Reduction in Severe, Chronic Mid-Back Pain Following Correction of Sagittal Thoracic Spinal Alignment Using...

We present the findings of a case showing an improvement in severe, chronic mid-back pain (MBP) and disability following sagittal correction of the thoracic spine using Chiropractic BioPhysics^® (CBP^®) spinal rehabilitation with a nine-month long-term follow-up. A 40-year-old female had suffered for years and was referred for spinal rehabilitation by her physicians and physical therapist to treat her severe, chronic MBP. The symptoms had not improved despite several months of physical therapy, traditional chiropractic spinal manipulation, and pain management trigger point injections. The pain was reported as severe and rated as 8/10 at worst on the numerical rating scale. The pain was severe enough to interfere with her normal activities including martial arts training. Postural analysis revealed increased thoracic flexion and spine hyperkyphosis. Lateral thoracic radiography showed a previously undiagnosed wedged vertebral body at T6. Mensuration of the radiograph found an increase in overall posterior tangent angulation from T3-T10 measuring 66.2°. Negative sagittal balance measured from a vertical of T3 above T10 was -16.3 mm. Treatment included Chiropractic Biophysics^® (CBP^®) orthopedic rehabilitation protocols including postural and radiographic based Mirror Image^® (MI^®) exercises, spinal manipulation, and traction. The patient was treated in-office 37 times over the course of 3 months and all initial subjective and objective outcomes were re-assessed. It was reported that the initial average pain of 8/10 for the mid-back had nearly resolved and was rated as 2/10. All ADLs were reported as pain free, including intense exercise and martial arts. Post-treatment radiography was taken following a 24 h "rest-period" and found reduction in the overall hyperkyphosis from T3-T10 now measured 45.2°. Due to the presence of the wedge vertebra, it was recommended that the patient continue home traction and exercises, and long-term follow-up was assessed at 9 months including a repeat of all initial examinations, for subjective and objective outcomes. Thoracic kyphosis was maintained at 47.7° and VAS was 0/10 at 9-month follow-up and symptoms remained nearly resolved.