Objective evaluation of the improvement of ROM and motor control in a case of “neck pain with mobility deficit”

Author: Doctor Riccardo Rosa

Anamnesis:

27-year-old girl. Profession professional dancer and teacher. He actively works with the body for more than 6h per day. For a month he has been suffering from “pressure” and “piercing” pain distributed to the right starting from the cervical spine and spreading to the cervicothoracic and peri-scapular junction. The intensity of the symptoms varies depending on the combination of movement and speed. When the symptoms are of the stabbing type, the patient experiences an associated feeling of dizziness. The morning and evening after class are the times when symptoms and related movement disabilities are most evident.

The patient reports having experienced an acute phase of “stiff neck” which lasted a week following a demanding artistic performance. This was followed by 3 weeks of home remedies (massages and hot shower), the use of heating patches and stretching, the intake of NSAIDs, but the symptoms and movement disorders remained stationary.

The intensity of the symptoms is not the main problem for the patient as, as a professional dancer, she reports having experienced more disabling pains. Her coping ability, that is the way she controls and copes with her condition is “positive” because she is willing to “actively participate” in the therapy, she continues her activities although with difficulty, she is ready to do what it takes to get better and this facilitates therapy.

After the general medical history and the exclusion of serious problems in progress that could have required a specialist visit with a doctor, the functional evaluation of the active movements supported by Baiobit was performed. Each movement was repeated 3 times using verbal commands with external focus (eg: “go and look at the window curtains on the right”).

In the rotational movements, the greatest differences emerged with a very large left rotation (with the extra contribution of a chest and shoulder movement) compared to the right. Sidebending was also different with a more pronounced limitation on the left. This “criss-cross” pattern (more limited rotation from a top and more limited opposite lateral flexion) may be indicative of a dysfunction of the upper cervical segments (first joints).

The evaluation of the average angular velocity of the movements was very interesting, which highlighted a clear difference between right and left rotation, indicative of a motor control problem. Also on the sagittal plane in flexion-extension movements, important limitations were highlighted considering the ballerina work (great mobility) bringing out even a small difference in the average speed of execution in the extension movement. The provocation of the patient’s familiar symptoms resulted mainly in the movement patterns in right rotation, extension, and retraction (combined movement not measured with Baiobit).

Excluding various differentiation tests, evaluation of passive regional and segmental movements was performed, as well as provocative soft tissue palpation tests which confirmed the presence of numerous hypersensitive and provocative myofascial areas associated with dysfunctions and hypersensitivity of corresponding joint segments at the level of the upper cervical (C2-C3 segment), middle (C3-C4), upper thoracic level (T1-T2).

Test with Baiobit:

Cervical ROM test before and after a session of pre-manipulative cervical (5 ‘) mobilization techniques, cervical and thoracic (3’) HVLA manipulation techniques, manual and hypotensive neuro-muscular techniques to restore joint mobility, and extensibility final dermo-neuro-myofascial (10 ‘). This was followed by a neuro-motor control exercise in cervical rotation and one in craniocervical and cervicothoracic retraction (15 ‘).

Results:

Movement tests with Baiobit show a clear improvement in ROM in limited directions and the average speed of execution, confirming the improvement perceived by the patient in terms of greater quantity and better quality of movement.

It should be noted that the pre and post-treatment visualization of the objective data collected with Baiobit by the patient amplified the therapeutic effects she perceived (objective feedback effect) and stimulated greater adherence to the exercises prescribed for home confirmed by the expression “now I have understood, I want to keep this situation and I will do the exercises every day ”.

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