Dear Dr. Roach • I’ve been going to chiropractors for 30 years. They help me when I have a pinched nerve, but they always want me to keep coming back. How do I know whether that exacerbates the problem? It seems to me that it may loosen things up so I have to keep coming back. — S.B.
Answer • Chiropractic spinal manipulation is considered a generally safe treatment for lower-back pain, and it is associated with some benefits in pain and function.
There remains controversy about rapid manipulation of the cervical spine in the neck, with rare reports of stroke following this procedure. It is not clear whether the apparent risk of stroke is due to the manipulation, or whether people with symptoms of a dissection happen to see a chiropractor, making an apparent connection when there is none. I am conservative and recommend against rapid neck manipulation, which is a plausible cause of damage to the arteries in the neck.
I do not believe that the manipulation of the lower spine for treatment of back pain causes problems that would require further treatment. I believe that chiropractors, like traditional medical doctors, truly want to help their patients, and offer follow-up appointments when they think they can be helpful. However, like any therapy, I would recommend against it if it isn’t clearly helping.
Dear Dr. Roach • I have high blood pressure, for which I currently take 10 mg of lisinopril. I had a transthoracic echocardiogram done, and “mild concentric left ventricular hypertrophy” was listed on the results. What does that mean? — D.K.
Answer • The left ventricle is the chamber of the heart that squeezes blood to the body (rather than to the lungs, which the right ventricle does). “Hypertrophy” means that the muscle of the ventricle is thicker than normal. “Concentric hypertrophy” means the thickening is symmetric, and that is most commonly seen in people with high blood pressure, especially if it wasn’t caught early or was not treated well for some period of time.
Lisinopril is generally a good treatment for most people with concentric LVH, but some people need additional treatment. Many physicians, including myself, try to get the blood pressure down into the 120/80 range in people with LVH, as long as they can tolerate the medication.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or request an order form of available health newsletters at 628 Virginia Drive, Orlando, Fla. 32803. Health newsletters may be ordered from rbmamall.com.