Case Summary
- Patient D suffered severe chronic pain in his upper back and neck, limited mobility, and a history of injuries.
- His exam revealed significant issues, including a reverse cervical curve and muscle tension, highlighted by x-rays.
- After treatment with upper cervical chiropractic care, including QSM3 (technique), he initially experienced pain relief but also temporary discomfort before improvement.
- Over time, Patient D regained full neck motion, reduced headaches, and returned to daily activities without severe pain.
- Key lessons include the importance of addressing neck alignment to treat shoulder and mid-back issues effectively in some cases.
Patient D was in middle of a four day pain attack in his upper right shoulder blade when we came into my office. He had experienced pain like this before, but not to this degree of severity.
The pain was in his upper back, just to the middle of of his scapulae bone, below the trapezius muscle. It radiated pain up into his neck. He experienced a lot of pain trying to rotate his head to look to the right. His mobility to the right was very limited.
Patient D’s story is important to anyone who deals with chronic pain between the tip of the shoulder blade to the top of the shoulder. Why? Because D’s story reveals why some people with this sort of chronic pain may not have improvement until a provider investigates the mechanics of the neck.
He could barely move his head back to look at the ceiling.
He experienced at least one minor headache on a weekly basis, with occasional mid- back pain.
In his past, Patient D had several hockey injuries, multiple concussions, and at least one car accident where he was rear ended.
So to review:
- Four days of intense pain in his upper back, near his right shoulder blade, with a history of a similar pain
- At least one headache weekly (which the patient did not necessarily find significant)
- A history of physical trauma, particularly in the head and neck
Patient D’s exam showed significant breakdown in his spinal structure contributing to should blade pain:
- Right head tilt
- Cervical rotation (turning of head left/right): decreased to right
- Cervical lateral bend (leaning side to side): decreased to right
- Cervical Extension (looking up): very limited
- Neck Tissue Changes: Hypertonus and trigger points in right scalene muscles (top front of chest), right above scapula (shoulder blade), with tension dominant down the right spine
- Dominant shoulder tension: Tension on right, with elevated right scapula, with forward rotation
- Short Functional Leg: left (tight Achilles tendon on left leg)
- The most important finding for this patient came from his x-rays, which revealed that he had a head-to-neck misalignment (chiropractic subluxation), and his neck was locked into a reverse cervical curve
Based on his posture, and his x-rays, Patient D’s neck was unlocked using several specific and gentle movements of my hands with the patient laying on his side.
The protocol used for this patient is called QSM3.
Patient D left after his first correction process still in pain. Even after resting for 20 minutes after his first correction he still hurt.
While this wasn’t ideal from Patient D’s perspective, I knew that any lasting relief would probably only come after his lower neck started shifting.
As it turns out, Patient D had a very extreme response to his first correction, as his neck began to unlock out of the reverse cervical curve almost immediately.
What happens when the injured neck moves very quickly?
Patient D experienced a few hours of temporary relief followed by 36 hours of pain and exhaustion. The patient stayed in bed for an entire day, reportedly being tired from the changes taking place in his spine.
Two days after his first correction process, he regained some energy and finally saw a drop in his resting shoulder pain. From that point on the extreme pain near his shoulder blade would gradually decline and disappear over the next four weeks.
Occasional flare-ups would only happen after Patient D started playing hockey again, and took a few hits into the board from an aggressive player.
The above image shows Patient D’s progress
The results of upper cervical chiropractic care
- Patient D’s neck went from an extreme reverse curve into a straight neck – not ideal yet but still better than reverse – and it may be his “normal” based on the level of trauma he has experienced in his spine
- Patient D was able to regain full range of motion in his neck, including most of his ability to look up toward the ceiling
- Patient D was able to return to working his full work day, and playing hockey, without worrying about the appearance of any extreme pain
- Patient D’s headaches became less frequent
The long term benefits?
I can’t say conclusively that Patient D avoided a future of poor health because his neck shifted. But we can speak in probabilities. Reverse curves in the neck are associated with a number of health problems. Since Patient D’s neck shifted after his adjustment – it’s possible that he’s going to avoid a future of annoying to debilitating symptoms just so long as his neck stays healthy.
He may also be more resilient to injury with his neck in a healthier alignment.
Important take-away lessons from Patient D’s case of shoulder blade pain
- Without x-rays, it would have never have been known that this patient had a reverse cervical curve, or that that curve improved, letting us know that Patient D’s painful flare-ups were a constructive sort of pain
- Sometimes the pain gets worse before it gets better, especially as alignment changes rapidly
- Shoulder and mid-back issues can be related to cervical problems, and trying to correct mid-back issues or shoulder issues without accounting for mechanical issues in the neck can be very frustrating for some patients
- Treating recurring headaches without addressing mechanical breakdown may also be missing a source of the problem in some cases
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Clinical Case Summary for Reverse Cervical Curve and Periscapular Pain
| Case Field | Data |
|---|---|
| Patient | Male age 33 |
| Primary Complaint | Severe right periscapular/shoulder-blade pain |
| Symptom History | Recurrent, acute 4-day exacerbation |
| Associated Symptoms | Restricted cervical ROM, headaches |
| Relevant History | Hockey trauma, concussions, rear-impact MVA |
| Objective Findings | Restricted rotation/extension, postural findings, muscle trigger points and hypertonicity |
| Imaging | X-ray with documented change in reverse cervical curve |
| Intervention | Cervical focused chiropractic care |
| Follow up | Approximately 4 weeks |
| Outcome | Resolution of severe flare, improved ROM, reduced headache frequency, return to work/hobbies with less pain |
| Long Term Follow Up | Yes, no reverse curve 4 months later and minimal symptoms |
About this case
This is a de-identified case progression of a real patient. Individual outcomes may vary, and a single case report cannot establish 100% certainty that the changes resulted from treatment alone. As always, consult with a health care provider.
Clinician: Zachary Ward, DC
Practice: Life In Alignment Chiropractic
Original evaluation: August 2014
Follow-up: December 2014
Case reviewed/updated: Reformatted for accuracy and readability in September 2026
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