Presentation
A middle-aged, black male patient entered my office suffering terribly from an acute exacerbation of a chronic lower back condition. Formerly a star high school and college athlete, the patient, a medical doctor, was now reduced to making his way through his grueling day of clinical rounds, hospital calls, and office hours often confined to a wheelchair to relieve the unbearable pain and pressure in his lower back and the concomitant weakness in his legs. When his colleague, a neurosurgeon, offered him the “drive-by” diagnosis of a herniated disk with possible spinal canal stenosis and recommended decompressive surgery, the patient wisely and cautiously decided, on the advice of a friend, to give chiropractic a try.

Examination revealed a physically fit patient in obvious distress. Vital signs were essentially normal with the exception of mildly elevated blood pressure and pulse, presumably due to pain. Family history revealed heart disease and degenerative arthritis on both sides without apparent compromise in longevity. Gait was altered, painful, and halting. Posture was stooped and guarded; asymmetric iliac crests were evident upon visual analysis. Neurologic examination was essentially unremarkable with the exception of some mild hyperesthesia noted over the spinous processes of the lower lumbar region. Orthopedic examination revealed positive Kemp’s, minor’s, bilateral bowstring, bilateral leg raise, and Gaenslen’s tests. Notably absent were signs of gross nerve root impingement or radiculopathy. Static palpation revealed muscular hypertonicity in the thoracolumbar paraspinal recesses extending from T11 down to L5, greater on the right than left.

Motion palpation revealed noticeable joint limitation in the lower lumbar segments, especially in left-side bending and rotation. Kinesiologic findings were within normal limits. Neurocalometry revealed increased surface heat at the L4 to L5 interface.

Radiologic evaluation included A-P, lateral, and right and left oblique studies of the lumbar spine. Left and right side-bending films were also taken. No apparent evidence of degenerative joint or disk disease was noted. Alterations in George’s line were apparent, with lumbosacral joint imbrication most notable. I began to wonder just what the neurosurgeon had been thinking. Granted, the patient’s presenting symptomatology, particularly the lower extremity weakness, could have led an inexperienced practitioner to think the worst, but based on the dearth of more dire exam findings, I could only surmise that the specialist had tried to convince the patient of the need for surgery through a “bending” of the facts.

After reviewing the case, I explained to the patient that we could “bend” the facts a bit differently. Essentially, what happened here is what happens in chiropractic offices all the time: The patient is grossly subluxated, as a result of overuse and abuse of bodily articulations without periodic correction, mobilization, or repositioning. I offered the patient the following analogy: If your car hits the curb every week when you go around a corner, pretty soon your front end needs alignment. And while our bodies, with all their miraculous abilities to adapt over and over again to constant inner and outer stress, can put up a good front for months, years, and even decades, as the old saying goes, eventually “something’s gotta give.” He accepted the metaphor and agreed to give chiropractic a shot.

I began adjusting the patient on the same day as his consultation and evaluation. This has been my protocol whenever a patient exhibits acute distress.

The patient began treatment in the prone position. Gentle, but firm manual traction with contact points at the occiput and sacrum was applied for approximately 15 seconds. This treatment protocol in most cases relaxes the patient, gets him used to what it is like to have hands-on treatment, and gives the DC an opportunity to initially assess tissue tonus/resistance. Keep in mind that most patients have no idea what’s coming if they’ve never been adjusted, so an initial, noninflictive stretch can do wonders for the doctor-patient relationship.

Subsequent to the application of manual traction, a Derifield leg check was performed to gauge or rule out pelvic joint dysfunction. In this case, the leg check was negative for primary sacroiliac involvement. The spine was then repalpated from bottom to top to assess which segments would require corrective adjustment. Invaluable information regarding the doctor’s stance relative to the patient’s size, girth, and tonus, contact points, tissue pull, stabilization, line of correction, and torque utilization can be gauged during this palpatory encounter. All of this is reflexive, automatic, and lightning quick in the experienced practitioner.

Diagnosis
The patient was found to be subluxated in several of the rotational axes of the lumbosacral apophyseal joints, as well as in the lower lumbar intersegmental junctures. Additionally, secondary subluxations were found at the thoracolumbar, upper-thoracic, and upper-cervical junctures. From a postural standpoint, all of this made perfect sense, as the patient had been trying to (unsuccessfully) adapt, over a period of years to an asymmetric spine, the product of a great deal of unilateral sports-related activity, especially tennis.

Treatment
With the analysis complete, adjusting began by releasing those vertebrae in the thoracic and thoracolumbar regions that had been fixated through a high-velocity, low-amplitude thrust applied to each of the involved segments. An audible sigh of relief was emitted by the patient at this point, and he stated that he already felt the stricture in his lower back and the weakness in his legs subsiding. I then positioned the patient in the right lateral recumbent position and adjusted and successfully released the lumbosacral facet. I then repeated the process on the opposite side, releasing the rotational restrictions detected between the third, fourth, and fifth lumbar vertebrae.

Finally, the patient was laid supine and the cervical spine was repalpated to discern whether the initial restrictions detected there remained or whether they were compensatory and had cleared. The atlas and axis were found to be fixated, primarily in rotation. Additionally, the atlas was found to be posterior. The two segments were then adjusted using a classical cervical rotary technique with an index contact to correct the rotation, and a toggle recoil was employed with the patient in the prone position for correction of atlas posteriority.

Again, the patient breathed a sigh of relief. I then asked the patient to stand and see how he was feeling. To his complete amazement, he was able to stand quite readily and without difficulty, noting only residual discomfort at the lumbosacral juncture with no leg weakness. I recommended he return the following day for his next adjustment, and he agreed.

I saw the patient frequently during the first month of care, performing several adjustments per week where and when needed. His spinal and extremity symptomatology quickly subsided, and his zest for life returned. Postural asymmetries normalized, muscle imbalances became significantly less notable, and strength and endurance improved greatly. These are, of course, the signs of clinical improvement we all strive for, and the patient’s spine behaved in classic fashion, responding to corrective spinal care in the form of diversified technique in high style.

The patient continues to pursue weekly maintenance, having had only minor recurrences.

Diversified technique, as practiced in my office, is a hands-on approach to the joyful and full-bodied experience of helping patients get well through old-fashioned chiropractic care. When learned well from the masters who have carried it down through the generations of our profession’s existence, it is an outstanding tool for providing patients with the opportunity to express their unique potential as only their Creator could have intended.

Neal Blaxberg, DC, is a 1985 graduate of New York Chiropractic College and holds a bachelor’s degree in psychology from Johns Hopkins University in Baltimore. He has been in private, solo practice in Pikesville, Md, for 21 years, and uses a melange of techniques loosely classified under the diversified heading. Contact him at Inn8doc@aol.com.