The Frozen Shoulder 

 A patient complained of having a "frozen shoulder".  She was treated by traditional physical therapy, which she felt was not successful. On evaluation, I could see that the PT she had received for the shoulder was excellent, but she still lacked her full range of motion.  Looking more closely with my assessment, I identified that the nerves from her neck to the shoulder were stuck/ adhered to the sheath through which they were travelling.   This is something I would not expect a traditional orthopedic physical therapist to be able to identify or treat without more advanced neurological training.  I switched to  neuromeningeal techniques which address this issue.  Following  this first treatment, she left with full pain-free range of motion. I commended the previous physical therapist who did the hard work of mobilizing and freeing the joint, and explained that it was only the nerve that needed help- as her arm  had not moved for such a long time, the nerve had scarred down. 

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The Headache That Won't Go Away

A patient complained of a headache that had persisted since a car accident long ago.  She had been treated with chiropractor, acupuncture, and massage therapies, but her relief only lasted a day or so.  On evaluation,  I could see that she had had a traumatic brain injury, with resultant fascial and soft tissue restrictions throughout the brain.  Using gentle neuromeningeal mobilization techniques, I was able to loosen the tissues and fascia so that the body could self-correct. Connecting the fascia in the skull to restrictions in the neck and shoulders, her muscles were finally able to relax and her pain abated.  All the ancillary therapies were an important component of her healing, but she ended up needing manual work to help the nerves and fasci be able to move normally again and without pain. 

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The Chronic Pain in One Spot in the Abdomen 

A patient complained of a pain in her left side that she had had since her teenage years, 40 years ago.  She described it as intermittent (but always if she moved a certain way) ,sharp, and deep.  She had had ultrasound tests, and CAT scans over the years but nothing showed up.  She had given up, thinking that she would just live with it.  On evaluation, I could feel restrictions in the ligaments that connect the gallbladder ligaments to the small intestine.  Working on this area, reproduced her pain on the other side of her abdomen!  I continued to release the ligaments, and she left thinking that there would be no change.  She returned to her next appointment and reported her pain was entirely gone! 

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The Plantar Fasciitis That Isn't

A patient complained of pain in her right calf and heel.  She had seen physical therapists in the past, but her pain was never relieved. I performed a comprehensive assessment to see what others might have missed - and indeed they did.  She had a pinched nerve in the lower back.  I explained to her that "sciatica" doesn't have to include low back pain or even have a straight line that runs down her leg.  I treated her for sciatica with traction, correcting the joints in the lower back,  soft tissue techniques to release the pelvic ligaments compressing the nerve, and used specialized nerve mobilization techniques to free the nerve from the area of the pinching to the calf and foot, as well as showed her some beginning core exercises and nerve stretches.  I also referred her to  1:1 Pilate's based rehabilitation place near to her home to help her take her strengthening and flexibility from beginning to returning her to activity.  

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The Persistent Low Back Pain

A patient complained of a deep ache in the low back that wouldn't go away - she couldn't reproduce it by pressing on the sore area, she had  undergone MRI's which showed nothing out of the usual,  she didn't have any health issues, she didn't have any leg pain - it just gnawed at her all the time locally in the low back.  She had had massage and physical therapy to the low back, but neither helped.  I performed a comprehensive assessment to see what others missed.  It turned out that all the spinal and nerves tests were normal.  But, on further assessment, her hip was not moving correctly in the socket, causing the deep hip rotators to spasm trying to control  the hip joint.  Pressing on the muscles near the pelvic floor reproduced her pain.  Her low back pain was not coming from her low back, but from the hip and pelvic floor muscles.  I explained all this to her, received her informed consent for pelvic floor assessment, and we started addressing her hip/ pelvic floor muscle spasms, the pelvic joint alignment issues, and the pinched nerves from all of it.  I referred her to neuromuscular massage therapy to help the muscles in a broader area and to a 1:1 Pilate's based practitioner I trusted to retrain her hip. I find that physical therapy alone, does not effectively treat these kinds of hip movement dysfunctions, but that Pilate's does so spectacularly! 

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When Pain Doesn't Go Away After Pregnancy

A patient complained of painful intercourse and low back pain after labor and delivery.  She explained that she had a forceps delivery, the baby was fine, she went to her  6-week follow up OB/GYN appointment and was told that the pain was normal and it should go away over time.  Now, 5 months later, she is still suffering with pain and it's affecting the relationship.  On assessment,  she presented with postural and joint dysfunction  in her head and body that reflected high stress and anxiety, joints that were "out of alignment" in the mid/ low back and head, her pelvic organ ligaments had tightened, she had a pinched nerve in the low back, and also in between pelvic ligaments in the buttocks.  I explained what I had found and what I thought had happened - the forceps delivery most likely caused a traction injury in a nerve along the vaginal wall, this in turn caused her pain, which caused muscle spasms to protect the area, which caused her pelvic joints to be "out of alignment", and over time, these joint and muscle dysfunctions "moved up the spine".  When we say that something "moves up the spine" or "up the chain", it means that over time the body adjusts and re-patterns itself to accommodate for the pain so we walk, stand, move from sitting to standing, etc, differently, but we never really notice this because it happens so slowly.  Her treatment involved orthopedic techniques,  visceral/ organ mobilization techniques, craniosacral therapy, stretches/ exercises.  I referred her to neuromuscular massage therapy, and medical practitioners who understand this condition and can oversee her medical management,   as well as suggested counseling support with referrals.  She was also referred to 1:1 Pilate's based rehabilitation at a later date.  Chronic pelvic pain should never be managed by one practitioner - it takes a team for successful resolution of this issue. It is a very complex issue and is often a symptom of something bigger, and should be approached accordingly, by treating the patient from the head to the knees/ feet. Over time, this individual developed her team, had excellent resolution of her symptoms, and an improved relationship with her partner.  

That Darn Upper Rib Pain Doesn't Resolve

A previous client scheduled with me to address her rib pain that just wouldn't go away. She had travelled for a work conference and slept on a hard mattress, which is when her pain started.  She believed it was a rib that was "out".  She was frustrated that no one seemed to know how to help her.  At our first appointment,  I asked her to detail the history of her pain - when it started, why she thought it started, and to show me where the pain was. There was no known injury. On assessment,  there were indeed 2 ribs that were jammed, but that wasn't all - her gallbladder was swollen and painful.  After treating the gallbladder and her ribs, she was instructed to return for one more appointment for follow up,  and to report to her general practitioner; if the pain returned, she was to immediately report to the emergency room. Why did all this happen? Most likely, she had been developing a gallbladder issue over time, and while out of town, her diet changed, causing a large spike in her gallbladder pain. The gallbladder commonly refers its pain to the right shoulder and the ribs and muscles will respond to warn the person, but also to protect the hurting area . She left therapy reporting 70% decrease in her pain from when she arrived. She was very happy to know the cause of her pain and what she needed to do for herself if it happened again.  Sometimes, medical issues look like orthopedic injuries.  It takes a skilled practitioner to be able to tease out which is which. 

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