April 2016 Volume 12 Number 1

Newsletter of the European Chiropractors’ Union

What’s new in this issue? 22

19 The Danes are back Chiropractic at QPR

3 Introducing the European Øystein Centre for Chiropractic 10 Ogre on Research Excellence moving the profession forward

14/15 Previous issues of BACKspace are Anniversary available from the ECU office. celebrations at BCA, See page 3 for Have you got your ticket for Oslo? 8 NCA and AECC contact details. … and much, much more

BACKspace www.chiropractic-ecu.org April 2016 1 BACKspace Mag_Layout 1 3/1/16 9:32 AM Page 1

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President’s message Moving the profession forward

NE OF the things I enjoy globe, a profession that will make Kingdom and Denmark which decided to create a European Omost as president of the them proud to call themselves have legislation of the highest Centre for Chiropractic Research ECU is that I get to meet and chiropractors. They fret when they level. And we have countries Excellence which this year will talk to chiropractic students - sense a profession divided. It is in Europe – for example Spain manage around €200.000 of chiropractors in training as I think our responsibility, as established and Greece - with no legislation research money. It will operate of them. This January I spoke at chiropractors, to make those at all. Collectively the national from the campus of the University the University of South Wales wishes and desires come true and associations of the ECU have of Southern Denmark, which has and at the McTimoney College; I the ECU accepts the challenge. made securing legislation in more established a very strong focus addressed more than 150 students. It is no accident that we are countries a major focus. on research into musculoskeletal In February I spoke to students called the European Chiropractors’ It is with great pleasure that I disorders. Also, as from 1 in Odense, Istanbul, Paris and Union. We exist to represent can tell you about the efforts that January, the Danish Chiropractic Toulouse. One of the things that chiropractors past, present and are being made in Belgium and Association has come back to the greatly impresses me is the sense of future. Our work is based on the Netherlands. Their leadership ECU after a 12-year absence. vocation in our new recruits and education, legislation and research. teams are working tirelessly to get The importance of attracting their desire to join a profession Let me give you some examples legislation through the national a strong intake of able recruits they can be proud of. to illustrate how we move the parliaments. Last autumn the to the profession is something What does this mean for us, profession forward. The General Belgian Chiropractic Association that all chiropractors can agree established chiropractors? Do we Council took a decision a few organised a colloquium for on. Each of us has a personal have a special responsibility to years ago to focus on expansion politicians, lawmakers, journalists obligation to show that, just as we these young people at the outset of of the profession - especially in and colleagues. With the support have benefited from the wisdom their careers? You bet we have. The countries where there are few of the ECU, experts in different of those who went before us, so students want to join a profession practitioners. Turkey is a case fields were brought in to give we are prepared to contribute which is dedicated to improving in point - a country with 75 evidence about the scientific basis personally to the continuing the well-being of people across the million people but only seven for chiropractic, undergraduate growth and success of chiropractic. chiropractors. Needless to say not education, the CEN standard for Together we will prosper, divided too many people in that country chiropractic services, pursuing we will fall. know what chiropractic is all legislation, the differences about. in medical and chiropractic Øystein Ogre DC, FEAC

BACKspace is published twice a Sometimes, however, a few education and the study of the ECU President year by the European Chiropractors’ dedicated colleagues can make a global burden of disease. The Blog address: Union (ECU) and distributed free big difference. Last August, on colloquium attracted a lot of ecupresidentblog.com to all ECU members. Opinions in BACKspace are not necessarily those the shore of the Bosphorus, the media attention and was a big Email: [email protected] of the editor or the ECU, who reserve medical faculty of the Bachecehir success. This is good example of the right to edit all contributions. University opened the first how national associations can The ECU accepts no responsibility for advertising content. chiropractic programme in this promote chiropractic in a sound European Chiropractors’ Union, part of the world. The university and professional way to get The Glasshouse, 5A Hampton Road, advertised the programme on attention from decision makers. Hampton Hill, Middlesex TW12 1JN its intranet, on a page almost It is something other national Tel: +44 (0) 20 8977 2206 Email: [email protected] impossible to find, and for only 12 associations could also do and the Website: www.chiropractic-ecu.org days. After the 12 days there had ECU would be happy to support Edited and produced by been nearly 90 applicants. Forty of such initiatives. Manya McMahon at these were accepted; even better, Healthcare is one of the most Pinpoint Communication Ltd the university has already received rapidly developing scientific www.pinpoint-uk.co.uk [email protected] more than 450 applicants for environments in the world. Its Tel: +44 (0) 1395 269573 the next semester. Amazing! The professions are valued according Design and print by Mongo Print ECU is determined to continue to to the amount and the quality of and Design, 6 Cassel Avenue, Bournemouth, BH4 8JN support this programme. I would the research they produce. What To advertise in BACKspace, please like to offer a big thank-you to our is best practice today will not be contact Claire Wilmot, Business dedicated colleagues in Turkey. good enough tomorrow as new Manager at ECU Head Office: Legislation for chiropractic in research produces new insights. [email protected] Europe is widely different. We The ECU already invests heavily © ECU. All rights reserved. Reproduction of any part of BACKspace is not allowed have countries like Switzerland, in research and that is about to without the written permission of ECU.

Norway, Liechtenstein, the United be further enhanced. We have Photograph © Ø H Haagensen

BACKspace www.chiropractic-ecu.org April 2016 3 ECU news ECU General General Council Council Meeting adopts targets for A report of the meeting on 20-21 November 2015 EU relations

Financial support Biomekanik (NIKKB) located HE GENERAL Council (GC) where chiropractic is not • A grant of up to €170.000 at the University of Southern Thas adopted as its prime recognised, in order that it over three years in support Denmark (see page 10). target an aim for chiropractic to might form the basis for draft of membership initiatives • Nomination of Dr Mariá José be recognised in all countries legislation. by the British Chiropractic Hernández as a candidate of Europe as the mainstream b. To promote aspects of Association. for the ECCE Council. (Dr spinal healthcare profession healthcare across EU bodies • A grant of €5.000 to support Hernández was subsequently with its patients protected (e.g. the importance of a colloquium organised by elected to the Council.) by effective regulation of the musculoskeletal disorders as the Belgian Chiropractic profession. a priority for healthcare in an Association to foster Strategy The top priority should be for ageing population building understanding of the profession • GC members shared insights all member states to recognise on the work of chiropractors by decision makers and those deriving from experience with the professional qualification in the Bone and Joint Decade who influence opinion about implementation of Vision 2020 of chiropractors under the EU project). healthcare matters. for chiropractic (see page 6 for Recognition of Professional c. To select not more than two • Agreement to subsidise access further details). Qualifications Directive EU areas in which the ECU to the Research Review Service • Adopted a recast strategy for (Directive 2005/36/EC as will participate in any one weekly reports for members of relations with the institutions amended by Directive 2013/55/ year. affiliated national associations. and working parties of the EC). To qualify requires that d. To encourage chiropractors As a result, individuals European Union. one-third of EU member states and researchers to engage will be able to take out an Awards has done so. There are currently with EU medical and scientific annual subscription at 50% • Agreed to offer the courtesy 28 member states1 which means committees as experts in of the normal cost. Member professional title of Doctor securing recognition in 10 of spinal health. associations will draw the offer of Chiropractic to suitably them. The prospects for doing e. To leverage work in member to the notice of their members. qualified and experienced so are examined in a separate states to inform discussion at chiropractors (see page 5). article on page 7. the European level and vice Membership • Agreed to seek nominations Other priorities adopted in versa. • Agreement to re-admit the for a possible ECU award for the November GC meeting f. To demonstrate through Danish Chiropractors’ Union outstanding humanitarian work were: assembled evidence that (DKF) as a member association by a chiropractor in the field. a. To promote the CEN chiropractic has a distinctive of the ECU. Member associations were invited chiropractic quality standard identity, is safe, non-addictive • Agreement to proceed with to put forward nominees by the in all European countries and cost effective. setting up a European Centre end of February (see below). for Chiropractic Research 1 Austria, Belgium, Bulgaria, Croatia, Republic of Cyprus, Czech Republic, Excellence in association Forthcoming meeting Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Lithuania, Luxembourg, Malta, Netherlands, Poland, Portugal, Romania, with the Nordisk Institut The General Council will meet Slovakia, Slovenia, Spain, Sweden and the UK for Kiropraktik og Klinisk again on 4 May 2016. ECU award for humanitarian work HE GENERAL Council of the not necessarily be made each have provided important free The intention is that the TECU has made the decision year. treatment for rescuers, whose award should be prestigious to look into the possibility Ian Beesley, the Secretary- musculoskeletal systems are often and attract professional of making an award for General, comments: “We know put under severe strain and risk of recognition; it will be presented outstanding humanitarian work that when there are natural damage during their efforts to save by the ECU president at the by a chiropractor in the field. disasters such as earthquakes or lives. Others have given pro bono annual scientific convention and Nominations would be sought other calamities that involve first chiropractic treatment to refugees it is hoped to make the first annually, though an award would response rescuers, chiropractors and to the dispossessed.” award in May in Oslo.

4 BACKspace www.chiropractic-ecu.org April 2016 Newsletter of the European Chiropractors’ Union

ECU news

October 2015 Volume 11 Number 2

Doctor of Chiropractic: Newsletter of the European Chiropractors’ Union What’s new in this issue? Øystein Ogre on unity in the Francine Denis’ hallmark of the profession profession hopes for development in the 3 profession HE CYPRUS national The courtesy professional title 24 Tassociation has successfully of Doctor of Chiropractic (DC) 22 moved that, following the positions chiropractic alongside 4 Introducing the new report of a working party other health professions that Secretary- Baiju Khanchandani 26 General on what he wishes comprising representatives also use courtesy professional he’d known years ago 28 What you should know of EAC, Cyprus and the titles, e.g., medical doctors about Special Interest Groups Netherlands, the ECU should (MD), doctors of osteopathy Lise Lothe on Previous issues of Athens convention 2015 the future of BACKspace are available offer the courtesy title of Doctor (DO), doctors of veterinary the Academy from the ECU office. 8 See page 3 for contact details. of Chiropractic to suitably medicine (DVM), doctors of … and much, much more

experienced chiropractors. The dental surgery (DDS) etc. BACKspace www.chiropractic-ecu.org October 2015 1 01-32 Backspace Oct15.indd 1

decision at the November 2015 It is also noteworthy that 21/09/2015 18:31 ECU General Council meeting physiotherapists are making means that successful applicants strong efforts to acquire a BACKSpace will receive a certificate with the Doctor of Physiotherapy title available wording: (DPT). ‘Having demonstrated The General Council agreed electronically the required knowledge and that chiropractic needs both professional competences academic qualifications ECRETARY-GENERAL through a chiropractic (Masters/PhD) and a recognition SIAN Beesley has announced qualification accredited by of professional qualification to that BACKspace is now available the European Council for ensure the survival and distinct electronically: Chiropractic Education, having “The courtesy identity of the profession. The “As Øystein completed a National Graduate Doctor of Chiropractic (DC) Ogre and I Education Programme in professional title has been the hallmark of have travelled accordance with the criteria title of our profession since 1897 and to the of the European Academy has different legal implications chiropractic of Chiropractic, and having Doctor of under some jurisdictions. colleges I have agreed to abide by the code Depending on the legislation been much of ethics as a member of a Chiropractic in place, practitioners in some struck by national chiropractic association (DC) positions countries do not need the DC the extent to participant in the European title in order to practise but in which students Chiropractors’ Union, or chiropractic other countries they do. carry all that they require by as an individual member, Those that meet the criteria way of textbooks, articles and the European Academy of alongside of the European Academy of essays digitally on laptops and Chiropractic recognises the other health Chiropractic (EAC) can now iPads. I should not have been courtesy title of Doctor of apply for their courtesy title surprised since I now find it Chiropractic.’ professions” of Doctor of Chiropractic. most convenient to read large European chiropractic For further information books, novels and magazines educational institutions grant completing a two-year please contact your national electronically. So, if, like me you qualifications as follows: postgraduate research association or the registrar are squeezed for archive space • Masters’ degrees are offered project (i.e. eight years of of the European Academy of or just want to be up with the by AECC, WIOC, McTimoney study). Chiropractic. trend and would like to receive and the Danish School • Italy will soon open a full five- Speaking after the decision, your copies of BACKspace which offers a Masters in year Doctor of Chiropractic Stathis Papadopoulos, president electronically, drop an e-mail Biomechanics. programme in Rome. of the Cyprus association said: to Claire Wilmot • Doctor of Chiropractic titles • The French and the Turkish “I am delighted by the wise ([email protected]). are awarded by the Zürich institutions also prefer to decision of the General Council You’ll get your copy sooner and be programme which offers give a courtesy Doctor and freely acknowledge the saving the ECU money as well.” a Doctor of Chiropractic of Chiropractic title after help in turning the decision of Medicine (DCM) after graduation. principle into a practical reality.” NB: The ECU will never pass your details to a third party without your permission.

BACKspace www.chiropractic-ecu.org April 2016 5 ECU news

Attracting recruits Positives Be active: Reach out to existing students in other healthcare professions; around five per cent would consider switching to a chiropractic course. Access: consider how difficulties of access can be overcome, such as by setting up a system Pursuing the vision of scholarships for chiropractic During the General Council meeting in November 2015 a breakout studies and other means. session focused on the lessons from national associations’ pursuit of the Buddying up: During the goals in the Vision 2020 project. Here Vivian Kil provides some insights. recruitment process put a prospective student in touch with someone who is already Legislation Education in a chiropractic educational Positives Positives programme – people often Preparation: It really pays off to be thoroughly prepared before Connections: Having links consult contemporaries when speaking to government bodies - having documentation and with local universities can help considering their educational supporting information readily available, especially the code stimulate academic interest in and career options. of ethics and bylaws of the national association, details of the chiropractic. Having a connection Negatives Graduate Education Programme, the commitment to research and with a partner in chiropractic Student fairs: Representing the arrangements in place to show that patients are safe. education (such as an established chiropractic education at large Connections: Link with a bigger profession so that if the law changes for college) also helps. student fairs does not work. that profession chiropractic is in with a chance of getting the changes Politics: Connections within It is not possible to compete by default. Focus on public health and what chiropractic contributes to the education authorities and with bigger university courses healthcare in general; do not focus on what is in it for chiropractic. national healthcare research that can afford bigger stands Communications: Hosting a colloquium for all stakeholders has community are an asset. and more enticing freebies. proved to be successful in obtaining support from decision-makers Varied sources of finance: Lack of information: If there and influencers. Money is often a stumbling block is no existing chiropractic Negatives to progress and there is a need education in a country it is Criticism of others: Criticising others tends to rebound on the to look at a variety of ways of often difficult for a national critic. It is better to talk about the strength of chiropractic and to obtaining the necessary backing association to answer all the avoid negatives. – through professional bodies, a questions which a prospective university, a government body, a student may have. benefactor etc. Lack of a career path: It is Public Awareness/PR Negatives difficult to encourage students Positives Ministry opposition: It is very to take up the profession if Everyday topics: Be up-front and personal; use everyday illustrations difficult to achieve a chiropractic they must travel abroad for such as car seat safety, breathing and stress, problems following educational programme in the the courses and may face an extensive use of mobile phones, bad posture, too much sitting down. face of Ministry of Education uncertain career at home. One message: It is important to have a clear and simple message opposition. They do not have They may have a vocation but which is repeated. Journalists often change wording and to be an active proponent of they also need an income. information so always ask to see a copy before print. chiropractic education but as a Clean up websites: Journalists will often look at websites for minimum you need to achieve background. Make sure that your website reinforces the simple their willingness to let it happen messages and avoids unsubstantiated claims. Check that (neutrality). information is up to date; if the latest message is more than a Lack of legal recognition: month old or inaccurate it can damage your reputation. Lack of legal recognition is a Negatives major obstacle to establishing Chiropractic per se: Using chiropractic as a topic for news items did a chiropractic education; active not work; the general public does not find it interesting and can be work in support of recognition put off by the title. can be an important step on Debate: Do not engage in debate with other professions, just focus the way to an educational on the strength of chiropractic. programme.

6 BACKspace www.chiropractic-ecu.org April 2016 Newsletter of the European Chiropractors’ Union

ECU news

Interdisciplinary Recognition of working Positives professional qualifications Flagship projects: projects such as the very successful As he steps down from the chairmanship of the ECU EU Bone and Joint Decade (BJD) Affairs Committee, Philippe Druart reports a promising project in Norway encourage step forward towards the recognition of professional continuing co-operation with qualifications across all member states. This recognition other healthcare professions. is key to the provision of good healthcare across Europe Association with national and at the heart of the European single market. © O Haagensen projects: if there is a national project related to ECOGNITION ENABLES that would probably mean that the European Union taxonomy healthcare or wellness it is Rprofessionals to work across recognition of qualifications was of occupations (ESCO – on important to be at the table national boundaries. It is enshrined automatic – the threshold is set at whose expert panel chiropractic is as a team player with other in two European Union Directives, two-fifths of member states with represented). The CEN standard professions. the latest of which came into force training programmes pitched at for quality in chiropractic services Reach out to others: when on 18 January 2016.1 the level beyond basic medical might also play a role in collecting organising a conference, According to a briefing from and dental training. (Currently the evidence of European agreement seminar or workshop invite the European Universities automatic recognition operates in on education, competences, people from different Association (EUA) the updated only seven large specific professions: professional responsibility and professions to join in. Directive opens up a route to medical doctor, general nurse ethics. Other healthcare professions Be imaginative: Teaming up wider automatic recognition of care, dentist, midwife, veterinary will, of course, be thinking on with an insurance company professional qualifications by the surgeon, pharmacist and architect.)3 similar lines. The question is which receives 4,000 calls introduction of common training Chiropractic is included in a whether there is sufficient common a day has helped one frameworks (CTFs).2 These will ‘General Sector’ category where ground between chiropractors and association create a situation allow groups representing at least recognition works by comparing other healthcare professions to where the company refers one-third of member states (i.e. the level of a mobile professional’s justify a reclassification to the area patients to chiropractors and currently 10 member states) to attainment against the level where recognition is automatic. has been very beneficial to agree curricula based on ‘common required by the host country and by the profession. sets of knowledge, skills and imposing appropriate compensation 1 Directive 2005/36/EC updated by Negatives competences’. Other member measures such as adaptation periods Directive 2013/55/EU Being inward looking: in states and those in the European and aptitude tests. 2 www.eua.be/Libraries/higher-education/ the UK it turned out to be Economic Area may then opt in. Here a door might open if EUA_briefing_note_on_amended_ too difficult to join in BJD The reference to ‘knowledge, skills chiropractic can demonstrate its Directive_January_2014.pdf?sfvrsn=0 projects due to the lack of and competences’ is significant and inclusion as a health profession in 3 Ibid unity within the chiropractic marks a shift towards competence- profession. based curricula in the amended Expense: Inviting other Directive. It is also noteworthy that healthcare professions to the curricula may be proposed by seminars, conferences and representative professional bodies workshops and covering their operating at EU or national level, expenses can be expensive. or by Competent Authorities (normally ministries or statutory [email protected] regulatory bodies). That means the ECU can propose a curriculum provided that it has the agreement of national associations that have obtained legislation/regulation. What is the relevance to chiropractic? When the EEA (and Portugal, which is not included in the EU data) are included in the set of countries that recognise and regulate chiropractic, the total is 13 (i.e. 40%). If chiropractic were regarded as a medical speciality

BACKspace www.chiropractic-ecu.org April 2016 7 Convention A ticket to Oslo Gitte Tønner, ECU Convention Academic Organiser, promises an exciting 2016 ECU Convention

HY SIGN up? Well, horse’s mouth; if you – like most Johan Moan, and renowned the message across and a session Wwherever you are in of us – have an opinion and you French orthopaedic surgeon from the Special Interest Group your career - a freshly-baked like to participate in the exchange Olivier Gagey, as well as a very on Neurology will be about graduate, in mid-career or closer to of ideas, and maybe be inspired or thought-provoking debate on recognising concussion. retirement - there’s something to inspire others, come along! Friday morning that will include a Nor is the social side of things interest you. What the convention We will be excited to have you Danish philosopher. And we will neglected – the City of Oslo offers includes insight into what join us to celebrate chiropractic be joined by leading personalities will welcome delegates in the is going on elsewhere in the in Europe. Local Norwegian from the World Federation. iconic Oslo City Hall and there profession and skills that you talent will demonstrate ultrasound Thanks to generous will be two further exciting might want to add to your tool diagnostics and will be present sponsorship, there is also an evening opportunities to party box (we have lots of hands-on stuff in numbers. In addition, we will opportunity to attend reasonably- whilst celebrating being part of for you). If you’re thirsty for what’s welcome people from beyond the priced pre-convention seminars something special, and all in Oslo’s new in research, you will hear it chiropractic profession, this year on 4 May: Researchers’ Day will beautiful capital. hear straight from the proverbial with world expert on Vitamin D, include discussion on how to get See you soon!

THE PROGRAMME (possibly subject to alteration) THURSDAY 5 MAY FRIDAY 6 MAY SATURDAY 7 MAY 08.30- SESSION 1 08:30- SESSION 5 A 09:00- SESSION 8 10:30 Welcome and Opening Ceremony 10:30 Clinical Uncertainty and Practitioner 11:00 ‘Bridging Gaps’ ‘Building Bridges’ Behaviour – a multidisciplinary and Heidi Haavik and Greg Kawchuk Greg Stewart, Søren O’Neill, interactive debate part I Richard Brown Kim Humphreys SESSION 5 B Ulrik Sandstrøm: part I Functional Muscle Testing 10.30-11.00 Break – Posters – Exhibition 11.00- SESSION 2 11.00- SESSION 6 A 11:30- SESSION 9 13.00 Clinical implications of current research 13.00 Clinical Uncertainty and Practitioner 13.00 ‘Building Trust’: Kent Greenawalt Abstract Presentations Behaviour – a multidisciplinary and Research Awards interactive debate part II Closing Address SESSION 6 B Ulrik Sandstrøm: part II Preview ECU Convention 2017 Functional Muscle Testing 13.00-14.30 Lunch – Posters – Exhibition 14.30- SESSION 3 14.30- SESSION 7 14:30- SESSION 10 16.00 a. Johan Moan: Sun and Vitamin D: 16.30 a. Olivier Gagey: A new look at the 16:00 a. Ellen Aartun: Function and muscles, bones, brain and beyond shoulder Disability b. SIG Paediatrics w/ Miller and Weber b. Douglas Johnson: MultiRadiance b. Thomas Lauvsnes: Foot and c. SIG Clinical Chiropractic: Managing c. Heidi Haavik: Student workshop ankle analysis and adjusting Risk through Incident Reporting d. Ultrasound diagnostics (max 50) c. Matthew Antonucci: Concussion d. Activator Methods Workshop: The from a functional neurology acute low back and osteoporotic perspective patients 16:00-16:30 Break – Posters – Exhibition (exhibit break-down after break) 16.30- SESSION 4 Get yourselves ready for Frock’n’Rock 16.30- SESSION 11 18.00 a. Alison Dantas: Lead, Govern, 18.00 a. TBA Innovate: ‘Let’s Start with the Patient’ b. Thomas Lauvsnes: Foot and b. SIG Neurology/Nicole Oliver: The ankle (repeat) Pons c. Matthew Antonucci: Functional c. Rubinstein: Abstract Presentations Neurology Grand Rounds d. SIG Sports: Assessment/ Performance enhancement of the Young Athlete Informal dinner Frock’n’Rock Drinks 19:00 and seating 20:00

8 BACKspace www.chiropractic-ecu.org April 2016 ECU PLATINUM 2016 Convention SPONSOR Building Bridges Oslo 5-7 May 2016 • Radisson Blu Scandinavia Registration is OPEN www.chiropractic-ecu.org

With a mix of interesting seminars including Vitamin D, Neurology and Paediatrics this convention is one not to be missed. This year we have invited international speakers who will enlighten, challenge and inform you. Come to the convention to update your skills, meet others and build bridges within our profession.

Social events Thursday Night – The organising committee have been able to arrange a night at one of Oslo’s most exciting on-trend restaurants which is walking distance from the convention hotel. This venue will offer all, the chance to network, dance and eat in a sumptuous venue. Friday Night – The Frock & Rock night will be an exciting evening with a Norwegian twist.

For up to date information look at our Facebook page (ECU Conventions) or the website.

Convention2016Oslo_A4Ad_v2.indd 1 11/02/2016 15:40 Research Focus on an enlarged research budget HE ESTABLISHMENT of knowledge that early diagnosis and their treatment of colic every Ta new European Centre for treatment is important to prevent day, and many parents seek help Chiropractic Research Excellence, children from continuing to suffer from chiropractors. But how does involving the Nordic Institute from headaches into adulthood. chiropractic treatment of infant of Chiropractic and Clinical Knowledge of what effect colic work? Currently there is Biomechanics (NIKKB), was chiropractic care has on children no secure scientific study of the agreed at the ECU General Council suffering from headaches is based on effect of the treatment. On the Meeting in November 2015. several years of clinical experience, Danish island of Fyn, NIKKB The Institute celebrated its 25th some limited paediatric research and the Department of General investigate the correlation between anniversary in 2015. During that and studies of adult patients. More Practice have initiated a study of back pain and motor skills. The time it has become one of the precise and concrete knowledge is chiropractic treatment on infant effects of other factors such as most respected research institutes needed. To increase this knowledge, colic. physical activity and obesity, MS, for chiropractic and clinical a randomised, controlled study of Children participating in the well-being, cognition, language biomechanics in the world. It chiropractic practice in Denmark study will be divided into two and other possible diagnoses will is affiliated to the University of has been launched. The project groups: half the children will be considered. A randomised Southern Denmark and has its home will examine how chiropractic care receive chiropractic treatment while study will be conducted to clarify on the university campus, where works in children aged 7-14 years the other half will receive a placebo whether motor intervention can it enjoys close collaboration with who have suffered from headaches treatment. After the treatment, the improve children’s lives through related institutes at the university. for a long time. The results of the parents are being asked to keep a its effect on balance, strength, Its researchers have many research study will help to determine who log registering their child’s crying coordination and agility. Children projects underway at any given time. benefits most from chiropractic pattern for two weeks. These data leaving school will be measured Some of the current studies are: treatment and provide knowledge will then be used to deduce the in a number of areas over time that can be used in future research of possible effect of chiropractic to follow their development. 30 Can chiropractic care paediatric headache and chiropractic. treatment. The study, which is kindergartens (1,500 children) help children with Data collection began in October/ funded by the Danish foundations from Svendborg Municipality in headaches? November 2015 and the study will Kiropraktorfonden and Fonden Denmark are invited to participate According to a Danish study from take place over a period of two years. for Almen Praksis, was launched in in the study. Test rounds begin this 2008, headache was the second October 2015. spring, followed by intervention most frequent cause for children Chiropractic treatment later this year. aged 2-17 years missing school and of colic Daycare Study You can follow NIKKB at seeing a chiropractor. It is common Chiropractors see the effect of A study of children in daycare will www.nikkb.com

European Academy of Chiropractic in partnership with RRS Education

50% Discount on RRS Education’s Research Reviews for EAC Members

HE EUROPEAN Academy of Chiropractic is pleased to announce RRS Education offers three ways to catch up on Ta new affiliation with RRS Education (formerly Research Review current research: Service), a trusted source of continuing-education solutions for 1 Research Reviews: weekly reviews of important, interesting and chiropractors, physiotherapists, osteopaths and other manual clinically-relevant research, as well as access to over 680 reviews in medicine providers around the world. Staying on top of emerging the database. research and integrating this information into practice is a daunting 2 Online Courses: CPD from the comfort of home or office. task for busy practising clinicians, who require understandable, 3 Seminars: catch up with colleagues and enjoy relevant, evidence- convenient, unbiased analysis of contemporary research. RRS informed content. Education is a continuing education company dedicated to enhancing When you subscribe to RRS Education’s weekly and promoting patient-centred, profitable, sustainable, evidence- Research Reviews you will enjoy: informed care. It delivers clinically-relevant information in multiple • WEEKLY REVIEWS of the most relevant, current scientific literature formats to suit the needs of busy clinicians. The weekly Research • Access to the GROWING DATABASE of reviews (now > 680 Reviews are written by clinicians, for clinicians, extracting important reviews), fully categorized and keyword searchable clinical pearls to enhance your practice and patient care. Now, thanks • MP3 AUDIO versions of new reviews (since the autumn of 2010) available to a subsidy from the European Chiropractors’ Union, EAC members for download or streaming. Subscribers can enjoy research on the go! can enjoy a 50% discount. • WEEKLY EMAIL ALERTS with information about new reviews and www.rrseducation.com links to other helpful research content*

10 BACKspace www.chiropractic-ecu.org April 2016 Newsletter of the European Chiropractors’ Union

Research Research Corner: Are psychosocial factors relevant for chiropractors? Part II

HE ROLE of psychosocial indicated that they believe the Secondly, we wanted to Tfactors in back pain was psychosocial factors influence pain determine what the added value is respond to treatment as for any introduced more than 25 years syndromes.1 In a recent symposium of the psychosocial status beyond similar non-depressed patient, but ago when it became clear that the in the Netherlands, two of the the clinical factors. The results the depression can affect his/her traditional pathological model of chiropractic speakers emphasised demonstrated that screening ability to return to work, which in disease did not adequately explain the role of the biopsychosocial psychosocial status on the turn, may cause chronicity. So, in the course of low back pain and model in chiropractic practice. first visit with a standardised, this way it is easier to understand response to treatment. The new Interestingly, many studies suggest validated questionnaire (4DSQ) the relevance of the psychosocial model proposed that each person’s that few patients in a chiropractic helps only marginally to predict factors. They are simply not the unique biological, psychological, practice have high (or complex) which patients will likely benefit black and white determinants and social circumstances be given psychological risk profiles.2 from care. We found instead that of results as the last 25 years’ equal weight in the aetiology and In this latest study conducted it is sufficient to have knowledge paradigm would lead us to believe. treatment. with our colleague, Luc Aillet on the nature and the severity of So, if screening for the psychosocial In the last edition of of Belgium, we addressed two the presenting complaint (e.g. factors is less relevant than was BACKspace, I described the questions: firstly, we wanted to duration, location, severity of pain). supposed, is the old pathoanatomical study carried out in Belgium and identify if there is a relationship These results would seem model the alternative? As with so the Netherlands which examined between the psychosocial profile to be consistent with findings many models, it is likely that some the role of psychosocial factors in of our patients and outcomes with from colleagues in the UK and combination of factors will provide chiropractic practice. Here we present chiropractic care. Interestingly, Scandinavia. There is, however, a the answer. It is incumbent upon its conclusions and discuss their we found that only patients small percentage of our patients the practitioner to identify those implications for clinical practice. with somatisation* are found who have complex psychosocial patients who are 1) unlikely to Do chiropractors believe to consistently have worse profiles, or in other words, are respond to care and not treat them that the psychosocial factors outcomes. All other psychosocial depressed, have abnormal levels of indefinitely, hoping for that magical are relevant and important? factors** which were evaluated were distress and internalise their stress moment when they might suddenly According to a study conducted in either inconsistently associated with resulting in physical symptoms recover, and 2) identify those at risk 2005, 80-90% of those surveyed worse outcomes or not at all.3 (i.e. somatisation). However, this of developing chronic complaints. small sub-group requires further Identifying whether chiropractors study, and does not represent the (or any other practitioners) are any OFFER majority of our patients. good at identifying these factors and 50% Discount on RRS Education’s Research Reviews for EAC Members In general, these results generating valid prognoses is fodder would suggest that screening for for another (PhD) study. • PROMPT, FRIENDLY CUSTOMER SERVICE – we are always just an psychosocial status at the first email away. visit has little additional benefit. Sidney Rubinstein, DC, PhD * Individual users can choose to receive our weekly newsletter when Does this mean we shouldn’t Chair, ECU Research Council they register their personal user account on the website. screen for these at all? From with Tammy de Koekkoek, DC, Thanks to an agreement between the ECU and RRS Education, previous studies we know that DABCO EAC members can now purchase 1-year professional (recurring) psychosocial factors help predict [email protected] subscriptions for 50% off the regular price (you will pay only who is likely to progress from an $89.50 CDN instead of the normal price of $179 CDN)! acute to a chronic stage of back * Somatisation refers to the physical expression of symptoms as a result pain-related disorders. Identifying of psychological distress To redeem this discount: this group is important in order to 1 Contact your ECU-affiliated national chiropractic association who ** e.g. distress, depression, anxiety and will provide the offer key after confirming your membership. prevent patients from becoming somatisation. 2 Click on the link to www.rrseducation.com/research-reviews. disabled. If kinesiophobia is 1 Walker S et al. J Chiro Med 3 Click SUBSCRIBE NOW, select ‘1-yr Recurring Payment $179’ and readily detected, for example, follow the instructions. 2005;1:11-18. then the treatment plan should be Chiropractic & 4 Enter your account information. 2 Kongsted A et al. Manual Therapie 5 Append the coupon code (case sensitive) at bottom of the adjusted accordingly by providing s 2011;34:204-210. Man Ther registration page before checkout. the patient with education and 3 Ailliet L et al. . 2015 Jul 20. 4 Ailliet L et al. Accepted. Physical 6 Proceed to PayPal to complete the transaction. information. In addition, depressed Therapy .J 2016 Feb 4. patients with back pain may

BACKspace www.chiropractic-ecu.org April 2016 11 General news 60-second interview BACKspace interviews three figures from the world of chiropractic

Name

Lone Kousgaard Jakob Bjerre Maria Jose Joergensen Hernandez Ortiz

Danish New member Association Danish of the ECCE President Association CEO Council Education Master’s degree in Clinical Biomechanics Master’s degree in public administration Bachelor of Medicine and Surgery from and from University of Southern Denmark. and economics. Leadership experience the Autonomous University of Madrid; practice Chiropractor since 2002. Co-owner of from different healthcare institutions. Pathology Specialty, Ramón y Cajal clinic with four chiropractors, two PTs, two Several management and coaching Hospital, Madrid; Diploma in underwater massage therapists and four receptionists courses. and hyperbaric medicine; Doctor of since 2011. Several years as president of Medicine; Doctor of Chiropractic, the Southern regional division of the DCA Life Chiropractic College West USA. as well as the committee responsible for Chiropractor since 2005. International the agreements with this regional health Vice-President of the Spanish Chiropractic administration. Since 2008 member of the Association (AEQ) in 2015. DCA board, vice president from 2010 and president since 2013. First job Intern (GEP) at chiropractic clinic Administrative officer in the finance I spent two years in a pharmaceutical department of one of the biggest research centre working as a toxicologist. hospitals in Denmark. Memorable I still remember my fifth day as a When I helped the board first design When I quit my job and gave up my salary professional chiropractor, where I had a patient carried ‘the prolapse package’, a new structured at the Son Dureta Hospital to embark moment in; he had not been able to rise from the procedure for patients with acute on an adventure to study chiropractic in floor at home all day. He walked out of my lumbar disc herniation, and then in 2013 the USA. It was very difficult, especially clinic 50 minutes later. Halleluja! Another succeeded in negotiating a settlement for because I had to teach in addition to memorable moment was when I realised it with the public health administration. It’s studying, but I also consider this the best that establishing the ECCRE (see page 10) a very innovative framing of chiropractic gift that life has given me. could be the key for the DCA to re-enter treatment in primary care. the ECU, followed by my colleagues supporting it at our annual meeting in November. Professional Kiropraktorerne Kongevej in Sonderborg, n/a QuiroVida Chiropractic Centre in Palma practice Southern Denmark de Mallorca Special I care for my patients at any stage of I take a special interest in how to Women’s health, writing and reading interests their level of pain and disease and have consolidate professionalism by always about health. I’m interested in healthcare a special interest in complex problems finding the right strategy for the right research and I very much enjoy teaching. and in sports medicine. I like to treat task. Sometimes it’s diplomacy behind the my chiropractic patients after having lines. Other times it’s direct confrontation. done a thorough examination as a body detective. Ambitions I would like to get to a point where Development, influence and growth - My vision for the chiropractic profession for the everybody knows what a chiropractor nationally as well as globally. is dedicated to true health promotion, chiropractic is and does. At the same time I strive especially through the optimal profession to maintain and fortify the chiropractic maintenance of the musculoskeletal unity in the evidence-based direction and system health. But very importantly, also strengthen our political impact through through advice, guidance and support dialogue, cooperation and alliances. I am of the patient’s decisions to make the fighting for chiropractors to be considered changes needed to maintain and increase as a natural first choice in any healthcare the body’s own ability to get and stay system for patients with musculoskeletal healthy. I would make the spine check-up pain, as a result, among other, of our and spinal adjustment an integral and academic education level. basic part of preventative healthcare. Contact [email protected] [email protected] [email protected]

12 BACKspace www.chiropractic-ecu.org April 2016 Newsletter of the European Chiropractors’ Union

General news BCU calls on Belgian universities to provide chiropractic education The Belgian Chiropractors’ Union (BCU) held a colloquium1 at the Federal Parliament in Brussels on 25 September 2015. Bart Vandendries, BCU president, reports. HE SESSION was supported European countries; in each maturity and credibility. as yet but, equally so, obligations Tby the chair of the Belgian chiropractic is integrated into • For over 30 years chiropractic with which we are not required Centre for Evidence-based primary healthcare. has had an independent to comply today but which we Medicine (CEBAM) Dr Patrik • The most important argument accrediting body in Europe welcome in the name of our Vankrunkelsven and attended by leading to recognition is usually (ECCE). In other words, patients. Having listened to the Belgian politicians, senior members that chiropractors are highly- Norwegian chiropractors experiences of Danish, Swiss, of the medical profession, medical qualified healthcare providers have been educated to the French and English colleagues in trades unions, the Belgian Higher who offer added value in same standards as Belgian establishing university alliances Council of Health and the Board tackling a huge social welfare chiropractors, or French and exploring new scientific of the BCU. It attracted positive issue (i.e. back and neck pain). or British practitioners. If horizons driven by a gigantic social press coverage, with calls for greater • This is not a coincidence: the chiropractors where there is welfare problem, I cannot escape funding for chiropractic treatment profession has always invested regulation offer added value, so the impression that surely Belgian by the Belgian health insurance on an international scale in a do their Belgian colleagues. universities must be interested in providers. Speakers were drawn university-level education. It • On the other hand it currently this topic as well. from across Europe, illustrating is about quantity and quality. takes time to generate growth Belgium has world-renowned the most important aspects of The high-quality educational in the number of chiropractors, universities. If British, French, the chiropractic profession: programme delivers healthcare especially when they must go Danish, Spanish, Swiss and global reach, higher education providers who can be deployed and study abroad for five years. Turkish students are being qualification in accredited immediately in a healthcare Despite powerful opposition from offered the possibility of studying institutions, scientific research and system. They move with the entrenched interests elsewhere in chiropractic on home territory Europe-wide quality standards times through access to research: the healthcare system, the BCU - and soon so will Norwegian under the European Committee for claims made at the beginning has committed itself publicly to and Italian students – surely Standardisation (CEN). of the last century have either a long process of achieving legal Belgian universities can rise to this The day drew out the following been proven or refuted and recognition for the profession. opportunity. important lessons: by embracing an evidence- Legal recognition is a matter of • Legal regulation of chiropractic based approach the profession rights and obligations: rights 1 An informal seminar for the exchange of views is an accomplished fact in 12 has slowly but surely gained which we have not been granted EU cross-border healthcare report highlights advances REPORT ON the state shows that European citizens’ • Patient mobility for planned In line with President Juncker’s Aof play with the Cross- awareness about their right to healthcare remains low – far commitment to ensure effective Border Healthcare (CBHC) choose healthcare in another EU below the potential levels implementation of EU legislation Directive shows significant country remains low. Less than suggested by Eurobarometer and follow-up on the ground, legislative advances at EU- two in ten citizens feel they are survey (49% showed willingness the Commission will continue level in the past two years informed about their rights in to travel in another EU country an in-depth examination of coupled with genuine efforts this area, and only one in ten is to receive medical treatment). the measures adopted by at national level. Furthermore, aware of National Contact Points • Information to patients member states to implement the Directive has contributed (NCPs) - offices set up under the about their general rights to the Directive, and to explore all to shaping healthcare reform Directive to provide information reimbursement should be possible means for ensuring the in many EU countries. It has to patients on their rights and improved. correctness of the Directive’s improved transparency and on quality and safety issues. • The same goes for data transposition into national law patient mobility throughout the Awareness of NCPs varies widely collection - to date, only 17 so that citizens in all 28 EU EU and enabled progress on between EU countries, with four of the 21 member states who countries are able to benefit. Health Technology Assessment, times as many Maltese citizens introduced a system of prior e-Health co-operation and knowing about them (24%) as authorisation were able to 1 Source: Eurobarometer on Patients’ rights in cross-border healthcare European Reference Networks. citizens from the UK (6%)1. supply data on applications in the European Union: http:// However, the report clearly Amongst other findings: for authorisation. ec.europa.eu/public_opinion/ archives/ebs/ebs_425_en.pdf

BACKspace www.chiropractic-ecu.org April 2016 13 General news 140 years uncorked Polly Hand gives an account of a double celebration in the UK – the 90th anniversary of the British Chiropractic Association (BCA) and the 50th anniversary of the Anglo-European College of Chiropractic (AECC).

N FRIDAY 25 September, I boarded a train in London with a good in the heated outdoor pool as the sun was starting to go down on Saturday Ofriend from university, cracked open a bottle of Prosecco and let the evening – blissful after a day of learning, mingling and getting inspired. weekend commence. We were on our way to Bournemouth for the joint There was a large focus during the weekend on the achievements of both BCA and AECC conference, celebrating their 90th and 50th anniversaries. the BCA and the AECC – we really mustn’t forget how far the profession Being a BCA council member, it is somewhat expected that I attend these has come and how much these two institutions have done for us – meaning events. And I would be lying if I said I was really excited about the weekend. we can practise today and continually help our communities. I like my weekends to be full of rest, perhaps a drink or two and catching Throughout the weekend a strong desire for unity grew organically; up with friends. I can, however, safely say that it ended up fulfilling all it became a common theme in many of the talks, and indeed during three of those criteria – and many more too! The setting was beautiful and break time coffee catch-ups. The atmosphere was fantastic – a real mix of perfect and the sun came out for ages, experiences, opinions, but again an overriding feeling of all being us for the whole weekend. The in this together and essentially that we all want the same things for our hotel conveniently included a profession – growth, acceptance and increased awareness. great health club and spa so we The gala dinner on the Saturday evening was fantastic. Champagne on made the arrival, pretty dresses, dapper suits (many of the men attempting their most of best Bond impression) and an incredible band who really got the dance it during floor busy. I have recollections of partaking in a shot or two too many, any down and dancing like a loon with a helium balloon, but as I said, it was my time – I weekend; I was determined to have fun. And that I did! Øystein Ogre and even Being a dedicated BCA member I am ashamed to say I didn’t attend Matthew Bennett, found BCA conferences for a few years as I felt they might be somewhat boring. BCA president myself Not any more; the future is bright. The future is chiropractic! The AECC at 50 HIS MILESTONE birthday could be cause for looking back at 50 years nurses and midwives. Using a multidisciplinary teaching team this is Tas a higher education institution during which time its reputation for inter-professional learning at its best. Most successful, as one might excellence, quality and standards has been recognised globally in the profession. expect, is musculoskeletal ultrasound and AECC is now arguably the But that is not the AECC way. Unashamedly resting on a bedrock of scientific leader of training in this field in the UK with unparalleled equipment and research, it is one of the leaders of the empiricist arm of chiropractic and facilities. Nor is it confined to the British Isles. As with the postgraduate expects shortly to attain the status of a public independent university college in MSc in paediatrics, the College now runs the MSc in ultrasound in the UK. It prefers to think of the next 50 years of chiropractic. Norway with the support of the Norwegian Chiropractic Association. For instance, the AECC relevance to practising chiropractors does not In the past 12 months, the College has started short courses in stop with graduation. It offers career-long support for practitioners to remain diagnostic ultrasound for Premier League football clubs in the UK. Three relevant through a range of postgraduate programmes and a portfolio of satellite training facilities have been set up, and medical staff from clubs CPD seminars and courses. The profession, not just in the UK, recognises the such as Arsenal, Southampton, AFC Bournemouth and Leicester are being AECC as a reliable and ready source of CPD events, helping busy people keep trained. This exciting development at AECC reflects the College’s drive and abreast of current developments and come together to debate the way ahead. motivation to build bridges to potential Some 20 years ago the College recognised that the profession would alliance partners. For a small profession start to develop postgraduate specialisations. The first postgraduate with a strong sense of identity could master’s degree in chiropractic in the world was established in 2000 this be a fruitful way forward? One (MSc Clinical Chiropractic), and it focused on the new rehabilitative thing is certain, approaches of the time. This was followed by a wider range of the AECC will postgraduate master’s degrees including paediatrics and medical not stand still ultrasound, open to all qualifying healthcare professionals. For details see and will push Haymo www.aecc.ac.uk/postgraduate-cpd. the boundaries Thiel, Postgraduate education and training in diagnostic ultrasound has of knowledge AECC been a notably successful venture and now recruits large numbers of as far and as principal and students from a range of healthcare professions, including medical hard as it Øystein consultants, sports physicians, GPs, radiographers, physiotherapists, is able. Ogre

14 BACKspace www.chiropractic-ecu.org April 2016 Newsletter of the European Chiropractors’ Union

General news Delivering the right message Over the years the Associazione Italiana Chiropratici (AIC) has organised various press conferences to represent and promote the The Netherlands chiropractic profession in Italy, but with only between 300 and 400 chiropractors in a country Chiropractors’ with 450,000 medical doctors, the association found it difficult to create sufficient interest Association turns 40 to convince the journalists to disseminate the message. AIC president John Williams explains Around 250 chiropractors and colleagues how they solved the problem. from other healthcare professions gathered in Almere to celebrate the 40th anniversary of the Netherlands Chiropractors’ Association N THE past, we had who collaborate with chiropractors (NCA) on World Spine Day, 16 October 2015. Iconcentrated on presenting in order to demonstrate the This report is from Gitte Tønner. chiropractic as a recognised complexity of diagnosing and primary healthcare profession with treating back problems, but also to HE MORNING started with newest and youngest member a top-notch five-year academic better illustrate how chiropractors Tgentle exercises to wake the with her hopes for the future. preparation, and quoted statistics fit into the healthcare team. muscles and prepare participants The afternoon programme concerning cost-effectiveness, The speakers consisted of two for the stimulus to come. appealed widely and made diffusion in Europe, political chiropractors, one MD/DC, President of the ECU, Øystein extensive use of local specialists: situations and all the familiar an orthopaedic doctor and a Ogre, and Secretary-General of neurology, paediatrics, sports, problems experienced by our nutritionist,and all presentations the WFC, Richard Brown, put the cervical radicular syndrome, profession in Europe. reflected the importance of Netherlands into an international pharmacology, the dangers of I must say that all those present the individual patient in the context. Dutch Olympic skating a sedentary lifestyle and world were sincerely touched by our treatment process. The session legend Jochem Uytenhaage record holder for remaining in an presentations and vicissitudes, was moderated by a journalist of gave an inspiring and energetic ice bath, Wim ‘The Iceman’ Hof! and the conference lasted much Italy’s top newspaper and there talk, and was followed by the From the lively atmosphere longer than foreseen, but none was ample time for interaction esteemed professor of surgery and from survey it was clear that of this enthusiasm carried between the speakers and the from Erasmus University, Hans the vast majority of attendees over to the mass media and journalists. Jeekel, who openly supported were very happy to be present the only announcement that This time was definitely more chiropractic as a complement to and proud NCA members. was communicated was the productive than in the past, and other medical procedures. Around the time of the future opening of a chiropractic within one hour of the conference, The NCA organising team anniversary it was made known course in Italy, which was only I was interviewed on Italy’s top introduced a novel way of that following a campaign by a footnote in the three hours medical television programme, showing the many faces and the NCA, Dutch chiropractors of discussion. At the end of the to be followed one week later facets of the Association: are once again VAT exempt session though, several of the by a live appearance on a news NCA president Reem Bakker – a splendid result which will journalists approached me and talk show with other health interviewed colleagues from encourage growing ambition for said they would like to be invited professionals. across the years, including the profession in the Netherlands, to our next press conference, but This caused me to reflect on Walther van Os, who is still in including title protection, would like to choose the theme the reasons why the media were practice and has seen the NCA recognition, legislation, more to be discussed. They all had back so responsive this time, and I pass all kinds of milestones, the PhD students and a domestic problems and wanted to hear what realised that, while our previous first PhD chiropractor Sidney undergraduate programme in chiropractic could do for them encounters generated enthusiasm Rubinstein and heads of NCA chiropractic. For the NCA and its that was different than what they among the journalists, the message committees, ending with our members life begins at 40! had already tried. that we were delivering was not We took their request to heart newsworthy, nor of direct and and at the end of 2015, held a personal interest to the general press conference in Rome on public concerned with their the complexities of low-back own health problems, but was problems. On this occasion, we more suited for an institutional invited other health professionals audience.

BACKspace www.chiropractic-ecu.org April 2016 15 General news

The future of chiropractic education In the light of continuing arguments about vertebral subluxation and what constitutes ethical patient management, six leading chiropractic colleges in Europe and South Africa issued a statement at the Athens ECU/WFC Convention last May declaring where they stand on these and other questions. As part of student recruitment the Colleges want to leave no doubts as to what they are and what they teach. We reproduce their statement for the record below.

HEREAS, THE welfare of the patient is paramount; and 5. The teaching of vertebral subluxation complex as a vitalistic2 construct W Whereas, chiropractic education should be of the highest that claims that it is the cause of disease is unsupported by evidence. Its quality and be founded on the principles of evidence-based care1; and inclusion in a modern chiropractic curriculum in anything other than an Whereas, curricula should be responsive to changing patient, societal historical context is therefore inappropriate and unnecessary. and community needs and expectations within a modern health care 6. Chiropractic education should reflect ethical practice and professional system; standards throughout the curriculum. Upon graduation, students must we, the undersigned chiropractic educational institutions, state as understand their responsibilities to their patients, their communities and to follows: the profession. 1. Chiropractic education and training must acknowledge the 7. Practice styles3, which may contribute to inappropriate patient biopsychosocial model of healthcare and be underpinned by dependence, compromise patient confidentiality or require repeated biologically plausible theories and peer-reviewed research. It should exposure to ionising radiation are not part of an undergraduate embrace the value of clinical experience, shared decision-making and a chiropractic curriculum. Students should be taught to recognise that patient-centered approach to care. such approaches are not acceptable in terms of the best interests of 2. Upon graduation, chiropractic students should be equipped to work patients or the chiropractic profession. effectively and collaboratively to deliver improved quality of life outcomes for patients with musculoskeletal disorders. This will, of necessity, On behalf of the following chiropractic educational institutions: incorporate: • Anglo-European College of Chiropractic, Bournemouth University a. An evidence-based approach to the case history, physical • The Welsh Institute of Chiropractic, University of South Wales examination, diagnostic imaging, diagnosis, report of findings and • The Education of Clinical Biomechanics, University of Southern management plan that may include a range of clinical interventions Denmark b. Effective communication in a language that is clearly understood by • Chiropractic Medicine, University of Zürich all stakeholders in healthcare, thereby facilitating interprofessional • Institut Franco-Européen de Chiropraxie practice and promoting effective collaboration between health care • Department of Chiropractic, University of Johannesburg teams • Department of Chiropractic and Somatology, Durban University c. Knowledge of preventative measures including but not limited to of Technology musculoskeletal care, encompassing wider public health and health • Department of Chiropractic, Macquarie University promotion initiatives • Discipline of Chiropractic, Murdoch University 3. Wherever possible, chiropractic educational programs should form or develop affiliations with established public and private universities 1 Sackett DL, Rosenberg WM, Gray JA, Haynes RB, Richardson WS. Evidence based medicine: what it is and what it isn’t. BMJ. 1996;312(7023):71-2. preferably within a medical or health science faculty. Such links may 2 Specifically the form of vitalism as distinct from holism that proclaims ‘If the develop opportunities for interprofessional education and collaborative specific vertebral subluxation is correctly adjusted, interference is released, pressure practice. is eliminated, carrying capacity restored to normal, tissue cell is re-established, and 4. Chiropractic educational institutions should support their faculties in life and health begin to regrow back to normal. All this is directed, controlled, and performed by INNATE INTELLIGENCE’ (Ref: BJP Fame and Fortune Vol. the provision of innovative models for the development of knowledge, XXXIII) learning and skills. These should focus on facilitating scholarly activity 3 Practice styles refers to routine ‘high volume’ chiropractic care models, ‘open plan’ including research, interprofessional education and teaching within the chiropractic care models and the delivery of unsubstantiated ‘treatment packages’ or context of emerging health care models. clinical techniques.

16 BACKspace www.chiropractic-ecu.org April 2016 Newsletter of the European Chiropractors’ Union

Improving everyday practice Test yourself A quiz set by Bert Ameloot of the Belgian Chiropractors’ Association. Find the answers on page 20.

Ben is a 42-year old competitive During the course of his career Physical Examination 5. Which one of the footballer, who presents to your Ben has had numerous soft tissue Vitals: not needed following statements is practice with a five-month history injuries to the hamstrings, calf Observation: Muscular and NOT correct? of right-sided anterior hip and muscles and hip flexors, which healthy looking. A. Trendelenburg test is a test groin pain. The pain started during were successfully managed by Palpation: tenderness of for hip strength and gluteal the course of pre-season training the team physiotherapist. hip musculature and spasm of tendinopathy on the weight and gradually worsened over a Ben is a social drinker and right piriformis, gluteus medius bearing leg two-month period. The hip feels does not smoke. He has no other and iliotibial band. Soft tissue B. Gluteal tendinopathy can be sore and very stiff after he has been symptoms of any kind. adhesions were palpated at tested by the resisted external playing and training for football. muscular insertion points on the derotation test When it flares up it is difficult for Questions greater trochanter and anterior C. Flexion, adduction and internal him to sleep on his right side. 1. Lumbar/lumbosacral referral superior iliac spine. rotation cause an abutment It is important to note the 2. Soft tissue injury 3. Intra-articular Hip range of motion: global between the femoral head and patient played professional football hip lesion 4. Sacroiliac referral reduced range of motion of the anterior acetabulum from the age of 19 until 29 years of 5. Extra-articular hip lesion right hip compared with the left. D. Flexion-adduction-internal age. His commitment to football 1. Select the option that Especially adduction and internal/ rotation test has low sensitivity involves about 1.5 hours of training displays the most likely external rotation. There is also and high specificity compared twice a week and a 90 minute order of possible general pain and limited flexion and to MRA and arthroscopy match on Saturday. At the moment causes of Ben’s hip pain. abduction, with a reproducible E. The Thomas test creates he is coping reasonably well A. 35214 painful click on the right. relative hip extension in the and can still run quite freely and B. 52134 testing leg performs reasonably well during C. 14325 Orthopaedic exam: the game. Despite his symptoms D. 41235 Pain on Patrick’s FABERE test on 6. Why was the Thomas test he still wants to continue playing E. 23145 the right evident/positive on the as he loves the game. Therefore Painful click on the Thomas right? he went to his medical practitioner 2. Which one of the options test on the right A. Most football players have for this, who ordered plain below is NOT an extra- Trendelenberg negative, short hamstrings. medical imaging and diagnostic articular hip disorder? bilateral adductor test negative B. Short iliopsoas on the right ultrasound. The MRI is planned to A. Internal snapping hip (resisted adduction in 30° flexion) compared to the left. happen in two weeks. The general B. Deep gluteal space syndrome, No abnormalities in the C. Short quadriceps group on the practitioner referred him to a previously known as piriformis evaluation of the lumbar and right compared to the left. physiotherapist, but as the team syndrome sacroiliac joints on orthopaedic D. Iliotibial band shortening physiotherapist could not alleviate C. External snapping hip testing, except for tenderness by and tenderness due to tensor this pain with his usual treatment D. Abductor tendon tears springing and palpating the right fasciae latae/gluteus maximus the patient went to see you. E. Acetabular dysplasia sacroiliac joint. imbalance. The nature of the pain was a Whereas imaging is clearly E. Pain in the groin or painful constant dull ache during the 3. What quality of pain may important for correct diagnosis, click possibly due to intra- first two months of pre-season, suggest intra-articular hip false positives with MRI and articular disorder. which became intermittent after lesion? MRI with arthrogram (MRA) are the patient noticed a greater A. Diffuse and aching common, requiring providers Investigations level of fitness. Lately it has B. Burning to determine whether a The findings of the plain X-ray become a sharp catchy sensation C. Sharp and catching distinct pathology is actually revealed early arthritic changes accompanied by clicking or D. Shooting symptomatic, further relying on with osteophytic spurring of popping in the joint located accurate and efficient physical the femoral neck junction mainly in the anterior aspect 4. Which sports are placing examination. and superolateral joint space of the hip and the groin. The hip soft tissue structures To look up background loss. Marginal changes at the intensity was reported at 3/10 on under most stresses? information to refresh your acetabulum raise the possibility a visual analogue scale. No other A. Swimming and running knowledge before continuing: of labral injury. No other symptoms were reported. There B. Running and cycling you may use this source: abnormalities were detected. is no previous medical history C. Squash and tennis http://bjsm.bmj.com/ Ultrasound demonstrated and no history of any other D. Spinning and stepping content/49/6/357.full a normal appearance of the serious lower extremity injuries. gluteal tendon insertions with

BACKspace www.chiropractic-ecu.org April 2016 17 Improving everyday practice no evidence of tendinopathy X-ray of a supine pelvis is the L3 nerve root. femoroacetabular or tear. There is no significant an indicator for CAM type B. The L3 dermatome crosses impingement: select the trochanteric bursitis. impingement the anterior thigh and extends only option below that is B. Athletic pubalgia should distally along the medial thigh inappropriate. 7. What is the most likely be differentiated from hip to the level of the knee. A. Initially, the patient is diagnosis of the case impingement, hence cannot C. The ‘C’ sign is described when educated on avoidance of presented based all occur together a patient shows deep interior compromising positions such information received so C. Acetabular retroversion as a hip pain. The hand is cupped as extremes of hip flexion and far? cause of pincer impingement above the greater trochanter internal rotation. A. Athletic pubalgia is indicated by a shallow with the thumb posterior and B. Generally, at least 4–6 weeks B. Anterior snapping hip posterior wall the fingers gripping deep into of conservative intervention syndrome (iliopsoas tendon D. The minority have a mix the anterior groin. should be employed prior to snapping) of cam and pincer type D. More commonly, posterior surgical treatment. C. Iliotibial band proximal friction impingement impingement may be C. Any measures that aims to syndrome E. Cam type impingement is encountered and is assessed reverse the iliopsoas being D. Labral hip tear more common in females by external rotation of the long and weak, the TFL being / femoroacetabular extended hip. short and dominant, and the impingement 9. Select the only statement E. Athletic pubalgia (or “sports gluteus maximus being short E. Advanced hip osteoarthritis that is incorrect hernia”) is a condition that and weak. A. The hip joint receives often occurs in athletes D. Lumbopelvic stabilisation 8. Select the only correct innervation from the L2 to S1 E. Manipulation or mobilisation statement branches of the lumbosacral 10. Conservative to increase the anterior glide A. A cross-over sign on plain plexus but predominantly from management of anterior of the hip joint

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18 BACKspace www.chiropractic-ecu.org April 2016 Newsletter of the European Chiropractors’ Union

Feature Small country – large ambition After ten years in the wilderness the Danes are back at the table as members of the ECU. But what is the situation for chiropractors in this small country which likes to call itself a chiropractic superpower?

The DCA in numbers • 550 chiropractors • 260 clinics • 250 students • 30 work at hospitals • 10 work in administration or education • 20 are engaged in research

ENMARK IS indeed a small country, with only 5.7 million Dinhabitants. However, with 550 practising chiropractors and 250 chiropractic students it is in the top ten countries in the world as far as access to chiropractic care is concerned. Conditions are unique for both chiropractors and their patients. Danish chiropractors have most of the things other chiropractors can only dream about: licence, title protection, laws and regulations, The ECU Executive Council meeting was hosted at the DCA offices in a recognised position inside the national healthcare system, March 2016 tax-funded patient subsidies for all chiropractic fees (although only 20%), a research fund that is partly publicly financed, a example, it establishes a right to subsidies for patients attending research institute with outstanding faculty and a publicly-funded clinics and a right for chiropractors to refer patients for imaging chiropractic education programme at a medical faculty. diagnosis at public hospitals. On the other hand chiropractors are How did all this come about? Let’s consult the history book for obliged to follow fixed fees for services (negotiated by the DCA a moment. The first Danish chiropractor settled in Copenhagen in with the national authorities), follow national clinical guidelines, 1920 and already by 1925 there were 11 practising chiropractors and, though they have been voluntarily supporting research since who formed the Danish Chiropractors’ Association (DCA). The 1987, will be required to undertake postgraduate education and to same year the Danish chiropractic patients’ association was also contribute to the financing of chiropractic research and education. formed. There were growing pains, with resistance especially from A further obligation will soon be to engage in a public quality the doctors, and attempts to gain recognition through licence control programme. failed. But as the patients’ association grew stronger and began 1989 was a further turning point as the DCA and the public to campaign for chiropratic legal rights, results began to show in healthcare administration agreed to establish a common fund the 70s. The breakthrough was not with a chiropractic licence, called the Foundation for Advancement of Chiropractic Research which came later on, but happened in 1978 when chiropractors and Postgraduate Education – and agreed to share its funding. became part of the agreed system underpinning Danish primary Consequently the fund gets its means directly from Danish healthcare. That meant that chiropractic patients could get a chiropractors and the public healthcare system (tax money). Each public contribution in the shape of a limited subsidy for treatment of the 260 enrolled chiropractic clinics pays 2% of their turnover – and a lot more. to the fund – the national healthcare system contributes an Central to primary healthcare are agreements between amount one-third smaller. The fund finances the research institute, the different health professions (the chiropractors, the GPs, the Nordic Institute of Chiropractic and Clinical Biomechanics the medical specialists, the physiotherapists and four more (NIKKB), which was established one year after the creation of professions at present) and the public healthcare administration. the fund. But the fund also finances other research activities, These agreements not only determine the size and coverage of development projects and postgraduate education – including the the different subsidies, but are part of an agreed complex of GEP, quality control development and other activities determined arrangements that fix the level and extent of public authorities’ in the agreement creating the fund. involvement in the exercise of health treatments. Enrolment of the DCA in the public healthcare system Since 1978 the agreement between the DCA and the public paved the way for achieving first a chiropractic licence and title healthcare administration, which is renegotiated every third protection (1991), then a publicly-funded chiropractic education year, has developed. Today it has several components, including programme (1993). Not to say that this was easy! These important the framework for and size of public funding, involvement in and giant steps required enormous efforts from chiropractors and chiropractic research, development projects, graduate education manpower in both the DCA and the patients’ association. programmes (GEP) as well as postgraduate education. To sum up, the success in integrating chiropractors as specialists The agreement establishes both rights and obligations. For in the formal healthcare sector is the result of the investment

BACKspace www.chiropractic-ecu.org April 2016 19 Feature

by all Danish chiropractors, who presented a politically unified profession and a firm dedication to what one could call ‘the Danish chiropractors have academic road’. They were ready to pay the costs of influence • licence to practise on the same level as MDs and dentists up front. That is evident in their continued support in financing • protection of the title ‘chiropractor’ the research fund, but also in the 1980s when the DCA, as one • reimbursement from both the state and all private of the first European associations, decided to professionalise insurance its secretariat. Today the DCA office employs seven full-time • recognition by the public Patient Compensation professionals, most of them highly educated. This secures many Association and The National Agency for Patients’ Rights activities and important continuity, but it does not come free. and Complaints Most of the members’ fees sustain the wages and costs linked to • acknowledgement as an integrated part of the primary this level of secretariat. sector in close collaboration with general practitioners What is the next mountain to climb for the Danes? On the and physiotherapists national level the DCA wants to get even more integrated into • acceptance of a ‘prolapse package’ - a structured both primary and secondary healthcare. More patients should procedure for patients with acute lumbar disc herniation have a chiropractor to take care of their musculoskeletal problems. • employment as chiropractors at hospitals, both in spinal The strategies therefore aim at making more alliances and joint clinics and imaging departments ventures with other health organisations and increasing the • a strong research environment with more than 20 branding of chiropractors as evidence-based clinicians. At the chiropractors having been awarded PhDs same time the DCA looks forward to playing an active part in • a publicly-funded chiropractic programme, known as ECU deliberations, helping to promote the profession’s political clinical biomechanics, at a medical faculty at the University goals in a European context. And, as we speak, the finishing of Southern Denmark touches are being put to The European Centre for Chiropractic Research Excellence which will combine funds from the Danish For more information see: Fund and the Research Fund of the ECU. www.danskkiropraktorforening.dk/english

Improving everyday practice

(iliopectineal eminence, femoral with 128 patients. Arthroscopy hip orthopaedic tests, including Answers: head, or lesser trochanter). criterion reference sensitivity the anterior hip and groin pain 99%, specificity 7%, across two as well as the painful clicking and 1. A: It is most likely an 3. C: diffuse and aching may studies with 157 patients. You popping, this would suggest the intra-articular hip lesion, suggest muscular pain, burning should put this test in context most likely diagnosis involves with concurrent soft tissue would be more sensitisation of with other orthopedic testing. intra-articular derangement abnormalities based on the a part of the nervous system, of the hip. The investigations quality of the pain, site of pain, shooting could be sclerotomal or 6. A positive test is reproduction confirm femoroacetabular relationship to movement, nerve structure related. of painful click or concordant impingement syndrome with presence of referral pattern groin pain. Monitor for 4. C: sports that involve a lot of possibly a hip labral lesion. (even though hip conditions are tightness/compensation of the cutting or short movements with notorious for masquerading as lumbar spine arching, tested 8. C: cross-over sign can be an changing direction put the hip lumbosacral, sacroiliac or knee leg abducting and externally indicator of pincer impingement; and related soft tissues structures conditions), long-term sports rotating. Although this test does athletic pubalgia can occur under high loads. These involve related history. not reproduce the mechanical together with hip impingement; repetitive internal or external abutment between the femoral 2. E: acetabular dysplasia is an about 80% have a mix of cam and rotation of the hip under head and acetabulum similar to inadequate development of an pincer type impingement; pincer loading in less stable kinematic the FADDIR or flexion internal individual’s acetabulum. The type is more common in females. formation. You could add rotation test, it does recreate hip resulting acetabulum is shallow football, rugby, etc to option C extension, which has been shown 9. D: posterior impingement is and ‘dish shaped’ rather than to recreate the greatest forces less common. ‘cup shaped’. Option A may 5. D: the FADDIR test has on the hip joint. The Thomas test have confused you, but the a high sensitivity and a low 10. E: manipulation or has value as both a screen and snapping sound comes from the specificity compared to MRA and mobilisation of the hip joint for diagnostic test as both sensitivity tendon of the iliopsoas muscle arthroscopy. Pooled diagnostic an anterior femoro-acetabular and specificity are high. as it moves through its normal accuracy: MRA criterion impingement should aim to motion across the extra-articular reference sensitivity 94%, 7. D: Considering the patient’s increase the posterior glide of bony structures of the hip joint specificity 8%, across four studies symptoms were reproduced by the joint.

20 BACKspace www.chiropractic-ecu.org April 2016 Newsletter of the European Chiropractors’ Union

Feature Newell’s notes Dave Newell, Director of Research at AECC, writes the first of a new regular series of features.

ECENTLY AT the Annual General Meeting of the Royal RCollege of Chiropractors (RCC) in the UK, Professor Charles “Professional Greenough, national clinical director for spinal disorders in NHS England outlined a new pathway for the management and treatment inclusion in a of low back and radical area pain that may see national coverage in the next few years. This pathfinder project was commissioned national pathway by NHS England and involved a range of stakeholders including for major MSK representation of the chiropractic profession. This new pathway is aimed squarely at the needs of the patient conditions is being and avoids the specific inclusion of professional specialities and sub specialities. To quote the report: ‘The pathway is based on the needs of based on clinical the patient at every point and on the structures of the services that might competency and meet these needs. It was acknowledged that throughout England many different services and many different pathways of care exist’. knowledge, not Instead it co-opts clinicians with identified competencies at each of the stages in the pathway thus allowing the inclusion of the traditional suitably qualified clinicians from a range of professions that can ‘go to’ professions include chiropractors. The key point here is that professional inclusion in a national pathway for major MSK conditions is already within being based on clinical competency and knowledge, not the traditional ‘go to’ professions already within the system. the system” Additional to these individuals who may include suitably qualified chiropractors at initial consultation and those delivering scope of practice and autonomy to name just a few when core treatments including manual therapy and manipulation within considering whether to engage with the system or not. In some the pathway, is the creation of a group of specialised clinicians European countries, notably in Northern Europe, those problems called triage and treat practitioner (TTP) or triage and management have been solved at least to the point where the chiropractic practitioner (TMP). These individuals will have high-level skills and profession are ostensibly embedded to varying degrees within the competencies. The report states that: ‘The function of the triage and national health system of the country. This I believe, as do many treat practitioner is to direct the pathway of care and provide continuity others, brings legitimacy and influence to a profession that is of care across the pathway … This clinician is highly trained and has struggling to expand in Europe and in some countries is still at the significant skills, competencies and high autonomy ...’ margins of the healthcare community. Importantly, the RCC has produced a set of competencies in Notwithstanding the considerable barriers that have stood, and the wake of these initiatives and they very much align with what a still stand, in the way of such inclusion, this UK initiative with its good proportion of chiropractors possess, albeit with some notable emphasis on competency not professional identity is a welcome upskilling perhaps needed.1 An important question about the change in rhetoric and seems to hold the promise of greater visibility role of the chiropractic profession was raised at the end of the talk. for the chiropractic profession. There is one key caveat however, and The pathway clearly states that any number of suitably qualified this I think is a general qualification on excessive optimism. clinicians can and should take a role at initial presentation and This new pathway may be defined nationally but it is local delivery of core treatments, including manual therapy. What was decisions that determine who will lead the patient along it; and noteworthy was that Professor Greenough also suggested that the that points to a major challenge. Chiropractors need to be known key post of triage and treat, responsible for directing and providing at a personal level to those who will be involved as clinical directors continuity of care throughout the pathway, could and should, where or administrators and they must show determination to step up to a suitably qualified individual with the requisite competences is such positions – including where necessary, the commitment to found, be a chiropractor. No professional boundaries, no automatic develop additional competencies and knowledge. As members of exclusion, only the requirement that chiropractors as individuals the profession we need to get up close and personal and to show our step up to the plate in terms of skills, competencies and knowledge. curiosity about where wider healthcare is going rather than focus on I found this both striking and groundbreaking. introspection within the profession about what it thinks it does. There is, and has been, a historical tension in Europe between Someone once said: “If you’re not part of the solution, then those in the chiropractic profession who do not want to be you’re part of the problem.” I guess in the end we will have to included in mainstream healthcare such as national health systems choose to articulate what and who the profession is in this regard. and those who feel this is the direction the profession should take. There are understandable disagreements and anxieties over tariffs, 1 http://tinyurl.com/h5bnf24

BACKspace www.chiropractic-ecu.org April 2016 21 People Identity and determination The secretary-general’s interview

T’S 7PM in the players’ lounge one of the fighters, John Wayne Iat Queen’s Park Rangers Football Hibbert, who is trained by Alex Club on a very wet Tuesday in Breading, the brother of a friend. December. QPR are to play While they were sitting and having Brighton & Hove Albion, currently some food he turned his head and top of the Championship. As the went into muscle spasm around evening unwinds, the word is that his shoulder and neck. He was this is the best game so far this due to be fighting the biggest season - which means, of course, fight of his career defending that it’s the best performance by the Commonwealth Light the home team so far. Their star Welterweight belt in four hours! player, Charlie Austin, is in the Alex asked Catherine to have a look starting line for the first time in a at him as he was unable to turn his month following a calf injury and head, so she ended up assessing and pulls back a two-goal deficit after but Catherine knows where each of Almost immediately she joined the treating him back at their hotel. Brighton scored twice in the space the home team is, by name, simply medical staff at London Irish, the Thankfully he was then fit enough of three minutes. Sky Sports calls the by the way they run and move. Premier League rugby club after to fight and went on to win by a game fantastic entertainment, and it Her role at QPR seems which she joined the QPR team knockout in the 12th round. Here’s is. The players’ lounge is full of wit, like a dream complement to in 2014. And between times she his subsequent posting: warmth and winding up aimed at Catherine’s other position at volunteered at the 2012 London the Brighton supporters who are just the busy Waldegrave clinic with Olympics, where she first met outside the (hopefully) reinforced Tom Greenway, who was the Tom Greenway. Not all of this was glass between us and the pitch. lead chiropractor for the 2012 planned – Catherine knows the I am the guest of Catherine Olympic and Paralympic Games value of signing up to a professional Quinn, the chiropractor member in London and previously spent identity and networking with The transition from student to of the QPR medical team. She 10 years working in professional people who are already doing the practitioner is not easy and we is clearly very popular with the football with QPR and Chelsea kind of work you want to do. That don’t all want to go down the same others in the room who show a Football Clubs. How did it come way it is possible to make the most route. Nevertheless, the lessons here warm, friendly respect for her. about? The answer is clear – of opportunistic openings if you have a general application. Sports Tonight she’s off duty. Normally Catherine knows where she wants show energy and enthusiasm. chiropractic has a glamour and she has 32 first team and 30 to be and that to get there means How does she fit into the offers an obvious potential benefit under-21 players to keep available being in the right place at the QPR medical team, which also to patients with a strong (some for training and selection. right time. That’s not accidental, includes a sports therapist, two would say obsessive) competitive Beneath the treatment room she has worked successfully at just physiotherapists and a massage streak. As a general patient I may banter, she tells me, the players that. Perhaps it is no coincidence therapist? She is seen as the spinal not fit that model. But I still need have learnt to trust her professional that her first sport was karate with specialist and is mostly consulted an answer to the question why I judgement: “You have to be strong its emphasis on counter attack, over degenerative or acute onset should trust you, the chiropractor, but not bossy or aggressive, so the discipline and persistent effort. spinal conditions, particularly with something so fundamental players recognise that you fully She took a BSc in sports lower back and neck problems. to my well-being and happiness. back the advice and treatment you science at St Mary’s University, Once again, a clear identity and Catherine offers her answer: “You are giving to help their performance Twickenham, and volunteered at standpoint for the day-to-day have to back your own judgment or bring them back from an injury. Harlequins Rugby League (now debate and the bouncing-off of during a multi-disciplinary debate, They recognise that they are able to the London Broncos), helping ideas with the other members of but you also have to interact with perform to their full potential when with massage and taping. For 12 the medical team. and learn from your medical they feel at their best, which at the months she worked at the Barron A few weeks after the interview colleagues as we all have the single top levels makes all the difference.” Clinic and then secured one of Catherine found herself in the aim of looking after the players in And as if to prove the point, the four FICS scholarships in 2010 – right place at the right time once the best way possible.” second of Charlie Austin’s goals is two Americans, one person from again. At the end of January she She leaves me inspired but a powerful header when he rises France and Catherine. The result was going to the MatchRoom also asking myself whether we higher than the defenders to power was a Master’s in Chiropractic at boxing event at the Copper Box do enough to create a distinctive home a cross from a corner. It the AECC, again volunteering at in the Olympic village. Before chiropractic identity that speaks to happens at the far end of the pitch Southampton FC whilst a student. taking her seat she looked in on the public at large.

22 BACKspace www.chiropractic-ecu.org April 2016 Newsletter of the European Chiropractors’ Union

People The FascialEdge® Ti. Bruce Walker Now with Video guidelines! honoured by the Australian The FascialEdge® is a simple, versatile tool government that covers 99% of myofascial contact areas

T WAS announced on (C&MT) which is supported The rounded ends let you work Australia Day 2016 that by the European Academy of I close in to origins and tissue associate professor Bruce Walker Chiropractic (the academic arm of Murdoch University Perth had of the ECU) and is available for planes where fingers simply been appointed a Member of the all ECU members. The other can’t reach. Order of Australia (AM). The European partners in the C&MT The long edges cover large Using the tip over award is made for achievement venture are the Royal College of the supraspinatus foss and merit in service to Australia or Chiropractors, where Bruce has areas quickly and thoroughly humanity. just been elected a Fellow, and the making sure even tiny lesions Bruce graduated in 1975 from Danish research institute NIKKB. and adhesions aren’t missed. Melbourne. After graduation, he Bruce has also devoted much spent 30 years in clinical practice of his time in the past six years With the FascialEdge® your as a chiropractor in Melbourne to researching the health and hands are always in contact with the patient, guiding the and Townsville, Queensland, education needs of aboriginal Using the long edge also completing a master’s and peoples in the Pilbara region of tool and feeling for feedback. over the lat. dorsi a doctorate in public health. He Western Australia. An outcome Patients love it! has held a number of executive of his work has seen advanced board positions in the Chiropractic planning for a mobile health Using the FascialEdge®, you College of Australasia, the United clinic for remote aboriginal can work deeper with less Chiropractors’ Association, communities. When fully funded, effort, and work longer with the Australian Chiropractors’ this Murdoch University project less strain. Your hands will Association and the Chiropractors’ will add considerable value to thank you! Association of Australia. One of the existing health and health his major achievements was the education services available to development of the Chiropractic & aboriginal communities in these “I have learned to appreciate this tool Perfect for greatly… I highly recommend it. A great plantar fasciitis Osteopathic College of Australasia remote areas. tool for our trade.” Dr Robert Schleip PhD. (COCA) - the leading vocational Bruce said that the award “I use the FascialEdge tool every working college for graduate chiropractors. was a tribute to the chiropractic day, with almost every patient … It started in 1959 and now has over profession at large and in … enough said ?” Dr David Darwent D.C. 1000 members nationally. particular to those evidence-based Working around the Bruce has long campaigned for chiropractors who have fearlessly greater trochanter The FascialEdge® Ti Package chiropractic to become a part of pursued science and guided the mainstream allied health medicine profession in the right direction. Beautifully finished in and has encouraged the profession He said the award was the result  Titanium plate for low friction. to ensure that science of a team effort and research are at its and belongs to all Instruction Booklet: “How core. Bruce himself has the very motivated  to hold” and “How to use.” Photos and detailed graphic over 66 peer-reviewed and talented teams guidelines. articles which have been of people who Memory Stick: Multiple cited over 2,500 times. supported him £145.00 inc UK delivery  short demo. videos and He is editor-in-chief throughout his career + £10.50 EU delivery animations. of the open access and paid particular journal Chiropractic tribute to his wife www.fascialedge.com 0044 (0)1834 860140 & Manual Therapies Dr Alison Hogg.

BACKspace www.chiropractic-ecu.org April 2016 23 People

Obituary: Obituary: Raymond Simon Bird Sandoz Matthew Bennett, president of the Priska Haueter, President of Chirosuisse writes: BCA, pays tribute to a passionate AYMOND SANDOZ passed initiated and managed the central and energetic Raway unexpectedly in January course for chiropractic assistants, the chiropractor. 2016, aged 86. In a full and rich forerunner of the Swiss Chiropractic life his influence on the chiropractic Academy and in 2001 he was made HIROPRACTOR SIMON Bird, who has died aged 47, was one profession was immense. He made an honorary member of the Swiss Cof the liveliest of his generation. Not only was he a highly- a considerable mark on several Chiropractors’ Association. skilled chiropractor, but also an inspirational leader, a stirring generations of Swiss, as well as Internationally, Raymond lectured speaker and a loving father. A 1998 graduate from AECC, he international, chiropractors. at many seminars and chiropractic served with distinction on the BCA Council from 2012-14 and on In Switzerland, he was instrumental colleges. His presentations were the board of SOTO Europe. He was a regular on the lecture circuit in the legislation for chiropractic at always scientifically based but also at AECC and WIOC as well as BCA and ECU conferences. both national and cantonal levels. He entertaining. He was respected He had boundless zest for being in practice, both the clinical and was a member of both the executive and appreciated not only by business side of things, which made him unusual amongst his peers. board of the Swiss Chiropractors’ the chiropractic profession, but His energy had him up at five most mornings and practice meetings Association and the Intercantonal also by other health authorities in his five clinics started early too. Examining Commission. He was and legislators. He contributed To know Simon was to experience enthusiasm and fun. He responsible for developing continuing significantly to the recognition and was always looking to the future and trying to improve his own education and organised the legislation of chiropractic in Europe. performance and that of those around him. His relaxed approach postgraduate courses (CE courses) He actively sustained the evolution belied a keen and inquiring mind. His energy and insights shaped for chiropractors in Switzerland. of the AECC in Bournemouth and the lives of many chiropractors who will forever be in his debt. Simon He was one of the founders of the of the ECU, where he held, among combined his passion for his profession with compassion for his Annals of the Swiss Chiropractors’ other duties, the position of president patients, transforming their lives. He was so young and had so much to Association. From the very beginning, of the Professional Council for several give to the world; his patients must feel bereft at his untimely death. the courses and the Annals earned years. We are proud to have known Simon touched the lives of all who came in contact with him. A great recognition internationally. He him and enriched by his wisdom. bright light has gone out and we will miss him greatly. Our thoughts go out to his loved ones. Obituary: Lindsay Rowe Stephen M Perle offers an appreciation of a life less ordinary R ROWE died of cancer on they couldn’t believe any chiropractor I recently heard an anecdote understated way, trying to exceed DMonday January 25, 2016. could read films as well as he could. about when Lindsay was in medical expectations. He brought out the I was fortunate enough to meet As he told us, they think we are school. One of his professors said, best in those he met, worked with him in the early 80s, when I was stupid until proven intelligent, so in what Lindsay described as a and taught and he wanted our a student at Texas Chiropractic prove yourself intelligent first. ‘supercilious tone’: “I heard you’ve profession to be better than it knew. College. Lindsay had come to do Two years ago at the WFC written a textbook. You know that Having dinner together in a lecture; in an attempt to gain biennial meeting in Durban, the average medical textbook sells Durban is a special memory for me. employment he was travelling around randomly I sat next to a doctor I 2,000 copies; mine has sold 3,000. Our profession will sorely miss him. from college to college. He told us didn’t recognise; it was Lindsay – it How many copies did your book I know we are all better chiropractors that as he travelled the US he would had been 30 years after all. We had sell?” Lindsay said: “20,000.” and our profession is immeasurably arrange meetings with the heads of a lovely opportunity to see each Lindsay was someone who better because we were fortunate radiology departments at medical other. For me it was the highlight wanted to make a difference and enough to have had Lindsay Rowe schools. He would play ‘name of a great trip to Durban for FICS while his textbook with Dr Yochum as one of us. I hope that everyone that disease’ sharing his and the and WFC. I told him how I had has clearly had an impact, anyone reading this, as Lindsay would department chair’s interesting cases. successfully used that technique for who interacted with him knew they want, thinks about how they can Only when this exercise was done years and had been teaching it to were in the presence of someone do better as a chiropractor and would he reveal he was a chiropractor students for the past 25 years I’ve who was extraordinary but never make our profession better – exceed and not a medical physician. They been an academic. He took great ever considered himself to be more expectations and make your life less were often dumbfounded because joy in hearing about this. than someone who was just, in his ordinary.

24 BACKspace www.chiropractic-ecu.org April 2016 Degenerative posterocentral disc protrusion, which is stable in supine and extended positions and reduces in flexion.

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With Steve Williams DC, DICS, FICS, FRCC (paed), FBCA Four Weekend Seminars Wk 4: Treatment Of Common Paediatric Syndromes Southampton, UK Saturday 3rd & Sunday 4th December 2016

Wk 1: Pregnancy & Birth Trauma Booking: For more information and to Saturday 3rd & Sunday 4th September 2016 book online visit www.stjameschiro.co.uk Wk 2: Neonatal Cranial & Spinal Care Contact: Should you have any questions, please contact Nicki McCarthy on +44 (0) 2380 788111 Saturday 1st & Sunday 2nd October 2016 or e-mail [email protected] Wk 3: Neurobehavioural Williams Disorders & Plagiocephaly Paediatric Saturday 29th & Sunday 30th October Seminars Review The Concise Book of Trigger Points 3rd edition Simeon Niel-Asher (2010) Lotus publishing; ISBN: 978-1-905367-51-1

HE FIRST chapter usefully targets self- of you who might want to get on with that indications, Thelp to those with trigger points (that’s MSc or PhD you always meant to do! It goes causes (which nearly all of us!). Trigger point therapy can be on to explore classifications of trigger points perhaps effective in a number of conditions so it’s a and physical findings in a comprehensive should refreshing start that the book targets the reader’s fashion although the diagram of an ‘ideal’ remain potential pain first. One thing I do note at sitting posture at the end of this chapter does speculative in the end of this chapter is the list of potential tend to give the impression that such a thing some cases), signs and symptoms supposedly linked with exists whereas the reality is that there is little hands-on possible sites of trigger points. Clearly some of evidence that such an ‘ideal’ actually does. techniques these should remain conjecture only as I am Chapters 4 and 5 look at therapeutic and self-help not aware of strong evidence necessarily linking interventions whilst chapter 6 makes a somewhat as useful all of the conditions (for example cardiac courageous leap into the complexities and single- or double-page quick reference guides. arrhythmia associated with trigger points in simplicities of chaos theory. Having published Overall then, this book is thin (always a pectoralis major) with particular trigger point something on this area myself I was intrigued as good starting point for students), colourfully positions, so would caution a little against to the suggestions put forward, particularly the illustrated and well laid out, providing quick assuming strong correlations in all cases. notion that strange attractors of neural firing and easy reference to a whole range of muscles The next chapter lays out an overview of may help to maintain local and painful muscle and associated trigger points. Whilst relying skeletal muscle structure and physiology which contraction. However, notwithstanding the probably more on clinical experience than is followed by a review of what trigger points tentative use of complexity theory in this chapter, evidence in some areas and the forgivable are thought to be and how they might come it’s probably wise to keep this as an interesting whimsical leap into speculation, it does a about. This attempts, successfully in my view, possibility rather than fact at this stage. good job in providing quick access to the to review what is known about the generation The remainder of the book then goes on identification and therapeutic modalities and maintenance of trigger points in a concise chapter by chapter to examine each of a large associated with these common and sometimes and accessible way with some nice unanswered number of muscles with their associated painful and disabling muscular phenomena. research questions hopefully stimulating those common trigger points, an overview of David Newell Does cervical lordosis change after spinal manipulation for non-specific neck pain? A prospective cohort study Michael Shilton, Jonathan Branney, Bas Penning de Vries and Alan C Breen This article was published on 7 December 2015 in Chiropractic & Manual Therapies 2015 23:33

PINAL MANIPULATION is a common neck pain) matched for age and gender also change in lordotic angle exceed the minimum Streatment for mechanical or ‘non-specific’ had cervical spine x-rays at baseline and at four detectable change of 13.5°. This study’s findings neck pain but the mechanism(s) by which it weeks. On each of these x-rays the lordotic angle suggest that the angle of the cervical spine affects pain remains unknown. One mechanism was measured to find out whether this angle lordosis is not a good indication for treating proposed in the literature is that neck pain might had changed in the patient group, and whether mechanical neck pain with spinal manipulation. be alleviated by changing or ‘correcting’ the any change was greater than that in the healthy While the measurement method was reliable alignment of the cervical spine. This study aimed volunteer group who received no treatment. and participant positioning highly standardised, the to determine whether cervical spine alignment The study determined that this measurement observer interpretation of x-rays may still have been changes to the lordotic curve occur after a course method was reliable and that a measurement an important source of measurement variability. of spinal manipulation for neck pain. repeated could be expected to be within 3.6° of Further, while no significant differences were found Twenty-nine patients with mild-moderate the original measurement. that does not preclude differences being detected in neck pain of at least two weeks’ duration had No difference in cervical lordotic angle a study with a sufficiently large sample size. low-dose cervical spine x-rays taken while was found between patients and healthy Editor’s note: This article has had over 2000 accesses seated in a standardised position. X-rays were volunteers and there was no significant change re-taken after a four-week course of spinal in lordotic angle in patients after four weeks CHIROPRACTIC & MANUAL THERAPIES manipulation. Thirty healthy volunteers (no of manipulation. In only four patients did the

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