Question
Hi
I am a 30 yr old female who works as a Clinical Research Associate monitoring clinical trials, have a PhD and good awareness of the musculoskeletal system. My work involves daily travel - by car/train/ plane. I have had a whiplash injury for 5 months now and have have physiotherapy, seen an orthopaedic surgeon and pain management consultant.
My whiplash was caused by Scottish dancing when I was swung around on my right arm by locking elbows with other people in the line dance). Symptoms did not start until 4 days after when I felt stiffness in my right shoulder and this side of the neck. The next day my entire upper body went into spasm and I was prescribed diazepam. I received physiotherapy for three months during which time I was advised to go back to work (including travelling). Each time I travelled something else would 'go' and I would be back on courses of diazepam. The pain spread down my traps on the RHS and into the rhomboids. At the front my SCM, scalenes and levator scapular also spasmed. I started to get burning on the RHS of my neck (anterior)and face plus my first rib and clavicle began to protrude with pain in my right pectoralis muscles 2 months into the injury so my physio referred me to an orthopaedic surgeon. He ordered an MRI of my cervical spine because he thought I might have a c4 radiculopathy. The findings were: The cervical lordosis is reversed. There are quite marked degenerative changes at all levels with disc-osteophyte bars producing quite marked deformity of the theca. There is no evidence of cord compression. At C4-C5 the disc-osteophyte complex extends toward the intervetebral foramen, but there is no convincing evidence of neural compression of either here or at any other site. The spinal cord returns normal signal.
As a results of the severe right-sided paravertebral pain I was experiencing, I was sent to a pain management consultant to have facet joing injections from C3-C7. After these, 2 months on, I still have spasming on the RHS, albeit of lower intensity but my left SCM and scalenes recently went into spasm too. I have tried muscle relaxants, analgesics and gabapentin which haven't really calmed it all down - each time I attempt physio exercises aside from stretching, I end up in painful spasms. I am seeing another pain management consultant now who plans to do trigger point injections to break the pain cycle. I know that I have to gain core stability and do regular muscle strenghtening and pilates to keep my back in order after this but I am really worried about keeping my job. I have have to take almost 30 days sick this year as a result of this. I am a very motivated patient - I have always kept fit with aerobic excercise, eat well and maintain a healthy weight. Do you think the results of my MRI indicate that if I continue travelling in my occupation I will accelerate the onset of osteoarthritis? How do I get my lordosis corrected - when would be the best time to begin seeing a chiropractor? All my appointments with physicians have been rushed and no-one seems to have time to answer my questions. When I ask if the bulges in my neck can go back in or whether they are likely to herniate, I never get a straight answer - just contradictions.
I just want to know what my prognosis is and what I should be doing to prevent my condition worsening. I tried to attach pictures of my MRI for your info in MS Powerpoint but your web-site won't accept them - I can email them to you.

Many thanks in advance for your help.

Answer
Minal;

It sounds awful what you are going through here. I am a reeaallly slow typist, so I'll try to answer the questions and give my thoughts as concisely as possible.  

In reading your history, it's pretty clear that there has been a long history of you not being nice to your neck, with osteophytes, degenerative disc issues, and others. A simple plain film x ray would show most of the issues I read about, and would give a true indication of what your lordosis looks like.

When it comes to injuries, I like to look at what's causing them.  WHY are you going into spasm?  The body does this as a splinting mechanism to stabilize on an emergency basis, in my humble opinion.  THe body is not telling you "hey, give me diazepam!"

It sounds more like the neck is the cause of your problems, but it is a slave in part to the thoracic spine.  If you slump when you travel, it will drive your head forward, and light up your underlying condition.  Try putting a small thin pillow right where a bra strap would be, and see if that helps.  Having an inflatable neck cushion helps a lot, too.

As for chiropractors, I think you may find it a better option or a worse one based on who you in fact go to see... there is no STANDARD chiropractor.  Adjusting your neck may be best, but it might not.  Strengthening the neck is never a good idea when someone is in pain, as there is no reciprocal inhibition neurologically speaking in the c-spine.  

The best correction, then, is passive.  The items that usually help the most are a cervical pillow, (I like the Therapeutica, usually one or two sizes lower than they recommend) and the Posture Pump (check ebay) .

These are awesome tools that get 80% of my whiplash patients up so they can work.  THe pump and pillow can reduce the disc bulges.  Adding cervical traction in the mix is great, too.  I hope you see that there are many tools to help here.

I've written a reasonable article regarding the lumbar disc on my website, www.dynamicclinic.com, and many of those concepts apply here.

I know I've missed something, please get back with a followup if you would like more.  Don't give up hope, though. THere is some for everyone.