Question
QUESTION: Dr. Gillman,

I read your very helpful responses to the other participants.  So, I too have a reverse curve (not straight but reverse) and my chiro was trying to get me to start with their physical therapist.  I have had constant headaches for 7 years (9 ibuporofen a day) and do a lot of computer work...my acupuncturist gave me some exercises to try before starting with a PT.  Do you have any other suggestions?

Thanks so much!

ANSWER: Becky,

Why would your chiropractor want you to first start with PT?  My suggestion is to have it all done at the same time.  The only research on neck curve improvment involves very aggressive traction in an extended position, and I'm still not sold on its benefits.  I'd prefer that the acupuncturist stick to acupuncture, and that the PT show you some exercises - likely would be scapular stabilization and paraspinal extension exercises - and that the chiropractor perform what chiro's do best, spinal joint manipulation.  Do not waste your time with ice/heat or electric stimulation (waste of your time and dollars, except maybe to apply heat before of after a lot of manual treatment help you relax).  In my opinion, you would be missing out if the DC failed to perform active myofascial release methods or Graston Technique along with the joint manipulation.   If you had a previous head trauma, and you are still fairly young, and if your headaches do not improve within a few weeks of treatment, then ask your DC to ponder the possibility of segmental instability.  This would involve "Stress films": x-rays of your neck in full flexion and full extension to determine if the bones are being held together by the ligaments.  I am also assuming that you had a general physical work-up to rule out other causes of headache, e.g. metabolic conditions, vascular problems, etc.   Your DC or PCP should be on top of this...  

Hope this was helpful,

Dr. G



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

QUESTION: Thank you Dr. G!

That was very helpful.  

Yes, we have ruled out everything from allergies to tumors.  Really, the DC was my last hope.  He did find that I was hyper mobile (If that's what you meant by Stress films.)  I bent my head forward, backward, etc...he was just a little unclear as to what was done and what was found.

 It was after 6pm on a Friday night and the waiting room was still full.  Very popular DC with a 'gym' in the center for PT.  They also have PT's and GP's in the office, so the GP can refer patients to PT's for insurance purposes.  I have to admit, it seemed like a "business".
I'll tell you what I know:
He wants to perform adjustments while the PT does traction and I'm hyper-mobile.

With the other folks writing in with awful prognosis, what is your medical opinion for this 28 year old.

Regards,

B


Answer
Becky,

Some folks are hypermobile, as in limber or loose jointed.  Unstable is different.  You can be loose jointed while your bones remain connected by ligaments and, thus, held in place at the end ranges of your movement.   Unstable is when you have a bone that is not well-tethered to the next by the ligaments.  It is where your bone will slide off of the next at the end of your range of motion or when the joints are stressed or loaded with weight.  You can have a very stiff spine but with one segment that slides around: an unstable segment.  You can also be limber or loose jointed (e.g. young gymnasts), and, too, have a bone that is not held in place by the ligaments.   Motion or stress xrays help determine this scenario in necks and lower backs.   My opinion is this: use your gut!  If you get a funny feeling that you are a number in a patient treatment mill, then split and find someone else to work with.  Also, I would ask very specific questions and demand specific, reasonable answers about your treatment.  Why traction?  What is tight that needs tractioning?  What kind of traction?  Static, intermittent, by hand, with a head harness?  Does traction even help headaches?  Is there any instability in the neck, or are you just very limber (hypermobile)?  Are there any signs of myofascia or muscular irritation, and if so what methods are going to be used to address it? Do you have one or more vertebral segments that are dysfunctioning, fixating, or otherwise out of whack, and if so why isn't the chiropractor adjusting them first, before any PT?  Is there a chance you have true nerve irritation from your upper neck that would require a direct injection to quiet down? [This would require a consultation with an MD physiatrist]  Becky, a well versed chiropractor can address all of these issues, provide the skilled joint manipulation, the soft tissue treatment, assist in exercises, and discuss whether you would benefit from a consultation with a physiatrist.   

I hope this helps.

Dr. G

www.drgillman.com