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For curious patients and fellow practitioners: a reading room for the publications behind our explanations, including the findings that call a treatment into question.
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Research, with context.
Published sources behind the discussion. Read the findings alongside the limits; a study is not a diagnosis or a promise of a result.
Efficacy of extracorporeal shock wave therapy combined with conventional physical therapy for chronic low back pain: a systematic review and network meta-analysis of randomized controlled trials
14 randomized trials of adults with chronic low-back pain, comparing shock wave therapy, conventional physical therapy, the two combined, and sham.
What it foundThe combination of shock wave therapy and physical therapy ranked first for pain and function and did better than physical therapy alone. Shock wave therapy alone reduced pain more than sham but showed no significant effect on function.
What it cannot tell usThe authors call for more high-quality trials before the finding is settled. Devices and doses varied across the trials; the result does not describe StemWave or any single device.
Publication details & citation
Qiao et al. Efficacy of extracorporeal shock wave therapy combined with conventional physical therapy for chronic low back pain: a systematic review and network meta-analysis of randomized controlled trials. Frontiers in Physiology. 2026. DOI: 10.3389/fphys.2026.1807929.
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Frequency and severity of adverse events associated with dry needling: a systematic review and meta-analysis
59 studies: case reports and series, surveys of 2,380 professionals, and trials and observational studies covering 1,947 patients.
What it foundMinor adverse events were common, reported in 0% to 48% of treatments depending on the study. Major adverse events were uncommon per treatment (0% to 0.43%) but were reported by a meaningful share of clinicians over a whole career.
What it cannot tell usWhat counted as an event, and how it was reported, differed widely between studies. The rates describe the literature as a whole, not any one clinician, technique or body region.
Publication details & citation
Rabanal-Rodríguez et al. Frequency and severity of adverse events associated with dry needling: a systematic review and meta-analysis. Physical Therapy. 2026. DOI: 10.1093/ptj/pzag050.
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Effects of dry needling on functioning and pain relief in patients with chronic nonspecific neck pain: a systematic review and meta-analysis of randomized controlled trials
Five randomized trials of adults with chronic nonspecific neck pain, comparing dry needling, alone or added to physiotherapy, with sham, physical therapy or nothing.
What it foundDry needling reduced pain more than the comparison groups, but was not significantly better for function on the Neck Disability Index.
What it cannot tell usFive trials only, and the authors call for further high-quality studies. It does not show dry needling is better than manual or physical therapy for function.
Publication details & citation
de Sire et al. Effects of dry needling on functioning and pain relief in patients with chronic nonspecific neck pain: a systematic review and meta-analysis of randomized controlled trials. Disability and Rehabilitation. 2026. DOI: 10.1080/09638288.2025.2529423.
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Extracorporeal shock wave therapy shows comparative results with other modalities for the management of plantar fasciitis: A systematic review and meta-analysis
15 randomized trials, 1,123 patients with plantar fasciitis, comparing shock wave therapy with placebo and six other conservative treatments.
What it foundShock wave therapy outperformed placebo for pain and function. Platelet-rich plasma injection did better than shock wave therapy for both, and custom orthotics improved function more than shock wave therapy; other comparisons showed no significant difference.
What it cannot tell usTrials published after 2013 only, with varied protocols and devices. The pooled result does not describe StemWave or any single device, and does not establish which device or dose produced it.
Publication details & citation
Tung et al. Extracorporeal shock wave therapy shows comparative results with other modalities for the management of plantar fasciitis: A systematic review and meta-analysis. Foot and Ankle Surgery. 2025. DOI: 10.1016/j.fas.2024.11.005.
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Decision aids for people facing health treatment or screening decisions
209 studies of decision aids across a range of treatment and screening choices.
What it foundDecision aids improved knowledge and understanding of risks and helped people make choices that reflected their informed values.
What it cannot tell usMost decisions were outside chiropractic care. This supports making options and trade-offs explicit; it does not rank clinics, verify credentials or prove the effectiveness of a particular treatment.
Publication details & citation
Stacey et al. Decision aids for people facing health treatment or screening decisions. Cochrane Database of Systematic Reviews. 2024. DOI: 10.1002/14651858.CD001431.pub6.
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- Between the shoulder blades
- Middle of the spine
- Ribs & side of the chest
- Groin & front of the hip
The effects of photobiomodulation and transcutaneous electrical nerve stimulation on chronic neck pain: A double-blind, randomized, sham-controlled trial
144 people with chronic neck pain, assigned photobiomodulation, electrical stimulation, both, or sham treatment for ten sessions over two weeks.
What it foundThe groups did not differ in the primary outcome of pain at rest. Some secondary outcomes favored the combined treatment.
What it cannot tell usSecondary findings from a combined intervention cannot establish the effect of light therapy alone. The treatment period was short.
Publication details & citation
Rampazo et al. The effects of photobiomodulation and transcutaneous electrical nerve stimulation on chronic neck pain: A double-blind, randomized, sham-controlled trial. Brazilian Journal of Physical Therapy. 2024. DOI: 10.1016/j.bjpt.2024.101124.
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Pneumothorax as a complication of dry needling technique
Four patients treated for pneumothorax after dry needling of the shoulder or neck region at one Belgian university hospital over 15 months.
What it foundThe authors conclude that pneumothorax after dry needling is not extremely rare, and that consent should name it as a considerable risk for needling in the neck, shoulder or chest region.
What it cannot tell usA case series establishes that a harm can happen, not how often. Frequency estimates come from the systematic review of adverse events, not from this series.
Publication details & citation
Bontinck et al. Pneumothorax as a complication of dry needling technique. ERJ Open Research. 2024. DOI: 10.1183/23120541.00156-2024.
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Spinal manipulation and mobilisation in paediatrics – an international evidence-based position statement for physiotherapists
Evidence and recommendations concerning infants, children and adolescents, developed through evidence reviews and professional consensus.
What it foundThe statement recommends against manipulation or mobilization in infants, cervical or lumbar manipulation in children, and these interventions for non-musculoskeletal childhood conditions.
What it cannot tell usThis is a physiotherapy position statement, not a treatment trial. High-certainty evidence was lacking, and reported harms ranged in severity with uncertain frequency. Adult back-pain research cannot establish safety or benefit for a child.
Publication details & citation
Gross et al. Spinal manipulation and mobilisation in paediatrics – an international evidence-based position statement for physiotherapists. Journal of Manual & Manipulative Therapy. 2024. DOI: 10.1080/10669817.2024.2332026.
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Is Neck Pain Related to Sagittal Head and Neck Posture?: A Systematic Review and Meta-analysis
26 studies comparing sagittal head and neck posture between people with neck pain and pain-free people.
What it foundThe craniovertebral angle was about 3 degrees smaller in people with neck pain (pooled difference -2.93 degrees) and correlated negatively with pain and disability scores. Two other posture measures showed no significant difference.
What it cannot tell usA 3-degree pooled difference is of the same order as the age and sex differences the same review found (about 2.4 and 2.6 degrees), and the studies were observational, so direction of cause is unknown.
Publication details & citation
Rani et al. Is Neck Pain Related to Sagittal Head and Neck Posture?: A Systematic Review and Meta-analysis. Indian Journal of Orthopaedics. 2023. DOI: 10.1007/s43465-023-00820-x.
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Management of chronic pain secondary to temporomandibular disorders: a systematic review and network meta-analysis of randomised trials
153 trials involving 8,713 participants contributed to the network analyses of chronic TMD pain.
What it foundAmong comparisons with more certain evidence, approaches supporting movement and coping improved pain. These included selected supervised exercises, mobilization and psychological approaches.
What it cannot tell usCertainty varied by treatment and outcome. Evidence about adverse events was low or very low certainty. This is not evidence for treating every headache or acute jaw injury.
Publication details & citation
Yao et al. Management of chronic pain secondary to temporomandibular disorders: a systematic review and network meta-analysis of randomised trials. BMJ. 2023. DOI: 10.1136/bmj-2023-076226.
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The effectiveness of corticosteroid injection versus night splints for carpal tunnel syndrome: 24-month follow-up of a randomized trial
Follow-up of 234 adults randomized to injection or night splinting for mild-to-moderate carpal tunnel syndrome.
What it foundSymptom, function and pain scores did not significantly differ between the groups at 12 or 24 months.
What it cannot tell usAbout 71–73% responded at 24 months. Severe carpal tunnel syndrome was outside this comparison, which did not test chiropractic treatment.
Publication details & citation
Burton et al. The effectiveness of corticosteroid injection versus night splints for carpal tunnel syndrome: 24-month follow-up of a randomized trial. Rheumatology. 2023. DOI: 10.1093/rheumatology/keac219.
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Appraisal of the New Posture Analyzing and Virtual Reconstruction Device (PAViR) for Assessing Sagittal Posture Parameters: A Prospective Observational Study
70 rehabilitation patients at one Korean hospital, each measured on the same day by full-body EOS radiography and by PAViR version 2.11 (Moti Physio, MG Solutions) with an Orbbec depth camera.
What it foundForward head, T1 tilt and pelvic tilt correlated moderately with the radiographs (r 0.62 to 0.80); knee flexion and lumbar lordosis correlated fairly (r about 0.5). Median values differed significantly on four of the seven measures. The authors call the validation acceptable and the accuracy in need of improvement.
What it cannot tell usOne clinic, one examiner reading the radiographs, patients in tight clothing with markers attached, and a test position the authors note the device does not normally use. The tested version has since been superseded, and no later validation is cited.
Publication details & citation
Jang et al. Appraisal of the New Posture Analyzing and Virtual Reconstruction Device (PAViR) for Assessing Sagittal Posture Parameters: A Prospective Observational Study. International Journal of Environmental Research and Public Health. 2022. DOI: 10.3390/ijerph191711109.
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Ankle Stability and Movement Coordination Impairments: Lateral Ankle Ligament Sprains Revision
People with lateral ankle sprains or chronic ankle instability.
What it foundThe guideline supports rehabilitation that includes mobility, balance and neuromuscular exercise. Manual therapy can accompany exercise.
What it cannot tell usThe plan depends on the injury and stage of recovery. These recommendations do not apply to fractures or establish that a brace alone resolves chronic instability.
Publication details & citation
Martin et al. Ankle Stability and Movement Coordination Impairments: Lateral Ankle Ligament Sprains Revision. Journal of Orthopaedic & Sports Physical Therapy. 2021. DOI: 10.2519/jospt.2021.0302.
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2021 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis
People with rheumatoid arthritis, including recommendations for disease-modifying medication and management strategies.
What it foundTreatment recommendations center on disease-modifying medicines and monitoring disease activity, with decisions informed by the patient’s circumstances and preferences.
What it cannot tell usMany recommendations are conditional. This is not a study of manual therapy, and symptom relief from hands-on care cannot demonstrate control of an autoimmune disease.
Publication details & citation
Fraenkel et al. 2021 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis. Arthritis Care & Research. 2021. DOI: 10.1002/acr.24596.
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Exercise therapy for chronic low back pain
249 trials of exercise therapy in adults with chronic nonspecific low-back pain.
What it foundExercise probably improves pain compared with no treatment, usual care or placebo. Average improvements in function were smaller.
What it cannot tell usPrograms and comparison treatments varied. This does not identify one best exercise for everyone or apply to a new fracture, infection or progressive neurological problem.
Publication details & citation
Hayden et al. Exercise therapy for chronic low back pain. Cochrane Database of Systematic Reviews. 2021. DOI: 10.1002/14651858.CD009790.pub2.
Read the publication recordBehavioral and psychological treatments for chronic insomnia disorder in adults: an American Academy of Sleep Medicine clinical practice guideline
Adults with chronic insomnia disorder, considering behavioral and psychological treatments.
What it foundThe guideline strongly recommends multicomponent cognitive behavioral therapy for insomnia. Sleep hygiene alone is not recommended as a single treatment.
What it cannot tell usThis guideline is about insomnia care, not a test of chiropractic treatment, mattress brands or sleep apnea treatment. Persistent sleep difficulties may need a separate medical assessment.
Publication details & citation
Edinger et al. Behavioral and psychological treatments for chronic insomnia disorder in adults: an American Academy of Sleep Medicine clinical practice guideline. Journal of Clinical Sleep Medicine. 2021. DOI: 10.5664/jcsm.8986.
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Photobiomodulation therapy is not better than placebo in patients with chronic nonspecific low back pain: a randomised placebo-controlled trial
148 adults with chronic nonspecific low-back pain, receiving 12 active or placebo sessions over four weeks; both groups received education.
What it foundThere was no clinically important difference in the primary pain and disability outcomes at four weeks.
What it cannot tell usPatients, therapists and assessors were blinded. The trial tests one protocol; it does not show that all laser devices are equivalent or support claims that light regenerates a disc.
Publication details & citation
Guimarães et al. Photobiomodulation therapy is not better than placebo in patients with chronic nonspecific low back pain: a randomised placebo-controlled trial. Pain. 2021. DOI: 10.1097/j.pain.0000000000002189.
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Progressive exercise compared with best practice advice, with or without corticosteroid injection, for the treatment of patients with rotator cuff disorders (GRASP): a multicentre, pragmatic, 2 × 2 factorial, randomised controlled trial
708 adults with a new episode of a rotator cuff disorder.
What it foundMore supervised exercise sessions did not improve the primary outcome over 12 months compared with a best-practice advice session. Injection offered no long-term benefit.
What it cannot tell usAdvice included home exercise and self-management. Major trauma and several other shoulder diagnoses were excluded; this is not a comparison of all shoulder treatments.
Publication details & citation
Hopewell et al. Progressive exercise compared with best practice advice, with or without corticosteroid injection, for the treatment of patients with rotator cuff disorders (GRASP): a multicentre, pragmatic, 2 × 2 factorial, randomised controlled trial. The Lancet. 2021. DOI: 10.1016/S0140-6736(21)00846-1.
Read the publication recordWorld Health Organization 2020 guidelines on physical activity and sedentary behaviour
Recommendations for children, adolescents, adults and older adults, including people living with selected chronic conditions or disability.
What it foundThe guideline recommends regular activity, strength work and less sedentary time. For adults, the general target is 150–300 minutes of moderate activity or 75–150 minutes of vigorous activity weekly.
What it cannot tell usPopulation targets need adaptation to health, capacity and recovery. Some activity is better than none; this guideline does not test chiropractic treatment or prescribe rehabilitation for an injury.
Publication details & citation
Bull et al. World Health Organization 2020 guidelines on physical activity and sedentary behaviour. British Journal of Sports Medicine. 2020. DOI: 10.1136/bjsports-2020-102955.
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Shock wave therapy for rotator cuff disease with or without calcification
32 trials, 2,281 participants with rotator cuff disease, most with calcific deposits; the main comparison was shock wave therapy against placebo at three months.
What it foundPain and function were slightly better with shock wave therapy than placebo, by less than the amount the authors considered clinically important. Adverse events were more frequent with treatment (41 of 156 versus 10 of 139 in five trials), with safety described as uncertain.
What it cannot tell usEvery trial was susceptible to bias and none measured quality of life. The devices were extracorporeal or radial shock wave systems at varied doses; the result does not describe StemWave or any single device, dose or protocol.
Publication details & citation
Surace et al. Shock wave therapy for rotator cuff disease with or without calcification. Cochrane Database of Systematic Reviews. 2020. DOI: 10.1002/14651858.CD008962.pub2.
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Physical Therapy versus Glucocorticoid Injection for Osteoarthritis of the Knee
156 patients with knee osteoarthritis in the US military health system.
What it foundPatients assigned physical therapy had less pain and disability at one year than those assigned glucocorticoid injection.
What it cannot tell usThis was a physical-therapy trial in a particular setting. It does not establish cartilage regeneration or validate every treatment offered for knee pain.
Publication details & citation
Deyle et al. Physical Therapy versus Glucocorticoid Injection for Osteoarthritis of the Knee. New England Journal of Medicine. 2020. DOI: 10.1056/NEJMoa1905877.
Read the publication recordNo consensus on causality of spine postures or physical exposure and low back pain: A systematic review of systematic reviews
41 systematic reviews and meta-analyses on spinal posture or physical exposure and low back pain, published 1990 to 2018.
What it foundBoth positive and null associations were reported for posture, sitting, standing, bending and heavy work. Reviews restricted to prospective studies were less able to reach consistent conclusions, and evidence that these factors precede first-time low back pain, or show a dose response, was lacking.
What it cannot tell usA review of reviews inherits the definitions and the quality of the reviews it includes, which varied. It concerns low back pain, not neck pain.
Publication details & citation
Swain et al. No consensus on causality of spine postures or physical exposure and low back pain: A systematic review of systematic reviews. Journal of Biomechanics. 2020. DOI: 10.1016/j.jbiomech.2019.08.006.
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The Relationship Between Forward Head Posture and Neck Pain: a Systematic Review and Meta-Analysis
15 cross-sectional studies comparing forward head posture between people with and without neck pain, or correlating it with pain and disability.
What it foundAdults with neck pain showed more forward head posture than adults without it, and the posture correlated with pain intensity and disability in adults and older adults. In adolescents there was no such difference and no association with most neck pain measures.
What it cannot tell usEvery included study was cross-sectional, so the review cannot say whether the posture came before the pain or after it. Age confounded the relationship.
Publication details & citation
Mahmoud et al. The Relationship Between Forward Head Posture and Neck Pain: a Systematic Review and Meta-Analysis. Current Reviews in Musculoskeletal Medicine. 2019. DOI: 10.1007/s12178-019-09594-y.
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Education plus exercise versus corticosteroid injection use versus a wait and see approach on global outcome and pain from gluteal tendinopathy: prospective, single blinded, randomised clinical trial
204 adults aged 35–70 with confirmed gluteal tendinopathy.
What it foundEducation with load management and exercise improved pain and global recovery more at eight weeks. Global improvement remained better than injection at 52 weeks.
What it cannot tell usAt 52 weeks, pain did not significantly differ from the injection group. These results concern gluteal tendinopathy, not all hip pain or hip arthritis.
Publication details & citation
Mellor et al. Education plus exercise versus corticosteroid injection use versus a wait and see approach on global outcome and pain from gluteal tendinopathy: prospective, single blinded, randomised clinical trial. BMJ. 2018. DOI: 10.1136/bmj.k1662.
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The Nordic Maintenance Care program: Effectiveness of chiropractic maintenance care versus symptom-guided treatment for recurrent and persistent low back pain—A pragmatic randomized controlled trial
328 adults aged 18–65 with recurrent or persistent nonspecific low-back pain who had already responded favorably to initial care.
What it foundScheduled maintenance care was associated with about 13 fewer days of bothersome pain over one year than symptom-guided care, with more visits.
What it cannot tell usThe trial was unblinded and selected previous responders. It does not establish a need for lifelong visits in healthy people or effects on immunity and general disease prevention.
Publication details & citation
Eklund et al. The Nordic Maintenance Care program: Effectiveness of chiropractic maintenance care versus symptom-guided treatment for recurrent and persistent low back pain—A pragmatic randomized controlled trial. PLOS ONE. 2018. DOI: 10.1371/journal.pone.0203029.
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Evidence for Dry Needling in the Management of Myofascial Trigger Points Associated With Low Back Pain: A Systematic Review and Meta-Analysis
11 randomized trials, 802 patients with low-back pain and myofascial trigger points.
What it foundDry needling of trigger points reduced pain intensity and disability more than other treatments immediately after treatment, and dry needling plus other treatment did better for pain than dry needling alone.
What it cannot tell usModerate evidence for the post-treatment effect only. The authors called the superiority for disability, and the effects at follow-up, unclear.
Publication details & citation
Liu et al. Evidence for Dry Needling in the Management of Myofascial Trigger Points Associated With Low Back Pain: A Systematic Review and Meta-Analysis. Archives of Physical Medicine and Rehabilitation. 2018. DOI: 10.1016/j.apmr.2017.06.008.
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Do schoolbags cause back pain in children and adolescents? A systematic review
69 studies involving 72,627 children and adolescents, including five prospective studies.
What it foundThe review found no convincing evidence that schoolbag weight, design or carrying method increased the risk of back pain.
What it cannot tell usMost studies were cross-sectional or retrospective, and the prospective studies had moderate to high risk of bias. This does not mean a painful bag should be ignored or persistent childhood pain needs no assessment.
Publication details & citation
Yamato et al. Do schoolbags cause back pain in children and adolescents? A systematic review. British Journal of Sports Medicine. 2018. DOI: 10.1136/bjsports-2017-098927.
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Workplace interventions for reducing sitting at work
34 studies involving 3,397 workers in the June 2018 review.
What it foundLow-quality evidence suggested sit–stand desks reduced sitting time in the short and medium term. Results for several other workplace interventions were uncertain.
What it cannot tell usThe review measured sitting time, which is not the same as preventing back pain. There was no evidence on effects beyond one year in this edition, and a later update is linked by the publisher.
Publication details & citation
Shrestha et al. Workplace interventions for reducing sitting at work. Cochrane Database of Systematic Reviews. 2018. DOI: 10.1002/14651858.CD010912.pub4.
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Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians
Adults with acute, subacute or chronic low-back pain considering noninvasive management.
What it foundThe guideline prioritizes non-drug options for chronic low-back pain, including exercise. Spinal manipulation is one of several options, supported by lower-quality evidence.
What it cannot tell usA guideline synthesizes evidence rather than reporting a new experiment. It does not establish disc realignment, a universal cure or superiority over all other care.
Publication details & citation
Qaseem et al. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Annals of Internal Medicine. 2017. DOI: 10.7326/M16-2367.
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Complications of extracorporeal shockwave therapy in plantar fasciitis: Systematic review
39 studies, 2,493 patients with plantar fasciitis, receiving roughly 6,400 shock wave treatment sessions across a wide range of energy settings.
What it foundTwo complications were recorded in the whole series. Pain during treatment and transient red skin afterwards were the most common side effects; transient pain, swelling, bruising, petechiae, altered sensation and headache were also reported.
What it cannot tell usFollow-up averaged 14.7 months and the authors call long-term complications unknown. The devices and doses varied widely; the result describes shock wave therapy for one condition, not StemWave or any single device.
Publication details & citation
Roerdink et al. Complications of extracorporeal shockwave therapy in plantar fasciitis: Systematic review. International Journal of Surgery. 2017. DOI: 10.1016/j.ijsu.2017.08.587.
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Chiropractic spinal manipulative therapy for migraine: a three-armed, single-blinded, placebo, randomized controlled trial
104 people with migraine, assigned spinal manipulation, sham treatment or usual pharmacological management.
What it foundMigraine days decreased in all groups, with no significant between-group difference in the primary outcome. The authors considered the observed manipulation effect probably a placebo response.
What it cannot tell usThe trial was small. Secondary outcomes do not overturn the primary result, and a treatment trial of this size cannot establish the frequency of rare serious harms.
Publication details & citation
Chaibi et al. Chiropractic spinal manipulative therapy for migraine: a three-armed, single-blinded, placebo, randomized controlled trial. European Journal of Neurology. 2017. DOI: 10.1111/ene.13166.
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The Effectiveness of Trigger Point Dry Needling for Musculoskeletal Conditions by Physical Therapists: A Systematic Review and Meta-analysis
13 randomized trials of dry needling performed by physical therapists for musculoskeletal pain, compared with sham, no treatment or another intervention.
What it foundIn the immediate to 12-week period, dry needling may reduce pain and raise pressure pain threshold compared with sham or no treatment. At 6 to 12 months the difference was not statistically significant, and it was not superior to other treatments for function.
What it cannot tell usEvidence was rated very low to moderate quality. The trials were of physical therapists using mixed techniques across mixed conditions; the result does not describe every needle placed by every clinician.
Publication details & citation
Gattie et al. The Effectiveness of Trigger Point Dry Needling for Musculoskeletal Conditions by Physical Therapists: A Systematic Review and Meta-analysis. Journal of Orthopaedic & Sports Physical Therapy. 2017. DOI: 10.2519/jospt.2017.7096.
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Prevention of Low Back Pain: A Systematic Review and Meta-analysis
21 randomized trials involving 30,850 participants, examining interventions to prevent low-back pain.
What it foundExercise with education reduced the risk of a low-back-pain episode. Education alone, back belts and shoe insoles did not show a preventive effect.
What it cannot tell usEvidence quality differed by intervention and outcome, and the search ended in 2014. This does not mean every injury is preventable or establish a preventive benefit from routine adjustments.
Publication details & citation
Steffens et al. Prevention of Low Back Pain: A Systematic Review and Meta-analysis. JAMA Internal Medicine. 2016. DOI: 10.1001/jamainternmed.2015.7431.
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Acute effects of muscle stretching on physical performance, range of motion, and injury incidence in healthy active individuals: a systematic review
Studies of stretching before activity in healthy, physically active participants.
What it foundStretching can increase range of motion acutely. Longer static stretches immediately before performance had larger performance reductions than shorter holds; the surrounding warm-up mattered.
What it cannot tell usThese are mostly immediate responses in healthy people. More range is not automatically less pain, and these findings do not establish treatment for an injured tendon, unstable joint or irritated nerve.
Publication details & citation
Behm et al. Acute effects of muscle stretching on physical performance, range of motion, and injury incidence in healthy active individuals: a systematic review. Applied Physiology, Nutrition, and Metabolism. 2016. DOI: 10.1139/apnm-2015-0235.
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Systematic literature review of imaging features of spinal degeneration in asymptomatic populations
33 studies reporting imaging findings in 3,110 people without symptoms.
What it foundDegenerative findings were common in people without pain and became more frequent with age. A scan needs interpretation alongside symptoms and examination findings.
What it cannot tell usThis does not mean every disc finding is harmless or that imaging is never needed. It cannot identify the cause of an individual patient’s pain.
Publication details & citation
Brinjikji et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. American Journal of Neuroradiology. 2015. DOI: 10.3174/ajnr.A4173.
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Adverse events following trigger point dry needling: a prospective survey of chartered physiotherapists
39 physiotherapists in Ireland trained in trigger point dry needling, recording 7,629 treatments over ten months.
What it foundMild adverse events followed 19% of treatments: bruising (7.6%), bleeding (4.7%), pain during treatment (3.0%) and pain afterwards (2.2%) were the common ones. No significant adverse event occurred, giving an estimated upper risk of 0.04% or less.
What it cannot tell usOne training lineage, one country, and clinicians reporting on themselves. A survey that records no serious event over 7,629 treatments bounds the risk; it does not show the risk is zero, and case reports elsewhere document serious harm.
Publication details & citation
Brady et al. Adverse events following trigger point dry needling: a prospective survey of chartered physiotherapists. Journal of Manual & Manipulative Therapy. 2014. DOI: 10.1179/2042618613Y.0000000044.
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Comprehensive physiotherapy exercise programme or advice for chronic whiplash (PROMISE): a pragmatic randomised controlled trial
172 people with grade I–II whiplash lasting more than three months.
What it foundAn intensive exercise program did not improve pain more than an advice session with telephone support at the measured follow-ups.
What it cannot tell usThis compares two specific approaches to chronic whiplash. It does not show that all exercise is ineffective or address every acute injury.
Publication details & citation
Michaleff et al. Comprehensive physiotherapy exercise programme or advice for chronic whiplash (PROMISE): a pragmatic randomised controlled trial. The Lancet. 2014. DOI: 10.1016/S0140-6736(14)60457-8.
Read the publication recordEffect of corticosteroid injection, physiotherapy, or both on clinical outcomes in patients with unilateral lateral epicondylalgia: a randomized controlled trial
165 adults with lateral elbow pain lasting more than six weeks.
What it foundSteroid recipients had lower recovery and more recurrence at one year than placebo recipients. Physiotherapy did not significantly change one-year recovery or recurrence.
What it cannot tell usResults concern the studied approaches to persistent lateral elbow pain. They do not establish that chiropractic care is superior.
Publication details & citation
Coombes et al. Effect of corticosteroid injection, physiotherapy, or both on clinical outcomes in patients with unilateral lateral epicondylalgia: a randomized controlled trial. JAMA. 2013. DOI: 10.1001/jama.2013.129.
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A randomized controlled trial comparing a multimodal intervention and standard obstetrics care for low back and pelvic pain in pregnancy
169 pregnant participants enrolled at 24–28 weeks, with outcomes assessed at 33 weeks.
What it foundManual therapy, stabilization exercise and education alongside obstetric care improved pain and disability compared with standard obstetric care alone.
What it cannot tell usThe combined program does not isolate the effect of an adjustment. This study does not establish benefits for delivery, fetal position or infant health. A correction is linked from the publication record.
Publication details & citation
George et al. A randomized controlled trial comparing a multimodal intervention and standard obstetrics care for low back and pelvic pain in pregnancy. American Journal of Obstetrics and Gynecology. 2013. DOI: 10.1016/j.ajog.2012.10.869.
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Effects of bracing in adolescents with idiopathic scoliosis
242 adolescents with the usual indications for bracing, in randomized and patient-preference groups.
What it foundIn the randomized group, 75% assigned bracing versus 42% assigned observation reached skeletal maturity without progression to a curve of at least 50 degrees.
What it cannot tell usThis supports appropriate orthopedic assessment and bracing in selected adolescents. It provides no evidence that adjustments reverse scoliosis.
Publication details & citation
Weinstein et al. Effects of bracing in adolescents with idiopathic scoliosis. New England Journal of Medicine. 2013. DOI: 10.1056/NEJMoa1307337.
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Spinal manipulation, medication, or home exercise with advice for acute and subacute neck pain: a randomized trial
272 adults with nonspecific neck pain lasting 2–12 weeks.
What it foundManipulation performed better than medication at several follow-ups, but there was no important pain difference between manipulation and home exercise with advice.
What it cannot tell usTreatment was unblinded. The study does not cover every cause of neck pain, traumatic instability or an unexplained neurological problem.
Publication details & citation
Bronfort et al. Spinal manipulation, medication, or home exercise with advice for acute and subacute neck pain: a randomized trial. Annals of Internal Medicine. 2012. DOI: 10.7326/0003-4819-156-1-201201030-00002.
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- Neck Pain
- Arm and Leg Pain
- General Chiropractic Care
- 4 Ways Choosing a Chiropractor in Clarksville TN is Beneficial
- What Can a Chiropractor in Clarksville TN Help With?
- How Can Chiropractic Care Help Posture in Clarksville TN
- Neck Pain – The Cause and the Options in Clarksville TN
- Neck
- Upper neck
- Side of the neck
- Base of the neck
- Around the shoulder blade
A comparison of the effects of 2 types of massage and usual care on chronic low back pain: a randomized, controlled trial
401 adults with chronic nonspecific low-back pain.
What it foundStructural and relaxation massage both improved function and symptom bothersomeness at ten weeks compared with usual care.
What it cannot tell usParticipants knew whether they received massage. Neither style was meaningfully superior, and benefits at one year were limited.
Publication details & citation
Cherkin et al. A comparison of the effects of 2 types of massage and usual care on chronic low back pain: a randomized, controlled trial. Annals of Internal Medicine. 2011. DOI: 10.7326/0003-4819-155-1-201107050-00002.
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Effect of unsupervised home based proprioceptive training on recurrences of ankle sprain: randomised controlled trial
522 athletes aged 12–70 with a recent lateral ankle sprain, receiving usual care with or without an eight-week home balance program.
What it foundOver one year, 22% of the training group reported another sprain, compared with 33% of the usual-care group.
What it cannot tell usRecurrences were self-reported. This supports rehabilitation after an ankle sprain; it does not test manipulation or promise immediate pain relief.
Publication details & citation
Hupperets et al. Effect of unsupervised home based proprioceptive training on recurrences of ankle sprain: randomised controlled trial. BMJ. 2009. DOI: 10.1136/bmj.b2684.
Read the publication recordNo effect of traction in patients with low back pain: a single centre, single blind, randomized controlled trial of Intervertebral Differential Dynamics Therapy
60 people with chronic low-back pain and disc degeneration or bulging, without radicular pain, receiving graded activity plus active or sham traction.
What it foundActive traction did not add benefit for pain, disability or quality of life at 14 weeks compared with sham treatment.
What it cannot tell usThe result concerns the studied protocol and population. It does not test every machine or acute sciatica, and it does not support claims of disc regeneration.
Publication details & citation
Schimmel et al. No effect of traction in patients with low back pain: a single centre, single blind, randomized controlled trial of Intervertebral Differential Dynamics Therapy. European Spine Journal. 2009. DOI: 10.1007/s00586-009-1044-3.
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Spinal curves and health: a systematic critical review of the epidemiological literature dealing with associations between sagittal spinal curves and health
54 epidemiological studies of the relationship between sagittal spinal curves (the side-on shape of the spine) and health outcomes, including spinal pain.
What it foundNo strong evidence of an association between sagittal spinal curves and any health outcome, including spinal pain. The included studies were generally of low methodological quality.
What it cannot tell usPublished in 2008 and, being a review of observational studies, unable to say whether a curve causes anything even where an association was found.
Publication details & citation
Christensen & Hartvigsen Spinal curves and health: a systematic critical review of the epidemiological literature dealing with associations between sagittal spinal curves and health. Journal of Manipulative and Physiological Therapeutics. 2008. DOI: 10.1016/j.jmpt.2008.10.004.
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Surgery versus prolonged conservative treatment for sciatica
283 patients with severe sciatica lasting 6–12 weeks, assigned early surgery or prolonged conservative care with surgery if needed.
What it foundEarly surgery provided faster relief and recovery, while one-year outcomes were similar.
What it cannot tell usAbout 39% initially assigned conservative care had surgery. This was not a chiropractic trial and does not show that treatment shrinks discs or guarantees avoiding surgery.
Publication details & citation
Peul et al. Surgery versus prolonged conservative treatment for sciatica. New England Journal of Medicine. 2007. DOI: 10.1056/NEJMoa064039.
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- Sciatica
- Disc Injury
- Do You Have a Slipped Disc in Clarksville TN?
- Clarksville TN Chiropractor Discusses Herniated Discs
- Clarksville TN Chiropractor Talks About Bulging Discs
- Benefits of Spinal Decompression in Clarksville TN
- Do Chiropractors Just Help Back Pain in Clarksville TN
- Sciatic Leg Pain in Clarksville TN
- Pain traveling into the leg
- Buttock & back of the pelvis
Short-term efficacy of Epley's manoeuvre: a double-blind randomised trial
66 people with confirmed posterior-canal benign paroxysmal positional vertigo (BPPV).
What it foundAt 24 hours, 80% receiving the Epley maneuver had neither vertigo nor nystagmus on positional testing, compared with 10% receiving the sham procedure.
What it cannot tell usThis was a short-term test of a specific repositioning maneuver for a specific diagnosis. It does not support neck manipulation for unexplained dizziness.
Publication details & citation
von Brevern et al. Short-term efficacy of Epley's manoeuvre: a double-blind randomised trial. Journal of Neurology, Neurosurgery & Psychiatry. 2006. DOI: 10.1136/jnnp.2005.085894.
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Diagnosis of sacroiliac joint pain: validity of individual provocation tests and composites of tests
48 patients assessed with clinical provocation tests and intra-articular anesthetic injections.
What it foundA cluster of pain-provoking tests was more useful than relying on a single finding to identify SI-joint pain in this sample.
What it cannot tell usThe sample was small and selected. This is diagnostic research, not proof of pelvic misalignment or the effectiveness of a treatment.
Publication details & citation
Laslett et al. Diagnosis of sacroiliac joint pain: validity of individual provocation tests and composites of tests. Manual Therapy. 2005. DOI: 10.1016/j.math.2005.01.003.
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Tissue-specific plantar fascia-stretching exercise enhances outcomes in patients with chronic heel pain. A prospective, randomized study
101 patients with plantar fasciitis lasting at least ten months.
What it foundPlantar fascia-specific stretching improved worst pain and first-step pain more at eight weeks than Achilles stretching.
What it cannot tell usOnly 82 patients returned. Both groups also received insoles, medication and education, so the results cannot be attributed to stretching alone or generalized to every heel problem.
Publication details & citation
DiGiovanni et al. Tissue-specific plantar fascia-stretching exercise enhances outcomes in patients with chronic heel pain. A prospective, randomized study. Journal of Bone and Joint Surgery. 2003. DOI: 10.2106/00004623-200307000-00013.
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A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache
200 people with cervicogenic headache, assigned to manipulation, specific exercise, both, or a control group.
What it foundManipulative therapy and exercise each reduced headache frequency and intensity, with benefits reported at 12 months.
What it cannot tell usParticipants were not blinded, and the combined approach was not significantly superior. These findings concern cervicogenic headache, not migraine in general.
Publication details & citation
Jull et al. A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache. Spine. 2002. DOI: 10.1097/00007632-200209010-00004.
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- Headaches & Migraines
- 4 Ways Choosing a Chiropractor in Clarksville TN is Beneficial
- What Can a Chiropractor in Clarksville TN Help With?
- 3 Common Conditions Chiropractic Care in Clarksville TN Can Help
- Chiropractor in Clarksville TN Talks About Headaches
- Headache Tips From a Clarksville TN Chiropractic Office
- Clarksville TN Chiropractors May Relieve Migraines
- Clarksville TN Chiropractor Discusses Different Types of Headaches
- Headaches – You Don’t Need to Suffer in Clarksville TN
- Back of the head
- Upper neck
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