Question
QUESTION: Hi Dr. G.  

Everytime I google a question, I find "your" answers to others' questions and have enjoyed being affirmed in what I think is the right treatment for me.

I've had chiropractic regularly for 15 years and have had various lower back subluxation episodes and SI trouble after pregnancy (six)and he has greatly helped me through these times.  

This, however, is the first time I've ever experience any shoulder pain and radiculopathy.

I do have quite a kyphotic curve, round shoulders and my thoracic vertebre are often hard to move.  I am also 30 lbs. overweight.

MRI on Jan. 9th showed an extrusion near the radial nerve  of C 6 and 7 and the report said it was minimal.  

My DO recommended ceasing Chiropractic and seeing a neurosurgeon.  He said I shouldn't have anything but massage and traction. No manipulations.  This disturbed me greatly because I've trusted him with my asthma for so long.

My index finger is numb and I have radiating nerve pain that is becoming less frequent.

Nearly all my muscle spasm is resolved and my range of motion and trigger points are good and being relieved.

This started at T giving, my chiropractic treament wasn't increased due to vacation scheduling for both he and I.  We both regret that.

On Dec. 9th, I had severe muscle spasm and only one week of daily treatment and then I insisted on another trip we needed to make.  I was good until Jan. 9 when the worst muscle spasm and pain happened.  Maybe the disc extruded, then.  But I don't think so since my finger has been numb since T giving.

Since that time I've had four times/wk. trigger pt. and chiropractic, then three times/wk. trigger pt.  Its been three weeks.

I'm now off all narcotics and muscle relaxers and antiinflam.

I do use ice a lot after my adjustments and it always relieves the discomfort.  I use Tylenol.

My question is, do you think I'm on the right track?  I realize my decrease in symptoms convinces me this must be so, still I fear a myelopathy each time I am adjusted.  Is that a real possiblity?

My movement today was excellent and I came home and took a two hour nap.  

I guess I want to be a testimony and only time will tell!

I am ordering the book you mentioned about strengthening muscles, not stretching them from  Stuart McGill, PhD.

Thanks for any thoughts.  
Joni in DE under the care of Harry L Heck, Jr. DC

ANSWER: HI Joni,

The posture you described is typical of an asthmatic.  You also likely have a forward carry of your head off your shoulders, and I bet you also have short/tight anterior neck muscles.  It is unfortunate that your DO puts all of "chiropractic" into the basket of joint manipulation.   How would he like it if I said no more osteopathy?   Osteopathy is not a technique.  It is a healthcare profession.  The same goes for chiropractic.  In his defense, however, much of what chiropractors do is joint manipulation.  But that's not all, as many DC's are expert at various forms of soft tissue release procedures.  Many people with disc protrusions, extrusions, and bulges are helped with: joint manipulation (as performed by a chiropractor).   Some find benefit with the combination of manipulation and traction (also performed by a chiropractor) or manipulation, traction, and active myofascial release methods (again, performed by the chiropractor).   The question that needs to be asked to the DO is: What are the chances of manipulation being dangerous?  Based on what?  Also, would he consider gentle manipulation to be safe verses the more forceful rotational multijoint manipulation?    My sense is this: if you are not getting relief with the methods your DC is providing, then those methods have to change.   Your DC is a doctor, and must, by law, diagnose.   Therefore, he should be checking neurologic signs such as skin sensation and reflexes and muscle strengths (and not just cracking your neck which is likely what the DO thinks is being done).   Bottom line:  if you're getting better, then treatment must be working.   Your DC should have the skills to read and understand your MRI, check your neurologic status, and also know when to recommend referral to the neurosurgeon.   Last thought...check your vitamin-D(3) levels, or just simply take 4,000 IU's/day.  There's more and more information about D3 and health, including spine pain.

'Hope this helps.

Dr. G

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

QUESTION: Hello Dr. G.  I am getting better. My question to you today is how much chiropractic is enough for my condition?  Since the incident on 1/9 that was my third episode of muscle spasm.  My MRI showed CDH and impingement on the radial nerve.  My chiro shedule was four times the first week, three times the second week, three times the third week and then twice this week because he had to cancel a day (he suffers from gout).  Next week I know I have one appt. but I am concerned that if I go to two times a week, I may regress.  I asked about a referral and this is such a rural area that they didn't have one for me. I will speak directly to the dr. next week, though, about this.  He often takes vacations and with my thoracic spine being so tight and my kyphosis, even skipping a weekly visit can be rough, although not always.  Thank you for any thoughts.  I realize you don't know my case nor can you examine me but I wonder if I am correct that I should still be receiving 3x a week trigger pt. and adjustments.  I am on tylenol only, not much, and celebrex at the moment.  I have a little tightness in my neck.  I do have radiating feelings down my arm and a numb index finger although I'm pretty strong still. I'm sleeping well and get a lot of rest.  Thank you!

Answer
Joni,

While I appreciate that every case is different, I do wonder just how long you've been doing 4x/week and 3x/week.  For most people, a few weeks at this frequency is more than enough, and many can do well at 2x/week once acute symptoms abate.   Regardless of frequency, it is the duty of the doctor to periodically assess.   You should be filling out a pain-questionnaire and a daily-living-activity (ADL) questionnaire periodically (e.g. the Neck Disability Index questionnaire).   These provide data to better understand how you are doing and to aid in prescribing treatment.    If you continue with the need for 3x/week for more than a month, then something's wrong.  Either the treatment is really not working and you're getting better on your own, or the treatment is no better that it would be at once or twice per week, or the treatment is not as effective because it's missing some component, e.g. neck exercises or ergonomic changes. Or, you have good insurance and the doctor is making more money at 3x/week... Also, the doctor should offer home care strategies, e.g. home cervical traction, and also referral options, e.g. neurosurgeon consultation or MD-Phyiatry consult for epidural steroid injection (which can provide immediate, though often not permanent or long-term) relief.  I've seen patients with your condition find some relief with epidural steroid injection (ESI) and then continued chiropractic care, with the ESI making it so that the chiropractic care is more effective and the frequency can be greatly reduced.  You have to explore and discuss this with your providers.  

Hope this helps,

Dr. G