Chronic neck pain, headaches, involuntary neck muscle contractions, and a tremor on the right side: these were the presenting symptoms of the subject of a recent case report carried in the Journal of Contemporary Chiropractic. But behind the symptoms was a condition not unfamiliar to many chiropractors: a diagnosis of cervical scoliosis and cervical dystonia (or spasmodic torticollis). What sets this case report apart is not necessarily the way the individual responded when subluxations were corrected, but the length of time the patient remained stable while under maintenance care.
The case report, authored by Jason Haas, Paul Oakley and Deed Harrison (all chiropractors), chronicled the case of a 59-year old female patient who presented with cervical dystonia and cervical scoliosis. Radiographs showed a right-sided head translation which lead the attending chiropractor to amend the historical diagnosis of “scoliosis” to “Pseudo-scoliosis” which involves “minimal or no vertebral rotation, whereas true scoliosis shows definitive vertebral body rotation [1].”
In addition to those symptoms noted above, the patient also reported osteoarthritis in her spine and a history of mental illness. She had been treated previously with steroid injections, medication for muscle spasms, and Botox, but reported “no relief [1].”
In this case, the Chiropractic Biophysics ® approach was used to detect and adjust subluxations. As part of the protocol, several orthopedic tests returned positive results. These included cervical compression, cervical range of motion, dermatomal testing (which revealed C6 and C7 dermotomal hypoalgesia”) and palpation along with a visual postural assessment. While full details of the findings can be found at the original report (referenced below), they included the following [1]:
- 35mm forward head posture
- 19mm right head translation
- Mid-neck cervico-dorsal angle of 12 degrees.
- Lower thoracic to vertical angle of 6.4 degrees (images in original case report).
- Severe degenerative joint disease “noted by the decreased disc spacing and anterior osteoarthritic lipping primarily between C5-C7.
- The patient “scored a 36% on the neck disability index (NDI) and rated her pain as 7/10 (0= no pain; 10= worst pain ever) on the numerical pain rating scale (NPRS). A quality of life (QOL) questionnaire (SF-36) showed a physical function component summary score of 65% and a mental health score of 36% (ideal= 100%) [1].”
The treatment came in the form of CBP technique adjustments 24 times over 2 months and then maintenance sessions 20 times over the following 1.5 years. During the original intervention period, the CBP technique interventions included “mirror image ® exercises, drop table adjustments, and lateral translation traction to reduce the asymmetrical head and neck subluxation.” Full details of all interventions can be found in the original case report referenced below.
The paper’s authors remarked that: “This case demonstrates mirror image unilateral head exercise, spinal adjustments and traction methods reduced the lateral head translation cervical spine pseudo-scoliosis in an older patient with cervical dystonia. The patient was treated 3 times weekly for 8 weeks with no home care initially, and the 1.5 year follow-up assessment demonstrated stability of the postural correction and symptom regression with minimal maintenance treatments (1x per month). [1].“
She said, “her neck felt stronger and had greater flexibility and that she was doing well symptomatically since the initial set of treatments.” The follow-up at 1.5 years revealed an unremarkable examination, a decrease in pain (now 2-3/10 on the NPRS) and significant reductions in her postural findings since the initial assessment.
The standard limitations apply, in that this is a single case report and thus generalizations cannot be made. While the original case report did included commentary on other literature available, it did not include follow-up measures of the patient’s quality of life or neck disability measures.
Still, the case report clearly showed the positive impacts of postural and subluxation correction combined with low-level maintenance care over time. This is an encouraging finding indeed.
REFERENCES:
- Haas J, Oakley P and Harrison D (2019), “Cervical Pseudo-Scoliosis Reduction and Alleviation of Dystonia Symptoms Using Chiropractic Biophysics ® (CBP®) Technique: A Case Report With a 1.5-Year Follow Up,” Journal of Contemporary Chiropractic, Vol.2 pp. 131-137, https://journal.parker.edu/index.php/jcc/article/view/83 retrieved 30 September 2019
