RE: another annoying chiropractic question

[Guest guest]

Joyous one.

Sounds to me perhaps like a mechanically-generated pain generated at the facet. Could be hyper-mobility between two facets , perhaps due to overstretched or permanently dysfunctional capsule. But could also be fibrous grizzly tissue moving over any number of intricate osseous prominances...this can generate a remarkably loud noise at times.

Figuring out exactly what effect the chiro had in this is difficult at best. But if she was giving the doc feedback regarding the vigor of the adjustments then the doc should practice the art of chiropractic and alter the approach so that there is harmony during and after the adjustment. Better to do too little then too much.

Worst case scenario?: doctor caused hypermobility by repeatedly overstretching capsular ligaments. best-case scenario?: doctor has done her a great service and dramatically improved her previously heavily-fibrotic, hypo-mobile intersegmental biomechanics and her body is in remodeling stages and needs your gentle guidance as the spinal biomechanics continue to seek long-term stability over the coming months.

Cheerio.

J. , DC

Springbrook Chiropractic

& Natural Health Center

1015 N. Springbrook Rd.

Newberg, OR 97132

503-538-0618

www.springbrookclinic.com

www.HealthyNewberg.com

SANITAS INNATUS EST

[Guest guest]

Get flexion and extension lateral cervical views and check for ligament instability. ( stair step effect). AMA Guide for impairment can help you if you are not familiar with doing the measurements. Ligament instability can cause apparent movement leading to a popping sound.

Carl Bonofiglio

-- another annoying chiropractic question

Yesterday I was a patient for the first time.

Her chief complaint was loud popping in her next with rotation.

The sound was so loud that it was actually quite surprising to me.

The neck popping started when she visited a new chiropractor four about

4 months ending in March.She said that she felt that the doctor was too

forceful with neck adjustments

and also encouraged her to stick to a schedule of frequent appointments

which she did not feel comfortable with.

She denied having any neck popping before this occured. Se stated she

did not remember any particular incident where she felt that her neck

had been injured or in pain after the visit to the previous

chiropractor, but she just stated that she felt that the adjustments

were too rough.

WHen she asked the previous chiropractor about the sound he said that

they would go away. She waited but they did not go away.

She preformed extension exercises which the doctor suggested.

When I palpate her neck I can feel a joint which feels like it has too

much movement and with rotation there is a definite clunking sound.

This patient had one previous mva where she rear ended the car in

front. She was turned to the right to restrain a child during the

impact.

She was treated for upper cervical tension by a chiropractor at the

time. She does not feel like she ever fully recovered from the injury.

Are there any definitive ways to diagnose what caused the clunking?

What can I best understand ( I am ordering previous chart notes and

films to get started) why loud popping sounds are coming from her

cervical spine

every time she turns her head?

Lilijoy Rothstein,D.C.

2525 NW Lovejoy Suite 404

Portland, Oregon 97210

(503)294-1235

www.yogacarenw.com

[Guest guest]

sounds like probable lax ligaments, iatrogenic,(chirogenic)

you sound like you know what is going on, and what is the probable cause.

I would send her to a prolotherapy doc, to inject the joint with glucose

solution, to tighten up the offending joints,

I know good prolo docs, Carl Osborne, and hefsky, in so oregon,

don't know any in portland area.

Marc Heller, DC

mheller@...

www.DrMarcHeller.com

another annoying chiropractic question

Yesterday I was a patient for the first time.

Her chief complaint was loud popping in her next with rotation.

The sound was so loud that it was actually quite surprising to me.

The neck popping started when she visited a new chiropractor four about

4 months ending in March.She said that she felt that the doctor was too

forceful with neck adjustments

and also encouraged her to stick to a schedule of frequent appointments

which she did not feel comfortable with.

She denied having any neck popping before this occured. Se stated she

did not remember any particular incident where she felt that her neck

had been injured or in pain after the visit to the previous

chiropractor, but she just stated that she felt that the adjustments

were too rough.

WHen she asked the previous chiropractor about the sound he said that

they would go away. She waited but they did not go away.

She preformed extension exercises which the doctor suggested.

When I palpate her neck I can feel a joint which feels like it has too

much movement and with rotation there is a definite clunking sound.

This patient had one previous mva where she rear ended the car in

front. She was turned to the right to restrain a child during the

impact.

She was treated for upper cervical tension by a chiropractor at the

time. She does not feel like she ever fully recovered from the injury.

Are there any definitive ways to diagnose what caused the clunking?

What can I best understand ( I am ordering previous chart notes and

films to get started) why loud popping sounds are coming from her

cervical spine

every time she turns her head?

Lilijoy Rothstein,D.C.

2525 NW Lovejoy Suite 404

Portland, Oregon 97210

(503)294-1235

www.yogacarenw.com

OregonDCs rules:

1. Keep correspondence professional; the purpose of the listserve is to

foster communication and collegiality. No personal attacks on listserve

members will be tolerated.

2. Always sign your e-mails with your first and last name.

3. The listserve is not secure; your e-mail could end up anywhere. However,

it is against the rules of the listserve to copy, print, forward, or

otherwise distribute correspondence written by another member without his or

her consent, unless all personal identifiers have been removed.

[Guest guest]

Lilijoy,

See if flexion/extension films were taken. If not - take

them. That is how I would start to investigate for instability. You are

looking for abberant motion, or possible anterior or posterior translation

from one segment to the next.

Matt Terreri, DC

another annoying chiropractic question

>

> Yesterday I was a patient for the first time.

>

> Her chief complaint was loud popping in her next with rotation.

> The sound was so loud that it was actually quite surprising to me.

>

> The neck popping started when she visited a new chiropractor four about

> 4 months ending in March.She said that she felt that the doctor was too

> forceful with neck adjustments

> and also encouraged her to stick to a schedule of frequent appointments

> which she did not feel comfortable with.

> She denied having any neck popping before this occured. Se stated she

> did not remember any particular incident where she felt that her neck

> had been injured or in pain after the visit to the previous

> chiropractor, but she just stated that she felt that the adjustments

> were too rough.

>

>

> WHen she asked the previous chiropractor about the sound he said that

> they would go away. She waited but they did not go away.

> She preformed extension exercises which the doctor suggested.

>

> When I palpate her neck I can feel a joint which feels like it has too

> much movement and with rotation there is a definite clunking sound.

>

> This patient had one previous mva where she rear ended the car in

> front. She was turned to the right to restrain a child during the

> impact.

>

> She was treated for upper cervical tension by a chiropractor at the

> time. She does not feel like she ever fully recovered from the injury.

>

> Are there any definitive ways to diagnose what caused the clunking?

> What can I best understand ( I am ordering previous chart notes and

> films to get started) why loud popping sounds are coming from her

> cervical spine

> every time she turns her head?

>

>

> Lilijoy Rothstein,D.C.

> 2525 NW Lovejoy Suite 404

> Portland, Oregon 97210

> (503)294-1235

> www.yogacarenw.com

>

>

>

>

> OregonDCs rules:

> 1. Keep correspondence professional; the purpose of the listserve is to

foster communication and collegiality. No personal attacks on listserve

members will be tolerated.

> 2. Always sign your e-mails with your first and last name.

> 3. The listserve is not secure; your e-mail could end up anywhere.

However, it is against the rules of the listserve to copy, print, forward,

or otherwise distribute correspondence written by another member without his

or her consent, unless all personal identifiers have been removed.

>

[Guest guest]

I agree with Bono and Matty...flexion/extension views to check for

LMSI and increased translation.

Dennis Nowack DC

:

>

> Yesterday I was a patient for the first time.

>

> Her chief complaint was loud popping in her next with rotation.

> The sound was so loud that it was actually quite surprising to me.

>

> The neck popping started when she visited a new chiropractor four

about

> 4 months ending in March.She said that she felt that the doctor

was too

> forceful with neck adjustments

> and also encouraged her to stick to a schedule of frequent

appointments

> which she did not feel comfortable with.

> She denied having any neck popping before this occured. Se stated

she

> did not remember any particular incident where she felt that her

neck

> had been injured or in pain after the visit to the previous

> chiropractor, but she just stated that she felt that the

adjustments

> were too rough.

>

>

> WHen she asked the previous chiropractor about the sound he said

that

> they would go away. She waited but they did not go away.

> She preformed extension exercises which the doctor suggested.

>

> When I palpate her neck I can feel a joint which feels like it

has too

> much movement and with rotation there is a definite clunking sound.

>

> This patient had one previous mva where she rear ended the car in

> front. She was turned to the right to restrain a child during

the

> impact.

>

> She was treated for upper cervical tension by a chiropractor at

the

> time. She does not feel like she ever fully recovered from the

injury.

>

> Are there any definitive ways to diagnose what caused the clunking?

> What can I best understand ( I am ordering previous chart notes

and

> films to get started) why loud popping sounds are coming from her

> cervical spine

> every time she turns her head?

>

>

> Lilijoy Rothstein,D.C.

> 2525 NW Lovejoy Suite 404

> Portland, Oregon 97210

> (503)294-1235

> www.yogacarenw.com

[Guest guest]

Lily:

About 6 months ago I had a patient (male) who could generate a loud "popping" every time he rotated the neck to one side (can't remember which side). Even though it sounded like a joint release, it happened every time, so it wasn't a joint cavitation. He did not relate injury or accident, had seen DC's in the past but not recently nor for this complaint, and had developed this pop w/o explanation. He is a computer engineer with typical poor sitting posture. There was neck pain present. I could palpate the level of the "pop". I took films, but not flex/ext. Reversal of curve was noted. Most interesting to me clinically was the presence of joint restrictions above the level of "clunk" palpated, and costovertebral as well. My treatment was adusting the fixations, leaving the clunking segment alone and prescribing postural training exercises. After approx. 3 weeks of care (1-2x/wk) the clunking/popping was gone and his neck no longer hurt.

Seitz, DC Tuality Physicians

730-D SE Oak St

Hillsboro, OR 97123

(503)640-3724

another annoying chiropractic question

Yesterday I was a patient for the first time.Her chief complaint was loud popping in her next with rotation.The sound was so loud that it was actually quite surprising to me.The neck popping started when she visited a new chiropractor four about 4 months ending in March.She said that she felt that the doctor was too forceful with neck adjustmentsand also encouraged her to stick to a schedule of frequent appointments which she did not feel comfortable with.She denied having any neck popping before this occured. Se stated she did not remember any particular incident where she felt that her neckhad been injured or in pain after the visit to the previous chiropractor, but she just stated that she felt that the adjustments were too rough.WHen she asked the previous chiropractor about the sound he said that they would go away. She waited but they did not go away.She preformed extension exercises which the doctor suggested.When I palpate her neck I can feel a joint which feels like it has too much movement and with rotation there is a definite clunking sound.This patient had one previous mva where she rear ended the car in front. She was turned to the right to restrain a child during the impact.She was treated for upper cervical tension by a chiropractor at the time. She does not feel like she ever fully recovered from the injury.Are there any definitive ways to diagnose what caused the clunking?What can I best understand ( I am ordering previous chart notes and films to get started) why loud popping sounds are coming from her cervical spineevery time she turns her head?Lilijoy Rothstein,D.C.2525 NW Lovejoy Suite 404Portland, Oregon 97210(503)294-1235www.yogacarenw.com

[Guest guest]

there are degrees of laxity,

yes, it would be good to rule out severe enough laxity to show up on flexion

extension views.

but it is possible to have laxity that will not show up in imaging studies

marc

Marc Heller, DC

mheller@...

www.DrMarcHeller.com

Re: another annoying chiropractic question

I agree with Bono and Matty...flexion/extension views to check for

LMSI and increased translation.

Dennis Nowack DC

:

>

> Yesterday I was a patient for the first time.

>

> Her chief complaint was loud popping in her next with rotation.

> The sound was so loud that it was actually quite surprising to me.

>

> The neck popping started when she visited a new chiropractor four

about

> 4 months ending in March.She said that she felt that the doctor

was too

> forceful with neck adjustments

> and also encouraged her to stick to a schedule of frequent

appointments

> which she did not feel comfortable with.

> She denied having any neck popping before this occured. Se stated

she

> did not remember any particular incident where she felt that her

neck

> had been injured or in pain after the visit to the previous

> chiropractor, but she just stated that she felt that the

adjustments

> were too rough.

>

>

> WHen she asked the previous chiropractor about the sound he said

that

> they would go away. She waited but they did not go away.

> She preformed extension exercises which the doctor suggested.

>

> When I palpate her neck I can feel a joint which feels like it

has too

> much movement and with rotation there is a definite clunking sound.

>

> This patient had one previous mva where she rear ended the car in

> front. She was turned to the right to restrain a child during

the

> impact.

>

> She was treated for upper cervical tension by a chiropractor at

the

> time. She does not feel like she ever fully recovered from the

injury.

>

> Are there any definitive ways to diagnose what caused the clunking?

> What can I best understand ( I am ordering previous chart notes

and

> films to get started) why loud popping sounds are coming from her

> cervical spine

> every time she turns her head?

>

>

> Lilijoy Rothstein,D.C.

> 2525 NW Lovejoy Suite 404

> Portland, Oregon 97210

> (503)294-1235

> www.yogacarenw.com

OregonDCs rules:

1. Keep correspondence professional; the purpose of the listserve is to

foster communication and collegiality. No personal attacks on listserve

members will be tolerated.

2. Always sign your e-mails with your first and last name.

3. The listserve is not secure; your e-mail could end up anywhere. However,

it is against the rules of the listserve to copy, print, forward, or

otherwise distribute correspondence written by another member without his or

her consent, unless all personal identifiers have been removed.

[Guest guest]

Hi Lillijoy,

Tough question. I don't know of any definitive way to dx what's causing the clunking, however, a flouroscopic or motion x-ray exam would allow her to produce the pop while under radiographic study, and this may reveal some answers.

D Freeman Mailing address: 1165 Union Street NE, Suite 300Salem, Oregon 97301ph 503 586-0127 fax 503 763-3581cell 503 871-0715 drmfreeman@...

-----Original Message-----From: Marc Heller [mailto:mheller@...]Sent: Thursday, June 17, 2004 10:17 PMgoldrb6; Subject: RE: Re: another annoying chiropractic questionthere are degrees of laxity,yes, it would be good to rule out severe enough laxity to show up on flexionextension views.but it is possible to have laxity that will not show up in imaging studiesmarcMarc Heller, DCmheller@...www.DrMarcHeller.com-----Original Message-----From: goldrb6 [mailto:drdennis@...]Sent: Wednesday, June 16, 2004 8:27 PM Subject: Re: another annoying chiropractic questionI agree with Bono and Matty...flexion/extension views to check forLMSI and increased translation.Dennis Nowack DC:>> Yesterday I was a patient for the first time.>> Her chief complaint was loud popping in her next with rotation.> The sound was so loud that it was actually quite surprising to me.>> The neck popping started when she visited a new chiropractor fourabout> 4 months ending in March.She said that she felt that the doctorwas too> forceful with neck adjustments> and also encouraged her to stick to a schedule of frequentappointments> which she did not feel comfortable with.> She denied having any neck popping before this occured. Se statedshe> did not remember any particular incident where she felt that herneck> had been injured or in pain after the visit to the previous> chiropractor, but she just stated that she felt that theadjustments> were too rough.>>> WHen she asked the previous chiropractor about the sound he saidthat> they would go away. She waited but they did not go away.> She preformed extension exercises which the doctor suggested.>> When I palpate her neck I can feel a joint which feels like ithas too> much movement and with rotation there is a definite clunking sound.>> This patient had one previous mva where she rear ended the car in> front. She was turned to the right to restrain a child duringthe> impact.>> She was treated for upper cervical tension by a chiropractor atthe> time. She does not feel like she ever fully recovered from theinjury.>> Are there any definitive ways to diagnose what caused the clunking?> What can I best understand ( I am ordering previous chart notesand> films to get started) why loud popping sounds are coming from her> cervical spine> every time she turns her head?>>> Lilijoy Rothstein,D.C.> 2525 NW Lovejoy Suite 404> Portland, Oregon 97210> (503)294-1235> www.yogacarenw.comOregonDCs rules:1. Keep correspondence professional; the purpose of the listserve is tofoster communication and collegiality. No personal attacks on listservemembers will be tolerated.2. Always sign your e-mails with your first and last name.3. The listserve is not secure; your e-mail could end up anywhere. However,it is against the rules of the listserve to copy, print, forward, orotherwise distribute correspondence written by another member without his orher consent, unless all personal identifiers have been removed.

[Guest guest]

I have a different opinion on this popping business. This began after a

series of adjustments that the patient " thought were too forceful " . I would

argue that if this patient were the victim of so forceful a series of

adjustments over a period of several weeks that it created that much

ligamentous damage that the patient would have complained of a clear injury

to the soft tissues. A lot of pain and reactive muscle spasm for a period

of weeks after being so injured. That didn't happen.

I have a different theory, which is that the forceful adjustments didn't

produce gross laxity of ligament but did upset the sensory/motor harmony in

the neck resulting in unbalanced muscle activity. The imbalance does not now

permit the joints of the neck to track through an excursion that is

consistent with the shape of these joints. The crepitus happens when neck

joints so affected reach a point in their motion where, instead of

experiencing a shear stress that accurately glides the joints through a

smooth motion consistent with their morphology, that this sensory/motor

imbablance instead produces a binding that causes the joint surfaces to lift

away from one another causing a cavitation that produces the pop. I have

treated many such cases and seen the crepitus vanish within a 15 minute NMT

treatment as the NMT treatment reestablishes proper sensoy/motor

coordination. This is the sort of treatment that I demonstrated at this

years CAO convention in which I corrected a longstanding sciatica and LBP

case of VAS 9/10 severity with a lasting result in a 25 minute NMT

treatment. The NMT approach affords a real time way of profoundly changing

physiology in a measurable way.

The clinical pathways of NMT: The Feinberg Technique are tools to assess

such neurological imbalance and resolve it to balanced function. The beauty

of this is that the assessment actually is an interaction with the other

than conscious control systems involved in the dysfunction. This

intelligent system responds to the queries performed in this method of

treatment to identify the various sensory end organs set at inappropriate

thresholds of sensitivity, facilitated or inhibited neurological pathways,

and inappropriate motor end organ thresholds of stimulation and other such

faults that constitute the substance of such a sensory/motor imbalance and

what is required to arrive at correct function. NMT: The Feinberg Techinque

permits us to work from the above down and from the inside out - the most

elegant way to produce rapid changes in physiology.

Best regards,

S. Feinberg, D.C.

Re: another annoying chiropractic question

I agree with Bono and Matty...flexion/extension views to check for LMSI and

increased translation.

Dennis Nowack DC

:

>

> Yesterday I was a patient for the first time.

>

> Her chief complaint was loud popping in her next with rotation.

> The sound was so loud that it was actually quite surprising to me.

>

> The neck popping started when she visited a new chiropractor four

about

> 4 months ending in March.She said that she felt that the doctor

was too

> forceful with neck adjustments

> and also encouraged her to stick to a schedule of frequent

appointments

> which she did not feel comfortable with.

> She denied having any neck popping before this occured. Se stated

she

> did not remember any particular incident where she felt that her

neck

> had been injured or in pain after the visit to the previous

> chiropractor, but she just stated that she felt that the

adjustments

> were too rough.

>

>

> WHen she asked the previous chiropractor about the sound he said

that

> they would go away. She waited but they did not go away.

> She preformed extension exercises which the doctor suggested.

>

> When I palpate her neck I can feel a joint which feels like it

has too

> much movement and with rotation there is a definite clunking sound.

>

> This patient had one previous mva where she rear ended the car in

> front. She was turned to the right to restrain a child during

the

> impact.

>

> She was treated for upper cervical tension by a chiropractor at

the

> time. She does not feel like she ever fully recovered from the

injury.

>

> Are there any definitive ways to diagnose what caused the clunking?

> What can I best understand ( I am ordering previous chart notes

and

> films to get started) why loud popping sounds are coming from her

> cervical spine every time she turns her head?

>

>

> Lilijoy Rothstein,D.C.

> 2525 NW Lovejoy Suite 404

> Portland, Oregon 97210

> (503)294-1235

> www.yogacarenw.com

OregonDCs rules:

1. Keep correspondence professional; the purpose of the listserve is to

foster communication and collegiality. No personal attacks on listserve

members will be tolerated.

2. Always sign your e-mails with your first and last name.

3. The listserve is not secure; your e-mail could end up anywhere. However,

it is against the rules of the listserve to copy, print, forward, or

otherwise distribute correspondence written by another member without his or

her consent, unless all personal identifiers have been removed.