By Dr. Yoon Jeon. MChiro, MB, BSc, Dip.TCM, PGCert.
A 33-year-old office worker, married father with one child, presented to the clinic with complain of neck pain and shoulder pain. The neck pain started at about a year ago, triggered by the stress associating with headache. The shoulder pain has also been developed last a couple of months. He had been treated by the several strong painkillers & muscle relaxants. However, these medications were not sucessful in his complaints. The neck pain is aggravated by the left lateral bend or rotation of the neck, but there is no specific relieving factor. The shoulder pain is mostly a dull ache.
On the examination, the trigger points the upper trapezium (a shoulder muscle) bilaterally causing the referral headache are noted (L>R). There are restricted left C0-C1 (upper neck spinal joints) and CT junction (between neck & upper back). Flexion and extension and left rotation/ lateral flexion of the neck cause the left upper trapezium pain. The cervical (Neck) and shoulder orthopaedic/ neurologic tests are not remarkable. The SMR(Sensory, Motor, Reflex) of upper/lower limbs are within the normal limits.
The patient also complained of the headache with the neck stiff ness. It is quite common that the headache is associated with the cervical joint dysfunction. However the headache may also associated with the referred pain pattern of the muscle trigger point.
Overall, the patient seems to coexist cervical spine dysfunction and trigger point. Therefore, treatment consists of cervical spinal manipulative therapy (SMT) and soft tissue work including trigger point therapy, dry needling, stretching involved muscles and myofascial release.
Chiropractic Cervical Spine Manipulation/ Adjustment
Myofascial therapies - Trigger point therapy and stretching suboccipital muscles
Dry needling (Acupuncture)
Posture and ergonomic advice
Chiropractic spinal adjustment was applied to the C1-C2 facet’s joint (Upper Neck Joint) with a high velocity and low amplitude thrust. Many studies reported that spinal manipulation was found superior to other therapies such as muscle relaxants and medical care (Hurwitz EL, Aker PD, Adam AH, Meeker WC, Shekelle PG.1996) and Dry needling (Acupuncture) was applied to the tender points & spasmed muscles directly. Putting a needle into a spasmed muscle causes the muscle to relax. This can be seen with an electromyogram. (Cummings & White, 2001).
By the three week of care the patient’s symptoms of severe neck, shoulder pain were completely resolved. He was last seen for this complaint three months after onset and was asymptomatic.
Hurwitz EL, Aker PD, Adam AH, Meeker WC, Shekelle PG.Spine,1996. Manipulation and mobilization of the cervical spine: a systematic review of the literature. 21:1746-60.
Cummings, T.M., White, A.R. 2001. Needling therapies in the management of myofascial trigger point pain. Archives of Physical Medicine and Rehabilitation 82:986-992