High-dose cervical mobilization to improve central sensitization for a patient with post-fusion neck pain.

BACKGROUND: Few studies have addressed the appropriate joint mobilization dosage for neck pain. Furthermore, the efficacy of manual therapy in patients with post-spinal fusion neck pain is unreported. CASE DESCRIPTION: A 63-year-old man with a 2-year history of unresolved neck pain post-cervical fusion presented to therapy with an exacerbation of neck and left-shoulder pain. The patient presented with cervical impairments of intervertebral hypo-mobility above and below the fusion site. He exhibited a high Numeric Pain Rating Scale (NPRS) score of 8/10 related to his neck pain. Additionally, he demonstrated marked loss of cervical mobility. Indicators of central sensitization were present, including both hyperalgesia and allodynia. High-dose cervical joint mobilization was applied for durations of up to 10 minutes. Corrective exercises were added to improve muscle strength and endurance. Treatment was applied for 12 sessions over 4 months. OUTCOMES: At the time of discharge, this patient reported a full recovery of neck function. This treatment reduced pain, improved passive joint accessory motion, and restored upper quarter function. The patient demonstrated a 33-point improvement in his Neck Disability Index (NDI) score and his pain was reduced to 0-1/10 on the NPRS. Markers of central sensitization were resolved. Intervertebral passive accessory joint mobility was pain free in addition to concurrent restoration of functional mobility. CONCLUSION: A paucity of evidence exists for appropriate dosage with manual therapy interventions. This case report demonstrates marked improvement of pain and function with the use of high-dose joint mobilization. Improved cervical accessory joint mobility and central pain modulation were achieved with high-dose joint mobilization.

The use of manual therapy post-hip arthroscopy when an exercise-based therapy approach has failed: a case report.

STUDY DESIGN: Case report. BACKGROUND: Although there is a growing body of literature on both surgical intervention and postsurgical rehabilitation of acetabular labral repairs and femoroacetabular impingement, there is a paucity of information on how to manage individuals who show a lack of progress postsurgery. CASE DESCRIPTION: A 30-year-old woman underwent surgical labral repair with femoroacetabular impingement osteochondroplasty. Postsurgery, she was initially treated with an exercise-based approach, but experienced an increase in hip pain and further decline in function. Her primary functional deficits were difficulty standing and pain (6/10) with ambulation. A combination of soft tissue mobilization and trigger point dry needling was used to address perceived muscle dysfunction, and nonthrust manipulation was used to address perceived hip joint hypomobility. OUTCOMES: Following 12 therapy sessions over 120 days, the patient returned to her demanding occupation with minimal residual symptoms. By the end of the period of care, the patient's Harris hip score had improved from 56 to 96 and her Lower Extremity Functional Scale score had improved from 26 to 70. DISCUSSION: This case describes a multimodal manual therapy approach and the health outcomes of a patient following labral repair with femoroacetabular impingement decompression who did not respond to an initial exercise-based postsurgical rehabilitation approach. Level of Evidence Therapy, level 4.