Number of hours: 3
Location: Essential Chiropractic Torquay
This patient is suffering from deep muscular pain slightly below his inferior angle of scapula after lifting a heavy box at work 9 days ago. He works as a roofer and has continued to work since developing the injury but has said that the pain eases as his muscles warm up as the pain is worse when he first wakes up and his muscles are cold. He has used deep heat to ease the pain but I explained to him that a heat pack would be more suitable to reduce a muscle spasm, as deep heat only heats the area superficially. Consequently, I advised him to alternate between ice (to reduce the inflammation) and heat (to reduce muscle spasm and pain).
I performed soft tissue massage of the area, starting lightly to ease the pain and get the area used to the feeling of touch, I then worked within the patient’s pain tolerance to apply neuromuscular technique to deactivate trigger points. Upon assessment I also noticed that the patient had reduced range of motion (ROM) in cervical flexion and side flexion, so I performed STM and NMT of the levator scapulae, sternocleidomastoid, posterior deltoids, rhomboids and trapezius to relax the muscles and reduce muscle tightness and guarding. I then performed muscular energy technique to lengthen the muscles, realign muscle fibres and improve ROM. I retested ROM and noticed a significant increase and the patient reported a decrease in pain in the area of injury and in the neck.
I prescribed the patient active MET to do on themselves at home, in side flexion. I advised they perform the exercises morning and night, 5 times on each side, holding each stretch for 12-15 seconds.
I saw this in clinic a week ago as she is suffering from lower back pain (LBP) from muscle tightness and guarding due to a discogenic problem which she is undergoing chiropractic treatment for.
Upon assessment and palpation I noticed the patient had a lot of tightness in quadratus lumborum and right internal oblique which I treated using STM, NMT and MET. I also treated the latissimus dorsi and hamstrings, as sometimes the muscles above and below can become tight due to guarding and altered posture.
I prescribed the patient the banana stretch and advised her to perform morning and evening 10 times on each side holding the stretch for 12-15 seconds each time.