Intro: Wow! That was some interesting discussion!! Let’s hear it for Chris Chase in doing such a fine job of moderating! This professional blog is followed by MD’s, PTs and OTs. It looks like most of the posts are, appropriately, by PTs. Yet, the following of this blog crosses many medical disciplines. For that reason, we ask that you give your name (rather than just initials) and your credentials, and know that you are as identifiable and professional as if you were at a conference. In the vein of utmost quality, we will be monitoring the posts, and only those professional posts with names attached to them will be funneled to the blog.
With that, I give you back to Chris Chase PT! We look forward to your comments!
At the conclusion of the subjective history and performing a neuro exam that was negative, I decided to proceed with my mechanical assessment of Sean’s condition. Because of the very sharp pain with transitions, I proceeded slowly with care and caution while constantly monitoring his symptoms for anything out of the ordinary. Typically, I initially perform postural correction and assess the effects. However, in this case any attempt to improve his sitting increased pain. Because of the forward position of his neck, he was most comfortable slouching –but even this was uncomfortable.
I observed the visible kyphosis as seen in the picture. It was not warm nor swollen, there was no redness noted and the patient was unaware of any pre-existing deformity as he described normally having excellent ROM that he used when rock climbing and during day-to-day activity. He did not demonstrate any significant muscle spasm or hypersensitivity, and reported only central pain during his movement portion of the exam.
Next I examined his Range of Motion. His loss of motion is clearly illustrated in the following images:
Protrusion: Minimal loss. Even though he was stuck in this position, he could not protrude further into range of motion.
Retraction: Major loss or completely obstructed. He was unable to retract at all.
Flexion : Major loss with no movement coming from his lower cervical spine
Extension: Major loss with minimal movement coming from his mid cervical spine and his lower spine was fixated in flexion.
Right and Left Rotation: moderate loss in both directions, however, significant pain in both directions.
Right and Left Lateral Flexion: major loss in both directions with pain.
At this point, it is time to decide to how to initiate treatment. A number of different treatment strategies have been suggested, but at this point I would like to know specifically how you would proceed.
- What specific direction would you start with in an attempt to restore his normal lordotic curve in his lower cervical spine? Or would you have a different initial treatment strategy?
- Once you have a direction, what particular loading strategy would you like to try? And why?
- Does manual therapy have a place in the treatment of this patient and if so, what techniques may you use?