68 y.o. female referred by a physician with a primary complaint of upper abdominal reflux pain, bloating, and thoracic pain. Original injury approximately 10 years previous while working as a flight attendant and exposure to jet fumes and lung injury. The company’s medical system basically ignored injury to the lungs. She underwent upper abdominal surgery with what appeared to be a fundoplication without long-term success. Her husband is a chiropractor, and he has treated her with spinal manipulation and active release work. She has seen multiple GI physicians, and the only thing they can recommend at this point is additional surgery. She has seen alternative medical providers with gut function tests and supplements.
The exam of the thoracic spine was fairly unremarkable, except for increased kyphosis. There wasn’t much in the way of segmental dysfunction, most likely due to the chiropractic work by her husband. Thoracic cage mobility was limited with respiratory inhalation more on the R. There were come segmental cervical restrictions, but they were not severe. From a cranial standpoint, there was cranial base, sphenobasilar, and temporal/occipitomastoid dysfunction.
On a visceral level, there was extensive restriction of the thoracic and upper abdominal structures. The pericardium was sheared superiorly, and large tension in the deep cervical fascias. Both lungs were restricted as a whole, between the lobes and within the parenchymal tissues. The esophagus was severely sheared superiorly, and there was a large restriction between the esophagus and the posterior aspect/esophageal impression of the heart. The sub-diaphragm structures were very restricted, with large lesions of the liver with the lung, lesser omentum, stomach, and D1-3. There was mild restriction of the small intestine mesentery. The respiratory diaphragm was moderately elevated, with limited inferior mobility with inspiration.
Treatment consisted mainly of treatment to the thoracic and abdominal visceral structures. I also worked on the cranium and cervical structures. The esophagus superior shear lesion was the most significant, and the mobility of this has steadily improved. I instructed her husband, a chiropractor, in the treatment method of the superio esophagus that they can do at home.
The patient reports an 80% improvement in her primary abdominal pain, bloating, and thoracic pain symptoms. She is delighted with her treatment progress and feels she will be able to avoid another gastric surgery. Thoracic resiliency and mobility in extension also improved with the treatment of the viscera. Remember, the esophagus is the “bow string” of the thoracic spine.
Takeaways: original injury of the respiratory system that most likely caused compensation/reaction of the sub-diaphragm structures via the diaphragm. Improvement in mobility of the visceral structures themselves resulted in improved diaphragm function. The severe tension of the esophagus most likely also resulted in altered vagal function to the sub-diaphragm digestive structures via the plexus on the esophagus. Always remember the neurologic consequences of restrictions that may affect other structures. This can lead to a “closed loop” self-perpetuating system.
I hope these case studies are helpful in treating your complex patients. Have fun!
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