A forty-four year old man enters this office with obvious pain and discomfort in the neck, upper back and right arm. The patient describes an on-the-job-injury where he heard and felt his neck “pop”. There was immediate, sharp pain in the neck and arm. The patient went to the emergency room immediately. He was examined and x-rayed. He was advised that he had pulled a muscle in his neck and shoulders. He was given prescriptions for muscle relaxer and advised to rest for three days before going back to work. Approximately forty-eight hours later the patient comes in this office with his complaints a lot worse. The patient can find no comfortable position and the prescriptions are not helping.
Examination of this patient revealed spasms in the neck and upper back with edema in the neck. Reflexes of the right upper extremity were absent at the biceps. Cervical compression tests were exquisitely painful on the right. There was a measured reduction in the range of motion of the neck.
The patient was x-rayed. The x-rays were reviewed with the patient. A very thin disc was demonstrated at C5-6 and C6-7. This was discussed with the patient. In light of his history and my clinical findings I decided to order an MRI of the neck.
MRI of the neck was performed. Evidence of a ruptured/extruded disc at C5-6 with a herniated disc at C6-7. The patient was advised of his surgical options. He refused to have surgery. I informed him of the possibility of limited success with spinal manipulations alone. I further suggested that spinal manipulations might give him temporary relief without affecting the extruded disc. He requested that I treat him. I advised a surgical opinion before proceeding. The patient agreed.
The patient returns after conferring with a neurosurgeon. He understand the necessity of surgery but still refused. He again requested I treat him. Treatment began the same day.
The patient was taken off work. Spinal manipulations were administered to the thoracic spine to use the mechanics of the spine to reduce the effects of the extruded disc. The patient returned the next day to declare that he got his first night’s rest since the injury.
The patient was placed on a conservative program of spinal manipulations to reduce nerve pressure with specific therapies to reduce the muscle spasms. After two weeks the patient was re-evaluated. The patient had a reflex at the right biceps. The cervical range of motion had improved but was still restricted. The patient was able to sleep all night. The patient remained off work.
Over the course of the next few months the patient progressed to the point of being comfortable. He could take care of himself and his kids, but he was permanently injured and unlikely to return to his previous employment. His work comp case settled to the patient’s satisfaction.