Neck pain when turning the head after twisting the neck during a basketball fall

A teenage boy developed left-sided neck pain after falling while playing basketball at school and twisting his neck during the fall.

Since the injury, he had experienced pain and discomfort on the left side of his neck when moving his head. In particular, turning his head to the left to look over his shoulder caused localized pain.

He also reported significant tension in the left side of his neck in the morning, with pain occurring when getting out of bed each day.

[Initial Examination]

Medical Interview

The patient had been playing basketball for approximately two years, both as part of his school club and at an external basketball club. He had never previously experienced significant pain or injury affecting his body during sports.

A few days after the injury, he visited an orthopedic clinic with his mother as a precaution. An X-ray was taken, and no significant abnormalities were identified. He was told that the injury should improve within a few days and was prescribed a topical patch.

However, after approximately two weeks, his symptoms had not improved.

Because his mother felt that another visit to the hospital might result in a similar assessment, she decided to bring him to our clinic based on his father’s previous positive experience at Spine Chiropractic.

Visual Inspection

No obvious abnormalities were observed at rest.

There was no significant difference in shoulder height, noticeable neck deviation, or obvious protective posture. The patient’s symptoms did not appear to be severe while the neck was in a static position.

Static Palpation

Mild muscle tension was noted in the left cervical region, including the splenius muscles. However, there was no significant difference compared with the right side.

Motion Palpation

Left cervical rotation was restricted and reproduced the patient’s characteristic pain.

Pain was also reproduced during passive movement, with the practitioner moving the patient’s neck while the patient remained relaxed.

Orthopedic Tests

  • Cervical Compression Test: Positive, reproducing pain around the left C5 region.
  • Valleix Test: Negative.

Because the symptoms developed following a fall and neck injury, vascular risk factors were also considered as part of the clinical assessment.

Although cervical vascular disorders are rare, they can present with neck pain and may have serious consequences. If a vascular disorder or other significant pathology is suspected, cervical manipulation should not be performed and medical evaluation should be prioritized.

In this case, the patient’s mechanism of injury, symptom history, interview findings, and physical examination did not reveal significant warning signs suggestive of a serious vascular condition. The Valleix Test was also negative.

However, a single positional or provocative test cannot by itself rule out a cervical vascular disorder or establish that cervical manipulation is safe. Therefore, the decision to proceed with treatment was based on the patient’s overall clinical presentation rather than the result of a single test.

Muscle Strength Examination

No significant weakness was found in the trapezius, sternocleidomastoid, or scalene muscles.

However, the testing position reproduced the patient’s neck pain.

[Treatment Content]

Based on the overall examination findings, I considered dysfunction of the C4-C5 cervical facet joint to be the most likely contributor to the patient’s symptoms.

The main findings supporting a facet joint-related source of pain were:

  • Pain was clearly reproduced during passive movement.
  • The pain was relatively localized.
  • The pain was reproduced primarily with specific movements and ranges of motion, particularly left cervical rotation.
  • No significant muscle weakness was identified during strength testing.

Taking these findings together, I considered cervical facet joint dysfunction to be the most likely contributor to his symptoms.

Considering his age, the mechanism of injury, symptom history, and examination findings, I also explained to the patient and his mother that the symptoms might respond relatively quickly to an appropriate joint adjustment.

Why I Did Not Over-Relax the Neck Muscles

During treatment, I performed only a minimal amount of soft-tissue work around the painful area rather than extensively relaxing the surrounding muscles.

The reason is that muscle tension is not necessarily something that should simply be eliminated. The muscles of the neck play an important role in supporting the head and maintaining cervical stability against gravity.

When muscle tension is excessive, appropriate relaxation may be beneficial. However, reducing muscle tone indiscriminately is not always appropriate and may potentially reduce the support provided to the cervical spine.

For this reason, I reduced the muscle tension only within an appropriate range and then performed a chiropractic adjustment at the C4-C5 level.

The treatment took approximately 30 minutes.

[Treatment Outcome]

Immediately after the treatment, the patient was able to turn his head to the left smoothly and without pain.

As his movement had returned to a comfortable range and his characteristic pain had resolved, the treatment was concluded after the first session.

He was advised to monitor his condition following treatment.

The following week, his father visited the clinic for his regular maintenance care. When I asked about his son’s condition, he reported that his son had not experienced any further neck pain or discomfort since the treatment.

As the symptoms did not recur, no additional treatment was required.

[Practitioner’s Opinion]

This case illustrates how a movement-related neck complaint following a sports injury can be associated with dysfunction of the cervical facet joints.

The patient had persistent pain for approximately two weeks after falling and twisting his neck while playing basketball. His X-ray did not reveal any significant abnormality, and there was no significant muscle weakness. However, his pain was consistently reproduced with specific cervical movements, particularly left rotation, as well as during passive movement.

From a chiropractic perspective, these findings suggested that restricted or altered joint motion at the cervical facet joint was contributing to his symptoms.

At Spine Chiropractic, I believe that assessing joint movement and functional mechanics is an important part of evaluating musculoskeletal complaints. Rather than simply attempting to relax painful muscles, treatment should be based on an assessment of what may be contributing to the patient’s symptoms.

At the same time, neck pain should never be treated simply by “cracking” or manipulating the neck without first determining whether chiropractic care is appropriate.

This is particularly important following trauma or sports injuries. Before performing a cervical adjustment, the practitioner should consider the mechanism of injury, the patient’s symptoms, neurological findings, and potential vascular or other serious conditions.

If there is any concern that a patient’s symptoms may indicate a condition requiring medical evaluation, the appropriate course of action is to refer the patient to a medical professional rather than proceed with chiropractic treatment.

In this case, after considering these factors, the patient’s presentation was considered appropriate for chiropractic care. Following a targeted C4-C5 adjustment, his pain-free cervical rotation returned immediately, and no recurrence was reported during the following week.

This case demonstrates the importance of identifying whether a patient’s symptoms are appropriate for chiropractic care and selecting treatment based on the findings rather than simply applying the same technique to every neck complaint.

If you are experiencing neck pain when turning your head, neck discomfort following a sports injury, or persistent neck symptoms after a fall, Spine Chiropractic is conveniently located just a 1-minute walk from Bashamichi Station, an 8-minute walk from Nihon Odori Station, a 7-minute walk from JR Kannai Station, and a 12-minute walk from JR Sakuragicho Station in Yokohama.