Question
QUESTION: Hi, 3 months ago I suffered from a chiro. adjustment from a specialist who used excessive force by cranking the head & neck flat to the right shoulder and cranking it back. I heard a large carrot-like crunch, pain, and immediately after, severe vertigo. I saw an ortho. doc who had x-rays and a MRI performed but nothing was found. The symptoms (vertigo or dizziness prompted by head/neck position and movement of lower back) faded back and forth over the first month but increased within month #2. Occasionally turning while walking (to the left, rather than the right) sets off dizziness.

Doubled checked with ortho-doc and affiliated neuro-doc who said the initial injury had caused a vascular event but couldn't explain continuing symptoms which now included increasing back & neck pain, as well as an increase in tinnitus levels (I had tinnitus before the injury). They said the pain was most likely compensatory ("nerve damage always gets worse before it gets better"), but I went for a second opinion.

Showed the same MRI results to a recommended chiropractor who found an annular tear at C-5 and C-6 and scheduled a cat-scan. He thinks that the pain & dizziness may stem from either vascular damage (arterial tear and/or clotting) or facet disk issues. There is no disc bulge present. Occasionally the lower back pain sets off muscular pain in the stomach region.

What would you make of this? Why would the pain be getting worse instead of getting better? If the injury was to the upper cervical, why would there now be more lower back pain than upper at this late point?

ANSWER: Michael,
 Sorry that you are going through this tough period of time from an adjustment.  I think from what you have described that the pain is getting worse because it is involving more areas.  That is why I think the lower back pain is worse now because since you know that if you turn to the left it sets off pain, you probably are compensating for the lack of range of motion in the neck with movement in the middle and lower back.  Also, did any of the doctors mention benign positional vertigo?  I am wondering if that is the case because if you had vascular damage(arterial tear), wouldn't your dizziness be the same whether you turn to the right or left?  It could be facets, but they usually hurt all the time vs occasionally.  I would seek out a third opinion and make sure that no one tries to adjust your neck at this present time.

Martin

---------- FOLLOW-UP ----------

QUESTION: Hi Martin, my doctor believes my problem is orthostatic hypotension, caused by the high velocity, low threshold adjustment. A vestibular expert ruled out the chances of it being relating to the ears (crystals, etc.) or being BPV. He was pretty certain that it had to stem from the spine/blood regulation to the brain stem.
The first several doctors I saw didn't see anything on the x-rays or the MRI, but my current doc showed me the white line representing the annular tear that the other doctors missed. A cat scan didn't show anything either (although there was one arterial wall it couldn't see past), but my doc (and myself, after researching it a little) have matched my symptoms to orthostatic hypotension, which is often caused by spinal column injuries. I even noticed myself experiencing dizziness after taking warm showers which matches the profile.

The onset of muscular pains - lower pain, shoulders, mid-back (regular but alternating in location & timing)- has been gradual in progression since the injury (almost 4 months back). Recently, I've been getting odd muscular pains in the left side of the body - left arm, shoulder, back, buttock, leg, knee, etc. with the knee & elbow joints feeling abnormally warm and "wet' (as an interior sensation, not exterior). One doc suggested fibromyalgia as an explanation, but that isn't a condition that pops up so long after the initiating trauma nor is it progressive in nature.

I am still rather confused and at a loss as whom to see. A cardiologist or a vascular doc for the hypotension, a neurologist for the other factors? Few of the doctors I'v seen can cope with the whole picture and I'm nowhere near a Mayo-clinic like hospital where doctors compare notes a la "House" - I can't even get the doctors I've seen here in SW Connecticut to communicate with each other.

Best,

Mike

Answer
Mike,
 I would go and see a vascular doctor for the hypotension.  For the related muscular pains I would go and see an neurologist and/or a physiatrist.  Fibromyalgia does not seem to be what you are experiencing.  Are you experiencing any headaches?  Did they rule out a dural sac leak?  If you at all are thinking of going to see anyone in NY, let me know because I will ask one of my close orthopedic doctors who's from NY if he has anyone he would recommend.  Good luck Mike.

Martin