A structural chiropractic approach to the management of diffuse idiopathic skeletal hyperostosis

J Manipulative Physiol Ther. 2003 Mar-Apr;26(3):202-6. doi: 10.1016/S0161-4754(02)54132-4.


Objective: To discuss a unique method of treatment for a patient with diffuse idiopathic skeletal hyperostosis (DISH) and the long-term result of this treatment.

Clinical features: The patient had a long-standing history of low back pain and stiffness caused by DISH. Coexisting conditions consisted of right-hand paresthesia because of a thalamic stroke, osteoporosis, Barrett's esophagus, thyroid and parathyroid disease, and hypercholesterolemia.

Intervention and outcome: The patient received chiropractic manipulation and drop table adjustments, along with range-of-motion exercise, extension exercise, and standing lumbar extension traction. The magnitude of lumbar lordotic alignment and Ferguson's angle improved with treatment. The patient's subjective perception of pain significantly improved, as documented with the use of numeric rating scales. Flexibility and activities of daily living were also improved. The effect was maintained for 19 months after termination of the active rehabilitative treatment period.

Conclusion: A paucity of literature exists regarding the chiropractic management of patients with a diagnosis of DISH. Chiropractors should be encouraged to report on their clinical experiences in treating patients with varied conditions and disorders.

Publication types

  • Case Reports

MeSH terms

  • Activities of Daily Living
  • Aged
  • Exercise*
  • Humans
  • Hyperostosis, Diffuse Idiopathic Skeletal / complications*
  • Hyperostosis, Diffuse Idiopathic Skeletal / diagnostic imaging
  • Hyperostosis, Diffuse Idiopathic Skeletal / therapy*
  • Low Back Pain / etiology
  • Low Back Pain / rehabilitation*
  • Male
  • Manipulation, Chiropractic / methods*
  • Manipulation, Chiropractic / standards
  • Pain Measurement
  • Radiography
  • Range of Motion, Articular
  • Time Factors
  • Traction
  • Treatment Outcome