Expert: Scott F. Gillman, DC, DACBSP - 2/8/2009

Question
About 1998/99 when I was about 41 yrs old, I somehow sustained an injury to my top disc, which caused pain and tenederness down one of my arms to the elbow and muscle stiffness in the neck/shoulder area. A physio said I had dislocated the top disc and she "put it back in place" and saw me for a few weeks. Later on I had trouble with pain and tenderness down the other arm and saw another physio who did what she could to help. Later I saw another lady who used a heat lamp. About two years ago I saw a chiropractioner. Her treatment, although it makes me initially stiffen up as she attempts her manipulation, it brings release for anything up to a couple of months. I have tried deep heat rubs and sprays, microwave heat bags, ice, electric massagers, etc at home but they don't quite do the job. Why?  
I did have the misfortune to fall over, last May. After some delay I did get to see a physio in Setptember, who found a tight knot of muscle in my shoulder muscle. The pain had got so bad I could barely carry an empty shopping bag, but her treatment soon had me ok, for a while. She also gave me some exercises, which I did try but found painful.
I have noticed that when I get very tired I am inclined to fall asleep at the computer or when sitting sideways on my and settee. I wake myself up as my head and neck jerk very violently like a whiplash. Is this making things worse?
I have not had an x-ray or MRI done on my neck. Is it worth asking my doctor to get one done? I have osteoarthritis in my hands, feet and probably both knees-one was x-rayed confirming this, 2 yrs back. (I had a lump removed from it 23 yrs ago)
I have had for a while a suspicion that the computer chair is not good for my posture, especially if used for more than a few minutes at a time.  
I take Ibuprofen retard-2 large tablets at night, prescribed by my doctor. Sometimes I take other painkillers like co-codamol or paracetamol.

Answer
Hazel,  

Your mention of arthritis in the hands and knees is a tip-off that you likely have it in your neck.  This can lead to bone spurs touching agains nerves or discs degnerating and bulging against nerves.   Chiro's or physios (you must be Canadian or Irish) do not put discs back in place.  THey can mobilize your joints and the chiro can do higher-velocity manipulation maneuvers.  This, for some people, provides a modicum of relief for reasons we do not fully understand.  X-ray is not a good idea.  Clinical research has shown that X-rays will not be effective in the management of your condition since the x-ray will only show bones and not give you a clear understanding about your discs or other soft tissue structures.  MRI really is the way to go.   Also, your physical examination should reveal how well-off or bad-off you are.   Do you have normal/full reflexes?  Do you have normal finger, hand, arm, shoulder strength?  Are there any signs that a nerve is being compressed in your neck?  If your physical examination shows that you have no nerve compromise, then odds are you should continue to try conservative methods.  Neck tracton may be helpful, both done by (the doctor's) hand and also with a home neck traction device.  You can often find the over-the-door traction devices in the stores or on line.  You must rig it so that you can lay on the floor and pull on your neck.  The chiro or physio can help you with this.  Be sure to wear an athletic mouthpiece when doing home cervical traction so you don't irritat your jaw joints (TMJ's).    If your neck and arm pain do not abate with treatment, then MRI is warranted.   The next step would be to consult an MD Physiatrist or other doctor certified in "interventional pain management."   

I hope this was helpful.

Dr. G