Archive for category Case Studies

Abstract

OBJECTIVE:

The purpose of this case report is to describe the response to chiropractic care of a pediatric patient with complaints of neck pain; headaches; and hand, leg, and foot pain after head trauma and the reports of changes in the patient’s history of chronic fatigue, vomiting, and coughing.

CLINICAL FEATURES:

A 6-year-old girl was pushed into a playground slide, hitting her head and resulting in acute complaints of her “neck and brain hurting” and hand, foot, and occasional leg pain. In addition, the patient had a several-year history of unexplained fatigue, vomiting, and coughing spells. She had a neck pain disability index of 17.8%; left lateral and rotational head tilt; cervical antalgic lean; loss of cervical range of motion; anterior cervical translation; and spasm, tenderness, trigger points, and edema along the cervical and thoracic spine.

INTERVENTION AND OUTCOME:

The patient was cared for using Activator Methods protocol. After the fifth treatment, all the patient’s symptoms dissipated, with a complete return to normal activity and spinal stability after 9 treatments. At 19 weeks, her spine continued to be asymptomatic; and her neck disability index was 0%.

CONCLUSION:

This case demonstrated that the Activator Method of chiropractic care had a beneficial effect for this pediatric patient.


J Chiropr Med. 2009 Sep;8(3):131-6. [PMID:19703669]

Author information: Roberts J, Wolfe T. HealthQuest Chiropractic, Farmington, ME 04938.


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Abstract

OBJECTIVE:

The purpose of this case report was to describe the observation of the manipulation of the fourth rib followed by the reproducible, rapid return of heart rate to normal in a patient with paroxysmal supraventricular tachycardia.

CLINICAL FEATURES:

A male patient had paroxysmal supraventricular tachycardia. He was evaluated using standard methods of palpation. He was followed over a 6-year period.

INTERVENTION AND OUTCOME:

The patient was treated during episodes of supraventricular tachycardia (SVT) with instrument-assisted manipulation of the fourth rib without treatment of any other segments. Tachycardia was eliminated after rib manipulation within less than 2 minutes. Over a 6-year period, effective control of episodes of SVT was consistently achieved associated with manipulation of the fourth rib.

CONCLUSIONS:

This case study is suggestive of a relationship between SVT and misalignment of the fourth rib. Controlled studies are necessary to validate this observation.


J Manipulative Physiol Ther. 2008 Jun;31(5):389-91. [PMID:18558281]

Author information: Julian MR. Private practice, Reston, VA 20191, USA.

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Abstract

OBJECTIVE:

To describe the chiropractic management of a 30-year-old woman with temporomandibular joint (TMJ) pain and to discuss the general etiology and management of TMJ conditions.

CLINICAL FEATURES:

The patient suffered from daily unremitting jaw pain for 7 years, which was the apparent sequela of a series of 8 root canals on the same tooth. Pain radiated from her TMJ into her shoulder and was accompanied by headache, tinnitus, decreased hearing, and a feeling of congestion in her right ear. Symptoms were not reduced by medication or other dental treatments.

OUTCOME AND INTERVENTION:

The patient underwent a series of chiropractic treatments using the instrument and protocol of Activator Methods, International. During the first 5 months, her VAS rating of jaw pain decreased from 60 (on a scale of 0 to 100) to 9, her ability to eat solid foods increased, headache intensity and frequency diminished, and her maximum mouth opening without pain measurement increased from 22 to 28 mm. Overall, 20 months of chiropractic treatment along with 2 concurrent months of massage therapy yielded slow but continual progress that finally resulted in total resolution of all symptoms except some fullness of the right cheek.

CONCLUSION:

Use of the Activator Methods protocol of chiropractic treatment was beneficial for this patient and merits further study in similar cases.


Altern Ther Health Med. 2005 Nov-Dec;11(6):70-3. [PMID:16320863]

Author information: DeVocht JW, Schaeffer W, Lawrence DJ. Palmer Center for Chiropiractic Research, Davenport, Iowa, USA.

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Abstract

OBJECTIVE:

To discuss 2 patients with Ehlers-Danlos syndrome seeking chiropractic evaluation and management of their disabling musculoskeletal pain and associated disorders.

CLINICAL FEATURES:

Two disabled patients diagnosed with Ehlers-Danlos syndrome had spinal pain, including neck and back pain, headache, and extremity pain. Commonalities among these 2 cases included abnormal spinal curvatures (kyphosis and scoliosis), joint hypermobility, and tissue fragility. One patient had postsurgical thoracolumbar spinal fusion (T11-sacrum) for scoliosis and osteoporosis. The other patient had moderate anterior head translation.

INTERVENTION AND OUTCOME:

Both patients were treated with mechanical force and manually assisted spinal adjustments delivered to various spinal segments and extremities utilizing an Activator II Adjusting Instrument and Activator Methods Chiropractic Technique. Patients were also given postural advice, stabilization exercises, and postural corrective exercises, as indicated in Chiropractic BioPhysics Technique protocols. Both patients were able to reduce pain and anti-inflammatory medication usage in association with chiropractic care. Significant improvement in self-reported pain and disability as measured by visual analog score, Oswestry Low-Back Disability Index, and Neck Pain Disability Index were reported, and objective improvements in physical examination and spinal alignment were also observed following chiropractic care. Despite these improvements, work disability status remained unchanged in both patients.

CONCLUSION:

Chiropractic care may be of benefit to some patients with connective tissue disorders, including Ehlers-Danlos syndrome. Low-force chiropractic adjusting techniques may be a preferred technique of choice in patients with tissue fragility, offering clinicians a viable alternative to traditional chiropractic care in attempting to minimize risks and/or side effects associated with spinal manipulation. Psychosocial issues, including patient desire to return to work, were important factors in work disability status and perceived outcome.


J Manipulative Physiol Ther. 2003 Sep;26(7):448-59. [PMID:12975632]

Author information: Colloca CJ, Polkinghorn BS. State of the Art Chiropractic Center, PC, 11011 S. 48th Street, Suite 205, Phoenix, AZ 85044, USA.

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Abstract

OBJECTIVE:

To discuss a case involving a patient with chronic chest pain, dyspnea, and anxiety. Although resistant to previous treatment regimens, the condition responded favorably to chiropractic manipulation of the costosternal articulations.

CLINICAL FEATURES:

A 49-year-old man had chronic chest pain, dyspnea, and anxiety for over 4 months. The severity of the condition gradually progressed to the point of precluding the patient’s active employment and most physical activity. Prior efforts to treat the condition had met with failure.

INTERVENTION AND OUTCOME:

The patient received mechanical force, manually assisted short-lever chiropractic adjustment of the thoracic spine and, in particular, the costosternal articulations. Adjustments were by means of an Activator Adjusting Instrument II. The patient responded favorably to the intervention, obtaining prompt relief from his symptoms. Sustained chiropractic care rendered over a 14-week period resulted in complete resolution of the patient’s previously chronic condition, with recovery maintained at 9-month follow-up.

CONCLUSIONS:

Certain types of chest pain may have their etiology in a subluxation complex involving the costosternal articulation. Although the possibility of myocardial involvement must be considered with all patients whose symptoms include chest pain, a musculoskeletal involvement, including costosternal subluxation complex, may be the underlying cause of the symptoms in certain patients. When this is the case, chiropractic adjustment may provide an effective mode of treatment. Further study in an academic research venue is merited to investigate the role that conservative chiropractic care can provide for patients with chest pain.


J Manipulative Physiol Ther. 2003 Feb;26(2):108-15. [PMID:12584509]

Author information: Polkinghorn BS, Colloca CJ. Department Faculty, New York Chiropractic College, Seneca, New York, USA.

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Abstract

OBJECTIVE:

To describe a novel orthopedic test (Polk’s test) which can assist the clinician in differentiating between me- dial and lateral epicondylitis, 2 of the most common causes of elbow pain. This test has not been previously described in the literature.

CLINICAL FEATURES:

The testing procedure described in this paper is easy to learn, simple to perform and may provide the clinician with a quick and effective method of differentiating between lateral and medial epicondylitis. The test also helps to elucidate normal activities of daily living that the patient may unknowingly be performing on a repetitive basis that are hindering recovery. The results of this simple test allow the clinician to make immediate lifestyle recommendations to the patient that should improve and hasten the response to subsequent treatment. It may be used in conjunction with other orthopedic testing procedures, as it correlates well with other clinical tests for assessing epicondylitis.

CONCLUSION:

The use of Polk’s Test may help the clinician to diagnostically differentiate between lateral and medial epicondylitis, as well as supply information relative to choosing proper instructions for the patient to follow as part of their treatment program. Further research, performed in an academic setting, should prove helpful in more thoroughly evaluating the merits of this test. In the meantime, clinical experience over the years suggests that the practicing physician should find a great deal of clinical utility in utilizing this simple, yet effective, diagnostic procedure.


J Chiropr Med. 2002 Summer;1(3):117-21. [PMID:19674572]

Author information: Polkinghorn BS. Private Practice of Chiropractic, Santa Monica, CA.


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Abstract

OBJECTIVE:

To describe a case of postsurgical neck pain, after multiple spinal surgeries, that was successfully treated by chiropractic intervention with instrumental adjustment of the cervical spine.

CLINICAL FEATURES:

A 35-year-old woman had chronic neck pain for over 5 years after two separate surgeries of the cervical spine: a diskectomy at C3/4 and a fusion at C5/6. Surgeries were performed 6 months apart in an attempt to resolve persistent neck pain and spasm of the cervical musculature. Neither surgery was effective in relieving the patient’s pain. Five years after the second surgery, a third surgery was recommended by the patient’s physicians to alleviate the chronic pain. The patient sought chiropractic evaluation of her condition to avoid further surgical intervention.

INTERVENTION AND OUTCOME:

The patient was treated with conservative instrumental chiropractic manipulation, consisting of mechanical force, manually assisted short-lever spinal adjustments rendered with an Activator Adjusting Instrument (AAI) II. She comfortably tolerated the treatment and responded favorably to this therapy. All chronic symptoms had resolved within 30 days of instituting the chiropractic instrumental adjustments with an AAI. More interestingly, longitudinal examination over the next 2 years showed that the patient experienced no residual effects or further recurrences of her previous chronic problem after her initial course of chiropractic care.

CONCLUSION:

Chiropractic treatment of postsurgical neck syndrome may be effectively treated, in certain cases, by mechanical force, manually assisted adjusting procedures with an AAI. The use of instrumental adjustment methodology may provide chiropractic physicians with an effective alternative to manual manipulation in those cases in which the patient’s surgical history or presenting symptoms make forceful manipulation of the spine, particularly performed at end range, inappropriate. This approach may be contemplated by physicians faced with managing this type of condition. Further study should be made in this regard, in an academic research setting, to determine the safest and most effective approaches to managing postsurgical patients in a chiropractic setting.


J Manipulative Physiol Ther. 2001 Nov-Dec;24(9):589-95. [PMID:11753333]

Author information: Polkinghorn BS, Colloca CJ. Private practice of chiropractic, Santa Monica, Calif., USA.

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Abstract

OBJECTIVE:

To discuss a case of coccygodynia that responded favorably to conservative chiropractic adjusting procedures with the Activator Methods Chiropractic Technique (AMCT) and the Activator II Adjusting Instrument (AAI II).

CLINICAL FEATURES:

A 29-year-old woman had unremitting coccygeal pain of 3 weeks’ duration. The problem began after she had moved heavy boxes while at work. The pain was characterized by a continual dull ache in the coccygeal region, accompanied by intermittent sharp pain, particularly upon sitting or rising from a seated position. She had been taking self-prescribed over-the-counter analgesics (aspirin and ibuprofen) for 3 weeks without obtaining relief.

INTERVENTION AND OUTCOME:

Treatment consisted of mechanical force, manually assisted, short-lever (MFMA) chiropractic adjusting procedures to the coccygeal area, primarily the sacrococcygeal ligament. The AAI II was used to deliver the adjustment according to diagnostic and treatment protocol specified for AMCT. The patient experienced first treatment.

CONCLUSION:

Chiropractic coccygeal manipulation may be effectively delivered via instrumental adjustment in certain cases of coccygodynia. The use of an AAI II in administering the coccygeal adjustment has the benefit of being a gentle, noninvasive procedure, as well as being comfortably tolerated by the patient. This method of coccygeal adjustment may bear consideration in certain cases of coccygodynia.


J Manipulative Physiol Ther. 1999 Jul-Aug;22(6):411-6. [PMID:10478774]

Author information: Polkinghorn BS, Colloca CJ. Postdoctoral and Related Professional Education Department Faculty, Logan College of Chiropractic, Phoenix, Arizona, USA.

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CLINICAL VIGNETTE:

A 36-year-old male suffered from  severe low back pain. His pain diagram indicated a localized region of  pain around his left lower lumbar region, sacroiliac joint and buttock.  He states that he occasionally feels a slight tingling sensation in his  left posterior thigh, but not distal to the knee. This tingling  sensation only occurs for a few moments once or twice a week. The lower  back pain is daily, and worse in the mornings upon rising from bed.  After he gets to work the pain subsides; but then worsens again by  mid-afternoon. The patient is employed as a car mechanic and must  frequently work bent over the hoods of cars in a flexed position, which  aggravates his pain. He says that occasionally he will get “stuck” in a  position where he is leaning forward and to the right, and that he must  slowly work out his back to be able to straighten up again. He does not  recall any specific low back injury that set off this particular episode  of acute pain, which began insidiously about 3 wks before his first  visit. How- ever, he has had such episodes about once or twice a year  for over 10 yr, and has previously seen chiropractors with fairly good  results.

Physical examination began with lumbar ranges of motion, which  were restricted into flexion at 25 degree, left lateral bending at 15  degree, and left rotation at 10 degree. He exhibited a mild antalgic  lean to the right. He does not walk with an obvious limp, but is  observed to avoid full weight-bearing on his left leg. Kemp’s maneuver  elicited sharp but localized left low back pain over the left L5/SI  facet and sacroiliac joint, with only mild left buttock pain. There was  no reproduction of any left thigh symptoms. Static palpation of the L5  and Sl spinous processes elicited sharp local pain, and motion palpation  P-A over- pressure on the left L5/Sl facet joint also caused sharp  local pain. Muscle palpation revealed some hyper tonicity of the left  erector spinae, quadratus lumborum, and gluteus medius / minimus muscle;  however, no true spasm was detected. Repeated extension in the standing  position elicited some increased pain over the left lumbar facets, but  repeated extension in the prone position afforded the patient some  relief of his low back pain.

Plain film radiographs of the lumbar spine demonstrates about  50% narrowing of the L5/Sl disc space, and a mild right lateral lean of  the lumbar spine. There is no apparent loss or accentuation of the  lumbar lordosis. There is slight rotation of the 15 spinous toward the  left, but no other gross malalignments were noted. He was scheduled for  an MRI by his primary care physician, but the insurance company denied  authorization for the test, citing “lack of compelling medical  necessity” to perform advanced diagnostic imaging tests. Tentative  diagnosis by his primary care physician was lumbar sprain, and he was  given a prescription for Ibuprofen 800 mg t.i.d.


Chiropr Technique Vol. 11, No. 1, February 1999

Author information: Michael J. Schnelder, D.C., James M. Cox,  D.C., Bradley S. Polkinghorn, D.C., Charles Blum, D.C., Harvey Getzoff,  D.C., and Stephan J. Troyanovich, D.C.

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Abstract

OBJECTIVE:

To describe a case of symptomatic lumbar disc herniation, successfully treated via chiropractic intervention using Activator Methods Chiropractic Technique.

CLINICAL FEATURES:

A 26-yr-old man suffered from a chronic multisymptom complex composed of low back pain, left groin pain, left leg pain, left foot drop and associated muscle weakness with atrophy. The symptoms had persisted for more than 2 yr after an athletic injury. Magnetic resonance imaging evaluation revealed a 6-mm focal central disc protrusion with accompanying deformation of the thecal sac, consistent with the presenting symptoms. Lumbar spinal surgery had been recommended to the patient as the appropriate medical management for optimal outcome.

INTERVENTION AND OUTCOME:

The patient elected to pursue chiropractic treatment in an effort to resolve his condition via conservative management. Chiropractic intervention consisted of mechanical-force, manually assisted short-lever adjusting procedures, rendered via an Activator Adjusting Instrument (AAI). The patient responded favorably and his multisymptom complex resolved within 90 days of treatment. No residuals or recurrences were noted at examination over 1 yr later.

CONCLUSION:

This report suggests that chiropractic treatment of lumbar disc disorders may be effectively implemented, in certain cases, via mechanical-force, manually assisted adjusting procedures using an AAI. We speculate that the use of an AAI, combined with Activator methods, may provide definitive benefits over side-posture manipulation of the lumbar spine in treatment of resistive disc lesions, because of the lack of torsional stress imposed upon the disc during instrumental spinal adjustment. Further study should be made in this regard to determine the safest and most effective method to treat lumbar disc lesions in a chiropractic setting.


J Manipulative Physiol Ther. 1998 Mar-Apr;21(3):187-96. [PMID:9567239]

Author information: Polkinghorn BS, Colloca CJ. Private practice of chiropractic, Santa Monica, CA, USA.

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