INTRODUCTION
AM began attending the clinic in August 2018 after being referred by 2 colleagues.
HISTORY
Calling himself a “grumpy old man” at 41, AM suffers from gripping pain with pronounced hip referral into the right leg, calf, and testicle (pulsing). He cannot bend forward to touch his toes or even simply bending forward to nod his head.
His pain is aggravated by getting out of bed, turning in bed, and getting into the car.
The only relief seems to be sitting down.
He is in a constant state of anxiety for as long as he can remember. Associated with this are profuse sweaty palms, pessimism, and a decreased social life and difficulty making future plans.
He wakes unrefreshed and has decreased memory – he feels like he is under a cloud.
He has seen various people including a physiotherapist, psychologist, and neurosurgeon.
He is heading overseas in 1 week though will have to shelve these plans due to the pain.
PAST HISTORY
As a child he had his tonsils removed and his right ear would often get blocked which still happens.
EXAMINATION
Lower back Range of Motion: Cannot bend forwards, nor nod his head whilst standing.
All range of motion limited and painful.
Walks with a limp. Cannot run.
Placing the client on his back was painful especially noticed in getting down and up from the bed.
In the prone position (lying on the stomach), revealed tenderness around the Right SI joint and lumbar spinous processes. (bumps)
Deep tendon reflexes, Motor strength, and sensory testing were all normal.
TREATMENT
Nerve referral can occur from many sites within the spine.
The use of soft tissue procedures can be employed when a patient is in too much discomfort.
Releases of interspinous ligaments and sacroiliac ligaments and manual manipulation of the Sacroiliac joint and lower thoracic spine over 4 sessions were used to decrease pain and increase range of motion.
RESULTS
Within 1 week of treatment, there was a considerable improvement as recorded by his daily monitoring. Care was then discontinued for the month as AM decided to make the trip overseas.
On his return, AM continually saw improvements in other areas that were covered in the spreadsheet.
DISCUSSION
History is in itself a very good determinant of an altered nervous system function. The diversity and severity of symptoms can be easily determined by the extent of a persons symptoms.
His goal was to complete the trip through the window of opportunity was narrow. stretching ligaments and tendons around the right sacroiliac area and lower part of his back (left lumbosacral area) were enough to address functional issues like bending. Modifying sleep positions, work-station placement, head-positioning, and simple bending procedures allowed this man to regulate nerve signals to a much more optimum level
In addition, AM responded well in many areas. By modifying key habits there was a notable change in other chronic health issues. With self-empowering recommendations, a cycle of dependency was avoided.