Routine screening for abuse: opening Pandora's box?

To review the case of a patient who had been physically abused by a previous partner and to discuss the importance of routine screening for abuse.

A 33-year-old female had neck pain, right shoulder pain, and low back pain. During the history taking, she disclosed that she had been in an abusive relationship, and her current complaints were thought to be a direct result of one of the violent episodes she suffered. Radiographs of her neck and shoulder were obtained to rule out a traumatic etiology. In the absence of any gross abnormalities, her symptoms were found to be biomechanical in origin.

Therapy included spinal manipulation and soft tissue techniques to the symptomatic areas. During the treatments, much consideration was given to the fact that she had been a victim of domestic violence and the emotional and physical impact this had on her current situation. Manipulative techniques were adapted so that the patient would not perceive them as threatening, and a considerable amount of time was spent on counseling. After a number of treatments, she reported significant improvement in her overall condition.

For practitioners of spinal manipulative therapy, routine screening for abuse is an essential part of history taking. Awareness of a patient's experiences with domestic violence is required to make appropriate adjustments in the management plan.