Central Annals of Sports Medicine and Research

Cite this article: Sanam R, Haq A (2018) Multidimensional Physiotherapy and Ergonomic Intervention for a Computer Professional with Cervical Spondylitis and Radiculopathy: A Case Report. Ann Sports Med Res 5(2): 1131.

*Corresponding authorRidwana Sanam, KRV Healthcare & Physiotherapy, Block C - 2772, Sushant Lok Phase -1, Near Paras Hospital, Gurugram, Haryana 122002, India, Tel: 999-979-8934 Email:

Submitted: 06 April 2018

Accepted: 26 April 2018

Published: 27 April 2018

ISSN: 2379-0571

Copyright© 2018 Sanam et al.

OPEN ACCESS

Keywords•Occupational overuse syndrome•Work-related posture•Neck-related arm pain•Repetitive strain injury (RSI)

Abstract

Prolonged poor posture results in cumulative trauma of structures due to their altered length-tension properties, and hence this Repetitive Strain Injury (RSI) arises if poor posture is adopted regularly for extended periods as typically happen in the work place in front of computer/ laptop. The prolonged misalignment of your neck, shoulder blade and upper arm puts significant stress on the ligaments and tendons around your neck& shoulder. The purpose of this study was to report of an adult male computer professional with cervical Radiculopathy & its successful management by physiotherapy.The best treatments were exercise, manipulation, KRV oil massage and mobilization, or combinations thereof. Radiculopathy had a good prognosis and may respond to conservative measures. Results of neck surgery for myelopathy or intractable pain are often disappointing. This study shows that comprehensive physiotherapy provides a valuable method of treatment in cervical spondylitis among computer professionals with 100% results.

Case Report

Multidimensional Physiotherapy and Ergonomic Intervention for a Computer Professional with Cervical Spondylitis and Radiculopathy: A Case ReportRidwana Sanam1*, and Afrozul Haq2

1KRV Healthcare & Physiotherapy, India2Department of Food Technology, School of Interdisciplinary Sciences, Jamia Hamdard (Deemed to be University) India

ABBREVIATIONSRSI: Repetitive Strain Injury; TENS: Transcutaneous Electrical

Nerve Stimulation; MMT: Manual Muscle Testing; ROM: Range of Motion

INTRODUCTIONCervical spondylitis is a common orthopedic disorder

involving degenerative changes in the cervical spine, including spondylarthrosis, epiphyseal joint osteoarthritis, and disc degeneration. It is estimated that 90% of males over the age of 50 and 90% of females over the age of 60 have radiographic evidence of degeneration in the cervical spine [1]. Radiographic introduction of the cervical spine observed in 25% of individuals by age 50 years [2,3]. Three overlapping syndromes can result from spondylitic osteophytic neural or vascular encroachment: nerve root compression (radiculopathy), spinal cord compression (myelopathy), and vertebral artery compression [4]. The cause is unknown but may be accelerated by trauma, overuse, or genetic predisposition. In many cases, this degenerative process.

Neck pain due to poor posture, if neglected for long time, can lead to intervertebral disc dehydration, desiccation and degeneration and hence the development of the cervical spondylosis. This study was aimed to analyze the relation between symptoms and signs originating from the cervical spine

and the duration of computer use, and the second part of the study aimed at reporting the combined effect of comprehensive physiotherapy in a male patient.

Studies on physiotherapy treatments reported mixed findings as follows: Mobilization, manipulation, and exercise seem to be equally effective [5-7]. A study comparing combined exercise and manipulation with either modality alone found the combination to be more effective at three months [8] but no difference was seen compared with exercise alone at one and two years [9]. However, another pragmatic study found no advantage at six weeks or six months of adding manual therapy (63% of patients had mobilization physiotherapy) or heat (shortwave diathermy) to exercise and advice [10]. Radiculopathy (nerve root compression) due to cervical spondylitis usually occurs at the C5 to C7 levels, although higher levels can also be affected. Neurological features follow a segmental distribution in the upper limb, with sensory symptoms (shooting pains, numbness, hyperaesthesia) being more common than weakness. Reflexes are usually diminished at the appropriate level (biceps (C5/6), supinator (C5/6), or triceps (C7)). Figures (1-3) shows the dermatomal distribution of the cervical and upper thoracic nerves.

CASE PRESENTATIONA computer professional aged 39 years working in Delhi for a

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software firm presented with extreme pain in the neck to the KRV Healthcare & Physiotherapy Clinic in Gurugram with extreme on 3rd of June 2014. This patient reported difficulty in sitting and aggravation of his symptoms lying on left side, radiating pain in left upper arm and slight pain in upper back too.

Patient experienced slight radiating pain in his left shoulder and hand every now and then and a tension in his neck and shoulder muscles often. Patient had been taking painkillers and muscle relaxant sometimes, which would give him complete relief from pain for few hours.

Neck was very stiff in the morning when he woke up for around 30 minutes and then slight relaxation. Pain could be rated as 8/10 on the day of arrival at KRV Healthcare & Physiotherapy

and generally its 6/10 on every morning on a numerical rating scale. By the time patient reached home, the discomfort was too much and holding the office bag with laptop also became unbearable.

Chief complaint

Pain in neck and it’s radiating to left upper arm and upper back

History of present illness

Patient was experiencing slight radiating pain in his left shoulder and hand every now and then and a tension in his neck and shoulder muscles often. Neck remains very stiff in the morning when he wake up for around 30 minutes and then slight

Figure 1 Physiotherapy treatment.

Figure 2 Ultrasonic Therapy.

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relaxation.

Personal History

• Regular cigarette smoker

• Non alcoholic

• Non-vegetarian

• Satisfactory bowel & bladder habits

RESULTSMMT

¾ Rest of muscle groups = 4+

¾ Neck flexors= 3+

¾ Neck extensors= 3 +

• ROM:

¾ Neck flexion is painful and restricted

¾ Neck extension is painful and restricted

¾ Left side rotation painful and restricted

• Tender Points: C4,C5, C6, C7, T1, T6 spinous process

• Spasm: B/L Trapezius spasm Lt>Rt

• Special Test: Compression test +ve, ULTT 1,2,3 +ve

• Tightness: Pectorals, Triceps, Trapezius

• On Palpation: There is an obvious spasm of the right upper trapezius muscle. Flexion and extension is painful and restricted. Tender points are seen and muscles have lost strength; are very tight. There is swelling around the neck area and shoulder.

• Gait- Normal

• Special tests

• Compression test- positive

• Distraction test: positive

• Spurling test: positive

• Blood Test:-Vit.D3 was 8 (Normal value- >25 mgdl)

As per assessment the diagnosis was made

Diagnosis:- Cervical Spondylitis with radiculopathy

MATERIAL & METHODS USED FOR PHYSIOTHERAPY TREATMENT

Various techniques and modalities were used in the treatment procedure that also involved a thorough review of the condition from time to time.

1. The common modalities used were Ultrasonic, Laser & TENS

1.1 Ultrasound: US Helps in controlling pain, relief, and inflammation and muscle spasm. Pulsed UST was applied 1 W/cm2 intensity 1:1 pulse ratio, for 8 mins at active myofascial trigger point identified on manual palpation.

1.2 Laser: Laser therapy has two main effects i.e. pain reduction and improved tissue healing. It increases the healing rate, regeneration of damaged tissue, healing response of fractures and decreases the deep seated inflammation. It is very effective as it is deeply absorbed by the cells. Low energy LASER (helium-neon) 920nm for 3 mins by 3 times at trigger points.

8. Transcutaneous Electrical Nerve Stimulation (TENS): The use of TENS is an extremely popular method of pain relief.

Figure 3 Modification of potential ergonomic exposure is important to prevent this chronic problem.

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It is easy to use and the side effects are minimal when compared to some oral pain killers. TENS can provide pain relief in almost 70% of cases suffering from an acute injury. High-frequency Burst TENS was applied on the painful region for 15 mins.

9. A relative new approach Myofascial Release (gross techniques- arm pull, shoulder girdle release, upper trapezius release; specific techniques- fascial glides and stretch; and direct techniques- manual ischemic compression at 7/10 VAS for 45 secs and 5 repetitions) was given combined with KRV Healthcare & Physiotherapy anti-inflammatory pain oil.

¾ Ayurveda Anti-inflammatory pain oil.

¾ Works wonder in all kinds of joint pain and muscle spasm.

¾ Non-greasy easily absorbable.

¾ No allergies safe to use.

¾ Can be mixed with body oil for full body application.

Exercise Therapy

• Neck Isometrics, 3 Point pressure, Pillow Bridging, Pectoralis/Triceps stretching.

• Resistive Thera Band exercises with 10 reps*5 sec hold, for shoulder shrugging, biceps & scapular retraction.

Home instructions (Do’s and Don’ts)

¾ Pain oil application: Just apply the pain oil with soft hands and leave it to get absorbed by the muscles (will help reducing muscle spasm).

¾ Hot fomentation with wet hot towel every 6 hourly.

¾ Do not hang you left arm and lift any kind of weight.

¾ Kindly sleep on your right side till the pain goes away. Take pillow of your shoulder and neck length. Keep your spine in a straight line.

LifestyleModifications

Regular exercises morning and evening.

Life style modifications like taking breaks every after 30 minutes of work. Like stretching the body and taking around for 2 minutes.

Medication

o Tab. Neugaba 75mg for 10days

o Tab. Etoshine 90mg once a day for 15 days.

o Architol 6 L Injection once for 6 months.

o Oral dose 1/week for 6 Weeks.

Action of T/t

1) On 3rd June, 2014

Chief Complaint: Patient has been feeling extreme pain in neck, difficulty in sitting and lying on left side, radiating pain in left upper arm and slight pain in upper back too.

Physiotherapy Treatment:

¾ Ultrasonic therapy:-

Positioning:-

Patient:-Prone lying with pillow under legs.

Therapist:- Standing by side of patient facing his back.

Duration:-7 min. over upper back.

- 7 min over tender points

Mode:-Continuous.

¾ Intensity:- 2.5 w/cm2.Transcutaneous Electrical Nerve Stimulation (TENS):

Positioning

Patient:-Prone lying with pillow under legs.

Duration:-15 min.

Mode:- sweep mode for 1week followed by burst mode for next week.

¾ Myofascial release with pain oil: Mid back to upper neck for 10 min. over back with pain oil application. Distal to proximal

¾ Hot fomentation with hot towels at home for 10 mins daily

¾ Exercises: Position of the patient: sitting

From 3rd day onwards

¾ 3 point pressure

¾ Shoulder isometrics

¾ Shoulder bracing

¾ Shoulder shrugging

¾ Neck isometrics.

¾ Stretching of tight muscles (biceps, triceps)

No. of repetitions:- 10 reps*5 sec hold

¾ Home Instructions

a. Pain oil application every 6 hourly: Just apply the pain oil with soft hands and leave it to get absorbed by the muscles (will help reducing muscle spasm)

b. Hot fomentation with wet hot towel every 6 hourly

c. Do not hang you left arm and lift any kind of weight

d. Kindly sleep on your right side till the pain goes away. Take pillow of your shoulder and neck length. Keep your spine in a straight line.

2) On 13th June, 2014

Chief Complaint: Pain localized to upper back with no radiating pain in Lt Upper arm. The stiffness that was felt in morning reduced to 5 minutes. Swelling around the neck area is gone. Muscle is gaining strength and spasm has been reduced.

¾ Ultrasonic therapy:- same as above

¾ Transcutaneous Electrical Nerve Stimulation (TENS):- with burst mode intensity100

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¾ Exercises: Position of the patient: sitting From 3rd day onwards

¾ 3 point pressure

¾ Shoulder isometrics

¾ Pillow Bridging

¾ Shoulder bracing

¾ Shoulder shrugging

¾ Neck isometrics

¾ Stretching of tight muscles (biceps, triceps)

¾ Pectoralis/Triceps stretching

¾ shoulder blade mobilisation

¾ scapular retraction.

¾ Biceps

No. of repetitions:- 10 reps*10 sec hold

¾ Resistive Thera Band exercises started with 10 reps*5 sec hold

¾ Myofascial release with pain oil: distal to proximal UE-Lt for 15 minutes- Now we can increase the duration and relax more muscles as the spasm and tightness has to be reduced completely.

•HomeInstructions

i. Pain oil application every 12 hourly: Just apply the pain oil with soft hands and leave it to get absorbed by the muscles (will help reducing muscle spasm)

ii. Hot fomentation with wet hot towel every 12 hourly

iii. Do not hang you left arm and lift light

iv. Take pillow of your shoulder and neck length. Keep your spine in a straight line.

3) On 23rd June, 2014

Chief Complain: No pain felt. Morning stiffness has gone. Muscle movement backs to normal.

Lifestylemodification

Do’s:-

¾ Do turn to one side while getting up from supine position.

¾ Use hot pack for your neck.

¾ Use towel roll under the neck during supine lying.

¾ Do isometrics for neck.

¾ Arms should be supported in one of the three positions

¾ Use pillow of normal thickness in side lying position.

¾ Hands on thighs/or on table.

¾ Hand behind back with elbow straight

¾ In order to avoid holding of the head in the same position

for long periods, take break while driving, while watching TV or working on a computer.

¾ Use a seat belt when in a car

¾ Use cervical collar in case of giddiness.

¾ Retraction of shoulders every hour: move shoulders backward.

¾ Hands in pocket

Don’ts:

¾ Don’t sleep straight.

¾ Don’t bend your neck.

¾ Avoid hanging of arms.

¾ Avoid sitting for prolonged period of time in stressful postures.

¾ Do not lift heavy weights on head or back.

¾ Do not drive for long hours; take breaks.

¾ Avoid habit of holding the telephone on one shoulder and leaning at it for a long time.

¾ Do not take many pillows elbow the neck and shoulder while sleeping.

¾ In order to turn around, do not twist your neck or the body; instead turn around by moving your feet first.

DISCUSSIONTreatment protocol was discussed with the patient in details

that and it was informed to patient that it can take 20-25 days to remove the pain completely and after getting agreed on all the points we got our declaration document signed by the patient. In Our first few sessions we concentrated on reducing spasm around the neck musculature using massage techniques with our pain oil, wet heat, ultra-sonic, tens modalities and light exercises. After 5 sessions we used some joint mobilizing techniques that are helpful in opening/stretching the small joints of the neck and shoulder which were restricted because of the prolonged repetitive stress injuries. Pain settled in 5 sessions and symptoms too started to settle.

After five sessions, we started working on regaining the range of motion using the further manipulation techniques and worked on soft tissues to achieve the target.

The exercise programme was progressed from basic stretching to active range of movement work and finally strengthening of the neck muscles that help in stabilising the neck and the pain went away completely after 20 sessions.

Initially the Vit.D3 was 8 only and after the 3 months, it increased up to 30 and with the oral dose of Vit.D3 once a week for4 weeks, The Vit.D3 reached at the level of 42.

Recently, better quality randomized controlled trials have suggested that exercise, mobilization physiotherapy, and manipulation are more effective than less active treatments [5,7,11]. Previous studies [7,12] have suggested further advantages of combining the exercises with mobilization or