Chiropractic Care for Multiple Neuromusculoskeletal Conditions Complicated by Polymyalgia Rheumatica

This was a 82 year old patient with multiple chief complaints of cervical (neck), thoracic (mid back), lumbar (low back), bilateral (both sides) hip and leg pain. To be HIPAA compliant, I will call her Jackie instead of her real name.  Jackie was diagnosed with Polymyalgia Rheumatica (PMR) over 10 years ago. She was seeing a rheumatologist for her PMR.  She finally went to a pain management clinic a year ago.  Jackie presented to my office in a lot of pain for  Chiropractic Care for Multiple Neuromusculoskeletal Conditions Complicated by Polymyalgia Rheumatica.

Jackie’s Medical History

She had a list of drugs which she took for her multiple comorbidities (presence of two or more diseases in the same person).  Jackie’s comorbidities (in addition to her neuromusculoskeletal complaints) included high blood pressure and thyroid problems which she saw an internist and endocrinologist for. Even with the drugs prescribed from the pain management clinic, Jackie was in tremendous pain.  In fact, she couldn’t sleep at night. 

Firstly, Jackie’s magnetic resonance imaging (MRI) of her lumbar spine (low back) from a few years ago showed severe disc degeneration with herniations (fragment of the disc nucleus  is pushed out) and annular tears (when the outer layer of a spinal disc, also known as the annulus fibrosis, suffers damage and tear) at several levels. Disc degeneration is the result of a gradual, aging-related wear and tear.

Secondly, Jackie had a left hip total replacement surgery last year. It felt better after the surgery, but still hurt. Her left hip joint was replaced by a (artificial) prosthetic implant.

Lastly, Jackie’s Polymyalgia Rheumatica (PMR) symptoms (what you feel) were aching and stiffness about the upper arms, neck, lower back and thighs.  So even though she was on a low dose of prednisone (corticosteroid), she still had the PMR symptoms which complicated her other neuromusculoskeletal conditions.

Jackie’s Examination and X-ray for: Chiropractic Care for Multiple Neuromusculoskeletal Conditions Complicated by Polymyalgia Rheumatica

On the intake form Jackie reported pain in her neck, mid back and low back.  She also reported pain down both the front and back of her thighs and legs to her ankles. Upon examination, there were positive tests for the cervical (neck), thoracic (mid back) lumbar (low back) spine, both hips, knees and ankles. Jackie’s left hip was a prosthetic hip and couldn’t be adjusted, but the muscles around it would be included in the soft tissue techniques rendered. After that, I took some x-rays of her full spine (neck, mid back, low back), right hip and both knees. Findings on all her x-rays was severe degenerative joint disease/ osteoarthritis (wear and tear arthritis).

The tests performed during the exam diagnosed a left sided sciatica (sciatica is a type of lumbar radiculopathy). Sciatica/ radiculopathy pain is caused by irritation, inflammation or compression of a nerve root in the lower back. The most common cause is a herniated disc that causes pressure on the nerve root which was a finding on her MRI. Jackie had pain down the back of her left leg due to the sciatica.  The pain down the front of her thighs and legs were due to her osteoarthritis in her right hip and bilateral (both sides) knees.  Moreover, she had significant swelling, stiffness and pain in her ankles due to her comorbidities.  Finally, some of Jackie’s pains were also due to the PMR.

Jackie’s Chiropractic Care for Multiple Neuromusculoskeletal Conditions Complicated by  Polymyalgia Rheumatica

Jackie’s chiropractic treatment consisted of chiropractic manipulation/ adjustments of her spine, right hip, knees, and ankles.  Additionally, soft tissue therapy (myofascial release, pressure point and post isometric relaxation procedures), modalities (cold/heat therapy and electric muscle stimulation), and home therapeutic exercises were provided.

Jackie’s Outcome for: Chiropractic Care for Multiple Neuromusculoskeletal Conditions Complicated by  Polymyalgia Rheumatica

The outcome for Jackie was excellent! She started feeling better after the first 2 visits.  Jackie was at 3 times a week of passive care phase of chiropractic care where her pain and inflammation decreased.  Soon she showed more joint motion and was able to tolerate more activity and went to 1-2 times a week in the active phase of chiropractic care (stabilization/ rehabilitation exercises added). At this point, she was sleeping much better.  It took many months before she was coming for maintenance care and/or exacerbations due to her excessive activities of daily living.  

Polymyalgia rheumatica is an inflammatory disorder that causes muscle pain and stiffness, especially in the shoulders and hips. Signs and symptoms of polymyalgia rheumatica usually begin quickly and is rare in people under age 50.

The cause of PMR is uncertain. It is believed to be an autoimmune disease where the body’s  immune system attacks healthy tissues. PMR could also be due to genetic/ environmental factors, and/or the aging process.

This condition is related to another inflammatory condition called giant cell arteritis which can cause blindness. Giant cell arteritis can cause headaches, vision difficulties leading to blindness, jaw pain and scalp tenderness. It’s possible to have both conditions together.