Chiropractic Patient Case Study: Cervical Postural and Repetitive Strain

Patient History and Examination
When Judy sees her chiropractor, she takes a complete history of her current complaints and reviews her past history. The chiropractor wants to know - has been any weakness in her arms? Judy says "no". Has there been any arm pain? "A little", says Judy. The doctor wants to know about her sitting arrangement at work and she asks Judy to describe her work routine.

When she examines Judy, the chiropractor is pleased to find that all neurological signs are normal. Generally Judy has full range of motion in her neck, except for some restriction when she bends her head to the left. The doctor palpates tight and very tender muscles in the upper back and along both side of the neck, more on the left. Static and motion palpation of the cervical spinal joints indicates restrictions in the mid-cervical spine in extension and lateral flexion. There are also joint restrictions in the middle back.

Radiographic Imaging
The chiropractor takes x-rays of Judy's neck, including a view that will allow her to examine the bony openings where the spinal nerves exit the spinal joint. These openings are called the foramen. The foramen may become smaller due to the formation of additional bone as part of degeneration; a response to wear and tear in the spine.

The doctor is aware that changes in the foramen have to correlate closely with physical findings, since degenerative changes of all kinds can be found in many people who do not have neck pain or arm symptoms. Fortunately, Judy's x-rays were normal.

Making a Diagnosis
The chiropractor's diagnosis of Judy's problem is "cervical neck strain". In her notes, Judy's chiropractor writes a fuller diagnostic description that will be more helpful clinically. A more exact diagnosis of Judy's condition is: cervical neck strain with spinal joint fixations, or subluxations secondary to postural stress with possible nerve entrapment. Let's take a closer look at this diagnosis to better understand how a chiropractor diagnoses neck conditions.

Neck strain is a broad term. For a chiropractor it means there is mechanical dysfunction in the neck with accompanying tightness and inflammation in the muscles.

Spinal joint fixations are an important characteristic of a spinal subluxation. In Judy's examination, the chiropractor found spinal joint "fixations" or restrictions in the left side of cervical spine accompanied by tightness and tenderness. In Judy's case, these joint restrictions were part of a complicated response on the part of the body to months of extra strain during her work activities. In trying to respond to unusual mechanical stress, the body tightened muscles at these spinal joints, which in turn became part of the mechanical dysfunction. This complex of factors often occurs in spinal problems. The body responds to a stress through the nervous system and tightens muscles or ligaments or shifts posture and then these responses -- originally intended to help matters become part of the problem itself.

Postural stress is a way of describing the strain on the nerves, blood vessels, and soft tissues resulting from Judy's work habits. Mechanical stress from sitting for long hours a day can lead to tight muscles, chronic soft tissue inflammation, and arm symptoms. The chiropractor found that Judy, like many whose work day is primarily spent sitting in front of a computer, slumped her shoulders and put extra stress on the upper back as she worked.

Nerve entrapment describes a "trapping" of a nerve or pressure against a nerve due to tight muscles. Judy's "postural stress" caused a tightening of the trapezius muscles in the upper shoulders. In this area, there is a group of nerve and blood vessels called the brachial plexus. Judy's tight muscles disturbed these nerves and blood vessels resulting in arm tingling and pain.