How do you measure results? Two case studies by Dr. Timothy Burkhart

“What really constitutes seeing results with our patient’s treatment?” This is a question that continues to rise within chiropractic practice. Did our patient get results because their pain went away? Or perhaps post evaluation revealed an improvement in ROM or changes seen on MRI, x-rays or other diagnostic testing. Are these results? What if the patient feels 90-100 percent better but no significant improvement is noted upon objective analysis? What if there is significant improvement in objective findings but the patient fails to experience symptomatic change?

I submit that determining results can be a complicated undertaking.

Over the course of a 27 year chiropractic practice, like many, I’ve observed a broad range of cases. From patients experiencing tremendous, nearly ‘miraculous’ results to those who have little to no response to treatment—no matter how effective treatment had been in the past. Two recent cases have strengthened my conclusion that a truly collaborative approach to treatment and technology gives us the best measurement of true results.

Case 1: An 18 year old male suffering from a motor vehicle accident.

The patient complained of neck pain, headaches, and numbness and tingling in his arms and hands. Upon examination, he had a positive cervical compression test, restricted ROM in the cervical spine with significant trigger point pain identified at multiple sites in the cervical and upper thoracic spine. Cervical x-rays were ordered and revealed a reversal of the normal cervical lordosis, paradoxical motion at the posterior motor units of C1, C3, C5, C6 and C7 in flexion and at C1, C3, C5 and C6 in extension. Cervical subluxation was confirmed through a correlation of motion palpation, x-ray and computer assisted motion analysis unitizing an adjusting instrument. Pain indices were noted at a 8-9 out of 10 for neck pain and a 5-6 out of 10 for headaches. The bilateral numbness was noted as intermittent and mild to slight.

The patient was recommended a 6-8 week treatment plan of chiropractic adjustment or CMT, exercise therapy or muscle rehab, and 8-10 visits of non-surgical axial spinal decompression. All of his symptoms abated within 4-6 weeks. Due to the significant level of improvement, a follow-up lateral cervical film was ordered to determine if a cervical posture pump or similar device should be recommended as ongoing support for postural improvement of the loss of curve. Upon re-evaluation it was noted however, that the patient had fully recovered from his symptoms. His ROM was normal, he had no positive orthopedic or neurological signs and on x-ray, his cervical spine had returned to the normal lordosis.

Case 2: A 36 year old female presenting with significant neck pain, headaches and numbness and tingling in both arms—primarily on the left side.

The patient had no history of trauma. The onset of her symptoms gradually increased over the period of about a year. Pain indices were noted as 6-8 out of 10 depending on the time of day and her level of activity. A cervical compression test and cervical distraction were both noted as positive. Reflexes were tested and noted as +2. Dermatomes were normal. Cervical x-rays showed a loss or slight reversal of the cervical curve and paradoxical motion in both flexion and extension at the C5 and C6 levels. A treatment plan of 4-6 weeks was recommended which included chiropractic adjustments, cervical exercises and non-surgical axial spinal decompression for 6-10 visits. After 5 weeks the patient noted significant improvement her subjective complaints were greatly decreased and a re-evaluation of the objective data correlated her healing. A follow-up lateral cervical view was taken and a near normal curve was noted.

Both of these patients were pleased with their results and while considered successful, these cases by no means constitute a study or fit a peer-reviewed outcome. Both cases used an effective combination of manual therapy and axial decompression. Both also suggest that decompression may have more influence on spinal function and the effective treatment or correction of dysfunction than studies to date have indicated. Whatever the case, it is clear that a collaboration of subjective and objective considerations must be combined when seeking to assess the true results of treatment.