Whiplash and lump in throat

[Taro Watanebe]

hello!
I am a Japanese physiotherapist and had a few manual therapy courses but no residency program. In Japan western manual therapy (Maitland, Kaltenborn,Paris) is not familiar and Japanese physios who graduated from western MT master course cannot find their clinical work place in Japan and go back to western country again.
I dream MT master course with residential program will be established in Japan.

Could you kindly give me advice about the treatment of a whiplash patient?
35 years old housewife was riding a motorbike and was hit by an automobile from a side. Then she was blown off from a bike. And she suffered from a fracture of proximal radius, which was treated conservatively and now almost healed (elbow flexion – 15 degrees)
Remarkable injury was nothing but it. While her elbow has gotten better,　she has begun to complain of neck problem(heaviness of head and lump in throat). My orthopedist referred me to perform mechanical traction and microwave(heat therapy). But she had a limitation of active ROM of neck (left rotation and flexion). So I decided to mobilize (P-A mob) her cervical facet gently. After my mobilization her ROM got better to almost normal range. Following is her physical examination.
Muscle strength : bilateral upper extremities are 5/5
Neurological : denies symptoms
Segmental mobility: Regrettably I could not distinguish hypermobility from hypomobility with confidence. As I have not had redidential manipulative program,(It doesn’t exist in my country.) I hesitate to mobilize patient’s cervical facet as strongly as my healthy colleagues’ one(exercise). Only I can do is to detect tender points and taut bands in musculature.
Tender point : right C4 or C5 facet
When I mobilized (P-A downward glide) it , she complained of lump in
throat, which she had been investigated thoroughly including thyroid
gland, and which proved to be intact before my mobilization. I think this
point (C4 or C5) may have hypermobility. === (( Is that possible???))
On the other hand she has no feeling of lump in throat in P-A
mob.(upperward glide).
Taut bands : were found at the hight of about right C4 or C5 facet.
Also found at left para-vertebral area from C2 to C7 especially when she
felt heaviness of head. This symptom gets better and worse from day to
day. ===== ((How to interpret???))
When she She feels heaviness of head, she complains of a strain(a feeling of stretched) in the upper and mid trapezius when in neck flexion. And at that situation it lacks smoothness in the motion of neck extension.

Now her ROM of the neck is almost normal but a feeling of heaviness of head and a lump in throat is still remaied. In the Maitland “Vertebral Manipulation” he refers A-P mobilization mob or cricothyroid mob.in the throat symptom. But I have never learned the skill of A-P, which seems to be risky in the point of arteria carotis interna.
I think she needs therapeutic exercise of deep neck flexor muscle.

Could you kindly tell me what treatments I should take?

Taro Watanabe
Japan