My recent time mentoring out of clinic had a lot of great cases. One of the cases, my mentee wanted to see how I would address chronic cervical pain with complicating factors of anxiety, myofascial pain syndrome (or fibromyalagia, not sure what her "Dx" was).
Quick Case breakdown:
- mid 40s, mother, very antsy - for lack of a better term
- difficult time looking who she is speaking with in the eye
- main complaint is moderate to severe right cervical pain and tightness with cervical rotation and SB to the right
Objectively, cervical motion was
- DP and mod limited with cervical flexion/rotation to the right
- DP and mod limited with cervical retraction and SB to the right
- she was unable to perform retraction and SB actively or relax passively during repeated motions of this
- supine cervical SB was FP, important difference to note to the patient as she had the motion, but did not know how to access it threat free
- supine breathing, and taught her to focus mostly on abdominal breathing, rather than sternal
- a healthy dose of Pain Science
- perceptions of tightness rather than a "muscle being tight"
- how to focus exhalation for reduction of tone and stretch perception at her CNS imposed barrier
- palpation of the "tight and tender" area in her upper trap, and having it reduce significantly with the appropriate breathing pattern
After doing about a 25 minute breathing session, she was able to realize that she could control her own perception of tightness and pain during motion. I had her sit back up, and afterward, she was able to retract and SB to a further barrier. Previously, she was limited to about 10 deg cervical SB right, now she was at 30 or so. At that barrier, I had her close her eyes, picture her son's face, and do the breathing pattern from supine. She was able to easily overcome the barrier and attain end range after 3-4 good breaths.
Her homework was
- "recharging" like her cell phone 1-2 times daily, or as needed, supine lying, listening to her favorite music and concentrating on her breathing pattern
- repeatedly move into her new ROM with cervical SB to the right, breath as necessary to move past any perceptions of tightness
|Only during stoplights, not driving!|
She came back 2 days later keeping most of her ROM and having minimal to no pain during ADLs. She reported at least 90% improvement. However, she was holding her neck in a prolonged sidebending position during driving! I neglected to mention this should be done only at stoplights, and not when driving! Lesson learned!
She was discharged by my mentee after a Pain Science and HEP review, with some light IASTM along right cervical patterns and upper trap to further reduce any increased tone.
Keeping it Eclectic...