I have written this mini-case study on Mrs Jones who has neck pain with an associated headache. I regularly see people with neck pain and some end up suffering with headaches, from their neck before they decide to seek chiropractic care. Mrs Jones is a fictitious patient. She is based on a combination of individuals that I’ve seen and I’ve added some details which are typical of this type of condition.
The sections in bold outline what I and my chiropractic colleagues at Lushington Chiropractic would do as part of working up someone’s case. Essentially with all our new guests we run through a triage assessment which consists of taking a medical history, carrying out an appropriate physical examination and if necessary x-rays in order to reach a diagnosis. We then take time to explain our findings and the potential care options to the guest.
Please also note I use the term “guest” instead of “patient” because I believe that customer care and a genuine personal touch is at the heart of all that I do. I appreciate the people I see are patients and I am responsible for their clinical care as I am their Doctor of Chiropractic. I never forget my clinical, ethical and moral responsibility to the people who see me. However, I also remember that the people who see me are people and not just a “case” or a “diagnosis” which is why I like the term guest.
My initial new guest consultation at Lushington Chiropractic is an hour long appointment. In this time I aim to get to the root of the problem, find out whether Chiropractic treatment is the best course of treatment for you and what other alternatives may suit you.
This was the first time Mrs Jones had ever suffered with neck pain and / or headaches. Her pain was mostly at the top of her neck and across her shoulders. It came on 3 months ago but she couldn’t think of anything that may have caused it. She did remember having a nasty cold at the time.
Mrs Jones noticed her neck movements were significantly reduced and was having trouble driving, because she couldn’t turn her neck at junctions or to reverse. She was finding that her neck movement was achy, stiff and made a gritty, grinding noise. The only time she felt comfortable was when she was resting and relaxing.
After I have taken the history and am happy that I’ve found out as much information as possible, I usually have a diagnosis in mind. However, I always do examination to find out exactly what’s going on and to rule out any more serious conditions whilst I confirm our diagnosis.
I started my examination by looking at Mrs Jones’ posture. A posture assessment can give a Chiropractor a lot of information. I found that Mrs Jones’ shoulders were a little rounded when I first met her.
Rounded shoulders are quite common and I’ve found a lot of office and computer users who sit over their machine all day end up with this type of posture. I’ve included a diagram to show this common rounded posture. Notice how your shoulders and back can become rounded with your neck leaning forwards. Mrs Jones was not as bad as this picture but I’ve seen plenty of people who are. It’s a common posture type and has its own name: “Upper Crossed Syndrome”. The reason it’s called a “Syndrome” is because it involves a range of muscles and joints.
As well as assessing Mrs Jones’ posture I observed her neck range of motion, which was very limited in all movements especially when trying to look up at the ceiling. I carried out a series of neuro-orthopaedic tests for her neck. After this, I examined how the rest of her spine moved.
Next I examined the muscles around her neck. These were all extremely tight and tender. There are two neuro-orthopaedic tests I do specifically for the neck. These are called Spurling’s test and Doorbells. Both these tests reproduced her neck pain, suggesting that it was more of a problem with the joints in her neck rather than the nerves exiting.
I then carried out a thorough series of muscle strength tests. Testing muscle strength can tell me how healthy the muscles are and how well it’s nerve supply is working. I also checked how accurate her sensation was using a tuning fork and pin wheel. As a final part of my neurological assessment I checked her reflexes. All the neurological tests were unremarkable and within normal limits.
I use pin prick sensation, vibration sensation, muscle strength and reflexes to help examine the nervous system, this enables me see if there is a compromise in the nerve supply.
From all the test results put together, I diagnosed her with a sub-acute, mechanical neck joint irritation with associated increased tension in the surrounding musculature leading to her suffering with headaches. Also known as cervicogenic headache.
When muscles in the body are tight they can refer a sensation of pain to other areas. One of the most common muscles to do this is the upper trapezius muscle. This runs from the edge of your shoulder (acromion process) up to the base of your skull (nuchal line) and down to your mid back area. It’s a very large muscle and gets especially tight with an upper crossed posture such as in this case.