Current Issue:  Volume 5, Issue 3 (2014)

Topics in Integrative Health Care: an International Journal (TIHC) is a peer-reviewed, open-access online journal. It is dedicated to advancing the integration of multiple disciplines, both complementary and mainstream, into diverse health care settings in order to provide optimal patient care. It presents themed issues on topics of current relevance to health care providers interested in integrative, conservative care, health promotion and disease prevention. It includes international, interdisciplinary Grand Rounds in order to facilitate communication and patient comanagement among various health professions, for the good of patients everywhere.

Topics in Integrative Health Care (TIHC) is published by Healthindex, Inc. (ChiroACCESS).


Topics in Integrative Health Care

Cheryl Hawk, DC, PhD, CHES    

Topics in Integrative Health Care 2014, Vol. 5(3)     ID: 5.3001   

Topics in Integrative Health Care welcomes unsolicited manuscripts with original research, Grand Rounds, clinical briefs and “fast facts” collections. All submissions are peer-reviewed.


A Culture of Collaboration at an Integrative Health Center - Interview with David Fogel, MD - Interviewed by Daniel Redwood, DC

Daniel Redwood, DC    

Topics in Integrative Health Care 2014, Vol. 5(3)     ID: 5.3002   

David Fogel, MD, is the cofounder (with his wife, Ilana Bar-Levav, MD), of the Casey Health Institute (CHI) in Gaithersburg, Maryland, a nonprofit integrative primary care practice that includes Internal Medicine, Family Practice, Chiropractic, Acupuncture, Massage Therapy, Yoga Therapy, Naturopathic Medicine and more. He is board certified in Internal Medicine with additional specialty training in mind/body focused individual and group psychotherapy.


Chiropractic Approaches to Discussing Weight Management With Overweight and Obese Patients: A Focus Group Study

Anna L. Walden, MS, DC

Stacie A. Salsbury, PhD RN

Dana J. Lawrence, DC, MMedEd, MA

Topics in Integrative Health Care 2014, Vol. 5(3)     ID: 5.3003   

Purpose: Most adults in the United States are overweight. Physician counseling on weight management is a recommended intervention for overweight patients. The purpose of this study was to describe the attitudes, perceptions, and barriers of faculty clinicians and chiropractic students toward the discussion of weight-management with overweight and obese patients.

Methods: Three focus groups were conducted; 1 consisted of faculty clinicians (n=4) and 2 included 8th-10th-trimester student interns (n=8). Focus groups were audio-recorded while researchers took field notes, and focus group participants were debriefed immediately following the discussion to confirm accuracy of field notes. Audio-recordings were transcribed verbatim and participant information was de-identified. Data were analyzed using thematic content analysis by 2 researchers and other researchers verified data interpretation.

Results: Participants noted many challenges to providing chiropractic treatments to overweight patients. Four themes on discussing weight management with these patients emerged: 1) perceptions about obesity, 2) soft-approach techniques, 3) barriers to discussing weight, and 4) the professional responsibility of chiropractors in weight management. Faculty clinicians and interns expected patients to initiate conversations about weight management with their chiropractors. When weight management was discussed, participants offered indirect suggestions for small-scale lifestyle changes, rather than directly addressing the need for weight loss with their patients. Participants identified the sensitive topic of obesity and fears of losing patients as barriers to discussing weight management.

Conclusion: Chiropractors may require further training in applying prevailing models of behavior modification and weight management counseling to overcome barriers to discussing weight management with their overweight patients.

The Effects of the Fascial Distortion Model on Chronic Hamstring Tightness

Christina J. Baird, DC

Sarah M. Shumate, DC

Melissa P.J. Tancredi, DC, MS

Laura M. Cayce, DC, MS

Jane L. Wibbenmeyer, DC

Topics in Integrative Health Care 2014, Vol. 5(3)     ID: 5.3004   

Objective: The aim of this study is to determine if a single treatment using The Fascial Distortion Model (FDM) significantly increases hamstring flexibility in patients with chronic hamstring tightness.

Methods: Thirty participants with current chronic hamstring tightness and no current history of lower extremity injury received treatment with the FDM on their hamstrings appropriate to the distortion presented. The sit-and-reach test was used before and after treatment to determine hamstring flexibility. Summary statistics were calculated, and pre and post hamstring flexibility scores are outlined.

Results: There was a significant difference from pre- to post-test (mean pre =40 cm, post= 47cm), representing a 15% increase in post treatment flexibility. All 30 participants increased their sit-and-reach scores following the application of FDM.

Conclusions: This study demonstrates that a single treatment with the FDM increased hamstring flexibility in a group of participants suffering from chronic hamstring tightness.

Resolution of Hearing Loss After Chiropractic Manipulation

Melissa Ferranti, DC

Kimberly Keene, DC

Chelsea Prothero, DC

Topics in Integrative Health Care 2014, Vol. 5(3)     ID: 5.3005   

Introduction: While chiropractic care is often associated with the treatment of musculoskeletal conditions, there are other, non-musculoskeletal conditions which may benefit from spinal manipulation (SM). This paper reports on the return of hearing in a woman treated with chiropractic adjustments after 8 months of lack of improvement through allopathic care. Pre and post audiograms were used for comparison.

Case Presentation: In this report, a 46 year old white female with neck pain, tinnitus, and hearing loss was treated with cervical spinal manipulation with positive results. A pre-treatment audiogram indicated low-frequency hearing loss, worse in the left ear.

Intervention and Outcomes: After being unsuccessfully medically treated over an 8 month period, she sought chiropractic care for the above symptoms. After 3 chiropractic adjustments, her hearing and associated symptoms were significantly improved. She received 12 treatments over a 4-month period. When asked to rate her hearing and fullness sensation in the ear on a Patient Specific Functional Scale with a 0-10 measure, where 0 is no deficits and 10 is completely impaired, initially she rated her symptoms as 7, and 5 months after the conclusion of care, her rating dropped to 1. Following treatment her audiogram was normal.

Conclusion: This report details the condition and treatment of a female patient with cervicalgia and associated hearing loss (HL). Possible mechanisms for these results are discussed. This case along with others previously published,1-4 aid in the consideration of (SM) as a possible intervention for HL associated with cervicalgia.

Fast Facts

Fast Facts

Stacie A. Salsbury, PhD RN    

Topics in Integrative Health Care 2014, Vol. 5(3)     ID: 5.3006   

Readers are welcome to contribute to Fast Facts. Please include the original abstract (with citation) that is the source of your contribution. Contributors’ names will be included along with the item.

The following is an excerpt:

The CAMbrella project developed a strategic research agenda for the evaluation of complementary and alternative medicine (CAM) in Europe through expert workgroups, Delphi processes, and a consensus conference. Six core research areas were identified: 1) the prevalence of CAM use in Europe; 2) public’s needs and attitudes toward CAM; 3) CAM safety; 4) comparative effectiveness of CAM; 5) meaning and context factors related to CAM outcomes; and 6) models for integrating CAM into current healthcare settings. The need for systematic research coordination, funding, and communication also was identified. Free full text article available at:

Fischer F, Lewith G, Witt CM, Linde K, von Ammon K, Cardini F, Falkenberg T, Fønnebø V, Johannessen H, Reiter B, Uehleke B, Weidenhammer W, Brinkhaus, B. High prevalence but limited evidence in complementary and alternative medicine: guidelines for future research. BMC Complement Altern Med 2014; 14: 46.