Chiropractic

[Jane424]

Can a chiropractic adjustment flare PMR? I have a separate back issue he treated and today I have flared badly. Thanks, Jane

[PMRpro Ambassador]

I suppose it depends on what they disturbed. I used to use Bowen therapy and therapeutic massage (still did up to Covid when it got a bit difficult here) and both would kick my myofascial pain syndrome problems and then I would aparently have a PMR flare. PMR and MPS are caused by the same inflammatory substance, IL-6, except while in PMR it is systemic, in MPS it is concentrated in so-called trigger points which can be felt in larger muscles and muscle groups as knots made of hardened inflamed muscle fibres. Therapeutic massage and manual mobilisation both work on those areas and as a result the IL-6 is released into the blood stream - with the apparent effect of causing a flare in PMR symptoms. In PMR the IL-6 is created every morning by the underlying autoimmune disorder - but in this case it is a one-off release and once it is flushed out of the system, the symptoms reduce. Gentle exercise in the fresh air (walking is ideal) and drinking lots of water helps a lot. In my experience, most alternative practitioners recommend doing that - did your chiropractor not say anything?

[Jane424 in reply to PMRpro]

No, he didn't. You make a lot of sense. I am hoping this is just a quick reaction and will calm down. Thanks so much, Jane

[Nightingales in reply to PMRpro]

Hi. Do you still recommend Bowen Therapy although it exacerbates the PMR? I have it and have increased pain for two or three days but I have such a good sense of well being after I have continued. I don’t know whether it releases endorphins or that my practitioner is so caring.

[PMRpro Ambassador in reply to Nightingales]

Oh yes - it doesn't exaccerbate the PMR, it just seems as if it does by releasing more inflammatory substance into the circulation which causes a brief period of pain but then goes. A bit like the Severn Bore causes transient high water - it isn't a lasting effect.

I used to use Bowen when I had access to a sensible down-to-earth NE lady and she was wonderful. They are a bit airy-fairy here with low lighting and music, charge a small fortune and aren't as good! OTOH, I can get a limited amount of therapeutic massage on the health service and I take all I can have!

[Nightingales in reply to PMRpro]

Thanks. That’s good to know. Oh I absolutely agree with the airy fairy, just makes me tense and irritable🤣🤣

[PMRpro Ambassador in reply to Nightingales]

I see it as an excuse to charge more! I expect efficiency and effect as I got with my NE lady - but anyone will struggle to be as good as she was!

[SnazzyD in reply to Nightingales]

I feel achey after mine but I don’t have PMR. I have to say, it is the only thing that has helped with all the Pred and deconditioning problems I’ve had. The other more hands on ‘heavier’ therapies and treatments have been too much to cope with.

[Coffeebeans in reply to PMRpro]

Completely agree PMRPRO. I'm a big fan of myofascial release because it works a treat.

At the last session I had a really stiff neck caused by a shoulder issue, completely resolved by two sessions but boy after that 1st session I knew about it. Hit by a bus feeling for 24 hours but fine after that.

Walked it off and drank lots too 🙂

[PMRpro Ambassador in reply to Coffeebeans]

Sounds crackers I know but if I feel rubbish for a couple of days after a session I know it has worked on something!!!

[Coffeebeans in reply to PMRpro]

Absolutely.

I've noticed that with PMR LOTS of weird tightenings and loss of flexibility that if I don't keep on top of I get other issues, like shoulder and hip pain.

I might mention that in our next PMR workshops!

[DorsetLady PMRGCAuk volunteer]

5 days ago you posted indicating that you were still struggling following an increase in steroids after Covid vaccine a couple of months ago.

Was your visit your chiropractor before or after your previous post?

I would say maybe your illness was already beginning to flare, and the chiropractic therapy was enough to send it over the edge.

Have a look at this for more info on treating a flare..and catch it quickly -

healthunlocked.com/pmrgcauk...

I appreciate you aren’t happy on Pred, but you do need to be on enough - otherwise you are between a rock and a hard place…

Pred side effects and not complete relief from symptoms.

[SnazzyD]

Before I had GCA, if I went to a chiropractor or osteopath, I would always get some sort of inflammatory response after a treatment, without exception. This would occur up to 4 days and this was for years, well before GCA was a threat. For this reason I steered clear of these treatments and found Bowen therapy much less provocative. Before thinking it’s a flare of your PMR, I’d wait a bit to see if it settles before a panic and whatever inflammatory response has receded.

[Jane424 in reply to SnazzyD]

Thanks. Some other PMR symptoms like skin tingly, hot and cold, exhausted. Don't usually have them after an adjustment. Bless you. Jane

[Kath567 in reply to SnazzyD]

That’s interesting. I went to my osteopath yesterday as my hips are feeling stiff and sore (I am 57) making it harder to walk, they certainly don’t feel any better today. I was on prednisone for two years, until October for PMR (round two). Maybe I shouldn’t go anymore.

[SnazzyD in reply to Kath567]

Hmm, sounds like PMR is still active which is not surprising after two years. Have you tried a trial week of Pred?

[Kath567 in reply to SnazzyD]

No I haven’t, couldn’t bare the thought of round 3 yet. If I start to feel like it’s intolerable, I may have to give it a try. Thank you for the suggestion.

[SnazzyD in reply to Kath567]

Looking back it is only about a year ago that you were thinking that PMR was the issue. Therefore it is likely that round three was still really round one. Do you mean you are taking Pred for a while and then stopping, having done that twice in a year?

[Jane424 in reply to SnazzyD]

I was diagnosed December 2020. Put on prednisone which stopped the symptoms dead. She then reduced me 5 mg a week. I reacted very badly, so she took me right off. I noticed that for several days after I stopped, I still had no pain. Then it came back. I asked if I could be on a low dose, which worked quite well. In June, things were getting worse, so she allowed me to increase the dose according to the international guidelines. I was maintaining at 7 mg and was about to reduce 1/2 mg after a month, when I had my first moderna. Three days later I flared badly which has lasted 10 weeks so far. My pred was increased, but I reacted to the higher dose, so was ordered to reduce slowly, which has improved things a bit. I had to be taken off dexamethasone during chemo, although they had drastically reduced my dose becaue of neuropathy and my blood work. So my doctor concluded I do not do well on steroids.

[SnazzyD in reply to Jane424]

May I ask what bad reactions you had and at what dose you started and for how long? Why did the GP reduce you so fast?

[Jane424 in reply to SnazzyD]

I don't know why she reduced me so fast. It was over the Christmas break and I couldn't get hold of her. Eventually, I went to ER, but the young doctor knew nothing and said so. He told me I could stop dead from 5 mg. Symptoms I was completely zonked till about 5 each day. No pain, but in a daze and off balance. Could hardly speak. Lay down a lot. I tolerate drugs poorly and have to edge in gently.

[SnazzyD in reply to Jane424]

What dose were you on at that time? Then what dose were you put on for your post vaccine flare?

I am one of those who become groggy and uncoordinated with Pred and whe. I was on from 60mg to about 20mg it made me feel like I had had a few drinks too many but without the fun. Since it was necessary to keep medicating, I took the Pred prior to bed so I was asleep for the bad bit, otherwise I could not function. Others on this forum have had the same issue. The trouble is most docs don’t really know about these effects so don’t warn you and become worried themselves rather than problem solving. I had Dexamethsone when on chemo too but didn’t know this was what it was as I felt too hideous already to know what was what.

[Kath567 in reply to SnazzyD]

I took prednisone starting fall 2017 until spring 2019; then again starting fall 2019 until just recently. I was off it for maybe 5 months in between. I think those are the dates although with this pandemic it’s harder to remember dates, everything becomes a blur.

[SnazzyD in reply to Kath567]

Is it worth considering staying on a small dose to hold things steady for a longer time rather than stopping and going up again and possibly giving yourself more Pred in the long run? Given that the median time for PMR has been sited as about 5 years, your relapses suggest that you need longer term support. What is your doctor’s opinion now you are facing another flare?

[Kath567 in reply to SnazzyD]

I don’t see him until February. He’s semi retired so hard to see. I go for blood work soon so will see how my numbers are. I was concerned about long term prednisone use and immunosuppression, especially with Covid and even with a low dose.

[SnazzyD in reply to Kath567]

I get that but a low dose of Pred may be better than a body coping with uncontrolled inflammation/ autoimmune activity if it meets with a Covid infection. If you had Covid badly you’d be given steroids. They saved my bacon when I got Covid in March 2020. Bear in mind symptoms can come up first before blood markers if they come up at all. If your hips are stiffening up, something isn’t right whether you are able to tough it out or not. Also, bear in mind the risk of developing GCA which makes PMR dosing pale. Is there no way you can call for advice via a rheumatology nurse?

[Kath567 in reply to SnazzyD]

There is no rheumatology nurse. Thanks for the information about Covid, I forgot they use dexamethasone. I will call and see if I can get an appointment sooner, with the holidays coming who knows. Thanks for your help.

[Jane424 in reply to SnazzyD]

That is what I am thinking of asking my doctor. I am now on 7.5mg which is maintaining me comfortably. I did have a blip with chiro, but that wore off in 24 hours. Will remain on this dose for at least a month and then see. Many thanks. Jane