Improvements in chronic cervicalgia, bilateral hand dysesthesia, and lumbar disability with instrument assisted soft tissue mobilization and spinal manipulative therapy
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1
Life University, United States
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2
Independent researcher, United States
Presentation
A 53-year-old female presented to a chiropractic clinic with chief complaints of chronic cervicalgia, bilateral shoulder pain, and bilateral hand tingling. Additional complaints included chronic low back pain, diminished activities of daily living (ADL) such as reaching overhead, grooming, dressing and sitting to standing, and difficulty walking and bending over. Symptomology started in 2013 after two cervical spinal fusion surgeries that included posterior fusion from C3 to T1 and an anterior fusion from C5 to C7 with parallel stabilizing rods and interpedicular screws. Exacerbating factors included two motor vehicle accidents post-surgery. Patient had a history of seizures that were medication controlled.
Findings
Cervical Oswetry Disability Index score was graded 51 percent (severe disability). Lumbar Oswetry Disability Index score was graded 48 percent (severe disability). Bilateral shoulder pain and chronic low back pain were both graded a nine out of ten on the universal pain scale. Neurological exam revealed bilateral hand tingling. All upper and lower extremity deep tendon reflexes were graded +2. Bilaterally, C4 and C5 muscle tests were graded four out of five on the Oxford grading scale. Orthopedic examination revealed the following positive tests bilaterally: shoulder depressor, Yergasons, Codmans, empty can, Neers and Patrick flexion, abduction, and external rotation (FABER). Musculoskeletal exam revealed bilaterally decreased shoulder active range of motion (ROM) by 80 percent and bilaterally decreased passive ROM by 25 percent in all directions. Bilateral trapezius, scalenes, levator scapula and supraspinatus, infraspinatus, teres minor and subscapularis (S.I.T.S) muscle groups were hypertonic. Right hip flexors, right quadriceps and bilateral lower lumbar paravertebral muscle groups were myospasmal. Cervical muscle tenderness was noted bilaterally C5 to C7. Posture analysis revealed high right shoulder, left pelvic tilt and left antalgic lean. Right hip flexor contracture with internal foot flare was noted. Patient was unable to lay prone, supine or on her left side without pain. Her gait was observed to be ataxic. X-ray evaluation revealed diffuse cervical osteopenia, thoracolumbar dextroscoliosis and vacuum phenomenon at L4 -L5 and L5-S1. Anterior and posterior osteophytes were apparent. Grade 1 spondylolisthesis was noted.
Methods
The patient was treated for a period of thirteen visits over a three-month period. Treatment was comprised of instrument assisted soft tissue mobilization (IASMT) and myofascial trigger point therapy which was performed bilaterally on the following muscle groups: trapezius, deltoid, pectoralis major and supraspinatus, infraspinatus, teres minor and subscapularis, erector spinae group, quadratus lumborum, hip flexors and quadriceps. Spinal manipulative therapy was administered in the form of drop and instrument assisted manipulations.
Outcome
The patient reported significant improvement with ADL’s specifically with reaching overhead, grooming, walking and sitting to standing with little to no pain. The patient’s inability to lay prone, supine or on her left side without pain was completely resolved. The patient regained her the ability to stand erect and her gait was no longer ataxic. Right shoulder active ROM returned to within normal limits in all directions with no pain reported. Left shoulder active ROM improved by 20 percent, mild to moderate pain was still present. Bilateral passive ROM improved by 25 percent. The bilateral hand tingling was resolved. The bilateral shoulder pain and low back pain diminished significantly, having decreased from nine out of ten to two out of ten. Cervical Oswestry Disability Index improved from a 51 to a 46 percent (severe disability). Lumbar Oswestry Disability Index improved from a 48 to a 24 percent (moderate disability).
Conclusion
The combination of spinal manipulative therapy and IASMT proved to be a clinically effective approach in the management of chronic cervicalgia, bilateral shoulder pain, low back disability, bilateral hand dysesthesia, and gait ataxia. Further investigation of these treatment strategies is warranted due to the positive outcomes in this case.
Keywords:
Cervicalgia,
Chiropractic,
spinal manipulation,
Dysesthesia,
soft tissue
Conference:
International Symposium on Clinical Neuroscience, Orlando, United States, 24 May - 26 May, 2019.
Presentation Type:
Poster Presentation
Topic:
Clinical Neuroscience
Citation:
Kinard
BL,
Esposito
SE and
Costello Hales
TL
(2019). Improvements in chronic cervicalgia, bilateral hand dysesthesia, and lumbar disability with instrument assisted soft tissue mobilization and spinal manipulative therapy.
Front. Neurol.
Conference Abstract:
International Symposium on Clinical Neuroscience.
doi: 10.3389/conf.fneur.2019.62.00027
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Received:
31 Mar 2019;
Published Online:
27 Sep 2019.
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Correspondence:
Dr. Susan E Esposito, Life University, Marietta, Ohio, 30060, United States, susanesposito@gmail.com