In our current series, we are examining the evidence behind chiropractic and the senses. From proprioception (our sense of where we are in space), to the more commonly known senses including touch, hearing, and smell. Though we lack RCT’s looking into chiropractic care and each of these, case report data (among other research or hypothesis work) does indicate that restoring optimal function to the nervous system can impact these areas in some cases. Of course, we need to be careful what we claim as we wait the RCT work to confirm and establish the data, but the indications are positive.
It would be a rare health practitioner indeed who has not stumbled upon patients dealing with neuropathies of some sort. Neuropathy is “a disease of or damage to nerves. When it occurs outside of the brain or spinal cord, it is a peripheral neuropathy [1].” A mono-neuropathy affects one nerve while a polyneuropathy affects many. Sensorimotor neuropathy, on the other hand, can be body-wide and systemic – possibly the result of a process that damages anything from nerve cells to axons or even the myelin sheath. Among the causes are inflammation, diabetes, substance abuse, cancer, and a range of deficiencies and syndromes [1].
Conventional treatment is varied, but “pharmacological treatment is recognized as the first-line approach based on current clinical trial recommendations [2].” While the various neuropathies differ in presentation and aetiology, there are several case reports in circulation that indicate chiropractic care can help in some cases.
First cab off the rank is a case report appearing in a recent edition of the Chiropractic Journal of Australia [2]. It followed the case of a 63-year old male who presented with a 4-year history of bilateral lower limb sensory polyneuropathy. This had been previously diagnosed using nerve conduction testing, but was confirmed using a range of tests by the author (chiropractor Dr David Russell).
A novel side note to the study is that it’s the first piece of peer-reviewed, published literature that features Spinal Research’s own definition of the vertebral subluxation. (Thank you Dr Russell!)
In this particular case, though the neuropathy was described as bilateral, the patient felt the cold, tingling sensation in his feet more severely on the right side than the left. He found that lying supine decreased the symptoms, but sitting exacerbated them. Russell performed a thorough examination (discussed in detail in the paper), before administered chiropractic care to correct vertebral subluxations twice weekly over the course of 7 weeks. The method used was full-spine activator methods chiropractic technique.
“During the course of chiropractic care the patient subjectively reported by the 6th visit he had noticed reduction in “tingling” over the shins and a sense of “tingling” over the feet that had previously felt numb. By the 8th visit the sensation over the shins had resolved, and by the 12th visit the numbness in the feet had resolved apart from rare tingling when driving [2].”
“Neurological sensory testing was repeated, revealing patient awareness of sensation to all points of soft touch and pin prick to the L4-S1 dermatomes of the feet,” which had previously revealed no sensation. This coincided with marked improvements in the patient’s vertebral subluxations.
Russell’s case report represents the latest addition to the body of knowledge surrounding chiropractic care and neuropathy. Russell’s work follows a number of other case reports that deal with restoration of sensation. A 2012 case report published in the journal Chiropractic Medicine covered the successful chiropractic management of a 35-year old woman who was suffering from chronic idiopathic meralgia parasthetica (numbness in the right thigh). She described her pain as 8.5 out of 10, and examination revealed bilateral sacroiliac joint dysfunction.
Her course of chiropractic care included pelvic mobilisations, myofascial therapy, transverse friction massage and stretching. After just 3 visits, her neurological evaluation was normal and there was no residual numbness (Full details at included in the case report) [3].
Later, in 2013, Chiropractic Medicine carried another case report covering the successful chiropractic management of a patient with peroneal nerve paralysis [4]. The 24-year old male presented with “nerve paralysis with decreased sensation, severe pain in the popliteal fossa, and steppage gait, which occurred 3 days prior to the consultation [4].” His examination (including MRI) revealed a lumbar disk herniation that had entrapped the peroneal nerve. He did not have any metabolic, inflammatory or infectious diseases, but his vocation caused him to kneel for long periods of time (which potentially caused his injury).
His intervention included 3 sessions over 1 week, and this included chiropractic manipulation and neural mobilization. When the patient returned for re-evaluation at 3 months, he had recovered full function and was pain free. His objective measurements indicated full motor and sensory recovery.
Being that peroneal nerve paralysis is among the most common of the lower limb mononeuropathies [4], this case is significant even though it has limitations (which include no follow-up MRI or EMG). Whilst a RCT would add to our confidence in this area, it isn’t hard to trace the possibilities in terms of chiropractic care and nerve entrapment leading to a peroneal nerve paralysis or similar mononeuropathy. Though we need to exercise caution in terms of what we can confidentially claim, this case study (and others) indicates that there could be something to see here.
So though the evidence is hardly abundant, it is also very much present. There are a number of other case reports and studies in existence as well, and these include:
- Brunelli and Gurson’s “Use of Complementary and alternative medicines by patients with peripheral neuropathy [5],” which studied 180 users of complementary and alternative medicines. 43% of participants suffered from peripheral neuropathy and chiropractic care was used in 21% of cases.
- Bova and Sergent reported on a 24-year old female who had suffered from “intermittent idiopathic right leg parasthesis [6].” Spinal manipulation was reported as an intervention, however it was not described in the report. Alternative therapies, including laser therapy, were reported on.
- Francio presented a case report on a “14-year old female presenting with peroneal nerve neuropathy resulting in right foot drop [7, in 2].” Francio’s case reported the resolution of neurological symptoms after only one visit in which manipulative procedures were performed.
- Morningstar presented a case report covering a 77-year old man with right lower limb parasthesia, confirmed to be L4 and L5 radiculopathy [8]. He received a series of manipulation procedures twice-weekly for 3 months resulting in partial resolution of the neurological symptoms. However, Morningstar did not report on the type of procedure used over the course of chiropractic care.
Of course, case reports are inherently limited and further research is required to counter the limitations of sample size, follow up types and objective measures. However, they do represent an indicator that chiropractic care does have something to offer in terms of restoring nerve function.
In an ideal world, randomized controlled trials would offer us the cause-and-effect generalisations we crave, potentially uncovering the mechanisms that explain the resolution of such symptoms under chiropractic care. While we wait for those, we do have some indicators that chiropractic care has a role here. Until the RCT’s emerge, we will keep our eyes peeled for new case reports to add to the bank of evidence.
References
[1] Staff writer (2017), “Sensorimotor polyneuropathy,” MedlinePlus Medical Encyclopedia, https://medlineplus.gov/ency/article/000750.htm retrieved 2 October 17
[2] Russell D (2017), “Resolution of lower limb sensory polyneuropathy in a 63-year old male receiving activator methods chiropractic technique for the correction of vertebral subluxation,” Chiropractic Journal of Australia, Volume 45, Number 3, pp 218-228
[3] Houle S (2012), “Chiropractic management of chronic idiopathic meralgia parasethetica: a case study,” Journal Chiropractic Medicine, Vol. 11, Iss. 1 March 2012, pp. 36-41, DOI: https://doi.org.au/10.1016/j.jcm.2011.06.008
[4] Villafane J, Pillastrini P, Borboni A, 2013), “Manual therapy and neurodynamic mobilization in a patient with peroneal nerve paralysis: a case report, J. Chiropractic medicine, Volume 12, Issue 3, Pages 176-181
[5]Brunelli B and Gurson K, (2004), “The use of complementary and alternative medicines by patients with peripheral neuropathy,” Journal Neurological Science, 2004 218: pp59-66
[6] Bova J, Sergent A, (2014), “Chiropractic management of a 24-year old woman with idiopathic, intermittent right-sided hemiparesthesia,” Journal Chiropractic Medicine, 2014;(13), pp. 282-286
[7] Francio V, (2014), “Chiropractic care for foot drop due to peroneal nerve neuropathy,” Journal Bodywork and Movement Ther. 2014(18), pp 200-203
[8] Morningstar M (2006), “Improvement of lower extremity electrodiagnostic findings following a trial of spinal manipulation and motion-based therapy,” Chiropr Oestop 2006; 14, 20 http://www.sciencedirect.com/science/article/pii/S155637071300223X
