Intriguing Patient Scenario: You Won’t Want to Miss This!
Let’s talk about a super interesting patient case today that highlights the importance of taking the time to thoroughly explain the movement and posture causes of pain.
A patient came into the clinic (who just so happen’s to be my sister, Emmalee) with a whole list of rather concerning symptoms that have seemed to be worsening over the past couple months.
A little backstory important to consider is that my sister just became a mom to my adorable little niece about 10 months ago.
As I was initially asking questions at the beginning of our evaluation, some of the things Emmalee brought up that she has been struggling with are neck and upper back pain, headaches, and even dizziness/lightheadedness.
Now what is super interesting is that all of these symptoms could commonly share underlying stiffness/tightness of the neck.
Upper neck/upper back stiffness can cause neck/upper back pain - that one doesn’t
seem super surprising.
But the neck can also be the generator of headaches - when this is the case, we typically call them cervicogenic (“cervico” = neck, “genic” = caused by) headaches.
And very interestingly, dizziness can be caused by the neck as well - when this happens, we term this cervicogenic dizziness.
So after gathering this initial information and then thinking through what all of the symptoms could have in common, I started to think about the potential root cause of the neck stiffness/tightness.
The fellowship program that I went through trained me to identify the repeated movements and prolonged postures that patients do all day long - if you can identify the things that the patient repeats over and over again, there is often a clue to the root cause!
And this where remembering that Emmalee is a new mom becomes important - almost everything she is doing throughout the day now involves looking downward.
Sitting to feed the baby, watching her play, changing her diaper, and most other tasks around the house… all of these are typically in a slumped posture with her head/neck looking down.
During the session, we then evaluated how well Emmalee’s neck and back moved, and go figure-- she certainly had stiffness in some expected directions.
What followed was some manual therapy targeted at loosening up tight joints and muscles, but MOST IMPORTANTLY choosing simply 1-2 practical exercises that she could do anywhere without any equipment, AND thorough education regarding how her posture and the movements she repeats frequently are likely related to the symptoms she is having.
About a week later after just this initial session, Emmalee has already reported that her symptoms seem to be lessening - I wish I could say that they were miraculously completely gone, but what she is experiencing is a very expected result.
The body will take some time to adjust to moving frequently in new directions, but the important thing is that she is on the right track - if this was not the case, we would change our thought process and not keep her doing movements that aren’t effective.
This case highlights a few important aspects of high-level rehab/medical care:
Providers should always be curious and invested in trying to figure out the underlying reasons for your symptoms
Providers should take the time to thoroughly ask questions and then thoroughly explain their reasoning
Providers should include the patient in the decision making process and empower them to take control of the situation to the best of their ability
If you are anyone you know has not been experiencing this level of care, please feel free to reach out via the link below, replying to this email, or shooting a call/text to 716-246-4806!
This skillset is what I have spent years developing and is exactly what I help teach to current Doctor of Physical Therapy students - while I certainly do not think I know everything or can help everyone, I always promise to try my hardest and to direct you elsewhere if I think the situation is out of my specialty scope.
Until next time!
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