Postural Case Study 1:
Patient – Client is a 24 years old male student, currently working as a bar tender. Few months ago he decided to start looking after his overall health and posture more seriously which is why he started a course of Sports Massage treatments with us.
Initial Appointment – Client came to me the first time being concerned about his posture which has become increasingly rounded forward. At that time he did not have any considerable pain, although he has noticed increased tightness and discomfort in his upper back and neck with some tension headaches.
As a therapist, I understood that his main concern was that his posture will continue to decline especially as a kyphotic back is something that runs in his family and his future job would be sedentary. Observation: I carried out my first static assessment of the client’s posture and I noticed the typical upper crossed syndrome with a kyphotic thoracic spine, a lordotic upper cervical spine, protracted head, protracted scapula and internally rotated arms. The lower back seemed fine with no issues present. Palpation of the pectoral muscles found a lot of tension, as well as subscapularis, latissimus dorsi and teres major muscles too.
Case Study 2:
Female, 37 year old, suffering with effects of ‘Long Covid’. 3 Manual Lymphatic Drainage treatments in a three week period.
Client has been suffering the effects of ‘Long Covid’, she is not testing positive for Covid anymore. She has been experiencing extreme fatigue after contracting Covid 19 a few months ago. This has taken a huge strain on her body and throughout the day the fatigue is overwhelming. It’s affecting spending time with her family and she has been signed off work for a little while to give her time to combat the symptoms. Her doctor has suggested this style of treatment to give her system a boost.
1st MLD session for 45 minutes
I positioned the bed into a ‘V’ shape to encourage lymph flow, and with client consent added grapefruit and lemon essential oils to the Grapeseed oil for an added boost to her system. I discussed how she would remain lying face up throughout and I would use a very light pressure to stimulate the lymph directly located under the skin. I used pulsing and pumping actions to stimulate stagnant lymph in the tissues, and then in areas such as the arms and legs, very long upwards strokes to increase the circulation of the lymph towards the lymph nodes. The idea being that this removes all the waste quicker from the body to detoxify and awaken.
Case Study 3:
53 year old female – presenting with constant Right sided shoulder pain following a Right sided Mastectomy and Lymphadenectomy 3 years prior (removal of Breast and Lymph Nodes).
During the surgery her Long Thoracic Nerve was damaged, which has lead to weakness and a lack of control around the shoulder and scapula, as the Long Thoracic Nerve innervates the Serratus Anterior which helps draw the scapula forward around the chest wall. The pain presents as a constant ache ranging 5-7/10 on the Visual Analogue Scale (VAS) scale which is aggravated by getting dressed, sleeping on it and pushing up through the arm. The client is semi-retired and still works as a Part-time Yoga instructor, taking 6 classes per week. An MRI of the shoulder showed nothing remarkable. She feels frustrated and is close to accepting that this is how her shoulder is going to be from now on.
Observations – Patient has fair sitting posture, with moderately rounded shoulders on the right side more than the left, with a slight winging of the right scapula at rest.
Range of Movement – There is a 10-15% loss of Flexion, Abduction and Medial Rotation with significant compensatory movements in the Upper Traps through their ranges of movement.
Muscle Strength – Patient is weak through Flexion and both Internal and External Rotations (when arm raised to 90 degrees) as she is only able to push against light resistance without the Upper trapezius heavily assisting.
Neurological – Reflexes are intact with no noticeable loss of Dermatomal sensation.
Palpation – Upper traps, rotator cuff (Infraspinatus and Teres Minor) and Pectoralis Major are all tight and tender on palpation.
Impression: It appears that the patient’s scapular winging is caused by her weak Serratus Anterior (punching muscle), which is causing her Upper Trapezius to work a lot harder by assisting with most other movements. Her Rotator Cuff (RC) muscles are also working in an unorthodox fashion due to the winging.
Treatment: To help with the immediate pain the patient received various Soft Tissue Massage techniques to her RC, Lats, Pecs and Upper Traps, as well as some Medical Acupuncture to her Upper traps.
Home Exercise Programme (HEP): To stabilise the scapula and to strengthen the RC the following exercises were prescribed to be performed daily:
First Follow-Up: One week After Assessment
Patient reports feeling a ‘breakthrough’, she notices an increased range of movement and feels stronger as a result of doing her HEP. She’s incorporated the exercises into her elderly yoga classes. She still feels the ache in the evenings and if she carries a bag on that shoulder but it’s no longer constant pain. She’s doing her HEP twice daily.
Assessment – Still significant weakness into shoulder flexion and external rotation. Knots into the upper traps are reduced but still significant. Patient is still tight and tender into Pecs, RC, traps and lats. Slight correction needed for HEP exercises and advised to slow them down.
Treatment – Various Soft Tissue Massage techniques used to loosen RC, lats, pecs and traps. Medical acupuncture used again into the Upper Traps.
HEP: progressed to Single Arm Wall Push Up and the addition of two exercises:
Case Study 4:
Logan Rees – Scotland International, Top Ranked British Under 23 in 2017 for 10km Road (29m28s)
Logan came to see us regarding an ongoing foot issue he has had since 2014. He saw our Physiotherapist for a total of 4 sessions…
45mins Physiotherapy Initial 01/02/18
Physiotherapist’s Account: Patient attended the NHS in 2014 due to a sudden and constant pain underneath the first toe, beginning of the first phalange, on the right foot, with a mild swollen Metatarsophalangeal joint. He could not run because of the pain. After several tests there was still no diagnosis for his pain. He was then seen by a private Physiotherapist who did massage and exercises for the calf and recommended a steroid injection to ease the pain. He received this privately in December 2015. Logan found the injection lowered the pain allowing him to start running again in March 2016 but not without some discomfort. He has been unable to get this injury completely resolved.
Logan finds that self-massage on the area with a spiky ball helps as well as running will stiff shoes with good support. Soft shoes seem to make it worse (they allow more toe movement).
I could see that swelling was present and that the toe was externally deviated (Mild bunion). I found as well a great deal of tension on all lower leg muscles, especially on the 1st toe flexors on the right, making it slightly stiffer than on the other foot. Pain was noted when running and on direct touch on the insertion of the Flexor Hallicus Brevis.
Diagnosis: Tendinitis of the Plantar Flexors of the 1st toe on the right foot.
Treatment: Massage to the calve muscles
Home care Advice: Specific stretches for Gastrocnemius and Soleus to release tension on the specific tendon causing the pain.
Logan’s Account: During the first appointment, we discussed my injury history with particular focus on the long-term foot/toe injury that prevented me from running from May 2014 to around March 2016. The Physio had some ideas on how to treat this and he also took some photos to show the extent of the swelling on my right foot. He thought with treatment that the excess skin might become reabsorbed and my feet would end up similar sizes again. In the first session, he gave me a short massage on my upper calf. He also showed me some specific stretches to work on for next time to generally loosen my calf so that he could try to release the tension on the specific tendon that was causing pain.
Case Study 5:
Norma, 83 Year Old Female
45 Mins Physiotherapy initial
Client presented with first signs of Dupuytren’s contracture (a condition in which one or more fingers become permanently bent in a flexed position. It usually begins as small hard nodules just under the skin of the palm) on the 3rd finger on right hand, creating dry and pale skin with adhesion’s in the pathway of the 3rd finger flexors tendon limiting its movement. A year ago Norma stated it started affecting the carpal tunnel compressing the median nerve creating paresthesia on 3rd and 4 finger.
Her grip in both hands is weak, but even weaker on her right hand. Things has been falling from her right hand lately as she has been unable to keep grip.
She had a fall two years ago falling on her right arm and fractured T8 to T12.
I believe lack of strength is due to the muscle tension in both shoulders and arms. With her consent, massage to the right hand, forearm, biceps, pectoral and infraspinatus muscles is performed, to free the median nerve and reduce tension throughout the muscle chain.
She feels much better after the massage, has a better grip and the paresthesia is now just on the tip of her 3rd finger.
I showed her mobilisation of the median nerve, and a mild stretch of the pectoral-biceps-forearm-hand to do at home everyday.
Norma agreed to gradually increase the physical activity as well as include a daily soft massage with moisturising cream on her palm.
Case Study 6:
47 Year Old Female
Client is a 47 years old, dedicated career woman running her own business whilst trying to manage her well being by doing regular exercise like cycling (indoor and outdoor) and long distance running.
Recently she has started to experience sleeping issues by having restless nights and struggling to unwind properly before bedtime.
The episodes were worse during times of stress, like the one she is going through just now. Most recently she has been suffering from pre- menstrual tension. She has hard skin in the ball of the foot and her feet were cold to touch which suggests signs of poor circulation but apart from that, her feet looked to have no other health issues.
My client wants to feel more relaxed and keep good energy levels to support her busy lifestyle. Her idea is to start implementing a monthly reflexology treatment as a preventative way for not feeling drained and fatigued but also to boost her immune system.
First of all, I advised making some changes to her weekly exercise routine and try to join if she could a Yin Yoga class once per week, which is known to alleviate pain and tension, relieve stress and anxiety, and improve overall well-being.