Creative dance was selected as a suitable therapeutic activity for Jane, who suffers from chronic stiffness; headaches; and neck, shoulder and arm pain as a result of a whiplash injury sustained 8 months ago. Dance will address some of the physical and emotional difficulties experienced by Jane due to her injury.

1. Decreased R.O.M. in cervical spine making lateral flexion,forward flexion, and rotation difficult. These movements are necessary for driving, bookkeeping activities, etc. .

2. Muscle tightness/spasm in neck and shoulders.

3. Weak rhomboids.

4. General weakness in left upper extremity, and altered sensation in fingertips as a result of brachial plexus injury.

5. Chronic pain due to muscle, ligament, and nerve damage. Pain is exacerbated by stress and promotes avoidance of certain activities (eg. helping kids with homework). It also makes sleeping difficult.

6. Constant frontal headache.

7. Lack of outlet for frustrations since she no longer takes long bike rides due to neck pain.

8. Decreased ability to perform productivity roles and leisure activities. She experiences difficulty with tasks included in homemaking, childrearing, DATS driving, bookkeeping and bike riding.

Jane would like to participate twice weekly in group creative dance classes offered by a private instructor.

1) Over the next two to three months, Jane`s endurance and functional ability to perform her productivity roles will improve by incorporating movements into creative dance that will,

• gently stretch the joints and muscles of Jane`s neck, and increase her R.O.M. during forward flexion, lateral flexion, and rotation to WNL.

• strengthen the muscles of Jane`s neck, trunk, and upper extremities to at least 4+. Hand-held objects of increasing weight will be used as her strength improves.

• increase the flexibility of her shoulder, back, arm and pectoral muscles through slow, fluid stretching .

• promote correct posture through increased body awareness, and by specific instructions and reinforcement by the dance instructor.

Hopefully the increased strength and flexibility of Jane`s musculature and joints will assist with correct posture which in turn will permit decreased discomfort and some healing of the damaged structures in her neck (Brisbee & Hartsell, 1993). With healing, pain may decrease; however, 40-70% of whiplash sufferers never experience complete resolution of their pain (Brisbee & Hartsell, 1993). Therefore our second goal is to,

2) Employ creative dance to promote positive mechanisms for mananging chronic pain by,

• promoting a "taking hold of life" approach through active participation in an engaging activiy (Teasell, Shapiro, & Mallis, 1993). Jane will be encouraged to not let pain get the best of her by involvement in an activiy she enjoys and benefits from.

• providing an outlet for frustrations and an opportunity for creative expression (Payne,1990).

• decreasing stress (and hopefully pain) by relaxation exercises (Reed, 1991).

• improving general fitness and therefore increasing overall sense of well-being.

• giving an opportunity for social interaction with others interested in the same activity.

Jane should avoid prolonged neck flexion which will irritate involved nerve roots and produce muscle fatigue. The optimal posture to assume when sitting or standing is to keep the neck straight and shoulders back, and to avoid 'poking out' the chin. She should also avoid holding her arms at or above the level of her shoulders for long periods and should avoid strenuous exercises at the onset of therapy to prevent more injury (Teasell, Shapiro, Mallis, 1993).

1. Jane should dance for short durations, and should rest before her pain forces her to stop. She should take, "rest breaks not pain breaks", (Reed, 1991). She should try to build up to 30 minutes of dancing since this duration of moderate exercise has been recommended for those who suffer chronic headaches secondary to whiplash injury (Kreeft, 1993).

2. Slow, fluid stretching movements should be implemented before strengthening movements; once Jane`s pain is no longer in an acute stage, she can slowly commence isometric strengthening exercises (Teasell, Shapiro, & Mallis, 1993).

3. Jane can ice her muscles for 3-5 minutes before class since this may relieve some soreness prior to stretching (Teasell, Shapiro, & Mallis, 1993).

4. Objects of varying weight (lighter to heavier) such as fabrics, flags, and percussion instruments can be incorperated into dance as strength and endurance improves.

1. Jane tends to see straightforward exercises as drudgery, and has difficulty performing them consistently but has a real interest in creative dance. She is open to practicing these exercises incorporated into dance at home.

2. Jane will enjoy watching rest of class when she is tired and will be encouraged to keep within the limit of her stamina.

3. The dance instructor is enthusiastic about assisting Jane in her rehabilitation and will work together with Jane and her O. T. to incorporate movements that will improve Jane`s strength and flexibility and promote healthful posture.

4. Jane`s friend wants to attend the class too and will pick her up and drop her off so that Jane can have a break from driving.

5. Jane`s husband and children are supportive and will help with household chores while Jane is undergoing therapy.

6. Jane is able to afford lessons with a private instructor.

1. initial feelings of ackwardness and inhibition as she gets to know the people in the group.

2. resistance of movement due to pain - must be encouraged that pain does not equal harm (Teasell, Shapiro, & Mallis, 1993).

3. may want to progress too rapidly to keep up with the rest of the group - must avoid physical injury by pacing (Teasell, Shapiro, & Mallis, 1993)

Creative dance is an excellent therapeutic activity for Jane since it holistically addresses many of her physical and psychosocial needs. She will benefit from increased functional ability in her productivity and leisure activities due to the improved strength and flexibility of her neck and upper body, and from the learned positive methods of coping with pain, stress, and frustration.

1. Brisbee, L. A., & Hartsell, H. D. (1993). Physiotherapy Management of Whiplash Injuries. In R. W. Teasell & A. P. Shapiro (Eds.). Spine - Cervical Flexion - Extension / Whiplash Injuries (pp.501-516). Philadelphia, PA: Hanley & Belfus, Inc..

2. Kreeft, J. H. (1993). Headache Following Whiplash. In R. W. Teasell & A. P. Shapiro (Eds.). Spine - Cervical Flexion - Extension/Whiplash Injuries (pp.391 - 401). Philadelphia, PA: Hanley and Belfus, Inc..

3. Payne, H. (1990). Creative Movement & Dance in Groupwork (p.8). Bicester , Oxon, United Kingdom: Winslow Press.

4. Reed, K. L. (1991). Quick Reference to Occupational Therapy (pp. 103-106). Gaithersburg, Maryland: Aspen Publishers Inc..

5. Teasell, R. W., Shapiro, A. P., & Mallis, A. (1993). Medical Management of Whiplash Injuries: an Overview. In R. W. Teasell, & A. P. Shapiro (Eds.). Spine - Cervical Flexion - Extension/Whiplash Injuries (pp. 481-496). Philadelphia, PA: Hanley & Belfus, Inc..
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