Question
Good evening! I'm 26 year old female in relatively good health. I've been seeing a chiropractor for about 2 months now. It had mainly been about symptom relief but I expressed a desire to move forward into "fixing" things. Per x-ray, my neck has a significant reverse curve. Before now, I was too sensitive to even do home exercises. The doctor emphasized a need to stabilize first. But today, visit 12, she felt comfortable beginning traction. The device she used consisted of a bolster-type pillow under my neck/shoulders so my head was kinda hanging, then a strap harness that went under my chin and across my forehead. She put 6lb on first and I told her it was too much - she reduced to 3lb which was challenging but didn't hurt. I did 6 minutes.
After the timer went off, the assistant came in and took it off. I sat up, felt fine, and went to go check out. While writing my check a few moments later, I realized I was losing my vision, my hearing became very muffled, and my knees began to buckle. I, amazingly, got to a seat before I hit the ground. I had nausea, severe dizziness, and was sweating.
The assistants got an ice pack on my neck, some cold water, and then helped me back to a room. After a second adjustment and some work on my neck, the symptoms seemed to dissipate. But it took some significant time. I had eaten and don't have any medical conditions that would have prompted this. Now, many hours later, I'm very sore, have a roaring headache, and my neck is quite tender. However, there's been no further dizziness, nausea, or associated symptoms. I am being treated by her for pulsatile tinnitus and this has become quite loud over the past several hours - much louder than normal.
Being a nurse - I want to know why it happened. My google searches are coming up empty and my doctor said I probably just didn't "tolerate it well". I want to know exactly what happened, why it happened, and if there will be any way now to correct my neck posture?

Thank you!

Answer
Dear Lyndsey,

I am sorry about your response following treatment with your chiropractor.  What you experienced is not uncommon, and here are a couple of ideas that I have had regarding this type of response.

1) First of all, there is a lot of controversy regarding cervical spine adjustments and possible vertebral artery dissection induced stroke.  Some suggest that manipulation or adjustments of the cervical spine can cause dissection or separation of the inner wall of the vertebral arteries, causing an obstruction of blood flow, resulting in stroke symptoms.  This thought is controversial because some studies indicate that the incidence or frequency of this occurring as a result of chiropractic manipulation is no greater than the frequency at which this happens in the general population.  Signs of stroke can be nausea, vomiting, dizziness, speech and communication issues, weakness on half of the body, numbness and tingling on half of the body, etc.  As you can see, you experienced some of these symptoms.

2) As a nurse, I am sure that you can recall in your studies of the circulatory system, that the carotid arteries have what is called the carotid sinuses. These are small bulges in the carotid arteries that are rich with baroreceptors, or nerve receptors that measure blood pressure. When they are stimulated (by hypertension, for example) they cause a feed-back to the central nervous system that helps to regulate the heart and the blood vessels.  If you think of the cervical manipulation, and cervical extension traction, it makes sense that it is possible that the position puts a stretch on the carotid sinuses bilaterally, causing tension on the barroreceptors, which then send the signal to the brain that the person is experiencing hypertension. The central nervous system then responds autonomically, resulting in a decrease of pulse rate and intensity and vasodilation... resulting is less blood to the brain... resulting in passing out or feeling dizzy or nauseated.  There are some that feel that significant carotid sinus stimulation can result not only in passing out, but in rare cases, death.

Now, these are a couple of explanations, and either one could describe what you experienced, and yet neither one could be true in your case and situation.

If I were you, and if I had a similar reaction to treatment, I would ask my chiropractor to use a technique that is not a high velocity thrust with rotation to the cervical spine. I would ask for adjustments using, for example, the Activator (low thrust, no rotational stresses to the cervical spine). In my mind, it is not as affective of a treatment method, but it is extremely safe.

I might also consider using extension traction without any adjustment to see if I had a similar response. I would start with assuming the position with NO weight, and staying in that position for only a couple of minutes... and then build up the time as I proved that it caused no relapse of symptoms.  Only after safely staying in extension for more than 15 minutes would I consider adding weight back into the equation, and I would start with only 1-3 lbs... again, for only a few minutes...

Correcting your neck posture, in my mind, is important, but if you cannot tolerate the treatment, it is not as important as making sure that you do not have a serious circulatory problem caused by the treatment.  Many people, for example, might benefit from having a hip surgically replaced, but some of those would never survive the surgery do to medical complications, so the hip replacement is avoided...

I hope that this gives you a few ideas about what happened, and some ideas about what you can do to get the care that you need to improve your neck posture and structure.

Good luck

Keith Biggs, DC