18/06/2019 (Clinical Hours)

First patient of the day was a female construction worker in her late 40s with upper limb weakness and prior left shoulder Impingement Symptoms. After scoring negative on the Hawkins/Kennedy, Empty/Full Can, Neer, Speeds and the Painful Arc Test her left shoulder was definitively cleared, regaining pain free full range of motion. Currently we’re working on regaining strength in the wrists during extension. Upon performing the Cervical Dermatome test there was an altered sensation, less sensation, on the left C5 and T1 region (Kassai et al 2006). Further research will be conducted for that aspect of rehabilitation. Her current exercise protocol consists of resistance band wrist extensions, rotations, dumbbell Active Soft Tissue releases, and Wall Press-Ups (Johnson 2013). The next time her dermatome sensation, strength, and cluster of symptoms will be re-assessed.

Second patient was the amateur rower from last week. He has regained nearly full range of motion in his left shoulder and is even able to apply minimal resistance with his left subscapular muscle during internal rotation, scoring 4/5 on the Oxford Scale. He mentioned during our session of his prior Portal vein thrombosis diagnoses that was not added to his base-line consultation paper. This subsequentnly meant that he is very vulnerable to hypertension and any overly demanding static/isometric exercises were contraindications and put on hold until a doctoral clearing (Boone et al 2010). We began working on further strengthening and mobilising his subscapularis through concentric/eccentrics and Active soft tissue release. Immediate increase in range motion was achieved in Shoulder external rotation after performing the exercise protocol that consisted of resistance band internal rotations, golf ball STRs and wall glides (Keating et al 1993). In our next session we will re-evaluate his strength, range of motion and hypertension progression.

The third patient of the day was an amateur boxer in his mid 30s with a suspected Grade 1 tear in the Long biceps head. After assessing his range of motion and conducting biceps-specific special tests the differential diagnosis given was Bices Tendinopathy of the long head (Hughes et al 2015). We began working on his posture, due to his slight kyphotic posture, through shoulder external rotations and face pulls, and then went through a biceps-specific light weight curls that favoured his long head.  All of the exericses were performed at a low intensity and were prescribed with applicable instructions and 2-3 days per week performance ratio (Hegedous et al 2012). On his next visit we will re-evaluate his posture and the strength in his left biceps.

Last patient of the day complained of low back pain after prolonged sitting and standing. She was diagnosed as a child with hip dysplesia. Her current relieving factors are movement and clicing the her hip with a modified Single-leg deadlift to Hip Extension maneuver. After performing range of motion and special tests the differential diagnosis fell within the realm of weak/atrophied gluteus medius (Benjaminse et al 2006). Her exercise protocol consisted of lateral leg raises, clamshells and Trendelenburg Drops aimed at muscular strengthening. In the next session we re-evaluate her levels of pain, irritability and strength.

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🇬🇧🇧🇬 Exercises: Trendelenburg Drops 3 sets 6-10 reps Clamshells 3 sets 6-10 reps Lateral Leg Raises 3 sets 6-10 reps Skiers 3 sets 12-16 reps Skiers (progression) 8-12 reps Упражнения: Тренделенбугови спадания 3 серии 6-10 повторения Миди 3 серии 6-10 повторения Странични вдигания 3 серии 6-10 повторения Скиори 3 серии 12-16 повторения Скиори (прогрес) 3 серии 8-12 повторения References/Източници: Cavaliere et al 2017 Distefano et al 2009 Williams et al 2009 #lowbackpain #piriformissyndrome #lumbarspine #exercise #intervention #sport #rehabilitation #marjonuni #marjonclinic #nik4health #болка #гръб #пириформиссиндром #физиотерапия🏥 #рехабилитация #тренировка #интервенция

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