Aims
This retrospective case study explores the rehabilitation of “Natalia,” a 44-year-old supermarket packer with persistent neck pain one year following an anterior cervical discectomy and fusion (ACDF) at the C5-C6 level for a left-sided C5/6 radiculopathy. The goals were to manage her pain, improve functionality, and restore full duty work and daily activities. The study emphasises a musculoskeletal physiotherapist's clinical reasoning, integrating pain education, motor control, endurance training, functional training, and manual therapy to highlight the benefits of a comprehensive approach to chronic pain management. It also relates the management to contemporary assessment frameworks for a holistic, evidence-based approach.
Methods
A multi-systems approach was used, incorporating pain education, motor control and endurance training, functional training, and manual therapy. Pain-focused behaviours were addressed with pain neuroscience education and pacing strategies. Risk stratification and outcome measures included the Orebro Musculoskeletal Pain Questionnaire (OMPQ) and the Neck Disability Index (NDI). Contemporary assessment frameworks guided the clinical reasoning process.
Results
Natalia's initial NDI score was 16/50 (32%), indicating moderate disability, and her OMPQ score was 113. Significant improvements were observed: her NDI score reduced to 4/50 (8%), cervical motor control and endurance improved (cranial cervical flexor endurance from 5 to 51 seconds), and lifting capacity increased (5 kg to 18 kg floor-to-waist, and 7 kg overhead).
Conclusions
The case demonstrates the effectiveness of a comprehensive, multidisciplinary approach in managing chronic neck pain, improving pain levels, functionality, and quality of life. This approach underscores the importance of addressing both physical and psychosocial factors in rehabilitation, using contemporary assessment frameworks for evidence-based evaluation and optimised patient outcomes.