Daily Headache for four years A film by Josef M An

Line is used to exercise and practice sports 4-5 times a week including football and badminton. Within a short period of time four years ago she began to suffer from neck pain, headache, anterior upper chest pain on the left and localized pain at the top of the left shoulder. She also developed pins and needles sensation at the 3-5th digit when lifting her arm over shoulder hight and chest pain related to simple physical activities. The headache ( Forehead and sub-occipital) and all other mentioned symptoms where experienced daily for the past four years. She attempted a barrage of treatment attempts including physiotherapy, chiropractic, osteopathy and other types and underwent a long series of hospital investigations. At four years she still feels that no one has been able to offer any help and she is on daily pain medication. She is also due to attempt additional types of pain medications during the coming weeks as suggested by a rheumatologist. Several suggestions where mentioned to her, like lung and heart condition and Thoracic outlet syndrome among other suggestions. However no therapy has proven effective to date. She reported good neck movement that may feel tense but not restricted, she experienced daily neck pain throughout the day and experienced difficulties finding an easing position or any strategy that offers relief of neck pain. Her arm and shoulder symptoms as well as her chest symptoms where related to any loading such as cycling or lifting objects for example carying a shopping bag. The symptoms forced her to stop all sporting activities and she has not been able to participate socially on many occasions including enjoying a holiday because she had trouble with simple activities that involved neck movements such as reading a book or using a mobile phone etc. At work as a secretary she needs to rest regulary during the day to manage job. She is worried and has no idea how and why she got all these symptoms and could not relate them to any specific incident. She misses sports and being able to be pain free and just having a normal life. She was advised by her mother who is a physiotherapist to try a different approach, in this case The Mulligan Concept that is the main approach that we at the clinic commonly use as a primary approach for assessment and treatment of musculoskeletal and sports injuries. . Initial testing revealed: Very restricted cervical spine extension. Also moderately limited flexion and rotation which was more limited to the right than left. Left shoulder end range pain when tested into flexion and abduction. Few shoulder tests seemed to aggravate her symptoms. Palpation revealed multiple levels of specific tenderness mainly on the left side of the cervical spine, upper cervical spine, cervico-thoracic junction, 1st and 3-6 rib. Flexion rotation test (FRT) revealed a marked restriction to R and L. Treatment included guiding of movement to a diffrent movement pattern and reassurance that the observed restrictions can be altered by mobilisations and simple home exercise. Mobilisations included SNAG to the Cx-tx region with extension ( Similar to reverse NAG but modified to a SNAG) based on Brian Mulligan s work. Bridge technique (Josef Andersen) for cervical extension. -C1/2 rotation (Brian Mulligan) -Rib MWM (Josef M Andersen) ------------------------------------------------------------------------------------------------------------- The film is self explanatory Filmed in the clinic MULLIGAN DK Hørsholm Denmark. With permission to film and publish. Date 26 february 2016. ------------------------------------------------------------------------------------------------------------- This film is made for educational purposes only and is only intended to share with my students and colleagues to inform and advance the understanding of the Mulligan concept and assessment, treatment of persons complaining of headaches related to musculoskeletal malfunctions. This film is mainly intended for sharing with MCTA members, CMP s and CMP candidates. The film should not be considered as a recipe for treatment of similar complaints. Management should always be based on individual testing and a sound clinical reasoning process that includes the individuals unique presentation perspectives and expectations. Kind regards Josef M Andersen Master of Musculoskeletal & Sports Physiotherapy (UniSA) CMP, MCTA, Manager MCTA Europe.