D: What brings you in?

P: Hi, yesterday I was grocery shopping and, yeah, just in the parking lot somebody bumped into my car and this morning I woke up and my neck is just really painful. It hurt yesterday a little bit, but I mean it was so mild I didn't think much of it. But today it's it's quite a bit worse.

D: OK, so can you tell me how this accident happened? Were you sitting in the passenger seat and the driver? And was the impact from like behind at the back of your car or at the front?

P: It was at the back so I was the driver and was just going over a speed bump in the parking lot so slowed down quite a bit and the person behind me must not have, and they bumped into me. There's just some scratches on the bumper. They didn't hit too hard, but I, I guess maybe hard enough.

D: OK, and did the neck pain start immediately after? 

P: Uh no it's I, like not immediately, yeah, I think it started a bit later on and then worse a bit, a bit today.

D: OK. Alright, and is there pain anywhere else on your body? 

P: Uh really like my. No, just just really, my neck. 

D: OK. OK, and does anything feel broken? Do, are there bruises anywhere? Any obvious signs of trauma?

P: No, I can’t, I didn't notice anything like that and I can move my neck around so I don't think any I don’t, I don't think anything is broken. Just hurts a lot.

D: Alright, and is a pain constantly there or does it come and go?

P: It kind of comes and goes, it just it's worse with movement. If I just kinda sit still, I don't notice much pain, but if I'm betting my head forward or. Mostly backwards, so I'll get, I'll get pain.

D: OK, and you said this happened yesterday, right? 

P: Yeah yeah, this happened yesterday afternoon.

D: OK. Um and does anything make this better? Like have you tried ice, say any topicals any positions that that helps with the pain?

P: I did try some like Advil last night, but like when I when the pain was coming on and it must've helped me sleep I guess, but I haven't tried any ice or anything like that, just mostly I guess resting. 

D: OK so you said the pain is at the back of the neck does it radiate anywhere up into your head or down into your shoulders or lower or upper back? 

P: Uhm. Maybe a little bit to the upper back, like when I like trap, trapezius, muscle area, or the traps like it if I push on those muscles around that area, I do get a little bit of tenderness.

D: OK, OK, and if you were to describe the quality of this pain, would you say it's sharp, dull, achy, throbbing? Uhm, how would you describe it?

P: I would say it's sharp. Yeah, especially if I do any movements like it'll be feels like I mean, it stabbed in the neck.

D: OK, alright, and have you ever had it had pain like this in the past?

P: No, this is the first time. 

D: OK. And do you feel like it's getting worse, the pain since it started yesterday?

P: Yeah, it could be that at first I didn't even have any pain at all. Maybe it was just the adrenaline pumping or whatever, but now I can notice the pain. 

D: OK. OK, and 1 to 10, 10 being the worst pain you've ever felt how bad is this pain?

P: It would be. I would say probably a 6 or a 7. 

D: OK, OK and. Have you had any tingling or numbness?

P: No, I haven't had anything like that.

D: OK, any dizziness or fainting spells?

P: No. 

D: Confusion or memory loss?

P: No. 

D: Any headaches? 

P: Um I. No. 

D: No OK. And. Is this affecting your sleep at all?

P: Oh no, I guess like last night it was a little bit more difficult because I was just I slept I just on my back so that I wasn't moving around as much, so that was a little bit awkward, but I was able to sleep though.

D: OK, I know you said you have some pain with certain movements, but do you find it's hard to move your neck at all?

P: Oh, it feels a bit stiff, but like I'm able to move it. But yeah, I feel stiff.

D: OK. Any issues with vision like is it blurry?

P: No. 

D: No, how about ringing in your ears?

P: No. 

D: No, any sorry yes that, any issues concentrating on on tasks?

P: Um. Yeah, this morning I I guess it's been a little bit more difficult to focus on things, but maybe I was just worried like focusing on the pain in my neck. 

D: Yeah, for sure. Any fevers or chills? 

P: No.

D: Any changes in your weight?

P: No, my weight it's been been the same.

D: Any changes to your hearing?

P: No, that's been been normal. 

D: Smell or taste?

P: That's been normal. 

D: Um chest pain or heart palpitations?

P: No, nothing like that.

D: OK. No cough, shortness or breath, shortness of breath or wheezing?

P: No, none of that.

D: How about Issues with their bowel movements?

P: No, I haven't had any diarrhea or any any any constipation nothing like that.

D: OK, any nausea vomiting?

P: No nausea or vomiting.

D: Changes in your appetite?

P: Uh, no that my appetite's been good.

D: OK how about changes in urine?

P: No, I haven't had any any changes to or any urinary symptoms at all.

D: OK, OK, that's good. And are you otherwise healthy? Do you have any longstanding medical conditions?

P: Uhm. No, I am otherwise healthy, I just I'd take birth control, and I am a multi vitamin but that's it. So no medical conditions.

D: OK, alright that's good um. And have you had any hospitalizations or surgeries in the past? 

P: Uhm, no, I haven’t. 

D: No OK. How about medications? Are you on any?

P: Just the the the birth control that I'm I'm taking. I've been taking that for about five years now.

D: Five years OK, any side effects or any issues with that?

P: No, it's been good day I, I've been really happy with it overall too. They help regulate my cycles.

D: OK, OK, good. And then are you up to date with your immunizations?

P: I am yes, I'll get the flu shot every year.

D: OK, that's good. Do you have any allergies? 

P: I do, yeah, but it's I think they're just all environmental, 'cause I'll typically get issues with seasonal changes and then then it goes away.

D: Oh I see. OK, any family history of lung or heart conditions?

P: I think my dad has high blood pressure, and diabetes. Yeah, but no heart or or lung conditions.

D: OK, how about a musculoskeletal issues?

P: I think maybe osteoarthritis and my grandpa, grandparents, but. 

D: OK. 

P: But yeah.

D: How about an autoimmune conditions?

P: No, nothing like that. 

D: No? OK how about cancers.?

P: Uh, no cancers. 

D: OK. And then, do you smoke?

P: No, I don't. No I've never smoked before.

D: OK, how about marijuana? Do you consume that in any form?

P: No, I don't. 

D: OK. And then do you drink alcohol?

P: Every once in a while I'll have a glass of wine, but it's usually a social thing or or at Christmas. 

D: OK. Come have out in terms of sick Contacts. Have you had any recently?

P: I don't believe so. Um I've been going to work, I work as a bank teller, um but everybody at work hasn't been sick and we've been using masks and cleaning our hands and all of that sort of thing.

D: OK, OK, that's good. And how about travel? Have you had any recently?

P: No, I've been put at home, but looking forward to a vacation though.

D: Yeah for sure. And then, where do you work and who do you live with and where do you live?

P: Yes, I I work at a bank. And I live with my husband and our time and our son, he’s, he's six. 

D: OK, OK. OK, um those are all the questions I have for history. We can move on to the physical exam part of this interview. Did you have any questions before we did that? 

P: Uh, no, no, that sounds good. 

D: OK so if you have someone there with you, or if you have a mirror, or if there's any way you can take a look at the back of your neck as well as the front of your neck um. Do you see any redness or swelling in that area? 

P: No, I don’t. 

D: No, OK. Do you see any muscle atrophy? Any deformities or skin changes?

P: No, nothing like that.

D: OK. And then when you kind of just with the back of your hand, place it on your neck in the front as well as the back, does it feel warm at all? 

P: No. 

D: No OK. And then I'm gonna get you to palpate certain areas so we'll start with the chin. Does that hurt when you press down?

P: No. 

D: No OK, how about just where the thyroid would be?

P: No pain or yeah, no pain there.

D: No pain there OK. How about to the sides, kind of where your. Sternocleidomastoid muscles are?

P: Yeah, I think like a little bit of tenderness in the the front of the neck muscles there. 

D: OK and then how about when you move towards the back and then on your C spine, cervical spine just like at the very back of your neck?

P: Yeah, so there's there's no pain when I push on the like bones I can feel like so, actually on that that like C spine itself there's no pain, but like oh off to the side so on the muscles. To the sides or there's a bit of tenderness.

D: OK, so kind of like where, so there's pain on their trapezius and deltoid muscles?

P: Uhm. Uh. Yeah, more trapezius not so not so much deltoid and then also, um, like the the perispinal muscles.

D: OK, I see, alright. Uhm. OK, and then let's move on to some range of motion exam so I'm gonna get you to flex your neck. So look down at the ground all the way as much as you can. Does that hurt? 

P: It does, yeah.

D: It does but you're able to fully flex your neck.

P: Yeah, I can touch my chin to my chest all almost uh but yeah, I'll get pain at the back of my neck when I do that and the front.

D: And the front? OK. And then how about when you extend your head all the way back so that you're looking at the ceiling?

P: I’m able to do it still is a bit stiff and it's slow to get there, but again I I get pain at the back in the front of my neck when I'm doing this.

D: OK, OK, how about when you flex your neck to the side so that your right ear is touching your right shoulder?

P: Um yeah, I get there's a little bit of a pain in the muscles on the left side when I'm doing that 

D: OK, and then how about when you do the opposite? Touch your left ear to your left shoulder so that you're laterally flexing your neck on the left side?

P: A little bit of pain there too, but I'm able to do it though. 

D: OK. So you're able to do all of these, it's just that you have some pain when you do that? 

P: Yeah, exactly, I could do all of the movements, but yeah, it's pain and stiffness.

D: OK, OK. Those are all the questions that I had for you. Did you have any questions of your own?

P: Uh no, that I just was wondering if I if you think I I don’t, needed an X Ray or like you think that anything is broken. Kind of like concerned about today, because of this pain.

D: Yeah. And for sure, um so right now it just to me it sounds like a whiplash injury and so kind of like low impact. But just to be certain, we can order an X Ray to rule out any fractures or dislocations. And in terms of like the management plan, for pain management you can rest, you can either apply heat or cold packs to your neck for 15 minutes every couple of hours or so. You can try some over the counter pain medications like Ibuprofen or Tylenol. And if it still doesn't get better, we can try like, we can try injections to the area to relieve some of that pain, but something else in conjunction we can try as physiotherapy and they'll basically help you with. Range of motion exercises and try to strengthen the muscles in that area and to improve your posture and normal movement. And that's kind of where we can start for now. And if it doesn't get any better, we can talk about alternative management plans, does that sound OK?

P: It does, yeah, that that makes sense. Thank you.

D: OK, yeah, no worries.