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Chiropractic Journal of Australia : CJA March 2012
22 Chiropractic Journal of Australia Volume 42 Number 1 March 2012 Birth history examination revealed that the patient’s birth was diffcult and traumatic. The mother reported that the patient’s umbilical cord was caught around the patient’s neck. The patient had a “nick” at the back of her neck where the cord had been cut during delivery. This was witnessed by the father. The patient’s APGA scores were 7 and 9 at 1 and 10 minutes respectively. It was a half-hour before the patient was brought to her mother. On visual examination, the patient was of stated age and were demonstrated no obvious deformities. Facial movements noticeable with the patient responsive to localised sound. On sitting, the patient was able to sit unassisted, demonstrating an erect head, a straight spine but with a forward lean. She sat in the position, described previously, prior to her abnormal crawl. The patient was able to use thumb and fnger to grasp at objects with both hands. Muscle tone in both upper and lower extremities appeared normal. Upon digital palpation of the cervical region of the spine, there was increased muscle tone in the sub-occipital region. This was particularly noted about the left occipital C1-C2 joint complex region. Static palpation of the occiput and C1 joint complex, revealed the left occiput as posterior and superior and the body of C1 rotated as left posterior. Upon motion palpation C1 was restricted in right cervical rotation and left side-bend. The patient’s sacro-iliac (SI) joint was examined while the patient was in a prone position on the bench. It was observed that asymmetry in the pelvis was due to the left glutei muscle group appearing larger than the right side. Upon digital palpation there was greater “tension” (i.e., relative hypertonicity) in the left glutei muscles compared to the right. By using a digital left and right thumb contact, a medial pressure or “squeeze” was directed on either side of the lateral aspect of the SI joint, towards the midline. Upon completing this procedure, it was observed that the midline showing the gluteal crease, was not straight (i.e, superior to inferior) but rather angled approximately 10 degrees to the right (based on a visual estimation). This indicated that the sacrum was not sitting symmetrically in the midline and was a refection of sacral subluxation. Upon digital palpation, there was greater hypertonicity in the paraspinal muscles of L5-S1 vertebral levels on the right. There was greater resistance to movement upon digital motion palpation of this vertebral joint complex on the right of the L5 vertebral body. Upon digital palpation there was greater tension in the left glutei muscles than on the right. Upon digital motion palpation of the left SI joint, there was greater resistance in digital spring palpation testing of the PSIS in an anterior superior direction, on the left than on the right. Based on the above history and examination procedures, it was concluded that there was a vertebral subluxation listing of LPS and RAI Sacrum and RPI Ilium and RL5 PI. At the left femoral hip joint, the range of motion had mild limited internal rotation and was fxated in external rotation. Her left foot compared to her right foot was in excessive internal rotation. The patient’s parents were apprised of the examination and subluxation fndings and consented to a trial of chiropractic care. On the first visit, the patient received full spine chiropractic care consisting of adjustments in the following manner: the infant was positioned prone on the bench. Her mother helped calm and stabilized her on the bench. The chiropractor was positioned on the left side of the patient, directly parallel to the patient and level with the sacrum. A chiropractic adjustment was made to the left posterior base of her sacrum, using the Activator instrument8 (i.e., level 1 force), in a posterior to anterior direction. This action was repeated 3 times. Finally, a technique of gentle sacral rocking motion was maintained for less than a minute; this involved primary contact using the left heel of the hand of the chiropractor placed over the base of the sacrum. With fngers pointing towards the patient’s feet, a gentle rocking back and forth motion mobilization was administered with the centre of the sacrum as a fulcrum. The hip joint was left alone. The left foot was gently palpated and mobilized. The infant was then turned supine. For the cervical adjustment, the position of the adjustment was made with the chiropractor at the head of the bench. The right hand supported the neck and stabilized the upper cervical spine on the right. The left hand held the Activator instrument and with the lowest tension level, placed over the contact point. The contact point was the left transverse process of the C1. The direction of the vector force was in a posterior-anterior direction with a lateral left to right and superior to inferior component. This action was repeated 3 times. On the second visit, the mother reported that her daughter had started crawling “on all fours” within hours of the frst chiropractic treatment (i.e. that evening) and was even trying to crawl up the stairs. According to the patient’s mother, “She did not crawl forward on all fours until her frst treatment. Up until then, she would bum shuffe everywhere.” The patient was cared for weekly for a period of 1 month, and cared for similarly to address sites of vertebral subluxations, as described above, using the Activator instrument and sacral- occipital adjustments. A total of 6 patient visits were made over a period of approximately 4 weeks. At 18 months of age, the patient returned for a check-up and was congruent with normal milestones for her age. She had begun walking after 12 months of age and at 18 months was a confdent walker. The patient’s mother did note that on occasion the toddler reverted back to a crawl and would sometimes be on all fours and rock back and forth. In the social context she was able to drink from a cup without spilling. During the chiropractic check-up, she was able to scribble on paper and make a tower with 3 bricks when shown, demonstrating fne-motor skill and visual acuity. In hearing and language, her mother reported that she did not have as much language as her older sister. However, she was able to understand and point to body parts. With respect to gross motor movements, the patient was observed as able to pick up an object from the foor with out overbalancing. DISCUSSION During the first year of life, the ultimate goal for the developing infant is to develop skills that allow for independent movement and the ability to explore his or her environment. It is at this time that the infant progresses from lying prone to rolling over to getting on “all fours” to sitting and eventually, pulling up to stand and ultimately walk.9 BOTTOM SHUFFLER AND CHIROPRACTIC BERNARD • ALCANTARA
CJA June 2012