Question
I have had severe pain and tension in my upped back and neck for a couple of years.  I was having some muscle spasms between my shoulder blades and also some mild discomfort in my neck.  I was seeing the Worker's Compensation approved physician and he made manual adjustments to my neck on about three occasions.  The very last time, he was feeling the bones on my neck and I did not know he was preparing to adjust it.  He twisted and lifted and whatever else is done completely out of the blue and there was a sickening crack/pop noise and it hurt.  My eyes had been closed and after he did it, my breath caught and I just laid there for a second.  He said, "Are you still with me?" kind of tentatively, and I said yes, of course.  Ever since that time, I've not been right.  There is a lot of crackling/pain/tension/discomfort from the base of my skull down to about my mid-back, mostly on the right side concentrated at the base of my skull.  I was under a lot of stress at the time and after due to the injury and how it affected my ability to work and so forth, so some TMJ-like symptoms came on and persist, making my neck even more tense and painful.  I've done some PT, massage, rolfing, low-force chiropractic (with a different doctor, of course), yoga, walking.  Staying active seems to help some, but nothing really fixes the problem and I am left feeling fatigued, uncomfortable, and in varying levels of pain from annoying to awful.  There is always a pulling, unbalanced sensation underlying it all.  Do I have any options left?  What about Prolo-therapy?

Answer
Dear Amanda,

First let me apologize for not getting back with you sooner. I have been literally swamped at my clinic and just couldn't get a response generated.

You have been going through the correct channels for conservative correction of your symptoms, however, it doesn't seem to me that anyone has actually tried to figure out what your problem is.  What diagnoses have you been given? Why did you initially go to a work comp doctor...did you have a specific job related injury or just pain at work?

Chronic neck and upper back pain is often the result of deconditioning of the spine, however, without a plan to correct it, spinal adjustments and massage will only offer temporary relief, and the symptoms will just return.  I you work at a desk all day, or if you have repeated tasks as part of your job responsibilities, these issues need to be addressed for proper movement patterns, correct posture and ergonomic considerations.  

Prolotherapy is not really an option at this point.  The treatment is really aimed at the abnormal inflammatory processes that have occurred due to injury in the cartilaginous structures.  This treatment is used quite frequently for cartilage injuries of the ribs and sternum to initiate a new inflammatory reaction so that proper healing can occur, but I have not seen it used readily for muscular injuries.  Again we need to figure out what the diagnosis is first to figure out an appropriate course of action.

What is the low force chiropractor doping for you?  If it is only spinal adjustments with no focus on strengthening the weak musculature or stretching of tight fibrous areas, then he is missing the boat as well.  You need to get to the root of the initiating problem first, and active rehab protocols are needed to regain function, mobility, biomechanical integrity in relation to the gravitational environment that you work in everyday, as well as pain reduction.  People in chronic pain often have structural and functional imbalances that have been present for years, and they will not be fixed in weeks.  You most likely have structural deformation of your neck curve from chronic poor posture, and this will need to be addressed to help fix the problem.

Let me know what diagnoses you have been given...what x-ray or MRI findings there are, and any additional information, and I will be happy to expand on this information.

Respectfully,
Dr. J. Shawn Leatherman
www.suncoasthealthcare.net