neck pain

hi
i have seen some patients with neck stiffness and pain radiates to occiput region. patients feels relief with manual therapy and posture care but re-occurs again after some intervals of time.
can somebody suggest me how to produce long lasting effect

sunil

Hi!
U r taking care of the posture and using manual therapy.But have u taken in account the strengthening of neck muscles after the pain has decreased??

[alophysio]

Try deep neck flexor strengthening ala Jull et al at Uni QLD

[MrPhysio+]

Hi
Occipital pain is generally caused by C2. If the patient also has retro orbital area pain, C7 can be involved as well. Posture is important. Check to see if the patient has a 'chin poke' posture, eg jutting chin, hyperextended upper Cx, and protracted shoulders.If so, teach shoulder retraction exercises, with the arms held at 90 degrees abduction, elbows at 90 degrees flexion. shoulders, elbows, and wrists are to be held parallel with the floor during an active retraction movement, bringinging the scapulae together.
The patient holds the position for 3 seconds, repeats 3 times, per session, and does 3 sessions daily for a week. In the second week the patient holds for 4 seconds, but repeats 3 times a session 3 times daily. The aim is to build up to 5 second hold 5 times , 5 times a day. This takes a total of 7 weeks, which not only re educates the patients posture, but strengthens the weak rhomoids and stretches tight pectorals.

The patient should be warned of possible increased occipital headache for up to 10 days, sore rhomboids and deltoids.
The levatore scapulae muscles should be checked for trigger points, with deep friction massage, stretches, or dry needling applied as appropriate.

[friendlypain]

Hey Sunil,

I have a feeling that your patient is either hyperkyphotic or a whiplash sufferer. It helps if I know what the degrees of head forward position or if PCIR of the humeral head is way off.

Everyone has been correct but we still seem to be unable to see the whole picture. First off, we need to assume a few things.

With a head forward or shoulder forward posture, we see a contraction of the suboccipitals, splenius capitus, upper traps, SCM, and most of the muscles of the anterior triangle. We also see lengthening of the midddle and posterior scalenes, omohyoid, and levator scap.

What comes first? The chicken or the egg or in our profession fxated joint or splinted muscle. We'll my own personal opinion is that muscles will fixate a joint allowing adhesions to form and thus you have a hypomobile joint. So if you just treat the joint then it will just come back.

Trigger point.... well... you really have to be very very thorough or it WILL always reactivate. The reason for this is referral pain. The brain is always confused about these little buggers. So... If you just treat one spot I can assure you that it will not go away. In fact it will return within hours or days. There are three types of trigger points. Primary, Secondary, and Latent. Primary trigger points are caused by trauma, cold, chronic fatigue. Secondary trigger points are caused by Primary trigger points that have referred pain into the secondary trigger point area. Secondary trigger points develop mainly because the brain causes the muscle in the referral zone to splint. Less blood penetrates into those muscles and trigger points form. A latent trigger point is a trigger point that does not show any clinical symptoms. They can be either primary or secondary but the main thing to know is that they are there even if there are no clinical symptoms.

So here is where it is important to remember to be very very thorough. Here is a site that can help you come up with a "battle plan" to deal with neck pain through trigger point therapy.

www.triggerpoint.fcpages....m1m1_1.htm

Remember to hit ALL of them.

The only way to ensure that trigger points dont come back is to streghten the muscles so they can endure times of low aerobic metabolism. Remember that trigger points form due to a lack of ATP, and that needs to addressed. Increase mitochondria numbers within the cell and trigger points will occur less frequently. Do this by performing anaerobic exercises. Now, I cant see anyone lifting 200lb with their foreheads so the next best thing is isometric exercises. Remember that it will take 2 weeks for the muscle to adapt to it's new work load and that trigger points will form because of it. But these should resolve on its own with proper self care.

Now if someone is hyperkyphotic then the outlook is less bright. Especially if the kyphosis is structural as opposed to functional. A functional Hyperkyphosis requires ALOT of retraining. Forget that whole 21 days to change a habit. It takes a year or more for someone to change posture since it is muscle memory and brain programing. Dont be surprised if you develop a treatment plan that can include months and months of preventative treatments.

Looking forward to your replies
Adamo

hi,
thanks adamo. i really appreciate your help. that patient was having some family tension which i came to knowlater so he was keeping his sh. girdler and neck tense always. after teaching him relaxation tech now he is fine.
can you suggest me some book or web site for biomechanics i want to learn particular direction range of motion and action for particular msl in particular through out its range

Sunil

[friendlypain]

Hi Sunil,

I have checked some things but I cant recommend anything at this time. You or anyone can email me at cocuzzoli@hotmail.com and we can go through muscles. It is important to not only focus on the movement of the muscle in question but all the antagonists and synergist of the movement.

Hope to hear from you soon.
Adamo

Hi Sunil, me being at Bangalore and treating such cases more, I would like to say to be with a neuro surgeon or a Ortho in your team for the best result.do use UST,IFT(Dipole Vector at Gymna Uniphy Phyaction) and for spasm give Manual traction with consultations to the specialists.Dont take your own risk.And teach the patient Isometric neck exercises and precautions.Definitely you will see results.Thanks.
bikuda2003@yahoo.co.in

[sdkashif]

Have a look over that article

Physiotherapy for Neck Pain