Uncovering Hidden Pathologies: Insights from Unusual Case Histories in Chiropractic Practice

Severe low back pain often leads patients to seek chiropractic care, expecting relief from musculoskeletal issues. Yet, sometimes, what appears to be routine pain masks more serious underlying conditions. Two unusual cases reported by Blum CL highlight how specific chiropractic examination techniques can reveal hidden pathologies that standard assessments might miss. These cases emphasize the importance of thorough evaluation and collaboration with other healthcare professionals to ensure accurate diagnosis and appropriate care.

The Challenge of Severe Low Back Pain in Chiropractic Practice

Low back pain is one of the most common reasons patients visit chiropractors. Typically, chiropractors use neurological and orthopedic examinations to identify the source of pain. However, when pain is severe, these standard tests can become difficult or impossible to perform effectively. In such situations, chiropractors must rely on alternative methods to assess the patient’s condition.

Blum’s report focuses on two patients who experienced intense low back pain following trauma. The severity of their symptoms made typical examination procedures impractical. Instead, the chiropractor used the Sacro Occipital Technique (SOT), a specialized chiropractic method, to evaluate the patients. This technique involves specific examination protocols designed to detect subtle dysfunctions in the sacroiliac and occipital regions.

How Sacro Occipital Technique Helped Uncover Hidden Issues

The SOT examination revealed incongruities between expected findings and the patients’ symptoms. Despite severe pain and sensitivity, the usual positive indicators in SOT assessments were absent. This mismatch raised concerns and prompted further investigation.

Key SOT evaluation tools used included:

• R+C Factors: Reflex and compensatory responses expected in typical musculoskeletal conditions.

• Trapezius Fiber Analysis: Assessment of muscle fiber tension and response.

• Category Diagnoses: Classification of dysfunctions based on SOT criteria.

  
  

The absence of positive findings in these areas, despite the patients’ intense pain, suggested that the cause might not be purely musculoskeletal. This insight led to ordering MRI scans to explore other possible sources of pain.

Case 1: Metastasis from Malignant Skin Cancer

The first patient had a history of malignant skin cancer on the scalp diagnosed a month before presenting with severe low back pain. Initial MRI reports described findings consistent with musculoskeletal issues. However, the lack of expected SOT findings encouraged a second look.

Further radiological evaluation revealed a metastasis in the mid-lumbar spine. This discovery was critical because metastatic cancer requires a very different treatment approach than typical back pain. Early detection through chiropractic examination and imaging referral likely improved the patient’s prognosis by facilitating timely oncological care.

Case 2: Spinal Staphylococcal Infection

The second patient’s MRI showed abnormalities in the lumbar spine, initially interpreted as musculoskeletal changes. However, the SOT examination again showed no typical signs of mechanical dysfunction. This discrepancy led to additional diagnostic work.

Subsequent tests confirmed a Staphylococcus infection spreading from the L2 vertebral body to L3 across the disc space. Spinal infections can be life-threatening if untreated, and early identification is crucial. The chiropractor’s vigilance and use of SOT examination helped uncover this serious condition, allowing for prompt medical intervention.

Uncovering Hidden Pathologies: Lessons for Chiropractors as Primary Care Providers

These cases underscore the evolving role of chiropractors as primary portals of entry into healthcare. Patients often seek chiropractic care first for back pain, expecting relief from common musculoskeletal problems. However, chiropractors must remain alert to unusual signs that suggest more serious pathology.

Key takeaways for chiropractic practitioners include:

• Use specialized examination techniques like SOT when standard neurological and orthopedic tests are limited by patient pain.

• Recognize incongruities between clinical findings and patient symptoms as red flags.

• Collaborate with radiologists and other healthcare providers to ensure thorough investigation of suspicious findings.

• Refer for advanced imaging such as MRI when indicated, especially if pain severity and sensitivity do not match typical musculoskeletal patterns.

• Maintain awareness of non-musculoskeletal causes of back pain, including infections and metastatic disease.

  
  

Improving Patient Outcomes Through Vigilance and Collaboration

The two cases demonstrate how chiropractic care can extend beyond symptom management to play a critical role in early detection of serious conditions. By combining specialized examination methods with a cautious approach to unexpected findings, chiropractors can help identify hidden pathologies that might otherwise go unnoticed.

This approach benefits patients by:

• Preventing delays in diagnosis of serious illnesses.

• Facilitating timely referral to appropriate medical specialists.

• Enhancing the overall quality and safety of care.

  
  

Chiropractors who adopt this mindset contribute to a more integrated healthcare system where patients receive comprehensive evaluation and treatment.

Blum CL, "Incongruent sacro-occipital technique examination findings: Two unusual case histories." Proceedings of the ACC Conference IX, Journal of Chiropractic Education Spr 2002; 16(1): 67.

Introduction: Background: Two highly unusual patients who were seen at my office for what they considered trauma induce severe low back pain stimulated the following paper. Objectives: Chiropractors who are or are becoming primary portals of entry into the healthcare field for many patients need to be cognizant of various however, unlikely sequelae. Purpose: The purpose of these two case studies are to alert the doctor to possible clinical findings that a specific chiropractic methodology, sacro occipital technique helped to uncover. Methods: The severity of the patients’ pain made the typical neurological and orthopedic examination procedures virtually impossible. Emergency treatment was performed using specific Sacro Occipital Technique (SOT) examination and evaluation procedures. Results: Incongruities between SOT anticipated examination and evaluation procedures were discovered. The location of the patients’ severe pain, the exquisite pain and intense sensitivity associated with negative SOT findings “demanded” an MRI of the area in question. Both radiology reports initially interpreted musculoskeletal related findings. However, due to the lack of positive SOT findings (R+C Factors, Trapezius Fiber Analysis and Category Diagnoses) a consultation with the radiologist encouraged further investigation for pathology. The results of the further investigation revealed with one case a metastasis to the mid lumbar spine believed associated from a malignant "skin cancer" found a month prior located on the patient’s scalp. With the other case an MRI of the lumbar spine revealed what was later to be determined a Staph infection spreading from the body of L2 to the body of L3, across the L2/3 disc space. Discussion: In both cases each patient presented with, according to their history, trauma induced lumbosacral related pain. The patient with the metastasis described noting the pain upon falling from a chair, and reported having injured his “back” over the years in the same area, with chiropractic care reducing the pain in 5-10 treatments. SOT chiropractic treatment had initially been employed however, due marked sensitivity at the vertebra no thrusting or pressure to the spine were used. The other patient with the infection reported falling when playing soccer with his friends, and presented with sciatica along with specific L2/L3 lumbar spine pain. Similar with the other case SOT chiropractic treatment had initially been employed however, due to marked sensitivity at the vertebra no thrusting or pressure to the spine were used. With this case of significance was the elimination of sciatic radiating pain while the L2/L3 pain persisted. Conclusion: With both cases the lack of congruent SOT examination findings associating with the patient’s presenting symptoms caused the practitioner to exercise extreme caution and by the second or third office visit both were referred for an MRI of the region in question. Regretfully the patient whose condition, which metastised to the spine, was so pervasive that surgery was not an option and he did not survive. The patient with Staph infection received bed rest and a course of antibiotics. He received chiropractic treatment at home and recovered full function of his lumbar spine and lower extremities. SOT examination procedures can be a valuable tool for the chiropractic practitioner for early detection of unusual pathology and help guide cautious management of the patient’s care until further in-depth diagnostic procedures can be performed or referrals to specialists made. It is suggested that greater research is needed into the SOT evaluation procedures and their ability to help the chiropractic diagnostic process.