Patient No. 1: Neck And Shoulder Pain

A 65-year-old gentleman presented with a two to three year history of neck and shoulder pain. The problems had not resolved with rest and medication. He noted that the pain was now starting in the right shoulder.

Findings on initial evaluation included extremely poor posture. He had a bent rigid upper back that placed the head in a very protracted position. He could not lie flat on a firm treatment table and have his head touch the table. The muscles in the front of the chest were extremely tight, restricting overall shoulder motion. Motion of the head and neck was extremely limited and painful in almost in all directions. Mechanical dysfunction was found and treated in the thoracic spine and rib cage. The patient was started on a home exercise program. Because of the severity of the patient's postural problems the exercises were modified for comfort and effectiveness.

On subsequent visits manual therapy techniques were used with good success, but their benefit would have been extremely limited if the patient had not been compliant with his home exercises. No changes were made with the home program on the second visit. By the third and fourth visits we were able to progress the intensity of his exercises. A significant reduction in pain was noted after the fourth visit. 

The fifth and final visit was three weeks after the patient's initial session. Even though his posture was not perfect, it was much better than what we started with. The patient could lie flat on his back comfortably without any support under his head. He could raise his arms over his head comfortably. All of his exercises were much easier. The patient was discharged with a recommendation that he continue with his exercises on a daily basis.