Question
QUESTION: Hello I'm a 41 year old male and for the pass year now I have experienced spasms and twitches in my legs (thigh and around the knee, left side), arms, shoulders and face (cheeks, lips and eye lids).  My family Doctor is a DO and he seems to think it has something to do with my spine.  I suffer from lower back pain and neck pain. At times my legs will ache down the back side (mainly my right leg) which my doctor thinks it is sciatic.  I also suffer from Hypothyroidism which I take synthyroid for. My Doctor has also stated that people who are Hypo get these symptoms also. My doctor has checked all my electrolytes and all came back normal. However he did state my B12 was at the low end of the normal range and he suggested B12 shots.  He states that being hypo can cause this also. My question is because I worry so much about these twitches/spasms could this actually stem from my spine and should I see a Chiropractor.  I have been told that a stiff neck and neck pain can cause the twitches in my face. My doctor has also been adjusting my spine about every 4 weeks.  Please advice and thank you for listening.
ANSWER: Dear Al,

Well, a chiropractic physician may be able to better diagnose the functional and structural problems associated with your spinal symptoms than your DO due to the amount of specialized training we go through in school.  The DO program has very little emphasis on manipulation and musculoskeletal issues and is more geared toward the traditional Medical school.  As a matter of fact less than 5% of all DO's even adjust the spine.

Now, I also have to tell you that the fact that you have low B12 is significant because B12 is a major nutrient used for proper nervous system functioning and the lack of it could easily contribute to your symptoms. You don't necessarily need injections though.

You need to be tested to see if you are deficient in a stomach chemical called intrinsic factor.  This is responsible for processing the B12 that you intake through your diet and allowing your body to utilize it effectively.  If you are deficient, then you can do B12 injections or B12 sublingual (dissolved under the tongue).  the sublingual dissolved and gets right into the blood system without ever getting into the stomach.

Lastly, do you have x-rays of your spine?  You need to if you are being adjusted...who knows what is going on in there unless you are able to see it.  If you are having neurological symptoms such as described, I would not personally be adjusting your spine without them...and they need to be taken standing up not laying down.

Anyway Al, hope this help you out a bit.  If you need to follow-up, feel free to do so.

Respectfully,
Dr. J. Shawn Leatherman
www.suncoasthealthcare.net



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

QUESTION: Dr. Leatherman, thank you for replying.  I do have x-rays which show possible bone spurs in my L4, L5 region.  My doctor thinks this might be the cause.  I have started going to a chiropractor who also took x-rays.  She said that my spine in my lower region seems to indicate some compression and in my neck area the structure show my neck to be almost strait.  She started some adjustments and I have noticed that it increased my spasms.  Dr. Pope (chiropractor) said that this is because my body isn't used to being properly aligned.  The military VA also stated that I have degenerative arthritis of the thoracolumbar spine.  You thoughts.

Answer
Dear Al,

Anytime you have degenerative changes in the spine problems are likely to start.  The degeneration itself does not necessarily mean that you will have a problem or symptoms though...it all depends on the amount of degeneration, how long it has been a factor, and if it is progressive.

I am not sure why your x-rays show "possible" bone spurs, either you have bones spurs, or you don't!  There is no maybe or possible.  Bone spurs are large focal areas of degeneration that stick out from the vertebral bodies and can push into the neuroforamen of the vertebra (holes in which the nerves exit the spine).  If the nerves become compressed due to actual bony encroachment, or just inflamed due to lack of motion which creates latent inflammation, then symptoms that go down the legs can easily occur.

Now concerning the spasms increasing after the adjustments, yes this can happen, but it doesn't have anything to do with the spine being aligned.  This is a big misconception with chiropractic care, and unfortunately is perpetuated by chiropractors themselves who do not correctly explain what is happening to the patient.

When you get a spinal adjustment, the chiropractor is not aligning your spine.  We are removing the fixated segment(s) to allow for increased and proper motion at the joints called the facets.  This normalizes pressure in the joint capsule and allows gas to escape from the joint space, while firing specialized neurological receptors that send signals to the spinal cord and brain.  

When normal movement is established, pain levels will decrease, muscle spasms should lessen, and degeneration is less likely to progress.  The degeneration you currently have can improve, but research has shown the improvements will be minimal at best.  Moreover, if you has arthritic changes in the thoracolumbar and lumbar areas, then it is likely that you also have degenerative disk disease as well which means that the disk gets thinner and more brittle as its water content is reduced.  This further compounds the problem by narrowing the space in the neuroforamen.  There is a special technique called flexion/distraction that can significantly help disk generated pain and inflammation with the use of a special table.  It is called flexion/distraction, and helps to pump fluid into the disk space.  Check out the below website for more information:

www.coxtechnic.com

Concerning the curve loss in your neck, this can cause additional problems due to the fact that it places increased stress on the spinal cord and nerve roots.  Here are a few quotes for you to appreciate:

揊or every inch of forward head posture, it can increase the weight of the head on the spine by an additional 10 pounds.?Kapandji, Physiology of Joints, Vol 3.

揕oss of the cervical curve stretches the spinal cord 5-7 cm and causes Disease.? Dr. Alf Breig, Neurosurgeon (Nobel Prize Recipient)

揊orward head posture leads to long term muscle strain, disc herniations, arthritis and pinched nerves.? The Mayo Clinic, Nov. 3rd, 2000

?0% of the stimulation and nutrition to the brain is generated by the movement of the spine?Dr. Roger Sperry, (Nobel Prize Recipient for Brain Research)

Additionally, Dr. Sperry demonstrated that 90% of the energy output of the brain is used in relating the physical body to gravity.  Only 10% has to do with thinking, metabolism, and healing, so when you have forward head posture your brain will rob energy from your thinking, metabolism, and immune function to deal with abnormal gravity/posture relationships and processing.

Chiropractic adjustments will not restore this curve, but the addition of specific exercise along with the adjustment and directional traction protocols, the curve can be re-established.  This is a program that requires commitment to make the change, and is comprehensive.  For more information on how this is accomplished please refer to this website:   

www.ideaslpsine.com

I think you should continue with the adjustments to the low back, but I believe that you also need to have some myofascial release/deep tissue massage techniques along with stretching and stability exercises added to your treatment protocols.  Chiropractic care is a great tool, but your muscular system probably needs to be addressed directly to eliminate these spasms.  You should discuss these options with your chiropractor and she should be able to refer you to someone outside the office if she doesn't have the training or staff to address these issues effectively.  Check out these websites for more information:

www.grastontechnique.com
www.activerelease.com

Al, you should expect to see results from treatment within 6-8 visits.  If you are not getting improvements, then you and the doctor need to discuss changes in your treatment or a referral to another doctor.

Respectfully,
Dr. J. Shawn Leatherman
www.suncoasthealthcare.net