Question
QUESTION: All was well until I woke up in Feb having trouble walking and couldn't bend over to put my shoes on.  I just started going to a chiropractor for tx of:
- L3/4 foraminal disc herniation w/narrowing of the R lateral recess w/disc material encroaching on traversing R L4 nerve root.
- Moderate narrowing of R neuroforamen w/disc material encroaching on R L3 nerve root.  
- small right peracentral disc protrusion at L1/2 where there is no evidence of spinal canal stenosis.  

I was initially was referred to a neurosurgeon but wanted to try other options first.  I selected a local chiropractor who does subluxations based on xrays.

Initially the treatments were working well.  Then the chiropractor started working on my neck.  I was told that my neck does not have a c-curve and that through adjustments of dropping the head of the table, neck rotating, or through pressure point vibrations this could be corrected.  As treatments increased more problems started arising throughout my body. I have a history of wearing braces for 9 years of my life (grades 3 thru 12).

Problems:  I have been finding that for 3 - 7 days after the neck adjustments my bite is changing.  One day it may chomp more to the left, or right, or the lower jaw may be back further in my mouth.  Are the adjustments capable of shifting my bite like this?  Is the C2 involved with this?  Are the bite changes I feel able to be out of alignment permanently or should I continue w/the treatments and everything will go back into proper alignment after the 18 month treatment plan?  Also, I have been experiencing new, very brief moments of dizziness since I have had the neck adjustments as well as increased pressure to my head while bending over and headaches.  I am not a person who has ever gotten headaches in the past.  Should I be concerned w/possible vertebral artery injury?  Or stroke resulting from the neck adjustments.  I am a 44 year old female in otherwise good health, 5'6", weighing approx. 128 lbs.  Any direction in other possible avenues of treatment would be appreciated as well.  This is my first experience using a chiropractor and I don't know if I have made a good selection or not.  I live in the 02360 zip code if you wanted to suggest another appropriate chiropractor or other doctor.

ANSWER: Heather,

First, there has been speculation about alterations in bite following neck joint manipulation but I have yet to see any research that proves it.    I've seen patients have their bite altered by an oral appliance and then show signs of neck joint dysfunction and tenderness afterwards (usually when the appliance is off), and have also seen tender neck joints become non-tender after an oral appliance is issued.  These are for TMJ patients, by the way.  So it is not far fetched that your bite can be altered by neck joint manipulation.  Obtaining treatment to alter your neck curve is not a good idea based on the current evidence.   I've answered this question extensively in previous postings.  It sounds like the joint manipulation is irritating the soft tissue structures in your neck and you are getting cervicogenic vertigo (the dizziness you describe).   While the researh clearly shows that the odds of stroke from cervical joint manipulation is the same as visiting your primary care doctor as it is for visiting your PCP, experiencing dizziness is not a pleasant situation.   I would ask your chiropractor if he/she would bet his bank account that the neck joint manipulation will correct your neck curve (it most likely won't change it at all, and even if it did change it a little, we don't know if or how you would benefit).   The drop piece table for the neck can be very irritating.  "Pressure point vibrations" via hand or instrument will not change your neck curve.   It sounds to me like these treatments are causing the dizziness, similar to the dizziness caused by whiplash injury.   I suggest giving it a rest and expect the dizziness to go away with time (probably a few weeks or so).  You're focus should be back pain treatment and it sould include a variety of methods.  You can look up top-notch DCs via: www.westhartfordgroup.com   I believe Dr. Paskowski is close to you.

'Hope this helps,

Dr. G

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

QUESTION: Thank you for your quick reply and expertise. You mention that my treatment plan should include a variety of methods.  Does this mean chiropractic methods or other methods which may include:  exercise, muscle strengthening, as well as the chiropractic methods.  Also, would you know how many visits per week one should go to the chiropractor?  I was going 3 times a week and seems like it may have been a bit too much but I am new to these treatments. I have talked to some people who only go once a month. Thanks again for all your help.

Answer
Heather,

I meant that a chiropractor that employs a variety of methods, not just a drop piece, etc., is a better bet.  In some cases that included exercises, strengthening, or even ergonomic considerations.  It is hard for a DC to fill every role in every case.  Tufts won't reimburse for anything except joint manipulation to the spine, so this makes it hard for a DC to consider delivering treatment to a patient such as exercises, laser therapy or manual soft tissue therapy, even though many DC's are the best trained to deliver such services (don't get me started on the moronic insurance policies...)   As for treatment frequency, consenses guidelines seem to indicate that 3x/week is common for many new/acute cases, and this can last for as long as a month in severe cases.   Otherwise, for young, healthy folks with acute back pain, something's wrong if there is poor progress after about six visits or two weeks.  In some trauma cases, it can take several weeks to feel better.  And again, "multimodal" care seems to be best - not just one modality.   In other words, while some folks do just fine getting spinal joint manipulation solely, others need the combination of manipulation and soft tissue work and exercise and whatever (laser, ultrasound, heat, etc.) in order to get results.  Using only one modality over and over 3x/week for weeks without results says something: It ain't workin'!   As for monthly treatment, in my 20 years observing this profession as well as being a patient since age 16, I truly believe that getting chiropractic joint manipulation and soft tissue therapy on a regular basis is a healthy and safe way to keep recurring symptoms in check.  I cannot justify monthly care for anyone that feels fine and functions well.  The chiropractic profession has yet to prove that regular care for a well population has any meaningful health benefits, so for the average well person, it's simply a lifestyle choice.   I believe, without solid evidence (just a gut feeling) that athletes can benefit from our work in that we might be able to uncover subtle, asymptomatic joint and soft tissue lesions that have the potential to impair athletic performance.   Again, while there is no data to prove this (yet), many athletes feel good when a sports chiropractor finds and alleviates tender or stiff body parts.   Is this necessary for a non-athletic well population?  That's a good question.  

'Best regards,

Dr. G