Examination identified a flat thoracic spine (indicating underlying spinal stiffness) her chin was protracted (poking forward) and her neck reduced in height. The cervical spine facets were all very mobile and tender on palpation but there was significant stiffness from T1 (just below the neck). Her arm pain was reproduced when her right C4/5 facet joints were mobilised suggesting ongoing overuse/shearing at these segments. This was all due to her worsening sitting posture in her daily life, resulting in ongoing compression of the spine affecting the facet joint metabolism.

As the facet joints have a large blood and nerve supply they really let you know when they are aggravated and take a while to settle down and so a longer course of anti-inflammatories are required and real lifestyle changes. In this case this client was willing to make some lifestyle changes prioritising her health by reducing her reliance on coffee and sugary foods to fuel her tiredness from her long hours. Her treatment included thoracic mobilisations with my foot and gentle soft tissue release and spinal mobilisation techniques with my hands. She had a workplace assessment to readdress her chair and desk position at work, but then she also needed to stop using her laptop on her coffee table or on her lap and instead work at the dining room table. She was given a 10 minute Sarah Key exercise regime to be completed when she came home from work. She was also given thoracic expansion exercises to be done at work. This client came weekly for 6 weeks for treatment and found that her neck pain would return if she sat at her desk for 4 hours when engrossed in her work, without a break, which she realised was unacceptable to her physical body. She came to see me once a month for 3 months to help learn how to control this pain. She now attends my back classes ad hoc when she needs a refresher of her exercises and continues with her 10min exercise regime.