Well, I saw Dr. Hepworth again for the first time since we ruled out trigeminal neuralgia. He showed my my ultrasound from last year, which showed very clearly that the jugular was compressed, even though subsequent imaging hasn’t repeated that.
He also said that my neck is too straight, and that may be contributing to the problem. And he referred me to a chiropractor. There is a Dr. Katz in Boulder who does a very specific form of chiropractic that he thinks might help me. So I’m going to start seeing him. If that doesn’t work, then he wants to discuss surgery at my next appointment in May.
It is worth a try, listen to your body and be your own advocate as things go. I had a very dramatic change in my IJ compression related to my C1 and C2 positioning which we stumbled onto on accident. My post op Doppler study showed continued elevated velocities on both sides so we scheduled another angiogram. I am a PT and could feel my upper cervical restrictions, now that both styloids had been removed I could tolerate manipulation there and had that done after the Doppler. As it turns it turns out my angiogram was delayed by COVID giving me time for 3 neck treatments. Well, as it went my angiogram showed completely normal pressure gradients in ALL positions, we were dismayed! Then I had a repeat Doppler and it was normal!!! The only thing that changed was having 3 neck treatments by a PT…incredible. I no longer have any neck restrictions…only 3 manipulation treatments needed and follow through motor control training for my neck musculature which I do at home.
Note of importance *** my jugular and carotid compression from the styloids limited my ability to have this upper cervical manipulation, had I allowed someone to do that before they were both removed it may have ended in dire consequences to my vasculature, including dissection.
Listen to your body. If it does not feel good or right tell the chiro or PT before they manipulate your neck. Hope it all works out for you!
@JustBreathe – thanks. So interesting! I’m so glad it worked out so well for you! I have had PT on my neck for years, due to TMJ issues. Wondering if that has made a difference in my symptoms, which are better than they were at onset. Dr. Hepworth is sending all of my records over to Dr. Katz, so I am assuming he will know not to manipulate upper cervical spine. But thanks for the reminder! Your experience does kind of make surgery sound appealing. My neck has been a mess forever. Now I wonder what role the ligaments have played in that.
The “alignment” is only as good as the muscle tone holding you up! Be sure to ask about home exercises to improve the muscles in that area immediately after any other kind of treatment. It is all connected and often is like peeling the layers of a onion which takes time and patients.
I am hopeful for you!
I hope that it helps! I’m sure that Dr Hepworth will pass on the info about what should & shouldn’t be done with your neck & if Dr Hepworth’s referring you to them, then they must be well qualified & experienced.
The confusion, which is common, lies not in who is doing the manipulation but what kind of manipulation is performed. PT and Chiro often use the same technique, a high velocity thrust manipulation, depending on their training. Thrust manipulation is not reserved only for chiropractors. I received 3 treatments of an isolated C1 high velocity low amplitude thrust manipulation by a PT followed by motor control training.
Sorry to jump in… If you have elongated styloids and especially stiff neck, it’s better to avoid high-velocity manipulations on the neck.
a) stiff neck might shift from one “stuck” position into another, which might be even worse
b) elongated styloids might tear your carotid arteries
c) if you had had a neck trauma (i.e. a whiplash), there is a chance there might be some scar tissue around your neck joints which has different characteristics than the original tendons/muscle/ligament tissue, and might get overstretched without gaining sufficient strength. Result-“loose” joint that doesn’t have strength to stay in place.
P.S. not a doctor here. Just a hobbyist anatomist.
UPD: it’s better to do a low amplitude, low velocity movements, literally, 1-2-3-4-5 mm at a time. That allows the tissue to “warm up” and become elastic, increase bloodflow (which means oxygen+nutrients) and also slowly gain strength+nerve control. All the professional athletes know how critically important is do to a proper warm-up before any high-intensity movements.
UPD2: think of high-velocity thrust manipulations as a micro-whiplashes.
Take a look at the post above dated March '21 - I addressed your point regarding avoidance of neck manipulation with elongated styloids. It is imperative the person working on your neck understands the deeply complicated anatomy and comorbidities related to ES and vES and is highly skilled, taking the appropriate pre manip/mobilization testing and precautions. There was a member who posted a great case study paper regarding this specifically, maybe one of the moderators can find it and link it to this conversation.