Case 1: 42 yr old female runner present with neck pain
42 year old runner training for marathon presents with neck pain that is progressively getting worse with time. Patient denies trauma or previous episodes of pain. Exam reveals chronic tightness into bilateral levator scapulae muscles, straightening of the cervical curve. Muscle strength and DTR within normal limits. After explaining what a chiropractor can do for this condition, patient agrees to try 4 visits. My treatment plan for this patients includes Heat to loosen up muscles. Graston Instrument Soft Tissue Mobilization to reduce inflammation, remodel scar tissue and further relax chronically tight muscles. NIMMO triggerpoint work to the attachment sites of the Levator Scapulae muscles. Goading or Massage to the Upper Trapezius muscles and Pin and Stretch to scalenes. Extension of the cervical spine exercises and stretches were demonstrated and patient was instructed to do these every night 3 times (forever). Self Stretch of the scalenes muscles were also demonstrated using strain/counterstrain method. Chiropractic Manipulative Therapy was used to restricted joint of the neck and thoracic spine. She was a great first time chiropractic patient, she was able to relax and let me do my work. I love working with athletes as they have a high tolerance for pain. After manipulation and exercises, Ice was applied for up to 10 minutes. Cervical Traction or Spinal Decompression was then given for recurrent headaches that she was reporting with neck pain. Cervical traction was set at 18 lbs of pull with intermittent drops down to 10 lbs of pull. Treatment time was 15 minutes. Ice Therapy was applied during cervical traction to reduce spasm and reduce post treatment soreness. After Cervical Traction she was placed on an Aquamassage bed for 12 minutes with ice on her middle back and her feet elevated. By the time we get to Aquamassage, the patient is feeling pretty good and that is the icing on the cake. Total treatment time: 46 minutes! 15 minutes of CMT and stretching, 19 minutes of Cervical Traction, and 12 minutes of Aquamassage. Not everyone has 45 minutes, we can adapt our treatment times to cater to your needs. I get my best results when I am not rushed, but some folks like to just get adjusted and get on with their day. This patient was seen 4 fimes and she is now pain free and is instructed to return PRN or as needed.
Differential Diagnosis: Cervicogenic headache, neck pain that is made worse with exercise. Segmental dysfunction of the cervical spine. Cervical kyphosis. Muscle Spasms. Dehydration headaches.
For discussion: Our bodies are over 60% water, so, as we exercise we have to rehydrate with electrolytes. If you forget to replenish your electrolytes, drinking lots of water can throw your electrolytes out of balance and you may actually have have heat strokes during extreme workouts.
Stretching should be an integral part of your daily routine. Michael Jordan, the famous basketball player, is rumored to have stretched up to 4 hours per day during basketball season. If you are not a person that likes to stretch, perhaps some beginning yoga classes could teach you the basics.
Just because we don’t feel pain doesn’t always mean we are healthy. Healthy tissue shouldn’t hurt. As I start examining patients, they are always surprised on how tender different parts of their bodies are. If you tell me your occupation and your hobbies, I can almost always pick out a few problem areas that will be either chronically weak or chronically tight. Both problems that can cause pain.
Sleeping in horrible positions can aggravate and exacerbate symptoms to a point of causing you to try drugs. Drugs complicate symptoms and conditions. Our body is designed to heal without drugs. Chiropractic is a drug-free, 100% natural, hands-on profession. This alone makes it a very good reason to try chiropractic first before you try prescription or over-the-counter drugs.
Patient was discharged after 4 visits, advised to return PRN (as needed)
Conclusion: Patient has segmental dysfunction and could of benefited from more care. Maintenance plan recommended for athletes. Future therapy should address reversal of cervical curve, home traction therapy recommended. Yoga to help stretch tight muscles. Calcium, Magnesium, and Zinc combination supplement for muscle spasms recommended. Increase Pure Water consumption to half your body weight (in ounces) 200 lb man should consume 96-100 ozs of water. More if she/he is a runner. Cross train as necessary, recommend cycle, swimming and or functional training to compliment marathon training.
