title: Chiropractic management of Ehlers-Danlos syndrome: a report of two cases.
abstract: OBJECTIVE
  To discuss 2 patients with Ehlers-Danlos syndrome seeking chiropractic evaluation and management of their disabling musculoskeletal pain and associated disorders.
  
  
  METHODS
  Two disabled patients diagnosed with Ehlers-Danlos syndrome had spinal pain, including neck and back pain, headache, and extremity pain. Commonalities among these 2 cases included abnormal spinal curvatures (kyphosis and scoliosis), joint hypermobility, and tissue fragility. One patient had postsurgical thoracolumbar spinal fusion (T11-sacrum) for scoliosis and osteoporosis. The other patient had moderate anterior head translation.
  
  
  RESULTS
  Both patients were treated with mechanical force and manually assisted spinal adjustments delivered to various spinal segments and extremities utilizing an Activator II Adjusting Instrument and Activator Methods Chiropractic Technique. Patients were also given postural advice, stabilization exercises, and postural corrective exercises, as indicated in Chiropractic BioPhysics Technique protocols. Both patients were able to reduce pain and anti-inflammatory medication usage in association with chiropractic care. Significant improvement in self-reported pain and disability as measured by visual analog score, Oswestry Low-Back Disability Index, and Neck Pain Disability Index were reported, and objective improvements in physical examination and spinal alignment were also observed following chiropractic care. Despite these improvements, work disability status remained unchanged in both patients.
  
  
  CONCLUSIONS
  Chiropractic care may be of benefit to some patients with connective tissue disorders, including Ehlers-Danlos syndrome. Low-force chiropractic adjusting techniques may be a preferred technique of choice in patients with tissue fragility, offering clinicians a viable alternative to traditional chiropractic care in attempting to minimize risks and/or side effects associated with spinal manipulation. Psychosocial issues, including patient desire to return to work, were important factors in work disability status and perceived outcome.
authors.affiliation: State of the Art Chiropractic Center, PC, 11011 S. 48th Street, Suite 205, Phoenix, AZ 85044, USA. cjcolloca@neuromechanical.com
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Colloca
authors.forename: Bradley S
authors.initials: BS
authors.lastname: Polkinghorn
mesh_terms: D000328:Adult; D004185:Disability Evaluation; D004535:Ehlers-Danlos Syndrome / Q000150:complications / Q000503:physiopathology* / Q000628:therapy*; D015444:Exercise; D005260:Female; D006801:Humans; D007738:Kyphosis / Q000628:therapy; D017116:Low Back Pain / Q000209:etiology / Q000628:therapy*; D008297:Male; D026882:Manipulation, Chiropractic / Q000379:methods*; D008875:Middle Aged; D010147:Pain Measurement; D010353:Patient Education as Topic; D017060:Patient Satisfaction; D012307:Risk Factors; D012600:Scoliosis / Q000628:therapy; D013997:Time Factors; D016896:Treatment Outcome