History:Patient presented to our Kimana Campus complaining of severe lower back pain from L2-S2 with severe immobility, severe neck pain from C0-C5 with limited range of motion, and moderate bilateral leg pain posteriorly into the buttocks and upper posterior compartment of the leg; with significant weakness and inability to ambulate or bear weight. He was nonambulatory and confined to a wheelchair for six months prior to presenting to our campus for chiropractic evaluation and care. The etiology for his non-ambulatory condition was unknown and described as progressive muscular weakness. As a result of his confined condition and gradual loss of bladder function, he had a catheter insertion that had been used continuously for six weeks prior to presentation. Review of systems was unremarkable otherwise. Family health history was unremarkable with no history of neurological disorder, heart disease, or other disease pathology.EvaluationTo evaluate the patient, he required two of his friends to lift him from his wheel chair and place him onto our portable chiropractic table. Jeffrey presented with severe spastic hyperkinetic muscles in his lumbar, thoracic, and cervical regions equally prominent bilaterally. His pain level to palpation in his mid-thoracic and cervical region was rated as a 10 out of 10, lumbar rating was an 8. His deep tendon reflexes were (patellar 0/0), Achilles (0/0), biceps (1/1), brachioradialis (1/1) triceps (1/1). Muscle strength (quadriceps 1/5 Left/1/5 Right), calf (1/5 Right/1/5 Left), hamstring (1/5 Right/1/5 Left), biceps (4/5 Right/4/5 Left), triceps (4/5 Right/4/5 Left). Cranial nerve function was WNL. Dermatome findings revealed mildly decreased dermatome sensitivity over the dorsum of the left foot consistent with L5 lesion and the right toes and arch of the foot consistent with an S1 lesion. The dermatomes were WNL in all other regions of the body. Breathing and heart rate were WNL. Although the patient was anxious and exhibited some elevated breathing and heart rate consistent with his anxiety.No laboratory or x-ray evaluation was availableChiropractic examinationExtreme hyperkinetic muscular guarding along the paraspinal muscles from L2 through C1. Tone of the muscles was described as “rope like” or a “steel cord” running along the spine. Palpation demonstrated strong kinesiopathology L1-5 in flexion, T1-T6 in all active planes of joint motion, and C0-C5 in right rotation, bilateral lateral flexion, and flexion extension with most prominent fixative motion noted at the C0-C2 region. During active palpation, patient was in a great deal of pain and found it difficult to even tolerate gentle palpation along his spine. Range of motion – LUMBAR (flex-15, LLF-5, RLF-5, LRot-10, RRot-10) all with guarding and moderate to severe pain), THORACIC (flex-5, ext-0, RLF-10, LLF-10, RRot-10, LRot-10) all with guarding and moderate to severe pain, CERVICAL (flex-10, ext-10, RLF-10, LLF-10, RRot-10, LRot-10) all with guarding and moderate to severe pain
Due to his extreme pain and restricted motion of the spine, he was unable to lie prone or fully supine initially. To perform the adjustments of his mid thoracic spine, patient was asked to wrap his hands over the doctor’s shoulders while the doctor reached around his mid thoracic spine and grasped hands together to make a contact over the segment requiring adjustment. Patient was instructed to breath and doctor provided a thrust into the spinal segments, which mimicked the motion made when providing a “hug”. Patient was extremely guarded and noted pain was severe as doctor provided five even thrusts along the subluxated spinal segments with restricted motion. Following adjustments, light PTLMS care was provided for 90 seconds along the paraspinal muscles from mid-cervical to S2. Patient could tolerate no cervical rotatory movements and was then helped into a semi recumbent position and placed on the Negative Z at the C0-C1 junction. Slight chin flexion was initiated and doctor placed hands on the forehead and applied a moderate A-P and S-I force, eliciting the drop action of the Negative Z. Patient responded favorably noting no increase in discomfort.
Patient was aided by his friends and lifted off the table and placed back into his wheelchair and told to return the following day for another adjustment.
Day 2
Patient presented sitting up straighter in his wheelchair and reported some reduction in the pain along his back and neck. He was lifted and placed on adjusting table like the previous day by his friends. Doctor palpated the spine noting approximately a 20 percent reduction in pain and spasticity along the paraspinal muscles. Adjustments were provided in the same regions with same technique. Patient tolerated all adjustments with more ease than the previous day, though considerable pain was still evident in his facial response as adjustments were provided. After receiving his adjustments, he was set up on edge of the portable adjusting table. Initially his ability to sit straight appeared more balanced and stronger. Doctor asked if he would like to make an attempt to walk and he indicated he would. A walking aid was provided for the patient and he was helped to his feet. After achieving his balance, he was encouraged to take a step and was successful. He took a second and then a third step, walking on his own for the first time in six months.
Unfortunately, after the second adjustment, the patient was unable to be seen again because our chiropractic team had to leave Kenya that day and there were no chiropractors for him to continue. It was reported he continued to gain strength and walk with less aid from the walker over the ensuing three weeks. Sadly, the patient continued to have the catheter insertion and developed a urinary tract infection due to poor medical follow-up in the local community. As a result of the urinary tract infection, he passed suddenly approximately three weeks after his final adjustment with our chiropractic team.
While enormous progress was made in restoring function to this patient so he was able to walk under his own power, the inability to provide ongoing care and follow-up was unfortunate. In under resourced regions of the world, chiropractic care is one of the most important vital healthcare systems that can significantly impact patient outcomes. Working in remote regions for the past five years, where medicine, physical therapy, chiropractic, and other health care practices are significantly hampered has demonstrated to our organization a significant need exists, which many doctors of chiropractic are unaware.
The majority of the world’s population still provides for their family in physically demanding jobs such as farming, construction, and transportation. Walking, lifting, carrying heavy loads on the head, and other taxing activities are common. In addition, the physical toll placed on the body by lack of proper nutrition, ample clean drinking water, waste, and other environmental strains has the capacity to bombard the central nervous system with inputs that can injure tissue and may even lead to permanent damage.
While many healthcare providers are required to adequately serve billions of people around the world, the chiropractor is in a unique position to become the provider of choice for most of the world’s population because of the unique skill sets chiropractors possess. Able to offer care to people with limited aids and no medicine, chiropractors can have tremendous impact because of the number of people they can care for on a daily basis and the significant impact their care has to change human potential. With an emphasis placed on training more doctors and healers to provide the unique care chiropractors can offer, it is possible major reductions in infant mortality, improvements in longevity, and human productivity could result.
Changing the health outcomes of the world is one of the most vital ways we have to end poverty and human suffering. The chiropractor is an important piece of this equation and that is why we call him/her “An Agent of Social Change.”
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