Joan Bernardino, patient of Melissa Baudo at One on One Physical Therapy, shares her courageous story of coping with Cervical Dystonia with dystonia Spasmotic Torticollis Magazine. Physical Therapy helped her along her journey. If you or anyone you know is coping with a musculoskeletal injury or condition, please share this article and encourage them to seek care from a physical therapist.
I would like to share my story in hopes that others may benefit from what I have learned about coping with Cervical Dystonia. I have been fortunate to have access to some excellent healthcare providers, including some very helpful complimentary therapies. In the seven years that I have had this disorder, I have learned a lot about what will make my neck straight and lessen the spasms and pain. My Physical Therapist, Melissa Baudo, and I have written an article that I hope you will publish in “Dystonia” Magazine.
My Cervical Dystonia began very gradually in 1999, following a serious car accident that hospitalized me for eight days. Although my neurologist cannot confirm that my Dystonia is related to the accident, it was shortly thereafter that I began to have headaches and muscle spasms in my jaw. Perhaps these spasms were a precursor to the spasms in my neck and shoulders.
In 2003, my husband became seriously ill and I returned to teaching after my retirement in order to obtain healthcare insurance for both of us. I truly enjoyed my teaching position. However, my long commute and hours at the computer took a toll on my body. I felt tightness, stiffness, and pain in my neck. Then one day, my husband mentioned to me that my neck looked crooked. Although I was aware of the tilt in my neck, I was depressed to realize that others could notice what I had been feeling. Along with the physical symptoms I was experiencing came the embarrassment for the way I looked.
After three months of chiropractic manipulations and trying to reduce my stress by using relaxation techniques, I was feeling hopeless. I was then seen by Dr. Susan Dreyer, MD, a physiatrist at the Emory Spine Center in Atlanta, Georgia who diagnosed me with Cervical Dystonia and referred me to a Neurologist. The first thing I did when I got home was feverishly search the Internet. I thought to myself, “What was this disorder? Was I finally on a path to a cure?” It was then that I finally felt some hope because I knew there were treatments available. Following my initial consultation with my Neurologist at the Emory Movement Disorders Centerin Atlanta, the plan of care would be Botox injections and physical therapy. The exact diagnosis was torticollis with later ocollis and slight anterocollis. My TWSTRS scores were moderate. With the Botox and my stretching exercises, I slowly began to see my neck straighten. Determined to get my neck straighter, I began a long-distance treatment program from Abbie’s Spasmodic Torticollis Recovery Clinic in Santa Fe, New Mexico. After four months of specific stretches and exercises, the sensation of pulling on my neck ceased. What a relief!
After about one year, I had made considerable progress and discontinued the Botox injections. My neck was almost completely straight but I still had moderate pain and muscle spasms in my neck and shoulders. I continued my search for answers. I had incorporated monthly massages from a therapist who was also a gifted Anusara yoga teacher. Anusara yoga is a type of Hatha yoga which focuses on universal principles of alignment. What I learned from my yoga teacher changed my life. I have been practicing yoga for six years now and it has helped me gain strength, improved posture, and a new sense of calmness. While enabling me to focus on my body alignment, I have also learned to slow down, breathe deeply and better cope with the stresses of life all while continuing to improve my neck. Lately, I have been practicing Pranakriya yoga which focuses on creating a state of deep introspection through the practice of breath work and asanas (postures). For anyone with cervical dystonia who would like to try yoga, I highly recommend starting with either a beginner’s series of classes or a gentle ortherapeutic yoga class. I have found that a few poses are not appropriate for me, especially Downward Facing Dog because it puts strain on the trapezius muscles.
I have also benefited from other complimentary therapies such as Acupuncture and Cupping both of which are treatments used in Traditional Chinese Medicine. Acupuncture restores the body’s flow of energy, referred to as Qi, allowing the body to heal itself. Cupping utilizes glass cups to create a vacuum to increase warmth and circulation to an injured region of the body releasing toxins from the muscles and soft tissues. Following my Acupuncture and Cupping sessions, I felt an overall feeling of lightness and relaxation.
While my neck had made considerable improvement, I still felt persistent strain, pain and muscle tightness in my neck daily. My most recent discovery has been a Physical Therapist in Atlanta,Georgia, who has worked with people diagnosed with Cervical Dystonia. Dr. Melissa Baudo,PT, DPT, SCS, MTC is Board Certified in Sports Physical Therapy, Manual Therapy Certified and is trained in Triggerpoint Dry Needling, Kinesio Taping and is a Certified Instructor for Neurac Redcord. Dr. Baudo took an innovative and comprehensive approach with me that went beyond my daily stretching and traditional physical therapy. The goal of her treatments was to enhance my neuromotor control and the way the muscles in my neck worked through the use of techniques including Triggerpoint Dry Needling, Kinesio Taping, Neurac Redcord and Manual Therapy. She explained that when pain enters the body, it shuts down our deep “local”stabilizing muscles and our “global” muscles take over, which causes more pain, muscle tightness, tonicity, postural changes, and weakness. Her approach was unique and she had had success with other patients diagnosed with Cervical Dystonia so I was ready to put my neck in her hands.
Muscle tightness, hypertonicity and spasm are all symptoms of Cervical Dystonia. Muscles that are hypertonic and spastic often have “myofascial triggerpoints” in them which are considered hyperirritable taut bands of muscle fibers that cause pain. Triggerpoint Dry Needling is a technique that is used to deactivate myofascial triggerpoints thus reducing the musculoskeletal pain that is associated with Cervical Dystonia. A thin filament needle is inserted into the skin and muscle directly at a myofascial triggerpoint eliciting a local twitch response which is a spinal cord reflex. Getting a local twitch response with Triggerpoint Dry Needling is effective in breaking the pain cycle and alleviating muscular pain for those with Cervical Dystonia.
Kinesio Taping is a therapeutic taping technique that is designed to facilitate the body’s natural healing process while providing support and stability to muscles and joints without restricting range of motion as well as providing extended soft tissue manipulation to prolong the benefits of manual therapy administered within the clinical setting. Kinesio Tape successfully treats a variety of orthopedic, neuromuscular and neurological conditions and has the ability to reeducate the neuromuscular system, reduce pain and inflammation and promote good circulation and healing, all of which are effective in the treatment of Cervical Dystonia.
Neurac Redcord is an evidence-based method utilizing Redcord for examination and treatment of neuromuscular insufficiencies and abnormal movement patterns. Studies have shown that injury,pain and inactivity disturb our brain’s capacity to switch on the right muscles at the right time and with the right amount of strength. This loss of neuromuscular function diminishes our“local” muscle control, often leading to decreased quality of movement and increased musculoskeletal pain and dysfunction, which is characteristic of Cervical Dystonia. There is also a tendency for our larger “global” muscles to take over (compensate) and eventually become stressed, strained and painful. The Neurac method aims to normalize this muscle interaction byre-activating the body’s deep stabilizing system through high levels of neuromuscular stimulation. By using the Redcord you will experience decrease in pain and improved function in less time than conventional treatment methods.
In addition to the techniques outlined above, Dr. Baudo implemented various manual therapy techniques including Osteopathic Muscle Energy Techniques, Connective Tissue Release and Joint Mobilization and Manipulation all aimed at soft tissue mobility and joint alignment. (To learn more about the techniques described above, visit www.onetherapy.com, www.redcord.us.com, www.kinesio.com, www.kinetacore.com. Dr. Melissa Baudo currently practices at One on One Physical Therapy in Atlanta, www.onetherapy.com.)
The stiffness and pain in my neck and shoulders has diminished significantly and my neck is almost perfectly straight. My plan is to continue physical therapy, massage and yoga indefinitely to manage my cervical dystonia. I have found that doing yoga on a daily basis has helped me the most. I usually attend two or three classes a week and on the other days I do a home practice(20-30 minutes/day). If I wake up feeling increased pain or stiffness yoga is what I do first. In addition to this, mindfulness meditation has helped keep stress under control. I learned how to meditate by attending a series of classes in Mindfulness-Based Stress Reduction.
While I may never attain complete remission of this disease, I am certain that I have achieved success. One lesson that I have learned from yoga is the importance of gratitude. I am grateful for what I have learned on this journey: the importance of treasuring everyday and those I love;feeling compassion and tolerance for those who suffer; the necessity of saying what I feel; and the belief that I alone know what is best for me.