Question
I had an anterial cervical fusion.  No wires, just a plate and screws.  As for the scalene muscles, should I have someone massage them or just do the push-ups.  I will ask the chiro to tape my rib down, he is good but I don't think he would appreciate me suggesting things. I will look into the SCRIP clavicle brace.  But why isn't he suggesting these things? I am getting more and more frustrated.

I do use a Therapeutica pillow (just started re-using it last night), I will try to locate a cervicle brace from SCRIP, and try the push-ups with no bent arms.  If you know of any physicians that do your type of rehab in my area, please let me know!

I live in Davenport, IA the home of chiropractic.  Palmer College is a mile from where I live!

Thanks,

Amy K Larson

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The text above is a follow-up to ...

-----Question-----
Doc,

I had a car accident in 1999.  There were 3 bulged discs and one sequestered and logged in my spine.  I had  emergency surgery and had a fusion at C3-4.  Did PT with a chiropractor for 3 months and was PERFECT.  5 years later one of the previous bulged disc got worse and had another surgery of the removal of the plate in C3-4 and fused C4-5.  I did not do re-hab and have suffered miserably!  I get adjusted 2 x a month by a FANTASTIC chiropractor but in the days between my adjustments I am miserable.  I know what my problem is....My first rib on the same side as my incision (went thru the front) left side goes out twice a day.  My husband can now stretch my shoulder and get it temporarily put back in place for a quick fix.  Once in the morning after a night of not sleeping due to uncomfortableness of my rib/neck.  And once after work or before bed.  I know when my rib POPS out of place. I have no idea how to stabilize it.  If I hear strengthening the rhomboids one more time, I will go crazy!

Please, please, please HELP!

Amy K Larson
-----Answer-----
Dear Amy,

This is a very complicated issue due to the trauma and multiple surgeries.  Yes rhomboid strengthening will help, but it is not the only area to address.

First I have to ask, was your spine only fused from the front into the vertebral bodies?  The ACDF surgery is the most common, but some remote instances require wire placement as well as plates.  If the spine has any wire around the facet joints, mobility is lost and you may never be able to "fix" the problem.  Additionally, did the surgeons fuse your spine in a Lordotic position (curve toward the front)?  This lordotic position (normal curve) is very important to maintain, and is very important for the biomechanical function of the spine, ribs etc...

Now there are specific muscle groups that must be addressed.  The scalene muscles are located on the front of the spine and attach to the first rib and clavicle. You have three scalenes; anterior, middle and posterior. If they are shortened and tight, they must be stretched to allow for reduced tension of the first rib and clavicle.  In addition, the anterior and posterior serratus muscles need to be balanced and functioning properly to alleviate upper thoracic rib cage stresses as well as stabilize the scapula and further reduce rhomboid tension.   A good exercise for this is a serratus push-up.  Normal push-up position, but keep the arms locked.  You lower your torso between your arms...the motion is only about 2-3 inches...then push your torso back up.  Your arms never bend!!

Now if you are visiting the Chiropractor, which I would recommend, make sure that he/she tapes down the rib after it is adjusted, and leave the tape on for 3-5 days for stabilization.  The joint capsule must have damage for the rib to continue "popping in and out", and this needs to be stabilized, or you will never improve.  You do not want to have your husband continually mobilizing a joint that is already inherently unstable...this will only create further dysfunction and ligamentous laxity in the joint.  There are also clavicle braces that will work well to aid in 1st rib stabilization that can be purchased for about $30.00...ask your chiropractor-he/she can order one from SCRIP Supply and have it for you in a week.

You should also be sleeping on an orthopedic pillow for correct support of the neck...Sleeping on your back...again your chiropractor can get you a good one.  Prices range from $45-$95, and it should last for years.  You need to reduce and try to eliminate sleeping on your side as it places asymmetrical stress on the shoulder/clavicle/rib/neck junctions.

Lastly, You should have gone through some type of neck conditioning program/PT after your last surgery.  Incorporating the above ideas/exercises will help, but I am sure your chiropractic physician can develop a more appropriate rehab regime due to more in-depth knowledge concerning your history, examination and current problem.  I encourage you to schedule an appointment with him/her to address these issues in more depth and to order some bracing for the area.

Good Luck Amy, let me know how things progress.
Respectfully,
Dr. J. Shawn Leatherman

Answer
Dear Amy,

As far a massage goes, yeah it would be a good idea to have a massage therapist work on the neck. Call around and find one who will also incorporate active an passive stretching in to the neck along with the massage...you will get faster and better results with the aid of stretching.  

Concerning the chiropractor, I do not know why he/she has not explored options with you, Remember not all doctors are created equal!!  In addition if your chiropractor has problems with you suggesting treatment options that he/she has not considered, then maybe you should look for a doctor that will consider alternative options, being in Davenport, there should be plenty to choose from. Remember that good hand skills and adjustment skills does not necessarily equate to good diagnostic and rehab skills. Conversely, the student clinic may be a hassle, but many times you get great care at the colleges because the students are truly invested in the learning process and have clinical supervision along the way.  The only problem is many times they are limited by the clinic phiolosophy, or procedure and rules.

Now the braces that I mentioned, can only be purchased by a doctor, or maybe through the school.  SCRIP does not sell to the public...sorry!  Also it is a clavicle brace, not a cervical brace...make sure you get the right one to stabilize the actual rib articulation.

Below you will find two doctors that should have a good understanding of injury and rehab protocols as they are sport certified.  I do not know them personally, but they have been through some of the same advanced curricula that I have.  Give them a call, and schedule a consultation.

Dr. James Owens(563) 884-5831    [email protected]
Dr. Jeffrey Wisdo(563) 344-6060   [email protected]

Good Luck Amy. Keep your head up!!
Respectfully,
Dr. J. Shawn Leatherman