Sarah's pain in the neck
Sarah, a 37-year old active woman, came to me for treatment for pain in her shoulders and neck. She had been troubled by this since falling off a ladder two years previosly. She described the pain as a toothache-like sensation at the anterior aspect of her left scapula when her neck was in a certain orientation. She also felt that her present condition may have been aggravated by an aquatic aerobics class she had attended two weeks earlier. Sarah also revealed, during the consultation, that she sometimes took St John's Wort to counter periods of depression.
Sarah had already attended physiotherapy, and for the six months before coming to see me, she had also been treated at a chiropractic clinic. Neither the physiotherapy nor the chiropractic treatment she had received had effected a sustained long-term cure for her. For the previous eight weeks, Sarah had resorted to wearing a neck collar to bed so that she could sleep.
Although Sarah had mentioned depression during the consultation, there was never any indication of this during the conversation or subsequent treatments. The observed tension around her neck and shoulders, during the initial examination, indicated stress and may have been a contributory factor to her condition.
The secondary effects of remedial massage therapy would assist in relaxation of the nervous system and encourage progress towards homeostatic balance.
I took a full consultation, recorded her medical history and noted her general practitioner. I confirmed that she had not sustained any fractures nor had any accidents and that she was not on any medication. She did not suffer from any condition which might have made me consider cautions or contra-indications to treatment. Also having had a chronic neck condition myself over the past seventeen years, as a result of a rugby injury, I was able to relate to her condition and also the treatment she would have been given by the Physiotherapist and Chiropractor. With the medical history and my assessment there was unlikely to be any significant structural problems in the region of the cervical spine, and that remedial massage therapy to the soft tissues involved in the neck and shoulders would be a very worthwhile plan to follow.
I carried out a visual examination on Sarah's posture and active mobility of her limbs and torso. I recorded that her left foot was slightly rotated and her left shoulder elevated. I also noted some imbalances in her neck and shoulder muscles. I asked Sarah to look up and down, side to side and to bring her ear towards her shoulder and compared sides. She found it painful to move her head to the right and the movement was also restricted. Looking up also caused some discomfort. I then assessed Sarah's shoulder movements comparing sides. Using my fingers, I then palpated around the areas and noted the ones that caused either pain or discomfort. Sarah showed me how she could move to produce the pain over her shoulder blade.
The assessment did not reveal any major problems with the superficial muscles around the neck and shoulders though the area that she complained of, was tender to touch. Sarah's shoulder mobility was impressive, which I put down to her job as a hairdresser.
We discussed the situation and decided on the following plan:
1. To treat neck and shoulder muscles with neuromuscular and myofascial-stripping techniques to release deep muscle tension and improve neck movement.
2. To search for any trigger points that may be causing the pain and making the condition be so resistant to treatment.
3. To use movements to help to balance muscles.
To discuss any self help that Sarah could do. Her job as a hairdresser obviously involves standing for long periods with extra stresses on neck, shoulders and arms. Stretches and some postural advice would be useful.
The first treatment. Since this was Sarah's first visit to a massage therapist, I gave her some information about Remedial Massage Therapy and how we concentrate on one area at a time. In view of her stating that she did suffer from depression, I considered a full body massage with relaxation techniques. However, our goal was to reduce neck pain so I concentrated on remedial therapeutic techniques, the major neck and shoulder muscles.
At the end of the session, Sarah felt very relaxed. However, she was not in a position to verify if any significant change had been made. Sarah's neck rotation remained restricted and still brought about pain.
On the second treatment, three days later, Sarah reported that she had slept like a log and felt better in herself. We repeated the treatment including finding a very active hot spot that did reduce dramatically during the session. We discussed posture, awareness and relaxation. When we have a painful area, it is very easy to maintain a strange posture. Sarah was much happier after treatment and promised to try and keep her neck and shoulders loose.
At the third session, one week later, Sarah reported that she has not needed to wear her collar since her treatment started. However, examination revealed that full neck rotation was still a little uncomfortable. I assessed again (I assess before and after every treatment so that I can see any changes). Sarah reported that, although she had a slight stiffness in her neck the day after the last treatment, she was beginning to get increased confidence with the general use of her neck. On examination, I detected a slight improvement in neck rotation.
At the fourth treatment session, four days later, Sarah stated that she had been gardening two days before and, despite much lifting and bending, she was happy to report that her neck did not give her any problems. However, she was aware of some discomfort around her right shoulder. During examination, Sarah could perform full active neck rotation without pain. We agreed that real progress was being made and I worked more deeply than I had been able to do before. I used mobilisations to help to balance the muscles.
Eight days later, at session 5, Sarah returned confirming that she has had no pain or discomfort with her neck or right shoulder and thought she would like a relaxation massage. I pointed out that it would be a good idea to check out her whole back and pelvis to ensure that all was balanced there. Sometimes, neck problems can occur as a result of a problem lower down. I found that her back did have some areas of tension and worked on them. As Sarah stands a lot, some Remedial Massage was applied to her legs.
At the next session, 1 month later , Sarah reported no changes from the last visit. She has now full confidence in the use of her neck.
During a follow up phone call 6 months later, Sarah confirmed that she has had the full use of her neck, without discomfort or pain. She reported that she attends the gym regularly three times per week and has started a yoga class.
The treatment that Sarah responded to was soft tissue remedial massage therapy which includes deep massage and mobilisations. This treatment, after several months of discomfort and pain, enhanced her own body's powers of self healing to reach and maintaining an increased homeostatic balance. I believe also that the relaxation aspects of the treatment were also a critical contributor. The relief to her discomfort and consequential increased awareness have given her confidence in the use of her neck, has reduced her stress levels, thus helping to maintain her present condition.