Preferred treatment approach to decreased motion (Full Version)

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JSPT -> Preferred treatment approach to decreased motion (May 10, 2005 5:24:00 AM)

I have read many postings on this site with great interest. As a recent graduate, I am trying to find the most effective approach (for me) of dealing with motion restrictions. Since the esteemed panel is so variable in their approach, I'd like opinions on the following patient. (I have not been able to sort through all of the threads, so please inform me if this has already been discussed):

68 y/o Female presents with cervical DJD/OA (per the referral) and c/o cervical stiffness, headaches, and pain with extension; no radiating symptoms at rest, with distraction, or with compression; 50% restricted R Rot, 25% restricted L Rot, 50% restricted SB bilaterally, pain with extension past 10 deg, 25% restricted flexion; deep cervical flexor inhibition; negate alar/VA, etc.; with the patient supine and the neck extended, significant restrictions to passive mobility to both the R and L from C2-C7; SCMs, upper traps, levators are all tight; significant FHP, winged scapulae, mild thoracic kyphosis.

After two treatments, her pain with extension is gone and she has no more headaches. I have not been able to produce improvements in movement.

Shoulde the muscle guarding be addressed first; should the segments be mobilized; what of the neuromodulation effects? I would appreciate any/all input.



JLS_PT_OCS -> Re: Preferred treatment approach to decreased motion (May 10, 2005 7:49:00 AM)

Active motion
Cervical mobilization and/or MET
Deep neck flexor activation

These will address all the issues you mentioned.

I do not believe that "muscle guarding" should be addressed. It is an effort to protect the body from further pain, and is a protective response, not a problem that needs treating.
Help her move more comfortably, and this guarding will decrease.

Cervical mobs may help her through many mechanisms, in segmental motion, neuromodulation, and global ROM improvement.

How have you treated her so far?
You seem to have improved her symptoms, whatever you are doing seems to be working...
J



JSPT -> Re: Preferred treatment approach to decreased motion (May 11, 2005 12:24:00 PM)

Thanks for the advice, Jason. I used some strain/counterstrain initially to decrease symptoms. Her mobility at this point is definitely limited by segmental restrictions, which have not cooperated with most of the glides I have used. Muscle energy has provided some short-term relief for her.

I'll keep at it and hope things start to release a bit. Again, thanks.



avalon -> Re: Preferred treatment approach to decreased motion (May 11, 2005 7:23:00 PM)

Hi Homo Vegetus,

[QUOTE]I do not believe that "muscle guarding" should be addressed. It is an effort to protect the body from further pain, and is a protective response, not a problem that needs treating.[/QUOTE]Suppose that the woman “thinks” (is convinced) that moving was painful when she did a move and it was an unpleasant thing to experience (that's normal). But suppose that she thinks that the next one will be also painful because the previous experience. Then you're facing to a patient experiencing the “painful armor” engaged by brain “helping” her to avoid the movement (see fear avoidance). But... How is it possible that she knew the future? But if she imagined that it will be painful while moving then brain will try to stop this painful movement with... muscle guarding and pain.

My first approach will be “abdominal” breathing and education about pain.



nari -> Re: Preferred treatment approach to decreased motion (May 12, 2005 1:38:00 AM)

Jason

I agree that muscle guarding/tension is not a problem that needs addressing - it will resolve with active, calculated movement.

JS

You seem to be getting there already. Don't worry about the guarding too much. Some passive mobilisations wil help the neuromodulation process, and the brain will release the tension.

Henry

I agree. Pain education with attention to fear of movement/pain is the first thing. Patients become obsessed with muscles; it's good to draw attention away from them with an understanding of the real problem- fear of movement.


nari



JLS_PT_OCS -> Re: Preferred treatment approach to decreased motion (May 12, 2005 2:12:00 AM)

Henry-
I don't disagree with your approach about pain education. Can't say I would do breathing exercises, but I guess anything that encourages some active movement in this patient to reinforce the mobilizations JSPT is providing would be a good thing.

I would not "address" the muscle spasm, I would address the pain and the fear of movement.

J



Randy Dixon -> Re: Preferred treatment approach to decreased motion (May 13, 2005 12:27:00 AM)

Come on Jason, anyone that will sign his name with Homo Vegetus should be all over the breathing thing.



JLS_PT_OCS -> Re: Preferred treatment approach to decreased motion (May 13, 2005 1:32:00 AM)

:)



JSPT -> Re: Preferred treatment approach to decreased motion (May 13, 2005 3:24:00 PM)

Well, I have seen my patient for her 8th visit, and she is quite a bit better. She still only has about 50 deg R rot and 65 deg L rot, but her pain is gone except at end range.

CO-C1 joint mobs and functional indirect MET's were the focus of treatment, as well as teaching segmental retraction between C7-C2. Also did some upper thoracic work.

I doubt that she will ever get full range, but I'm not sure if that is realistic. I guess having to turn your shoulders when you look behind isn't the worst thing in the world when you are otherwise in perfect health at 68 y/o (pt's words, not mine).

Thanks for everyone's input. It's good to hear that you're headed in the right direction when someone's well-being is on the line.



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