How Would You Treat a Patient with Central Cervical Pain and Acute Kyphotic Deformity? (a case study)
By guest blogger Chris Chase
I’m so pleased to introduce you to guest blogger Chris Chase PT — Chris is not only an outstanding PT, but he also provides continuing education courses for St. David’s Rehab Hospital.
In this series of posts, Chris will discuss the case of a patient that came to him with severe cervical pain, expose the course of treatment, and show you the results, with lots of “before” and “after” images.
As always, we invite (encourage!) your participation and comments on how you would approach the patient, knowing that collaborative international knowledge has lead us to fantastic new viewpoints!
Enjoy the case study! And now, I give you Chris Chase!
PART 1: INITIAL ASSESSMENT
Sean arrived at the clinic complaining of severe cervical pain (10/10) and limited motion secondary to pain. He could not turn his head side to side, look up or down, and any sudden movement, laugh, or transition from one position to another was extremely painful. His head was severely protruded and he was wincing in pain.
He is a 34 year old male, who has no prior history of neck or any spine problems. He awoke with the pain two days before coming in, after sleeping in the back seat of his car when camping. He is an avid rock climber who exercises regularly and has never seen any medical professionals for any musculoskeletal injuries. That morning he had been assessed by his physician, who told him he had severe muscle spasm in his upper traps and gave him an exercise sheet for the treatment of acute torticollis which included numerous stretches. He was also given muscle relaxers to take if the physical therapy did not work. No diagnostic imaging was ordered.
The patient reported that two days prior, when he awoke, the pain was not as severe; it had also intensified significantly over the last 48 hours and was now limiting his range of motion. He was unsure how stiff it was when he first experienced symptoms but felt that his extreme loss of movement worsened over the last two days when compared to when he first had pain. His forward head deformity was unmistakable and even the task of getting out of the chair in the lobby to go to a treatment room was very painful. Fortunately, his pain was central with no radiating symptoms or any numbness or tingling. He did not report any difficulty with his vision, swallowing, coordination or tinnitus. He had no symptoms of nausea or any other red flags and denied any car accidents, falls, or any trauma recently or ever in his life.
At this point a couple of critical questions come to my mind, and I’d like your thoughts. And stay tuned because over the next weeks we will move onto the eval, then the treatment to end with a review the outcomes.
- Is it safe to progress to a mechanical evaluation of his neck?
- What provisional mechanical classification would we place him in?
- How aggressive are we going to be in our assessment and treatment?
- What direction and force would we like to treat him with?