Expert: J.R. Strecker, B.S., D.C. - 5/4/2008

Question
I went to chiropractor for mid back pain.  Now I have neck crepitus.  Every time I turn my head it has sounds of popping cracking,  Just terrible.  So I went to a Nucca doctor.  Now I have nausea.  Should I get an MRI.  What do you think I should do?  Thank you

Answer
Disclaimer: please do not take any of my advice without at least consulting with your doctor(s) first.  If necessary, print this email in its entirety for your doctor(s) to read.  In addition, please do not attempt to use this website or my advice as a substitute for your healthcare needs or as a substitute for the advice of your doctor.  There is no way a thorough health evaluation or assessment of any medical condition can be properly made via email.  Please only use the contents discussed as a guide or tool to address your health matters with your doctor(s).  If any of the information I provide conflicts in anyway with the information your doctor(s) provide, it is always best to default to the information provided by your consulting doctor(s) or to seek additional opinions from qualified, licensed healthcare providers as needed.

Hello C.,

Unfortunately I need to take your history and examine you before I can really determine what the best management is for you.  Keeping that in mind, here are some thoughts I have.

Crepitus can be caused by a variety of things.  It's impossible for me to know why your neck is making those sounds.  Even if I examined you, I still may not have a clear answer as to why you are having those sounds.  Crepitus is a funny thing like that.  There is a lot unknown about it, and it's not commonly the chief, or primary, complaint of a patient.  Usually the primary complaint revolves around pain.  BUT, crepitus is commonly an indication of degenerative joints -- not always, but more often than not.  Occasionally, when a new patient begins chiropractic care, it can "wake up" the joints a little bit.  And if you receive a few extra treatments (not necessarily the rest of your life) the crepitus can sometimes be eliminated and range of motion can increase to an amount greater than when you originally underwent care.  Again, this scenario I'm presenting is not set in stone and can have individual patient variations, so please do not substitute this advice as the advice of a doctor.

Nucca is a whole different ball game.  There are over 100 types of chiropractic technique, and nucca is just one of them.  The most commonly used techniques are Diversified, Gonstead, and SOT.  But even going to the same type of practitioner can vastly vary from one to the next.  So if you are now experiencing nausea from a NUCCA adjustment, it's difficult to know why.  There are several reasons why your body experiences nausea.  It can be stimulated from your central nervous system or your peripheral nervous system.  In other words, nausea is just a symptom, like running a fever.  Through an email, there is no way for me to know where the problem is coming from.  All that we know is it is not normal for you to feel nauseated.  You can talk to your chiropractors about your symptom.  If they can provide you with a scientific explanation (independent of chiropractic philosophy, ie-too many toxins in the body), then perhaps they will be suitable doctors for managing your nausea.  If they brush it aside and say it's a part of treatment, have your nausea "worked up" by a medical doctor.  You need to figure what is causing the nausea.  In other words, you need a diagnosis, which any knowledgeable chiropractor should be able to help you with.

As far as an MRI goes, I wouldn't jump that far ahead yet.  If you're having crepitus in the neck, I would evaluate your neck with an x-ray to get a bird's eye view of the degree of degeneration, if there is any at all.  However, it would also show on an MRI.  For the nausea, the problem may be identified by an MRI at the correct region, but if your nausea is stemming from migraines, then that is a "normal" associated symptom of migraines, and thus, an MRI is not warranted.  In other words, you need the proper workup by a doctor who can determine if an MRI is necessary or not.

I hope my answer makes sense.  And don't take anything I've mentioned as the be all, end all.  Rather, use this information to guide your management under the proper care of a licensed practitioner.  Unfortunately, this is the best I can provide by just an email.

Best of luck!
Dr. J.R. Strecker, D.C.