Answers to Questions about Chiropractic:
Will Monthly Adjustments Prevent
Progression of Spinal Arthritis?

Samuel Homola, D.C.

Question

I went to a chiropractor for lower back and neck stiffness. I have a straight neck with next to no curve, and I have frequent headaches and neck stiffness. The chiropractor told me that he believes I have a condition known as DISH. He told me that monthly visits to get my neck and back aligned will help slow progression of the condition. Am I being fed a line, or is this a reasonable approach? I am 35 years old. It is my understanding that this condition does not normally appear in men until after the age of 50.

Answer

DISH is an abbreviation for "diffuse idiopathic skeletal hyperostosis," a form of osteoarthritis characterized by bony overgrowth. Its cause is unknown, and there is no cure. It is usually treated symptomatically.

Loss of the normal cervical curve as a result of osteoarthritis cannot be corrected with manipulation. While manipulation might improve mobility in the affected joints, risk may outweigh benefit when the cervical spine is manipulated. When DISH is advanced, bony overgrowth in the cervical spine can encroach upon vertebral arteries and the spinal cord and should not be manipulated.

Since you are only 35 years of age, your arthritis might be mild and may not progress to an advanced stage. In any event, the progress of the disease cannot be slowed or halted by manipulation. Since you have been advised to the contrary, it is possible that you have been unnecessarily frightened in an effort to encourage you to continue with treatment.

Get another opinion from an orthopedist who can help you develop a self-help plan that you can follow at home. Range of motion and stretching exercises will help maintain mobility. When pain and inflammation are present, simple nonsteroidal anti-inflammatory drugs such as aspirin can be used to ease symptoms and to inhibit the inflammatory process. You should avoid postures that place a strain on your neck and back, and so on. Any treatment you adopt should be approved by your physician.

Since you are a young man, it's unlikely that you have advanced osteoarthritis, and you might benefit from an occasional manipulation. But remember that such treatment will not slow progression of the disease. And because of the risks associated with neck manipulation, it is not prudent to continue it.

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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 April 4, 2003.