Case Studies

In an effort to give you an insight into how our skilled physiotherapists work, we bring you a sample of actual cases and how they are managed.  As each individual is different and complex, please consider that specific results may differ from person to person and this is not to replace actual human interactions!

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Shoulder Pain after a Fall

 

 

History: A 21 year old male presents with an acute fall of his shoulder on grass during running. He felt immediate pain and he could not move his arm. What can physiotherapy do to help?

 

Clinical examinations

The patient could not move his arm by himself due to pain. In the passive movement examination, his arm was able to be lifted forward and sideway to shoulder height before being stopped by pain. His arm across his body was the most painful and restricted movement. His shoulder internal and external rotation range is good, only mild pain is reported at end of range. His left acromioclavicular (AC) joint was the most painful on palpation. No step deformity was seen, which is a good sign for a lower grade injury.

 

His mechanism of injury and clinical presentation indicate an AC joint sprain (mild to moderate).

 

Management

Acute AC joint injury management includes supported immobilisation to allow the sprained joint capsule and ligaments to have time to heal. He was given a sling to wear during the day and his shoulder was strapped. He had trigger point muscular pain in the surrounding area such as upper trapezius and deltoid muscles, which is a common problem because these muscles are trying to compensate for the injured AC joint. This patient responded well with dry needling which helped him to alleviate resting pain and muscular ache.

Over the next two to three weeks, this patient improved well and was able to gradually reduce the usage of sling without symptoms. His horizontal adduction movement range was still restricted compared to the other movement which is common after AC joint injury because this is a stressful position to the AC joint. This would gradually improve with treatment and exercises.

He was given rotator cuff strengthening exercises and scapular stability exercises as a progression at a later stage of his rehabilitation. 

In six week post injury, he was able to return to gym and perform his normal workout routine without issues.

 

If you have any questions regarding your specific problem or are interested in seeing if we can help you, please give us a call at (02) 8411 2050. Here at Thornleigh Performance Physiotherapy, we can give you an accurate diagnosis and treatment, to help you get back in action as soon as possible. We are conveniently located near Beecroft, Cherrybrook, Hornsby, Normanhurst, Pennant Hills, Waitara, Wahroonga, Westleigh, West Pennant Hills, and West Pymble.

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Low Back Pain in the Office

 

Question: A 35 year old office worker presents with a recent episode of lower back pain and left buttock pain from prolonged sitting at work. Is there anything physiotherapy can help with?

 

Clinical examinations

In sitting, the patient finds it sore, stiff and tiring to sit upright. It is more comfortable to slouch at the beginning after it starts to hurt after a few minutes. In standing, the patient finds it painful to bend all the way forward and it is very stiff and painful bending backward.

 

Management

A combination of education, sitting posture adjustment and exercises help to address the cause of the problem and manage appropriately. Manual therapy helped to reduce the time it took become pain free.

As this is a sustained posture related issue, understand and be able to recognise ‘’prolonged sitting’’ is the most important part of the management. "Get up and move" will be a good first step.

After adding a lumbar support in sitting, the patient feels sitting is a lot more tolerable and less symptomatic.

The patient also responded well with repeated extension exercises, where his buttock symptom is centralizing (shifting towards the back) during exercises and the entire symptoms are abolished after the exercises. This particular symptom change often means a good prognosis for lower back pain.

 

Although extension exercise is commonly beneficial for lower back pain patients, this is not a one size fits all remedy. Please do not try it on your own without having an assessment done by medical professionals. 

 

If you have any questions regarding your back pain or are interested in seeing if we can help you, please give us a call at (02) 8411 2050. At Thornleigh Performance Physiotherapy, we can give you an accurate diagnosis and treatment, to help you get back in action as soon as possible. We are conveniently located near Beecroft, Cherrybrook, Hornsby, Normanhurst, Pennant Hills, Waitara, Wahroonga, Westleigh, West Pennant Hills, and West Pymble.

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 Knee Pain whilst Running

 

History: A 43 year old female presents with recurrent knee pain after training at the gym or running on and off for a few years. The location of her knee pain is in the front of her knee near the inside. She does not have a history of knee injury. What can physiotherapy do to help?

 

Clinical examinations

The patient does not have any symptoms walking and climbing stairs. Her knee pain is predominantly from squatting and worse in a single leg squat. While squatting, excessive knee adduction is observed. No flat feet are seen. Her knee joints are hypermobile but her right patella-femoral joint is not painful on palpation. Meniscus and ligament orthopaedic tests are negative. During quadriceps activation test, her vastus medialis oblique (VMO) was under-active and her patella was moving laterally.  Her calves and hip external rotators are weak as well.

 

Her clinical presentation indicates a lateral tracking patella disorder.  

 

Management

The cause of patella lateral tracking disorder is often multi-factorial. In terms of initial symptoms management, this patient responded well with McConnell Taping (medial glide of the patella with rigid tape), where she could squat without pain afterwards.  

After a week, her knee pain settled. She then started a specific muscle training program focusing on activation, strength and endurance of the VMO, calves and hip external rotators. In her next review after another two weeks, there was noticeable improvement in her lower limb biomechanics since she started the exercises and she was happy with the results.

 

Clinically being able to have at least satisfactory closed chain lower limb biomechanics is very important to rehabilitation and injury prevention. For specific groups of people, such as runners and sports players, further dynamic, agility and plyometric assessment and training will be a key to their performance and sports specific injury prevention.

 

If you have any questions regarding your knees or are interested in seeing if we can help you, please give us a call at (02) 8411 2050. Here at Thornleigh Performance Physiotherapy, we can give you an accurate diagnosis and treatment, to help you get back in action as soon as possible. We are conveniently located near Beecroft, Cherrybrook, Hornsby, Normanhurst, Pennant Hills, Waitara, Wahroonga, Westleigh, West Pennant Hills, and West Pymble.