Updated: Sep 14, 2020
Sometimes the diagnosis is so evident and so apparent it can't be ignored. I have been working with a pati
ent for a while with neck and upper thoracic pain. She has been charming to work with, but there has been this persistent pain that she is determined to change. The journey has not been easy for her or me. Each time she will present with a different way to explain what could potentially be the same pain, I am then left trying to figure out if I have done anything good for the patient in the past and what I will change to improve for the future. I have been pretty confident in my diagnosis and was aware that the outcomes would be limited due to the limitations of what we were dealing with. She had a broad chest and was overweight. My working thoughts lead me to think that the trunk was putting excessive stress on the neck and is keeping us from seeing more improvement. Considering that the posterior structures were overstressed, I would try to work them and get the muscles to calm down. Unfortunately, I did not get the improvements that I anticipated. The patient started to worsen.
The learning moment
I was frustrated when a buddy of mine told me that he no longer could do a lot of what he wanted due to increased neck pain. The primary problem was cycling and holding his neck in an extended position for extended periods. I can empathize with him due to my neck getting irritable after being on a bike for extended periods. At that point, it was my mission to figure out his problem so we can get back to playing! I came up with a brilliant plan of releasing the posterior neck and upper traps that were irritated from extended positions. I tried using tool-assisted release and cupping to try to decrease the tone of the upper thoracic spine. I tend to learn the hard way, and this was no different. I had woke up that morning with some irritation but nothing I would have treated. I quickly stirred the pot by working on my neck and made it to where I could barely move my head without annoying pain. Trying to make it through the day, I was continually fiddling around trying to figure out why I flared up, and secondly, how do I calm it down? For me, it was the anterior structures that were a problem. I could press on pressure points, and all of a sudden, I could move with almost no pain.
I went back to the female patient and changed her treatment. I primarily did anti-inflammatory therapy to the back of the neck and then treated her anterior structures the same as I had to myself. For the first time, she was able to finish the session feeling much better. I then decided to share my story with her about how I concluded how to treat her. She was very appreciative of the efforts and continued thought of trying to find resolve in her problem.
An expert continues to learn every day. An expert accepts failure and learns from it. I am not an expert, but I continue to play with theories and ideas until I figure out a solution. In this case, by accident, figuring out how to treat my buddy it helped me treat my patient.
About the author,
Rajesh is a Physical Therapist who is passionate about health and wellness. He is interested in all aspects of general well being including fitness, nutrition, and mindfulness. He continues to learn and grow from the profession he loves.
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