intervention in menorrhagia through chiropractic and spondylotherapy: a case report

Intervention in Menorrhagia Through Chiropractic and Spondylotherapy: A Case Report

William J. Boro, D.C., C.C. | Annapolis, MD | www.nosnappingnocracking.com

Dr. William J. Boro™, Advanced Chiropractic Techniques™

Hey Doc, you gotta help me!

I don’t want surgery!

“I’ve never had regular periods.

I’ve been bleeding heavily for over two weeks.

My gynecologist says “deal with it.”

Can you help?”

Menorrhagia“Surgical management has been the standard of treatment in menorrhagia due to organic causes (eg, fibroids) or when medical therapy fails to alleviate symptoms. Surgical treatment ranges from a simple D&C to a full hysterectomy.”

Why Chiropractic?

• According to the National Board of Chiropractic Examiners job analysis report, ‘menstrual disorder is the only female reproductive condition that chiropractors see more than rarely’

• 72% of patients with dysmenorrhea also have low back pain

Incidence of Common Female Problems

Fibroids

Benign tumors on the uterus

Affects 4-18% of women

Adenomyosis

Endometrial tissue grows into wall of uterus

Affects 20% of women

Endometriosis

Uterine lining becomes implanted outside the uterus

Affects about 10% of women, 25-35% of infertile women

• Dysmenorrhea—pain during menstruation that interferes with daily activities (50%)

• Menorrhagia—heavy bleeding (20%)

Normal Menstrual Cycles

• 21-35 day cycle, with 3-5 days of bleeding

• Average blood loss 25-80 ml

Normal Tampon Use in a Whole Menstrual Period

In a typical period, a woman will lose 25-80 ml of blood. If regular tampons used, this will soak 9 tampons.

Menorrhagia Tampon Use in 2 Days

This patient was going through a super plus tampon every hour and a half for 2 days straight. This amounts to 32 super

plus tampons, each holding 12-15 grams.

Menorrhagia Facts

• Affects up to 10 million American women in their 40’s and 50’s (that’s 20%)

• Only about a third ever discuss it with their doctor

• Many doctors prescribe: • NSAIDs help reduce blood loss and relieve cramps

• Hormone therapy regulates cycles and reduces episodes of prolonged bleeding

• IUD (progestin) makes the uterine lining thin and decreases blood flow and cramping

• Tranexamic acid controls heavy bleeding

Menorrhagia Symptoms

• Blood loss more than 80 ml

• Period lasting more than 7 days

• Soaking of one or more sanitary products every hour for several consecutive hours

Normal Blood Loss Compared to Menorrhagia

Normal Menorrhagia

Surgical Options

• Hysteroscopy allows a view of the uterine cavity to possibly remove polyps

• D&C scrapes the lining of the uterus

• Endometrial resection removes the lining of the uterus

• Endometrial ablation destroys the lining of the uterus

• Hysterectomy removes the uterus and cervix

Case History

• 37 year old woman

• 5’4”, 164 lb.

• No children

• History of severe pain in left hip, headaches and asthma

• Nonstop menstrual bleeding for 2 weeks

• Similar bout of nonstop bleeding the previous spring

Case History

• Since the age of 16, never had a normal menstrual cycle• Migraines and significant cramping every month• Typical cycles were 36-45 days, with bleeding lasting 7 days• On days 2 and 3, she needs to use a super plus tampon every 1-1½

hours• This calculated to more than 80 ml of blood on each of these days,

which is the high side of normal for an entire period

Case History—MRI (3/29/11)

• Moderate postero-central disc protrusion with annular tear at L4/5, pressing on L5 nerve root bilaterally. Also, mild left lateral stenosis at L4/5.

• Large central and left posterior herniation at L5/S1 with posterior displacement contacting S1 nerve root bilaterally.

• Moderate postero-central disc protrusion with annular tear at L5/S1, pressing on L5 nerve root bilaterally.

Prior Doctor’s Visits

• Gynecologist suspected fibroids

• No fibroids observed on ultrasound

• Hormone levels were normal

• Gynecologist recommended that the patient “just deal with it”

• Patient said to me, “Because you fixed my back and I thought...what the hell? I was willing to try. Plus no cramps, etc. since seeing you.”

Treatment—Three Sessions Over Ten Days

• Positive Trendelenberg

• Positive sitting SLR

• SOT™ CAT II indicators

Assessment—Limited Examination

Visit One—11/6/12

• SOT™ CAT II supine block placement• Standing lumbar adjustment with range of motion• Adjustment to femoral heads bilaterally

Spondylotherapy—Visits One and Two

• 200 beats per minute• C7, 4 minutes• L3, 2 minutes• L5, 2 minutes

Plexor

Pleximeter

Spondylotherapy Applied to C7

Patient reported bleeding had stopped by

the morning after the first treatment

Visit Two—11/13/12 (one week later)

• Adjustment to T3,T5,T7,T9 vertebral levels and discs, using disc plexor • Spondylotherapy, 200 beats per minute• C7, 4 minutes• L3, 2 minutes• L5, 2 minutes

Visit Three—11/16/12 (on the 10th day)

• Adjustment to lumbar spine, discs and associated muscles• Adjustment to cranium using anterior cranial pattern according to

Van Rumpt protocol

Anterior Pattern Findings

Challenging for Pattern DeterminationPosterior sphenoid

Anterior sphenoid

Anterior Pattern Correction

Interview with Patient—3/5/14 (1 ½ years later)

• Patient reports more normal periods• Mostly every 28 days• Not very heavy• Minimal cramping

Spondylotherapy Explained

• Developed by Albert Abrams around 1903

• He believed that visceral reflexes can be evoked by concussion of the spinous processes

• In his words:

“The author has thus far examined about fifty patients who suffer from painful menstruation and has noted points of tenderness located either to the right or left side or both sides of one or more of the spines of the first four lumbar vertebrae. Firm pressure with the end of the thumb over one or more sensitive areas will abolish the pain for several hours or during the entire period of menstruation.”

Spondylotherapy Explained

• Alva Gregory, DC stated that “spinal concussion, combined with adjustment is more effective than either method alone.”

• Spondylotherapy was part of the curriculum at the National College of Chiropractic in the 1940’s

• Stimulation of C7 induces a very decided and general vaso-constriction

• Stimulation of L1-3 produces the following results:• Excites uterine contraction, overcomes uterine hemorrhage

• Overcomes atonic constipation

• Excites contraction of liver, spleen, stomach and intestines

• Increases tone of colon and intestines

Conclusion

• There is little research correlating the relationship of menorrhagia to low back pain.

• There is little research discussing the use of spondylotherapy as a treatment protocol.

• The chronicity of the patient symptoms and the temporal relationship between treatment and response to care is of interest.

• While there have been few studies reported utilizing conservative chiropractic methods in the care of menorrhagia, it appears that such treatment can provide therapeutic benefit to those suffering from this disorder.

• It is hoped that this study may generate greater interdisciplinary cooperation so that patients can have an option of therapy that offers a lower risk than surgery.

ReferencesJensen, AM, Bewketu B, Sanford D. Intermittent low back pain referred from a uterine adenomyosis: a case report. J

Chiropr Med.10.1 (2011): 64-69. Print.Livdans-Forret AB, Harvey PJ, Larkin-Thier SM.

Menorrhagia: a synopsis of management focusing on herbal and nutritional supplements, and chiropractic. J Can Chiropr Assoc. 2007 Dec;51(4):235-46.

Radler M. Dysmenorrhea: chiropractic application. Am Chiropr: Mar/Apr 1984(:) 29, 31-32.Arnold-Frochot S. Investigation of the effect of chiropractic adjustments on a specific gynecological symptom:

dysmenorrhea. J Aust Chiro Assoc, 1981; 10:14-16. Liebl NA, Butler LM. A chiropractic approach to the treatment of dysmenorrhea. J Manipulative Physiol Ther.

1990 Feb;13(2):101-6.Dobrik I. Disorders of the iliopsoas muscle and its role in gynaecological diseases. Journal of Manual Medicine.

1989; 4: 120·2.Bull PW, Genders WG, Hopkins SS, Lean EK. Dysmenorrhea and pelvic dysfunction: a possible clinical

relationship. Chiropr J Aust. Mar 2003(33:1) 23-29.Henry SJ, Polus BI, Walsh MJ. Dysmenorrhea: to treat or not to treat? Chiropr J Aust. Mar 1996(26:1) 21-24.Holtzman DA, Petrocco-Napuli KL, Burke JR. Prospective case series on the effects of lumbosacral

manipulation on dysmenorrhea [case report]. J Manipulative Physiol Ther. Mar 2008(31:3) 237.-246.Kokjohn K, Shmid DM, Triano JJ, Brennan PC. The effect of spinal manipulation on pain and prostaglandin levels

in women with primary dysmenorrhoea. J Manipulative Physiol Ther. Jun 1992(15:5) 279-285.Liebl NA, Butler LM. Case Report: A Chiropractic Approach to the Treatment of Dysmenorrhea. J Manipulative

Physiol Ther. 1990 Feb;13(2): 101-106. Dupe of #5Proctor ML, Hing W, Johnson TC, Murphy PA. Spinal manipulation for primary and secondary dysmenorrhoea.

Cochrane Database of Systematic Reviews. 2006 Jul 19;(3):CD002119. Smith D. Chiropractic care of a patient with low back pain and primary dysmenorrhoea [case report]. Chiropr J

Aust. Dec 2007(37:4) 141-144. Thomason PR, Fisher BL, Carpenter PA, Fike GL. Effectiveness of spinal manipulative therapy in treatment of

primary dysmenorrhoea: a pilot study. J Manipulative Physiol Ther. 1979: 2: 140-5.Wiles M. Gynecology and obstetrics in chiropractic. J Can Chiropr Assoc. 1980 Dec; 24(4): 163–166. Print.Spears LG.

A narrative review of medical, chiropractic, and alternative health practices in the treatment of primary dysmenorrhea. Journal of Chiropractic Medicine. J Chiropr Med: Spr 2005(4:2) 76-88.

Heavy Menstrual Bleeding [Internet] [cited 2014 March 17]. Available from: http://www.cdc.gov/ncbddd/blooddisorders/women/menorrhagia.html

What Do Tampon Absorbency Ratings Mean? [Internet] [cited 2014 March 12]. Available from: http://pms.about.com/od/hygiene/f/tampon_absorben.htm.

DeJarnette MB. Manual More information needed

Abrams, A. Spondylotherapy. San Francisco, CA: Philopolis Press, 1910. Print.

Abrams, A. Spondylotherapy. San Francisco, CA: Philopolis Press, 1914. Print.

Gregory, AE. Spondylotherapy simplified; a compendium of the science of spinal concussion and

sinusoidalization and the technique of their administration; the specific centers of nerve origin

through which we control the function of various viscera; the results of stimulation of the

different spinal centers of nerve origin, what affected and how, and directions for the correct

application of those methods in the treatment of diseases amenable to them. Oklahoma City, OK:

A. E. Gregory, 1922. Print.

VanRumpt R. Personal Correspondence. Should be in text of document only, EX: “According to R. Van

Rumpt, DC (written communication, November 1989),”

Boro WJ. Treatment of low back pain by cranial adjustment: a case report. 4th Annual Sacro Occipital

Technique Research Conference Proceedings; May 2012; Atlanta, GA. P. 27-33.

Courtis G, Young M. Chiropractic management of idiopathic secondary amenorrhœa: a review of two

cases. Br J Chiropractic. Apr 1998; 2(1):12-4

Cook K, Rasmussen S. Visceral manipulation and the treatment of uterine fibroids: a case report. ACA

Journal of Chiropractic. Dec 1992; 29(12): 39-41.

Benner CD, Blum CL. CMRT and acupuncture in the treatment of dysmenorrhea (oligomenorhea) and

low back pain: a case report. World Congress on Low Back & Pelvic Pain Conference. Dubai, Oct.

Lin JA, Wong CS, Lee MS, Ko SC, Chan SM, Chen JJ, Chen TL. Successful treatment of primary

dysmenorrhea by collateral meridian acupressure therapy [case report]. J Manipulative Physiol

Ther. 2010 Jan;33(1):70-5.

Abrams, A. The cardiac reflex of Abrams. Lancet. 10 Oct 1903; 162(4180):1052.

Auld, AG. The lung reflex of Abrams. Lancet. 19 Dec 1903; 162(4190):1118.

Buck, AH, Stedman, TL. Reference handbook of the medical sciences embracing the entire range of

scientific practical medicine and allied science. 3rd ed. New York, NY; W. Wood; 1917. p.910-915.

Warren, K, Walton, D. The effects of spondylotherapy on the hypertensive patient. [DC Thesis]. Logan

College of Chiropractic, Missouri, 1995.

Janse J, Houser RH, Wells BF. Chiropractic Principles and Technic. National College of Chiropractic:

Chicago; 1947.

Abrams, A. Progressive spondylotherapy. Philopolis Press: San Francisco, CA; 1913.

So how much does a hysterectomy cost? [Internet] 2012 Aug 12 [cited 2014 Mar 17]. Available from:

http://www.hystersisters.com/vb2/showthread.php?t=490988.

http://emedicine.medscape.com/article/255540-treatment#a1128

intervention in menorrhagia through chiropractic and spondylotherapy: a case report

Health & Medicine

8.03.501 chiropractic services - student.lifewiseac.com ·...

chiropractic subject headings · 2009. 7. 9. · named...

dr. carol mdrtamtini mancini chiropractic: certified in...

chiropractic safety - northside chiropractic clinic

long-term results in the treatment of menorrhagia and...

chiropractic intervention in the treatment of joint and soft...

management of menorrhagia

chiropractic assistant registration - arizona€¦ ·...

cpg malaysia - management of menorrhagia

case study: recurrent myoma with menorrhagia

welcome to herring chiropractic | herring chiropractic

policy title heavy menstrual bleeding (menorrhagia) v1.0

body mass index and menorrhagia among adolescent female...

menorrhagia seminar 7

menorrhagia best care and practice - haemophilia … · •...

management of pubertal menorrhagia

dr manal idris menorrhagia. introduction menorrhagia is one...

can we predict menorrhagia with intrauterine contraceptive...

research article the effects of menorrhagia on women s...

terry a. rondberg, d.c. - chiropractic · ¾ chiropractic...