This week I would like to highlight an aspect of our practice that often goes unmentioned.

There are some conditions that we can't treat. As part of our five-year training to become a chiropractor we study a wide range of medical conditions giving us an excellent base for general diagnosis.

As many non-biomechanical conditions can include symptoms such as joint pain, head pain, neck and back pain as well as muscle aches, these patients often present themselves to a chiropractor.

It is therefore vital, when examining a new patient, to be sure that the symptoms are within the chiropractic remit before any treatment is given. It is as important to know when NOT to treat a patient, as to know when it is appropriate. Polymyalgia Rheumatica (PMR) is a flu-like illness characterised by an abrupt onset of stiffness and intense pain of the muscles around the shoulders and pelvic girdle.

It is most common in the elderly patient. There may be associated constitutional symptoms such as malaise, fever and weight loss.

PMR can also be associated with temporal arteritis which is inflammation of the temporal arteries causing headache, temporal artery tenderness and loss of pulsation.

The diagnosis is usually based on clinical findings of a very high ESR.

Case History Not long ago I was asked to see an acute patient, Mrs P. who was visiting the area through work. The patient was a 48-year-old female who had recently been under great stress.

She lived about 170 miles away and had driven up the day before to attend an afternoon meeting.

During the meeting and through the night, she had developed a stiff and painful neck and bilateral severe shoulder pain which was radiating down her arms.

She had hardly slept during the night and the pain was becoming so severe she booked the appointment with me, as chiropractic treatment had helped her neck problem in the past.

This lady had great difficulty filling in the forms prior to examination as she couldn't write well due to the pain.

She wanted me to treat her so she could drive back home! From the history alone I was suspicious that this was not a typical neck problem.

During our discussion she was unable to remain still due to the rapidly worsening arm pains.

On examination it was clear that the shoulder and arm pain was far more severe than the neck.

This lady could hardly let me examine her shoulders or arms as they were so acutely painful.

From my examination I established fairly normal neck movement and on palpation very little segmental restriction. Neurological and orthopedic tests were normal. This did not reflect the severity of her symptoms and I was therefore suspicious she was suffering from Polymyalgia Rheumatica. I recommended she saw a local GP for assistance with medication for pain relief but she insisted she would only wish to see her own GP on returning home.

Following a discussion about her return journey home, she agreed she would either ask a colleague to drive her or take the train.

To afford her some pain relief ultrasound and acupuncture was utilised on her shoulder girdle muscles. I wrote to her GP and faxed it off so she could be seen the following day.

About two weeks after our meeting Mrs P. kindly called to report that PMR had been confirmed by blood tests, and she had been placed on a course of corticosteroids.

To my horror she also informed that the treatment had helped ease her symptoms to such a degree that she had actually driven home.

I wasn't too pleased about the fact she had driven but was pleased she was now getting the treatment needed.

It is worth mentioning here that just because patients have other conditions such as PMR, I am not saying I would not treat her biomechanical problems.

Many patients have all sorts of additional complaints but we can treat them despite their other health problems.

I now receive emails every week asking for advice or information, so please contact me on ilkleychiro@tiscali.co.uk with your questions or suggestions. You can of course call the clinic on 605060.