Question
How long can a chiropractor perform adjustments on my back, if after a couple of these procedures I developed rib's dislocation on my back? For two months I haven't seen  any improvement with the pain along my shoulder blade, in fact, it's getting worse with his continuous adjustments.I went to see this doctor after a small car accident, in which I slid driving 15 mph and hit a curb. As a result, the front air-bag got deployed and hit my left arm. The doctor found out I had my thumb dislocated and he fixed it, but the next day he performed an adjustment on my back, which didn't hurt at the time of the accident, but did hurt the same night.After two days being out of breath and aching , I came back to the doctor. He suspected rib's dislocation and started 2-3 times a week adjustments... The rest you know. Please answer me as soon as possible, what could have possibly happened, and what treatment should I get? Thank you. Elly.

Answer
Hello E.,

I抦 sorry to hear about your traffic accident.  Sometimes it can take a little while before feeling comfortable behind the wheel again.  I think it抯 great you are looking for a chiropractor to take care of you after the accident, but I抦 a bit concerned about the status of your condition.  And as a side note, before I make any recommendations, please understand that this letter should in no way substitute as the advice of a doctor, as I am not able to evaluate you or take your history.  I always recommend printing my letter and going through it with your doctor.

To start, my biggest concern is your lack of improvement.  This is concerning.  The standard of care in chiropractic is to treat two weeks with a certain technique of chiropractic.  If there is no resolution of symptoms, especially if symptoms get worse, the doctor should then change their technique and try some different technique for another two weeks.  If there is still no improvement of symptoms, and again, especially if symptoms continue to get worse, it is time to refer the patient to another doctor or refer for further evaluation, such as an MRI.  I don抰 know your case well enough, so I can抰 say what the proper next step would be.  However, it is critical that you express to your doctor that you do not feel your symptoms are improving and that they might be getting worse.  If your doctor brushes off your complaints with a terrible excuse, such as, 搃t抯 just your body healing.. you have to get worse before you get better.? Then, I抎 say it抯 time to start shopping for another doctor.  The problem with auto accidents is that it has been corrupted by so many malingerers and shady, greedy doctors that even a decent doctor can dismiss the complaints of a patient in pain as just an attempt to justify unneeded treatment in order to make money off an accident that should never go to court in the first place.  I抦 not at all saying this is your situation, but there have been some major traffic accident scams by both doctors and patients alike in the personal injury industry that it has tainted this whole area of treatment, sometimes leaving patients that truly need treatment in the dark.  This is a very sad reality, unfortunately.  

If the accident was bad enough, it will take time to heal, but you should be feeling a little better after a couple months, even without treatment.  You may still have some pain that hasn抰 resolved.  That is different.  Injuries that are bad enough can stick with you for months or years or even a lifetime.  But like I said, the key phrase is to notice some improvement.  If you start to notice something a week or two after the accident, it may be secondary to your treatment or it may be from the accident still.  For example, one of the most common causes of arthritis is a major history of trauma 15-30 years prior.  So in other words, if you had a major whiplash in your 20s, it could be a situation that predisposes your neck to arthritis in your 40s.  Basically, if you were injured during that accident, there can be joint and muscle aches and pains that start to show up a week or even a month or even 6 months after the accident.  There is no way for me to know if it抯 coming from a chronic injury from the accident or from the doctor.  But patients are smart.  If your gut instinct tells you it抯 coming from your chiropractor, you抮e probably right.  Perhaps he/she is adjusting you very hard.  If the adjustments are extremely forceful, and you are receiving treatment 2-3 times per week, then maybe treatment is not spaced enough to let your body heal.  My approach is to adjust with as little force as possible to move the bone with about 1-2 times per week of treatment if the patient is in a lot of pain, but still, I rarely ever see patients this much.  Treatment of 2-3 times per week for two months might be a bit too much unless you have a gentle chiropractor.  I don抰 know.  Again, this is only speculation since I can抰 know enough about your situation to make a proper judgment call.  

Sometimes chiropractors have a tendency to overlook the muscular component.  If you are having pain in your shoulder blade, yes, rib adjustments can help, but I would at least get some work done on the muscle with either massage or trigger point.  If it抯 muscular work for a healing injury, you may not notice improvement unless you go to an experienced muscle therapist who knows what he/she is doing.

In my opinion, I can抰 see much reason to continue a 2-3 times-per-week treatment protocol into the second or especially the third month.  I think that抯 a bit much.  I would at least be backing you off to 1-2 times per week, if not less.  But there are also many chiropractors that make their patients come once a week for the rest of their life.  I抦 more of a once per month kind of guy if there is little pain.  But that抯 just me, and every chiropractor is different.  And because of that, I always stress to patients to please shop around if you are a bit concerned.  You may go to another chiropractor down the street just like this guy/gal, and then find a third chiropractor completely different, utilizing a different technique and protocol.  It is important for you to find a doctor you mesh well with.  Listen to your gut, because it will help you find a doctor that is mostly likely to help you heal the best.  Chiropractic is a hands-on profession, meaning it is unlikely for you to have the exact, same experience with every chiropractor out there.  It抯 a free world, so feel free to shop around.  If it sounds like a sales pitch on your first visit, then that抯 probably all it will ever be.  But if your doctor listens to you with an open ear and understands your concerns and tries to work with you on them, you are much more likely to have a positive experience.

Best of luck!!

Dr. J.R. Strecker, D.C