I cracked my husbands neck and thought I killled him

[modsar]

I cracked my first neck today...on my husband. I heard it crack and freaked out!! He thought that I thought I killed him...he laughed for like 10 mintues straight!!!

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[musclemilk619]

 

[Newusername]

I heard Dr. Oz is doing a bit about this technique on his show next week.....

 

[MLT2MT2DO]

I cracked my first neck today...on my husband. I heard it crack and freaked out!! He thought that I thought I killed him...he laughed for like 10 mintues straight!!!

You actually did kill him. Unfortunately until Hailey Joel Osment can verify this, you'll be shacking up with a ghost.

 

[OrganicDOc2BE]

It's quite scary... my classmate and I practice on eachother a few times a week. Not sure if I would feel comfortable with my spouse yet - but good job

 

[DrMediterranean]

How effect is this for back neck pain? I saw the segment on Dr. Oz where the DO PM&R physician did it. It definitely looked legit. Maybe I am just desperate bc I have recently been noticing lots of neck pain/stiffness. There is a student run OMM clinic near me (local osteopathic school) and I want to make an appointment.

 

[napsilan]

How effect is this for back neck pain?

Here is a 2010 review article in a journal on manipulation, by chiropractic researchers. It concludes "Spinal manipulation/mobilization is effective in adults for: acute, subacute, and chronic low back pain; migraine and cervicogenic headache; cervicogenic dizziness" and "thoracic manipulation/mobilization is effective for acute/subacute neck pain". However, it also states that evidence is inconclusive for a number of other treatments, including "cervical manipulation/mobilization alone for neck pain of any duration, and for manipulation/mobilization for mid back pain".
Source: Chiropr Osteopat. 2010; 18: 3.

Another article in a family practice journal states that manipulation for low back pain is unsupported, and may not be cost-effective.
Source: Am Fam Physician. 2012 Feb 15;85(4):343-350.

So, the literature isn't exactly consistent. Personally, I've seen some good results from shadowing a couple OMM docs, but N≈15 patients doesn't make a good data set, and I wasn't able to follow up with any of them. I also believe that skill and training have a lot to do with the results, whereas any prescription for X mg of Y drug is the same no matter who prescribes it, diagnosis skill aside.

Edit: On topic, if you localize well enough, you really shouldn't need that much rotation or force. For example, I've had a neck click back into place several times just by approaching the barrier while I was localizing. I usually don't need to go much beyond ~45 degrees rotation or sidebending for C2-7.

 

[facetguy]

Edit: On topic, if you localize well enough, you really shouldn't need that much rotation or force. For example, I've had a neck click back into place several times just by approaching the barrier while I was localizing. I usually don't need to go much beyond ~45 degrees rotation or sidebending for C2-7.

You mean you made some noise come out of your neck. What do you mean by "click back into place"? Was something out of place to begin with?

 

[napsilan]

Example from yesterday: A friend had a C5 or 6 that was FRS right, so it was out of place to begin with. I sidebend indirect (right) at the segment around 45 degrees, and apply some traction. I then rotate the segment direct (left) about his thorax's vertical axis to again about 45 degrees to find the barrier. Without any thrust, I heard a click, set his head back down and rechecked. The dysfunctional segment was still present, so I repeated the above procedure, heard another click, and rechecked again. This time the segment was no longer dysfunctional. He commented that he felt much better.

As far as "click back into place", I suppose the easiest analogy is cracking your knuckles, although it's not perfect. You have a finger joint that doesn't flex as much as it should, you apply a force, hear a pop, and now your finger joint has a larger range of motion.

 

[facetguy]

Example from yesterday: A friend had a C5 or 6 that was FRS right, so it was out of place to begin with.

Out of place, or not moving as it should?

I sidebend indirect (right) at the segment around 45 degrees, and apply some traction. I then rotate the segment direct (left) about his thorax's vertical axis to again about 45 degrees to find the barrier. Without any thrust, I heard a click, set his head back down and rechecked. The dysfunctional segment was still present, so I repeated the above procedure, heard another click, and rechecked again. This time the segment was no longer dysfunctional. He commented that he felt much better.

As far as "click back into place", I suppose the easiest analogy is cracking your knuckles, although it's not perfect. You have a finger joint that doesn't flex as much as it should, you apply a force, hear a pop, and now your finger joint has a larger range of motion.

So is the goal to produce a popping sound? Is that where the benefits come from?

 

[Bacchus]

Out of place, or not moving as it should?



So is the goal to produce a popping sound? Is that where the benefits come from?

We're told "No" in lab. I think the popping sound adds to the fanfare and contributes to a placebo effect, honestly. I even do it myself when I'm HVLA'd by friends. I equate the "pop" with a successful technique and filter out all the other things that happened before the pop: stretching of fascia, muscle and tendons/ligaments.

IMO, its really the stretching that does most of the work. I've had the same situation as above where I'm setting up for the cervical HVLA technique and simply positioning the patient and stretching them to their barriers elicits the pop without a thrust.

So in the end, a pop isn't the end all be all.

 

[napsilan]

Out of place, or not moving as it should?

A little of both. In this case, that joint did not bend to the left much, and the vertebra was rotated slightly to the right while he was relaxed looking forward. "Out" is informal language.

So is the goal to produce a popping sound? Is that where the benefits come from?

No, although it's often coincidental. That is why I rechecked the motion of my friend's neck after I heard the first noise to see if the segment was fixed. The benefit is from moving the joint back into a position where it has its full range of motion, and stretching/relaxing the related soft tissue. In tough cases, a good amount of soft tissue work is needed. Most of the docs I have shadowed spent probably >80% of their treatment time on soft tissue.

 

[facetguy]

A little of both. In this case, that joint did not bend to the left much, and the vertebra was rotated slightly to the right while he was relaxed looking forward. "Out" is informal language.

No, although it's often coincidental. That is why I rechecked the motion of my friend's neck after I heard the first noise to see if the segment was fixed. The benefit is from moving the joint back into a position where it has its full range of motion, and stretching/relaxing the related soft tissue. In tough cases, a good amount of soft tissue work is needed. Most of the docs I have shadowed spent probably >80% of their treatment time on soft tissue.

Just be aware that the bone-out-of-place concept is an antiquated one. And your focus seems to be primarily on the mechanical aspects, if you will, of HVLA, which are true but only part of the picture vis-a-vis benefits.

 

[facetguy]

Is that audible pop really necessary? Most of the available papers say no, although I agree with Bacchus that there is likely a placebo-enhancing effect when you get a really wicked crack from a patient's spine.

http://www.ncbi.nlm.nih.gov/pubmed/20170777

http://www.ncbi.nlm.nih.gov/pubmed/16396728

http://www.ncbi.nlm.nih.gov/pubmed/12881834

Where do all those cracks come from anyway?
http://www.ncbi.nlm.nih.gov/pubmed/21986305

And how soon after I get cracked can I be cracked again?
http://www.ncbi.nlm.nih.gov/pubmed/18394496

 

[napsilan]

the bone-out-of-place concept is an antiquated one

Do you happen to have any articles on the subject? I'd be interested in reading them.

Is that audible pop really necessary? Most of the available papers say no

As I said above, I agree with this. If you hear a pop before a thrust, it does seem to be useful as a notification that "something" happened and the targeted joint should be rechecked.

Where do all those cracks come from anyway?

The conclusions indicate that most cavitations were on the targeted side (93.5%) and in the targeted segment (71.7%), which seems expected. Was there something else I am missing?

And how soon after I get cracked can I be cracked again?

For N=3, this paper said the average time was 68 minutes before they got 50% of the pops again. This is probably the most interesting paper you linked. It could mean that cavitations are unrelated to actual function and treatment, like we said above. I suppose another explanation is that, since they only treated the lumbar spine and nothing else, other dysfunctions in the body could cause the lumbar to compensate again. The paper only says that the subjects were "made to sit or stand" between treatments. All 3 subjects were treated on the same side, however, so I'm not sure how likely all 3 subjects would have other dysfunctions to cause the same lumbar dysfunction again.

The paper says that the cavitation sound is created by creating negative pressure in a joint capsule and causing "the snap back of the capsule, the formation/collapsing of a bubble, or some other means". I wonder if the same situation that allows for cavitation, such as the synovial fluid sealing the capsule, would also cause the joint to be hypomobile. I'm imagining one of those suction cups that you stick to a window and won't move once the suction is applied. I'm just an OMS1 though, so I could easily be mistaken about this.

 

[Bacchus]

Don't forget the muscle memory that has built up. I can HVLA your T-spine all I want and if you go back to improper posture as one example I'll be able to elicit the same results tomorrow. Just look at us, hunched over our books or EMRs, somatic dysfunctions abound and they keep reoccurring.

 

[Whiskeypunch]

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[napsilan]

My school gave a presentation on cervical HVLA safety before we started it. They put the risk at 1 in 400k to 3.8M, I assume per treatment. They compared this to a 1 in 17k risk of death per year involving NSAIDs, and a 1 in 6k risk of death per year from a car crash.
Their sources were:
Spine. 27(1):49-55, January 1, 2002
Stroke. 2005;36:1575-1580
NEJM June 17, 1999; 340(24): 1888-99
www.cdc.gov/nchs under NVSS: Deaths, Injuries 2002
U.S. Census

Another article from Neurologist in 2008 puts the cervical manipulation risk at 1.3 in 100k (=1 in 77k) per treatment.
Source: Neurologist. 2008 Jan;14(1):66-73.

 

[facetguy]

My school gave a presentation on cervical HVLA safety before we started it. They put the risk at 1 in 400k to 3.8M, I assume per treatment. They compared this to a 1 in 17k risk of death per year involving NSAIDs, and a 1 in 6k risk of death per year from a car crash.
Their sources were:
Spine. 27(1):49-55, January 1, 2002
Stroke. 2005;36:1575-1580
NEJM June 17, 1999; 340(24): 1888-99
www.cdc.gov/nchs under NVSS: Deaths, Injuries 2002
U.S. Census

Another article from Neurologist in 2008 puts the cervical manipulation risk at 1.3 in 100k (=1 in 77k) per treatment.
Source: Neurologist. 2008 Jan;14(1):66-73.

Most thorough study on this issue to date, published in Spine, 2010:
http://www.ncbi.nlm.nih.gov/pubmed/18204390

Another recent analysis, published in Spine, 2008:
http://journals.lww.com/spinejourna..._Vertebrobasilar_Artery_Stroke_in_Two.18.aspx

Best summary article on the issue of HVLA and stroke; a must read:
http://chiromt.com/content/18/1/22

Interesting paper on bias of perceived risk of HVLA:
http://www.ncbi.nlm.nih.gov/pubmed/14589464

 

[Bacchus]

The only thing about OMM that I'm worried about is HVLA. When I was shadowing there was a patient that came in with an arterial dissection. She had gone to a chiropractor the night before and then in the morning her husband couldn't wake her up. Husband called 911 and they brought her in. She went to neurosurgery pretty quickly. Apparently she had a really low chance of survival at that point. Never heard how it turned out.

From what the D.O. ER doc said, it's a known complication and the dissection was likely caused by her visit to the chiropractor the night before.

Hopefully that risk doesn't exist for HVLA if it's done right, otherwise I'm going to be a nervous wreck for that part of OMM and never use it again outside of that class.

I'd venture to say an OMM specialist wouldn't have HVLA'd this woman's neck.

 

[facetguy]

I'd venture to say an OMM specialist wouldn't have HVLA'd this woman's neck.

How do you know that? OMM specialists don't perform HVLA on the cervical spine?

Whiskey, do we know what symptoms this woman presented to the chiropractor with?

 

[Whiskeypunch]

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[facetguy]

Nope.

So we don't know if she had a dissection already in progress, creating symptoms for which she sought chiro care. Bear in mind that the vast majority of vertebral artery dissections occur spontaneously.

 

[primadonna22274]

I absolutely suck at cervical HVLA. It's weird--I can localize forces ok for thoracic, lumbar, sacral...but can't get a neck to go. My lab partners tell me I lack "oomph" in my hands. Help! I'm not a wimp except it seems in my wrists.

 

[Bacchus]

How do you know that? OMM specialists don't perform HVLA on the cervical spine?

Whiskey, do we know what symptoms this woman presented to the chiropractor with?

I can't say for certain. I doubt it was a case of a 1 in (X,)XXX,XXX accident though. There was probably underlying pathology that predisposed the patient. Could a physician have not screened properly? Sure. Same for the chiro. But I'm hoping the extensive medical knowledge of the DO would have stopped a dangerous manipulation.

 

[facetguy]

I can't say for certain. I doubt it was a case of a 1 in (X,)XXX,XXX accident though. There was probably underlying pathology that predisposed the patient. Could a physician have not screened properly? Sure. Same for the chiro. But I'm hoping the extensive medical knowledge of the DO would have stopped a dangerous manipulation.

There may have been underlying pathology, we don't know. But I disagree that a DC dismisses it due to, as you suggest, lack of knowledge. This topic is covered extensively in chiro training. In fact, over the years I've had patients tell me a DO does/has done HVLA on them, whereas I would never perform HVLA on them due to risk.

 

[cdmguy]

Just to let everyone know, chiropractic isn't equivalent to PT and DO manipulation. They don't use clinical prediction rules and manipulate everyone based on apparent segmental restriction and myospasm. About 3/4 are glorified massage therapists with xray machines who will manipulate regardless of medical necessity (they attended straight chiropractic programs) based on this analysis, the other 1/4 are called mixers because they practice like naturopaths with more emphasis on diagnosis and limited scope primary care. So take comments from chiropractors with a big heaping of suspicion.

 

[facetguy]

Just to let everyone know, chiropractic isn't equivalent to PT and DO manipulation. They don't use clinical prediction rules and manipulate everyone based on apparent segmental restriction and myospasm. About 3/4 are glorified massage therapists with xray machines who will manipulate regardless of medical necessity (they attended straight chiropractic programs) based on this analysis, the other 1/4 are called mixers because they practice like naturopaths with more emphasis on diagnosis and limited scope primary care. So take comments from chiropractors with a big heaping of suspicion.

Gee, there's a non-biased opinion.

Which one did you used to be: the glorified massage therapist?

 

[cdmguy]

Lol you don't even understand it and you call it biased.

Massage therapists don't diagnose, they identify red flags and refer out. This is the outdated but popular straight chiropractic model. Modern accreditation guidelines specifiy full primary care diagnosis and having to meet medical necessity at least for the beginning portion of treatment (after that anything goes which more often than not is quacky subluxation treatment schemes and lifetime care) but aside from a few minimum course hours they are weak in overall curriculum integration and straight programs just set up a straight subluxation diagnosis program with a few sham differential courses thrown in to meet the guidelines. It's easy to see this done when students are allowed to treat age groups before taking appropriate diagnosis coursework (i.e. pediatrics, geriatrics). Students graduate from these programs thinking that chiropractors who diagnose are sell outs to insurance companies and that diagnosis is an unnecessary waste of time.

 

[nads1219]

I cracked my first neck today...on my husband. I heard it crack and freaked out!! He thought that I thought I killed him...he laughed for like 10 mintues straight!!!

Hahaha. Last weekend I had to bribe my husband to let me do HVLA on his neck as well. It took an hour of convincing and he ended up with a head massage, hand massages and dinner for letting me fix his neck (not a bad deal, right!?!?).
He kept guarding in the set up so I finally did soft tissue until he wasn't paying attention.. then POP! probably 8 loud cracks. He freaked out and immediately checked to make sure he could move his legs.... baby.
I believe his exact words were "if you paralyze me, it may put a strain on our marriage"

 

[primadonna22274]

Um yeah, it would take much more than "massage" to bribe my husband.... Ahem of course it's a moot point since he's 700 miles away so not convenient for practice ;(

 

[facetguy]

Hahaha. Last weekend I had to bribe my husband to let me do HVLA on his neck as well. It took an hour of convincing and he ended up with a head massage, hand massages and dinner for letting me fix his neck (not a bad deal, right!?!?).
He kept guarding in the set up so I finally did soft tissue until he wasn't paying attention.. then POP! probably 8 loud cracks. He freaked out and immediately checked to make sure he could move his legs.... baby.
I believe his exact words were "if you paralyze me, it may put a strain on our marriage"

Hoping you're not 'Pre-Medical' currently?

 

[nads1219]

Nope! Not pre-med. I guess I should update my profile OMS1

 

[MedicinaeDoctor]

i notice that some D.O. students complain about a bunch of different aspects of OMM. in any case, as a straight male pre-med, i do not understand why any single male D.O. student would pass up an opportunity to touch a sports-bra-wearing female in class. actually, that goes for anyone regardless of orientation. that is a pretty glorious perk, if you ask me.

 

[Whiskeypunch]

.

 

[nads1219]

Um yeah, it would take much more than "massage" to bribe my husband.... Ahem of course it's a moot point since he's 700 miles away so not convenient for practice ;(

I hear you! My husband is about a 5 hour car ride away... booo medical school (in that regard).

And to the person who commented on women in sports bras-
1) look around at the women around you, do you want to see all of them in sports bras?
2) they don't want to see you shirtless.
3) people like you, sitting on your partner's pubic tubercles for 10 full minutes, make the class painful for the rest of us.

 

[Dharma]

Grow up.

Chill out. He was making a joke. But he should remember, that he has to touch dudes too! Mostly dudes.