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Dear Dr. Leatherman

I had seen a sorsi chiropractor today. He has diagnosed with category II, pelvis misaligned from the rest of the body. He beleives that my pressure in the head is due to that. He also did a thorough evaluation and it showed that my neck is like a rock. Does this diagnosis make sense to you?
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Dear Dr. Leatherman

Which test ( MRI or ct-scan) would serve as a more reliable instrument to examine further my decreased disc space and the reason for my pain generating from the back of my head? I would like to come to a chiropractor with some information of what is happening with my neck. I know you mentioned in the previous messages that an MRI would reveal bulging discs, however what else would it reveal that would benefit me?  nerves?  muscle tension ???Thank you for your time, once again.

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Dear doctor Leatherman

I noticed on your website that you listed the things to look for in a good chiropractor. One of the chiropractors that you recommended in philly had the following on their website. Please let me know if the treatments that he listed will suit my condition. He seems to stress natural remedies. I am not sure if thats what I need. PLease advise me. Thank you
Diagnostics and treatement may include:

1. Exceptionally thorough & detailed physical examinations,
2. State of the Art flexibility and muscular strength testing,
3. Complete biomechanical analysis of your posture, vertebral alignment & spinal curves. This system of analysis tells us about your strengths and weaknesses and frequently identifies problems that have been overlooked by traditional medical methods.
4. In-house nerve function testing without the use of painful EMG needles.
5. Therapeutic massage with Yoga and Pilates inspired exercises integrated into pain relief and rehab programs.
6. Contact Reflex Analyis; A method of testing your bodies sytems via the bioenergetic fields. Ancient China & India have used similar methods of analysis for thousands of years.
7. Nutritional testing including a scientifically patented method that identifies your aging rate. Successful follow-up testing proves that your program is really working.
8. Edgar Cayce natural remedies may also be incorporated into your health programs.
9. Advanced methods for correcting abnormal curvatures of the spine as well as disc problems.



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I actually consulted with a chiropractor showing him my xray not to long ago.  However, he adjusted my neck a few times while I was laying down and that was the end of it. It sounds to me that the treatment that you were referring to earlier was a lot more theraputic. I have made an appt to see a sorsi doctor that I located on their site, who has nearly 700 hrs in this technique. I really hope he can help me. Also do you know of any good chiropractors in the philadelphia area?  I would come to Florida to visit your office, however it is too far :)

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Thank you once again for your professionalism and your expertise in the subject matter. So in this case, would you recommend me getting an MRI done to investigage further into my decreased disc space as well as pressure? Also you suggested seeing a chiropractor, what about a physical therapist for messages of the neck?
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I made a typing error when I said the pressure is in the forhead. What I meant to say is that the pressure is at the sides of my head by the temporal bone. So can pain at the back of my head, when my neck starts, be contributing to my pressure at the sides? Thank you

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Dear Dr Leatherman

Thank you once again for your kind response last week regarding pressure in the head. I cannot find the previous link so I decided to start a new one. I wanted to tell you that I had an x ray done on my cervical spine, and it showed little disc space in two places. Can that be contributing to my pressure in the forhead, near/around temporal bone and the headaches? ALso do you advice  for me to go to a sorsi certified chiropractor for this?
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Dear Maria,

Narrowing of the disk spaces is due to degeneration of the disk itself.  When this occurs, pain levels can be produced or heightened, but the area where the pain travels is not generally regarded to encompass the forehead. These decreases in disk space can account for associated pain levels and this is called referred pain or sclerotogenous pain. This referred pain usually encompasses the back of the head, neck and upper back with some projections into the shoulder and the arms.  However, decreased disk space complicates the movement of the joints in the neck by decreasing their distance from one another and this also can create increased referred pain.

Anatomical researchers Bogduk and Marsland (1,2,3) demonstrated that cervical facet joints (neck joints)could be the source of neck pain. Naturally, the significance to chiropractic physicians is great, although this news came as something less than a revelation.  They (4) injected the cervical facet joints of human volunteers with saline solution and dye and recorded their responses. They found that the upper cervical joints, C2-3, were associated with suboccipital headaches when injected (they did not inject C1-C2 joint or Occiput-C1 joint, but presumably these would have resulted in headaches as well). So, the implication is that yes there could be referred pain to the frontal portion of the head instead of the rear portion, but it is not a direct effect of the disk degeneration.

1) Barnsley L, Lord S, Wallis BJ, Bogduk N: The presence of chronic cervical zygapophysial joint pain after whiplash. Spine 20(1):20-26, 1995.
2) Bogduk N, Marsland A: The cervical zygapophyseal joints as a source of neck pain.  Spine 13(6):610-617, 1988.
3) Dwyer A, Aprill C, Bogduk N: Cervical zygapophyseal joint pain patterns I: a study in normal volunteers.  Spine 15(6):453-457, 1990.
4) Aprill C, Dwyer A, Bogduk N: Cervical zygapophyseal joint pain patterns II: a clinical evaluation.  Spine 15(6):458-461, 1990.

Anyway, chiropractic care is a great avenue for you to try in the attempt to alleviate your continued headache pain because of the fact that we utilize adjustments / manipulation of the spinal joints to activate neurological impulses for the reduction of pain as well as establishing improved movement at the joint space.  As far as the SORSI certified chiropractor goes, I am sure that they will be able to help you, but most chiropractors would be able to help you if the pain is being generated from the upper cervical and cranial junctions.  SORSI certification means that the chiropractor is certified in a technique called Sacral-occipital technique(SOT), which is similar but distinct from Cranio-Sacral therapy.  Most chiropractic students are exposed to it in their respective school programs, but certification would require ongoing study. just make sure that you are comfortable with the doctor you choose.

Good luck Maria.

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


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Dear Maria,

OH...yes temporal pain is much more in the realm of symptoms you would expect.  Radiation from the back to the sides behind the ear and just above the ear, is in the mapped pain patterns that have been validated through the research.

So, yeah, definitely contributory.

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

I would not recommend the MRI at this point without seeing the x-rays.  You see the degeneration could be from a longstanding problem that has just begun to get symptomatic, and an MRI is a very expensive test...$1200 to $2000 range.  It is much more cost effective to try an initial trial of conservative therapy before getting an MRI.  

Effective care has a high chance of reducing your symptomatology in 4-6 visits which will save you a bunch of money, and the MRI is only a diagnostic tool..it will only let you know if the disks are bulging into the spinal canal or the nerve roots.  That information alone may alter a conservative treatment plan, but not significantly.  If you take the x-rays to the chiropractor, and a thorough functional examination is performed to include orthopedic tests of the neck, the doctor will be able to determine if an MRI is clinically warranted or not, and you can actually start to rehab the problem.

Concerning a physical therapist, they are not likely to massage the neck, and they are not trained to analyze and evaluate x-rays or other diagnostic tests such as MRI's.  They are trained in rehabilative functional exercises.

A massage therapist may help the affected musculature, and would be a good addition to chiropractic care, but it will not address the disks or the facet joints which are the likely cause of the pain.  In addition you should probably be treated with some axial traction of the neck to reduce the spinal load under gravity to the disks.  

Other things to consider:  other degenerative areas of the spine, the structure of the curve of the spine, and your functional capacity such as pain free range of motion.  These issues should also be addressed in the examination process.  I recommend chiropractic care because your issues are the conditions we see and treat in our offices on a daily basis.  We are highly trained to be muscles experts in diagnosis and treatment.  Below is a link about a chiropractors training so you can become more familiar with our level of education and expertise.  I am also going to include one about disk injury and degeneration.

http://suncoasthealthcare.net/chiropracticinformation/chiropracticeducation.html

http://suncoasthealthcare.net/chiropracticinformation/discherniation.html

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




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Dear Maria,

I do not personally know any Chiropractic Physicians in the Philadelphia area, but I am going to list a few through trusted referral networks for you to consult with. These doctors have spent time attaining advanced training and certifications in programs that I know to be of high caliber.  Any of the doctors listed would be good choices.  

Remember to ask logical questions and expect logical answers, ask about their credentials and training, ask for a referral to a patient of theirs who would not mind talking to you about their treatment experiences.

Leonard Molczan, DC
Philadelphia , Pennsylvania
Phone: 215-928-9171

Michael Petroski, DC
1520 Sansom St.
Philadelphia , Pennsylvania
Phone: 215-564-4700
http://drmikeski.chiroweb.com

Duncan Catherine, DC, CCST
Phone:(215) 331-5954
[email protected]

Hannigan Maureen, DC, CCST
Phone:(215) 483-6948
Philadelphia, Pennsylvania  

Wahner Barry, DC, CCST
Philadelphia, Pennsylvania
Phone: (215) 842-2227
[email protected]

Stephen Ralston, DC
Philadelphia , Pennsylvania
Phone: 215-425-1110

Leonard Roberts, DC
Philadelphia, Pennsylvania
Phone: 215-487-2500

Best of luck to you Maria.
Respectfully,
Dr. J. Shawn Leatherman
www.suncoasthealthcare.net





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Dear Maria,

By definition chiropractic care is based in "natural" or "holistic" healing approaches.  All this means is that we do not employ the use of drugs or surgery with our patients, and if they need to be evaluated for those types of treatment protocols we refer them to the appropriate medical professionals in the community.

What the chiropractor has listed on his site all seems straight forward and logical as options for care.  They are options because different patients need different approaches, you cannot put all patients/problems into the same treatment regimes...therefore he just has lots of tools to implement if needed depending on your specific presentation.  Again, ask logical questions and expect logical answers.

We offer a wide range of techniques and services in our clinic as well, but we don't utilize every tool or technique with every patient.  The treatment id individualized toward the patient, the problems and expectations as well as the goals for outcome.

Concerning your specific complaints, the doctor will likely focus on the structure of the neck curve, your functional capacity and active range of motion, as well as a thorough examination process.  Only after that should other avenues such as nutrition be addressed.  Nerve testing if warranted is a valid tool, but many patients do not need these tests.  Again it is a case by case basis.

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

In your case the MRI would be more appropriate due to the fact that it is the gold standard for visualization of the disks, ligaments, and nerves around the spine.  It will also give information about the musculature such as atrophy or fatty infiltration due to deconditioning and misuse, but these are secondary issues and usually are only addressed when requested by the treating doctor.

A CT scan is more specific to conditions related to the skeletal structure, or to look for large lacerations to the organs and bleeding that may occur after trauma.  The CT is evolving as a great diagnostic tool and is now even used to visualize the coronary arteries around the heart with great detail, but in your case the MRI would be more appropriate.

Again Maria, I would get the examination before the MRI.  If you truly need the MRI, the chiropractor will order it.  We frequently order MRI scans on patients when warranted...the doctor will be more able to make an appropriate decision on what type to order. (T1 weighted image, T2 weighted image, contrast or no contrast, or possibly a high field MRI)  It depends on what needs to be visualized.

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

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Dear Maria,

Again I am not a Sorsi certified chiropractor and I do not choose to practice the sacro-occipital technique in my practice, but I am aware that SOT chiropractor tend to classify the pelvis in terms of categories such as I, II and III due to the relationship of the ilium(s) and the sacrum.  In theory this will cause disruptions to the cerebro-spinal fluid and the cranio-sacral rhythm of movement which also can affect the coverings of the brain called the meninges.  This would be the relationship that could possibly explain your headache symptoms, because the meninges attach from the skull all the way down the spine to the tail bone, therefore movement of the pelvis could affect the tension and create headache pain.

I would give the doctor 4-6 visits to see if he/she can make any appreciable changes in your symptoms.  If you do not see a reduction in frequency or intensity, I would suggest you find another chiropractor that will address the more relevant anatomy of the head and neck.

Good Luck Maria, I hope you gain the relief you seek.

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