Master Classes
This section of the Journal collects papers considered by the Editorial Board to be definitive in their subject area.
Each paper represents the current Clinical Benchmark in the field it addresses.
The papers provide evidence-based clinical guidance from an expert in the field to better allow you to be an 'Evidence-informed practitioner'.
Applied Kinesiology Chiropractic and Traditional Chinese Medicine
Narrative abstract: In modern Western chiropractic health care we find many similarities between our approach and that of both ancient and present-day Traditional Chinese Medicine (TCM) doctors or the acupuncture profession. First, we are concerned with the control of organs, glands, and tissues, primarily by way of the nervous system. Rather than give a patient a drug to influence an organ, we find out why the organ is not functioning as it was designed to and then release that interference. This correlates with the acupuncturists’ attempts to balance Chi within the body. Second, chiropractors are concerned with diet and nutrition and lifestyle in order to give the body the building blocks it needs to live, and to be certain there are no adverse chemicals and pollutants interfering with normal body function. This paper presents a detailed explanation of the integration of TCM within Applied Kinesiology Chiropractic, and its justification within modern biomedical science.
Indexing terms: Applied Kinesiology; Chiropractic; Traditional Chinese Medicine; TCM, Chi
Cite: Cuthbert S, Stump JL, Stark B. Applied Kinesiology Chiropractic and Traditional Chinese Medicine. Asia-Pac Chiropr J. 2023;4.1. URL apcj.net/papers-issue-4-1/#CuthbertAKandTCM
A critical approach for learning the Operating Principles of Sacro Occipital Technique (SOT) Chiropractic
Abstract: This paper presents a structured approach to understanding the principles of the Sacro Occipital Technique (SOT) and its contemporary application. The guidance is presented as narrative with key points to facilitate learning the technique.
The paper is presented as a Master Class in chiropractic technique.
Indexing Terms: Chiropractic; Sacro Occipital Technique; SOT; technique; DeJarnette.
Cite: Getzoff H. A critical approach for learning the Operating Principles of Sacro Occipital Technique (SOT) Chiropractic. Asia-Pac Chiropr J. 2023;3.4. URL apcj.net/Papers-Issue-3-4/#GetzoffSOTPrinciples
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A review of manual methods of traditional biofeedback for improving brain and body health and fitness
Abstract: Manual biofeedback is applicable for clinical use with some components as a beneficial lifestyle routine. These approaches include simple, low-cost, effective methods that can be applied quickly in the clinical setting with the potential to provide rapid and significant improvements in physical and mental health. Three separate types of manual biofeedback are detailed:
1) EMG-type biofeedback employs manual muscle testing and is useful for both assessment and treatment of brain, spinal cord, and local injuries that cause sensorimotor deficits associated with neuromuscular dysfunction;
2) EEG-type manual respiratory biofeedback addresses brain and body function through the promotion of alpha brain waves using short (~5-minute) deep-breathing exercise sessions shown to improve cardiovascular and autonomic function with potentially far-reaching health effects; and
3) Heart rate exercise training is a biofeedback approach employing simple wearable technology to help prevent physical, biochemical, and mental-emotional stress common in sports, while improving fitness performance and reducing the accumulation of excess body fat that raises the risk of chronic disease and infection.
Manual versions of tradition biofeedback are directly relevant and applicable to various clinical practice approaches including in-office patient care, rehabilitation, follow-up in-home care, and lifestyle recommendations. With the capability to influence a wide range of brain and body health and fitness, manual biofeedback is a low-cost, time-saving natural approach. In addition to a potential clinical research topic, it also has important healthcare and public health implications. Manual biofeedback can complement many types of manual therapies and play a role in preventative care.
Indexing Terms: EMG; EEG; neurofeedback; manual biofeedback; manual muscle testing; respiratory biofeedback; heart rate training.
Cite: Maffetone P. A review of manual methods of traditional biofeedback for improving brain and body health and fitness. Asia-Pac Chiropr J. 2023;3.4. URL apcj.net/Papers-Issue-3-4/#MaffetoneBiofeedback
The GenitoUrinary system in chiropractic: The neuroanatomy of the muscle-organ-gland correlation
Abstract: As used in chiropractic applied kinesiology (AK), manual muscle testing (MMT) procedures are diagnostic tools in the examination of a system frequently ignored and even unexamined by traditional physicians today: the reproductive system of both men and women. Using AK MMT we can work directly with the position, motion, innervation, nutritional needs, tissue tone and functional capacity of the reproductive organs, their motor nerves, as well as their adjacent and supportive tissues. AK MMT procedures permit us to restore proper tone and structure/function relationships throughout this critical area, and to improve its potential for health. The genito-urinary system needs not be viewed differently than other body systems, i.e., it does not need to be ignored as a specific clinical entity and therapeutic target of care.
This paper argues that it makes no sense for the chiropractic profession to deliberately shy away from the genito-urinary system in its patient recruitment, history taking, functional examinations or therapeutics. We possess methods within our therapeutic system that permit us to evaluate and treat the genito-urinary system – with respect, reverence, sensitivity, and skill. Visual and laboratory inspection of the tissues and fluids of the reproductive organs is only one aspect of the proper evaluation of this integrative neuro-endocrine system.
The relationship of applied kinesiology to the endocrine system is one that creates success for the clinician where other manual modalities might fall short. Each of the endocrine organs has been given diagnostic tests, therapeutic protocols, nutritional correlations, and treatment monitoring methods. The endocrine glands are of course controlled by the nervous system, and this is why chiropractic has proven to be helpful throughout its history for endocrine-related disorders.1 But applied kinesiology offers an exhaustive and repeatably accurate way to monitor both the endocrine symphony and the effect of our natural therapies upon it. This system of chiropractic diagnosis and treatment offers us as much endocrinology for the general practitioner as will be found anywhere.
Indexing Terms: Piriformis; genitourinary; manual muscle test; muscle imbalance; Applied Kinesiology (AK); diagnosis.
Cite: Cuthbert S. The GenitoUrinary system in chiropractic: The neuroanatomy of the muscle-organ-gland correlation. Asia-Pac Chiropr J. 2022;3.2. URL apcj.net/Papers-Issue-3-2/#CuthbertPiriformis
Best Practice Guidelines for Diagnosing Muscle Imbalance: Chiropractic versus Physiotherapy
Abstract: Professor Vladimir Janda, an accomplished physiotherapist and neurologist, was a key figure in the 20th Century rehabilitation and manual therapy movement. Janda founded the rehabilitation department at Charles University Hospital in Prague, Czechoslovakia.
He was one of the seminal members of the Prague school of manual medicine and rehabilitation that expanded its influence throughout Central and Eastern Europe. Janda published over 16 books and more than 200 publications about muscle function, and has had a major influence over the physical therapy profession around the world. A review of Janda’s published works demonstrates the breadth of his clinical interest and influence. His published papers varied greatly in their focus: from pediatrics to geriatrics, in addition to the lasting effects of pediatric conditions upon the adult, from postural to neurologic disorders, and from ankle conditions to obscure facial pain. His 1964 college thesis paper was on the association between sacroiliac pain and gluteus maximus weakness. (Janda, 1964)
In addition to publishing several texts in Czech, Janda subsequently published books in German and English. Janda’s approach has been discussed in many text books, often in chapters that he authored. Many years ago, Janda published a manual muscle testing book in English that is now out of print. (Janda, 1983) Many leaders in the manual therapy world, like Drs. Chaitow and Liebenson, have depended upon the work of Vladimir Janda for their concepts of muscular imbalances and the use of the manual muscle test (MMT). These leaders interact and write in one another’s books spreading the Janda-model far and wide.
This is unfortunate because of 5 PROBLEMS in Dr. Janda’s view of muscle inhibitions … and fortunate as well because it has increased the worldwide understanding of the significance of MMT’s diagnostic potential of muscle imbalances in human health.It may be that an entire generation of manual therapists has abandoned the diagnostic gold-mine of the MMT in part because of Janda’s approach to the assessment of ‘muscular imbalance’. This paper explores this contention.
Indexing Terms: manual muscle test; muscle imbalance; Applied Kinesiology (AK); diagnosis; physical therapy profession; Goodheart; Janda.
Cite: Cuthbert S. Best Practice Guidelines for Diagnosing Muscle Imbalance: Chiropractic versus Physiotherapy. Asia-Pac Chiropr J. 2022;3.1. URL apcj.net/papers-issue-3-1/#CuthbertBestPractice
Integration of Post-Concussion Support Strategies into chiropractic practice
This is a clinically orientated paper which explores an evidence-based rationale for the inclusion of concussion screening protocols and clinical support of the concussion patient in a general chiropractic practice. It includes topics such as: definitions of concussion, concussion screening, clinical assessment, development of an interdisciplinary referral protocol and network, a description of some in-office clinical treatment and support strategies and a discussion of how to enhance patient and community awareness of the illness burden of undetected post concussion syndrome. This document is not a clinical training or certification document or manual; it is recommended that chiropractors wishing to implement the strategies in this paper undergo clinical training in basic concussion diagnostic and treatment protocols.
Indexing Terms: Chiropractic, Concussion, Post Concussion Syndrome, Vestibular Rehabilitation, Chiropractic Manipulative Therapy
Cite: Noone P. Integration of Post-Concussion Support Strategies into chiropractic practice [Master Class]. Asia-Pac Chiropr J. 2020;1:014 URL https://apcj.net/the-basics-of-concussion--paul-noone/
The meaning and value of vitalism in chiropractic
Abstract: Vitalism has a long history of guidance and controversy in the chiropractic profession, yet there is little clear understanding of its meaning or value in chiropractic. This study therefore sought to answer two research questions. The first asked what chiropractors mean when they speak about vitalism. The second asked what value do chiropractors believe that chiropractic thinking and practices based on vitalism might offer in addressing current global prevalence of non-communicable lifestyle-related conditions.
This study used a constructivist approach, a predominant research stance of descriptive phenomenology, and a mixed methodology design of exploratory sequential qualitative and quantitative research methods. In Phase I data collection, semi-structured interviews of 18 key informants from eight countries explored the research questions.
Phase I findings informed the development of an 82-question online survey which was used for data collection in Phase II (composed of closed-ended questions) and Phase III (composed of open-ended questions). Phases II and III explored the generalisability of the findings of Phase I to a wider sample of the profession. Chiropractor members of the Chiropractors’ Association and Australia (CAA) and of the New Zealand Chiropractors’ Association (NZCA) were invited to participate in the survey. Data from a total of 307 respondents were analysed. This represented 9.6% of CAA members and 16.8% of NZCA members.
Synthesis of data from all three phases revealed that participants attributed multiple meanings to vitalism. To a majority, vitalism meant innate intelligence, a traditional form of vitalism, a guide to a good life, and an essence of the identity of chiropractic. To a minority, vitalism meant an obsolete and unscientific doctrine. To a smaller minority, vitalism meant a neo-vitalism. These differences of opinion presented a marked division over vitalism within the sample. Very few participants occupied the middle ground between the pro- and anti-vitalism groups. A majority of participants believed that chiropractic thinking and practices based on vitalism could offer great value in addressing prevalence of non-communicable lifestyle related conditions. To address this prevalence, the majority proposed a vitalistic practice model composed of chiropractic adjustive care and healthy lifestyle advice. A minority proposed a non-vitalistic practice model of manipulative therapy for the treatment of musculoskeletal pain.
This study’s findings offered the first empirical data concerning the meanings and value that a sample of chiropractors attributed to vitalism. Future research could explore the potential of this knowledge to add value to the profession’s activities.
Indexing Terms: Vitalism, health, non-communicable disease, non-communicable disorder, chiropractic, philosophy.
Cite: Richards DM. The meaning and value of vitalism in chiropractic [Thesis]. Asia-Pac Chiropr J. 2021;1.3. URL https://apcj.rocketsparkau.com/richards--mc-vitalism/
Clinical efficacy of Guasha Therapy for shoulder pain [Thesis].
About the candidate: Professor Santos is Executive Director, Graduate and New Program, College of Allied Health Studies, University of Makati. His Technical Competencies include:
Abstract: Traditional and alternative forms of medicines have been utilized in the Philippines long before the wide spread use of pharmaceutical products. This is not limited to the use of herbal plants, but is also involved in the growing scope of the alternative medicines including the guasha therapy, acupuncture, ventosa, chiropractic medicine and taping medicines. This study aims to determine the clinical efficacy of the Philippine carabao horn used in guasha therapy in reducing the level of shoulder pain experienced by the athletes of University of Makati as compared to the use of spoon for the spoon therapy.
Guasha therapy can be applied to virtually any part of the body; however, there are certain strokes for each muscle and joint for it to become effective. The guasha therapy has gained popularity in the recent years, but there is paucity of studies and evidences of its use. The limited information available on the guasha therapy suggests improved function and decrease in the level of pain. Guasha therapy appears to have been proven effective and useful in other countries, despite these, the Philippines still lack knowledge, researches and clinical trials about the therapy.
Scraper tools from other countries are made up of ceramic plates, jade and ox horn. As observed by the researcher these raw materials are composed of protein called the keratin. The researcher performed a thorough study to find a material that is closely related to the composition of other scraper tool, wanting to utilize the available raw materials in the Philippines, the researcher decided to use the Philippine carabao horn.
Indexing Terms: Guasha Therapy; carabao horn; community health; Philippines.
Cite: Santos E. Clinical efficacy of Guasha Therapy for shoulder pain [Thesis]. Asia-Pac Chiropr J. 2020;1.2:online only. URL apcj.net/clinical-benchmarks/#Santos
Integration of Post-Concussion Support Strategies into chiropractic practice
This is a clinically orientated paper which explores an evidence-based rationale for the inclusion of concussion screening protocols and clinical support of the concussion patient in a general chiropractic practice. It includes topics such as: definitions of concussion, concussion screening, clinical assessment, development of an interdisciplinary referral protocol and network, a description of some in-office clinical treatment and support strategies and a discussion of how to enhance patient and community awareness of the illness burden of undetected post concussion syndrome. This document is not a clinical training or certification document or manual; it is recommended that chiropractors wishing to implement the strategies in this paper undergo clinical training in basic concussion diagnostic and treatment protocols.
Indexing Terms: Chiropractic, Concussion, Post Concussion Syndrome, Vestibular Rehabilitation, Chiropractic Manipulative Therapy
Cite: Noone P. Integration of Post-Concussion Support Strategies into chiropractic practice [Clinical Benchmark]. Asia-Pac Chiropr J. 2020;1:014 URL apcj.net/clinical-benchmarks/NooneConcussion
Leon Chaitow: Fascial Dysfunction: Adaption as a major feature
In 2014 Dr Leon Chaitow gathered some of the most distinguished practitioners and researchers from across the spectrum of the bodywork professions to produce the first edition of this book; a multidisciplinary array of evidence-informed approaches at the cutting edge of new knowledge about fascia. In his own words: ‘This book should be seen as work in progress – a translation of current research-based knowledge, designed to counterbalance the plethora of misinformation related to fascial function, dysfunction, and treatment.’ ()
He completed the draft revision of the second edition just days before becoming critically ill in February 2018. I helped him to complete the proofs and images in his final days. Fascial Dysfunction: Manual Therapy Approaches 2e represents the culmination of his exploration of musculoskeletal function and dysfunction that had concerned him from the beginning of his career, and combines the two aspects that he considered most important: translational research and multidisciplinary clinical perspectives.
This excerpt summarises the spirit of the book, demonstrating its breadth and potential for practitioners in all fields.
Sasha Chaitow, PhD
Cite: Chaitow S. Fascial Dysfunction: Adaption as a major feature. Introduction to: Except from Chaitow L. Fascial Dysfunction: Manual Therapy Approaches 2e, presented as Clinical Benchmark. Asia-Pac Chiropr J. 2020;1:018 URL apcj.net/clinical-benchmarks/#Chaitow
Plagiocephaly: The Oblique Skull; A method of chiropractic correction, with a case report.
Abstract: Introduction: Plagiocephaly is general term used to describe cranial asymmetry. Pathologenically, plagiocephaly is classified as synostotic (SP), caused by abnormal sutural development or deformational (DP) (non-synostotic or positional), caused by external forces acting on the cranium. Commonly accepted treatments for DP include alternate sleeping postures, carefully monitoring the child when placed in a prone position, as well as in resistant cases use of cranial orthoses or helmets. Chiropractic -Sacro Occipital Technique (SOT) cranial care might offer a conservative option that is a bridge between alternate sleeping and use of a helmet.
Case Report - Assessment: This case report presents a four and a half month old male child presenting at a chiropractor’s office. The child’s working diagnosis was: (1) Occipital condyle compression, (2) Plagiocephaly; and (3) KISS syndrome type 1. Specific SOT cranial treatment was used to correct the child’s presenting plagiocephaly. This patient received 12 treatments over a period of 3 months and showed a significant improvement in head shape.
Discussion: DP has some concomitant syndromes that might be coincidental or related in a primary or secondary manner, which include scoliosis, KISS, and torticollis. From a biological plausibility standpoint it would seem that allowing the brain to grow in a symmetrical fashion, balanced stress on vascular membranes, and maintaining normal anchoring of muscular attachments would be beneficial. Recent research has indeed found a relationship between DP and neurodevelopmental delays and that posterior DP may even affect visual field development.
Conclusion: The purpose of this paper was to offer an alternative view of how DF might be treated in a chiropractor’s office and at what stage intervention might prove effective. Since parents often are not willing to “just wait and see” and are leaning towards some degree of intervention, chiropractic cranial care appears to be a viable intermediate therapy and may facilitate a reduced need for helmet therapy.
Indexing Terms: Paediatric care, chiropractic, sacro-occipital technique, cranial technique, plagiocephaly correction.
Cite: Williams S, Blum CL, Billings S. Plagiocephaly: The Oblique Skull; A method of chiropractic correction, with a case report. Asia-Pac Chiropr J. 2021;1.3:Online only. URL www.apcj.net/williams-plagiocephaly--a-method-of-correction/
Trapezius fibre muscle analysis: A pilot inter/intra-examiner reliability study
Abstract: This paper is an evidence-based report of DeJarnette’s ‘trapezius fibre technique.’ DeJarnette describes that the palpation of the trapezius muscle begins at the lateral border of T1 and moves out laterally in 7 equally spaced steps to finish at the acromioclavicular junction. The relationship between a palpated nodule and its causative vertebrae is documented in chart-form. The indicated thoracic or lumbar vertebrae shows irritation or off-centering on digital palpation That vertebra is designated as the one causing the greatest stimulation of the trapezius muscle. Inter- and intraexaminer reliability was determined in this study with a cohort N=36 Australian chiropractors trained (advanced certification in Sacro Occipital Technique) and experienced (m=12y, R=r=12-34y) in the application of the trapezius fibre technique. In 72% (26/36) of cases there was at least one nodule/no nodule located by at least two examiners. The reliability of the examiners in so far as they could detect the same nodule on all three occasions was impressive and far greater than the inter-examiner reliability. Indeed there were 10 out of the 18 occasions where the one nodule was identified on all three occasions. We conclude that the examiners were relatively able to reliably detect nodules in the trapezius muscle.
Indexing Terms: subluxation; Sacro Occipital Technique; trapezius fiber/fibre; DeJarnette; spondylogenic reflex syndrome; conventional chiropractic.
Cite: Cashman S, Blum C. Trapezius fibre muscle analysis: A pilot inter/intra-examiner reliability study. Asia-Pac Chiropr J. 2020;1.2:online only. URL https://apcj.rocketsparkau.com/trapezius-fibre-technique--casham-and-blum/
Lumbosacral transitional vertebra as a potential contributing factor to scoliosis: a report of two cases
Abstract: Lumbosacral transitional vertebrae (LSTVs) are the most common congenital anomaly of the lumbosacral spine that presents either as L5 sacralisation or S1 lumbarisation. Although most of the LSTVs are of minor clinical importance, these anomalies may contribute to disruptions in biomechanics and alterations in spinal and paraspinal structures. Here, we present two cases of adolescent idiopathic scoliosis to illustrate some overlooked effects of a unilateral LSTV on spinal deformity. Cure correction was not attained in both cases. While a unilateral LSTV was on a different side of their lumbosacral spine, it is incidentally noticed that the direction of the curve was convex on the contralateral side of the LSTV. Most likely, unilateral LSTVs on certain occasions could cause the growing spine to curve and rotate. The aim of this report is to demonstrate an overlooked association between minor anomalies and the growing spines, which may be important to tailor an appropriate treatment plan.
Indexing Terms: Adolescent idiopathic scoliosis; congenital anomaly; lumbosacral transitional vertebra, Chiropractic adjustment, Vertebral adjustment.
Cite: Chu ECP, Huang KHK, Shum JSF. Lumbosacral transitional vertebra as a potential contributing factor to scoliosis: a report of two cases. Asia-Pac Chiropr J. 2020;1.1 Online only. URL https://apcj.rocketsparkau.com/chu-hung-and-shum-l5-transitional-case-report/
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