[fusion_text]By Tina Beychok
With chiropractic becoming more popular with patients over time, as well as its inclusion in Medicare, VA benefits, and health insurance plans, outcome measurements are also becoming more important. Outcome measurements allow DCs to objectively document changes in patients’ health and functioning over the course of time with chiropractic treatment. Part of these outcome measurements include patients’ self-reporting, as well as testing for range of motion.
A study published in the June 2010 issue of the Journal of the Canadian Chiropractic Association found that neurological reflex testing was one of the most common methods that DCs used to assess patient outcome. As many as 84 percent to 95 percent of DCs regularly used deep tendon reflex testing or muscle strength testing to help them objectively chart patients’ progress during treatment.1
[/fusion_text][fusion_text]Much of this neurological reflex testing has been performed manually and has been found to be consistent and reproducible among different patients, as well as not localized to just the specific area treated.2 However, there is some exciting research being done on the use of adjusting instruments to perform reflex testing.
An article published in the Journal of Manipulative and Physiological Therapeutics attempted to characterize the neurological reflex response following six instrument assisted adjustments given to each of nine healthy subjects. The adjustments were measured in 16 different muscle groups by means of surface electromyography. The reflex response was most detectable in the SI joints (94 percent), and 68 percent of the overall adjustments resulted in a detectable neurological reflex. Unlike previous research using manual adjusting, the neurological reflexes following instrument adjusting did vary between subjects but were consistent within the same subject. The reflex response was also more localized in nature.2
A second study published a year later in Spine appeared to confirm the findings from the 2000 study.2-3 In this case, a group of 20 chiropractic patients with low back pain (10 male, 10 female) underwent 20 instrument adjusted treatments, in which surface electromyographic data was collected on the neuromuscular response to the treatments. Consistent, localized reflex responses were found for each of the instrument adjustments. Almost all patients (95 percent) had a reflex response to treatment, and those patients with frequent to constant low back pain showed a much stronger neuromuscular reflex response.3
Although patient self-evaluations are important for determining efficacy of instrument assisted adjustments, the use of surface electromyography to measure neuromuscular reflex response may be able to provide a scientific means to show the benefits that can be gained from chiropractic.
1Broker B, Hinton PM, MacLellan CE, McLeod R. “Outcome measures and their everyday use in chiropractic practice.” J Can Chiropr Assoc. 2010:54(2);118-131.
2Herzog W, Leonard T, Nguyen H, Symons BP. “Reflex responses associated with activator treatment.” J Manipulative Physiol Ther. 2000:23(3);155-159.
3Colloca CJ, Keller TS. “Electromyographic reflex responses to mechanical force, manually assisted spinal manipulative therapy.” Spine. 2001:26(10);1117-1124.[/fusion_text]