NOT ALL CHIROPRACTORS ARE CREATED EQUAL!
COULD THE CAUSE OF YOUR CHRONIC PAIN BE YOUR CHIROPRACTOR?
Ross Hauser, M.D.

“OVERMANIPULATION SYNDROME”

Please note, we have had great experiences with chiropractors and Marion and I visit our chiropractors regularly.
 

I like making stuff up so I am going to call someone who has chronic pain due to joints or vertebrae being too lax (ligament laxity) caused by too much manipulation by chiropractor Over-Manipulation Syndrome (OMS).  Here are some recent cases I have seen.
 

A female patient states that she found out about Prolotherapy because her chiropractor said her sacroiliac joint was hypermobile.  She then researched this on the internet and came across Prolotherapy as a treatment for hypermobile joints.  Her history was interesting in that she originally saw the chiropractor for headaches, then she started getting low back manipulation.  She said that she must have had 120 manipulations of her sacroiliac joints over the course of the last 4 or 5 years. Prior to seeing a chiropractor, she had no low back pain.  Her diagnosis as far as I am concerned is Overmanipulation Syndrome.

Another female patient did have low back pain for which she saw a chiropractor, actually about eight chiropractors in total. She found out about Prolotherapy because a friend of hers had a similar problem so she came in for an evaluation.  She could just tweak her pelvis a little and you could hear an audible pop in her sacroiliac joint.  She was massively hypermobile in her sacroiliac joint.  Her extremities had no hypermobility.  She stated she felt she had over a hundred manipulations of her sacroiliac joints.  I concluded that she had Over-manipulation Syndrome.
 

The majority of cases that I see for hypermobility have had excessive chiropractor manipulation.  I do not doubt the effectiveness of a short course of manipulation to relieve tension or pain, but to see someone over and over again when they are hypermobile is ridiculous. To me if after 10 visits or so if the person’s joints are not staying in place after manipulation then the cause is obviously ligament injury or weakness and the treatment of choice is Prolotherapy, not continued manipulation.

Here are some practical guidelines that I use for chiropractic care:

1. A chiropractor who spends little time with a patient and just manipulates them is a manipulator and not a chiropractor. 
 

2. A chiropractor in the true sense of the word is a 'family physician'.  They may choose to just treat pain but they can treat a whole lot more.  
 

3. I get treated once in awhile for a sports injury and Marion gets treated more regularly. Marion is in front of the computer for 6 hours a day and as such has a forward head posture.  She gets chiropractic care about once every eight weeks, but she goes to chiropractors who do not use manipulation as their primary tool. 
 

4. Marion and I know of two great chiropractors, in our opinion.  Dr. Kurt Ehling in Morton, Illinois and Dr. William Hambach in Oak Park (same building as us). They both treat us.
 

5. When a manipulation is needed these chiropractors spend the time to relax the muscles so a very gentle manipulation can be done that is very specific.  Most of the time is spent on stretching muscles and using modalities such as cold laser to relax muscles and help rebalance the body at specific points.  If you want care by a chiropractor, go to a chiropractor, not a manipulator.

A good chiropractor is worth their weight in gold. Someone who is honest and caring, but also very skilled. Ideally one should go to a chiropractor who can help you with your overall health.

For acute pain that may have caused moderate damage, most can be resolved by a good chiropractor in five visits.   If you are on your twentieth visit for an acute muscular-type injury by a chiropractor, it is almost 100% predictable that the pain will not resolve with that treatment (There are special cases, of course).  Most likely you will need Prolotherapy, because there has been ligament damage (either initially or because of the excessive manipulation).

Manipulation can stretch ligaments and cause hypermobility.  Even one manipulation can cause hypermobility.  Manipulation is using a super-physiologic force to push a bone into a certain direction that it is not going on its own.  Chiropractors who don't relax the muscles ahead of time have to use an extraordinary force to move the bone the certain way.  It is easy to understand how during this 'movement' that ligaments can get sheared and ultimately produce hypermobility.  The hypermobility would need Prolotherapy to resolve.

Even one manipulation can cause hypermobility which leads to chronic pain.  Stated again for emphasis.

A good percentage of chronic pain patients have had excessive manipulation. It may be that the cause of their chronic pain is not the 'original' injury but the injury to ligaments caused by excessive manipulation.

Preventative manipulation has a role, but it is very limited.  A person who has no chronic pain and has had almost no pain their whole life does not need monthly preventative manipulations, in my opinion. The person who is always getting pain and that pain can be relieved by chiropractic care could benefit from preventative chiropractic care.  I would qualify the latter by saying the care can include some manipulation, but again if this is the sole modality used, then the person should call themselves a manipulator not a chiropractor.  Ultimately the person will get manipulated out of a lot of money.

I should explain some about hypermobility.  Hypermobility occurs when a ligament is stretched and then can no longer perform its function to stabilize a joint or vertebral segment.  The body then recruits muscle to do it with resultant chronic muscle spasms produced in the patient.  I believe the cause of the majority of chronic muscle spasms in people is due to ligament injury beneath the muscles.  Prolotherapy to strengthen these ligaments relieves the chronic pain by providing stability back in that area.  The ligaments strengthen and tighten and thus there is no more need for the muscles to spasm.  The musculature relaxes and the person gets their range of motion back.

Prolotherapy is given to cure a person of their chronic pain.  It takes typically 3 to 6 visits.  It can be used for acute or chronic pain.  Most people with acute injuries need two visits.