ECU Conference Proceeding’s Abstracts

Introduction: The awareness of sports-related concussions with post-concussion syndromes is gaining exposure in the chiropractic profession. The following case describes a 21-year-old female patient who had a concussion with subsequent post-concussion syndrome symptoms that persisted for five months.

Methods: Along with reduced TMJ functioning the patient presented with some altered cranial nerve findings related to photophobia, contrast sensitivity, and convergence insufficiency. Sacro occipital technique category one and two findings relating to pelvic torsion and sacroiliac joint hypo/hypermobility was found and treated along with cranial and TMJ adjusting. A dentist equilibrated the patient’s mandibular occlusal splint over a 9 week period which was immediately preceded by chiropractic care.

Results: As of March 18, 2014 the patient was completely pain free with no symptoms of lightheadedness, brain fog, or nausea. She has been able to exercise, and has been lifting light weights. She was also able to run five miles. This is a significant improvement given that her symptoms and lack of function were consistent since her accident of September 2013.

Conclusion: Further research is needed to determine whether a subset of post-concussion or head trauma patients may have TMD which is limiting their ability to fully recover function and return to their activities of daily living. Collaborative efforts between emergency room doctors, chiropractors and dentists (with TMD care training) with post concussion patients may help ultimately lead to improved patient outcomes.

Introduction: Low back pain secondary female reproductive problems are the source of frequent consultations to a chiropractor. This case report describes the clinical course, treatment, and response of a female patient suffering from uncontrolled uterine bleeding of over two-weeks duration to the application of sacro occipital technique (SOT) chiropractic adjustments and spondylotherapy. A 37-year-old, nulliparous female presented with a history of back and hip pain, headaches and asthma, as well as nonstop menstrual bleeding for the previous two-weeks that also occurred a few months earlier. The patient indicated that her menstrual cycle has never been “normal”, and since the age of 16 her cycles were of 36-45 days duration with bleeding lasting about seven days. She stated that her periods were often accompanied with migraines and significant cramping. Prior to her visit, she had been seen by her gynecologist with unremarkable findings observed on ultrasound and normal hormone levels, however the patient noted, “it is incredibly uncomfortable to bleed for that long.”

Methods: Three complementary methods were utlized for this patient’s specific menorrahagic condition which included of SOT category-two supine block placement, adjustments (with activator instrument) to the lumbar spine (L1-5) and femoral heads bilaterally. Van Rumpt cranial therapies were used and spondylotherapy was administered to C7 (4-minutes), L3 (2-minutes) and L5 (2-minutes) at a percussive rate of 200-beats-per-minute.

Results: Following the third-office visit the patient reported that the chronic menstrual bleeding had stopped. The patient has returned to this office on 8 other occasions over the past couple years for various reasons (mostly for hip pain), but has had no menstrual or bleeding complaints.

Conclusion: Of interest is that the patient had the menstrual condition for years and her response to care and maintained improvement suggests a causal relationship between her presenting condition and the treatment rendered.

Introduction: Sacroiliac joint dysfunction (SJD) is a common problem in the general population and diagnosis is primarily made with the use of manual orthopedic tests [1,2]. Whether clusters of these tests can be used to accurately diagnose SJD is being studied [3]. This study is designed to assess the validity and specificity of the Arm Fossa Test (AFT), which is part of the Sacro Occipital Technique (SOT) evaluation protocols [4]. This may contribute to the research related to diagnostic tests that assess the specific joint dysfunction related to SJD. An ethics committee at Technikon Witwatersrand (TWR) (now Johannesburg University) approved the study in January 2005.

Methods: To perform the AFT, the examiner tests the responsiveness of the latissimus dorsi muscle on the supine patient, as the examiner successively makes light contact with the upper and lower portions of the left and right inguinal ligaments. The finding of a delayed or slow responding latissimus dorsi muscle is thought to be consistent with sacroiliac hypermobility; whereas a strong muscle points toward either a normal sacroiliac joint or one with sacroiliac hypomobility.

Eighty subjects were selected for the study, 35 females and 45 males. They were sourced from the TWR health clinic. Prior to testing subjects a case history was taken, and they underwent a full sacroiliac regional examination using generally accepted diagnostic techniques. The subjects were then taken to a different room where an assessor tested for SJD using the AFT. This was done by two different assessors, each without knowledge of the other’s results and was therefore double blinded.

Results: Of the 160 sacroiliac joints (right and left side for each of the 80 subjects) evaluated, the AFT correctly evaluated 166 (28 true positives and 88 true negatives). This gives a percentage correlation of 72.5%. The AFT incorrectly evaluated 44 (40 false positive and 4 false negatives) as shown by the misclassification rate of 27.5%. The Kappa Coeffiient, indicated as 0.40, is bordering on a moderate strength of agreement.

Discussion: Since the AFT’s main purpose is to assess the presence of a specific type of SJD hypermobility, it is possible that it is not as sensitive for assessing SJD associated with hypomobility. Yet in several separate studies of various SOT examination procedures including the AFT test, Leboeuf-Yde reported the following for the AFT:

– intraexaminer reliability: high in one study [5] and low in another [6]

– interexaminer reliability: low [6]

– validity: some value in correctly distinguishing a correctly treated from an incorrectly treated group of participants [7]

– validity: in relationship to lumbopelvic pain: sensitivity=54%, specificity=69% [8]

– validity: no relation between side of involved fossa and side of sacroiliac fixation [7].

Conclusion: The AFT clearly has some validity but should not be used on its own as a tool for the diagnosis of SJD but rather as part of a comprehensive diagnostic evaluation of the joint. Further research is needed to determine whether the AFT is better suited for evaluating the subset of patients with SJD that is related to hypermobility or SJD associated with hypomobility.

References: :

1. Arab AM, Abdollahi I, Joghataei MT, Golafshani Z, Kazemnejad A. Inter- and intra-examiner reliability of single and composites of selected motion palpation and pain provocation tests for sacroiliac joint. Man Ther. 2009;14(2):213-21.
2. Hestìk L, Leboeuf-Yde C, Are chiropractic tests for the lumbo-pelvic spine reliable and valid? A systematic critical literature review. J Manipulative Physiol Ther. 2000 (May);23:258–75.
3. Kokmeyer DJ, Van der Wurff P, Aufdemkampe G, Fickenscher TC. The reliability of multitest regimens with sacroiliac pain provocation tests. J Manipulative Physiol Ther. 2002;25(1):42-8.
4. Monk R. Sacro Occipital Technique Manual. Sacro Occipital Technique Organization – USA: Sparta, NC, USA. 2006: 15-87.
5. Leboeuf C, Jenkins DJ, Smyth Ra. Sacro-occipital technique: The so-called arm fossa test. Intraexaminer agreement and post-treatment changes. J Australian Chiropr Assoc. 1988;18(2):67-68.
6. Leboeuf C. The reliability of specific Sacro-occipital Technique diagnostic tests. J Manipulative Physiol Ther. 1991;14(9):512-517.
7. Leboeuf C, Jenkins DJ, Smyth Ra. Sacro-occipital technique: An investigaton i into the relationship between the arm fossa test and certain examination findings. J Australian Chiropr Assoc. 1988;18(3):97-99.
8. Leboeuf C. The sensitivity and specificity of seven lumbo-pelvic orthopedic tests and the arm fossa test. J Manipulative Physiol Ther. 1990;13(3):138-143. br>

Introduction: Orofacial myofunctional therapy, a neuro-muscular re-education of the oral facial muscles, is a modality that promotes the stability of the stomatognathic system.

Case Report: The patient was a 48 year old female referred by her chiropractor, who had heard about OMT by his referring functional dentist. Patient was born with a restricted lingual frenum which may have led to her low tongue-rest position and mouth breathing habit. In a craniofacial evaluation she exhibited an open mouth at rest, was clenching and grinding, and had an overbite, chronic sinus infections, vertigo for eight months, earaches, and intermittent tinnitus.

Method/Intervention: Treatment consisted of jaw stabilization exercises, habit elimination and behavior modification, and re-patterning the oral facial muscles and changing their function for optimal rest position, chewing and swallowing. the tongue does not drop into the airway. .

Results: At a one-week follow up visit, after treatment for jaw stabilization, the patient reported that her pain was gone. Structural support incorporating chiropractic adjustments, along with eliminating habits and muscle re-patterning, led to long term stability.

Conclusion: An interdisciplinary team approach for health care is critical for benefit of the patient and treating the cause of TMJ and obstructive sleep apnea (OSA) related disorders.

Introduction: A 19-year-old male presented with a history of attempting a back flip on a trampoline but landed on his head and compressed his neck. While taking the case history his parent noted that he also had persistent and intense bruxism at night creating significant sounds that would waken others near his room at night.

Methods/Intervention: Evaluation revealed decreased cervical range of motion, category two sacroiliac joint sprain and significant TMJ related findings, relating to a dental class III (protruded) occlusion and concurrent class II (retruded) condylar position. He was treated with sacro occipital technique (SOT) category two block placement, cervical stairstep adjusting, and SOT cranial/TMJ related care.

Results: The cervical spine range of motion and pain improved immediately following the treatment. However the dental presentation suggested a referral to a dentist familiar with functional orthodontics and trained within a dental chiropractic co-treatment methodology.

Conclusion: The purpose of this case report was to illustrate a working treatment program where both chiropractic and dentistry can play an integral part in an attempt to improve patient care and outcomes. Further research is needed to investigate the subset of patients needing chiropractic and dental collaborative care for optimal outcomes.

Background: Lumbar disc injuries to L5-S1 and the accompanying neurological radicular syndrome are one of the most common discogenic injuries to the spine having devastating effects on a patient’s health and well-being. The purpose of this paper is to demonstrate how conservative SOT chiropractic care safely, effectively, and efficiently helped a patient with sciatica believed caused by a 16mm paracentral disc extrusion return to normal functional capabilities in a relatively short period of time with no negative side effects.

Case Study: A 47-year-old female, presented at this clinic with LBP and pain radiated into her left buttock and down her leg to the ankle. She was barely able to walk, could not stand or sit for more than a few minutes. She described the pain as a 9-10 on a pain 1-10 pain scale with 10 being the worst pain imaginable.

Design/Method: Besides the SOT specific protocols, orthopedic, and neurological tests were performed on the patient to determine the most appropriate form of treatment. Upon incorporating the SOT evaluation findings, and the patient’s symptomatology, the determination of an active category three discogenic radicular syndrome with lumbar vertebral involvement was made.

Given the probability of lumbar disc trauma SOT category three pelvic blocking procedures and orthopedic blocking (low force leverage adjusting using pelvic blocks in accordance with SOT indicators) was initiated. Also used was the Step Out Toe Out (SOTO) procedure to determine piriformis involvement and treatment as indicated.

Results: An MRI was performed after 4-weeks to confirm the diagnosis and determine future care. The significant findings of the MRI were: at L3-L4 there is central disc protrusion and annular tear, at L4-L5 a listhesis and disc bulge resulted in mild lateral recess narrowing without significant central narrowing, disc and osteophyte resulting in inferior foraminal narrowing and effacement of fat around the exiting L4 nerve roots and at L5-S1 there was a 16mm left paracentral epidural mass suspicious for disc extrusion, that resulted in effacement of left lateral recess and impingement on the descending left S1 nerve within the lateral recess.

After the initial 2-weeks of care the patient showed marked improvement in her symptomatology and functional ability. By the 3rd-week of care her condition stabilized significantly with 90% reduction of radicular pain. At 1-month the patient continued to make excellent progress, continued to resume normal activities of daily living without pain or discomfort, and 3-months later was able to play golf.

Conclusion: Even with the limitations of this study the significance of the patient’s reduction of pain and improved function, while still having a L5-S1 16mm left paracentral epidural mass, suggests that the care rendered is worthy of further investigation and research.

Clinical Implications: Patients may present with severe LBP and profound limitations and using conservative SOT chiropractic care may help patient’s to recover full function even in the presence of marked MRI findings. Utilizing MRI findings as a means for aggressive high-risk treatment procedures, before instituting chiropractic conservative care, should be reconsidered.

Introduction: Generalized joint hypermobility (GJH) is a hereditary connective tissue disorder characterized by lax joints and the presence of musculoskeletal symptoms. The syndrome has been under-recognized and has only recently been taken more seriously. GJH has been considered a predisposing factor for the development of temporomandibular disorders (TMD). The purpose of this case report is to share a novel protocol for chiropractic and dental treatment of a patient with TMD that presented with concurrent hypermobility of the sacroiliac joint (sacro occipital technique’s category two) and TMJ. Pasinato et al., noted that “as more health-care professionals and patients un­derstand TMJ hypermobility, the more contributions we’ll have to develop a more specific preventive approach to the TMD. Thus, the GJH could be included as a standard diagnostic component of this dysfunction.”

Case History: A 47-year-old female patient presented November 2010 with chief complaints of pain when chewing, jaw pain, limited mouth opening range of motion, and TMJ crepitus. Imaging revealed disc displacement without reduction on left TMJ, and early degenerative joint disease (as well). Following dental evaluation and delivery of a daytime repositioning orthotic and a night deprogramming orthotic, the patient was referred for concurrent chiropractic treatment. Chiropractic evaluation noted pain to the jaw, left leg, right hand and sacroiliac joint.

Methods/Intervention: Dental orthotic therapy was initiated within the first two-weeks, with a daytime and night orthotic, to be worn 24-hours. Referral to chiropractic was initiated after orthotic delivery. After approximately 8-week, when it was determined that capsulitis of TMJ was no longer present, procaine injections were initiated at one-month intervals, followed by prolotherapy. SOT chiropractic and cranial technique care was used for the patient for her sacroiliac joint hypermobility syndrome as well as to the craniomandibular system. Dentally the patient received prolotherapy injections every 2-3 weeks on the side of TMJ adhesions and joint restriction, secondary to the hypermobile retrodiscal tissue. The prolotherapy was also used to create increased retrodiscal tissue tension to start a posterior ‘pull’ on the disc, owning to the anteriorly displaced disc.

Results: The patient had good recovery of TMJ function and was mostly pain-free, had full range of motion in the cervical and lumbar spine, negative sacroiliac hypermobility findings, and could open her mouth greater than 42mm (presented with only 27mm) with normal joint tracking and translation. Supportive chiropractic care was needed due to the patient’s chronic jaw clenching habit and without care would have a tendency to relapse.

Conclusion: Much of the interrelationship between dentistry and chiropractic treatment of TMJ conditions involves an interrelationship between posture and occlusion. Head position, TMJ condylar position, airway space, and posture all seem to work together to create a relationship between occlusion and the body’s position in space.

Clinical Implications: Further research is indicated to determine if patients with GHS, TMD, and sacroiliac joint instability may require the need for dental chiropractic interdisciplinary care. GHS may be an important differential diagnostic component for chiropractic treatment since joint instability may lead to modified treatment application and rehabilitation.

Introduction: Plagiocephaly is general term used to describe cranial asymmetry. Pathologenically, plagiocephaly is classified as synostotic (SP), caused by abnormal sutural development or deformational (DP) (non-synostotic or positional), caused by external forces acting on the cranium. Commonly accepted treatments for DP include alternate sleeping postures, carefully monitoring the child when placed in a prone position, as well as in resistant cases use of cranial orthoses or helmets. Chiropractic -Sacro Occipital Technique (SOT) cranial care might offer a conservative option that is a bridge between alternate sleeping and use of a helmet.

.

Case Report – Assessment: This case report presents a four and a half month old male child presenting at a chiropractor’s office. The child’s working diagnosis was: (1) Occipital condyle compression, (2) Plagiocephaly; and (3) KISS syndrome type 1. Specific SOT cranial treatment was used to correct the child’s presenting plagiocephaly. This patient received 12 treatments over a period of 3 months and showed a significant improvement in head shape.

.

Discussion: DP has some concomitant syndromes that might be coincidental or related in a primary or secondary manner, which include scoliosis, KISS, and torticollis. From a biological plausibility standpoint it would seem that allowing the brain to grow in a symmetrical fashion, balanced stress on vascular membranes, and maintaining normal anchoring of muscular attachments would be beneficial. Recent research has indeed found a relationship between DP and neurodevelopmental delays and that posterior DP may even affect visual field development

.

Conclusion: The purpose of this paper was to offer an alternative view of how DF might be treated in a chiropractor’s office and at what stage intervention might prove effective. Since parents often are not willing to “just wait and see” and are leaning towards some degree of intervention, chiropractic cranial care appears to be a viable intermediate therapy and may facilitate a reduced need for helmet therapy.

Introduction: Obstructive sleep apnea associated with airway compromise has far-reaching social implications. Forward head posture (FHP) also affects a large aspect of the population, and typically is considered associated with the aging process. Various factors have been recently found to be contributory regarding FHP. One in particular is associated with, airway dysfunction contributing to obstructive sleep apnea secondary to temporomandibular joint dysfunction (TMD) and its related myofascial dynamics affecting the oral cavity airway space. The following is a case report of a patient with a complex presentation involving obstructive airway dysfunction, FHP secondary to TMD related and related to ascending and descending patterns of postural influence.

Case Report – The Assessment: 58 year old female was referred for chiropractic care for severe chronic migraines headaches and associated disabilities. She needed daily medication for the headaches (Furinol, Codeine, and Tylenol) which along with prior chiropractic care limited her symptoms but did not resolve them. She had a history of chronic TMJ dysfunction with decades of dental treatment including TM disc implant, multiple tooth implants, and two full mouth reconstructions. Evaluation found significant sacroiliac joint hypermobility syndrome (category two) along with significant apnea associated with an obstructive TMJ dysfunction.

Treatment/Intervention: The treatment involved SOT management of the patient’s primary TMJ dysfunction while stabilizing whole body dynamics and function. SI joint treatment was performed with the patient supine, reducing pelvic torsion and stabilizing the posterior aspect of the SI joint. Cervical treatment involved myofascial balancing methods and cervical stairstep procedures to improve intersegmental cervical function and reducing suboccipital tension. SOT sutural cranial procedures were used to restore symmetrical motion of the craniomandibular muscles. Dental treatment involved developing a nighttime device that assisted in maintaining sufficient airway space associated with mandibular advancing and adequate vertical dimension.

Results: Improved pelvic balance and strength, reduced TM tension, reduced night time apnea episodes associated with reduced FHP were noted by the patient, dentist and chiropractor. Approximately 6-8 weeks into care the patient was able to decrease her medication. With the combined dental and chiropractic care, she was able to reduce chiropractic treatment from 2 times per week for years to 2 times per month. Within 3 months she had eliminated all medications except for occasional flare-ups occurring 4-5 times per year. The goal of having the patient gain independence from chiropractic/dental care with reduced discomfort and increased function was successful.

Discussion: Chiropractors treating both TMD and FHP will need to be able to differentiate the various types of TMD causing airway compromise as well as investigate the various causes of FHP. Patterns of influence to the TMD/FHP can be ascending from the feet, lower extremities, pelvis, spine or neck or descending from the stomatognathic or craniofacial systems, and mediated in either direction by way of visual, vestibular, or somatosensory righting mechanisms. The typical patient that may likely need chiropractic dental co-treatment will have a low pain threshold, low physiological adaptive range, and a history of musculoskeletal joint pain or injuries.

Conclusion: Based on the relationship between the chiropractic and dental approach view of FHP, before dental occlusion or TM condylar modification are performed, reducing ascending postural dysfunction as much possible may optimize dental procedures. Greater research is indicated into the relationship between the various components of FHP to determine if this condition is associated with quality of life and if improvement of the condition will assist the patient with greater function and well being.

Introduction: There have been inquiries by our scientific community to isolate what subset of patients with nonmusculoskeletal conditions might respond to chiropractic care. This paper attempts to facilitate a glimpse into a chiropractic clinical practitioner’s office where nonmusculoskeletal conditions are routinely being treated. Methods: As standard practice of this office an active group of pediatric patients (2000-07) were (n=127) sent a questionnaire via the mail.   For the purposes of this case series children treated for nonmusculoskeletal symptoms (n=37) out of those who responded to the questionnaire were used for this case series. All pediatric patients were treated by the same clinician utilizing sacro occipital technique and cranial pediatric treatments.

Results: 65/127 parents responded from our standard follow up outreach and 37/65 were treated for nonmusculoskeletal presentations. Of the 37 (17♂, 20♀) nonmusculoskeletal pediatric patients, 5 were treated for immune dysfunction, 7 for developmental delays/dysfunction, 9 for birth trauma, 1 for seizure activity, 4 for learning problems, 3 for endocrine problems, 3 for migraines, 2 gastrointestinal issues, 2 for fussiness/agitated/anxiety, and 1 for enuresis.

Discussion: Developing a pediatric chiropractic evidence base for practicing doctors should start with expanding the doctor’s knowledge of pediatric diagnosis and treatment options. The International Chiropractic Pediatric Association and Sacro Occipital Technique Organization – USA have postgraduate certification programs of value to practioners focusing on pediatric care.

Conclusion: To build a representative evidence base it is essential that research into chiropractic treatment of nonmusculoskeletal conditions incorporates successful chiropractic clinical practices treating this subset of pediatric patient.