AUTHOR: Ferran Vega
The Client57 year old female client office worker (5/7), attends gym and walks 3/7. She comes into the clinic with pain in her right shoulder/traps and neck area which she has had for about one year and she has been getting remedial massage for it. She thinks it is a result of her constant use of the mouse on her computer and she is under quite a lot of stress. She appeared to be very guarded with her neck movements when she walked into the bay
AssessmentHer pain rating was VAS 4/10 and she described it as a constant dull ache. Aggravating factors were the use of her mouse at work and the current stress that she was under. She does get some relief from remedial massage, but it does not last long.
Because the client presented with pain, the assessment chosen was the SFMA. After finding multiple dysfunctions with the top tier test, further testing with the SFMA indicated that the client had:
Cx JMD (Joint Mobility Dysfunction)/TED (Tissue Extensibility Dysfunction)
Her Cx A/P ROM was ↓ (R) rot which indicated a Cx JMD
Tx SMCD (Stability Motor Control Dysfunction) on extension
When asked to point to the painful area she indicated along her (R) upper traps.
Goal: Her primary goal was to eliminate the pain so that she could feel more comfortable at work
TreatmentThe Myotherapy treatment performed was:
DN (Dry Needling) on Up. Trap. (Upper Trapezius), Lev. Scap (Levator Scapulae), Rhomboid, Sub Occipitals and SCM (SternoCleidoMastoid).
MFR (Myo Facial Release) on E.S (Erector Spinae), Up. Trap. and Lev. Scap.
Maitland mobilization on Cx rot and ext.
Tx seated stt (Stretch) and Tx flex(R)rot. mobilization.
Because she felt that her posture and use of the mouse at work are exacerbating factors, Tx positional taping was applied to help give the client some proprioceptive feedback related to her posture. She was instructed to only leave it on for a couple of hours.
Cat-camel stt and pec stt with Tx ext.HEP (Home Exercise Program): The client was instructed to do the cat-camel, corner stt and pec stt with Tx ext.
The client was re-assessed with the SFMA assessment tool before the application of the positional taping was applied
MSE (Multisegmental Extension) was FN (Functional non painful)
MSR (Multisegmental Rotation) was FN (Functional non painful)
Pain scale was VAS 0/10
Follow upOn her second visit, after 2 weeks, the client didn’t report any pain on the cervical region during the 2 weeks but on that day, she started to feel some pain (reported as VAS: 2/10) on the Cx region. MSE was DN (Dysfunctional non pain full) and the SFMA outcome was a Tx SMCD which was addressed with exercises for the tx region:
Cat-camel stt and pec stt with Tx ext.
Ts, Ys, Ws
Half Turkish get up with no weight
Arm Bar with no weight
Tx extension Maitland mobilization
The client felt no pain after the treatment and her MSE was FN. All the exercises were added into her HEP and she is coming into clinic once every 4 or 5 weeks to progress on her exercises and maintenance of her good posture.
DiscussionThe functional assessment tools of Myotherapy allows for assessment of the client in a broad manner. The functional assessment and broad approach lead towards a specific disorder in the Cx region (JMD at Cx on rot.) which could have been the cause of her pain but also identified an SMCD in the Tx which could cause the pain and the Cx dysfunction.
In this case, Myotherapy has proved to be a therapy that has the ability to assess a dysfunction from a functional approach, making it easier for the therapist to identify the cause of the dysfunction rather than the compensations. As a result, it allows the Myotherapist to design a more tailored treatment plan for the client’s condition in a quicker and more accurate manner.
The diverse choice of treatments in Myotherapy covered all the dysfunctions that were presented (joint dysfunction at the Cx and motor control at the Tx muscles) and allowed the client to be part of the recovery process by being actively involved with the exercises.