Expert: Scott F. Gillman, DC, DACBSP - 5/18/2010

Question
QUESTION: Dr. Gillman,

I have never been to a chiropractor so I am somewhat leary and want to do my research. I've never had neck problems in the past, but for an extended period of time now, probably at least 6 months, my neck has felt extremely stiff and sore. My head also feels very heavy and I occasionally feel pressure in my head at the base of my skull. Sometimes I feel like it radiates all the way through the front of my skull and comes out my nose, almost like sinus pressure. I feel like my head has a tendency to want to tip forward and when I let it, it normally clicks, I wouldn't classify it as a large cracking sound. I also have an overwhelming urge to tip my head back and up. I don't know if this is my body attempting to stretch or realign my neck.

Over the past couple years I've occasionally had what I call "episodes". During these episodes I normally will experience visual defects, not my vision going black, but more like a tv with no signal, and it's normally just a spot in my left eye. I have also experienced tingling or numbness in my left lower arm/hand and my left leg feels heavy. I have recently started experiencing nausea also with the last two and they always vary in the degree of severity. I assimilated this with a stroke and have visited the ER, where they could not find anything wrong with me. They drew blood, ran a battery of tests, I had a CT of my head and they found no masses or evidence of stroke or blockage, no high blood pressure. There was no dye during the CT scan though.

I have determined that if I have pressure applied to the back of my neck for an extended period of time, or have my head turned to the left or in a certain position for an extended period of time these symptoms will start to present.

Could I be suffering from a vertebral artery compression from misalignment? My hesitance in seeing a chiropractor now is related to vertebral artery dissection or some other sort of vascular neck complication related to neck manipulation.

Any insight you can provide in regards to this phenomenon or my condition would be graciously appreciated.

Best Regards,

Andy

ANSWER: Andy,

The research is now conclusive that your chances of having a stroke are the same whether you see a chiropractor or medical doctor.   If you have an artery dissection in your neck that has gone undetected, then it is likely to get worse regardless of what you do.  The data seems to indicate that in stroke cases where chiropractic joint manipulation was performed, the patients were already in the midst of dissection and the manipulation simply furthered it along.   There have been cases of manipulation by MD's and PT's that have gone the same route.  Frankly, you don't want to have anyone doing neck joint manipulation except for those with exceptional training, and nobody has more training than the DC.  You very likely have spinal joint dysfunction and an accumulation of myofascial soft tissue lesions.  I'm guessing, based on what you told me, that you are a bit older, like in your 50's or so, and also have some degenerative joints.  A doppler ultrasound of your neck arteries will clearly show if you have a dissecting aneurysm.   If not, then go the the doctors that fix neck problems routinely: chiropractors.  Find someone that has good training in soft tissue mobilization.  Odds are, someone from this list will fit the bill:  www.acbsp.com

Best regards,

Dr. G

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

QUESTION: Thanks Dr.G,

My neck seems to have been getting worse, despite my meager attempts at home care; moist heat, sleeping on a contoured pillow, careful of straining and excessive mobility.

I am not older, depending on your opinion of old I suppose. I am just about to turn 34 and have never had any neck issues in my life. Although I do tend to get bouts of upper back pain, which is relieved by a step to the back which usually elicits a nice crack and much needed relief. I'm sure you'll yell at me for that, but we all do what we have to in this economy, right?

I would gladly visit a chiropractor now for my neck manipulation if I was sure that I did not have a dissecting vertebral artery or possibly a VBI, vertebral basilar insufficiency. The testing for both seem quite extensive and in depth and I currently lack any sort of medical insurance, back to the economy and cost of living, etc.

Thank you again for your information and insight. Are there any chiropractors you could recommend in my area. I'm in Michigan, 48451 is my zip code.

Thanks again!

Answer
Andy,

The odds of you having a dissecting aneurysm is like the odds of you winning megabucks.  I would suggest that you get over your fears and see the chiropractor.   They will assess you and determine if you are safe to treat.   Go to www.westhartfordgroup.com or www.acbsp.com and/or www.grastontechnique.com to find a provider.   You'll be in good hands with folks on Westhartfordgroup, and surely with any DACBSP on the ACBSP list.   You may also do very well with Grastontechnique if you have soft tissue lesions (which likely you do).  

'Best,

Dr. G