Neck pain for 20 years

A 38-year-old man came to my practice, slim and well-trained and with neck pain on the right side for 20 years, recurring almost daily and then lasting all day. Since he changed jobs 12 months ago (difficult physical work before), the pain has decreased and regular fitness training has also led to an improvement. All imaging procedures such as MRI, etc. have not brought any findings. Likewise, therapy attempts did not improve the symptoms.

The medical history revealed no special features.

In the physical assessment, I noticed some joint dysfunctions of the thoracic vertebral, otherwise a sporty man stood in front of me with neck pain that has been unexplained for 20 years.

The exact location of his pain area was at the transition from the shoulder roof to the neck on the right. It was not superficial pain, but "deep in it." He could still describe exactly the day and the situation when this pain first occurred. In 1996, at the age of 18, he slept camping with his head on a root as a pillow. This root was exactly at his pain area and the pain began afterwards.

That was a good hint that the one who wants to listen hears. This is always my experience with my patients: they know quite well where their complaints come from. Listening is an important part of my daily work.

At the pain area described, I found a hard tense muscle, the Levator scapulae, which was clearly painful on light palpation pressure. The whole region was like "bulged" from the fascia side. Admittedly, this is not a professional expression, but describes the situation quite well. Because just as a car can carry away a dent through rough acquaintance with a limit pile, etc., its fascia have received a "dent" through the root, which could still be detected there 20 years later. In my experience, this is typical of the fascia: They do not forgive anything, maintain their deformation and have to be "bent" manually.

I now treated this recognized area by stretching the fascia there, detonizing the muscle and treating its trigger points. I also took care of the dysfunctions of the thoracic spine. As a homework, I gave up stretching of the right-sided neck muscles.

4 weeks later we had the second appointment. He told me that from the second week after the first treatment, he had no more neck pain. He carried out the work exercises daily during this time. When scanning the former pain area, no abnormality could be found: normal muscle tone and fascial tension. We agreed that he would continue to carry out the self-exercises even independently.

Even after such a long time after the original trauma, the traumatized tissue can still be influenced well. It is important to work with the patient through appropriate self-exercises. This often shortens the therapy process very significantly.

My patient told me about the second appointment an observation he had made in the weeks between treatments: He suffered from poor nasal breathing before starting treatment. This also bothered a lot at night, the nose was always closed. With the improvement of his neck pain, nasal breathing also improved by 20%. Sufficient for him to see his quality of life improved. This can be explained by the fact that the vegetative nerves (sympathetic) for the glands of the head and thus also the nasal mucosa run from the traumatized area upwards to the head. It is possible to impair the nerves due to pressure damage caused by the root.