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CHRONIC NECK AND BACK PAIN

Initial Visit

History

Imaging

Exam

Report of Findings

The above four videos are from the initial visit. Do not treat on the first visit.

 

First Treatment

First Treatment Commentary

First Treatment Commentary

Second Treatment Commentary

Third Treatment

Third Treatment Commentary

Fourth Treatment
(There is no 4th Treatment Commentary)

Fifth Treatment

Fifth Treatment Commentary

Sixth Treatment

Sixth Treatment Commentary

Seventh Treatment

Seventh Treatment Commentary

Eighth Treatment

This patient was seen for 4 more visits. We maxed out his cervical progress and switched to shoulder assessment. He had limited shoulder abduction with very little adhesion. Based on his chronicity, multiple regions of complaint and only partial response to treatment he was referred for metabolic workup. 

His labs showed elevated bilirubin, low iodine, low carnitine and elevated creatine kinase.

It is incredibly difficult to find a good functional medicine doc that can determine what is responsible for the patients pain and problem. Lot’s of these large blood panels will show a few positive tests.

I feel for the patient but I will not practice outside my area of expertise and experience. A few email exchanges helped to make this clear:

Email 1 from me to patient:

Thanks for the follow up. For an overview, I am a musculoskeletal specialist. My focus is biomechanics, diagnosis and conservative treatment. I can help with some direction regarding metabolic/stress/nutrition/hormone etc. problems but it is not my area of expertise and beyond a few metabolic tests this area needs to be addressed with another doctor.

I was going to refer you to a functional medicine doc but you had already had one. My impression was that you would be working with this doctor to establish additional diagnoses. While a panel of tests with some positive tests is a start it requires the thoughtful interpretation form a experienced professional in that field. 

This is why I wanted to know what you doctor thought about your overall condition in light of the handful of positive test results? To answer your question, I can’t tell you what you need to ask/tell your other doctor. He/she should already have taken a history and interpreted the test results… and have something to contribute, suggestions for care or referral?

I am happy to work with you, but until we find out what else is wrong manual care, advice and exercise won’t be of sustained value. Let’s start with: what did your doctor have to say? Diagnosis? Treatment suggestions from their specialty perspective?

Thanks

He was still a little confused and his other doc wasn’t very helpful.

Email 2 from me to patient:

Got it. Thanks for the clarification. Your diagnosis:

1. Cervical disc annular tear
2. Multiple areas of muscle adhesion

3. Limited range and sensitivity of the shoulders

However, based on the following this is not all that is wrong.

  • History: chronic, long standing pain and dysfunction in multiple regions resistant to multiple forms of treatment.
  • Exam: multiple regions of movement restriction
  • Response to Treatment: Adhesion reduced, range of motion improved some symptoms improved. Still limited ranges and pain remains.

In my experience, patients with this presentation often have a problem healing. Manual therapy is only part of the solution. The possibilities that need to be investigated:

  1. Stress
  2. Systemic Inflammation
  3. Hormonal Imbalance/Deficiency
  4. Nutritional Deficiency
  5. Sleep Problems
  6. Other Metabolic (diabetes, Celiac disease etc.)

I would like your other doc to investigate these possibilities. They would not be treating your “shoulders, neck or back” specifically but rather identifying an underlying metabolic reason for your slow healing.

Sometimes none of the tests are positive or there is no smoking gun. You might need to reduce activity, cut out supplements, eat healthy whole foods and relax???

I am not saying you specifically do or do not have any of these things. I am saying you need to have these possibilities ruled in/out by a professional. Again, they are not treating your XYZ body part per se but rather looking for a systemic cause of reduced healing.

Thanks

That ends this case. With only about 12 visits we could determine that he does not need more conservative care. He should not spend more money or time on massage, chiro, PT etc. He needs to assess his metabolic, stress and activity levels to start healing. Then manual therapy could resume.