Strengthen your core, spare your low back

Strengthening core muscles can improve balance and stability and are an important part of fitness routines that have “real-world benefits“. Doing this strengthening in a way that spares the low back has been promoted by Stuart McGill, Ph.D., Director of the Spine Biomechanics Laboratory at University of Waterloo. He recently appeared in a New York Times Magazine video demonstrating three exercises that strengthen core muscles while sparing the lower back. CHP network provider, Dr. Phillip Snell, expands on the “stirring the pot” exercise in his video series “Fix Your Own Back”.



New NCCIH fact sheet on low back pain

The National Center for Complementary and Integrative Health (NCCIH) has published a fact sheet that provides basic information about low back pain, summarizes research on spinal manipulation for low back pain, and suggests sources for additional information. The information is in layman’s language and would be useful for patients and others who may not be familiar with spinal manipulation. The NCCIH summary is here.

New paper on frequency of emergency department diagnostic errors available

All clinicians in practice strive to make correct diagnoses. Making a correct diagnosis usually means an appropriate treatment plan for the patient and a positive outcome. Medical providers, however, are not perfect. A recent paper by Dubosh, et al., investigates the frequency of diagnostic errors in the emergency department. Click here to download the open access paper.

Acetaminophen is ineffective for low back pain

A systematic review and meta-analysis published in The BMJ March 31, 2015, found “strong evidence” that paracetamol (aka, acetaminophen and Tylenol) is not effective for low back pain. The review of randomized controlled trials included over 1600 patients. There was no difference in low back pain relief or disability when comparing acetaminophen to placebo.

Acetaminophen has been the drug of choice for many clinical practice guidelines (see here, here, and here). But acetaminophen is not without its side effects. Three of the trials in this review (that were for osteoarthritis not back pain) measured patients’ liver enzymes looking for signs of damage due to toxicity. Patients taking acetaminophen were nearly 4 times more likely to show abnormal liver function tests compared to those taking placebo.

While acetaminophen is generally considered to be safe enough for over-the-counter distribution, Propublica reported the CDC’s National Hospital Discharge Survey estimates that 33,000 people are hospitalized as a result of acetaminophen poisoning. The FDA has linked as many as 980 deaths annually to medications containing acetaminophen.

Recent systematic review of commonly used clinical tests

Clinicians who treat low back pain (LBP) are interested in findings that predict the outcome in order to develop treatment plans that will enhance the potential for full recovery. The usual clinical testing procedures include symptom response classification schemes (e.g. centralization/peripheralization) ranges of motion, palpation, provocative testing maneuvers, neurological testing and identification of non-organic signs. A recent systematic review published in Chiropractic & Manual Therapies (open access) assessed the association between these commonly used clinical tests with short- and long-term outcomes.

The review concluded that, with the exception of two, most of these clinical tests have not been adequately evaluated for their associated clinical outcomes. The two tests that seem to be predictive of the clinical outcome were the centralization phenomenon for less short term pain (a positive prognostic indicator) and non-organic signs where three of the five signs were predictive of failure to return to work.

Despite the lack of clear associations between most tests and clinical outcomes, the authors note, “…most clinical tests are designed and used for other purposes, and a poor association with prognosis does not discredit the test as being diagnostic or otherwise informative for clinical management. Clinical tests may still have potential as treatment effect modifiers or as part of comprehensive predictive models.”

“Opioid Epidemic” in the United States

There is an “opioid epidemic” in the US. The National Center for Health Statistics documented this alarming trend in a September 2014 data brief. The brief noted, “Poisoning is the leading cause of injury death in the United States. Drugs—both illicit and pharmaceutical—are the major cause of poisoning deaths, accounting for 90% of poisoning deaths in 2011.” The number of these deaths is greater than the number of people killed by firearms or traffic accidents.

The more prescriptions are written for opioids, the more people die. A recent paper from the National Bureau of Economic Research has published research that ties increases of opioid use, both legitimate and illicit, to increases of opioid prescription to the Medicare population. The CDC estimates that for every prescription painkiller death there are 10 admissions for abuse, 31 ER visits, 130 people who abuse or are dependent and 825 “nonmedical” users.

New RAND Study of the Chiropractic Health Encounter Seeking Participants in Oregon

A new study of the chiropractic health encounter is being conducted in Oregon by the RAND Corporation and funded by the NCCIH. This study is attempting to find elements of the health encounter that are specific to chiropractic health.

If you are a chiropractor practicing in the state of Oregon and are interested in participating in the study, please use the contact information below to contact the research chair or review this document about the study.

Ian D. Coulter, Ph. D.
RAND/Samueli Chair for Integrative Medicine
Senior Health Policy Researcher
RAND Corporation
1776 Main St
PO Box 2138
Santa Monica CA 90407-2138
Tel 310-393-0411 x745
Fax 310-260-8161

The CHP Group is not affiliated with the RAND Corporation and has no financial interest in this study. This information is provided as a public service.

CHP Now Accepting Applications for New Network Providers in Greater Oregon Area

The CHP Group is excited to announce that, due to new business partnerships in Oregon, we are currently focused on accepting credentialing applications for network providers in all Coastal, Southern, Central, and Eastern Oregon areas including the cities/towns of Roseburg, Grants Pass, Ashland, Coos Bay/North Bend, Klamath Falls, Bend, Redmond, Madras, La Pine, Pendleton, Prineville, John Day, The Dalles, Hermiston, Baker City, Joseph, Lincoln City, Florence, Seaside, Tillamook, Astoria, and more!

If you are a chiropractor, massage therapist, licensed acupuncturist or naturopathic physician practicing in one of these areas, please use our online form to request an application or e-mail us at

We look forward to hearing from you soon!

2015 Learning Opportunities for Providers and Staff

CHP is hosting a variety of free workshops and continuing education events in 2015 including: two conferences that will include courses on ethics, ICD-10, CPT® coding, HIPAA compliance, security, and clinical record keeping; two Basic Gua Sha for Massage Providers seminars; and multiple small workshops on HIPAA and ICD-10. For more information on each event, please use the links below to view the registration pages:

Provider & Staff Continuing Education Conference – May 21 and October 1

Basic Gua Sha for Massage Providers – June 13 and July 25

HIPAA Compliance Basics – June 4 and September 3

Preparation for ICD-10 – June 4 and September 3

Advanced Gua Sha for Massage Providers – June 14 and July 26 (Registration for this seminar is by invitation and limited to massage providers who have completed the Basic Gua Sha seminar)

We look forward to seeing you at one of our upcoming events!

New Continuing Education for Providers and Office Staff Coming Soon!

We are busy preparing a new slate of continuing education programs and workshops for providers and office staff in 2015! Keep a close watch on your mailbox and inbox in March for a list of upcoming classes.

Questions or suggestions about continuing education? Contact us at 503-203-8333 or use our easy, online message form.