The initial evaluation and treatment of neck pain in the case of Sukie B. investigated the causes of her pain by manually examining the muscles usually targeted in these complaints and others suspected to be involved based on her reported symptoms.
The attachments of the upper trap at the midline of the skull were so tight and tender that it made her feel nauseous! The knots between the top two vertebrae were hard and unrelenting with Trigger Point referrals “everywhere.” All of the attachments of muscles on the transverse processes of the spine and the deeper posterior layers beside the spine were painful. To be thorough, I treated her SCM for Trigger Points causing headaches and the scalenes beneath them for referrals to her arm, but these are not primary causes of pain in the neck.
At Sukie’s second treatment, she reported that she had been sore that night but had felt better the next day. (Soreness is from nerve irritation caused by the release of waste products stored by the tight muscle. As the circulation flushes the wastes, the soreness goes away.) She reported less pain with some days a 70-80% improvement, fewer headaches, and fewer medications needed even with higher work stress. Pain was no longer nauseating. The same muscles were treated as in her evaluation session and extra work was done in a side-lying position on the left shoulder where she felt burning pain. She left feeling taller and lighter.
At her third treatment she said she felt good with an 80% improvement a majority of the days. Pain was more localized now in the middle of the left trapezius. The same muscles were treated as in the second treatment plus the scalene muscles which addressed the referrals down Sukie’s arm. I taught her two basic Active Isolated stretches to do at home.
In the following treatments, Sukie continued to improve slowly and was able to add in activities like yard work that would have put her down before. She was able to complete an all-day meditation challenge in her MBSR course and was able to sit up straight longer. She added some exercise and a little yoga and found she was no longer in pain afterward. Around her thirteenth treatment she worked for two days painting her apartment! After the fifteenth treatment she reported that she felt good. She was able to do yoga almost daily with much less pain during and after and she was hardly taking any medications!
As she continued weekly 30 minute treatments, she would have flareups, and each time we would evaluate the source and make suggestions. The primary perpetuating factor turned out to be holding the telephone on her left shoulder. For this we decided on daily ice and stretch at night to relieve the day’s tensions, daily morning stretch to warm up the muscles before work, changes in phone postition and continual work on stress reduction.
To date, she is definaltely better overall but needs maintenance because of her perpetuating factors. She is using meditation, breathing, imaging and stretching to manage her symptoms at home between treatments.