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Myofascial Release improved Regional Kyphosis in a 20-year-old Female patient with Cervical Neuroforaminal Encroachment: A Case Report

PURPOSE: This paper describes the effects of the myofascial release (MFR) approach in a 20-year-old female patient with neuroforaminal encroachment and regional kyphosis in the cervical area, who also had neck pain. METHODS: A 20-year-old female presented with the chief complaint of neck pain while studying with a level of seven on the rating analogue scale (RAS) and was not taking any drugs or undergoing treatment for the control of neck pain prior to visiting. The cervical radiograph demonstrated neuroforaminal encroachment from C4-5. The patient showed 3.5° kyphosis at C4-5 and 22.9° lordosis at C2-7 according to the Harrison posterior tangent method. The anterior head translation (AHT) was 13.9mm. She reported pain of RAS 5 at the scapular medial border while rotating her neck in the left direction and flexing forward. The patient was treated a total 16 times, three times/week for six weeks using

indicate neck pain or radiating pain on the upper extremity most of the time [3].
Myofascial release (MFR) is an approach that focuses on the limitation of movement felt from the soft tissue of the body and is aimed at improving the suitability of the fascial tissue. Therefore, by providing mechanical stimulation as pressure in the site of the problem within the fascia network, the tissue alters the mechanical properties and potentially allows new mobility and organic mobility of the surrounding structures [4]. This paper describes the effects of the MFR approach on a 20-year-old female with neuroforaminial encroachment and neck pain.

1) Personal Information
The patient was a 20-year-old female living in Daejeon, who was 163 cm in height and weighed 58 kg. The patient was diagnosed with cervical fascia pain syndrome without neurological symptoms after screening from a clinician.
She had not taken any drugs or undergone any treatment before visiting. After visiting the clinician, she received Eperinal Western Medicine, Stogae 10mg, Cetila 10mg, Pelubi Western Medicine twice a day for seven days in total.

2) Chief Complain and Goal
Her pain started one year ago as her level of study has increased. She complained of pain of RAS 7 along inside the scapula from the left posterior neck and stiffness in front of her neck with swelling on both sides above the scapula after approximately one hour of study with her head bowed forward to read a book. She had a pain level of RAS 2 while taking a break. In addition, she complained that there was pain at a level of RAS 3 on the internal side of her left arm approximately twice a month. She had not performed exercise. Her treatment goal was to increase the time for study.

1) Motion test
The therapist examined the motion test. The pain of RAS 5 appeared at the scapular medial border during neck left rotation and forward flexion.

2) Cervical Posture
The cervical posture was measured by anterior head translation (AHT) and for the absolute rotation angle (ARA) for cervical lordosis using the internal measurement program of the Medical Image Information System (PACS).
AHT was measured as the horizontal distance of the posterior superior body corner of C2 compared to a vertical line originating at the posterior inferior body corner of C7 at the sagittal plane of the radiograph. The cervical lordosis was measured using the Harrison posterior tangent method, which is a method for measuring the ARA between the lines following the two vertebral posterior margins; a positive and negative value means kyphosis and lordosis, respectively [5]. The therapist measured the regional lordosis to ARA between C4-C5 and global lordosis to ARA between C2-C7.

3) Myofascial Release Approach
The patient was treated with the MFR approach by a physical therapist with ten years' experience, who is a regular member of the Korean Society of MFR. MFR was performed with reference to Smith's practical book , which was a direct approach based on Rollfing [4] and was performed on the patient for fifty minutes. Treatment was performed on the posterior cervical fascia, nuchal line of occiput, rectus sheath, sturnum fascia, superficial cervical fascia, upper trapezius, superior angle of the scapular, and sulcus between the deltoid and pectoralis major.
The patient was educated to perform self-stretching for the area of sub-hyoid once a day. She received 18 treatments three times a week from January 4, 2018 to February 14, 2018. Ⅲ . Results

Chief Complain and Goal
After treatment, she achieved the treatment goal as the study time increased from one hour to two hours. The feeling of swelling into the upper trapezius disappeared, but after 2 hours of study, persistent pain with a level of RAS 6 and a stiff feeling in front of the neck were reported. She still had pain with a level of RAS 1 while resting.

Motion test
The patient did not experience the pain that she had previously occurred at the posterior neck and scapular inner border with some of neck motion.

Cervical posture
After treatment, her AHT was decreased from 13.9mm to 0.3mm. The global lordosis improved from -22.9° to -24.4°, and the regional lordosis was improved from 3.5° to -3.8°. In addition, neuroforaminal encroachment between C4 and C5 was not detected after treatment (Fig. 2, Table 1).

Ⅳ. Discussion
The fascia maintains its form in the body as well as tension and elasticity by transmission and preservation for power. This not only receives and transmits stimulus information but also transfers moisture and nutrition by engaging in the metabolism [6].
Gauns and Guruput [7] divided randomly 40 people, who had mechanical neck pain and were aged between In the present study, after treatment, the patient reported no pain during neck motion. The possible study time without pain was increased because MFR puts the fascia in good condition, which would improve the activity of the muscle around the neck.
Caneiro et al. [8] reported that when the same subject underwent the anterior head translation posture, the neck extensor showed more activity than at the neutral head posture. Peolsson et al. [9] recounted that when the same