Are You A Ticking Time Bomb? Try This Simple Exercise To Find Out Your Risk Of Heart Disease

cardiovascular disease

A friend (a practicing neurosurgeon) sent me an email the other day about cardiovascular health that really caught my attention. The subject line read;

“Association Between Push-up Exercise Capacity and Future Cardiovascular Events Among Active Adult Men.” (1)

I quickly went to check the validity of such a statement.  I mean, could it be?  A simple, no-cost, exercise that can be used as a tool to predict future cardiovascular events?

The study looked at whether a clinician could determine an association between a person’s fitness level and cardiovascular disease (CVD) risk.  All while using an office-based assessment tool.

Physical inactivity, lifestyle and increased CVD risk have all been well documented. (25)  The importance of researching this topic is obvious.  Heart disease remains one of the leading causes of mortality in the world.  In fact, The World Health Organization has posted that;

  • CVD is the number 1 cause of death globally – more people die annually from CVDs than from any other cause.  An estimated 17.9 million people died from CVD in 2016, representing 31% of all global deaths. Of these deaths, 85% are due to heart attack and stroke.
  • Most cardiovascular diseases can be prevented – by addressing behavioral risk factors.  These include;
  • Tobacco use
  • Unhealthy diet
  • Obesity
  • Physical inactivity
  • Harmful use of alcohol using population-wide strategies. (6)

Click here to read, “Sitting Too Much is the New Smoking”.

firemen

A Retrospective Longitudinal Cohort Study

This study followed over 1100 occupationally active men.  Firefighters, 18 years of age and older, for over 10 years, stratified into 5 groups based on two factors;

  • Fitness level
  • The number of push-ups they could complete.

Baseline and follow-up physical examinations were completed within a 7-year window.  It included exercise tolerance in addition to push-up ability.  The outcomes were adjusted for age and body mass index among other variables (BMI).

The Findings

When the statistical analysis was completed in 2018 researchers found;

A significant negative association between baseline push-up capacity and increased CVD risk.  This was across 10 years of follow-up.

So how many push-ups were associated with decreased CVD risk?  Participants able to complete more than 40 push-ups had a significant reduction with risk of CVD.  This was compared with those completing fewer than 10 push-ups.

cardiovascular exercise

The findings of this study suggest that;

Performing 40 or more push-ups significantly decreases the incidence of heart disease events among active, adult men.

As a clinician, it is worthwhile to assess the functional capacity of our patients.  Talk to your doctor before starting any new exercise program.  Especially if you are taking medication.  Alternatively, it would be interesting to see studies observing females as well as different age-groups to see if the results could be replicated.

Click here to read, “Stroke And Heart Attack Linked To Drinking This!”

Now drop and give me 40!

 

References:
  1. JAMA Network Home
  2. The American Heart Association. Circulation.
  3. A policy statement from the American Heart Association. Circulation. 
  4. Steps to move the science forward. 
  5. The PURE study. Lancet. 
  6. The World Health Fact Sheet on cardiovascular diseases.

How To Choose The Best Running Shoes – Part 2

If you’re new to the running world and unsure of where to start, don’t sweat it (no pun intended).  If you are on the search for the types of shoes best for running, I highly recommend you click here to read, “How To Choose The Best Running Shoes – Part 1”

By now you have determined:

  1. The type of foot arch you have
  2. Whether you over- or under-pronate when you walk or run
  3. The appropriate shoe category

After reading Part 1 of my article, you will have a little more confidence in your ability to pick out the types of shoes that are right for you.  Remember, most seasonal workers at a department store that sell runners are equipped to get you the desired size and not much more.  So, if you require a little more assistance or input from a gait and biomechanical perspective, I would recommend going to a store that deals exclusively with runners.  They have staff that may be able to offer more insight from a runner’s perspective.

So, You’re In The Store, Looking At The Wall Of Different Types Of Shoes, What’s Next?

Follow these steps to help you pick the correct runner for you.

1. Try on shoes at the end of the day

Our feet normally swell by the end of the day.  This is important when trying on shoes so that you don’t pick a shoe that is too small for your foot.  Tight or small shoes will affect circulation and may cause blisters and foot irritation.  Especially after a run.

2. Bring your custom orthotics with you

If a health professional has recommended and made orthotics for you because of a condition related to your feet, bring these with you.  Especially if you are planning on running while wearing the orthotics.  Better yet, ask your orthotic office to make you a pair designed specifically for a running shoe.  These will differ from a standard orthotic used for every day use.

Click here to read, “Custom-Made vs. Over-The-Counter”.

3. Moderate-severe over-pronator?  Pick a stability shoe!

If you already know that you over-pronate when you run, consider picking a motion control shoe with moderate stability.  These shoes have special internal construction with material to help control excessive pronation.  When you press into the inside of the shoe, you may notice one side “softer” than the other.  However, most people will not be able to tell the difference.  Sometimes shoe manufacturers display different colours on the outside of the shoe to indicate different material being used.  But this isn’t always the case and unethical which is why you should only buy from an authentic shoe store.  Also, keep in mind if you under-pronate, search for a “neutral” shoe.

4. Check the ankle collar and heel

The ankle collar is the part that wraps around your Achilles tendon and holds the heel in place.  Check that the inside padding properly supports your heel and prevents your foot from slipping out.  Consider a different shoe if the collar feels uncomfortable on your Achilles tendon. If not, you may irritate the tendon once you start running.  The heel counter is generally made of a rigid material at the rear foot.  This is to help centre the heel for support.  Make sure that you can’t collapse the heel by pressing down on it from the back. (Minimalist shoes have no heel counter to allow for more freedom).

5. Check the toe box and pick the correct size

When you put the shoe on make sure your toes have free movement and can flex and spread comfortably.  Remember, mommy isn’t buying these shoes for you.  Avoid buying a shoe that is too big, so it ‘lasts many years’.  If you’re a serious runner, your shoes will last you 1 or maybe 2 seasons.  This all depends on the mileage you accumulate.   Also, a large shoe will cause your foot to slip back and forth which will predispose you to injury. 

Don’t assume your size.  Different types of shoes may vary on size and fit.  For example, I wear a whole size smaller for dress shoes than I do for runners.  If you’re unsure, get measured in the store.  This is a common mistake a newbie makes.  They either pick a shoe that is too big (maybe it’s on clearance?) or too small (maybe it looks fashionable?).  These days, shoe manufacturers are making uppers (the material above the sole that covers the foot) in a variety of material that is comfortable, stretchy, and breathable.  Therefore, pick a shoe that allows the toes to move freely and not feel crowded in the toe box. 

6. Check the outsole

Look at the rubber and material on the bottom of the shoe.  Observe the shape.  I usually match the shape of the outsole to my foot.  There are certain shoes that I unfortunately have to rule out because the design just doesn’t fit the shape of my foot.  For example, if you have flat feet, you probably don’t want to choose a shoe that has a midsole or outsole designed for a person with a high arch.  

7. Cushioning

Put the shoes on and allow the feet to feel the cushioning on the heel (which is important for heel strike) and the forefoot.  Walk around in the store.  Ask yourself how they feel.  I have placed my feet in shoes which felt like I was walking on clouds and some that felt like I had just placed them in a medieval torture chamber.  If you ask nicely, a specialty store owner might allow you to go outside for a quick dash on the sidewalk to test them out.  I assure you that a big box store will not allow you to do that!

What About Heel-To-Toe Drop?

I will keep this section brief.  The research is inconclusive at this point whether a low drop is any better than a high drop.  Ever since the emergence of the barefoot running craze (of which I participated in until I injured myself training for a 30K), this has been a topic of interest.  Is there any evidence that low to no drop prevents injuries?  We’re not sure. Maybe?  The jury is still out!  My professional opinion?  Look for a sweet spot.  Too high of a drop causes your running alignment to tilt forward.  This may promote more heel strike which I’m not a fan of.  Too low and it mimics the barefoot running style. 

The Flex Test

Take the shoe into your hands holding the toe with one hand and the heal with the other.  Flex or bend the shoe upwards.  Observe where the shoe bends.  I choose the shoe that I am unable to bend in the middle. Why?  Can you bend your foot in half?  That’s what I thought.  The shoe should flex and roll similar to the way your foot wants to move. 

The Twist Test

Over ten years ago this test was important.  Manufacturers were using less supportive material in the shoe, perhaps to save on costs.  Thus some shoes have little to NO support.  This test is simple to perform.  Take the shoe in your hands.  If you can twist it like you’re wringing a wet towel, put the shoe back and move on to the next.  With the onset of minimalist shoes, I’ve seen this tactic used in runners and I’m not sure why.  The only time this test doesn’t need to be performed is in the example of barefoot/minimalist shoes.  All other runners should provide enough support that you are unable to twist the middle of the shoe to 90 degrees.

Recap:

5 Quick Tips

To Buying Shoes

  1. Go to a specialty shoe store instead of a large department store.
  2. Shop at the end of the day when your feet are more swollen.
  3. Bring your old shoes and custom made orthotics with you when buying different types of shoes.
  4. Buy based on design and construction, not looks! (I learned this the hard way when I purchased a cool looking shoe which caused me to sprain my sacroiliac joint)
  5. To save money, buy the previous year’s model which may be on clearance. You will hardly notice the improvements. A good shoe model 25 is usually not significantly better than a Model 24.

For further reading, click here for, “The Most Common Cause Of Foot Pain!”

How To Choose The Best Running Shoes – Part 1

how to choose running shoes

Ever get overwhelmed when walking into an athletics store?  You stare at the long wall of colorful shoes and wonder how to choose running shoes that will be perfect for you?

Depending on the store, you may be welcomed by anyone from the student, whose knowledge of shoes is which are the nicest looking or a runner’s store that employs individuals with some basic understanding of foot mechanics.

I’m going to teach you how to choose running shoes best suited for you by following these simple tests.  You will be required to do a little homework on your feet first.

What Type Of Foot Arch Do You Have?

People generally have either a low arch (flat foot), a normal arch or a high arch.  The easiest way to test to see what type of foot you have is to stand and have a friend or family member stick three fingers under the inside of the foot.  If they can fit their fingers up to the second joint line, then you likely have a normal arch.  If they can only fit the tips of the fingers underneath, then you probably have flat feet or a collapsed arch.

Do You Over/Under-Pronate When You Walk Or Run?

Next, you need to determine if you over-pronate.  Before you determine that, you must know what pronation is.  Pronation is the rolling of the foot from heel to toe through the foot strike.  If you have a tendency to roll the foot excessively inwards when walking due to a flat foot, then you are an overpronator.

Under-pronation (or supination) is when you roll too much on the outside of the foot.  A normal foot strike occurs when you strike your heel slightly on the outside, and the pressure evenly moves up to the ball of your foot.  Too much deviation one way adds further stress to your foot.

Keep in mind some pronation is normal when you walk or run.  If you have difficulty with figuring this part out consider contacting a Kinesiologist, Chiropractor, or Physiotherapist for assistance.  Click here to search our directory to find a health professional near you.

When shopping for new shoes, bring a pair of old running shoes with you.  The wear pattern on your old shoes could provide clues on the type of runner you are.  For example, if your shoe has excessive wear on the insides of the heel and forefoot, it could be a sign of over-pronation.  Same thing goes if the wear is predominantly on the outside of the shoe which may indicate supination.  Click here to learn more about Pronation, Overpronation, and Supination in Walking and Running.

Determine The Appropriate Shoe Category

This seems obvious but you’d be surprised how many people I’ve seen wearing the wrong shoe for the activity they are engaged in.  For example, you should never pick a cross-training shoe as a runner.  These shoes are built to prevent excessive side-to-side motions and are more appropriate for gym workouts or for individuals engaging in balance activities who require more contact with the ground.

In the running category you will generally see three sub-categories of shoes:

  • Road-running
  • Trail-running
  • Cross-training

Pick the appropriate category for you.

Now that you have some preliminary information, it’s time to go shopping!  Normally, I recommend going to the national chain stores only if you really know what you want and have a good understanding of how running shoes are built.  I have noticed that it’s hit or miss with knowledgeable staff at these types of stores as most are trained to get you the right size and not much more.

In my experience I have found that going to a store that exclusively deals with running shoes and apparel is a better option for a novice.  The staff tend to know a bit more than your average athletic store in shopping malls.  Some even have health professionals operating their practices in-store which is convenient.

This was part 1 of how to choose running shoes for yourself.  Part 2 will provide you with simple tests to perform on the shoe itself when you are in the store.  As stated earlier any sports chiro, physio or kin can help determine the best shoe for you.  My patients have access to a list of the best running shoes for specific foot and gait types chosen by the medical team of our custom orthotics company every year.  All you have to do is ask!

Stay tuned for part 2.

Further Reading

People rarely acknowledge how important their feet are to their everyday life….that is until they experience foot pain!  Think about it…you use your feet to pivot, turn, step, walk, run and to keep you balanced.  But when you experience foot pain, these seemingly simple functions can become quite challenging.  Click here to learn more about The Most Common Cause Of Foot Pain and what you can do to prevent it.

Top Tips To Manage Your Emotions

For most people the holidays are a time to take a break from the hustle of every day life and a time to spend with family and friends.  It is a time that people observe special religious festivities and a time of gift giving and merriment.  A great many of us will make new year’s resolutions to either give up something that is detrimental to our health or add something to our regimen.  Like something that will help cope with things like depression and anxiety and bring us closer to health and happiness.

But now it’s January.  You’ve just realized you have overeaten, overdrank, overspent, and indulged in a great many behaviours that you normally wouldn’t have if it was any other time of the year.

When it comes to spending habits in Canada, one in three Canadians said they ended up spending more than they meant to last year.  (1) It’s easy to fall into despair, disarray as well as frustration and fear as a result of our actions during the holidays.

According to motivational speaker Tony Robins, “Gratitude is the solution to anger and fear.”  (2) In other words, you one cannot hold feelings of anger/fear and gratitude simultaneously.  This is good news if we are searching for methods to cope with the aftermath of the holidays when all festivities have concluded, all the gifts are opened, and perhaps some anxiety about our credit card bills start to arrive making us ever so reluctant to pay a visit to our post office box.

For more on Tony Robbins, click here for THE 5-STEP PLAN TO AN EXTRAORDINARY YEAR.

How To Manage Your Emotions

Here are some tips you can use to manage your emotions and transform your state of being into a healthy and positive state.  This exercise is the HeartMath Institute’s Heart-Focused Breathing® Technique and I would like to share it with the reader as it is entirely possible to calm both our nervous system and our overactive mind.  In other words, attempt to turn down the frantic fight or flight sympathetic nervous system and turn up the parasympathetic system.

Over activity of the sympathetic nervous system will cause our breathing and heart rate to increase as well as release stress hormones like cortisol into our bloodstream to help prepare us for a fight or flight scenario.  This is innately programmed into our nervous system as a protective mechanism. By calming the sympathetics and shifting to the parasympathetics, which control our resting, relaxation and digestive responses, we can put ourselves in a state of ease. The good news is that we can do it relatively easily with this simple exercise.  Click here to read about A Scientific Validation Of Your Emotions.

Step by Step Instructions:

Start with sitting in a quiet place, in an upright posture and begin breathing through your nose and exhale out through your mouth.

Focus:

Focus your attention on your heart area, and breathe a little deeper than normal, in for 5 or 6 seconds and out 5 or 6 seconds.

Breathing:

Imagine breathing through your heart.  Picture yourself slowly breathing in and out through your heart area.

Remember that you are not breathing from upper chest region that uses more accessory muscles and body part and is usually the pattern of breathing of someone suffering form anxiety or anxious state but rather from the heart.  There is a difference.  If this is difficult to visualize try diaphragmatic breathing where your belly expands as you draw oxygen in.  It’s ok if it looks funny and makes the belly look larger than usual.  Nobody is watching remember you’re alone?  Hehe.

Feeling:

Activate a positive feeling as you maintain your heart focus and breathing. Recall a time you felt good inside and try to re-experience the feeling. Remember a special place or the love you feel for a close friend, relative or treasured pet. The key is focus on something you really appreciate.

Conversely, you can attempt a more meditative method and practice NOT thinking about anything other than your breath.  I’ve found both methods effective.  The key is to make sure your exhale is slightly longer than your inhale.

Practice this for at least 5 minutes and observe your mood change in short matter of time.  Click here for 4 Tips to an Abundant, Joy Filled Life

Yes folks, it is literally that easy.  You are in complete control of your mood and emotions.  The mind is a powerful entity and each of us has the capacity to alter our state of well-being should we choose to.  Harness the feelings of gratitude and appreciation.  Appreciate yourself and others.  Be grateful that you are alive.  My wish for you is that this exercise will help you reduce emotional stress and improve your health.  Blessings to you all.

Reference:
https://globalnews.ca/news/4671068/2018-black-friday-canada-holiday-spending/
https://medium.com/thrive-global/tony-robbins-gratitude-is-the-solution-to-anger-and-fear-c3fa819825c
E-mail newsletter: Heart Math Institute, A 3 step exercise to better health.

Scientific Key To Anti-Aging

supplement

Years ago, I found myself in the company of intellectuals having breakfast on the outskirts of New York.  During our meal, I noticed one of my colleagues pleading with a friend to take this ‘special supplement’ to help with his health.  This is a very familiar scenario for many health professionals.  Dealing with the outrageous claims made by some supplement companies is, dare I say, a problem.  Firstly, you don’t want to give people false hope when they are in crisis mode requiring medical attention.  Secondly, some claims are just outright false or at the very least misleading.  However, this was a person with a PhD from a very prominent university in America, so I continued to listen.

The term “cellular repair” kept coming up.  After realizing she had been using the supplement herself, I couldn’t help but think that anti-aging could be affiliated as one of the effects of this supplement.  From all the years I’ve known her, I would definitely describe her appearance as a person who hadn’t aged in decades.

I was interested in learning more about this wonder supplement.  Therefore, I began to look into the contents and research behind its claims.  In short, what I came across was intriguing.

The Role Of NAD+ And Sirtuins

Researchers have demonstrated that cellular health is dependent on two things: A coenzyme called nicotinamide adenine dinucleotide (NAD+).  And proteins called sirtuins that are dependent on NAD+.

Nicotinamide adenine dinucleotide is a vital coenzyme that exists in all of your cells.  It ensure that your cells function properly.  A coenzyme is like a “helper” molecule.  It binds to other enzymes to help cause reactions at the molecular level (3).  The supply of NAD+ in the body is critical in supporting our health.  Also, it plays an important role in processes like DNA repair.  NAD+ is also used for the following processes and mechanisms:

– Energy production (ATP)
– Chromosome Stability
– Immune Cell Signaling
– Energy Enzyme Activity
– Brain Health
– Longevity

During the aging process, NAD+ levels drop dramatically.  Sirtuins are proteins that depend on NAD+ levels to function.  Sirtuins have been implicated in influencing a wide range of cellular processes.  Examples include anti aging, inflammation, stress resistance, energy efficiency and alertness.  Furthermore, it can also control or influence circadian rhythms and mitochondria (1).  Too sciency right?  Let’s just say, sirtuins are very important proteins.  Regardless if you have a scientific background or not, it’s important that we all try to understand a little more about the chemicals that we put on and in our bodies.  So many of use potentially harmful chemicals without giving it a second thought especially when it comes to the fight against aging.  Click here to learn more about what chemicals are you putting on your face.

Important Discoveries

During an e-mail exchange with the company that produces the supplement, they revealed to me that “there are two notable discoveries worth mentioning.  During the year 2000, it was demonstrated that many critical cellular metabolic processes are NAD+-dependent.  However, in 2013, it was demonstrated that declining NAD+ levels, leading to poor mitochondrial and cellular health, could be reversed.”

Wait what?  The reason we age and eventually die is because mitochondria fail to repair, and our cells die (4).  If research has demonstrated that this process can be reversed, could we theoretically live forever or at least longer?

“Based on these findings, researchers were able to pinpoint natural compounds that help our cells to produce NAD+ and stimulate sirtuin activity at a level we once had.  This supplement is targeting your cellular health to ensure they have what they need to continue to function at an optimal level of health.”

Well that seems promising doesn’t it?  In reality that’s what all this really is, a start with promising test results.  Clinical trials are mostly conducted by the company’s own research scientists own bias may be a factor when interpreting these results.

Clinical Trial Results

The company directed me to their website to read about the results.  Their first full-scale double blind, placebo-controlled, clinical trial (the gold standard of drug testing).  Conducted throughout 2016, the results of the study showed that in participants taking the recommended dose of this supplement, NAD+ levels increased from baseline in whole blood by an average of 40%.  This at four weeks and maintained that increase for the duration of the trial.  Forty percent is a significant increase and deserves further investigation.

It’s important to note that a majority of the studies on NAD+ demonstrating positive outcomes like improved muscle function, DNA damage repair, and cognitive function were tested on mice and worms.  They have yet to look at similar effects in humans.  So at best, the results show the potential for significant benefits in humans.

Another thing to note is that you may not necessarily feel the benefits of adequate NAD+ levels in the body.  This because it is hard to feel your cells repairing accumulated damage. However, if what this supplement claims to do is true, it is equally important to recognize the benefits derived at a cellular level.  Even if they don’t manifest themselves in a way that we can feel and see. The same can be said for stem cell therapy, another regenerative treatment that aims to turn back the clock. These treatments, like NAD+, work at the cellular level to repair damage and support energy levels to help you look and feel younger. For further information about Myths vs Reality when it comes to anti-aging supplements click here Click here for further information about Myths vs Reality when it comes to anti-aging supplements.

Sources:

1. HTTPS://EN.WIKIPEDIA.ORG/WIKI/SIRTUIN
2. PREYAT N, LEO O (MAY 2013). “SIRTUIN DEACYLASES: A MOLECULAR LINK BETWEEN METABOLISM AND IMMUNITY”. JOURNAL OF LEUKOCYTE BIOLOGY. 93 (5): 669–80.
3. HTTPS://WWW.ELYSIUMHEALTH.COM/EN-US/KNOWLEDGE/SCIENCE-101/EVERYTHING-YOU-NEED-TO-KNOW-ABOUT-NICOTINAMIDE-ADENINE-DINUCLEOTIDE-NAD
4. J CLIN INVEST. 2013 MAR 1; 123(3): 951–957. PUBLISHED ONLINE 2013 MAR 1. DOI: 10.1172/JCI64125

A Natural Proven Solution To The Opioid Crisis

opioids

The pharmaceutical industry has come under heavy fire in the media recently.  They’re being blamed for the opioid crisis facing many communities.  The irony of it all is that the Company responsible for initiating the opioid crisis is now claiming to offer a solution.  They want to introduce yet another drug to help suffers cope with their addiction.  I don’t have to tell you about the dangerous and unethical practices of this particular company for you to know we cannot place our health in their hands.

Break The Cycle Of Opioid

Pharmaceutical companies are showing time and time again that instead of helping manage peoples pain, they are instead only out to further benefit their investors.  In order to tackle the problem of opioid addiction, which is now a pandemic, we need to look past the big Pharma for help.  Their solution will only place more people under the influence of their drugs.  They will only provide solutions within their capacity creating a vicious cycle of drug dependence as a means of solving a health problem.  It’s important that patients and health professionals look for natural alternatives to put an end to this crisis.  Click here for more facts about the opioid crisis.

Where To Turn To For Help!

In 2017 a new systematic review was published in a medical journal which confirmed an association of spinal manipulative therapy (SMT), with clinical benefit and harm for acute low back pain.  This is the standard treatment method utilized mainly by chiropractors.  The review looked at 26 eligible randomized controlled trials (RCTs) and showed that 15 of the trials (involving 1711 patients) provided evidence that Chiropractic care, in the form of spinal manipulative therapy, recorded improvements with their pain.

Twelve RCTs [1381 patients] produced evidence that SMT has a statistically significant association with improvements in function.  No RCT reported any serious adverse event.  This is important to consider given the multitude of side effects that drugs produce.  High quality studies tended to report larger benefits.  So, the analysis of 26 randomized clinical trials, spinal manipulative therapy was associated with statistically significant benefits in both pain and function of, on average, modest magnitude at up to six weeks [compared with sham or alternative treatments].

The Evidence Is Clear

Chiropractic adjustments reduce pain, increase comfort, and lead to increased functional abilities.  Chiropractic adjustment is not just effective compared to placebo or sham adjustment, it is also more effective than surgery, usual medical care, or physiotherapy.

The key take-home points from the study are that opioid are addictive, deadly, expensive, and ineffective in the long-term.  Introducing more drugs to fix the problem created by opioid does not lead to better results based on lack of evidence for effectiveness and have their proven side effects.  Physiotherapy was also shown to be ineffective for spinal conditions and back pain compared to chiropractic.  There is only one scientific logical conclusion from all this: Chiropractic is the safest, most effective, and most cost-effective choice for patients with spinal health issues if you exclude spinal fractures, spinal infections, and spinal cancer.  To learn more about natural healing click here read about what conventional medicine doesn’t want you to know.

Source:

Paige et al. (2017) Association of Spinal Manipulative Therapy with Clinical Benefit and Harm for Acute Low Back Pain. Systematic Review and Meta-analysis. JAMA;317(14):1451-1460
Dr. James Chestnut (2018) Newsletter: New Systematic Review in Medical Journal Confirms Benefits of Manipulation for Low Back Pain