Quick Case! Chronic Neck Pain with Anxiety | Modern Manual Therapy Blog

Quick Case! Chronic Neck Pain with Anxiety


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
Instead of trying repeated motions, I regressed to
  • 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.


Interested in live cases where I apply this approach and integrate it with manual therapy and repeated motions? Check it out on The OMPT Channel!

Keeping it Eclectic...

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