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Case Studies

Neck pain and headaches

I saw a 65 year old lady who had been noticing right sided neck pain and headaches that had been worsening for the past six months. There had been no specific cause of her pain and her symptoms had come on gradually and tended to worse with stress and on sustatined postures during the day. It was effecting her activities of daily living, especiallt the headaches which were having a huge impact.

On examination she had reduced neck movement, especially when turning towards the right, which reproduced her neck pain. There was tenderness to palpate around the upper neck on the right side, which caused a slight headache. Specific tests for the upper cervical spine revealed reduced range of movement in the right upper cervical spine.

I explained the underlying anatomy and that stiffness in the upper cervical spine can cause cervicogenic heachaches on that side. Treatment included manual therapy/hands on treatment to mobilise the upper cervical spine. We also used acupunture which she found relaxed the soft tissues around the neck. I suggested some gentle range of movement exercises for her to try little and often during the day. I encouraged her to change positions regularly and try and improve her general fitness.

After the first session she felt significant improvements with better neck movement and less frequent heachaches, after four sessions she reported no heachaches at all the preceeeding week and her neck movement had increased. She was really pleased with her progress and was happy to continue with her home exercise program.

Osteoarthritic knee

A 62 year old man came into my clinic with pain from his left knee. It had been episodically painful over the past 5 years, but had been particuarly sore over the past three months. He'd tried some exercises but felt the pain was getting worse. It effected his sleep and his walking was getting more restricted and he couldn't manage to walk his dog on his normal route. He was frustrated at becoming more limited and wanted some help. His GP had organised an xray which showed some underlying mild degenerative changes in the knee.

On assessing the knee he had reduced movement in the joint. There was pain on palpating the joint line. His strength was less on the left when compared to the right, particuarly his quads. He was limping due to the knee pain.

We discussed his x-ray and the normal dgenerative changes that occur in the knee. I reassured him that things weren't hopeless, and that imaging doesn't always correlate well with symptoms, and that his pain would hopefully settle and that he could manage it well. Having some wear and tear in the knee certainly didn't mean he was heading towards a knee replacement, which had been a worry for him.

I showed him some lower limb strengthening exercises which weren't painful but that he found challenging- hopefully by giving just a couple of exercises he was able to fit it into his routine.

Some gentle manual therapy around the knee gave some immediate relief. We spoke about other self-management strategies- such as pacing and modifying his activities, and use heat, pain killers (which he could discuss with his GP or pharmacist), a compression brace and he could try a trekking pole when walking his dog.

After a couple of sessions he felt the knee pain was much less. He told me he understood his problem much better and was confident with the knee and what was happening. He was happy to continue with his exercises to keep the knee strong.