Abdominal pain is one of the most common complaints of patients attending physical therapy clinics. It interferes with both function and quality of life for most patients. It might happen because there are so many different reasons in so many different ways so there are good reasons for possible explanations changes when chronic pain and optimal treatment strategies are needed.
Changes in Chronic Pelvic Pain.
- Pain Centralization – A reduction in pain is one of the findings of researchers in patients with chronic neck pain. The decrease in pain was recorded both locally and distally in the upper and lower extremities suggesting central changes in chronic cervical pain.
- Cervical changes – Patients with chronic cervical disease show a deficit in proprioceptive input affecting postural stability .
- Neuromuscular dysfunction – Studies have shown that patients with chronic cervical pain exhibit up to 90% increase in cervical spinal muscle strength.
- Deep neck flexors have reduced EMG activity and delayed activation during arm movements so the feedforward mechanism is disturbed.
- Neck flexor muscles (SCM and anterior scalene) have shown side-specific weakness in unilateral cervical pain.
Assessment of chronic cervical pain should focus on different areas:
- Position analysis – viewed from three different positions:
- Posterior: the shoulder appears to be elevated (due to tension of the upper trapezius and levator scapulae muscles).
- Lateral: as in frontal head position.
- Anterior: hammer like anterior in SCM.
- Balance assessment – patients with chronic neck pain often present with impaired postural instability.
- Gait assessment – In extreme cases of cervical dysfunction, gait patterns may change.
- Flexibility and Muscle Strength Assessment
Physical therapy treatment
The main goal of physical therapy is to restore balance between muscles by stretching tight muscles and strengthening weak muscles, as well as improving proprioception. Some physical therapies are:
- Stretching for tight muscles
The most common tight muscles:
Sternocleidomastoid muscle (SCM)
Stretching alone is not enough for patients with chronic cervical pain, you should also undertake a deep neck flexor stabilization program as it is a very important step in your rehabilitation program.
- Proprioceptive exercises.
As mentioned above patients with chronic neck pain exhibit a deficit in proprioception that affects postural stability. Exercises involving head and eye movements are thought to improve proprioception because the vestibular visual and proprioceptive systems are connected .
You can also look at Sensorimotor Impairment in Neck Pain to see the proprioceptive exercises.
Practical Diagnosis and Treatment of Cervicogenic Headache
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- Malmström EM, Fransson PA, Bruinen TJ, Facic S, Tjernström F. Disturbed cervical proprioception affects perception of spatial orientation while in motion. Experimental brain research. 2017 Sep 1;235(9):2755-66.https://www.ncbi.nlm.nih.gov/pubmed/28623390
- Prushansky T, Gepstein R, Gordon C, Dvir Z. Cervical muscles weakness in chronic whiplash patients. Clinical Biomechanics. 2005 Oct 1;20(8):794-8.https://www.ncbi.nlm.nih.gov/pubmed/15996800
- Falla D, Jull G, Hodges PW. Feedforward activity of the cervical flexor muscles during voluntary arm movements is delayed in chronic neck pain. Experimental brain research. 2004https://www.ncbi.nlm.nih.gov/pubmed/14762639 Jul 1;157(1):43-8.
- Falla D, Jull G, Rainoldi A, Merletti R. Neck flexor muscle fatigue is side specific in patients with unilateral neck pain. European Journal of Pain. 2004 Feb;8(1):71-7.https://onlinelibrary.wiley.com/doi/full/10.1016/S1090-3801%2803%2900075-2
- Revel M, Minguet M, Gergoy P, Vaillant J, Manuel JL. Changes in cervicocephalic kinesthesia after a proprioceptive rehabilitation program in patients with neck pain: a randomized controlled study. Archives of physical medicine and rehabilitation. 1994 Aug 1;75(8):895-9.
- Jull G, Falla D, Treleaven J, Hodges P, Vicenzino B. Retraining cervical joint position sense: the effect of two exercise regimes. Journal of Orthopaedic Research. 2007 Mar;25(3):404-12.