CASE STUDY – Backache of Pregnancy, 1st time mom

Case History: 30 year old woman presents on April 20, 2006 with backache of pregnancy


The patient is pregnant for the 1st time.  


She is currently complaining of low back pain, water retention, neck pain, sinus trouble and headaches with this pregnancy.  She also reported suffering from headaches, sinus trouble and neck pain prior to this pregnancy.   None of her current symptoms are interfering with her activities of daily living.  


She is currently under the care of an OB/GYN for this pregnancy.   


Consultation:
She communicated the following automobile accident history:
At age 9, she was a passenger in the front seat of a car when it was impacted at a high rate of speed on that same side.  She suffered head trauma resulting in a concussion.  She was not hospitalized.  She also injured her right wrist in that accident.   


At age 13 she reports a notable impact to her coccyx.  She fell while running and landed on her coccyx which left visible bruising in the coccyx area.  She has had dysmenorrhea and irregular menstrual cycles for her entire menstrual history.   


Her current complaint of low back pain started suddenly the day before she was seen in our office.  She describes the pain as being intermittent but severe.  When it is at its worst, the pain brings tears to her eyes.  She details that the pain is worse with lifting and bending.  Since she teaches toddlers which require these motions, this pain is impacting her activities of daily living.  She further explains that the pain starts in her low back, radiates down her left thigh and into her leg.  Due to her pregnancy and her concern for her unborn baby, she has not utilized any other modalities to try and alleviate the symptoms and was subsequently referred to our office by her OB/GYN for evaluation.


She denies smoking. She reportedly drinks one cup of coffee per day.  She reports that she eats a well-balanced diet.  She exercises on a regular basis; at least four to five times per week.  She claims to get at least eight hours of quality sleep per night.  She is taking pre-natal vitamins as directed by her physician.  This supplement is not causing digestive distress that is sometimes common with this particular supplement.  

Physical Examination:


A thorough examination of her lumbar spine was conducted due to her chief complaint lower back pain and sciatic neuralgia.   Postural evaluation revealed was within normal limits with the exception of a slight antalgic lean to the left.


Cervical active range of motion was within normal limits with no noted pain or discomfort.  Lumbar active range of motion was within normal limits however pain was present at the left Sacroiliac joint during lumbar extension, lumbar right lateral flexion, lumber left rotation and lumbar right rotation.   
Palpation revealed taut and tender fibers in the lumbo sacral region bilaterally from L-3 through Sacrum.  Palpatory tenderness and spasm was noted at the left sacroiliac joint.    
Deep Tendon Reflexes:  Biceps (C5\C6):  left: normal;  right: normal. Brachioradialis (C5\C6):  left: normal; right: normal. Triceps (C7\C8):  left: normal;  right: normal. Patellar (L2\L4):  left: normal; right: normal. Hamstrings (L4\L5):  left: normal;  right: normal. Achilles (S1\S2):  left: normal; right: normal. Cranial Nerve Exam:  Myotome evaluation revealed no weakness in the  upper and lower extremity. Dermatome evaluation revealed no altered sensation to pin prick in the upper and lower extremity.


Spinal analysis using muscle testing uncovered the following misalignments:
Posterior L5  (PL)on the left, Sacral apex rotation to the left, posterior T-4 on the left, C4 body left and an anterior right trochanter.


Prone leg checks uncovered a right short leg of ¼ inch and a negative Derefield.  Therapy localization was negative.  Supine leg checks also uncovered a right short leg of ¼ inch.  


Using Basic Sacral Occipital analysis, the patient was found to be a Category II left Major.   


All cervical orthopedic tests were found to be within normal limits.  The lumbar orthopedic tests that are not contraindicated during pregnancy were also found to be within normal limits.  


A thermal spinal scan showed areas of severe thermal asymmetries in the cervical (specifically C2) and lower lumbar (specifically L5-S1) regions which correlates and supports the initial exam findings and the patient’s presenting history and chief complaint.  


Care Plan
Based upon the patient’s history of traumas, previous pregnancies, weeks gestation of current pregnancy and presenting symptoms, the following care plan has be recommended:


Due to the acute level of this patient’s presenting symptom, specific Prenatal Chiropractic spinal adjustments are recommended two to three times weekly for at least three weeks for symptomatic relief.  Once relief is obtained, one to two weekly adjustments is recommended until the birth of the baby.  A 6 week post-partum check up is also recommended to evaluate a continued need for care.  


Treatments


This patient received her first chiropractic adjustment on April 20, 2006.


C2 (BL) was adjusted on the left, manually, in the prone position as was T4.  L5 (PL) was adjusted in the prone position using an instrument.  A Sacral Apex left was also adjusted in the prone position using an instrument.  A posterior right trochanter was adjusted in the prone position with an instrument as well.  The patient was blocked a Cat II following basic SOT protocol.   


Due to the 75 minute commute to our office from her home, this patient was not able to maintain our recommended care plan.  Therefore she received her second chiropractic adjustment one week later on April 27, 2006.   She reported a tremendous improvement in her sciatic neuralgia.   Atlas (ASRP) was adjusted using toggle recoil technique.  C5 (BL) was adjusted on the left, manually, in the prone position as was T4.  L5 (PL) again, was adjusted in the prone position using an instrument.  A superior right pubic bone was adjusted in the supine position using and instrument.  A posterior right trochanter was adjusted in the prone position with an instrument as well.  The patient was no longer a Category II


Re-evaluation , discussion and follow up


This patient continued to be adjusted on a weekly basis until August 23, 2006.  On this last visit in our office, she had just come from her OB/GYN’s office and reported that she was 2 cm dilated.  


After the initial Cat II correction, she never returned to that category.  She continued to require adjustment to her right trochanter for the remainder of her pregnancy.  After adjusting her pubic bone on her third visit, she never required additional correction in that area until closer to her due date.  One month before her due date, the pubic bone misalignment showed up again and needed correcting on each subsequent visit.  Also to note, on every single visit she did need her sacrum adjusted.   

As with the previous case, this patient experience trauma to the coccyx.  Trauma to the coccyx almost always impacts a woman’s reproductive system in some way.  This patient suffered her whole menstrual history with dysmenorrhea and menstrual irregularity.  After the birth of her baby, she reported a more normal menstrual cycle with a lot less low back pain and uterine cramping.  It is not uncommon for the passage of the baby through the birth canal to provide some sort of “correction” to the apex anterior coccyx misalignment.  Many women will report relief of menstrual difficulties after they give birth.  Again, it is essential to take a thorough history of coccyx trauma in these cases.  


Want to build, grow and perfect your Pregnancy Practice? Let’s get on a call to discuss your strategy. The first call is on me! Schedule now


Dr. Karen, just wanted to say wow…I’ve learned so much and I’m only into the 2nd module. This is the stuff we need to know in everyday practice! I could listen to you all day long!        ~ Dr. Katie Gelesko Stull

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