Chiropractic management of a hypertensive patient
Plaugher G, Bachman TR. J Manipulative Physiol Ther 1993; 16:544-549.
Objective: Although many chiropractors may treat patients who have concomitant hypertensive disease, there is a paucity of literature on the nuances of case management for these patients. We report a patient who underwent a course of chiropractic care with a previous diagnosis of chronic essential hypertension.
CLINICAL FEATURES: A 38 year old male presented for chiropractic care with complaints of hypertension, drug-related side effects and lower back pain. He was also receiving concurrent medical care for his hypertension.
INTERVENTION AND OUTCOME: The patient received specific contact, short lever arm spinal adjustments as the primary mode of chiropractic care. During the course of chiropractic treatment, the patient's need for hypertensive medication was reduced. The patient's medical physician gradually withdrew the medication over 2 months.
CONCLUSION: Specific contact short lever arm spinal adjustments may cause a hypotensive effect in a medicated hypertensive patient that may lead to complications (e.g. hypotension). Since a medicated hypertensive patient's blood pressure may fall below normal while he or she is undergoing chiropractic care, it is advised that the blood pressure be closely monitored and medications adjusted, if necessary, by the patient's medical physician.
Chiropractic care of a patient with low back pain associated with subluxations and a Malgaigne-type pelvic fracture
Alcantara J, Plaugher G, Elbert R, Gatterman B. J Manipulative Physiol Ther 2004;27(5):358-65.
OBJECTIVE: To describe the chiropractic care of a patient with a pelvic ring fracture and concomitant subluxations of multiple segments of the spinal column.
CLINICAL FEATURES: A 23-year-old male, after falling down a flight of stairs, was initially hospitalized for fractures of the pelvis. Five weeks posthospitalization, the patient initiated chiropractic care with complaints of severe low back pain with lower extremity involvement. He also complained of neck pain and occipital headache. The patient had several positive low back orthopedic tests with bilaterally absent Achilles deep tendon reflexes. The anteroposterior radiographic view revealed ununited fractures at the left superior and inferior pubic ramus, noted as a type I Malgaigne fracture. Subluxations were detected at the left innominate (ie, fracture-subluxation) and at the patient's lumbar, thoracic, and cervical spine.
INTERVENTION AND OUTCOME: The patient was cared for with contact-specific, high-velocity, low-amplitude adjustments to sites of vertebral and sacroiliac subluxations. The patient's response to care was positive, receiving great pain relief. Less than 3 months after initiating care, the patient returned to work on regular duty.
CONCLUSION: There are indications that patients suffering from the injuries described above may derive benefits from chiropractic care. The practitioner must pay careful attention to issues of biomechanical and vascular stability and adjustment modifications in these types of patients.
Chiropractic care of a geriatric patient with an acute fracture-subluxation of the eighth thoracic vertebra
Alcantara J, Plaugher G, Elbert R, Cherachanko D, Konlande J, Casselman A. J Manipulative Physiol Ther 2004;27(3):E4.
OBJECTIVE: To describe the chiropractic care of a geriatric patient with complaints of midthoracic and low back pain.
CLINICAL FEATURES: A 74-year-old woman sought chiropractic care with complaints of thoracic spinal pain following a fall. Palpation findings included hypertonicity and tenderness along with painful muscle spasms in the paraspinal musculature of the thoracolumbar spine. Limited range of thoracolumbar motion was found on extension and lateral flexion, most notably on right lateral flexion, with pain. Radiographic examination revealed a compression fracture at T8, in addition to spinographic listings. Signs of sprain injury were also detected at T8.
INTERVENTION AND OUTCOME: The patient was cared for with contact-specific, high-velocity, low-amplitude adjustments to sites of vertebral subluxations and at the T8 fracture-subluxation. The patient's response to care was positive.
CONCLUSION: This case report describes the clinical features, care, and results of 1 geriatric patient with a thoracic compression fracture-subluxation treated with specific chiropractic procedures. The patient had an apparent decrease in pain as a result of the treatment. Due to the inherent limitations of a case report, it is inappropriate to generalize this outcome.
Chiropractic care of a pediatric patient with myasthenia gravis
Alcantara J, Plaugher G, Araghi J. J Manipulative Physiol Ther 2003;26(6):390-4
OBJECTIVE: To describe the chiropractic care of a pediatric patient with complaints associated with myasthenia gravis.
CLINCIAL FEATURES: A 2-year-old girl was provided chiropractic care at the request and consent of her parents for complaints of ptosis and generalized muscle weakness (ie, lethargy), particularly in the lower extremities. Prior to entry into chiropractic management, magnetic resonance imaging of the brain and acetylcholine receptor antibody tests were performed with negative results. However, the Tensilon test was positive and the diagnosis of myasthenia gravis was made by a pediatrician and seconded by a medical neurologist.
INTERVENTION AND OUTCOME: The patient was cared for with contact-specific, high-velocity, low-amplitude adjustments to sites of vertebral subluxation complexes in the upper cervical and sacral spine. The patient's response to care was positive and after 5 months of regular chiropractic treatment her symptoms abated completely.
CONCLUSION: There are indications that patients suffering from disorders "beyond low back pain" as presented in this case report may derive benefits from chiropractic intervention/management.
Chiropractic care of a patient with vertebral subluxation and Bell's palsy
Alcantara J, Plaugher G, Van Wyngarden DL. J Manipulative Physiol Ther 01/2004; 27(3)
ABSTRACT: To describe the chiropractic care of a patient medically diagnosed with Bell's palsy and discuss issues clinically relevant to this disorder, such as its epidemiology, etiology, diagnosis, care, and prognosis. A 49-year-old woman with a medical diagnosis of Bell's palsy sought chiropractic care. Her symptoms included right facial paralysis, extreme phonophobia, pain in the right temporomandibular joint (TMJ), and neck pain. Signs of cervical vertebral and TMJ subluxations included edema, tenderness, asymmetry of motion and posture, and malalignment detected from plain film radiographs. The patient was cared for with full spine contact-specific, high-velocity, low-amplitude adjustments (Gonstead Technique) to sites of vertebral and occipital subluxations. The patient's left TMJ was also adjusted. The initial symptomatic response to care was positive, and the patient made continued improvements during the 6 months of care. There are indications that patients suffering from Bell's palsy may benefit from a holistic chiropractic approach that not only includes a focus of examination and care of the primary regional areas of complaint (eg, face, TMJ) but also potentially from significant vertebral subluxation concomitants.
Chiropractic care of a patient with temporomandibular disorder and atlas subluxation
Alcantara J, Plaugher G, Klemp DD, Salem C. J Manipulative Physiol Ther 02/2002; 25(1):63-70
ABSTRACT: To describe the chiropractic care of a patient with cervical subluxation and complaints associated with temporomandibular disorder. A 41-year-old woman had bilateral ear pain, tinnitus, vertigo, altered or decreased hearing acuity, and headaches. She had a history of ear infections, which had been treated with prescription antibiotics. Her complaints were attributed to a diagnosis of temporomandibular joint syndrome and had been treated unsuccessfully by a medical doctor and dentist. High-velocity, low-amplitude adjustments (ie, Gonstead technique) were applied to findings of atlas subluxation. The patient's symptoms improved and eventually resolved after 9 visits. The chiropractic care of a patient with temporomandibular disorder, headaches, and subluxation is described. Clinical issues relevant to the care of patients with this disorder are also discussed.
Chiropractic care of a patient with vertebral subluxations and unsuccessful surgery of the cervical spine
Alcantara J, Plaugher G, Thornton RE, Salem C. J Manipulative Physiol Ther 10/2001; 24(7):477-82
ABSTRACT: The chiropractic care of a patient with vertebral subluxations, neck pain, and cervical radiculopathy after a cervical diskectomy is described. A 55-year-old man had neck pain and left upper extremity radiculopathy after unsuccessful cervical spine surgery. Contact-specific, high-velocity, low-amplitude adjustments (i.e., Gonstead technique) were applied to sites of vertebral subluxations. Rehabilitation exercises were also used as adjunct to care. The patient reported a decrease in neck pain and left arm pain after chiropractic intervention. The patient also demonstrated a marked increase in range of motion (ROM) of the left glenohumeral articulation. The chiropractic care of a patient with neck pain and left upper extremity radiculopathy after cervical diskectomy is presented. Marked resolution of the patient's symptoms was obtained concomitant with a reduction in subluxation findings at multiple levels despite the complicating history of an unsuccessful cervical spine surgery. This is the first report in the indexed literature of chiropractic care after an unsuccessful cervical spine surgery.
Chiropractic management of a patient with myasthenia gravis and vertebral subluxations
Alcantara J, Steiner DM, Plaugher G. J Manipulative Physiol Ther 07/1999; 22(5):333-40
ABSTRACT: The chiropractic management of a patient with myasthenia gravis and vertebral subluxation is described. We discuss the pathophysiology, clinical features, and treatment of patients with these diseases. The 63-year-old male patient suffered from complaints associated with the disease myasthenia gravis along with signs of vertebral subluxation. The patient had an initial complaint of dysphagia. In addition, the patient experienced swelling of the tongue, nausea, digestive problems, weakness in the eye muscles, difficulty breathing, myopia, diplopia, and headaches. Balance and coordination problems resulted in walking difficulties. Contact specific, high-velocity, low-amplitude adjustments were applied to sites of patient subluxation. Myasthenia gravis is no longer debilitating to the patient; he is medication free and has resumed a "normal life." The clinical aspects of the disease, including the possible role of chiropractic intervention in the treatment of patients suffering from myasthenia gravis, are also discussed. This case study encourages further investigation into the holistic approach to patient management by chiropractors vis-a-vis specific adjustments of vertebral subluxation.
Management of a patient with a lamina fracture of the sixth cervical vertebra and concomitant subluxation
Alcantara J, Plaugher G, Abblett DE. J Manipulative Physiol Ther 03/1997; 20(2):113-23.
ABSTRACT: To discuss the chiropractic management of a patient who sustained a unilateral lamina fracture of the sixth cervical vertebra. The patient had suffered cervical trauma from a motor vehicle accident. Clinical evaluation revealed acute global neck pain with associated left arm radiculitis and approximately 75% loss of useful left-arm motor function. The patient also complained of headache and low back pain. Computerized tomography and radiographic findings indicated a left lamina fracture of the sixth cervical vertebra. A rigid cervical collar was prescribed for the patient and specific-contact, short lever-arm, high-velocity, low-amplitude adjustments were applied at the levels of C2, C7 and L5, on different treatment visits, 11 days after trauma. The patient continued to wear the orthosis after each adjustment. The patient recovered from his injury and had no late biomechanical or neurological instability as a result of this management approach. The chiropractic management of a patient who sustained a unilateral lamina fracture of C6 with concomitant subluxations at C2 and C7 is discussed. This case study is the second reported in the scientific literature in which conservative chiropractic methods were applied to a patient with a lamina fracture.
Management of the patient with a Chance fracture of the lumbar spine and concomitant subluxation
Plaugher G, Alcantara J, Hart CR. J Manipulative Physiol Ther 11/1996; 19(8):539-51
ABSTRACT: To document the chiropractic management of a patient who sustained a Chance fracture of the third lumbar vertebra. This case study represents the first report in the scientific literature of such an injury managed through chiropractic methods. An 18-yr-old man complained of low back pain and paresthesia in the lower extremities 10 days after suffering an automobile accident. Examination revealed a large circular edematous area from L1 to L4, tenderness to palpation at the L3 spinous process, reduction in global range of motion at the thoracolumbar region, and positive Lasègue and Kemp tests (bilaterally). Radiographic and computed tomographic scans revealed a Chance fracture of the L3 vertebra. The patient received specific-contact, short-lever arm spinal adjustments delivered primarily at L3 and L5, as well as bracing. Four months after initial treatment, the patient's complaint of paresthesia had resolved and he suffered only occasional minor low back pain. The comparative radiographs demonstrate a reduction in the separation of the fracture fragments. A case report is presented of a patient who suffered a Chance fracture of L3. The patient was eventually managed by chiropractic methods including a specific contact high-velocity thrust procedure administered at the level of the fractured vertebra. The case represents the first known reporting of this type of chiropractic procedure applied to a patient with a Chance fracture.
Missed sacral fracture before chiropractic adjustment
Plaugher G, Alcantara J, Doble RW. J Manipulative Physiol Ther 10/1996; 19(7):480-3.
ABSTRACT: Reports of complications after chiropractic adjustments were administered to the lumbar spine and/or pelvis are rare. This case report provides the events associated with a sacral fracture that was not identified before a side-posture sacroiliac adjustment. The patient suffered from blunt, low back trauma as a result of a fall. Clinical evaluation indicated fixation dysfunction at the left sacroiliac articulation, with minimal edema/tenderness at the inferior portion of the left sacroiliac joint. Initial radiological evaluation failed to disclose the zone 2 sacral fracture because of an underexposed radiograph; thus, the patient was given a diagnosis of a sacroiliac sprain subluxation. A specific contact sacroiliac adjustment that uses the innominate as the short lever arm was administered to the patient in the side-posture position. Two adjustments were administered over 2 days. The patient developed sciatic pain after the second adjustment and subsequently referred herself to a medical orthopedist. Additional plain films were obtained, and a diagnosis of a zone 2 sacral fracture was made. The patient was prescribed bed rest; at 6 wk, her symptoms resolved and she returned to normal activity levels. Fractures of the spine and pelvis need to be considered in a patient who suffers blunt trauma. An adequate radiographic examination is necessary to make the appropriate diagnosis. Failure to diagnose the fracture may lead to complications, because the adjustment is not administered with regard to the biomechanics of the trauma or the actual clinical entity under scrutiny. This case study represents the first report of a complication after a sacroiliac adjustment in a patient who had a zone 2 sacral fracture that was missed in the diagnosis.