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Physical Therapy as Conservative Management for Cervical Pain and Headaches in an Adolescent with Neurofibromatosis Type 1: A Case Study

Helmers, Kristin M. DPT, CLT; Irwin, Kent E. PT, MS, GCS

Journal of Neurologic Physical Therapy: December 2009 - Volume 33 - Issue 4 - pp 212-223
doi: 10.1097/NPT.0b013e3181c1fac3
Case Studies

Background and Purpose: Neurofibromatosis is a group of genetic disorders that affect the development and growth of nerve cell tissues. These disorders include tumors of myelin-producing supportive cells that grow on nerves and can cause changes in bone formation, skin integrity, and nerve transmission. Common musculoskeletal impairments associated with neurofibromatosis type 1 (NF 1) include cervical pain, muscle weakness, muscle stiffness, headaches, and postural deviations.

Case Description: This case study describes successful physical therapy management and outcomes for cervical pain and headaches in a 17-year-old girl with a 16-year history of NF 1. Difficulties in driving, studying, lifting, and participating in recreational activities were all associated with the patient’s pain, decreased cervical range of motion, decreased scapular strength, and postural deviations.

Interventions: Physical therapy interventions included posture training, dynamic shoulder/scapular strengthening, cervical stabilization, stretching, ultrasound, interferential current, and a progressive home exercise program.

Outcomes: By the end of 13 weeks (20 sessions) of physical therapy, the patient was completely pain free, demonstrated increased cervical range of motion, and had improvements in scapular strength. She returned to full and unrestricted recreational activities, driving, studying, and household chores. Furthermore, scores on the Neck Disability Index improved from 44 of 50 (complete disability) to 2 of 50 (no disability).

Discussion: Physical therapy may be a viable option for conservative management of musculoskeletal dysfunction and functional limitations resulting from NF 1.

Department of Rehabilitation, Evergreen Hospital Medical Center (K.M.H.), Kirkland, Washington; and Physical Therapy Program, College of Health Sciences, Midwestern University (K.E.I.), Downers Grove, Illinois.

Address correspondence to: Kent E. Irwin, E-mail:

© 2009 Neurology Section, APTA