effective way to provide pre- and postnatal care. Therefore, the purpose of this study is to determine if there is an increase in knowledge of chiropractic care in pre and postnatal populations following a 4-hour educational intervention.
Medical schools and other healthcare professional schools are changing the way basic science materials are being delivered in the classroom and laboratory and many studies are documented in the literature. With novel technologies, including the internet, specialized instruments and software, there are now many options that were not previously available. This survey is to determine the current laboratory practices and methods of instructional delivery in the Colleges of Chiropractic and to evaluate how these practices are related to current trends in medical schools and other healthcare professional schools. The conclusions of this survey will help guide the curriculum development at Parker University.
The results from this study will allow us to assess the knowledge of concussions among North American chiropractors, which will identify the gaps in knowledge throughout the profession. Identifying these areas will improve patient care and treatment. The results of this study will also inform the public of North American chiropractors’ knowledge of concussions.
In collaboration with the Karolinska Institutet and Swedish Tennis Association this project has been designed to investigate the period prevalence and associated factors for back pain among junior elite tennis players. Injuries to the low back account for the greatest loss of playing time in adolescent tennis players. The results of this study will help better inform players, coaches and parents about training volumes and loads and may lead to broader research investigations regarding preventive measures.
Group exercise classes improve physical, emotional, and quality of life outcomes in seniors.The Ministry of Seniors Affairs outlined a series of objectives in their plan “Aging with Confidence: Ontario’s Action Plan for Seniors” (Plan). The Plan focuses on initiatives that provide opportunities for seniors to be part of the social fabric of their communities. This includes use of senior group exercise classes to improve the health and wellness of seniors in the community. One such program is Staying Well, Independent and Fit Together or SWIFT. The SWIFT program was developed by CMCC in collaboration with Tri-Congregational Churches Parish Nurse. Preliminary empirical evidence of the SWIFT program suggests it has a positive impact on seniors’ quality of life. Our study will assess if seniors’ participating in SWIFT program have improved physical, mental and social well-being outcomes compared to non-participants.
The geriatric population is noticeably under-represented in low back pain literature, however back pain is amongst the most important factors affecting physical health status in old age. In addition, fatigue is a common complaint amongst older adults and associated with decreased physical function, disability, and increased mortality rates. Using previously collected data from the Health Ageing Network of Competences dataset in Odense, Denmark; this study aims to examine the associations between low back pain, fatigue, and physical function in a cohort of community-dwelling Danish citizens over the age of 75.
Balance is a key feature of athletic performance and something that is routinely assessed in athletes. The potential relationship between dynamic balance performance, in particular asymmetry of dynamic balance, and injury is especially relevant. Given the prevalence of lower extremity injuries and the asymmetric nature of fencing, it is surprising that no studies have quantified dynamic balance in these athletes. This preliminary investigation will quantify dynamic balance, and its degree of symmetry, in fencers. Dynamic balance will be assessed while fencers complete repetitions of the Y Balance Test.
Musculoskeletal disorders/pain is a prevalent health issue. Studies suggest that people with an early onset of musculoskeletal pain are likely to experience recurrent or chronic pain in future. Therefore, studies have investigated risk factors for musculoskeletal pain in occupations that require high physical demand, including healthcare students (e.g. nursing students). However, no studies have investigated and compared the prevalence of musculoskeletal pain and its corresponding risk factors in healthcare and non-healthcare students over time. Given the globalization of higher education, many college-aged students are studying abroad and differences in cultures, education systems and healthcare resources may affect the prevalence of musculoskeletal disorders among local and overseas university students in different countries. A better understanding of this issue can help develop more effective prevention strategies for university students in different countries.
The number of minutes of moderate exercise one engages in each week is an excellent indicator of a person’s health and likely longevity. Primary health care professionals using exercise as a vital sign can better: introduce new opportunities for physical activity counselling, increase lifestyle related referrals, and influence the decision making process towards developing a healthier lifestyle. As primary health care providers, chiropractors are well positioned to incorporate exercise as a vital sign in every patient interaction to assess, monitor, and promote healthy lifestyles and to further prevent and manage chronic diseases.
This project, by interviewing athlete patients, will seek to better understand athletes’ perspectives about the care they receive from sports chiropractors and will ask them their opinion about what they consider important areas for future research in sport. This type of research is important in that it ensures that patient values and opinions continue to inform both treatment and research.