CHRONIC NECK PAIN
SUBLUXATION, SCAR TISSUE (FASCIA), OR TRIGGER POINTS?
As I start my 26th year of practice, I have to admit that I've figured a few things out. The first is that I rarely have anything completely figured out. So, while the following is certainly not true all the time and with every individual person --- anytime you deal with real people there are always plenty of outliers ---- it's true more often than not. Here are some simple evaluations that I automatically look for when seeing patients (you can do some of these at home).
- POSTURE: The very first thing I look at is posture. No; I'm don't make a list of every single thing that's not perfect like some people do. But when there is Forward Head Posture (FHP) present, you need to know that it is usually a very big deal. How do I recommend addressing it? Various sorts of EXTENSION THERAPY (ET) Just be sure to realize that you may have to be very intentional about the way you go about doing this (HERE). Also remember that ET is not usually the best place to jump in with treatment; particularly true in people with greater problems. For the record, FHP is rarely just a Subluxation issue.
- RANGE OF MOTION: NORMAL ROM'S ("sectional" ranges of motion) are utterly simple to check. They'll also frequently fool you. Why? Because there are lots of people out there (especially younger or petite women) who have restricted neck motion even though according to the charts, it looks "normal" (HERE). And while sectional motion is fairly easy, you'll have to be proficient in MOTION PALPATION to effectively check SEGMENTAL MOTION (for instance, is C4 moving properly on C3?). Thus, problems with ROM can be either Subluxation or Scar Tissue --- sectional or segmental. I've gotten to the point that with MOST NEW PATIENTS, I simply check both.
- SUBLUXATION: These are the vertebra that have lost their normal alignment and / or motion in relationship to each other. It also happens to be the area where most chiros live. Don't get me wrong, addressing SUBLUXATION is a big deal --- a really big deal. The truth is, I spend the biggest part of my normal office hours dealing with Subluxations. But all too often (HERE and HERE are examples), people are getting lots of adjustments with only short-term relief. Why is this? Click the bracketed links and the picture will become clearer.
- SCAR TISSUE: When you adjust people who have lots of SCAR TISSUE and ADHESED FASCIA without addressing it first, a couple of things happen. Firstly, because these individuals are perpetually "TETHERED," they'll only hold adjustment for a short time (HERE). Secondly, FIBROTIC TISSUES in the area not only make it difficult for patients to hold their adjustment, they can make it very difficult to even perform the adjustment. If a person has only half the normal range of neck motion because of copious amounts of Scar Tissue (extremely common), getting them to the point to actually get a good adjustment without addressing said tissue can present a significant challenge (it's either uncomfortable for the patient, or it simply doesn't work). And none of this deals with THE MANY OTHER REASONS that Scar Tissue is so often the "Perfect Storm" of Chronic Neck Pain.
- TRIGGER POINTS: In some ways, TRIGGER POINTS are the wild card in this equation. If they are active (or crazy overactive), they have the ability to affect tissue and subluxation alike (HERE). TP's are hard marble-sized or pea-sized nodules of chronically contracted muscle --- not to be confused with a muscle spasm, although they can be very related (see last link). Start digging around with a thumb or fingers, and when you get to a hard knot, start rubbing over it back and forth. Most of the time you can feel the knots kind of "squishing" and "popping" as you run your thumb over them. Difficult to describe, but once you feel it you'll never forget it. Just remember that TP's are common in the neck (Traps, LEVATOR, Scalenes, SCM, etc, etc, as well as the Pec Minor, which, while not in the neck, are involved in many of these cases).
- INFLAMMATORY LOAD: Although there are many people who couldn't care less about addressing this last point (unless they can DO IT WITH DRUGS), skipping it has the potential to be a deal-breaker due to CHRONIC SYSTEMIC INFLAMMATION. Why? Namely because inflammation always leads to fibrosis (the medical word for Scar Tissue) and fibrosis always leads to degeneration --- NO EXCEPTIONS. This is why if you are trying to solve your Chronic Neck Pain and the things that so frequently go along with it (HEADACHES are definitely the big dog in this category), you are working against yourself if you have INFLAMMATION coursing through your body. HERE is a little self-test for determining whether or not you are inflamed.
Each one of these problems has to be dealt with a bit differently. This is why trying to deal with every patient the same way is doomed to fail with lots of them. Honestly, this post is just a little bit different way of looking at PHASE I NECK REHAB -vs- PHASE II NECK REHAB. Oh; and for those of you who may have be dealing with a concussion or head injury on top of everything else --- particularly one that involved LOSS OF CONSCIOUSNESS --- you need to read THIS, THIS, and THIS.