Expert: Dr. Victor Dolan, DC, DACBSP - 6/14/2010

Question
Wife has been on disability for more than a year after suffering severe upper trapezius strain on both sides due to repetitive motion (she was an overworked accountant who had a bad workstation).

MRIs are negative, it's all soft tissue injury. She has seen several orthopedic doctors, chiros and physical therapists with mixed results. Usual chiro adjustments do nothing or actually make it worse. 2 trigger point injections seem to have done little although they may not have been in the exact right spot.

We finally figured out she has trigger points below the base of her neck on both sides, perhaps with scar tissue.  but the left is worse. We first used a golf ball massage, now I use my elbows to give her a deep tissue massage in those specific areas. I can feel clicking of her muscle fibers and this gives her temporary relief.

Is there anything else we can try?

Answer
Active Release Technique, A.R.T., A.R.T. Chiropractic, Staten Island Active Release, Graston, Graston Technique, Staten Island Graston, FAKTR-PM, Staten Island A.R.T., Staten Island ART, Soft Tissue Techniques, DACBSP, Staten Island DACBSP, Chiropractic Sports Injury Specialty,






Hello Theo,

I am sorry to hear of your wife's condition.  Soft tissue is difficult to diagnose, difficult to treat.  Sometimes I hear people say- "...Thank God it was not a broken bone....",,,, well sometimes a broken bone is a 'better' problem to have than many 'soft tissue' injuries!  Broken bones heal in 6- 8 weeks and are EASY to diagnose, usually EASY to treat.
Soft tissue injury can persist,,,, sometimes for months, even years.

You state: ".....disability for more than a year after suffering severe upper trapezius strain on both sides due to repetitive motion (she was an overworked accountant who had a bad workstation).....".  First- this shows the importance of a properly designed, ergonomic work station.   This problem could have built up over YEARS and YEARS of improper position, improper movement patterns.

The body's reaction to injury is SCAR tissue- 'adhesions'.  For instance in the shoulder, we can get 'adhesive capsulitis', scar tissue in the shoulder. Sometimes physical modalities can cure the adhesive capsulitis, sometimes manipulation is necessary, sometimes manipulation- under anesthesia, rarely is surgery provided.

You tell me, ".....MRIs are negative, it's all soft tissue injury.....".  The Doctor of Chiropractic is used to being the last place people turn to.  When people come into our office (for instance, my Staten Island Chiropractic office)- patients have been to the 'biggest and best', the specialist, the guy that 'wrote the book';  many- many patients have Xrays, EMGs, MRIs, CT scans, Ultrasounds, etc, etc.  The GOOD thing about this heavy workup is that it is NOT likely the patient has some undiagnosed BAD thing like a tumor or cancer,,,, the bad or sad thing is that often, Chiropractic can be very effective in cases like these- and the patient has suffered (needlessly) for months or even years.

The TYPE of Chiropractic that I would recommend given your description would include Chiropractic Spinal Adjustment- to assure proper BALANCE in the musculature, proper joint motion, remove nerve irritation; along with this adjustment, I would recommend SOFT TISSUE Approaches such as A.R.T. (or something similar) and/or Graston (or something similar).
         These Chiropractic soft tissue approaches will be just as important as the traditional osseous chiropractic spinal manipulation.


".......orthopedic doctors, chiros and physical therapists with mixed results....", Doctor of Chiropractic pride ourselves at NOT covering up a problem- ie; pain medications, we pride ourselves at getting to a CAUSE of a problem- ie; often a joint misalignment ( a subluxation- often overlooked by other health professionals).  With the addition of sot tissue techniques to most DCs approaches- we truly cover a wide gamut of neuro-musculo-skeletal conditions.

I would look up on the internet the techniques named above, I would look for pratitioners of those approaches.

Resources:   http://www.acatoday.org/pdf/ApprovedChiropracticSpecialtyPrograms.pdf ,
http://www.activerelease.com/ , http://www.grastontechnique.com/



PAIN           
Pain  is a  ‘red light on the dashboard’.   
RED  LIGHT  =   Trouble !!

Pain  is  your  body  telling  you  that  something  is  wrong.   
Think  you  should  listen??

That RED LIGHT on the dashboard of your car-
-- do you ignore it until the car breaks down,
or do you get it checked and correct the problem?  
Pain,
pain in your body-
-- do you ignore it until your body breaks down, or do you get it checked and correct the problem?   

Pain,  
do you cover up the pain by taking a painkiller?  
Take a painkiller,
mask the pain,
and allow a problem to progress in your body?

Pain  Killing  medication???  =    16,000  deaths   ( probably  under-reported )
                         DEATH ! ? ! ?    better   watch  out  on  those  medications!!!  

                             NOTICE  ON  PAIN  RELIEVERS:
 
Label changes ORDERED by FDA;  the FDA announced proposed label changes for OTC over-the-counter pain relievers to  include the potential for stomach bleeding and liver damage (FDA news  206- 207;  12-9-06) ;
SIXTEEN THOUSAND DEATHS: "Nonsteroidal anti-inflammatory drugs (NSAIDs) are effective medications for the treatment of many chronically painful medical conditions. However, it is estimated that 25% of all serious adverse drug reactions involve NSAIDs, with more than 100,000 hospitalizations and 16,000 deaths occurring annually due to NSAID-induced gastrointestinal (GI) events."----- http://hhc.sagepub.com/cgi/content/abstract/13/6/468   Home Health Care Management & Practice, Vol. 13, No. 6, 468-475 (2001)  Motrin, Advil = NSAIDS

The  American Heart Association issued a scientific statement   recommending medical doctors change the way they prescribe OTC pain relievers from a first choice    to an alternate of recommending non-pharmacologic treatment (AHA statement  2-26-07).

NSAID Acceleration of ARTHRITIS; an important side effect of Aspirin and other NSAIDS is that it will inhibit cartilage repair and accelerate cartilage  destruction ( Journal of Rheumatology, 1982; 9: 3- 5 ).   Many times people take NSAIDS  for  the pain of Arthritis,  not realizing these drugs may make the underlying condition worse.   These medications  cover  up  the  pain,  and  cause  the  problem  to   worsen.

Pain  can  often  be  the  result  of  the  Vertebral  Subluxation  Complex.

Vertebral  Subluxation           (  ‘VSC’ ,    ‘subluxation’   )
Vertebral Subluxation  is  actually  a  quite  common  condition.   Doctors of Chiropractic look for pathological conditions which may require referral to other specialties,   and also look for ‘Subluxation’. Other disciplines look for pathology, but overlook the importance of alignment and movement in the spine which affects our nervous system  (the master control system- ALL health disciplines learn this).  VSC- ‘Subluxation’ – can be the cause of many symptoms and conditions.


Only  a  Doctor of Chiropractic  will  evaluate  and  treat  for  VSC,   as  well  as  other  pathology.


The course of VSC is highly variable.   Some patients with VSC literally cannot walk, yet other patients with similar test findings may be able to run marathons or lift heavy weights.    Some patients immediately develop symptoms related to the VSC,  some patients take years to develop symptoms.  Some people suffer for only a few days with pain and symptoms, some people suffer for months.  Some people recover in days, some take months or years, depending upon severity of the condition.
              A subluxation interferes with the proper functioning of the nervous system (the master system which controls and coordinates all function within the body) and may cause various other conditions, symptoms and problems.
The Vertebral Subluxation Complex describes what happens when spinal bones lose their normal movement patterns and position.  When subluxated, joints are in a stressed, vulnerable, compromised condition.  Subluxation may cause Arthritis, Disk Herniation, or aggravate such conditions.
       Vertebral  Subluxation   cannot   be corrected through chemicals (medicine), stretching,  yoga,  vitamins  or  physical  therapy  alone.       Subluxation- a neuro/skeletal/muscular-    mechanical-    problem  requires  a    mechanical correction-  -  -    a manipulation,         best  performed  with  the  chiropractic  adjustment.

Dr. Victor E. Dolan,   Doctor of Chiropractic;   Diplomate, American Chiropractic Board of Sport Physicians; Diplomate, American Academy of Pain Management; Certified Clinical Nutritionist (IAACN); FIRST  Chief of Chiropractic  in  a  Hospital  in  New York State (DHSI);  As  Seen  in  PREVENTION  Magazine , Invited to Colorado Springs (Olympic Training Center) to  Care for USA Olympic Athletes 2010

++++++++++++++++++++++++++++++++++++++++++++++++


".......We finally figured out she has trigger points below the base of her neck on both sides, perhaps with scar tissue.  but the left is worse. We first used a golf ball massage, now I use my elbows to give her a deep tissue massage in those specific areas. I can feel clicking of her muscle fibers and this gives her temporary relief....."- I highly recommend ART or Graston chiropractic techniques.

I hope this helps!

If you need further, do not hesitate to re-contact me here at AllExperts.com

Thank You,

Dr. Vic Dolan, DC DACBSP


Dr. Victor E. Dolan,   Doctor of Chiropractic;   Diplomate, American Chiropractic Board of Sport Physicians; Diplomate, American Academy of Pain Management; Certified Clinical Nutritionist (IAACN); FIRST  Chief of Chiropractic  in  a  Hospital  in  New York State (DHSI);  As  Seen  in  PREVENTION  Magazine , Invited to Colorado Springs (Olympic Training Center) to  Care for USA Olympic Athletes 2010