The following scenario exists only in my imagination. While these specific patients are unlikely to appear in any of our offices, their clinical presentations are plausible. I invite you to assess the implications of the following thought experiment.
A Thought Experiment
Jesse James and his brother Frank are partners in various illegal business ventures. Both came under your care for back and neck pain a few weeks ago. (They pay cash! No insurance paperwork!) Both suffered concussions during a violent episode (the details of which have not been revealed to you for some reason) approximately seven months ago. They both recovered from all symptoms in a week or two without intervention. During their most recent visits, in addition to neck and back pain, they have both been complaining of fatigue.
They both go to the same primary care physician, who offered no specific diagnosis for the fatigue, but suggested they undertake a less stressful and tiring method of making a living.
You ask Jesse if he has noticed a reduced sex drive recently. After calling you a number of unflattering names, he angrily denies this symptom, and asks you if you have any other stupid questions.
You reply, "Yes, have you noticed any changes in your appetite and food choices?" Jesse calms down and considers this thoughtfully. "As a matter of fact," he replies, "I can't seem to put enough salt on my food these days."
Frank answers no to both of the questions you asked Jesse. You go on to ask whether or not he has been feeling unusually hot or cold lately. Frank replies: "As a matter of fact, I seem to want a sweater or a jacket when everyone else in my gang (oops, I meant company, not gang) seems to be comfortable."
What's Going on Here?
Post-concussion chronicity has many manifestations. Emerging research indicates depressed pituitary function can emerge months or years after a concussion. In effect, concussion can function as a pituitary dimmer switch. Because the pituitary influences many other endocrine glands, the clinical picture of hypopituitarism can include symptoms related to low levels of human growth hormone, antidiuretic hormone, thyroid hormones, adrenal hormones, the estrogens or the androgens.1-5
If Jesse James had answered yes to the libido question, it would have suggested low androgen levels secondary to reduced pituitary secretion of luteinizing hormone (LH). His report of salt craving suggests low levels of aldosterone due to hypoadrenia. The sensitivity to cold suffered by his brother Frank suggests hypothyroidism.
Can Chiropractic Help?
I have not found any published reports on chiropractic amelioration of post-concussive hypopituitarism. This is not surprising, as awareness of the concussion-pituitary connection has only recently emerged within the bioclinical community. However, there are several factors that make a positive chiropractic contribution plausible. To illuminate a few examples:
In addition to the chiropractic adjustment, good care for Frank and Jesse James should take into consideration possible co-management with a medical endocrinologist, patient education on the effect of certain prescription and non-prescription drugs, and nutritional considerations.
Editor's Note: Access Dr. Masarsky's previous three articles, which also address concussion, via the Previous Articles section of his DC columnist page. He also offers a seminar for chiropractic associations on concussion as it relates to the vertebral subluxation complex.
References
When sports chiropractors first appeared at the Olympic Games in the 1980s, it was alongside individual athletes who had experienced the benefits of chiropractic care in their training and recovery processes at home. Fast forward to Paris 2024, where chiropractic care was available in the polyclinic for all athletes, and the attitude has now evolved to recognize that “every athlete deserves access to sports chiropractic."
It is estimated that 61% of patients with CTS avoid taking surgical options due to postoperative complications and costly surgical procedures. Chiropractic care offers a comprehensive and effective treatment for carpal tunnel syndrome, addressing the condition from multiple angles. Recent studies also have unveiled a game-changing adjunct to chiropractic treatments for CTS: nerve flossing.
Some doctors thrive in a personality-based clinic and have a loyal following no matter what services or equipment they offer, but for most chiropractic offices who are trying to grow and expand, new equipment purchases help us stay relevant and continue to service our client base in the best, most up-to-date manner possible. So, regarding equipment purchasing: should you lease, get a bank loan, or pay cash?
