Chiropractic Management of Performance Related Musculoskeletal Disorder in a Career Violist

Abstract

BACKGROUND Music performance is a highly stressful activity, requiring skilled neuromuscular dexterity. A lack of reported strategies for musicians suffering performance-related musculoskeletal disorders (PRMDs) exists. Papers investigating the role that postural distortions or spinal structural anomalies that could play a role in setting the stage for PRMD do not exist. The purpose of this paper was to provide a description and discussion of the use of a specialized upper cervical manual correction at the cranio-cervical junction (CCJ) to treat a violist who had disabling pain in her wrists, arms, neck, and hip. Differential diagnoses are required regarding possible confounding elements within the cervical spine. CASE REPORT After 40 years of music performance, a violist experienced severe pain while attempting to play the simplest student musical pieces. Early retirement seemed imminent. To determine appropriate chiropractic approach, the patient's clinical assessment included active range of motion, chiropractic tests, palpation, and radiographic study. Postural distortions, hypertonic muscles, joint pain, arthritis, and ponticulus posticus (PP) were noted. Upper cervical spine orthogonal radiographic series were used to develop a correction strategy. These images identified excursion of the cervical spine away from the vertical axis and C0-C1-C2 misalignments. After performing low-velocity, low-force manual correction to the CCJ, the patient experienced immediate relief of wrist pain. Over a 9-month follow-up period, the patient reported gradual decrease of pain and increased stamina while performing. Upon completing chiropractic care, the violist's career was restored. CONCLUSIONS This case supports the hypothesis that evaluating and correcting spinal structures proximal to painful extremities may represent an efficient and long-lasting solution for PRMD.

Figure 1.

This violist depicts the use of a pillow under the left axilla to assist the effort of left arm abduction and external rotation. A healthy violist will not require assistance.

Figure 2.

The lateral cervical radiograph shows ponticulus posticus on the atlas and degenerative joint disease throughout. The bucky has lead lines marking vertical and horizontal axes as true reference points for evaluating patient positioning.

Figure 3.

The frontal (nasium) radiograph depicts excursion of the cervical spine into the right frontal plane, creating an acute angle between the atlas (C1) and the skull (C0). The right side of the patient is on the right. On the right of the center line is recorded the elements of the misalignment: AT (atlas) right 2 degrees, OD (odontoid) right 3 degrees, BC (C2 body center) right 2 degrees, SP (spinous process of C2) right 0 degrees. To the left of center line is the calculated correction vector designed to restore the system to the vertical axis.

Figure 4.

The post adjustment frontal (nasium) radiograph depicts the return of the cervical spine to the y-axis directly underneath the skull and effective reduction of the acute angle between the atlas and the skull. N (normal atlas-skull relationship), L1 (describes tilt of the head to the left 1 degree off the vertical axis, not a misalignment component).

Figure 5.

Patient-reported data points on a numeric 0–15 scale, 10 indicating original level of pain, 0 indicating no pain, 11–15 indicating levels of aggravation above initial pain level.