Chiropractic Management of Multi-Factorial Low Back Pain in a Patient Diagnosed with Transthyretin Cardiac Amyloidosis: A Case Report

Littzi NM, Kelly S, Bonavito-Larragoite G

Objective: To describe chiropractic management for a patient with multi-factorial low back pain (LBP) and coexisting wildtype transthyretin cardiac amyloidosis (ATTRwt), a progressive and often underrecognized infiltrative cardiomyopathy in older adults. According to the Amyloidosis Foundation, ATTRwt (formerly “senile systemic amyloidosis”) may present subtly with musculoskeletal symptoms—such as lumbar spinal stenosis, carpal tunnel syndrome, or spontaneous tendon ruptures—years prior to cardiac involvement. Given emerging associations between ATTRwt and degenerative spinal pathology, chiropractors should maintain a high index of suspicion for systemic disease when encountering patients with persistent or atypical LBP presentations.

Clinical Features: A 53-year-old male veteran presented with chronic LBP attributed to lumbar spondylosis, central canal stenosis, and spinal epidural lipomatosis, as confirmed by magnetic resonance imaging. He also had a complex cardiovascular history including heart failure with reduced ejection fraction, hypertension, and obstructive sleep apnea. Cardiology follow-up revealed a positive pyrophosphate scan, supporting a suspected diagnosis of ATTRwt.

Intervention/Outcome: Chiropractic care focused on non-invasive techniques, including mechanical lumbar traction and flexiondistraction therapy tailored to tolerance. The patient remained clinically stable under New York Heart Association Class II heart failure guidelines, without worsening of cardiovascular symptoms. A pharmacy consult was placed to initiate tafamidis, a transthyretin stabilizer, as part of coordinated care.

Conclusion: This case illustrates the importance of adapting chiropractic treatment plans for patients with systemic conditions such as ATTRwt. Recognizing characteristic symptom clusters and referring appropriately may help facilitate earlier diagnosis, improve interdisciplinary collaboration, and ultimately enhance patient outcomes in complex cases of LBP.

Perceived Impact of Multimodal Chiropractic Care on Sports Performance among Older Track and Field Athletes

Merkier,C, Karamanidis K, Pollard H, Langweiler,M, Spreckley M.

Objective: To explore UK aged 60+ athletes’ perceptions and experiences of pre-competition sports chiropractic care.

Methods: Online interviews through a qualitative description approach were conducted with athletes after competing. The interview component was the final phase of the three-part mixed-method research. Participants were recruited from the second phase trial to relate their experiences regarding chiropractic care. The lead researcher identified and analysed the transcripts by using content analysis to create categories for each of the coded selected themes.

Results: Ten athletes (70% international and 30% national levels) were interviewed post-competition from May 2022 to February 2023. Participants generally felt chiropractic care positively influenced their championships, reporting reduced soreness and quicker recovery times. They expressed satisfaction with the professionalism and provided therapies. Ten percent of mild adverse reactions were reported, reinforcing the perceived safety and positive impact of care. Athletes reported individual performance differences in strength and coordination tasks, with some attributing improvements to familiarity rather than the chiropractic care itself. Longer treatments, shorter testing durations, improved equipment design, pre/post-testing activities, and documentation simplification were suggested for future research.

Conclusion: Athletes aged 60+ perceived a positive impact of chiropractic care on championship performance. The results of this study should be interpreted with caution as the sample size was small. Further, the study recognises the necessity for additional investigation and emphasizes the significance of the sports chiropractor in maximising athletic performance.

Effective conservative management to improve function and reduce pain in elderly patients with degenerative lumbar spinal stenosis (LSS)

Fukakusa da Silva K

Objective: To review non-surgical options for managing symptoms and improving function in elderly patients with degenerative LSS.

Clinical Features: A 77-year-old male presented with six-month history of lower back pain, bilateral leg weakness, and intermittent neurogenic claudication worsened by standing or walking. Examination showed a stooped posture, antalgic gait, and limited spine mobility. Neurological findings included decreased patellar reflexes and L4 dermatome sensation. MRI revealed spinal canal narrowing at L4-L5 with ligamentum flavum hypertrophy and disc protrusion. Epidural steroid injections were ineffective. Diagnosed with degenerative LSS, he seeks conservative management for functional improvement and to avoid surgery.

Intervention and Outcome: A personalized treatment plan integrating education, activity modifications, exercises, and multimodal rehabilitation was introduced. Chiropractic care included flexion-distraction, soft tissue therapy, and joint mobilizations. Homecare included leg-strengthening, aerobic, and flexion-inducing exercises. After six weeks, the patient reported significant pain reduction and improved walking capacity. Pain intensity reduced from 8/10 to 3/10 using the Visual Analogue Scale. Back specific disability and functional capacity reduced from severe disability (57%) to moderate disability (21%) using the Oswestry Disability Index.

Conclusion: Managing elderly patients with LSS requires an individualized, multimodal approach. Medication may temporarily alleviate pain, while allied health or chiropractic care can offer patient-specific rehabilitation exercises, decompression techniques, manual therapy interventions, education, and activity modifications to improve function and reduce pain.

Conservative Management of Chronic Phantom Orchialgia with Spinal Manipulation and Manual Therapy: A Case Report

Neff S, Holguin S, Neff V

Objective: Describe the care of a veteran with low back pain and chronic phantom orchialgia using spinal manipulation and manual therapy.

Clinical Features: A 29-year-old Caucasian male veteran with a 7-year history of low back pain developed left testicular pain following a vasectomy. He was diagnosed with testicular cancer undergoing a left orchiectomy and removal of 36 lymph nodes from the left pelvis and lumbar spine. The L testicular pain continued.

Intervention and Outcome: Treatment included spinal manipulation and myofascial release of the bilateral iliopsoas as well as training in iliopsoas stretches and self-myofascial release. The pain steadily decreased over the initial trial to 1/10. The QVAS improved by 53% and the BBQ by 54%.

Conclusion: Chronic orchialgia or chronic scrotal pain is a common problem affecting 100000 men per year in the US. As many as 50% of the cases are of an unknown etiology. Though the urology literature does not include spinal manipulation and manual therapy in standard conservative care for chronic orchialgia a growing number of publications have shown it to be safe and effective for this condition. This case demonstrates a successful treatment of chronic phantom orchialgia. A trial of chiropractic care in cases of chronic orchialgia would potentially reduce orchiectomy in idiopathic cases and could provide relief in post orchiectomy cases.