Chiropractic is a care modality. We nurture and support the nervous system through checking for and adjusting subluxations, and we allow the body to do the rest. While there are a plethora of randomised controlled trials, clinical trials and case reports that look into the wide breadth of possible outcomes tied up with this, there is something that is at the core of chiropractic: every person under our care is unique. So every time we step up to the adjusting table, there is a sacred duty to care for them using the best that research and technique has to offer. Core to this is the history and examination, especially when a new practice member begins care or has a new symptom or life event.
A recent case report drove this home, as an individual presented for care with one complaint that had not resolved under other care modalities. We are about to take you through that case. But it is not the only one in published literature in which a misdiagnosed condition was picked up by a chiropractor, whose thorough history and examination went on to reveal there was something else at the root cause of the problem.
An earlier case involved a diagnosis of juvenile idiopathic arthritis, an autoimmune condition with a very different management plan to the eventual corrected diagnosis – that of pediatric temporomandibular disc dysfunction. [1] Other case reports have hinted that this is not the first time a chiropractor has been able to assist in a patient getting a correct diagnosis, and the great likelihood is that it won’t be the last.
So what happened with this case then?
Case details
A 23-year-old athletic woman presented for chiropractic care with pain in her left shin and intermittent pain in her lower back. She had been struggling with her symptoms for ten years, beginning while she was participating in track and field events. She was assessed and diagnosed with ‘shin splints’ (medial tibial stress syndrome).
Shin splints is a common sport injury that occurs following periods of physical exertion and, if left unresolved, can lead to more serious conditions. Over the course of the ten years, the patient sought care from multiple providers including, medical physicians, chiropractors, physical therapists, athletic trainers, and a nurse practitioner. X-ray and MRI results were unremarkable and the patient had been recommended many treatments including ice, heat, deep massage, electrical stimulation, and exercises; none of which provided any significant relief.
Previous chiropractic care was not related to the shin pain as the patient did not mention it. Instead, care was focused on the neck and upper back during the 16 treatments she received. During the five years previous, she had been participating in competitive pole vaulting, causing the pain to become intermittently worse. She described the pain as a superficial burning and stabbing, and a deep aching. She also reported the pain was most keenly felt when in the launching phase of her vaults, when the left hip and lumbar spine were hyperextended.
The current chiropractic examination (outlined in the case report) revealed no postural abnormalities or asymmetries and the patient had a high overall fitness level. There was no tenderness around the injured symptomatic shin, suggesting there were no stress fractures or periostitis.
The chiropractor considered her symptoms to be consistent with a neuropathy of the terminal branch of the saphenous nerves, although when the nerve was palpated there was no tenderness or exaggeration of symptoms. Following this possibility of neuropathy, sensory testing was completed.
The patient was diagnosed with chronic dynamic inflammatory stenosis of the L4-L5 IVF. Following evaluation, the patient received adjustments two days consecutively, resulting in the ongoing and provokable pain being absent for the two weeks following. The patient was then seen three times a month for 6 months, at which point a re-evaluation was completed. By the third visit the symptom relief was maintained and at the six-month mark, the patient was symptom free, experiencing only a brief episode of back pain.
What this means for chiropractic
While the details of the case may be somewhat unexciting to read, there are a few things to take away from it. The first is that a thorough history and examination is always vital – no matter if the patient is novice to chiropractic, or an old hand at it. You never know what they’re not telling you.
The second is that chiropractors know the nervous system well. This is our area of expertise. To recognise a neuropathy that looks like something else, and to be able to provide a course of care that leads to relief is core a gift to the patient but it is also core to what we do. If anything this case report, and others like it, shows that while we always listen to the advice of other practitioners and take it seriously, if something isn’t feeling right, it is worth further investigation.
The third aspect of this is the contribution that chiropractic care can make not only to the quality of life of a patient, but potentially their ability to perform optimally when it comes to athletic endeavours. We have heard the stories of elite athletes using chiropractors as part of their care regime, and we have research (such as the New Zealand College of Chiropractic studies into bite force, cortical silent period, strength, fatigue and pain) that may hint as to why some people feel they perform better while under chiropractic care.
We have a way to go before these stories and these studies are connected in a way that we can confidently claim a boost to human performance. All we know from this study is that there is one athlete back out on the track and doing better than she was.
What a story to be part of.
Trager, R. J., Vincent, D. A., Tao, C., & Dusek, J. A. (2022). Conservative management of pediatric temporomandibular disc displacement presenting as juvenile idiopathic arthritis: a case report. The Journal of the Canadian Chiropractic Association, 66(1), 92–101.
