Post-polio syndrome presenting as isolated neck extensor myopathy : a case report

Abstract

Background: Post-polio syndrome (PPS) is characterized by new or worsening muscular weakness, atrophy, muscle and joint pain, and muscle fatiguability decades after paralytic poliomyelitis infection. Case Description: A 56-year-old man was diagnosed with paralytic poliomyelitis at the age of five, which left him with flaccid paralysis and weakness of the right leg. One year before seeking chiropractic care, the patient saw his primary care physician with neck pain, low back pain, and fatigue. At the time, he had been diagnosed with degenerative spondylosis and was being treated with tricyclic antidepressants, clonazepam, and tramadol. Despite taking the drugs, his spinal pain and fatigability deteriorated, and he acquired head ptosis during the following six months. As a result, he sought chiropractic care for second opinion. Due to the patient's failure to respond to oral analgesics, radiographs were performed, which revealed degenerative spondylosis, cervical flexion deformity, right pelvic drop, and right thoracolumbar scoliosis. The patient met the PPS diagnostic criteria. PPS related isolated neck extensor myopathy (INEM) was impressed. Multimodal intervention including cervical and lumbar manipulation, spinal traction, micro-vibration deep muscle massage, and core muscle training was provided. As a result of 40-month treatment, the patient reported full resolution of physical complaints. Head posture restored, cervical curvature retrieved and pelvic obliquity relatively corrected. Conclusions: Survivors of paralytic polio are especially vulnerable to developing leg weakness and length discrepancy, pelvic obliquity, asymmetric axial loading, and trunk muscular imbalance. The current case demonstrates a rare myopathy in a patient at post-polio stage, as well as the restoration of neck function with chiropractic intervention.