Tuesday, August 16, 2016

Chiropractic effective in chronic pain unresponsive to Physical Therapy

I wanted to share this case with you because it highlights how Chiropractic and physical therapy are different and each excels at different things. Many people, especially primary care doctors, start off with physical therapy because of familiarity. This case is a perfect example of how not considering Chiropractic Care early on can lead to greater expense and a lot of wasted time.

This unfortunate patient had a fish hook go through the front of his ankle in Camp a year ago. He had the typical wound care to avoid infection of the puncture wound.  Shortly thereafter he developed paresthesia (almost like numbness) and tingling in the medial foot.  He also developed ankle pain on walking and he could not partake in running anymore. This was significant for the patient because he was a cross country runner on his school team.

He started care for several months of physical therapy but he's tingling and inability to walk long and run continued. He proceeded to have an MRI which showed nothing of significance aside from mild inflammation around a nerve at the ankle presumably causing the tingling.  

The patient was told he had to wait and that hopefully time will take care of it. This is after a year now! Fortunately for the patient one of the Orthopedic Physicians treating him in Rhode Island had heard of our practice and referred them to our office.

On examination the patient revealed the standing posture with pronation of the feet worse on the right side (another way to say flat feet), right lower hip - suggesting sacroiliac joint dysfunction. Range of motion evaluation revealed a 30% reduction in most ranges of motion especially lifting the toes up towards the head called dorsiflexion. This motion is noteworthy because your foot needs to go in that direction to push off when you're walking or running.

Joint evaluation revealed restricted or stuck joints in the right sacroiliac joint or belt line dimple above your buttock, and the subtalar joint at the ankle. I also located a small nodule or bump next one of the tendons that would reproduce the patient's foot tingling.  Very tight tender muscles were also noted at the right posterior calf, and on the leg muscles above the ankle.

Chiropractic management included correction of the sacroiliac joint and ankle joint dysfunction (chiropractic adjustments),  soft tissue mobilization/massage trigger point therapy of the leg muscles, myofascial release of the nerve at the ankle, (IASTM - instrument -assisted soft tissue mobilization that uses dull edge steel foods and ointment used to  break up scar tissue and properly orient muscle and connective tissue fibers).

Immediately after treatment the patient felt a lot better with walking. On the follow-up visit he demonstrated significant improvement in range of motion with only minimal restriction in dorsiflexion (moving foot up).  He was able to walk much better with pain.  

You may watch the follow-up visit with patient testimonial here:

Just one chiropractic manipulation did more then several months of physical therapy.  That's not to say that physical therapy is not effective. Rehabilitative exercise is very important in injury recovery and prevention, however if the structural foundation, (skeleton and joints), is not functioning properly there will be compensatory muscle imbalances that no amount of exercise will correct.  

That is why joint dysfunction chiropractic correction should be one of the first courses of care for musculoskeletal injuries (assuming contraindications like pathology, and severe nerve impingement/compression have been ruled out).  

This is what I tried to explain those not familiar. We do postural screenings in a gym and people will complain of shoulder or other back injuries and then say: "I don't understand why am having this. I exercise!".   If it's not the proper exercise, and the muscles compensate for joint dysfunction, your body will be out of balance and eventually break down some where.

If you're not familiar with chiropractic, or have not been to your chiropractor for a long time, do yourself a favor and go in for an evaluation whether you are in pain or not.  Regular chiropractic care not only optimizes joint mechanics and reduces wear and tear but reduces interference from the nervous system and optimizes function and health overall.