Chiropractic Management of Performance Related Musculoskeletal Disorder in a Career Violist

Patient: Female, 64-year-old Final Diagnosis: Atlas subluxation complex Symptoms: Hip pain • neck pain • wrist pain Medication: — Clinical Procedure: Chiropractic adjustment • manual therapy Specialty: Family Medicine OBJECTIVE: Challenging differential diagnosis 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.