When most of us are asked to put our hand on our heart, the right hand goes to the left side. It’s a rule of anatomy that is just assumed: our heart is on the left side of our body. Around that is a natural fit for the different organs that sit inside the human torso. Yet in the case of Situs Inversus, there is a complete reversal of all of this. We are dealing with a mirror image of the normal human anatomy. What then does this mean for the chiropractor?
A new case report appearing in the Asia Pacific Chiropractic Journal has covered this fascinating and rare condition – and its more complicated than it seems. Not only is the heart on the opposite side of the body, but the abdominal organs and colon are all in a mirror-image placement, which means that things like the liver and appendix are in the opposite side as-well. Most patients are unaware of their condition, but when complications occur, it can be a confounding factor. It is estimated that only 1 in 10,000 people have this condition and it seems to affect all genders and races equally.
This makes the case report in question an interesting one. The full case report can be found at the reference below, and if you are a chiropractor, it is well worth a full read! But here’s the scoop – the patient in question was a 60-year-old mother of 4 who had been under chiropractic care for more than two decades. She was one of the rarer Situs Inversus patients who was actually aware of her condition for most of her adult life (due to its discovery during a gallbladder removal surgery). Never-the-less, she had a list of ailments that had developed over the years due to asthma, allergies, a traumatic birth and more. She was taking a significant amount of medications to manage these conditions. Up until the point of the case-reports authorship, she had been undergoing spine-only chiropractic care for twenty years.
While she had been managed by numerous chiropractors, family physicians and specialists over the years, her transfer to a new chiropractor triggered a new range of imaging and tests to determine a baseline. At this point, it was found that she had :
- An above average pain threshold
- Significantly decreased range of motion in her lumbosacral (lower back) and cervical (neck) spine. These were also areas of patient-reported chronic pain.
- Sacroiliac joint hypermobility
- Multiple reflex imbalances
- She had sympathetic dystonia in her lower cervical spine (which indicates higher than normal sympathetic tone or activity. The sympathetic nervous system is essential the stress-reactive, fight or flight responses that are a part of our autonomic nervous system.
The last item on this list is potentially significant, as sympathetic dystonia suggests this is not a system at rest. This is a person under long-term strain, and this strain can be either physical, emotional or chemical. But then again, with advanced cervical degeneration, numerous neck and back injuries, spastic colon, anal fissures and a dislocated hip from a traumatic labor, right shoulder pina, pelvic imbalance and a course of 14 medications to manage her conditions, it seems logical that her nervous system would be under the pump.
What then could a chiropractor do to help?
Upon commencement with a new clinic, the chiropractor began treating her with the Blair Upper Cervical (BUC) protocol and the Sacro Occipital Technique (SOT) along with Chiropractic Manipulative Reflex Techniques (CMRT). The latter involves “Palpation of painful regions associated with viscerosomatic [visceral body] reflexes and their reduction following treatment .” The authors go on to say that “CMRT involved occipital fibre neutralization, vertebral adjustment and reflex manipulations to balance reflex arcs between the organ, spine and the autonomic nervous system.”
It is a fascinating case to read in full, as the patient would highlight an issue, the chiropractor would find tenderness in corresponding reflexes and then an improvement would be noted. However, the chiropractor had to perform these palpations in a mirror image to normal. “While the BUS and SOT Category II protocols were as anticipated, the CMRT evaluation and treatment was unusual based on the patients situs inversus presentation.” The authors also noted research that indicated “the normal spine of humans with a situs inversus totalis shows a pre-existent pattern of vertebral rotation opposite of what is seen in humans with normal organ anatomy.” Thus, modified technique was required.
The patient did report a reduction in neck pain and an increase in movement ability. “After 5 visits, SOT protocols indicated an improved capability in bilateral supine leg lift capacity. Arm fossa tests results were continually improving. Also, her right shoulder pain subsided completely and her thoracolumbar junction pain subsided.”
While these are great results, they need to be taken alongside the consideration that 35 years of health concerns and chronic pain don’t disappear overnight. It is worth nothing, however, that it is not only possible to modify techniques to suit differences in anatomy, but it is also possible to gain good results by delivering modified chiropractic care.
- Zablotney, J., and Blum, C., (2021), “Chiropractic care and the Situs Inversus Patient: Modifying technique to match anatomy. A case report.” Asia Pacific Chiropractic Journal. https://www.apcj.net/site_files/4725/upload_files/Zablotney&BlumSitusinversus.pdf?dl=1