Chronic or Acute (Non-Cardiac) Chest Pain and Chiropractic

A report on the scientific literature 



By
William J. Owens DC, DAAMLP
Mark Studin DC, FASBE (C), DAAPM, DAAMLP
 

Having chest pain can be a very scary experience and is a MAJOR cause for concern.  The obvious condition to evaluate and rule out is a heart attack.  There are many cases where the heart has been verified to be okay and there are no conditions related to blockage of the arteries in the chest, but the pain continues.  One common problem that is more benign, but can produce constant moderate/severe chronic pain, is chest pain of mechanical origin.  In other words, the bones and joints of the chest and middle back are not working properly and are causing irritation of the nerves.  This type of pain is actually quite common and related to posture, working activities (computer work) and trauma (car accidents, karate or even surgery).  YOU MUST BE RELEASED BY A CARDIOLOGIST WITH ANY TYPE OF CHEST PAIN prior to exploring treatment for mechanical chest pain.
 
Chiropractic continues to show up in the research as being effective for the treatment of mechanical chest pain.  In a recent paper published in conjunction with the New York Chiropractic College, the authors discuss such a case.   The clinical features of this case were “A 49-year-old man had chronic chest pain, dyspnea [trouble breathing] and anxiety for over 4 months.  The severity of the condition gradually progressed to the point of precluding the patient’s active employment and most physical activity.  Prior efforts to treat the condition were met with failure" (
Polkinghorn & Colloca, 2003, p. 108).
 
The authors went on to describe the treatment.  “The patient received mechanical force, manually assisted short-lever chiropractic adjustment
[the most common type of adjustment] of the thoracic spine and, in particular, the costosternal articulations [where the ribs meet the breast bone on the front of the chest]...Sustained chiropractic care rendered over a 14 week period resulted in complete resolution of the patient’s previously chronic condition, with recovery maintained at 9 month follow-up” (Polkinghorn & Colloca, 2003, p. 108).
 
Clinically, Dr. Studin (a co-author of this article) had a similar case this past month.  A 30-year-old painter had significant chest pain, chest tightness, shortness of breath and spontaneous perspiration.  He was rushed to the emergency room for an urgent cardiac work-up and subsequently released with a diagnosis of anxiety and a prescription for Xanax (anti-anxiety drug).  The next day, the patient still experienced the same signs and symptoms and began chiropractic care. After 1 chiropractic adjustment of both the sternum-rib complex and the spine, his entire symptom pattern was gone immediately and the patient was pain free.  It is now 4 weeks later and the patient is still symptom free.
 
These clinical case reviews are a very common finding when the cause is a neuromuscular (spinal nerves and muscles) finding called a vertebral subluxation.  These cases also illustrate that the chiropractic subluxation complex can be found in many places in the body.  Although the spine is the most common area, we now know that it can be found anywhere two bones come together, including the chest.  A doctor of chiropractic is a very important part of your healthcare team, even when it comes to chest pain. 
 
This study along with many others concludes that a drug-free approach of chiropractic care is one of the best solutions to chronic, non-cardiac chest pain. To find a qualified doctor of chiropractic near you go to the US Chiropractic Directory at www.uschirodirectory.com and search your state.
 


References:

1.  Polkinghorn, B. S., & Colloca, C. J. (2003). Chiropractic management of chronic chest pain using mechanical force, manually assisted short-level adjusting procedures. Journal of Manipulative and Physioliological Therapeutics, 26(2), 108-115.

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Chest Pain, Mid-Back Pain and Chiropractic

A report on the scientific literature 


By
William J. Owens DC, DAAMLP
Mark Studin DC, FASBE (C), DAAPM, DAAMLP
 
Chiropractic care is targeted to reducing the Vertebral Subluxation Complex and associated neuro-muscular conditions after more serious medical conditions have been ruled out with chest pain. Vertebral Subluxation Complex is the most common reason for pain in the middle back and chest that is not the result of a heart problem or acid reflux. In cases of non-cardiac (not involving the heart) middle back and chest pain, Chiropractic has been shown to have significant results in reducing or eliminating pain and discomfort. Many people experience pain between the shoulder blades, over the breast bone or the collar bones. In today’s society of increasing demands in the office setting, endless hours in front of a computer or all day commutes in our vehicles the stress on the thoracic spine (middle back)and chest continues to increase. Unfortunately when we sit and slouch forward, the brunt of the forces are condensed to the area just below our shoulder blades and our breast bone. We have all been cautioned to “have good posture”, but anyone that has worked a full day knows, once you are tired there is really not much you can do about your posture.
A recent study stated that “Traditionally, patients with chest discomfort are admitted to a cardiology ward because the heart is under suspicion as the pain source; however, the etiology of pain may be non-cardiac in up to 50% of cases”1 (p654). The authors continue on to say “Although patients with non-cardiac chest pain have an excellent prognosis for survival and a future risk of cardiac morbidity [complications] similar to that of the general population, approximately 3 quarters of these patients continue to suffer from residual chest pain, one half remain or become unemployed, and one half report being significantly disabled”1 (p 654)
 
The most important aspect of this study states “There is a broad agreement among clinicians that the musculoskeletal system is a potential source of pain in non-cardiac chest discomfort, but very few studies have addressed this issue systematically despite the compelling issues discussed above.”1 (p 654)   This study found that there was a significant reduction in the anxiety associated with the patient’s chest pain, the patients had a better understanding that the musculoskeletal system was the source of their discomfort and 96% of patients believed that chiropractic treatment had helped.1
 
In a case study published in 2003, the authors discovered that after the possibility of cardiac involvement was considered, Vertebral Subluxation Complex located at the junction of the breast bones and ribs in the front of the chest was the cause. Reducing the Vertebral Subluxation Complex with Chiropractic techniques had resolved this patients symptoms. 2
Chiropractic interventions into managing and/or eliminating chest and middle back pain have been shown to be safe once cardiac causes have been ruled out. Doctors of Chiropractic are trained to not only evaluate for non-musculoskeletal conditions, but to work as part of your healthcare team. 3
1.       Henrik W. Christensen, DC, MD, PhD, Werner Vach, PhD, Anthony Cichangi, Claus Manniche, MD, DMSc, Torben Haghfelt, MD, DMSc, and Poul F. Hilund-CaHsen, MD, DMSc. Manual Therapy for Patients with Stable Angina Pectoris: A Nonrandomized open prospective trial. J Manipulative Physiol Ther 2005;28:654-661
2.       Bradley S. Polkinghorn, DC, Christopher J. Colloca, DC. Chiropractic management of chronic chest pain using mechanical force, manually assisted short-lever adjusting procedures. J Manipulative Physiol Ther 2003;26:108-15.

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