A thorough history and examination is always an important aspect of the chiropractic experience. We know what we are looking for, and we know the red flags. But a case report appearing in the Journal of the Canadian Chiropractic Association presents a very compelling case for taking note when the symptoms change, or when something just doesn’t feel right.
It covers the case of a 53-year-old man who presented to a chiropractor with lower back pain. This in itself was unremarkable. He was an avid golfer, and lower back pain is not uncommon in this group. What makes this case report particularly interesting though, is that the patient saw is GP first. The GP diagnosed him with a lower back strain, and two days later the man presented to a chiropractor for care.
The chiropractor also performed a thorough case history. It turned out the patient had fallen on his tailbone previously and had an episode of low back pain. In this current flare up, which happened after a session with his personal trainer, he was rating his pain as a 7-8 out of 10 on the numerical pain scale. He also suffered with Crohn’s disease, although he was asymptomatic at the time of writing, and had plantar fasciitis.
At the time of presentation, the chiropractor ascertained that he “did not report any radicular symptoms such as numbness, tingling, or sharp pain, and no changes to his bowel or bladder habits were noted [1].”
After a full examination, full details of which are provided in the original case report referenced below, his course of care began based on a diagnosis of Sacroiliac joint dysfunction. After just two and a half weeks, the patient reported “a 60% improvement in his pain.” He did report another symptom though: pain in the midline of his buttocks that got worst toward the end of the day and felt like it was separating.
However, as he could now golf again, things seemed trending in the right direction. The same was true at the four-week mark at which the pain in his sacroiliac joint was “almost resolved.” However, there was now hamstring tendinopathy to deal with.
The Plot Twist
At seven weeks, this case report took at turn. His pain was now worse, whether sitting, standing or lying down. It was now pulsating in nature but there were “no radicular symptoms, night sweats, changes in gait, or changes to bowel or bladder function.” By nine weeks, the original trend towards improvement had disappeared and he was now in terrible pain at the end of the day and felt “constant pressure in his upper gluteal and sacral areas.”
The chiropractor, at this point, recognised some concerning factors and requested the patient return to his GP and request imaging. It was at this point that the patient was diagnosed with Kappa (κ) Light Chain Multiple Myeloma.
Why does this case report matter, then, if the patient was diagnosed with a rare cancer? The fact is that Multiple Myeloma (MM), especially this particular strain of it is difficult to diagnose. Thus, sufferers often find out about their condition after significant delays. The authors of this case report cited research stating that “Out of 24 common cancers, patients with MM experiences the greatest diagnostic delays in primary care.” They went on to say that “this delay may be directly related to primary care providers focusing on acute problems and therefore overlooking myeloma symptoms.” It seems easily done, as MM symptoms can be hard to spot.
This particular patient had Crohn’s and back pain, and these two existing in the same patient makes sense. In this particular case though, the chiropractor routinely assessed signs and symptoms as part of thorough evaluation and care. The simple act of noticing when something wasn’t right and sending the patient back to their GP for scans meant that this particular case was diagnosed when it was just stage 1. While the chiropractor certainly makes no grand claims, and does not take credit for the early diagnosis, it does raise and important point.
Chiropractors are trained to notice. Thankfully, in this case, they did.
REFERENCES:
[1]. Belchos, M., Kumar, V., and Weis, C., (2020). Rare Subtype of multiple myeloma presenting as sacroiliac joint pain in an avid golfer: a case report. Journal of the Canadian Chiropractic Association. 64(3) https://36febd2e085i4aafwh1r32m2-wpengine.netdna-ssl.com/wp-content/uploads/2021/01/119476-1_Chiro_64_3j_Belchos.pdf
