(ChiroWire) www.ChiroCredit.com, the World's #1 Site for Online Chiropractic Continuing Education, is proud to announce that they now offer coursework leading towards eligibility to take the examination leading to certification as a Diplomate of the American Board of Chiropractic Internists.

"The same coursework that has been taught for nearly two decades has been revised, updated, and enhanced with new information and scientific references. With major improvements in technical material, over 1800 pages of course text, more than 4,000 color slide images, in addition to enhanced "voice over" audio discourse, are now economically available to you on the internet and are sponsored by the Postgraduate Division of the University of Bridgeport College of Chiropractic, a CCE accredited college" stated Michael Cessna, DC, DABCI, the lead instructor of the online program.

Doctors who complete the 23 Online Sessions and attend three live weekends of hands-on-workshops will be eligible to sit for the certifying diplomate examination in Chiropractic Family Practice, Diagnosis and Internal Disease from the American Board of Chiropractic Internists (DABCI) of the American Chiropractic Association.

Paul Powers, DC, site editor of ChiroCredit.com states "This is an important opportunity for Chiropractors to earn continuing education credits online while working towards a Diplomate. As Chiropractors are considered primary care physicians, the information contained in this program is highly applicable towards clinical practice. We have created an informational web page at www.chirocredit.com/diplomate/dabci which contains more detailed information".

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(ChiroWire) Do you or does your chiropractic association/society think that performance oriented chiropractic research is important?

Will you financially support future research investigating the effects of chiropractic adjustments on perception, cognition, motor control, human movement and wellness?

We would like to inform you about Dean Smith, D.C., M.S., Ph.D.

He is a chiropractic researcher and also has a chiropractic practice with his wife, Dr. Jane Palmer Smith. His research is driven by the chiropractic principle that subluxation impairs well-being and that adjustments can restore health and improve performance.

His research focuses on function and performance. In his young career, Dr. Dean Smith has so far published eight peer-reviewed scientific articles in JMPT, JVSR, Human Movement Science and others. He has also presented his research at numerous scientific conferences.

Highlights of his research include:

• postural control and balance has been enhanced with chiropractic adjustments
• movement time is improved by a statistically significant amount with adjustments

(ChiroWire) Here is an except of what you will learn by taking Research Trends 104, an online continuing education course on www.chirocredit.com authored by Dean Smith, DC, PhD

The author's goal for the paper was to review the experimental evidence demonstrating neuronal and synaptic plasticity using the concepts of long-term potentiation (LTP) and long-term depression (LTD) with respect to spinal neurons in particular. The authors further explore the implications of these studies as possible mechanistic explanations of low back pain and its 'remediation' by spinal manipulative therapy (SMT).

The authors also provide a brief description of LTP and LTD as well as elaboration of the key roles of calcium, glutamate, and glutamate receptors in LTP/LTD, which were provided in the appendices, but will be touched upon in this summary of their work.

The research from both in vitro and in vivo studies identifying LTP and LTD in dorsal horn nociceptive neurons is reviewed. The studies of most interest were those showing LTP in response to intense noxious stimulation and reports that Adelta -mechanosensitive afferent activation can reverse an existing LTP condition in dorsal horn neurons.

A relation between SMT, back pain and neural plasticity?

• spinal manipulation has a growing evidence base for its treatment in LBP, but the mechanisms underlying its effectiveness need to be elaborated
• not only is manipulation effective for acute back pain, but also for chronic back pain
• almost all studies looking at the effectiveness of manipulation for LBP have focused on pain as the chief outcome measure and so the discussion of neural plasticity in relation to SMT will also focus on pain
• virtually all attempts to explain the effects of SMT have focused around the concept of subluxation which have evolved from a bone-out-of-place theory to more current thoughts dealing with the vertebral subluxation complex
• the foundation of subluxation rests on the correction of a biomechanical lesion that can also have neurologic effects
• the correction of the biomechanical lesion is thought to restore normal function and relieve pain
• in regards to neural plasticity, it is thought that the subluxation can cause release of pain producing (algesic) agents, and spinal manipulation is thought to restore normal biomechanics and calm the release of these agents producing a reduction in symptoms
• the commonality between all of these proposed processes is that peripheral biomechanics/tissue are related to clinical signs and symptoms
• spinal manipulation has also been proposed to alter afferent input to the central nervous system and thus modify reflex actions as well as ascending and descending pain modulators
• the afferent effects could be due to secondary changes induced by biomechanical changes in the peripheral tissues or could be due to more direct modulators of pain
• SMT is thought to be a complex mechanical stimulus that can attenuate pain signals via neural mechanisms
• One of the authors of this paper (Gillette) has speculated previously that SMT produces coactivation of two different types of afferents:
  1. low threshold (Abeta/group II) and;
  2. high threshold (Adelta/group III, C/group IV)
     (physiologically, according to the authors, this would place SMT in a similar category as TENS, acupunture, and deep massage, so called "counter-irritation" modalities
• however, SMT also has biomechanical effects much different from the other counter-irritation modalities and this is thought to have unique therapeutic effects.

Efficacy of preventive spinal manipulation for chronic low-back pain and related disabilities: a preliminary study. Descarreaux M, Blouin JS, Drolet M, Papadimitriou S, Teasdale N. J Manipulative Physiol Ther. 2004 Oct;27(8):509-14.

OBJECTIVE: To document the potential role of maintenance chiropractic spinal manipulation to reduce overall pain and disability levels associated with chronic low-back conditions after an initial phase of intensive chiropractic treatments.

METHODS: Thirty patients with chronic nonspecific low-back pain were separated into 2 groups. The first group received 12 treatments in an intensive 1-month period but received no treatment in a subsequent 9-month period. For this group, a 4-week period preceding the initial phase of treatment was used as a control period to examine the sole effect of time on pain and disability levels. The second group received 12 treatments in an intensive 1-month period and also received maintenance spinal manipulation every 3 weeks for a 9-month follow-up period. Pain and disability levels were evaluated with a visual analog scale and a modified Oswestry questionnaire, respectively. RESULTS: The 1-month control period did not modify the pain and disability levels. For both groups, the pain and disability levels decreased after the intensive phase of treatments. Both groups maintained their pain scores at levels similar to the postintensive treatments throughout the follow-up period. For the disability scores, however, only the group that was given spinal manipulations during the follow-up period maintained their postintensive treatment scores. The disability scores of the other group went back to their pretreatment levels.

CONCLUSIONS: Intensive spinal manipulation is effective for the treatment of chronic low back pain. This experiment suggests that maintenance spinal manipulations after intensive manipulative care may be beneficial to patients to maintain subjective postintensive treatment disability levels. Future studies, however, are needed to confirm the finding in a larger group of patients with chronic low-back pain.

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