Question
QUESTION: Dear Dr. Gillman:

Is it possible chiropractic manipulation of the lower spinal area can cause protruding disk problem?  "Side Posture" adjustments?

ANSWER: Maria,

It was once thought that side posture joint manipulation put a lot of force on the discs but research on this proved it wrong.  While it is possible for any manual therapy to irritate a disc or other spine structure, including side posture joint manipulation, carefully performed chiropractic side posture joint manipulation causing is not likely to cause a protrusion.  Conversely, some people with disc protrusions find relief with side posture joint manipulation.  Some practitioners that espouse "low force" techniques, like the "Activator" tool, promote their methods by falsly stating that other manual methods are dangerous.  This is wrong.  

I hope this answers your question.

'Regards,

Dr. G'

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

QUESTION: Dear Dr. Gillman:

Thank you so much for your response, very helpful, see below for follow up question/explanation/give recommendation and advice please.  Very concerned.

started, 2X week for couple months for sciatic nerve.  (wednesdays and saturdays)  (chiro - alignments including side posture).  Side posture I found very harsh, not to mention - with the kind of "crack" or "pop" and I seemed to be very sensative to it.

Not enough response in that amount of time, for sciatic nerve problem.

Went to 3X week.  (Mons, weds, sats).

But, when went to 3X week, that's when side posture started hurting.  Each and every time, starting with the first week when started at 3X week, starting with the wednesday visit of the first week --  -- right after the manipulation (side posture), sacrum area would start hurting.  It would hurt real bad, and to relieve it, I had to apply ice, and heat (heating pad), take anti-inflammatory/anti-pain and muscle relax pills and/or herbal remedies, and an herbal massage gel (Arnica/Vitamin K) for swelling, bruising, pain, stiffness - with my electric massager. It would take about a whole day and a half to two days to heal (and/or for the pain to stop) to where it started feeling good or normal again.  Then, as soon as I got side posture on my next visit, the whole process would start over again, each time, each visit, with the same kind of pain, and my having to go home and do all these remedies to relieve it.

That went on for a month to a month and a half.

What they told me during that month to month & a half...was that you have to keep doing the alignment or you won't get better with your sciatic nerve problem.  You're going to feel some pain in the sacrum area because your muscles and nerves in that area are not use to being in alignment.  That will all go away once your muscles and nerves get trained into being in alignment, and so you're going to have some bruising for a while, and inflammation. .... in spite of the fact that I told them of such harsh pain, and did not think such harsh type of alignment was good for me, that everyone's different, I happen to be very sensative, find another method of alignment, more gently, etc.  And also telling them that I was afraid it could be making problems with my back, and that I didn't have any kinds of these problems or pain in that area (sacrum <lower spine>) when I came there, and only had the sciatic nerve area condition (pain from lower right side of back, running down through middle of buttox cheek, down back of thigh of leg).  And that either 3X a week may be too much for me, or too harsh (high velocity???) method alignment used.  They told me that standardly the body responds to 3X per week with any kind of physical therapy, and that two times per week is why my sciatic nerve condition wasn't improving as fast as it should.

Then when I was not making too much progress, they said they suspected protruding disk and sent me for MRI.  At that time, they said side posture alignment can make protruding disk problem worse.  In the mean time, and/or until the MRI results came in, they did Activator, and some type of hand motion alignment where all they did was put their hands on my spine and do a sort of stretching twisting motion with their hands, and they said it aligned me with these less harsh methods used.  Results of MRI, I was told "slight" protruding disk.  They talked about options with me, traction, steroid type shot, and told me that chiropractic alignment was one of the things that actually helped protruding disk.  At this time, we did traction, and since the traction, I have not stopped hurting in the sacrum area for two weeks now, despite my home therapies explained above.  That was my last appointment with them, two weeks ago, as family medical care for my dad came up, so I had to stop care for myself as far as doctor appointments for my back at this time.  To resume when my dad is stable, etc.

They did take x-rays before any manipulation.  And along with alignments, of course, electronic pulse muscle stim/stem massage, and sort of deep tissue massage, and stretching exercises had been being done.  They stopped the exercises when suspicion of protruding disk.

I do not think chiro appointments (manipulations/adjustments/alignments) whatever you want to call them, should have been resulting in this kind of pain.  I'm concerned about only how to fix the problem, so that I can resume my normal active life.  Not interested in any legal action; just want to fix my body.  What kind of medical care do you recommend?  I've gotten a good recommendation to a neurologist for steroid type shot for this condition, and that once you take the inflammation out of the back, the back will generally heal itself.  What is your opinion on that too.  Please help with info on kind of care I should consult to fix the problem.

Maria, thanking you in advance, reaching out.

Answer
Maria,

First: there's no reason to experience such negative side effects of joint manipulation for such a long time.  There are other options and styles of manipulation.  If you have not obtained relief with a month of 3x/week treatment, then odds are you are not ever going to get relief with whatever that doctor was doing.  Either find a new chiropractor that uses a different set of manual methods (which I would have suggested after a month with no positive effects), or seek other types of medical care.  An epidural steroid injection, often performed by physiatrists or other types of MD's, can provide short term relief of back pain.  I would caution you on stretching, and consider focusing on back strengthening.  See the text book on back pain by Stuart McGill, PhD. (or advise your DC to get it).   In summary, find a new DC and consider a second opinion by the MD that will perform the steroid injection.  That MD should be able to work hand-in-hand with the DC.  

'Good luck.

Dr. G