A 41 year old man. He has been suffering from neck pain since March 2009 which was severe but is now mild, though constant, down the L side. He feels his neck is tense and tight and the pain is radiating down to the L shoulder area, mainly down the upper trapezius and deltoid.
He described the pain as sharp and shooting and is constantly present when moving head about. Work makes the condition worse (neck is flexed while welding over work station) and rest improves it.
Today the pain is very mild (1/5) but this can vary up to 3/5. R side of neck is pain free.
The primary complaint is neck pain radiating down the L side to the shoulder. Client has had 15 treatments with a Chiropractor who also specialise in Network Spinal Analysis (N.S.A) and trigger point work. I have enclosed a leaflet explaining more about N.S.A. My client had great results with his treatment – severe pain reduced to mild and L shoulder abduction was very limited (about 45 degree’s) which has improved to 90 degree’s. My client does not experience any pain while actively abducting his L arm but simply “can’t do it”. Chiropractor thinks the condition is a delayed reaction from serious injury in May 2006.
Client was the driver in a car accident May 06. He suffered 8 broken ribs, fractured horizontally and vertically, on the L side. This resulted in a collapsed L lung for which he had a chest drain. He was given no referral for any physiotherapy. He was off work for 6 weeks but it took much longer than that to heal and he was left physically weaker.
Objectives of Treatment
- break down scar tissue from previous injury
- improve mobility in L shoulder and scapula
- reduce neck pain
- strengthen, tone & lengthen muscles
- release any trigger points
- restore balance
- relieve fascial restrictions
- Spring test – tight and guarded between T5-T8, Strip erector spinae, rhomboids, pectorals, deltoids trapezius, scalenes, lateralising and vibration stripping to intercostals triangles
- frictioning around scapula, mobilisations to scapula, broadening to infraspinatus
- finger pressure to supraspinatus, teres major and teres minor
- NMT trapezius and rhomboids, cervical traction, friction TMJ
- cranial release, mobilisation – neck rotation, “russion dancer” stretch for thoracics
- lumbar roll – this helped improve ROM flexion of the trunk
Client feels relaxed but spaced out after treatment. he found the work around scapula/supraspinatus and deltoid a bit uncomfortable on L side. He found the intercostal work ticklish! Muscles and fascia on L posterior torso evened out. No trigger points found. No pain at rest after treatment.
Client felt pain free in L neck/shoulder after last treatment, felt re-vitalised and slept well that evening. He feels very tired today and energy levels are low. His R knee is better and there is no niggling/discomfort present. He is pain free today and there is no stiffness in his neck or shoulders. Stress levels are low.
There are no other changes to the consultation. There are no changes to the general assessment.
Client felt very tired but relaxed. He noticed his L side has more area’s of pain than the R but feels the treatment is helping and is pleased with the improved range of movement in abduction of the L shoulder. He also noticed that neck rotation has improved.
Client has been pain free since his last treatment and feels his energy levels are up. He is very cheery today as he is on holiday from work for two weeks. He feels the treatment is helping with stiffness in his neck and shoulders. He starts his training for 1/2 marathon this week.
- Spring test – tight and guarded between T4-T6, Strip erector spinae, rhomboids, pectorals, deltoids, trapezius, triceps, biceps & scalenes, lateralising and vibration stripping to intercostals triangles
frictioning around scapula, mobilisations to scapula, finger pressure to teres major and latissimus dorsi at axilla & supraspinatus
- NMT rhomboids, cervical traction, friction TMJ, cranial release, mobilisation – neck rotation, diaphragm release and stretch, abdominal ‘woosh’, “russion dancer” stretch for thoracics
Abduction L arm is slightly better after treatment but there is not the improvement I had hoped at this stage although client seems pleased about the tiny improvement that is there. Client noticed he felt less pain during this treatment and feels relaxed. There is a noticeable improvement with his posture after diaphragm stretch – his shoulders and ribcage are more open.
If client wants more of an improvement with range of movement of abduction of L shoulder then I will refer him to an Advanced Remedial Therapist or Osteopath. In the meantime I advise he continue to see me for the continuing breakdown of scar tissue and also for leg work/preparation for 1/2 marathon.
- Healing crisis – client may feel nauseous/headachy over next 24-48hr period as the body rids itself of toxins. This is perfectly normal and may or may not happen.
- Muscles may be sore and tender next day due to muscles being stretched / re-aligned. Again, normal and should pass over 24-48hrs.
- Water increase essential to help body rid itself of toxins – 2 litres p/day is necessary for the body to work efficiently.
- Rest and relaxation is important after a treatment to encourage the body to reach homeostasis.
- A hot compress may help with neck pain/stiffness. Be aware of posture when working
There has been a definite reduction in pain within the neck and shoulders and treatment has improved joint mobility in this area. Continuing to work on the relevant muscles will strengthen and lengthen them which will, in time, improve mobility further. L abduction of shoulder may not actually improve much further, depending on the extent of damage from previous injury. Continuing to work on the thoracic area and diaphragm will improve posture and open out the ribcage which was very damaged with previous trauma and will improve breathing and really help with training for 1/2 marathon. Including some leg work within a treatment will help prepare muscles for exercise and can help prevent injury.