Quick Case: Capnotrainer, Headaches and Neck Pain | Modern Manual Therapy Blog - Manual Therapy, Videos, Neurodynamics, Podcasts, Research Reviews

Quick Case: Capnotrainer, Headaches and Neck Pain

Just an update on my use of The Capnotrainer during eval and treatments. I had a recent blog follower from Canada call and ask me to evaluate his headaches and neck pain.

Everything seemed to fit into the regular patterns I see, job where he uses a computer (unloading the head/neck into flexion), and loss of cervical retraction and sidebending to the same side of the headaches and pain. The patient was very compliant with cervical retraction and sidebending right, probably doing several hundred the 2-3 days after I saw him the first time.

Upon the first visit, his baseline of right sided headache and radiating cervical pain was 7/10 and upon leaving was 4/10. The normal light IASTM, subcranial distraction had no effect. I tried unilateral variations and right OA gapping, which only decreased Sx during the motion, but did not remain better as a result. AA rotation mobilizations in sitting finally reduced Sx to 4/10. It was 4/10 the remainder of the next day, which was good (normally raises to 7.5/10 or so as the day progresses). Over the weekend, Sx raised to 7.5/10 and the exercises did not alleviate his complaints.

I reviewed his other stretching program which sometimes lowered his resting Sx in the evening. It was mostly cervical/upper trap stretching and thoracic extension exercises in supine and against the wall. After trying similar techniques to decrease his current 5-6/10 right upper cervical pain and headaches, I started with the Capnotrainer and measured his ETCO2. It was 40 mmHg at rest and different positions, which was amazingly good. I was surprised. We talked a bit more, and I tried to get him to overbreath to reproduce or increase his complaints. Nada.

After about 20 more minutes of various visualizations, I asked him what position he is in work at the most, and it was standing with cervical flexion, or sitting with cervical flexion.  In this position, his ETCO2 values plummeted to 25-27 mmHg (you want at least 35 mmHg) and he was unable to raise them unless he laid supine with his eyes closed.

Teaching Diaphragmatic Breathing in WB
Replicating his breathing patterns from supine in sitting and standing did not raise his ETCO2 as expected, so it was not necessarily the breathing rate. After another 20 minutes of trying different breathing patterns (diaphragmatic which was fine supine, but sternal in WB) I tried manipulating his thoracic spine. Immediately in WB and cervical flexion, ETCO2 was back up to 40 mmHg. I realized that I was just doing IASTM to upper and mid thoracic pattern right before the initial Capnotrainer baseline.

HEP then became thoracic whips and instruction on scapula setting repeatedly throughout the day as well as focusing on diaphragmatic breathing at the 10-12 bpm he uses while lying supine. An email follow up just today from the patient stated his complaints were now 4/10 baseline since last visit. Fingers are crossed that restoring ETCO2 will help balance his pH and increase his pain/movement thresholds. I'll keep you updated on his progress.

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Keeping it Eclectic...

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