Number of hours: 6
Location: Essential Chiropractic Torquay
Summary: Client complaining of localised lower back pain (LBP) following a kettles class last week.
I tested their lumbar ROM in flexion and they had reduced ROM compared to their reported norm, with a slightly spongy end feel, suggesting muscle tightness. Their ROM in extension and rotation was in line with the norms for their age (Fitzgerald, Wynveen, Rheault, & Rothschild, 1983). Upon palpation of the obliques I felt a few TrP, so I performed neuromuscular technique to deactivate these, to reduce muscle tightness. I performed STM of her erector spinae, obliques, quadratus lumborum (QL) and latissimus dorsi, to reduce muscle spasm, increase ROM and decrease pain. I also did myofascial release of her glutes as glute tightness can cause LBP.
I performed PA to assessed her lumbar spine and noticed that her L1 and L2 had restricted movement, which I improved using posterior anterior (PA) spinal mobilisations.
ROM increased, and pain decreased following treatment.
I suggested that QL stretches at home may help her to reduce muscle shortening and tightness and improve overall ROM.
This patient suffers from increased lordosis of the spine and an anterior pelvic tilt which she says is caused by carrying heavy bags by her sides for years when she used to work. She has since retired and now does Pilates and has regular STM in an attempt to manage the muscle tightness that this causes. Upon palpation and static assessment, I noticed she had a lot of tightness in her left rhomboids and UFT which was causing her shoulder level to be off. I tested her cervical ROM and noticed a decrease in right side flexion, due to the left UFT being tight. She also had very tight erector spinae, latissimus dorsi, QL and gluteus maximus, which may be due to her posture altering her gait and causing her muscles to become tight.
I performed STM and NMT of her left and right UFT, rhomboids, middle and posterior scalene and MET of her rhomboids to increase ROM in side flexion and lengthen the muscle fibres. I then treated the latissimus dorsi and erector spinae using STM and NMT and checked her facet joints using PA, which caused no pain and no stiffness was present so no treatment was required. I then did NMT on the glutes and QL and used MET to lengthen the muscle fibres and realign muscle fibres. I retested ROM and right side flexion had really improved.
Aftercare: rest and ice if painful.