[dfpt]

Bryanc, thanks for the reply. You've given some food for thought, but I'm still hungry, so here's my take on some of your comments.

So first off, if soft tissue work isn't going to fix the radiological findings (which for MAXX's concern if we were to speculate, would be that his shoulder symptoms are being caused by compression of the spinal cord in a narrowed spinal canal), then what good, exactly will "normalizing biomechanical forces" though soft tissue work do in terms of alleviating this primary complaint?

I'm not convinced, given his primary c/o, that his symptoms ARE caused solely by compression of a narrowed spinal canal. I would speculate that IF his symptoms are primarily related to compression, then we would be able to reproduce his symptoms (bilateral shoulder pain) with movements or positions which physiologically narrow the spinal canal, i.e. cervical extension, sidebending and/or rotation. In any event, is there any other option, besides surgery, that will truly fix the radiological findings?

There is the possibility of axial loading causing remodelling of bone thickening in an annular pattern, but if a trauma is the trigger for an otherwise normally weighted head, we would not expect to see loss of both the cervical AND lumbar lordosis on radiological exam

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Let me expand on this possibility: we know according to Maxx's films that he has a forward head carriage and loss of cervical lordosis. So instead of a well-balanced "bowling ball", we have muscles trying to keep this bowling ball from falling forward. The force needed to keep his head from falling forward would create an axial load on his straight, but forwardly tilted neck. Look at the line of force of the upper traps, levator scap and scalenes. The SCMs posteriorly rotate his cranium, thus facilitating constant upper trap tone due to their neuro relationship. Wouldn't this constant axial load be sufficient stimulus for bone remodelling? As far as his loss of lumbar lordosis, we don't have a way of determining when that occurred; but clinically, I've never seen a normal lumbar lordosis in the presence of a flat upper T-spine (I can see it on his avatar) and forward head carriage or vice versa.

if this was a case of "accelerated degeneration" in the face of abnormal biomechanics rooted in repeated neck trauma (and MAXX reports only one trauma he can remember), we would not expect there to be both loss of cervical and lumbar curvature as an adpatation to "balance his head properly".

MAXX recalls one major trauma b/c he experienced brief paralysis, but in my mind, he's gotten several per every day of football practice and game day; unless he was the kicker. Plus, what's the weight of those helmets.

Yes, trauma can be a triggering factor, but in order for abnormal degeneration to take place, there has to be an underlying pathology; and muscles that pull dysfunctionally doesn't cut it.

How about repeated small traumas (football games and practice, weightlifting, powerlifting, prolonged static positioning (probably slouched) 6-8hrs/day) on top of dysfunctionally pulling muscles?

I've treated many people with heel spurs for plantar fasciitis and they've gotten better, despite still having a heel spur (and I guess this a poor example, because the presence of a heel spur doesn't actually mean much of anything at all--EXCEPT that the heel spur grows in the direction of the pull of the plantar fascia), so yes, you can spurious radiological findings which may never improve with any kind of therapy (but usually because the radiological finding has nothing to do with the causative factors of the symptoms, as in the case of the heel spur).

So why wouldn't/couldn't this be applied to the spine, or any joint for that matter. Bone spurs in the shoulder, herniated discs, spondylolisthesis and retrolisthesis....many people have gotten better with soft tissue work with these underlying pathologies without causing changes to the radiological films.

but that the signs he's reporting are enough to warrant a comprehensive investigation--not just medical clearance for conservative management

. I'm totally with you here; I'm not trying to dilute the possible seriousness of his case, I'm letting you see inside my head if MAXX were to walk off the street into my clinic; and I wouldn't let him leave without hearing me say, "Have it checked out by your doctor".