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Case 8. Headache after the Car accident?


Signs and Symptoms: Headache (Migraine), Neck Pain, Limited ranges of motion in cervical spine.

Type of Trauma: Motor Vehicle Accident (Rear-Ended)

Adjustments: Cervical spinal adjustments with a specific force. (X-ray guided)

Outcome: Fast resolution of the symptoms.


A gentleman in his late 60s visited Silverdale Chiropractic for his neck pain and headache caused by a recent car accident.

His neck was so tight and stiff (and painful), was unable to move in all direction.

X-ray was ordered to investigate for any bony lesions or cervical spinal ligamentous instability.

X-ray revealed number of findings and followings are the highlights.


His C2 (Axis; the second vertebra of the spine) has rotated significantly to the left. Notice the spinous process and the dens is not aligned.

Below is the example of what the normal anatomy looks like

The dens and the spinous process are aligned perfectly.

The clinical significance of the C2 Spinous process rotation is very profound and it is due to the muscle insertion place for the muscles and one of the most important muscle that can be involved with the neck pain and the headache is the, suboccipital muscle; Rectus Capitis Major. (Below is the picture of the Rectus Capitis Major; RCP Ma)

If the spinous process of the C2 is displaced away from the midline of the spine, one of the RCP Ma will be stretched and another will be shortened. This muscle length discrepancy can bring certain symptoms; Non-specific (wide array of possible symptoms and signs) depends on the individuals but most commonly headaches and neck pain and sensation of locked joint at the upper neck area.


Below is the lateral view of the patient's cervical spine.

The red lines must be continuous. It is called a Spino-Laminar Line. Spinolaminar line is one of the line to assess the ligament instability. If it is showing a discontinuation, it suggests a possible ligament damage along the cervical spine. Notice the C2 has moved posteriorly on C3 and C3 itself is also misplaced posteriorly on C4.


With all the information (X-ray and the physical examination), specific set of forces were introduced to correct the misalignments and generated a very successful outcome.

The headache disappeared after the first treatment and neck pain and mobility improved after only few visits.


Limitation:

The patient visited 10 visits in 2 months period. The headache disappeared completely during the period. The neck pain (cervicalgia) also disappeared about 2 or 3 times of visits. Increased ranges of motion was also observed on 5th visit. The mobility of the neck dramatically increased immediately after the treatment. However, sadly the improved state of the mobility and stiffness did not last for long period of time. Such findings could be from a spondylotic (degenerative) changes over the cervical spine. Therefore I recommended him to visit once in month for a regular maintenance. However if he shows any sign of holding the improved state longer than a month, then surely will change the frequency of visits.


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