Number of hours: 5
Location: Essential Chiropractic Torquay
The first patient came into clinic complaining of neck pain and stiffness and during the subjective assessment she told me that she frequently suffers from migraines. Is it suspected that neck tension may increase the likelihood of migraine onset, with a study finding that most patients who suffer from migraines also experience tightness in the neck (Ashina et al., 2014).
I tested her ROM in her neck (cervical spine) and found significant decrease in side flexion bilaterally and a slight decrease in flexion compared to the norm values (Lind, Sihlbom, Nordwall, & Malchau, 1989), I checked with her that her ROM is normally more than this as it is important when checking ROM to treat each person individually as the guidelines are not always relevant to every patient. I performed STM on the upper fibres of trapezius (UFT), rhomboids, scalene, posterior deltoids and levator scapulae. I performed neuromuscular technique on the UFT to deactivate TrP. At the end of treatment, I performed STR in side flexion on both sides to increase ROM.
The client has reduced pain and increased ROM (in flex and side flexion) following treatment.
After care: I informed them that they may experience tightness and pain tomorrow which is normal and to manage this and any swelling with ice (for 15 minutes at a time regularly).
The second patient suffers from tight hamstrings and tight calves which he says he has always suffered with but has got worse since he went back to football after a broken wrist 18 months ago. In the subjective assessment I asked him:
- how many times a week he plays football
- does he play on real or artificial grass
- what footwear does he wear (studs or no studs) (old or new shoes)
- does he stretch afterwards?
- does he warm-up and cool down?
This allowed me to find out that he always warms up but never cools down or stretches after a game which could be why his muscles are so tight. I have advised he cools down at the end of every training session (which he should encourage his whole team to do) by a gentle job around the pitch, followed full body stretches, especially focusing on: calf, hamstring, quadricep, glute, bicep, triceps and shoulder stretches (rhomboids and UFT). A way of incorporating the cool-down and stretching would be for the whole team to run together for 50 metres, then stop and perform one body part stretch holding for 10 seconds on each side for 5 repetitions, run for 50 metres and then stretch the next body part in the same way, continue until all muscle groups have been targeted. I explained the importance of this to him.
For treatment I performed STM and NMT on the hamstrings, quadriceps, calves and plantar fascia. I treated the quadriceps, as although he didn’t say these were tight, hamstrings shortening can lead to quadricep tightness.
I then performed MET – IR to lengthen the hamstrings and PIR on the calves to lengthen and realign the muscle fibres and decrease tightness.
Aftercare: hamstring, calf and quadricep stretches advised and foam rolling of the plantar fascia.
For the third hour and fourth hour at placement I practiced with my placement supervisor, different active home stretches patients can do to decrease muscle tightness between appointments. We focused on the lower limb exercises for the first hour such as calf raises and the different variations dependent on the individual and their stage of rehabilitation. For the second hour we worked out way through each upper body muscle ensuring we thought of an exercise for each, one I hadn’t seen before was the use of a doorframe with the arm flexed at the elbow and the palm against the frame pressing through to stretch the pectoralis major. I took photos of each stretch, which I am going to make into a folder of exercises to help me with exercise prescription in the future.
For the final hour, I treated a patient with posterior knee pain. On assessment, no Bakers cyst, bruising or swelling was present around the knee. Muscle bulk was even between the quadriceps and the hamstrings, however upon palpation I noticed that the hamstrings were a lot tighter which could be causes muscle shortening leading to the pain behind the knee. I performed STM and NMT of the hamstrings to decrease muscle tightness and deactivate myofascial trigger points which could be leading to this muscle tightness and pain. I then performed MET – RI to realign muscle fibres and lengthen the muscle. I advised the patient uses a foam roller and stretches the hamstrings in between appointments to avoid muscle tightness building up.
Aftercare: ice if painful or swelling builds up. Keep leg elevated when resting to avoid build-up of swelling behind the knee.
Ashina, S., Bendtsen, L., Lyngberg, A. ., Lipton, R. ., Hajiyeva, N., & Jensen, R. (2014). Prevalence of neck pain in migraine and tension-type headache: A population study. SAGE Journals, 35(3), 211–219.
Lind, B., Sihlbom, H., Nordwall, A., & Malchau, H. (1989). Normal range of motion of the cervical spine. Archives of Physical Medicine and Rehabilitation, 70(9), 692–695.