What is the optimal treatment plan for a 33-year-old male patient with upper back and neck pain, poor posture, and a history of lifting heavy weights?

From the Guidelines

The optimal treatment plan for a 33-year-old male patient with upper back and neck pain, poor posture, and a history of lifting heavy weights should prioritize non-pharmacologic treatments, including physical therapy and posture correction, with the addition of nonsteroidal anti-inflammatory drugs or skeletal muscle relaxants for pain management, as recommended by the American College of Physicians 1.

When considering the treatment plan, it's essential to address the underlying causes of the patient's pain, including poor posture and the history of lifting heavy weights. The patient's current symptoms and history suggest a subacute or chronic condition, given that the pain started a couple of months ago and has continued despite a brief cessation of weightlifting.

Key components of the treatment plan should include:

• Physical therapy to strengthen the upper back muscles and improve posture, which can help alleviate pain and prevent future episodes.
• Posture correction exercises, such as chin tucks, shoulder blade squeezes, and wall angels, to be performed daily.
• Modification of the weightlifting routine to avoid exacerbating the condition, with a gradual reintroduction of heavier loads and overhead movements as the pain subsides.
• Pain management using nonsteroidal anti-inflammatory drugs, such as ibuprofen or naproxen, for a short period, or skeletal muscle relaxants like methocarbamol, as prescribed, for a limited duration of 14 days, as per the initial plan.

It's crucial to follow up with the patient after the completion of physical therapy to assess the effectiveness of the treatment plan and make any necessary adjustments. The current plan to follow up in two months is reasonable, allowing sufficient time for the patient to undergo physical therapy and make lifestyle adjustments.

The use of ketorolac 60 mg injection as an initial treatment may provide immediate pain relief but should be considered in the context of the patient's overall treatment plan, focusing on non-pharmacologic interventions for long-term management, as emphasized by the guideline from the American College of Physicians 1.

From the Research

Treatment Plan for Upper Back and Neck Pain

The patient's symptoms of upper back and neck pain, poor posture, and a history of lifting heavy weights can be addressed through a combination of physical therapy and medication.

• The treatment plan includes physical therapy to improve posture and reduce pain, as well as medication such as Methocarbamol and Ketorolac to manage pain and inflammation 2, 3.
• A study published in the Journal of Sport Rehabilitation found that exercise programs that include deadlifts can yield improvements in both pain and function for those living with low back pain, but were not found to be more beneficial than low load motor control exercises 4.
• Another study published in The Orthopedic Clinics of North America emphasizes the importance of physical therapy in the treatment of cervical disk disease, including the use of active modalities and addressing psychosocial dysfunction 5.
• A review of the role of physiotherapy in managing non-specific back pain and neck pain recommends a stepped approach, including patient education, self-management, and a return to normal activities, with physiotherapy offered for patients who are not recovering after a few weeks 6.

Medication and Physical Therapy

The prescribed medication, Methocarbamol 500 1-2T BID for 14 days and Ketorolac 60 mg injection, can help manage the patient's pain and inflammation.

• Physical therapy can help improve the patient's posture, reduce pain, and increase range of motion, as seen in a case study published in Physical Therapy 2.
• The patient's poor sitting and standing posture can be addressed through physical therapy, which can help improve their overall posture and reduce their risk of further injury.

Follow-up and Further Treatment

The patient will be followed up in two months after physical therapy ends to assess their progress and determine if further treatment is needed.

• If the patient's symptoms persist or worsen, further treatment options may be considered, such as a multidisciplinary approach or liaison with the workplace and/or social services 6.
• The patient's treatment plan will be tailored to their individual needs and goals, with a focus on improving their function and reducing their pain.