Question
QUESTION: In February I began seeing a Chiropractor for intense muscle pain in my
upper back, neck and shoulder area, which left me unable to do anything but
lie down.  It was the 4th time in about 15 years that I'd had such debilitating
pain.  The X-rays showed a reverse curve in my upper cervical spine, so the
DC recommended traction, where I put my head back while sitting in a chair
(to which I later added a 2lb weight).  Since I was in so much pain, initially he
just corrected me and once the worst
of the pain subsided I began traction, along with an exercise (lying on my
back tucking me chin to my chest, head slightly off the table) to strengthen
my core.  After three months, I was left with only a slight pain when I turned
my neck to the left.  He did another X-ray at that time which showed a fair
amount of correction had taken place.  So I started doing an exercise where I
sit on a ball and pull back my shoulders (attached to a rubber band).  A
couple of weeks later intense pain in my upper back occurred, which he said
might be a response to over compensation due to the correction and that
those muscles were working harder.  During that time I also began seeing a
massage therapist and a physical therapist who assigned me some stretching
exercises and had been doing some ultra sound.  Now, my upper back pain is
gone, but pain remains in my left shoulder/neck area.  I feel so tired of this
pain and am unsure whether the pain during some of my exercises and
traction is good or bad pain.  I had gotten up to about 5 minutes of
tractioning but now can barely do 3 minutes with out a lot of shooting pain in
my left neck. Someone suggested a neurologist.  I was
wondering what you recommend.  The DC has also been doing active muscle
work on me.  My question is:  could there be some pain being caused by too
much muscle work/tractioning?    Some times I feel worse after some of the
exercises and
tractioning.

ANSWER: Hi Lottie,

Traction, stretches, exercise and manipulation should never hurt. If an exercise hurts, quit.
Only do what you can tolerate. I would recommend an MRI and a visit to a neurologist.
Be sure to bring the, "before and after", x-rays documenting your current progress.
Only see the neurologist to rule out anything more serious, be very cautious going with any treatment plan he advises. These include epidurals, PT, VF guided facet injections and Neurontin type meds. None of these will correct your problem, they will only worsen or mask your symptoms. Also, you might want to find another D.C. that is certified in Flexion/Distraction, this is the standard of care for patients with your condition.
Some D.C.'s can't afford the tables, most can. Find one that is proficient in F/D, you will be amazed at the results. I will help you find one if you are unable.

Flexion-Distraction Therapy - What is it?


Flexion-Distraction, (F/D) is a gentle, chiropractic treatment procedure utilized for back and neck pain. Flexion-Distraction is a safe alternative to back surgery for those 95% of patients whose conditions do not demand surgical intervention. The doctor is in control of the treatment movements at all times.

Flexion-Distraction is utilized for many conditions such as:

Failed Back surgical Syndromes
Disc Herniation/Ruptured Disc / Bulging Disc / Herniated Disc
Sciatica / Leg pain
"Whiplash" injuries
Stenosis
Arm Pain
Neck Pain
Failed course of Steroid Injections
Chemical Radiculitis
Spondylolisthesis
Headache
Transitional segment
Many more conditions?
How does Flexion-Distraction Work?

For Disc related conditions:

Increases the intervertebral disc height to remove annular tension on the annular fibers and nerve by making more room and improving circulation.
Allows the nucleus pulposus, the center of the disc, to assume its central position within the annular fibers and relieves irritation of the spinal nerve.
Restores vertebral joints to their physiological relationships of motion.
Improves posture and locomotion while relieving pain, improving body functions, and creating a state of well-being.
For Non-Disc related conditions:

Patients with other conditions causing back pain (facet syndrome, spondylolisthesis, sprain/strain, scoliosis, transitional vertebra, sacroiliac restrictions and misalignment, certain types of spinal stenosis), Flexion/Distraction provides all of the above benefits plus the ability to place the spinal joints into normal, painless movements so as to restore spinal motion without pain:

The posterior disc space increases in height.
F/D decreases disc protrusion and reduces stenosis.
Flexion stretches the ligamentum flavum to reduce stenosis.
Flexion opens the vertebral canal by 2 mm (16%) or 3.5 to 6mm more than extension.
Flexion increases metabolite transport into the disc.
Flexion opens the apophyseal joints and reduces posterior disc stress
The nucleus pulposus does not move on flexion. Intradiscal pressure drops under distraction to below 100mm Hg. On extension the nucleus or annulus is seen to protrude posterior into the vertebral canal.
Intervertebral foraminal openings enlarge giving patency to the nerve.

Reference: Cox JM, Feller JA, Cox-Cid JA: Topics in clinical Chiropractic 1996; 3(3):45-59

It sounds like you PT and message therapist are doing some good as well, ultrasounding something that is inflamed can make the problem worse. Make sure you ice it down for 15 minutes when it flares up. I suspect there is a subluxated rib in the upper thoracic area. This is easily corrected if identified correctly by a skilled D.C. practitioner. If you go the medical route, it usually leads to failed surgery and a life time of opiate addiction. Keep trying the approaches you enjoyed in the past and only change the doctor. This will ensure you covered all your bases before jumping into something irreversible.
Many F/D tables are only set up for low back conditions, some have cervical traction options.

I practice without the cervical option because I get just as good results from towel traction. The doctor uses a light weight fiber towel, like patient gowns are made of, and puts it under the base of your skull while you lay on the table face up. Grabbing both ends of the towel, I pull for 5 seconds with 60 lbs of force and end it with a slight thrust or extra pull. This usually elicits a release of vacuum in the neck sounding like an adjustment, this is normal and should not hurt! Of course, without examining you, I can only speculate as to the cause of your pain, that's why I want you to get a couple more opinions.

Good Luck, keep in touch and I will help you further if you need it!

Dr. Timothy K. Durnin
drs.chiroweb.com


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

QUESTION: Dear Dr. Durnin,

Thank you very much for your helpful reply.  I have an appointment with my
GP to discuss a referral for a neurologist.  

My PT also suggested a physiatrist (sp?), which I have never heard of but I
gather is more like a PT and an MD?  Might this be a good path to pursue? I
will look around for a DC that does the FD work you suggest.  

Do you think it's not a good idea to do the ultra sounding if I have
inflammation?  I just started taking advil yesterday and it seems to make me
feel better.

You mention a subluxated rib in the upper thoracic area.  I am not exactly
sure where that is.  However, I'm wondering if it might be connected to a
problem I had in my last month of pregnancy and first two post-partum
months after I gave birth in November 05.  I had contracted pneumonia at
about 34 weeks.  During that time my ribs began to hurt a lot and my Dr. said
it unlikely was a broken rib but perhaps a pulled muscle, pleurisy, etc., and
that there wasn't much to do anyway.  After giving birth (naturally and in
water) one evening I was nursing my son in an upright chair and I felt a click
and a stab in my middle back rib, I experienced an excruciating stabbing pain
(I thought the spindle of the chair had broken and gone into me).  I could
barely make it to the bed to lie down. The Dr. recommended Advil and I came
in later to a DO in the office who adjusted me and it gave me instant relief
(which didn't last that long).  I was adjusted a couple of more times and
eventually the pain went away.  The Dr. basically said he had no idea what
that was.  Anyway, I was just wondering if you thought there might be a
connection between that episode a year and half ago and my current
condition.

Thanks again!  Lottie

Answer
Hello again Lottie,

I think there is a definite connection. I firmly believe it is a subluxated rib articulation where the rib connects to the vertebrae in your back. A subluxation is basically a partial dislocation. Having had "instant" relief prior with manipulation, I think if you go to a specialist in manipulation, Chiropractor, then it should be corrected in short order.

Your D.C. should be able to handle most of these problems efficiently and without using medications. The Advil is a nonsteroidal anti- inflammatory drug that actually inhibits cartilage reproduction while artificially masking the problem. This is no good for long term correction, you need to take Glucosamine Sulfate not Advil if you have joint pain. Read up on it and you'll see why.

Find a D.C.!

Dr. Timothy Durnin
drs.chiroweb.com