Expert: Gerald Anzalone, D.C. - 7/20/2010

Question
I have been seeing a Chiropractor 3 days a week for 5 weeks. He told me that when he adjusts me my spine will let off acid and I need to drink lots of water to wash this out of my system. I am not a big drinker, I have been doing my best to drink as much fluids as I can but some days I don't do so well.And for the last week I have been having a headache in my left temple and sharp pains in the top of my head. And today when I saw him he said that I had trigger points on my back and he didn't have to search for them he found them quick. And when he pushed on them it hear but it made my headache go away for most the day. I would like to know if this acid that gets released could hurt me or cause me to have side affects? is that what is causing my headaches?

Answer
Donna,

Thank you for your question, which actually has several independent parts that I will attempt to answer for you.

First, there are many distinct and different types of headaches, each of which may have multiple causes. Chiropractors typically deal with headaches that are caused by structures in the head and neck.

Myofascial trigger points may certainly be one cause of headaches, or at least, a factor which may worsen headaches.

As you may know by now with your experiences, myofascial trigger points are extremely tender nodules found in taught bands of muscle; they typically produce pain which radiates away from the focal trigger point. Causes of trigger points are most commonly poor posture, stress, muscle overload, fatigue, or injury.

Secondly, it is a common misconception that trigger points (or vigorous exercise) produce lactic acid. Please refer to this article from the New York Times, which explains some of the common misperceptions about lactic acid, and its role in producing muscle energy:

http://www.nytimes.com/2006/05/16/health/nutrition/16run.html

Third, trigger points actually produce multiple pain-producing inflammatory chemicals. These inflammatory chemicals include bradykinin, prostaglandins, hydroxytryptamin/serotonin, protons, adenosine triphosphate, interleukins, and glutamate, all of which irritate nerve endings in the muscle tissue which carry sensations that are perceived as pain in the brain (Shah J, Gilliams E. Uncovering the biochemical milieu of myofascial trigger points using in vivo microdialysis: an application of muscle pain concepts to myofascial pain syndrome. Journal of Bodywork and Movement Therapies 2008; 12: 371-384).

Treating trigger points (most commonly by manual pressure techniques, or by injection) helps to disrupt the abnormal muscle tone and generation of painful inflammatory chemicals. Left untreated, trigger points can lead to chronic pain, neurological abnormalities, impaired muscle function, and fibrosis (the formation of abnormal connective tissue) (Yap EC. Myofascial pain - an overview. Ann Acad Med Singapore 2007; 36:43-8).

Hydrating after treatment (that is, drinking more water) is important, because it helps the body to rehydrate and flush these metabolic wastes from the body, similar to the need to take in fluids after exercise. People who do not rehydrate will often complain of deep aching, soreness, increased pain, and nausea after treatment. Water is best; beverages with caffeine, sugar, artificial sweeteners, and alcohol should be avoided (Manheim C. The myofascial release manual, 4th ed. Post-treatment protocols. 2008; SLACK, Inc. p. 36).

Finally, spinal manipulation does not release lactic acid. Some patients who may be more hypersensitive because of tissue changes due to their condition may experience soreness after spinal manipulation; rehydrating also helps to reduce this. In more severe cases, the patient may need to apply heat therapy prior to manipulation to help vasodilate tissue (increase blood flow), and ice after treatment to decrease inflammation.

I hope that this helps to answer your question.