AUTHOR: Sandra Liversedge
1) The Client
58 year old female who works as an office professional. She regularly walks 4/7 but is unable to increase her level activity due to chronic lower back pain that she has suffered with off and on for 8 months. She has a history of broken ribs and a punctured lung due to an accident she had 8 years ago. She smoked for 42 years but made the decision to give up the habit 3 months prior to attending the clinic. She has had regular treatment for her lower back pain since the onset and was ‘diagnosed’ with ‘tight hamstrings’ by a Remedial Therapist.
2) The Assessment
The client was assessed via SFMA due to the nature of her pain. Her total score on her first visit was 13/49. She described her pain level as VAS 7/10 controlled with anti-inflammatory medication. She also takes regular medication for anxiety. She identified her aggravating factors as sitting for long periods of time and driving. She finds resting and using medications help to relieve her symptoms.
Following through the breakouts for SFMA the client was found to have the following:
- Straight Leg Raise (SLR) indicated JMD/TED on left leg
- Supine Knee to Chest indicated JMD/TED
Special Orthopaedic Tests indicated a positive result for the following tests:
- Duncan Ely Test
- Modified Thomas Test
The SFMA breakouts indicate to treat FABER and Modified Thomas Test. Following a local examination the firing sequence on her lower back indicated Erector Spinae initiated first followed by Hamstrings and Gluteus Maximus.
The client indicated she wanted an outcome of reduced pain in her lumber in order to increase her walking which she enjoys immensely.
The treatment carried out focused on treating FABER and Modified Thomas Test for adductors and quadriceps.
Using dry needling and soft tissue techniques, upon re-assessment an improvement in FABER was noted but Duncan Ely remained the same. As a part of the Myotherapy treatment, the client was instructed on corrective exercises and encouraged to continue them at home. Due to the nature of her lower back pain and her lower extremity firing sequence of her muscles, she was prescribed the following exercises:
- Crocodile breathing to assist with pain management
- Bridges for Gluteus Maximus
- Clams targeted for Gluteus Medius
4) Follow Up
On her second visit, the client was re-assessed using SFMA. On this visit her score went up to 21/49. A significant improvement from her first visit. She indicated that her pain was now at VAS 5/10 and was managing on less medication. She was very happy with her progress and was very keen to increase her corrective exercises, indicating she felt able to ‘do more’.
On her third visit the client reported a return in the pain in her lower back with her VAS back up to 8/10. Lumbar quadrant test was uncomfortable for her and her spirits were low. Due to the return of the pain she had stopped her exercises and had lost her ‘faith’ in the treatment plan. After a thorough consultation she agreed to give the exercises another go.
On her fourth visit her pain was back down to VAS 4/10. She had increased her walking back up to 4/7 and was a lot more positive in her progress. Following back up on her re-assessment her SFMA score was 12/49.
This case study indicates that recovery from an injury or dysfunction will not go from A – B in a smooth line. Recovery is usually up and down with 2 steps forward and 1 step back. This is perfectly normal and recognised within a Myotherapy treatment timeline. Clients will get disheartened, losing ‘faith’ in the Myotherapy treatment plan. It is very important to relay this information to our clients in order to keep them in a positive frame of mind regarding their treatment. A positive frame of mind is also important when assisting a client through the barriers that are usually built up with chronic pain. In this case, the client had a very positive result in a short period of time and believed she was ‘healed’. Therefore, the setback was unexpected for her and it affected her frame of mind in a negative way. After lots of encouragement, over the next 4 weeks she started to notice a marked improvement in her pain. This reinforced to her that recovery takes time, patience, commitment and perseverance.