Manual Therapy Fellowship

INTRODUCTION: PHYSICAL EXAMINTATION: METHODS (cont): RESULTS (cont):

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.
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.
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): 28/50
Impact of Events Scale (IES): 34/75
Fear Avoidance Belief
Questionnaire (Physical 21/24
Activity):
Fear Avoidance Belief
Questionnaire 0/42
(Work):
• 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.
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
METHODS:
• The patient was essentially symptom free
CERVICOTHORACIC MANIPULATION
SCAPULOTHORACIC TRAINING
GRADED EXERCISE
CONCLUSION and CLINICAL
RELEVANCE
• Manual therapy and a pain educational treatment
approach with graded movement appeared to be
effective in resolving her symptoms.
MOTOR CONTROL PAIN
TRAINING NEUROPHYSIOLOGY
EDUCATION • This case report is the first to use the IES as a
screening tool for an individual with a non-
RESULTS: traumatic neck pain episode that may have been
influenced from a previous history of WAD.
following 7 treatments over 12 weeks and
continued to be relatively symptom free at a 4 • Clinical examination of patients with mechanical
month follow up. non-traumatic neck pain should aim to identify any
previous history of traumatic neck injury including
SELF-REPORTED MEASURES (Discharge) the use of the IES aimed at identifying factors that
Patient Specific Functional Scale
9.7/10 have shown to impact prognosis and functional
(PSFS): outcomes within this patient population.
Neck Disability Index (NDI): 0/50
• Future research should investigate the potential
Impact of Events Scale (IES): 5/75 existence of a sub-group of patients presenting
Fear Avoidance Belief with non-traumatic mechanical neck pain with a
0/24
Questionnaire (Physical Activity): previous history of head and or neck trauma.
Global Rate of Change (GROC) +7
Contact info: mleal@regis.edu