Filling in...

Today I filled in for the regular intern on the schedule who was at his graduation ceremony. To know graduation looms for me someday, makes me very excited! I cannot wait to one day open the clinic I have been working on for nearly 6 years! Seeing these interns clock in for their very last time was quite inspiring to see.

A patient presented with neck, thoracic and lumbar stiffness. There was a history of a long bout of heavy coughing, which had caused a few new complaints in the lower anterior ribs as well as the left iliopsoas region. Initially, I suspected a hernia in the left lower abdominal region and perhaps a minor fracture in the right lower ribs. After evaluating the patient, I found no evidence of a hernia and the ribs were not fractured. There was a little tightness in the muscles around the ribs and thoracic spine, but nothing severe enough to suspect anything other than joint dysfunction.

I palpated the patients cervical spine and found segmental restrictions in the C2-C4 region with some lower cervical muscle hypertonicity. I adjusted the restricted segments and performed CRAC stretching (contract-relax-antagonist-contract) to the neck rotators. The cervical spine range of motion became symmetrical and within normal limits post treatment and the patient reported no stiffness or discomfort.

Dr. Roberts adjusted the thoracic spine before I could palpate it, so I did not get a chance to see how affected these segments were from the excessive coughing. She found a lumbar restriction that was causing the patient pain at about L3-L4. She had me palpate it and I found a very obvious restriction. I had the patient lie with the right shoulder down, I pulled the right arm down to add some right lateral flexion, found the segment, added some counter-rotation and the spine adjusted. I didn't have to add a lot of force. The patient sat up and told us the back symptoms and neck symptoms were gone. Next, I had the patient lie face up so that I could stretch the left iliopsoas/rectus femoris muscle. Apparently, coughing caused pain in the groin, so I used coughing to test whether my treatment worked. I used PIR (post-isometric relaxation) stretching on this muscle and checked in with the patient frequently to make sure it wasn't too deep of a stretch. The patient sat up, coughed and said there was no rib or groin pain.

This case is a great example of how the musculoskeletal system is effected by a bad chest cold. Coughing utilizes accessory muscles of inspiration to expel mucous from the lungs and bronchials and if severe enough, the iliopsoas muscle can be recruited abnormally. Interestingly, the lumbar restriction was on the same side of iliopsoas hypertonicity at the level of its origin on the spine. If a large muscle such as the iliopsoas can be affected by coughing, think about the smaller muscles around the spine and how the diaphragm affects the abdomen and rib cage. A chest cold is complicated! Over time, excessive coughing can lead to increased stress on the musculoskeletal system and faulty movement patterns begin. This leads to joint dysfunction and pain during normal daily activities. If the joint issues remain present, they can become more and more painful and eventually become quite debilitating, hence the reason this patient came in for treatment!

Chiropractic care is helping this patient heal from the severe chest cold. Correcting restrictions in movement will take stress off of this patient's body, shifting the focus to the lungs in order to heal. There was no need for anti-inflammatory medications or muscle relaxants for this case, however, if this patient did present to a medical clinic, there would be no doubt pharmaceuticals would be used to treat this patient. A dose of muscle relaxants would be given for the rib, back and groin pain and rest would be prescribed. In turn, the liver would be taxed by the drugs and further stress would be added to an already stressed system.

As you can see, we essentially "cured" this patient's ailment by using manual medicine. Not to suggest manual therapy is a good treatment for a chest cold, but it is theoretically plausible to suggest reducing musculoskeletal stress may reduce the allostatic stress load on the entire system. In that realm, getting adjusted preventatively makes good sense.

Thanks for reading