Chiropractic + Naturopathic Doctor

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Book Review: September 2006


January 7, 2008
By Julie O’Shaughnessy

Instant Access to Chiropractic Guidelines and Protocols, 2nd Edition

48Instant Access to Chiropractic Guidelines and Protocols, 2nd Edition
Lew Huff, David M. Brady
Elsevier Mosby, 2005, 442 pages

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The principal objective of this book is to guide chiropractors through the clinical decision-making process (including history taking, physical examination, radiographs and other testing) and to help them establish the proper management protocol for their patients.  With the help of 14 contributors, the book was co-authored by two individuals: Lew Huff, DC, is an associate professor at the Texas Chiropractic College and at the University of Texas School of Medicine; David M. Brady, DC, ND, CCN, DACBN, is the director of the Human Nutrition Institute and associate professor at the University of Bridgeport College of Chiropractic and Naturopathic Medicine, a clinical instructor at the Texas Chiropractic College, and also in private practice.

The new edition is quite similar to the first edition, which was published in 1999.  However, the authors have added material on lumbar spinal stenosis and fibromyalgia syndrome (a general overview), an appendix of suggested reading, and references in nutritional, metabolic and botanical medicine, as well as additional information on nutritional and herbal supplements for each different condition.

The book is divided into 10 chapters followed by four appendices.  In it, the authors examine neuromusculoskeletal conditions that chiropractors commonly treat in general practice such as headache, thoracic outlet syndrome, facial and neck pain, low-back pain, and injuries of the extremities. 

It would be beneficial to readers if the authors separated clinical experience from evidence based on scientific literature.

The last chapter covers fibromyalgia syndrome, hypertension, osteoporosis and other related disorders. Appendices A and B outline different nutritional product manufacturers and list contact information for the clinical laboratories, which thus may not be relevant for chiropractors who work outside of the United States.  Appendices C and D note different outcome assessment questionnaires (i.e., Owestry Low Back Pain Disability Questionnaire), and convey a list of suggested reading and references for nutritional, metabolic and botanical medicine, which may be useful for those who are not currently using outcome measures and/or who want to pursue further knowledge in the nutritional field.

Some conditions, such as fibromyalgia syndrome, are well-described and well-referenced, with definitions, algorithms, taxonomy and theory, while the discussion of other conditions could be improved upon.  For example, the different headache conditions could be described according to current accepted guidelines such as The International Classification of Headache Disorders.(1,2) It would be beneficial to readers if the authors separated clinical experience from evidence based on scientific literature.  Moreover, the authors should critique the evidence presented according to the type and level of the various studies, for example case report versus randomized controlled trial (RCT).

Another issue for the reviewer pertains to the description of various procedures that may not be regulated or permitted in certain jurisdictions.  As an example, for a doctor of chiropractic to palpate the piriformis muscle using the rectal or transvaginal method might not be legal in some countries or even some Canadian provinces.

Readers should also consider the risks (adverse reactions, interaction with medication, and cost, etc.) versus benefits that may be associated with herbal and nutritional supplements, especially when these effects are not strongly reported in the literature.  Certain recommendations are referenced from non-peer-reviewed publications such as Dynamic Chiropractic and The Digest of Chiropractic Economics.

This book could be used by students who might not be familiar with some conditions, and chiropractors who search for different approaches in daily practice.  Without providing a cookbook approach for chiropractic care, the authors give an overview of differential diagnoses, different theories on specific conditions, as well as protocols of care.

References:
1. Headache classification subcommittee of the international headache society. The International Classification of Headache Disorders: 2nd Edition, Cephalalgia 2004; 24, supp. 1:9-160.
2. Headache Classification Committee of the International Headache Society. Classification and diagnostic criteria for headache disorders, cranial neuralgias and facial pain. 1st Edition, Cephalalgia 1988; 8 supp. 7:1-96.

Dr. Julie O’Shaughnessy graduated with a degree in chiropractic from
the Université du Québec à Trois-Rivières in 2004.  She is currently a
post-graduate resident in clinical sciences at the Canadian Memorial
Chiropractic College.