CASE STUDY - headaches, low back pain and a breech baby at 35 weeks gestation.

Case History: 31 year old woman presents with headaches, low back pain and a breech baby at 35 weeks gestation.

The patient is pregnant with her fourth child and denies ever experiencing a breech presentation with her previous pregnancies.  

Her main reason for coming to our office for care to is have her pelvis evaluated for its possible contribution to the current breech presentation of her baby.  

In the past, she has had headaches prior to this pregnancy and is currently complaining of low back pain and water retention; neither of which interfere with her activities of daily living  She is currently under the care of a midwife for this pregnancy.   She does not have a history of any hernias, uterine fibroids, or ovarian cysts.  She had never had any abdominal surgeries.  Her midwife reports this patient’s uterus is normal and is free from any abnormalities that may be contributing to the breech presentation of the baby.

Consultation:
She communicated the following accident history:

At age 7, she fell off of a horse and injured her coccyx.  No medical treatment was obtained for this injury.  At 10 years of age she was involved in a “fender bender” type auto accident as a back seat passenger.  She was not wearing a seatbelt and reports that she did not experience any symptoms after the accident and therefore did not receive any medical care.  This patient also experienced a fairly serious fall down a flight of stairs at age 17.  She reports that this fall tore a ligament in her right knee but was not able to remember which ligament.  She did not undergo any surgical repair for this tear.  

Although this is her fourth pregnancy, this is the first time she is carrying a breech baby.   Her previous three pregnancies were delivered vaginally with the aid of the same midwife who is currently caring for her.  

This patient denies smoking.  She reportedly drinks an occasional cup of coffee as well as one cup of tea per day.  She is taking pre-natal vitamins and cod liver oil as directed by her midwife.  Neither supplement is causing digestive distress that is sometimes common with these particular supplements.  She reported being unaware if her amniotic fluid levels were within normal limits.  

Physical Examination –

A thorough examination of her lumbar and cervical spine was conducted due to her complaints of headache, lower back pain, and breech baby.   Postural evaluation revealed a lumbar hyperlordosis most likely due to her advanced stage of pregnancy.  

Cervical active range of motion was within normal limits with no noted pain or discomfort.  Lumbar active range of motion was within normal limits with the exception of extension which was decreased with some mild pain presenting at the L5-S1 level.  

Palpation revealed taut and tender fibers in the lumbo sacral region bilaterally from L-3 through Coccyx.  Palpatory tenderness was noted at the Coccyx and Sacrum, also bilaterally.  The right round ligament was also found to be taut upon palpation.  

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 coccyx on the right, Sacral Apex left, Posterior Inferior Ilium on the right, posterior right trochanter, superior pubic bone on the right, posterior L4 on the left, and left posterior occiput.

Prone leg checks uncovered a left short leg of ¼ inch and a positive Derefield.  Therapy localization indicated a left posterior occiput.  Supine leg checks also uncovered a left short leg of ¼ inch.  

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

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 upper cervical (specifically atlanto-occipital) and lower lumbar (specifically lumbo-sacral) regions which correlates and supports the initial exam findings.  

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:

Specific Prenatal Chiropractic spinal adjustments two to three times weekly until baby turns to the vertex position.  Once the baby turns, 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 Jan 20, 2010.  A left posterior occiput was adjusted using an occipital lift, C6 was adjusted, manually, in the prone position as was T6.  L4 (PLS) was adjusted using an instrument.  Left sacral apex rotation was corrected using extremely light drop table.  A posterior right coccyx was adjusted with an instrument as was a right superior pubic bone.  Light contact was held on the right round ligament until the residual spasm subsided.  

Re-evaluation and follow up

The baby turned to a vertex position after the first adjustment.  Therefore this patient returned in one week for a follow up chiropractic evaluation.  A brief kinesiological exam revealed a right Atlas and a left posterior coccyx.  Both were adjusted using an instrument.  A follow up thermal scan showed the previous severe thermal asymmetries have improved and were described as mild to moderate in nature.  

Discussion

Prior to her first visit in our office, this patient was taking Homeopathic Pulsatilla (a dilution 200C) as recommended by her midwife.  Pulsatilla is a widely used homeopathic remedy derived from the vegetable kingdom, from the wind flower.  It is often referred to as “the” pregnancy remedy as is addresses many common complaints of pregnancy.  It also has some notable success in getting babies to turn head down.  The 200C dilution is an extremely potent dilution and in some states in the U.S. it isn’t available without a prescription.  The midwives we work with on a regular basis will often suggest Pulsatilla to their breech patients as they did the case discussed above.

Since the remedy did not work in this case, the patient decided to follow another recommendation made by her midwife and come to our office for evaluation.  As expected, her pubic bone and coccyx were misaligned and needed to be adjusted regularly; even after the baby turned to the vertex position.  

On January 21, 2010 – the day following her initial chiropractic treatment, the patient visited her midwife where, through the Leopold maneuver, it was determined that the baby had turned into a vertex position.  The vertex positioning of the baby was later confirmed by ultrasound.  

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CASE STUDY - Breech presentation, backache of pregnancy, dizziness and indigestion at 37 weeks gestation.

Case History: 39 year old woman presents on June 16, 2009 with a breech presentation, backache of pregnancy, dizziness and indigestion.  She is 37 weeks gestation.

The patient is currently pregnant with her third child.  

She is currently complaining of dizziness, low back pain, and indigestion with this pregnancy.  She also reported suffering from dizziness, and back pain prior to this pregnancy.   None of her current symptoms are interfering with her activities of daily living except for an occasional restless night of sleep due primarily to her lower back pain.    

She is currently under the care of a midwife for this pregnancy.  Her first two children were delivered vaginally.  She is hoping for a home birth which she cannot do if the  baby remains in the breech position.

Consultation:
She communicated no automobile accident history:

This patient communicated the following accident history:

She has previously been an avid field hockey and basketball player.  She had arthroscopic surgery performed on her right knee in 1985 and does not have any further complaints or symptomotology worth noting on that knee.  

This patient admits to falling on her left hip a few years ago but offers no real details regarding that incident and claims it was minor.  There were no other remarkable traumas disclosed during the initial consultation.  

Her current complaint of low back pain started last week She describes the pain as being intermittent and dull in nature.  She explains that the low back pain is primarily at the L5-S1 level and that it radiates into her left hip and sometimes into the right groin area.

This patient denies smoking and drinking tea.  She reportedly drinks one cup of organic coffee per day.  She reports that she eats a well-balanced diet.  She does not exercise 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 when her back pain isn’t interfering with that.  She is taking pre-natal vitamins, Calcium and Magnesium supplements and Omega 3 Fatty Acids as directed by her midwife.  

Physical Examination :

A thorough examination of her lumbar and cervical spines was conducted due to her chief complaint lower back pain and breech baby and secondary complaints of dizziness and indigestion.  Postural evaluation was within normal limits with the exception of a mild lumbar hyperlordosis most likely due to her advanced pregnancy.  

Cervical active range of motion was within normal limits with no noted pain or discomfort.  Lumbar active range of motion was also within normal limits with no noted pain or discomfort.  
Palpation revealed taut and tender fibers in the trapezius at the  lower cervical and lower lumbar  regions.  Trigger points and muscle spasms were noted upon palpation of the paraspinal musculature of the lumbar area.  Palpatory tenderness and spasm were also noted bilaterally at the L5-S1 region.      

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 or 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 on the left (P-L), Left Sacral Apex Rotation (SAL),  Right anterior trochanter, posterior T5 and T6, T1 posterior on the right (PR), C7 (BL), and C2 (BR).

Prone leg checks uncovered a left short leg of ½ inch and a negative Derefield.  Supine leg checks also uncovered a right short leg of ½ inch.  This patient also had a left cervical syndrome and therapy localization at C2.

Using Basic Sacral Occipital analysis, the patient was found to be a Category II with a right major.  

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

A thermal spinal scan showed areas of moderate thermal asymmetries in the cervical spine (specifically C2)  in the thoracic spine (specifically T1) which correlates and supports the initial exam findings and the patient’s presenting history and chief and secondary complaints.  

NOTE: C2 almost always shows thermal asymmetries with a breech presentation.

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:

Specific Prenatal Chiropractic spinal adjustments two to four times weekly until baby turns to the vertex position.  Once the baby turns, one to two weekly adjustments are 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 June 16, 2009

C2 (BR) was adjusted using an instrument in the prone position as was C7 (BL) and T1 and T5. L5 (PL) was also adjusted in the prone position using an instrument.  A Sacral Apex Left,  and a right anterior trochanter were also adjusted in the prone position using an instrument.  

She received her second chiropractic adjustment one day later on June 17, 2009.   She reported a tremendous improvement in both of her chief complaints of low back pain and dizziness.  Additionally she admits to having a very restful night’s sleep. She mentioned that there was also a lot of fetal movement in the hours directly following her first adjustment and that she no longer “felt breech”.  On this second visit T5 was adjusted in the prone position as was L5, both with an instrument.  This time it was an anterior Left trochanter that was adjusted in the prone position.  

NOTE:  It is not unusual for the side of trochanter anteriority to switch from left to right from visit to visit.  

Re-evaluation , discussion and follow up

This patient’s next adjustment was one week later on June 24, 2009. C2 and T5 were adjusted in the prone position as was L5.  This time a right superior pubic bone was found and adjusted in the supine position using an instrument.  It was confirmed, on this day, by an ultrasound performed by her midwife that the baby was in a vertex position.  Thermal Scan did not show thermal asymmetries at the C2 level as it did when the baby was breech.    

This patient has one more adjustment before delivering her baby.  The same cervical and lumbar segments were adjusted exactly the same as her previous visits.  Her trochanters required adjustments on every visit; some visits on the left and some on the right.  In either case the trochanter always rotated anteriorly.  Regardless of the misalignment, it was always adjusted using an instrument as before.  

Her pubic bone only showed up once and was only adjusted once.  Although misalignments to the pelvis, especially, the pubic bone and sacrum, are seemingly a causative factor in a breech presentation, it is not entirely impossible for a breech baby to present when the mother doesn’t have major pelvic misalignments; as it was in this case.  She experienced no major trauma or repetitive injuries or stresses to her pelvis.  Therefore, the fact that no major pelvic misalignments were uncovered during examination was not entirely unexpected.   

It bears repeating that low back pain of pregnancy will present many times, with a breech presentation and also with a trochanter rotation.  Most usually it will appear on the same side of symptomatology initially and may change sides once changes to the pelvis occur; as it did in this case.  

Based on the information in this case study, when a pregnant patient presents with a breech baby with no major history of trauma to her pelvis and no major pelvic misalignments, which is mostly likely to be found in need of adjustment?

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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

CASE STUDY - Posterior Occiput Presentation and low back pain at 38 weeks

Case History  : 37 year old woman presents with a posterior presentation at 38 weeks gestation on August 9, 2009.  She is a previous patient.

The patient is pregnant for the 7th time.  She had suffered a miscarriage during the 12th week of a previous pregnancy in July of 2004.  She was referred to our office for care by her midwife. Her previous 5 births were vaginal and reportedly without interventions.  

She is currently complaining of a posterior presentation of her baby and backache of pregnancy.  She also is complaining of water retention which she admits has occurred during all of her previous pregnancies as well.  Her midwife reports this patient’s uterus is normal and is free from uterine myomas and free from any anomalies, such as a bicornuate, septate, or unicornuate uterus.  

Consultation:

She denies having any automobile accident history.

She communicated the following accident history:

This patient has played soccer throughout high school and college.  She sustained many impacts to her knees and suffered from “water on the knee” in her left knee.  She did not have any surgery, fractures or stitches directly related to her involvement in this sport.   

She is a labor and delivery nurse and denies any on the job injuries.

This patient denies smoking.  She reportedly does not drink coffee or tea.  She reports that she eats a well-balanced diet.  She exercises on a regular basis; at least four to five times per week by way of walking on a treadmill.  She claims that she does not get at least eight hours of quality sleep per night.  She is taking pre-natal vitamins as directed by her midwife.  This supplement is not causing digestive distress that is sometimes common with this particular supplement.  She reported being unaware if her amniotic fluid levels were within normal limits.  

Physical Examination –

A thorough examination of her lumbosacral spine was conducted due to her advanced stage of pregnancy and due to her chief complaints of low back pain and posterior presentation of her baby.  Postural evaluation revealed a lumbar hyperlordosis most likely due to her advanced pregnancy.   

Lumbar active range of motion was within normal limits with no noted pain or discomfort except for lumbar extension which caused pain at the lumbosacral area.   

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:

Sacrum was posterior on the left (P-L), Right superior pubic arch, Right anterior trochanter, T4-T7 Posterior, C7 body right, and C2 body left.  

Prone leg checks uncovered a right short leg of ¼. George’s test was found to be negative.    

Using Basic Sacral Occipital analysis, the patient was not found to be a Category.      

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 mild thermal asymmetries in the cervical spine (specifically C2 through C4) and in the lumbosacral spine (L5-S1) which correlates and supports the initial exam findings.  

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 and limited time before the birth of the baby, Specific Prenatal Chiropractic spinal adjustments are recommended two to three times weekly 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 has been a long time patient of this office and regularly receives care when pregnant.  She received her first chiropractic adjustment for this complaint on August 5, 2009.

C2 (BL) was adjusted on the left, manually, in the prone position as was C7 (BR) and T4 (PL).  .  L5 (PR) was also adjusted on the prone position using an instrument.  A right anterior trochanter was adjusted using an instrument in the prone position.  A right superior pubic bone was adjusted in the supine position using an  instrument.  Because of the urgent nature of her condition and the time constraint to make significant changes prior to the start of labor, this patient was also advised to start taking Homeopathic Pulsatilla at 30C potency.

This patient received her second chiropractic adjustment one week later on August 12, 2009.     She reported marked improvement of her primary complaint after the first adjustment. The low back pain that accompanies a posterior presentation was much better.  C4 (BL) was adjusted on the left, manually, in the prone position as was T5 and T12. Her sacrum was adjusted on the left (PL) in the prone position using an instrument.  A right superior pubic bone was adjusted in the supine position using an instrument.   

This patient only received two adjustments as she delivered her baby the following week and wasn’t able to maintain her scheduled care plan at that time.  

Discussion

Because of this patient’s primary complaint of a posterior presentation and concomitant low back pain, it was vital that her pelvis be evaluated thoroughly.  

Left Occiput Anterior LOA is the most common position at the start of labor.  In this position the baby is lined up so as to fit through the pelvis as easily as possible.  

The baby is head down; facing the mother’s back – specifically, the sacrum.  Its left occiput is resting on the left anterior portion of the mother’s pelvis.

In an occiput anterior position, the baby’s head is easily 'flexed', so that the smallest part of its head will be applied to the cervix first. The diameter of its head (suboccipitobregmatic diameter) which has to fit through the pelvis is approximately 9.5 cm.

In a Vertex, Occiput Posterior, the baby’s occiput is resting on the posterior portion of the mother’s pelvis.

• This makes for a more difficult vaginal delivery.  
• It almost always causes a great deal of back labor.  
• The baby cannot fully flex its head in this position
• The diameter of its head (occipitofrontal diameter) which has to enter the pelvis is approximately 11.5cm and can reach up to 12.5 cm.
• If the baby is in the occiput posterior position (right or left) during late pregnancy, it’s possible that it won’t engage (descend into the pelvis) before labor starts.   
• By not engaging, it is harder for labor to start naturally and usually leads to induction of labor with Pitocin.  
  

Furthermore, in the occiput posterior position

• Braxton-Hicks contractions especially painful
• The baby will put a great deal of pressure on the bladder.  
• By not engaging it is likely that the mother may go past her due date and therefore more likely to be induced.   
• Posterior presentation is more of a problem for a first time mother (Primigravid) than it is for subsequent births (Multiparous) because when a mother has given birth before, there is generally more room for the baby to maneuver and rotate during labor.

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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

CASE STUDY - Severe arm and hand pain and numbness at 36 weeks gestation.

Case History  : 33 year old woman presents with severe arm and hand pain and numbness at 36 weeks gestation.

The patient is pregnant for the 5th time.  She had suffered a miscarriage during the 15th week of a previous pregnancy in July of 2004.  She was referred to our office for care by her midwife. Her previous 3 births were vaginal.  

She is currently complaining of water retention and severe arm and hand pain during this pregnancy.  She denies suffering from this complaint or any others prior to this pregnancy.     Although very painful and consistent, none of her current symptoms are interfering with her activities of daily living.  

Consultation:

She communicated the following automobile accident history:

At age 15, she was a passenger in the front seat of a car when it was impacted at 25 miles per hour on the driver’s side of the car.  She detailed that she hit her stomach but did not receive any medical treatment for her injuries

In the spring of 2005 she was involved in a more serious automobile accident in which the car she was in was totaled.  The patient was seated in the driver’s seat of the car in a parking lot.  Her car was struck in the rear at a high rate of speed by another car.  Her car then lurched forward and impacted a pole.  She sustained injuries to her face as a result of hitting the steering wheel.  She claims that she never received medical care for her injuries.

She is a nurse in a hospital setting and denies any on the job injuries.

Her current complaint of severe arm and hand pain and numbness started a few weeks prior to coming to the office for an evaluation.  She describes that it starts in her fingers and works it way up to her shoulder.  This pain and numbness is bilateral.  She reveals that the discomfort has become more constant in nature and is worse when talking on the phone for extended periods of time.  She also awakens frequently during the night due to the severe discomfort.  

This patient denies smoking.  She reportedly does not drink coffee or tea.  She reports that she eats a well-balanced diet.  She exercises on a regular basis; at least four to five times per week by way of walking on a treadmill.  She claims that she does not get at least eight hours of quality sleep per night due to her current complaint.  She is taking pre-natal vitamins as directed by her midwife.  This supplement is not causing digestive distress that is sometimes common with this particular supplement.  She reported being unaware if her amniotic fluid levels were within normal limits.  

Physical Examination –

A thorough examination of her cervical spine was conducted due to her complaints of arm and hand pain and numbness.  Her lumbar spine was also thoroughly evaluated due to her advanced stage of pregnancy. Postural evaluation revealed a lumbar hyperlordosis most likely due to her advanced pregnancy, a high right shoulder and a high right ilium.  

Cervical active range of motion was within normal limits with the exception of right lateral flexion and left rotation which were both decreased with no noted pain or discomfort.  Lumbar active range of motion was within normal limits with no noted pain or discomfort.   

Palpatory tenderness was noted over the spinous of T10 and also over the right sacroiliac joint.  Spinous percussion was positive at the levels of L3 and C7  

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:

L5 posterior on the right (PR), T10 posterior on the right (PR), T5 Posterior, T1 posterior on the right (PR), C7 body right, C2 body left and a right anterior trochanter.

Prone leg checks uncovered a right short leg of ½ inch and a positive Derefield on the right as well as a right cervical syndrome.  Supine leg checks revealed no short leg.  Although George’s test was found to be negative, the patient complained of ringing in her left ear while performing the test.  

Using Basic Sacral Occipital analysis, the patient was not found to be a Category.      

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 spine (specifically C1 and C7) which correlates and supports the initial exam findings.  

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 May 26, 2005.

C2 (BL) was adjusted on the left, manually, in the prone position as was C5 (BR) and T4(PL).  T10 was adjusted (PR) in the prone position using an instrument.  L5 (PR) was also adjusted on the prone position using an instrument.  A right anterior trochanter was adjusted using an instrument also in the prone position.  Due to her primary complaint or arm and hand pain and numbness, her upper extremities were mobilized as well.  It was also recommended that she increase her intake of Vitamin B6 to help with the carpal tunnel type symptoms she was experiencing.  

This patient received her second chiropractic adjustment on June 2, 2005.   She reported marked improvement of her primary complaint after the first adjustment. However, she still had considerable, asymptomatic swelling in both of her hands.   Again C2 (BL) was adjusted on the left, manually, in the prone position as was C5 (BR).  T1 and T10 were adjusted in the prone position, manually.  Manual traction was used in the cervical spine following her adjustment.  

This patient only received two adjustments as she delivered her baby the following week and wasn’t able to maintain her schedule care plan at that time.  

Discussion

Because of this patient’s primary complaint of arm and hand pain and numbness, it was vital that her cervical spine be evaluated thoroughly.  Oftentimes, supplementing one’s diet with foods high in Vitamin B6, symptomatic relief can be obtained.  

Food Sources of vitamin B6 include

• sweet potatoes
• avocados
• brown rice
• sunflower seeds
• chick peas
• salmon
• pork
• chicken
• turkey
• potatoes
• bok choy
• barley
• bananas
• Mangoes

Women who are more like to suffer from a vitamin B6 deficiency normally have a diet lacking in vitamin B6, a history of using oral contraceptives or hormone replacement therapy a diet of foods that contain yellow dye #5, such as some types of macaroni and cheese and pickles and/or have a history of stress.  A typical dose of vitamin B6 for carpal tunnel syndrome is 50 mg 2 to 3 times a day.   It can take up to 6 weeks to notice an improvement in symptoms.  Note:  The maximum intake of B6 from all sources (supplements and food sources) should be less than 200 mg a day

Enzyme supplements such as bromelain may help to reduce tissue swelling associated with carpal tunnel syndrome. It should be mentioned that it can take several weeks to notice results.

www.premierpregnancypractic.com

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