Expert: Dr. Victor Dolan, DC, DACBSP - 6/12/2008

Question
I have been treated twice now for chest pain and tingling in my left arm/neck/shoulder and hand by a physical therapist.  Each time he tells me the muscles are causing my nerves to be compressed and each time he was able to relieve them so the tingling went away.  But now it is back in both arms and I tried a DC in town Robert L Graham who thinks he can fix it. I have never been to a Chiropractor before and am scared about the safety of it.  My PCP has a mri scheduled to check for a pinched nerve. Should I wait on the Chiropractor until the MRI is done? It gets the worst when I lay down, spreading into the left side of my face and my neck and the base of my skull. The DC thinks it comes back because the alignment is off and continues to cause muscle spasms and contractions. But I am really scared of back 'cracking,' causing paralysis or stroke.

Thanks,
concerned patient

Answer
Numbness, Tingling, arm/neck/shoulder pain/numbness, chest pain, muscles compressing nerves,  MRI,  pinched nerve, Doctor of Chiropractic.

Hello Tim,  

Sorry to hear of your numbness ,  tingling , pain , condition.
I am glad that two treatment regimens with the physical therapist were able to even temporarily remiss your complaints.   How many treatments did you have to see the Physical Therapist (PT) for ?, A few weeks, several weeks each time?,  How long did the problems stay away?  What seems to have initially caused the problem- car accident, slip, trip, fall, sleeping wrong, bad posture habits, bad movement patterns ? - You say you are afraid of back cracking, man, so am I, so am I.

You also mention chest pain along with the symptoms in your left arm is chest pain.  Since you are going to a physical therapist, I assume you were first cleared by a medical doctor who gave you the prescription for the PT and evaluated you for any cardiac involvement.
Cardiac involvement cleared, we move into the neurological ( pinched nerve ) arena.

In most states  you must see a Doctor before going to a physical therapist, pharmacist, or be treated by a nurse.  Since you have seen the PT, I assume your Doctor must be an MD, has cleared you of cardiac concerns, and determined you have a 'pinched nerve'.  The MD realized that chemical medication would probably be less efficient and more problematical at treating your condition than physical medicine.  The Physical medicine approach, to your MD, meant referral to a Physical Therapist.  The physical therapist probably massaged you, heated you, electrical muscle stimulated you, ultrasounded, stretched and exercised you.  All helped temporarily to calm the irritated pinched nerve.

On to the Doctor of Chiropractic.  Your local family 'pinched nerve' specialist, the Doctor of Chiropractic is an excellent choice at any point in a condition such as this.  Many patients with your complaints would start with the Doctor of Chiropractic.  The Doctor would take a history, examine, probably Xray, probably MRI the patient.  Depending upon the results of physical examination, subjective history and subjective complaints, objective findings, Xray and MRI review, the Doctor of Chiropractic has many treatment approaches at his(her) finger tips (pun intended).

You say you have been forwarded by your PCP MD for an MRI, make sure you get the MRI films so that your Doctor of Chiropractic, the spine specialist, can read the films.  After viewing the MRI, your doctor can then decide the best, safest, most efficient chiropractic treatment approach.

You state you are hesitant about 'cracking', so am I.  Unfortunately many different professions are starting to 'crack' the spine.  Spinal manipulation is being utilized by Physical Therapists, Medical Doctors, even massage therapists.  Years ago ONLY Doctors of Chiropractic adjusted the spinal column.  After four years of college, and four years of professional chiropractic school; adjusting the spine was second nature to the Doctor of Chiropractic (DC).  Chiropractors know IF, when, how, what to adjust- and that includes knowing when NOT to adjust, how NOT to adjust, how to do what is best for that patient at that time.  Chiropractic Adjustment has proven so safe and effective, that other professions, with less education and experience in spinal adjustment have begun to manipulate the spine.  In my opinion this is not advisable.  The Doctor of Chiropractic is the expert in spinal adjustment, years of training, continuing education and daily evaluation of pinched nerves and conservative management gives the DC the 'edge' in spinal adjustment.

Safety is proven through a comparison of malpractice insurance rates. Doctors of Chiropractic pay hundreds to thousands of dollars for malpractice.  Doctors of medicine pay thousands of dollars to hundreds of thousands of dollars for their malpractice insurance.

The Medical Doctor pays many times more the malpractice insurance of the Chiropractic Doctor.  

So when it comes to treatment, especially of 'pinched nerves', especially with potential manipulative approaches; I would NOT have anyone 'crack' my neck.  IF I had a pinched nerve and I was looking for a safe, effective, cost-effective approach; if I was looking for a spine specialist, looking for a manipulation expert who may/may not precisely ADJUST the spine, I would attend my local family Doctor of Chiropractic.

This is an explanation of 'pinched nerve' I utilize as part of my Staten Island Chiropractic Office procedure:

++++++++++
“Pinched  Nerve”   ( Also Known As-  neuritis, neuralgia, brachial-neuritis )

Sometimes  we  can  wake  up  with  a  ‘pinched nerve’,  or  a  muscle spasm.... sometimes a slip, trip, fall, heavy lift, or even a motor vehicle accident can cause a ‘pinched nerve’.  Ultimately-  the true    c a u s e   of  the pinched nerve, pain in the neck and/ or  shoulder  and/ or  arm  and/ or  hand;    is a misalignment,  a  ‘kink’ in the neck- more properly termed a Vertebral Subluxation.
              Vertebral   Subluxation   Complex    (a.k.a.  ‘subluxation’)
The vertebral subluxation complex is the underlying cause of many healthcare problems.
A subluxation interferes with the proper functioning of the nervous system (the master system which controls and coordinates all function within the body) and may cause various other conditions, symptoms and problems.
This is a serious condition identified by its five parts:
      Spinal Kinesiopathology:
         This is fancy way of saying the bones of the spine have lost their normal motion and position. It restricts your ability to turn and bend. It sets in motion the other four components.
      Neuropathophysiology:
         Improper spinal function can choke, stretch, or irritate delicate nerve tissue. The resulting nerve system dysfunction can cause symptoms elsewhere in the body.
      Myopathology:
          Muscles supporting the spine can weaken, atrophy, or become tight and go into spasm. The resulting scar tissue changes muscle tone, requiring repeated spinal adjustments.
      Histopathology:
         A rise in temperature from an increase in blood and lymph supplies result in swelling and inflammation. Discs can bulge, herniate, tear, or degenerate. Other soft tissues may suffer permanent damage.
      Pathophysiology:
         The VSC contributes to OsteoArthritic degeneration.  Bone spurs and other abnormal bony growths attempt to fuse malfunctioning spinal joints. This spinal decay, scar tissue, and long-term nerve dysfunction can cause other systems of the body to malfunction.

The Vertebral Subluxation Complex describes what happens when spinal bones lose their normal movement patterns and position.
         Automobile accidents, improper lifting, improper posture, alcohol, emotional stress, chemical imbalances, and long periods of sitting can cause the Vertebral Subluxation Complex.
          Vertebral  Subluxation  cannot be corrected through chemicals (medicine), stretching, yoga, vitamins or physical therapy alone.  Subluxation- a neuro/skeletal/muscular- mechanical- problem requires a mechanical correction-  -  -    a manipulation,     best performed with the chiropractic adjustment.  For good health- Treat the   Cause,  not just the Symptoms.
+++++++++


I agree with your concern about safety, in a landmark article by authors::  Gary Null, PhD; Carolyn Dean MD, ND; Martin Feldman, MD; Debora Rasio, MD; and Dorothy Smith, PhD :: They state the following:

"..... is that the total number of deaths caused by conventional medicine is an astounding 783,936 per year. It is now evident that the American medical system is the leading cause of death and injury in the US. (By contrast, the number of deaths attributable to heart disease in 2001 was 699,697, while the number of deaths attributable to cancer was 553,251.5)
We placed this article on our website to memorialize the failure of the American medical system. By exposing these gruesome statistics in painstaking detail, we provide a basis for competent and compassionate medical professionals to recognize the inadequacies of today’s system ....."

Table 1: Estimated Annual Mortality and Economic Cost of Medical Intervention
    Condition       Deaths      Cost              Author
Adverse Drug Reactions    106,000   $12 billion   Lazarou(1), Suh (49)
Medical error    98,000         $2 billion   IOM(6)
Bedsores    115,000        $55 billion      Xakellis(7), Barczak (8)
Infection    88,000       $5 billion         Weinstein(9), MMWR (10)
Malnutrition    108,800       -----------        Nurses Coalition(11)
Outpatients    199,000      $77 billion     Starfield(12),Weingart(112)
Unnecessary Procedures    37,136    $122 billion     HCUP(3,13)
Surgery-Related    32,000   $9 billion   AHRQ(85)
Total         783,936 deaths     $282 billion

(Null et al,  "Death by Medicine")   


The above statistics show why medicine has a higher malpractice insurance cost than chiropractic.  

In thirty years in chiropractic I have not read of a Doctor of Chiropractic utilizing Chiropractic techniques causing death, paralysis, stroke.  I have read of manipulation causing injury, but not by DCs, as reflected by malpractice costs.

So, in summary Concerned Patient, I agree with you and your skeptical analytical approach.  Know the facts. Ask the questions.  Look for a safe, effective, cost effective answer to your complaints.  At any time in this process a visit to the local family Doctor of Chiropractic is advisable.  Perhaps safe, effective, cost effective, non invasive, conservative chiropractic approaches can be of help to you.  Communicate to your Doctor of Chiropractic your concerns, bring the Doctor your MRI and any other health information you have for the Doctor to digest and help make DX, TX, PX decisions upon.

This Staten Island Chiropractor wishes you good luck, a safe, effective, cost effective, long lasting answer to your pain, and of course; Good Health Naturally !

Dr. Victor Dolan, DC
http://www.DocDolan.net
http://www.GoodHealthNaturally.info
http://drvictordolan.chiroweb.com   (email newsletter)