JSC Case History

Patient SS is a 62 year old female retired teacher who was evaluated in my office in mid-2005 for complaints of right-sided low back and posterior thigh pain. My initial evaluation revealed a condition of right sacroiliac joint instability which was resolved within 4 physical therapy (PT) sessions. The patient returned to my practice 6 months later with another episode of right sided low back and thigh pain aggravated by having to sleep on the floor for 2 weeks. This again was resolved within 4 PT sessions. The patient again returned after 3 months with a worsening of her symptoms with pain radiating further down her leg to her toes. This time treatment lasted for about 4 months with a significant decrease in pain intensity but no resolution as previous treatments. It was obvious that another treatment approach was necessary. In my training as a CHEK Practitioner, we are taught to take an integrated and holistic approach to chronic musculoskeletal pain. Upon reassessment, it was discovered that her right sacroiliac joint and posterior-lateral thigh pain was created by increased right lower extremity weight bearing caused by a right rotated atlas (C1, or 1st cervical vertebrate) influenced by her right eye dominance (she has a left eye strabismus, or “lazy eye”) and a recent switch towards chewing on the right side of her jaw (due to 3 teeth on the upper left mouth being removed). It was discovered that stress played a major role in her symptoms. When exhausted or fatigued her right eye vision worsens which drives her atlas excessively to the right, aggravating the right lower extremity pain. Before this reassessment her MD wanted to give her epidural injections for the pain and to “seriously” consider spinal surgery.

Fortunately, within 4 sessions after the reassessment she was pain-free and able to fully weight bear on her right leg without creating pain for the first time in 5 months. Treatment consisted of neuromuscular therapy (a soft tissue manipulation technique) to the extra ocular eye muscles followed by adjustments to correct her atlas. Vision therapy exercises and self atlas mobilisations were instructed. Self pelvic correction exercises were also taught. It should also be known that this patient also had some mental-emotional stressors that aggravated her symptoms. She was the sole care taker of a dying brother and had issues with an estranged daughter. These were addressed with sessions with a psychotherapist. Nutrition and lifestyle issues such as circadian stress, hydration, avoidance of processed foods and refined sugars, and parasympathetic-stimulating activities (ie. tai-chi) were also addressed.

Early in my career, I was taught that cases like the one above were not possible to “fix” by the ordinary PT and that these are the patients that would most likely require surgery. I was also led to believe that only a select few of the elite PTs would be the ones that can possibly “solve” the riddle. These were the PTs that were teaching courses to other PTs because of their clinical successes. After years of experience I can honestly say that those same elite PTs would not have achieved as good results as I did with this patient unless they were able to think outside of the box. And what’s outside of the box are the many pieces of the puzzle of each person’s condition. This is the approach that I take in my practice and is what separates me from the rest. By taking a holistic and integrated approach and “walking the walk”, results like the one above are made possible.