Men’s mental health is an issue that typically only gets discussed in Australian circles around November when it’s all about moustaches, prostates, and depression. However, the sad fact is that many men still aren’t aware of common signs that there’s a problem with their mental health. [1] Social expectations, societal norms and a feeling of shame or embarrassment combine with a lack of awareness about the signs of depression, anxiety or other mental health issues to create poor outcomes for men.
That is one reason why creating conversations around this topic in a supportive, connected environment can be an important part of not only awareness but improvement. How can chiropractic help, though? The first answer to that question is simply the supportive, therapeutic relationship between chiropractor and practice member. But research into the matter is a little less common.
In two recent case reports, mental health, coping or mental processing were patient-reported outcomes following subluxation-based chiropractic care. In both cases, the original presentation was for low back pain, but as the care plan unfolded, new outcomes were realised.
The first case – Improvement in self-reported Mental Processing and Quality of Life in a 74-year-old male concomitant with Chiropractic care for low back pain
In the first case, appearing in the Asia Pacific Chiropractic Journal’s recent men’s health edition, a 74-year-old male presented for chiropractic care with a primary complaint of low back pain, headache, and reflux. An active person and a well-being patient in the past, he was living with prostate cancer at the time of presentation – though it was described as ‘low grade and in remission’, and was being managed by his oncologist through ongoing lifestyle change.
Following years of wellness-focused care, the patient commenced a new course of care, with the aim of resolving the low back pain, headaches, and reflux, as well as maintaining his quality of life. As an active member of his community, volunteering in multiple roles, it was important to the patient that he remained physically and mentally capable to contribute meaningfully to his community.
A thorough examination upon commencement of the new care plan revealed several abnormal functional exams and postural anomalies, and subluxations in the cervical, thoracic, and lumbopelvic regions of the spine. Interestingly, a mid-thoracic subluxation was often noted when the patient reported a flare-up in his reflux. As such, the key areas of focus for adjustments were the upper cervical and mid-thoracic regions. The chiropractor used
Diversified Technique, Gonstead Methods, and ABC protocols to deliver care, as well as drop-assisted adjusting and Charrette’s extremity adjusting protocol.
Over the 15 weeks of care, the patient had a steady improvement in functional exams over this period and significant increases in his Insight Station scans. There was also a big decrease in low back pain and a decrease in the frequency and severity of headaches and reflux. But the most notable improvement to the patient was an increase in his ability to mentally process information. He remarked his ability to think quickly and strategically increased, comparable to those who had more education and youth on their side. He noted that ‘It was him in his younger days.
A major benefit of care, to the patient, was Increased mental clarity despite the ever-increasing workload, meaning his productivity was still up, and he was able to fit more into the time he has.
This case report raises some very interesting points about quality of life, in that a person’s ability to connect meaningfully with their community, through whichever means available to them is a major part of the richness and quality of life. The ability to support this through subluxation-based care may be quite meaningful, depending on how the individual responds to care.
The Second Case – Improvement in Forward-Head Posture, Mental Health and Erectile Function in a 42-Year-Old Male under Chiropractic Care
In this case, a 42-year-old male presented for care with the primary complaint of low back pain, extending down the glutes and legs. His main issue was that the pain was limiting his activity level, making his profession, bricklaying, difficult. He had been experiencing worsening pain for approximately five years before presenting for care. Previously he had been able to ‘push through’ and continue to work, worsening the pain.
MRI and CT reports within the past two years indicated disc herniation. Initial attempts at managing the pain included dry needling by a physical therapist, referral to a specialist overseas, and eventually being placed on a surgical waitlist by his general practitioner. Currently taking Panadol Osteo and Nurofen, and Lyrica
He described several major stressors during the initial consultation, including two major car accidents, one of which involved the death of the driver. He had also witnessed a death in the workplace, and his father had passed away.
At the initial presentation, he was unable to walk further than 150 metres and could not work due to the severity of his condition. Also complained of neck pain, and hip issues, and noted he was aware of problems with anxiety, alcoholism, and depression.
His aims for care included the avoidance of surgery, but the chiropractor advised that this case would almost certainly remain surgical but given the wait, conservative management was sensible. The chiropractor considered the high pain levels, concerns for psychological well-being, drinking and smoking history, and significant stressors. The patient was also hoping for improved sleep, increased capacity to walk, and an eventual return to work.
He was adjusted using ABC, SOT, Gonstead and Logan techniques, using a CBP lens to interpret radiographs. Particular focus was given to reflexes and range of motion in the hopes that this would impact sleep quality, pain levels, and self-reported quality of life. Adjusted five times per week for 12 weeks due to the severity of the pain.
This particular patient is another case where someone presented for one issue (back pain) and found another benefit in particular. In this case, the two big benefits were the resolution of erectile dysfunction and the improvement in mental health and coping.
- At the 4-week progress exam, he reported greater ease moving his upper body, and reducing his Lyrica dosage (although initially, that was concomitant with a spike in pain). His self-rated health had increased, and deep tendon reflexes were generally normalising.
- At the 8-week progress exam, pain in his feet and leg radiations were lessening, however back pain was more intense. He had stabilised Lyrica dosage at an 80% reduction of the original dosage. He was now noticing improvements in sleep quality and quantity.
- At a 12-week comparative exam, he was breathing easier and self-reported that circulation had improved, normalising erectile function (a novel finding met with some enthusiasm), improved ability to bear weight on feet and walking easier. Overall subjective quality of life improved significantly, and sense of humour returned. Findings were confirmed by posture photos, physical examination findings, radiographs, and patient self-reports.
The impact of these outcomes on quality of life cannot be understated. Like we often say – chiropractic aims to add years to life and life to years. This case certainly shows the latter can be true.
Both cases cast an interesting light on the humble “low back pain” complaint. These patients are in a group that has been well studied and in which brain changes post-chiropractic care has been seen. Chiropractic care supporting the nervous system led to improved executive functions in both of these cases. Unfortunately, changes in brain activity cannot be shown objectively without fMRI scans, but case report evidence does add weight to the case for further studies. The self-reported changes were significant enough for the patient to note an increase in productivity and attribute it to chiropractic care, but in future cases, a dedicated psychological scale to elicit more3 objective findings would be desirable. The return of reproductive function in the second case is a strong indication of a system returning to normal.
All in all, these cases present a strong argument for the involvement of the local chiropractor in the men’s health discussion. We look forward to seeing what else emerges.
References:
- https://mensline.org.au/mens-mental-health/mens-mental-health-common-challenges/
- Seaman R, Postlethwaite R, McIver C. Improvement in self-reported Mental Processing and Quality of Life in a 74-year old male concomitant with Chiropractic care for LBP: A case report. Asia-Pac Chiropr J. 2023;3.4. URL apcj.net/Papers-Issue-3-4/#SeamanMentalProcessing
Croke O, Postlethwaite R, McIver C. Improvement in Forward-Head posture, Mental Health and Erectile Function in a 42-Year-Old Male under Chiropractic care: A case report. Asia-Pac Chiropr J. 2023;3.4. URL apcj.net/Papers-Issue-3-4/#CrokeErectileDysfunction.
