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Regis Leal AAOMPT Poster 2008

Regis Leal AAOMPT Poster 2008

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Published by: smokey73 on Nov 29, 2008
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06/14/2009

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Manual Therapy Fellowship

INTRODUCTION:
Currently no published literature exists describing an assessment and treatment strategy for a subgroup of patients presenting with non-traumatic mechanical neck pain and signs and symptoms of posttraumatic stress that may be due to what was considered a recovered WAD.

PHYSICAL EXAMINTATION:
• Cervical Spine ROM: (Measured using a gravity dependent goniometer – pain reported in parenthesis) FLEX 36º (8/10) EXT: 32º (8/10), SBL: 17º (8/10), SBR: 16º (9/10), LROT: 42º (6/10), RROT: 62º (4/10). • Cervical Muscle Control: (Tested using the cranoicervical flexion test via biopressure feedback cuff) Was able to hold at 22mm Hg for three repetitions at 10 seconds each before superficial muscle activity occurred. • Shoulder Girdle Muscle Strength: MMT of both the middle and lower trapezius tested 3+/5 bilaterally. • Manual Examination: Clinically noted reduction in cervical spine P-A accessory joint motion left C5/C6 segment as well as centrally over her cervicothoracic junction C7/T1.

METHODS (cont):

RESULTS (cont):

PURPOSE:
The purpose of this case is twofold; 1) to describe the multimodal assessment and treatment approach for an individual presenting with what appeared to be an insidious onset of neck pain, and 2) to establish preliminary methods aimed at identifying a potential subgroup of patients with a previous history of whiplash presenting with what may be considered a recurrence of their original whiplash syndrome.

GRADED EXERCISE

KEY FINDINGS FROM THE EXAMINATION:
• • • • • Moderate levels of disability (NDI 28 = 56%) Moderate levels of posttraumatic stress (IES > 30) Moderate levels of fear avoidance (FABQ-PA 21/24) Severe limitations in CS ROM testing limited by pain Previous history of a WAD 18 years ago

SUBJECT:
PATIENT INTERVIEW AND HISTORY: 37 year-old female presented to physical therapy with a complaint of insidious onset neck pain and persistent symptoms for 21 days. Further questioning revealed a previous history of WAD 18 years ago that had presumably resolved and no other significant trauma had occurred between that episode and her current complaint. Work: Physical Therapy Assistant Medical history and red flag screening : Negative Pain: Left sided intermittent superficial “achy type” neck pain and discomfort (NPRS: 6.3) SELF-REPORTED MEASURES (Initial) Patient Specific Functional 6.3/10 Scale (PSFS): Neck Disability Index (NDI): Impact of Events Scale (IES): Fear Avoidance Belief Questionnaire (Physical Activity): Fear Avoidance Belief Questionnaire (Work): 28/50 34/75 21/24 0/42

CONCLUSION and CLINICAL RELEVANCE
• Manual therapy and a pain educational treatment approach with graded movement appeared to be effective in resolving her symptoms. • This case report is the first to use the IES as a screening tool for an individual with a nontraumatic neck pain episode that may have been influenced from a previous history of WAD. • Clinical examination of patients with mechanical non-traumatic neck pain should aim to identify any previous history of traumatic neck injury including the use of the IES aimed at identifying factors that have shown to impact prognosis and functional outcomes within this patient population. • Future research should investigate the potential existence of a sub-group of patients presenting with non-traumatic mechanical neck pain with a previous history of head and or neck trauma.
Contact info: mleal@regis.edu

METHODS:

MOTOR CONTROL TRAINING

PAIN NEUROPHYSIOLOGY EDUCATION

RESULTS:
• The patient was essentially symptom free following 7 treatments over 12 weeks and continued to be relatively symptom free at a 4 month follow up.
CERVICOTHORACIC MANIPULATION

SELF-REPORTED MEASURES (Discharge) Patient Specific Functional Scale 9.7/10 (PSFS): Neck Disability Index (NDI): Impact of Events Scale (IES): Fear Avoidance Belief Questionnaire (Physical Activity): 0/50 5/75 0/24 +7

SCAPULOTHORACIC TRAINING

Global Rate of Change (GROC)

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