Mrs P came to see us a few months ago after researching our whole body approach online and reading our Google reviews.
She is a mum in her early 40s who had been suffering a 5 year history of neck, shoulder pain and headaches. The headaches were at the base of her skull and would occur twice weekly and last for several hours. While there were no features of migraine, Mrs P found the headaches quite debilitating, as often her neck and shoulder pain would worsen with them.
Her neck movement was severely restricted also, finding it hard to reverse the car, check blind spots and also to look up with activities like hanging the washing and reaching up to cupboards. Mrs P played netball and found shooting in netball was also painful, and so she had stopped playing. In fact, her enjoyment of life had really taken a hit. She couldn’t enjoy playing with her young daughter as she wanted. She was frustrated and felt down.
She was otherwise in good general health.
Mrs P had also tried other practitioners, including other Physios, with no long term help.
Examination Findings
On initial assessment, we found lots of unhappy areas in Mrs. P’s body that could contribute to her problems. Most notably she had neural tension in all 4 limbs and through the upper cervical spine. This had to be treated first to ensure she responded well to further manual therapy and her results would hold.
There were several muscles in the neck, shoulders, jaw and lower back that were tight and in a protective state, as well as joints in the neck and thoracic spine. The main movements that were restricted were neck rotation (we haven’t shown these for privacy reasons), shoulder internal and external rotation, shoulder abduction and passive neck flexion/rotation. The last test has been shown to correlate well with the incidence neck related headaches.
Below are the pictures of limb range before and after nerve clearing. All tests are performed to the first point of resistance/muscle guarding.
Problem Solving Process
Through a systematic process of treatment trials and clinical reasoning, we narrowed down to a list of 15 structures that were affecting Mrs P’s neck and shoulder movements. With further treatment we narrowed down further to the primary contributor to Mrs P’s condition. This was a segment in her upper neck which was essentially ‘’stuck” (C2) and not gliding to the right as it normally should. There was a secondary contributor in her left shoulder (infraspinatous).
Treatment to this structure made significant changes to Mrs P’s movements, and all other problematic structures.
Results
Over a period 4 weeks (interrupted by Covid!), Mrs P’s movements returned to an optimal state. Concurrently her headaches ceased, her neck and shoulder pain resolved and she was able to finally enjoy playing with her young daughter, as well as move normally and return to netball without pain!
We gave Mrs P strategies to manage her condition long term, including postural, strengthening and motor control exercises, as her posture affected her neck tension and head position.
Postural Corrections
These postural corrections were made for Mrs P, as the corrected position reduced strain and tension on the primary contributors in the neck. Thees new postures will require practice and awareness over time to become natural postures. Mrs P was shown how to check for tension in her neck and whether she was in the correct posture.
Mrs P was overjoyed and quite emotional with her result. She felt that after so many years, she had finally found an approach that worked. She felt confident in her body, and empowered to prevent the condition recurring. She was relieved and excited about enjoying her upcoming holiday, finally being painfree.
This is an example of how a thorough, whole body, systematic problem solving approach can work well for persistent long term musculoskeletal problems.
