Chronic Neck and Back Pain – a Case of Over “Self-Treatment”?

Recently a 23-year-old female patient with no prior history of trauma or related medical conditions presented to the clinic with primary complaint of persistent neck pain and stiffness, headaches and upper-mid back pain, recurring over the last 3-4 years.  She was self-employed, and spent the majority of her day in front of a computer. 

 She had tried PT and massage which were ineffective.  She was working with her family MD on an ongoing basis, had been prescribed a low dose of Flexeril to be taken on the ‘bad’ days.  The MD had recommended an MRI scan of the neck, then referral to a chronic pain center.  However the patient has a large insurance deductible, so could not afford this route.

Examination revealed an otherwise healthy appearing young adult female of normal weight, but with very chronic-appearing, ropy, nodular muscle tissues palpated bilaterally from the upper neck down to the mid-back between the shoulder blades.  The tissues were particular rigid and tender along the lateral and posterior neck, yet the neck range of motion was entirely normal.  Misalignments of the spine were identified, particularly in the upper back, yet the bony segments of the neck were found to be somewhat hypermobile. 

Radiographs obtained from the MD were essentially normal.

Summary:  This patient’s situation is seen with uncommon frequency.  An otherwise young, healthy, non-traumatic patient, but with chronic pain and stiffness.  Further history revealed that the patient had an ‘addiction’ to frequently stretching and pulling on her head and neck to get the bones to ‘pop’.  In fact, the patient reported that as she sat in front of the computer working, it was not uncommon for her to pull on her head and neck every 5-10 minutes.

She was diagnosed with self-induced cervical strain/sprain.  In essence the patient gave herself a mild form of whiplash and was suffering from chonic inflammation and low grade spasm of the muscles, tendons and ligament.

I recommended that the patient immediately decrease the frequency of her self-treatments over time, with a goal of stopping entirely, by explaining that she was damaging her neck tissues by the repeated yanking on her neck.  I advised her that she will likely go through a withdrawal period, of sorts, during which her neck will be even more symptomatic.  To heal her injuries, we initiated her on electical muscle stimulation treatments, along with adjustments of the upper back to the segments that were misaligned.  I briefly considered placing her in a neck brace, but the patient declined.  She was given strengthing exercises.  The outcome of treatment is pending, and much depends upon her own compliance.

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