A Real Pain in the Neck!
Last weekend I had the pleasure of travelling to Ireland for a Pop Up Clinic in Dublin.
I had some interesting cases, but easily the most interesting was a case of a gentleman who had recently undergone surgery on his neck for severe pain and a loss of function in some of the muscles of his upper body. He had also experienced some altered sensation in forearm and hands.
He told me that he had experienced months of pain, culminating in being unable to lift his arms above shoulder height. He was unable to tightly close his hands and his golf swing had deteriorated completely. Being quite a competitive golfer, this was clearly not acceptable!
Having had neck surgery which involved a discectomy and fusion in the lower cervical vertebrae only weeks before, he had expected that his pain would disappear after the surgery. And it did, but only for two days.
Unfortunately for this gentleman, it seemed that there was more contributing to his pain and loss of function than just the structural issue that had been resolved through surgery.
During assessment, it was clear that there was a loss of function in the muscles of his grip and forearm. Using P-DTR® we found that he was able to withstand a one off test of function, yet with repeated testing, his functionality declined rapidly. In a scenario like this, if there have been MRIs. X-rays and even surgery to find out about and treat a problem, it is very likely that the person in pain will have had all potential structural issues assessed and treated.
As alluded to before in this blog, structural issues are a contributing factor to painful presentations, but they are only one contributing factor. Not necessarily the main one in a lot of cases either!
As this gentleman had undergone surgery, which was successful in its objective to remove the cervical disc and stabilise the lower vertebrae, this effectively meant that any potential structural problem in the vertebrae of the spine had been dealt with.
We turned our attention to potential functional issues that were impacting upon his symptomatic areas. In this gentleman history, was a significant cycling accident about 30 years previous, that had caused him to need (in his words) "roughly 150 sessions of physiotherapy", at the time.
What we found from our assessment was a state of upregulation of the scalenes muscles bilaterally, and inhibition of the SCM muscles (larger more powerful muscles that rotate, side bend, flex and extend the neck). The scalenes were serving a protective function, to help manage the movement of the head and neck whilst the SCM muscles had been inhibited. Unfortunately in performing this function, the scalenes themselves were causing their own issues!
After restoring the function of the SCM muscles using P-DTR® treatment techniques, both the SCM and Scalene muscles were now functioning normally on both sides. This resulted in much greater range of motion in the neck, and much less pain.
Functionally, the muscles of the forearm and grip were much improved. So much so that the gentleman reported that he was now able to fully close his fists and maintain them gripped tightly without any pain at all and that most of the altered sensation of his forearms was improved.
In this case, it appeared that the gentleman was suffering the effects of a functional compression of some of the nerves as they passed under the scalenes muscles in the neck. By treating the functional issue that caused the upregulation of the scalenes, he no longer suffered from the results of the compensation strategy outlined above.
I will look forward to following up with this gentleman at my next Pop Up Clinic in Dublin in August and I hope to hear that his golf game has improved again :) If you wish to put your name down to be contacted for my next clinic please email me using the following address: