Chiropractic Treatment of Lower Extremity Conditions: A Literature Review

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Chiropractic Treatment of Lower Extremity Conditions: A Literature Review
Received 23 April 2006; received in revised form 13 May 2006; accepted 20 June 2006
Wayne Hoskins, MChiroa, Andrew McHardy, MChirob, Henry Pollard, Grad DC, PhDc, Ross Windsham, MChirod, Rorey Onley, MChiroe
Journal of Manipulative and Physiological Therapeutics (JMPT)

Abstract
Objective
The purpose of this study was to document the quantity and type of research conducted on the chiropractic management of lower extremity conditions.

Methods
A review of the literature was conducted using the CINAHL, MEDLINE, MANTIS, and Science Direct databases (each from inception to December 15, 2005). Search terms included chiropractic, hip, knee, ankle, foot, with Medical Subject Heading terms for each region. Inclusion criteria included studies with a lower extremity diagnosis, and the treatment was performed by doctors of chiropractic. Articles were excluded if pain was referred from spinal sites and if there was a duplicate publication; articles published in non̉peer-reviewed literature and abstracts in conference proceedings were also excluded. Of the articles identified, an analysis was conducted assessing those including peripheral and/or spinal treatment. Clinical trials were assessed for quality using the Physiotherapy Evidence Database scale.

Results
There was a total of 1652 citations. Of these, 76 were deemed relevant; 24 were related to the foot, 10 to the ankle, 25 to the knee, and 17 to the hip. Twenty-nine citations included spinal treatment, 47 solely peripheral, and 2 solely spinal. Ten citations were clinical trials and scored on the Physiotherapy Evidence Database scale.

Conclusions
Literature on the chiropractic management of lower extremity conditions has a large number of case studies (level 4 evidence) and a smaller number of higher-level publications (level 1-3 evidence). The management available in the peer-reviewed literature is predominantly multimodal and contains combined spinal and peripheral components. Future chiropractic research should use higher-level research designs, such as randomized controlled trials.

a PhD candidate, Macquarie Injury Management Group, Department of Health and Chiropractic, Macquarie University, Australia

b PhD candidate, Macquarie Injury Management Group, Department of Health and Chiropractic, Macquarie University, Australia

c Senior lecturer, Macquarie Injury Management Group, Department of Health and Chiropractic, Macquarie University, Australia

d Private practice of chiropractic, Sydney, New South Wales, Australia

e Private practice of chiropractic, joslin, south Australia, Australia

Submit requests for reprints to: Wayne Hoskins, MChiro, Macquarie Injury Management Group, Department of Health & Chiropractic, Macquarie University, C/-: PO Box 448 Cronulla, Australia 2230

No source of funding was used in the preparation of this manuscript. The authors have no conflict of interest that is directly relevant to the content of this manuscript.

PII: S0161-4754(06)00219-3

doi:10.1016/j.jmpt.2006.08.004

© 2006 National University of Health Sciences. Published by Elsevier Inc. All rights reserved.

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