As a Neuromuscular Therapist, how did I think about the case of Katy H.?
First I thought about Trigger Points because that is the focus of NMT evaluation and treatment. There are three muscles that have this pain pattern, so I examined Katy and found hyperactive twitching and Trigger Points in the suboccipitals, referred pain when compressing the upper trapezius, and Trigger Points to the head and throat from the SCM (sternocleidomastoid). Recall that one of her first symptoms was a sore throat? All three muscle groups were tight and referred to where she complained about pain in her head.
For the pain at the angle of her neck and shoulder, the levator scapula muscle that lifts her shoulder was examined.
Thinking about sources for pain: posture, a heavy backpack and stress were the suspected three main contributors.