case 1 > 5 Flashcards
case 1: cervicogenic headache
- 25y/o female
- R) sided neck pa. + headache for past 3 months
- symptoms getting worse since new job 6 months ago
- spends more time on computer
- using the computer mouse makers her neck feel tired and stiff
case 1: 25 y/old female office worker - r) neck pain and headache
Assessment:
o Standing: observe posture, scapular assessment* (posture and F, ABD, ER w/ resistance)
o Sitting: ROM – esp upper Cx, Postural assessment/correction (reassess ROM) maybe also correct scap posture here, functional position/action from work, palpation
o Supine: Flexion rotation test, CCFT, PIIVM (if time)
o Prone: PAIVM*, scap hold test
o 4 point: E and Rtr strength/control, serratus? - maaaybe
case 1: 25 y/old female office worker - r) neck pain and headache
Treatment
- A& E
o A & E*:
§ About posture at work, regular breaks, ergonomic set up of computer and mouse. Common problem. V common for office workers - reassurance, often recover well and with this type of headache can often respond well with correction of neck musculature. If pain is bad see pharmacist and doc for pain meds - be aware of too much bc can make it worse
case 1: 25 y/old female office worker - r) neck pain and headache
Treatment
other
Postural correction exercise at desk. How to progress? Reduce reminders, hold for longer each time
o Scapular holds in side lie. Dosage depends on assessment: just action initially or do 5 x 5s holds or 10s holds. Progress to sitting and then more functional like set it and then do movement or at desk.
o Potentially serratus training? Less likely
o CCFT holds/exercises. Dosage depends on what they can do. Initially might just be training the action. Then holds (10 x 10s at lowest level they are capable of for training). Progress through levels at the same dosage. Then off pillow, off bed, off wall in sitting.
o MANUAL THERAPY
§ SNAG teach snags as apart of HEP. Teach both types. No more than 6 (MWM dosage)
§ Upper cervical unilat Paivm or piivm or both at level noted from assessment. Start with grade 2 and can quickly progress to grade 3 for 30s. If highly irritable start with Piivms.
case 1 - priorities
Assessment - scap. assessment in standing Sitting ROM - esp. upper cx Postural assessment/correction* supine: flx rotation test, CCFT prone = PAIVM
Treatment
- A & E
- CCFT holds/exersises
- MT - SNAGS
Pt 2 - Acute mechanical mid-cervical neck disorder
Acute mechanical mid-cervical neck disorder:
- 30 y/old plumber
- mid l) sided neck pain that extens into his upper shldr girdles regions (VAS 7/10)
- pa. w/ turning to L) and looking up at the ceiling
- eases w/ turning to r)
Pt 2 - acute mechanical mid-ervical neck disorder
Ax
- Irritable. Limited assessment and initial treatment
- Assessment
o Standing: Observation, scap assessment/correction
o Sitting: ROM, Postural assessment/correction,
o Functional position?
o Prone: PAIVM (v gentle and within limits of pain to find level – ONLY if pain permits, likely too irritable), Scap holds?
o Supine: PIIVM*
o 4 point: Muscle assessments of E and Rtrs?
Pt 2 - acute mechanical mid-cervical neck disorder
Treatment
AROM in all directions as far as possible
o PIIVM to OPEN joint. Lower grade – 2
o Rotation PIIVM? Grade 2 to open so to the right
PAIVM: Grade 2 unilat only if pain permits but likely too sore for first session.
Traction?
Address muscle impairments?
HEP: AROM (dosage? Every direction x2 twice a day?). Maybe SNAG??? Not much he can do
Case 3 - chronic mechanical lower-cervical neck disorder
chronic mechanical lower-cervical neck disorder
- 45 y/old lawyer
- bilateral pa. over lower neck and upp. thoracic
- increase. intensity pa. over past year
- agg. by reading in bed at night and stiffness when looking up at ceilling
Case 3 - chronic mechanical lower-cervical neck disorder
Ax
o Standing: Observation, Scapular assessment/correction
o Sitting: Postural assessment/correction* ROM - including Tx*
o Prone: PAIVM (including upper Tx)* scap hold test?? - if scap assessment indicated it. Extensor endurance*
o Supine: PIIVM if time (/sidelye Tx), CCFT - bc of bed position, flexion rotation? - flexion rotation is for upper cervical only isn’t it??. Perhaps Flexion endurance is better than CCFT? Functional position lying in bed
o 4 point: Serratus, extensor and rotator strength/control - from lack of going into E
Case 3 - chronic mechanical lower-cervical neck disorder
tx - A& E
o Postural positions while lying in bed can lead to neck pain, especially if your neck is bent too much, this also applies to desk/office work (which assume they do a lot of as lawyer)
- reassess bed position - sit up more - ergonomics of bed and desk.
- Expect that with treatment you will improve but I’ll see how you are after the first week and then should be able to give you a better prognosis after that based on how you respond.
- Bc you’ve had this pain for quite a long time it usually means that structures where you feel pain can become a bit more sensitive because it hasn’t fully gone away, and the threshold where your pain alarm goes off, becomes lower. So more pain doesn’t necessarily mean there is more damage happening in the area. So, don’t be afraid of moving neck, it’s important to continue to move as much as possible, especially to help increase the range into extension and reduce the stiffness. It’s possible that your neck has become more stiff in extension because of you guarding your neck and avoiding that movement and spending more time with your neck bent. Doctor/pharmacist for pain relief. Heat can help esp at night and can be good to loosen stiff structures - 4layers of towel for 10min.
Case 2 - acute mechincal mid cervical neck pain
A & E
Pain relief highest priority
o A & E: Reassure - what has happened at your neck is similar to a normal strain that could happen elsewhere in your body and it should resolve fairly quickly. It should heal within normal healing time frames for soft tissue which is generally no more than 6 weeks and for this kind of injury I suspect it will resolve much faster - within 1-2 weeks. Good to avoid positions causing pain and those awkward work positions, but it is still important to try and maintain normal movement and range of motion in every-day activities. I don’t want you to rest in bed or keep your neck still. Try to move it as much as possible within your pain limits. Is there any ways we can modify your work so you don’t have to be in those awkward positions - perhaps do office work for a few days or get apprentice to do it. Avoid days off. Pain relief - doc/pharmacist. See you again at the end of the week - see how it is progressing. Heat/ice may be helpful for pain relief - 4 layers of towel between heat for 10min I think
case 1
HEP
HEP: SNAG (5 reps of each kind), CCFT (as mentioned above - depends on Ax findings - 10 x 10s holds) and postural control - every 15min for 10-15s. Could add in scapular holds as well (5 x 5s holds). Start with 3 main things (postural control more of advise).
case 2 HEP
HEP: AROM (dosage? Every direction x2 twice a day?). Maybe SNAG??? Not much he can do
case 3 HEP
HEP: Postural control at desk/in bed - more advise. Thoracic SNAG?? 6 reps per day. AROM exercises. E and F endurance (dosage). E motor control twice per say until fatigue
