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Clinical Reasoning Typical cases are discussed there. The cases are brought by practioners.

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Old 16-12-2004, 06:42 AM   #1
sybilvox
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Default Persistant headache w/SCM syndrome & trapezius muscle...

Hi,
I am new here. I am plagued by health problems relating to spinal stenosis and constant muscle spasms. I would be happy to expand on these if anyone needs more info.
My main issue are headaches. Tension type with throbbing around the eyes and tight band. Usually constant. I believe they are trigger point related (I am almost 100% postive). My degenerative disc disease - worse at C5/6, but also moderate at C3/4 - has "caused" my system to respond to tension, exercise, everyday activity in unpleasant ways. My tapezius seems to be the most unhappy as it will tighten up if the winds blows, but ride a bike, hang a shower curtain, ab crunches, etc and it tightens up - sometimes with a constant spasm. This usually leads the SCM to kick in with the spleinus(sp?). Now the fun part - I get the SCM syndrome part. Vestibular issues - gas, nausea, dizzy, yawning, sickness feeling. It is so horrible right now that I can barely function.
Ok, on with the story - I have been in and out of PT for over 14 years. I have a great PT right now who sees me mostly for maintenance of neck and also IT band. I have a physiatrist and have seen at least 20 doctors and had as many tests - I try to keep my films updated. Meds include, zanaflex, lorazepam, prozac.
What I am hoping to gain from this post is someone out there who can help me understand this phenomenon and help me gain insight, knowledge, power, technique, support, etc. I want to still live, but be smart about it. If anyone can provide any insight I would be forever grateful.
Thank you very much for your time.
sybil
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Old 16-12-2004, 08:42 AM   #2
bernard
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Hello Sybil,

You're welcome on SomaSimple and I hope we will help you a bit with your complex medical story.

You were told that something goes wrong with the cervical spine and you felt related consequences in the area. Muscular tension is often a trigger and a keeper of headaches. You seem to have also a branch of a facial nerve that makes problems but it remains related to the previous statement.

The cervical region is a zone of tension in the way that it is the first to enter on the scene when have problems of any kind in our lives. We may say that it is a major stress zone. Normally we have time to reduce the tension occurring there but life is more stressful than before and perhaps we lose some ability to listen to our body.

We are like some inhabitant plunged in an unpleasant house where some walls are cracking and pushing him until it hurts. We are constantly suffering of it (body) and it is quite the only cases where our body is telling something to us => pain.

'This body is making me mad' is a wrong idea since I must admit that it my body which belongs to me and if it hurts me that is certainly for some good reasons? Perhaps it must tell some other stories? Perhaps, it is the inhabitant which is responsible of unpleasantness of the house. But how to like/love a place that we do not know? It is also possible to have an opposite thinking and then affirm that we're doing things that our body don't like and it's why it tells us!

This way opens to discuss on the ability to govern a body in a more comfortable manner.

BTW, it will be great to know your job/occupation and it would be helpful, too, the duration of taking the medication you told us?
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Old 17-12-2004, 12:24 AM   #3
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Hi Sybil!
Have you ever considered cognitiv therapy!
To get you interested i would recomend a book by Beverly Thorn"Cognitive therapy for chronic Pain"
I now i this way of looking into pain have helped alot of chronic pain patients!
I use lot of cognitiv therapy in my clinical practise,which mostly copnserns chronick pain.
Good luck!
RIN :wink: :wink: :wink:
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Old 18-12-2004, 07:19 PM   #4
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Hi sybil & and all :

Welcome to Somasimple .

Bernard :

Good post , you are writing very well ideas even in English Language , seems to me physiotherapists begin to ive great attention to communication skills :lol: .

Rin :

Please tell us more abouit cogintive Therapy , I think since months ago i found a lot of researchs /evidences support the efficiency of cognitive Therapy in Pain .

Sybil ;

yes , we need to know more about your activities , work , durations of work, positions of siting , daily activities .
It will be nice to descirbe us more about your activities , previous physiotherapy programs , your comment on previous exercises.

cheers
Emad
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Old 20-12-2004, 05:35 PM   #5
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Thanks Emad,


If I take more time to write my posts, many errors are corrected directly by the program and it helps to have a more global vision than the ridiculous size of the message window of the board.
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Everything should be made as simple as possible, but not a bit simpler.
If you can't explain it simply, you don't understand it well enough. Albert Einstein
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Old 20-12-2004, 07:56 PM   #6
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Hi Sybil,
Quote:
My main issue are headaches. Tension type with throbbing around the eyes and tight band. Usually constant. I believe they are trigger point related (I am almost 100% postive). My degenerative disc disease - worse at C5/6, but also moderate at C3/4 - has "caused" my system to respond to tension, exercise, everyday activity in unpleasant ways. My tapezius seems to be the most unhappy as it will tighten up if the winds blows, but ride a bike, hang a shower curtain, ab crunches, etc and it tightens up - sometimes with a constant spasm. This usually leads the SCM to kick in with the spleinus(sp?). Now the fun part - I get the SCM syndrome part. Vestibular issues - gas, nausea, dizzy, yawning, sickness feeling. It is so horrible right now that I can barely function.
Ok, on with the story - I have been in and out of PT for over 14 years. I have a great PT right now who sees me mostly for maintenance of neck and also IT band. I have a physiatrist and have seen at least 20 doctors and had as many tests - I try to keep my films updated. Meds include, zanaflex, lorazepam, prozac.
What I am hoping to gain from this post is someone out there who can help me understand this phenomenon and help me gain insight, knowledge, power, technique, support, etc. I want to still live, but be smart about it. If anyone can provide any insight I would be forever grateful.
I've been thinking about you and would like to contribute some thoughts. Please run these thoughts past your regular PT and if there's any contraindication please abide by his/her advice.

If your knees can take it, I'd advise some movement work in four point kneeling (on hands and knees). In this position, gravity is distributed differently to different tissues. The traps, lats and abs, ITs etc all experience a rest from the usual loading. The SCMs and scalenes will all be glad for a break.

The lats will be loaded the way they evolved, i.e.: as a quadruped structure. (They attach in the armpit, are innervated from the neck, and cover the entire low back.)

There will be different areas of the hip and shoulder joints exposed to weightbearing. As different muscular layers of your body experience gravity differently, old parts of your motor cortex will recieve new information, which may well trigger elongation of various tense structures that have defied you til now. It will still take awhile of course, maybe a few days or weeks of practicing... 2 or 3 times a day... whether you are experiencing a headache at the time or not, and finding time to practice no matter how busy you are. The longterm goal is "pain reduction", the method is "graded exposure", the point is "novel stimulation" for motor centers in your brain. Then let your brain work out how to help you.

I think that movement work you do in that position should be global, that is to say, work on a whole bunch of things at the same time, take your mind off just your neck, for example. Think of your now horizontal spine as a whole structure from tailbone to head. Hopefully some old buried quadruped program in your motor cortex will open itself and a lot of pain will disappear.

While in that position you could try the following:

1. Go into swayback, belly lowered toward floor and head and tail raised up, (spine like a shallow "U"). Hold that position while deeply breathing with the abs, 3 or 4 times, all the way in and more importantly, all the way out. This will disengage your abs from having to be support structures for your trunk, and will let them do what they originally did, cradle your organs while your diaphragm breathes. It's important to learn to let that belly relax for a change. Often tight abs will be pulling the front of the ribcage down, causing stress on the SCMs and scalenes from below. (Shirley Sarhmann)

2. Go into humpback position (opposite of "U". Think "humpback camel.") Tuck tail down and head down. Repeat breathing exercises.

3. Allow your body to fold back about halfway (legs in "Z" formation, arms stretched out in front.) Repeat the swayback/humpback efforts and breathing exercises. You'll notice that it will all feel more difficult in this position. Keep trying, within your limits. Persistance will pay off. Especially in the swayback position you will be able to feel your hips stretch and with any luck, stretch out a bit.

4. Go into a complete fold, arms fully stretched out in front, nose near the floor. Repeat the swayback/humpback attempts and breathing one last sequence. Don't worry if it feels impossible, try anyway, do what you can manage. It's a learning curve, for you, your body, and your brain. Be content with all lack of perfection. Your cerebellum will figure it all out in a few days.

5. Another exercise you could do in four point kneeling could be some gentle slow neck movements. Full head lift, full head release downwards; in a head straight out position, look back over one shoulder slowly, then the other, long slow arcs within your comfort zone, breathing fully all the while; look up toward the ceiling one side, then look up toward the ceiling on the other side. This will maybe unload your neck joints a bit. Get a little more oxygen into the deep layers of tissue in there.

Hope this helps,
Diane
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Old 21-12-2004, 08:08 AM   #7
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Hi All,

Thanks Diane for this perfect example of global and natural movement which may help Sybil in a great manner.

Of Course, do not forget do practice slowly, it helps to feel where it works.
A question raises frequently when we're suffering from pain. Is it a good point to move since it hurts already when I'm doing nothing?

Normally it is quite true and pain may be a signal to keep our body without moving, the time needed for a complete repairing. A good way to stop you, moving, (injuring it further) is certainly carrying an unpleasant feeling with movements => pain. Another way used to stop you moving is increasing the muscular tension and then all movements become painful when tried. So pain is a fate and a miracle at once! It protects ourself!

But, now pain is also an evil companion when it stops, for a too long duration, our normal activity. We need to move in order to complete the normal repairing/recovery and movements need to be done slowly at the beginning. Pain may be brought in abnormal duration when we feel that a movement will be certainly painful before really doing it. We are engaged in an dangerous spiral of thoughts.

1/ we can't know the future thus we don't know if the movement will be painful!
2/ try to move slowly, a movement made in this way has few chance to hurt yourself because you're doing it and you may stop it when you want it!

Here is some exercises that may help to decrease the muscular tension =>

http://www.somasimple.com/forums3/viewtopic.php?t=42

http://www.somasimple.com/forums3/viewtopic.php?t=47
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Simplicity is the ultimate sophistication. L VINCI
We are to admit no more causes of natural things than such as are both true and sufficient to explain their appearances. I NEWTON

Everything should be made as simple as possible, but not a bit simpler.
If you can't explain it simply, you don't understand it well enough. Albert Einstein
bernard


Last edited by bernard; 10-02-2006 at 08:18 AM.
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Old 21-12-2004, 04:50 PM   #8
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Hi Sybil,
I fully concur with Bernard that slow is not only the best way to do global therapeutic exercise, it is the only way that I have found works.
Best
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Old 21-12-2004, 11:19 PM   #9
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I would like to add that I tell patients to imagine they are moving through a warm oil bath...feeling their way through the movement.


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Old 10-03-2009, 08:48 AM   #10
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Post Your not alone with these symptoms

Sybil,

I've been injured in my thoractic spine a fewt imes now, and one injury hasn't always mimicked the last and the specific muscles involved now sound much more like you set of problems in our share. I have torn discs in my neck a the same l locations and, managing my muscles is now a confusing challange, where I'd been reading a lot online about the body-systems and common PT diagnoses and Chrio Diagnosis and differing techniques to support healing. I'm not familiar with the IT band? I have at present my SCM muscles very overfired/used and it's being contrinuting to an auto accdent/whiplash injury and weak chin-area muscles not doing their part to hold my head up normally and stop me from experienceing dizziness,. I'm in physical therapy right now. I am the kind who wants to know how I'm being fixed or how the biomechanical exercises are rearranging how the muscles fire back into a normal in-sync pattern and recover. I am personally seriously considering acupuncture soon for my SCM muscle?



Quote:
Originally Posted by sybilvox View Post
Hi,
I am new here. I am plagued by health problems relating to spinal stenosis and constant muscle spasms. I would be happy to expand on these if anyone needs more info.
My main issue are headaches. Tension type with throbbing around the eyes and tight band. Usually constant. I believe they are trigger point related (I am almost 100% postive). My degenerative disc disease - worse at C5/6, but also moderate at C3/4 - has "caused" my system to respond to tension, exercise, everyday activity in unpleasant ways. My tapezius seems to be the most unhappy as it will tighten up if the winds blows, but ride a bike, hang a shower curtain, ab crunches, etc and it tightens up - sometimes with a constant spasm. This usually leads the SCM to kick in with the spleinus(sp?). Now the fun part - I get the SCM syndrome part. Vestibular issues - gas, nausea, dizzy, yawning, sickness feeling. It is so horrible right now that I can barely function.
Ok, on with the story - I have been in and out of PT for over 14 years. I have a great PT right now who sees me mostly for maintenance of neck and also IT band. I have a physiatrist and have seen at least 20 doctors and had as many tests - I try to keep my films updated. Meds include, zanaflex, lorazepam, prozac.
What I am hoping to gain from this post is someone out there who can help me understand this phenomenon and help me gain insight, knowledge, power, technique, support, etc. I want to still live, but be smart about it. If anyone can provide any insight I would be forever grateful.
Thank you very much for your time.
sybil
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