Effective restoration of the normal lumbar curvature and diminishment of pain in a male patient after four months of chiropractic spinal manipulative therapy (SMT)
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1
Cardwell Chiropractic Clinic, United States
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2
Life University, United States
Background:
A forty eight year old male presented to a chiropractic clinic reporting a chief complaint of right chronic sacroiliac joint stiffness that he had experienced for the past twenty years concomitant with low back pain and fatigue.
Methods:
A chiropractic physical examination was performed in which a three dimension visual analytical method with no numerical values was performed, revealing postural distortion. The patient demonstrated an anterior head translation (AHT), right thoracic translation (RTT), right pelvic flexion (RPF), and right head translation (RHT). Treatment of this patient was performed using Chiropractic Biophysics Protocol (CBP)® protocols. CBP® is a postural rehabilitative technique, which is based upon a mathematical model using linear algebraic and engineering principles to measure the postural displacements in a three-dimensionally configured Cartesian plane along three axes (x, y, z). The primary goal of this technique is to restore the human body’s neutral sagittal and coronal position to the ideal spinal posture using spinal manipulative therapy, traction and stretching. The treatment in this case consisted of spinal manipulative therapy (SMT) using a diversified technique of high velocity and low amplitude manual thrusts, which attempt to restore motion, proper spinal alignment along with proper joint function. At each patient encounter, the patient received bilateral cervical, thoracic and lumbar SMT. Within a period of 4 months, the patient received treatment for a total of 26 encounters. A Cox spinal flexion-distraction table was utilized manually in the first two visits, by having the patient lie prone and having the doctor gently apply interspinous pressure. Mechanical Cox flexion distraction was employed in the consecutive visits with treatment time ranging from 4-8 minutes. The Cox flexion-distraction aids by increasing the range of motion of the lumbar region. In addition to Cox flexion-distraction, the patient was also placed on a Spinalator® table that provides muscle relaxation. For the anterior head translation and right thorax translation, a trigger point therapy for the upper trapezius and erector spinal fibers (lumbar region) was applied in an attempt to release the myofacial tissue that creates the postural distortion. Additionally, the patient initially received horizontal cervical traction for five minutes with fourteen pounds of pressure increasing in subsequent visits to fifteen and then twenty pounds of pressure for correction of the postural distortion of the head. The utilization of the Denneroll® spinal orthotic is part of the CBP® protocol used for traction and to help restore proper sagittal alignment of the cervical, thoracic and lumbar region. In this case a small sized Denneroll® was used in seven of the visits for ten minutes in the cervical area. A large sized spinal orthotic Denneroll® was employed in seventeen of the visits. After every SMT, ice was placed in the lumbar region for 10 minutes. At the sixth visit, the patient was assigned left thoracic translation mirror-image® exercises to be performed at home at a frequency of three times per day and to be held for sixty seconds. The mirror-image® exercises, can be defined as having the patient position themselves in the mirror-image position from the position with which they currently present (for example, if they present with their head held in a left translational position, they would hold their head in the right transitional position for a specified period of time). Lastly, the patient was also assigned extension exercises of the cervical and lumbar spine to be performed at home at a frequency of fifteen repetitions per day, held for fifteen seconds each per area.
Results:
Post-radiographic films and visual postural analysis indicated an improved change in the lumbar curvature. Lumbar lordosis is considered normal if its curvature falls within the range of 70º-73º, when measured from a lateral lumbar radiograph from the first lumbar segment (L1) to the first sacral segment (S1) or 40º if measured from L1 to the 5th lumbar segment (L5). Ideally, the sacral base angle (SBA) is considered normal if its measurement is 40º. The initial measurement in this case showed 65º for lumbar lordosis, obtained from a lateral lumbar radiographic film and a SBA of 21º. After the three-month period of care, a post-radiographic film and visual postural analysis were performed to compare initial results. The lumbar lordosis was measured again resulting 70º, with a sacral base angle of 30°, attaining lordosis within the normal range and vastly improving the SBA. The patient reported significant improvement in pain and right sacroiliac joint stiffness by the twelfth treatment visit.
Conclusions:
The effectiveness of the chiropractic intervention for the restoration of the primary curves of the spine along with the reported reduction of pain and stiffness in this case demonstrates the need for continued research in this area.
Keywords:
Posture,
Chiropractic Biophysics Protocol,
lumbar lordosis,
anterior head translation.,
Chiropractic Treatment
Conference:
International Symposium on Clinical Neuroscience: Clinical Neuroscience for Optimization of Human Function, Orlando, United States, 7 Oct - 9 Oct, 2016.
Presentation Type:
Poster Presentation
Topic:
Abstracts ISCN 2016
Citation:
Cardwell
A,
Acosta
M and
Esposito
SE
(2016). Effective restoration of the normal lumbar curvature and diminishment of pain in a male patient after four months of chiropractic spinal manipulative therapy (SMT).
Front. Neurol.
Conference Abstract:
International Symposium on Clinical Neuroscience: Clinical Neuroscience for Optimization of Human Function.
doi: 10.3389/conf.fneur.2016.59.00035
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Received:
29 Aug 2016;
Published Online:
07 Sep 2016.
*
Correspondence:
Dr. Susan E Esposito, Life University, Marietta, United States, susanesposito@gmail.com