INTRODUCTION, by Marilyn Pink, PT, Ph.D: I have known and admired Dr. Landel for many years as a top orthopedic clinician, researcher and educator, recognized with numerous awards. Just this year, Dr. Landel was named a Catherine Worthingham APTA Fellow, the highest honor among APTA membership categories. So, we are particularly pleased to bring you the first on a series of posts by Rob and encourage you to comment & pose questions. This is an opportunity to interact with a real luminary in PT!
An evolving patient presentation: what else is going on here?
by guest blogger, Rob Landel, PT, DPT, OCS, CSCS, FAPTA
You are a physical therapist treating a 67-year-old female accounts payable administrator for the past 2 weeks for neck pain and headaches (HA).
Her neck pain is bilateral, localized to the suboccipital region, without radiation into either upper or lower extremitiy. Her headaches are mainly in her bilateral forehead region. Both her neck pain and HA began after a motor vehicle accident (MVA) 4 weeks ago but both are improving since starting PT with you.
Radiographs taken the day of the MVA were negative and the MD referred her to PT for a diagnosis of “muscle strain.” Your plan of care has been to address the impairments associated with soft tissue damage in the cervical spine following her whiplash injury: early immobilization and inflammation-reducing modalities followed by progressive AROM as tolerated, gradually introducing gentle PROM including manual therapy, and postural re-education. You have just recently started working on improving her muscle function through exercise.
Today as you begin her treatment when she goes to lie down she grabs the plinth for several seconds, shutting her eyes and swaying slightly, before gradually relaxing and proceeding to assume a supine position. She opens her eyes, notes you looking at her, smiles grimly and sheepishly apologizes. When you question what just happened, she says she’s been getting dizzy spells for the past several days. She hadn’t mentioned it to you since you were treating her for her neck pain, not for dizziness.
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I look forward to hearing from you!