A 42-year-old female patient presented with neck pain that had been present for two months. The pain came on gradually and without a specific cause. Her vocation is answering the phone for a busy mail order shoe store. She works 40 hours a week, 5 days per week. Her neck pain worsens with work, especially by the end of he eight-hour shift. Other pain producers include driving more than 30 minutes, reading more than 30 minutes, and washing her hair with the head back. Her pain improves when she rests her head on a chair or pillow, moves her head in circles, takes 600 mg of ibuprofen (repeated 3x/day), and after a hot shower. She describes the pain as an ache with intermittent sharp pain that is becoming more frequent, “…when I move the wrong way.” There is no shooting pain into her arms or hands.
Sound familiar? People with neck pain present to chiropractic offices around the world every day; however, each patient is different and every person is unique and each case must be individually managed. For example, some patients “hate doctors” or are extremely anxious about going to any doctor. This might stem back to a prior “bad experience” with a healthcare provider at a very young age or perhaps even a more recent event. Nonetheless, the approach used in this type of presentation may be best if it is very methodical, reassuring, and fully explained. A “low-force” type of manipulation may be best suited for this type of person as “cracking” of the neck may be too frightening for them. On the other hand, a different patient may not be happy unless there is a “good crack” and will not be satisfied until a chiropractic adjustment is performed.
It is equally important in both cases that a patient get a complete explanation regarding:
- What is the condition causing the symptoms?
- What can be done to treat it (that is, “what are my treatment options”)?
- Will the proposed treatment “fit” into their busy schedule, financial situation, and philosophy about healthcare?
Providing answers to these questions will usually aid in achieving the best results, as the patient will understand the issues most important to them and will have confidence that those issues are understood and appreciated by the doctor. In either case, management for this particular patient may include:
- Modifying the workstation by switching to a headset rather than pinching a phone between the neck and shoulder.
- Evaluating the patient at their workstation to check for proper posture at the desk, proper computer monitor positioning, etc. and making modifications as needed.
- Teaching the patient cervical range of motion exercises and other stretches that can be done at the workstation multiple times a day that only take a minute or two to perform.
- Cervical traction (if this “feels good” when tested during the exam).
- Use of a cervical or contoured pillow.
- Neck/upper body-strengthening exercises.
- The use of ice as needed.
- An anti-inflammatory diet (for example, a gluten-free diet).
- Nutritional supplementation, as indicated. Of course, most of the time, all of these approaches do not have to be included, but are options.
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