By Zac Mackenzie
SESSION 2
This week I followed up with this a patient I wrote about previously. I was interested to see how he fared headache wise. During our session, he advised me that his headaches had significantly improved and his neck was feeling less stiff. So, we planned in this session to do some more hands on treatment to hopefully completely resolve his symptoms then head over to the gym to have a look at his technique with overhead exercises.
When we reviewed his overhead technique, I noticed that he had significant recruitment of the neck and upper back muscles as he started to fatigue. I suggested that he utilized a simple cue such as keeping the point of his shoulder away from his ears during above head exercises which will reduce the activation of these muscles. I also suggested that over the next week or so until his headaches had completely settled that with above head and shoulder exercises he keeps a few reps in the tank during his sets, which will make sure that he doesn’t utilize the neck muscles as his shoulder fatigues.
We also went over a few neck and upper back strengthening exercises to work into his routine. The aim of these will be to progress them over time as part of his headache prevention program to perform 2x a wk. We planned to review again next week where we would look to complete his program. After this we will look at monthly reviews to progress these exercises.
I followed up with this patient again this week. We had a chat about how his symptoms had been going in the past week. He advised me that his headache symptoms had all but resolved. He also said that he’d been concentrating on those cues we spoke about when lifting overhead although he hadn’t been lifting too heavy. He also said that he’d had a couple of sessions of the upper back and neck strengthening exercises and they seemed to go okay.
SESSION 3
Our plan this week was just to review those existing exercises as part of the maintenance program and add in 2 more exercises. I showed him a good way of progressing the exercises as they became too easy, and how to regress them if he found that they aggravated his symptoms. We also spoke about how he could manage relapses, by going over the mobility exercises and dropping the overhead work until symptoms settle. We also spoke about how he can gradually increase his overhead lifting over the next couple of weeks back to his normal level.
We planned to review again in one month to go over the exercises and see if we can progress.
session 4
Following up with this patient again, I was pleased to hear that he had no headache symptoms since the previous visit. We used this session to again go over his technique when lifting over head in the gym. This time we increased load back to similar weight that he was lifting before the headache episode. Again we looked at keeping his shoulders away from his ears, and concentrated on this as he begun to fatigue. After the session he said he felt fine headache wise which was pleasing.
We went over 1 more exercise to complete his neck and headache strengthening program and agreed to review again in a month to update the exercises.