Yusuf – Severe Neck Pain
Yusuf, a 39 y/o patient, who is a desk-based service advisor and busy dad of 2 came in suffering from severe neck pain and reduced function in his left arm. He had a long history of neck pain and “trapped nerves,” but he had never experienced anything of this nature before. His recent episode started 3 days prior to his appointment and came about the night after lifting something heavy into his loft, following a recent house move.
His pain was extremely severe and a constant 8/10 with restricted movement. It radiated from his neck all the way into his back and was significantly affected by arm movements.
On assessment, there was a marked reduction in his cervical (neck) range of motion more notably to the left. He had a postural presentation consisting of forward head carriage and rounding of the shoulders. All his upper limb neurological markers were normal, but there was a profuse spasm in the posterior neck musculature as well as the scapular stabilisers predominantly on the left-hand side. Segmental range of motion was restricted most notably at the level of C3-4 consistent with the attachment site of the left levator scapulae which was in spasm. There was a notable weakness of the left arm and pain in all shoulder movements.
Given the combined history of desk-based work and repeated neck spasms, it would be fair to say that Yusuf’s postural changes were a gradual progression over a number of years. These gradual changes had resulted in compromised spinal mechanics increasing the loads upon his posterior cervical musculature and the cervical spine itself. Without undergoing any imaging, it would be fair to assume a degree of degenerative disc disease in his cervical spine. These existing observations coupled with his recent house move created a mismatch between his physical demands and his physical efficiencies. This resulted in an overloading strain injury to his levator scapular and subsequent cervical vertebrae creating a vertebral subluxation complex at C3-4.
Correction of this Acute episode would not only require management of the local inflammation and restoration of spinal segmental function, but it would also require management of the local muscular spasm. Ideally, long term management would entail postural correction and re-education in order to alter the lifestyle factors that led to the development of the dysfunction in the first place and prevent progressions that would likely lead to more severe degenerative disc disease in the cervical spine with the risk of significantly impacting the quality of life.
Yusuf initially underwent an 8-week program of multimodal therapies consisting of chiropractic manipulative techniques, cervical distraction, IASTM (Instrument Assisted Soft Tissue Mobilisation) technique, manual therapy, fascial stretch, wet cupping (Hijama) and dry cupping methods.
During his program, Yusuf saw a significant improvement in his cervical range of motion, pain levels and function. There were mild alterations to his posture, however, these changes require a much more active approach and Yusuf has committed to implementing a more active lifestyle that will encourage better function and alignment of his spine and general biomechanics. He will now progress with a monthly maintenance care plan in which we will coach him with further rehabilitative exercise and supplementary care.
This is an all too common scenario that we see on a daily basis in which patients are led to believe that their issues are the consequence of a one-off minor incident. Unfortunately, conventional management will usually guide these individuals to unnecessary and expensive MRI imaging that will pick up often pre-existing spinal degenerative changes that consequently justify recommendations for unnecessary high-risk surgical intervention.
Although scientific data demonstrates that imaging in such cases plays little significance to clinical outcomes, this level of dangerous mismanagement is still extremely common and driven by ill-informed physicians, outdated protocols and an unhealthy demand of consumers for a quick fix instead of understanding and taking responsibility for postural biomechanics.