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Lee WT, Chu ECP, Chau C. Understanding the Utilization, Challenges, and Attitudes Towards Laboratory Testing and Radiological Imaging Among Chiropractors in Hong Kong: A Cross-Sectional Survey. Cureus 2023; 15:e40784. [PMID: 37363113 PMCID: PMC10286685 DOI: 10.7759/cureus.40784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2023] [Indexed: 06/28/2023] Open
Abstract
Objective This cross-sectional survey aimed to investigate the utilization, challenges, and attitudes of chiropractors in Hong Kong towards laboratory testing and radiological imaging. Method An online survey was conducted between May 1, 2023, and June 1, 2023. The target population for the survey was registered chiropractors in Hong Kong, which has a total of 325 practitioners. A total of 151 chiropractors participated in the survey, resulting in a response rate of 46.5%. The respondents provided information on their demographics, years of experience, practice settings, awareness of their right to request diagnostic tests, utilization of laboratory testing and imaging, and attitudes towards evidence-based practice. The survey data were analyzed using descriptive statistics. Result The survey findings revealed that a significant proportion of chiropractors in Hong Kong utilized laboratory testing and radiological imaging in their practice. Most respondents reported using laboratory testing to diagnose medical conditions and monitor existing conditions. Imaging is commonly used for diagnosing medical conditions and monitoring disease progression. However, a notable proportion of chiropractors reported facing rejection of their tests and imaging requests, which limited their ability to provide optimal care to their patients. The identified challenges included high rejection rates for specific imaging requests, leading to patient frustration, increased costs, and delayed diagnosis. Nevertheless, chiropractors in Hong Kong showed a strong belief in evidence-based practice and demonstrated a willingness to search for literature and incorporate it into their daily practice. By addressing this issue, our aim was to gain valuable insights into the status of laboratory testing and radiological imaging among chiropractors in Hong Kong. The findings of this study underscore the necessity for collaborative efforts among chiropractors, healthcare professionals, healthcare facilities, policymakers, and insurance companies to effectively address the challenges identified and improve patient care outcomes. Specifically, enhancing access to diagnostic tests and working towards reducing rejection rates will play a pivotal role in supporting chiropractors' role as primary healthcare providers in Hong Kong.
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Affiliation(s)
- Wai Ting Lee
- Research Committee, Chiropractic Doctors Assocaition of Hong Kong, Hong Kong, CHN
| | - Eric Chun-Pu Chu
- Research Committee, Chiropractic Doctors Association of Hong Kong, Hong Kong, CHN
| | - Cherie Chau
- Research Committee, Chiropractic Doctors Association of Hong Kong, Hong Kong, CHN
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Chu ECP, Sabourdy E. Non-surgical Restoration of L3/L4 Disc Herniation. Cureus 2023; 15:e40941. [PMID: 37496528 PMCID: PMC10368486 DOI: 10.7759/cureus.40941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2023] [Indexed: 07/28/2023] Open
Abstract
We report the case of a 52-year-old Asian man presenting with severe lower back pain and bilateral radiculopathy due to acute L3/L4 disc extrusion, causing severe spinal canal stenosis and bilateral L4 nerve root compression. Following a ten-week conservative management plan consisting of high-velocity, low-amplitude spinal manipulation, adjunctive therapies, and home exercise, the patient experienced significant pain relief, functional improvement, and near resolution of deficits. A six-month follow-up MRI revealed the resolution of the L3/L4 disc extrusion, and the patient remained asymptomatic at nine months. This case highlights the potential for spontaneous resorption of a lumbar disc herniation and symptomatic improvement with conservative management, including chiropractic treatment. A favorable natural course of a disc herniation should be considered when deciding between early surgical intervention and conservative management, warranting further prospective studies to evaluate the effectiveness of chiropractic treatment and the role of spontaneous regression in symptomatic lumbar disc herniation.
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Affiliation(s)
- Eric Chun-Pu Chu
- Chiropractic and Physiotherapy Centre, New York Medical Group, Hong Kong, CHN
- Research, Mctimoney College of Chiropractic, Abingdon, GBR
| | - Edouard Sabourdy
- Chiropractic Clinic, FV (Franco-Vietnamese) Hospital, Ho Chi Minh, VNM
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Yan XJ, Wu B, He X, Tian ZK, Peng BG. Testicular pain originating from lumbar disc degeneration: A case report. World J Clin Cases 2023; 11:1794-1798. [PMID: 36969992 PMCID: PMC10037293 DOI: 10.12998/wjcc.v11.i8.1794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 01/07/2023] [Accepted: 02/15/2023] [Indexed: 03/07/2023] Open
Abstract
BACKGROUND Testicular pain caused by lumbar disease is uncommon in the clinic. Here we reported a case of discogenic low back pain with testicular pain that was successfully cured.
CASE SUMMARY A 23-year-old male patient presented to our department with chronic low back pain. Based on his clinical symptoms, signs and imaging, he was diagnosed with discogenic low back pain. Since conservative treatment for more than half a year did not significantly improve his low back pain, we decided to treat it with intradiscal methylene blue injection. During the course of surgery, we again identified the low back pain as originating from the degenerated lumbar disc by analgesic discography. Interestingly, the patient’s low back pain disappeared along with the testicular pain that had been present for more than 3 mo. After the operation, the patient’s low back pain improved, and the testicular pain did not reappear.
CONCLUSION Intradiscal methylene blue injection is a convenient and effective surgical intervention for the treatment of discogenic low back pain. Lumbar disc degeneration may also be a possible clinical cause of testicular pain. Methylene blue injection in the diseased disc improved the low back pain, and the accompanying testicular pain was successfully managed.
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Affiliation(s)
- Xiu-Jie Yan
- Department of Spine Surgery, The Third Medical Center, PLA (People’s Liberation Army) General Hospital, Beijing 100039, China
| | - Bing Wu
- Department of Spine Surgery, The Third Medical Center, PLA (People’s Liberation Army) General Hospital, Beijing 100039, China
| | - Xin He
- Department of Spine Surgery, The Third Medical Center, PLA (People’s Liberation Army) General Hospital, Beijing 100039, China
| | - Zi-Kai Tian
- Department of Spine Surgery, The Third Medical Center, PLA (People’s Liberation Army) General Hospital, Beijing 100039, China
| | - Bao-Gan Peng
- Department of Spine Surgery, The Third Medical Center, PLA (People’s Liberation Army) General Hospital, Beijing 100039, China
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Chu ECP, Yau KHY, Bellin DL. An L2/3 Disc Herniation-Related L5 Radiculopathy. CURRENT HEALTH SCIENCES JOURNAL 2023; 49:129-133. [PMID: 37780195 PMCID: PMC10541075 DOI: 10.12865/chsj.49.01.129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 12/12/2022] [Indexed: 10/03/2023]
Abstract
The key factors contributing to radiculopathy caused by lumbar disc herniation include mechanical compression. It was commonly believed that the disc herniation causes the compression on the nerve root exiting under the pedicle of the vertebral body at the adjacent inferior level. However, a disc herniation might occasionally result in non-adjacent, isolated radicular symptoms. We report the case of a 74-year-old female who presented with a 2-years history of progressive low back pain associated with L5 radiculopathy and reduced quality of life. The patient had undergone a magnetic resonance image showing a large L2/3 disc herniation. Symptoms had progressively worsened and failed to respond to conservative treatments including pain medication, exercise rehabilitation, and acupuncture at the lower lumbar region. The patient was diagnosed with L5 radiculopathy caused by L2/3 disc herniation. Consequently, her symptoms improved with chiropractic rehabilitation which involved spinal manipulative therapy and intermittent motorized traction at the L2/3 level to reduce herniated disc. Therefore, an L2/3 Disc herniation-related L5 radiculopathy should be considered in the differential diagnosis of cases of inconsistency of level of disc herniation and nerve root pattern.
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Zhao XY, Wang ZP, Quan Z, Gao GD, Zhang HW, Zhang XG, Cao LZ, Liu S, Li JF. Use self-gravitation traction to treat lumbar disc herniation: Study protocol for a double-center, single-blind randomized controlled trial. Medicine (Baltimore) 2022; 101:e31717. [PMID: 36451510 PMCID: PMC9704885 DOI: 10.1097/md.0000000000031717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Self-gravitation traction is 1 of the most popular treatments for lumbar disc herniation (LDH). This study aims to evaluate the effectiveness and safety of the self-gravitation traction device in the treatment of LDH and to confirm its positive treatment effect. METHODOLOGY This trial is designed as a pragmatic double-center, single-blind, and 3-arm (1:1:1 ratio) randomized controlled trial. The recruited patients with LDH will be randomly allocated to the intervention (traction weight is 40% or 60% of its body weight) or control (traction weight is 20% of its body weight) group. Traction will be completed within 6 consecutive weeks (3 times a week), with 10 minutes of traction for the first 3 weeks, 20 minutes of traction for the next 3 weeks. After the experiment is completed, we will establish an experiment-related database. The software of SPSS, version 21 (SPSS Inc. Chicago, IL) will be used for statistical analysis, and measurement data will be expressed via mean and standard deviation (mean ± SD). DISCUSSION Once the trial is completed, we will publish the study in journals in both Chinese and English to promote the dissemination and use of the results. In addition, we also plan to promote the research results at various academic conferences both domestically and internationally.
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Affiliation(s)
- Xi-Yun Zhao
- Clinical College of Chinese Medicine, Gansu University of Traditional Chinese Medicine, Lanzhou, China
- Spine Surgery, Affiliated Hospital of Gansu University of Traditional Chinese Medicine, Lanzhou, China
- * Correspondence: Xi-Yun Zhao, Spine Surgery, Affiliated Hospital of Gansu University of Traditional Chinese Medicine, No. 732, Jiayuguan West Road, Chengguan District, Lanzhou 730000, China (e-mail: )
| | - Zhi-Peng Wang
- Clinical College of Chinese Medicine, Gansu University of Traditional Chinese Medicine, Lanzhou, China
- Spine Surgery, Affiliated Hospital of Gansu University of Traditional Chinese Medicine, Lanzhou, China
| | - Zhen Quan
- Clinical College of Chinese Medicine, Gansu University of Traditional Chinese Medicine, Lanzhou, China
- Spine Surgery, Affiliated Hospital of Gansu University of Traditional Chinese Medicine, Lanzhou, China
| | - Guo-Dong Gao
- Spine Surgery, Affiliated Hospital of Gansu University of Traditional Chinese Medicine, Lanzhou, China
| | - Hong-Wei Zhang
- Spine Surgery, Affiliated Hospital of Gansu University of Traditional Chinese Medicine, Lanzhou, China
| | - Xiao-Gang Zhang
- Clinical College of Chinese Medicine, Gansu University of Traditional Chinese Medicine, Lanzhou, China
- Spine Surgery, Affiliated Hospital of Gansu University of Traditional Chinese Medicine, Lanzhou, China
| | - Lin-Zhong Cao
- Clinical College of Chinese Medicine, Gansu University of Traditional Chinese Medicine, Lanzhou, China
- Spine Surgery, Affiliated Hospital of Gansu University of Traditional Chinese Medicine, Lanzhou, China
| | - Shuo Liu
- Clinical College of Chinese Medicine, Gansu University of Traditional Chinese Medicine, Lanzhou, China
| | - Jin-Feng Li
- Clinical College of Chinese Medicine, Gansu University of Traditional Chinese Medicine, Lanzhou, China
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Cao B, Zhou X, Zhang SP, Zhu QG, Kong LJ, Fang M. Effect of traditional Chinese manual therapy on alleviating pain and dysfunction of lumbar disc herniation: a randomized controlled pilot study. Am J Transl Res 2022; 14:6941-6952. [PMID: 36398213 PMCID: PMC9641462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 08/20/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To investigate the effect of traditional Chinese manual therapy (TCMT) in alleviating pain and dysfunction in patients with lumbar disc herniation (LDH). METHODS Sixty-six patients with LDH were recruited as the study cohort and randomly assigned to an observation group and a control group. The patients in the observation group underwent TCMT, whereas those in the control group underwent conventional lumbar traction (LT). The observed indexes comprised primary index, which referred to clinical efficacy, and secondary indexes, which include Simplified McGill Pain Questionnaire, Oswestry Disability Index (ODI), range of motion (ROM) of the lumbar spine, difference in muscle tone (MT) and pressure pain threshold (PPT) of the bilateral erector spinae, and serum inflammatory factor levels. RESULTS The total effective rate was significantly higher in the observation group than in the control group (96.67% vs. 66.67%, P < 0.001). Compared with the control group after treatment, patients in the observation group had significantly lower ODI, pain rating index, visual analog scale and present pain intensity scores (all P < 0.05), and had significantly smaller differences in MT and PPT of the bilateral erector spinae (both P < 0.001), but had remarkably greater ROM of the lumbar spine (P < 0.001). In addition, interleukin (IL)-6, IL-8, and interferon-γ concentrations in the observation group were significantly lower than those in the control group after treatment (all P < 0.05). CONCLUSION TCMT has positive effects on alleviating pain and improving dysfunction of patients with LDH and helps in reducing serum inflammatory factor levels.
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Affiliation(s)
- Ben Cao
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese MedicineShanghai, China
| | - Xin Zhou
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese MedicineShanghai, China
- Institute of Tuina, Shanghai Institute of Traditional Chinese MedicineShanghai, China
| | - Shuai-Pan Zhang
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese MedicineShanghai, China
| | - Qing-Guang Zhu
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese MedicineShanghai, China
- Institute of Tuina, Shanghai Institute of Traditional Chinese MedicineShanghai, China
| | - Ling-Jun Kong
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese MedicineShanghai, China
- Institute of Tuina, Shanghai Institute of Traditional Chinese MedicineShanghai, China
| | - Min Fang
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese MedicineShanghai, China
- Institute of Tuina, Shanghai Institute of Traditional Chinese MedicineShanghai, China
- Shuguang Hospital, Shanghai University of Traditional Chinese MedicineShanghai, China
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Chu ECP. Large abdominal aortic aneurysm presented with concomitant acute lumbar disc herniation - a case report. J Med Life 2022; 15:871-875. [PMID: 35928356 PMCID: PMC9321497 DOI: 10.25122/jml-2021-0419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 03/01/2022] [Indexed: 11/21/2022] Open
Abstract
The purpose of this case report was to describe chiropractic management of acute lumbar disc herniation in a patient with a large abdominal aortic aneurysm. A 72-year-old male patient presented with low back pain and right lower leg numbness for 12 months. A review of full-spine X-ray and lumbar MRI revealed moderate spondylosis at L2-5, moderate lumbar scoliosis, and a 7.15 cm abdominal aortic aneurysm (AAA). Given the minimum 2-weeks of referral waiting time to receive treatment for AAA, the patient received chiropractic treatment with a hybrid rehabilitation to address the disc herniation causing severe physical disability. Through the treatments, the patient's pain was significantly alleviated with careful consideration of potential risk factors associated with AAA. In addition, the acute disc herniation was successfully managed by a series of chiropractic treatments before and after the operation for AAA. This case supports that low back pain in patients with AAA can be managed by manual therapy, in contrast to a widespread belief that manual therapy is contraindicated in AAA. More case reports of AAA patients with low back pain are warranted to assess the effectiveness and safety of manual therapy along with surgical treatment for AAA.
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Affiliation(s)
- Eric Chun-Pu Chu
- New York Chiropractic and Physiotherapy Centre, Hong Kong SAR, China,Corresponding Author: Eric Chun-Pu Chu, New York Chiropractic and Physiotherapy Centre, Hong Kong SAR, China. E-mail:
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Chu ECP, Lin AFC. Knee Pain Following Total Knee Arthroplasty Secondary to Cervical Spondylotic Myelopathy. CURRENT HEALTH SCIENCES JOURNAL 2022; 48:226-229. [PMID: 36320881 PMCID: PMC9590355 DOI: 10.12865/chsj.48.02.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 05/26/2022] [Indexed: 11/24/2022]
Abstract
We report the case of a 78-year-old woman who presented with a 14-month history of progressive bilateral knee spasms and pain and reduced quality of life. The patient had undergone bilateral total knee arthroplasty after a diagnosis of osteoarthritis and failure of conservative treatment. Symptoms reappeared 8 months postoperatively, and the patient was diagnosed with cervical spondylotic myelopathy. Consequently, she was successfully treated with chiropractic rehabilitation which involved scraping therapy, spinal manipulation, and intermittent motorized traction to relieve cervical nerve pressure. Thus, cervical spondylotic myelopathy should be considered in the differential diagnosis of cases of persistent knee pain.
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Affiliation(s)
- Eric Chun-Pu Chu
- New York Chiropractic and Physiotherapy Centre, 41/F Langham Place Office Tower, 8 Argyle Street, Hong Kong SAR, China
| | - Andy Fu Chieh Lin
- New York Chiropractic and Physiotherapy Centre, 41/F Langham Place Office Tower, 8 Argyle Street, Hong Kong SAR, China
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Chu ECP, Wong AYL. Chronic Orchialgia Stemming From Lumbar Disc Herniation: A Case Report and Brief Review. Am J Mens Health 2021; 15:15579883211018431. [PMID: 34027733 PMCID: PMC8141999 DOI: 10.1177/15579883211018431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Chronic orchialgia can be the result of pathological processes of the scrotal contents or stem from non-intrascrotal structures. Successful pain management depends on identifying the source of localized or referred pain. This is a case report of a 39-year-old male sports coach who presented with low back pain, right orchialgia, and sciatica refractory to conservative management. Magnetic resonance (MR) imaging revealed disc protrusion at L3/L4 and L4/L5 levels. Positive outcomes in relieving back and testicular pain were obtained after a total of 30 chiropractic sessions over a 9-week period. The evidence of the subjective improvement was corroborated by regression of the herniated discs documented on the repeat MR imaging. While chronic orchialgia is not an uncommon problem for men of all ages, it has seldom been described in association with lumbar discogenic disease. The current study provided preliminary support for a link between orchialgia and lumbar disc herniation. Chiropractic manipulation had provided a mechanistic alleviation of noxious lumbar stimuli, leading to symptomatic and functional improvements.
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Affiliation(s)
- Eric Chun Pu Chu
- New York Chiropractic and Physiotherapy Centre, Hong Kong, China
| | - Arnold Yu Lok Wong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China
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