Chiropractic Spinal Manipulative Therapy in a 32 year old Female with Neck Pain, Rib Cage Asymmetry, Unicornuate Uterus and Persistent Infertility.
Shadia Koury-Hajal, DC, DACCP
Abstract
Introduction: The purpose of this case report is to examine the possible connection of a woman with a unicornuate uterus and infertility and Chiropractic spinal manipulative therapy (SMT) documented subjectively and objectively during the course of her treatment. “A unicornuate uterus represents a uterine malformation where the uterus is formed from one only of the paired mullerian ducts while the other mullerian duct does not develop or only in a rudimentary fashion. The sometimes called hemi-uterus has a single horn linked to the ipsilateral fallopian tube that faces its ovary [1].”
Unicornuate uterus is a Mullerian anomaly with prognostic implications for poorer outcomes during pregnancy. Women presenting with a history of this anomaly are considered high-risk obstetrical patients with a significant risk of pregnancy loss and preterm labor, as well as ectopic pregnancy. Miscarriage risk may be due to abnormalities in the blood supply of the unicornuate uterus that might interfere with the functioning of the placenta (or increase the odds of implantation in the tube). The risk of preterm labor is thought to be because of space restrictions; because a unicornuate uterus is smaller than a typical uterus, the growth of the baby might trigger early labor. Doctors may recommend cerclage, also known as a cervical stitch, used for the treatment of cervical incompetence (or insufficiency), for women at risk of preterm labor [2].
The following is a case study of a 32 year-old female who presented to the chiropractor with chronic neck pain and misaligned rib cage, and a diagnosis of a unicornuate uterus and infertility since October 2002. She was referred to a chiropractic office by her Oriental Medical Doctor (OMD) who was treating her for infertility for 3 months. The OMD had difficulty accessing her liver meridian for acupuncture due to her asymmetric rib cage. When the patient began chiropractic SMT, she chose to discontinue her herbal infertility treatments prescribed by her OMD.
Methods and Interventions: The patient was seen at this office for care at 3 times a week for 12 weeks. She had tonal, low force specific chiropractic spinal and cranial manipulative therapy using Torque Release Technique, Koren Specific Technique, Chiropractic Cranial Therapy, and Webster Technique. A hand held integrator instrument (ArthroStim and a VibraCussor) was used to deliver the specific spinal manipulative therapy (SMT).
Results: Improvements were seen with decreased neck pain and quality of life scores were subjectively documented by the patient after 5 weeks of non-cavitational care chiropractic (Torque Release Technique) SMT at 3 times per week. Objective results were seen with subsequent Surface EMG scans on every 12 visit indicated by greater muscle symmetry patterns. The patient conceived after 3 months of chiropractic SMT and delivered at 38 weeks gestation. The patient was seen 3 times a week for 12 weeks at this office due her unusual presentation and because clinically deep seated neuromusculoskeletal imbalance can sometimes take 8-12 weeks of care to reduce chronic neurological and myofascial habituation in order to help facilitate body symmetry and greater function.
Discussion: There have been studies that support a relationship between chiropractic and infertility [2] however the evidence base of this relationship is in its formative state. While it is unclear if the patient’s scoliosis is a direct factor in her current presentation a disorder associated with congenital scoliosis, Mayer-Rokitansky-Kuster-Hauser syndrome, has been found to have mullerian duct agenesis [3]. The field of chiropractic is expanding its care of patients with non-musculoskeletal complaints and is also developing an evidence base for integrative treatment of other related uterine type abnormalities [4].
There are various possible rationales why the chiropractic care might have facilitated this patient’s issue with fertility. It may be possible that the balancing the pelvic bones with their affect on the pelvic myofascial floor and its related attachment to the uterus could have ameliorated a dysfunctional biomechanical condition. It is also possible the relief of the patient’s discomfort associated with neck pain and rib cage deformity reduced her stressful conditions this improved her ability to become pregnant. There is also a possibility that the cranial treatment stimulated a positive autonomic response that either relaxed the patient and/or facilitated her becoming pregnant [5].
Conclusions: In this case, chiropractic SMT appeared to have a significant impact on improving infertility for this patient. Based on the finding from this case report further study is warranted to determine the role of chiropractic in helping women with a unicornuate uterus and infertility and how chiropractic may serve as a part of an early intervention team for women with uterine anomalies and reproductive challenges.
References:
1. Unicornuate uterus. Wikipedia. [http://en.wikipedia.org/wiki/Unicornuate_uterus] Last accessed May 4, 2010.
2. Behrendt M. Insult, Interference and Infertility: An Overview of Chiropractic Research. J Vert Sublux Res. May 2003:1. [http://www.jvsr.com/abstracts/2003-068_behrendt.htm]
3. Fisher K, Esham RH, Thorneycroft I. Scoliosis associated with typical Mayer-Rokitansky-Küster-Hauser syndrome. South Med J. 2000 Feb;93(2):243-6.
4. Leroy NR. Uterine fibroids: An integrative approach. J Chiropr Med. 2004 Win;3(1):15-19.
5. Retzlaff EW, Jones L, Mitchell FL Jr., Upledger J. Possible autonomic innervation of cranial sutures of primates and other mammals. Brain Research 1973;58:470-477.
