35 year old female secretary to a law firm, whose job involves prolong periods of computer work (up to 3 hours without break, twice daily), answering phones and working as receptionist. She presents with low cervical and bilateral supraspinous fossa pain as her initial complaint, with headaches that come when this first pain is worse. Once the headaches are there, she finds it very difficult to ease them off without lying down with medication.
Aggravates: Working at computer, particularly as the day goes on, so that by mid-day, she almost always has a headache, making completing the day’s work very difficult. Driving long distances will provoke the neck and supraspinous ...view middle of the document...
She has spoken to the principal of the firm about the workload, but he is unsympathetic.
Activity / fitness level: sedentary, spend most of her time with kids and busy with house work
Posture: Middle height, slightly overweight woman with a prominent dowager’s hump and upper thoracic kyphosis, FHP, heavy breasted, such that her bra straps leave deep grooves in her shoulders, long sloping and anterior tilted shoulders.
Breathing pattern: apical and shallow breathing, excessive use of neck accessory muscles
Cervical active movements: Flexion – poor segmental flexion, no low Cx movement, stretching pain low cervical spine; Extension – all movement occurring in mid Cx, none at low Cx, pain through C7/T1 region at EOR, sharp when movement localized to low Cx; LFs - symmetrical, but very stiff; Rotations – symmetrical and moderately stiff, pulling in C7/T1 region of opening side.
PPIVMs: Flexion – C7/T1, T1/2 moderately stiff; Extension – C7/T1, T1/2, T2/3 very stiff; LF and Rot – symmetrical, both stiff in cervico-thoracic junction.
PAIVMs and palpation: Very tight soft tissue in cervico-thoracic junction, centrally and laterally, very tender; thickened dowager’s hump prominent over cervico-thoracic junction C7, T1-3 stiff ++ centrally, unilaterally, transverse, all painful.
Muscles length: bilateral upper trap √, tight bilateral levator scapulae, pecs minor, scalene
Craniocervical flexion test: able to hold at pressure level 22mmHg but jerky
Neurodynamic: ULTT 1, 2A, slump – nil significant.
• Poor posture
• Lack of low cervical movement with flexion and extension
• Stiff cervico-thoracic junction
• Weak deep neck flexor
• Poor breathing pattern
• Increased work stress, extensive periods of computer work
• Poor physical fitness with obesity and sedentary lifestyle
• Pain-free neck with prolong sitting activities
• To engage slightly more active lifestyle
• Improve posture – to reduce upper thoracic kyphosis, FHP, heavy breasted
FHP has found to be associated with neck pain for population younger than 50 years old and may lengthen the anterior neck structures while tighten the posterior muscles which could cause pain (Silva et al. 2009). Johnson (1998) also support that sustained FHP may increase loading and stress to the posterior cervical structures and lead to myofascial pain. This may tension the levator scapular and other muscles involved in lifting the head (Bonney & Corlett 2002). According to Lau et al. (2010), a person with a greater upper thoracic angle might be more likely to have neck pain. Poorly fitted bras and inadequate breast support can also cause musculoskeletal pain (McGhee & Steele 2010).
• Improve low cervical movement with flexion and extension
Subjects with chronic neck pain showed abnormal cervical muscle recruitment patterns during dynamic and work-related tasks (Johnston et al. 2008). In the analysis of the dynamics of individual cervical motion segments...