The Implementation of Musculoskeletal Principles in a Clivus Chordoma Survivor with Neck Pain

Background: Long term side effects of cancer treatments can have a significant effect on functional mobility. Radiation therapy can have significant effects on all body tissue, including muscle and connective tissue. Surgical resection of malignant tumors also carries post-operative side effects that can influence function. The purpose of this case study is to highlight the successful treatment of neck pain despite limited treatment options from a complex past medical history. Case Description: This case study details the treatment of a 56-year-old female with a history of a clivus chordoma. Adverse effects following surgical resection, cervical fusion, and radiation therapy compelled this patient to present to an outpatient orthopedic clinic with complaints of neck pain and the presence of multiple functional deficits. Intervention: The intervention focused on manual therapy to address soft tissue adhesions in the upper quarter, therapeutic exercise to increase thoracic mobility, neuromuscular re-education of the transverse abdominus and diaphragm, and education for the successful integration of therapy principles to activities of daily living and exercise. Outcome Measures: The outcome measures utilized with this patient were limited to the Focus On Therapeutic Outcomes survey. Discussion: Several publications on the topic of clivus chordoma treatment, radiation therapy, and the overall neuromuscular complications experienced by cancer survivors acknowledge the role that physical therapy must play in the successful rehabilitation of these patients. Review of the related literature provides support for the interventions utilized in this case study including soft tissue mobilization, joint mobilization, therapeutic exercise, and neuromuscular re-education