PT worsening upper cervical strain?

[jljrn]

Like many, I've always carried stress in my upper back/shoulder area so I'm familar with having an achy neck region and big knots along my shoulders.  Several weeks ago however after a particularly grueling few days at work, I noticed an unremitting ache along my left trap,  Nsaids and heat didn't help.  I finally went to a PT who said "No wonder you're miserable, your back is like a brick"; after 2-3 sessions of ultrasound/heat and a tens unit, my range of motion seemed to improve and the 'hard' lumps were beginning to soften a bit.  I was told I have "postural issues" and a slightly 'winged scapula"  I never suffered from any numbness/tingling to my extremities, but the pain often radiates to right behind my eyeballs.  My job as an RN on a busy unit doesn't help with all its accompanying stress, stand up computer work and continual twisting and bending over patient beds.  I've religiously done the PT exercises they've given me along with heat application at home.  The other day my PT started me on strengthning exercises in the gym portion of the office.....scapula pinches with pulleys, resistance exercises.  Nothing really hurt until I went to work that evening.  I wound up being in pain all shift....even a simple turn of my head to the left left me in spasms.  Today the back of my neck and entire L scapula region is sore.  I'm so discouraged.  Do you think I did too much too soon?  Could my problem be more than muscular, that is bone spurs, a stenosis,....or something else an MRI might show?  I'm not looking for problems I just want to get better and show continual improvement so I can function in my job without misery.  I had to call in sick today because I was so sore and sleep deprived and was afraid of making the situation even worse.  I go back to the PT tomorrow where I'll update her, but in the meantime I'm a wreck wondering if I'm going the correct route.  I literally felt better on my iniital visit than I do now.  Any suggestions/advice?

[S. Kaul, MD]

Hi there!

Well, without a detailed clinical evaluation it would be difficult to determine the cause of your symptoms. The symptoms may or may not be related to one another. Possibilities that may need to be considered include postural issues, neuro-muscular causes such as muscle sprain, nerve impingement, injuries to muscles/ ligaments etc inflammations, fractures/ dislocations, referred pain from other regions, micronutrient deficiencies etc. I would suggest giving up PT for a few days and taking adequate rest before resuming work. I would also advise an evaluation by an orthopedician for a detailed evaluation. After a cause is identified, a management plan can be drafted accordingly.
Hope this is helpful.

Take care!

[jljrn]

I did wind up seeing an orthopedist who did films of my cervical neck; they showed a straightening of my lordosis and a couple of lower vertebrae aligned in the opposite way; he said the information was caused by spasm and put me on Celebrex ( didn't work) He alsomsaidnhed speak to my PT about Tx changed ( never did) but scribbled a note on a script to them about "stabilization" My PT said "we're already doing that".  I wound up taking 2 weeks off from work but now back to work and am finding during a particularly busy stressful shift my neck feels vulnerable to locking up again with movements like bending forward and toward the right.   Maybe I've watched too many YouTube videos but the problems seems to originate in my rt levanter scapula and radiatet toward the  lower cervical vertebrae.  The
Exercises Ive to stretch the LS muscle on a good day result in more pain the next.  could I be exacerbating an injury there perhaps?  Think an MRI is an order?  Any thoughts?  I were start PT again after Jan 1st when new insurance kicks in.

[Chuckie327]

Hi,

Hope you don't mind my giving you some ideas. Sounds like an MRI is a good idea. I personally get that done and have an orthopedic or neurosurgeon evaluate it before any therapy. Have you had your work place environment evaluated for proper height of your desk, chair and
relationship to computer if used. I know after working at a desk for 30 minutes I change position and do relaxing neck exercises advised by the PT. Can you find a local source for a massage. Ah to be wealthy!

I  have lots of nasty things going on in my neck and know quick sudden moves are not good to work out kinks. Also was taught the proper way to
shrug my shoulders. Sometimes rest is the first approach to stop muscle spasms. You sure are on the right track taking time off. Good luck and hope
your New Year becomes a healthy one. Chuckie