Myofascial Release and Muscle Retraining for Dropped Head Syndrome Attributed to Radiation Fibrosis in Hodgkin Lymphoma: A Case Series

Background and Purpose: This article reviews the current knowledge base of dropped head syndrome and presents the case histories of 7 patients with a diagnosis of this condition at the Royal Hallamshire Hospital, Sheffield, through the Late Effects Clinic. All patients were referred for physiotherapy, and the assessment findings and subsequent treatment provided are discussed in detail. Case Description: Seven patients who were consecutively referred to physiotherapy and presented with signs and symptoms of suspected dropped head syndrome following previous treatment with mantle radiotherapy for Hodgkin lymphoma are discussed. Physiotherapy was delivered at various time intervals and duration on a one-to-one basis. Interventions were delivered to restore soft tissue length, rehabilitate proprioception, increase neck stabilizer strength, and retraining of muscles through range both locally and distally. Outcomes: All 7 patients reported subjective improvements in pain and function, with objective improvements in local and distal posture, tolerance to maintain head on neck position, and ability to grade through range neck movement locally. No formal outcome measures were used, as this is a retrospective report. Conclusion: Physiotherapy can offer short-term subjective and objective improvements in head on neck posture and control and effect more distal postural changes. Longer-term maintenance of improvements gained has yet to be determined. The most effective time point posttreatment for therapy intervention requires further research as does the type of physiotherapy intervention to be offered.