One of the many strengths of chiropractic is the individualised, patient-centred care approach we offer all our practice members. In truth, it may just be why many people present at chiropractic practices in the first place. Here, they are cared for by skilled, caring hands and a chiropractor who looks at their whole picture of health and vitality, not just their presenting symptoms.
As you well know, sometimes providing a patient with the best care involves recommending a multimodal approach. This was the situation in a recently published case report. Published in the Asia Pacific Chiropractic Journal, an ASRF case report centres around the presentation and improvement of a patient following a traumatic injury.
The 38-year-old female presented for chiropractic care following an incident in which she was hit by a bus while riding her bicycle. She was under regular chiropractic care prior to the incident and was used to having a moderate level of activity. She had sustained multiple open fractures of the left tibia and fibula, and bone loss in the diaphysis and distal portion of the fibula, creating approximately 2.3 centimetres difference in leg length. These injuries required her to undergo 5 reconstructive surgeries, after which she presented for chiropractic care.
At the time of her initial presentation and examination, she was using a walker to assist her movement. She also noted low back pain, left lower iliac postural abnormalities, and left sacroiliitis. Her primary reason for seeking care was support in her recovery from the accident and her recent surgeries, and to reduce the risk of losing the affected leg. Other clinical findings noted by the chiropractor included right-convex lumbar scoliosis, left posterior and inferior thoracic rotation, weakness and soft spots in gastrocnemius, adductors, and tibialis muscles. Subluxations were identified at multiple levels throughout the spine.
Due to the severe nature of her injuries, the chiropractor thought the best approach to care was to break the aims of care into stages.
- Stage one: conservative management of pain, facilitation of mobility, reduction of stress due to load on the sacrum and pelvis, and muscle facilitation in the lower limbs
- Stage two: improve mobility, gait, and load in the pelvis, sacrum, and lower limbs. Facilitate ergonomic postures for simple exercises, transfers, and activities of daily living.
- Stage three: maintenance and monitoring. This included correction of segmental limitation of movement and empowering for load, power and resistance in lower limbs.
“She received platelet-rich plasma from her Primary Care Physician to support her recovery and to aid in the facilitation and adaptation of new tissue and recovery in grafting and surgeries. Physical therapy was also deployed in relation to mobilistion, walking, recovery of balance, and muscle strength.”
Adjustments began with low-force interventions, using advanced Activator™ adjustments, before progressing onto gentle adjustments with the Thompson and upper cervical techniques. In later stages, the patient was able to tolerate HVLA adjustments using Gonstead and Diversified techniques.
At the time of publication, the patient was performing light-load physical activity, undertaking regular cycling, and taking part in CrossFit three times a week with a prior check-up and adjustments once a week. She was also doing supervised rehabilitation, recovering her walking ability, muscle strength, and balance. This in itself is significant, given the severity of her injuries. Additionally, the following outcomes were noted:
- A change from 23mm to 16mm difference in leg length
- Left pelvic deficiency was now only minor when compared to when she initially presented for care, having changed from 18mm to 11mm.
- She reported recovered functional capacity, strength, and sensitivity in her left leg, as well as her ability to undertake activities of daily living.
- She no longer needed to use a cane as much, and cycling became her preferred method of transportation.
- She regained a dynamic life and continuously talks about the chiropractic and multidisciplinary experience
- The patient also did not lose her limb!
While the multidisciplinary approach means that the benefit was not achieved by, or cannot be attributed to, chiropractic alone, it is a great report of the improvement that can be achieved by the cooperation of multiple care modalities. Sometimes, when there is significant trauma or pathology, a multimodal approach is best. In this particular case, her surgeons worked in a multidisciplinary manner, recognising the contributions that other areas of care given to this type of post-traumatic case.
That being the case, it is always important to come back to the main benefit – that of a person with a complex, traumatic injury regaining her quality of life, and participating in exercise, recreation and other activities once again.
Isn’t that what chiropractic is all about?
- Real-Jiménez CI, Postlethwaite R, McIvor C. Chiropractic and multidisciplinary management of a traumatic injury in a 38 year old female: A case report. Asia-Pac Chiropr J. 2023;3.4. URL apcj.net/Papers-Issue-3-4/#CesarTraumaticInjury