Archive for category Case Studies

Abstract

OBJECTIVE:

The objective of this case series was to investigate the feasibility and safety of a novel method for the management of chronic lower back pain. Injections of recombinant human growth hormone and testosterone to the painful and dysfunctional areas in individuals with chronic lower back pain were used. In addition, the participants received manual therapies and exercise addressing physical impairments such as motor control, strength, endurance, pain, and loss of movement. Pain ratings and self-rated functional outcomes were assessed.

STUDY DESIGN:

This is a case series involving consecutive patients with chronic lower back pain who received the intervention of injections of recombinant human growth hormone and testosterone, and attended chiropractic and/or physical therapy. Outcomes were measured at 12 months from the time of injection.

SETTING:

A community based hospital affiliated office, and a private practice block suite.

PARTICIPANTS:

A total of 60 consecutive patients attending a pain management practice for chronic lower back pain were recruited for the experimental treatment. Most participants were private pay.

INTERVENTIONS:

Participants who provided informed consent and were determined not to have radicular pain received diagnostic blocks. Those who responded favorably to the diagnostic blocks received injections of recombinant human growth hormone and testosterone in the areas treated with the blocks. Participants also received manipulation- and impairment-based exercises.

OUTCOME MEASURES:

Outcomes were assessed at 12 months through pain ratings with the Mankowski Pain Scale and the Oswestry Disability Index.

RESULTS:

Of the 60 patients recruited, 49 provided informed consent, and 39 completed all aspects of the study. Those patients receiving the intervention reported a significant decrease in pain ratings (P<0.01) and a significant improvement in self-rated Oswestry Disability Index scores (P<0.01). In addition, in the Oswestry Disability Index results, 41% of the patients demonstrated a 50% or greater change in their disability score. Of the subjects who withdrew from the study, one was due to the pain created by the injections and nine were for nonstudy factors.

CONCLUSION:

The intervention appeared to be safe and the results provide a reasonable expectation that the intervention would be beneficial for a population of individuals with chronic nonradicular lower back pain. Due to the design of the study, causality cannot be inferred, but the results do indicate that further study of the intervention may be warranted.


J Pain Res. 2015 Jun 23;8:295-302. [PMID:26203272]

Author information: Dubick MN, Ravin TH, Michel Y, Morrisette DC;  Charleston, SC, USA.


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Abstract

Objective:

To review the outcome of chiropractic care in the case of a fifteen-year-old female with a history of concussion.

Clinical Features:

A fifteen-year-old female presented with constant pain on the top of her head, headache, and difficulty concentrating after being hit on the head by the trunk door of a van. She was diagnosed with a concussion nine days after her initial injury. Two weeks after the diagnosis she sought out chiropractic care for her symptoms.

Intervention and Outcome:

The patient was given specific spinal adjustments using the Activator technique. After 9 adjustments the patient showed improvement in her symptoms and was tested with the ImPACT concussion test. The patient’s cognitive efficiency index improved from 0.28 (pre injury) to 0.43 (after  9 adjustments).

Conclusion:

This case report reviews the benefits of chiropractic care in the management of a patient with concussion. Further research is required to better understand how chiropractic adjustments can help patients suffering from concussion


J of Ped, Maternal & Family Health 2014 Sep 30; 60-64.

Author information: Jean-Marc Slak DC – Private Practice of Chiropractic, Burlington, MA, Kyle Price, DC – Private Practice of Chiropractic, Simpsonville, SC.


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Abstract

OBJECTIVE:

The purpose of this article is to report the response of chiropractic care of a geriatric veteran with degenerative disk disease and diffuse idiopathic skeletal hyperostosis.

CLINICAL FEATURES:

A 74-year-old man presented with low back pain (LBP) and loss of feeling in his lower extremities for 3 months. The LBP was of insidious onset with a 10/10 pain rating on the numeric pain scale (NPS) and history of degenerative disk disease and diffuse idiopathic skeletal hypertrophy. Oswestry questionnaire was 44% and health status questionnaire was 52%, which were below average for his age. The patient presented with antalgia and severe difficulty with ambulation and thus used a walker.

INTERVENTION AND OUTCOME:

Chiropractic care included Activator Methods protocol. Two weeks into treatment, he reported no back pain; and after 4 treatments, he was able to walk with a cane instead of a walker. The NPS decreased from a 10/10 to a 0/10, and his Revised Oswestry score decreased from 44/100 to 13.3/100. His Health Status Questionnaire score increased 25 points to 77/100, bringing him from below average for his age to above average for his age. Follow-up with the patient at approximately 1 year and 9 months showed an Oswestry score of 10/100 and a Health Status Questionnaire score of 67/100, still above average for his age.

CONCLUSION:

The findings in this case study showed that Activator-assisted spinal manipulative therapy had positive subjective and objective results for LBP and ambulation in a geriatric veteran with degenerative disk disease and diffuse idiopathic skeletal hyperostosis.


J Chiropr Med. 2012 Dec;11(4):293-9. [PMID:23843763]

Author information: Roberts JA, Wolfe TM. Chiropractor, Private Practice, HealthQuest Chiropractic, Farmington, ME.


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Abstract

OBJECTIVE:

The purpose of this report is to describe the response of a geriatric patient with low back pain and a history of leukemia, multiple compression fractures, osteoporosis, and degenerative joint disease using Activator chiropractic technique.

CASE REPORT:

An 83-year-old man who is the primary caretaker for his disabled wife had low back pain after lifting her into a truck. The patient had a history of leukemia, multiple compression fractures, osteoporosis, and degenerative joint disease. His Revised Oswestry Low Back Pain Disability Questionnaire was 26%, with a 10/10 pain rating at its worst on the Numeric Pain Scale. The patient presented with a left head tilt, right high shoulder, and right high ilium with anterior translation and flexion of the torso and spasm and tenderness from the lower thoracic spine to lumbar spine.

INTERVENTION AND OUTCOME:

The patient was cared for using Activator Methods protocol. After 8 treatments, the patient was stable and remained stable for 4 months without spasm or tenderness in his spine. His Revised Oswestry score dropped to 6%, with a 4/10 Numeric Pain Scale pain rating when at its worst; and the patient reported being able to take care of his wife.

CONCLUSION:

The findings of this case suggest that Activator-assisted spinal manipulative therapy had a positive effect on low back pain and function in an elderly patient with a complex clinical history.


J Manipulative Physiol Ther. 2013 Feb;36(2):68-77. doi: 10.1016/j.jmpt.2013.01.004. [PMID: 22942837]
Author information: Roberts JA, Wolfe TM. Doctor of Chiropractic, HealthQuest Chiropractic, Farmington, ME 04938.


 

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Abstract

Objective:

To describe the results from chiropractic care of a patient presenting with a breech pregnancy using the Webster Technique analysis with Activator Adjusting Instrument thrust.

Clinical Features:

A 30 year old woman in her 34th week of pregnancy with her second child presented for a regular chiropractic visit after having an ultrasound that determined the baby was in a breech position. She had a previous cesarean section and was continuing chiropractic care with hopes of avoiding another cesarean section.

Intervention and Outcome:

Webster Technique was used to analyze the patient and a light force adjusting instrument (Activator Adjusting Instrument) was used to administer an adjustment. Trigger point therapy was also performed according to Webster protocol. After three adjustments, the fetus moved from a breech position to a normal vertex or head down position.

Conclusion:

Webster Technique protocol while using the Activator Adjusting Instrument along with trigger point therapy was successful in decreasing sacral subluxation and the fetus assumed a normal vertex position according to a follow-up ultrasound.


Journal of Pediatric, Maternal & Family Health – Chiropractic ~ Volume 2012 ~ Issue 3 ~ Pages 66-68.

Author information: Miranda Abbott, DC. Private practice, Appleton, Wisconsin, USA.

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Abstract

Objective

The purpose of this report is to discuss the outcome of a patient with non-cardiac chest pain treated with chiropractic spinal manipulation combined with instrument-assisted soft tissue mobilization.

Introduction

Chest pain is the fourth most common presentation in emergency rooms in the United States. The direct and indirect costs of chest pain are high in terms of disability, medication, repeated hospital admissions and physician visits, and costly diagnostic procedures.

Clinical features

The case of a 45 year-old male presenting to a chiropractic clinic with complaints of chest pain is discussed. Although the source of this chest pain was likely non-cardiac, cardiac risk factors were present and were addressed as well.

Intervention and outcome

The patient was treated with manual thoracic spinal manipulation and instrument-assisted soft tissue mobilization with complete resolution of chest pain at 3 weeks and no chest pain at 1 month and 3 month follow-up visits. Conservative cardiac prevention approaches were encouraged with good outcome.

Conclusion

This case points out the promising role the combination of chiropractic manipulation and instrument-assisted soft tissue mobilization may have in the management of non-cardiac chest pain arising from musculoskeletal dysfunction.


Topics in Integrative Health Care 2011, Vol. 2(3)

Author information: Cooper SR, Pfefer MT. Cleveland Chiropractic College, Kansas,USA.


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ABSTRACT:

Objective:

The purpose of this case study is to describe the clinical course and treatment of a female patient with intermittent low back pain (LBP) that was associated with a uterine adenomyosis.

Clinical Features:

A 45-year-old woman presented for chiropractic care with intermittent LBP of 4 years’ duration. History revealed concurrent dysmenorrhea, menorrhagia, and a uterine leiomyoma (fibroid). Physical and radiological examination findings were unremarkable, and the LBP was not reproducible.

Intervention and Outcome:

Activator Methods chiropractic adjustments/manipulations were given twice per week for 4 months with moderate results. The frequency and duration of low back and pelvic pains were reduced; however, the severity remained constant. A further gynecological opinion was sought, a transvaginal ultrasound was performed, and the patient’s diagnosis was changed from leiomyoma to adenomyosis.

Conclusion:

In this case report, a woman presented with a 4-year history of intermittent LBP, which was sometimes associated with menstruation. Despite being diagnosed with uterine adenomyosis, she received some relief from chiropractic care.


J Chiropr Med. 2011 Mar; 10(1): 64–69. [PMC3110405]

Reference: Anne M. Jensen MSc, DC; Brutawit Bewketu BS; Douglas Sanford MSS, DC, CCSP. Parker Research Institute, Parker College of Chiropractic, Dallas, TX, USA.


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Abstract

OBJECTIVE:

The purpose of this case report is to describe the clinical presentation and chiropractic management of Tietze syndrome.

CLINICAL FEATURES:

A 34-year-old woman presented with unexplained left-sided chest pain. Electrocardiogram and radiographs were taken at a medical emergency department to rule out cardiovascular and pulmonary causes, and pain medication did not relieve her pain. Physical examination showed tenderness on palpation and swelling of the second and third chondrosternal joints, as well as thoracic joint dysfunction. Heart and lung pathology was ruled out, and chondrosternal joint swelling was present, Tietze syndrome was diagnosed.

INTERVENTION AND OUTCOME:

A treatment plan aimed at restoring normal thoracic and rib joint movement and decreasing inflammation of the chondrosternal joints resulted in lower pain levels. Treatment consisted of diversified high-velocity, low-amplitude chiropractic manipulation; Activator technique; and cryotherapy.


J Chiropr Med. 2011 Mar;10(1):60-3. [PMID:22027210]

Author information: Gijsbers E, Knaap SF. Chiropractor, Private Practice, Hoofddorp, The Netherlands.


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Abstract:

Objective:

The purpose of this article is to describe chiropractic management of a 5-year-old boy with urinary and bowel incontinence.

Clinical Features:

A 5-year-old boy presented with the primary symptoms of a complete lack of bowel and bladder control with prior surgical correction for lumbar meningocele, spinal lipoma, and tethered spinal cord. Examination revealed spinal and pelvic dysfunction.

Intervention and Outcome:

Chiropractic treatment methods included using the Activator adjusting instrument and shortwave diathermy to the lumbar spine and sacrum. A total of 5 treatments were initially provided over a period of 4 weeks. After the initial treatment period, he was able to maintain satisfactory control of his bladder and bowel, day and night, for a period of approximately 6 months. A second course of treatments was initiated approximately 6 months later because of a recurrence of bladder and bowel incontinence. Four additional treatments were provided over a period of 4 weeks. This second course of treatment reestablished satisfactory control of bladder and bowel function.

Conclusion:

For this patient, chiropractic care was successful in establishing satisfactory bladder and bowel control.


J Chiropr Med. 2010 Mar;9(1):28-31. [PMID:21629396]

Author information: Kamrath KR. Chiropractor, Private Practice, Hutchinson, MN 55350.


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Abstract

Objective:

To describe the results obtained in three women with breech presentations (In-Utero Constraint) who experienced a turning of the fetus using the Activator Adjusting Instrument (AAI) in conjunction with the Webster’s Protocol.

Clinical Features:

Three women presented to the author’s office specifically for reduction of In Utero Constraint and were found to have subluxations consistent with the Webster analysis and protocol. Interventions and

Outcomes:

Webster’s Technique was administered with the sacral component completed using the Activator adjusting instrument. Each fetus successfully turned within 4 visits. Of the three, two went on to have normal vaginal deliveries while one developed other complications during delivery and required an emergency C-section.

Conclusion:

The Activator Adjusting Instrument was used successfully in these cases to reduce the posterior sacral subluxation component of the Webster In-Utero Constraint Technique.


Journal of Pediatric, Maternal & Family Health – Chiropractic ~ Volume 2010 ~ Issue 1 ~ Pages 18-21

Author information: Drew Rubin, BS, DC, CCSP, DACCP. Private Practice of Chiropractic, Smyrna, GA. Adjunct Faculty, Life University, Marietta, GA.


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