Chiropractic Cases

Chronic headaches

Posted by Marc Croker | 3 comments

I have recently treated two women who have suffered from headaches for as long as they could remember.  Nora, a 49 year old woman, reported having migraines since she was a teenager.  Her headaches would last for a few days at a time with pain in and around her eyes.  She would be light sensitive and would have blurry vision.  Nora had no neck pain.

Li, a 41 year old woman, reported having headaches around her forehead for as long as she could remember.  Li had nausea, and vomiting with a throbbing headache.  She reported that vomiting used to relieve her headache but not any more. She also had neck pain and lower back pain.

On examination both women were found to have acute inflammation of the facet joints at C23 with muscle spasm of their sub occipital muscles.  Both women had acutely inflamed rib joints at T4 and tight scalene muscles. Both women were treated using chiropractic manipulation, massage and stretching techniques.

Nora found relief from her headaches after the first adjustment.  She has not suffered from a headache since her first adjustment on the 3 June 2011.  Nora found her headaches were originally preceded by light sensitivity.  She still suffered from some light sensitivity after the first visit but it didn’t result in a headache which she found surprising.  By the fourth visit Nora was no longer feeling any light sensitivity and was generally feeling much better.  She found that she was sleeping better and was beginning to feel less stressed about getting a headache.  It has now been over four months since her last headache.  Nora had a total of 8 chiropractic treatments over the last four months.  Her last visit was 6 weeks ago.

Li has had 6 chiropractic treatments since 10 September 2011.  It took three chiropractic treatments before her headaches disappeared.  It has now been two weeks since her last appointment and she has been headache free and feeling much better.

One of the common things that we find with pain is that the longer you suffer from the symptoms the harder it is to fully alleviate them.  There are of course exceptions to the rule.  Nora and Li are the cases in point.  Here we have two women that have suffered from headaches for decades and their symptoms were completely alleviated within a few treatments.  So what was the cause of their headaches?  In most cases there is inflammation of one of the joints of the upper cervical spine.  This could have been caused by just about anything.  Once pain and inflammation have started there is often a heightened sensitivity which can trigger headaches from even the slightest stress.  The most common causes of neck pain and headaches are poor sleeping positions, working on the computer and stress.

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3 month old baby girl with a torticollis

Posted by Marc Croker | 2 comments

On 24 May 2011 a three month old baby girl was brought into this clinic by her parents who weren’t actually chiropractic patients themselves.  They had noticed that she couldn’t turn her head to the right side at all.  When she was being changed and when she slept she always had her head turned to the left.  When she was being cuddled she would look at people over her left shoulder but wouldn’t turn her head to look at people over her right shoulder.  This little girl had had a normal uncomplicated delivery and was feeding and sleeping normally.

On examination it was noted that she wasn’t feverish or unwell.  She was generally settled and happy while ever her head was turned to the left.  She became uncomfortable and cranky when her head was turned towards the right side.  On palpation it was found that she had an inflamed and restricted facet joint at C12 (upper neck joint) on the left causing an acute torticollis, and there was a mild inflamed facet joint at T67 (mid rib cage).

These joints were treated using the activator (a non manipulative, low force impulse instrument) over five visits.  After the first consultation this little girls parents noticed that she seemed more settled and happier than normal but hadn’t noticed a great deal of improvement in the amount of movement in her neck.  After two visits she was able to turn her neck to the right better.  Her third visit was eleven days after her first visit and she was able to turn her head to the right with ease although she didn’t have full range of movement.  Her last two treatments were each two weeks apart and her symptoms have fully abated.  She is now able to turn her neck fully to the right without any obvious pain or discomfort.  She is also a happier and more settled bub.

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It hurts to run.

Posted by Marc Croker | 0 comments

A 38 year old woman presented to this clinic in July 2010 complaining of lower back pain and right hip pain.  She reported that the pain had started three months prior without any specific injury.  The pain was initially mild but it was getting worse.  It was stopping her from running which is a passion for her – so much so that she had suffered from stress fractures of her right femur and fibula.  In 2006 she had had three pins inserted into her right leg to stabilise the stress fractures in her femur.

Her initial examination revealed a fairly classic presentation of pain with inflammation of the facet joints of L5S1 and obvious muscle spasm of her right gluteal muscles.  There was no restriction of movement of her right hip joint.  There was increased muscle tension in her calf muscles.

Her treatment consisted of chiropractic manipulation to her lower back, specifically at L5S1, to which she reported feeling better.  However after the 4th treatment there was no additional improvement and the pain was returning as soon as she started running.

Further examination revealed that there was no longer any sensitivity of L5S1 on physical examination but there was tenderness on examination of her sacrum (tailbone).  It was discovered that there was pain and restriction of movement when examining the movement of the right side of her sacrum.

Her fifth treatment consisted of manipulation of her sacrum to which she found immediate relief of her pain.  The crucial test of course was to see how she fared while running.

I was delighted to hear on her sixth visit that her pain had significantly subsided and she was able to run for much longer periods before the pain started to return (and this was only mild pain that she felt that she could push through).  After three more chiropractic treatments all of her pain was completely gone and she was able to enjoy her running again without fear of it starting all over again.

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Tinnitus

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A 54 year old man presented to this clinic in October 2010 complaining of a high pitched ringing sound in his ears.  He had been suffering with this tinnitus for the last eight months.  His GP could not find any medical reason for the tinnitus.  He found that the tinnitus was aggravated by certain neck movements and also by putting pressure on his head.  Thinking that it might be coming from his neck he decided to give chiropractic a chance to alleviate his symptoms.  He had previously seen a chiropractor 20 years ago.  In the last two years he had also suffered from a headache on a weekly or fortnightly basis.  The headache was accompanied by some blurry vision and loss of balance.

The short movie below shows how the middle ear works.

On examination it was found that the tinnitus was aggravated by all movements of his neck and by compression of the cervical spine.  It was found that there was acute inflammation of the C12 facet joint on the right side of his neck and there was muscle spasm and pain in his suboccipital muscles.  He also had acutely inflammed ribs on both sides at the level of T34.  Otherwise the rest of his spine and musculoskeletal system was unremarkable.

An upper cervical adjustment was performed on the initial consultation and there was an immediate relief of the tinnitus in the right ear.  There was no change in the tinnitus in the L ear.  By the third consultation there was a definite improvement in the tinnitus in both ears.  By the fifth and final consultation the patient reported that there was no longer any tinnitus, and that he had complete relief of his headaches.

This patient suffered from subjective tinnitus and the most common cause of this disorder in the absence of any ear pathology is inflammation of the upper cervical spine or inflammation of the tempero-mandibular joint.  It is thought to be the result of abnormal neuronal activity caused by inflamed structures immediately adjacent to the ear canal.

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Neck spur and MVA

Posted by Marc Croker | 0 comments

In November 2002 a 55 year old woman suffered a car accident on the way home from work. She was sitting in the rear of a stationary car with her head turned slightly to the right. The car was rear ended and she had to have the next three weeks off work as she was experiencing neck pain and severe headaches. Her headaches were felt around her forehead on both sides and she had some light-headedness. She saw a physiotherapist three times a week for the next six months.

In May 2003 this woman started to feel severe pain around her right shoulder blade and pain into her right arm. She reported a tingling sensation in the 4th and 5th fingers and numbness in her right index finger. She was unable to turn her head fully to the right and was starting to get some lower back pain and pain in her right hip. She was still suffering from neck pain and headaches.

She presented to this clinic seven months after the accident. On examination this woman could not turn her neck to the right hand side and felt pain in her arm whenever she tried. The examination revealed that she had inflammation of the facet joints of C23, C67, T23 and the rib on the right at the same level, and L5S1. She had limited movement of her neck in all directions together with neck pain and pain in her right arm on most movements.

X rays and CT scans revealed disc degeneration at C45, C56 and C67 with bony narrowing of the foramina where the nerves exit the spine at C56. There were large bone spurs narrowing the spinal canal, the lateral recesses and the exit foramina on both sides. She had recently been told that an operation was needed to remove one of the spurs in her neck.

Chiropractic manipulation was initially performed on the joints below the level of the degeneration, at C67 and some soft tissue massage was also utilised. Her treatments were initially 2-3 days apart and after 6 visits this patient reported feeling pain free for the first time in 7 months. After 11 visits she found that the pins and needles and numbness also went away and that she did not feel the need to have an operation to remove the spur in her neck. Her treatments at this stage were only once per month and incorporated treatment for her upper neck pain and headaches which also subsided quickly.

This woman has continued her chiropractic care for the purpose of good spinal health and to prevent any recurrence of symptoms that may arise due to the degeneration in the lower neck. As of her most recent visit in May 2010 she continues to do well without any of the symptoms that she had sustained from the car accident.

It is important to note that having degeneration or arthritis anywhere in your spine is not necessarily a contra indication to having chiropractic treatment. In many cases the degeneration is not severe and can be successfully treated. In severe cases the arthritis is not the level of the spine causing the pain. It is often a level above or below the level of the arthritis responsible for the symptoms as the degenerated level is simply not moving at all and not capable of being strained. This is unlike the levels above and below that are now working harder than they should be to compensate for the arthritis. It is a common experience for a patient to present with lower back pain without any evidence of arthritis in their lower back but have severe arthritis in the neck without any neck pain.

In summary arthritis should give you a sense of stiffness or a lack of ability to move fully in one or more directions but it shouldn’t be painful. If there is pain associated with spinal arthritis then the painful joints can be treated with manipulation and the patient returned to a pain free state. Joints can only be inflammed if they still have some function left in them.

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Grade IV Spondylolisthesis

Posted by Marc Croker | 0 comments

In March 2010 a 58 year old man presented to this clinic with pain in the left sacro-iliac joint (the left pelvis joint) and pain in the left calf muscle.  He reported suffering with lower back pain intermittently for the last 15 years.  The pain that he felt in the left sacro-iliac joint had been worse for the last two months, there was some pain in the left hip and some tingling in the left calf muscle as well.

When I examined him standing his pelvis was tilted so that the right side was lower than the left.  His lower back looked like it had reversed and was curved backwards rather than forwards.  This man was able to perform all movements without any significant pain but found changing positions difficult.  He reported finding it difficult to roll in bed, get out of bed and get up out of a chair.

The examination took on a really interesting turn when I examined his back while he was lying on his stomach.  For a person that was able to move in all directions without any pain his lower back was very sensitive to touch.  So much so that light pressure resulted in a very sharp sensation of pain and his back was reactively spasming.  Now when people have lower back pain they are often very sensitive to touch but his was very jumpy.  Due to the unusual degree of sensitivity and the reversal of his lumbar curve I sent him off for xrays.

The xrays revealed a Grade IV Spondylolisthesis.  What this means is that the very bottom vertebra just above the tailbone had slipped forward to the point where over 80% of the vertebra was in front of the tailbone below.  This is quite rare and in most people the vertebrae sit precisely on top of each other.  To say that his spine was precariously perched was an understatement.

In this image there are three vertebra that run diagonally down the screen from left to right.  One third up the right side of the image is the tailbone.  This is the bone that should be directly below the other vertebra and should be in the bottom right corner of the image not one third of the way up the picture.

Having made a definite diagnosis of this man’s condition it was time to progress to the treatment.  There is a specific chiropractic adjustment for this condition however the question was would he be able to receive the treatment without aggravating the condition.  There is a specific safety test to make sure that the adjustment is not going to worsen the condition and he passed it so we proceeded to gently adjust him.

After two treatments the patient reported feeling better and after four visits he felt significantly better.  This patient received a total of six treatments and is now symptom free.  His last treatment was two months ago and the symptoms have not returned.  Now to qualify the chiropractic adjustments did not “fix” his back as he will always have a grade IV spondylolisthesis  however the treatment was sufficient to clear out the inflammation that was present and remove his symptoms.  He should now get a chiropractic check up every three to six months to ensure that his symptoms do not return.

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