A recent case report, the first to emerge from ASRF’s Case Report Project, has been published in the Asia Pacific Chiropractic Journal. The novel report discussed the case of a 30-year-old male who had been diagnosed with Motor Neuron Disease (ALS type) . This devastating and fatal disease is carries a poor prognosis with disease progression usually taking its full course within three years. While research continues to reach for a cure, ways of managing the disease and slowing its progression are imperative.
Sadly, there is a paucity of published literature on chiropractic care for Motor Neurone Disease. One previous case report in existence concentrated on the impact of misdiagnosis on outcomes for a patient who had their Motor Neurone Disease show up atypically. In this case, it was the chiropractor who recognised red flags, which lead to a diagnosis. Sadly, it was too late to slow the progression of the disease.
That’s what makes this present study, authored by chiropractor Liz Ullman in collaboration with ASRF as part of our Case Report Project, a noteworthy one. This time, care was focused reducing subluxations and caring for the nervous system with the aim of slowing disease progression. Upon commencement of a 4-week (initial) course of care, a frank conversation was had with the patient in which the chiropractor stated that she could not “fix” or “cure” MND, and that care would be subluxation-focused and aimed at maintaining nervous system function, quality of life, and function for as long as possible.
His initial presentation showed a classic presentation of MND. He was beginning to experience speech difficulty, and difficulty with upper limb movement.
As his course of care commenced, the chiropractor began using a variety of techniques, modified to accommodate for his level of muscle wastage and bone density. Among the techniques used were SOT blocking, activator methods, shoulder mobilisation, TMJ adjustments and muscle releases, wrist diversified adjustments, Talus traction pull, drop piece adjusting, and gentle diversified technique .
The authors stated that, “The percentage of normal force used was in direct response to the patient’s state of strength and ambulatory ability. While 10% of normal force was used when more muscle wastage was noted, and activator methods were used before gentle manual adjusting in response to the patient’s X-rays and history of concussion, up to 60% of normal force was used when the patient was strong and ambulatory. Lower force was used to avoid ligamentous strain due to decreased muscle support, also taking into account that bone density would likewise be decreasing. The approach to treatment remained dynamic through the two years of care.”
Other areas of focus included lumbopelvic stability to prolong the patient’s mobility as well as glutes, hamstrings and the brachial plexus.
After the four weeks of care, he reported a number of improvements including speech, a reduction in falls, decreased levels of discomfort and pain, a self-reported slowing of functional deficits and increased speed in recovering from viruses (which are known to be dangerous in cases of MND). The patient also noted that, while he usually had difficulty sleeping, he slept quite well after care. His partner also noted that his “claw hand” had disappeared.’
At the conclusion of his 4 weeks of care, the patient opted to continue on under chiropractic care, as he felt it to be of benefit. Two years later, he still continues under care. The patient’s partner remarked that, while he would sometimes skip his other therapy appointments (such as acupuncture or physical therapy), he would never skip his chiropractic appointment.
The patient himself noted that “chiropractic care was of great benefit to him in terms of retaining function, recovering as well as possible from setbacks, and retaining quality of life for as long as possible.” While notable outcomes in this case include the improvements listed above, as his care continued, his other care providers remarked on the slower-than-expected nature of the disease’s progression.
This perhaps, is the most significant takeaway from this case report. Certainly, chiropractic did not cure his MND, but it appears to have slowed its progression, and assisted him in maintaining his quality of life for as long as possible. The patient is now four years post-diagnosis. While the progression of the disease has been inevitable, it has been slower than expected. The impacts of this not only on the patient but on his family is significant but difficult to quantify.
Full details of the case report, including a comprehensive care breakdown, can be found at the reference below. These include techniques, outcomes and a full history. While we certainly have a long way to go before we understand why MND occurs and how it can be cured, this case report certainly shows us that we need to dig a little deeper into how chiropractic care might be of benefit to other MND sufferers.
In MND circles, they say we need to continue on the path of “Care until cure.” Perhaps its time chiropractic took up its role as part of that picture.
- Ullman E, Postlethwaite R, McIvor C. Chiropractic management of a 30-year-old male with Motor Neurone Disease: A case report. Asia-Pac Chiropr J. 2021;2.3. URL apcj.net/papers-issue-2-3/#UllmanALS