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This patient was involved in a motor vehicle accident
She is a 58 yr old female who came into therapy with a lot of stiffness in her neck, shoulders, had very limited cervical motion in all directions, 6/10 pain and complained of pounding headaches since her accident which was 10 days prior to coming in for therapy. She is an accountant as well so work consists of a lot of sitting and looking at a computer.
I first took the patient on my 3rd day of clinical. At this time I didn't know very much about her diagnosis, all I was told is to just complete manual therapy.
After, I took a look at her chart and found that she was diagnosed with cervicalgia, mm strain at the fascia and tendon, mm weakness, and mm spasm of the back.

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Dry Needling Combined with Guideline Based Physical Therapy Provides No Added Benefit in the Management of Chronic Neck Pain: A Randomized Controlled Trial

Summary: : 116 patients were randomly assigned to receive either guideline-based PT consisting of exercise and manual therapy or guideline-based PT plus dry needling for a period of 1 month. After that month of treatment, those who received dry needling treatment along with guideline-based PT had a small reduction in average pain intensity. There was no effect in adding dry needling to guideline-based PT.

My CI is certified in dry needling. I felt like at some point he would've wanted to try that on the patient. The article helped me back my reasoning for not recommending it for the patient. Plus, she hated needles anyways.

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I've worked with this patient a total of 4 times out of the 17 times she's visited. Patients at my clinic are scheduled based on therapist availability so patients that come to the clinic are not necessarily assigned a patient that they see solely.
Over the course of her time there, he pain has decreased from 6/10 to an average of about 2-3 and 4 being the highest.
Depending on time and patient load, sometimes a patient will start with the chiropractor --> E-STIM if needed --> PT/PTA --> Traction. The order varies. It always mixed up.
Once we were able to decrease her pain and muscle tone, she was given cervical stretches, pec stretches, chin tucks, and stretches for her upper thoracic.
At about week 3, cervical isometric exercises we given along with scapular and thoracic exercises.
My last 4th session with her didn't involve any therex due to her just having a lot of increased pain, tenderness in between her shoulder blades, and increased muscle tone in her upper traps and levator. As I mentioned before, she mostly works at a desk so she has all the signs of having an upper cervical crossed syndrome (all muscles in the upper thoracic stretched out, forward neck, anterior rolled shoulders, and tight pec major/minor.
She has been doing much better than when she came in. We're now just working more postural training/strengthening and keeping the pain and muscle tone down.

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I'd say 80% of what we do in the clinic is manual therapy.
So deep tissue massage, myofascial release, cross fiber friction, pin and stretch, active release technique.
I've also done joint mobs, manual distraction, cervical lateral glides, cervical downglides, PNF contract-relax for improved ROM, decreased pain and muscle tone.
I feel like I use a lot of the same techniques to patients because I get a lot of good feedback.

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Her HEP consists of:
Stretches: Upper trap, levator, rhomboids, scalene, thread the needle, thoracic shimmies
Strengthening: Wall angels, wall walks, I, Y, T's, and UE D1

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My favorite part about treating this patient is seeing improvements after every treatment. Some days she still leaves with a little pain and tightness but it's always better than when she walked in. It makes me believe that I did something right.
My least favorite part is the time crunch. We only have 30 minutes to work with a patient before moving onto the next.
The most important thing I've learned while working on this patient is that sometimes progress comes slow and no one gets 100% better overnight. Documenting correctly, trying different techniques, and collaborating with other PT's/PTA's can make a big difference in how a patient progresses.