Decrease pain in cervical spine and thoracic spine

Reference no: EM133658198

Question 1. Based on the patient information provided, is mobilization/manipulation to the cervical and thoracic spine supported by evidence-based research as an appropriate treatment for this patient? Why or why not?

Question 2. What other treatments would or could be recommended for this patient? What is the reasoning behind the other treatments recommended? Provide evidence-based research to support your recommendations.

Question 3. consider you have worked with a patient who had this type of issue.

what type of treatment was given?

Male 43 years old

Medical diagnosis: Cervical and thoracic spine pain Past medical history: fibromyalgia, hypertension, right knee meniscectomy3 years ago

Current history: Pt has pain rated at 5/10 (at rest) in the cervical spine and the thoracic spine. The pain can increase to a 6-7/10 depending on the day and his activity level.

He has occasional numbness and tingling down the arm and into the hands, usually with the right worse than the left. This tends to increase as the day progresses and with the following activities: driving for greater than 20 minutes, reaching for/lifting objects overhead, working out at the gym. He also has achy to throbbing headaches that start in the "back of my head and wrap to the front of my head." The headaches can range from a 4/10 to a 7/10, and they occur at least 5-7 times per week. They can last up to 1-2 hours at a time even after taking his medication (Percocet and Flexeril). They do not keep him up at night as he usually takes his medication before he goes to bed, and the pain that usually awakens him is the pain in his upper back.

Overall, he has tried the following treatments: rest, ice, chiropractic treatments, and acupuncture. None of these treatments have helped to decrease his pain or increase his activity level. Therefore, he has been sent to physical therapy. Social history: Pt lives in a ranch home with spouse and 3 children (5 years, 8 years, and 10 years old). He normally works as a long distance (over-the-road) truck driver, and he has been driving for 20 years. He has been on disability for the past month due to his back pain. He used to work out at the gym 5-7 days per week, performing cardiovascular exercise (running, biking, or elliptical) for 30 minutes and weight lifting for another hour. On occasion he would attend a Boot Camp offered through his gym. He no longer goes to the gym due to his pain.

OBJECTIVE MEASURES Posture: forward head and shoulders; left cervical spine rotation and lateral flexion; increased thoracic spine kyphosis; decreased lumbar spine lordosis with posterior pelvic tilt. C/S ROM: flexion = 30 degrees, extension = 30 degrees, right lateral flexion = 10 degrees, left lateral flexion = 15 degrees, right rotation = 50 degrees, left rotation = 65 degrees Strength: shoulder elevation = 5/5, shoulder abduction = 5/5, elbow flexion = 5/5, elbow extension = 5/5, wrist extension = 5/5, wrist flexion = 5/5, finger abd/add = 4/5 Sensation: No significant findings with light touch and sharp dull sensation to bilateral UE's. Reflexes: C5/6 = 2+, C7 = 2+

Palpation: Tenderness at the suboccipital muscles with reproduction of posterior headache. Tenderness upon palpation of the upper traps and levator scapulae muscles bilaterally (left greater than right). Tender at C5-6 zygapophyseal joint with left rotation at the C4-7 levels. Hypomobility (posterior to anterior) at C7 to T7. Elevated 1st rib on the left.

Goals to be reached in 8 visits (2x/wk for 4 weeks):

1. Increase cervical spine ROM such that right = left rotation and right = left lateral flexion

2. Decrease pain in cervical spine and thoracic spine to minimal levels (2-3/10) such that pt can return to the gym, drive for up to 1 hour at a time, and lift objects overhead.

3. Decrease frequency of headaches to no more than once per week. Plan of care: Manual therapy, therapeutic exercise, modalities as needed, patient education, neuromuscular re-education

Reference no: EM133658198

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