Question
I have chronic pain in my upper neck, almost always limited to the right side, and chronic headaches. The headaches are disabling at times. It started a few years ago. I was reluctant about chiropractors and may never have gone at all except last year my lower back became a problem, I developed sacroiliitis on the right side, and one day suddenly my whole right butt cheek was numb.  So in May of 2010 I started receiving chiropractic treatment on a fairly aggressive schedule. My initial xray showed a rotation of C2 by 6 degrees and almost complete absence of curve in my cervical spine. And one tiny inconsequential bone chip. Also, retrolisthesis of L4 on L5.

Chiropractic has had some effect on my lower back, but it requires constant attention. My neck has never stopped hurting. And it seems about 30 minutes after an adjustment and my neck is right where it started or worse. I have changed chiropractors and found a great one but my neck still hurts. And the headaches start at the same point at the base of my skull on the right side, and they pull up and over the entire head at times.

I need to know what's wrong. The new chiropractor says it could take up to two years to make my neck normal.  I am 31, 120lbs, I have numerous other medical issues and can't work. No insurance. I have recently gained access to a local program with low cost medical access but it has many limitations. MRIs are still very expensive and, since I am I'm need of a GI series...

What are the potential affects does a rotated C2 cause?  What makes it so unresponsive to adjustments? It will hardly adjust to the left at all(and if it does it makes a horrible gravely, grinding noise.) One Dr thought I had a damaged ligament, possibly from a fairly significant car accident I was in at 18, and never sought medical treatment afterward.

And why does my right SI act up all the time? sometimes All the chiros have said I'm pulling up on the right side. Sometimes the left SI acts up too. Sometimes the whole sacrum radiates pain. I frequently experience joint pain several other places, shoulders, elbow, wrists, fingers, toes, hips and knees. I dot think this OS normal for a healthy 31 yr old, is it? Why am I having so many problems?

Answer
Dear Natalie,

I see a couple of issues with what is going on.  First of all, you can be adjusted for your entire life and never change the distortions that are seen on an x-ray film... and it is impossible to know if the "rotated C2" is truly the cause of your headache anyway.  What are the other potential causes of headaches?  You say that you have numerous other medical conditions, but yet you assume that there can be no connection between those medical conditions, your current medications, and headaches.  Are you on medications at all? If you are, could they cause your headaches?  Do you suffer from food or air born allergies? Could that cause your headache? Do you suffer from hormonal imbalances, and could that cause your headaches? Do you have vision issues... do you have a spinal tumor... do you have a cranial tumor... do you have any other neurological conditions or diseases? IF you have a ligament injury or damage to the neck... wouldn't high-velocity manipulation of the neck potentially make things worse? Are you diabetic? Do you have hypertension or hypotension? Do you have hypglycemic tendencies? Do you have a spinal distortion that is congenital and will never change? Do you suffer from autoimmune disorders or arthritic disorders? Do you have or have you had chronic viral infections or bacterial infections? What past surgeries have you had? Do you have scoliosis?

I have a hard time thinking that if you haven't seen any significant improvement over the past two years, that continued manipulation... doing the same thing... is going to give you a different outcome over the next two years.

The definition of insanity is doing the same thing over and over and always looking for a different outcome...

The problem with "headache" as a symptom is that it can be caused by almost ANY ailment or disease... heart and lung, kidney,reproductive, hormonal, infectious, neurological, structural, digestive, connective tissue, reumatological, etc.    I think that it is time to look for another cause.  Have you exhausted the resources of a good diagnostic oriented medical doctor?  It will cost you, but it very well might give you an answer.  Try and get yourself to a Mayo clinic... for example.

As far as the lower back pain is concerned...  My experience is that most lower back issues are disc related. An MRI might be warranted and would tell you if you have lumbar disc problems.  The problem with lumbar disc issues is that they disc is very difficult, if impossible, to heal.  Again, you can be adjusted every day of your life, but if you do not include a rehabilitative/strengthening protocol with your manipulative treatment, what are you truly accomplishing?  Treatment in lumbar disc issues should be aimed at stabilization of the region, not "alignment".  Adjustments can be an important part of therapy, but they are not the only part of therapy.  A major misconception regarding chiropractic care is that the chiropractor is putting a bone back in place....

Manipulation of the spine... at its very core... is simply joint mobilization.  It does not, in my experience, result in a new re-alignment of joints.  If it did, why won't your chiropractor take a picture right before and then again right after adjustment to show you how much the adjustment changed your posture and alignment?  Now, don't get me wrong, manipulation and mobilization has many wonderful physiological affects, but in and of itself, after two years, it is not going to cure your "inflamed SI joints"... again, if that is truly what you are suffering from... could it be that you have disc injuries in the lower back... or maybe a facet joint inflammation, or perhaps a spinal cord tumor that is undiagnosed, or maybe a connective tissue disorder or autoimmune disorder... or perhaps kidney issues, or bowel issues, or bladder issues, or female organ issues.

I think that you get the point of my writing to you. There are many potential causes of your symptoms, and if chiropractic adjustments do not appear to address your issues, it is time for a different point of view.  I wish that I could diagnose you through email and text, but that is truly impossible. You would stand a better chance of getting what you need with a face to face consult with almost any other physician or chiropractor.  It is time to start asking hard questions to those that are providing your care.

Granted, there are times when we have symptoms for which science just doesn't have an answer... yet.  But, until you have exhausted all diagnostics, I can't tell you that your search for answers is hopeless.

I hope that this gives you some food for thought.  Ask questions, demand answers that make more sense than "you just need more of the same care that hasn't worked yet"

Good luck,

Keith Biggs, DC