Well, last weekend we had our first ever ACN live event, Core Concepts in Chiropractic Nutrition Live on the beautiful Tuckon river, at the Captain club in Christchurch.
Yes we did lots of learning.
And we enjoyed the river side location
And we enjoyed some gluten and diary-free cake with kombucha on the side.
Next year we will head to Birmingham and are planning some events for non-CCCN members as an introduction to nutrition throughout the UK.
One thing the attendees enjoyed was the case studies to see exactly how this all fits together.
And I am also keen to show case studies where things do not always go to plan, and the result is not always miraculous.
Because that is real life.
All too often, we hear miracle stories from people on stage.
They do not say it but they imply that you should get these all the time.
But the reality is they are giving you the exceptions, not the rule, the outliers.
Then you go back to clinic, try the new technique out and when miracles are not forthcoming, it is easy to slowly get despondent and move onto the next new jazzy technique promising miracles.
So here is a case study with a dose of reality and a dose of brilliant cervical adjusting courtesy of Simon King who developed Afferent Input, a technique I could not practice without.
This was a referral from another Chiropractor about an hour away with a young man suffering from a long-term leg pain diagnosed as being of nerve root origin.
Remember I do not want to do nutrition per se with clients, it has become a necessity in order to achieve results.
These first bits of info came through on email before I met him in 2021 and I am trying to piece together this case and work out if I need to see him in clinic or online zoom for nutrition or both.
Note, the aggravating positions are very classic for a disc
He has had a huge amount of imaging, from x-rays to MRI and more.
No suggestion of inflammatory issues, as ankylosing spondylitis (AS) is a common cause of pseudo-sciatica mimicking discs and can go un-diagnosed for up to ten years.
It was noted that he has a right convex scoliosis and the MRI did indeed show left side nerve entrapment at multiple levels which fits at least a neuro-mechanical component.
Treatment has been substantial, and with relatively little success, though he is less acute now than at onset, but is now left unable to sit still.
His bloods are -ve for overt inflammatory issues, but his CRP (inflammation marker) is 3, and while not hitting the magical 5-7.5 the NHS need, it is over 1 which would be an ideal level.
Thus, we can say he has a sustained low grade inflammatory response, which can contribute to nerve pain by lowering the pain threshold.
This could contribute to his ongoing pain from a nerve compression which may or may not give pain in other people.
Now one thing that is a common cause of that is food intolerance, such as gluten and dairy. But he has already consulted a functional medicine doctor and done a 6 week strict elimination diet with paleo plus nightshades, and eggs/nuts.
With no changes.
This was mildly concerning/annoying, as it is so often low hanging fruit to pick for excellent clinical changes.
His bloods also showed.
Alkaline phophatase is a enzyme found in liver and bone mostly, and when high can indicate liver distress, but when under 70 u/L can suggest low zinc as it is a zinc dependent enzyme.
Also noted was a high ALT liver marker
Directly, this was unlikely to be an issue but can be secondary to a defect in the PEMT gene which makes phosphatidylcholine, which keep bile slippery. With low levels, this makes the liver congested and might then push up liver enzymes.
I also noted the bile is a potent anti-bacterial and with low bile flow it might encourage gut infections which might be part of his sustained low grade inflammation.
Note, this is why pregnant women are prone to gall stones, they need high amounts of choline for making that baby and when it runs low the bile drys up and they get gall stones.
TUDCA is a life changing supplement, anyone with raised liver enzymes should be on it. The NHS even has a version they use, albeit very rarely.
So, at this point, I had still not met him, I felt it was unlikely to be undoagnosed inflammatory arthropathy as his imaging was all -ve esp his MRI pelvis.
But it seemed likely the pain was coming from his lumbar nerves/discs, BUT with hyper-excitation locally from a sustained low grade inflammatory response, and potentially deficiencies as yet undiagnosed.
The exam itself confirmed the nerve tension on the left but no myotomal weakness which again suggested hyper-excitation as part of the persistent pain.
I also did quite a lot of afferent input (AI) testing from Simon King and picked up quite a few areas of significant inhibition.
Overall I felt:
On that last part I have found it very common to have peripheral tethering of the sciatic nerve as it runs over the deep external hip rotators.
This is secondary to the inflammation in the nerve itself, creating scarring and a second source of nerve irritation.
One key finding on the first visit was in afferent input terms a “hidden cervical disc”, these are often related to significant weakness throughout the body and can be a significant finding.
From the testing, I felt this was contributing to his loss of normal efferent control in key stabilising muscles in his core.
I gave him three supplements at his first visit:
Our one a day multi which is very high in B vitamins to help get krebs cycle working more efficiently.
Remember your mitochondria are the number one source of free radicals and thus oxidative damage which gives a sustained inflammatory response.
Plus, we added Magnesium Plus, a blend of chelated magnesium with active B6 in P5P form, in a 10:1 ratio.
Remember magnesium needs B6 to get into the cells of your nervous system from the blood.
And magnesium then blocks your main excitatory neurotransmitter GLUTAMATE.
Less neuro-excitation = less pain.
Check the research:
48% pain reduction AND 66% increase in lumbar ROM.
Plus, magnesium is a potent anti-inflammatory.
And liposomal B12 1000 mcg daily to also calm the nerves.
So by visit 4 (week 4) we had done very specific adjusting and his efferent output aka his strength was much better, but the pain was pretty stubborn.
This is hardly surprising given his severe and protracted history.
So we added in alpha lipoic acid and acetyl L carnitine, what would become META-BOOST.
And we also started manual releases of his sciatic nerve at the deep external rotators. I had noted his SLR was stubbornly tight on the painful leg at 60-65 degrees.
And by visit 5 then we saw some obvious changes symptomatically that matched the functional changes we were seeing in strength, and note the left SLR suddenly increased.
Then again, at visit 6 (this was 2022). Note SLR now 80 degrees.
And I saw him last week (over a year later) and he is doing well, very well from where he was, BUT, let’s be really clear, is he asymptomatic all the time living his best wellness life?
He has plenty of pain free time, but I see him once a month for care to fine tune his function.
And occasionally he does get some symptoms, but they are rare-ish and he is totally functional working as a personal trainer.
The reality is with scoliosis and x2 sites of nerve entrapment with a 2 years history of constant pain, he needs management in the long term.
He can come and go as he pleases, but I wouldn’t ever be able to suggest he simply stops care and goes it alone.
He was a jigsaw of pieces.
I had to stabilise his afferent input to get his efferent output correct and stable.
I had to dampen down the inflammation and calm his nerves. They were in a vicious cycle of inflammation and pain.
I had to release his sciatic nerve at the deep external rotators to break that part of his vicious cycle.
It is all too easy to break out the “miracle” stories on stage.
But those are the exceptions, not the rule.
If we then when we go back to practice, we “expect a miracle” all the time with our jazzy new technique.
And then it doesn’t happen like the guru said it would.
We go into a cycle of constantly looking for a new simple one size fits all solution to complex problems.