“I am so grateful,” Miss M. said as she sat in my office. “The accident could have been so much worse. I was very sore the day after the collision. The soreness surprised me, as I didn’t feel much of anything right after the crash, and we weren’t going more than a few miles per hour.”
I then asked Miss M., an energetic woman whose accident had occurred about a week earlier, to describe what happened.
“I was at a parking lot and was backing out to leave. I had my head over my right shoulder, but I didn’t see the car backing out across from me until the last moment. He didn’t see me and backed into my car, giving me quite a jolt. I suppose my neck would have been better off if I had just relaxed, but I tensed at the moment of impact.”
“Actually, you did the right thing and that is probably why your neck is doing relatively well after the accident.”
Miss M. looked at me with surprise. “Seriously? I thought it was better if you were completely relaxed at impact.”
“The data is in the opposite direction,” I explained. “When you tense, your muscles protect the ligaments and the delicate joint capsule from massive compression and/or shear force. Muscle tissue does suffer in the process, but muscles heal far more quickly than does a ligament or joint. The body will always sacrifice muscles to protect deeper structures.”
“What about the idea that people who are drunk seem to survive terrible crashes?” she asked. “That seems conflicting.”
“Actually, a whiplash and a typical drunk-driving accident are two different scenarios. The whiplash process is essentially over in less than one second. An accident where an intoxicated person drives off the road and rolls the car several times is a multisecond event. In that case, being relaxed is probably an advantage. In a whiplash, being unaware is definitely a liability. Numerous studies have shown this to be true.”
“Wow, I guess I did the right thing without knowing, or, at least my body knew what to do. Why is the left side of my neck so sore?”
“You were looking over your right shoulder, correct? If the head is turned to the right and the impact shoves the torso forward, the neck will be pushed into further right rotation and extension. If the neck is turned to the right and you want to stop it from going too far you …”
“… tighten the muscles that turn the head to the left,” Miss M. blurted out with excitement. “You’d also tighten muscles that stop the head from going backward, too,” she exclaimed with a big smile on her face. “That’s why the left side of my neck hurt the next day; it stopped the motion from going too far.”
“You are correct. Great reasoning skills—I’m impressed! Shall we examine the muscles to see what is most involved?”
After Miss M. was supine on the table, I checked her range of motion in right and left rotation. She had very little restriction: slightly less range to the right than to the left. To check any involvement on the right side, I put her into right rotation and a little extension and compressed her neck slightly. This created no discomfort, a good sign that no facet inflammation resulted from the impact. The only discomfort Miss M. felt was on the left side of her neck, just anterior to the trapezius. As I palpated the posterior scalene, I could feel it overreact in response to my pressure. The muscle was overreactive to length changes—hyperresponsive to both passive lengthening and passive shortening. Just as I was ready to zero in on the posterior scalene, she spoke up.
“Have you ever had the feeling that your arm was too heavy—like it was tired or something? My left arm feels different than my right, and the feeling goes down to my thumb and behind my shoulder blade, too. Maybe you could check my midback out before the end of the session?”
“I will, but first let me try something,” I replied.
As I carefully searched the posterior scalene, Miss M.’s eyes widened the moment I hit the right spot. One spot replicated all her symptoms: the pain on the left when turning right, the pain down her arm, and the pain near her scapular border. The excitement on her face was captivating, a childlike enthusiasm for solving the puzzle at hand. Showing her the scalene referral pattern, I could see her relief as she understood what she felt and why. Her understanding of the mechanics of the injury, the muscle involvement, and the seemingly random symptoms now coalesced into a clear picture. I’d bet that facilitating her understanding was at least as important as the treatment I did to the scalene muscle.
Douglas Nelson is the founder and principal instructor for Precision Neuromuscular Therapy Seminars and president of the 16-therapist clinic BodyWork Associates in Champaign, Illinois. His clinic, seminars, and research endeavors explore the science behind this work. Visit www.nmtmidwest.com or email him at doug@nmtmidwest.com.