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Trouble treating without flaring up symptoms.

Exit forum ID Forum Discussion Trouble treating without flaring up symptoms.

This topic contains 5 replies, has 4 voices, and was last updated by   Doc Nina January 6, 2020 at 1:01 pm.

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    Scott Glidden

      Here’s the rundown:

      42 YO female

      8/10 neck pain/tension that shoots from CT junction to ribcage medial to scapula, tension from Co to C7.

      Pro: Lying on side, driving, sitting too long

      Pal: laying on back

      Onset: First injured neck in 2003; fell and hit head on ground. Has pain EVERYWHERE on diagram. Lots of X’s to mark spots.

      Just started a new job that she really likes BUT is currently going through a nasty divorce.

      Also reports to have fibromyalgia and takes Lyrica, thyroid meds, and omeprazole to treat various conditions.

      UCF: 7 CF: 40 CTF: 67

      CF+CTF have 6/10 tension between scapulae, slightly worse on left side. This pressure is relieved when overpressure is applied in CTF.

      Significant adhesion in suboccipitals, L C5-T2 adhesion.

      Cervical rotation: Left 81 degrees with suboccipital tension, Right 77 degrees with mid trap/neck tension
      Mild/Moderate adhesion at joint capsules C5-C7.

      Diagnosis: adhesion in lower cervical erectors, joint capsules. Significant degeneration of facet joints, moderate lower cervical disc degeneration. Complicated by metabolic and psychosocial conditions.

      Started with UCF for 3 treatments but couldn’t get sustainable results. Switched to CTF to attempt to calm down CT junction. Treated CT erectors and levator bilaterally (5 passes each). Next appointment reported that her symptoms flared up after treatment, especially with a 8.5/10 deep ache/pain medial to left scapula (goes from 67 degrees to about 60 in CTF post tx). Reduced passes to 3/adhesion. Same results.

      I have a clinical assistant moving the patient’s head for treatment, I’ve reduced amount of treatment and I have also worked on her shoulder abduction as well (65 to 90 percent funciton on L shoulder, 72 to 88% on right shoulder over 3 visits) to get less levator activation during her workday. She reports that her shoulders feel more loose, but her neck symptoms persist.

      At this point I am 8 visits in and considering co-care with an orthopedic specialist to get a cortisone shot so I can get treatment in without flaring her neck up. My questions are as follows:

      1) Am I missing something?
      2) If cortisone is the appropriate route, would it be the L C7/T1 facet, or somewhere else?



      Doc Nina

        Hey there! Do you think your patient would be willing to change her diet to something low inflammatory such as Paleo, Primal, Whole30 or AIP? I see she is going through a lot and that this suggestion may not be realistic for her, but before suggesting cortisone which can be detrimental to the joints, and is only a quick fix I would approach her and see if she is open to doing something that has the potential to help her reduce inflammation in general and thus improve her quality of life in a big way. I don’t think you are missing anything, you are clear that there is a metabolic and psycho-social aspect to her pain and that’s definitely accurate based on the information you shared with us.


        Brian Zelasko, DC

          Have you gotten any imaging done at this time?


          Carl Nottoli, DC

            What was her FAST MAP score?

            Have you considered lower cervical disc pathology in the equation? This looks like it would fit the scelorotome referral pattern and very load capacity part of the clinical picture.

            Load management is going to be huge outside of the office. I also agree with Brian, get an MRI to confirm severity and levels involved for better understanding.


            Scott Glidden

              She has a cervical MRI and “shared” it with me via google drive but I can’t figure out how to open it. I need to get a disc from her. I have certainly thought about a lower cervical disc since her CTF scores are at times worse post-check and them flaring up would do that. At her next appointment I will breach the subject of diet an try to get a cervical MRI that I can actually read from her. Thanks everybody!


              Doc Nina

                Hey Scott! I have run into that issue with google drive files sometimes, its because they are DICOM files and you need a DICOM reader.. simplest way is to download RADIANT free DICOM viewer off the web. If you have a Mac the DL process is more complicated but it can be done. I run it successfully on my Mac. Here is the link to the download for PC, if you have a MAC they have instructions on what to do to get it loaded. Hope that helps. And really its probably easier to just get the disc if she can bring it in.. but for the future it may be helpful!

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