Follow up: Case Study: Cervical pain post concussion

Follow up to Case study: cervical pain post concussion

I treated patient on 11/13 two days after the initial evaluation. Patient reported that her neck pain and movement was a lot better and working on HEP throughout day including at school. She continues to have no headaches or dizziness. Her major complaint now is with sidebending and lack of activity. She really wants to be ready for indoor soccer season which starts in a couple weeks.

Re-check of measurements:

  • Bilateral Rotation and sagittal AROM of cervical remains full and only a 1/10 pain (in upper traps)
  • Her cervical retractions look great and can repeat without incident
  • Thoracic rotation actively is good
  • Upper trap spasms continue but subjective report of much improvement and no more medial scapular border pain
  • Sidebending is limited to about 50% of max (she has a long slender neck and should get a lot of motion in this directions) and has moderate pain

Treatment

  • C-T distraction again
  • IASTM to upper traps and cervical paraspinals
  • Weight bearing cervical retraction with sidebending
    • Reported a lot of pain and was apprehensive to continuing
  • Non-weight bearing cervical retraction with sidebending
    • Tolerated much better and performed until able to get what looks like full PROM
  • Revisited the weight bearing cervical retraction with sidebending
    • Able to tolerate now and improves her motion and pain but still not full AROM that she had passively and pain is still present.
  • Supine mobilizations of cervical segments (right to left and left to right)
    • Moved into more closing with reps
    • Rechecked AROM sidebending and now improved and only mild pain to perform
  • Attempted Upper rib manipulation to left side to reduce upper trap spams but unable to get a good lock and no cavitation. Did on right side and same result
  • Bike, bird dogs, mid/low trap (T/Ys), planks and squats
    • Performed some mild exertion activities to increase blood flow and to begin exertion training for return to sports.
    • No neck pain and no concussion symptoms throughout this part of the program
  • HEP:
    • Same as previous, added the exertion components listed above, cervical retraction with sidebending and also gave a towel pull (isometric horizontal abduction) with row.
    • The towel pull with row seems to get some scapular retraction without flaring up the upper traps

What could I have done different? What would you have done differently?

Any advice on the sidebending? Any advice on upper trap/cervical spasm reduction?

What would you give next visit?