Neck and Upper Back Injuries
SIGNS AND SYMPTOMS
Mr x , is a 43 year old office worker who attended the clinic with a 3 month old NECK and UPPER BACK/SHOULDER PAIN .The patient has a continual area of pain and irritation in the neck and upper back which is worse on sitting for prolonged periods at a desk top computer , which he must do for this job, ALL WORK STATION ANALYSIS HAS BEEN CARRIED OUT AND ALL RECOMMENDATIONS IMPLEMENTED, such as , alteration of desk height and change of chair, etc. There is an increase in pain and irritation when doing more strenuous activities such as playing squash and going to the gym.
On examination the patient has restriction on all neck and upper back movements with a mixture of pain,stiffness .On palpation the patient presents with increased tissue tension in all the neck muscles with major trigger points in Right and Left trapezius .
The patient has visited the Doctor and was given a 2 week course of anti inflamatories which soothed the problem initially but normal level of irritation returned after stopping medication. The Doctor the organised some physiotherapy on the NHS.
TREATMENT PROTOCOL
It was then explained to Mr x the treatment and rehabilitation protocols required with regard to the “ boxes that needed ticking “ and the time scale required to achieve these outcomes.
The GOALS of the management strategy are to :
1. Improve the quality of the soft tissues by reducing the tissue tension and removing the triggers
2. Restore normal , or near to normal spinal mechanics
The management strategy can be divided into times from the initial consultation onwards so that the patient knows what to expect at each stage and how long each stage will last. Outlined below is a typical scenario.
To improve the quality of tissues , this is achieved by various types of deep soft tissue massage, specifically working on the tight and stiff areas , as well as the various triggers ( areas of muscular pain ) in the soft tissues. Normally this would be carried out twice a week for 30 minutes with maximum time between the two sessions to let the soft tissue bruising settle before next session , it must be painful to have an effect !! The patient has around 4 to 6 sessions of this. PROTOCOL FOR ONGOING MANAGEMENT To maintain the improvement in the soft tissues the patient would need to visit the clinic on a 2 monthly basis to have a “ top up “ treatment session.
PROTOCOL FOR 0 -4 WEEKS
To restore normal spinal mechanics , this is achieved by manipulating the lower back joints that are “ stuck “ and not “moving correctly”.These manipulations are carried out at the end of the soft tissue massage sessions above.
At the end of the protocol the patient reported 90% decrease in pain and irritation in the workplace and all recreational activities.
