Question
I am being treated for long term spastic torticollis. I felt better after the first few adjustments, this week my neck muscles are jerking worse than ever. Also, my doctor has been adjusting my pelvis 3x a week and I now feel a strange and uncomfortable pressure in my pelvic area. Should I discontinue? I feel worse!

Answer
Louise,

Spasmodic torticollis, or cervical dystonia, is a complicated, chronic neurological disorder caused by a central nervous system dysfunction in the brain. The condition may be complicated by certain medications, and in particular, psychotropic drugs. In some manifestations of the disorder, the head turns and remains fixed to one side, backwards, or forwards. In other cases, the head shakes, and sometimes people afflicted with this disorder have a combination of both of those symptoms.

Treatments for spasmodic torticollis vary. Conservative options may include soft tissue and joint manipulation, muscle stimulation or ultrasound therapy, stretching, or acupuncture. Medical treatments may involve injections of Botulinum toxin ("Botox"), or as a last resort in the most severe cases, neurosurgery, which may involve a procedure called Selective Denervation (cutting the nerves that supply the muscles of the neck).

People will respond differently to treatment interventions, and while I do not have the benefit of understanding your complete medical history or your current clinical scenario, in general, some patients may respond with increased neck muscle contraction in response to manipulation or other interventions. However, if beyond several treatments these symptoms continue or worsen, the doctor or practitioner may need to discontinue that procedure, and modify treatment to incorporate a different modality.

I see no benefit in having your pelvis adjusted three times a week for torticollis, and if pelvic adjustments are producing pain, your doctor should modify the treatment approach. Chiropractic treatment might include pelvic blocking, in which soft wedges are strategically positioned under the hips while the patient lays prone on the adjusting table. Pelvic blocking helps to level the pelvis and support the spine, and the effects may be augmented if the doctor includes trigger point therapy to release the tension in contracted pelvic and spinal muscles by pressing on trigger points, a technique which is roughly equivalent to acupressure. The same method could be used on the cervical spine, without the need for thrusting adjustments/manipulations of the joints.

Pelvic drop technique may also be used, in which table pieces are cocked at tension, and released when a quick thrust is applied to the pelvis. Typically, this technique does not produce the "cracking" sound associated with thrusting manipulations of the joints. Pelvic drop techniques are designed to correct joint dysfunction and postural imbalanves without the use of much force.

The common-sense approach, and the bottom line answer to your question, is that if one modality or technique is not helping, the doctor should modify his or her approach to the patient's comfort and in order to obtain better results.

You might also consider seeing an acupuncturist or a massage therapist for additional co-treatment for this condition. It may be necessary to experiment to see which approach is the most effective for you. Not every patient responds the same way to the same modalities. Because spasmodic torticollis may sometimes resolve on its own, or in other cases, linger for long periods of time, it is difficult to know whether the most effective treatment you receive will be supportive for a chronic condition, or corrective. Time will tell.

I hope that this answer has been of some help to you.