Conservative chiropractic management of urinary incontinence using applied kinesiology: a retrospective case-series report

Abstract

Objective: The purpose of this case series is to describe the chiropractic management of 21 patients with daily stress and occasional total urinary incontinence (UI).

Clinical features: Twenty-one case files of patients 13 to 90 years of age with UI from a chiropractic clinic were reviewed. The patients had a 4-month to 49-year history of UI and associated muscle dysfunction and low back and/or pelvic pain. Eighteen wore an incontinence pad throughout the day and night at the time of their appointments because of unpredictable UI.

Intervention and outcome: Patients were evaluated for muscle impairments in the lumbar spine, pelvis, and pelvic floor and low back and/or hip pain. Positive manual muscle test results of the pelvis, lumbar spine muscles, and pelvic floor muscles were the most common findings. Lumbosacral dysfunction was found in 13 of the cases with pain provocation tests (applied kinesiology sensorimotor challenge); in 8 cases, this sensorimotor challenge was absent. Chiropractic manipulative therapy and soft tissue treatment addressed the soft tissue and articular dysfunctions. Chiropractic manipulative therapy involved high-velocity, low-amplitude manipulation; Cox flexion distraction manipulation; and/or use of a percussion instrument for the treatment of myofascial trigger points. Urinary incontinence symptoms resolved in 10 patients, considerably improved in 7 cases, and slightly improved in 4 cases. Periodic follow-up examinations for the past 6 years, and no less than 2 years, indicate that for each participant in this case-series report, the improvements of UI remained stable.

Conclusion: The patients reported in this retrospective case series showed improvement in UI symptoms that persisted over time.

Keywords: Kinesiology, applied; Manipulation, Chiropractic; Pelvic floor; Urinary incontinence.

Figures

Fig 1

The AK lumbar disk challenge. The vertebrae above and below the possible intervertebral disc involvement are challenged by separating or compressing the spinous or transverse processes, then testing a strong indicator muscle for inhibition following the challenge. (Image used with the kind permission of David S. Walther, DC.)

Fig 2

AK challenge to the lumbosacral spine produced weakness in a previously strong indicator muscle (the category III challenge procedure). Flexion distraction decompressive treatment corrected the AK sensorimotor challenge to the lumbosacral spine.

Fig 3

Pincer palpation of the PFM (A) produced weakening of the previously strong hamstrings. Percussion (B) on the PFM (C) corrected this finding and reduced palpation tenderness and referred pain from the MTrPs present in the PFM.