Neck and shoulder pain that is worsening for no particular reason; what did these two women have in common?
This is a story of two patients who developed chronic neck and shoulder pain, but had no idea why their problems worsened after having conventional treatments. One said her problem worsened after a massage. The other had a number of treatments that should have worked but didn’t resolve her problem. What did they have in common other than neck pain?
Her description; My neck has been painful on and off for the past few years. My regular doctor was unable to help so after a while, I saw a local doctor of chiropractic who performed manipulations to my neck and shoulder, while applying electrodes to the area on each visit. The doctor had an acupuncturist who also worked on me. The problems are getting worse over time and I am afraid I may be ill and something more serious may be going on so I am very nervous. I tried to use a special pillow which did not help at all and I am having problems sleeping so I am taking medication for that. I had plantar fasciitis three years ago and saw a podiatrist who made me custom foot orthotics which I do not wear.
During our history, the patient said she had was unable to squat due to chronic knee problems which are worsening. She was told the knee problems were due to aging. Prior to her neck hurting, she did not have any problems related to the neck or back. Also, she had a C-section years ago when she had her second child.
During our evaluation, her pelvis was markedly distorted and she had difficulty doing a squat without pain and felt like she would fall over if she went down further. One foot fell in while the other turned out and her left leg on the side of the foot falling in was slightly bowlegged. She also had no ability to bend to the right and felt the tension into her neck when doing so.
When she tried to extend, there was a notable restriction on the left side of her C-section scar preventing her from lateral bending to the right or extending. Those movements made her neck feel more tense and painful.
Her description; My neck has been sore on and off for the last year or two and it worsened a lot after having a massage this past weekend. I thought it was just tension and I have high blood pressure and I am on medication for the problem from my doctor. I am also a nervous person as well which can make me feel worse at times. I have no problems in the lower body but did have a c section when I had my children a few years ago.
During our history, the patient did not reveal any other details other than the fact she had a C-section years ago and did not think that was related to her current problem in her neck. Her blood pressure was slightly elevated but not alarmingly so.
During our evaluation, her pelvis was markedly distorted and she dipped to the left when trying squat. Both feet fall in, but the left side was more notable. She also had no ability to bend to the right and felt the tension into her neck when doing so. When contacting the C-section scar which has been tender to the touch for years, the restriction in her neck and shoulders worsened as she tried to bend to the right side, rotate or extend to the right side while standing.
What did they have in common?
You may notice that both women had foot problems that caused asymmetry but the larger and more difficult concern was their old C-section scars.
There is a growing body of evidence that is showing a link behind many abdominal surgeries and problems such as chronic back or neck pain, shoulder, problems, knee pain or even plantar fasciitis. Also, our office has had numerous patients who would describe their back locking up months after they gave birth, performing activities such as changing their baby on a changing table.
Over time, doctors have been developing many surgical procedures that avoid cutting into the abdominal area, because problematic scars, also known as active scars are difficult to treat since many of them can attach to organs, or affect the way our postural muscles work and function.
The second notable trait was both women were built asymmetrically and while, their lower back and legs did not function normally, they had no noticeable symptoms. Part of the problem is that since as discussed in the book Cheating Mother Nature, what you need to know to beat chronic pain, their inherited body type is prone to back problems because they are body are asymmetrical from the ground up. Asymmetry in the gait cycle is thought to cause back problems.
The problem for most doctors to overcome in cases like this is that they are taught to ask about a patients symptoms and to evaluate those symptoms, classify them as conditions and then treat each one of those conditions. They are not taught to ask or evaluate questions regarding how that person functions and then use that history to do a holistic evaluation. They are not taught to treat the whole person.
Our healthcare system has often failed to properly evaluate and resolve back and neck problems. The reason is likely that we are training healthcare providers to evaluate symptoms and we have failed to properly educate medical providers on how to evaluate the musculoskeletal system. This has led to too many expensive tests and a poor record of referring to the appropriate provider which is a large cost driver in our healthcare system. It is also why the growth of alternative or complimentary medicine has been extraordinary.
There is also a slowly growing awareness that existing abdominal scars may be active and problematic. An early attempt to screen and treat these patients when properly identified may prevent back and neck problems for years to come. Doctors need to embrace and be educated in why these scars may be a problems and understand how to properly evaluated them and advise their patients.
When having neck and shoulder problems, who should you see first?
Chiropractors are taught to evaluate and treat holistically and are a good first choice. Current data suggests that your experience with a health problem is dependent on who you visit first. Find a chiropractor who is trained in myofascial release, specializes in athletes and uses active evaluation and treatment protocols to get the best outcome.