Patient History
This patient was first seen because of problems with his right shoulder. Pain levels were VAS 5 on a scale and felt deep under the deltoid muscle. The patient had also had a thyroidectomy and takes two pills daily (Levothyroxine Sodium) 212 mcg. His work as a welder kept his body under constant stress; nothing was providing relief, and he found that excessive movement made the pain worse. He had difficulty putting his shirt on and buttoning his pants due to shoulder pain. He could not bring his arm behind his body and felt that the arm “wants to pop in and out of the socket” when he walked. He had seen another local chiropractor intermittently but had never had his foot pronation or spinal X-rays analyzed. His goals for care were to be able to play softball and to return to archery. His shoulder issue prevented him from pulling back the bowstring.
Exam Findings
I found that his abduction was limited to about 25% of the normal range, though he was able to bring his arm forward without any pain.
Reflex testing revealed inhibition of the bicep reflex on the right (C5) (1+ with reinforcement) and the tricep reflex bilaterally (C7) (right 1+ with reinforcement, left 0 with reinforcement). The left patellar reflex (L4) was hyper-reflexive (3+).
Muscle testing revealed weakness of the right deltoid (C5) (4/5) and pain in the right shoulder. Wrist extension (C6) and wrist flexion (C7) were both weak on the left (4/5). Grip strength (T1) was slightly reduced on the left (5-/5). Tests of the lower body were within normal limits except for left knee extension (L2-5) (4/5).
Orthopedic testing of the cervical spine was within normal limits except for Soto Hall, which produced pain around the T2-3 area of the spine VAS 1/10. FABERE testing of each leg produced ipsilateral pain ~2-3 VAS in each hip joint. Kemp’s test produced right rib pain around the T10-11 region VAS 2-3 only when the patient was bent to the left.
Clinical Impressions
Seven radiographic views were taken: 3 A, three lateral views of the spine and pelvis, and 1 A view of the knees. The patient was instructed to stand with the feet parallel to each other, under the knees, the hips, and the armpits for the lateral views. For the anterior to posterior views, the patient was instructed to keep the feet as they were for the lateral views but with arms slightly abducted (~10-15 degrees). In addition to the whole exam, a scan of the patient’s feet through the Foot Leveler scanner was completed. The foot scan showed severe pronation. (See Fig. 1)
An A-P X-ray of the knees showed that the lateral edges were level, but there was a significant medial angle. Pronation was most pronounced on the right side, which appeared to increase the medial angle at the right knee and pelvic obliquity, affecting the right ilium. The level of the medial angle at the knees was significant.
Results
My treatment plan was adjustments 3 times weekly for two months, then two times weekly for two months, followed by weekly adjustments for the remainder of the year. When this study was written, the patient was approximately five months into his treatment program. My goal with chiropractic adjustment is to mobilize joints that have tensed as part of compensational patterns and to free the spinal nerves so that proper communication reaches muscles that have atrophied because of impeded or stenosed nerve communication. This patient was fitted with custom orthotics to support the feet and begin to balance the tibial plateaus and the pelvis. The patient had no difficulty acclimating to the changes from the orthotics in his work boots. Some patients have difficulty acclimating to the changes their Foot Levelers custom orthotics make, but this patient could wear them consistently from the time he put them in. The effect of proper foot support can be so dramatic that I need to order only a 50% correction. This seems wisest if the patient has a history of foot pain or other foot issues, is older, or is on their feet consistently in a stressful environment, e.g., electrician, construction worker, etc. This is not always the case, as I can also think of someone in each category who can wear their orthotics consistently from day one. Over approximately five months of treatment, the patient experienced significant improvements in reflexes, muscle strength, and orthopedic test results, with the complete resolution of right shoulder pain. Follow-up X-rays showed progressive knee and pelvic alignment improvement, with the patient’s patellas returning to the midline and better tibial plateau positioning.