Patient No. 2: Neck and Arm Pain
A pleasant 55-year-old professor presented with a one-year history of neck, right shoulder, and arm pain. The arm pain would radiate down to the elbow. Her evaluation revealed extremely poor posture with the mid and upper portion of the thoracic spine being very bent. This caused severe protraction of the head and neck. Her low back was fairly flat. Moderate mechanical dysfunction was found in the thoracic spine and rib cage. Mild problems were found in the neck. Movement of the head and neck caused pain in the neck with radiation of pain in the right arm with rotation and/or side bending to that side. There was essentially no movement of the thoracic spine with movement of the head and neck, indicating a "kink in the upper thoracic spine.
We found very poor strength and recruitment in the postural musculature throughout the neck upper back. Muscles that control the shoulder blade were extremely weak and very poorly recruited. She had substantial difficulty isolating and controlling the trunk muscles. The patient was started on a home exercise program and manual therapy was provided to the spine and rib cage.
Five days later the patient noted substantial improvement. Her home program was reviewed and upgraded. Manual therapy was again provided with other modalities to further improve motion and reduce pain. With the patient's third visit we continued to upgrade her exercise program and work towards improving overall range of motion.
The patient's next visit was three weeks after her initial session. She noted discomfort only after walking her dog (who pulled on a leash) and working out on the same day. This session included and overview of upper body exercises.
When seen the following week the patient was doing extremely well. We made minor corrections to her upper body exercises and added additional exercises for her trunk and pelvic stabilization. She was shown advanced abdominal strengthening exercises. All of the areas were well recruited but fatigued rapidly.
The patient's sixth and final visit was five weeks after her initial session. She reported complete resolution of her original pain. She had occasional upper back and shoulder fatigue with sustained kitchen activities. A review of her exercises showed good technique. The patient was discharged after this visit.