A 15 year old girl developed R shoulder pain one year ago after sleeping on it weird. Pain is constant and unable to raise hand above shoulder height (for instance raising her hand in school to ask a question).
3 months after the onset she had a diagnostic ultrasound which found a small supraspinatus tear (rotator cuff muscle). She then had 24 physical therapy visits over 12 weeks with no improvement. 2 months later she had a shoulder MRI - this did NOT show a supraspinatus tear.
11 months after initial onset the patient was referred to me. Pain was still constant (10/10 on VAS) EXSTORE exam was as follows:
•unable to flex shoulder above 90 deg on R
•scapular stability (serratus anterior) on R is inhibited
•during testing of serratus anterior upper trapezius is in spasm
•c spine ROM to the left is 45 deg
•patient cannot do any pushup or modified pushup in school gym class.
•Patient is afraid of needles.
TREATMENT
•the patient agrees to only one needle with some convincing from her mother but does NOT agree to Pointer Plus stimulation.
•I insert needle into serratus anterior with a twitch response - and leave for 30 seconds then follow up with some manual fascial release to the mid axillary line.
RESULT
The patient was off for Christmas for 2 weeks and when she returned she reported her shoulder was 80% less painful (2/10 of VAS)
•shoulder flexion improved to 170 degrees and the scapular stability was 100% stable on EXSTORE re-exam. Her c spine ROM was now 80 deg rotation bilateral.
DISCUSSION
Being specific with your assessment will pay dividends. Take diagnostic imaging into consideration but do not lean on it - do a functional exam. For a joint to move you need two things: muscles to stabilize the joint being moved and muscles to do the moving. This is why learning to assess and treat the serratus anterior is non-negotiable when aspiring to become consistently proficient in treating shoulder and neck dysfunction. This girl had 24 visits with another therapy. 24 visits! Clearly those therapists didnt know what they didnt know. We have the tools and its easier than you think folks.
January’s webinar is here! This one is a favorite of mine because it includes the fascial lens when teaching the movement of the foot and ankle. It cover anatomy, fascia, and accessory motion of the foot and ankle. Definitely worth checking out.
Give this a read after you watch the video: https://pmc.ncbi.nlm.nih.gov/articles/PMC7689775/
Athletic Intensive Myofascial Release
Location: Shokunin CrossFit, Mesa, AZ
Pre-requisite: EXSTORE
Register here:
https://aseseminars.com/event/athletic-intensive-myofascial-seminar/
What permissions are generally needed for a hospital visit? I have a patient that wanted me to do a hospital visit for her parent. I told her with approval from her physician and hospital that I could do a visit.
Is there any paperwork outside of the normal paperwork I should know about to keep myself protected?
I have a new patient, 44 year old man, who has L sciatic pain, starting in his left gluteals and down his left leg upon standing or walking/running for 7 or more minutes, but all other positions or activities actually improves the pain: sitting, lying, weightlifting, biking, squatting, jump rope, sit ups, etc although it worsens after hours of sitting at work. On walks he often has to squat to get relief. Sensation is numb tingling to knife sharpness or electrical. He has had imaging diagnosing mild stenosis L5-S1 but nothing the doctors considered worth intervening for. Onset of sciatica was insidious 2 years ago with no clear initiating incident. He’s had PT for a year with no effect.
EXSTORE: He is very strong and my pressure is not that well calibrated I think, so at best I felt a little sponginess in the TFL and gluteus minimus/posterior gluteus medius. But it was unclear. He did have more restriction in SLR, about 60-70 degrees compared to 80-90 for right.
Only other thing going on...
