WFC’S 10th Biennial Congress. International Conference of Chiropractic Research. Montreal, Canada | Apr 30 – May 2, 2009: 222-3|
Introduction: This case report investigates the therapeutic benefits of utilizing the sacral block to balance sacrospinal and cranial dural tensions ultimately assisting to balance sacral nutation. A relationship between intrathecal tensions, Milgram’s sign, and sacral block technic is also explored. Sacral block technique was initially developed by M. B. DeJarnette in 1976 and was used to treat, when applicable, any related cranial dural imbalance, and was termed, “cranial vault balancing technique.” Since Milgram’s sign is related to intrathecal pressure imbalance, leg lift testing was incorporated to evaluate the effectiveness of the sacral block technic. While reduced sacral nutation is commonly associated with SI fixation (category one) , DeJarnette also found some restriction to sacral nutation with SI joint hypermobility (category two).
Methods: The arm fossa test is an evaluation tool developed by DeJarnette to differentiate between SI joint fixation or hypermobility . He found that SI joint hypermobility, with altered sacral nutation, at the full inspiration or expiration phase of pulmonary respiration, would cause inhibited response during the arm fossa test. With the patient supine the sacral block or wedge would be placed under the sacral apex when there was an inhibited response on inhalation to the arm fossa test and under the sacral base when there was an inhibited response on exhalation. Clinically a relationship was found relating to the patient’s inability to lift their legs when supine, an inhibited arm fossa test with a specific phase of respiration, and improvement of these indicators with sacral block technic.
Case Report: Assessment: A 75 year old male patient who had received chiropractic care since 1989 noted that in mid 2006, his gait and balance started to deteriorate which was of concern since he had a history of diabetic neuropathy in the lower extremities. In early 2007 he was seen for treatment and physical examination findings noted the patient had a positive Milgram’s Test and was unable to lift his legs in a supine position. Treatment/Intervention: During 2007 he was treated approximately 5 times using the sacral block technic and gradually responded to treatment, had improved gait/balance, and was able to lift his legs in a supine position. Three months later, July 2007, the patient returned with inability to lift his legs in the supine position along with some decreased gait/balance functioning. He was adjusted again with the sacral block technic, the gait/balance improved and he could lift his legs. Subsequently while he suffered from some dizziness and knee pain with over exertion, his gait and stability remain improved through the spring of 2008.
Discussion: Sacral nutation involves anterior and posterior cyclic rotation (rocking) of the sacrum focusing at the anterior sacroiliac (SI) joint . Nutation occurs secondary to pulmonary respiration and during walking and is postulated to assist with cerebrospinal fluid mixing from the lumbopelvic cistern cephalward. SI joint fixation secondary to pelvic torsion  or any factor that alters sacral nutation would then purportedly adversely affect CSF circulation and leading to some degree of CSF stagnation and resultant catabolic build-up in the sacrospinal subarachnoid space. The cranial-sacral dural system continues from the periosteal/meningeal cranial dura to the spinal canal ending within the sacrum at the 2nd sacral segment. This dural system also has various myoligamentous connections (Trolard’s Ligament, Thoracolumbar Ligaments of Hoffman, and ligamentum flava), which maintain balanced intrathecal tensions. Any factors limiting sacral nutation would likely alter dural tensions creating ascending influences on the spinal dural space and adjacent spinal subarachnoid space where CSF circulates .
Conclusion: The sacral block technic may be an effective tool for treatment of conditions associated with CSF stagnation secondary to reduced sacral as well as patients with a positive Milgram’s sign. Further study is necessary to evaluate greater clinical correlations to determine the effectiveness of the sacral block technic. While this patient had a significant response to treatment further research is indicated to determine what subset of patients would best respond to this care. Since the treatment represents a low force, low risk intervention further study to evaluate its benefit would be warranted.
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A case study of a 38-year-old female with chronic otitis media and loss is presented. The symptoms subsided and hearing was restored through chiropractic care with an emphasis on cranial adjustments. Chiropractic treatment of chronic otitis media of adults and children as an alternative to tympanotomy and ventilation tubes is discussed.