My Personal Bout with Acute Neck Pain: The Onset ~ Part 1 of 3
The Onset
Evaluating and treating individuals with neck pain has been my specialty over the past 15 years. I have literally treated over a thousand people suffering from this affliction. Recently, neck pain became a much more personal issue, as I experienced the sort of agony which some of my patients deal with. For the past 20 years, my neck has been intermittently stiff, with the occasional inability to turn my head for a day or two and what felt like an acute muscle spam, but there has been nothing of serious concern. This was different. While still in bed, I opened my eyes in the morning and noticed neck stiffness when turning over. Could this be one of those mornings where there would be trouble turning my head? Better to get up slowly. I sat up and immediately felt a rush of nauseating pain sweeping into my low neck and then shooting into my left shoulder blade. I don’t have time for this I thought. Into the shower for some hot water on the neck and down the hatch with 600mg of Ibuprofen. I drove to work applying traction to my neck with both hands and steering with my elbows and knees. A smarter man would have just stayed at home and called in sick. But I had patients that depended on me.
Luckily, this was my short day of the week at work. My neck pain steadily grew worse and by 2PM I was stuck with my head down and turned to the right, avoiding the worst ache. I utilized a home traction unit from work and had to go very slowly and gently not to aggravate my symptoms. That night, I managed about 2 hours of sleep, constantly readjusting to avoid pain.
The next morning, I called a physician friend of mine and he prescribed me a round of oral steroids. After 3 days, my neck pain slowly started to improve and within 1 week I was 75% better and training on my road bike for short periods. Unfortunately, this progress did not last.
8 days after the initial onset, my symptoms suddenly returned in the morning and were even worse. At this point I had to be honest with myself about the serious nature of my neck problem. My symptoms included weakness in the left arm, severe pain behind the left shoulder and into the shoulder blade, severe neck pain, numbness in the left hand, and I could not extend my neck or turn to the right. This was a very familiar presentation, a cervical radiculopathy. It had to be a disc bulge in my low neck that was inflaming and compressing one of the spinal nerves. Megan Peach, DPT, here at Excel PT did a great job at treating my acute problem, but my presentation was too severe to benefit from PT at that time. I decided to make an appointment with a local orthopedic specialty physician.
My Personal Bout with Acute Neck Pain: Recovery ~ Part 2 of 3
Recovery
As a physical therapist specializing in treatment of the spine, I had a great deal of experience with the physicians at Bridger Orthopedic & Sports Medicine. This seemed like a good place to seek advice and help for my agonizing condition. I called Christine, a patient care coordinator at Bridger, and she was kind enough to get a same day appointment for me with Dr. Speth and Bryce Wiley, PA-C. They performed a very thorough evaluation and determined that I most likely had a cervical radiculopathy. I was in for a cervical MRI the next day and Bryce called to inform me that the imaging revealed a left C5/C6 disc bulge with compression on the C6 nerve root. There was also some cervical arthritis present in the mid to low neck.
Again, the patient care coordinators (Christine & Shane) quickly scheduled me for a cervical steroid injection with Dr. Slocum at the surgery center, just below Bridger Orthopedics & Sports Medicine. Dr. Slocum was kind enough to come downstairs between seeing patients and perform a transforaminal steroid injection in the neck. During the procedure, I took the opportunity to dissect what was going on. Some of my patients go through spinal injections and they will often ask me if it is painful. Now I was about to find out. I’m sure the experience is different for all people, but my procedural pain was considerable, though quite brief. Dr. Slocum injected around C6 on the left and for about 5 to 6 seconds I felt all of the pain that I had experienced over the last week and a half condensed into my neck, shoulder blade, and arm. Within a few minutes there was some relief. Dr. Slocum explained that the injection could take 1 to 2 weeks for the full positive effect, but I would experience an initial decrease in pain within the first day, which might not last.
The next morning I woke up and felt 90% better. I could move my neck, lie down comfortably on my back, and work on patients without concentrating on my own pain. Slowly, by the next day this reduction in pain slid backwards to about 50% better. I had a problem. Two days later, I was to be on a flight to Chicago for a much anticipated PT continuing education course. Bryce prescribed me another round of oral steroids and more hydrocodone for pain relief. I made it to Chicago, wearing a soft cervical collar on the airplane to support my neck.
I arrived at my continuing education course tired, now only 40% better, and unable to sit during the presentation. I was truly blessed to be traveling with Jason Lunden, one of our sports specialist PTs from Excel PT, and sitting next to another experienced PT named Effie. During the first break she looked at me and asked if I was OK. She got the full story. Effie said “I can help you.” I immediately explained how serious this problem was and that I probably was not appropriate for hands-on PT treatment. She assured me that her specialty was in spine. Sounds familiar. Effie performed left sided cervical and upper thoracic joint mobilizations, soft tissue techniques to the shoulder blade and shoulder muscles, and traction to the neck. These techniques were more aggressive than I would have chosen for my patients, but I was willing to try anything and I trusted her. After 10 minutes of treatment, my pain was reduced greatly and I practically fell asleep on the table.
Effie treated my neck again on the following 2 days of class and, by the time I returned home to Bozeman, the symptoms were improved to 75% of normal. I continued under the care of Megan Peach, at Excel PT, and I reached 95% improvement over the next month with physical therapy treatments 2x/weeks. The remaining 5% of symptom reduction and full strength in the left arm took 2 to 3 more months of performing my exercises independently.
My Personal Bout with Acute Neck Pain: Lessons Learned ~ Part 3 of 3
Lessons Learned
I believe that there was a silver lining or a purpose to why I experienced this cervical radiculopathy. As health care practitioners, we sometimes lose perspective on the severity of what our patients are dealing with. The terrible pain, decrease in function, and loss of sleep will be hard to forget. I gained valuable familiarity with the use of a Saunders Cervical Traction Unit and other treatments that are best for an acute and sub-acute radiculopathy. I also became more personally familiar with the use of different medications to treat this condition.
Perhaps the most valuable lesson learned was an appreciation for how important good physical therapy and excellent physician specialty care are. I would not be where I am today without the tremendous care from Megan and Effie (my physical therapists), Dr. Slocum, and the doctors at Bridger Orthopedics and Sports Medicine. Hands on manual therapy, exercises, diagnostic imaging, and epidural steroid injection were all very helpful to me.
This ordeal has helped me to be a better physical therapist when treating the neck. I value the experience over any class or formal education in my past.
Jason Lunden, DPT, SCS specializes in the rehabilitation and prevention of sports-related injuries, with a particular interest in the biomechanics of sporting activities – running, cycling, skiing, snowboarding and overhead athletics. He has published on the topic of shoulder biomechanics and the rehabilitation of knee injuries and has a strong commitment to educating others. Jason serves as a physical therapist for the US Snowboarding and US Freeskiing teams and is a frequent, well-received local and national presenter on the topics of sports rehabilitation and injury prevention. He is a recent recipient of the New Horizon Award from the American Physical Therapy Association and he as received advanced training in dry needling techniques for the extremities.
Just in case you missed our most recent library presentation on pregnancy & exercise, here’s a recap with some helpful tips for exercising while pregnant!
Pregnancy is an incredible time in a family’s life with LOTS of changes for everyone involved and LOTS of questions about the unknown. As an expectant mother myself, I realized that not a lot of guidance exists regarding exercise during pregnancy. With a little research, here’s what I found:
Exercise during pregnancy can be beneficial for both mother and baby, however you must check in with your prenatal care provided prior to beginning an exercise program and also regularly throughout your pregnancy to ensure the health of you and your baby. Benefits of exercise during pregnancy can include reduced risk of premature labor, reduced swelling, reduced risk of gestational diabetes & preeclampsia, decreased low back pain, and increased regularity of the digestive system.
The American College of Obstetrics and Gynecology recommends 30 minutes of daily exercise of moderate intensity for healthy pregnant women. Examples of moderate intensity are walking 3-4 miles per hour (15-20 minute miles), light swimming or cycling, and light resistance exercise. Can you maintain a conversation while exercising? If so, you are likely exercising at a moderate intensity.
Water walking or aerobic water exercise is a good option as water exercise can decrease force across joints as well as prevent an harmful rise in core temperature. Resistance and core exercises are appropriate during pregnancy provided that resistance is kept low (preferably body weight only) with high repetitions, and no sit-ups! Yoga is a great alternative to traditional core exercises although some positions may have to be modified to accommodate your growing belly and you should avoid inverted positions after 32 weeks gestation. Don’t forget the Kegels! It’s important to maintain your pelvic floor strength with kegel exercises during pregnancy to help prevent incontinence and to support the pelvic floor as it becomes stressed with the weight of the growing baby.
Some general advice for exercising during pregnancy:
Warming up and cooling down may be even more important during pregnancy than before to redistribute blood flow to working muscles in preparation for exercise.
Due to weight gain, changes in center of mass and balance, and hormonal fluctuations, exercise during pregnancy may feel different from exercise prior to pregnancy.
Listen to your body and stop if you feel discomfort! It’s important to stop exercise immediately if you experience the following signs and symptoms and contact your care provided should symptoms persist: dizziness, headache, chest pain, calf pain or swelling, bleeding, pre-term labor, amniotic fluid leakage. The farther along you are you are in your pregnancy, the more you may have to decrease the intensity and/or duration of exercise depending on your energy levels.
Pay attention to hydration, heat stress, fatigue, & exercise intensity as these may change from one week to the next.
Without a doubt, exercise during pregnancy has substantial benefits to mother & baby provided it is practiced safely. Please do not hesitate to contact your prenatal care provider should you have questions regarding exercise & your pregnancy!
Benefits of exercise during pregnancy can include reduced risk of premature labor, reduced swelling, reduced risk of gestational diabetes & preeclampsia, decreased low back pain, and increased regularity of the digestive system.
If you have any specific questions, contact Megan Peach of Excel Physical Therapy at 406.556.0562 in our Bozeman office.
Excel Physical Therapy Participates in a Research Study on Cervicogenic Headaches
Seeking Research Study Participants
Headaches can cause lost time from work, visits to multiple physicians, and a general loss in quality of life. The major categories include migraine headaches, tension headaches, TMD headaches, and cervicogenic headaches. While cervicogenic headaches are not the most common type of headache, the prevalence in the general population is estimated at 15%.
Cervicogenic headaches are defined as one sided, or one side dominant, head pain, which is caused by a neck problem. Other symptoms include stiffness in the neck, decreased range of motion in the neck, increased headaches with neck movements or poor cervical postures, and a possible history of trauma. Although physical therapy can be effective in treating tension headaches and TMD related headaches, cervicogenic headaches have shown, in multiple studies, excellent response to manual therapy. Mechanical joint and muscle restrictions in the neck lead to a referral of pain into the head (cervicogenic headache). Manual therapy based physical therapy utilizes hands-on techniques to restore muscle and joint mobility, eliminating the head pain.
Interestingly, research indicates that manual therapy success in treating cervicogenic headaches does not depend on chronicity. Cervicogenic headache patients can benefit from manual therapy treatments whether the symptoms have been present for 20 days or 20 years! As a manual physical therapist for 15 years, my success rate with treating cervicogenic headaches has been very high. Our research from this study hopes to clinically show which manual therapy techniques are the most effective for treating cervicogenic headaches.
Excel Physical Therapy is enrolled as a clinical site in a national research study to determine the best manual therapy techniques to treat cervicogenic headaches. There are several other clinical sites throughout the United States also collecting data on real patients being treated in a physical therapy environment. Mobilization or manipulation of the neck and upper back are the two manual therapy variables in this study. Mobilization is a joint “popping” technique and mobilization is a joint “stretching” technique.
The Treating PT at our clinical site is skilled and trained in performing both spinal mobilization and manipulation. One treatment group will receive only manipulation and the other treatment group will receive only mobilization and exercise. We anticipate that both groups will benefit from the manual therapy treatments, but the magnitude of improvement is part of our research question. Both groups will have 6 physical therapy visits over 2 to 4 weeks.
We are looking for patients to be part of this study – To be included:
patients must have one side dominant head pain, pain in the neck or the base of the skull that is felt to project into the head, and at least one headache per week for at least 3 months.
Patients cannot be included in the study if they have a history of stroke, high blood pressure, high cholesterol, diabetes, heart disease, peripheral vascular disease, smoking, or whiplash injury to the neck in the last 6 weeks.
Patients are not being offered free treatments in this study. As with all of our patients, cost for physical therapy services will follow our normal fee schedule and we are happy to bill your insurance or provide you with a payment plan. In most cases, a doctor’s prescription is not required to receive physical therapy services in Montana. Excel Physical Therapy is a preferred provider for many insurance companies as well.
Please contact me if you meet the criteria for this study or if you have any questions.
Community Education Series – free and open to the public
What You Will Learn:
The various types of headaches that originate from
neck problems
Understand why you are suffering from headaches.
Learn what to do when you experience headache pain with simple exercises, treatment options and suggestions to self-treat.
Q&A session to follow.
David Coletta, MPT, CMPT specializes in the treatment of back and neck pain, spinal issues, whiplash, headaches, TMJ/jaw pain, and postural dysfunctions. David received his masters in physical therapy from Mount St. Mary’s College in Los Angeles, California. He enjoys finding long-term solutions for his patients — solutions that involve a fine-tuned combination of manual manipulative therapy and a targeted exercise program that address even the most difficult patient presentations.
A considerable amount of David’s advanced training has occurred through the North American Institute of Orthopedic Manual Therapy (NAIOMT). He has completed advanced certification in manual therapy (CMPT) with NAIOMT, and he is working towards his Orthopedic Clinical Specialist (OCS) certification with the American Physical Therapy Association.
It has been a long stressful day and you can feel your head getting tight, like it’s being squeezed in a vise. The pain in your head becomes bad enough that you pop some ibuprofen and go to bed early. Sound familiar?
Tension headaches are included as one of the major classifications in the all too common world of head pain. Other types of headaches include migraines and cervicogenic headaches. A study by Haldeman (2001) found that 78% of adults will experience tension headaches once in their lives. This type of headache can range from the isolated incident that is illustrated above, to people who have severe and unrelenting tension headaches.
A tension headache is described as pain on both sides of the head (often in the temples and the back of the head), pressing and tightening in quality, with tenderness in the muscles on the sides of the head and on the base of the skull. The source of chronic tension headaches is poorly understood, but many researchers think that there is a link between dysfunctional brain interpretation of pain and the muscles of the head and upper neck becoming hypersensitive.
How do you treat tension headaches when they become more than just the limited occurrence, which is resolved quickly with over the counter medication? A visit to your general physician or a neurologist and trial of prescription medication is a good starting place. However, some patients don’t find adequate relief with medication. I would advise that the next step should be an appointment with a physical therapist specializing in headaches and neck dysfunctions. The physical therapist will be able to thoroughly evaluate your neck, head, and posture to determine if chronic poor postures and strain to the head and neck is present. Often, improving posture and showing the patient gentle stretching exercises will lead to a reduction in tension headaches.
Headaches can take on many forms and be the source of major disability in the general population. 20% of all visits to a Neurologist in the United States are made because of headache complaints. Major classifications of this diagnosis include migraines, tension headaches, and cervicogenic headaches. As a physical therapist, specializing in the evaluation and treatment of musculoskeletal dysfunctions, I am particularly familiar with the cervicogenic headache.
Temporomandibular Joint (TMJ) Dysfunction is a disorder of the joint where the jawbone meets the skull or the muscles surrounding that region. People suffering from TMJ Dysfunction complain of popping or locking in the jaw, pain in the face with eating or opening the mouth, and headaches. TMJ Dysfunction can be further classified into joint dysfunction, myalgia, or a combination of dysfunction and myalgia. Myalgia is simply defined as intra-muscular pain. Pure joint dysfunction of the TMJ involves popping in the jaw, pain coming from joint structures (bone, cartilage, disc, ligaments, joint capsule), and a predictable and measureable loss in mouth opening or closing range of motion. Myalgia in the TMJ region relates to inflammation and dysfunction in the muscles surrounding the TMJ. These muscles can cause local facial pain, neck pain, headaches, and changes in how the jaw is actively moved. Combined joint dysfunction/myalgia of the TMJ is the most common presentation and can include all of the elements in the individual disorders previously described.
David Coletta's Personal Bout with Acute Neck Pain: The Onset Part 1
