Silent Neck Problem Presenting as Heart Pain: Where Did the “Really Bad Chest Pain” Come From?

“They did a bunch of tests and they still can’t find anything wrong with my heart!” Brandon was a 55 year old male referred to physical therapy for left shoulder pain. Orthopedic special testing seemed to present with impingement of the left shoulder. In the first 2-3 minutes of the initial examination, Brandon commented rather loudly that he had to deal with waking up every morning worrying about his family. In fact, he mentioned this at every treatment session. “And that sometimes when the family problems get really bad,” he continued, he wakes up with “really bad chest pain.” Thank you, COVID-19.

Brandon was being treated for his left shoulder. It was getting better rather quickly. An open and shut case. His blood pressure was monitored at every visit. They were often high. He said, “Someone taking my blood pressure just gets me worked up!” He was fast approaching discharge for his left shoulder impingement. But there were still no answers to his symptoms of chest pain when he got really stressed out.

I repeated some of the questions from the initial examination. Did he snore? Have a sleep study done? History of sleep apnea? He said he snored but didn’t have any of the other problems.

As Brandon approached the end of his episode of care, we started cleaning things up that could further cause his left shoulder impingement. We improved the flexibility of his neck & head complex. We fine tuned his rib cage. We provided patient education about the functional aspects about his posture that can stem from personality and culture. We cleaned out the solid organs in his viscera that referred to his left shoulder. We took out the nerve tension that went from his neck to his wrists. Hopefully, these treatments could also help with his chest pain as well.

We had good gains. Brandon left each visit with a natural volume to his voice. His shoulders were dropped. His blood pressure and heart rate were within normal limits. His posture settled. His breathing came naturally. But he kept coming back the next visit the same way he came in for previous other visits. He explained, “I’m too worried and I get too busy to do the exercises.” So we did more somatic clean up. There was still very poor carryover.

“It’s just this nagging chest pain!” Brandon already had a plethora of tests done to his heart from his medical doctor. But there were no answers. So I began preparing for the next steps: gathering more information for Brandon’s primary care physician and/or for a referral to an appropriate specialist.

I did some special screening of his main artery that flowed from his heart to his abdomen, the aorta. My hands had to feel through the thick tissues of his abdomen. He was built but overweight. I even tried it with him laying on his side. The results were inconclusive. After all, I didn’t want to send him back to his medical doctor on a hunch. Jokingly I told myself, “I don’t have enough gray hairs and skin wrinkles to have that sort of credibility yet.” But I chose Brandon over myself.

I referred him back. Brandon didn’t present with the other signs and symptoms that would cluster together to induce a working diagnosis of problems with his aorta. But he had a medical history of calcification of the arteries in his body. I hypothesized that the bounding of his pulse in his aorta when he got stressed out could reproduce his chest pain… Maybe…? After all, clinical presentations often have a lot of yet-to-be-discovered gray areas, right? And I chose his safety first.

His primary care physician (PCP) consented to test his aorta.

Brandon came in to his next physical therapy treatment with the results. He walked in with an attitude of proudly–and sadly–accepting his fate of life-long chest pain. The tests of his aorta from his PCP came back negative.

Yes, I was being exhaustive but I needed to make sure. There went my credibility with THAT PCP…

I had Brandon lay on the table again. Supine. I did some special screening of the main arteries that flowed from his heart to his head. I was unable to reproduce his symptoms. Negative. However, when I checked the spacing of the bony landmarks between the base of his skull and his spinous process of C2, they were practically touching each other. There were a pair of main arteries that passed through this area…

Knowing that chest pain can also be referred from this cervical artery, I proceeded to treat this region with the intention to increase this physical space. We’ve done some treatments in this area before. But it was to improve neck mobility that helped with Brandon’s left shoulder. However, this time, we worked on it to improve arterial flow. The treatment was completed in that session. Brandon was also prescribed appropriate home exercises to help manage this area independently.

Brandon came back the next visit looking different! He denied having his “heart problem.” I double checked the area that we treated. The physical space between the base of his occiput and his spinous process of C2 were satisfactory. The home program to help manage this area was supervised. He did them perfectly. Brandon was slowly weaned from physical therapy treatments to supervise carry-over. Brandon’s “really bad chest pain” never came back. And his left shoulder did well with conservative care.

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