Annals of Sports Medicine and Research. Central ABBREVIATIONS INTRODUCTION CASE PRESENTATION. Case Report. Abstract

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1 Annals f Sprts Medicine and Research Case Reprt Multidimensinal Physitherapy and Ergnmic Interventin fr a Cmputer Prfessinal with Cervical Spndylitis and Radiculpathy: A Case Reprt Ridwana Sanam 1 *, and Afrzul Haq 2 1 KRV Healthcare & Physitherapy, India 2 Department f Fd Technlgy, Schl f Interdisciplinary Sciences, Jamia Hamdard *Crrespnding authr Ridwana Sanam, KRV Healthcare & Physitherapy, Blck C , Sushant Lk Phase -1, Near Paras Hspital, Gurugram, Haryana , India, Tel: Submitted: 06 April 2018 Accepted: 26 April 2018 Published: 27 April 2018 ISSN: Cpyright 2018 Sanam et al. OPEN ACCESS Keywrds Occupatinal veruse syndrme Wrk-related psture Neck-related arm pain Repetitive strain injury (RSI) (Deemed t be University) India Abstract Prlnged pr psture results in cumulative trauma f structures due t their altered length-tensin prperties, and hence this Repetitive Strain Injury (RSI) arises if pr psture is adpted regularly fr extended perids as typically happen in the wrk place in frnt f cmputer/ laptp. The prlnged misalignment f yur neck, shulder blade and upper arm puts significant stress n the ligaments and tendns arund yur neck& shulder. The purpse f this study was t reprt f an adult male cmputer prfessinal with cervical Radiculpathy & its successful management by physitherapy.the best treatments were exercise, manipulatin, KRV il massage and mbilizatin, r cmbinatins theref. Radiculpathy had a gd prgnsis and may respnd t cnservative measures. Results f neck surgery fr myelpathy r intractable pain are ften disappinting. This study shws that cmprehensive physitherapy prvides a valuable methd f treatment in cervical spndylitis amng cmputer prfessinals with 100% results. ABBREVIATIONS RSI: Repetitive Strain Injury; TENS: Transcutaneus Electrical Nerve Stimulatin; MMT: Manual Muscle Testing; ROM: Range f Mtin INTRODUCTION Cervical spndylitis is a cmmn rthpedic disrder invlving degenerative changes in the cervical spine, including spndylarthrsis, epiphyseal jint stearthritis, and disc degeneratin. It is estimated that 90% f males ver the age f 50 and 90% f females ver the age f 60 have radigraphic evidence f degeneratin in the cervical spine [1]. Radigraphic intrductin f the cervical spine bserved in 25% f individuals by age 50 years [2,3]. Three verlapping syndrmes can result frm spndylitic stephytic neural r vascular encrachment: nerve rt cmpressin (radiculpathy), spinal crd cmpressin (myelpathy), and vertebral artery cmpressin [4]. The cause is unknwn but may be accelerated by trauma, veruse, r genetic predispsitin. In many cases, this degenerative prcess. Neck pain due t pr psture, if neglected fr lng time, can lead t intervertebral disc dehydratin, desiccatin and degeneratin and hence the develpment f the cervical spndylsis. This study was aimed t analyze the relatin between symptms and signs riginating frm the cervical spine and the duratin f cmputer use, and the secnd part f the study aimed at reprting the cmbined effect f cmprehensive physitherapy in a male patient. Studies n physitherapy treatments reprted mixed findings as fllws: Mbilizatin, manipulatin, and exercise seem t be equally effective [5-7]. A study cmparing cmbined exercise and manipulatin with either mdality alne fund the cmbinatin t be mre effective at three mnths [8] but n difference was seen cmpared with exercise alne at ne and tw years [9]. Hwever, anther pragmatic study fund n advantage at six weeks r six mnths f adding manual therapy (63% f patients had mbilizatin physitherapy) r heat (shrtwave diathermy) t exercise and advice [10]. Radiculpathy (nerve rt cmpressin) due t cervical spndylitis usually ccurs at the C5 t C7 levels, althugh higher levels can als be affected. Neurlgical features fllw a segmental distributin in the upper limb, with sensry symptms (shting pains, numbness, hyperaesthesia) being mre cmmn than weakness. Reflexes are usually diminished at the apprpriate level (biceps (C5/6), supinatr (C5/6), r triceps (C7)). Figures (1-3) shws the dermatmal distributin f the cervical and upper thracic nerves. CASE PRESENTATION A cmputer prfessinal aged 39 years wrking in Delhi fr a Cite this article: Sanam R, Haq A (2018) Multidimensinal Physitherapy and Ergnmic Interventin fr a Cmputer Prfessinal with Cervical Spndylitis and Radiculpathy: A Case Reprt. Ann Sprts Med Res 5(2): 1131.

2 Figure 1 Physitherapy treatment. Figure 2 Ultrasnic Therapy. sftware firm presented with extreme pain in the neck t the KRV Healthcare & Physitherapy Clinic in Gurugram with extreme n 3rd f June This patient reprted difficulty in sitting and aggravatin f his symptms lying n left side, radiating pain in left upper arm and slight pain in upper back t. Patient experienced slight radiating pain in his left shulder and hand every nw and then and a tensin in his neck and shulder muscles ften. Patient had been taking painkillers and muscle relaxant smetimes, which wuld give him cmplete relief frm pain fr few hurs. Neck was very stiff in the mrning when he wke up fr arund 30 minutes and then slight relaxatin. Pain culd be rated as 8/10 n the day f arrival at KRV Healthcare & Physitherapy and generally its 6/10 n every mrning n a numerical rating scale. By the time patient reached hme, the discmfrt was t much and hlding the ffice bag with laptp als became unbearable. Chief cmplaint Pain in neck and it s radiating t left upper arm and upper back Histry f present illness Patient was experiencing slight radiating pain in his left shulder and hand every nw and then and a tensin in his neck and shulder muscles ften. Neck remains very stiff in the mrning when he wake up fr arund 30 minutes and then slight Ann Sprts Med Res 5(2): 1131 (2018) 2/6

3 relaxatin. Persnal Histry Regular cigarette smker Nn alchlic Nn-vegetarian Satisfactry bwel & bladder habits RESULTS MMT ¾ Rest f muscle grups = 4+ ¾ Neck flexrs= 3+ ¾ Neck extensrs= 3 + ROM: ¾ Neck flexin is painful and restricted ¾ Neck extensin is painful and restricted ¾ Left side rtatin painful and restricted Tender Pints: C4,C5, C6, C7, T1, T6 spinus prcess Spasm: B/L Trapezius spasm Lt>Rt Special Test: Cmpressin test +ve, ULTT 1,2,3 +ve Tightness: Pectrals, Triceps, Trapezius On Palpatin: There is an bvius spasm f the right upper trapezius muscle. Flexin and extensin is painful and restricted. Tender pints are seen and muscles have lst strength; are very tight. There is swelling arund the neck area and shulder. Gait- Nrmal Special tests Cmpressin test- psitive Distractin test: psitive Spurling test: psitive Bld Test:-Vit.D3 was 8 (Nrmal value- >25 mgdl) As per assessment the diagnsis was made Diagnsis:- Cervical Spndylitis with radiculpathy MATERIAL & METHODS USED FOR PHYSIOTHERAPY TREATMENT Varius techniques and mdalities were used in the treatment prcedure that als invlved a thrugh review f the cnditin frm time t time. 1. The cmmn mdalities used were Ultrasnic, Laser & TENS 1.1 Ultrasund: US Helps in cntrlling pain, relief, and inflammatin and muscle spasm. Pulsed UST was applied 1 W/ cm 2 intensity 1:1 pulse rati, fr 8 mins at active myfascial trigger pint identified n manual palpatin. 1.2 Laser: Laser therapy has tw main effects i.e. pain reductin and imprved tissue healing. It increases the healing rate, regeneratin f damaged tissue, healing respnse f fractures and decreases the deep seated inflammatin. It is very effective as it is deeply absrbed by the cells. Lw energy LASER (helium-nen) 920nm fr 3 mins by 3 times at trigger pints. 8. Transcutaneus Electrical Nerve Stimulatin (TENS): The use f TENS is an extremely ppular methd f pain relief. Figure 3 Mdificatin f ptential ergnmic expsure is imprtant t prevent this chrnic prblem. Ann Sprts Med Res 5(2): 1131 (2018) 3/6

4 Central It is easy t use and the side effects are minimal when cmpared t sme ral pain killers. TENS can prvide pain relief in almst 70% f cases suffering frm an acute injury. High-frequency Burst TENS was applied n the painful regin fr 15 mins. 9. A relative new apprach Myfascial Release (grss techniques- arm pull, shulder girdle release, upper trapezius release; specific techniques- fascial glides and stretch; and direct techniques- manual ischemic cmpressin at 7/10 VAS fr 45 secs and 5 repetitins) was given cmbined with KRV Healthcare & Physitherapy anti-inflammatry pain il. ¾ Ayurveda Anti-inflammatry pain il. ¾ Wrks wnder in all kinds f jint pain and muscle spasm. ¾ Nn-greasy easily absrbable. ¾ N allergies safe t use. ¾ Can be mixed with bdy il fr full bdy applicatin. Exercise Therapy Neck Ismetrics, 3 Pint pressure, Pillw Bridging, Pectralis/Triceps stretching. Resistive Thera Band exercises with 10 reps*5 sec hld, fr shulder shrugging, biceps & scapular retractin. Hme instructins (D s and Dn ts) ¾ Pain il applicatin: Just apply the pain il with sft hands and leave it t get absrbed by the muscles (will help reducing muscle spasm). ¾ Ht fmentatin with wet ht twel every 6 hurly. ¾ D nt hang yu left arm and lift any kind f weight. ¾ Kindly sleep n yur right side till the pain ges away. Take pillw f yur shulder and neck length. Keep yur spine in a straight line. Lifestyle Mdificatins Regular exercises mrning and evening. Life style mdificatins like taking breaks every after 30 minutes f wrk. Like stretching the bdy and taking arund fr 2 minutes. Medicatin ¾ Ultrasnic therapy:- Psitining:- Patient:-Prne lying with pillw under legs. Therapist:- Standing by side f patient facing his back. Duratin:-7 min. ver upper back. - 7 min ver tender pints Mde:-Cntinuus. ¾ Intensity:- 2.5 w/cm 2.Transcutaneus Electrical Nerve Stimulatin (TENS): Psitining Patient:-Prne lying with pillw under legs. Duratin:-15 min. Mde:- sweep mde fr 1week fllwed by burst mde fr next week. ¾ Myfascial release with pain il: Mid back t upper neck fr 10 min. ver back with pain il applicatin. Distal t prximal ¾ Ht fmentatin with ht twels at hme fr 10 mins daily ¾ Exercises: Psitin f the patient: sitting Frm 3 rd day nwards ¾ 3 pint pressure ¾ Shulder ismetrics ¾ Shulder bracing ¾ Shulder shrugging ¾ Neck ismetrics. ¾ Stretching f tight muscles (biceps, triceps) N. f repetitins:- 10 reps*5 sec hld ¾ Hme Instructins a. Pain il applicatin every 6 hurly: Just apply the pain il with sft hands and leave it t get absrbed by the muscles (will help reducing muscle spasm) b. Ht fmentatin with wet ht twel every 6 hurly Tab. Neugaba 75mg fr 10days c. D nt hang yu left arm and lift any kind f weight Tab. Etshine 90mg nce a day fr 15 days. Architl 6 L Injectin nce fr 6 mnths. Oral dse 1/week fr 6 Weeks. Actin f T/t 1) On 3 rd June, 2014 Chief Cmplaint: Patient has been feeling extreme pain in neck, difficulty in sitting and lying n left side, radiating pain in left upper arm and slight pain in upper back t. Physitherapy Treatment: d. Kindly sleep n yur right side till the pain ges away. Take pillw f yur shulder and neck length. Keep yur spine in a straight line. 2) On 13 th June, 2014 Chief Cmplaint: Pain lcalized t upper back with n radiating pain in Lt Upper arm. The stiffness that was felt in mrning reduced t 5 minutes. Swelling arund the neck area is gne. Muscle is gaining strength and spasm has been reduced. ¾ Ultrasnic therapy:- same as abve ¾ Transcutaneus Electrical Nerve Stimulatin (TENS):- with burst mde intensity100 Ann Sprts Med Res 5(2): 1131 (2018) 4/6

5 ¾ Exercises: Psitin f the patient: sitting Frm 3 rd day nwards ¾ 3 pint pressure ¾ Shulder ismetrics ¾ Pillw Bridging ¾ Shulder bracing ¾ Shulder shrugging ¾ Neck ismetrics ¾ Stretching f tight muscles (biceps, triceps) ¾ Pectralis/Triceps stretching ¾ shulder blade mbilisatin ¾ scapular retractin. ¾ Biceps N. f repetitins:- 10 reps*10 sec hld ¾ Resistive Thera Band exercises started with 10 reps*5 sec hld ¾ Myfascial release with pain il: distal t prximal UE-Lt fr 15 minutes- Nw we can increase the duratin and relax mre muscles as the spasm and tightness has t be reduced cmpletely. Hme Instructins i. Pain il applicatin every 12 hurly: Just apply the pain il with sft hands and leave it t get absrbed by the muscles (will help reducing muscle spasm) ii. iii. Ht fmentatin with wet ht twel every 12 hurly D nt hang yu left arm and lift light iv. Take pillw f yur shulder and neck length. Keep yur spine in a straight line. 3) On 23 rd June, 2014 Chief Cmplain: N pain felt. Mrning stiffness has gne. Muscle mvement backs t nrmal. Life style mdificatin D s:- ¾ D turn t ne side while getting up frm supine psitin. ¾ Use ht pack fr yur neck. ¾ Use twel rll under the neck during supine lying. ¾ D ismetrics fr neck. ¾ Arms shuld be supprted in ne f the three psitins ¾ Use pillw f nrmal thickness in side lying psitin. ¾ Hands n thighs/r n table. ¾ Hand behind back with elbw straight ¾ In rder t avid hlding f the head in the same psitin fr lng perids, take break while driving, while watching TV r wrking n a cmputer. ¾ Use a seat belt when in a car ¾ Use cervical cllar in case f giddiness. ¾ Retractin f shulders every hur: mve shulders backward. ¾ Hands in pcket Dn ts: ¾ Dn t sleep straight. ¾ Dn t bend yur neck. ¾ Avid hanging f arms. ¾ Avid sitting fr prlnged perid f time in stressful pstures. ¾ D nt lift heavy weights n head r back. ¾ D nt drive fr lng hurs; take breaks. ¾ Avid habit f hlding the telephne n ne shulder and leaning at it fr a lng time. ¾ D nt take many pillws elbw the neck and shulder while sleeping. ¾ In rder t turn arund, d nt twist yur neck r the bdy; instead turn arund by mving yur feet first. DISCUSSION Treatment prtcl was discussed with the patient in details that and it was infrmed t patient that it can take days t remve the pain cmpletely and after getting agreed n all the pints we gt ur declaratin dcument signed by the patient. In Our first few sessins we cncentrated n reducing spasm arund the neck musculature using massage techniques with ur pain il, wet heat, ultra-snic, tens mdalities and light exercises. After 5 sessins we used sme jint mbilizing techniques that are helpful in pening/stretching the small jints f the neck and shulder which were restricted because f the prlnged repetitive stress injuries. Pain settled in 5 sessins and symptms t started t settle. After five sessins, we started wrking n regaining the range f mtin using the further manipulatin techniques and wrked n sft tissues t achieve the target. The exercise prgramme was prgressed frm basic stretching t active range f mvement wrk and finally strengthening f the neck muscles that help in stabilising the neck and the pain went away cmpletely after 20 sessins. Initially the Vit.D3 was 8 nly and after the 3 mnths, it increased up t 30 and with the ral dse f Vit.D3 nce a week fr4 weeks, The Vit.D3 reached at the level f 42. Recently, better quality randmized cntrlled trials have suggested that exercise, mbilizatin physitherapy, and manipulatin are mre effective than less active treatments [5,7,11]. Previus studies [7,12] have suggested further advantages f cmbining the exercises with mbilizatin r Ann Sprts Med Res 5(2): 1131 (2018) 5/6