October 2015 Volume 11 Number 2

Newsletter of the European Chiropractors’ Union

What’s new in this issue? Øystein Ogre Francine Denis’ on unity in the hopes for profession development in the 3 profession 24 22 4 Introducing the new Secretary- 26 General Baiju Khanchandani on what he wishes 28 he’d known years ago What you should know about Special Interest Groups

Lise Lothe on Previous issues of BACKspace are available the future of from the ECU office. the Academy See page 3 for Athens convention 2015 8 contact details. … and much, much more

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President’s message Is unity important?

he Sydney Morning versus the ‘straights’, and that changes; ideas, understanding and your way. You are not entitled to THerald made an interesting split exists even today. We see it treatments move on as knowledge walk away if you don’t like the observation in July this year when most clearly when we debate the and experience grow. So it is too conclusion. Sometimes you must it claimed that “the chiropractic scientific evidence for the existence with chiropractic and chiropractic show great restraint in the interests profession is notorious for its of the philosophy. of mutual respect and tolerance. infighting, with quarrels over the complex. There is probably not a The diversity of fundamental This unity must not be mistaken value of vaccination, the evidence single chiropractor on the face of viewpoints, and how we have for uniformity or a grey dullness of or lack thereof to support the the earth who has not taken part handled that diversity, has had a mediocrity. There can be a thriving theory of subluxation and whether in such a debate. In 100 years, negative effect on the unity of the diversity within a profession that spinal adjustments should be that on-going debate has not chiropractic profession. But, why yet presents a vibrant common performed on children.” The moved the profession forward one is unity important? Well, for one front that celebrates a blend of statement came from a journalist inch. On the contrary, in many thing the associations in those science, experience and curiosity. with only a general knowledge of areas of the world it has led to a countries which have experienced One example would be the the profession, commenting on a division of the profession, which great progress will tell you that medical association, which stays recent development in Australia again has led to stagnation and without unity in the profession it unified and speaks with one voice where yet another chiropractic in some instances a decline. The would not have been possible to despite the fact that some of its association has been formed. debates have often been forceful, move forward and achieve effective members perform abortions and If this is how the profession aggressive and without any legislation and proper working some of its members are forcefully looks from the outside, it is signs of the two parties finding conditions for chiropractors. pro-life. certainly something we should be common ground. The result is that The learning experience and the Unity within the chiropractic addressing from the inside. many colleagues do not want to take-home message have always profession is long overdue. It is Chiropractic has a 100-year get involved because they find the been: When dealing with political about time we spoke with one voice history of a split in the profession. climate of the debates destructive, authorities speak with one voice. If and stopped trying to navigate Originally, it was the ‘mixers’ unproductive and tiresome. you do not, the health bureaucracy, through the rear-view mirror. Facing deadlock in the national the politicians and the law-makers association, we have seen several will simply not listen. Øystein Ogre DC, FEAC different associations being formed The unity I am talking about ECU President

BACKspace is published twice a within many countries. can be a very difficult companion, Blog address: year by the European Chiropractors’ Division weakens the profession almost as difficult as democracy. ecupresidentblog.com Union (ECU) and distributed free and confuses our patients. It It means that you have to accept Email: [email protected] to all ECU members. Opinions in BACKspace are not necessarily those is often unhealthy. The main that you cannot always have it of the editor or the ECU, who reserve argument for continuing to the right to edit all contributions. squabble seems to be a view The ECU accepts no responsibility for advertising content. that the beliefs of the founders European Chiropractors’ Union, of chiropractic constitute an The Glasshouse, 5A Hampton Road, eternal truth and should not Hampton Hill, Middlesex TW12 1JN be tangled with or questioned. Tel: +44 (0) 20 8977 2206 Email: [email protected] I don’t sympathise with that Website: www.chiropractic-ecu.org viewpoint. President Obama said Edited and produced by in a speech in Kenya recently, Manya McMahon at when he referred to the on-going Pinpoint Communication Ltd discrimination against Kenyan www.pinpoint-uk.co.uk [email protected] women: “Just because something Tel: +44 (0) 1395 269573 is a part of your tradition, doesn’t Design by Impress Publications Ltd make it right. It doesn’t mean that Print by Advent Colour Ltd, it defines your future.” Likewise in 19 East Portway Industrial Estate, Andover, Hampshire SP10 3LU chiropractic we must acknowledge To advertise in BACKspace, please that just because someone we contact Claire Wilmot, Business admire postulated something 100 Manager at ECU Head Office: info@ chiropractic-ecu.org years ago, that doesn’t necessarily make it right today. In science © ECU. All rights reserved. Reproduction of any part of BACKspace is not allowed and healthcare, there is no such without the written permission of ECU.

thing as eternal truth. Everything Photograph © Ø H Haagensen

BACKspace www.chiropractic-ecu.org October 2015 3 ECU news Making an impact – and quickly! The new ECU secretary-general Ian Beesley introduces himself.

t the May General Council if you have talent it is a sin not next level of achievement and A I was asked why I had been to use it or, as people in North recognition and I wanted to be attracted to the ECU and if I had America say: “Use it or lose it.” part of that journey. any initial thoughts about the role. A look at the ECU website had So, I asked myself the question: To the first question I said that convinced me that here was a “Why would anyone listen to my father had taught me that profession ready to step up to the me?” Well, I have had a career in four parts and I have taken lessons from each. I started at grammar school in the north-west of England and ECU secures won a place at Oxford University where I read Politics, Philosophy sponsorship and Economics. My first job was as a professional statistician in the s a parting gift on leaving negotiations between the ECU Government Central Statistical A for the World Federation and Activator, the Honorary Office. There I learned the value of Chiropractic, Richard Brown ECU Treasurer, Vasileios of evidence and the power of signed a ground-breaking Gkolfinopoulos, said: “I numbers. After a few years, with sponsorship deal on behalf of the warmly welcome the support trepidation because of its awesome “Evidence is ECU with Activator Methods from Activator Methods. It is reputation, I moved to the British International. encouraging to see equipment Treasury to help control public not enough, The agreement, signed on 10 suppliers investing in the expenditure. There I learned that June, runs to the end of 2018. leadership of our profession and evidence is not enough, you have you have In return for a generous annual I look forward to many years of to win the arguments and, above to win the contribution to ECU funding, fruitful co-operation.” all, you have to take action. Activator becomes the exclusive Judi Fuhr, CEO of Activator In 1980 I joined the staff arguments Platinum Convention and Methods International, added: working for the British prime Seminar sponsor and exhibitor “Chiropractic is a young minister, the scientifically-trained and, above all, of leading instrument adjusting profession with a long history. Margaret Thatcher. I spent five- you have to devices. Further, the company Throughout that history there and-a-half years there and led is authorised to advertise itself have been trailblazers of high her Efficiency Unit, dedicated to take action” as ECU Platinum Convention integrity and a driving passion reducing the costs and improving sponsor in its promotional to improve patient care. We are the performance of central literature and will be the named delighted to help the current government. There I learned that from those studies is that there is sponsor of one convention plenary generation of chiropractic leaders you have to make an impact – no standing still, you either move session with associated platform in Europe as they continue in that and quickly. You only get one forwards or you slide backwards. presence. It will also be the sole noble tradition.” chance to impress. Now I have taken on a fifth sponsor of ECU General Council Then I joined challenge, in the large footsteps of meetings. PricewaterhouseCoopers (PwC) as my predecessor Richard Brown. The ECU will provide two a consulting partner and worked He leaves a European profession full-page advertisements for on four continents. I learned that is on its way to great things Activator in BACKspace and that if you exceed the client’s provided that it looks to the good will advertise, via social media (the patient’s) expectations your it can do for the patient and is not channels, Activator-organised business will prosper; and I also afraid to apply the lessons I have events. ECU stationery will learned that it is more fun making drawn. show the Activator logo and money than saving money. After four months in the role, acknowledge its sponsorship. In After leaving PwC I took a I know from the reception I have return, Activator will publicise Doctorate (PhD) in History at the had from everyone and from the ECU conventions. University of London and became leadership I have seen in Øystein Commenting on the successful the official historian of the British Ogre that I made a good choice. conclusion of sponsorship Cabinet Secretaries. The lesson [email protected]

4 BACKspace www.chiropractic-ecu.org October 2015 Newsletter of the European Chiropractors’ Union

ECU news New faces at General Council BACKspace introduces the recently-elected ECU General presidents of two national associations Netherlands Switzerland Council Meeting A report of the meeting on 13 May 2015

Financial support to existing projects which the Name Reem Bakker Priska Haueter n-going funding Research Fund supports. Oof €35,000 a year was granted in support of the Membership European Council of Chiropractic The ECU will no longer recognise Education (the accrediting body a distinction between Associate for chiropractic colleges). and Full membership of national Full or part-time 40% 80% A grant of €5,000 was associations. Education AECC University of Bern awarded to assist the Turkish The Danish Chiropractors’ Union Qualifications BSc Chiropractic Lic.phil.hist. national association with current (DKF) will decide in early November UEFA TC3 licence legal proceedings over recent whether to re-join the ECU. Discipline Chiropractor Administrator government legislation. Exceptionally, Clause 3(a) of Name of clinic Reem Bakker, Chiropractor n/a The Research Council evaluated the ECU Constitution (which Type of clinic Solo general practice n/a four requests for funding from restricts membership of a national Special interests Sports n/a Norway, Spain, the UK and association to graduates of Ambitions in the Improve the status A stronger profession: post of chiropractic in legally and as a primary IFEC in collaboration with the accredited educational institutions) the Netherlands and care provider in chiropractic college in Quebec. was suspended for two years for eliminate legal and tax integrated healthcare. Funding was agreed for the graduates of the Barcelona College discrimination. Retaining and bringing Norwegian project (Identifying of Chiropractic and the chiropractic Strengthen chiropractic on the next generation recognition in the EU. of talented young the course of neck pain in programme at Zürich University chiropractors. chiropractic patients and possible pending further developments in Mentors My clients My predecessors subgroups related to selected accreditation of these institutions. Other City Councillor for the Family predictive factors) and to the UK An updated ECU website appointments Liberal Party (VVD) (A study of lumbar inter-vertebral (incorporating the European – spokesperson for motion patterns to inform the Academy of Chiropractic) has gone healthcare, social care, sports design of clinical trials and live at www.chiropractic-ecu.org. Relaxation ‘What did I learn Physical activities; prognostic studies). The financial today?’ history, the arts commitment to these projects Forthcoming meeting Contact address [email protected] Priska.haueter@ represents approximately €80,000 The General Council will meet chirosuisse.ch over four years, in addition again on 20-21 November 2015. Welcome to the new ECU vice-president

ivian ‘Viv’ Kil is a never doubted there would be evidence-based research and At the same time, Viv will V chiropractor with ideals, who work as a chiropractor and that continuous improvement. remain a busy practitioner at has ambitions for the profession I would be allowed, by law, to Chiropractic in Europe has Nervus Praktijk Voor Chiropractie, across Europe. She has the energy work in the Netherlands. But that come a long way since the the clinic which she has set up in of a dynamo and unlimited freedom was won by the efforts founding of the ECU in 1932 but Valkenburg, a pretty town in the optimism. It is an engaging and of many who went before me.” there is still much to be achieved. south of the Netherlands which exciting combination. Now, elected vice-president Viv will have special is a thriving tourist attraction. It Shortly after being elected the of the ECU in May this year, responsibilities in the has been Vivian’s goal ever youngest, and the first female, Viv has the opportunity to help Executive Council since starting training to president of the Netherlands shape a future across Europe for for growing public bring chiropractic back to Chiropractic Association, Viv told all generations of chiropractors, awareness and the area where she grew BACKspace: “My generation built on the pillars of recognition trust in chiropractic up and, as a result, she was needs to take responsibility for of the profession, superior care and lifestyle the first chiropractor to practise our future. When I graduated I education and a devotion to advice. there.

BACKspace www.chiropractic-ecu.org October 2015 5 ECU news ECU honours Richard Brown

ystein Ogre a particular Øpresented interest in sports Dr Richard Brown, chiropractic; the outgoing he spent a secretary-general, period as team with the ECU’s chiropractor for most prestigious Wolverhampton award, the Honour Wanderers Award, at the May Football Club 2015 Convention, in and in 2012 he recognition of his outstanding was a member of the medical work on behalf of the European team at the London Olympic profession over many years. Games. He served four years George Gedevanishvili, the intermediary on behalf of the TSMU, Thanking him for his service, as president of the British and Øystein Ogre the ECU president said: Chiropractic Association “‘We would have liked to and from 2010 on the ECU have Richard on board as our Executive Council, being Georgia and Turkey secretary-general for many years appointed as the first ECU to come. At the same time, we secretary-general in 2012. He is plan chiropractic feel proud that our man was also the chair of trustees of the selected to lead the main office Chiropractic Research Council. of the World Federation of With an exceptional capacity education Chiropractic. I know that I have for work and an instinctive he Tbilisi State Medical proposes a European Union all my European colleagues interest in how fellow TUniversity (TSMU) took the Higher Education Area designed behind me when I wish him chiropractors are contributing first steps towards a post-graduate to ensure comparability in higher good luck in his new challenge. to healthcare throughout the programme education qualifications. It has been both fun and world, Richard has left his mark in June. The ECU is funding an rewarding working with Richard on the profession in Europe. Just a few days after the initial study to map the TSMU and he will be missed.” He is known as an eloquent devastating floods hit Tbilisi, in undergraduate courses against the Richard graduated as a speaker and has travelled Georgia, at a ceremony led by normal requirements for post- chiropractor in 1990 from the extensively to promote the the University Rector, Dr Zurab graduate chiropractic education Anglo-European College of chiropractic profession. Now, Vadachkuria on 19 June, 60 in Europe. The General Council Chiropractic; he also holds a as the new secretary-general members of the university faculty of the ECU plans to discuss the Master’s degree in law from of the World Federation he heard ECU president Øystein results of this study at its meeting Cardiff University. For over 20 follows in the footsteps of the Ogre speak about the role of in November and will then decide years he practised in a multi- legendary David Chapman- chiropractic in primary healthcare. on the most appropriate actions. disciplinary clinic in Stroud, Smith – a challenge he will both They enthusiastically supported Meanwhile, on 27 July, the England, where he developed relish and rise to. a decision to develop, with ECU Turkish Ministry of Education help, the new programme at the approved a proposal from Clinical Centre of Sports Medicine the University of Bahecesehir ECU WIOC Graduates and Rehabilitation under Professor (BAU) in Istanbul to launch a of the Year – Lela Maskhulia. chiropractic programme and Nicola Thalmann and Since its foundation in 1918 discussions are taking place with Alex Becu Steinson the TSMU has produced over the ECU about the curriculum 40,000 doctors. It has almost to be followed. BAU is a private 5,000 undergraduates (20% from university with over 14,000 overseas) and 200 post-graduate students (4,000 of whom are students. Georgia is one of 29 post-graduates). It has a Graduate countries that are signatories of School of Health Sciences with 11 the Bologna Convention that faculty members.

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093-201504[advERGOSTYLE]02.indd 1 02-09-15 20:50 Convention

The Alpha and Omega of Spinal Healthcare The ECU Annual Convention and the WFC’s Biennial Congress were held in Athens during May. Entitled The Alpha and Omega of Spinal Healthcare the Convention was hosted by the ECU and the Hellenic Chiropractors’ Association and welcomed over 900 delegates from more than 45 countries around the world. All photos by Ø H Haagensen. No ordinary convention Having attended most ECU conventions since graduating in 2001, Prab Chandhok was certainly excited, though a little nervous, to be attending this one. The Greek Eurozone crisis was all over the media and he expected to arrive in the middle of a dysfunctional city in chaos.

othing could have care. Heidi Haavik, Stuart McGill, chiropractors I had just met, There was also the opportunity Nbeen further from the truth. Charlotte Leboeuf-Yde, Mark enjoying sumptuous seafood. We for ECU to bid farewell and give A smooth arrival, check-in to the Gurden, Nadine Foster, Brian Nook made great memories and then thanks to Richard Brown, who hotel and straight into the hustle and regulars such as Joyce Miller escaped to the Greek bars at the foot has similarly elevated ECU into an bustle of 900 delegates signing in and Lisa Killinger all entertained of the Acropolis, finishing up at the organisation that enjoys even greater to the convention. A true sense and informed with their chosen convention hotel’s rooftop bar, with influence and respected status today. of collective camaraderie exists at areas of special interest, whilst breathtaking views over Athens. We Fittingly, Richard celebrated taking ECU, and especially joint ECU/ backing up their presentations with stared awestruck at the Acropolis lit over the secretary-general’s role from WFC, conventions. There are the latest research. up in front of us. Oisten Haagensen David Chapman-Smith at WFC surprise meetings with old college I loved the short, but engaging, managed to snap a masterpiece of a and will continue his great work. friends, and opportunities to meet informative format of the lectures, photo from the bar. Quietly in the background new connections and forge lifelong something that ECU has mastered This was however, no ordinary of the gala dinner, another friendships from around the world. for some years. You always convention. The gala dinner was in of chiropractic’s great leaders So what made this ECU/WFC walk away with new gems and honour of David Chapman-Smith, celebrated his retirement alongside convention so special for me? The clinically-relevant ideas to take marking a career of over 27 years his two long-standing colleagues. I speakers covered a wide range of back to your practice. as secretary-general of the WFC, am especially privileged in making subjects. A It’s not all lectures, workshops undeniably raising the worldwide mention of Tony Metcalfe, as he by Jan Hartvigsen (see page 12) and trade stands in the sun. The status of chiropractic. He was introduced me to chiropractic included a comic depiction of the great thing about ECU and joined by his supportive wife, Sira, back in the mid-nineties and I early fascination practitioners had WFC conventions is the social and surprised by a presentation was glad to help celebrate his epic with instruments many of which time, which naturally supports of his ‘best bits’ which was set to career at the same time. resembled the rack! the professional aspects of the a beautiful song, later revealed to The evening, though Greg Kawchuk presented convention. The Greek night at an be beautifully sung by his own emotionally-charged, was lively a blunt description of the idyllic venue, the Vorres Museum, daughter. A fitting tribute to a man and thoroughly enjoyable with a perceptions chiropractors and gave us the opportunity to enjoy to whom the profession and every first-class band and music keeping chiropractic students commonly Greek hospitality amidst traditional chiropractor and patient owes a everyone on the dance floor and hold, which more often than not architecture coupled with modern great debt of thanks. then in the bar until the early hours. oversimplify the reality of what art in a truly wonderful art To me, ECU conferences L-R Prab Chandhok, David Chapman-Smith, represent the best of all chiropractic truly has to offer. museum. Richard Brown He urged us to see chiropractic The free night on Friday aspects of the chiropractic as an amalgamation of not just allowed us to attend alumni profession. Lifelong biomechanical or neurological receptions from various learning, furthering of concepts but also a blend of others colleges as well as venture our skills and knowledge including genetic and biological. into the city to sample the combined with camaraderie The authority that is Scott best of Greek hospitality. I and a whole lot of fun taken Haldeman updated us on the latest dined on a lake with a group to a new country each year – in the neurology of spinal health of Dutch and South African it’s just not worth missing!

8 BACKspace www.chiropractic-ecu.org October 2015 Newsletter of the European Chiropractors’ Union

Convention The opportunity to sample the best Greece has to offer BCA Vice President, Elisabeth Angier, enjoyed the venue as much as the convention.

thens, one of the and philosophy of spinal to discuss the findings with the feeling refreshed and invigorated, A world’s oldest cities, nestled manipulation, the prevalence of researchers themselves. up-to-speed with the latest at the foot of the beautiful musculoskeletal problems and It wasn’t all work and no play; research and bursting with all Acropolis and Parthenon, was the burden that these place on we delegates had the opportunity things chiropractic. However, a fitting location for this year’s global healthcare systems and the to sample the best that Greece has for me, some of the best times Convention. The ancient city is management of different aged to offer with a spectacular Greek were to be had exploring the famed for its classical heritage populations. All the speakers were night held at the famous Vorres cobbled streets or leafy tree-lined and some of the world’s greatest lively and dynamic and supported Museum, complete with traditional avenues, discussing the world of philosophers, scientists and their talks with the most recent Greek dancing and entertainment, chiropractic with my colleagues academics – where better to gather research and evidence. They as well as the splendid gala dinner from around the world. and discuss the science, art and were sure to include plenty of and awards ceremony. It made me wonder just how philosophy of chiropractic? take-home ‘clinical pearls’ to use There was even a little time many other academics, researchers There was a fantastic academic in clinic and there were hands- to explore the Plaka, the ancient and philosophers had wandered programme with three full days on workshops and interactive centre of Athens, or to kick back, along those tree-lined streets, of fascinating lectures delivered sessions every afternoon. The latest chatting with friends and colleagues or sat below the pillars of the by a wide range of international research was very well-represented on a roof-top terrace watching the Parthenon, discussing the subtle speakers. Well-moderated and with over 200 original research sun set behind the Acropolis. nuances and delicate intricacies of fast-paced, the huge range of presentations, plenary sessions It really was a fabulous their chosen profession over the topics included the history and posters, and there was time convention, and I came away last two millennia ... Jean Robert Research Award One of the judging panel, former ECU Convention academic organiser Vassilis Maltezopoulos, reflects on the success of these awards at the Athens Convention.

he ECU introduced the the winners with enthusiasm 2nd Prize –€1000 Jan Hartvigsen, Henrik Wulff Tprestigious Jean Robert and pride for what chiropractic Cynthia Peterson, Christian Christensen award some years ago in an research has offered to the Pfiffmann, Jürg Hodler, Compensation claims for effort to improve the quality profession in recent years. Christof Schmid, Serafin chiropractic in Denmark and of research, and this year I was Leemann, Bernard Anklin, B. Norway 2004-2012 honoured to be invited to be This year’s winners Kim Humphreys a member of the team that 1st Prize – €2000 Symptomatic, MRI confirmed As far as the ´inside´ story goes, evaluated the papers, and I felt Dave Newell, Jenni Bolton, cervical disc herniation patients: I can reveal how difficult it was very privileged to be the one to Emily Diment A comparative effectiveness for us in the research evaluation hand the awards to the winners. The UK PROMs collection observational study of two age team to come up with the It was definitely the best part of initiative: Final results and and gender matched cohorts winners in all categories, when the convention for me. reflections on an 18 month study. treated with either spinal all papers were of such high It was, as always, part of manipulative quality and the top two scored the closing ceremony. As therapy or almost equally. It was such a I stood up in front of the imaging guided gratifying experience to be full amphitheatre, I felt cervical nerve part of this exercise, alongside so glad to recognise in root injections. some of the top researchers, the faces of participants and I felt that my view as a field a warm gratitude for all Best new chiropractor was more than that had taken place over researcher welcome. the three convention –€500 I’m looking forward to events days. They applauded Jørgen Jevne, as successful as Athens 2015.

BACKspace www.chiropractic-ecu.org October 2015 9 Convention WFC Research Council awards Chair of the WFC Research Council, Professor Greg Kawchuk, reports on the high quality of the competition in these leading awards for the chiropractic profession.

uilding on the success of Mentions were given for the first sensorimotor function of the neck instrument-assisted spinal Bthe last meeting in Durban, the time this year. that can disrupt processing and manipulative therapy may help 2015 joint WFC/ECU Biannual In addition to the Lou Sportelli integration of sensory inputs. to reduce neuropathic pain Congress in Athens showcased a Awards, poster awards were induced by primary sensory stunning array of scientific papers selected from the entire pool of Second Prize – $7,500 neuron compression by activating and posters. Marking a new format accepted poster submissions. The UK PROMs collection endogenous anti-inflammatory which allowed more high-quality Congratulations again to all the initiative: Final results and cytokines IL-10 in the spinal cord. platform and poster presentations, winning authors. The Research reflections on an 18 month the Research Council would like to Council anticipates an even greater study Private Practice Award – congratulate all the authors of the competition when these awards Dave Newell, Jenni Bolton, Emily $3,000 almost 200 submissions that were are next given in 2017. Diment Direct access to chiropractic accepted for presentation this year. This prospective multi-centre services versus physician It was evident to all that not only LOU SPORTELLI observational study of 844 referral: Analysis of a large is the Congress the premiere venue AWARDS patients explored the feasibility data set from the UK to present chiropractic research, it First Prize – The Scott of implementing a web-based Jonathan Field, Dave Newell is a growing global community that Haldeman Award $12,000 patient reported outcome This prospective study utilised spans a diverse range of disciplines Neck pain participants show measures collection process in UK a web-based system to monitor and professions. impaired ability to perform a chiropractic practices to explore outcomes of 8222 patients The principal research awards mental rotation task in a four the practicality of this method presenting to chiropractors given at the Congress are the Lou week longitudinal study as for collecting a number of key through referral from National Sportelli Awards for best papers. compared to healthy controls outcomes, particularly cost analysis Health Service (NHS) primary These are the most lucrative of Julianne Baarbé, Michael Holmes, using Quality-Adjusted Life Years care physicians compared with research awards in the profession, Heather Murphy, Heidi Haavik, (QALYs). This study found that those presenting privately. It was and the Sportelli winners are Bernadette Murphy the collection of patient-reported found that patients presenting for selected by the Research Council This longitudinal study tested the outcome measures is feasible, chiropractic care, either privately from a pool of papers submitted ability of subjects with subclinical that the majority of patients or through their NHS primary into this voluntary competition neck pain and healthy controls to undergoing chiropractic care care physician, experienced and then published in the Journal recognise an object’s orientation. experienced substantial clinical excellent results for patient- of Manual and Physical Therapies They found that healthy improvement at reasonable cost, reported outcomes thus showing (JMPT). The first prize is named participants performed the task of and that the level of care exceeded that chiropractic services in the after the first chair of the Research mental rotation better than those their expectations. UK may be appropriate for both Council, Dr Scott Haldeman. with neck pain, suggesting that the private and NHS-referred patient Demonstrating the ever-increasing ability to perform a complex mental Third Prize – $5,000 groups. quality of the competitors and rotation task may involve cerebellar attenuates the difficulty in judging these connections and that those with neuropathic pain through Honourable Mention submissions, two Honourable neck pain may have altered activating endogenous anti- Who will have sustainable inflammatory cytokine IL-10 employment after a back Xue-Jun Song, Zhi-Jiang Huang, injury? The development of a William B. Song, Xue-Song Song, clinical predication model in a Arlan W. Fuhr, Anthony L. Rosner, cohort of injured workers Harrison Ndetan, Ronald Rupert Heather M. Shearer, Pierre Côté, This small animal model Eleanor Boyle, Jill A. Hayden, John study investigated the effect W. Frank, William G. Johnson of instrument-assisted spinal manipulative therapy on Honourable Mention inflammatory markers (cytokines The effect of high and low interleukin (IL) -1β, TNF-α, force cervical manipulation and cytokine IL-10) on chronic on mechanical neck pain: A compression of the dorsal root randomized controlled trial WFC poster regional awards ganglion. They found that Lindsay Gorrell, Roger Engel

10 BACKspace www.chiropractic-ecu.org October 2015 Newsletter of the European Chiropractors’ Union

Convention

POSTER AWARDS Asia – $500 Ibrahim Moustafa, Aliaa Mohamed Bellangero, Bianca Leme, Tamires First prize – $1000 Effect of chiropractic Diab, Deed Harrison Canin, William Marchetto Are chiropractic patients afraid treatment, ultrasound, and of moving? You can easily find kinesio taping treatment North America – $500 POSTER – Student out if your patients are on active rotational Behaviour-related factors awards Alice Kongsted, Kai Leland, Sture range-of-motion of associated with low back pain Student first prize – $750 Hammern sternocleidomastoid muscle in the US adult population Health professional JinOk Choi, SungBum Choi, Haiou Yang, Scott Haldeman, Dean perspectives regarding the Second prize – $750 HyeRin Cho, HanSuk Jung, Baker use of patient-reported Pain and physical activity SungEun Kim outcome measures in an in adolescents: Analyses Pacific – $500 integrated primary care of a population-based Europe – $500 The prevalence and impact health centre: A pilot project. international survey Somatotopy of the lumbar of neuropathic pain in older Kirsten Olesen, Peggy Howard, Michael Swain, Nicholas Henschke, spine in the secondary women with arthritis Shirley Xing, Fok-Han Leung, Steven Kamper, Inese Gobina, Veronika somatosensory cortex Katie de Luca, Parkinson Lynne, Deborah Kopansky-Giles Ottová-Jordan, Christopher Maher Sabina Hotz-Boendermaker, Bart Julie Byles, Henry Pollard, Fiona Boendermaker, B. Kim Humphreys, Blyth Student second prize – $500 POSTER – Regional Michael L Meier Development of an effective Awards South America – $500 and low-cost system to Africa – $500 Mediterranean – $500 Symptoms associated with monitor PROMs using mobile A systematic review to Does improvement towards chiropractic treatment: technology and the internet: determine the evidence to a normal cervical sagittal adverse effects and An exploratory trial of the support the use of flexion configuration aid in the improvement of primary Patient Health Information distraction chiropractic technique management of lumbosacral complaint (PHI) software application. Dillon Cuppusamy, Charmaine Maria radiculopathy: A randomised Eduardo Bracher, Gilberto Ahmet Ulusan, Andrew L. Vitiello, Korporaal,Glenn's LauraCPD Program Maie O’Connor 1-2 Page Ad2:Layoutcontrolled 1 trial 31/8/15 9:19 AM PageBarros, 1 Dayane Cabral, Julianna David Newell An online paediatric resource for the family chiropractor T H E P A E D I A T R I C C P D P R O G R A M

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BACKspace www.chiropractic-ecu.org October 2015 11 Convention The lessons of history

rofessor Jan Hartvigsen of the University of Southern Denmark Jan Hartvigsen called for more and better research into the clinical P(SDU) and Nordic Institute of Chiropractic and Clinical Biomechanics effectiveness and mechanisms of action of SMT.H ow such research should (NIKKB) intrigued a packed plenary hall with a lightning-fast historical survey be defined and funded in collaborations between clinicians and researchers, of spinal manipulation therapy (SMT) from Ancient Greece to the modern day. and also how the profession should show unity and identity (see President’s He showed fascinating illustrations of treatments in widely different Message on page 3) are topics for debate in future issues of BACKspace. cultures across many centuries, ranging from frescoes to middle-eastern On the final morning of the convention, Bill Meeker of Palmer College manuals, from Japanese woodcuts to what looked suspiciously like an presented the results of research in the United States that offered a global extract from the Karma Sutra. Such treatments were part of a spectrum identity: The experts in spinal healthcare within the healthcare system based on: from medicine to manipulation. a) An ability to improve function in the neuromusculoskeletal system, In the 19th century, however, medicine slowly embraced natural and overall health, well-being and quality of life. science and distanced itself from theology and spirituality. Doctors were b) A specialised approach to examination, diagnosis and treatment, increasingly university-educated, well-organised and subject to legislation. based on the best available research and clinical evidence with particular Their recognition and authority rose dramatically. By contrast, spinal emphasis on the relationship between the spine and the nervous system manipulation slowly fell out of grace, along with those who practised it. c) A tradition of effectiveness and patient satisfaction So-called were unorganised, unregulated and disunited, and d) Enabling patients to avoid drugs and surgery where possible they often had little formal education. e) Expertly qualified providers of , manipulation and Different therapy and belief systems including chiropractic evolved in other manual treatments, exercise instruction and patient education. the late 1800s and early 20th century and practitioners of SMT became f) Collaboration with other health professionals organised and better-educated. Many chiropractors, however, defined g) A patient‐centred and biopsychosocial approach, emphasising the mind/ themselves in opposition to medicine and were reluctant to accept new body relationship in health, the self‐healing powers of the individual, and knowledge and scientific advances in healthcare; consequently they individual responsibility for health and encouraging patient independence. were left with a sense of cultural inferiority. It was only slowly towards The chiropractor should be seen to be a combination of expert, the latter part of the 20th century that chiropractors started to embrace professional, ethical, knowledgeable, accessible, caring, human, and positive. scientific thinking and academic underpinning of their practices. Some thought the proposed identity too limiting. The BACKspace Drawing on epidemiological research by Eric Hurwitz1, Hartvigsen team and your national association would like to hear your views; e-mail drew our attention to Hurwitz’s conclusion that around 10% of the North the editor, Manya McMahon ([email protected]). American population receives SMT each year, overwhelmingly delivered by 1 Eric L. Hurwitz, Epidemiology: Spinal manipulation utilization, Journal of chiropractors and mostly for back and neck pain. Around the world there are Electromyography and Kinesiology (2012) large variations in usage of SMT and in practice patterns for chiropractors. Researchers’ Day

usculoskeletal In a provocative speech, message about the importance In the parallel sessions, use of Mdisorders are now Professor Jan Hartvigsen, of MSK disorders to people administrative data in Health the leading causes of disability University of Southern Denmark, outside the field. Services Research and Practice- worldwide and the costs and pointed out that apparently MSK There were several key based Research Networks were suffering associated with them disorders are not governmental messages that came out of the discussed, based on examples are astronomical. Intuitively, top priority, because even though discussions, not least of which from around the world. one would think that research we know very little about how was the call to open up dialogue The organisers, Lise Hestbaek, into effective prevention to prevent and best treat, for with other professions, be David Newell, and Sidney and effective early treatment instance, back pain, funding for inclusive instead of divisive, and Rubinstein, were delighted with would be a top priority for research, guideline development to integrate our research with the day. David said: “There was governments everywhere. and implementation of guidelines other public health research. an overwhelming interest from This year’s Researchers’ Day is negligible in most countries. In the afternoon, delegates the new researchers in meeting saw over 70 researchers from Also speaking at the event split into two parallel sessions. and presenting, and this session Europe, Australia, Asia, and was Christine Goertz, the only New researchers had the chance will surely be repeated. It is a North America meet to debate chiropractic member of the to meet each other and senior wonderful opportunity to meet how research could counter the Patient-Centered Outcomes researchers. In a lively, informal with other new researchers. challenge of raising awareness Research Institute board session, 14 new researchers We’re looking forward to of MSK disorders and attract (PCORI). She gave a personal gave short presentations of their meeting up again next year in funding for research. account of how to convey the projects and research interests. Oslo.”

12 BACKspace www.chiropractic-ecu.org October 2015 Newsletter of the European Chiropractors’ Union

Convention

ECU PLATINUM 2016 Convention SPONSOR Building Bridges Oslo 5-7 May 2016 • Radisson Blu Scandinavia

Exciting topics: Value added care • Biomechanics 2.0 • Vitamin D • Ultrasound • Lower extremity • Muscle testing • Professional Integration • Discussion and debates Special Interest Groups in: Neurology, paediatrics, clinical chiropractic & sports

Invited speakers: Greg Kawchuk • Heidi Haavik • Johan Moan • Arlan Fuhr • Ulrik Sandstrøm • Simon Bird • Nicole Oliver • David Byfield • Kent Greenawalt • Thomas Lauvsnes • Jørgen Jevne and many more

BACKRegistrationspace www.chiropractic-ecu.org opens 1 November October 2015 2015 www.chiropractic-ecu.org13

Convention2016Oslo_A4Ad.indd 1 08/09/2015 12:04 Convention Building Bridges

n our practices, offices and will be: Is it possible to stay true Thomas Lauvsnes; neurology, connecting and reaching out – Iclassrooms, we may feel a little to our roots and native language sports, paediatrics and clinical perhaps this is why Norway is isolated some of the time. The while at the same time connecting chiropractic will be showcased in considered one of the leading ECU Convention 2016 will be with other islands in the ever- collaboration with the European countries for chiropractic in in Oslo, Norway, and will play growing archipelago of modern Academy of Chiropractic; we’ll Europe. Inspired by the Norwegian host to all of the diverse ‘islands’ healthcare? How do we initiate have top people, both local and resilience and geography, the theme a chiropractor can inhabit: and maintain contact with other international, from neighbouring for the 2016 ECU Convention is Student, Researcher, Educator, key players to optimise patient healthcare ‘islands’ presenting their Building Bridges. Policy Maker and Clinician. This care? That will be a starting point expert views distilled from years of is the one European chiropractic in Oslo, and sessions throughout experience. We’ll start off Thursday Gitte Tønner event of the year where we easily the convention will have bridge- with Building Bridges, then on to Academic Organiser cross bridges from one ‘island’ to building as an underlying theme. The Clinician’sD ilemma (chaired another, hear what’s going on in We will have plenty of debates by Charlotte Leboeuf-Yde) on the current research and refresh our and workshops to shorten the Friday morning and end by Bridging New knowledge, meet old friends and distance between the islands: there the Gap with Heidi Haavik and make new ones. will be technique workshops with Building Trust with Kent Greenawalt Convention One central discussion in Oslo the popular Ulrik Sandstrøm and on the Saturday morning. Names will be made public as soon as Features in “How do we initiate and speakers are confirmed – please keep an eye on our ECU Conventions Oslo! maintain contact with other Facebook page. e are hosting a Viking A true Scandinavian gem, WExtravaganza – the key players to optimise patient the city of Oslo inhabits the working title is Frock’n’Rock – care? That will be a starting mountainsides at the bottom on the Friday night instead of of a spectacular fjord, like those the traditional Saturday night. point in Oslo, and sessions found all along the rugged Anyone who’s had the pleasure coastline of Norway. Generations of knowing Norwegians knows throughout the convention of Norwegians have eked out an that they throw a great party, will have bridge-building as an existence with harsh winters in and we want as many of you to isolated villages. They’ve always be able to attend as possible. underlying theme.” known the strength there is in Hosting it on Friday will save a night’s accommodation, thus making it more feasible for you to be there, frocking and rocking!

Local Organising Committee he young, energetic Tand talented Norwegian team will keep you fit throughout the convention with early morning exercise before we start the day’s academic programme. Many thanks in advance to Lovisa, Hege, Haavard and Martin!

14 BACKspace www.chiropractic-ecu.org October 2015 Newsletter of the European Chiropractors’ Union

Research Research Corner: Are psychosocial factors relevant for chiropractors?

n 1987, Gordon Waddell decision-making during the initial Nevertheless, experience in Iintroduced a paradigm shift treatment consultation in patients chiropractic practice and recent to the treatment of low-back with LBP. studies have led some of my concerning the effect of physical pain, which questioned the The role of psychosocial factors colleagues and me to question activity and work; and social traditional medical model of has also been the subject in whether or not psychosocial factors support structures. disease.1 He noticed the failure prominent international spine are as important in the chiropractic Data was collected at the end of the traditional pathological conventions as well as ECU practice as the current trend in of the second visit, and at 1, 3, model in the treatment of conventions. For example, a general practice would suggest. 6 and 12 months. Patients were back pain, and called for a new position statement was introduced The value of this tool has also been also queried about their pain and approach, hailing the introduction following the 12th International examined in chiropractic settings, disability weekly using SMS- of the biopsychosocial model. LBP Forum, held in Denmark and while it appears to be useful tracking. This is a relatively new In fact, this model had been in 2012, which called for more in some back pain populations, and exciting method of data introduced a decade earlier in clarity about the role of the it does not appear to differentiate collection, most notably in use psychiatry by Engel,2 but had not biological, but more notably, outcomes in low-back pain patients by our Scandinavian colleagues been previously applied to the the psychosocial factors in the seeking chiropractic care.5 in order to enable more frequent neuromusculoskeletal system. aetiology and prognosis of LBP.4 In order to examine this, Luc data collection than is otherwise Essentially, the model states that In addition, the psychosocial Ailliet and I, along with our possible with traditional methods. the complex, multi-dimensional factors were deemed by the colleagues at the VU University So, what did we find out? Did nature of low-back pain cannot chiropractic profession in Europe in Amsterdam, conducted our data support the psychosocial be explained by the reductionist to be important predictors of a prospective study in 97 model in chiropractic practice? Are biomedical model. Instead outcome, whereby this subject chiropractic practices throughout psychosocial factors (as) relevant of reducing the cause of the was given top priority in a Belgium and The Netherlands. for us and our patients? Should complaint to a specific pathology, research agenda established for the We wanted to find out if the you be measuring them in clinical the new model proposed that European chiropractic profession psychosocial factors are, in fact, practice? And, do they help a person’s unique biological, in 2014. associated with improvement or predict recovery? psychological, and social factors These studies and this paradigm recovery in chiropractic patients; Answers to these questions (such as illness beliefs, coping shift has led to some positive and whether they provide more and perhaps many others (!) will strategies, fear and depression) be results in the world of back pain predictive information that can be provided in the next issue of given equal weight in the aetiology care. We see, for example, in otherwise be explained by the BACKspace … and treatment of LBP.3 the Netherlands, fewer patients traditional biological factors, such It has been more than 25 with permanent back pain, fewer as the nature and severity of low- 1 Waddell GL.1987 Volvo award in clinical sciences. A new clinical years since this ‘revolution’, surgeries, and more appropriate back pain. If not, it would then model for the treatment of low-back and the results are telling. The use of medication and advice be a reason not to focus too much pain. Spine1987;12(7):632-44. last two decades have witnessed for those consulting the general attention on them during the 2 Engel GL. The need for a new intense efforts to identify those practitioner. initial patient contact. medical model: a challenge for biomedicine. Science psychosocial factors, such as fear, The implications to the clinician In order to study this, we 1977;196:129-36. depression, and catastrophisation, would seem to be apparent: if a looked at more than 900 patients 3Weiner BK. The biopsychosocial which can help determine patient exhibits such behaviour with neck and low-back pain, model and spine care. Spine 2008; the outcome of a patient with as fear-avoidance, depression, and used an observational study 33(2):219-23. 4 Pincus T et al. Twenty-five years with back pain. In short, it has been has irrational thoughts and design, in which the care given by the biopsychosocial model of low found that these factors can makes an incident appear worse the chiropractors was at their own back pain-is it time to celebrate? help predict whether a patient than it is (catastrophisation), or discretion. We collected data on: Spine 2013;38(24):2118-23. is likely to benefit from care, exhibits physical symptoms as a • sociodemographics: e.g. age, 5 Field J et al. Relationship between STarT Back Screening Tool and and whether another approach result of psychological distress gender, education, employment; prognosis for low back pain patients may be necessary. A well-known (somatisation), the chiropractor • biological factors: e.g. nature receiving spinal manipulative example of such efforts is the should then modify his treatment and duration of the pain; therapy. Chiropractic & Manual STarT back screening tool, which plan accordingly, including where • social and psychological factors: Therapies 2012, 20:17. was introduced for the purpose needed, referral to the proper e.g. distress, depression, anxiety Sidney Rubinstein PhD, DC of assisting general practitioners’ professional. and somatisation; beliefs Chair, ECU Research Council

BACKspace www.chiropractic-ecu.org October 2015 15 Research History of the ECU Research Fund Alan Breen stepped down from his position on the ECU Research Council in spring of this year, having served there since 1999. This position will be hard to fill, as his work has meant much for chiropractic research in general, and for the Council specifically. In this article, Alan reflects on the humble beginnings of the Council and its development over the years.

riginally, research (Langworthy 1997). This was neurophysiologist Oby chiropractors in Europe provided by the new European from Paris consisted of nothing more Chiropractors’ Union (ECU) University, Huite) than the profession’s leaders Research Fund. who had a sympathy transforming their thoughts to The Fund was started to bring and interest in chiropractic. When Bronfort and Sidney Rubinstein, paper. Examples of this include order to financial requests for I joined (1999) there was a fund who obtained their PhDs in Fred Illi and Henri Gillet. Few, research, which at the time were and a small flow of applications. university centres of excellence, if any, gathered data and none managed by the ECU General These were difficult to judge brought that culture to bear. These collaborated with a university or Council. In the beginning, there because there was no policy, no and workers like them abroad research institution. The main were few requests. One of these priorities, no application form and made chiropractor researchers interest at the time was to explain was from me and went back to very little funds. All meetings were much more credible on the world how spines functioned and how the questions first asked by Gillet conducted in French, with which stage. chiropractic treatment affected and Illi about how intervertebral I struggled. European chiropractic owes them. function works. The only way to As time went on and policy much of its success and credibility I entered the field in 1971, observe it seemed to be through and procedures became better to people who were supported by when an epidemiologist from fluoroscopy and the only way to established, it became apparent the Research Fund. People like Manchester University wanted measure this was by tracking the how tough research life is. Henrik Lauridsen, Lars Ureholt, answers to the following questions: vertebral images. So in 1986, I Research Council members Iben Axen, Sidney Rubinstein, “What is a chiropractor?”, “Who asked the ECU for a grant to buy like Lise Haestbaeck and Inger Alex Webb, Cecilia Bergström and are his patients?” and “What does one of the first image processing Grunnes-Scheel understood both many others owe their start to the he do?” Once these questions computers. I was successful, the chiropractic and university Fund. It is a great testimony to the were answered, we could move and it started what is now a cultures and could bridge the vision of the profession’s leaders on to the next question: “Does it programme of work and spine gap in decision-making, while in keeping the Fund alive and its work?” technologies known as OSMIA pure university academics like early leaders who fought, often The first questions were (Objective Spinal Motion Imaging Norbert Freymann and Claude under siege, to keep it fair and answered by the British Assessments). However, it also Perret could only look on in transparent. Chiropractic Survey1 (Breen pointed to the need for a fair wonder at the naivety of some of 1977) and the latter (partially) by system for receiving, judging and the applications. The survival of References a trial by a UK Medical Research awarding research grants. the Fund rested on a culture of 1Breen, A. C. (1977). “Chiropractors and the treatment of back pain.” Council unit2 (Meade 1990). In the early stages, the kindness and firmness combined Rheumatology and Rehabilitation 16: Following this, it became apparent profession’s main motivation with scientific rigour in the midst 46-53. that no treatment works for was to ‘prove that chiropractic of endless sources of confusion, 2Langworthy, J. M., Breen, A.C. everything and this led to further works’. Needless to say, this did suspicion and conflicts of interest. (1997). “Rationalising back pain: the development of a classification questions about how we stratify not win it much respect with the Fortunately, Jean and Claude had system through cluster analysis.” care. In other words, how are the rest of the research community. these in abundance and were soon Journal of Manipulative & conditions classified and what The ECU was, therefore, wise to joined by Tom Michielsen. His Physiological Therapeutics 20(5): works best for whom? As there appoint people with a scientific organisational skills and political 303-310. 3Meade, T. W., Dyer, S., Browne, W., were no chiropractic researchers background to the first ECU astuteness lead to an era of greater Townsend, J., Frank, A.O. (1990). to help, I looked for funding Research Council. security. “Low back pain of mechanical for a PhD student to develop The first Council chairman was In the 1990s, some of today’s origin: randomised comparison of a case-history based system of Jean Robert. Jean is a man with chiropractic research giants chiropractic and hospital outpatient treatment.” British Medical Journal classification of low-back pain scruples and is open-minded. He entered the scene. Europeans 300: 1431-1437. based on hierarchical clustering3 was joined by Claude Perret (a like Charlotte Leboeuf-Yde, Gert

16 BACKspace www.chiropractic-ecu.org October 2015 Newsletter of the European Chiropractors’ Union

Research Research progresses well at CTDRU

hronic back pain, Council which will definitely held at Cardiff University. Its title International Congress of Cmartial arts and rugby help. I will be joined in Kent’s was On Not Neglecting the Near for Metrology in Paris in September. are among the current research supervisory team by Dr Mark the Far - The Practice of Wu Style Tai The Research Unit is now close topics at the Clinical Technology Langweiler in the UK and Dr Sil Chi Chuan. to the end of the data collection and Diagnostic Research Unit Mior of the Canadian Memorial Together with Andrew stage of its longitudinal rugby (CTDRU) at the University of Chiropractic College.” Heusch, Lee McCarthy and union/league study with two South Wales. Another PhD student from Bianca Zietsman, Professor London clubs (London Welsh and The CTDRU has a new PhD Canada, Mohsen Kazemi, is an ex- McCarthy recently attended the London Broncos) and the team student, Kent Stuber, who is Olympian whose PhD thesis, due Physiological Society meeting in is soon to meet the management looking at the treatment of for completion this year, is about Cardiff, to present their work on of a Premiership football team to patients with chronic back pain. the martial art of Tae kwon do. Active Cervical Range of Motion consider possible research with its Kent is based in Canada, as Further involvement with (ACROM) in elite male athletes: Academy squads. head of the unit, Professor Peter chiropractic for the martial arts has “Feedback was interesting,” he McCarthy explains: “Kent is based come from senior lecturer Mark reports, “and gave us pause for Follow the CTDRU: in Calgary, over 2,000 miles from Langweiler, who chaired a panel thought regarding our next moves On Twitter at (@CTDRU), Toronto and nine-and-a-half hours on Pedagogy and presented a paper in this area.” Facebook at www.facebook.com/ flying time from Wales. He has jointly with Stefani Sachsenmaier In addition, recent PhD ctdru.usw and on our website been awarded funding of £18,000 of Middlesex University at the graduate Nadia Nair showed some http://ctdru.research.southwales. from the Chiropractic Research Martial Arts Studies Conference, of her work on sensor calibration ac.uk/

General news AECC is 50! he students and staff see that those who Tof the Anglo-European have become part College of Chiropractic (AECC) of the AECC family have this year celebrated its truly do care about half-century. its future. The AECC has grown The AECC is significantly since its set to continue beginnings in 1965. Not only its expansion. is the college the founding In addition to teaching institution for excellent campus chiropractors in Europe, but facilities, undergraduate and it has also produced some of postgraduate programmes are the finest and most respected continuously being developed BCA advertising success chiropractors in the world. and refined to offer students The AECC’s name and the best mix of knowledge and he British Chiropractic BCA president Matthew Bennett reputation has continued to grow clinical skills in order to enable TAssociation (BCA) recently reports a successful outcome: throughout the years and the them to achieve the best for met with the UK’s Advertising “I am pleased to say they are support shown by its graduates their patients and the profession. Standards Authority to push for prepared to change their stance and alumni has been remarkable. The college would like to changes in the way chiropractors’ and have already amended their With events such as the openings thank all alumni and supporters claims in advertising have been online advice, taking chiropractic of the new clinic building in who have contributed so much treated. Currently, chiropractors’ out of the Therapies section 2009 and of the new MRI facility to its successes over the years claims suffer discrimination, and putting it in the Health in 2015, and over £300,000 in … and looks forward to next 50 because they are treated section. Further developments are donations received, it is clear to years of chiropractic and AECC! differently from those made by expected with regard to claims in physiotherapists and osteopaths. advertising.”

BACKspace www.chiropractic-ecu.org October 2015 17 General news DXA and MSK ultrasound Full five-year reaccreditation services introduced at WIOC for WIOC he Clinical Services academic staff, Angela Sims, local hospital trust, and also with TUnit at the Welsh Institute of is being trained to operate the SportWales: he Commission Chiropractic (WIOC) is becoming scanner and drive the service. “We have established a working Ton Accreditation of well-established. Angela also teaches on the relationship with SportWales’ Elite the European Council on Following the installation of chiropractic programme and will Performance Group in Cardiff to Chiropractic Education (ECCE) a state-of-the-art DXA (Dual integrate the DXA service into it. scan their elite athletes as part of has announced that the Welsh Energy X-Ray Absorptiometry) As of the end of August, 50 their biannual health status checks. Institute of Chiropractic (WIOC) bone mineral density and body patients, referred by WIOC student The Faculty and SportWales will has been reaccredited for the composition scanner last year (see clinicians and local chiropractors, encapsulate this work as a research maximum period of five years. BACKspace volume 10 number have been scanned, and the official project looking at a number The Commission’s report 2), the DXA service commenced launch of the service was on 21 of parameters related to body recognised the overall quality on 12 March 2015. This was September. The DXA service will composition, training effect and of the chiropractic education initially as part of a staff training be accepting referrals from a wide competition results. The project and training provided by the exercise, under the supervision range of health professionals in the is currently being reviewed by university. of an applications specialist from South Wales region and Head of the Faculty Ethics Committee for Head of Chiropractic at WIOC Vertec, the supplier of the scanner. Chiropractic David Byfield reports approval.” David Byfield, is delighted A member of the WIOC that they are collaborating with the An additional service – MSK at the news: “This is a great ultrasound – moved into the WIOC achievement and I would like to at the end of September under the thank everyone for their efforts direction of Dr Alf Turner. The in reaching this outcome.” relocation will have significant WIOC has been an benefits in terms of patient care and accredited institution of the New MChiro (Hons) the local referral base. ECCE since 2002. at AECC Netherlands court rules in he AECC’s new Master learning opportunities. favour of chiropractic Tof Chiropractic, MChiro 4. The estates planning and (Hons), degree programme the facilities enrichment that hiropractic in the in the revision of the law. The new has successfully undergone enhance student learning. CNetherlands is not currently deadline is now summer 2016. What Bournemouth University validation The new programme is an regulated by the BIG law (Beroepen started as an update and refreshment and General Chiropractic Council integrated 1+4 undergraduate in de Individuele Gezondheidszorg of this law from 1997 now starts (GCC) accreditation. Masters programme; a five-year – Professions in Individual to look like a big renovation in The GCC panel made the programme with two entry Healthcare) that exempts regulated progress. The NCA is very active and following commendations: points where students will either professions from VAT. Dutch tries to stay maximally involved.” 1. The shared strategic vision start in Year 0 (a foundation year Chiropractors were, until very On the VAT issue, the NCA for the future of the College specific to the programme) or recently, therefore not exempt from was involved in a court case against and its academic programmes Year 1 dependent on the level VAT, unlike their physiotherapy the tax office. The court ruled that that was manifest across all of their academic qualification and colleagues. chiropractic care and physiotherapy staff groups. at application. It will allow all The BIG law was due for revision are at the same medical level and 2. Staff engagement with the eligible UK and EU students to this year, and the Netherlands compete with each other and full range of the work of the receive Student Loan Company Chiropractic Association (NCA) different tax regimes (VAT) are College was very positive. funding for the entire duration used this opportunity to get therefore not allowed. The Dutch Across all groups there was a of their studies and it began chiropractic onto the political Ministry of Finance and tax office palpable enthusiasm and spirit enrolling students in September. agenda. The NCA’s Reem Bakker appealed against the decision, of being forward-looking. The MChiro (Hons) programme explains: “We are establishing good but then withdrew that appeal at 3. The enhanced educational will keep the same ethos and contacts in parliament. A political the beginning of September. As experience that is being values that the AECC has always party (VVD) has asked questions a result, with retrospective effect, provided for the students had with the education centred about chiropractic within the health chiropractors working in The arising from multi-disciplinary on clinical training and evidence- system to the Minister of Health. Netherlands and who are members and inter-professional informed practice. Many other questions have been of the NCA will be VAT exempt asked which have resulted in a delay from 1 January 2013.

18 BACKspace www.chiropractic-ecu.org October 2015 Newsletter of the European Chiropractors’ Union

General news Move on chiropractic education in the Norwegian parliament Establishing a national chiropractic education on a university level has long been the main priority for the Norwegian Chiropractors’ Association (NCA). Joachim Tansemb Andersen, communications officer at NCA, provides an update.

espite broad endorsement by past political leadership and with a huge disadvantage with regard to continual professional D‘thumbs up’ from several universities, a national chiropractic development and careers in academia,” she continued. education is yet to be included in the fiscal budgets. Provoked by The debate that followed exposed great support by many MPs this lag in the political machinery, two parliament committees joined for a priority boost in the field of musculoskeletal care and a swift forces on 5 May, pushing for a prompt resolution on the matter. establishment of a national chiropractic educational programme. The debate centred on the increasing societal burden of Amongst those who were in favour of Aasen’s appeal was liberal musculoskeletal pain and its oversized load on the welfare budget. representative Ketil Kjenseth. He encouraged his colleagues to look Similar to other western countries, a large proportion of the to Denmark where chiropractors and medical students study together Norwegian population is suffering from pain somewhere in the during the first years, proposing a similar model of education in Norway. musculoskeletal system, which in turn may lead to disability and loss Although the interpellations fostered great enthusiasm amongst of quality of life. The financial burden of musculoskeletal pain alone the majority of the speakers that afternoon, no promises were made amounts to more than 70 billion Norwegian kroner per year. Hence, by the ministers of the governing parties. Thus yet again the NCA there is a great demand for high-quality healthcare services in the is left with anticipation for the upcoming fiscal budget. However, as management of such disorders. this was the first time two parliament committees collaborated on Two MPs from the Norwegian Labour Party, representing the one clear cause, another milestone has been reached in the ongoing parliament committees on healthcare and education, addressed professionalisation of chiropractic in Norway. the respective ministers in two separate interpellations. Both MPs “We are very pleased with what is now happening in parliament focused heavily on the need for a solid educational programme for and in the political milieu at large,” said NCA president Jakob Lothe. chiropractors in Norway as an important step to ensure high-quality “At present there are strong political forces eager to strengthen the health services in the domain of musculoskeletal care. chiropractic profession with its own place in academia. The parties “There are obvious challenges to the fact that Norway now has are in agreement; what now remains are mere practicalities, and of an authorised group of healthcare personnel who perform over two course financing. million consultations per year but still have to travel abroad in order “The NCA will, of course, continue to lobby for our goal so that to obtain a degree,” claimed one of the MPs, Marianne Aasen. we may finally realise what we have been fighting for over the past “Furthermore, without university affiliation chiropractors are left decades.”

GP training programme IFEC teacher gains at the AECC doctorate inal year trainee general simple physical and chiropractic r Arnaud Lardon, Hamaoui, lecturer (HDR) from Fpractitioners (GPs) have, for examination procedures and Dchiropractor, head of Université JF Champollion the past six years, attended the advised on patient self-care for back department and teacher at the (Albi, France) and Professor AECC to spend a day with interns pain, along with some aspects of Institut Franco-Européen de Charlotte Leboeuf-Yde from and clinical staff. This year, 45 GP how and why chiropractors would Chiropraxie (IFEC) successfully the University of Southern registrars and their supervisors, as assess function and performance in defended his doctoral thesis Denmark. well as a consultant orthopaedic and the asymptomatic individual. on Predictors of spinal pain in In parallel to his teaching, spinal surgeon, formed the largest Principal of AECC, Professor children and adolescents in July. Doctor Lardon will continue group the college has seen so far. Haymo Thiel, is enthusiastic about The distinguished jury his research with a one-year The day provided an opportunity these annual visits: “It is fantastic to included Professor Olivier postdoctoral programme at to show the GPs the college’s be able to see the two professions Gagey and Christine LeScanff the Université du Québec on-site facilities and to outline the working more closely together now, from Université Paris-Sud à Trois Rivières, specialising nature of chiropractic education as and it is an experience that provides (Orsay), Professor Claude in biomechanics and motor well as the range of clinical services a strong platform on which to Dugas from Université du control, with Professor Martin available at the AECC. further mutual respect and learning Québec à Trois Rivières, Alain Descarreaux. The doctors were shown some from each other.”

BACKspace www.chiropractic-ecu.org October 2015 19 General news Madrid College enters research

he development of a Biennial Congress in Athens, Head of Research Department of MCC TResearch Department at the Greece in May of this year. Dr Arantxa Ortega-De Mues with Madrid Chiropractic College – One month prior to the Dr Ana López-Herradón, performing DEXA scan on rats in Real Centro Universitario (MCC- Congress, the communication, the Healthcare Research RCU) arises from the need to find Musculoskeletal Effects of Institute-Jiménez Díaz answers to our questions. These Chiropractic Manipulation in Foundation answers help us comprehend not an Osteoporotic Animal Model only the benefits of chiropractic was accepted at the 4th Joint treatment, but also how our body Meeting of European Calcified responds to such intervention. Tissue Society (ECTS) and the With this understanding, we will International Bone and Mineral be able to improve quality of life Society (IBMS). The primary for our patients, as well as the objective of this study was to quality and safety of our treatment evaluate the effects of chiropractic interventions. manipulation on skeletal muscle in At the MCC-RCU we seek ovariectomised rats, hypothesizing to expand our knowledge, and that chiropractic manipulation research is without a doubt the best may improve osteoporotic bone way to achieve this. As a result, we through a mechanism involving plan to incorporate research as one skeletal muscle. of the pillars of academic training in At present the MCC is investing the chiropractic programme. Our in basic research, although we are to find changes in the proteome greatest challenge at present is to aware that this type of research of muscle and bone cells caused provide scientific evidence through must be accompanied by clinical by chiropractic treatment. We objective data. This will not only research. Therefore, in the short will count on the participation allow us to verify the relevance of or medium term, we propose of specialists at the Healthcare the chiropractic profession, but will to apply the results obtained Research Institute-Jiménez Díaz also help to define its role in the in animal models to patients. Head of Research Department Foundation. current healthcare system. In the long term, we propose of MCC Dr Arantxa Ortega- We have also started a We are presently working in translational research (‘from de Mues with Dr Ana López- collaborative agreement with collaboration with the Healthcare bench to bedside’) where the Herradón and students of MCC, RMIT University (Melbourne, Isabel Muñoz and Pilar Ruiz in the Research Institute-Jiménez Díaz results obtained in animal models Australia) and the University Healthcare Research Institute- Foundation. The initial findings are used for improving patient Jiménez Díaz Foundation of Seville (Spain) involving a from current research being carried treatment. multi-centre project related to out at the Foundation, Positive At the MCC, we believe that funding, but also to incorporating musculoskeletal disorders. Effects of Chiropractic Manipulation the establishment of collaborative different perspectives. Currently, We are aware that this is only on the Bone Status of Ovariectomized agreements with other institutions the Fondation de Recherche du the beginning, but research has Rats, were presented at the World opens the door not only to Quebec is financing a Proteome become an important priority in Federation of Chiropractic’s 13th accessing other sources of Project, where the objective is the future growth of the MCC.

Barcelona College to reapply for ECCE accreditation

he Barcelona College of Quiropráctica from the BCC and in this year’s graduating class.” INPECS, which is run by the TChiropractic (BCC) and the a Master en Quiropráctica from Regarding the modifications head of the local branch of the Universitat Pompeu Fabra (UPF) the UPF. to the programme of study Cochrane Collaboration. Across are planning to reapply for full According to principal Adrian related to accreditation, August and September key staff accreditation with the ECCE in Wenban, enrolment for the Dr Wenban reports that all received 40 hours of advanced April 2016, having successfully coming academic year (2015-16) is proceeding as planned. evidence-based training with graduated their second cohort is satisfactory: “More incoming “Importantly, the BCC now INPECS, focused on teaching of chiropractors this July. students have met all entry has a collaborative agreement and applying the evidence- A total of 20 graduates were requirements and paid their with a very well-respected based approach in clinical awarded the Titulo Superior en related admission fees than were evidence-based institution, settings.”

20 BACKspace www.chiropractic-ecu.org October 2015 Newsletter of the European Chiropractors’ Union

Improving everyday practice A challenge for you Take the time to test your knowledge with this clinical quiz, supplied by AECC. Find the answers on page 23.

Theme: Cutaneous Theme: Conditions and touch are also reduced d. Fracture of the radial head Innervation of the injuries affecting the distally. e. Supracondylar fracture of the Upper Limb extremities a. Diabetes mellitus humerus For each of the options below, For each of the options below, b. Lyme disease identify the innervation of the identify the most likely condition c. Alcoholic polyneuropathy 10. A 10 year old child fell skin. There is one correct answer or injury. There is one correct d. Guillain-Barré syndrome on her outstretched hand for each question. answer for each clinical scenario. e. Myasthenia gravis one hour ago. The child is complaining of severe 1. Distal attachment of the 6. A 36 year old man returns 9. A 70 year old woman pain in the elbow, which deltoid muscle from a walking holiday. falls on her elbow. She is swollen and tender. a. Musculocutaneous nerve Whilst away he developed has marked bruising and Examination reveals an b. Posterior cutaneous nerve of a red rash associated with tenderness of the upper absent radial pulse. the arm a headache and a ‘flu- arm. Examination reveals a. Colle’s fracture c. Radial nerve like illness’. On his return an inability to extend the b. Fracture of the radial head d. Axillary nerve he has had generalised wrist. c. Supracondylar fracture of the e. Anterior interosseous nerve weakness in all four limbs a. Acromioclavicular joint humerus and pins and needles in dislocation d. Subluxation of the radial head 2. Medial epicondyle of the his hands. b. Colle’s fracture or ‘pulled elbow’ humerus a. Diabetes mellitus c. Fracture of the shaft of e. Smith’s fracture a. Ulnar nerve b. Sarcoidosis humerus b. Medial cutaneous nerve of the c. Lyme disease forearm d. Critical illness polyneuropathy c. Median nerve e. Guillain-Barré syndrome d. Musculocutaneous nerve e. Posterior interosseous nerve 7. A 51 year old obese man with a known peripheral SAVE THE DATE 3. Scaphoid fossa sensory neuropathy and a. Median nerve retinopathy presents THE CHIROPRACTIC EVENT OF THE YEAR b. Radial nerve with increasing pain and c. Ulnar nerve weakness in his left thigh. d. Medial cutaneous nerve of the a. Diabetes mellitus forearm b. Sarcoidosis e. Anterior interosseous nerve c. Lyme disease d. Critical illness polyneuropathy 4. Thenar eminence e. Guillain-Barré syndrome a. Median nerve b. Radial nerve 8. A 38 year old man, c. Ulnar nerve previously well, presents AN IDEA WHOSE TIME HAS COME d. Medial cutaneous nerve of the with a ten day history forearm of a ‘flu-like illness’ and e. Anterior interosseous nerve weakness in his lower limbs. Neurological 5. Nail bed of the little assessment of his cranial finger nerves and upper limbs a. Median nerve are normal, but his b. Musculocutaneous nerve lower limbs have grade AUGUST 5-6, 2016 c. Posterior interosseous nerve 4/5 distal weakness, SAN FRANCISCO, CALIFORNIA, U.S.A. d. Radial nerve diminished reflexes e. Ulnar nerve and equivocal plantar www.lifewestwave.com responses. Vibration, joint position sense and light

BACKspace www.chiropractic-ecu.org October 2015 21 Improving everyday practice The things I wish I’d known … Baiju Khanchandani considers the advice he wishes he’d had on graduation day, and offers it to all newly-qualified chiropractors.

hen I was invited to to try and understand the world other professions and health policy applied in so many other fields, Wpick the three top things around us over the millennia makers? Which brings us full circle fortunes made and Nobel Prizes I wish I had known the first day was a revelation. That simple to chiropractic philosophy: the (Kahneman) awarded, perhaps after graduating in 1986, I was book on philosophy took me to contentious views on this topic there is a place for this topic in our taken aback by how close to a reading about the actual thinking were easier to contemplate once profession too. panic attack was the sensation process of cognitive neuroscience, I learned that philosophers had The third top tip is the I got while thinking about the a fledgling discipline then, been enjoying heated arguments study method, breadth, depth thousands of micro and macro and to behavioural psychology for thousands of years: sometimes and application, which came actions and decisions I take every and behavioural economics. on matters of life and death in the via and day and trying to select the three Philosophy and thinking, our own case of Socrates; and sometimes Functional Neurology. Why key ingredients that count the and that of our patients and staff on small stuff such as how many did I file away Mr Tyler’s class most today, 29 years, almost to the and colleagues, are fundamental to more grains of sand does it take to notes on neurophysiology from day, out of college. daily practice. Why don’t patients make a pile of sand as opposed to AECC instead of re-reading them The first concept I wish I had stop smoking, take exercise and a collection of granules. Centuries every day after graduation?! The embraced right after graduation “come back next Tuesday” when later that last debate lead to fuzzy nervous system, I discovered in is Level of Intensity. This was I say so? Or on a wider scale, logic maths and the software 1994, really is the system that explained to me three times why don’t colleagues join their to regulate air-conditioning integrates the function of the rest (before I finally got it): at a the national association, invest in units, to make sure rockets don’t of the body and the patient: the student bar over a beer paid for research; and wider still, why is topple over at launch, and to chemical, structural, and mental by a well-travelled colleague; by the profession reluctant to lobby guess the ups and downs of the aspects of a person. Just like the a PC Magazine manager, again in Brussels and build bridges with stock market. So if philosophy is books say. And the philosophers at a bar, in New Jersey, and at have always thought. Going back an osteria in Italy. Basically the to first principles is a mantra concept is to immerse yourself I learned at college from Des in every aspect of the profession: McCann our pathology lecturer, work on your skills, build your but the importance only registered reputation and relationships in almost a decade later. AK and FN your community; attend as many offer the knowledge, tools and seminars as your budget permits; procedures to read a problem, join your national association; patient, person through the prism work for your association; hire of a paradigm other than that of a associates; write papers. In simple symptom. What I learned summary investigate every angle in 1994 was to read a subject in of the chiropractic profession its breadth, then go into depth in and participate at every level. But areas pertinent to our work, and first: sort out who you are: write a then apply the knowledge in the mission, aims and then set goals, clinic the next day. based on your own personal and One last point, to make four professional principles and values; not three, I remember putting off and they advised me to read stuff marriage one year to 1995 in order by Anthony Robbins, Steve Covey, to work at the Commonwealth Napoleon Hill ... and attend Games and open a clinic in Parker Seminars - which I did not 1994. There is no justification do till 1993. for putting off the festa of a Number two, Philosophy, in life-time. And there is one person the broadest and most superficial who gently reminds me of this sense would have been enough. at every wedding anniversary. I read Sophie’s World in 1997 Draw your own lesson from this when studying the meaning of my final paragraph, and thank me at daughter’s name. Learning how the bar one day at some future people have reasoned in order seminar or convention.

22 BACKspace www.chiropractic-ecu.org October 2015 Newsletter of the European Chiropractors’ Union

Improving everyday practice

4. A – Median nerve being bitten. This is known as directed against the myelin sheath. Answers: The median nerve supplies the erythema migrans. The rash is Patients usually develop motor and lateral palm and skin over the often described as looking like a sensory symptoms several weeks 1. D – Axillary nerve anterior aspect, and the tip of bull’s-eye on a dart board. There after the onset of an infection The upper lateral cutaneous the nail bed of the lateral two then follows a latent second stage, although up to 40% have no nerve of the arm supplying and a half digits. marked by cardiac, neurological identifiable preceding event. the skin over the deltoid is a and arthritic symptoms. The branch of the axillary nerve. The 5. E – Ulnar nerve neurological sequelae include 9. C – Fracture of the shaft of axillary nerve can be damaged in The ulnar nerve supplies the cranial nerve palsies, meningitis and the humerus dislocation of the shoulder joint anterior and posterior aspects of a peripheral radiculoneuropathy. This is a common injury in the and fractures of the surgical neck the medial side of the hand, and elderly. The extensive bruising is of the humerus. the palmar one and a half, and 7. A – Diabetes mellitus characteristic and the diagnosis 2. B – Medial cutaneous nerve dorsal three and a half fingers, This diabetic man has a long- is supported in this case by the of the forearm through its palmar and dorsal standing sensorineuropathy and finding of a wrist drop which has The medial cutaneous nerve of the branches. has now developed diabetic been caused by a radial nerve forearm pierces the deep fascia in amyotrophy. This is a motor injury where it lies in the spiral 6. C – Lyme Disease the mid upper arm with the basilic neuropathy of the lower limbs groove of the humerus. Lyme disease, or Lyme borreliosis, vein and supplies the skin over the which occurs principally in Type II is a bacterial infection spread to 10. C – Supracondylar fracture medial aspect of the lower arm diabetic, middle aged to elderly, humans by infected ticks. It is of the humerus and forearm to the wrist. obese men. The symptoms are estimated that there are 2,000 to often asymmetrical. This injury is typically confined to 3. B – Radial nerve 3,000 new cases of Lyme disease childhood. The humerus fractures The radial nerve passes under in England and Wales each year. 8. D – Guillain-Barré syndrome just above the condyles and the the brachioradialis muscle in the About 15% of cases occur while This man has developed Guillain- distal fragment is pushed and forearm and crosses the scaphoid people are abroad. Many people Barré syndrome following a tilted posteriorly. The danger fossa. It innervates the skin over with early-stage Lyme disease viral respiratory tract infection. of a supracondylar fracture is the posterior aspect of the hand develop a distinctive circular This disorder represents a direct injury to the brachial artery and the lateral two and a half rash at the site of the tick bite, polyneuropathy which is thought to leading to immediate and severe digits, as far as the nail bed. usually around 3 to 30 days after be an autoimmune cellular response peripheral ischaemia as in this case.

Continuing Professional Development

Mobilisation of the Nervous System - Tim Beames 24-25 October A day in the Infant Clinic - J Miller and guest speakers 7-8 November The Joint by Joint Approach – Managing Lower Extremity Injuries in Athletes - Jonathan Mulholland 7-8 November Certified Chiropractic Extremity Practitioners Programme - Keith Rau 14-15 November Sports Nutrition for Athletes and Patients in Chronic Pain - David Seaman 14-15 November Clinical Whiplash & Neck Pain - Christian Worsfold 21-22 November Rehab to Performance: Core Skills Integration - Jason Brown 21-22 November Motion Palpation Institute – Lower Dynamic Movement Assessment - Sarah Macchi 28-29 November Benign Paroxysmal Positional Vertigo - Richard O’Hara 5 December Gonstead Seminar of Chiropractic - John Cox 16-17 January Motion Palpation Institute – Adjustathon - Mark King & Brett Winchester 6-7 February Rehab of the Athlete & Continuum of Care - Craig Liebenson 5-6 March Professor Stuart McGill- Building the Ultimate Back: From Rehabilitation to Performance 16-17 April (McGill Level 2 to follow in Feb 2017) Extremity Adjusting - Mark Charrette 21-22 May

For more information [email protected] +44 (0) 1202 436 200 aecc.ac.uk/cpd

BACKspace www.chiropractic-ecu.org October 2015 23 Feature Moving forward As Francine Denis stands down as ECU vice-president after four years in the post, she offers some thoughts and hopes for the future of the profession.

am very pleased with the changes I have observed in the IECU while I served on the Executive Council and I am confident that the present Executive team will continue to work well to achieve the goals of the ECU. In particular, I applaud the work done to promote unity within our profession, focusing on our common ideals while respecting the differences that exist among national associations, in order to move forward proactively. It’s great to see that there are new education programmes on the horizon, although there’s still a long way for us to go if we are to grow the profession in countries with very few chiropractors and no educational institutions. During my time in office, two national associations have left the ECU. However, Malta, Austria and Estonia have joined, and they, together with the imminent return of the Danish association, allow for continued growth. It is quite promising to see that communication has remained open with Portugal and France and it is my fervent hope that they too will return to the Union in the near future.

The ECU and student chiropractors Students are the future of the profession. With that in mind, it is of utmost importance that we guide and support them in becoming the people whom we want to see taking chiropractic forward. Students who participate in the World Congress of Chiropractic Students (WCCS) have a direct influence on the larger student body worldwide. Furthermore, they are often the same people who take on leadership roles once they graduate. For these

reasons I think it is imperative to maintain communication Photograph © Ø H Haagensen with representatives of the WCCS, to continue inviting them to participate as observers at General Council meetings, as well as “Our patients are, supporting them both financially and with mentorship. essentially, who we work A Leadership Development Programme, to educate and mentor future leaders of our profession, was introduced to the General for ... so we should always Council at their meeting last November in Stockholm. The idea is to identify future leaders among chiropractic students and our be patient-centred in our members, and to establish access to leadership programmes. By policies and actions.” doing so, we will provide them with the tools and skills required to be effective leaders. This will help ensure continuity and patients. It is a means by which we can understand patients’ succession of leaders within various chiropractic associations and needs and preferences as well as allowing us to provide them organisations. I hope to see this proposal, which was very well- with educational information on lifestyle, diet, exercise, etc. received, set in motion in the near future. Furthermore, Patient Associations can be effective in lobbying health authorities to ensure their right to a high standard of safe, Patients’ Associations effective chiropractic care within their country and across Europe. Our patients are, essentially, who we work for. They are the people From a political perspective, it simply makes sense to have we serve on a daily basis. Without them there would be no need Patients’ Associations - both national and pan-European. The for us, so we should always be patient-centred in our policies patients, as consumers and a collective group of exponentially and actions. It therefore seems fundamental to have a Patients’ larger numbers than ourselves, have much greater influence Association within each country. Ideally, a Patients’ Association on government policy-makers than we as a profession can ever creates a mutual support system between chiropractors and their have. In the past few years it has been observed that there is an

24 BACKspace www.chiropractic-ecu.org October 2015 Newsletter of the European Chiropractors’ Union

Feature increasing influence of Patients’ Associations on government policy, especially at the EU level. I suggest, therefore, that there be continued effort made by War refugees National Associations to help create Patients’ Associations where they do not yet exist. I hope that soon we will collectively reach desperate for help the required number of national Patients’ Associations that will allow the European Chiropractic Patients’ Forum (ECPF) to There are over two million refugees in Turkish camps, become a full member of the European Patients’ Forum. I’d like most of them from war-torn Syria. Aurelie Belsot to see a revitalised ECPF enjoying the full confidence of the ECU. and a colleague have been to one camp and offered Without our wholehearted support I fear that our profession will chiropractic help. As she reports, it’s an urgent lose a potentially very significant ally. problem and volunteers are desperately needed, but you have to be well-prepared for the experience. Presenting chiropractic to the world One of the current challenges discussed within the profession is y colleague Fatima Karagöz and I went to one of the many agreeing on a united identity with which to present ourselves to Mrefugee camps in Turkey last March. We spent just two days there, the world. So often I hear people tell me that they are not sure and it changed our way of thinking. what chiropractic is. They may have vague ideas, some more These are not the poor; they are war refugees. This is very different from erroneous than others, but in general, most people don’t really working with poor people – there is physical and mental trauma, they’ve know what we do. Yet we have already officially agreed on an lost relatives, they’ve lost limbs and they’re really damaged. These people identity for the profession. are also from another culture that is completely different from ours and the In 2005, at the World Federation of Chiropractic’s Congress communication isn’t easy, even with a translator. in Sydney, Australia, there was unanimous agreement on a public They have absolutely nothing, not even a change of clothes, and they identity for the profession, that being: “The spinal health care don’t get food every day; we had to hide to eat our lunch. experts in the health care system.” This was the result of the work We have plans to return during October, and are working on a project done by the WFC Identity Task Force, a project which required a with two different associations who can provide better working conditions great investment of time, money and energy. It’s interesting to note for chiropractors. the conclusion made by the task force: “…the profession’s work on However, the war in Syria is not going to end soon, and nobody knows identity has just begun …there must then be a well-planned and what is going to happen to all these people. They need help, and if you prolonged program of implementation.” I won’t go into details would like to volunteer, please contact Aurelie on [email protected] or about the key recommendations on identity, but I do suggest that Fatima on [email protected]. But be warned: if you come from you read the report which can be found on the WFC website. a nice European city, this will be a big shock, especially if you have never Ten years later we’ve not made much progress with implementing volunteered before. It will be traumatic, and you need to prepare yourself the agreed identity and indeed the profession still has much for this difficult, but essential work. We recommend that you read the work to do regarding this important challenge. We should utilise WHO Psychological first aid: Guide for field workers http://tinyurl.com/ the report created by the WFC Identity Task Force, review its pcxrodc to prepare yourself. recommendations, adapting them if necessary. It would be a shame A powerful article about Aurelie and Fatima’s first visit to the camp, to overlook the extensive work that has already been done. written (in French) by Nathalie Ritzmann, appeared in Lepetitjournal.com (http://tinyurl.com/qbqhjc2). New personal endeavours Now that I have stepped down from political involvement in both the ECU and the Asociación Española de Quiropráctica (AEQ), I have more time to focus on family and new professional endeavours. My three girls are growing up quickly. Although they’re now young ladies (24, 20 and 15 years of age) they still need their mum, at times more now than when they were small. Last September we moved to Barcelona which presented me with new job opportunities, especially teaching, something I hadn’t aspired to until recently. Apart from having a small private practice, I now teach at the Barcelona College of Chiropractic. I fully enjoy working with the students as well as the challenges presented by unfamiliar experiences. I’m confident that these will keep me quite content, not to mention busy, over the next few years.

Stop press! Watch this video promoting an active lifestyle by Estonian chiropractor Karl Pärjamäe www.youtube.com/watch?v=qz1RTO2lCUQ

BACKspace www.chiropractic-ecu.org October 2015 25 Chiropractic trailblazers Getting to know Lise Lothe – new Dean of the EAC Now that Martin Wangler has handed over responsibility for the European Academy of Chiropractic (EAC), Ian Beesley has been talking to the new Dean, Lise Lothe.

ise Lothe grew up in only effective treatment was Improving CPD good-quality events to attend Lthe north of Norway, and chiropractic: “Its effect on my availability for their continuing professional completed her chiropractic performance and the good feeling Lise became involved with the development. My aim has been to education in the United Kingdom coming from treatment inspired EAC in 2008 when she became be open-minded when deciding and the United States. In 1991, me to become a chiropractor Registrar, responsible for the on whether or not an event should she returned to Norway and and later to research the award of continuing professional receive the stamp of approval began her career in Grimstad: “I neurophysiological mechanism development credits. This allowed from EAC while adhering to the was born and raised above the behind what chiropractors do.” her to improve the availability academic principles that underpin Arctic Circle where summer is She also spent seven years as of CPD events for European the organisation. short and cold,” she explains. “We a researcher at the University of chiropractors: “We have been “We have also helped organisers have a saying: ‘If snow can carry Oslo, completing a PhD, so she able to set up a website where become better at promoting the weight of a grown man at fully understands the demands all organisers of CPD events in their seminars – for example, by midsummer, then you know that of a research career, not least the Europe can promote their courses challenging them to highlight spring will come late.’ funding issues: “I am a curious and seminars for free or for a what the participant will get out “I first got a taste of living in person and like all aspects of small fee. This gives European of attending, by clearly stating the south when I moved to a high research. Being integrated into chiropractors a tool to find learning outcomes.” school for top athletes in Lillesand a research environment at a when I was 15, and in the national university was probably the most swimming team. I then realised fulfilling thing I could do. You that this is the area where I would can’t do research in a vacuum and like to live - not having to wear being part of a PhD university mittens in summer was an eye programme gave me the technical, opener! Grimstad has the most sun administrative and academic hours in Norway and when there support that is needed to succeed. was a job opening, I took it.” “I am still involved in a project similar to my PhD project Chiropractic treatment where we are now studying the inspired a career neurophysiology of neck muscles. Lise’s first experience of The university hospital has been chiropractic was the inspiration open and willing to hire me, but for her career. An old injury the problem is, as always, funding. had been bothering her and the Having to work part-time as a national swimming team coach chiropractor to finance research sent her both inside and outside takes time away from research. the Norwegian healthcare system Research should be a full-time to find treatment that could activity, otherwise it has a help. It turns out that that the tendency to become a hobby.”

“Being integrated into a research environment at a university was probably the most fulfilling thing I could do.”

26 BACKspace www.chiropractic-ecu.org October 2015 Newsletter of the European Chiropractors’ Union

Chiropractic trailblazers

CPD over the next way to enable our profession to practice is a major challenge. As in regular clinical practice. As of decade have impact in settings outside a clinician you have limited time 2015 ALL chiropractors who are The new EAC Dean is very of private practice and to give and resources to keep up-to-date members of an ECU national keen to emphasise the on-going chiropractors opportunities in a on every aspect of research. The association have automatic importance of CPD to every broader job market. Being able to EAC recommends at least 30 membership of the EAC. We offer chiropractor: “CPD is not just to show that we have an academic hours of CPD yearly, self-study a website where chiropractors can uphold your level of knowledge, base for our speciality training and/or with others. The academy seek out CPD events; we offer but also to increase your is particularly important when has an agreement with Research membership in SIGs, discount competency. As society becomes dealing with decision-makers, Review Service to give members to RRS service, an opportunity more informed, our patients regulatory boards and reference a discount on the price of weekly to share and learn from clinical will seek out practitioners who incidents through CPiRLS and the have special skills. Patients and opportunity to attend events such third-party payers will be more “As society becomes as the ECU conference.” aware of research and demand more informed, our patients evidence of effect. Our profession And relax … maybe … must step up to this challenge will seek out practitioners Lise is a busy chiropractor with an both by informing practitioners impressive career and a family, so of new developments to keep who have special skills. it’s not surprising when she admits their knowledge current and Patients and third-party that she’s not good at relaxing: “I also by providing post-graduate know how to relax, but I am not education such as advanced MSc payers will be more aware good at it! or PhD programmes. These will “I used to be a fairly good give chiropractors the opportunity of research and demand competitive swimmer, and I still to be awarded academic merit for evidence of effect.” use swimming as a way to keep in their CPD investment. contact with old friends through “The British model of various systems such as the European summaries of relevant research. In Master Swimming. Last year my exit levels for postgraduate Commission ESCO project. future Academy programmes we relay team set a European master training; certificate, diplomat or “The Academy recognises will continue to support research record and I have a few national advanced MSc, is an attractive chiropractors who have made and researchers through the ECU and Nordic individual records in model. I am impressed by the way the effort to increase their skills fund and Researchers SIG, and my age group. As you get older it AECC has used this model to by dedicating themselves to just as important, support the gets easier as competition seem to develop the Advanced Professional programmes that give academic dissemination of knowledge into die off… Practice (Clinical Sciences) credentials that are meaningful clinical practice through the SIGs “I am restless and enjoy programme where you attend outside our profession as well, by and through our conference.” travelling. Nowadays training CPD courses of your choice and awarding EAC Fellowship. This The SIGs were established to is mostly to keep fit enough to use these towards your Advanced is given to chiropractors with an connect chiropractors with a be able to run from one end of MSc with the opportunity to exit additional MSc, MPhil or PhD. I special interest in a particular field. Schiphol to the other when I am at the lower PgCert or PgDipl trust that EAC Fellows will help Three Fellows are required to set late for my flight without getting levels. I hope chiropractors seek advance our profession in the next up and run each one, and they the taste of iron in my mouth, or this opportunity to develop their decade through the work they do utilise the expertise within it to to enjoy hiking in the mountains skills and attitudes and that both locally and through the EAC disseminate knowledge through by foot or on skis. I also instruct more chiropractic institutions Special Interest Groups (SIGs)” workshops, masterclasses, case a couple of fitness classes through will offer similar post-graduate presentation and discussions. The Friskis & Svettis, a non-profit programmes in the future. I also Balancing education SIGs are open to all chiropractors organisation. This is my way of hope that private organisers liaise and research and other groups may form as the practising what I preach to my with educational institutions in Lise understands that in this day need arises. (Information on the patients and giving back to the order for their attendees to obtain and age, the profession needs individual SIGs can be found on community. But none of this is academic qualifications. There are chiropractors with research page 28). relaxing. some very good seminar series on competence as well as practitioners “I am an incurable ailurophile offer from private organisers that who know how to put research EAC benefits in clinical and relax best with a cat on my lap deserves such recognition. into practice. She also appreciates practice and a box of dark chocolate next to “Stimulating chiropractors that this requires the profession to Some people may ask what me, either watching Netflix with to seek university-based post- embrace new methods, but also benefits chiropractors gain on a Tim or preferably by the fireplace graduate programmes relevant take difficult and painful steps day-to-day basis from the EAC. on our terrace looking out over the to chiropractic, such as sports to discontinue using methods Lise has a very clear view of its fjord as the sun sets on the islands. medicine or public health, at that are shown to be ineffective: importance: “The Academy is first Usually that gives me an urge to their local university, is another “Translating research into and foremost for the chiropractor get the kayak on the water…”

BACKspace www.chiropractic-ecu.org October 2015 27 EAC Martin Wangler hands over role of EAC Dean fter eight years at the European of long standing in Switzerland, for example, enabled AAcademy of Chiropractic (EAC), Martin inclusion of chiropractic in the Swiss Law of Medical Wangler has handed over control to Lisa Lothe. Professions (2007). When Martin arrived on the European scene But, Martin emphasises, a good professional is in 2007, the foundations were there for a committed to life-long learning and key to this is giant step forward in the development of the reflection on what happens in clinic and how this profession. First as Director of Academic Affairs relates to the experiences of others. So, in addition and lately as Dean of the EAC he has led an to the transitional programmes for new graduates, initiative for a Graduate Education Programme Martin is rightly proud of his role in helping set up the (GEP) focused on the transition from new open access, peer-reviewed, online research journal graduate to seasoned professional fit to practise Chiropractic & Manual Therapies which is included in the in an autonomous and independent manner. world’s leading biomedical bibliography PubMed. As the Many of the most distinguished chiropractors journal’s publication costs are met by a consortium of have been through that transition, from nervous European and Australian chiropractic bodies the result ingénue to earning a living in a competitive is that authors need not pay an article publishing charge. world. But that does not make the change any easier. Now, eight Other initiatives during Martin’s stewardship include seminars for years later, two-thirds of the 22 member countries in the ECU have more senior clinicians on how to mentor more junior colleagues and a defined their own GEP requirements. paper on the attributes of a professional in practice. The challenge, as In 2010 the education accreditation agency created by the ECU, ever, is to guide and stimulate but not to prescribe. the European Council on Chiropractic Education (ECCE) was formally Martin sees the next challenge as professional development in an recognised by the European Association for Quality Assurance in environment of integrative care, involving a wide range of healthcare Higher Education. In some European countries graduation from an professionals. It is a challenge he is up to facing at a personal level ECCE-accredited institution is a now a condition of lawful practice as he becomes a partner in a medical centre that involves general in the profession. The work to set up a GEP adds to an accredited medical practitioners, paediatricians, an orthopaedic surgeon, a qualification by creating strategies for professional and personal neurosurgeon, psychiatrists and psychologists and physiotherapists all development for new entrants to chiropractic. A well-structured GEP working in Burgdorf, Switzerland. EAC Special Interest Groups Below we highlight the EAC SIGs and their activities. SIG Sports SIG Education ho we are: Practitioners with an interest in the use of chiropractic ho we are: Chiropractors and other professionals with an W in the assessment, treatment and management of athletes. Winterest in chiropractic education, with the mission to facilitate What we do: We support the facilitation, endorsement and and support educational skills within the chiropractic profession. establishment of the advanced knowledge, skills/techniques and attitudes What we do: We organise training conferences, liaise with the required for the effective assessment of athletes, both with injuries ECCE and ECU, and act as a resource for educational consultation. (incorporating an awareness of risks and best management) and without Why we exist: Chiropractors, like all other health care professions injuries (incorporating an awareness of risks of provoking injuries and in the modern world, have an educational role, whether it is improving and enhancing performance). supervising a new graduate, formal teaching in a chiropractic college, Why we exist: We wish to endorse and collaborate with institutions presenting a seminar or presenting a case study to colleagues. We offering post-graduate academic training in the field of . exist to support and nurture chiropractors in fulfilling that role. Who we’re reaching out to: ICCSP chiropractors who wish to further Who we’re reaching out to: All chiropractors with an interest in their academic and research qualification and qualify for Fellowship in clinical supervision, teaching, or sharing knowledge. the Academy. Present and future activities: We will be involved in presenting Present and future activities: We are eager to get involved in setting seminars at the ECU conferences for the next three years. These include: up online courses, and to endorse and promote the Internationally 2015 – ECCE Evaluator course in collaboration with the ECCE Certified Chiropractic Sports Practitioner (ICCSP) programme. We also 2016 – GEP Mentor Course aim to organise pre/post ECU convention seminars. 2017 – How to present a short seminar – PowerPoint skills, organisation etc. If you are interested and would like to know more or get involved, If you are interested and would like to know more or get contact Angelo Battiston at [email protected] involved, contact Valerie Nichols at [email protected]

28 BACKspace www.chiropractic-ecu.org October 2015 Newsletter of the European Chiropractors’ Union

EAC SIG Neurology SIG Paediatric ho we are: We are chiropractors who agree on the supreme ho we are: The Fellows leading this SIG are Sue Weber and W importance of the nervous system for human health and the WJoyce Miller (current chairperson). Our primary purpose is to potential for the nervous system to change and adapt to the challenges of life. promote and advance post-graduate education and research in this What we do: We have set up a collaboration with one of the best focused area. We are working to involve chiropractors in providing providers of postgraduate neurology seminars: Neuroseminars.co.uk. safe care along with research that gives evidence of what constitutes This is the first-ever collaboration between a SIG and a third party and effective care to improve the quality of our patients’ lives. has already paid off on both sides. What we do: Our learning objectives are to improve risk Why we exist: We are committed to enriching chiropractors with new management and safe practice in all chiropractic paediatric practices, knowledge and clinical applications that are directly based on the latest to improve the standard of post-graduate education and to guide and insights in the neurosciences. Developments and understanding in the develop paediatric research. To achieve these goals, the team, along neurosciences in their broadest sense are evolving at an exponential rate. with EAC members, will develop seminars and lectures on current topics, This will be of huge importance for us as clinicians and will change the disseminate new research and research ideas and propose interactive way we will treat our patients in the next few decades. learning strategies. A part of our work is participating in an international Who we’re reaching out to: Are you interested in the neurological team of paediatric experts helping to form guidelines for the treatment aspects of chiropractic (of course you are!)? of the paediatric patient. This is critical to our profession as this group is Present and future activities: CPD points and multiple lecture particularly vulnerable and safety is of greatest importance. site locations all over Europe are now a fact. Instructional videos from Why we exist: To act as a resource for chiropractors providing care Neuroseminars are available to EAC members on our Facebook page for paediatric patients and for those interested in understanding the (search on EAC SIG Neurology, and ask for access). type of care provided by chiropractors for this patient group. We wish Future masterclasses by the Neurology SIG at the ECU conventions to collaborate with those providing research and research ideas to will be co-ordinated with Neuroseminars as well. For Oslo we are advance the evidence in chiropractic care for paediatric patients. We planning a masterclass on (low-tech!) clinical applications for the also want to increase awareness on an international level of the need to pontine area. The pons houses many important nuclei that have a high promote education, research and high standards of paediatric care. capacity for neuroplastic change and as such provides great opportunities Who we’re reaching out to: All chiropractors interested in care for for clinical implementation. Moreover, the pons is essential in the paediatric patients. We welcome chiropractors with an MSc in Paediatric communication between cortex and cerebellum. If we focus on neurology as Fellows of the Academy and wish to facilitate collaborative research there is no escaping: you’ll need to know and study the pons. on the safety, efficacy and cost-effectiveness of chiropractic care for this We are looking at ways to provide online education in several ways. patient group. To get involved, contact [email protected]. Instructional videos, PowerPoint presentations, article evaluation, case Present and future activities: We will continue to develop our descriptions and so on. We are hoping to launch these early in 2016 successful masterclasses for future ECU conventions. These aim to If you are interested and would like to know more or get involved, contact raise awareness of the importance of mastering skills in differential Igor Dijkers [email protected], become a member of our SIG, start diagnosis and treatment for this group. participating on our Facebook site, and come up with ideas and initiatives. SIG Clinical Chiropractic Researchers SIG ho we are: A SIG which focuses on evidence based clinical he EAC SIG in Research facilitates the interaction and W issues relevant to chiropractic practice. Tcollaboration of European researchers with a background What we do: We develop workshops of interest to the chiropractic in chiropractic. Each year the it hosts the Researchers’ Day community, dealing with challenging topics such as treatment frequency in conjunction with the ECU Convention. The purpose of the and manipulation skills. Researchers’ Day is to provide an opportunity for researchers to Why we exist: We exist to represent clinical practice issues, raise the interact, learn and formulate common strategies. profile and engage other chiropractors who wish to participate The report of this year’s Researchers’ Day is on page 12. Who we’re reaching out to: All ECU chiropractors Present and future activities: The ECU as an organisation is committed to creating an incident reporting culture within the profession Details of the SIG Orthopaedics will be featured in the next issue of in Europe to manage compensation claims and provide chiropractors BACKspace with a risk-management tool to introduce into their practice as a learning aid. The Clinical Chiropractic SIG has put forward a workshop proposal to be considered for the next ECU Conference in Oslo in 2016. This The European Commission is recruiting for its scientific workshop would introduce a programme linked to current compensation committees. Appointments will be for 2016-2021 and claims data from various associations and provide some important context attract an allowance of €450 per meeting day. For further and meaningful rationale to engage in an incident reporting scheme. details and how to apply see http://tinyurl.com/q26b7xt. If you are interested and would like to know more or get involved, The deadline for applications is 2 November. contact [email protected]

BACKspace www.chiropractic-ecu.org October 2015 29 Review Chiropractic care and the risk of vertebrobasilar : results of a case–control study in US commercial and Medicare Advantage populations Thomas M Kosloff1*, David Elton1, Jiang Tao2 and Wade M Bannister2

Research recently published and available in the EAC/ECU journal Chiropractic & Manual Therapies [www.chiromt.com/content/23/1/19] has found no significant association between chiropractic visits and vertebrobasilar stroke. In this guest review, Professor Stephen Perle from the University of Bridgeport discusses the findings and their limitations.

he association between The research reviewed below is important for The authors acknowledge certain limitations Tvertebrobasilar artery system (VBA) all practitioners. People who develop a stroke of their study due to the nature of insurance stroke and cervical spinal manipulative therapy are likely to seek care immediately before claims data. These data do not code for what (C-SMT) is a controversial topic and it evokes the stroke, including from chiropractors. This specific treatment was rendered or immediate strong emotions in some. research should serve as a warning when a responses to treatment. Thus it is not known Damage to the VBA system usually leads to patient walks into a clinic complaining of a if chiropractic manipulation was performed major disability or death. sudden onset of neck or head pain. during any office visit and if there was any Vertebrobasilar stroke carries a mortality immediate adverse response. Further, the rate of more than 85%. Because it involves the Data from approximately 5% of the US accuracy of the VBA stroke diagnoses is brainstem and cerebellum, most survivors have population, over 39 million persons from 49 unknown. Finally as the authors note there is multisystem dysfunction, such as quadriplegia of the 50 US states (only North Dakota was a loss of “contextual information surrounding or hemiplegia, ataxia, dysphagia, dysarthria, excluded) were used. Three years’ worth of clinical encounters between chiropractors and gaze abnormalities, and cranial neuropathies. data were searched to find cases, which were all primary care physicians and their patients.” VBA cases are rare, which means that more patients admitted to an acute care hospital with This limits the knowledge of other known risk is unknown than is known. The knowledge VBA occlusion and stenosis (chosen by factors. vacuum magnifies the value attached to ICD-9 codes). The authors’ conclusions are correctly anecdotes, which are prone to the logical Four age- and gender-matched controls were reserved given the limitations. The dataset fallacy of post hoc ergo propter hoc (after this, randomly selected. Exposures were encounters does not find a significant association therefore because of this). with either a chiropractor or a primary care between chiropractic manipulation and VBA The literature has many case studies physician (in the US a medical doctor who is stroke, thus adding weight to the view that documenting VBA stroke following violent typically an internist or family practitioner) chiropractic care is an unlikely cause. But this neck movements that apply unusual forces to prior to the VBA stroke. finding does not exclude the possibility that the neck. So the biological plausibility for VBA The cases included 1,159 VBA strokes in chiropractic manipulation might have some stroke following forceful neck manipulation is the commercial health plan and 670 in the role in causation. reasonable. MA plan. Consistent with previous research, Professor Stephen Perle, University of However, from a research point of view no significant association was found between Bridgeport, Connecticut, USA the condition’s small incidence means that chiropractic visits and VBA strokes in the older inevitably the most commonly-used method population. However, contrary to other case 1 Optum Health – Clinical Programs at United Health Group, 11000 Optum Circle, Eden Prairie to establish causation is the case control study. control studies Kosloff and colleagues also MN 55344, USA Case control studies are usually retrospective found no association between chiropractic visits 2 Optum Health – Clinical Analytics at United and are known for their bias including recall and VBA strokes. Health Group, 11000 Optum Circle, Eden Prairie bias. In a study published on 16 June 2015, Kosloff and colleagues have analysed the largest health insurance data set (both commercial CHIROPRACTIC & MANUAL THERAPIES insurance and Medicare Advantage (MA) plans) used to investigate the association between chiropractic visits and stroke.

30 BACKspace www.chiropractic-ecu.org October 2015 15 EAC Credits Activator-Online-Backspace_Layout 1 9/1/15 10:55 AM Page 1

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