Physiotherapy Case Studies

Read about the physiotherapy treatments on Fort Healthcare patients.

Janet

Janet is a 25 year old accountant. She spends most of the day in front on computer at work and at home and recently has joined the gym in an effort to get fitter. She used to dance and a netballer in high school but stopped all exercises during high school and university. She is doing mainly cardio and group gym classes now.

She is concerned with her poor posture (slumped shoulder and large bump on the back of her neck that she feels is getting bigger in size). She does not complain of any regular pain in particular but of a dull ache and fatigue in the neck and shoulder area with prolonged sitting and some pain in her lower back while she is doing her ab workouts and running.

When we examined Janet, she did have quite poor posture. Her head and neck were in front of her center of gravity and her shoulders slumped forward especially on the right. She was very flexible all over body given her dancing and sports background. However Janet had difficulty activating her core even though she could complete all her ab workouts (crunches, planks, mountain climbers and situps) easily.

Flexible joints are fantastic. But we must have the strength to support that flexibility. When janet was still actively dancing she was flexible as well stable. However as she stopped her muscles got weaker but her joints stayed just as flexible. Especially if her core was not able to activate all the forces are placed onto the spine. A large part of posture is core strength. Without the ability to activate her core, the requirement of her job sitting in front of computer will force her to have bad posture. Even though Janet could finish her ab workouts, her core was weak as shown by her getting back pain afterwards. If Janet was activating her core properly she would not be experiencing back pain.

We taught Janet how to activate her core, glutes and deep neck muscles properly are more importantly taught her how activate these muscles in day to day life. The strength of these muscles and their ability to work together is the foundation of our “core”. The core providers force transfer between the top and bottom halves of the body and providers stability and absorbs and dissipates forces minimising forces on the spine. Starting from very basic activation exercises to some very intensive exercises. By improving her core muscle, they stabilised and protected the spine throughout daily activities and exercises. Because she was able to sit upright and stand up right without feeling fatigued she was able to improve her posture.

“They taught me the importance of having a strong core. I’ve always been very flexible but now I feel strong and stable as well. I’m able sit and stand for longer now and I feel confident in the gym to push myself. I run, do yoga classes and weight lift now!”

Andrew

Andrew is a 28 year old basketball player. He complained of lower back pain that radiated into his left leg. There was sharp pain and numbness into the foot. He was previously diagnosed with sciatica arising from a bulging disc which was confirmed by MRI. Andrew has had two right knee surgeries – one ACL repair in 2006 and another meniscotemy in 2008. Although he has seen other physios regarding ongoing knee pain he still feels knee pain frequently.

When Andrew came to Fort Healthcare, he was very concerned with his lower back pain as it was stopping him from staying on the court. His back would flare up everytime he would take some contact and he will be out of action for at least 2 weeks. He has seen 2 other physios and an osteopath with minimal relief. He has played basketball for over 20 years and was seriously considering stopping playing due to his back pain. Over the last 10 years he was playing 3-4 competitively games per week.

On assessment, Andrew did exhibit symptoms of sciatica but it was also apparent that he had not fully rehabilitated from his previous knee surgeries. As a result, his lower back were compromised due to the altered biomechanics and weak core, gluteal and quad muscles irritated his disc. In fact Andrew’s core and glute muscles were so weak that he was unable to consciously activate them and if he was asked to balance on one leg he was became extremely unbalanced within 5 seconds. Normally the core and glut muscles are responsible for absorbing the forces placed through the spine.

Due to his weak muscles and poor balance, everytime Andrew ran or took some contact it would irritate his disc causing swelling. When their is swelling there is pain. With a disc bulge we are unable to remove the bulge or herniation unless through surgery. However we can limit the amount of disc swelling or inflamation by focusing on training up the musces.

We put Andrew on a strengthening regime that focused on teaching how to activate his core and glute muscles and how to improve his balance. Within a fortnight he was able to play a game without a flareup at low intensity. Within a month he was able to play a game at full intensity.

Andrew stated the difference between care received at Fort Healthcare compared the care he received elsewhere was that there was time taken to educate him on his condition and the treatment plan was logically. He was taught mainly stretches for his lower back and legs elsewhere but it was actually strengthening work for his core and legs that was needed.