Presenting Concerns:
- Disc bulge with pinched nerve pain radiating into left arm (radiculopathy)
- Neck pain
- Headaches (12 years)
- Vision disturbances.
- Chronic stomach pain
- Chronic joint pain with fibromyalgia diagnosis (5 years)
- Spinal pain
- Hip pain
- Knee pain
- Poor sleep quality
Brief summary:
This patient’s story is difficult to summarize. He is a 44 year old male who presented in October 2012 with chronic pain for eight years, with headache pain for 12 years.
Though some of his chronic pain his preceded his head injury, many of his problems got worse after 2007, when a steel beam hit in the head at work. He was working on all fours, and was struck in the left with enough force to knock him upright. After “walking off” his head injury, his memory, balance, and depth perception began to fail later in the day. With the addition of his speech becoming slurred he was diagnosed with a traumatic brain injury.
His recovery was slow and incomplete and four to five months prior to October 2012 he began to experience chronic stomach pain. He had a history of constipation, requiring a stool softener on a frequent basis.
His stomach pain worsened and he presented to multiple medical doctors and received imaging for his stomach/pelvic pain, and his spinal pain. Imaging was taken in September 2012 at Beaumont Hospital, Royal Oak, Michigan.
An abdominal CT showed no significant source of his stomach pain, and MRI of his spine showed multiple disc bulges and disc tears at different levels.
Imaging Results: See below.
Physical Trauma:
- Traumatic brain injury from work accident five years prior
Structure/Posture Findings:
- Right tilt of the head
- Left list (lean) of neck
- Left low shoulder, with backward rotation
- Left list of spine
- Left functional short leg of 1 inch
- High left hip with forward rotation
- Decreased ability to rotated head to left and right with pain
- Decreased ability to bend head to side on left and right, with pain toward left
- Decreased ability to look up, causing pain in mid- back
- Painful, and tender muscle bundles in left upper neck, right SCM muscle, Scalene muscle group on the right, with spinal tension more dominant on left side
Counter rotation of shoulder and pelvis can place torque into diaphragm and create tension in the viscera of the stomach. Left compression of the spine between the shoulder and hip.
X-Ray Findings:
- Loss of neck curve and loss of disc height
- Neck leaning to left with right head tilt
- Upper cervical (orthogonal) x-ray measurements: right type 2 misalignment
Posture Photos:
- Before and after posture picture on same visit
- Upper cervical correction on 10/19 and 10/23
- No adjustment needed between 10/23 and 11/13
- 11/13 posture photo shows maintenance of structural improvement without pre correction
It is hard to see in this picture, but the counter rotation between the shoulder and pelvis were reduced on the first correction. Also, you will see a darkening of the patient’s shirt between the shoulder blades. At the time of the initial correction he began sweating, the sign of strong autonomic nerve system response.
Chiropractic methods: Orthogonal upper cervical chiropractic care, via National Upper Cervical Chiropractic Association (NUCCA), and Quantum Spinal Mechanics (QSM3)
Outcomes: 90% or greater resolution of abdominal pain by November 2012, with decreased neck stiffness, decreased incidence of headache, neck pain, and left radiating arm pain. Constipation no longer a problem. SF-36 taken at intake (Left, 10/19) and five weeks later (Right, 11/26).
Notes for providers:
- No active/passive rehabilitation or traction
- Low force cervical corrections without extension/rotation to C1 transverse region
- Side posture patient placement
- Soft tissue release of diaphragm supine and mobilization of mid-thoracic spine were also completed on one visit
Previous Imaging:
- Neck MRI: Mild degenerative changes, worse at C6-C7 with posterior disc bulge with a small radial tear; no central canal stenosis; foraminal narrowing on left at C3-C4 and C5-C6
- Mid-Back MRI: Mild degenerative changes; thickening of longitudinal ligament at T6 with distortion of central spinal cord; disc bulge at T7-T8
- Lumbar MRI: Degenerative changes at L4-L5
Abdominal CT: No significant findings