Question
In August 2008 I twisted my spine in two places (1 lumber, 1 T8)while lying on the floor and twisting my upper body to do an exercise (incorrectly). This was put right by an Osteopath but left me firstly with a feeling as if part of my spine was protruding - noticeable when sitting against a chair back - which developed into a burning pain. Over time this was relieved by exercises and ultrasound but I could still feel a pain in T8 when bending over fully. Unfortunately in April of this year while gardening I had a facet joint move in the T3-5 area which again was put right by an Osteopath. However, when this was done instead of a gentle pooping noise under manipulation there was a very very loud popping noise which I immediately questioned but was told it was not unusual. Within hours I had significant pain in the T8 area and after having treatment 1 week later the pain got worse and I started to have pain in the coxis area. I have not injured the coxis but there is clear pain and discomfort. I have taken Naproxen for several weeks to no avail, have had an MRI which has confirmed there are no injuries to either the discs or facet joints, and have had X-rays to confirm no fractures anywhere. If I bend forward I will inflame whatever is wrong with my back and my coxis will hurt too.I am told by the spinal consultant that it is a soft tissue problem, maybe ligaments or muscle but he has no idea why my coxis hurts.

Answer
Dear Steve,

First, the manipulative treatment by the osteopath sounds appropriate from the diagnoses and symptoms that you have given.  The loudness of the sound is not an indication of anything more than the speed in which gas escapes the joint capsules that surround the facet joints in the spine.  So it has no real bearing, but if he manipulated the spine forcefully at the T3-5  location, this can often result in an increase of pain in that area, but should only last a few days...this is actually very common.  However, you may have needed to be manipulated at T8 as well.  Now continued pain in that area can be due to muscular strain, capsular strain or lingering inflammation around the joint.  

From what you have described, I am not really sure why your coccyx hurts either...there doesn't seem to be any mechanism of injury in that area.  The only thing that would make any sense here is that the outer covering of the spinal cord (A.K.A. thecal sac/meninges) was stressed or inflamed causing the continued pain in that area, and that can result in coccyx pain due to the fact that that the thecal sac is attached at the coccyx.  This is the same mechanism of why women who have an epidural shot at can get birth get severe headaches...due to this meningeal irritation.

The above does make some sense because when you bend forward and the spine flexes, the meningeal covering get stretched and if they are irritated in those area, pain can result.  However, meningeal irritation is not a common thing to happen,and it would be a very rare complication of spinal manipulation.  Now...a more likely scenario is that the ligamentous attachments around the spine are inflamed red, and ligamentous injuries take a long time to heal due to their deficient supply.

Either way here...both of the above scenarios should be self limited. I would suggest that you go back to the Osteopath and have him evaluate the movements of the spine first and manipulate what needs to be addressed then assess for ligamentous injury...they proabably won't do anything for that though, and time may be your best asset other than heat for flexibility and ice to reduce inflammation and pain.  Good Luck.

Respectfully,
Dr. Shawn Leatherman
www.suncoasthealthcare.net