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Patient:
63 year-old female hairdresser
Diagnosis: Bilateral elbow tendonitis (epicondylitis),
bilateral shoulder pain, neck pain, and chronic low back pain.
Patient history Patient owns a hair salon,
and reports chronic low back pain (10 years) and severe bilateral
elbow, shoulder, and neck pain (for several months) when working.
Significant findings: Patient presented with
painfully limited cervical rotation and side bending to the right.
Bilateral elbow flexion and right shoulder abduction were also
limited moderately and painful at the end ROM. Backward bending
of the lumbar spine was also painfully limited. Muscular hypertonicity
and tender points were present in the right posterior cervical
spine, right shoulder and ribcage, both elbows, and right hip
flexors.
Intervention: Patient was treated twice weekly
for seven visits total. Treatment consisted of a neuromuscular
treatment approach (Strain/Counsterstrain)
to eliminate the muscular hypertonicity and ROM limitations, followed
by instruction in spinal stabilization exercises for the cervical
and lumbar spine, and strengthening exercise for both upper extremities.
Outcome: Patient was discharged after seven
visits with no complaint of pain in elbows, shoulders, neck, or
low back, and she reported no difficulty with working. Patient
did return for one follow up visit four weeks after discharge
for minor low back stiffness, and correction of her technique
with her lumbar stabilization home exercise. Patient reported
four months later that she was still pain-free and working without
restrictions.
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Patient: 33 year-old female administrative assistant
Diagnosis: Headache, neck pain
Patient history: The patient reported that she
turned her head and felt a "pop" in her neck which resulted
in significant left sided neck and shoulder pain. Two days later,
she went to an urgent care center and her X-Ray reported was negative
for any cervical abnormality; she was seen for her initial evaluation
at ARC. At the time, she was c/o 5 out of 10 constant pain, and
she described pain as "a ton of bricks on my shoulder:. She
reported sharp neck pain and shoulder pain when she turned her head.
She was also c/o frequent sub-occipital headaches.
Significant findings: The patient presented with
significantly limited and painful cervical active movement in all
directions, but especially while rotating her head to either right
or left. With palpation, she presented with marked tenderness and
increased tone at the sub-occipital region and left cervical musculature,
including elevator scapula.
Intervention: The patient was seen for five total
sessions over the course of two weeks. Treatment consisted of Strain/Counterstrain,
myofasial release, manual cervical traction at her first two sessions,
then mechanical cervical traction, PROM, scapula stabilization,
and cervical isometric exercises, at her last three sessions.
Outcome: Patient contacted us two weeks later
after her last session to report she has no complaint of pain.
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Patient: 58 year-old, female, social worker
Diagnosis: Low back pain, piriformis spasms
Patient history: Patient began experiencing low
back and left posterior thigh pain during her recovery period from
bladder surgery. She reported severe pain after walking about 20
feet. She also reported pain with sitting, especially in a recliner
chair. She had been prescribed an anti-inflammatory, but had no
significant relief.
Significant findings: Patient presented with
severely limited lumbar flexion which caused low back pain and extreme
cramping in hamstrings. Left hip ER was also moderately restricted
and SLR was positive on the left. Severe hypertonicity and tenderness
were noted in the left medial hamstrings and buttocks.
Intervention: Patient was treated three times
a week for two weeks then weaned to two times a week for two more
weeks. Treatment consisted of a neuromuscular treatment approach
(Strain/Counterstrain) to hyper tonic areas of left hamstrings and
buttocks, joint mobilizations to the sacrum, muscle energy techniques
to improve spinal alignment, and a home exercise program of gentle
stretching an isometric abdominal exercise.
Outcome: Patient was able to do some light gardening
after four sessions and returned to work full-time after four weeks
of treatment. Patient discharged after four weeks of treatment with
no complaint of pain or loss of function.
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Patient: 17 year-old female gymnast
Diagnosis: Status post left knee ACL reconstruction
Patient history: Patient was referred to clinic
by her orthopedic surgeon, at 8 weeks post-op, after having received
8 weeks of physical therapy treatment at another provider. The surgeon
reported displeasure with the lack of full knee extension.
Significant findings: The patient presented with
a 13º flexion contracture of her surgical knee. Passive knee extension
was painfully restricted, with the patient reporting severe anterior
joint line pain at the end of range. Palpation of the popliteal
space revealed a 2cm diameter zone of dense, tender soft tissue,
directly adjacent and medial to the posterior border of the lateral
femoral condyle.
Intervention: A neuromuscular treatment approach
was applied to the painful area, one visit only.
Outcome: After one visit, patient achieved an
80% reduction of the pain at end range extension, gaining 10º of
knee extension (3º short of full extension). With the surgeon's
permission, the patient was referred back to the original physical
therapy clinic she had been treated at.
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