cases Flashcards
A 25 year female presents to your clinic
with right sided neck pain and headache that
has been present for the past 3 months
Cervicogenic headache - postural related
cervicogenic HEP
Self management and maintenance program
Postural correction - 10s holds every 15min
HEP: SNAG (5 reps of each kind), CCFT (as mentioned above - depends on Ax findings - 10 x 10s holds) and postural control - every 15min for 10-15s. Could add in scapular holds as well (5 x 5s holds). Start with 3 main things (postural control more of advise).
cervicogenic headache A&E
- cervicogenic headache
- commonand treatable with PT - expect painful symptoms to subside within the next few weeks.
- pain in your neck due to poor posture which abnormally loads the joints > and causes referred pain
from neck (upper 3 joints) - optimal Posture at work
- advise ergo assessment for mouse and chair set up
- encourage regular breaks - move around + postural exercises 10 secs every 15 mins
- Encourage activity as tolerated
Advise on task modifications to protect neck
Maintenance of general activity – walking, low-load exercise
discuss with patient
Muscle dysfunction advice:
+ [pain talk to dr/pharmactist
30 yr old plumber w/ l) sided neck pack that extends into upper shldr -
vas 7/1-
Acute mechanical mid-cervical neck disorder - z-joint dysfunction with referred local nocipetive pain and somatic referral into shldr blade
- USE A SELF MANAGEMENT - MAINTENANCE PROGRAM FOR HIM - AROM IN EVERY DIRECTION, SNAGS
Acute mechanical mid-cervical neck disorder - A& E
Explanation
- similar to a normal strain that could happen elsewhere in body
- soft tissues injry resolve around 6 weeks but can expect early w zoint within 1-2 weeks
- pain a result of increased loading on z-jt due to awkward and sustained working posture-inflammatory component, muscle
overactivity)
-Common condition, only early stages which is
why pain is so severe
-Work practices and postures at work to prevent
recurrence (avoid awkward and sustained
postures) - more breaks, potentially do office work for a few days to allow symptoms to settle
-Demonstrate positions of ease (eg sleeping on
back pillows- flexion, neutral LF/rot)
-Advise relative rest (eg may take a few days off
work or don’t do aggravating work)
Mx plan and goals
- ↓ pain, restore muscle function, regain
movement, restore function
- still important to be active - gentle rom and low load activity
45 y/o lawer with bilater neck pain and thorca
Chronic mechanical lower-cervical neck disorder - Postural overload causing z-jt dysfunction
and stiffness, likely degenerative bilaterally
Chronic mechanical lower-cervical neck disorder
-Explain condition. E.g. joint overload from
sustained poor postures - sustained neck flexion cause kyphosis and postural muscle
weakness
-Importance of posture correction. - inbed being more upright with less flexion - maybe have a book up on pillow
Avoid poor
postures esp for long periods of time. Explain
how N posture deloads unnecessary strain from
neck.
-Advise to set timer on phone/email every
15mins, or red dots around office to remind to
correct posture. Can use a postural brace
initially as a reminder to correct posture.
- Reassure patient: chronic problem so will take
time, can get good improvements w/ postural
correction; common prognosis. As chronic condition, can have sensitivity as well meaning you feel pain even though no damage is done.
-Encourage to increase general exercise e.g.
swimming, running etc
Ergonomics:
-Correct work and home practices (stop the
adverse loading) e.g. correct reading posture in
bed, correct work posture - more breaks
-Teach correct spinal and scapular postural
positions, encourage to get out of end range
postures regularly at work.
pain relief
Chronic mechanical lower-cervical neck disorder HEP
Self management and maintenance program
Postural control at desk/in bed - more advise. Thoracic SNAG?? 6 reps per day. AROM exercises. E and F endurance (dosage). E motor control twice per say until fatigue
- postural holds
