The patient, a 32-year-old male, had neck pain for 2 years, aggravated for 2 days and came to our outpatient clinic on May 6, 2020. The patient had not taken any medication or received any physical therapy for the last 3 months. Before this visit, the patient had not had a cervical spine radiograph. Physical examination: stiff bilateral neck muscles; tenderness between the C5/6 spinous processes; no other positive signs. The visual analogue score (VAS) was 4 and the radiograph showed he had CK (Fig.1). Combining the patient's history, signs, and radiograph, the current diagnosis is neck pain. Cervical spine manipulation is a routine treatment for neck pain, and many studies have reported its effectiveness and safety. Prior to manipulation, we sought the patient's consent and informed him of the possible benefits (cervical pain relief) and risks (increased pain, nerve and even spinal cord injury) of undergoing manipulation, and the patient gave informed consent and requested manipulation. Ethics approval was obtained from Suzhou TCM hospital and its ethics committee before the treatment.
Therapeutic intervention
CMT was conducted on the patient, it is a single, low-amplitude, high-velocity manipulation. Steps: Firstly, the index finger of the operator's left hand is pressed against the patient's C5 left vertebral plate, which is chosen based on the x-ray, while the palm of the operator's right hand is used to stabilize the patient's head and help it rotate to the right. Secondly, push the patient's cervical spine forward with the index finger of the left hand and guide the patient's cervical spine to rotate to the right with the right palm, which required a high velocity and low amplitude. (Fig.2). At the end of the treatment, we told the patient to reduce the time spent with his head down at work and recommended a second radiograph to assess the effect of CMT on CK, which had been shown to be possible in previous case reports[6, 7]. The patient's VAS was 1 then, and the second radiograph showed CK was reversed into lordosis (Fig.3).
Follow up
2020-08, the patient came to our hospital for a follow-up and complained of neck pain coming back. We scheduled him for another sagittal cervical spine radiograph and evaluated the pain level. The VAS score was 5 and radiograph showed the reappearance of CK in the patient, and after communication with the patient, CMT was given again (Fig.4). After the treatment, the patient’s VAS was 1, but we did not take further radiograph due to the amount of radiation.
2021-02, the patient went to the outpatient clinic of our hospital again with no obvious neck pain and the VAS score was 0. Radiograph showed the cervical spine was lordotic (Fig.5).
During the course of CMT treatment and follow-up, the patient did not show or mention any discomfort.