CHIROPRACTIC COALFACE

Case histories of interest

FROM THE CHIROPRACTIC COALFACE is a series of interesting case histories from the practice, updated weekly.

OBVIOUSLY NAMES ARE FICTITIOUS.

1. Mr John Mayer reported today that the pain in his chest - actually the joints right adjacent to his breastbone - has completely gone. He's had the pain for nearly two years. His doctor thought at first he had a heart condition, but extensive tests proved negative. Then it must be a gastric ulcer. A gastroscopy and other tests proved negative. He was referred to me for headaches actually, but chiropractors mostly do, and certainly should, do a full examination of the whole musculo-skeletal system. It wasn't rocket science to diagnose a case of Tietze's Syndrome. The headaches I must confess are being more difficult, but then he's had dreadful headaches for twenty years. For ten days after an adjustment he has no headaches, and then they start up again. The good news is that he is using half the headache medication he was three months ago. I was hoping for better ... it can be difficult at the chiropractic coalface.

2. Mr Laflamme consulted me a nastly little problem. Two years ago he fell down the stairs, on his buttocks, from top to bottom. For two weeks he was black and blue, but now for two years, sitting remains very awkward. He has injured his coccyx.

   The coccyx was very tender (deep down in the crease between the buttocks) and interestingly a very marked Sacro-Iliac fixation.

   Nobody was more astonished than I, when he reported yesterday that just one adjustment of the SI joint, and an external manipulation of the coccyx, has decreased the pain by 50%. Miracles we do at once, the impossible takes a little longer! This is rather unusual, a chronic problem like that often requires a proper course of treatment at the Chiropractic Coalface, then rehab, followed by an occasional treatment.

3. A lady in her mid thirties consulted me recently with severe headaches. Whilst she had been suffering for many years, the last three weeks were simply terrible. She was ashen faced.

   Her history revealed one source of the problem (constipation - she had at most one bowel movement in ten days), and the examination revealed two possible causes: an acute left TMJ syndrome, with significant facial pain, and a cervical facet syndrome. She also reported a whiplash injury some ten years earlier.

   Just one treatment of her jaw joint, cleared the severe headache of the last three weeks, but niggling headaches remained. She was reluctant to change her diet, saying my suggestions were too radical, but on further enquiry, it was the recent death of her father from bowel cancer (in his 50"s, also suffering from constipation) that finally convinced her. She reported yesterday that she has had bowel movements of three consecutive days this week since start on my simple and effective constipation treatment. In addition she was experiencing quite significant buttock, lateral thigh and groin pain that is now nearly over since the commencement of treatment of her ilio-tibial band syndrome. At the end of the day, does it really matter whether it was the treatment of her jaw joint at the Chiropractic Coalface, or her neck or the change of diet that is fixing her headaches? Does it really matter whether it was the adjustment of her sacro-iliac joint or the salads, fruit and beetroot that has fixed her constipation?

   She is still having some mild headaches, but no longer takes any medication. Rome wasn't built in a day. Neither were Aachen or Cologne as they say in Holland. Got those three T-shirts? All three are definitely worth a visit.

4. A veteran former national marathon and 800 m champion consulted me with typical lateral knee pain recently. Six months earlier he had orthopaedic procedures done to both knees. The 'kijkoperatie' as they call it here in Holland ("look-operation" or arthroscopy) helped the left knee considerably but did absolutely nothing for the (worse) right leg.

   There were four very significant findings:

   • very restricted dorsiflexion of the right ankle (an old ankle sprain that was never corrected),

   • wasting of the peroneus longus muscle on the side of the lower leg,

   • a fixation in the sacro-iliac joint, and

   • a very positive Noble's test.

   There were also some signs of a patello-femoral pain syndrome.

   To cut a long story short, he is doing very nicely with the iliotibial band stretch (at home) and my treatment of his ankle and sacro-iliac joint. The pain is already about 70% less in about two weeks, and I will allow him to resume training soon. On a flat surface.

   Update: he told me today he ran for the first time in a year this morning - without pain.

   New update: He ran for 30 mins yesterday, without pain. I'm having to restrain him! His best time? A very creditable 2hr, 24 mins, some twenty years ago. We chatted about who will be the first to break the two hour barrier, as Roger Bannister did to the four minute mile.

5. De heer van Hoogendorp has had a very troublesome low back pain. First he went to his doctor, who referred him to physiotherapy. That did not help. His first visit to the chiropractic coalface helped a little, but not that much. Then he consulted me. I can't say that we have had miracles either. It's been hard work over a two month period, with some discouraging times. Nevertheless, the pain in his leg has stopped completely and, while the low back still troubles, he can now sit and ride his bicycle again. We are involved in the rehab program now and we are sort of happy. He is about 70% better. What is particularly encouraging is that the leg pain has stopped completely, so he is out of the clutches of the neurosurgeon, who interestingly has encouraged him to stay at the chiropractic coalface.

   What was the difference? The Derefield test indicated a sacral lesion and, since I have been adjusting the sacrum, he has been improving. He is vigilant about the exercises, and I have no doubt that also helps. An MRI shows significant loss of disc space, and fluid within the body of the vertebra. Deep seated inflammation. I think the Thompson drop table is making the difference.

   Needless to say, the Chiropractic Coalface is an extremely interesting place to work. How many people, with their 60th staring them in the face, are TOTALLY satisfied with their career path!

6. Mrs van Dieren is a very happy lady. She can enjoy intimacy in her marriage again. During the last trimester of her last pregnancy (the child is now 13 months old) she started to develop severe pubic pain. Told by her gynae that it is a normal part of pregnancy, that there was no treatment, and it would resolve after the birth, she quite naturally accepted it. But the pain didn't resolve, and started to spread into the groin and down the inner thigh. Spreading her legs was very painful, and the pain woke her every night. Walking for more than twenty minutes, particularly shopping, was very awkward.

   There was only marginal improvement for the first two weeks of treatment (and the treatment of the groin is very painful), but she stuck it out and yesterday she reported that the condition is 70% better. After only one month of treatment. This is not an unusual complaint, and it's not only related to pregnancy, though pregnant women seem more prone. For more information about this very awkward syndrome, click here.

7. Mr Boersma is a successful middle-aged businessman. He is extremely fit. Last summer (July) he and his family went to a Greek island resort for two weeks. One night he developed severe chest and arm pain (left) and was rushed to hospital.

   An aside: Many people get sick on holiday. Tip: Take a day or two at home before rushing off. And a day at the end of your holiday. Release of stress is the single most important part of a holiday. Should rush and bother getting off on holiday simply add to the stress of life ...

   To cut a long story short, he had exhaustive tests, both in Greece and after returning to the Netherlands. Unfortunately no one thought to do Adson's test , (careful, choose the right test, two are listed here) a standard orthopaedic test that every chiropractor learns at Uni and uses on a daily basis when patients present with arm pain.

   The heart-related tests all proved negative despite further episodes of chest pain and tingling in his left arm, and another midnight ordeal in the Emergency rooms. Almost every night for a whole year he was wakened with tingling in his arm.

   The only significant fact that came out of the history, was that day he played tennis, throwing the ball up with his left hand. This raises the clavicle and first rib, using the scalene muscles in the neck and closes down the so-called Scalene Triangle. Mr Boersma reported yesterday that after only five treatments of the first rib in the neck, over a six week period at our Chiropractic Coalface (he has to travel extensively on business out of Holland), the condition has almost completely resolved. We are now into the rehabilitative part of the treatment to ensure he doesn't relapse. Strengthening the shoulder girdle, and stretching the scalene muscles is important.

   Another aside: His medical insurance company could have saved themselves a small fortune, should they have encouraged their clients to visit the chiropractic coalface. I must remember to ask him to tot up the cost in Euros over the last year of all his medical costs. Sadly there are none so blind as those who will not see. (French proverb)

8. Mrs Juliana, named after a famous Dutch queen, is a very beautiful young woman with a serious problem. Aged 26 whilst on holiday she was involved in a supposedly minor car accident. She had no immediate pain, but within a few months she started to develop headaches, dizziness and inability to concentrate.
   
   An over-achiever, her inability to perform to her previous high standards quickly led to depression and serious self-doubt. Only her husband believed she had a serious problem and stuck by her. All her doctors, even family and friends pooh-poohed that it had anything to do with the accident. She dropped out of work and society and by 31 when she consulted me had become something of a recluse. And when I say beautiful, I mean beautiful, not that has anything to do with it. Whiplash can affect any of us.
   
   Three observations and tests were immediately obvious. Anterior carriage of her neck, a positive Jull's test and a profound fixation of the joint between the base of the skull (called the occiput) and the first bone in the neck (the atlas). An x-ray confirmed the loss of the normal lordosis in the neck (actually a serious kyphosis). She had a history of neck pain, so pre-accident x-rays were available. The injury was immediately evident.

   To cut a long story short, I am having great difficulty restraining Juliana. Free from her headaches and malaise she is painting the town! Last Friday night she and her husband went 'op stap', a Dutch phrase for partying, got involved in street dancing in a local village celebration, and wining and dining not possible since the accident. Needless to say, the chiropractic coalface is a profound place to work.

   Jull's test is particularly significant. It indicates marked weakness of the deep neck flexor muscles, proved many times in research to atrophy and become weak after trauma. She was quite unable to hold her head steady for the required 10s.

   Perfect? Far from it. Rehabilitating back to as near-normal neck as possible, and a bruised ego is going to be difficult. But she's a quite different person to the woman who consulted me two months ago. Body language alone speaks volumes.

9. Elderly Mrs Wiebenga is astonished how only one treatment using the Epley manoeuvres could fix the dizziness and disorientation that she has been experiencing since a very severe attack of Vertigo six months ago. The nasty symptoms went over with her doctor's treatment, perhaps despite his treatment as all the new research says that medication is not the treatment of choice, but the feeling of floating, unsure where her feet were, was very distressing. Now that she walk confidently again, and old problem is rearing its head: pain in the ball of the foot. We're busy there now.
   
   
10. Baby Thomas has been one of those delightful babies to treat at the Chiropractic Coalface. At nearly nine months, he is the exception that proves the rule. Absolutely fine in the day, but even at seven months he was still a demon at night. Not once did he cry in my offices though. Could he really be such a nightmare?

    Some suggest that such little monsters are really the result of poor parenting. But Thomas has four elder sisters. All were angels as babies. His mother is no beginner.

    It all started soon after his birth. And he had a C-section birth, and was breast fed. So what was the cause of all his crying, arching of his back, and driving his parents, and sisters crazy?

    A nasty subluxation of the first rib. He was also having difficulty raising his arm on that side.

    Five treatments over a six week period, and his mother says Thomas is now almost a normal child. I love treating kids. The Chiropractic Coalface is a wonderful place to work. Hard work though, spines can be stubborn. Their owners too!

    Perhaps one day he will grow up and join us at the chiropractic coalface! Mum, do you know what the Rule of Three is?
    
    

11. Mrs van den Hoek* is a youngish woman, mid thirties. She consulted me on the recommendation of a friend. Body language told much of the story, this woman was in severe pain. She had had blinding headaches and severe pain on the side of her face for some six months. A neurologist diagnosed Trigeminal Neuralgia, one of the most painful conditions known to man, and she had to learn to live with the pain. Other than killing the nerve, there is no known treatment. Patients have been known to commit suicide.

    Fortunately, he was wrong. She had a relatively simple Temporo-mandibular joint condition (TMJ). The opposite joint was fixated, and the lateral pterygoid muscle, deep in the pteryoid pocket was red hot. We used to think it a coincidence, but there is a strong neurological link between the upper neck and the TMJ: she also had a severe subluxation of the axis bone in her neck.

    She had an extreme reaction to the first treatment, as I warned her, but within a 10 days she was 50% better. At the Chiropractic Coalface, a bad reaction to a treatment is always hard to gauge. Did I do something wrong? Was there a better way to manage it? Or is the proof of the pudding the only criteria? It's now six weeks since her first consultation (8 treatments) and has no facial pain, though she is still having occasional headaches. We are into the rehabilitation phase (I wrote this page so she could the TMJ exercises correct) and is a different person. TMJ pain can be severe. If for no other reason, the chiropractic coalface is such an interesting place to mine your living, simply because there are so many conditions, joints and syndromes that effect us that can be well managed at the chiropractic coalface. Cured? Not really.

    * Names are for obvious reasons fictitious.
    
    

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12. Two brothers consulted me about a month ago at the Chiropractic Coalface, both around the 60 mark. Brother ONE, let's call him Mr BL, works in a high stress job and broke a basic health decree. RULE I: Before going on holiday, take a couple days rest at home. For you see, many people get sick on holiday, and the solution is to relax for a few days before continuing the mad rush of life, and dashing off on holiday.

    Brother TWO, Mr DL, was suffering from a chronic, debilitating lower back and leg pain. The nagging pain was getting worse, and quite distressing. He also broke another basic health decree. RULE II: Don't ask a family member to treat you. Mr DL lives in a remote part of the Dominican Republic where no mining is occuring at the Chiropractic Coalface, and the doctor's pills weren't helping either. Worse, they were irritating his stomach. His brother, a chiropractor from the Netherlands, was on a family visit.

    Brother ONE, actually Dr BL, developed a very sore back within a day or two of the 12 hour flight, and a nasty bronchitis and high temperature. He tried desperately to do various exercises, about which he was knowledgeable, but to no avail, knowing that he was breaking a third decree! RULE III: Any doctor who treats himself has a fool for a patient and an idiot for doctor. After two days of bed-rest, the bronchitis passed without medication, and although the back eased a little, it continued to trouble him.

    Brother TWO, Mr DL, decided he had no other option. Better ask his brother if he could help. With no adjusting table, Dr BL treated his brother twice on a couch, with difficulty, and gave him a few hip exercises. There were no audible releases from the spine, and they were both disappointed. That is, until Brother ONE received an email this week from Brother TWO: "By the way, my back and R hip are much better. The exercises stop any slight recurrence."

    Brother ONE, struggled for a few days at work and had eventually to consult a colleague for help. After a few consultations at the chiropractic coalface, on a proper chiropractic table, he too is much better, and with the exercises I insist every patient should do, is having little trouble. At the chiropractic coalface you have to be a bully sometimes, goading patients to better health.

    A couch? A proper chiropractic table? It's all in the hands! Enjoy this if you love music. Paste into your browser, you'll enjoy it. "Lay your hands on me."
    Like good music? Go to this link "Lay your hands on me".
    
    

13. Mrs Thomas* confessed that she really didn't believe me when the doctor told her how quickly she would respond to the vertigo that was troubling her. After just a few treatments at the Chiropractic Coalface we managed to clear the debris out of the semi-circular canals and the exercises I have taught her will help her when she has setbacks.

    Chiropractic adjustments of the neck are used to treat dizziness, but with caution, and only after certain tests have proved negative. For more information on the treatment of DIZZINESS and VERTIGO
    
    

14. Mr Jansen was explosively pleased. It's been a tough call at the chiropractic coalface, but then you would expect that with a problem that medicine says chiropractic cannot help. Actually two problems that overlap. Lumbar stenosis of twenty years duration, and progressive arthritis in the hip. Finally Mr J can sleep through the night, he can walk again without excessive pain, though at 75 he's never going to manage 10 kilometres again. Probably not even 5.

    I had to try several different techniques until I found the one that really helped. Fortunately he had the patience to work with me when there was little improvement in the early weeks. He understood well that Rome wasn't built in a day.

    Update: Mr Jansen came for his monthly treatment last week. He stood for a whole day at an exposition last week! He hasn't been able to do that years. He did pay for it, for three or four days, he reported, but of itself, the pain went away.

    Recommendation: Don't let anybody tell you that you MUST have surgery for a hip, or spinal stenosis, before consulting a chiropractor in your neighbourhood. It's true we can't fix them all, but it's certainly worth a try ... the chiropractic coalface, not the knife, is the place to start. You may yet have to have surgery, your chiropractor will advise you.

    Update from the Chiropractic Coalface: Mr Jansen is having difficulties again. It's proving a nuggety case, often what happens when you have two different conditions that conspire against you. In his case, spinal stenosis, and arthritis of the hip.
    
    

    

    
    General information on ARTHRITIS
    
    
    
15. Mrs Tilbury is astonished, and I must admit that I am too, that the pain in her back, and her constipation is 80% better after only three treatments. Mostly with chiropractic, we have to work really hard with chronic cases, but sometimes ... magic happens! The pain in Mrs T's back started some 5 years ago - in the upper lumbar spine. At the same time, she started getting alternating diarrhoea and constipation. There was talk from the internist of an irritable bowel syndrome, even a colitis, that would probably end up with a stoma. 6M months ago the pain in her back became so bad that she could do nothing except cry. Her words. The syndrome of Maigne is one of my favourites. It responds so well at the chiropractic coalface, and interestingly that page gets far more hits on this site than any other. It's why life at the chiropractic coalface is so interesting, and I have no plans to retire.

    Update: Mrs Tilbury is doing fantastically well. Her tum is working regularly. Yesterday she reported she is taking no medication, is eating a healthy diet, with plenty of roughage including beetroot and apples, and has no back pain that she cannot manage herself with the exercise program we have given her. It's fun at the Chiropractic Coalface.

16. Whilst it may seem from this little chiropractic coalface list that every patient has unique and interesting problems, probably 70% of every chiropractor's life is taken up with the humdrum - routine maintenance of the body. There is lots of research showing that an occasional regular treatment helps prevent gradual deterioration again. So we have heaps of people coming in every two or three months for an adjustment.

    We chiropractors are roundly criticised for this, and I confess to having struggled conceptually with maintenance care for many years. I have gradually come round to the opinion that those folk who have an occasional, regular treatment, have fewer problems, and generally less treatment (and money) than those who wait until it is painful again.

    Having said that, there are a good many people who, after a course of treatment, and a faithfully done set of home exercises, have no more troubles for years. They are the exception though.
    
    

PS. Did you get it? Yes, I confess that I am Brother TWO, in case (2). Even chiropractors suffer low back pain when they sit too long, and especially if they start sneezing and coughing.

Been to Rome, Aachen and Cologne? If not, and you love to travel, add them to your next holiday in Europe. You won't be disappointed.

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