During my muscolskeletal prac, a patient presented with what I had diagnosed as cervicogenic headache due to C1-3 hypomobility. When I reasessed her Cx AROM after G3 central PA on C2-3, she complained that her headache had worsened with movement. I then treated her with STM to the posterior neck and gave her some stretches for her levator scapula and upper traps. This lady never turned up for her next appointment.
I wonder if I should have been less aggressive during her treatment (used G2 mob for pain relief instead). I couldn't work on retraining her Cx posture as the underlying problem was the hypomobility. Looking back, maybe I should have strengthened her deep neck flexors first to provide more stability to the segments before I mobilised the joints. I guess I could also have focused entirely on pain-relief on the first session.
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Hi Steve,
Those senarios when pt's dont return are tough hey.
I would have done the same thing as you initially with a Dx like that. Thats interesting its hard to say if a G2 would have not also inc her head ache.
So she was not hypermob in the segments above or below the hypo seg? maybe something like that was a factor of her headaches and it was hard to feel. Yet easier to feel the obvious relative hypo segment... then mob the hyposegment meant an overflow of increasing the mvmt of the segment adjacent to the hypo seg due to their close proximity to the mob and worsening the prob?... So with that in mind I think thats a good idea to try strengthening ex like u said in case?
I really dunno tho just hypothesising ideas that are very long winded sorry. Hope that all made sense?
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