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Dr. Arun Phophalia
Dr. Arun Phophalia, Doctor (MD)
Category: Health
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Experience:  MBBS, MS (General Surgery), Fellowship in Sports Medicine
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Hello, I have chronic neck pain from a whiplash injury 16

Resolved Question:

Hello,

I have chronic neck pain from a whiplash injury 16 mo. ago. The pain started out all over and now is down to a strip down the right side of my neck from the base of my skull to the base of my neck. Also, I hear clicks when I turn my head. Because of this I suspect tendons or ligaments. Any other opinions? If a tendon or ligament is out of place, what type of treatments should I seek?
Submitted: 1 year ago.
Category: Health
Expert:  Dr. Arun Phophalia replied 1 year ago.

Greetings Lisa.

 

Your symptoms are suggestive of myofascial pain syndrome. Muscles of the neck and shoulder girdle, namely; trapezius, scalene, sternocleidomastoid, levator scapulae etc can develop myofascial trigger points. These are hyperirritable tender spots in palpable tense bands of skeletal muscle that refer pain. This can be associated with degenerative disc disease in neck causing pinched nerves and can be related to the whiplash injury. Trigger points may develop after an initial injury to muscle fibers. This injury may be a noticeable traumatic event or repetitive microtrauma to the muscles. The trigger point causes pain and stress in the muscle or muscle fiber. As the stress increases, the muscles become fatigued and more susceptible to activation of additional trigger points. The treatment is following;

 

1) passive stretching of the affected muscle after application of sprayed vapocoolant.

2) physical therapy; simple muscle stretch, augmented muscle stretch, post-isometric relaxation.

3) deep electrotherapy; iontophoresis, phonophoresis, short wave diathermy, electrical stimulation, high voltage galvanic stimulation, biofeedback.

4) local analgesic patch / ointment / spray

5) anti-inflammatory analgesics; Ibuprofen (Motrin / Advil)

6) ischemic compression therapy; pressure on the points

7) massage

8) steroid shots

9) acupuncture

 

A concomitant pinched nerves in the neck can also cause neck, upper back and shoulder girdle pain. This can be due to;

1) Herniated/degenerated disc in neck

2) Cervical spondylosis; bone spurs in the neck vertebrae pressing on the nerves.

Following investigations would be required for the confirmation of the diagnosis;

1) X-ray of the neck spine

2) MRI of the neck

 

Following measures would be helpful;

1) Neck care in the activities of daily living.

a) No working on computer for more than half an hour in a single stretch. Same for TV.

b) Monitors and televisions exactly in front (180 degrees).

c) Contour pillow: Should fill the hollow when lying on back or straight. Available over the counter.

2) Cervical Collar or Brace

3) Cervical traction

4) Anti-inflammatory analgesics like Ibuprofen

5) Physical therapy: gradually increasing exercises from passive stretching to active against resistance regime.

 

6) Electrotherapy in the form of TENS, interferential and laser and ultrasound.

7) Hot fomentation

8) Local analgesic patch / ointment / spray

You can consult following specialists;

a) Orthopedist

b) MD in Physical medicine and rehabilitation

 

Please feel free for your follow up questions.

 

I would be happy to assist you further, if you need any more information.

 

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Dr. Arun Phophalia, Doctor (MD)
Category: Health
Satisfied Customers: 29886
Experience: MBBS, MS (General Surgery), Fellowship in Sports Medicine
Dr. Arun Phophalia and 4 other Health Specialists are ready to help you
Customer: replied 1 year ago.

In response to your answer, I’ve tried the following of your recommended therapies


 


1) passive stretching of the affected muscle


2) physical therapy; simple muscle stretch, augmented muscle stretch, post-isometric relaxation.


3) deep electrotherapy; iontophoresis, phonophoresis, short wave diathermy, electrical stimulation, high voltage galvanic stimulation, biofeedback. – TENS unit


4) local analgesic patch / ointment / spray


5) anti-inflammatory analgesics; Ibuprofen (Motrin / Advil)


7) massage


8) steroid shots


9) acupuncture and cupping


Chiropractic


 


 


A concomitant pinched nerves in the neck can also cause neck, upper back and shoulder girdle pain. This can be due to;


1) Herniated/degenerated disc in neck


2) Cervical spondylosis; bone spurs in the neck vertebrae pressing on the nerves.


Following investigations would be required for the confirmation of the diagnosis;


1) X-ray of the neck spine


2) MRI of the neck


 


Both X-ray and MRI were grossly normal with the MRI showing some mild disk degeneration ~C5-7. I was told the amount of degeneration seen is typical for my age.


 


Following measures would be helpful;


2) Cervical Collar or Brace - Is there a style or brand you recommend?


3) Cervical traction – Unsure what you mean


4) Anti-inflammatory analgesics like Ibuprofen – being taken


5) Physical therapy: gradually increasing exercises from passive stretching to active against resistance regime. – already tried three times. PT helps, but pain lingers.


6) Electrotherapy in the form of TENS, interferential and laser and ultrasound. – I have a home TENS unit I use ~2x week 30 min


7) Hot fomentation -


8) Local analgesic patch / ointment / spray – I use Mentholateum or Arnica.


 


You can consult following specialists;


a) Orthopedist – done, they recommended PT, steroid shot, stretching and the TENS. At this point they have no further recommendations.


b) MD in Physical medicine and rehabilitation


 


When I turn my neck I feel a clicking sound in one spot, repeatedly. This is why I suspect it may be related to a tendon or ligament. Also, there is an increase of pain associated with the clicking. Sometimes the pain is immediate and sometimes a slight (few minutes) delay.


 

Expert:  Dr. Arun Phophalia replied 1 year ago.
Hello Lisa,

A clicking spot can be due to myofascial trigger point. As you mentioned, a ligament sprain, tendonitis can be the other possibility of the diagnosis. But the local treatment remain same as we have discussed. Massage and physical therapy and therapeutic ultrasound are the mainstay of the treatment.

It is privilege assisting you.
Dr. Arun Phophalia, Doctor (MD)
Category: Health
Satisfied Customers: 29886
Experience: MBBS, MS (General Surgery), Fellowship in Sports Medicine
Dr. Arun Phophalia and 4 other Health Specialists are ready to help you

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Dr. Arun Phophalia
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MBBS, MS (General Surgery), Fellowship in Sports Medicine