There was a correlation between chiropractic care and subsequent vertebrobasilar artery (VBAI) stroke in persons <45 years, but a similar association was seen in patients receiving general medical practitioner treatment. This may be explained by patients with VBAI dissection-related headache or neck pain seeking care before having their stroke.
We will take great care when adjusting your patient. There are a variety of technical procedures for adjusting the neck.
If any neck pain patients do not respond to the first few treatments, I will let you know. Case series of chronic whiplash patients have shown they can improve their symptoms with chiropractic care (Injury, 1996). A marked increase in symptoms would contraindicate further treatment with that type of manipulation.
Ask how I examine patients, and whether I feel x-rays are needed to screen for instability or anomalies. If your patient responds positively to treatment, this would justify continued care, provided there is gradually less weekly frequency. Six to eight adjustments in the first two weeks would not be unusual. This frequency would be rare for a patient in the second month of care.
Published articles and books concerning the healing of injured soft tissues (Oakes 1982; Roy and Irving 1983; Kellett1986; Buckwalter/Woo 1988, Majno 2004) indicate that the time frame for such healing is approximately one year.
Needless to say the difference between a recovery time of 4-8weeks and 12 months dramatically impacts both clinical practice and expected outcomes.
Healing Takes Place In Three Specific Phases.
This phase will last approximately 72 hours. During this phase, after the initial injury, an electrical current is generated at the wound, called the "current of injury."
This "current of injury" attracts fibroblasts to the wound (Oschman,2000).
Because there is disruption of local vascular supplies, there is insufficient availability of substrate (glucose, oxygen,etc.) to produce large enough quantities of ATP energy to initiate collagen protein synthesis to repair the wound.
During the regeneration phase the disruption in the injured muscles and ligaments is bridged. Some references call the regeneration phase the phase of repair, which creates confusion about the timing of healing (Jackson,1977).
"Repair" connotation is that the process has completed, which, as we well see, is not the case. The fibroblasts manufacture and secrete collagen protein glues that bridge the gap in the torn tissues. This phase will last approximately 6-8 weeks (Jackson, 1977).
In 1975, Stonebrink addresses that the last phase of the pathophysiological response to trauma is tissue fibrosis. Boyd in 1953,Cyriax in 1983, and Majno/Joris in 2004 note that there is tissue fibrosis subsequent to trauma.
In addition, Cyriax notes "fibrous tissue is capable of maintaining an inflammatory response long after the initial cause has ceased to operate."
Since inflammation alters the thresholds of the nociceptiveafferent system, physical examinations in these cases will show these fibrotic areas display increased sensitivity, and digital pressure may show hypertonicity and spasm.
One of the conclusions of this study is that the patient's symptoms would not improve after a period of two years following the injury.
It is established neurologically (Wyke 1985, Kirkalady-Willisand Cassidy 1985) that when a chiropractor adjusts(specific directional spinal manipulation) the joints of the region of pain and/or spasm, that there is a depolarization of the mechanoreceptors that are located in the facet joint capsular ligaments, and that the cycle of pain and/or spasm can be neurologically aborted. This is why many patients feel better after they receive specific joint manipulation from a chiropractor following an episode of increased pain and/or spasm.
So Many Patients Suffer From?
A good explanation is found from Gunn (1978, 1980, 1989). He refers to this type of pain as super sensitivity.
The super sensitivity type pain is a residual of the scarring or the fibrosis that was created by the injuries sustained in this accident.
Gunn, C. Chan, Pain, Acupuncture & Related Subjects, C. Chan Gunn, (1985).
Kellett, John, "Acute soft tissue injuries-a review of the literature," Medicine and Science of Sports and Exercise, American College of Sports Medicine, Vol. 18 No.5, (1986), pp 489-500.
Kirkaldy-Willis, W.H., M.D., & Cassidy, J.D.,"Spinal Manipulation in the Treatment of Low-Back Pain," Can Fam Physician, (1985), 31:535-40.
Stonebrink, R.D., D.C., "Physiotherapy Guidelines for the Chiropractic Profession," ACA Journal of Chiropractic, (June1975), Vol. IX, p.65-75.