Dowagers Hump? Help!

[Ocimom]

Hello!
I need to pick the brains of all you genius therapists out there. I have a client with what appears to be a Dowagers hump. He is unable to lay flat without experiencing nausea He gets an immediate headache if he has a pillow in the wrong position under his neck. He also experiences lower back pain when laying flat on a hard surface or leaning back in a recliner chair (some of the discomfort in this instance may be be the sudden effort required to fling the chairback back). Generally working anything from C7 up causes discomfort. I am wondering if this will cause some type of disability later in his life. Any help you all can offer would be great! I have pics but can't post them yet. I could e-mail or post them as soon as I meet the required number of posts which should be soon!
Thanks!

 

[Pompal 09.]

how old is he, this is already a disability! Work on the anterior aspect of the neck...

 

[gutter_fly]

Yeah, anterior neck, shoulders, chest, all of the usual for forward head position. But if he is having nausea and "instant headache" he needs to be evaluated by a medical professional. If everything checks out "normal," then a combination of chiropractic and massage would probably be more progressive than massage alone.

Also, what is his hip posture like?

 

[teresa g]

Dowagers hump...

He is 42, not very interested in self-care, unfortunately. He generally doesn't "like" anterior neck work, even though it's what he needs. He won't really allow me work that area.

I am still a newbie therapist. Breathe, help me with the hip posture, if you will. How do I evaluate that? Check to see if the ASIS's (?) are level? And?? Can I send you the photo link, would it help?

I know he needs to do a lot of self care such as stretching and walking and such, but he seems content with the path he's on.

 

[tatooedpriestess]

Dowagers hump

I think I finally reached 10 posts, so I am going to post the link to the pic.
http://i173.photobucket.com/albums/w42/dawnrayebay/DSC04569.jpg
I tried to put the pic here directly but it's huge and I can't seem to resize it!

 

[AhManDuh]

Doesn't matter if he's "not interested" in self-care or not. Ethically, you need to stand firm on what you feel is in his best interest. Tell him his current path is a downward spiral leading to severe disability and constant pain if he continues to ignore it and doesn't obtain the kind of care he needs. This includes anterior work.

Further, I feel that photo shows a somewhat severe-looking neck situation. Refer him to a medical pro for evaluation and probable treatment. If he refuses, you may need to refuse service until he returns with a diagnosis and treatment plan. I have done so myself, and will do so again if necessary.

Last, if you feel this guy's situation is simply over your head or that he simply won't listen to reason, refer him to another therapist that you feel could better serve him. I have done so, and never once regretted it.

Good luck!

 

[sweetsonia]

Is he there for therapeutic work, or is he looking for relaxation only? The client's agenda is the one that counts for most. You can possibly convince him that real work can be done and real progress can be made if he participates, but if he doesn't *want* the progress, just to feel good for an hour, you may as well just relax and help him relax. As he feels more trusting of you, he will be more trusting of your judgment and you can talk about that again. If he wants his neck to feel better but won't participate, there isn't much you can do to even give him a "feel good" hour because he won't be satisfied with anything.

 

[Michael]

Hi dawnray, from the looks of that photo, I think he has some really tight shoulder and pectoralis muscles. As others have mentioned he must have a pretty significant forward head posture?
Maybe you can ease into the anterior neck work by first addressing those shoulders while he is in a supine position. Most of my clients are so surprised by the tenderness that they are feeling in their anterior chest and shoulders that they decide that they WANT anterior neck work. At times I can ease on up into that area without any discussion, it just seems like a natural progression of the massage to the client.
If not, sometimes you are able to release neck muscles with some gentle MFR and stretches for the neck and upper back/chest.
I wish you luck, it is tough when the client doesn't have the same goals as you do.

 

[IntenseDesire]

Dowagers hump...

He is 42, not very interested in self-care, unfortunately. He generally doesn't "like" anterior neck work, even though it's what he needs. He won't really allow me work that area.

I am still a newbie therapist. Breathe, help me with the hip posture, if you will. How do I evaluate that? Check to see if the ASIS's (?) are level? And?? Can I send you the photo link, would it help?

I know he needs to do a lot of self care such as stretching and walking and such, but he seems content with the path he's on.

If the client isn't interested in following up with self-care, there's probably not much you can do for a forward head posture. But if he WERE interested in improving posture, (through stretching, strengthening,) you would start with a visual and ROM assessment, looking for anterior tilt (or less commonly, posterior,) high ilium, one leg forward, one or both knees locked. Test ROM when on the table, psoas (hip extension), internal/external rotation of hip, flexion of knee, etc.

To check if the ilium are level, make sure they are lying straight on the table, head in neutral, no bolster, then close your eyes and palpate to the PSIS. Keep your finger on the landmarks on either side, then open your eyes and look. If on one side your finger is higher, voila! look for an imbalance - tight muscles on one side of the back, pulling the ilium up.

You can do the same thing in supine with the ASIS, but that is a little more complicated to know what to do for low ASIS. You can check Whitney Lowe's work for some interesting discussions on innominate rotation, and lateral tilt.

In forward head posture, you really can't get a lasting change in posture if you don't balance the rest of the body. Pelvic imbalances affect tensions on the spine. (short leg can also affect head posture, but you need to eliminate restrictions in the pelvis before you can get a good estimate at possible leg length discrepancy issues.)

After that work, you can then look at the muscles that pull the head forward, and others that have to tilt it back up once it's pulled forward. It's not relaxation work. You do need to get deep into the anterior neck, and although it doesn't have to hurt, it's not the type of work you would do in a relaxation setting.

Erik Dalton and James Waslaski* have some great protocols for dealing with forward head posture (upper crossed syndrome) and pelvic balance.

You say you're a newbie therapist. Don't be afraid to work on people with complicated conditions, but if you're going to do cervical work, make sure you're doing all necessary tests (I learned about that this weekend- and I have to say I have NOT been doing the necessary tests - alar ligament, VBA insufficiency and cervical compression/distraction- so glad I haven't yet had any issues. *gulp*) Be conscious of learning about what you want to try and be aware of the science behind treatment work-- primarily, is what you are doing creating balance, or contributing to imbalance? (Primary example of that is doing deep tissue to loosen up the rhomboids for thoracic pain. WHY would a therapist do that? Who in here has ever seen a shortened rhomboid? Yes, the rhomboids need work, but don't be lengthening an overstretched muscle and expect long lasting benefits.)

But...
The client must have a desire to change their postural habits and their self-care, otherwise, why waste your efforts? Use the situation for what it's worth... a real life example that you can use as a learning tool to become a better therapist. But do not expect change from a client who is not looking for it. You will only be disappointed.

You can educate your client though:

"I'd like to show you something Mr. Forward Head. Massage therapy can do more than just take your stress down, it can increase your comfort in your body, and we might be able to change some of those headache issues (after we and your doctor have ruled out any serious conditions.) We can do that by lengthening these muscles so that your lower back has more room, your upper back is less curved and your neck muscles don't have to work so hard to keep your head up and stable.

Let me show you in this book which muscles I am concerned about: (show nice big pictures.) If you want to try these techniques in your next session it requires a commitment, because to keep any gains we make, you will have to do some stretching for a few minutes every day at home, and later on, some specific strengthening. Do you think you might want to try something like that?"

Your dialogue may vary, but treatment work is a collaborative process. If your people are coming in, getting on the table, pointing and saying "fix me," then lying quietly or chatting for an hour while you rub them, it is palliative work. Palliative work has tremendous health benefits, but it has a lesser effect on structural issues.



* I'm familiar with the work of these three educators, having taken workshops with them or studied their published works. There are many fine educators out there doing and teaching structural bodywork, so others might prefer the work of another teacher.

 

[Benny]

AH, wonderful helps! I appreciate everyones input. I wish that I could transplant everyones know-how right into my brain!

Breathe, you gave me lots of info to assimilate and I truly appreciate that! And as far as self care- he needs to strengthen his back muscles, correct? Say with some Pilates back extensions and such? And babalnce that with stretches for the front...

I will re-post if he decides to consider taking this seriously. I may be crazy, but it seems like a wonderful challenge to me. Yeah. I'm nuts.

 

[Lord_Darkclaw]

Strong back muscles are important to posture, but they are the LAST piece of the puzzle. If he doesn't have length in the muscles that are currently tight, he cannot effectively strengthen the overstretched muscles.

First: restore flexibility. When the person has restored range of motion, then restore (or build) strength and stability.

Your primary goal in upper and lower crossed syndrome is to lengthen psoas/iliacus, quads, lateral rotators of the hips, then chest and anterior neck muscles, suboccipitals. THEN, strengthen hamstrings, lower back, rhomboids.

Pilates is a wonderful addition to structural bodywork. Just make sure he is not stretching the muscles that are already over stretched.

 

[Shelby. (:]

Nice summary, and it matches up with everything I've been studying, too! Good to see such fine advice.

 

[Scream Your Secrets]

Sorry to divert a little but...

Breathe, I've been a keen follower of Erik Dalton. I had never heard of James Waslaski' until your post. Just took a look at his website and liked what I saw. I can't attend his courses I'm afraid because I'm based in London, but have you seen his dvds and if yes, would you recommend them?

Happy Xmas BTW

Henry

 

[FunctionalDisfunctions]

Acupuncture can also help relieve this condition. It worked wonders for me, Mr. Former Forward Head. :woohoo:

 

[........yewwww]

Dowagers Hump? Help!

This individual has a forwardly pulled neck due to SCM hypertension, most likely he is rolling his shoulders forward, his SCM has develoded a trigger point or several, aggravated by the stretch of putting his head down on the table. He must have anterior work. Roll the SCM between your fingers, torque it by grasping it right above the connection on the clavicle. He needs heat and stretching. Roll his shoulders back. Work on loosening his pectoralis minor and get his arm in the "chicken wing" behind his back, grasp under the edge of his scapula and pull up, this will stretch his subscapularis tendon.

 

[Pompal 09.]

Sorry to divert a little but...

Breathe, I've been a keen follower of Erik Dalton. I had never heard of James Waslaski' until your post. Just took a look at his website and liked what I saw. I can't attend his courses I'm afraid because I'm based in London, but have you seen his dvds and if yes, would you recommend them?

Happy Xmas BTW

Henry

Erik Dalton and James Waslaski are constantly sharing info with each other and incorporating each other's work into their own. I just spent 5 days studying with Waslaski and he was all praises for Dalton, frequently pointing out different concepts or methods that he had learned from Dalton. His videos are good, too. You will find their work very compatible with one another.