Case Study #5

This case happened approximately 20 years ago. The patient was a 48 y.o. female grade school teacher. She was referred by her husband, who was a patient who had done well. She was injured approximately 3 years previous, resulting in severe lower back pain. The patient reported that she was walking toward the school from recess, and she stepped on black ice. She describes that she did not fall down, reporting that she did a sort of “break dance” so as not to wind up on the ground with her skirt over her head in front of 4th-grade boys. This was a work comp injury; a chiropractor and 2 different PTs treated her. All imaging was fairly normal. Her condition was not improved, and she settled her work comp case. At the time of evaluation, she was working with great difficulty due to lower back pain.

On exam, the patient presented with a fairly severe R on L sacral torsion with mild lumbar dysfunction. The lumbar spine and sacral torsion were treated out, and there wasn’t much improvement in her condition/pain. At that point, I focused on the visceral structures of the abdomen and pelvis. She presented with a myriad of abdominal pelvic restrictions. I started treating the abdominal structures, and she started to improve with overall mobility of the lumbar spine and general pelvic mobility. She was approximately 50% improved when I treated her R kidney (remember the interface of the kidney with the psoas and then the psoas influence on the SI joint). When I started releasing the kidney, I could feel it start to soften up. Then the tears started to come. I assured her that she was OK and safe, and we worked through the release. I asked her what that was about, and she related sexual abuse as a child from an uncle.

When she returned for the next treatment, she reported having about 7 days of no pain. WOW, we were really on the right track. I worked on her again, making sure the lumbosacral mechanics were staying reasonable, and then I certainly went back to that R kidney. We got some more release, and there was some emotion, but it was not as significant as the first.

When she returned the next time, she was great for a week, and then the pain started returning. It was then that I told her she needed to seek counseling for the childhood sexual abuse. She said that she would. I continued seeing her once every 2 weeks. Over the course of 2 or 3 more treatments, I was able to again take away the kidney restrictions. She would do fantastic for a week, and then the pain would return. She hadn’t yet sought counseling. Finally, I told her that I wouldn’t treat her again until she did counseling. She found her way back on my schedule approximately 12 weeks later.

At that point, this patient was doing fantastic. The lower back pain was gone for the last 8 weeks. She came in essentially to show me how well she was doing. On exam, the previous R kidney restriction that I was able to take away temporarily was completely absent.

Takeaways: Abdominal visceral dysfunction can be implicated in musculoskeletal dysfunction via viscero-somatic reflexes as well as direct structural connection…..the posterior abdominal wall is the anterior aspect of the spine. Check out renal fascia attachments and the relationship of the kidney with the psoas. The viscera are related to emotions and can perpetuate or even cause musculoskeletal lesions. The kidneys are related to fear. The L kidney is the “reproductive kidney” due to the connection of the venous drainage of the gonads into the L renal vein. The R kidney is the “digestive kidney” as the venous drainage of the gonads goes into the inferior vena cava vs the R renal vein……interesting anatomical difference. Hence, the L kidney is related to the individual as a parent, while the R kidney is related to the individual in relation to their parents. My patient related to me that she tried to tell her parents of the abuse by the uncle, but the parents didn’t believe her. In theory, while I am not a mental health practitioner, the lack of parental support and intervention caused the emotional R kidney lesion. That was most likely the underlying situation but the “break dance” made the house of cards tumble down. The referral I make most frequently, outside of a dental referral, is for counseling.

This patient is an excellent example of the need to treat the person as a whole, integrated being…….body, mind, and spirit. We treat the entire body as a general rule, but don’t be afraid to refer out. Our patients trust us to do what is best for them; sometimes, our patients and us need help.

Have fun!!