I am 60 years old and have a long history of back pain with occasional leg pain. I went to chiropractor who told me that something wrong with my neck is causing my back pain. He wants to work on my neck. I have never had any trouble with my neck. I have been to orthopedists in the past. None of them have ever told me that my back pain was coming from my neck. Most of them said I had arthritis. Is it possible that the chiropractor is right? Should I go back for a series of neck adjustments? Should I keep going to this chiropractor?
It makes no sense to have neck adjustments for back pain. Even if there is something wrong with your neck, there is no reason to believe that a neck problem could cause back pain. Since you are not having any trouble with your neck, you certainly should not undergo neck manipulation. Neck manipulation for any reason entails risk. When it not done for a good reason, risk outweighs benefit.
The theories chiropractors offer to explain how neck adjustments can cure back pain are nonsensical. Although chiropractors learn neurology and anatomy from medical textbooks, many draw conclusions with which the authors would disagree. One theory, for example, proposes that misalignment of the atlas (the vertebra supporting the skull) triggers a chain reaction through nerves and muscles that tighten the lower back or cause a “functional short leg” to cause back pain. Some claim that a misaligned atlas affects the spinal cord to cause all kinds of problems from the neck down. Some “upper cervical specialists” theorize that slight misalignment of the atlas affects the spinal cord by placing tension on tiny ligaments that anchor the spinal cord in the spinal canal, affecting nerve centers that send harmful reflexes to all parts of the body.
Measured irregularity, or what appears to be a slight misalignment of the atlas, is often the result of uneven bone structure and is meaningless when there are no symptoms and the atlas is freely movable. Displacement of the atlas severe enough to compress the spinal cord would be painful and dangerous and could damage the spinal cord (myelopathy). A true displacement of the atlas should not be manipulated.
Because of the danger of stroke caused by injury to the vertebral arteries, the top two cervical vertebrae (atlas and axis) should rarely, if ever, be manipulated. Adjusting the neck as a treatment for low back pain or sciatica (leg pain) cannot be justified under any circumstances.
Some chiropractic “upper cervical specialists” who manipulate the neck of every patient they see, using orthogonal, Blair, Palmer “hole-in-one,” and other techniques to correct an alleged “atlas subluxation complex.” I advise people to steer clear of such practitioners.
Dr. Homola is a second-generation chiropractor who has dedicated himself to defining the proper limits on chiropractic and to educating consumers and professionals about the field. His 1963 book Bonesetting, Chiropractic, and Cultism supported the appropriate use of spinal manipulation but renounced chiropractic dogma. His 1999 book Inside Chiropractic: A Patient’s Guide provides an incisive look at chiropractic’s history, benefits, and shortcomings. Now retired after 43 years of practice, he lives in Panama City, Florida.
This article was posted on May 9, 2003.