Laura Shahinian Kara M.S. L.Ac., C.SMA completed the SMAC Program in September 2014. She is currently a sports acupuncturist in Connecticut — certified in Sports Medicine Acupuncture® — with offices in Bethel and Westport.
Inspired by Matt and Brian Lau’s recent Telemedicine Guide, Laura presents a telehealth session with one of her patients below.
“The following is an account of a patient’s initial TeleHealth session performed in April 2020. She followed up a week later reporting she was 80% better!
The patient is a 29 year old elementary teacher who had previously seen me for neck and shoulder pain, stress, and jaw pain. One month before her visit, she had to quickly learn online teaching for her third-grade classroom during the recent COVID-19 shutdown. This caused a tremendous amount of stress for her. In addition, she has had to work at her dining room table or from the couch since she doesn’t have a home office, and her pain had increased dramatically as a result.
She is now experiencing more pain in her neck and jaw, and is reporting headaches around her temples especially on the right side. Upon her first telehealth visit, she included that she has tightness in her throat, and she pointed to the region of the right anterior scalene and also into her pectoral muscles on the same side.
The pain radiated past her shoulder, indicating possible cervical radiculopathy.
I started her session with a full body postural assessment. I observed her pelvis to be posteriorly tilted on both sides (I know this to be true from seeing her previously, so I encouraged her to continue to foam roll her hamstring muscles, as well as do Cat/Cow exercises, which I have previously given her). There were no signs of an elevated ilium or any other imbalances that I could observe through my computer screen.
I asked her to sit in a chair so I could see the right side of her upper body. She definitely showed some upper crossed syndrome postural disparities, such as a forward head, upper cervical extension (indicated by the chin tilted upward), and a forward-rounded shoulder. I asked the patient to change positions so I could observe the left side, where a similar posture was found, though the postural imbalances were more pronounced on the right side. I asked the patient to stand so that I could see her back and I observed that her right shoulder was elevated. I then asked the patient to face me and to do some neck ROM tests:
Flexion/Extension—On flexion, she felt the muscles in the back of her neck were sore, but felt good to stretch. Extension felt worse on the back of the neck and a pulling sensation on the throat.
Lateral flexion (R side)—Painful on the same side
Lateral flexion (L side)—Painful on the lower left shoulder blade
Rotation to the (R side)—Painful on the opposite side
Rotation to the (L side)—no issues
For treatment, I showed the patient some distal points to massage for her neck, throat and anxiety. Points I included were: SP 3-4, PC 6, TW 5, GB 41, and Luozhen, while rotating and moving neck. SP 9 (distal points for upper traps in Kiiko’s work), LI 10-11 area. I also included a “raking” of the front of the neck with her fingers down the throat for some lymphatic drainage and help the plum pit sensation of the throat.
- Corrective Exercises (from PACE classes in SMAC):
- Cat/Cow and foam rolling hamstrings
- Lateral flexion stretch (both sides for the upper traps)
- Pec stretch
- Seated wall squeeze
- Elbow press
For her radicular pain, I also showed her how to use the myofascial tool with two tennis balls in a sock that she could perform on her yoga mat at home. I coached her through the proper positioning of the exercises and led her in a breathing exercise of five counts of belly breathing in through her nose to seven counts out through her mouth to reset her nervous system, creating a craniosacral still point and tractioning her neck, bringing her posture into alignment.
In retrospect, I could have even kept it simpler for her, giving her only 2-3 exercises to do. Although, on her second telehealth appointment, she did feel about 80% better with no signs of radiculopathy, and seemed to have a more relaxed disposition. Because she was feeling better, I focused more on her overall constitution.
I am so thankful for my SMA training and also for Matt and Brian’s demo on how telehealth can work for our patients. While I am now back at the office, it was a wonderful experience to help my patients from a distance. I work on a lot of school teachers and it was great to help alleviate pain and help to correct their posture due to the many hours of computer use and stress.”
To connect with Laura, visit her C.SMA Directory Listing.