Background Linda is a 31-year-old resident in oral surgery. She was referred for rehabilitation for complaints of upper back and neck pain with frequent headaches. She states that she has been experiencing the symptoms off and on for about 2 years. Her symptoms are worse at the end of the work day, especially on days she is in the operating room. There is no history of trauma to the affected region.
Physical exam reveals a forward head, rounded shoulder posture, spasm of the cervical paraspinal and trapezius muscles, and very sensitive trigger points throughout the region.
Impression Her symptoms were consistent with pain of myofascial origin secondary to posture, jobrelated stress, and fatigue of the postural muscles.
Treatment She was treated with TENS over the trigger points using a Neuroprobe and soft tissue mobilization, and she was instructed in a routine of postural exercises. She was encouraged to perform postural exercises and relaxation activities during breaks in her schedule. Linda returned to the clinic indicating she had experienced near complete relief following her first visit for about 6 hours. The stimulation of trigger points was repeated and Linda was instructed in the use of a TENS unit with conventional parameters over her most sensitive trigger point. She had access to the TENS unit through the surgical clinic where she worked.
Response Linda was seen for two additional visits. She indicated her compliance with the exercise program, which was subsequently expanded into a general conditioning program with an emphasis on upper body endurance. She also indicated that her symptoms were becoming much less severe and less frequent and that the home TENS unit gave her a means of controlling her pain before it became severe enough to affect her activities. Over the subsequent several months, Linda completed her residency without additional care for her neck and upper back.