New Case Studies

Just going to get the ball rolling with some ideas for a case study. Feel free to be as general or specific as you like with suggestions.

Client presents with multiple issues.

General Cervicothoracic pain and tightness, headaches, shoulder pain (R>L), numbness w/ I/M pins and needles in right hand, snapping ulnar nerve in (R) + (L) elbow, burning pain in the calves (R)>(L) on stairs / hills. Pain presented 3-4 months previously, starting in the right anterior shoulder. After 3-4 weeks right shoulder pain started restricting gym work, after 4-6 weeks pain did not ease w/ dec. gym and started restricting ADLS and getting Sx. in (R) hand. 2-3 months post symptoms started presenting in left hand, along with pain in the right medial elbow. 3 months post initial shoulder pain, calves bilaterally started I/M burning pain, usually when walking up stairs / hills. Client also notices that occasionally symptoms worsen while sleeping with arms above the head, or working with arms up.

Works fixing printers (awkward postural positions including lifting / handling in such positions), feels Cx.Tx. tightness during work but does not aggravate other symptoms unless arms are as previously described.

Client now has depression / substance abuse (marijuana, nicotine and alcohol) due to lack of motivation for exercise and stress over symptoms / condition. Due to psychosocial issues, client regularly feels fatigued to the point of being unable to work.

I have put together quite a general case study in this scenario to allow us to discuss a lot of topics. What we would prioritize and why, how to help target psychosocial issues, what to refer on for, further investigations you might want, differential diagnosis which may also help fit a more holistic viewpoint etc. alongside the physical presentation, treatment options / assessments etc.

Another idea may be something along the lines of...

Complex reasoning of muscle activation patterns during cycling phases.

I have had a few cyclists come in lately with varying symptoms. We could discuss literature of muscle activation during various cadence / intensity / stages of a race, trying to relate these to common compensation strategies and injuries we see in athletes to try and find a more specific HEP regime or prevention strategies. We could look at the exercises we give and try to specify these more towards cycling (in terms of cycling specific ranges and loads) and correcting presenting imbalances.

??

I think we should stick to the first one in this post. Then we can have the cycling one for another post. On the first topic of the cervicothoracic issue can I ask if there have been any investigations. Also what are the results of the upper and lower limb nerve tests (mm, babinsky, cauda equina etc).

And is the snapping ulnar nerves bilaterally something normal for him i.e. This is just a feature he has always had or is this truly something new. Sounds like a read herring on that one.

Wrote a post the other day, must not have gone through?? Was just getting ideas for the first case study in this thread. Will post the actual case study w/ more info tomorrow morning.

Hey all, sorry a few things have come up this month (changing jobs) and I will not have much of a chance to post / monitor the case study this month as planned. Keep posted for future updates.

can you post some complex case studies of sports conditions..

Hi, I don't know if this is a coplex case for you, I would like to express my thanks to all of you for the very kind help and advice you are going to give us.
My 12 years old son is playing basketball professionally since he is 7 years old. Now he is 180 cm long and 70 kg.
He had a backache and we went to an orthopedist. The MRI report says that "L4-L5 right paracentral disk protrusion no bilateral foraminal root compression" and "L5-S1 mild opsterior disk protrusion".
The orthopedist started a physical therapy program for him immediately.
Will you pelase help me with other treatment options ?
Is the physical therapy program a complete treatment to get rid of those disk protrusions?
Will he be able to play basketball again?
Thanks for concerning. I wish you merry christmas and a happy new year.

L4-L5 paracentral disc bulge :
- chiropractic adjustments with myofascial manipulation work to go along with exercise rehab is about right combination of work you should look for in rehab. More info regarding the onset of pain and history attached to the same will help provide a much more specific answer for your query.