Addressing Old School Explanations for Cervical Pain | Modern Manual Therapy Blog - Manual Therapy, Videos, Neurodynamics, Podcasts, Research Reviews

Addressing Old School Explanations for Cervical Pain

A case I evaluated today was very ingrained in pathoanatomy. She presented with cervical Sx with bilateral radiating arm and hand pain for 1 year.

She was told

  • your neck has arthritis - from a neurologist after x-rays
  • your shoulder and neck are weak - from a well meaning MT
  • you neck keeps going out of place, and don't get massages anymore, it makes your neck go out of place
    • ironically she felt worse after adjustments and better after a massage - go figure!
After hearing her say these things, I step by step educated her on the realities of her condition
  • 87% of asymptomatic people have positive MRIs, including arthritis and disc issues
  • your nervous system is under threat and needs to have novel and non-threatening input that is reinforced (by her) to reduce the perceived threat
  • you don't like having the same meal over and over for months, right? It may taste great at first, but eventually you get tired of it, or it does not have the same "wow" factor
    • the same goes for massage, adjustments, or any treatment she had received over and over again
    • once an input is no longer novel, it loses the effectiveness
  • passive treatments like massage, adjustments are like having someone exercise for you and expecting to be fit/stronger without doing your own work
  • education on The Window of Improvement and Resetting Pain/Movement Thresholds
    • once reset, the "safety" needs to be reinforced with continuous movement to end range for the brain to give the area in danger a green light
Since her main complaints were neck and arm/hand pain with gardening, cooking, and repetitive use of her arms, I avoided the term "postural correction" and instead described it as...
  • cervical retraction with overpressure centralized her constant hand pain and abolished it
  • sitting in her normal, forward head position reproduced it
  • I described her peripheral nervous system as sensitized and sitting or standing with head and shoulders forward as giving a light tug upward on the "strings"
  • the tug upward combined with repetitive use of down downward in repetitive ADLs is perceived as threatening
  • giving the top of the strings some slack in a cervical retracted position gives more wiggle room and less sensations of "pulling" 
  • the nervous system has this normal motion built in until it is sensitized
  • the nervous system also craves variability, so the longer you are repeating an activity that is associated with danger, the more you have to reinforce safety with the directional preference (in this case cervical retraction with overpressure)
The education maybe took 25-30 minutes, and the only manual treatment was light IASTM to occiput, cervical patterns and upper traps. This made the cervical retraction with overpressure much easier for her to perform and more of a green light rather than a yellow light.

Keeping it Eclectic...

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