Tänapäeva kiropraktika

Viimaste aastakümnete, eriti viimaste aastate jooksul on märkimisväärselt kasvanud selliste kiropraktikaga seotud uurimuste arv, mis on suunatud biomehhaanilisele ja neurofüsioloogilisele mudelile. Meetodite kvaliteet on paranenud ning tänaseks suudetakse kvantitatiivselt mõõta liigesmanipulatsiooni teatud efekte. Uuringud näitavad, et kiropraktilise korrigeerimise efektid tulenevad neurofüsioloogilisest mõjust. Kuigi seletusmudelid on üles ehitatud juba olemasolevale biomehaanikale ja füsioloogiale, on siiski hüpoteese ebapiisavate tõenditega, mis nõuavad rohkem teaduspõhiseid uuringuid.

Mis puudutab kroonilist nimmepiirkonna problemaatikat, leidub suur hulk kõrge kvaliteediga teostatud eksperimentaalseid uuringuid, millele toetuda kiropraktilises ravis. Terve rida rahvusvahelisi sõltumatuid institutsioone nagu SBU Rootsis ning Danish Institute for Health Technology Assessment toovad välja oma raportites seose manuaalselt korrigeerivas ravis. Seos tuuakse välja ka mõnedes tipptasemega uuringutes nagu Aure m fl Giles ja Muller, Niemisto jt, samuti Meade jt.

Mis puutub akuutsesse alaselja valusse, siis leidub taas tõestust ülalnimetatud Rootsi ja Taani institutsioonide poolt , samuti kahe suure rahvusvaheliste uuringute teostajate nagu Agency for Health Care Policy and Research ja RAND poolt.

On läbi viidud palju uuringuid krooniliste kaelavalude puhul.Põhjendusi toetavaks raviks korrigeerimistehnikatega leidub uuringutes, mida on läbi viinud Hoving et al ja Evens et al, kuid toetus seda liiki ravile leidub ka kahes suures rahvusvahelises kontrollinstitutsiooni uuringus nii Cochrane kui ka RAND.

Akuutsed kaelaprobleemid on piirkond, mis nõuab rohkem kõrge kvaliteediga teostaud uuringuid. Kuid juba tänaseks leidub uuringuid, millega on pandud alus manipulatsiooniraviks sellel alal. Tõestust juhivad raportid SBU ja RAND.

Kuna kiropraktik tegeleb kogu liikumiselundkonna raviga siis on uuringud, mis puudutavad ülejäänud piirkondi samuti huvitavad. Tõendusmaterjal, mis puudutab manipulatsiooniravi whiplash'i puhul on avaldatud The Quebec Task Force'is. Leidub kaks uuringut, mis annavad aluse korrektsioonravile nii pingepeavalu kui ka cervikogeense ehk kaela piirkonnast tuleneva peavalu puhul -need on teostanud McCrory ja Penzien samuti RAND. Korrigeeriv ravi seoses rindkere valudega on avaldatud Australian Acute Musculoskeletal Pain Guidelines Group'i poolt ja on mahukas uuring,mis on saanud suure rahvusvahelise kajastuse.

Mõned uuringud näitavad et kombinatsioon "manipulatsioon ja treening" annab hea efekti nii kaela- kui ka seljaproblemaatika ravis. See toetab kiropraktika teooriat, mis põhineb liigeste ja lihaste düsfunktsiooni tähtsusele. Korrigeering osutab paranenud ja suurenenud liikumisele ning treening omakorda aitab kaasa, et stabiliseerida hüpermobiilseid segmente. Mõlemad meetodid põhinevad närvisüsteemi suutlikkusele koordineerida liigutusi. Nende meetodite korrigeerimine aitab kaasa mittekorrektsete liikumismustrite efektiivsemale korrigeerimisele . See ravistrateegia kombinatsioonis rehabiliteerimisega on hetkel väga aktuaalne ning paljud teadustööd uurivad seda probleemi ka lähitulevikus.

Kokkuvõtteks võib konstateerida, et on olemas kindel tõestus kiropraktilistele seletusmudelitele ning kiropraktilisele korrigeerimisele. Aastakümnete jooksul kiropraktikale panustatud uurimine on kandnud vilja ja tänapäeval on kiropraktikud etableeritud, litsentseeritud tervishoiutöötaja kutseala esindajad.

Kirjandus:

Agency for Health Care Policy and Research (AHCPR). "Clinical Practical Guidelines, 1994. Office of the Forum for Quality and Effectiveness in Health Care", AHCPR, Willco Building, Suite 310, 6000 Executive Boulevard, Rockville MD 20852.
Amiel D, Woo SL, Harwood FL, Akeson WH, "The effect of immobilization on collagen turnover in connective tissue: a biochemical-biomechanical correlation", Acta Orthop Scand, 1982 Jun;53(3):325-32.
Aure OF, Nilsen JH, Vasseljen O. "Manual therapy and exercise therapy in patients with chronic low back pain: a randomized, controlled trial with 1-year follow-up". Spine. 2003 Mar 15;28(6):525-31.
Australian Acute Musculoskeletal Pain Guidelines Group 2003: "Evidence-Based Management of Acute Musculoskeletal Pain. By the National Health and Medical Research Council". Australian Academic Press, Brisbane.
Bergman T, Petersen D, Chiropractic Technique, s. 131, Mosby, 2:ed, 2002, ISBN 0-323-02016-x.
Bogduk N et al, "Clinical anatomy of the lumbar spine and sacrum", ed 2, New York, 1991, Churchill Livingstone.
Bogduk N, Twaoney LT, "Clinical anatomy of the lumbar spine", ed 2, Melbourne, 1991, Churchill Livingstone.
Brodeur R. The audible release associated with joint manipulation". JMPT 1995: 18:155.
Cassidy JD, Lopes AA, Yong-Hing K. "The immediate effect of manipulation versus mobilization on pain and range of motion in the cervical spine: a randomized trial". JMPT 15:570, 1992.
Colloca C, Keller T, Gunzburg R, "Biomechanical and neurophysiological responses to spinal manipulation in patients with lumbar radiculopathy", J Manipulative Physiol Ther, 2004, 27 (1), Coulter ID, Hurwitz EL et al. (1996) "The Appropriateness of Manipulation and Mobilization of the Cervical Spine". Santa Monica, Califormia: RAND, Document No. MR-781-CR.
Cyriax JH, Lumbago, "Mechanism of dural pain", Lancet 1:47,1945.
Dabbs V, Lauretti WJ." A risk assessment of cervical manipulation vs. NSAIDs for the treatment for neck pain. JMPT 1995: 18(8); 530-536.
Danish Institute for Health Technology Assessment:" Low-Back Pain. Frequency, Management and Prevention from an HTA perspective". Danish Health Technology Assessment 1999;1.
Evans R, Bronfort G, Nelson B, Goldsmith CH. "Two-year follow-up of a randomized clinical trial of spinal manipulation and two types of exercise for patients with chronic neck pain". Spine 2002; 27(21):2383-2389.
Giles L, "Innervation of zygapophyseal joint synovial folds in low-back pain", Lancet. 1987 Sep 19;2(8560):692.
Giles L, Taylor JR, "Human zygapophyseal joint capsule and synovial fold innervation", Br J. Rheumatol. 1987 Apr;26(2):93-8.
Giles LG, Muller R. "Chronic spinal pain: a randomized clinical trial comparing medication, acupuncture, and spinal manipulation". Spine. 2003 Jul 15;28(14):1490-502.
Gillette RG. "A speculative argument for the coactivation of diverse somatic receptor populations by forceful chiropractic adjustments". Manipulative Medicine 3:1, 1987.
Grieve Gp, Common vertebral joint problems, Edinburgh, 1998, Churchill Livingstone
Gross AR, Hoving JL, Haines TA, Goldsmith CH, Kay T, Aker P, Bronfort G. "Manipulation and Mobilisation for Mechanical Neck Disorders" (Cochrane Review). The Cochrane Library, Issue 1, 2004. Chichester, UK: John Wiley & Sons, Ltd.
Hack GD et al, "1998 Medical and health annual", Chicago, 1997, Encyclopedi Britannica Herzog W, "Biomechanical studies of spinal manipulative therapy", J. Can Chiro Assoc, 35(3):156, 1991.
Herzog W, Conway PJ, Zhang YT, Gal J, Guimaraes AC, "Reflex responses associated with manipulative treatments on the thoracic spine: a pilot study", J Manipulative Physiol Ther. 1995 May;18(4):233-6.
Herzog Walter, Scheele David, "Electromyographic Responses of Back and Limb muscles associated With Spinal Manipulative Therapy", Spine, 24(2)146-153, 1999.
Hoving JL, Koes BW, de Vet HC, van der Windt DA, Assendelft WJ, van Mameren H, Deville WL, Pool JJ, Scholten RJ, Bouter LM. "Manual therapy, physical therapy, or continued care by a general practitioner for patients with neck pain. A randomized, controlled trial. Ann Intern" Med. 2002 May 21;136(10):713-22.
Kirkaldy-Willis WH, "The pathology and pathogenesis of low back pain"; Managing low back pain, ed 3, New York, 1992, Churchill Livingstone.
Kos J, Wolf J "The significance of intervertebral meniscoids for the origin of vertebral blockade" (author's transl), Cas Lek Cesk. 1975 Sep 5;114(36):1099-101. Czech Maigne R, Orthopedic medicine, "A new approach to vertebral manipulations", Springfield, III, 1972, Bannerstone House.
Manga P, Angus D, Papadopoulos C et al: "The Effectiveness and Cost-Effectiveness of Chiropractic Management of Low-Back Pain", Kenilworth Publishers, Toronto 1998.
McCrory DC, Penzien DB et al. (2001) "Evidens Report: Behavioural and Physical treatments for Tension- Type and Cervicogenic Headache" , Des Moines, Iowa, Foundation for Chiropractic Education and Research, Product No 2085.
Meade TW, Dyer S, Browne W m fl. "Low back Pain of mechanical origin: randomised comparison of chiropractic and hospital outpatient treatment". Brittish Medicla Journal, 1990; 300:1431-1437.
Meade TW, Dyer S, Browne W m fl. "Randomised comparison of chiropractic and hospital outpatient management for low back pain: results from extended follow up". Brittish Medicla Journal, 1995; 311:349-51.
Meal GM, Scott RA. Analysis of the joint crack by simultaneous recording of sound and tension. JMPT 1986: 9(3);189-195.
Moore JC, "The Golgi tendon organ: a review and update", Am J Occup Ther. 1984 Apr;38(4):227-36.
Niemisto L, Lahtinen-Suopanki T, Rissanen P, Lindgren KA, Sarna S, Hurri H.A "Randomized trial of combined manipulation, stabilizing exercises, and physician consultation compared to physician consultation alone for chronic low back pain". Spine. 2003 Oct 1;28(19):2185-91.
Pellow JE, Brantingham JW. "The efficacy of adjusting the ankle in the treatment of subacute and chronic grade I and grade II ankle inversion sprains". JMPT January 2001 Volume 24 Number 1.
Pickar JG, McLain RF, "Responses of mechanosensitive afferents to manipulation of the lumbar facet in the cat.", Spine. 1995, Nov 15;20(22):2379-85.
Pickar JG, Wheeler JD. "Response of muscle proprioceptors to spinal manipulative-like loads in the anesthetized cat.", Manipulative Physiol Ther. 2001 Jan;24(1):2-11.
Salter RB, "The biologic concept of continuous passive motion of synovial joints. The first 18 years of basic research and its clinical application", Clin Orthop. 1989 May;(242):12-25. Review.
SBU rapport 2000. "Ont i ryggen, ont i nacken. En evidensbaserad kunskapssammanställning". Nr 145. SBU, Box 5650, 114 86 Stockholm.
Shekelle PG, Adams AH, Chassin MR m fl. "Spinal Manipulation for Low-Back Pain". Ann Intern Med 1992; 117:590-7.
Spitzer WO, Skovron ML et al. (1995) "Scientific Monograph of the Quebec Task Force on Whiplash-associated Disorders. Redefining Whiplash and its Management". Spine 1995;20:8S.
Suter E et al, "Reflex response associated with manipulative treatment of the thoracic spine", J. Neuromusculoskeletal Systems, 2,124,1994.
van Tulder MW, Koes BW, Bouter LM. "Conservative treatment of acute and chronic nonspecific low back pain. A systematic review of randomized controlled trials of the most common interventions". Spine. 1997 Sep 15;22(18):2128-56.
Vernon HT, Dhami MS, Howley TP, Annett R, "Spinal manipulation and beta-endorphin: a controlled study of the effect of a spinal manipulation on plasma beta-endorphin levels in normal males", Manipulative Physiol Ther. 1986 Jun;9(2): 115-23.
Watts DG et al, "Analysis of muscle receptor connection by spike-triggerd averaging, spindle primary, and tendon organ afferents", J. Neurophysiology, 1976, 39(6),1378.
Wyke B, "Articular Neuorolgy – A review", Physiotherapy, 1972. 58, 94-99.