Articles Table of Contents

Case Study: Resolving Neck and Left Arm Pain

A 49-year-old female health care worker was referred to Back In Action Physical Therapy for neck and left arm pain.

Prior treatment included chiropractic and acupuncture. She had an MRI that revealed C5-6 disc herniation. On initial assessment, patient presented with constant neck and left arm pain and limited cervical range of motion in all directions, although more limited into extension (bending backward). She also tested positive for neural tension L UE to Median N. glides. Findings were consistent with cervical posterior-lateral derangement with inflamed nerve root.

I initiated treatment with traction and ultrasound. Home program included neck retraction, neutral posture during activity and natural anti-inflammatory. She had some relief of symptoms with traction and retraction, however symptoms worsened in left arm with extension. Adjusted home program to neck flexion which also gave relief to left arm symptoms and stopped home traction. Left arm symptoms reduced to intermittent with flexion stretching and ultrasound treatments.

After 6 weeks at 1 visit every 2 weeks, patient had no pain in left arm or neck with only occasional flare up after activity. At that time, she was able to start neck extension stretching. After a few weeks of her home program with extension exercises, she regained full range of motion without producing arm symptoms.

Discussion: Throughout treatment the symptoms remained consistent for inflamed nerve root which responded to decompression through traction and flexion exercises along with ultrasound and anti-inflammatory use. As the inflammation reduced, she was able to reduce the derangement (disc bulge or herniation) with extension exercises. The extension exercise mechanically pushes the nucleus of the disc into the correct position and maintaining good posture allowed for healing the ligaments around the disc.

Prior to physical therapy, she was aggravating this condition by getting chiropractic adjustments and bending forward to work on clients. As she maintained good posture and correct exercises for the stage she was in at the time, she was able to reduce her symptoms, over time allowing her to regain full function without pain.