A fifty-two year old male musician consulted me for a persistent cough and headache. He was referred by a local General Practitioner through a National Health Service fundholding scheme. He complained of a harsh cough and slightly restricted breathing which had been present for about five weeks, after apparently recovering from a common cold. This problem had become constant during the day and had not responded to oral antibiotics administered by his GP. The headaches had started at the same time as the cough and were described as “tension” at the base of the skull. These became worse during the day and were not associated with any visual problems, nausea or dizziness. A similar episode of coughing and breathing difficulty had troubled him fifteen years previously and had been significantly helped at the time by osteopathic manipulation.
Physical examination revealed the following statistics: Vital signs were normal and a heart and lung examination was unremarkable. Cervical and thoracic spine active and passive range of motion was full and pain free. However, there was tenderness and restriction of normal joint movement on palpation of the upper cervical joints with associated muscle spasm. There was also significant tenderness and restricted joint movement at the upper thoracic joints and the overlying musculature was in a state of tension. A full upper limb orthopaedic and neurological examination was normal.
X-rays of his cervical spine were viewed at the local hospital and revealed no abnormalities, other than a reduced cervical lordosis (the normal curve in the neck). A lung function study was requested and performed by the patient’s GP prior to treatment and was normal.
A treatment programme was started with weekly manipulation directed to the dysfunctional segments in the cervical and thoracic spine, together with soft tissue therapy in the form of massage, trigger point therapy and specific upper limb exercises. After three treatments the patient stated that his cough had dramatically improved in both frequency and severity and that his headaches and neck tension had also dissipated. By the sixth treatment he reported a complete resolution of all symptoms and was feeling less stressed. His symptoms have since returned only three times in the last eighteen months and each time a short course of treatment has resolved each episode.
This case demonstrates two important aspects of chiropractic care. The first is that the patient himself believed in the benefits of manipulation through his previous positive experience with an osteopath. Secondly and significantly, a GP was prepared to fund the patient for a course of treatments for an apparent organic complaint along the same guidelines put forward by the Clinical Standards Advisory Group for the Treatment of Low Back Pain. The same diagnostic triage was used and when antibiotics failed to work the patient was recommended chiropractic intervention. Following treatment the patient improved dramatically with a subjective reported resolution of coughing and headaches and objective reduced cervical and thoracic joint restriction and associated muscular tension.
At a time of increasing contact between chiropractic and medical practitioners, awareness of each others potential and the treatment of the type of patient described should be developed. Patients are at a risk of being dismissed for lack of a pathological focus for their problem that might so easily be treated with appropriate and specific manipulative methods with excellent results as in the case reported.
Max Atkinson, Doctor of Chiropractic
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