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  • Any suggestions?

    * Client gave permission to share

    Have a client in her 40's who works long hours at the computer at home. For many years she rested her elbows on her desk and leaned on her arms- she has since stopped that and sits in her chair with back against back of chair- also gets up more for breaks.

    When she first came in over a year ago, she was suffering daily "excruciating" headaches along with pain and spasming in upper right quadrant of back.

    With weekly DNM sessions and now intermittent when she's in town- she no longer has any of those issues. Only every now and then after longer hours than normal in front of the computer.

    My question is the area of congestion that I can feel around the upper right quadrant- it's always there whether or not her symptoms are. I've worked her neck, cranium, trunk, hips, and low back and nothing seems to help it diminish completely.

    I've worked with her prone, with arm over front of table and extended 45 degree angle to work the area of the traps and scapula. I've worked all around the spine.

    The one thing I haven't done is a lot of work to the left side........maybe I just answered my own question?

    I've also showed her some Feldenkrais movement.

    I was wondering if there was anything I was missing?
    "The danger is not that the soul should doubt whether there is any bread, but that, by a lie, it should persuade itself that it is not hungry" (Simone Weil)

  • #2
    Rajam,

    How does she want to move?
    Barrett L. Dorko

    Comment


    • #3
      Has she tried alternating her chair such as sitting with her chair back to front 180 degrees (straddle like a horse) or, if it doesn't have sides, turning the chair 90 degrees (so back is at right angles to desk and either L or R of her body depending on which way she swings it)?

      If she doesn't want to give up long hours and sitting then maybe changing the initial conditions of the situation will give her background movement brain a stimuli to move differently. Doesn't solve the problem so much as distribute it.
      "Whereof one cannot speak, thereof one must be silent." ("Wovon man nicht sprechen kann, darüber muss man schweigen.“) Tractatus Logico-Philosophicus Ludwig Wittgenstein
      Question your tea spoons. Georges Perec

      Comment


      • #4
        I would check out the left side, also the front: anterior cutaneous nerves, axillary nerves, everything around clavicle/sternum.
        Diane
        www.dermoneuromodulation.com
        SensibleSolutionsPhysiotherapy
        HumanAntiGravitySuit blog
        Neurotonics PT Teamblog
        Canadian Physiotherapy Pain Science Division (Archived newsletters, paincasts)
        Canadian Physiotherapy Association Pain Science Division Facebook page
        @PainPhysiosCan
        WCPT PhysiotherapyPainNetwork on Facebook
        @WCPTPTPN
        Neuroscience and Pain Science for Manual PTs Facebook page

        @dfjpt
        SomaSimple on Facebook
        @somasimple

        "Rene Descartes was very very smart, but as it turned out, he was wrong." ~Lorimer Moseley

        “Comment is free, but the facts are sacred.” ~Charles Prestwich Scott, nephew of founder and editor (1872-1929) of The Guardian , in a 1921 Centenary editorial

        “If you make people think they're thinking, they'll love you, but if you really make them think, they'll hate you." ~Don Marquis

        "In times of change, learners inherit the earth, while the learned find themselves beautifully equipped to deal with a world that no longer exists" ~Roland Barth

        "Doubt is not a pleasant mental state, but certainty is a ridiculous one."~Voltaire

        Comment


        • #5
          Thanks Mark- we've talked about changing sitting and chair positions- but I will talk about it again- I know that kind of stuff bears repeating.

          Great Diane! I'll work some on the L and also the L anterior. And more around both clavicles/sternum.

          It doesn't surprise me that her headaches/pain return only when she's at the desk for 12 hours at a time- which doesn't happen often- but I've benn perplexed at why the area of tension stays (although may be dormant for a time).

          I see her today and will utilize these suggestions. Even toss in a little Simple Contact!
          "The danger is not that the soul should doubt whether there is any bread, but that, by a lie, it should persuade itself that it is not hungry" (Simone Weil)

          Comment


          • #6
            She has GOT to move more often.
            Movement "pills" every 2 hours, for at least a minute or two. Get up, move around, bend over, whatever. Climb up and down a few flights of stairs, get the heart pumping a little.
            Move move move.
            Diane
            www.dermoneuromodulation.com
            SensibleSolutionsPhysiotherapy
            HumanAntiGravitySuit blog
            Neurotonics PT Teamblog
            Canadian Physiotherapy Pain Science Division (Archived newsletters, paincasts)
            Canadian Physiotherapy Association Pain Science Division Facebook page
            @PainPhysiosCan
            WCPT PhysiotherapyPainNetwork on Facebook
            @WCPTPTPN
            Neuroscience and Pain Science for Manual PTs Facebook page

            @dfjpt
            SomaSimple on Facebook
            @somasimple

            "Rene Descartes was very very smart, but as it turned out, he was wrong." ~Lorimer Moseley

            “Comment is free, but the facts are sacred.” ~Charles Prestwich Scott, nephew of founder and editor (1872-1929) of The Guardian , in a 1921 Centenary editorial

            “If you make people think they're thinking, they'll love you, but if you really make them think, they'll hate you." ~Don Marquis

            "In times of change, learners inherit the earth, while the learned find themselves beautifully equipped to deal with a world that no longer exists" ~Roland Barth

            "Doubt is not a pleasant mental state, but certainty is a ridiculous one."~Voltaire

            Comment


            • #7
              Hi Diane!

              She has GOT to move more often.
              Movement "pills" every 2 hours, for at least a minute or two. Get up, move around, bend over, whatever. Climb up and down a few flights of stairs, get the heart pumping a little.
              Move move move.
              Some in the coaching world are now suggesting the same thing, which is a vast departure from the RICE formula that many trainers still advocate. For just about every injury that can occur on the playing field, ice and compression remain the first course of treatment.

              Below Iced author Gary Reinl talks about the process of recovery from a broken collarbone he suffered after tripping during a morning run.

              "I also started functional movements within the first 48 hours, beginning with the involved fingers and hand berfore progressing along all the way to my arm and shoulder. But, keep in mind that most of these movements--especially in the very beginning--were exceedingly minor.

              This was, however, perfectly okay, since that was all that I could to at the time. My only goal was to move whatever I could in as many non-pain-inducing directions as were feasible. I repeated this protocol literally dozens of times every day for the first month, gradually increasing the intensity and duration of the movements.

              So, what was the result? Well, other than a slight, soon-to-pass, catch near the top of my reach (e.g. when I straightened my arms above my head), I had full range-of-motion by the sixth day post-injury. By the twenty-first day, I had resumed my normal distance running schedule and was back lifting weights the next day.

              Most people would have iced the injury, which would have delayed the healing process, and would not have introduced movement anywhere near as soon, and, once they did, they would not have been as aggressive in carrying out their movement protocol (because of the painful swelling--which I did not have!)

              Unfortunately, some degree of this vastly inferior icing/stillness protocol is what most people undertake. They are told to ice and by the time that they move, it is far too late to ensure optimal healing."

              Comment


              • #8
                Originally posted by Ken Jakalski View Post
                "I also started functional movements within the first 48 hours, beginning with the involved fingers and hand berfore progressing along all the way to my arm and shoulder. But, keep in mind that most of these movements--especially in the very beginning--were exceedingly minor.

                This was, however, perfectly okay, since that was all that I could to at the time. My only goal was to move whatever I could in as many non-pain-inducing directions as were feasible. I repeated this protocol literally dozens of times every day for the first month, gradually increasing the intensity and duration of the movements."
                EGGGGGGGGGGGGGGzactly. Motion is lotion.
                Diane
                www.dermoneuromodulation.com
                SensibleSolutionsPhysiotherapy
                HumanAntiGravitySuit blog
                Neurotonics PT Teamblog
                Canadian Physiotherapy Pain Science Division (Archived newsletters, paincasts)
                Canadian Physiotherapy Association Pain Science Division Facebook page
                @PainPhysiosCan
                WCPT PhysiotherapyPainNetwork on Facebook
                @WCPTPTPN
                Neuroscience and Pain Science for Manual PTs Facebook page

                @dfjpt
                SomaSimple on Facebook
                @somasimple

                "Rene Descartes was very very smart, but as it turned out, he was wrong." ~Lorimer Moseley

                “Comment is free, but the facts are sacred.” ~Charles Prestwich Scott, nephew of founder and editor (1872-1929) of The Guardian , in a 1921 Centenary editorial

                “If you make people think they're thinking, they'll love you, but if you really make them think, they'll hate you." ~Don Marquis

                "In times of change, learners inherit the earth, while the learned find themselves beautifully equipped to deal with a world that no longer exists" ~Roland Barth

                "Doubt is not a pleasant mental state, but certainty is a ridiculous one."~Voltaire

                Comment


                • #9
                  Hi Diane!

                  It's good to know that other colleagues from the coaching profession are not the only ones challenging the standard protocol of Rest, Ice, Compression, Elevation--and are questioning the prescription of basically "restricting/avoiding movement until the swelling goes down."

                  Gary seems to have caught the attention of trainers from a majority of the professional sports teams. I think that's a good thing.

                  Comment


                  • #10
                    Rajam,

                    I am just sitting here at the computer and realized that when I am sitting in a chair, my legs are short. As in, only my toes touch the ground. Now, I am not on the computer much. I'd say it's about 10 - 15 hours a week. But, I see that this foot thing could easily be an issue that translates up my whole body, if I were to be in one place all day doing computer work.

                    When I sit on the floor in front of the coffee table with my laptop there at home, then I always have right neck issues, and I am sure it is because of where my right arm lays on the coffee table, just a bit above where it would function better from.

                    So, I'd say, look at how she's sitting, where her feet land, etc.

                    And, I'd try to also make her aware of her forward head translation. It doesn't take much forward head translation to cause an issue. More frequent breaks, with a little roll of the neck may help a lot. And, if her computer is in front of her, then that forward translation is likely to be bilateral and not just on the right. So, I think working with the left is a very good idea.

                    Best of luck.
                    Last edited by Curious One; 04-07-2014, 07:07 PM.
                    C.O. ( gender: ) - LMT, BS(Anatomy), DC
                    Music Fog... pick a song to listen to... you can't go wrong.
                    Need relaxation samples for your office? I have made a Deep Relaxation Massage Music Pandora Station and have others that may also be useful - about 8 massage music stations and about 49 other nifty options.

                    Comment


                    • #11
                      Curious One says:

                      It doesn't take much forward head translation to cause an issue.
                      Completely untrue.
                      Barrett L. Dorko

                      Comment


                      • #12
                        Originally posted by Barrett Dorko View Post
                        Curious One says: "It doesn't take much forward head translation to cause an issue."


                        Completely untrue.
                        I don't think it can "completely untrue", if I have experienced it myself and seen it with regard to others. However, it may be something that you have not experienced or have seen differently.

                        For example, if I am sitting at a computer for two hours without a break and am able to pay attention to when my head begins to translate forward (I'd say it doesn't move much more than a half an inch to an inch), I will notice that I begin to have issues into my sub-occipital muscles. I attribute many of my personal neck issues to some old injuries I sustained as a child, teenager and one as an adult. But, when I am not moving a lot (i.e. not on the computer for more than an hour or relaxed in a sitting position with my head leaned back against something) the neck will not flare up near as poorly as when my head begins to move forward.

                        Could you please let me know of your own experiences with forward head translation and why you deem my thoughts to be completely untrue? I am interested in your interpretation of this.

                        Thanks in advance.
                        Last edited by Curious One; 05-07-2014, 07:32 PM. Reason: *needed to put the "sub" in sub-occipital... worked late last night and was not typing most proficiently.
                        C.O. ( gender: ) - LMT, BS(Anatomy), DC
                        Music Fog... pick a song to listen to... you can't go wrong.
                        Need relaxation samples for your office? I have made a Deep Relaxation Massage Music Pandora Station and have others that may also be useful - about 8 massage music stations and about 49 other nifty options.

                        Comment


                        • #13
                          Across the masses, posture is not predictive of pain. But that doesn't mean certain postures aren't provocative to individuals, including forward head translation.

                          I think the prevailing opinion here would be that any sustained position would likely be detrimental, as opposed to frequent and instinctual movement.
                          Brian Allen, DC, ART, CSCS

                          Comment


                          • #14
                            Update- she is doing well overall- I think she gets on the computer for long periods of time and that's when it bothers her most.

                            Diane, your suggestions about working around the clavicles and sternum was a great reminder!

                            Actually, what seemed to bother her most was my frustration at not being able to resolve her issue. She has felt much better over the years she has been in to see me and prefers the DNM work to massage.

                            The area where I feel "congestion" is always there, yet doesn't always hurt or feel tender to the touch. At one point I think that my frustration was leading her to feel like something was wrong with her! So I've been even more careful about how I talk about it with her. Even though I was careful not to show actual frustration, I think she picked it up anyway.

                            I'm suspecting now that she's just on the computer a LOT and where she is now is so much better than when she first came to see me a couple years ago and we've also developed a personal repertoire.

                            She's happy with the work we've done and feels satisfied with it, has been much better off, and is looking at retiring soon- so there's where we'll see even more progress I'm sure!

                            Anyway, just wanted to update.
                            Last edited by rkathryn; 12-08-2014, 04:13 PM.
                            "The danger is not that the soul should doubt whether there is any bread, but that, by a lie, it should persuade itself that it is not hungry" (Simone Weil)

                            Comment

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