by Thomas D. Groover, BS, BSCI, MA, DC, CCEP
TREATING MENIERE’S DISEASE — THE CRANIOCERVICAL JUNCTION DISORDER
Boulder Chiropractic Clinic successfully treats Meniere’s Disease and the individual symptoms associate with that disease. This presentation is about our work with a patient named Kathy who suffers from Meniere’s Disease, a disabling Craniocervical Junction Disorder involving a number of symptoms – many of them disabling. In this case, her Craniocervical Junction Disorder was caused by her Upper Cervical Subluxation Complex, the origin of which is the abnormal mechanical and structural relationships between the base of her head (cranium), the top two vertebra of her neck (cervical) and resulting local and global — mechanical and neurological complications resulting from her Upper Cervical Subluxation Complex.
The National Institute on Deafness and Other Communication Disorders says 615,000 people in the United States have Meniere’s Disease. Meniere’s is a collection of symptoms including fullness of the ear, loss of hearing, tinnitus, dizziness, vertigo, nausea and vomiting.
Our clinic has routine success treating each of these symptoms individually and in various combinations. However, as with most neuromusculoskeletal conditions, the work we do is not “one and done”. It’s a process involving specific diagnosis, treatment planning and progressive phases of recovery. Our most successful patients have specific health goals and want to be diagnosed and treated holistically. They are usually interested in optimal outcomes — meaning timely relief from their symptoms, stabilization of their conditions and long-term, sustainable wellness.
- The Upper Cervical Subluxation Complex
- 8 Phases of Recovery
- Kathy’s Holistic Screening Evaluation
- Cervical Regional Evaluation
- Kathy’s Initial Upper Cervical Corrective Procedure
- Pelvis/Lumbar/Thorax/Rib Cage Evaluation
- Initial Pelvis/Thorax/Rib Cage Corrective Care w/Upper Cervical Follow-Up
- Shoulder Regional Evaluation W/Established Treatment Plan Follow-Up
- Initial Shoulder Corrective Care with Established Treatment Plan Follow-Up
- TMJ Regional Evaluation/Treatment w/Established Treatment Plan Follow-Up
- Stabilization, Healing and Wellness Follow-Up
THE UPPER CERVICAL SUBLUXATION COMPLEX
The Upper Cervical Subluxation Complex includes the joint misalignments, or subluxations, of the occipito-atlanto-axial joints. Your atlanto-occipital joint is the articulation between top of your neck, your Atlas (C1 vertebra) and your occiput (cranial base). Your atlanto-axial joint is the articulation between the second vertebra at the top of your neck, your axis (C2 vertebra) and your Atlas (C1 vertebra). Chiropractic subluxations are joint mechanical misalignments, less that dislocations, with their harmful mechanical, neurological, muscular, inflammatory and painful effects.
That subluxation complex miss-aligns the uppermost part of your neural canal (the conduit through which your spinal cord travels from your foramen magnum (hole in the base of your head or occiput) on its way from your brain to the bottom of your spine). It also miss-aligns the upper cervical intervertebral foramen, the openings through which your C1, C2 and C3 spinal nerve roots emerge from your spinal cord and branch out into your head and neck. The upper cervical subluxation complex also miss-aligns and occludes the uppermost passageway for your right and left vertebral arteries. These arteries provide blood to the base of your brain. They rise from your subclavian artery and pass through the foramina of the transverse processes, the boney arms protruding from each side of your cervical vertebra. At the top of your neck, your vertebral arteries pass though the foramina of your C1 Atlas vertebra and enter the base of your head trough your foramen magnum. Misalignment of the base of your occiput with your C1 and your C1 with your C2 vertebra will tense and compress this artery and reduce the blood flow to your brain, vertebra and neck muscles.
Therefore, the upper cervical subluxation complex includes several critical joint mechanical abnormalities which produce abnormal head and upper neck posture and movement causing nerve tension and compression of the upper cervical nerve roots, the spinal cord and brainstem, and encroachment upon the arteries supplying blood to your neck and the base of your brain.
EIGHT PHASES OF RECOVERY
Boulder Chiropractic Clinic’s program defines 8 overlapping phases of patient recovery.
Phase one is informed consent. Informed means you understand your condition’s, their causes and their complicating factors, and the reasoning behind our sequentially prioritized diagnosis and treatment plans. Consent means our cooperative agreement and partnership with you throughout your diagnosis, treatment and recovery.
Phase two, differential diagnosis, is Holistic Screening Evaluation of your health history, your fundamental posture and frame, all your major joints, nerves and muscles throughout your body and the creation of a prioritized problem list for further detailed, Regional Confirmatory Evaluation.
Phase three is your confirmatory diagnosis acquired from specific, sequential regional evaluations. That sequence is planned according to priorities assigned from your phase two holistic screening evaluation. Your confirmatory diagnosis differentiates between potential causes and gives the specific details required for providing the most effective corrective care.
Phase four is corrective care and accompanying confirmatory reexaminations according to the sequence specified in your regional evaluations. Each region’s corrective care follow-up continues during each subsequent visit until stabilization of the region.
Phase five is regional stabilization. Regional stabilization occurs when several of your follow-up examinations are negative, showing your corrective care is maintained.
Phase six is your regional healing phase. Regional stabilization is the foundation for regional healing. When the corrective care for your miss-aligned joints is maintained, healing of related articular surfaces, ligaments, discs, membranes, tendons, muscles and nerves begins; with corresponding reduced inflammation, pain, stiffness, weakness and dyscoordination.
Phase seven is your regional wellness phase. Each of your body’s regions has its unique history and therefore unique capacity for healing. The rate and extensiveness of your healing is individual and subject to the laws of physical matter. Some injuries heal fully while others are improved, but permanent. For most people, the wellness phase is symptom-free and highly functional. For the more severely injured, symptoms tend to be significantly reduced, function greatly enhanced and are manageable through long-term follow-up care.
Phase eight is your regional maintenance phase. This phase is the fulfillment of Boulder Chiropractic Clinic’s purpose. We maintain your wellness by monitoring your body’s structure and function and the health of your joints, nerves and muscles throughout life’s many bumps and stumbles, blips and bleeps. The human physiology is dynamic and requires ongoing inspection and maintenance to be healthy. We are here to assure that you meet your diagnostic, corrective, rehabilitation, strength and conditioning requirements needed for your changing lifestyle.
Our patient, Kathy likes this holistic approach and she chose to be treated accordingly.
KATHY’S HOLISTIC SCREENING EVALUATION
Kathy first visited our clinic for her Holistic Screening Evaluation including her health history and screening of all her major joints, muscles and nerves. She reported the following symptoms.
MENIERE’S DISEASE SYMPTOMS
Kathy’s primary complaint was Meniere’s disease. She rated it on the Visual Analogue Scale at 8-10 out of 10, with 10 being the worst and 0 being the absence of symptoms. Her Meniere’s began 9 years previous and occurred 80% of the time. Her individual Meniere’s symptoms were as follows:
- Fullness of the left ear, 6/10, which, as it became more intense and frequent, lead to hearing loss and dizziness.
- Hearing loss: 8/10 of the left ear.
- Tinnitus: 5/10, which would drive her crazy at night, compelling her to sleep with the fan on in the room as a distraction.
- Dizziness: 7/10, which as it becomes more severe, transformed into vertigo.
- Vertigo: 10/10, which began 9 years ago as a sudden attack. While practicing yoga she performed trikonasana, the triangle pose, and was thrown to the floor. Her original vertigo symptoms involved spinning of the environment which prevented her from walking or doing anything. At the time of her first visit to our clinic, she still had the vertigo, but thought her brain had either adapted to it or she had learned to function with it.
- Nystagmus: 10/10
- Cyclic vomiting: 10/10, occurring every 20 minutes if not treated in time.
MOTOR VEHICLE COLLISION INJURY SYMPTOMS
Kathy reported two previous car collisions, one occurring 33 years previous which damaged her neck, shoulder and back, broke 7 ribs and gave her a concussion. The 2nd car collision was about 15 years previous. The ongoing symptoms she attributed to her car collisions were:
- Headache, 5/10
- Neck pain, 5/10
- Shoulder pain, 1/10
- Upper back pain, 1-2/10
- Low back pain, 5/10
- Jaw pain, 0-1/10
- Wrist and hand pain, tingling and numbness, 8/10
- Knee pain, 2/10
- Foot pain, 0-5/10
- Digestive and elimination issues, 2/10
- Sleep disturbance, 5/10
KATHY’S SOCIAL AND HEALTH HISTORY
- Her exercise and hobby activities have included Rock and ice climbing, trail running, hiking, skiing, snowshoeing, road biking, backpacking and photography.
- She had seen an ear, nose and throat specialist but not experienced any benefits from that treatment.
- She had previous surgeries for sinus infections.
HOLISTIC SCREENING EXAMINATION
Kathy’s Holistic Screening Examination began with visualization of the core frame of her body. I checked her frontal plane for left to right postural distortions which are positive signs for upper cervical subluxation complex:
- She had moderate to severe head tilt and moderate to severe pelvis, thorax, neck and head displacements both to the right and left of mid line.
- Her pelvis was moderately to severely tilted.
- She had a physiologic short leg.
These findings were all positive for upper cervical subluxation complex and correlated with her Craniocervical Junction Disorder.
I examined her sagittal plane for front to back postural distortion patterns associated with syndromes of her neck, thorax, shoulder and ribs, lumbar spine, pelvis and hip. By identifying these syndromes locates subluxation complexes and resulting disrupted neuromuscular control of spinal and extremity joints, abnormal posture with abnormal spinal loading, acute injury risk, viscoelastic creep (or remodeling of bones, discs, ligaments, tendons and muscles) and risk for degenerative arthritis.
- In relation to her center of gravity, her head and neck were forward, demonstrating anterior loading of her cervical spine and high probability for viscoelastic creep of that region.
- Her pelvis was anterior to her center of gravity and knees were hyperextended, demonstrating posterior loading of lumbar facet joints.
I screened her ankles, knees and hip sockets. Her ankle dorsiflexions were restricted, consistent with the presence of ankle subluxations.
I looked at her sacroiliac joints for subluxations, with an eye toward differentiating between sacrum subluxation and ilia subluxations. She had complicated pelvis subluxations causing structural and functional asymmetries, including:
- Unilateral superior iliac shear
- Contralateral iliac lateral rotation or out-flare
- Fixation of one sacroiliac joint with the other being hypermobile
I checked the inter-vertebral joints of the lumbar, thorax and cervical spine.
- Her whole spine had restricted right lateral flexion and resisted posterior to anterior motion.
- The direction of restrictions in her spinal lateral flexion alternated from right to left to right at the lumbar, thoracic and thoracocervical spine.
- Her left wrist joints were resistant to passive movements.
- Her jaw deviated from side to side when closing and opening, jaw joints were painful to touch — findings consistent with temporomandibular joint subluxations.
I performed neurological muscle testing for joint abnormalities of her knees, hips, pubic symphysis, lumbar and cervical spine, ribs, shoulders and elbows. Abnormal joint position, pressure, tension and joint pain are sensed by joint nerve endings called mechanoreceptors which alert and confuse your brain. Then your brain gives garbled feedback to your joints causing breakdown in your joint neuromuscular control. The resulting muscle weaknesses and dyscoordination indicate joint injuries, subluxations and joint disease.
- Kathy had weak bilateral hip abductors tested while both hips were flexed – a positive sign for pubic symphysis abnormality.
- She had weakness of all L1 through L5 myotomes, indicating inhibition of those spinal nerve roots.
- She had weakness of bilateral pectoralis major sternal suggesting abnormal joints of her rib cage.
- Her bilaterally weak pectoralis major clavicular, anterior deltoid and coracobrachialis muscles pointed to her six shoulder joints.
- Weakness of bilateral triceps with wrist held straight, flexed and extended signaled elbow subluxations.
Her sensory, reflex and orthopedic screening tests was normal.
Based upon Kathy’s history of two previous motor vehicle collisions, there is a high probability that her upper cervical subluxation complex is primary to her Meniere’s Disease and these collisions caused subluxations of her pelvis, lumbar, thoracic, lower cervical spine and most of her extremity joints. Kathy had multiple whole-body subluxations amounting to a Global Subluxation Complex. Our clinic defines Global Subluxation Complex as the sum of all joint misalignments and their affects upon the peripheral and central nervous system.
It seemed most likely that her shoulder and elbow weaknesses were from cervical subluxations or shoulder, elbow and rib cage subluxations or both. Her hip weaknesses were probably from any combination of lumbar subluxations, subluxations of her hip sockets or of her pubic symphysis.
MY DIFFERENTIAL DIAGNOSIS
- Segmental and somatic dysfunctions of the cervical, thoracic and lumbar spine. subluxations of the sacroiliac joints, pubic symphysis and rib cage.
- Bilateral sternoclavicular, glenohumeral, acromioclavicular joints; subluxations of her left radiocarpal and temporomandibular joints.
- Radiculopathy of the cervical and lumbar regions, muscle weakness, abnormal posture and unequal limb length.
My prognosis was complicated by her long-term pre-existing injuries from her two previous motor vehicle collisions. There were no contraindications.
KATHY’S TREATMENT PLAN
My treatment plan was:
- To see Kathy 1 to 3 times per week for 1-3 months to complete necessary confirmatory regional evaluations and start treatment and follow-up exams and treatments for all these long-term injuries.
- Continue seeing Kathy for 1 to 3 visits per week, for 4-8 months to complete her corrective care and to progress through the phases of stabilization, healing, wellness and maintenance care.
- Reevaluations would be performed within reasonable intervals of time, and her treatment plan will be modified according to progress.
The planned sequence of Regional Confirmatory Evaluations needed to confirm Kathy’s diagnosis and perform detailed chiropractic analysis for providing specific chiropractic treatment procedures were planned as follows:
- Cervical Regional Evaluation
- Pelvis/Lumbar/Thorax/Rib Cage Multi-Region Evaluation
- Shoulder Regional Evaluation
- Elbows Regional Evaluation
- Temporomandibular Joint Regional Evaluation
- Wrist and Hand Regional Evaluation
KATHY’S TREATMENT PROCEDURES
- Sequentially planned, specifically vectored chiropractic joint corrective procedures to normalize joint structure and function throughout her body, to resolve the neurological disorganization and stress contributing to Kathy’s pain and weakness, remove impairments to her central nervous system and eliminate her global subluxation complex.
- Activities of daily living instruction, practice and prescription to reverse unhealthy posture and movement habits, specifically her upper crossed syndrome, superior Frankfort Line and swayback, for eliminating joint and nerve stress and to stabilize Kathy’s chiropractic corrective procedures.
- Neuromuscular acupuncture for eliminating residual muscle trigger points and contractions, nerve facilitations, joint inflammations and pain: specifically used for her neck and temporomandibular joint regions.
- Manual therapy tissue release for residual muscle contractures to stabilize joint structure and function after establishing chiropractic joint corrective care and neuromuscular acupuncture: used specifically for Kathy’s temporomandibular joint and neck muscle trigger points.
- Therapeutic exercise to activate and strengthen residual deactivated muscles for normalizing joint movements, balance posture and to stabilize her chiropractic joint corrective care.
- Cervical extension traction to stretch Kathy’s neck muscles, decompress her neck intervertebral discs, improve neck vertebral motion, reduce the anterior loading of her cervical spine, balance her posture and reduce spinal cord, spinal nerve root and brain tension after having established her chiropractic joint corrective care.
- Station and Gait training to lessen the posterior load place upon her lumbar spine, the anterior load upon her thoracic and lower cervical spine and posterior load upon her upper cervical spine, and to further normalize her posture and movement for advancing and stabilizing Kathy’s spinal and extremity joint corrective care.
CERVICAL REGIONAL EVALUATION
Kathy’s Holistic Screening Evaluation determined her primary complaint, Meniere’s Disease, was from Craniocervical Junction Disorder from upper cervical subluxation complex. Therefore, specifically diagnosing and treating that region was the first priority of her treatment plan. I began my program of regional confirmatory evaluations and treatments with her Cervical Regional Evaluation.
Kathy’s history and symptoms remained the same.
CERVICAL REGIONAL EXAMINATIONS
My visual inspection of Kathy’s cervical-related postural distortions confirmed the continued presence of head and pelvis tilting, pelvis and upper back deviations from her vertical axis, occipital hyper-extension, anterior head carriage with thoracic kyphosis and protrusion (or forward rounding) of her shoulders.
My instrumentation examinations included measurements of the frontal distortions of her posture associated with the upper cervical subluxation complex with the Anemometer Instrument.
From Kathy’s Progress notes:
My palpation examination included the Upper Cervical Supine Leg-Leg Length Examination, spinal intersegmental motion testing and feeling for muscle contractions and trigger points and facet joint pain.
- Her neck vertebrae resisted right lateral flexion, right rotation and posterior to anterior motions.
- Palpating all her cervical facet joints invoked pain and she had painful trigger points of her right sternocleidomastoid, anterior scalene, middle scalene, posterior scalene, cervical trapezium, erector spinae and suboccipital muscles
RANGE OF MOTION
Kathy’s neck range of motion was normal.
Neurological testing revealed significant muscles weaknesses of the bilateral C5, C7 and C8 myotomes, but sensation and reflex testing were normal.
Orthopedic testing was also normal.
CERVICAL X-RAY EXAMINATION
I took X-rays of her upper and lower cervical spine to evaluate for preexisting conditions and complications such as:
- Neck degenerative arthritis
- Abnormal neck curvature
- Vertebral joint instability
- Masses, fluids and exudates
- Developmental abnormalities
Analysis of these X-rays provided the details of Kathy’s abnormal intervertebral joint biomechanics.
LATERAL CERVICAL, LATERAL CERVICAL FLEXION AND LATERAL CERVICAL EXTENSION X-RAYS
Kathy’s lateral cervical X-rays were taken while her head and neck were upright, flexed and extended. Her neck curve was hypolordotic (decreased by 66%). She had mild neck degeneration including reduced intervertebral disc spaces and bone spurring.
Her lateral cervical flexion X-ray showed her inability to fully flex her neck forward. There were anterior and posterior translations of two neck vertebra, the total translations of which revealed moderate ligament traumas having occurred at those cervical vertebrae.
The moderate mild ligament injuries represent correspondingly moderate cervical ligament laxities and joint instabilities with resulting increased probability for more frequent and longer-term chiropractic follow-up and pain management.
VERTEX AND NASIUM PRE-X-RAYS
I performed nasium and vertex X-rays and X-ray analysis according to National Upper Cervical Chiropractic Association standards. Her head was laterally rotated at the Atlantooccipital joint (occiput to C1), tilted to the right 3°. Her C1 Atlas vertebra was translated laterality to the right 3 ½ °. Her Atlas was right rotated 1°, Atlas plane line was level, her C2 axis was rotated to the right 2 1/2° and her neck vertebra were rotated and leaning 1 ½ ° into her right frontal plane.
CERVICAL X-RAY ASSESSMENT
The patient has upper cervical spinal subluxation complex with direct effects upon the Atlanto-occipital and Atlanto-axial joints and there corresponding C1 and C2 nerve roots. The subluxation complex’s compressive and tensile forces upon these nerve roots could have a direct adverse effect upon the following:
- Geniohyoid (moves the hyoid bone anteriorly and upwards, expanding the airway) and thyrohyoid (which depresses the hyoid bone and elevates the layer next).
- Ansa cervicalis innervations to the superior belly of the omohyoid, sternohyoid and sternothyroid which act to depress the hyoid bone, an important function for swallowing and speech.
- Rectus capitis anterior and lateralis
- Longus capitis
- Prevertebral muscles and sternocleidomastoid
- Greater auricular sensory innervations to the external air and skin over the parotid gland
- Auricular branch of the vagus nerve and the posterior auricular branch of the facial nerve innervations of the small muscles around the ear.
- Transverse cervical nerve sensory innervations to the anterior skin of the neck and upper sternum.
- Lesser occipital nerve sensory innervations to the posterior superior scalp.
The upper cervical subluxation complex also adversely affects the joint-related motion, nerves, muscles, inflammation and pain. The also directly affect the central nervous system by miss-aligning the superior neural canal at the foramen magnum, posterior arch of the Atlas vertebra and neural canal of the axis vertebra. These misalignments produce abnormal compression and tension forces upon the brainstem, spinal cord and indirectly to the upper brain and spinal nerve roots. These forces may directly affect cranial nerve function, ascending/descending spinal nerve tracts and produce dural tension of the brain and spinal cord.
The patient’s hypolordosis places abnormal compression at the anterior vertebrae and discs with deformation of the cervical vertebra and intervertebral disc, posterior displacement of the disc’s nucleus pulposus, corresponding stress upon the posterior annulus fibrosis, overstretching of the posterior ligaments of the cervical spine, distraction and flexion fixation of the facet and spinal cord tension.
Vertebral subluxation throughout the cervical spine adversely affects the joint-related motion, nerves, muscles, inflammation and pain. They predispose that spine to further degenerative in acute injury and may have deleterious effects upon the cervical myotomes and dermatomes.
Joint corrective procedures, joint mobilizations, joint strengthening, and joint stabilization are required.
INDICATIONS/CONTRAINDICATIONS TO TREATMENT:
FOLLOW-UP PROCEDURES INDICATED:
Reevaluation of the spinal biomechanics should be performed after 12 treatment visits, or as needed, through physical examination and instrumentation procedures. New x-rays may be performed after at least one year of treatment or as needed.
My conclusions from this X-ray examination were, Kathy had moderate ligament injuries of her cervical spine from cervical spine trauma consistent with her 2 previous motor vehicle collisions. She had abnormal biomechanics of the upper cervical spine or Upper Cervical Subluxation Complex and abnormal lower cervical spinal biomechanics (subluxations of her lower cervical spine).
My assessment of this Cervical Regional Evaluation was:
- Her shoulder, elbow and finger weaknesses were from neurological inhibitions of spinal nerve roots from cervical subluxations or neurological inhibitions of peripheral nerves from rib, shoulder and elbow subluxations, or both. Further differentiation of the cause for these weaknesses would be accomplished after treating Kathy’s lower neck vertebra.
- The patient has subluxations of her upper cervical spine, lower cervical spine and probably subluxations of her shoulders, ribs and elbows.
- Her physical and X-ray examinations gave information specific to performing vectored corrective procedures needed to normalize her abnormal upper cervical and lower cervical spinal biomechanics.
My diagnosis prognosis remained the same.
My planned treatment procedures specifically for her upper cervical spine included:
- The upper cervical corrective procedure
- Upper cervical post-correction physical and X-ray examinations
- Crainosacral Therapy stabilization of the upper cervical corrective procedure
- Activities of daily living training of posture and movement requirements specific to maintaining Kathy’s neck corrective care.
KATHY’S INITIAL UPPER CERVICAL CORRECTIVE PROCEDURES
Kathy returned to our clinic for her initial upper cervical correction appointment. Her lower cervical spinal care was planned to begin at the time of her initial pelvis, lumbar, thorax and rib cage treatment visit.
UPPER CERVICAL CORRECTIVE PROCEDURE
I administered Kathy’s upper cervical corrective procedure and her upper cervical subluxation complex related frontal plan Postural Measurements were normalized.
POST UPPER CERVICAL CORRECTIVE PROCEDURE EXAMINATION
Her pelvis had moved from 4° left of her center gravity to 0° center. Her 3° pelvis tilt was eliminated to 0°. Her 1 ½° left lower neck was removed to 0°.
Her Anatometer standing weight distribution measurements had normalized. That 8% difference between her right and left sides of her body was reduced to .2%.
UPPER CERVICAL POST-X-RAYS
Her X-ray reexamination, planned to be performed only after her initial upper cervical corrective procedure, revealed her head tilt was reduced from 3° to the right to 1° to the right. Her Atlas laterality was eliminated from right 3 ½ ° to 0°, Atlas 1° right rotation was eliminated to 0°. Her cervical 1 ½° rotation with side bending into the right frontal plane was eliminated to 0°.
My upper cervical spine diagnosis, prognosis and treatment plan and were confirmed.
PELVIS/LUMBAR/THORAX/RIB CAGE REGIONAL EVALUATION
WITH UPPER CERVICAL TREATMENT-PLAN FOLLOW-UP
Kathy returned to our clinic to follow-up on her upper cervical spinal corrective care and for her Pelvis/Lumbar/Thorax/Rib Cage Evaluation and for follow-up examination of her upper cervical spine.
Her history remained the same.
Her symptoms had significantly improved:
FOLLOW-UP UPPER CERVICAL SPINAL EXAMINATION
Kathy’s Anatometer Examination was negative for upper cervical subluxation complex. Her hips were level, pelvis and upper back centered upon her mid line and her standing weight balanced between the right and left side of her body. Her follow-up Supine Leg-Length upper cervical exam confirmed her leg lengths were even, another negative for upper cervical subluxation complex. Further treatment of the upper cervical spine was not indicated.
PELVIS/LUMBAR/THORAX/RIB CAGE REGIONAL EXAMINATION
Visual inspection of her upright posture revealed:
- Her original pelvis tilt had resolved with her upper cervical corrective procedure and were still level.
- Lower lumbar spine was hyper-lordotic.
- Knees were hyperextended.
Palpation of her spinal intersegmental motions found:
- Restricted posterior to anterior motions of her lumbar and thoracic spine
- Her entire spine rotated to the right
- She had alternating resistances to side-bending. Her Lumbar spine resisted left lateral flexion, thoracic spine resisted right lateral flexion and thoracic-cervical spine resisted left lateral flexion.
- Left rib 1 and right ribs 6 and 7 resisted anterior to posterior with superior to inferior motions.
- She had contractions and trigger points of the left paraspinal muscles at L5 through T5, her bilateral T4 through T1 paraspinal muscles and her bilateral tensor fascia lata.
- Her bilateral hamstring muscles were contracted and resisted straight-legged hip flexions.
- Kathy’s sacrum was left rotated and her right ilium superiorly displaced with right sacroiliac joint fixation and left sacroiliac joint hypermobility.
RANGE OF MOTION
Her active lumbar and thoracic ranges of motion were normal.
Neurological testing revealed weaknesses of Kathy’s bilateral L1 through L5 myotomes and her bilateral hip adductor muscles tested when both hips flexed.
Her orthopedic testing was normal.
FULL-SPINE X-RAY EXAMINATION
Full spine anterior to posterior and lateral x-rays were performed to evaluate pathology and spinal biomechanics for optimal corrective care.
- Kathy’s right acetabular joint space was slightly reduced.
- Left vertebral rotation persisted throughout her lumbar, thorax and cervical spine.
- There was left lumbar curve with apex at L2-3, right thoracic curve with apex at T10-11 and left thoracocervical curve with apex at T3.
- Bone spurs were located at the T10-T12 vertebral bodies and the L1-2 and L2-3 disc spaces were reduced.
Her lumbar lordosis measurement was 68°/50°- 60° average.
Her intervertebral disc angles were:
- L1 – 3°/8°
- L2 – 6.5 °/10°
- L3 – 10 °/12°
- L4 – 13°/14°
- L5 – 12 °/14°
My conclusions from this study were:
Her increased lumbar lordosis depicts:
- Posterior loading of her lumbar spine.
- Reduced disc angles are from accompanying intervertebral disc compression.
- Accompanying lumbar facet joint compressions, anterior nucleus pulposus displacements and stretching of the lumbar anterior longitudinal ligaments.
- Her thoracic kyphosis measurement was normal and sacral base angle were normal.
Kathy had complex, restricted whole-spinal intersegmental motions widespread spinal subluxations which cause corresponding widespread muscle contractions and trigger points.
Kathy has Lower Crossed Syndrome (Swayback) with accompanying Upper Crossed Syndrome, signs of which are:
- Larger lower lumbar disc angles with smaller-than-normal upper lumbar disc angles Posterior loading of the lower lumbar spine
- Knee hyperextended and displaced posterior to her pelvis and center of gravity line
- Thoracic kyphosis
- Anterior head carriage
- Forward rounded (protracted) shoulders
Kathy has Iliosacral-Pubic Symphysis-Lumbar Subluxation Complex, characterized by:
- Frontal plane and sagittal plain distortions of her pelvis
- Fixation of one sacroiliac joint and hypermobility of the other
- Hip adductor weakness during hip flexion
- L1-L5 myotome weaknesses
There are Subluxations of Right Ribs 6 and 7 and Left Rib 1:
- These ribs were stuck in their inspiration pattern and resisted expiration movement.
- They resisted superior to inferior motion.
- They resisted anterior to posterior motion.
Kathy’s physical and X-ray examinations gave information specific to vectored corrective procedures needed for effectively treating subluxations of the sacroiliac joints, pubic symphysis, lumbar, thorax and ribs.
My diagnosis was confirmed except, her general rib cage subluxation was differentiated specifically to right ribs 6 and 7 and left rib 1 subluxations.
INITIAL PELVIS/LUMBAR/THORAX/RIB CAGE/LOWER CERVICAL CORRECTIVE CARE W/ ESTABLISHED UPPER CERVICAL FOLLOW-UP
Kathy returned to our Clinic for follow-up and the initial treatment of her ilia, sacrum, pubic symphysis, lumbar, thorax, rib cage and lower cervical spine, L1 through L5, T12 through T1, C7 through C3, right ribs 6 and 7 and left rib 1.
UPPER CERVICAL SPINAL FOLLOW-UP
Kathy’s Anatometer Examination continued to be negative for upper cervical subluxation complex. Her hips were level, pelvis and upper back centered upon her midline and her standing weight balanced between the right and left side of her body. Her follow-up Supine Leg-Length upper cervical exam confirmed her leg lengths remained even, another negative for upper cervical subluxation complex. Further treatment of the upper cervical spine was not indicated at that time.
INITIAL PELVIS/LUMBAR/THORAX/RIB CAGE/LOWER CERVICAL CORRECTIVE CARE W/ ESTABLISHED TREATMENT PLAN FOLLOW-UP
Treatment included correction of her right superiorly translated and left internally rotated ilia, pubic symphysis subluxation, subluxations of L1 through L5, T12 through T1 and C7 through C3, left rib 1 and right ribs 6 and 7.
My post-correction examination showed:
- Her lumbar myotome strengths associated with her lumbar subluxations had normalized from 4.5/5 to 5/5.
- Her hip adductor muscles tested with hips flexed, associate with her pubic symphysis subluxation, normalized from 4.5/5 to 5/5.
- Her pectoralis major sternum weaknesses associated with her rib subluxations and normalized from 4.5/5 to 5/5.
- Kathy’s sacral rotation and pelvic frontal and sagittal plane asymmetries had normalized.
- Her spinal intersegmental motions, muscle trigger points and muscle contractions were reduced.
SHOULDER REGIONAL EVALUATION WITH ESTABLISHED TREATMENT PLAN FOLLOW-UP
Kathy returned to our clinic to follow-up on the corrective care she had received for her upper cervical spine, lower cervical spine, pelvis, lumbar and thoracic spine and her rib cage, and for her Shoulder Regional Evaluation.
Kathy’s history was the same.
Kathy’s over-all Meniere’s Disease, originally 8-10/10 had improved to 6-7/10 and was then 3/10. Her 6/10 fullness of her ear had improved to 3/10, hearing Loss, originally 8/10 was 5/10, tinnitus had gone from 5/10 to 3/10, dizziness from 7/10 to 0/10 and vertigo, nystagmus and cyclic vomiting, originally 10/10 had quickly resolved to 0/10 and was maintained at 0/10. Her original 5/10 headaches also had quickly resolved at 0/10 and were maintained at 0/10. Kathy’s neck pain had gone from 5/10 to 3/10 and was then 2/10. Her wrist and had pain, originally 8/10 had quickly resolved to 0/10 and was maintained at 0/10. Her low back pain, originally 5/10 had initially reduced to 3/10 and was still 3/10 and 0-5/10 foot pain had quickly resolved to 0/10 and was maintained at 0/10.
UPPER AND LOWER CERVICAL, LUMBAR, THORAX SPINE AND PELVIS FOLLOW-UP EXAMINATION
- Kathy’s Anatometer Examination, which had been normal up to this time, was positive for upper cervical subluxation complex.
- Her pelvis was still level but was displaced 2 degrees from her center of gravity.
- Her upper back was displaced 2 degrees from her center of gravity.
- Her previous right ribs 6 and 7 and left rib 1 corrections were maintained.
- Subluxation of her right rib 10 subluxation was discovered.
- Examinations of her L1 through L5 and pubic symphysis were negative.
- Subluxations of all her thoracic vertebra had reduced T12-T1 just to subluxations of her T10, T8 and T6 through T1.
- The complexity of her cervical subluxations had reduced.
- C7 through C3 resisted right rotation
- Right lateral flexion and posterior to anterior motion was simplified to resisted posterior to anterior motion of that region.
UPPER AND LOWER CERVICAL, LUMBAR, THORAX SPINE AND PELVIS FOLLOW-UP TREATMENT
Kathy’s follow-up treatment normalized her Anatometer upper cervical examination and examinations of her ribs and lumbar spine were negative and her thoracic and cervical spine continued improvement.
SHOULDER PHYSICAL EXAMINATION
- Her Frankfort Line was reduced from 15° superior to 5° superior.
- Her head carriage was reduced from 1 ½ inch to 1 inch.
- Her right shoulder was still inferior.
- There were trigger points of the bilateral anterior deltoids, lateral deltoids and clavicular pectoralis major muscles.
- Her left proximal clavicle was anterior and resistant to anterior to posterior motion.
- Bilaterally, the distal clavicles were posterior to the acromion and resistant to both superior to inferior and posterior to anterior motions.
- Kathy’s shoulder rages of motion were normal, except her right medial rotation was 10° /90°.
- She had weaknesses of her bilateral C5 and C7 myotomes.
- Her bilateral C8 myotomes weaknesses had then become normal.
- Neurological inhibition of her C8 nerve roots, secondary to C7-T1 spinal subluxations had resolved.
- Her orthopedic tests ruled out bicipital tendon instability, subacromial bursitis, shoulder dislocation trauma or rotator cuff tear.
SHOULDER X-RAY EXAMINATION
- Bilateral distal clavicles were superior to her acromion (collar-bone articulation with her shoulder blade).
- There were no degenerative or general positioning abnormalities of her shoulder bones or her joint cartilage or soft tissue.
Kathy’s lower cervical corrective care had normalized her cervical myotomes. Therefore, the remaining shoulder muscle weaknesses were not cervical subluxations, but from subluxations of her shoulders.
Previously, neurological muscle testing of her shoulders revealed right and left sternoclavicular joint subluxations. However, this shoulder evaluation confirmed that her right sternoclavicular joint was normal and only her left sternoclavicular joint was subluxated.
Update to Kathy’s original shoulder diagnosis:
- Bilateral sternoclavicular, glenohumeral and acromioclavicular subluxations.
- To right sternoclavicular and bilateral glenohumeral and acromioclavicular subluxations.
INITIAL SHOULDER CORRECTIVE CARE WITH UPPER CERVICAL/PELVIS/LUMBAR/THORAX/RIB CAGE/LOWER CERVICAL FOLLOW-UP
- Kathy’s Anatometer Examination was slightly positive for upper cervical spinal subluxation complex, with 1.4% more weight on the right side of her body.
- She had 4.5/5 weaknesses of her L3 and L5 myotomes
- Posterior subluxations of T8 through C3 with resisted right rotation and right lateral flexion.
- Upper cervical chiropractic corrective procedure to re-align the upper cervical spine with negative Anatometer and Supine Leg Length Post Examinations.
- L3 and L5 corrective procedures with 5/5 myotome testing.
- T8-T3 mirror image chiropractic corrective procedures with negative post palpation examinations.
- Chiropractic corrective procedures to the left sternoclavicular and bilateral acromioclavicular and glenohumeral joints with 5/5 post-treatment shoulder muscle testing.
- Her upper cervical, lumbar and shoulder reexaminations were negative.
- Thoracic and lower cervical spinal subluxations were reduced.
- Patient responded well to shoulder, neck, rib cage stabilization instructions and training.
TMJ REGIONAL EVALUATION AND TREATMENT WITH ESTABLISHED TREATMENT PLAN FOLLOW-UP
New to Kathy’s medical history was a previously scheduled steroid injection into her inner ear to help with her hearing loss. Following the injection, Kathy reported that she had constant dizziness and horrible hearing loss, tinnitus and fullness of her ear.
Her Meniere’s symptoms had increased from 3/10 to 6/10 but she still had no vertigo, nystagmus, cyclic vomiting. All her other motor vehicle collision symptoms had worsened.
Kathy reported that her jaw pain had increased from 0-1/10 to 4/10 now, but still less than 10% of the time since her first MVA.
- Kathy was positive for upper cervical subluxation complex.
- Her lumbar subluxations had increased from L3, L4 and L5 to include L1 and L2.
- She had subluxations of T8-T1.
- Her right acromioclavicular joint subluxation had returned but her right glenohumeral, left sternoclavicular, glenohumeral and acromioclavicular joint corrections were maintained.
- The corrections to her ilia, sacrum and pubic symphysis were also maintained.
TEMPOROMANDIBULAR JOINT EXAMINATION
- Kathy’s right cheek appeared fuller than the left.
- Her jaw deviated to the left and then to the right during jaw closing.
- Her lower oral frenulum was 2 mm to the right of her incisor mid line.
- With her jaw in her neutral position, Kathy’s mandibular condyles were positioned more to the left within their mandibular fossae.
- Passive right translation of the mandible was restricted.
- Her left masseter and temporalis are contracted and painful with palpation.
- Active jaw opening, closing, right and left lateral translation ranges were normal.
- Her cervical reflexes and sensory dermatomes were normal.
- She had 4.5/5 weakness of her right coracobrachialis, otherwise, C5-C8 myotomes were normal.
- Kathy’s cervical orthopedic tests were normal.
My assessment was Kathy’s facial asymmetry, palpation of the left TMJ produced left TMJ pain, left jaw translation while at rest and jaw deviations during jaw closing, all were positives for left temporomandibular joint subluxation.
Left temporomandibular joint subluxation.
My prognosis for her TMJ treatment was good, and without complications.
During this visit I administered her TMJ joint corrective procedure and saw good reductions in all positive signs of TMJ subluxation (reduced facial asymmetry, static and dynamic jaw deviations and jaw muscle contractions and trigger points.
STABILIZATION, HEALING AND WELLNESS FOLLOW-UP: MONTHS 5-9
Kathy returned for follow-up 1 to 2 visits per month and after 5 months of care, her Meniere’s symptoms were 2/10. Over the next 4 months her Meniere’s symptoms intensity was: 3/10, 4/10, 5/10 and 2/10.
STABILIZATION, HEALING AND WELLNESS FOLLOW-UP: MONTH 11
- Compared to the baseline symptoms she reported at her initial evaluation, Kathy’s Meniere’s symptoms had improved from 8-10/10 to 2/10.
- Her 10/10 vertigo, nystagmus and cycling vomiting had not returned since the beginning of her care.
- Her 8/10 hearing loss, 5/10 headaches, 0-1/10 jaw pain and 2/10 knee pain were gone.
- Her 6/10 ear fullness had reduced to 1/10.
- 5/10 tinnitus reduced to 1/10.
- 7/10 dizziness to 1/10.
- 5/10 neck pain reduced to 2/10 neck stiffness.
- Numbness and falling asleep of her hand from 8/10 to 4/10.
- Upper back pain from 1-2/10 to 1/10.
- Lower back pain from 5/10 to 1/10 stiffness.
- Her sleep quality had improved from 5/10 to 4/10.
- Digestion had remained the same.
- During this visit Kathy reported new 2-3/10 pain of her right Achilles tendon which, upon examination, was related to a new right ankle subluxation.
Patient was negative for upper cervical subluxation complex. Subluxations of her pubic symphysis, left glenohumeral and acromioclavicular joints, left rotation of her sacrum, subluxation of her right first rib, subluxations of T10 and T4-C2.
Over the past 11 months, Kathy has attended 32 visits, 30 of them being treatment visits. During this time, she has remained extremely active with her trail-running, ice and rock-climbing, bicycling, camping, etc. The broad scope and severity of injuries to her upper cervical, lower cervical, thoracic, lumbar, pelvis, shoulder, knee and temporomandibular joints are consistent with those from motor vehicle collisions. The rate and extent of her recovery, and her treatment frequency and duration are consistent with the standards for chiropractic motor vehicle collision injury treatment.
My current prognosis is Kathy continues to improve and her joint corrective care will continue to stabilize and heal over time. Her treatments and recoveries are complicated by the long-term harm done by her unresolved motor vehicle collision injuries. These complications will require life-long monitoring and follow-up for her to continue improving and managing any permanent injuries which remain after a reasonable period of follow-up.
Kathy’s Meniere’s was most likely caused and complicated by 15-33 years of untreated or unsuccessfully treated motor vehicle collision injuries including Upper Cervical Subluxation Complex and whole-body spinal and extremity joint subluxations. The neurological feedback to her central nervous system from these spinal and extremity joint subluxations was overwhelming and made it difficult for her to function, adapt and cope. More treatment frequency and duration are required by such demanding complications.
The positive clinical outcomes from the correction of her Upper Cervical Subluxation Complex strongly suggest a strong causal relationship between her Meniere’s Disease, Craniocervical Junction Disorder and her Upper Cervical Subluxation Complex.
Kathy has experienced 300%-400% improvement in her Meniere’s Disease symptoms which has dramatically improved the quality of her life. Her progress should continue with further stabilization and healing of her injuries. As with many motor vehicle collision injuries, Kathy’s prognosis for full recovery is uncertain. She will probably require less frequent follow-up visits in the future with life-long periodic monitoring.
Please share this story with the people in your life who suffer from Meniere’s Disease, dizziness, vertigo, tinnitus, nystagmus, vomiting, headaches or any other Craniocervical Junction Disorder, or complaints involving their joints, nervous system or muscles.If you suffer from Meniere’s Disease yourself or form any of these conditions, we hope to have the opportunity to help you.
Contact us by phone at 303-442-7772.
Our email is info@BoulderChiropraticClinic.com
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