Number of hours: 5
Location: Essential Chiropractic Torquay
Patient suffering from tight hamstrings and tight piriformis as a result of increasing exercise load due to starting the twelve-week challenge at the gym. I tested her ROM and she had decreased knee flexion but knee extension and internal and external rotation was fine and all hip movement ROM was good apart from external rotation of the hip, which may indicate piriformis tightness.
I performed STM of the hamstrings, particularly focusing on the biceps femoris as this was the most tight, I also did myofascial release to deactivate the trigger points (TrP) to reduce the muscle tightness. I then did soft tissue release (PIR) of the hamstrings in flexion and extension. I then did myofascial release of the glutes as I have noticed that glute tightness contributes to a lot of hamstring tightness. I then did STM and myofascial release of the piriformis and gave the patient two piriformis stretches; the figure of four stretch and prone lying with the hip in maximal adduction (with the knee flexed) across the other leg. I advised that the patient performs each stretch 4 times on each leg, twice a day, aiming to hold each stretch for 30 seconds.
The second patient slipped a disc in his back 8/12 (around L4) and has been having chiropractic treatment ever since, due to the pain he has been guarding when he walks which has caused muscle shortening in the erector spinae and hamstrings and tightness in the latissimus dorsi, gluteus maximus and QL. The chiropractor has advised he has a STM to loosen these muscles and reduce his guarding to allow his chiropractic treatment to be more effective. It is possible that if he continues to have severe muscle tightness and guarding, he could risk sustaining another injury.
I performed STM and NMT of the erector spinae, latissimus dorsi, gluteus maximus and QL. Upon palpation of the erector spinae, I felt a large hard lump, I immediately stopped treatment and asked him if he knew he had this. He told me that it had been pointed out to him before during treatment so he went to the doctors who confirmed it was a lipoma and therefore it was safe for him to be treated. I performed MET of the hamstrings and gluteus maximus to lengthen the muscle fibres and reduce tightness.
Aftercare: Ice if painful the next day or if experience any swelling.
For the final two hours of placement, I spent practising mobilisations with my clinic supervisor who is a qualified sports therapist. Mobilisations are performed if a patient has a facet joint problem which could be indicated by a hard end feel in flexion, side flexion, rotation or extension with a reduced ROM and pain. PA can be used to test an individual’s facet joint movement to detect which level requires treatment. Mobilisations are performed in four grades; grade 1 and 2 are used to reduce pain and are only used if a patient has high irritability, grade 3 and 4 are more useful as they improve ROM as they reach the end range. It was really useful to practice on someone qualified as it allowed me to make sure I was reaching the right depth for each grade.