Case of the Week 8-20-12: "Serious" Structural Issues! | Modern Manual Therapy Blog - Manual Therapy, Videos, Neurodynamics, Podcasts, Research Reviews

Case of the Week 8-20-12: "Serious" Structural Issues!

Today's COTW was mentioned previously in one of my Top 5 Craziest Mechanisms of Injury. This guy was one of the first patient's who made me actually exclaim "OH!" out loud (is that OOL?)

History: The patient was an older gentleman who had served in WW2. I was typing at the computer when he came in and placed his script beside me. My peripheral vision told me he was very tall as I could only see the start of his waste from where I was sitting. His script said "eval and Tx for HA and cervical pain." So as I was holding the script and bringing my gaze up to his head/neck saying, "So it says you're here for OH!" His head and neck were sidebent to the left at least 60 degrees, but upper cervical was sidebent to the right almost as much so that his eyes were nearly level. His chin was literally almost over his acromion.

He said, "I get that a lot," and "my army truck hit a landmine, rolled over, and my head and neck have been like this ever since."

His complaints were left sided headache and neck pain, which were intermittent, but worsening over the past few years. Sx were rated 6-7/10 at worst, worse in the morning, with sitting, head/neck movement to the right, and when still. Sx were better as the day progressed.



  • Flexion DN, mod loss
  • extension DN, sev loss
  • rot Left DN mod loss, right DP sev loss
Myofascia: sev restrictions in left cervical paraspinals, upper trap, levator scapula, scalenes, SCM, mod on right

Asssessment: Signs and Sx consistent with chronic multi-directional cervical dysfunction with radiating cervical pain and cervicogenic HA.

Treatments: I won't go into too much detail because despite having a severe asymmetry that I would never change, he improved rapidly, plus this case I saw literally 10-12 years ago.

  • STM and functional release to the upper trap, levator scapula, cervical paraspinals
  • light OA distraction with unilateral nods left and right
  • 1st rib mobilizations to the right
HEP consisted of light OA nods for gapping and repeated SB to the right, hourly throughout the day. It probably took at least 4-6 visits, but his HA and neck pain abolished completely and his still limited ROM became non-painful in all planes. This is all he ever wanted and certainly did not expect his asymmetry to be "fixed." I was more amazed that he lived through the trauma, the human body is certainly capable of amazing things!

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