Case Studies

car-accident-gainesville-fl-neck-pain.docx

Patient: 62 year old male, 6’-1”, 200lbs, blood pressure 138/94mmHg, pulse 86bpm, and 18 breaths per minute.

Accident Description: The victim was involved in an accident where he was stopped at a red light and was rear-ended while stopped. He recalls attempting to brace himself for the impact as he saw the car coming in his rear-view mirror. He immediately had pain in his neck, back and left shoulder from where the seatbelt restrained him.

Hospital Treatment and Medications: He had x-rays taken of the neck, low back and left shoulder, a CT scan of the head and neck, both coming back negative for fractures, dislocations, or internal bleeding. He was prescribed 150mg of Ibuprofen (pain reliever and inflammation treatment) and 15mg Flexeril (muscle relaxer) per day.

Subjective: Patient’s neck, low back and shoulder pain persisted throughout the week leaving him
unable to work, sleep, and bathing was difficult. He came in for an evaluation to the clinic, rating his neck pain 7/10, low back pain 6/10 and his left shoulder pain a 8/10 with pain radiating down into the elbow area.

Visual Inspection: Patient presented with antalgic lean to the right, high hip on the right, high left shoulder, head tilted to the left.

Manual Palpation: Muscle guarding and severe spasms found in the lumbar paraspinal muscles, and quadratus
lumborum on the right showed muscle guarding upon palpation. Severe muscle spasm of the left cervical paraspinal musculature, along with the trapezius,levator scapulae, and pectoralis major and minor on the left side. Left
shoulder palpation was able to recreate the radiating pain down into his elbow when the deltoid muscle was palpated.

Range of Motion Assessment: He had decreased range of motion in his neck when turning to the left and right,
but more decreased when turning left, approximately 30 degrees. He was unable to raise his arm past shoulder level and had pain with any overhead motions. He had decreased right lateral bending in the lumbar spine due to pain and restriction.

Chiropractic Treatment Week 1: His neck pain decreased to a 5/10 and was able to turn his neck to the left with
less restriction and increased range of motion up to 50 degrees. Flexion distraction was used on his lumbar spine, which led to a decrease in low back pain from a 6/10 to a 3/10. Shoulder adjustments were given along with manual
therapy to that area to improve muscle function and to release restrictions in the pectoralis, trapezius and levator scapulae regions.

After 3 Weeks of Treatment: His neck pain decreased to 3/10 and motion was restored to the cervical spine.
Shoulder pain improved greatly with patient having full shoulder range of motion and no pain with overhead motions. Patient was shown exercises to stretch and strengthen certain areas which lead to a decrease in his low back
pain and no more antalgic lean to the right. Blood pressure was reduced to 122/80mmHg.

At 6 weeks, patient was back at work, sleeping better and able to function without pain.

Many patients who seek our chiropractic services have similar outcomes, with improved ranges of motion, increased
strength, improved mood, and normalized blood pressure.

Call us today if you have been in an accident in Gainesville, FL. We will be happy to assist you on your way back to health. 352-373-9911 at Bensen Family Chiropractic.