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Remedial Treatment Case example

Case 1. Sciatic pain and lower back tightness

Case 2. Arm numbness and other problems

Case 3. Lower back discomfort

Case 4. Doctor's soreneck

Case 5. Knee pain

Case 6. Spondilolithesis

Case 7. Severe knee pain

Case 8. Shoulder pain

Case 9. Disc bulge (Herniated disc)

Case 10. Achilles tendinitis

Case 11. Long term lower back problem

Case 12. Gardener's arm numbness

Case 13. Chronic shoulder tightness

Case 14. Posture Correction

-Age

-Gender

-Occupation

-Symptom(s) & the cause

-Examination

-Treatment received

 ~Case 1~

-mid 50

-male

-retired, used to be a film engineer

-pain in lower back and severe sciatic pain to left leg. Undecided to go either chiropractic or massage. Chose to come to our clinic as it is close to his house and reasonable price.

-straight leg raise test positive with left leg, causes severe sciatic pain (around posterior knee and anterior toes) all the time and great discomfort all over the leg. Left leg longer than right by 1 cm. unable to move the leg without numbness and pain.

-1st treatment, concentrating loosing tension the unbalanced tight muscle group around hip, adjusting the angle of hip joint, stretching the shortening muscle groups. Finishing with some homework he should do at home every day.

-2nd treatment (5 days later), the condition has greatly improved, sciatic problem has gone completely, but still tightness is in around lower back area. No pain whatsoever.

-3rd treatment (2 weeks later), no sciatic pain, no pain, just little bit tired calves from long walk. Following treatment session has ended here.

-4th treatment (after 9month) felt a bit of sciatic feeling. had a 1 hour treatment. completely dissapear after that. No need to come back for a while.

 ~Case 2~

-early 40

-male

-developing manager

-pins & needles in both arms, left shoulder pain, tight neck and lower back, couldn’t sleep at night due to discomfort in arms.

-left leg longer than right by 1.5cm, bilateral quads extremely tight, forearm flexor tight, tender point present in left palm.

-1st treatment, loosening all tight muscle group in arms, including problematic brachioplexus, passive range of motion, he feels “my arms are warm and light”. Tingling sensation has gone away.

With combination of a trigger point therapy and a stretching, left shoulder movement has retained. The pain in left shoulder has gone.

After basic technique, retest has revealed he has improved flexibility in lower back, moves a lot smoother. First 2 hours session is over with some “homework”.

-2nd treatment (7days later), the condition has a lot better. Told me he could lift 80 kg object “very light” at work after the 1st session. The arm numbness almost disappears. Right arm feels bit heavier than left. Continue following session. Generally muscle condition is lot healthier and softer.

 ~Case 3~

-mid 40

-male

-truck driver

-lower back discomfort at work, causing great discomfort at night time. Aggreavates during driving, eases at stretching.

-left leg longer than right about 2-3mm, right pelvic laterally open, right ankle twist inward, suggesting that anterior tibialis might be shortened as overused for driving.

- loosening all tight muscles including bilateral quadriceps, anterior tibialis, gluteus max/mid/mini. Improving shoulder movement by passive joint articulation technique.

After retest lower back discomfort has decreased significantly and moves more freely. Went home so happlly.

 -he still sees me once a month for maintenance and his well-being.

~Case 4~

-mid 60

-female

-medical doctor

-sore neck after wake up 2 days ago, pain present when bend

-testing passive range of motion positive with side bend (lateral flex) to right, pain present with active range of motion test.

-After palpation, found out that her left side pelvic laterally open, same leg length, tight bilateral quadriceps and glutes muscles

45 minutes treatment, retest revealed the pain decreases from 10 to 2. Range of motion of the neck has recovered completely.

60 minutes treatment, retest reveals the pain has decreased from 10 to 0.

Only one treatment is necessary.

~Case 5~

-early 40

-female

-housewife

-right knee pain, aggrevates when going down stairs rather than going up. Pain presents even side sleeping position.

-positive with squatting test at 90 degree on anterior/inferior side of the right patella.

Right leg shorter than left by 2cm as picture shown below.

Right pelvic laterally open, suggesting that right leg is facing outwards, even though lower leg faces front. Twisted knee might be happening when walk, that can eventually lead gonarthrosis.

-1st treatment, loosening tight muscle groups around the knee, including gastroc nemius, soleus, anterior tibialis, quadriceps. Passive range of motion of right ankle as the movement is limited and unsmooth.

Retest shows almost no pain. Given her homework, 60 minutes 1st treatment is over.

-2nd treatment (2 weeks later), after the 1st treatment the pain has gone away but start coming back slightly 2 days ago. Concentrate on more pelvic adjustment technique, response well as she does regular stretching and exercise.

Retest suggests that still pain present.

Move to work around the local area. Loosening the surrounding muscles and stretching work.

Retest shows pain has gone from 10 to 0. Leg length photo after the treatment below.

Left for home with lots of homeworks.

-treatment still continue

 ~case 6~

-mid 30

-male

-train guard

-discomfort on lower back, diagnosed spondilolithesis (slipped one vertebral foward) between L3&4 three years ago by GP, saw a number of physio, but did not really improve the condition.

-right sciatic pain present all the time when sitting down on a chair while interviewing, increases with Kemp testing towards right big toe, great discomfort, relatively Ok with range of motion of lower back

-Apperered with CT scan, which shows a mild spondilolithesis. found that pelvic is unlevel and twisted, leg length different (pictures below), muscles between right and left, front and back, upper body and lower body, all unbalanced.

-1st treatment. Tone all muscle inbalance and manipulate shortening muscles. Some muscles are extremely tight probably because of overused and a compensation of the injury.

During the treatment, he started feeling "more blood flow to the area". which hasn't happened for more that 2 years.

After 90 minutes, sciatic prblem cannot be felt at all and feels a lot better. The leg length is OK as the photo shown below.

-treatment continues

~case 7~

-mid 40th

-male

-farm land owner

-He has been suffering a great pain in left knee for more than 2 weeks. Because he's been building a farm fence for his land intensively. Tried another soft tissue treatment, GP, and trigger point therapy, but not much improvement seen. Couldn't work without pain. had a number of anti-inflammatory beforehand.

-Obviously the left knee is swollen due to overuse and the range of motion is very limited as the picture below. Great pain of 10 out of 10 in pain scale, even though he has taken a strong pain killer that morning. Could barely walk without limping and pain.

-1st treatment reveals that his muscles surrounding the knee, such as hamstrings, anterior tibialis, quads, adductors, poplitius,are all extremely tight, so I've loosen all those with trigger point and stretching and increased the range of motion of the ankle, retain and improve the range of motion for the knee by using passive range of motion techniques.

After those techniques done, the pain goes down to 2, still inflammation is active. Icing and resting at home are recommended.

-2nd visit (3 days after the 1st treatment), pain is a lot less, the range of motion has improved greatly, but still not perfect. Same techniques are applied. The results are below.

He was running back home (Literally!) on the way back:P, saying "you've changed my life!"

-3rd visit (5 days later), pain, the range of motion, discomfort and movability has greatly improved. Still little bit of pain when walk and straighten knee. After an hour treatment, everything going well:)

There is no more treatment required for his knee.

~Case 8~

-late 30th

-male

-oil ship officer

-pain in right shoulder, starts 2 days ago during shoulder press exercise at weight training gym.

-pain on anterior aspect of deltoid with right shoulder flex at 90 degree. the active range of motion ok, could not abduct without pain in the region.

-bilateral pectoralis obviously too tight, due to lack of stretching, deep grinding and passive range of motion technique on pec, loose all relevant muscles, such as biceps, deltoid, triceps, arm flexor/extensor as the range of motion is poor, especially arm flexor.

retest reveals that pain has decreased to 4 from 10.

adjust the pelvic level

the pain has decreased to 1

abdominal muscle release technique applied

the pain has decreased to "0.5"

finish treatment within 45 min. At the end of session, he claimed "didn't expect this much improvement!"

2 days later, he emailed me, told "My shoulder has no pain at all and I have full range of movement".

~case 9~

-late 30th

-female

-house wife

-pain & discomfort in lower back area, diagnosed as disc bulge (herniated disc) between L5 & S1 by specialist, bed-bound for more than 2 weeks with strong pain-killer & anti-inflammatory, sciatic appeared in hip area, looking for the alternative solution as she wanted to avoid the surgical operation if possible.

-flex, extend low back significantly limited range of motion with great pain, movement quality is poor, hyperlordosis

-1st treatment loosening all tight muscle groups especially around gluteus area (gluteus max, med& mini), also her pelvis was quite uneven and twisted, so adjusted the unlevelled pelvis into the even level. Retest revealed the big improvement that is the clear indication of her prolong improvement.

-2nd treatment (5days later), she could do a lot of things that she couldn't do. 6 days later after the 1st treatment, she starts feeling tight around the lower back area. Same kind of treatment has been done. Significant improvement in movement as pictures below, less pain, sciatica disappeared.

-3rd treatment (11 days later from 2nd treatment), 5 days ago, she had a long drive (4 hours) then felt bit of tightness in lower back. Same kind of treatment has been done, no pain at all. She no longer needs further treatment as progress going on.

~Case 10~

-mid 40

-female

-nurse

-pain in both Achilles tendons area for one and half year, aggravates when standing and after work, morning stiffness is significantly painful, saw physio, acupuncture which didn’t ease. Frustrated and stressed by not being able to move.

-PO (posture observation) suggests hyperlordosis in lower back, hypertension in bilateral knee, Left ankle limited range of motion and hypermobility to inversion due to the old injury.

-1st treatment loose whole tight muscles, including glute max, med, and mini, hamstring, calves, anterior tibialis, increase the range of motion of bilateral ankles, stretching calves.

-2nd treatment,(after 8 days) moves a lot better and able to move more distance without suffering as much as used to. Low back feels lighter.

-3rd treatment (after 8 days) generally feels a lot better, but still feel tight around calves especially after long walk.

-4th treatment (2 weeks later), pain in bilateral heels after dancing (!) all night 2 days ago, delighted to see the improvement, can do lots of things that she could never do before, such as standing up from long time position smoothly, wearing socks without suffering and dancing:)

Below are the pictures before and after the 4th treatment.

As you can see on the left picture, the angle of the heel bone, Achilles tendon and calf muscles is unnaturally and unhealthily tight (yellow line) and so is the angle of the instep (red line), whereas the second photo on the right, they are obviously improved into better position, meaning that muscles surrounding are in healthier tone, enhancing the recovery process smoothly.

~Case 11~

-almost 60

-female

-after falling off the horse lower back pain and discomfort for more than 30 years. She has been having lots of treatments. has healed temporally, but not permanently. so looking for the ultimate treatment.

-standing cause her pain in lower back, pain scale 4/10. extension very limited range of motion with great pain (as pictured below), Kemp test reveals the quality of movement is very poor. couldn't move without pain.

knee height differs by 2 cm, meaning her pelvis is out of alignment significantly.

-1st treatment (75 minutes), picture below. no pain has been felt with this movement. the range of motion on each movement has greatly improved and the quality of it has been improved as well.

-after 3rd visits, no pain and no discomfort at all. so we modify the treatment forcusing for maintenance, adding more relaxing component.

-after 4 th visit, she has told me that she joined the walking race and has achieved 37 km long walk and her back pain has still not come back :)

~Case 12~

-almost 80　

-male

-retired, loves being active &gardening

-right arm numbness for "long time that I can nnot remember", right shoulder pain,

-Active range of motion test, abduction great pain in right shoulder, flex great pain in anterior aspect of deltoid area with limited range of motion (pictured below), numbness increases into right no.4 &5 phalangeas with all movement. the quality of movements is poor and not smooth, could not perform any shoulder movement without pain.

-adjust leg length and pelvis level, work on glutes area, the numbness goes down from 10 to 4. (note: I did not touch the right shoulder region at all), the range of motion has increased.

Then work on right arm, releasing all tight muscle group, numbness has gone to 0.

retest reveals no pain at all with all movements, (pictured below), no numbness, the quality of movements has retained as optimised.

only one treatment (60 minutes) required.

~Case 13~

-mid 40th

-male

-trading company

-tight shoulder for more than 30 years(!), also requires to improve his posture, especially for his "O shaped legs".

- AROM shoulder test Abduction, flexion limited range of motion with great pain. The movement quality is poor. O shape legs apparently visible. Posture analysis reveals his head tilt forward, arms length different (below picture), hyperlordisis in lower back, and weak stomach muscle.

-stretch & massage the shortening muscles group, balance the muscle tone, fix the whole body alignment as the pelvis was significantly twisted.

Here is the result of one 90 minutes treatment.

~Case 14~

-mid 20

-male

-came to clinic in hope to improve his posture, lots of limitation of his hobby and daily activities, due to muscles tightness and fatigue.

-With PO(posture observation) test, obviously head tilt forward, both shoulder forward, arms internally rotation, stomach and rib cage cannot be widely straight which makes him shallow breathing, that may be causing him tired easily, pelvis rotating and muscles imbalance are quite significant in whole body. AROM test showed poor quality of movement and limited range of motion.

-He has had first 4 session every 2 weeks, then only once a month session needed. Here is the result after 6 months total of 8 sessions.

Can you spot the differences:)?

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