Usually when we hear about cranial work in the wide world of chiropractic, it has to do with the care of infants and young children. The bones of the cranium are still malleable in the months immediately post birth, and even a gentle touch-and-hold type intervention can create profound changes for the baby. But is cranial work beneficial in adults? Believe it or not, there is anecdotal evidence (including case reports) that indicate it may be of benefit long into adulthood. A new case report published in the Chiropractic Journal of Australia has covered the case of a 48-year-old patient which is certainly of note when it comes to this topic.
It is a noteworthy case report, not only in terms of the techniques used (especially given the paucity of literature around this topic), but also in terms of the nature of the complaint. While many chiropractors are quite familiar with the benefits of cranial care in adults, the people who potentially benefit from such care might not think to check in with their chiropractor for things like a deviated septum, TMJ (temporomandibular joint in the jaw and up near the ear) pain or difficulty breathing through their nose.
Thus, the case report makes for a important contribution to the conversation surrounding the scope and benefit of chiropractic care beyond back and neck pain.
The case report in question involved a male patient who presented for care with complaints that were quite far-removed from any neck, back or typical musculoskeletal complaints. He reported [1]:
- Occluded breathing on the right side of his nose
- Right sided sub-occipital headaches which he “described as migraines occurring once a week and lasting 24-48 hours.
- His headaches severe and did not respond to medication
- His breathing (on the right side of his nose) was rated a 1-2 out of a possible 10, indicating a significant obstruction.
As always, the chiropractor undertook a thorough examination before commencing a course of care. The clinical findings included a nose deviation to the left, the TMJ deviated to the right, and “a right sided side-bending sphenobasilar cranial strain pattern.” The latter is an interesting observation, as the sphenobasilar junction essential joins the base of the occiput (the back of your head/upper neck) with your sphenoid (which is above and behind your temples and cheekbones). While further research would certainly be necessary to make any claims, we can say that a potential connection between headaches, deviated septum and sphenobasilar strain doesn’t take a great leap anatomically.
The chiropractor also noted abnormalities in jaw opening motion, as well as a C1 imblance, along with C7 and T1 imbalances with “spinous rotations … toward the left with right unilateral costotransverse and scalenus muscle mid-belly sensitivity to palpation.”
Essentially, this was a cranium and upper back/neck area that was pulling significantly out of alignment.
A course of care commenced in which the patient received 17 sessions of chiropractic care. The case report notes that the following techniques were part of this course of care:
- Cranial Facial Release
- Cranial Balloon Treatments
- The Sacro Occipital Technique including pelvic blocking
- The use of a sacroiliac joint (SIJ) support belt to stabilise the right SIJ
Happily, the patient responded favourably to chiropractic care and “noted increased/improved breathing from right side and left side of his nose” post cranial fascial release. He rated this as a 7 out of 10 which represented a marked improvement from the original 1-2. He also noted a significant decrease in the frequency and severity of his headaches. They dropped from an 8/10 in pain severity to a 4-5, and dropped from once a week and lasting all day, to once every two weeks. However, as they did not fully resolve, the first chiropractor referred the patient to a chiropractor who specialised in the sacro occipital technique and a dentist who could help with cranio-dental co-treatment.
The dentist focused on TMJ treatment (including a night-time device for the patient to use at home) and used acupuncture, and cold laser therapy. The dentist also noted evidence of Upper Airway Resistance Syndrome which is not uncommon in people with nasal septal defects.
Following this referral and co-management, more positive results were noted. These included [1]:
- Headaches reduced by 80% in frequency, duration and intensity
- Jaw range of motion and alignment improved
- Nasal breathing further improved
- A notable improvement in Upper Airway Resistance Syndrome
While the original course of care is now ceased and the positive improvements noted, at the time of writing, the patient is continuing under care.
While we certainly can’t generalise findings, and the co-management means that some improvements may be attributed to the dental care, there are a few key takeaways from this report. Firstly, the successful collaboration between dentist and chiropractor ought to be applauded. While these modalities are vastly different, they can collaborate quite well for the sake of the patient under care. Secondly, the success in terms of both visual and function changes from occiput to pelvis (SIJ) and especially with regards to the headaches, nasal septum and upper airway makes this case report a notable consideration for people who may suffer from similar issues but may not have considered a chiropractor to be a valuable part of their health plan.
We congratulate the authors on their contribution to chiropractic research.
REFERENCE:
- Shirazi, D., Del Torto, A., Blum, C., (2021). Dental Chirorpactic Non-Surgical Co-treatment of a 48-year-old male patient with a deviated septum, headaches, and TMJ Dysfunction: a Case Report. Vol 48. Number 1. 1-9
