Late blog/blogs

Well finally the manipulator strikes again, everytime i have been trying to log in it keeps telling me my invite has expired, seems like the story of my life. Anyhow, i will describe a few scenarios in this blog and hopefully that will fulfil my blogging obligations.

Case 1.
A 26 yr old lady was referred to the clinic with SA bursitis, however on presentation she listed neck pain as her main complaint. This threw me off a little as i had just been preparing myself for a shoulder examination. On AROM examination i was unable to detect a consistent pattern, almost all directions were painful. Similarly PAIVMS/PPIVMS at all levels were too provocative to get any diagnostic info. By this point i was completely thrown and had no real idea of how to effectively Rx this lady. I ended up doing some light STM of the sub occipitals, caudad traction and taught stretching for the related muscle and educated re use of heat and stretching. I felt pretty bad afterwards as i had'nt made a diagnosis and didnt feel like i had implemented an effective Rx; although the pt felt much better afterwards. Upon speaking to my clinical supervisor later i was told that how i managed the session was appropriate and that when people are acutely sensitised it is almost impossible to diagnose them. On the whole very unrewarding to the aspiring musculo physio :(

Case 2
83yr old female referred to the clinical with a 40+ yr Hx of LBP which had been unsuccessfully treated with an L5 laminectomy and nerve sleeve injections. Luckily however, when she presented she also complained of a 2/52 Hx of cervicogenic headaches and neck pain. Unselfishly i decided to Rx the neck pain and leave the 40 yr LBP for Ed to manage when he arrives at the clinic next week.
On AROM examination extension and R rot was almost non-existant. PAIVMS revealed global hypomobility in the Cx region, as one might expect from a women of her advanced years, but sig more pain in the upper Cx segments on the R hand side. Rx consisted of unilaterals to the R upper Cx segments + education re heat and stretching. Following Rx extension and rot had improved dramatically and her neck and head pain had reduced dramatically. Overall i very rewarding experience, and one that restored my faith in Cx Rx after the debacle described in case study 1.

The Manipulator